Objectives: To assess maternal and fetal morbidity associated with placenta previa and morbidly adherent placenta (MAP). Methods: All patients with placenta previa who delivered in services hospital from April 1, 2017 to March 31, 2019 were included. Maternal and fetal outcomes were compared amongst patients with placenta previa and MAP. Results: Total of 8002 patients delivered with 152 (1.9%)diagnosed as placenta previa and 56 (36.8%) amongst them had MAP. One hundred thirty-one out of One hundred fifty-two (86.1%) of our patients were booked. Increased number of caesarean section, multi parity and anterior placenta had significant association with MAP (p<0.0001). Maternal morbidity in terms of postpartum hemorrhage >2000ml, caesarean hysterectomy, number of blood transfusions, bladder injury, need for ICU admission was significantly more in patients with MAP (p<0.0001). Case fatality was 3% with two maternal deaths in MAP and none in placenta previa. Fetal outcome was good in both groups as gestational age at delivery was 36 weeks or more, birth weight was ≥ 2.5 kg and >6 APGAR score (p<0.05). Two neonatal deaths occurred in MAP and one in placenta previa owing to prematurity. Conclusion: MAP is a dreadful complication of placenta previa with increased maternal morbidity. Regular antenatal care with adequate arrangement of blood transfusion and multidisciplinary approach can reduce maternal mortality. doi: https://doi.org/10.12669/pjms.36.5.1647 How to cite this:Wasim T, Bushra N, Riaz S, Iqbal HI. Fetomaternal outcome in patients with placenta previa. Pak J Med Sci. 2020;36(5):---------. doi: https://doi.org/10.12669/pjms.36.5.1647 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Aim To compare the distribution of various causes of perinatal mortality in a public hospital in low‐middle‐income country setting. Methods A prospective cohort study was conducted from January 2016 to December 2018 at a large public hospital, Services Institute of Medical Sciences, Services Hospital, in Lahore, Pakistan. We applied the World Health Organization's perinatal mortality coding in the International Classification of Diseases. All stillbirths after 28 weeks' gestation weighing more than 1 kg were identified and followed up till delivery. All live births were followed up till discharge or early neonatal death. A multidisciplinary group of obstetricians, pediatricians, midwife and related healthcare professionals was established to assess each case of fatality. The associated maternal conditions were identified for each of the antepartum, intrapartum and neonatal deaths. Results Of 11 850 births, there were 690 perinatal deaths, with 240 stillbirths (antepartum 167, intrapartum 73) and 450 early neonatal deaths (perinatal mortality rate 58.2/1000 births). Among antepartum deaths, hypoxia accounted for 70 (42%) cases. Among intrapartum deaths, an acute event was responsible for 50 (68%) cases. Among neonatal deaths (450, 65% of total), low birthweight and prematurity contributed to 152 (34%) cases. A maternal condition was found in 183 (76%) of stillbirths and 355 (79%) patients with neonatal death. Conclusion In our study, the most important causes of perinatal deaths were maternal in origin. There was an excess in the distribution of neonatal causes of perinatal deaths. These data should inform policy and practice.
The increased risk of caesarean section after induced labour is well documented. Rate of induction of labour has doubled in the past decade from 10 to 20%. Low Amniotic Fluid Index (AFI) as an isolated finding leads to increased obstetrical interventions but without any improvement in outcome.Objectives: To determine the frequency of caesarean section due to failed induction in pregnancies at term with borderline AFI.Patients and Methods: This cross-sectional study was conducted at Department of Obstetrics and Gynaecology, Unit-III, SIMS/Services Hospital, Lahore. The duration of study was one year from January, 2015 to December, 2015. A total of 150 patients were included in this study. AFI was measured by recent obstetric ultrasound. All patients with borderline AFI (5 – 8 cm) were included in the study. They were induced by glandin E2 gel. If induction of patients failed with two doses of glandin E2 gel, given vaginally 6 hours apart, patients were considered for cesarean section. The outcome measure was rate of caesarean section due to failed induction. All data were analyzed by SPSS version 20.Results: Mean age of the patients was 30.34 ± 6.68 years. Mean gestational age was noted 38.34 ± 1.05 weeks. Out of 150 patients, 103 (68.7%) were para 1 – 3 and 47 patients (31.3%) were para 4 – 6. Caesarean section due to failed induction with borderline AFI was performed in 27 patients (18.0%). Stratification with regard to age, gestational age and parity was carried out and was found significant only for gestational age being > 39 weeks.Conclusion: It is concluded that failed induction of labour at term in women with borderline AFI is not associated with increased risk of caesarean delivery.
