ABSTRACT
This is a case study of anaphylactic reaction to cefotaxime sodium in a 23-year-old female who underwent a lower segment cesarean section under spinal anesthesia. Cefotaxime sodium, an antibiotic belonging to the class of cephalosporins, was administered intravenously postoperatively for prevention of infection. The patient complained of breathlessness, swelling around both eyes, and pruritus and urticarial rash over her abdomen, legs, and forehead. The case was successfully managed by withholding the medication and treatment of symptoms. According to the WHO-Uppsala Monitoring Centre causality assessment scale, a probable causal relationship between the suspected drug (cefotaxime sodium) and anaphylactic reaction was made. The severity was found to be moderate (Level 3). Although cefotaxime has well established place in surgical prophylaxis, this case study emphasizes on constant observation and meticulous follow-up of patients receiving it in clinical practice as there is possibility of an adverse drug reaction (ADR) which can be life-threatening. Such happenings can add to challenges faced by the treating physician in the present COVID-19 era. Recognizing ADR helps reduce morbidity and mortality. Reporting ADR helps in documentation and education of healthcare professionals.
ABSTRACT
Background: Recent years have witnessed a rise in rate of primary caesarean section (CS). No. of women reporting with a previous CS scar is also increasing. Judicious trial of labor in such patients can prevent repeat caesarean section. Aim of this study was to assessing the safety and success rate of vaginal birth after caesarean (VBAC) in selected cases of patients who have undergone previous lower segment CS (LSCS) is the main aim of this study.Methods: In this prospective observational study carried out in a tertiary care teaching hospital over a period of 1 year. 375 pregnant women with a history of one previous LSCS for non-recurrent indications were enrolled. The statistical technique of t-test was administered for relative comparison with respect to maternal and neonatal complications across the two groups, i.e. repeat LSCS and vaginal delivery.Results: Out of 375 patients 187 patients (49.9%) underwent elective LSCS for recurrent indication and for non-recurrent indication associated with some complicating factor. Trial of labor in 188 (50.10%) was given out of which 59.3% had spontaneous vaginal delivery,7.20% had instrumental delivery and 33.50% landed into emergency CS. Commonest cause of Em. LSCS being Fetal distress. As regards maternal complications, no statistically significant difference was found between the Repeat LSCS and Vaginal delivery groups (t = 0.779, p > 0.05). On similar lines, there was no statistically significant difference across both groups as regards neonatal complications (t = 0.632, p > 0.05).Conclusions: Taking into account the increased trend of primary CS, trial of VBAC in selected cases is very important. It can be concluded that VBAC has chances of success in cases with previous one LSCS but it must be carefully investigated and monitored.
ABSTRACT
Background: Over the time the caesarean delivery rate has significantly increase worldwide from 18.2% in 2002 to 30.3% in 2012. In parous women, previous caesarean section has been found to be the most common indication for caesarean delivery in as high as 67% cases. Unsecure prediction of the integrity of the scarred LUS during labor appears to be one of the reasons for high repeat caesarean rates. The purpose of this study was to assess the usefulness of sonographic measurement of the lower uterine segment scar before labour for deciding whether it is a reliable safeguard for trial of labour or not in a woman having previous one caesarean delivery.Methods: This study was a prospective observational study, carried out on 108 pregnant women having previous one CS, gestational age >37, singleton pregnancy, cephalic presentation. Trans-abdominal USG was done to measure scar thickness. Trial of labour was given to each patient irrespective of scar thickness. Pregnancy outcome were noted in terms of successful VBAC or emergency LSCS and compared with scar thickness. Correlation between sonographic and intra-operative finding of scar were noted.Results: Result shows strong correlation between scar thickness and successful trial of labour. Scar thickness increases chances of successful vaginal deliveries.Conclusions: Sonographic assessment of previous scar has a practical application to predict the thickness and thinness of previous scar and can be taken as a reliable safeguard for trial of labour after previous cesarean but cut off value above which vaginal delivery could be considered safe is yet to be identified.
ABSTRACT
Background: Twin pregnancy being one of the causes of high-risk pregnancy is associated with both maternal and fetal complications. This study aims at analysing the fetal and maternal outcome in such cases. All cases were studied according to their parity, maternal age, fetal presentation, mode of delivery and gestational age.Methods: This prospective study was conducted at one of the tertiary care teaching institutes over a period of one year from January 2018 to December 2018. Out of a total number of 7295 deliveries, 130 were twin pregnancy. It included all women admitted in labour room with clinical or ultrasound diagnosis of twin pregnancy after 20 weeks of gestation.Results: In the present study incidence of twin pregnancy was 1.78%. We observed the highest incidence of twins in the age group of 20-29 years. The least incidence was below the age of 20 years. Incidence of twin pregnancy in our study in primipara was 47.7% and in multipara was 52.3%. Most of the patients (43%) delivered at 32-36 weeks of gestation. Maternal complications were noticed as anemia in 29.2% patients, pregnancy induced hypertension in 55.4% patients, post-partum hemorrhage in 4.6% patients, polyhydramnios in 3.1% patients, premature rupture of membranes in 8.5% patients, gestational diabetes in 0.8% patients and urinary tract infection in 2.3% patients. Majority of the patients delivered vaginally (60.8%), others by lower segment cesarean section (LSCS). In this study 95.8% babies were low birth weight. There were 34 neonatal deaths (13%).Conclusions: Twin pregnancy is a high-risk pregnancy associated with significantly increased maternal morbidity, neonatal morbidity and mortality. Such pregnancies require good antenatal care, early detection of maternal and fetal complications and timely referral to a centre well equipped for management of such cases.
