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Wilson’s disease, also known as hepato-lenticular degeneration, is one of the very rare autosomal recessive disorder of copper metabolism.There is impaired liver metabolism of copper thereby causing decreased biliary excretion and deposition of ceruloplasmin levels mainly in the liver, corneas of eyes and brain. Untreated Wilson’s disease has been associated with menstrual irregularities, amenorrhoea, miscarriages and infertility. Hence proper chelationwith strict antenatal surveillance will lead to a successful feto-maternal outcome.
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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.
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Background: Acute kidney injury occurring during pregnancy, labour, delivery, and/or postpartum period. Proper management of AKI (acute kidney injury) is challenging because (i) both maternal and fetal health must be considered and (ii) the cardiovascular and renal adaptations of pregnancy add to the complexity for management.Methods: The objective of this study was to study association and contributing factors in AKI, a retrospective study of 20 cases of AKI complicating pregnancies carried out in department of obstetrics and gynecology, SVPIMSR over a period of 12 months and results were studied and analysed. Etiological factors, associated liver pathology, coagulation abnormality, thrombocytopenia, sepsis, recovery status and fetomaternal outcome were studied and tabulated. AKI was analysed in terms of maximal stage of renal injury attained as per risk, injury, failure, loss of function, and end-stage renal disease (RIFLE) criteria.Results: The incidence of ARF (acute renal failure) in pregnancy was about 0.3%. Hypertensive disorders were the major causative factor. Amongst the 20 cases, 8 cases were referred from outside and two of them died. Total 5 of 20 cases required hemodialysis and two of them had partial recovery.Conclusions: AKI complicating pregnancies are not uncommon. If recognized and treated promptly, recovery is assured in majority of cases. Early identification and prompt management of pre-eclampsia and sepsis can prevent majority of cases. Ultrasonography revelation of placenta previa or abruption helps in early management eventually decreases the chances of bleeding which is one of the causes of AKI (pre-renal cause).
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Background:Gestational diabetes mellitus (GDM) is a global health challenge and is known to affect pregnancy adversely. Glycosylated haemoglobin (HbA1c) level reflect long term glycaemiccontrol and is a more accurate measure than Fasting Plasma Glucose and post prandial plasma glucose level.Aims and Objectives:To determine the levels of HbA1c, perinatal outcomes and the relationship between maternal HbA1c level and perinatal outcomes in women with GDM at the University of Port Harcourt Teaching Hospital.Materials and Methods: This was a longitudinal study of 80 pregnant women from 36 weeks of gestation with GDM attending the antenatal clinic of the University of Port Harcourt Teaching Hospital (UPTH). Blood samples from all consenting pregnant women were collected and sent to the Chemical Pathology laboratory to determine the HbA1c level. The blood samples from the babies were also sent to determine the random plasma glucose (RPG) level. A structured proforma was used to obtain socio-demographic characteristics and other information. Data collected was analyzed with SPSS version 22.0.Results:The mean age of the women was 32.58 ± 4.95 years. A total of 57 (71.3%) women with GDM had elevated HbA1c levels (≥ 6.5%). Fetal macrosomia occurred in 17.5%, while 8.8% had birth asphyxia. The perinatal mortality ratio was 1.3%. There was a statistically significant relationship between HbA1c levels and neonatal hypoglycemia and perinatal mortality(p <0.05). Conclusion: Despite the higher proportions of adverse perinatal outcomes occurring among those with elevated HbA1c levels, onlyneonatal hypoglycemia and perinatal mortality were significantly associated with elevated HbA1c
