A study of primary cesarean section-its rate, indications, and complications in a tertiary healthcare in Sikkim

Background: The indication of performing lower uterine section caesarean section has been changing a lot in recent year and they are expected to go on changing on basis of continuing trials. Aims and Objectives: The aims to study are to assess rate, frequency along with complications of primary cesarean section. Along with to study the incidence and indications of primary cesarean section and causes maternal as well as fetal morbidity and mortality in these cases. Materials and Methods: This prospective study included all pregnant women after 28 weeks period of gestation who underwent caesarean section for the 1st time between December 2016 and June 2018 at Central Referral Hospital of Sikkim Manipal Institute of Medical Sciences (SMIMS), Gangtok, Sikkim – India. Over a period of 1.5 years, 750 women at Central Referral Hospital, SMIMS, Sikkim, India, underwent primary cesarean section. Results: The percentage of primary lower uterine section cesarean section was 27.38% and total cesarean section rate was found to be 49.59% which is far more than the expected rate of 15% as proposed by the world health organization. Elective lower uterine section cesarean section was done in 341 cases (45.47%) and emergency lower uterine section caesarean section was done in 409 cases (54.53%). Patient’s desire was the most frequent indication for elective lower uterine section cesarean section (38.40%). Conclusions: There is tremendous rise in rate of primary cesarean section with patient’s request being the most common indication of elective lower uterine section cesarean section.

Study of Maternal and Fetal Outcomes in Obese Women

Background: Obesity in Indian women had increased from 10.6% to 14.8% in India. Mothers who are overweight or obese during pregnancy and childbirth cause significant antenatal, intrapartum, postpartum and also neonatal complications. Aim and Objective: The present study aimed to explore various maternal and fetal outcomes influenced by maternal obesity. The objective was to find the effect of obesity on maternal and perinatal outcome among obese pregnant women compared to those of normal weight. Methods: The study was conducted in antenatal women attending antenatal outpatient department of of Obstetrics and Gynecology in a teriary care referral hospital in Mumbai. Results recorded in simple percentages. Results: Eighteen percent cases developed gestational diabetes mellitus during their antenatal period and 15% developed gestational hypertension. 44% patients underwent lower segment caesarean section. The need for induction of labour and caesarean section was found to be 37% which is significantly higher. Increased NICU admissions due to hypoglycemia or congenital malformations,prematurity was found to be on a higher side. Conclusions: It was clearly evident from the present study that maternal obesity had adverse maternal and fetal outcomes. Maternal obesity was strongly associated with antenatal complications like gestational diabetes mellitus, gestational hypertension, preeclampsia and increase in need for induction of labour and operative interference.

Comparison Of Artificial Neural Network and Decision Tree Methods for Predicting the Maternal Outcome in A Tertiary Care Hospital in Odisha, India

Background: This study used an artificial neural network (ANN) and a decision tree to predict maternal outcomes and their major determinants. An artificial neural network (ANN) and a decision tree were used in this study to determine maternal outcomes and their significant determinants. Methods: Data was gathered from 955 pregnant women at a tertiary care hospital in Bhubaneswar, Od-isha. A popular machine learning algorithm, artificial neural networks (ANN), was used to predict mater-nal outcomes and their determinants. Results: In the bivariate analysis, we found gestational age is significantly associated with maternal out-come (p=<0.001). The accuracy of the ANN model and decision tree was 0.882 and 0.823, respectively. Based on the variable importance of ANN, the significant determinants of maternal outcome were birth weight, systolic blood pressure, haemoglobin, gestational age, age of mother, diastolic blood pressure etc. Conclusion: This model can be utilized in future for Proper precautions and medical check-ups required during the maternal period to avoid a negative maternal outcome.

