A study of primary cesarean section-its rate, indications, and complications in a tertiary healthcare in Sikkim

Background: The indication of performing lower uterine section caesarean section has been changing a lot in recent year and they are expected to go on changing on basis of continuing trials. Aims and Objectives: The aims to study are to assess rate, frequency along with complications of primary cesarean section. Along with to study the incidence and indications of primary cesarean section and causes maternal as well as fetal morbidity and mortality in these cases. Materials and Methods: This prospective study included all pregnant women after 28 weeks period of gestation who underwent caesarean section for the 1st time between December 2016 and June 2018 at Central Referral Hospital of Sikkim Manipal Institute of Medical Sciences (SMIMS), Gangtok, Sikkim – India. Over a period of 1.5 years, 750 women at Central Referral Hospital, SMIMS, Sikkim, India, underwent primary cesarean section. Results: The percentage of primary lower uterine section cesarean section was 27.38% and total cesarean section rate was found to be 49.59% which is far more than the expected rate of 15% as proposed by the world health organization. Elective lower uterine section cesarean section was done in 341 cases (45.47%) and emergency lower uterine section caesarean section was done in 409 cases (54.53%). Patient’s desire was the most frequent indication for elective lower uterine section cesarean section (38.40%). Conclusions: There is tremendous rise in rate of primary cesarean section with patient’s request being the most common indication of elective lower uterine section cesarean section.

The influence of the colonization of Streptococcus agalactis in the lower genital tract during pregnancy on the perinatal outcome / 中国综合临床

Objective:To investigate the effect of the colonization of group B streptococcus (GBS) in pregnant women and the use of intrapartum antibiotic prophylaxis (IAP) on perinatal outcomes.Methods:The clinical data of 1 078 pregnant women and their newborn babies delivered in Tongzhou and Xicheng hospital areas of Beijing Friendship Hospital from January 2020 to February 2021 were analyzed retrospectively. The clinical characteristics, complications, perinatal outcomes and neonatal prognosis of the pregnant women with positive and negative GBS were compared according to the GBS colonization, and the effects of IAP on the clinical characteristics, complications, perinatal outcomes and neonatal prognosis of the pregnant women with positive GBS was compared. The measurement data with normal distribution is expressed by x±s, two independent sample t-test was used for comparison between groups. Counting data were expressed in cases or cases (%), Inter group comparison χ 2 test. Results:Among 1 078 pregnant women, 93 were GBS positive (8.6%, GBS positive group), and 93 cases matching the clinical data of the GBS positive group were selected as the GBS negative group. There was no significant difference in age, gestational age, number of pregnancies, number of births, mode of delivery, abnormal blood pressure, abnormal blood glucose, abnormal thyroid function and the proportion of any complication in the GBS positive group (P values were 0.630, 0.613, 0.311, 0.761, 0.163, 0.601, 0.467, 0.388, 1.000, respectively). The proportion of neonates in GBS positive group transferred to pediatrics, the incidence of neonatal infection, pneumonia, anemia and bacterial infection rate were higher than those in GBS negative group (57.0%(53/93) vs 23.7%(22/93), 10.8%(10/93) vs 3.2%(3/93), 29.0%(27/93) vs 14.0%(13/93), 21.5%(20/93) vs 8.6%(8/93), 22.6%(21/93) vs 6.5%(6/93)) (χ 2 values were 21.47, 4.05, 6.24, 6.05, 9.75, respectively; the P values were <0.001, 0.044, 0.012, 0.014, 0.002, respectively). The hospitalization time of neonates transferred to pediatrics was longer than that of GBS negative group (4(0,5) d vs 0(0,0) d, Z=-4.03, P<0.001). The proportion of neonates in IAP group transferred to pediatrics and the incidence of pathological jaundice and adverse outcomes were lower than those in non IAP group (51.1% (24/47) vs 78.1% (25/32), 44.7% (21/47) vs 78.1% (25/32), 42.6% (20/47) vs 65.6% (21/32)) (χ 2 values are 5.92, 8.76 and 4.06, respectively, P values are 0.015, 0.003 and 0.044 respectively). The hospitalization time of neonates transferred to pediatrics was shorter than that of non IAP group (3(0,5) d vs 5(2,7) d, Z=-2.60, P=0.009). There was no significant difference between the two groups in terms of delivery mode, water breaking time, birth weight of neonates, infection, pneumonia, bacteremia/sepsis, and anemia ( P values were 0.073, 0.085, 0.479, 0.538, 0.157, 0.161, 0.238). Conclusions:GBS colonization in the lower genital tract does not increase the incidence of intrauterine infection, premature rupture of membranes and spontaneous preterm delivery in pregnant women, but the risk of bacterial infection and adverse outcomes in newborns is higher, the rate of paediatric transfer is higher, and the hospital stay is longer. IAP can reduce the incidence of neonatal pathological jaundice and shorten the hospital stay.

