Fetomaternal outcome in pregnancy with thrombocytopenia: A prospective study from one of the teaching health-care institutes of Ahmedabad, Gujarat

Background: During pregnancy, hemodilution of plasma volume leads to reduction in platelets count by approximately 6–7% during 3rd trimester. Pregnant women with thrombocytopenia have higher risk of bleeding excessively during pregnancy, labor, and puerperium. The present study focuses on fetomaternal outcome among pregnant women having thrombocytopenia. Aims and Objectives: This study aims to study the incidence of thrombocytopenia in pregnancy, to identify various factors responsible for thrombocytopenia in pregnancy, and to evaluate fetomaternal outcome in patients with thrombocytopenia in pregnancy. Materials and Methods: A prospective study was conducted in the department of obstetrics and gynecology at tertiary care center of Ahmedabad. A total of 96 cases of thrombocytopenia in pregnancy were included in the study. Fetomaternal outcome was assessed among the study participants. Results: The incidence of thrombocytopenia in the present study was 0.77%. Obstetric causes (53.12%) accounted for most common cause of thrombocytopenia, followed by gestational thrombocytopenia (27.08%), dengue (10.41%), malaria (4.16%), and immune thrombocytopenia (4.16%). Postpartum hemorrhage (15.62%), eclampsia (14.58%), disseminated intravascular coagulation (11.45%), and abruption (8.33%) were the most common maternal complications. The most common neonatal complication was prematurity (67.7%) followed by intrauterine growth retardation (23.95%) and birth asphyxia (9.3%). Conclusion: Hypertensive disorders of pregnancy including severe preeclampsia, eclampsia, and HELLP syndrome are found to be the most common cause of thrombocytopenia followed by gestational thrombocytopenia and infectious causes. The present study widened the spectrum of the causes for thrombocytopenia in pregnant women. Gestational thrombocytopenia is associated with mild-to-moderate thrombocytopenia and hardly having any complications.

Study Of Fetomaternal Outcome In Indoor Booked And Emergency Patients

Background:In current maternal mortality situation in India, it is pertinent to determine the relationship between booking status of mother and maternal and fetal outcomes. Material And Methods:In present study 1500 patients were studiedfrom July 2019 to June 2021 in department of Obstetrics and Gynaecology Smt. S.C.L general hospital, Ahmedabad. Amongst these 1000 were booked (>= 3 antenatal visits) and 500 were emergency (unbooke d) cases (<3 antenatal visits). Result:Majority of patients was between 21 to 30 year age group, lower socioeconomic class and from urban area. In booked patients incidence of Antepartum, Intrapartum, Postpartum complications, medical complications, blood transfusion requirement, rate of caesarean section, incidence of Preterm babies, low birth weight babies, NICU admission, perinatal mortality and maternal mortality was less. Conclusion:In booked cases fetomaternal outcome was good. Hence targeted, integrated, patient friendly, affordable, accessible health services need to be delivered in an equitable manner and through routine screening, monitoring and follow up complications, mortality and morbidity can be reduced.

Study of fetomaternal outcome in eclampsia

Background: Eclampsia is a life-threatening emergency that continues to be a major cause of maternal and perinatal mortality. The purpose of our study was to analyse the trend of eclampsia in a tertiary care teaching institute and to find out the fetomaternal outcomes of eclampsia.Methods: A retrospective epidemiological study was undertaken in the department of Obstetrics and Gynaecology, Jhalawar medical college, Jhalawar during the period ‘September 2018 to August 2019’. Women who presented as eclampsia or developed eclampsia during hospital stay were included in the study. Data analysed included various maternal parameters, fetal parameters, and the outcome of the pregnancy.Results: The incidence of antepartum eclampsia was (0.92%). High risk associated factors were primigravida (65.90%), low maternal age (21-30 years), illiteracy, and inadequate antenatal care. Caesarean section was the mode of delivery in 48 cases (54.54%) most common indication was unfavourable cervix, 80.6% women had antepartum eclampsia and 68.18% women had severe preeclampsia. There was 6.8% maternal mortality, attributed to pulmonary edema and acute renal failure. Perinatal mortality was 14.77% with 8 still births and 5 neonatal deaths. Prematurity complicated 46.66% pregnancies. Thirty neonates were admitted to NICU.Conclusions: Eclampsia is one of the important causes of maternal and perinatal morbidity and mortality due to lack of proper antenatal care, low socio-economic status, and lack of education. It can be concluded that better antenatal care, early recognition of disease, timely referral, early initiation of treatment and termination of eclamptic patients improves outcome. Management of eclamptic patients should be performed at tertiary care centres, where ICU facilities, NICU facilities, and multidisciplinary units are available.