Maternal Outcome of Eclamptic Patients Admitted in Gazi Medical College Hospital

Background: Eclampsia is one of the major causes of maternal and perinatal mortality. Eclampsia is more common in developing countries compared to developed countries.This study aimed to assess the maternal outcome in eclamptic patients.Material & Methods:This cross-sectional study was conducted in the Department of Obstetrics and Gynecology, Gazi Medical College, Khulna, Bangladesh, during the period from September 2017 to February 2019.Results:The mean age of study people was 23.84 years (SD±5.03 years), among them 58% had postpartum eclampsia and 42% had antepartum eclampsia. Most of the study people (62%) did not take regular antenatal check-ups during pregnancy and 47% of study people had 1-4 convulsions before admission, and most of the study people (80%) had high blood pressure stage 2 (?140/?90 mmHg), Oedema was presented in 98% of study people, 44% of study people and 3gm/l(+++) albumin in the urine. In this study, 56 % had LUCS delivery and 44% had a vaginal delivery, 7% of study people had pulmonary oedema, 7% had renal failure, 2% had DIC, 7% had CVA, 9% had abruption placenta 16% had PPH, 31% needed admission in ICU. There was no maternal death, mean duration of hospital stay was 7 days (SD±3 days). For most of the study people (56%), BP on discharge was normal (?120/?80 mmHg) and for all study people, urine albumin was nil.Conclusions:Eclampsia was a major cause of maternal and fetal mortality and morbidity in Bangladesh. Race and age appear to be risk factors for eclampsia with Bangladeshi women and those at the extremes of reproductive age at greater risk. Antenatal care is important in reducing perinatal mortality and possibly maternal complications.

COVID and Women’s Health in India

Background : COVID-19 disease surfaced in Wuhan in December, 2019 and rapidly spread in the World as a pandemic (March, 2020) Till date (10 August) COVID-19 has affected 20 million people. Many women have delivered and many conceived during this time. Till date very few adverse effects and vertical transmission is observed. WHO later changed the terminology to SARS-COV-2 and removed ’19’ from the name. Material and Method : We studied Maternal and Perinatal outcome of COVID confirmed pregnancies and the effects of CORONA infections on Women’s Health. Results : Most of the patients were asymptomatic. Majority 80% cases of our cases were delivered by Cesarean Section. Cesarean Section was done for Obstetric reasons along with early consideration due to COVID concerns. Meconium Stained Liquor and Fetal Distress was the indication of Cesarean in 14% cases. Previous Cesarean Sections was a major cause of repeat cesarean in our study. Preterm labour was reported in only one case of Twin Pregnancies. Premature Rupture of Membranes was not seen in any of the pregnancies. Maternal and Fetal outcome were favorable with only few cases of mild to moderate Pneumonia in mothers. Most of the women were psychological disturbed due to the Lockdown and had unwanted pregnancy (due to lack of contraceptive availability), domestic violence and also family disputes and child beating were reported by many in the survey. Due to lack of Medical Services by the GP’s and the friendly small Obstetrics Gynaecology clinics (closed due to Lockdown) small problems got aggravated and a lot of these women one now coming up with Anemia, Polycystic Ovarian Syndrome (PCOS), Fibroids, Abnormal Uterine Bleeding (AUB), Endometriosis, Pelvic Inflammatory Disease (PID), Cervical Crosiers, Vaginitis, Obesity etc. Conclusion : Coronavirus infection in pregnancy did not adversely affect the pregnancy and has a benign course. Pregnant women are not at higher risk of developing Pneumonia compared to non pregnant women. There is no evidence of increased risk of miscarriage or foetal losses with COVID-19 infection during pregnancy. But SARS-COV2 disease a lot of other Gynaecological problems and adversely affected Women’s Health.

