Introduction: The umbilical cord around the neck of the fetus at the time of birth is nuchal cord. Objectives : To study the perinatal events and fetal outcome in cases with nuchal cord and formulate a plan for safe delivery. Methods: This cross sectional prospective study of 152 cases of nuchal cord (out of 1646 deliveries) was carried out in department of Obstetrics and Gynaecology of a Combined Military Hospital of Bangladesh during the period of two years. The nuchal cords were classified as tight coils or loose coils. Apgar score at 1 and 5 minutes after birth were recorded. Birth weight and sex of all babies were noted. Cord length was measured and considered as long (>70 cm) and short (<35 cm). Results: Out of 152 cases 128 (84.21%) had normal vaginal delivery, 3 (1.97%) cases had instrumental delivery, 21 (13.82%) cases underwent caesarean section and fetal distress was the main indication (16 out of 21). Only 22 (14.47%) of fetuses manifested fetal heart rate variation mostly variable deceleration (10 out of 22). Neonates born with tight nuchal cord had low Apgar score in one minute in comparison to loose (p<0.05), whereas significantly low Apgar score after 5 minutes was observed in babies born with multiple nuchal cord. Conclusion: The presence of a nuchal cord per se is not found to be an indication of operative delivery. However, such patients require close monitoring during labour, preferably by continuous electronic fetal heart rate monitoring as well as strict maintenance of partogram. Key words: Nuchal cord; normal delivery; caesarean section; fetal outcome DOI: http://dx.doi.org/10.3329/jafmc.v7i1.8622 JAFMC Bangladesh. Vol 7, No 1 (June) 2011; 25-27
Objectives: To determine frequency of fetal iron deficiency anemia at the time of birth in obese mothers. Study Design: Cross-sectional Descriptive study. Setting: Department of Obstetrics and Gynecology, Nishtar Hospital Multan. Period: September 2018 to February 2019. Material & Methods: A total of 368 obese pregnant women with singleton pregnancy between 37 -40 weeks of gestation were included in the study after informed consent. Cord blood was collected after delivery via syringe aspiration from the umbilical vein. Fetal Iron status in the form of serum iron, hemoglobin, transferrin saturation was measured with calorimetric endpoint assay. Obesity in pregnancy is defined as BMI equal and more than 30kg/m2. Fetal iron deficiency anemia was defined as fetal hemoglobin less than 14.5g/dl, fetal iron 97.3micro gram/dl and transferrin saturation 39.6% at birth. Results: Among 368 cases, 87.8% of cases were having their BMI 30kg/m2 to 34.9kg/m2. BMI between35kg/m2 to 39.9kg/m2 was noted in 10% of cases and in 2.2% of cases BMI was equal to or more than 40kg/m2. Frequency of neonatal iron deficiency anemia was 22.8%. Conclusion: There is a increase prevalence of obesity in women of childbearing age however maternal obesity has no significant correlation of fetal iron deficiency anemia.
Objective: To determine the association of meconium stained amniotic fluid with puerperal pyrexia. Study Design: Cohort Study. Setting: Department of Obstetrics & Gynecology, Nishtar Hospital, Multan. Period: 1st January 2018 to 31st December 2018. Material & Methods: A total of 66 women with singleton pregnancy, gestational age 37-40 weeks of any parity undergoing elective caesarean section were eligible for study. Patients with rupture of membranes (≥18 hours), preterm delivery and postdate pregnancy were excluded. During elective caesarean section, after rupture of membranes, women were divided in two equal groups. Thirty three patients with meconium stained liquor group (MSAF) and 33 patients with clear liquor group. Puerperal pyrexia was defined as temperature of ³ 38°C on any two occasions was reported during first ten days postpartum excluding first 24 hours. Frequency, percentage and mean ±SD were presented for variables. Chi-square test was applied to compare puerperal infection in both groups taken p £ 0.05 as significant. Results: Age range in this study was from 15 to 45 years with mean age 15 to 45 years with mean of 29.5± 2.5 years in MSAF group while 28.5 ± 3.5 years in clear liqour group. Mean gestational age was 39.1±1.0 weeks in MSAF group while 38.5±1.10 weeks. Puerperal pyrexia was seen in 45.5% patients in MSAF group as compare to 10% in clear liqour group (p=0.005). Conclusion: There is strong correlation between meconium stained amniotic fluid and postpartum febrile illness.