Fetomaternal outcomes in pregnancy with different cardiac disease at a tertiary care center in Udaipur

Background: The incidence of maternal cardiac diseases has an adverse effect on pregnancy outcomes. The present study was done the objective to determine the Incidence and distribution of cardiac disease in pregnant patients, to assess mode of delivery and fetomaternal outcome in pregnancy with heart disease patients.Methods: This was a hospital based prospective observational study that include 65 pregnant women with diagnosed cardiac disease or had symptoms and signs suggestive of cardiac disease during the period from January 2018 to December 2019. Baseline data recorded including age, parity, gestational age, cardiac lesions, New York heart association (NYHA) functional class, use of cardiac medications, thorough clinical examination including chest and cardiovascular auscultation, ECG and echocardiographic assessment of left and right ventricular systolic function. Fetomaternal outcome was analysed in the study.Results: The mean age of the patients was 24.33±2.93 years (ranging from 19-36 years). 34 patients (52.30%) were primigravida. Majority (58.46%) cases were from rural area. Majority patients (70.77%) are present between 37-40 weeks of gestational age. Most of patients had vaginal delivery (64.62%). 43 patients (66.15%) diagnosed with heart disease after pregnancy, while 22 patients (33.85%) are diagnosed before pregnancy for heart disease. Neonatal complications were seen in in 35.38% of patients. Cardiac complications were present in 40% of patients. majority of fetal complications are in nonoperated patients (46.15%).Conclusion: The management of pregnant women with cardiac diseases requires multidisciplinary approach to prevent morbidity and mortality. It is necessary to optimize healthcare facilities to obtain maximum maternal and fetal outcome.

Comparative study: normotensive and preeclampsia mother presenting with imminent symptoms of eclampsia in third trimester of pregnancy

Background: This prospective study compares the maternal and fetal outcome in normotensive and preeclampsia mother presenting with imminent symptoms of eclampsia in third trimester. This prospective study was conducted in the department of obstetrics and gynaecology, Government Theni Medical College, Tamil Nadu, India in 2019.Methods: A total 100 antenatal mothers were selected for the study. Group A - 50 known case of preeclampsia presented with imminent symptoms. Group B-50 previously normotensive patients present with imminent symptoms of eclampsia. Maternal and fetal outcome were analysed.Results: Incidence of eclampsia - 0.1%, HELLP syndrome - 0.04%, pulmonary edema - 0.06%, PRES - 0.07%, abruptio placenta - 0.14% and maternal death in Group A was 2% and in Group B was 8%. Maternal complications are more in normotensive women (46%) presented with imminent symptoms than in preeclampsia women (26%) with imminent symptoms. Incidence of IUGR in Group A was 46%, whereas in Group B 12%. Incidence of preterm babies in Group A was 18%, whereas in Group B was 42%. Perinatal death incidence was 2.2% in imminent eclampsia.Conclusions: Because known preeclampsia patients were aware of imminent symptoms and presented early to hospital. Early identification and treatment of this dreadful outcome at the imminent state itself can reduce the complications. In current status on preventive aspect of eclampsia, atypical presentation should also be considered for which new screening and diagnostic tools has to be developed.

Serum magnesium at 18-20 weeks of gestation: can it be a predictor of gestational hypertension and fetomaternal outcome?

Background: Hypertensive disorders of pregnancy (HDP) is a major cause of maternal, fetal morbidity and mortality complicating 10% of all gestations. As effective treatments are very limited, prediction of HDP occurrence is most importance. Though many biomarkers have shown relationship with HDP, serum magnesium (Mg) has shown better predictor as involved in maintaining vascular contractility, tone. This study is intended to analyse incidence of GHT and fetomaternal outcome in pregnant women with normal and low serum magnesium level measured at mid trimester (18-20 weeks).Methods: A total of 105 consecutive singleton pregnant women in between 18-20 weeks of gestation attending OBG outpatient department were enrolled. After obtaining the informed consent, structured proforma was used to collect demographic, clinical details. Serum magnesium was measured by the colorimetric method and study participants were divided into two groups based on Mg cut off 1.5 mg/dl and followed up throughout pregnancy for fetomaternal outcome.Results: This study results revealed that 35.2% (37/105) pregnant women had serum Mg level < 1.5 mg/dl and mean value of Mg of all participant is 1.7 mg/dl, just above the lower limit. During follow-up of these two groups, statistically significant correlation between serum Mg levels (< 1.5 mg/dl) with GHT (8/12) occurrence and pre term birth was found. Other fetomaternal outcome not had significant correlation.Conclusions: As per the findings, serum Mg concentration measurement in between 18-20 weeks can be considered as a one of the predictors for subsequent occurrence of maternal outcome of GHT and fetal outcome of pre-term birth.

