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Background: Diabetic Pregnant women with hypothyroidism are associated with adverse obstetric outcome with various maternal and fetal complications. The aim of this study was to evaluate hypothyroidism in diabetic pregnancy and its effect on maternal and fetal outcome. Material & Methods: This cross-sectional study was conducted in department of Obstetrics and Gynaecology, Women & Children Hospital, NHN, Uttara, Dhaka, Bangladesh, during the period from 13th February 2020 to 9th December 2021. Total 120 pregnant women with diabetes were included in this study. All patients were divided into two groups which include- Group A: 60 pregnant women with diabetes and Group B: 60 pregnant women with diabetes and hypothyroidism. Results: Mean age was 29.3 years (SD±4.9 years) in group A and 29.9 years (SD±6.1 years) in group B. Mean TSH was 2.2 ?IU/ml (SD±1.7 ?IU/ml) and in group A and 4.4 ?IU/ml (SD±3.0 ?IU/ml) in group B. Mean TSH was higher in group B than group A with statistically significantly difference (p< 0.0001). Most of the pregnant women had lower uterine cesarean section in both group A (51.7%) and in group B (68.3%) with statistically significant difference (p=0.0409) between the groups. The commonest maternal complication was fetal distress in both group A (13.3%) and in group B (16.7%). Most of the neonates had normal weight in both group A (83.3%) and group B (78.3%). Majority of the neonates had normal Apgar score in one minute in both group A (50%) and group B (58.3%). The Apgar score in 5 minutes was also normal in most of the neonates of both group A (71.7%) and group B (78.3%). The neonatal mortality rate in group B was 1.7%. The commonest fetal complication was low birth weight in both group A (16.7%) and in group B (21.7%). There was no statistically significant (>0.05) difference among both groups in neonate’s outcome. Conclusion: Fetal distress and preeclampsia are most common complication in diabetic pregnant women with hypothyroidism. For neonates, low birth weight, hypothyroidism and respiratory distress are commonly seen. There is higher death rate of neonates in diabetic pregnant women with hypothyroidism. Majority of the pregnant women needed lower uterine cesarean section for the complications.
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Background: Referral is a crucial aspect of emergency obstetric care in India. Adequate and timely referrals help to improve the quality of health‑care services and maternal and child well‑being. Objectives: Studies are needed to assess the outcome of obstetric mothers’ emergency admissions in relation to referral patterns. Materials and Methods: A hospital‑based cross‑sectional descriptive study was done among obstetric patients admitted to a tertiary care hospital’s emergency department (emergency medical service [EMS]). Aretrospective cohort was analyzed. The data were entered in Epicollect5 and imported to STATA software version 16 for analysis. Results: A total of 685 mothers admitted to EMS were selected for the study, with a mean (standard deviation) age of 26.5 years (4.2). Among the study participants, 181 (26.4%) were referred from other institutions, 382 (55.8%) were nonreferral who received antenatal checkups in the tertiary hospital, and 122 (17.8%) were self‑referral who had not received any antenatal checkup in the tertiary hospital. The adverse fetal outcome was 1.88 (1.21–2.95) times higher in the referred mothers compared to the self‑referral. Conclusion: We observed that a higher percentage of referrals were from the primary health centers. This kind of direct referral to tertiary care hospitals can be avoided by availing the emergency obstetric services at secondary hospitals to prevent adverse fetal outcomes and unnecessary referrals to the tertiary hospital.
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Background: Raised body mass index (BMI) and excessive gestational weight gain (GWG) are important determinants in development of gestational diabetes.Methods: A prospective, observational study carried out on antenatal women since their first trimester. These women were screened for gestational diabetes mellitus (GDM) by diabetes in pregnancy study group of India (DIPSI) criteria. All participants were followed up by measuring their BMI, weight gain, blood sugars in every trimester. Also, data was collected regarding any adverse outcomes.Results: Among all participants, 16.8% were diagnosed as GDM. 44% women of study group had weight gain beyond Institute of Medicine (IOM) recommendations. Higher risk of GDM was observed in women with raised BMI and excessive GWG. Also, odds of preeclampsia, preterm deliveries, caesarean section, macrosomia, intrauterine fetal death, neonatal intensive care unit (NICU) admissions were higher in women with GDM.Conclusions: Compliance of recommended weight gain during pregnancy have a strong impact on the fetal outcome. Amount and timing of weight gain plays a crucial role in GDM.