Maternal prepregnancy obesity and gestational diabetes influence on adverse perinatal outcomes

ABSTRACT Objective: Evaluate the influence of isolated and associated prepregnancy obesity and gestational diabetes mellitus (GDM) on adverse perinatal outcomes. Materials and methods: Cross-sectional observational study with women who delivered at a Brazilian Maternity Hospital, between August and December 2020. Data were collected by interview with application form, and medical records. Sample was stratified by body mass index (BMI) and GDM screening in four groups: no obesity (BMI < 30 kg/m2) no GDM - reference; isolated GDM; isolated obesity (BMI ≥ 30 kg/m2); and obesity with GDM. Preeclampsia (PE), cesarean section (CS), large-for-gestational-age (LGA) newborn and admission to neonatal intensive care unit (NICU) were analyzed by odds ratio (OR) adjusted for confounding factors, adopting 95% confidence interval (CI) and P < 0.05 statistically significant. Results: From 1,618 participants, isolated obesity group (233/14.40%) had high chance of PE (OR = 2.16; CI: 1.364-3.426; P = 0.001), isolated GDM group (190/11.74%) had high chance of CS (OR = 1.736; CI: 1.136-2.652; P = 0.011) and NICU admission (OR = 2.32; CI: 1.265-4.261; P = 0.007), and obesity with GDM group (121/7.48%) had high chance of PE (OR = 1.93; CI: 1.074-3.484; P = 0.028), CS (OR = 1.925; CI: 1.124-3.298; P = 0.017) and LGA newborn (OR = 1.81; CI: 1.027-3.204; P = 0.040), compared with reference (1,074/66.38%). Conclusion: Obesity and GDM enhances the chance of different negative outcomes, worsening this prognosis when associated.

Impact of Midwife-led Supportive Educational Intervention on Perinatal Outcome among Fearful Primipara Mothers

The aim of the study was to develop and assess the effect of supportive-educational intervention on perinatal outcome among primipara mothers with a fear of childbirth. This randomised controlled trial was conducted on 205 primipara mothers with a fear of childbirth attending a Gynae OPD. At 24-28 weeks of pregnancy primipara mothers were screened for fear of childbirth WDEQ-A and then randomly allocated to experimental and control group. Within one week of delivery perinatal outcome was assessed with help of self-made checklist. After the interventions, there were signi cant differences between groups on post-intervention scores for term of delivery and newborn birth weight at p'lt;0.001. Based on the results of the study it can be concluded that supportive educational intervention was effective in primipara mothers for positive birth outcome.

Efficacy of fetal left ventricular modified myocardial performance index in predicting adverse perinatal outcomes in intrahepatic cholestasis of pregnancy

SUMMARY OBJECTIVE: This study aimed to evaluate the effectiveness of fetal left ventricular modified myocardial performance index in predicting adverse perinatal outcomes for intrahepatic cholestasis of pregnancy. METHODS: A cross-sectional study was conducted, including 51 women with intrahepatic cholestasis of pregnancy and 80 healthy controls. Using Doppler ultrasonography, E-wave, A-wave, isovolumetric contraction time, isovolumetric relaxation time, and ejection time were recorded and the left ventricular modified myocardial performance index was measured. RESULTS: Findings showed that the mean left ventricular modified myocardial performance index, isovolumetric contraction time, and isovolumetric relaxation time values were statistically significantly higher while the ejection time and E/A ratios were statistically significantly lower in the intrahepatic cholestasis of pregnancy group than the control group. In the intrahepatic cholestasis of pregnancy group, a statistically significant positive correlation was found between left ventricular modified myocardial performance index and adverse perinatal outcomes in the intrahepatic cholestasis of pregnancy group (r=0.478, p<0.001), while a statistically significant negative correlation was found between the E/A ratio and adverse perinatal outcomes (r=-0.701, p<0.001). CONCLUSIONS: For intrahepatic cholestasis of pregnancy cases, high fetal left ventricular modified myocardial performance index values were an indicator of ventricular dysfunction, and this correlated with negative perinatal outcomes.

