Cardiac disease in pregnancy

Cardiac disease is an important cause of maternal morbidity and mortality. It can invariably affect fetus with variable intensity depending upon nature of cardiac disease in mother. Cardiac disease can affect women antenatally, in labor and even in post-partum period. It is a case series of 12 cases who presented to labor room in a particular unit at SSG hospital, Baroda over a period of 1 year starting from 1st May 2022 to 30th April 2023. Mean age at presentation was 24.8. 3 women were having valvular heart disease while 4 were having peri-partum cardiomyopathy (PPCM), 4 were having atrial septal defect (ASD), 1 was having ventricular septal defect (VSD). Associated medical comorbidities and obstetrical factors were evaluated. 2D ECHO findings of all cases were recorded. Risk assessment must be done for the mother and fetus to minimize the effect of cardiac disease in pregnancy. Joint consultation with cardiologist should be done in already known case of cardiac disease.

Recent trends of interventions in labor management at a tertiary care hospital

Background: Aim of the study were to identify the changing trends in labor management in terms of rate of cesarean section (C-section), rate of trial of labor after C-section (TOLAC), rate of primary and repeat C-section, rate of episiotomy in primi and multi-gravida and percentage contribution of red cell concentrate (RCC) to total blood transfusion.Methods: The data was collected retrospectively for every year at SSG hospital, Baroda from 1st January 2014 to 31st December 2022. C-section rate was calculated per annum in percentage, which was again split into primary and repeat C-section rate. Leading indications for primary C-section were identified. Rate of total episiotomy, in primigravida and multigravida, trends of RCC transfusion rates and its contribution to total blood products were estimated. Appropriate statistical tests were applied to check level of significance.Results: C-section rate contributing to total confinements increased from 30.76% in 2014 to 37.6% in 2022, which was statistically significant. Contribution by primary C-section has decreased but repeat C-section has increased over these years. Common indications for primary C-section included fetal distress, MSL, breech presentation, non-progression of labor etc. Overall rate of episiotomy has increased from 41% in 2104 to 54.4% in 2022, with decrease in primigravida and increase in multigravida over these years but these rates are not significantly changed. Contribution of RCC to total transfusion significantly decreased from 76.1% in 2014 to 66% in 2022.Conclusions: Rate of total and for repeat C-section are increasing with time, so TOLAC and other strategies to reduce primary C-section should be focused upon. Episiotomy must not be routine and should be given when indicated only. Interventions to reduce requirement of blood transfusion must be strengthened. New oral and parenteral iron preparations should be accepted based on evidences.