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Introduction: Placenta previa occurs when a baby's placentapartially or totally covers the mother's cervix or the outlet forthe uterus. The aim of this descriptive retrospective cohortstudy was to identify maternal complications, placentalposition, mode of delivery, management and fetal outcomes inPlacenta Previa (PP) and Morbidly adherent placentaMaterail and methods: Study was conducted in Departmentof Obstetrics and Gynecology, Pak Red Crescent Medical andDental College (PRCM&DC) Hospital Lahore from June 2017to June 2019. A total of 62 pregnant women were registered.All booked and un-booked mothers with and without historyof previous section with provisional clinical and/or USGdiagnosis of Placenta Previa or MAP.Results: In total, 62 patients with PP were identified 22.58%patients with morbidly adherent placenta were unbooked andother wise are booked. 61.2% patients were the age groupbetween 20-30 years and remaining are more than 30 years. In25.8% type IV placenta previa and same 25.8% are morbidlyadherent placenta and remaining are type I,II &III PP. Placentaprevia, only 6.45% cases were diagnosed in 2nd trimester and93.5% cases were diagnosed in 3rd trimester.Conclusion: Placenta Previa and Morbidly adherent placentaare not a very uncommon condition. Frequency of Incidenceincreases as the rate of cesarean section or abdominal surgerywere increases. Early diagnoses and pre plan mode of deliverywill decrease the risk of low birth weight and low APGARscore infants
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Background: First trimester bleeding complicates around 20-27% of pregnancy. Objective of this study was to evaluate and compare the feto-maternal and pregnancy outcome in patients presenting with live pregnancy complicated with first trimester bleeding and subchorionic hematoma with those without subchorionic hematoma.Methods: In this prospective observational study, based on ultrasonography, live pregnancies were categorized into two groups, first group having first trimester bleeding with subchorionic hematoma and second with first trimester bleeding only without any hematoma. They were evaluated for the end outcome of pregnancy in terms of abortion and continuation. Continued pregnancies were evaluated for antenatal complications, delivery and intrapartum events along with fetal outcomes.Results: Outcome of pregnancies presenting with first trimester bleeding in terms of abortion was similar in both the groups, 22.8% and 21.5% with hematoma and without hematoma respectively. Incidence of preeclampsia was 11.4% and Fetal growth restriction was 7% in pregnancies with first trimester bleeding with hematoma and was significantly higher than those without hematoma which was 3.07% for preeclampsia and 3% for fetal growth restriction. Incidence of antepartum haemorrhage was higher in hematoma group but the result was not statistically significant. 20% pregnancies with first trimester bleeding with hematoma had preterm deliveries, while it was 7.7% in pregnancies without hematoma and the difference was statistically significant. Low birth weight had occurred in 20% of babies in first group of patients while 4.6% in second group, difference being statistically significant.Conclusions: We found that live pregnancies with first trimester bleeding and subchorionic hematoma were associated with similar risk of miscarriage and antepartum haemorrhage while increased risk of preeclampsia, fetal growth restrictions, preterm birth, non-reassuring fetal heart pattern, caesarean delivery and low birth weight baby when compared to patients with first trimester bleeding without subchorionic hematoma. There was no difference in 5 minutes Apgar score and the NICU admission in both the groups.
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Background: Serum pregnancy-associated plasma protein-A (PAPP-A) levels fluctuate in continuation with the pregnancy and thus become an important standalone marker in monitoring the adverse outcomes that may occur in pregnancy.Methods: A prospective observational study was conducted in the department of obstetrics and gynaecology. A total of 240 pregnant women in their first trimester were included in the study. Serum PAPP-A levels were measured at 11-13+6week of gestation and were evaluated with respect to the feto-maternal outcome. The data was entered in MS excel spreadsheet and analysis was done using Statistical Package for Social Sciences (SPSS) version 21.0.Results: The mean age of the study population was 27 years. Among the maternal pregnancy parameters, PIH, pre-term labor and Emergency LSCS were significantly associated with low (<0.5 MoM) Serum PAPP-A levels, P<0.05. All the fetal outcome measures: IUGR, IUD, low birth weight, SGA babies, prematurity and NICU admissions, were significantly associated with low (<0.5 MoM) Serum PAPP-A levels, p <0.05.Conclusions: Serum PAPP-A in the early pregnancy showed significant correlation with feto-maternal outcome. Thus, it has the potential to be used as a prognostic factor and in the management of adverse outcomes by increasing surveillance for pregnant women with high-risk factors.