ROLE OF DOPPLER ULTRASOUND IN PRE-ECLAMPSIA AND ITS PERINATAL OUTCOME

Background: The main purpose of providing antenatal care is to identify women at risk ofcomplications as a result of impaired uteroplacental circulation such as pre-eclampsia.Aim: To describe practical application of Doppler ultrasound in obstetrics with analysis of bloodflow velocity waveform in pre-eclampsia and to examine perinatal outcome in pregnancies withaltered Doppler indices.Material and Method: This is a prospective study of 40 pregnant women with pre-eclampsiaevaluated sono-graphically with color Doppler and to be followed subsequently for any adverseperinatal outcome.Result: Out of 40 cases 45% of cases were found in 25-29 years age group. 25 cases had abnormaluterine artery Doppler indices accounting for 62.5%, while 15 cases had a normal doppler indicesaccounting for 37.5%. Out of 40 cases, 24 cases had abnormal Middle cerebral artery accounting for60%. In our study 14 cases had abnormal umbilical artery Doppler indices accounting for 35%,while 26 cases had a normal Doppler index accounting for 65%. In this study total 6 cases (15%) ofperinatal mortality were seen.Conclusion: The knowledge of Doppler arteries waveform may help to improve pregnancyoutcome and any permit identification and assessment of pre-eclampsia at earliest gestational age ascompared to other ante partum test modalities.

COVID and Women’s Health in India

Background : COVID-19 disease surfaced in Wuhan in December, 2019 and rapidly spread in the World as a pandemic (March, 2020) Till date (10 August) COVID-19 has affected 20 million people. Many women have delivered and many conceived during this time. Till date very few adverse effects and vertical transmission is observed. WHO later changed the terminology to SARS-COV-2 and removed ’19’ from the name. Material and Method : We studied Maternal and Perinatal outcome of COVID confirmed pregnancies and the effects of CORONA infections on Women’s Health. Results : Most of the patients were asymptomatic. Majority 80% cases of our cases were delivered by Cesarean Section. Cesarean Section was done for Obstetric reasons along with early consideration due to COVID concerns. Meconium Stained Liquor and Fetal Distress was the indication of Cesarean in 14% cases. Previous Cesarean Sections was a major cause of repeat cesarean in our study. Preterm labour was reported in only one case of Twin Pregnancies. Premature Rupture of Membranes was not seen in any of the pregnancies. Maternal and Fetal outcome were favorable with only few cases of mild to moderate Pneumonia in mothers. Most of the women were psychological disturbed due to the Lockdown and had unwanted pregnancy (due to lack of contraceptive availability), domestic violence and also family disputes and child beating were reported by many in the survey. Due to lack of Medical Services by the GP’s and the friendly small Obstetrics Gynaecology clinics (closed due to Lockdown) small problems got aggravated and a lot of these women one now coming up with Anemia, Polycystic Ovarian Syndrome (PCOS), Fibroids, Abnormal Uterine Bleeding (AUB), Endometriosis, Pelvic Inflammatory Disease (PID), Cervical Crosiers, Vaginitis, Obesity etc. Conclusion : Coronavirus infection in pregnancy did not adversely affect the pregnancy and has a benign course. Pregnant women are not at higher risk of developing Pneumonia compared to non pregnant women. There is no evidence of increased risk of miscarriage or foetal losses with COVID-19 infection during pregnancy. But SARS-COV2 disease a lot of other Gynaecological problems and adversely affected Women’s Health.

Role of doppler ultrasonography in prediction of adverse perinatal outcome in intrauterine growth retardation (IUGR)

Introduction: A Doppler ultrasound is a noninvasive test that can be used to estimate the blood flow through the blood vessels by bouncing high-frequency sound waves (ultrasound) off circulating red blood cells. Objective of current study was to determine and compare accuracy of various Doppler parameters for perinatal outcome - Umbilical artery (UA), middle cerebral artery (MCA), and ductus venosus (DV) for predicting adverse perinatal outcome in patients of intrauterine growth retardation. Materials and methods: A total of 172 singleton pregnancies between 33 to 36 weeks of gestation complicated by intrauterine growth restriction were prospectively examined with Doppler ultrasound of the umbilical artery, middle cerebral artery and ductus venosus. Patients kept under surveillance till confinement. According to increasing severity of Doppler indices categorized the cases into six grades from grade 0 to grade 5.Duration of this study was two years, from December 2019 to November 2021. Results: Out of 172 cases, 146 were live born and 26 were neonatal death. There were 7 cases of intrauterine death of fetuses and 5 were still born. Out of the live born 27 had increased perinatal morbidity like poor APGAR score, development of necrotizing enterocolitis, hypoxic ischemic encephalopathy, meconium aspiration syndrome, hyperbilirubinemia, and prolonged admission in neonatal care unit for reasons like sepsis / birth asphyxia. Conclusion: Absent end diastolic flow (EDF) / reversal in umbilical artery had high positive predictive value in predicting adverse fetal outcome. Ductus venosus changes seem to be an ominous sign of a severely compromised fetus with poor perinatal outcome. Doppler investigation of the MCA, UA and DV plays an important role in monitoring the compromised fetuses and helps to determine the optimal time of delivery.