Background: Non-anemic iron deficiency precedes iron deficiency anaemia and has an estimated prevalence of 1-2 billion worldwide. Few studies have comprehensively researched the idea of treating non-anemic iron deficiency (NAID) with iron to improve the outcome of the mother and the offspring. Methods and Analysis: FAIR will be a multicenter randomized controlled trial that will be conducted in multiple clinical academic obstetrics units in Lahore (including Services Institute of Medical Sciences, Lahore, Allama Iqbal Medical College, Lahore and Fatima Jinnah Medical University). Pregnant women at gestational age <20 weeks with hemoglobin 11-13 g/L and ferritin below the threshold (<30 ng/ml) will be invited to take part in the study. Randomization will be done by computer based generated random numbers. One group (usual care or oral group) will be offered routine care prophylactic dose of oral iron (30-45 mg/day) and the other group (intervention arm or IV group) will be offered therapeutic dose of IV iron (dose calculated by Ganzoni formula) in addition to usual care. All patients will be followed up till delivery. Primary maternal outcome will be hemoglobin at 36 weeks’ gestation. Secondary outcomes are fetal birthweight or small for gestational age, preterm birth, preeclampsia, multidimensional fatigue inventory, breast feeding initiation, blood transfusion, and fetal cord ferritin and hemoglobin. Discussion: The study will generate evidence as to whether screening serum ferritin in non-anemic pregnant women and replenishing their iron stores will likely reduce the rate of predelivery anemia in pregnant women, improve birthweight and preventing perinatal complications. Roles and responsibilities: Tayyiba Wasim is principal Investigator and other members of data management team are Natasha Bushra, Shamsa Humayoun, Khalid Saeed Khan, Fatima Shehbaz, Saba Rasool, Anam Riaz and Sonia Irshad. Principal investigator will assume the full responsibility of Fair trial including training of research assistants, administration of informed consent and protecting participants confidentiality. Data management team will help in the management, development and execution of trial. Khadija Irfan Khawaja is the operational lead for fair trial´s technology team comprising of Aziz Fatima and Zubia Zafar, responsible for gathering requirements from study teams and supporting the operational implementation of technology to drive the collection of high-quality study data. Protocol contributors are Gynae unit I of Services Institute of Medical Sciences/ Services hospital, Lahore, Gynae Unit II of Allama Iqbal Medical College/ Jinnah hospital, Lahore and Gynae unit 1 of Fatima Jinnah Medical College/ Sir Ganga Ram hospital, Lahore. These coordinating centres will recruit patients (sample size=600) and will discuss their progress in trial management meetings quarterly. Steering committee has an independent chair Prof Samia Malik, one expert member Prof Faiza Bashir and Ms Neelam to represent patients, public and consumers. Trial steering committee with independent chair and member with a patient representative will oversee the study. Chair of steering committee has the authority to stop the trial whenever needed in case of positive or negative results. Steering committee meetings will be held on annual basis. Independent Data monitoring committee comprises of Dr. Shehnoor Azhar as chair and Prof Ejaz Hussain and Dr. Shehla Javed Akram as members. Data monitoring committee will assess the progress, data safety and if needed critical efficacy points of the clinical study and will show their results quarterly in data interim meetings. The committee will focus on integrity of the whole process and compliance of all sites with all aspects of the protocol. It will perform confidential interim analyses quarterly, which may be used to determine if an effect` is observed and if the study should continue to its planned sample size. Data monitoring committee will report to the Chair of the steering committee. Trial Registration No: NCT04228627 www.clinicaltrials.gov (Dated 14 January 2020) Version Date/ No: Version 1.3 Updated 06.05.2021 doi: https://doi.org/10.12669/pjms.39.1.6686 How to cite this: Wasim T, Bushra N, Tajammul A, Humayun S, Rasool S, Shahbaz F, et al. Ferritin screening and Iron treatment for maternal anemia and fetal growth restriction prevention - A multicenter randomized controlled trial (FAIR Study). Pak J Med Sci. 2023;39(1):---------. doi: https://doi.org/10.12669/pjms.39.1.6686`This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Background: Hypertension in pregnancy has an impact to improve the perinatal and maternal morbidity and mortality which is very important determinant to improve sustainable developmental goals. The high perinatal mortality in women with hypertension in pregnancy is mainly due to fetal growth restriction and iatrogenic preterm