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Background: Pregnancy related acute kidney injury (PRAKI) is acute kidney injury occurring during pregnancy, labour, delivery, and/or postpartum period. Proper management of PRAKI is challenging because (i) both maternal and fetal health must be considered and (ii) the cardiovascular and renal adaptations of pregnancy add to the complexity of diagnosis and management. A multi discipilinary team is often needed to optimize all aspects of the pregnant women’s care.Methods: To study association and contributing factors in pregnancy related Acute Kidney injury, a retrospective study of 39 cases of acute kidney injury complicating pregnancies was carried out in department of obstetrics and gynaecology, B. J. Medical college over a period of 6 months, and results were studied and analysed. Etiological-factors, associated liver pathology, coagulation abnormality, thrombocytopenia, sepsis, recovery status and fetomaternal outcome were studied and results were tabulated. AKI was analysed in terms of maximal stage of renal injury attained as per risk, injury, failure, loss of function, and end-stage renal disease (RIFLE) criteria.Results: The incidence of ARF in pregnancy was found to be 0.3%. Hypertension and its related complications were the most common causative factor. 59.5% of cases required hemodialysis and except for 6 cases (14.3%) all had complete or at least partial recovery from failure.Conclusions: AKI complicating pregnancies are not uncommon in tertiary care centres. If recognized and treated promptly, recovery is assured in majority of 85.7% of cases. Early identification and prompt management of pre-eclampsia and sepsis can prevent majority of ARF cases.
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Background:One of the major causes of maternal mortality is obstructed labor. Identificationof abnormal labor at earliest and timely management can prevent prolonged labor and significantly reduce its sequel. Partograph is a useful tool in hands of labor caregiversto monitor labor course.The study was done to compare feasibility of two WHO partographs a composite partograph including the latent phase with a simplified one without the latent phase to predict prolonged laborin randomized control trial.Methods:A randomized controlled trial, with parallel arm design was conducted. Sample size was calculated as 404 pregnant women .They were randomly categorized in two groups,each group having 202 participants.Results:labor had crossed the alert line in 108 (53.4%) cases monitored by composite partograph and 38(18.8%) cases monitored with simplified partograph. The calculated P value was <0.0001. The odds ratio calculate was 4.95 and 95% confidence interval was 3.16 to 7.76. Labor crossing the action line was found in 16 (7.9%) in composite partograph whereas in simplified partograph, labor had crossed the action line in 18 casesin simplified group. Calculated P value was 0.72 (>0.05). The odds ratio was 0.8793and 95% confidence interval 0.43 to 1.77 which was not significant statistically .Most participants (70%) experienced difficulty with the composite partograph, but no participant reported difficulty while plotting the simplified partograph. Conclusions: WHO simplified partograph was found to be as good as WHO composite partograph in identifying maternal and perinatal outcomes and was more user friendly.
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Premature rupture of membranes (PROM), also called Prelabour Rupture Of Membranes, is classically dened as rupture of membranes before labour and accounts for 0.8-0.9% of all pregnancies at term. this study was conducted over a period of 14 months ( from March 2018 to May 2019) in a tertiary care medical college . A total of 100 term PROM patients were recruited in our study – and divided into two groups randomly--50 (Group A) patients were managed conservatively and 50 (Group- B) patients underwent induction of labour. Both these patient groups were studied to compare the feto-maternal outcome. Group-A (conservative management group) patients were observed to await the spontaneous onset of labour pains for at least 24 hours. Patients in group B were induced with either - PGE1 tab (misoprostol) 25 μgm 4 hourly orally or iv oxytocin infusion. the PROM-delivery interval was < 12 hours in 72 % of induced groups (Group B) and 10% (5) in group- A (conservative or expectant group). LSCS rate was 10 % in group-A (expectant group) & 15 % in group –B (induced group). Sepsis rate, maternal and fetal, hospital stay, NICU admission & duration of NICU stay were notably higher in group – A (expectant management group). therefore, from our study we concluded that immediate induction of labour in term PROM cases shortens the PROM- delivery interval, hospital stay, NICU stay and reduction in both maternal & neonatal sepsis.
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Background: Diabetes mellitus (DM) is defined as increased blood glucose level due to defect in insulin secretion, insulin action or both. Undiagnosed or inadequately treated diabetes mellitus during pregnancy can lead to significant maternal and fetal complications. The study was conducted to review feto-maternal outcome in pregnancy with diabetes and to plan management of pregnancy with diabetes and to study the modalities for treatment of DM in pregnancy.Methods: A prospective case study was conducted from July 2015 to December 2018 at a tertiary care center. Study group used single step 75gm oral glucose tolerance test (OGTT) test recommended by WHO for GDM diagnosis.Results: GDM (85%) was more common than overt diabetes (15%) and in younger age group (53.75%) and Multiparous patients (18.2%). Most of patients required insulin (81.2%) for treatment of DM during pregnancy along with medical nutrition therapy and exercise. Most common association in this patient was hypertension (41%). Rate of caesarean section (60%) was more common. Average birth weight was of >3.5 kg, intrauterine death (4.2%), preterm delivery (14.2%) and admission to NICU were also common.Conclusions: There was significant fetomaternal morbidity in patients with diabetes mellitus. Early diagnosis and treatment reduces the fetomaternal outcome.