Perinatal outcome and risk factors of precipitate labor in term primipara: an analysis of 381 cases / 浙江大学学报·医学版

OBJECTIVE@#To investigate the perinatal outcome and risk factors of precipitate labor in term primipara.@*METHODS@#A total of 6951 full-term singleton primiparas with cephalic vaginal delivery in Women's Hospital, Zhejiang University School of Medicine from January 2020 to December 2020 were enrolled, among whom 381 cases of precipitate labor were classified as the precipitate labor group and 762 cases of normal labor were randomly selected as the control group. The perinatal outcomes of the two groups were compared, and the risk factors of precipitate labor were analyzed by multivariate logistic regression.@*RESULTS@#The incidence of precipitate labor in full-term, singleton pregnancy and cephalic primiparas was 5.48% (381/6951). The durations of the first and second stages of labor in the precipitate labor group were significantly shorter than that in the control group ( P<0.01); while there was no significant difference in the duration of the third stage of labor between the two groups ( P>0.05). Compared with the control group, the incidence of soft birth canal laceration in the precipitate labor group was increased ( P<0.01). However, there was no significant difference in postpartum hemorrhage and neonatal related perinatal outcomes between the two groups (all P>0.05). Multivariate logistic regression analysis showed that maternal height ( OR=1.038, 95% CI: 1.010-1.067, P<0.01), gestational age at delivery ( OR=0.716, 95% CI: 0.618-0.829, P<0.01), late miscarriage ( OR=1.986, 95% CI: 1.065-3.702, P<0.05), membrane rupture before labor ( OR=1.802, 95% CI: 1.350-2.406, P<0.01), labor induction by transcervical balloon ( OR=3.230, 95% CI: 2.027-5.147, P<0.01), labor induction by propess ( OR=2.332, 95% CI: 1.632-3.334, P<0.01) and labor induction by oxytocin ( OR=0.291, 95% CI: 0.219-0.386, P<0.01) were independently associated with precipitate labor.@*CONCLUSIONS@#The incidence of precipitate labor in full-term, singleton pregnancy was not low. Precipitate labor could lead to a significant increase in perineal laceration. Maternal height, history of late miscarriage, membrane rupture before labor and labor induction by transcervical balloon, labor induction by propess are risk factors, while labor induction by oxytocin and late gestational time of delivery are protective factors for precipitate labor in term primipara.

Desfechos adversos perinatais e apoio matricial em Vitória, Espírito Santo, 2013-2014: um estudo de coorte / Perinatal adverse outcomes and matrix support in Vitória, Espírito Santo, Brazil, 2013-2014: a cohort study

RESUMO Introdução O apoio matricial (AM) em saúde da mulher é um processo normativo de trabalho que visa qualificar e aumentar a resolubilidade dos profissionais inseridos no contexto da assistência pré-natal na Atenção Primária à Saúde (APS). Objetivo Avaliar o efeito do AM sobre os desfechos perinatais adversos mais prevalentes em uma capital da região Sudeste do Brasil. Método Estudo de coorte que avalia prematuridade, baixo peso ao nascer e mortalidade neonatal precoce em filhos de mulheres acompanhadas nos serviços de APS do município de Vitória, de 2013 a 2014. Resultados O modelo final de análise hierarquizada, que incluiu 443 recém-nascidos, inferiu que a chance de uma gravidez evoluir para um desfecho perinatal adverso aumenta quanto maior o número de gestações anteriores (OR 4,39; IC: 1,93-10,0) e menor o número de consultas pré-natais realizadas (OR 4,99; IC: 2,18-11,42). Não foi observado efeito do AM sobre os desfechos. Conclusão O modelo hierárquico proposto não demonstrou influência do AM nos desfechos perinatais adversos estudados.