MATERNAL AND FOETAL OUTCOMES IN SPONTANEOUS VERSUS INDUCED LABOUR- A CROSS SECTIONAL STUDY

Introduction: Induction of labour is the artificial initiation of labour before its spontaneous onset for the purpose of delivery of the foetoplacental unit. The purpose of this study was to determine whether the current practice of elective labour induction was associated with differences in mode of delivery, demand for pain relief and foetal outcomes when compared with labour of spontaneous onset. Methods And Materials: This cross-sectional study carried out on 100 pregnant women with singleton pregnancy between 37 and 41 weeks of gestation with cephalic presentation delivering in labour room. This study included two groups: Electively induced (50) and spontaneous group (50). Results: In electively induced group 44% had normal vaginal delivery and 6% had instrumental delivery. With spontaneous labour, 78% had normal vaginal delivery and 4% had instrumental delivery. Postpartum hemorrhage (PPH) was 20% in electively induced group and 6% in the spontaneous group (p-0.038).Apgar scores, mean birth weights were comparable. Analgesia demand was 22% in the electively induced group when compared to 6% in the spontaneous group. Conclusion: The present study emphasizes that elective induction of labour in nulliparous women with a single cephalic presentation is associated with increased risk of caesarean section, which is predominantly related to an unfavorable cervix. Hence, elective induction is safe and efficacious. Caesarean delivery rate was more due to nulliparity or unfavorable cervix not due to elective induction itself.

Maternal outcomes among HIV positive pregnant mothers and birth outcomes of HIV exposed newborns in Nyahururu County Referral Hospital, Kenya

Background Approximately 37 million people were living with HIV by the end of 2015. This led to high morbidity and mortality among women of childbearing age, especially in SubSaharan Africa which was the epicentre of this global pandemic. Strengthening and implementing prevention of mother-to-child (PMTCT) services could reduce the incidence of vertical transmission and improve quality of life. We aimed to determine maternal and birth outcomes among HIV-positive pregnant mothers and HIV-exposed newborns in Nyahururu county referral hospital, Laikipia, Kenya. Main Outcomes Measures Reduce maternal morbidity and mortality and other birth-related complications. In addition, this will also reduce infant mortality and morbidity among HIV-exposed infants. Materials And Methods This was a hospital-based descriptive prospective study conducted at the PMTCT department at the Nyahururu County referral hospital. A sample of 180 HIV-positive pregnant women enrolled at the PMTCT consented to participate in the study. We monitored them until delivery and labour complications were addressed. Babies were scored against the APGAR scale, weighed and spot dried blood samples taken before breastfeeding; and started on prophylactic antiretroviral therapy. RESULTS Out of 180 participants, only 17 did not complete the study. Our findings indicate that 97.5 % of the mothers delivered in the hospital, had labour lasting less than 12 hours, 92.6% had a normal delivery and 94.9% had no complications during the labour period. About 2.5 % of the women had misoprostol administration. The majority of exposed babies had an average weight of between 2.51 - 3.00kg. No neonatal asphyxia was evident among exposed babies. Conclusions: The majority of the respondents delivered in the hospital; no neonatal asphyxia was evidenced and there was a significant correlation between APGAR scores and infant weight. There is a need for active follow-up and monitoring of HIV pregnant women and their unborn babies until delivery.

Knowledge of emergency preparedness among nurses in Machakos level five Hospital in Machakos County, Kenya

BACKGROUND An emergency is an unexpected event that disrupts normal operations within a health facility and requires immediate interventions to address it. Knowledge of emergency preparedness is an important role of clinical nursing to enhance patient outcomes. This study aimed to determine the types of emergencies received at Machakos Level 5 Hospital (ML5H) and to assess the nurses' level of knowledge on emergency preparedness. MATERIALS AND METHOD This was a descriptive cross-sectional research design. The study was conducted at Machakos Level 5 Hospital, Machakos County, Kenya. The sample included 132 nurses working at ML5H, who were randomly selected and consented to participate in the study. Data was collected using a self-administered questionnaire and an observation checklist. Data were coded and entered into SPSS version 25 software and the analysis included descriptive statistical tests. RESULTS A little more than a half (56%) of the nurses were found to have adequate knowledge of emergency preparedness; 65% had attended training on emergency preparedness and 63% indicated that training had enhanced their competence. CONCLUSION A higher proportion of nurses reported not participating in emergency drills that could be used to improve their knowledge and skills in emergency preparedness. The results of the study indicate that there is a need to enhance the knowledge of nurses' on emergency preparedness.

