Postdated pregnancy: its maternal and fetal outcome

Background: Postdated pregnancy is one of the commonest obstetric conditions. Pregnancy is called term when it lies between 37 weeks to 42 weeks from the last menstrual period. If the pregnancy exceeds 40 weeks it is called as postdated pregnancy. The overall incidence of post term pregnancy is 7% of all pregnancies.Methods: This observational study was carried out in the department of obstetrics and gynecology in Dr Ram Manohar Lohia Institute of Medical Sciences, Lucknow, Uttar Pradesh, India from September 2019 to February 2020. Total 100 postdated pregnancy enrolled in the study those willing to participate and fulfilling the inclusion and exclusion criteria. Aim is to assess maternal and fetal outcome in postdated pregnancy.Results: In present study, incidence of postdated pregnancy was found to be 5% and number of normal deliveries was 66 (66%), LSCS were 32 (32%) and 2 (2%) were instrumental delivery. Maternal complications were seen in 14 (14%) cases and fetal complications were found in 23 (23%) cases.Conclusions: Postdated pregnancy was associated with perinatal complications like fetal distress, meconium aspiration syndrome and fetal asphyxia. There was increased risk of obstetrics complications like postpartum haemorrhage (PPH), perineal tear, cervical tear and shoulder dystocia. Management of postdated pregnancy is a challenge to obstetrician and a careful advice and monitoring can alleviate maternal anxiety and untoward complications.

Study of implications of thyroid status over feto-maternal outcomes in pregnancy

Background: Thyroid disorders are reported at clinically significant prevalence during pregnancy, affecting ~5% of all pregnancies. Maternal thyroid status during pregnancy purportedly affects fetal as well as maternal outcomes. The objective of present study was to analyse the relationship of thyroid status in pregnancy and various maternal and fetal outcomes.Methods: In this hospital based observational study, a total of 913 pregnant women were enrolled as per fixed criteria and all the study participants were screened for thyroid disorders. Further, they were followed up throughout pregnancy and puerperium and evaluated for various maternal and fetal complications by predefined outcome measures. The results were compared by subgroup analysis.Results: Of the 913 patients screened, 105 were diagnosed with thyroid abnormality and followed up till delivery, with newborn thyroid profile on day 7. Total 49 patients were diagnosed with anaemia (46.66%), of which 46 (43.80%) had subclinical hypothyroidism (p <0.05); along with pregnancy induced hypertension in 42 (40%) cases of which 40 (38.09%) had subclinical hypothyroidism were observed to have statistically significant associations. Intrauterine growth restriction (IUGR) (37, 35.23%) and prematurity (19, 18.1%) were the most common fetal occurrences; the association of IUGR and subclinical hypothyroidism being statically significant.Conclusions: Thyroid disorders during pregnancy are commonly associated with maternal and fetal complications and thyroid profile is recommended as universal screening method in early pregnancy to diagnose and start required treatment early.

A Prospective Study to Find Out the Perinatal and Maternal Outcome in Patients with Polyhydramnios: A Institutional Based Study

Background: Polyhydramnios is the term for abnormalincrease in the amniotic fluid. With better facilities for detailedinvestigation of mother and fetus, more causative factors canbe identified and this helps in the counseling of parentsregarding etiology of polyhydramnios, fetal prognosis,recurrence risk and different management options for the babyif it needs medical & surgical care after birth. The aim of thisstudy to find out the perinatal and maternal outcome in patientswith polyhydramnios.Material & Methods: This is a prospective study done on 100unselected pregnancies attending the antenatal clinic inDepartment of Obstetrics and Gynecology department of RNTMedical College Udaipur. All patients attending ANC wereasked to participate at the time of booking (between 16 to 20weeks gestation) and were subjected to USG to rule outcongenital anomalies. We than investigated the relative risks ofthese events to adverse perinatal outcome by adjusting thevariants.Results: In our study, there were 30% preterm deliveries, 4%cases have small for gestational age babies, 5% had large forgestational age babies, 10% had meconium for which they hademergency caesarean section, 16% cases were admitted inNICU , for respiratory distress syndrome and prematurity. 45%of the patient had anemia, 12% were Rh negative while 43%had no associated abnormality. There were many perinatalcomplications. Out of them preterm birth was the mostcommon complication.Conclusion: We concluded that PPROM, Preterm labor andPPH were the major maternal complications during pregnancy.Polyhydramnios is associated with high perinatal mortality rate