ABSTRACT Background Matrix support (MS) in women's health is a normative work process that aims to qualify and increase the resolvability of professionals working in prenatal care in Primary Health Care (PHC). Objective To evaluate the effect of MS on the most prevalent adverse perinatal outcomes in a state capital city in the Southeast region of Brazil. Method A cohort study evaluating prematurity, low birth weight, and early neonatal mortality in infants of women followed up in PHC services in the city of Vitória from 2013 to 2014. Results The final hierarchical analysis model, which included 443 newborns, showed that the larger the number of previous pregnancies (OR 4.39, CI 1.93-10.0) and the smaller the number of prenatal consultations (OR 4.99, CI 2.18-11.42), the greater the chances of a pregnancy progressing to an adverse perinatal outcome. No effect of MS on outcomes was observed. Conclusion The proposed hierarchical model demonstrated that MS has no influence on the adverse perinatal outcomes studied.

Complicaciones obstétricas y perinatales en mujeres infértiles que se embarazan / Obstetric and perinatal complications in infertile women who become pregnant

Las pacientes infértiles tienen un riesgo aumentado de resultados obstétricos y perinatales adversos que dependen de los factores de infertilidad subyacentes previos y de factores inherentes a los tratamientos recibidos para lograr el embarazo. La edad materna, las patologías previas ginecológicas, hormonales, endocrinológicas, metabólicas y anatomo funcionales son reconocidas como factores de riesgo para resultados adversos obstétricos y perinatales. Los tratamientos como la hiperestimulación ovárica y los tratamientos de reproducción asistida condicionan riesgos adicionales, especialmente por el aumento de embarazos múltiples que se generan con estas terapias. El aumento de la edad materna de pacientes tratadas por infertilidad y la necesidad creciente de tratamientos de reproducción asistida determinan probablemente, un mayor riesgo futuro de complicaciones obstétricas y perinatales. Muchos de estos factores de riesgo pueden ser modificados y manejados antes de iniciar los tratamientos con la finalidad de mejorar el pronóstico para la madre y el recién nacido. La consideración de estos factores de riesgo y sus consecuencias en el embarazo son parte esencial del consejo reproductivo que debiera recibir toda paciente que se somete a tratamientos por infertilidad.El objetivo de esta revisión es mostrar la relación existente entre las pacientes que consultan por infertilidad, los tratamientos usados y los potenciales riesgos obstétricos y perinatales cuando se produce el embarazo.

Infertile patients have an increased risk of adverse obstetric and perinatal outcomes that depend on underlying infertility factors and on those treatments recieved to become pregnant. Maternal age, hormonal, endocrinologial, metabolic and anatomic/functional gynecological diseases are widely recognized risk factors for adverse obstetric and perinatal outcomes. Infertility treatments like controlled ovarian hyperstimulation and assisted reproductive technologies add aditional risks, specially related to multiple pregnancies that are associated to. The higher maternal age of patients seeking for infertility treatment and the increasing need of assisted reproductive technologies probably determines a higher and increasing risk of obstetric and perinatal adverse outcomes. In many cases risk factors can be adequately modified and controlled before treatments are initiated thus improving maternal and neonatal prognosis. This risk factors and their consequences in pregnancy have to be strongly considered in reproductive counselling that should recieve every patient treated for infertility.The aim of this article is to show the relation between infertile patients seeking for treatment and their potential risks of obstetric and perinatal adverse outcomes when they get pregnant.

Study of umbilical coiling index and perinatal outcome

Background: Study was to evaluate the relationship between umbilical coiling index (UCI) and hypo-and hyper coiling of the umbilical cord and parity, neonatal weight, Ponderal Index (PI), APGAR (Appearance, pulse, grimace, activity, and respiration) score, meconium staining of the amniotic fluid, Intrauterine growth restriction (IUGR), hypertensive disorders of pregnancy and delivery interventions.Method: A prospective analytical study was performed from January 2017 to December 2018. Total of 300 patients giving birth at labour room of SCB Medical College, Cuttack were taken into study. Immediately following delivery, the umbilical cord was clamped at the foetal end and cut with scissors. UCI, mode of delivery and perinatal outcome was followed up.Results: There were 149 lower segment caesarean sections accounting to 49.7% and 151 vaginal deliveries including instrumental deliveries which was accounting to 50.3%. Minimum number of coils observed was 2. The maximum number of coils observed was 50. Caesarean section was more in hypo coiling group. APGAR score at 5 min was calculated and there was a total of 109 neonates who had APGAR <7 at 5 minutes (36.33%) out of which there were 17 neonates with hypo coiling (2.33%), 77 neonates with normo-coiling (25.66%) and 15 neonates with hyper coiling (5%). Meconium staining and instrumental delivery was more associated with hyper coiling.Conclusion: Both hyper-coiling and hypo-coiling had significant correlation with adverse perinatal outcome. If the UCI can be measured reliably in utero by ultrasound, then it might be a promising prognostic marker for adverse pregnancy outcome.

