RESUMO
Background: Diabetes complicating pregnancy has become common worldwide. However due to advances in the management of diabetes and its complications, there has been an overall improvement in the maternal and perinatal outcome. Diabetes occurs quite often during pregnancy even in unsuspected cases which can be either pregestational diabetes mellitus or gestational diabetes mellitus. Our objective was to study the impact of diabetes on pregnancy outcome. Methods: A prospective observational study was conducted at department of obstetrics and gynaecology of a tertiary care centre over a period of 18 months (January 2019 to June 2020). All patients were subjected to detailed history and clinical examination followed by relevant investigations such as complete blood count, blood sugars, HbA1C, renal function test, liver function test, urine albumin/sugar/ketones including ultrasonography obstetrics, congenital anomaly scan and doppler study of uterine and umbilical artery. All the data was compiled in Microsoft excel-sheet and was subjected to appropriate statistical tests. Results: Incidence of diabetes was found to be 9.72 % in our study population which included gestational diabetes mellitus (77/107) as well as overt diabetes (30). Diabetes was found to be more common in overweight and obese patients (75.7%). Macrosomia (19.6%) followed by polyhydramnios (15.6%) was the most common complication seen in pregnancy complicated by diabetes. Most common neonatal complication seen was hyperbilirubinemia 19(17.75%) and respiratory distress 18 (16.82%) in babies born to diabetic mother.Conclusions: Pregnant women with diabetes have more maternal, fetal, and neonatal complications, with overt diabetic group being more prone to complications.
RESUMO
Background: Cardiovascular disease in women is associated with 4% complications during pregnancy and is the most frequent leading cause of maternal mortality reaching up to 15%. It stands third among the most common causes of maternal mortality after obstetric haemorrhage and preeclampsia respectively.The objective of this study is to study the maternal outcome of heart disease in pregnancy.Methods: An Observational study was conducted over a period of 8 months over 50 antenatal patients with heart disease from January 2020 to August 2020 in the department of obstetrics and gynaecology, grant government medical college and JJ group of hospitals, Mumbai with appropriate inclusion and exclusion criteria. Prevalence of congenital and acquired heart disease complicating pregnancy, complications, age wise and parity wise distribution were mainly studied.Results: The incidence of heart disease was 1.8% amongst the 2,750 total deliveries conducted. In this study 46 (92%) were registered and 4 (8%) were unregistered antenatal cases. 45 (90%) belonged to upper lower class and lower class as per Kupuswamy scale with poor nutrition and antenatal care. 34 (68%) of patients had rheumatic heart disease and 11 (22%) patients had congenital heart disease. Mitral stenosis was found to be the dominant valvular lesion in rheumatic heart disease in 12 (24%) cases. Over 25 (50%) of the patients had normal vaginal delivery and 9 (18%) had instrumental vaginal deliveries, 7 (14%) with vacuum and 2 (4%) with forceps. Congestive cardiac failure was found to be the major complication found in 4 (3.9%) cases. About 8 (16%) patients required intensive care unit admission. Maternal maternity is about 4% (2 patients) in the present study.Conclusions: Maternal mortality in heart disease patients can be brought down significantly by effective preconceptional counselling, and improvements in medical, surgical, antenatal, intranatal, and postnatal care and effective motivation for contraception.
RESUMO
Background: Intrauterine fetal death is a major obstetrical complication and a devastating experience for parents as well as obstetricians. If the causes of IUFD can be found, an effective strategy for prevention of IUFD can be formed and maternal complications can thus be prevented. This study aims at identifying the various causes, etiological factors and complications of IUFD.Methods: Prospective observational study was carried out in a tertiary care hospital from 1st January 2016 to 31st July 2017.Results: Total number of deliveries during the study period was 3944 and still birth was 170. Still birth percentage was 4.31.Majority of patient belonged to maternal age group of 21-30 year of age that is 138 out of 170 around 68.5%. Only 8.82% of patients presenting with IUFD were having more than three antenatal visits. Among 61 cases (35.8%) cause was not identified while 109 cases cause was identified. Hypertensive disorder contributed to major cause of IUFD i.e. 34 out of 170 (20%) Maternal complications like hypovolemic shock occurred in 13 out of 170 (7.6%), Acute Renal failure 7 out of 170 (4.11), Sheehan syndrome. Maternal mortality was 3 out of 170 cases.Conclusions: Despite availability of modern interventions like ultrasonography, Non stress test, majority of the causes of IUFD remains unknown. Early diagnosis and delivery is important in cases of IUFD to prevent various complications like septicaemia, acute renal failure, DIC, hypovolemic shock etc.