Study of Intrauterine Foetal Death in Government Medical College in Tribal Area of Bastar.

IUFD is a major obstetrical complication and is an important indicator of perinatal health in a given population. Literally, intrauterine foetal death (IUFD) is considered as all foetal deaths weighing 500 g or more occurring both during pregnancy and during labour. We wanted to asses maternal and foetal factors associated with intrauterine death, and formulate effective strategies for prevention of IUFD. MethodsThis was a prospective study carried out in a GMC Jagdalpur from July 2019 to mid-November 2019. All the admitted patients of our department with gestational age >28 weeks (confirmed by LMP or by USG) diagnosed as having IUFD (confirmed by USG) were included in the study. ResultsTotal number of deliveries during the study was 1455 and total number of IUFD was 109. Incidence of intrauterine death was 7.49%. Majority of the cases were of age group 26-30 years that is 39.44% (43/109) while teenager (16-20 years) pregnancies were only 11.92%. Most of the cases were preterm (67/109) around 61.46% and only 2.75% cases were post term. In 22.01% (24/109) cases, causes were not identified while in 77.99% cases (85/109) causes were identified. Hypertensive disorder was the major cause of IUFD (27.5%) followed by unknown aetiology (22.01%), infection (14.67%) and rupture uterus (10.09%). Rural population was 66.97% and urban population was only 33.02%. Most of the cases were primipara 43.11% (47/109) while least number of cases 8.25% (9/109) was of grand multipara. ConclusionsDespite being a tertiary center, incidence of IUFD is much higher than other areas of our country. Cause may be attributed to lack of awareness, illiteracy, and poor infrastructure in periphery, and this being a referral centre for a large area.

A rare case of abdominal pregnancy: diagnostic and therapeutic challenges

Abdominal pregnancy refers to a pregnancy that has implanted in the abdominal cavity, the estimated incidence being 1 per 30,000 births. A 36-year-old primigravida with term pregnancy with fetal demise was referred to us. Examination was suggestive of single foetus of 30 weeks’ gestation with longitudinal lie and cephalic presentation with absent foetal heart sounds. The cervical os was closed, uneffaced. Ultrasound done at 18 weeks’ gestation had reported pregnancy in a bicornuate uterus. Present ultrasound revealed intrauterine foetal demise of 28.4 weeks. Cervical ripening, done using prostaglandins, mechanical dilation with Foley’s catheter and oxytocin, had failed, and thus patient was taken up for surgery. Findings revealed an abdominal pregnancy with a macerated fetus of 1070 grams (severely growth restricted). Placenta was found to be implanted on multiple areas of both small and large intestine and posterior peritoneum. Placenta was left in situ. Postoperative recovery was uneventful. She was given higher antibiotics, 4 doses of tablet mifepristone 200 mg and monitored regularly with ultrasound/ MRI and bHCG which showed slow placental resorption. Conclusion- Abdominal pregnancies, associated with a high maternal and perinatal morbidity and mortality, are diagnosed preoperatively only in 45% of cases. Thus, a high index of suspicion and improvement in diagnosis is the need of the hour. Successful management includes prompt intraoperative recognition and management of the placenta (we advocate leaving the placenta in situ), multidisciplinary approach with involvement of surgeons and interventional radiologists, access to blood products, meticulous postoperative care and close observation during the subsequent delayed reabsorption.

Mifepristone Followed by Prostaglandin Vs Prostaglandin alone for induction of Labour in Intrauterine Foetal Death at or more than 28 Weeks of Pregnancy.

Introduction: Intrauterine fetal death (IUFD) is a rare butdevastating event for the mother and family. Rapid expulsionof the foetus is usually requested, although there are nomedical grounds for it. Labour following IUFD often needsto be induced by medical means. Prostaglandin analogues,such as misoprostol and gemeprost, have been extensivelystudied and proven to be safe and effective in the inductionof abortion in the second trimester of pregnancy. Hence, theaim of the present study was to compare the required dose ofprostaglandin and induction delivery interval in Mifepristonewith Prostaglandin and Prostaglandin alone in IntrauterineFoetal Death at or more than 28 weeks of pregnancyMaterial and methods: The present was a prospective studyin which women came with ultrasonography confirmedintrauterine death were counselled and divided into twogroups randomly. First group had Tab mifepristone (200mg)orally followed by Dinoprostone gel intracervically after 24hrs and misoprostol (50mcg) 4 hourly thereafter, whereassecond group had a multivitamin tablet orally and after 24hours dinoprostone gel applied intracervically followed bymisoprostol tab (50 mcg) 4 hourly upto maximum 6 doses inboth groups.Results: The induction to delivery interval in hours wasfound to be higher in Group B than A. This was found to bestatistically significant at p value 0.021. Number of dosage ofmisoprostol was also seen higher in majority of cases in GroupB which was also found to be statistically significant.Conclusion: This study showed that combination ofMifepristone (200 mg) and prostaglandin was found to bemore effective than Prostaglandin alone for induction oflabour in intrauterine foetal death of 28 weeks or more.