Risk factor and perinatal outcome of preterm delivery in a tertiary care centre in rural Haryana

Background: Aim of the study was to identify risk factors and to assess neonatal mortality and morbidity associated with preterm delivery in patient attending a tertiary care centre in rural Haryana.Methods: This retrospective cohort study was conducted in Shree Guru Gobind Singh Tricentenary Medical College, over a period of one year (January to December). All pre-term deliveries were included in the study. They were followed up from admission till delivery and till discharge from hospital. Various, parameters like maternal age, associated medical disorder, obstetric complications, gestational age, neonatal mortality, need of neonatal intensive care and condition of baby at discharge were analyzed.Results: In the present study, incidence of preterm deliveries was 16.1%. The most common risk factor found to be history of previous abortion (23.6%), preterm premature rupture of membrane (17.1%), Intra-uterine growth restriction (IUGR) with oligohydramnios (10.5%), hypertensive disorder during pregnancy (5.9%), and antepartum hemorrhage (4.6%). But majority of the patient (56.5%) no cause could be identify. Out of total 160 preterm births 3 were still born and 157 live preterm births, and out of which total Neonatal intensive care (NICU) admission were 60. Mortality rate was 100% in neonate weighing less than 1000 gm and 18% in babies weighing less than 2000 gm.Conclusions: The commonest risk factor for preterm delivery is previous history of abortion and adverse perinatal outcome is inversely proportionate to the period of gestation at the time of delivery. All efforts should be made to prolong the pregnancy beyond 34 weeks by identifying and actively managing the risk factors for better neonatal outcome.

Meconium stained liquor in labour and mode of delivery: a time for reappraisal

Background: The objective of this study was to determine the significance of meconium staining of the amniotic fluid and find out an appropriate mode of delivery in women with MSL.Methods: A retrospective study was carried out in Lady Hardinge Medical College and Smt Sucheta Kriplani Hospital, a tertiary government hospital, New Delhi over a time period of 1 year between 2009 to 2010 on 1425 consecutive women of which 142 women were diagnosed as having meconium staining of the amniotic fluid during labour.  All cases were critically analysed and maternal and fetal outcomes were studied in these women.Results: The incidence of MSL was 10% (142/1425), 45% had thin MSL and 55% had thick MSL. In women with thick MSL, 85% had early thick MSL and 15% had late thick MSL. In women who had early thick MSL (n=66), 55 (83.3%) delivered by LSCS and 11 (16.7%) delivered vaginally. On correlating the perinatal outcome with mode of delivery irrespective of fetal heart rate abnormality in early thick MSL, it was seen that the perinatal outcome was significantly affected by mode of delivery. The rates of respiratory distress and MAS was significantly higher in babies who delivered vaginally compared to those by LSCS (18% & 100% vs 9% & 40%, p=0.012, RR- 5.2 [95% CI: 1.8-3.42]. There were no perinatal mortality in early thick MSL.Conclusions: In distinguishing between thick and thin meconium, it was noted that finding of thick meconium in the latent phase of labour (i.e. early thick MSL) is ominous and demands an urgent caesarean delivery.

Lactate Dehydrogenase - A Biochemical Marker for the Prediction of Adverse Outcomes in Pre-Eclampsia

