A Retrospective Study to find out Factors Affecting Maternal Mortality in a Tertiary Care Hospital in Ahmedabad City, Gujarat

Background : Data pertaining to preventable causes of maternal mortality are valuable in each set up to design interventional steps for the significant reduction of the maternal mortality ratio. Objectives : (1) To study the trend on Maternal Mortality Rate (MMR); (2) To find out the factors for the Maternal Mortality. Material and Methods : A retrospective cross-sectional study of maternal death was conducted in the Obstetrics Department of Tertiary Care Hospital of Ahmedabad city. The data of total 9 years from 1st April 2013 to 31st January 2021 were taken in the study. Epidemiological factors and causes affecting maternal mortality were assessed through pretested questionnaire that includes parity, duration between admission and mortality etc. Results: Maternal Mortality Rate (MMR) was 180.2 per 1 lac live births during the study period. Young mothersaged 20 to 30 years (78.5%), and rural residence (76.6%), multiparous mothers (66.7%)were at risk for Maternal Mortality. Obstetric haemorrhage (25.8%) was the most common cause whereas COVID-19 pandemic later on were indirect causes contributing to Maternal Mortality. Conclusion: Great Care should be taken for high-risk pregnancy like young age, multiparous women and also of postpartum women. Postpartum haemorrhage was the commonest direct cause of Maternal Mortality. Strengthening of existing obstetric care facilities, facility for easy transport, appropriate referral linkages are keys to reduce Maternal Mortality to further extent

Proportion of Consanguineous Marriages in Community and Factors Affecting Pregnancy Outcome : A Hospital based Study in Ahmedabad City, Gujarat

Objectives : To find out (i) the proportion and the types of consanguinity and (ii) its correlation with fetal loss, neonatal deaths, complication related to obstetric and congenital abnormalities. Methods : All the delivered women at Tertiary Care Hospital were included in the cross sectional study during the study period. Total sample size was 6775. Information regarding educational status, occupation, consanguinity and pregnancy outcome was collected. Results : 17% consanguinity was found in selected people and among these marriages, 59.8% were between first cousins. There was highly significant difference observed between the consanguineous status of women and pregnancy outcome (Congenital malformations, abortion, Intrauterine death). Conclusion: The incidence of congenital abnormalities, Intrauterine Device (IUD) and abortion was found higher in Consanguineous marriages. There is a need to improve public awareness regarding problems related to Consanguineous marriages

Anaesthetic Management of a Complicated Bilateral Tubo-Ovarian Abscess Posted for Diagnostic Laparoscopy followed by Laparotomy

A middle aged female presented with abdominal distension due to tubo ovarian abscess compressing both ureters leading to Acute Kidney Injury and reactive pleural effusion posted for diagnostic laproscopy and laparotomy done under general anaesthesia with Rapid Sequence Induction. The aims of anaesthetist during surgery were 1) To maintain hemodynamic stability and prevent regurgitation. 2) To provide optimum analgesia intraoperatively and post operatively and 3) To maintain Peak Airway Pressure within normal limits to prevent the basal lung atelectasis. Intra-operatively hemodynamic vitals were monitored and airway pressures were maintained within normal limits. Intra operatively laryngospasm occurred that was treated with i.v. succinylcholine and regurgitated contents were suctioned immediately. Patient was uneventfully managed and underlying pathology was corrected. Post-operatively; patient was shifted to ICU with endotracheal tube in situ that was weaned off eventually and successfully. Thus finally meticulous and collaborative efforts of Anesthesiologist, Gynecologist and para-medical staff, such critical patient can be well managed pre, intra and postoperatively uneventfully.

Assessment Of feto maternal hemorrhage in antenatal period in Indian females – need of modifications in Anti D prophylaxis in India.

Objective: -To assess Feto maternal Hemorrhage in pregnant Indian Females. Method: - 516 consecutive antenatal patients attending the Fetal Medicine Department of Vadilal Sarabhai General hospital under NHL Municipal Medical College, Ellis Bridge, Ahmadabad were analyzed for Feto maternal Hemorrhage by Kleihauer Betke test after taking informed consent. Result: - All the 516 antenatal patients including those who underwent invasive procedures like Chorionic villus sampling, Amniocentesis, Amnioinfusion and Intrauterine blood transfusion had Feto maternal Hemorrhage less than 2 ml. Conclusion: - Study shows that Feto maternal hemorrhage in Indian women is very insignificant even after invasive procedures. Feto maternal Hemorrhage has special importance in Rh Negative Women, carrying an Rh positive fetus.FMH can lead to isoimmunization leading to a wide spectrum of antenatal and postnatal fetal complications ranging from anemia to stillbirth. Answer to this is Antenatal Anti –D prophylaxis which is not a standard practice in our setup due to high cost of Anti D. As we have found FMH to be less than 2 ml even a dose of 50 microgram can suffice if given at 26 and 32 weeks of gestation to prevent isoimmunization thus reducing the cost and encouraging the practice of Antenatal Anti D prophylaxis.

Study of management in patient with ectopic pregnancy.

Background: ectopic pregnancy has always challenged ingenuity of the Obstratrition and Gynaecologist by its bizarre clinical picture. If it is not attended in time, it may lead to maternal morbidity and mortality. It is one, which can mimic practically each and every gynaecological disorder as well as many surgical catastrophes Method: The present study consist of 60 cases of ectopic pregnancy from may 2007to September 2009 admitted at department of obstetrics and Gynaecology at our hospital. All data was collected in to pre designed structured Performa. Results: In present study 71.66% patients are in age group of 21-30 years of age, this may be because this time period is the maximum fertile period and use of contraception is infrequent and occasional. 80% of patients were or more then two parity. Out of 60 patient in 70.75% case aetiology was made out with majority case with infection. In only one patient was heaving post operative infection, suggested by presence o adhesion. Conclusion: Due to advance diagnostic technique, conservative treatment is also possible and with recent surgical technique, the morbidity and mortality is drastically reduced.