ABSTRACT
Background: As Indian women has increased risk of developing GDM, screening for GDM is essential for early diagnosis and treatment and hence to reduce the adverse neonatal outcomes.Methods: The antenatal women are screened for GDM by administering 50g GCT and the screening test value of >130mg/dl measured at 1 hours were considered screening test positive and subjected to standard 2 hour 75gm OGTT and the neonatal outcome were observed in relation to neonatal birth weight, Apgar, and the occurrence of complications like hypoglycemia, hypocalcemia, hyperbilirubenemia.Results: The average neonatal birth weight in the study population was 3kg. The women with GDM who required diet alone had average neonatal birth weight of 2.9kgs and the GDM women who were on diet and insulin therapy had average neonatal birth weight of 3.4kg. There was increased incidence of hyperbilirubinemia 33.3% .There was only 1 preterm birth.Conclusions: There is association with neonatal Complications like hyperbilirubenemia and hypoglycemia with women who had screening positive for GDM.
ABSTRACT
Background: In recent times, gestational diabetes is becoming more common Worldwide and complications are seen in fetal development, growth, labour and delivery due to maternal hyperglycemia. Gestational Diabetes Mellitus(GDM) is associated with adverse maternal and fetal outcomes. Among South Asian Population, Indian Women are at high risk of developing carbohydrate intolerance during pregnancy. Hence this study is undertaken to screen for gestational diabetes mellitus by two step method in Indian Women.Methods: This study was done in 153 nondiabetic pregnant women of gestational age 24-28 weeks, excluding diabetes mellitus diagnosed prior to pregnancy. Two step method was followed in the present study and GDM was diagnosed and the pregnancy outcomes were noted.Results: In our study the prevalence of GDM is 8.1% by two step method. Most of the women diagnosed with GDM were of age 26-30 yrs (41.66%). Among the women who were diagnosed as GDM, (58.33%) cases required Insulin along with diet control. In our study 33.33% had vaginal delivery, 8.33% had Emergency LSCS and 58.33% had Elective LSCS.Conclusion: Indian Women have high prevalence of GDM, hence universal screening is essential to diagnose GDM, which will improve the pregnancy outcome.
ABSTRACT
Background: With a steep fall in maternal mortality and morbidity and with much more liberalization of indications, the incidence of cesarean section rate has greatly increased over the last thirty years and almost doubled in the current decade. The objective of this study was to study incidence of maternal morbidity in emergency lower segment cesarean section.Methods: Hospital based prospective study was carried out among 200 women undergoing emergency lower segment cesarean section. Data relating to demographic characteristics, clinical characteristics, maternal and fetal indications, incidence of morbidity, and types of morbidities, Intra operative complications, and Post operative complications was noted down. Chi square and odds ratio was used for statistical analysis.Results: The incidence of LSCS was 24.21%. Incidence of emergency LSCS was 96.74%. 71% were having primary LSCS and 20.5% were booked cases. The most common maternal indication for emergency LSCS was pregnancy induced hypertension and eclampsia in 32.5% of the cases. The most common fetal indication for emergency LSCS was fetal distress in 60%. Incidence of morbidity was 35% and it was associated with booking status, parity and social class. Incidence of intraoperative complications was 23.5%. Majority (18.5%) developed febrile morbidity followed by wound sepsis in 12.5%, urinary tract infection in 8%, mastitis in 7.5%, respiratory tract infection in 7%, wound gaping in 4%, paralytic ileus in 3%, endometritis in 2.5%, postpartum hemorrhage in 1.5%, 2 cases of burst abdomen and one case of small bowel obstruction.Conclusions: Emergency LSCS was more common than elective LSCS and it was associated with booking status, parity and social class.
ABSTRACT
Background: The objective of this study is to evaluate the outcomes of induction of labor in women attempting trial of labor after cesarean delivery and to compare maternal and neonatal morbidity and mortality in women who were induced to those delivering spontaneously.Methods: The prospective study was carried out in the Department of Obstetrics and Gynecology in collaboration with the Neonatal Section, Department of Pediatrics at J.N. Medical College and Hospital, AMU Aligarh. The sample included 280 women with one previous cesarean section, of whom 130 women underwent induction of labor (study group) and 150 were admitted with spontaneous onset of labor. Prostaglandin gel and intracervical Foley’s were used for cervical ripening in the study group. Indication of cesarean section, mode of delivery, maternal and neonatal outcome were studied in between groups.Results: Overall rate of vaginal delivery after cesarean section was 45.3% and 56% in both study and control group respectively. The rate of cesarean section were higher in women who were induced and having unfavorable cervix. Maternal and neonatal morbidity were not significantly higher as compared in both groups, however one case of scar rupture was found in study group.Conclusions: Induction of labor in women with previous cesarean section had higher rates of cesarean section however it does not adversely affect neonatal and maternal morbidity. Overall vaginal birth is safe and effective in women with previous cesarean section by prostaglandin gel or intracervical Foley’s. Authors cautiously suggest, induction of labor should be considered in preselected patient with strict monitoring.