Hypertensive disorders are one of the leading causes of maternal mortality. Lactate dehydrogenase (LDH) is one of the markers to study the severity of pre-eclampsia. It is an intracellular enzyme which increases in pre-eclampsia due to cellular lysis. We wanted to assess the LDH levels in normal pregnant women and women with pre-eclampsia in antenatal period and study the role of LDH as a biochemical marker to predict adverse outcomes in pre-eclampsia. METHODSThis is a prospective observational study conducted between October 2016 and August 2018 at Sri Ramachandra Institute of Higher Education and Research. Antenatal women > 28 weeks were grouped as healthy normotensive women and those with pre-eclampsia and eclampsia. Antenatal women < 28 weeks, with pre-existing diabetes mellitus, renal disease, liver disease and epilepsy were excluded from the study. LDH levels were assessed. Both groups were followed up closely for new or worsening signs and symptoms of pre-eclampsia, till delivery and early postpartum period. LDH levels in both groups were broadly divided into 3 groups (< 600 IU / L, 600 - 800 IU / L, > 800 IU / L). Maternal and perinatal outcomes were studied in these groups. RESULTSAll normotensive antenatal women and 128 out of 147 (87 %) hypertensive antenatal women had a normal LDH value (< 600 IU / L). While the babies of 58.6 % of hypertensive antenatal women with normal LDH required NICU admission, babies of 68.4 % of those with elevated LDH required NICU admission (p value > 0.05). Hence, levels of LDH do not correlate with the severity of pre-eclampsia and neonatal outcome. Also, 47.4 % of hypertensive antenatal women with elevated LDH had HELLP syndrome; 10.5 % had disseminated intravascular coagulation and 63.2 % required ICU admission. P value was < 0.05. Therefore, increasing LDH level had a positive correlation with maternal complications like HELLP syndrome, disseminated intravascular coagulation and the need for ICU admission. CONCLUSIONSOur study showed no correlation between lactate dehydrogenase and the incidence of pre-eclampsia. LDH is a good biochemical marker to predict adverse maternal outcomes of pre-eclampsia but not neonatal outcome.

Perinatal outcome associated with oligohydramnios at term

Background: Oligohydramnios is a severe and common complication of pregnancy and its incidence is reported to be around 1 to 5% of total pregnancies. The aim of this study was to perinatal outcome of oligohydramnios (AFI <5) at term.Methods: A prospective study was conducted in which 200 patients at term with oligohydramnios AFI <5 cm with intact membranes were analyzed for perinatal outcome.Results: There were increased chances of FHR decelerations, thick meconium, increased LSCS, low Apgar score at 5 minutes, birth weight <2.5 kg, admission to NICU in pregnancy with oligohydramnios.Conclusions: An amniotic fluid index (AFI) of <5 cm detected after 37 completed weeks of gestation is an indicator of poor perinatal outcome. Determination of AFI can be used as an adjunct to other fetal surveillance methods that helps to identify those infants at risk of poor perinatal outcome.

Effects of twin pregnancy chorionic properties on fetal outcomes: a comparative study

Background: Twins carry significant risks to both mothers and babies. The purpose of this study was to evaluate chorionicity and its impact on perinatal outcomes in twins.Methods: This prospective observational study was conducted in the department of obstetrics and gynecology, Government T. D. Medical College, Alappuzha, Kerala. A total of 106 cases of twin pregnancies were included in the prospective descriptive study. Based on the ultrasound results and methods of the postpartum pathologic examination of the placental membranes, the cases were divided into the twin group with monochorionic diamniotic (MCDA) and twin group with dichorionic diamniotic (DCDA group). The relationships of different chorionic properties and fetal outcomes were determined by comparing various fetal outcomes.Results: Among 106 twin pregnancies, 61.3% were DCDA twins, 38.7% were MCDA. Average maternal age of monochorionic twin was 25 and that of dichorionic twin was 27. Perinatal mortality of monochorionic twin was 14.7% when compared to 8.6% for dichorionic twin. The mean gestational age for monochorionic twin pregnancy was 34.78 weeks whereas it was 35.91 weeks for dichorionic pregnancy. Elective and emergency LSCS was done more for dichorionic twin pregnancies compared to monochorionic twin pregnancies. Low Apgar scores were seen in monochorionic twins compared to dichorionic twins.Conclusions: The incidence of fetal outcomes in the monochorionic group was inferior to those in the dichorionic group. The fetal outcomes may be improved by determining the chorionic properties in early pregnancy by using ultrasound and consequently planning for pregnancy monitoring and intervention.