Association of Risk Factors with Maternal Outcomes In Abruptio Placenta at Tertiary Care Hospital

Introduction: Abruptio placenta is a serious condition that increases maternal and neonatal morbidity and mortality. The incidence of abruption placenta is between 0.49% -1.8%. Primary cause of abruption is not known but the main precipitating and predisposing factors of abruption are age, parity, anemia, poor nutrition, pregnancy induced hypertension, eclampsia, gestational diabetes mellitus, preterm premature rupture of membrane, and previous medical termination of pregnancy. Methodology:It is a retrospective observational study done by analyzing the case sheets of abruption placenta in tertiary care hospital from January 2020 to December 2020. All those patients of antepartum hemorrhage presenting directly as typical cases of abruption placenta were included. Also, those cases in which placenta previa and other causes were ruled out after clinical, per speculum examination and/or USG examination were ruled out. Result:The total number of abruption placenta collected during this period was 21. We found 38% patients with chronic hypertension, 33 % of patients with severe preeclampsia, 14% with eclampsia, 15% were normotensive. Advanced maternal age and multiparity were also the risk factors of abruption placenta. Conclusion: Antenatal care which identifies the risk factors like PIH plays an important role in decreasing the incidence of abruption placenta. Early detection and active management will reduce morbidity.

Can Prenatal and Postnatal Cell Phone Exposure Increase Adverse Maternal, Infant and Child Outcomes? / A exposição pré-natal e pós-natal a telefones celulares pode aumentar os resultados adversos para mães, bebês e crianças?

Abstract Objective To determine the association between maternal mobile phone use and adverse outcomes in infants, children, and mothers. Method In March 202, we conducted a search on the MEDLINE, Embase, and Scopus databases. Data extraction and an assessment of the quality of the studies were performed by two authors. The quality of the studies was assessed using the checklist of the Newcastle-Ottawa scale. Results Studies assessing behavioral problems in infants aged 6 to 18 months reported null findings. However, an increased risk of emotional and behavioral disorders was observed in children aged between 7 and 11 years whose mothers had been exposed to cell phones. The findings regarding the association between maternal cell phone exposure and adverse outcomes in children aged 3 to 5 are controversial. A study found a significant association between the call time (p=0.002) or the history of mobile phone use (in months) and speech disorders in the children (p=0.003). However, another study found that maternal cell phone use during pregnancy was not significantly associated with child psychomotor and mental developments. Inconclusive results were observed about the adverse outcomes in fetuses, such as fetal growth restriction or t scores for birth weight in cell phone users as opposed to non-users. On the contrary, the children ofmothers who were cell phone users had a lower risk of scoring low on motor skills. Similar results were observed regarding the adverse outcomes of cell phone use in infants, such as fetal growth restriction or low birth weight, and the risk of preeclampsia was lower among subjects with medium and high cell phone exposure, as opposed to those with low exposure. Conclusion Studies on behavioral problems have reported different postnatal results, such as null findings among infants and a positive association in children.

Resumo Objetivo Determinar a associação entre o uso de telefone celular pela mãe e os resultados adversos em recém-nascidos crianças e mães. Método Em março de 2020 realizou-se uma pesquisa nas bases de dados MEDLINE, Embase e Scopus. A extração de dados e avaliação da qualidade dos estudos foram realizadas por dois autores. A qualidade dos estudos foi avaliada por meio da lista de verificação da escala Newcastle-Ottawa. Resultados Estudos que avaliavam problemas comportamentais em recém-nascidos de 6 a 18 meses relataram resultados nulos. No entanto um risco aumentado de transtornos emocionais e comportamentais foi observado em crianças de 7 a 11 anos de idade cujas mães foram expostas a telefones celulares. Os resultados relacionados à associação entre a exposição materna a celulares e resultados adversos em crianças de 3 a 5 anos são controversos. Um estudo encontrou associação significativa entre o tempo de ligação (p=0.002) ou o histórico de uso de celular (emmeses) e distúrbios de fala nas crianças (p=0.003). No entanto outro estudo descobriu que o uso de telefone celular pela mãe durante a gravidez não estava significativamente associado ao desenvolvimento psicomotor e mental da criança. Resultados inconclusivos foram observados com relação aos resultados adversos de fetos como restrição de crescimento intrauterino ou valores de t para peso ao nascer em usuárias de telefone celular em oposição a não usuárias. Pelo contrário os filhos de mães usuárias de telefone celular apresentaram menor risco de pontuação baixa em habilidades motoras. Resultados semelhantes foram observados com relação a resultados adversos em recém-nascidos como restrição de crescimento intrauterino ou valores de peso ao nascere o risco de pré-eclâmpsia foimenor em indivíduos comexposição média e alta a celulares em oposição àqueles com baixa exposição. Conclusão Estudos sobre problemas comportamentais relataram resultados diferentes no pós-natal como achados nulos em recém-nascidos e associação positiva emcrianças.

