RESUMO
Background: Caesarean delivery is one of the commonly performed surgical procedures in obstetrics in today's practice. The objective of this study was to estimate the overall incidence and indications of primary caesarean delivery among multiparous women and to study the immediate maternal and perinatal outcome.Methods: It was a prospective observational study done in Sikkim Manipal Institute of Medical Science, Sikkim, India. It included all pregnant women after 28 weeks of gestation who had normal vaginal delivery in previous pregnancy but underwent caesarean delivery during current pregnancy (n=120) from January 2016 to December 2016. Authors collected data using a pro forma. Relevant history including demographic details, relevant clinical, laboratory and radiological examination, indication for caesarean delivery, details of delivery and neonate, and duration of hospital stay were noted. Data was described using descriptive data like mean and percentages.Results: Out of 1646 deliveries conducted, 49% were by caesarean section. It included 7.29% primary caesarean delivery in multigravida. Majority of women (27%) were in the age group 25-29. Maternal request was the commonest indication for caesarean delivery (21.66%). Atonic PPH was the commonest intraoperative complication (2.5%). Surgical site infection was the commonest post-operative morbidity (3.33%). There were 51 perinatal morbidity and 2 perinatal mortality. There was no maternal mortality.Conclusions: Caesarean section rates in this study was higher than WHO recommendation (15% versus 49.69%). This shift in trend can be attributed to higher number of maternal request for caesarean delivery which can be avoided by good analgesic facility and good counselling.
RESUMO
Background: Vitamin D deficiency is thought to be common among pregnant women and is associated with adverse maternal and perinatal outcome. Maternal and foetal outcome in pregnant women with standard obstetric care was compared with women with additional vitamin D supplementation.Methods: A randomized comparative study was conducted on 100 patients attending the antenatal clinic at JSS Medical College and Hospital, Mysuru, Karnataka, India who were randomly grouped into group A (50 patients) who received standard obstetric care (500 mg calcium+200 IU vitamin D) and group B (50 patients) who received in addition to standard obstetric care supplementation of Vitamin D 1000 IU/day starting from 14 weeks of gestation till delivery. Vitamin D levels were assessed in both the groups with onset of labour by chemiluminescence immunoassay and obstetric and neonatal outcomes in both groups were compared.Results: High incidence of vitamin D deficiency (96%) in standard care group compared to vitamin D supplemented group ( p= <0.0001) was noted. The study showed significant reduction in risk of Preeclampsia (P=0.004), GDM (P= 0.02) and primary caesarean delivery (0.008) in Vitamin D supplemented group. Significantly high birth weight in vitamin D supplemented group, an increase in 320 grams in birth weight was noted (P <0.0001).Conclusions: There is a high incidence of subnormal vitamin D levels in antenatal women and is associated with maternal and neonatal adverse effects. Measuring Vitamin D levels and appropriate supplementation of higher dose of vitamin D is an effective strategy in prevention of adverse maternal and neonatal outcomes.