delivery. Aim: The diagnostic accuracy of modified biophysical profile is assessed in predicting perinatal outcome in hypertensive pregnancies taking Apgar score at 5 minutes at gold standard Methods: A cross sectional study was conducted in Department of Obstetrics & Gynecology, Unit II Services Hospital, Lahore from 26-6-2021 to 26-12-2021. After meeting the inclusion criteria 180 females were enrolled. Then all females underwent assessment of MBPP. All females were managed efficiently as per standard management protocols. Then females followed-up till delivery of baby. Data analysis was done on SPSS version 22. Results: In this study the mean age of the females was 30.27±5.91 years, there were 29(16.11%) females were nulliparous, 44(24.44%) females had parity 1. MBBP predict poor perinatal outcome in 42(23.3%) females. The sensitivity, specificity and diagnostic accuracy of MBPP was 72%, 95.38% & 88.89% respectively. Conclusion: This present study concluded that the modified biophysical profiles a useful and cost effective tool for predicting perinatal outcome in hypertensive pregnancies Keywords: Pregnancy, Perinatal outcome, Modified Biophysical Profile
Background: Hypertension in pregnancy has an impact to improve the perinatal and maternal morbidity and mortality which is very important determinant to improve sustainable developmental goals. The high perinatal mortality in women with hypertension in pregnancy is mainly due to fetal growth restriction and iatrogenic preterm delivery. Aim: The diagnostic accuracy of modified biophysical profile is assessed in predicting perinatal outcome in hypertensive pregnancies taking Apgar score at 5 minutes at gold standard Methods: A cross sectional study was conducted in Department of Obstetrics & Gynecology, Unit II Services Hospital, Lahore from 26-6-2021 to 26-12-2021. After meeting the inclusion criteria 180 females were enrolled. Then all females underwent assessment of MBPP. All females were managed efficiently as per standard management protocols. Then females followed-up till delivery of baby. Data analysis was done on SPSS version 22. Results: In this study the mean age of the females was 30.27±5.91 years, there were 29(16.11%) females were nulliparous, 44(24.44%) females had parity 1. MBBP predict poor perinatal outcome in 42(23.3%) females. The sensitivity, specificity and diagnostic accuracy of MBPP was 72%, 95.38% & 88.89% respectively. Conclusion: This present study concluded that the modified biophysical profiles a useful and cost effective tool for predicting perinatal outcome in hypertensive pregnancies Keywords: Pregnancy, Perinatal outcome, Modified Biophysical Profile
Objectives: To determine the frequency of anemia, severity, its various types and determinants among primigravida attending the antenatal clinic of tertiary care hospital. Methods: It was cross sectional study conducted in Antenatal clinic, Gynecology and Obstetrics department, Services Hospital Lahore for duration of one year from 01-07-2017 to 30-06-2018. All primigravida presenting to antenatal clinic for their first antenatal visit uptil 24 weeks were included in study. Blood samples of the patients was sent in complete blood count vial to pathology laboratory. Patients having hemoglobin level less than 11 gm/dl were labelled as anemia and typing was done according to RBC indices, S. Ferritin and hemoglobin electrophoresis if required. Characteristics of patients anemic and nonanemic patients were compared. Severity of anemia was also noted. Results: Total 210 primigravida were screened and 53 (25.2%) patients were found to be anemic. Iron deficiency anemia was noted in 40(75.5%) patients, beta thalassemia in 9(17.0%) patients and megaloblastic anemia in 4(1.9%) patients. Mild anemia was seen in 28(52.8%), moderate anemia in 19(35.8%) and severe anemia in 6(11.3%) primigravida. The mean age of the patients was 25.68±4.68 years in patients without anemia and 26.47±4.76 in patients with anemia. The mean gestational age at booking was 16.15±4.87 weeks for non anemic patients and 22.23±3.67 weeks for anemic patients (p<0.05). Mean hemoglobin in anemic patients was 9.2+0.8 mg/dl while 11.1+0.6mg/dl in nonanemic patients (p<0.05). Illiteracy, low socio- economic status and no intake of iron supplementation had significant association with anemia (p<0.05). Conclusion: The frequency of anemia among primigravida attending the antenatal clinic of tertiary care hospital was 25.2% and the most common type was iron deficiency anemia. Poverty, illiteracy, late booking and no iron and folic acid intake were significant determinants of anemia. Key Words: Anemia, Primigravidas, Iron deficiency anemia How to Cite: Bushra N, Wasim A.Z, Feroze J, Masood M. Pattern of anemia among primigravida attending the antenatal clinic of tertiary care hospital. Esculapio.2020;16(04):92-96.
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