Thyroid disorders in pregnancy: prevalence and its fetomaternal outcome in a tertiary hospital of Delhi, India

Background: This study was conducted to determine the feto maternal outcome in pregnant women with thyroid disorders. The prevalence of thyroid disorders in present study was 15.75%.Methods: This was a prospective observational study carried out in all pregnant women irrespective of their parity, who attended ANC clinic in department of obstetrics and gynaecology in a tertiary care hospital over a period of 2 years. After registering, the patients were followed up with routine antenatal visits up to delivery and records were reviewed for development of abortion, PIH, preterm delivery, GDM, anemia, placental abruption, still birth, anomalies, fetal distress, meconium stained liquor, low birth weight and neonatal outcome by neonate Apgar score and TSH value.Results: Mean age group in our study was 27.61±3.14. Family history was present in 8% of study group versus 0% in control group which was statistically significant (p=0.028). Eighteen percent of preeclampsia was diagnosed in study group as compared to 4% in control group which was statistically significant (p-value= 0.005). Fourteen percent patients had preterm labour in study group as compared to 6.7% in control group which was statistically significant (p value= 0.047). Increased neonatal TSH was found in study group (61.3%) as compared to control group (32%), this difference was statistically significant (p-value <0.001). There was increased importance of measuring TSH in first trimester as it was statistically significant in study group (p-value <0.001).Conclusions: All pregnant women should be screened for hypothyroidism as early as possible or before conception to prevent any fetomaternal complications.

The association of chronic hepatitis B infectivity with fetomaternal outcome: A retrospective cohurt study in a tertiary hospital / Philippine Journal of Obstetrics and Gynecology

Background@#Hepatitis B infection on pregnancy has been linked to preterm labor, risk of prematurity, low birth weight, and the occurrence of gestational diabetes mellitus.@*Objective@#To determine the association between Chronic Hepatitis B infectivity and fetomaternal outcome such as preterm birth, low birth weight, gestational diabetes and preeclampsia among pregnant patients admitted in a Tertiary Hospital.@* Methodology@#A retrospective cohort study was done among pregnant women diagnosed with chronic hepatitis B infection admitted in a tertiary hospital from January 1, 2014 to December 31, 2018. The association of Hepatitis B infectivity and fetomaternal outcomes namely preterm birth, gestational diabetes, preeclampsia and low birth weight was determined.@*Results@#Chronic Hepatitis B infection had 1.43% prevalence among the study group. 149 patients were able to able to fulfill the inclusion criteria. Pregnant women with high infectivity Hepatitis B infection tend to be younger, have lower BMI, have lesser gravidity and parity than patients who are nonreactive to Hepatitis B e-antigen. AST and ALT were also higher among those with high infectivity Hepatitis B. However, there was no significant difference among the two groups in terms of elevated ALT. There was no significant association between Hepatitis B infectivity and fetomaternal outcomes such as preeclampsia, gestational diabetes mellitus, preterm birth and low birth weight. There is no increased risk for patients with high infectivity for preeclampsia, gestational diabetes mellitus, and low birth weight. There appears to be an excess risk in the likelihood of preterm birth/labor among those women who have a high infectivity Hepatitis B infection during pregnancy.@*Conclusion@#The prevalence of chronic hepatitis B infection among Filipino pregnant women admitted in a tertiary hospital was 1.43% from 2014 to 2018. There was no association between chronic hepatitis B infectivity and preeclampsia, Gestational diabetes mellitus. There seems to be an increased risk for HBeAg positive patients for preterm birth preterm labor, and occurrence of low birth weight, but was not statistically significant in the study population.

