RÉSUMÉ
Background: Intraventricular hemorrhage (IVH) is the commonly encountered clinical event in preterm neonates which imposes significant morbidity and mortality. Although there is a rapid advancement in the neonatal care, IVH is the common cause of neonatal intensive care units admissions. The present study was carried out to evaluate the risk factors, mortality and neurological outcomes in preterm neonates with IVH.Methods: This was a prospective study conducted on 75 preterm neonates who were delivered before 37 weeks of gestation. The neonates were subjected to cranial ultrasound for the diagnosis of IVH and graded as per the severity. The neonatal and prenatal variables were recorded and analysed to find its association with IVH progression and mortality. Immediate neurological outcome was also assessed among the IVH preterm neonates. Results: In this study out of 75 preterm neonates, the prevalence of IVH was 18 (24%). The main neonatal factors for IVH are less gestational age at delivery, 28-31 weeks (p=0.001), birth weight <1500 gm (p=0.001), APGAR scores <5 at 1 and 5 minutes (p>0.05) and maternal factors associated with IVH is premature rupture of membranes (p=0.01). The mortality rate among the IVH preterm neonates was 7 (38.9%). The significant predictors of mortality were male gender (p=0.004), grade III and IV IVH (p=0.001) and birth weight (p=0.001). The main neurological outcomes observed were seizures and post-hemorrhagic ventricular dilatation.Conclusions: Increased severity of IVH, early gestational age and low birth weight were associated with mortality in preterm neonates with IVH.
RÉSUMÉ
Placenta accreta is a condition characterized by the abnormal invasion of the placenta into the uterine wall, leading to torrential hemorrhage. This case series, highlights the importance of accurate diagnosis and early detection of this life-threatening complication. The incidence of this iatrogenic complication is rising due to increased caesarean deliveries. While in advance stages of pregnancy the chances of missing accreta are less but in early pregnancy the diagnosis may be elusive. Timely detection by using imaging modalities like ultrasound both 2D and colour Doppler, provide valuable clues. Misdiagnosis may be fatal, especially in the first trimester. The present case series presents 3 cases where initial diagnosis of missed abortion followed by repeated curettage and gestational trophoblastic disease (GTD) was made respectively. The agony of suffering leads the patient to our tertiary care center where the diagnosis of accreta was made. Accurate diagnosis and early detection of placenta accreta are vital to optimize patient outcome. Detecting the nicheand an anteriorly situated low lying placenta with history of previous birth by caesarian section should raise suspicion, and vigilance on the part of treating obstetrician is must.
RÉSUMÉ
Placenta accreta is a condition characterized by the abnormal invasion of the placenta into the uterine wall, leading to torrential hemorrhage. This case series, highlights the importance of accurate diagnosis and early detection of this life-threatening complication. The incidence of this iatrogenic complication is rising due to increased caesarean deliveries. While in advance stages of pregnancy the chances of missing accreta are less but in early pregnancy the diagnosis may be elusive. Timely detection by using imaging modalities like ultrasound both 2D and colour Doppler, provide valuable clues. Misdiagnosis may be fatal, especially in the first trimester. The present case series presents 3 cases where initial diagnosis of missed abortion followed by repeated curettage and gestational trophoblastic disease (GTD) was made respectively. The agony of suffering leads the patient to our tertiary care center where the diagnosis of accreta was made. Accurate diagnosis and early detection of placenta accreta are vital to optimize patient outcome. Detecting the nicheand an anteriorly situated low lying placenta with history of previous birth by caesarian section should raise suspicion, and vigilance on the part of treating obstetrician is must.