RESUMO
The aim of this study was to study the outcomes of all patients who presented with breech presentation at term (≥37 weeks), to assess what percentage of patients were offered External cephalic version (ECV), the rates of success of the procedure and the rates of vaginal delivery following successful ECV. It was a retrospective study of 669 patients diagnosed with breech at term, their clinical records were retrieved and data like age, BMI, parity, type of breech and scan findings noted. ECV was done in 256 patients and was successful in 35.5% of women with 51.1% being multigravidas and 26.8% in primigravidas. 76.9% of women with successful ECV delivered vaginally. There was no significant fetal or maternal morbidity documented as a result of ECV in this study.
RESUMO
Caesarean hysterectomy (CH) is considered the gold standard for management of morbidly adherent placenta, now termed as placenta accreta spectrum (PAS). If bleeding is not controlled following removal of uterus, it is sometimes necessary to pack the pelvis and continue monitoring with correction of bleeding and physiological parameters in operating room and intensive care unit. This now comes under the damage control approach, being driven primarily by abnormal physiology rather than anatomical reconstruction. The pelvic packs are removed after about 48 hours. This retrospective study was done in patients with antenatal diagnosis of PAS who required CH, comparing those who required pelvic packing with those who did not. The variables compared were pre-operative (clinical and radiological), intra-operative (duration of surgery, blood loss and transfusion requirements of whole blood and blood products), and the final histopathological diagnosis. Outcome variables in terms of duration of hospital stay, re-admissions, re-laparotomy and complications were also compared. Over two years, three of eight patients with PAS required pelvic packing following CH. There were no differences between the two patient groups with any of the predictor variables or outcomes other than requirement of blood products. This suggests pelvic packing is a safe and efficacious procedure in intractable haemorrhage following CH for PAS. Pelvic packing needs greater awareness amongst obstetricians as the incidence of PAS is likely to increase.
RESUMO
Background: Aim was to estimate the prevalence of vitamin D deficiency in pregnant women and their infants and to analyse the effect of maternal vitamin D deficiency on the infant.Methods: A prospective study was done in the Department of Obstetrics and Neonatology in a tertiary centre in South India with 150 women seen in the antenatal clinic after 36 weeks of pregnancy were recruited. Serum vitamin D levels were obtained. Babies were followed up and sampled once between 10 and 20 weeks of age for vitamin D, calcium, phosphate and alkaline phosphatase. Vitamin D levels less than 20 ng/ml was considered as deficiency. Analysis of the data was done using SPSS 16.0 version.Results: Vitamin D deficiency was seen in 64.8% of the pregnant women. Follow up of 76 babies showed vitamin D deficiency in 72.6% infants. Significantly high levels of alkaline phosphatase were noted in infants who were born to mothers with vitamin D deficiency, which indicates risk of developing bone disease.Conclusions: This study highlights the high prevalence of Vitamin D deficiency in pregnant women and their infants in South India in a region with abundant sunshine. This study also emphasises treating vitamin D deficiency in pregnancy to reduce the risk of developing rickets in infancy.