Fetomaternal Outcome in Gestational Diabetes Mellitus at a Tertiary Care Hospital

Introduction: Gestational diabetes mellitus (GDM) is a common medical problem that results from an increased severityof insulin resistance as well as impairment of the compensatory increase in insulin secretion. GDM has profound effects onfetomaternal outcome.Aims and Objectives: This study aims to evaluate the impact of GDM on pregnancy and fetal outcome.Materials and Methods: The present study was a prospective observational study. The screening was done by glucosechallenge test and 3 h, 100 g glucose tolerance test. The study population was divided into two groups, cases and controls. Allthe patients were followed up for maternal complications, fetal complications, mode of delivery, and neonatal complications.Results: A total of 350 randomly selected pregnant females who met the inclusion criteria were subjected to oral glucosechallenge test. Of 350 women, 22 women were found to have GDM and were compared with non-GDM patients. GDM patientshad significantly higher percentage of pregnancy-induced hypertension (13.6% vs. 2.6%, P = 0.031), polyhydramnios (22.7%vs. 4.3%, P = 0.004), urinary tract infection (40.9% vs. 14.5%, P = 0.003), and excess weight gain (36.4% vs. 6.3%, P = 0.001).GDM patients had higher cesarean deliveries in 13 (59.1%) and assisted vaginal deliveries in 2 (9.1%) as compared to non-GDM(110 [36.3%] and 6 [2%], P = 0.006, respectively). Among the fetal outcome, GDM patients had higher macrosomia (31.8%vs. 8.3% in non-GDM group [P = 0.003]), neonatal convulsions (18.2% vs. 2.3% in non-GDM group [P = 0.003]), respiratorydistress (22.7% vs. 3.3% [P = 0.002]), and neonatal intensive care unit admission (72.7% vs. 12.9% [P = 0.001]).Conclusion: GDM is associated with both maternal and fetal complications, most notably macrosomia leading to increasedcesarean section rate and instrumental deliveries.

Thyroid dysfunction in preeclampsia and related fetomaternal outcomes

Background: Changes in thyroid function in normal pregnancy are well-documented but in complicated pregnancy like preeclampsia, very little is known. Studies have shown evidences of hypothyroidism in preeclampsia necessitating thyroid function tests to be done in preeclampsia. The study was done to analyze the fetomaternal outcome of preeclampsia with coexisting thyroid dysfunction.Methods: A cross-sectional analytical study was done over 18 months on 95 preeclamptic patients admitted at the antenatal ward and fetomaternal outcomes were analyzed according to thyroid status.Results: Out of 95 patients with preeclampsia, 42 (44.2%) had thyroid dysfunction. Among these 42 patients, 37 (38.9%) patients had subclinical hypothyroidism, 4 (4.2%) had overt hypothyroidism and 1 (1%) had hyperthyroidism. Severe preeclampsia was seen in 64.3% of the patients with thyroid dysfunction compared with 39.6% in euthyroid patients. The mean thyroid stimulating hormone (TSH) level was significantly higher and means free thyroxine (fT4) level was significantly lower in severe preeclampsia compared with non-severe preeclampsia. Complications like abruption, intrauterine fetal death (IUD), intrauterine growth restriction (IUGR), oligohydramnios, preterm deliveries, postpartum hemorrhage (PPH), low birth weight babies, birth asphyxia in babies and subsequent neonatal intensive care unit (NICU) admissions were significantly higher (p <0.05) in the preeclampsia patients with thyroid dysfunction in comparison with euthyroid ones.Conclusions: Hypothyroidism may be a modifiable risk factor for preeclampsia. Thyroid screening early in pregnancy may be helpful in predicting the occurrence of preeclampsia and timely thyroid hormone administration can reduce the maternal and perinatal morbidity and mortality associated with preeclampsia.