Pronóstico Perinatal en embarazadas de tercer trimestre recuperadas de infección por COVID-19 / Perinatal Prognosis in third trimester pregnant women recovered from COVID-19 infection

INTRODUCCIÓN Y OBJETIVOS: COVID-19 es una patología producida por el virus RNA SARS-CoV-2, declarada pandemia por la OMS en marzo de 2020. La literatura mundial describe mayor incidencia de parto prematuro y cesáreas en pacientes infectadas por COVID-19 principalmente de origen iatrogénico, sin embargo, existen escasos datos del pronóstico del embarazo al decidir diferir el parto hasta después del período infeccioso del virus. Este trabajo reporta un grupo de embarazadas diagnosticadas con COVID-19 en tercer trimestre donde se decidió no interrumpir el embarazo y diferir su parto hasta recuperación de la patología. MÉTODOS: Estudio observacional retrospectivo que analiza resultados materno-perinatales en 9 casos de mujeres infectadas por COVID, diagnosticadas posterior a las 33 semanas y cuyo parto se verificó después de recuperadas del COVID. RESULTADOS: Se observó un 77% de pacientes sintomáticas, 77% requirieron hospitalización, 33% por COVID, todas ingresaron a unidad de paciente crítico, sólo una requirió ventilación mecánica no invasiva. Dos cursaron con cetoacidosis normo-glicémica y dos con neumonía por COVID-19. Un 88% resultó en parto de término, sólo una paciente tuvo parto prematuro de causa obstétrica. La vía de parto fue un 67% vaginal y 33% por cesárea, todas por indicación obstétrica. La latencia al parto promedio fue de 17.3 días. Los puntajes de Apgar fueron todos mayor a 7 al minuto y 5 minutos. CONCLUSIÓN: Los resultados de esta serie sugieren que, en casos seleccionados, los partos posteriores al período infeccioso del COVID se asocian a buenos resultados materno-perinatales, sin embargo, resulta importante aumentar la casuística.

INTRODUCTION AND OBJECTIVES: COVID-19 is a pathology produced by the RNA virus SARS-CoV-2, declared a pandemic by the WHO in March of 2020. The world literature describes more preterm birth and caesarean section in pregnant women infected by COVID-19, principally by medical indication, but it has not been described in depth what happens when we differ delivery after the infectious period. This report reviews a subgroup of patients who were diagnosed with COVID-19 in the third trimester and decided to differ birth until they recovered from the disease. METHODS: Retrospective observational study that analyzes maternal and perinatal outcome of 9 women who were diagnosed with COVID-19 after the 33 weeks of pregnancy, decided to differ delivery and had their birth recovered from the disease. RESULTS: We observed 77% of patients symptomatic, 77% required hospitalization, 33% because of COVID, all admited to critical patient care, only one required non invasive mechanical ventilation. 2 patients suffered normoglycemic ketoacidosis, 2 had COVID-19 pneumonia. An 88% resulted in term birth, only 1 was prematurely interrupted by obstetric cause. 66% patients had vaginal delivery and 33.3% caesarean section, all by obstetric cause. The average latency to birth was 17.3 days. Apgar scores were all more than 7 at minute 1 and 5. CONCLUSION: The results of this series suggest that in selected cases where the clinical characteristics allow it, to differ interruption of pregnancy until after the infectious period can associate to good outcomes of maternal and neonatal morbimortality, however, it's fundamental to continue research.

Changing trends in the indication of caesarean delivery in multigravida- experience from a referral center in Eastern India: a prospective study

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.

Evaluating the factors influencing perinatal outcome in breech presentation

Background: The objective of this study was to analyse the current obstetric practice regarding breech presentation, document the incidence, perinatal outcome and the factors influencing perinatal outcome in breech deliveries.Methods: It was a retrospective observational study including 252 cases of breech presentation during January 2018 to December 2019 in a tertiary teaching institute in Vidarbha region of Maharashtra.Results: Total number of breech deliveries 252 (incidence is 2.5%). Caesarean section for breech presentation 95 (37.6%). With vaginal deliveries the Apgar score at 5 min below 7 were among 48 out of 157 breech deliveries whereas with LSCS it was only amongst 7 out of 95 deliveries. The maximum percentage of perinatal mortality is seen with birth weight below 2000 gm. Maximum mortality is seen prior to 32 weeks and in babies who delivered by vaginal route. Respiratory distress with prematurity and severe birth asphyxia are the common causes of perinatal deaths. Total 32 (12.69%) babies were transferred to NICU. 20.38% of the total vaginal breech deliveries and 5.26% of the total LSCS were transferred to NICU. Out of total 32 NICU admissions 22 are for the preterm babies and babies with birth weight below 2000 gm.Conclusions: The perinatal outcome does not depend only on the mode of delivery, it is also affected by the weight of the baby, its maturity, associated congenital anomalies, equipped neonatal intensive care unit and also substantially on the expertise of the obstetrician and the neonatologist.