Maternal factors affecting outcome of induction of labour

Background: Induction of labour is a common procedure in modern obstetrics and accounts for 20% among all deliveries. This study aims to assess the factors associated with success/failure of induction of labour.Methods: This is a cohort study involving 220 women who underwent induction of labour in the department of obstetrics and gynaecology, MGMCRI from December 2016 to May 2018. After obtaining informed consent, patients were recruited into the study. Maternal parameters like age, parity, gestational age, BMI, Bishop score, indication of induction, method of induction, mode of delivery, maternal complications and neonatal parameters like Apgar score, birth weight and NICU admission were analyzed. Association of all parameters with mode of delivery was done by chi square test or Fisher exact test.Results: Out of 220 women who were induced, vaginal delivery rate was 56.4%. Vaginal delivery rate was high in young women of age 20-25 years (65.2%), multiparous women (65.1%), gestational age of > 40-42 weeks (64.7%), with normal BMI (67.7%), with Bishop score ≥ 5(94.6%), induced for PROM and postdates (68.6%) and induced with single agent (74%). Most common indication of caesarean section was fetal distress (43.7%) followed by meconium stained liquor (30.2%). There were no adverse perinatal outcomes.Conclusions: Women of age 20-25 years, normal BMI and induced with single agent showed statistically significant successful induction of labour.

Maternal genital bacteria and surface colonization in early neonatal sepsis.

OBJECTIVE: The study was intended to evaluate the role of maternal genital bacteria and baby's surface colonization in early onset neonatal sepsis. METHODS: Babies (born in the hospital of Jawaharlal Institute of Postgraduate Medical Education and Research) who developed clinical signs of sepsis were studied. Swabs were collected for culture from baby's umbilicus, ear, throat in addition to gastric aspirate and blood culture. The genital tract of the mother was also studied for bacterial colonization. The organisms isolated from the maternal genital tract and baby's surface colonization were correlated with those isolated from blood culture by calculating Phi correlation coefficient. RESULTS: Esch coli was the most common organism isolated from maternal genital tract and surface cultures of babies, but Klebseilla-Spp was the most common organism isolated from blood. There was a significant correlation between surface colonization of babies and maternal genital bacteria, so also was baby's surface culture and blood culture. However, correlation between maternal genital bacteria and baby's blood culture was not significant. CONCLUSION: Surface colonizing bacteria and not maternal genital bacteria are important in early onset neonatal sepsis.

Ectopic pregnancy--changing trends.

This study is an attempt to have an overall view of the changing trends in the clinical presentation, diagnostic modalities and management of ectopic pregnancy over a period of three and a half decades. The incidence of ectopic pregnancy was one in 368 during the 15-year period from 1959-1973 (group A) and has increased to one in 160 during the latter part of the study period from 1988-1993 (group B). Medical termination of pregnancy, abortion, intra-uterine contraceptive device and previous tubal ligation were the important risk factors recently (group B). Unruptured tubal pregnancy was diagnosed in 9.8% (group B) as compared to only 3% in group A. However, as most of the patients came to the hospital with disturbed pregnancy, the use of ultrasonography and urine gravindex test was helpful in only 14% in the latter part of the study. The characteristic clinical features like pain abdomen with amenorrhoea, vaginal bleeding and positive culdocentesis were the most reliable diagnostic criteria in both the groups. There is an increasing trend towards conserving the tubes and methotrexate use recently.

Impact of mode of delivery on maternal mortality in eclampsia.

Determinants of maternal mortality and causes of death pertaining to mode of delivery have been discussed. There were 23 deaths (case fatality rate of 7.2%) and maximum deaths occurred in intrapartum eclampsia (12 ie, 52.17%). Caesarean section was performed in 92 cases (28.7%) of which 4 women died (4.3%). Maternal mortality in cases who delivered vaginally was 7.1% (16 out of 225) and 3 cases died undelivered. Authors feel that at the referral centres early caesarean section in eclampsia may help in reducing maternal mortality.