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.

Risk factors and outcome analysis of post-partum haemorrhage in a tertiary care centre

Background: Maternal haemorrhage is the major cause of maternal mortality and morbidity all over the world and more so in developing countries. PPH is the commonest cause of maternal mortality in India. Identification of risk factors, early diagnosis and timely intervention can help in reducing maternal mortality and morbidity significantly. The aim of this study is to analyse the risk factors and causes and study the maternal and perinatal outcomes of PPH in North Karnataka.Methods: It is a retrospective study of 228 patients admitted with the diagnosis of PPH, at KIMS, Hubli during 2016.Results: Average age of the patients was 27 years. Commonest risk factor was PIH, followed by APH and prolonged labour. The commonest cause of PPH was atonicity followed by retained placenta. Majority of the patients recovered successfully with medical management. While 29 patients required Para cervical clamp. Sixteen patients underwent hysterectomy. Commonest complication was anaemia. Total maternal deaths were four; all of them were due to DIC, mostly due to late referrals.Conclusions: Maternal mortality and morbidity due to PPH can be reduced by encouraging regular anti natal visits, timely referral of high-risk patients, training of the health personals and timely intervention. Well stocked blood banks play an important role in management of PPH.

Assessment of the Knowledge and Utilization of the Partograph among Non-physician Obstetric Care Givers in the University of Calabar Teaching Hospital, Calabar, Nigeria.

Background: Obstructed labour and ruptured uterus contribute a significant proportion to the alarming maternal mortality ratio in sub-Saharan Africa. Proper management of labour by using the partograph, a simple tool that is designed to detect early signs of abnormal progress, can significantly reduce incidence and complications of prolonged labour. Objective: The objective of this study was to assess the knowledge and utilization of the partograph among non-physician obstetric health care providers in University of Calabar Teaching Hospital (UCTH). Methods: This was a descriptive cross-sectional survey which employed the use of a semi-structured self-administered questionnaire with purposive sampling conducted among 132 consenting non-physician obstetric health care providers in UCTH. Results: The mean age of the respondents was 37.84±9.38 years. About 66% of them used partograph but only 13.6% of those who had used partograph were very confident with the tool in monitoring labour. Fifty-six percent of them had received formal training on partograph. Only 34 percent of those surveyed could correctly interpret various sections of the partograph, like the cervicogram. The main reasons for non-utilization of the partograph were inadequate knowledge (73.5%), non-availability (46.2%) and shortage of manpower (34.8%). Knowledge of the partograph (X2=38.1, P=.00) and partograph availability (X2=52.5, P=.00) significantly affected its utilization. Years of experience did not significantly influence partograph use. Conclusion: The knowledge and utilization of the partograph in our hospital can be enhanced by periodic training and retraining of obstetric care givers, developing protocols, ensuring its availability, as well as increasing the staff strength in the delivery units.