A Successful Feto-Maternal Outcome In Pregnancy With Wilsons Disease: An Extremely Rare Case Report With Review Of Literature

Wilson’s disease, also known as hepato-lenticular degeneration, is one of the very rare autosomal recessive disorder of copper metabolism.There is impaired liver metabolism of copper thereby causing decreased biliary excretion and deposition of ceruloplasmin levels mainly in the liver, corneas of eyes and brain. Untreated Wilson’s disease has been associated with menstrual irregularities, amenorrhoea, miscarriages and infertility. Hence proper chelationwith strict antenatal surveillance will lead to a successful feto-maternal outcome.

Maternal and neonatal outcomes of pregnant women with clinically confirmed COVID-19 admitted at the Philippine General Hospital

@#Objectives. The effect of COVID-19 infection in pregnant women and her neonate is not well-understood, with no clear evidence for vertical transmission. This study aims to determine the maternal and neonatal clinical characteristics and the dyad’s outcomes among those infected with COVID-19 infection. Methods. An ambispective cross-sectional study involving pregnant women with confirmed COVID-19 infection was conducted at the Philippine General Hospital from April to August 2020. Two hundred nine obstetric patients were included, 14 of whom consented to specimen collection to determine vertical transmission. Results. The majority of pregnant women with COVID-19 infection and their neonates had good outcomes. Labor, delivery, and the immediate postpartum course were generally uneventful. The all-cause maternal morbidity rate was high at 75.6 per 100 cases during the five-month study period. COVID-19 related morbidities included the development of Guillain-Barré Syndrome. The in-hospital all-cause maternal mortality rate was 1.91 per 100 cases. The causes of maternal death were acute respiratory failure, septic shock, and congenital heart disease (atrial septal defect with Eisenmengerization). The in-hospital, all-cause neonatal mortality rate was 1.04 per 100 neonates of cases. The lone mother and infant deaths were in a postmortem rt-PCR swab negative mother with an rt-PCR swab positive live neonate who eventually succumbed after nine days of life. All 14 dyads with collected specimens that included amniotic fluid, placental tissue, umbilical cord, and neonate nasopharyngeal swab tested negative for SARS-CoV-2 rt-PCR. Conclusion. The prognosis for COVID-19 infected pregnant patients was generally good, with most of the patients discharged improved. Almost all of the neonates born to COVID-19-infected mothers were stable-term infants. There was no evidence for vertical transmission, as shown by negative rt-PCR results for all the additional specimens obtained. In general, the prognosis for COVID-19 infected dyads was good. The majority of the mothers were discharged well with their term infants. All possible maternal sources of COVID-19 infection to the neonate tested negative. This study provided no evidence for vertical transmission.

Obstructed Labour and Maternal Outcome at the Intensive Care Unit of the University of Port Harcourt Teaching Hospital: A Ten Year Review

