ABSTRACT
According to the World Health Organisation (WHO), a caesarean section is a surgical procedure that can save the life of a woman and her baby when undertaken for medical reasons. Thus, the procedure should only be used in complicated pregnancies.However, C-sections have gradually become common in developing countries, and it is already quite common in the developed countries for a long time. A number of obstetric complications such as dystocia, foetal distress, breech births, post-term pregnancy, multiple pregnancy, and pregnancy-induced hypertension are recognized as reasonable motives behind caesarean section deliveries. Approximately 18.5 million caesarean births have been recorded each year globally, accounting for 19.1% of total births, which is beyond the cut-off recommended by the World Health Organization (WHO). In India, the rate of caesarean section delivery is dramatically increased from 3% in 1992–93 to 17% in 2015–16. In terms of regional variations, south Indian states have recorded substantially higher levels of caesarean deliveries in comparison to north India.Despite several studies that have investigated the factors contributing to caesarean section delivery, systematic evidence is still lacking towards understanding the determining factors and formulating effective policies to address the increasing rate of caesarean section deliveries in India. With this backdrop, this study attempts to observe the major indications and prevalence of caesarean section among pregnant women in a tertiary care hospital in India.
ABSTRACT
Background: Placenta previa contributes substantial maternal and neonatal morbidity including management challenges for obstetrician. This study was to evaluate the potential risks factors and feto-maternal, outcome in placenta previa. This study was done with the intent of developing insight into risk factors, clinical presentation, various interventions and management for overall improvement in maternal and fetal outcome in placenta previa.Methods: A prospective observational study, where 30 cases of placenta previa confirmed after 28 weeks POG, treated in a public sector tertiary care hospital from June 2016 to June 2018 were included. Authors analyzed the data to evaluate the potential risks factors and maternal and fetal outcome in placenta previa.Results: In this study, major contributing risk factors for placenta previa were associated with multiparity (76.7%), maternal age >30 in 50%, previous LSCS in 46.7%, repeated uterine procedure like suction evacuation/curretage. There was a high rate of maternal morbidity mainly due to haemorrhage. Perioperative uterine artery embolization (UAE) in 3 (10%), intra-operative procedures namely devascularization, internal iliac ligation in 66.6% cases, peripartum hysterectomy in 2 (6.66%) were done to control haemorrhage. Blood and blood products transfusion required in 26.7% of cases. Fetal morbidity included prematurity in 9 (33.3%), NICU admission in 11 (36.6%) majority of which included 8 (26.7%) babies of birth weight <2000 grams.Conclusions: Placenta previa contributes to significant maternal and neonatal morbidity. Multiparity, post LSCS pregnancy constitute major factor for placenta previa. Management requires high-risk obstetrical care with frequent antenatal visits. Serial ultrasonography in reported cases of low-lying placenta is mandatory to exclude over diagnosis or migration. All cases of placenta previa need to be managed in a higher centre with facility of blood component therapy and neonatal intensive care unit. Prematurity and low birth weight remain a significant cause for neonatal morbidity.
ABSTRACT
Background: Induction of labour (IOL) is a common procedure that remains a relevant Obstetric procedure. The maternal and perinatal outcomes are paramount hence the need to review the intervention in order to implement needed change. Objectives: To determine incidence, indications, outcome and complications of induction of labour at the Jos University Teaching Hospital (JUTH), Jos, Nigeria. Methods: This was a retrospective study reviewing 584 women who had IOL in JUTH from January 2004 to December 2007. Parameters selected for review include parity, gestation age, outcome and cervical state prior to IOL. Results: Four hundred and eighty women had vaginal deliveries (82.2%). There were fifty two induced on account of antepartum Intra Uterine Foetal Deaths (IUFD), while 1.5% of the deliveries ended up as still births, 10.5% had birth asphyxia and neonatology review and care. Thirty two patients had various complications after IOL. There were no maternal mortalities. Conclusion: Parity and presence of IUFD were found to influence the outcome of IOL.