Challenges Faced by an Obstetrician while Dealing with Obstetric Emergency in Cases of Placenta Previa.

Placenta previa itself is a challenge for obstetrician as it may be a fatal condition. Placenta previa is a life-threatening condition and bleeds frequently after second trimester with complaints of bleeding per vagina, mildly or severely. Incidence is 35% of antepartum haemorrhage. We wanted to determine the maternal and foetal outcome at any cost by strengthening the casualty team for emergency management of unpredictable APH and PPH by giving training for the same.METHODSIt is a descriptive observational study was conducted among 35 patients of placenta previa who were diagnosed clinically as well as on ultrasonography, from June 2017 to August 2018 in Gujarat Adani Institute of Medical Sciences. A detailed history was taken as per fixed proforma for all pregnant women.RESULTSPlacenta previa was common in the age group of 21-30 (71.8%) and amongst them multiparous group of more than 5 parity (29%). 3 cases (9.09%) were bilateral uterine artery ligation and 1 case of B-Lynch suture. A single case of internal iliac artery ligation and obstetric hysterectomy was observed. In this study 3 cases of placenta accreta, 1 case of placenta increta, 15 cases of preterm baby, 5 cases (14.2%) of IUFD and 7 cases (20%) of NICU admission were studied.CONCLUSIONSPlacenta previa is a challenging job. A proper multidisciplinary approach based management including expert obstetricians, anaesthetists, neonatologists, radiologists, surgeons as well as trained nursing staff is required for saving mother’s as well as baby’s life.

A study of maternal risk factors and the perinatal outcome in meconium stained amniotic fluid in central referral hospital

Background: Meconium staining of amniotic fluid (MSAF) is a significant risk factor for the subsequent development of meconium aspiration syndrome (MAS), respiratory distress and eventual respiratory failure in neonates. To learn more about the risk factors and outcomes associated with MSAF, a prospective case control study was conducted. The objective of the study was to study various maternal risk factors associated with MSAF and to study the outcome of neonates born through MASF and to compare the perinatal outcome in patients with thick and thin meconium stained amniotic fluid.Methods: A hospital based prospective case control study was conducted comparing pregnant women with meconium stained (cases) amniotic fluid with pregnant women having clear liquor (control), 200 in each arm. Singleton pregnancies complicated with MASF were included in the cases group on the basis of predefined inclusion criteria. Various risk factors, mode of delivery, outcome of neonates and perinatal outcome in babies born through thick and thin meconium stained amniotic fluid was studied.Results: Out of 200 patients who had MSAF 114 patients (57%) had thick meconium stained liquor while remaining 86 patients (43.00%) had thin meconium stained amniotic fluid. Post-maturity, pregnancy induced hypertension; oligohydramnios and prolonged labor were found to be statistically significant risk factors for MSAF. Nonreactive non-stress test and Need for cesarean section was more common in women with MSAF as compared to women with clear liquor (p <0.05). Common morbidities in neonates were Birth asphyxia (15%) followed by meconium aspiration syndrome (10%) and hypoxic ischemic encephalopathy (15%).Conclusions: Meconium stained amniotic fluid is more commonly associated with post-maturity, pregnancy induced hypertension, oligohydramnios and prolonged labor low APGAR score and higher incidence of birth asphyxia and NICU admissions. Appropriate management of neonates with meconium aspiration syndrome is crucial to prevent neonatal mortality.

Evaluate The Efficacy And Safety Of Intrathecal Plain 0.75% Ropivacaine Solution For Elective Caesarean Section

Background:A prospective, randomised double blind study to evaluate the efcacy and safety of intrathecal plain 0.75% ropivacaine solution for elective caesarean section and also to study its side effects and complicationsMaterial and Methods:80 patients planned under spinal anaesthesia requiring sensory level upto T4-T6 & duration of 1-2 hours were included in the study. They were divided into two groups of 40 each & received one of the 2 drugs intrathecally. Group R - 2.4ml isobaric plain 0.75% ropivacaine(18 mg) Group B - 2ml hyperbaric 0.5% bupivacaine(10 mg)Results:In our present study, duration of sensory block was shorter in Group R (141.87±13.57 mins)than in Group B (203±18.83 mins) and it was statistically signicant. The mean duration of analgesia was less in Group R 189.25±17.30 mins than in Group B 296.25 ± 13.33 mins and the difference was statistically signicant. Mean(±SD) onset of motor block was slower in Group R (207.25±38.89 secs) as against Group B (115.12±26.34 secs) and the difference was statistically signicant. The time needed to reach Grade 3 motor block was delayed in Group R 6.19±0.88 mins, compared to Group B 4.09±0.86 mins, which is also signicant. The mean duration of motor block was signicantly less in Group R(174±24.36min) as compared to Group B (252.5±18.63mins).Conclusion:Use of Ropivacaine in caesarean section patients is associated with shorter duration of both sensory and motor block .Therefore ,ropivacaine is safe and effective without any adverse effect on maternal and neonatal outcome.