ntroduction:Obstructed labour is a major cause of maternal mortality. Admissions into the intensive care unit (ICU) especially for post-delivery monitoring and treatment of patients with obstructed labour entails critical care for favourable outcome for the mother.Aim:To evaluate the maternal outcome of mothers admitted into the intensive care unit who had obstructed labour at the University of Port Harcourt Teaching Hospital (UPTH).Methodology:The study was a retrospective study of all the cases of obstructed labour admitted into the ICU of UPTH between 1stJanuary, 2007 to 31stDecember, 2016. Information were retrieved from the patients case note and analyzed using SPSS version 20.Results:A total of1549 patients were admitted into the ICU for the period under review, of which 218(14.1%) were obstetric admissions. One hundred and forty were unbooked mothers while 78 were booked. The mean age was 30 ± 2 years and the modal parity was 2. All the 64 cases of obstructed labour were unbooked mothers and comprised 29.4% of the obstetric admissions. The number of maternal deaths from obstructed labour were 23, which comprised of 10.6% of the obstetric admissions. Conclusion:The study revealed that the maternal deaths following obstructed labour admitted into the ICU was high. The reason is that these patients present late. There is therefore need for patients at risk of obstructed labour to register for antenatal care early and delivery conducted by skilledbirth attendant for improved outcome.

Maternal and fetal outcome in placenta previa: our experience

Background: Placenta previa contributes substantial maternal and neonatal morbidity including management challenges for obstetrician. This study was to evaluate the potential risks factors and feto-maternal, outcome in placenta previa. This study was done with the intent of developing insight into risk factors, clinical presentation, various interventions and management for overall improvement in maternal and fetal outcome in placenta previa.Methods: A prospective observational study, where 30 cases of placenta previa confirmed after 28 weeks POG, treated in a public sector tertiary care hospital from June 2016 to June 2018 were included. Authors analyzed the data to evaluate the potential risks factors and maternal and fetal outcome in placenta previa.Results: In this study, major contributing risk factors for placenta previa were associated with multiparity (76.7%), maternal age >30 in 50%, previous LSCS in 46.7%, repeated uterine procedure like suction evacuation/curretage. There was a high rate of maternal morbidity mainly due to haemorrhage. Perioperative uterine artery embolization (UAE) in 3 (10%), intra-operative procedures namely devascularization, internal iliac ligation in 66.6% cases, peripartum hysterectomy in 2 (6.66%) were done to control haemorrhage. Blood and blood products transfusion required in 26.7% of cases. Fetal morbidity included prematurity in 9 (33.3%), NICU admission in 11 (36.6%) majority of which included 8 (26.7%) babies of birth weight <2000 grams.Conclusions: Placenta previa contributes to significant maternal and neonatal morbidity. Multiparity, post LSCS pregnancy constitute major factor for placenta previa. Management requires high-risk obstetrical care with frequent antenatal visits. Serial ultrasonography in reported cases of low-lying placenta is mandatory to exclude over diagnosis or migration. All cases of placenta previa need to be managed in a higher centre with facility of blood component therapy and neonatal intensive care unit. Prematurity and low birth weight remain a significant cause for neonatal morbidity.

Maternal outcome in pregnancy with thrombocytopenia

Background: Thrombocytopenia is second most common haematological abnormality in pregnancy after anemia. The aim of this study was to find out the prevalence, causative factor of thrombocytopenia and to observe the obstetrics outcome of pregnancies complicated with thrombocytopenia.Methods: This is prospective study of maternal outcome in pregnancy with thrombocytopenia carried out at tertiary care center from February 2019 to January 2020. Out of 350 antenatal screened women, 25 women who were diagnosed with thrombocytopenia, were included in the study.Results: The incidence of maternal thrombocytopenia in this study was 7.1%. 60% of the women had mild thrombocytopenia while 24% and 16% of women were moderate and severe thrombocytopenic respectively. Amongst 25 thrombocytopenic women 68% had gestational thrombocytopenia, 24% had gestational hypertensive disorder,4% had HELLP syndrome, 4% had immune thrombocytopenic purpura. 60% were delivered vaginally and 40% were delivered by LSCS. The most common indication of LSCS was acute fetal distress (40%) followed by failed induction (30%), breech (10%), and the rest (20%) for other obstetrical indications. The most common indication for induction was pre-eclampsia followed by IUGR, and post-date.Conclusions: In pregnancy with thrombocytopenia, gestational thrombocytopenia is the commonest and benign condition which does not alter the obstetrical management. Still a vigil 4 should be kept on maternal platelet count in antenatal period to prevent unfavorable outcome in serious conditions that may require specific and urgent management (HELLP syndrome, severe pre-eclampsia, ITP).