Objective: this study is conducted to compare the maternal outcomes of expectant management versus induction of labour within 24 hours of premature rupture of membranes. Study Design: Randomized controlled trial. Setting: Obstetrics and Gynaecology Department, Nishtar Hospital, Multan. Period: From 15 March 2018 to 15 September 2018. Material & Methods: A total of 130 pregnant women with parity 0 – 4 having singleton pregnancy, ≥37 weeks pregnant and having premature rupture of membranes were taken in the study. Women having previous caesarean section, with history of hypertension or diabetes, features suggestive of chorioamnionitis, preterm pre-labour rupture of membranes and women with foetal distress were excluded from the study. Two groups were made. In Group (A) women were subjected to expectant management in which patients were observed for uterine contractions for a period of 24 hours. In Group (B) women were induced with tab dinoprostone 2 doses each 3 mg given 6 hours apart. Information regarding caesarean section, vaginal delivery and chorioamnionitis was recorded on a specially designed proforma. Results: In this study age range was from 18 to 35 years while in both groups most patients were 28 – 35 years old. In Group (A) mean gestational age was 38.246 ± 0.84 weeks while in Group (B) it was 37.953 ± 0.95 weeks. In Group (A) mean parity was 1.076 ± 1.16 and in Group (B) it was 1.815 ± 1.16. in Group (A) 2.092 ± 0.67 hours was mean duration of PROM while in Group (B) it was 2.092 ±0.67 hours. Mean BMI in Group (A) was 26.088 ±3.80 kg/m2 and in Group (B) it was 26.361 ±4.33 kg/m2. In Group (A), 24 patient (36.9%) delivered vaginally while 42 (64.6%) patient delivered vaginally in Group (B). 41 patients (63%) had cesarean section in Group (A) while in Group (B) 23 patients (35.4%) had cesarean section. Chorioamnionitis was seen in 14 patients (21.5%) in Group (A) while 3 patients (4.6%) had chorioamnionitis in Group (B). Conclusion: Our study concluded that induction of labour with twenty four hours of premature rupture of membranes does causes a reduction in occurrence of chorioamnionitis. By this approach patients are usually delivered within 24 hours and caesarean section rate is not increased. This approach also causes a reduction in augmentation of labour by oxytocin.
Objectives: To determine the frequency of uterine rupture after one successful vaginal birth after caesarean section. Study Design: Cross Sectional Study. Setting: Department of Obstetrics and Gynecology of Nishtar Hospital Multan. Period: From12-May-2017 to 11-May-2018. Material & Methods: Total number of 135 patients of 16-45 years with singleton pregnancies were admitted for 2nd Vagina Birth after cesarean Section at gestational age ≥ 28 weeks of gestation. Data in shape of parity, gestational age and BMI was taken. These patients were assessed for frequency of uterine rupture after one successful vaginal birth after caesarean section. Data was analyzed with statistical analysis program (SPSS version 21). Frequency and percentage was calculated for qualitative variables like parity and uterine rupture. Mean ± SD was calculated for quantitative variables like age, BMI and gestational age. Results: Mean age of patients was 29.88+5.34 years. Mean body mass index (BMI) of study patients was 25.17+4.88 kg/m2. Mean gestational age at the time of delivery was 39.01+2.54 weeks. Uterine rupture after vaginal birth occurred in 2 (1.48%) patients. There was no association of gestational age, parity and gestational age with the frequency of uterine rupture. Conclusion: Women with prior successful VBAC are at low risk of maternal and neonatal complications during subsequent trail of VBAC with lower risk of uterine rupture and perinatal complications.
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