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Background: Women with gestational diabetes mellitus pose an important health problem because diabetes not only affects maternal and fetal outcome but these women and fetuses are also at an increased risk of developing diabetes and related complications later in their life. Objectives: The study was aimed to find out prevalence, risk factors, maternal and fetal outcome in patients of gestational diabetes mellitus. Materials and methods: Retrospective study was conducted over a period of 6 months in the Department of Obstetrics and Gynecology, King George Hospital, Visakhapatnam, a Tertiary care centre. Detailed information regarding maternal, fetal and labour outcome parameters was recorded. Results: Prevalence of GDM was found to be 3.12%. Of the affected women, 34.5% were in the age group between 26-30 years, 10.9% were having GDM in previous pregnancy, 14.5% were having family history of diabetes, 20% were managed with diet alone, 41% were on insulin treatment, 65.4% underwent C-Section, 43% of babies were of birth weight 3.1-3.5 kg, 25% of cases were associated with other risk factors like pre-eclampsia. Conclusion: Diabetes during pregnancy is associated with higher maternal and fetal morbidity. Therefore, early screening, detection, close monitoring and intervention is essential to reduce maternal and fetal short and long term adverse effects in high risk groups. Pregnancy provides an opportunity to the clinician to control the disease process and inculcate healthy lifestyle practices in these patients.
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Background: To study maternal outcome in eclampsia in relation to respiratory complications, fever, DIC, renal system affection and electrolyte imbalance. (2) To study the fetal outcome in eclampsia in relation to small for gestational age, intrauterine death, neonatal mortality, perinatal mortality and need for NICU admission. Methods: It was a cross-sectional prospective study conducted at Department of Obstetrics and Gynaecology at Department of Gynaecology, Adesh Institute of Medical Sciences and Research, Bathinda, Punjab, India. All patients admitted with eclampsia was enrolled for the study as per the criteria given. It was a a cross-sectional prospective study conducted on women admitted with eclampsia after the gestational age of 20 weeks and presented with convulsions. The outcome in relation to maternal and neonatal morbidity and mortality was studied on the basis of various complications and defined parameters. Results: A total of 50 patients were enrolled in the study. The most common age group of patients who had eclampsia after 20 weeks of gestation belonged to age group of 31-35 years followed by 26-30 years and the least common age group was between 41- 45 years of age. The mean age was found to be 28.23 years. The most common indication of LSCS in patients with eclampsia was fetal distress followed by Unfavourable cervix, failure of induction and contracted pelvis. The most common complications seen in patients with eclampsia included Respiratory complications like aspiration pneumonia, pleural effusion and pulmonary edema. Conclusions: Less ANC visits were associated with more threat and complications. Eclampsia was found to be associated with preterm delivery. Increase in convulsion to delivery interval lead to increase severity of complications.
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Background: We aimed to evaluate the predictive value of two screening tests - 50 gm GCT and 75 gm GTT for adverse maternal and fetal outcome in patients with gestational diabetes mellitus. Methods: This was a prospective study of 200 antenatal women booked at tertiary care hospital Delhi during the year 2010-2012. Pregnant females at 24-28 weeks gestation were randomly selected and subjected to 50 gm GCT and 75 gm GTT. The women’s history, clinical examination recorded, 50 gm GCT and 75 gm GTT values recorded and the two tests were compared for maternal and fetal outcome. Results: 75 gm GTT had higher specificity, positive and negative predictive values as compared to 50 gm GCT for both maternal and fetal outcome. However 50 gm GCT was more sensitive for predicting maternal and fetal complications. Conclusions: 75 gm GTT is better than 50 gm GCT for predicting adverse maternal and perinatal outcome in gestational diabetic patients.
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Background: Medical experts for many years have daunted the occurrence of pregnancy in homozygote sickle cell patients. This is because of associated high risk for mother and fetus. The aim of this study is to determine the prevalence and maternal and fetal outcome of pregnant mothers with sickle cell disease at the University of Port Harcourt Teaching Hospital, Nigeria. Materials and Methods: This was a retrospective descriptive study of medical case files of all booked pregnant mothers who attended the antenatal clinic of the University of Port Harcourt Teaching Hospital, Nigeria from January 2007 to December 2011. The parameters extracted from the folders included: age, level of education, hemoglobin genotype, full blood count, malaria parasite, urine analysis and culture, complications of pregnancy, Apgar scores and birth weight. Results: A total of 4,650 mothers were booked for antenatal care. Eight hundred and forty (18.1%) of them were HbAS, five (0.1%) were HbAC, nine (0.2%) were HbSS and 1(0.02%) HbSC. Age and gestation at booking were 18–42 years (mean 28.6± 2.1) and 9–34 weeks gestation (mean 16.6±3.3), respectively. Malaria and vaso-occlusive crisis were the commonest complications encountered in pregnancy. Twenty percent of women had induction of labour and 60% were delivered by emergency caesarean section. Twenty percent had postpartum haemorrhage. Forty four percent of women delivered before 37 completed weeks. Birth weight below 2500 g occurred in 50% of singleton pregnancies. Two neonates developed transient complications related to maternal opiate exposure postnatally. There were 2(20%) maternal and fetal losses from toxaemia of pregnancy. Conclusion: Pregnancy is uncommon among females with sickle cell disease in Port Harcourt, Nigeria. Sickle cell disease remains a severe complicating factor to pregnancy and associated with increased fetal and maternal losses.