Effectiveness of forceps delivery in modern day obstetrics

Background: There has been an alarming rise in number of caesarean sections all over the world. Instrumental delivery plays an important role to reduce this trend globally. Forceps delivery though proper training and expertise can definitely reduce the rising caesarean section rates in the modern-day obstetrics. The aim of this study is to study the effectiveness of forceps delivery in modern obstetrics.Methods: In the present observational study, 20 cases of forceps delivery were studied for maternal and foetal outcomes including postpartum hemorrhage, perineal tears, Apgar score, NICU admissions, birth injury, and mortality.Results: The most common indication for forceps application was maternal exhaustion (80%) followed by foetal distress. All the cases of forceps application in the present study were associated uneventful vaginal delivery. No any adverse maternal outcomes including perineal tears, post-partum hemorrhage was observed in this study. Average birth weight in the present study was 3.2 kgs and Apgar scores at birth and five minutes was within normal limits. No any birth injury was noted in any of the newborns.Conclusions: Forceps delivery is a safe and effective option in modern day obstetrics to reduce the alarming rise in rates of caesarean section globally. Training should be encouraged to develop the expertise of this art of forceps delivery.

Acute kidney injury and its outcome in obstetrics

Background: Acute kidney injury occurring during pregnancy, labour, delivery, and/or postpartum period. Proper management of AKI (acute kidney injury) is challenging because (i) both maternal and fetal health must be considered and (ii) the cardiovascular and renal adaptations of pregnancy add to the complexity for management.Methods: The objective of this study was to study association and contributing factors in AKI, a retrospective study of 20 cases of AKI complicating pregnancies carried out in department of obstetrics and gynecology, SVPIMSR over a period of 12 months and results were studied and analysed. Etiological factors, associated liver pathology, coagulation abnormality, thrombocytopenia, sepsis, recovery status and fetomaternal outcome were studied and tabulated. AKI was analysed in terms of maximal stage of renal injury attained as per risk, injury, failure, loss of function, and end-stage renal disease (RIFLE) criteria.Results: The incidence of ARF (acute renal failure) in pregnancy was about 0.3%. Hypertensive disorders were the major causative factor. Amongst the 20 cases, 8 cases were referred from outside and two of them died. Total 5 of 20 cases required hemodialysis and two of them had partial recovery.Conclusions: AKI complicating pregnancies are not uncommon. If recognized and treated promptly, recovery is assured in majority of cases. Early identification and prompt management of pre-eclampsia and sepsis can prevent majority of cases. Ultrasonography revelation of placenta previa or abruption helps in early management eventually decreases the chances of bleeding which is one of the causes of AKI (pre-renal cause).

Lactate dehydrogenase as surrogate marker of preeclampsia and eclampsia

Background: Hypertensive disorders of pregnancy is a spectrum of disorder which include chronic hypertension that antedates pregnancy and gestational hypertension or pre-eclampsia that is unique to human pregnancy. It is still a poorly understood condition. The clinical course is progressive and characterized by continuous deterioration that is arrested only by termination of pregnancy. Hence the disease must be detected in early stage and managed appropriately for improved maternal and fetal outcome.Methods: The study consists of 173 antenatal patients of gestational age 28 weeks and above. Study population was divided into two groups, Group 1 consists of 50 antenatal women of normotensive nature served as controls and group 2 consists of 123 antenatal women with confirmed hypertension. Venous blood samples were collected used for the estimation of lactate dehydrogenase enzyme.Results: Out of the total 173 patients 104 women delivered by C-section, 67 by normal vaginal delivery and 2 by assisted breech delivery. Among the women who delivered by caesarean 60 (57.69%) had serum LDH less than 600, 18 (17.30%) had serum LDH between 600 and 800 and 26 (25.00%) had LDH above 800. Among the women who delivered vaginally 61 (91.04%) had LDH less than 600, 1 (1.49%) had LDH between 600 and 800 and 5 (7.46%) had LDH above 800. Only 2 women delivered by assisted breech delivery one with LDH between 600 and 800 and another with S. LDH above 800.Conclusions: The study was done in search of a valuable marker for preeclampsia and Eclampsia which would reflect the severity of the disease and would predict the maternal and fetal outcome. Such markers can help in decision making and can influence the current management protocols in order to achieve a better maternal and perinatal outcome.

