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Background & Objective: Umbilical cord length and number of loops around fetal neck leadsto intrapartum complication which can predict by antenatal screening.This study was carried out to find the effect of length of umbilical cord on intrapartumcomplication, mode of delivery, perinatal outcome.Methods: This is a prospective study conducted at NHL MMC from August 2020 to July 2021.Total 300 cases were taken. Antenatal ultrasound carried out to screen nucle cord and afterdelivery number of loops were noticed and APGAR score noted.Results: Out of 300 cases 5 case were <35 cm and 2 cases >102 cm ,97 cases were 66-75cm.86% had medium cord length, 8.67% had long, 5.3% short cord length. 11.5% case with longcase had IUFD. 85.7% with 3 loops delivered by cesarean section.Conclusion: Increase umbilical cord length and loop associated with complication like fetalheart rate variation, fetal asphyxia, increase cesarean rate. Intrapartum fetal monitoring avoidsperinatal morbidity and mortality.
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Background: The death of a fetus is emotionally traumatic for the parents. It is also distressing for the treating obstetrician. Besides being emotionally challenging, fetal demise raises a lot of questions and increases an obstetrician’s medicolegal risk. The aim of this study was to identify various maternal conditions and socio-demographic factors associated with fetal death and to find the preventable causes of fetal death.Methods: A retrospective observational study was undertaken at Lalla Ded Hospital, Srinagar, Kashmir - a tertiary care centre. The cases of singleton intrauterine fetal deaths (IUFD) with either ultrasound reports proving IUFD or diagnosed on clinical examination by absence of fetal heart sound with gestational age >28 weeks were included. Exclusion criteria includes molar pregnancy and multiple pregnancy.Results: Still birth rate in our study was 19.6 per 1000. Most of the patients with stillbirth belonged to age group of 21-30 years accounting for 67.1% of all cases. Unbooked cases comprised of 58.9%. Most of the study patients i.e. 74.7% belonged to lower middle class. In our study 39% of stillbirth cases were in the range of 28-32 gestational weeks followed by 33.6% cases in 33-37 gestational weeks. Maternal hypertensive disorders had a strong association with IUFD 33.6% (pre-eclampsia 27.4%, eclampsia 6.2%). This was followed by placental abruption comprising 11.7%. Gestational diabetes and severe anaemia accounted for 6.2% and 3.4% respectively. Gross congenital anomalies and fetal infections contributed 2.7% and 2% respectively.Conclusions: Routine antenatal checkups with identification of high risk pregnancies, better access to emergency obstetric care especially during labor, emphasis on institutional deliveries community birth attendant training should help in reducing stillbirth rates in developing countries. Optimal evaluation for future pregnancy is necessary. Counseling and support group should be involved.
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Background: To study the incidence, management and to determine maternal and perinatal outcome in cases of twin pregnancy with one twin demise in the second half of the pregnancy.Methods: This retrospective study was carried out at Cheluvamba Hospital, a tertiary care hospital attached to Mysore medical college and research institute between September 2009 and 2014. 19 twin pregnancies complicated by single intrauterine fetal demise (IUFD) after 20 weeks of gestation were identified from the hospital records. Data collected included maternal age, parity, antenatal complications, cause of IUFD, gestational age at diagnosis, time interval between diagnosis of IUFD and delivery, mode of delivery, birth details, type of placentation and neonatal complications.Results: The incidence of twin with one twin demise was 2.056%. Mean gestational age at presentation was 33.86 weeks. Most common cause of death was growth discordance in 7 cases followed by placental insufficiency in 4 cases. 57.89% of cases had monochorionic placentation. Neonatal course was most commonly complicated by prematurity. Maternal course was uneventful in majority (63.15%) of cases with two maternal deaths due to intravascular coagulopathy sequelae.Conclusions: Single fetal death occurs more often in monochorionic twins. The main problem for the surviving twin is prematurity. It is very important to identify the chorionicity by ultrasound examination in early pregnancy and implement specific surveillance of monochorial pregnancies.