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Background: Human cytomegalovirus (CMV) infection is the most common cause of perinatal viral infection. congenital CMV infection can produce varying degrees of neurodevelopmental disabilities. Aims and objectives were to study the fetomaternal outcome in CMV-Specific IgM antibodies.Methods: The study was prospective for a period of one and a half year. Hundred high risk patients with hundred controls were screened for CMV serology IgM. Maternal & fetal outcomes were noted.Results: Out of 100 cases in study group 27(27%) were positive for CMV IgM while in control group 6(6%) were positive(p<0.05). Primary CMV infection in mothers led to abortion in 2(7.4%) patients, pre-term labour in 5(18.5%), Postpartum hemorrhage in 6 (22.2%), fetal distress in 11(40.7%) while 37% had uneventful outcome. Among CMV positive cases 48.1% were born term live, 6(22.2%) were preterm, 1(3.7%) had IUD, Intrauterine growth restriction in 10 (37%), 6(22.2%) with congenital defect and 4(14.8%) with neonatal manifestations.Conclusions: CMV remains a significant public health concern. Education of young women in our community regarding hygienic and behavioral approaches that can help prevent CMV transmission is mandatory.
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Background: Intrahepatic cholestasis of pregnancy (IHCP) is one of the commonest pregnancy related liver disorder. Although the maternal course is usually benign, there is an increased risk of spontaneous preterm delivery, fetal compromise, meconium stained amniotic fluid and even intrauterine fetal demise. The objective of this study was to study the incidence of IHCP and its impact on maternal and perinatal outcome.Methods: A prospective study carried out in 68 number of IHCP cases. Diagnosis was done on the basis of clinical and laboratory parameters. All the cases were followed up to the puerperium to find out maternal and perinatal outcome.Results: The incidence of cholestasis of pregnancy was 2.73%. Most (88%) of the cases were presented with generalized pruritus, relived with ursodeoxycholic acid and complete recovery was observed after delivery. The rate of instrumental delivery was 8.82% and caesarean section rate was 30.88%. Most common indication of caesarean section was fetal distress and non-progress of labour. There was one stillbirth at 35 weeks however none of the mother had complication during labour or puerperal period.Conclusions: Increased level of liver enzymes in patients of IHCP associated with poor perinatal outcome. Therefore, careful monitoring during antenatal period and termination of pregnancy at term will result in favourable outcome of both mother and baby.
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Background: The objective of the present study was to describe management of morbidly adherent placenta with placenta previa and feto-maternal outcome.Methods: All antenatal USG diagnosed cases of morbidly adherent placenta were analyzed. The cases were managed by elective caesarean hysterectomy and non-separation of placenta at delivery. Amount of blood loss, blood transfused, ICU admission, postnatal complications and hospital stay was recorded.Results: From January 2010 to October 2018, 22 cases of morbidly adherent placenta were diagnosed on gray scale and color Doppler during antenatal ultrasound scan. Scheduled caesarean hysterectomy without attempting placental removal was done. Subtotal hysterectomy was performed in 17(77.2%) cases and total hysterectomy in remaining 5(22.8%) cases. All the patients required blood transfusion. Seven (31.8%) patients had urinary bladder injury. One case developed DIC and One needed ventilatory support. No patient died in this series.Conclusions: Antenatal diagnosed cases of morbidly adherent placenta, avoidance of placental separation and caesarean hysterectomy results in better maternal outcome.