Relationship between Glycosylated Haemoglobin Levels and Perinatal Outcome among Women with Gestational Diabetes Mellitus at the University of Port Harcourt Teaching Hospital, Nigeria

Background:Gestational diabetes mellitus (GDM) is a global health challenge and is known to affect pregnancy adversely. Glycosylated haemoglobin (HbA1c) level reflect long term glycaemiccontrol and is a more accurate measure than Fasting Plasma Glucose and post prandial plasma glucose level.Aims and Objectives:To determine the levels of HbA1c, perinatal outcomes and the relationship between maternal HbA1c level and perinatal outcomes in women with GDM at the University of Port Harcourt Teaching Hospital.Materials and Methods: This was a longitudinal study of 80 pregnant women from 36 weeks of gestation with GDM attending the antenatal clinic of the University of Port Harcourt Teaching Hospital (UPTH). Blood samples from all consenting pregnant women were collected and sent to the Chemical Pathology laboratory to determine the HbA1c level. The blood samples from the babies were also sent to determine the random plasma glucose (RPG) level. A structured proforma was used to obtain socio-demographic characteristics and other information. Data collected was analyzed with SPSS version 22.0.Results:The mean age of the women was 32.58 ± 4.95 years. A total of 57 (71.3%) women with GDM had elevated HbA1c levels (≥ 6.5%). Fetal macrosomia occurred in 17.5%, while 8.8% had birth asphyxia. The perinatal mortality ratio was 1.3%. There was a statistically significant relationship between HbA1c levels and neonatal hypoglycemia and perinatal mortality(p <0.05). Conclusion: Despite the higher proportions of adverse perinatal outcomes occurring among those with elevated HbA1c levels, onlyneonatal hypoglycemia and perinatal mortality were significantly associated with elevated HbA1c

Maternal and perinatal outcomes in multiple versus singleton pregnancies in Dakar, Senegal: a cross sectional study over 10 years

Background: The birth of twins is a singular event in most societies, and even more when it comes to multiple births. The objective of this study was to investigate maternal and perinatal outcomes in multiple versus singleton pregnancies.Methods: Cross-sectional study carried out at Philippe Maguilen Senghor health center in Dakar, Senegal from January 1, 2011 to June 30, 2019. Data were extracted from this E-perinatal electronic database and then analyzed in statistical package for social science software (SPSS 24, Mac version).Results: A total 42,870 mothers delivered 44,149 newborns including 1250 twins (2.8%) and 29 triplets. The mean maternal age was 27 years. Mothers with multiple pregnancies had 3 times the odds of poor maternal outcome compared to mothers with single pregnancies (OR 2.42, 95% CI; 1.98-2.94, p <0.001, for high blood pressure; OR, 2.66; 95% CI, 2.11-3.32, p= <0.001, for severe pre-eclampsia; and OR, 3.04; 95% CI, 1.64-5.66, p <0.001, for postpartum hemorrhage). Likewise, women with multiple gestations had significantly higher rates of preterm birth (OR 5.62; 95% CI: 4.91-6.41, p <0.001), breech presentations (OR = 11.02; CI = 9.68-12.53, p <0.001) and neonatal deaths (OR = 2.94; CI = 9.6852-12.5328 p= 0.004) as compared to women with singleton gestations. Furthermore, women with multifetal gestations had increased risk for caesarean section (OR 2.14; 95% CI: 1.91-2.41, p <0.001) compared with their singleton counterparts. The risks for episiotomy and perineal injuries were higher for women with singleton gestations as compared to multiple gestation mothers.Conclusions: This study results are in line with previous findings and contradict others. Particular attention should always be paid to multiple pregnancies’ management. However, the pattern of certain complications traditionally correlated with multiple pregnancies is to be confirmed.