Evaluation of partogram in 100 cases of both primi and multi gravida each, their outcome in labour and perinatal outcome

Background: the objective of this study was to study the utility of partogram in both primi and multi gravida and evaluate its role in preventing prolonged labour; assess the rate of cervical dilatation on admission, and to evaluate the maternal and perinatal outcome by comparing their partogram in labour.Methods: This observational prospective clinical study involved randomly selected 200 patients in labor divided into 2 groups of 100 each admitted in Khaja Banda Nawaz Institute of Medical Sciences, Gulbarga. Modified WHO partogram was used. Statistical analysis done by Chi square test.Results: Mean age group in primi was 22.05 years with standard deviation of 2.38 years and in multi mean age group was 25.19 years with standard deviation of 3.09 years. Mean duration of active phase of labor in primi was 2 hrs 12 mins and in multi was 1 hours and 35 mins from time of admission into hospital. Mean duration of second stage of labor in primi was 57 mins and in multi was 35 mins. Out of 100 primi gravida 68% had NVD, 1% had outlet forceps. 13% had vacuum application and 18% underwent LSCS. Out of 100 multigravida 86% had NVD, 1% had outlet forceps, 7% had vacuum application and 6% underwent LSCS. In group A in primi 75% had NVD, 0% had forceps, 5% had vacuum application and 0% LSCS whereas in multi 93% had NVD and 7% had vaccum, NO forceps /LSCS. In group B, in primi 20% had NVD, 4% had forceps, 33% had vacuum application and 43% had LSCS whereas in multi 34% had NVD, 8% had forceps, 8% had vacuum application and 50% LSCS. In group C, in primi 100% had LSCS whereas in multi there were no NVD/Vaccum/ forceps/ LSCS cases. In primi 100% and in multi 96% had no maternal complications. In primi 96% and in multi 97% had no neonatal complications.Conclusions: The partogram is used to assess the labor progress and identify when intervention is necessary. This study showed that it can be highly effective in reducing complications from prolonged labor for both mother & neonate, in reducing operative intervention and improving their outcome.

Prospective, non-randomized, parallel group, comparative observational study to compare maternal and neonatal outcome after regional and general anesthesia for Lower Segment Caesarean Section

Background: LSCS is a routine obstetric procedure performed under general anesthesia (GA) or regional anesthesia (RA). Choice of anesthesia depends on factors like gestational age, parity, co-morbidities, urgency of situation, etc. Both GA and RA involve the use of various medications which may influence maternal and neonatal outcome. As there are few studies comparing maternal and fetal outcome in RA and GA for LSCS in Indian population, the present study was taken up. Objectives of the study was to compare the maternal and neonatal outcome after RA and GA for LSCS.Methods: 60 subjects with indications for LSCS were assigned non-randomly into two groups, 30 for GA and 30 for RA, at the discretion of anesthesiologist. The demographic, anthropometric and clinical data was recorded for all subjects. The maternal outcome after RA and GA for LSCS was assessed by parameters like maternal blood loss, postoperative pain, postoperative nausea and vomiting, maternal satisfaction and neonatal outcome by parameters like birth weight, APGAR scores and NICU admissions. The maternal and neonatal outcome between the two groups was compared.Results: All subjects had clear indications for CS. In most of the subjects it was undertaken as an emergency procedure. GA was preferred in high risk subjects. Maternal blood loss, postoperative pain, NICU admissions, need for resuscitation was less under RA compared to GA. There was no difference in PONV, maternal satisfaction, birth weight and need for intubation.Conclusions: LSCS under RA showed a more favourable maternal and neonatal outcome.