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Background: Increasing BMI in women poses multiple threat of illness especially in the reproductive age group impacting pregnancy. Pregnant women with overweight and obesity are at a higher risk of developing complications at all stages of the physiological pregnancy. A focus on the methods to prevent this trend of increasing weight gain in adolescence is essential curb the complications due to obesity.Methods: This prospective study was conducted in the Department of Obstetrics and Gynecology, Madras Medical College, Chennai. Written informed consent was obtained and pregnant women visiting the antenatal OP were registered. Detailed history taking and examination was carried out with the measurement of body mass index as weight in kg/height in meter square. The women were followed up for the antepartum, intrapartum, post-partum variables and neonatal outcome.Results: Two hundred pregnant women with high BMI >25 kg/m2 and two hundred pregnant women with normal BMI were selected and were followed prospectively. Present study showed an increased incidence of pre-eclampsia in patients with high BMI (28% as compared to 8% of the normal BMI) and a higher incidence of Gestational diabetes mellitus among women with high BMI with a value of 27.5 % compared to a value of 7.5% in women with normal BMI. Caesarean delivery was found in 54.5% of the high BMI mothers compared to 31.5% in normal BMI mothers. Postoperatively, wound gaping was found with an incidence of 4.5% in high BMI mothers. IUGR was found in 10% of babies of women with high BMI and still birth occurred in 2.5% of deliveries of high BMI mothers compared to 0.5% in mothers of normal BMI group.Conclusions: The obstetrician needs to be well versed with dietary advice and life style pattern advice to the women of the reproductive age group in order to prevent the complications of high Body mass index in pregnancy. Its imperative to counsel these women about the pre-pregnancy loss of weight, healthy food and exercise, and healthy life style pattern during pregnancy in order to have a healthy outcome.
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Objectives - To study the fetal and maternal outcome, in pregnancies complicated by polyhydramnios with that of pregnancies having normal fluid volume. Maternal and Methods This prospective case control study was conducted on 100 patients with polyhydramnios and 100 pregnant women with normal fluid volume over a period of 18 months from April 2017 to September 2018. Results Out of 100 patients with AFI > 24, 12% had congenital anomalies, out of which GIT were maximum as compared to control group only 2%. The most common maternal complication in the study group was preterm labor, malpresentation, PROM, eclampsia, auptio placenta, dyspnea, cord prolapse and atonic PPH, slightly more as compared to study group. Gestational age at delivery in the study group was 37.6 weeks as compared to 38.2 weeks in control group. The study group had more number of labor inductions, LSCS, fetal distress, low 1 and 5 minute Apgar Score, NICU admissions, meconium aspiration, respiratory distress and perinatal deaths as compared to control group. Conclusion Polyhydramnios poses danger for both mother and baby, hence there is a need to have an anomaly scan at an earlier gestation and monthly amniotic fluid assessment from 20th week onward for diagnosis of polyhydramnios and timely intervention so as to reduce the maternal morbidity and perinatal morbidity and mortality.
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Background: Over half-a-million women die each year from pregnancy-related causes, and 99 percent of these occur in developing countries. In Bangladesh though maternal mortality rate (MMR) declined significantly around 40% in the past decade, still eclampsia accounts for 20% of maternal deaths. Eclampsia is uniquely a disease of pregnancy, and the only cure is delivery regardless of gestational age. A rational therapy for general management of hypertension and convulsion has been established in Bangladesh by the Eclampsia Working Group. But controversy still exists regarding obstetric management. Objective: To evaluate the feto-maternal outcome in cesarean section compared to vaginal delivery in eclamptic patients. Materials and Methods: This prospective cohort study was conducted in the department of Obstretics & Gynecology, Dhaka Medical College & Hospital (DMCH), from January to December 2011. A total 100 eclamptic women with term pregnancy and live foetus were purposively included in the study (Group I, 50 patients with vaginal delivery and Group II, 50 with cesarean section). Results: Out of these 100 patients 56% were aged <20 years, 71% were primigravida and 77% were from low socioeconomic status. Sixteen percent patients from vaginal delivery group and 18% from cesarean section group had no antenatal care. The mean gestational age was about 38 weeks in two groups. No significant difference was found between the two groups regarding blood pressure, proteinuria, consciousness level and convulsion. Recurrence of convulsion occurred in 30% patients of vaginal delivery group compared to 6% in cesarean section group. Maternal complications such as postpartum hemorrhage, cerebrovascular accident, renal failure, obstetric shock and abruptio placenta were higher among vaginal delivery group patients (46%) than cesarean section patients (16%). Maternal mortality was 6% in the vaginal delivery group and none in the cesarean section group. Regarding fetal outcome, stillbirth was 20% after vaginal delivery and 6% after cesarean section, the result was statistically significant. Birth asphyxia was less in the cesarean section group (23.4%) than in vaginal delivery group (60%) and this was statistically significant. Conclusions: The result of the present study shows a better feto- maternal outcome in the cesarean section group than in the vaginal delivery group.