Large chorangiomas: a seven years study in a tertiary care obstetrics and gynaecology hospital

Background: Chorangioma is a benign vascular placental tumour. It is composed of fetal capillary proliferation within the chorionic villi supported by a variable stroma. Smaller lesions are incidental, are often missed and carry no clinical significance. Larger lesions are associated with feto-maternal complications and are infrequently sent for histopathological examination.Methods: The study was conducted at the department of pathology, at a tertiary care obstetrics and gynaecology hospital. The study was a retrospective study which covered 7 years. Paraffin embedded blocks of placental specimens containing mass were taken up for the study. Sections were stained with haematoxylin and eosin (H and E). The results are compared and correlated with clinicopathologic factors. The statistical data are analysed manually.Results: A total of seven cases were included in the study, 4 cases were primi gravida, 1 case each in second, third and fourth gravida. Pregnancy outcome was intrauterine death in 1 case, dead born in 1 case, alive healthy children in 5 cases, birth weight was normal in 4 children, low birth weight in 2 children and 1 was extremely low birth weight. Of the total of 7 placental specimens 3 showed extraplacental mass and rest 4 showed intraplacental mass. All cases showed solitary lesions and measured > 5cm (large). Histopathological examination of all 7 specimens showed features of chorangioma.Conclusions: Careful inspection of the placenta is necessary following all deliveries. Any suspicious lesions should be documented and evaluated by histopathological examination there by predicting feto maternal complications and help the clinicians in better management of the mother and child accordingly. Meagre documentation of such cases prompted us to present this series of 7 cases of large chorangiomas with a mixed fetal outcome.

Embarazadas con lupus eritematoso sistémico en el hospital Clínico Regional de Concepción, Chile / Pregnant women with systemic lupus erythematosus in the Regional Clinical Hospital of Concepcion, Chile

Antecedentes: El lupus eritematoso sistémico (LES) afecta principalmente a mujeres en edad fértil. El embarazo en estas pacientes puede asociarse con múltiples complicaciones. Objetivo: Caracterizar a las embarazadas con LES durante 10 años en el Hospital Clínico Regional de Concepción. Métodos: Se realizó un estudio descriptivo retrospectivo que consistió en la revisión de fichas clínicas. Se analizaron las variables: edad, años de enfermedad desde el diagnóstico, historia obstétrica, presencia de reactivaciones, anticuerpos maternos y complicaciones materno-fetales. Resultados: Durante el periodo de estudio hubo 49 embarazos en 21 pacientes con LES. El 12,2 por ciento terminó en aborto, un 2 por ciento en óbitos, y un total de 43 nacidos vivos. La edad promedio de las pacientes al momento del diagnóstico de LES fue 24,5 años. El 67 por ciento fueron diagnosticadas antes de su primer embarazo. En el total de pacientes el 85,7 por ciento presentaron ANA positivo, 57,1 por ciento antiDNA positivo, 52,4 por ciento aRo positivo y 33,3 por ciento aLa positivo. En los caso de abortos, aRo y aLa se encontraban positivos en 66,7 por ciento. Las anticardiolipinas se encontraban alteradas en 33,3 por ciento de los abortos. Durante el embarazo el 32,6 por ciento tenía LES activo y 34,7 por ciento en el postparto. El 53,5 por ciento de los recién nacidos no tuvieron complicaciones. La complicación más frecuente fue la prematuridad con 55 por ciento. La mortalidad perinatal de la serie fue de 46,5/1000 nacidos vivos (2/43). No hubo muertes maternas. Conclusión: Es importante la educación respecto al embarazo en pacientes con LES. Debemos resaltar en promover que estas pacientes planifiquen el embarazo en periodo de inactividad, y con controles frecuentes para pesquisar precozmente cualquier complicación.