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Background: Pregnancy-related acute renal failure (ARF) can be caused by any of the disorders leading to ARF in the general population. We aimed to study the clinical profile of pregnancy related acute renal failure, management and clinical outcomes. Materials and methods: After obtaining ethical committee’s approval, a prospective observational study was carried out on hospitalized patients in our hospital from 1st August 2007 till 30th September 2008, where all pregnant females referred to nephrology unit were enrolled. Results: A total of 41 patients were included in the study in which oliguria was the commonest symptom (58.53%). Fluid overload was the most common complication encountered (33.33%). Respiratory system involvement was associated with increased mortality. No correlation between serum creatinine level and mortality was observed. Neonatal deaths were seen in 2.43% of patients while IUFD was seen in 19.51% of patients. Conclusions: Incidence of PR-ARF is still high in our country as compared to western countries. Multigravidas were more commonly affected than primigravidas. More than two organ involvement was associated with higher mortality and majority of the patients were treated conservatively. Maternal and fetal mortality were high, 17.07% and 2.43% respectively.
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Objective: Study was conducted to determine the rates, documented causal factors and obstetric outcome for intrauterine fetal deaths at a tertiary care centre in Gujarat. The study also aimed to prove the value of antenatal care in prevention of intrauterine fetal death. Methods: A prospective descriptive study was conducted at a tertiary hospital in Gujarat, India. The study was performed over 14 month’s period (Jun 2004 to July 2005). Patients having intrauterine fetal death on admission in the third trimester were included in this study. Total number of deliveries during this period was 9802. Among this, total numbers of antenatal IUFD in third trimester were 161. The causes of IUFD were determined purely on close clinical observations and preliminary investigations. Results: Total number of deliveries were 9802.Incidence of still birth at our centre was 31 per 1000. Antenatal IUFD rate was 16.5 per 1000 after excluding early trimester fetal deaths and intra partum fetal deaths. IUFD amounts to one third of perinatal mortality in this study. Among the identifiable causes,Hypertensive disorders (31%), placental abruption (15.5%), severe anemia (13%), were most common causes. Congenital malformations were responsible for 4.3% cases .Induction was done in 36, augmentation was done in 53 patients,67 patients had spontaneous onset of labor and caesarean section was done in 5 patients. The most devastating complication of IUFD was DIC found in 3 patients (1.9%). Conclusions: The present study is an effort to compile a profile of maternal, fetal and placental causes culminating to IUFD at our centre. This emphasizes the Importance of proper antenatal care and identification of risk factors and its treatment. Considerable number of IUFD are still labeled as unexplained, hence cannot be prevented. Decrease in the incidence of IUFD would significantly reduce the perinatal mortality.
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In diamnionic dichorionic twins, the type of placenta consists of fused and separate types. The expansion of one twin placenta often occurs in the direction of the other implantation site in fused type. Placental development often leads to collision, and the growth of one or both placentas may be hindered, which can cause intrauterine growth restriction (IUGR). We represent a single case of one placental implantation above the another which caused IUFD in one fetus in diamnionic dichorionic twin pregnancy with a brief review of literatures.
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Humans , Fetal Death , Fetus , Placenta , Placentation , Pregnancy, Twin , TwinsABSTRACT
The intrauterine fetal death(IUFD) is the death of the fetus prior to complete expulsion or extraction from its mother when the fetus is over 20 weeks gestation or weights more than 500 gm. This is a clinical study of 262 cases of IUFD and 262 control cases among 18542 deli-veries at Chung Goo Sung Sim Hospital during 10 years from 1987 to 1996. The results obtain-ed were as follows: 1. The incidence of IUFD was 1.41%. 2. The risk of IUFD was high in women older. 3. The risk of IUFD was high in women with parity of three or more, there was a previous history of IUFD in 11.2% of the IUFD cases and in 6.3% of the control cases, but there was no difference between the two groups of women in history of spontaneous abortion. 4. The sex ratio of male versus female was 1.24:1 in the IUFD cases, 1.11:1 in the control cases. 5. The low birth weight and preterm infants were much more frequent in the IUFD cases. 6. The mode of delivery IUFD was induced labor(77.5%), laparotomy(12.2%), spontaneo- us delivery(10.3%). The indications for laparotomy were placental abruption, placenta previa, transverse lie, previous cesarean section status, cephalopelvic disproportion and uterine rupture. 7. The most common cause of IUFD was unexplained causes(45.1%). 8. There were 67 cases(25.6%) of maternal complication, and the most common complica- tion was fever(35.8%). 9. In the incidence of abnormal coagulation test, the low platelet count(14 seconds) was 7.2%, the prolonged partial thr- omboplastin time was 1.0%, the hypofibrinogenemia(40 ug/ml) was 8.4%. 10. The risk of IUFD was lowered as the number of antenatal care was increased.