A study of fetomaternal outcome of hepatic disorders in pregnancy

Background: Liver is a vital organ to maintain physiology of the body and supports every organ of the body. Its proper functioning during pregnancy is essential for a good maternal and fetal outcome. The study analyses the causes and fetomaternal outcome in pregnancies with jaundice and suggests measures to reduce morbidity and mortality.Methods: This is a one-year prospective study in a tertiary care institute during which 7165 deliveries are conducted. Total 55 cases of Jaundice with pregnancy are identified and studied for clinical, biochemical profile, etiology and maternal and fetal outcome. 8 maternal deaths are reported amongst this study group.Results: In this study 55 cases of hepatic disorders in pregnancy are studied. The age group reported is 21-29 years. Majority 72% cases belong to rural areas and 85% in lower socioeconomic class. 96.3% patients were in the third trimester of pregnancy. Most common etiology of hepatic disorders in pregnancy is acute viral hepatitis followed by intrahepatic cholestasis of  pregnancy and preeclampsia and HELLP syndrome. In acute viral hepatitis 81% patients were hepatitis E positive. Most common complication are DIC followed by hemorrhagic shock and subsequently AKI and septicemia. 77.7% babies were born alive and 30.9% NICU admission due to severe birth asphyxia and prematurity. Of these 16.6% died in neonatal period. Maternal mortality in 14.5% patients due to viral hepatits, HELLP and septicemia.Conclusions: Jaundice in pregnancy is a rare medical disorder and deadly combination affecting maternal and fetal outcome. Earl detection and timely intervention with multidisciplinary approach including obstetrician, neonatologist, intensivist and skilled nursing care can help to reduce maternal mortality and morbidity.

Assessment of Thoraco-abdominal injury pattern due to blunt trauma in Kashmiri Population by contrast enhanced Computerized Tomography (CECT)

Background: The most common causes of blunt abdominal trauma are motor vehicle collisions, falls from height, assaults, and sports accidents. Computed tomographic (CT) examination of the head, neck, chest, abdomen, and pelvis has become an essential element in the early evaluation and decision-making algorithm for hemodynamically stable patients who sustained abdominal trauma. Although the decision to surgically intervene is usually based on clinical criteria rather than findings from images. CT information often increases diagnostic confidence and decreases rates of unnecessary exploratory laparotomy. Aim and objective: To study the pattern of Thoraco-abdominal injuries due to Blunt Trauma in Kashmiri population. Methods and materials: Study was done in the department of Radiodiagnosis and Imaging, GMC Srinagar. 64 patients with Positive extended FAST (focused assessment with sonography for trauma) done by expert in emergency Radiology were subjected to contrast enhanced CT. Results: According to our Study, Lung was the most commonly injured organ being injured in 67% cases followed by Spleen and Liver, being injured in 59% and 45% cases respectively. Most common pattern of lung injury was Contusion. Grade III was the most common grade of injury followed by Grade IV injury amongst splenic and liver injuries. Rib was the most commonly injured bone. Suhail Rafiq, Ishfaq Kuchay, Sheema, Sajad Dar. Assessment of Thoraco-abdominal injury pattern due to blunt trauma in Kashmiri Population by contrast enhanced Computerized Tomography (CECT). IAIM, 2019; 6(6): 23-31. Page 24 Conclusion: Multidetector CT has very high accuracy for optimal evaluation of the patients with Blunt trauma. CT plays a vital role in deciding mode of treatment whether medical or surgical for patients with blunt trauma. Lung was the most commonly injured organ in our study followed by Spleen and liver.

A study of progress of labour and feto-maternal outcome with epidural labour analgesia

Background: Experiencing labour pain and giving birth to infant is normal physiological process. In the present study the merits and demerits of epidural analgesia and its effect on progress of labour and its outcome is evaluated. Materials and methods: The present study on epidural analgesic technique for painless labour had been carried out at King George Hospital, Visakhapatnam, in cooperation with Department of Anesthesia, King George hospital. A total number of 100 patients were studied (50 cases and 50 controls). They were divided into total two groups. GROUP – 1 (Study Group) included 50 low risk primigravida, fulfilled the inclusion criteria. In this group cases received epidural analgesia. GROUP – 2 (Control Group) included 50 low risk primigravida in active phase of labour, fulfilled the inclusion criteria but were not willing for epidural analgesia. Results: 50 healthy parturient receiving epidural analgesia were compared with 50 parturient in the control group. Maximum number of parturient in both groups belong to age group of 18 to 25 years. The parturient in both groups were comparable as regards to their age distribution. Mean duration of first stage of labour in both cases and control group was compared and there was no significant difference in both groups. p value >0.05, which was non-significant. 80% of parturient in cases has pain score between 1 and 2 in control group none of the parturient has pain score of <7. Conclusions: Labour pain is associated with biochemical and physiological changes that may have adverse effects on both the mothers and the fetus. Epidural analgesia is an excellent method of relieving labour pains.