Background: The systemic lupus erythematosus (SLE) affects mainly fertile age women. Pregnancy in these patients can associate with multiple complications. Aims: To characterize the pregnant women with SLE during 10 years in the Hospital Clínico Regional de Concepción, Chile. Methods: We made a retrospective descriptive study which consisted in clinical files revision. The following variables were analyzed: age, years with disease since diagnose, obstetric history, history of reactivation, maternal antibodies and mother-fetus complications. Results: During the time of study there were 49 pregnancies on 21 patients with SLE; 12.2 percent ended in abortion, 2 percent in late fetal death giving a total of 43 living newborn. The average age of these patients at the moment of diagnose of LES was 24.5 years old; 67 percent were diagnosed before their first pregnancy. From the total of patients, 85.7 percent presented positive ANA, 57.1 percent positive antiDNA, positive aRo in 52.4 percent and positive aLa in 33.3 percent. In case of abortions, aRo and aLa were positive in 66.7 percent. Anticardiolipins were altered in 33.3 percent of abortions. During pregnancy 32.6 percent had active SLE, and 34.7 percent post-partum. Among the newborn, 53.5 percent did not have any complications. The most frequent complication was prematurity with a 55 percent. The perinatal mortality was 46.5/1000 lives births (2/43). There were no maternal deaths. Conclusion: It is important to educate about pregnancy in SLE patients. We must emphasize to promote in those patients a planned pregnancy in inactive period and with frequent controls for early diagnose of any complication.

A Clinical Experience in 16 Pregnancies with Hemolysis, Elevated Liver Enzymes, and Low Platelets (HELLP Syndrome) / 대한산부인과학회잡지

OBJECTIVE: Our purpose was to describe the clinical progress and the maternal and fetal outcome in 16 pregnancies complicated by the HELLP(hemolysis, elevated liver enzymes, low platelet). Material: We reviewed the maternal and neonatal charts from 16 consecutive pregnancies complicated by the HELLP syndrome among 302 pregnancies complicated by preeclamsia and eclamsia managed at our hospital during the period of 4 years from June 1994 through June 1998. The HELLP syndrome was defined by previously published laboratory criteria. We assessed the time of onset, presenting symptom, laboratory finding, mode of delivery, fetal and maternal complication in each case. We also reviewed the clinical finding in detail in the case resulted in maternal death. RESULTS: In regards to the time of onset, 15 cases (93.7%) occurred at antepartum period and only 1 case (6.2%) occurred at postpartum period. Among the 15 cases occurred at antepartum period, 13 cases (81.25%) developed at 27 to 36 weeks gestation and 2 cases (12.5%) developed at near term. In regards to the presenting symptom, twelve patients (75%) complained of right upper quardrant or epigastric pain. Of 16 patients, 12 patients (75%) experienced headache and 10 patients (62.5%) complained of nausea, or vomiting and 5 patients (31.2%) had visual disturbance. The laboratory finding of all 16 cases were as follow; the mean level of platelet: 68700/mm3 (range: 48000 to 91700), the mean level of serum asparate aminotransferase: 335 IU/L (range: 62 to 135), the mean level of lactic dehydrogenase: 910 IU/L (range: 558 to 5794), and the mean level of total bilirubin: 2.6 mg/dl (range: 0.7 to 10.4). To review the mode of delivery, cesarean sections were done on 10 patients (62.5%) including 7(43.7%) emergency and 3(18.7%) elective operations. However, 6 patients (37.5%) delivered vaginally. Maternal complications were as follow; abruptio placenta in 1 case (6.2%), DIC in 2 cases (12.5%), pulmonary edema in 3 cases (18.7%), pleural effusion in 4 cases (25%), renal failure in 4 cases (25%), and 1 case of death. Fetal and neonatal outcome was assessed; 9 cases of intrauterine growth retardation (56.2%), meconium stained in 3 cases (18.7%), 2 stillbirth (12.5%), and 2 neonatal death (12.5%). CONCLUSION: HELLP syndrome is associated with serious maternal and fetal morbidity and mortality.

Statistical Analysis of 96 Twin Pregnancies / 대한산부인과학회잡지

No abstract available.