Twin pregnancy, the study of maternal and perinatal outcome: what being a twin is like?

Background: Twin pregnancy is considered as a high-risk pregnancy due to associated high maternal and perinatal morbidity mortality in comparison with singleton pregnancy. The objectives of this study were to study the maternal and perinatal complications in twin pregnancies. To find out various factors that contribute to adverse perinatal outcome.Methods: This retrospective study was conducted at Kempegowda Institute of Medical Sciences Hospital, Bengaluru. 92 women with twin pregnancies admitted in KIMS Hospital from September 2014 to September 2018, both booked and referred patients were studied. Individual patient parameters like age, parity, gestational age, mode of delivery, maternal complications were tabulated. Neonatal morbidity and mortality were noted, data thus obtained was analysed and results studied.Results: In the study the incidence of twin pregnancies was more in second gravida (53%). 72% of the patients were admitted between 28-36 weeks of gestation with preterm labour (23%) as the main cause for admission. Anaemia (8.69%), hypertensive disorders of pregnancies (17.39%), PPROM (21%), single foetal demise (5%) and IUGR (5.4%) were the antenatal complications observed. Out of the 92 patients, 29 (35.4%) patients delivered by vaginal route whereas 53 (64.6%) had to undergo C-section. DCDA twin constituted 66% of twins in the study and mal presentation was the commonest indication for caesarean section (50%). Among the 164 babies out of 92 twin pregnancies 8 babies were still born and 12 babies died by the end of one week due to complications related to prematurity like hyaline membrane disease, IVH.Conclusions: Early detection of twin pregnancies and proper antenatal care reduces both maternal and perinatal complication thereby improving maternal and perinatal outcome.

Clinical Characteristics and Outcome of Obstetric Patients Who Required Mechanical Ventilation in a Tertiary Care Hospital in North Kerala.

Objectives: To describe the clinical characteristics of obstetric patients requiring mechanical ventilation in a tertiary referral hospital and their maternal and perinatal outcome in order to identify their risk factors and clinical outcome and determine adverse prognostic factors in these patients. Study design: A prospective study was conducted in the Dept. of Obstetrics and Gynecology, Government Medical College, Kozhikode on all pregnant women up to 6 weeks postpartum from January 1, 2011 to December 31, 2013 and who subsequently required mechanical ventilation. Data was recorded in a predesigned proforma and was analyzed and frequency, and percentages were calculated. Results: In the 3-year period, 75 obstetric patients required mechanical ventilation. Majority were between 20-35 years (88%) and were primipara (53.3%). Eighty percent were admitted in the antepartum period and most were in the gestational age of 30-36 weeks (41.3%). Hypertensive disorder is an important antepartum complication (29.3%). Postpartum hemorrhage was the important cause (45.3%) of ICU admission. About 49.3% required mechanical ventilation for <24 hours and multiorgan failure was the important complication encountered (13.3%). Conclusions: Providing optimal prenatal care and improving the management of hemorrhagic complications and hypertensive disease can improve the morbidity and mortality of critically ill obstetric patients requiring mechanical ventilation.

Intussusception in Pregnancy: A Rare Case Report.

Intussusception is a surgical emergency characterized by invagination of a segment of bowel into a distal portion. It leads to obstruction and compromise of mesenteric blood flow with resultant inflammation and the potential for ischemia of the bowel wall. It is very rare in pregnancy, and the high fetal and maternal mortality is due to a delay in diagnosis and treatment. We report a case of intussusception at a gestational age of 14 weeks and 6 days, when she presented with severe lower abdominal pain and vomiting. Diagnosis was confirmed by ultrasonography which revealed heteroechoic bowel in bowel appearance. Emergency laparotomy was done. Lead point was a submucosal lipoma at 60 cm from the ileocecal junction. Iloeocecal intussusception reduction and segmental ileal resection and end-to-end anastomosis was done. The post-operative period was uneventful.

High division of brachial artery with superficial course of radial and ulnar artery in left forearm.

Background: Variations in the vascular pattern of the upper limb are common in Indian population. Brachial artery is a continuation of axillary artery, it divides into its terminal branches namely radial and ulnar arteries at the level of neck of radius in the cubital fossa. In the present case, brachial artery bifurcated at its commencement below the lower border of teres major. Both the terminal branches, ulnar and radial artery had superficial course along the medial aspect of biceps brachii. In the cubital fossa, radial artery gave off common interosseous artery. In the forearm, radial artery had more superficial course than ulnar artery. Knowledge of these variations is important during vascular and re-constructive surgery and also in evaluation of angiographic images. Superficial position of ulnar and radial artery makes it more vulnerable to trauma and more accessible to cannulation.