Objective:
To determine the stillbirth rate in 2017 at Christian Medical College, a tertiary care perinatal center in South India, and to identify causes for the various stillbirths that occurred using the Relevant Condition at Death (ReCoDe) classification.
Material and Methods:
Medical records of the women with stillbirths between January 1
st
, to December 31
st
, 2017, were retrieved and analyzed using the SPSS software (IBM, version 23). The study was approved by the institutional review board (minute no: 11273, retro dated: 28/3/2018).
Results:
Of the total 14696 deliveries between January 1
st
, 2017, to December 31
st
, 2017, there were 247 stillbirths, a rate of 16.8 per 1000 births. Maternal factors: 156 (64.2%) women were booked and the rest were un-booked. Hypertensive disorders of pregnancy were detected in 27.5% (n=67). A greater number of un-booked women had gestational hypertension as compared with booked women (41% vs 24%, p=0.005). Fetal characteristics: still births secondary to lethal congenital anomalies were seen in 18.2% (n=45). Lethal congenital anomalies were diagnosed 10 times more in the booked patients than un-booked ones (24.7% vs 2.3%, p=0.001). Obstetric factors: one or two previous miscarriages were seen in 29.5% cases. Seventeen women (6.9%) had a prior stillbirth. ReCoDe Classification: we were able to successfully classify 84.2% of the stillbirths, leaving 15.78% unclassified. Fetal growth restriction secondary to uteroplacental insufficiency was found in 25.9% cases. Of the placental causes, abruption accounted for 10.9% of cases. Medical co-morbidities were seen in 46.5% pregnancies.
Conclusion:
The ReCoDe method of classifying stillbirths is useful in the developing world. It helped to elucidate the cause for stillbirths in 84.2% of cases. The majority of cases in our set were due to fetal growth restriction, hypertensive disorders of pregnancy, and uteroplacental insufficiency. Stillbirths can be prevented by a comprehensive antenatal care system, early recognition, and close monitoring of high-risk pregnancies.
Introduction The World Health Organization (WHO) defines stillbirth as the delivery of a fetus after 22 completed weeks of gestation, weighing 500 grams or more, with the newborn showing no signs of life at delivery (1). According to the WHO, there were 2.6 million stillbirths in 2015. One out of every 45 babies was stillborn. Nearly three-quarters of them were from South Asia and sub Saharan Africa. The stillbirth rate in India was 23/1000 births in 2015, compared to a worldwide rate of 18.4/1000 births (2). Since then, the stillbirth rate in our country has declined by 10%, with an annual reduction rate of 2% between 2000-2015. This decline, however, is slow in comparison to the annual reduction in maternal mortality rate and under 5 infant mortality rate at 3% and 3.9%, respectively, during the same period (2). The WHO targets reducing the stillbirth rate to 12/1000 by 2030 by adopting the "Every newborn action plan" (2).
Background: Gestational hydronephrosis (GH) is result of dilatation effect of the progesterone and mechanical compression of the gravid uterus. Management during pregnancy is challenging as routine radiological investigations and surgical treatments cannot be applied due to the potential harm to the fetus. Intervention is indicated in women who fail to respond to conservative management. Acute hydronephrosis and renal colic are common etiologies for loin pain, and can lead to severe form of urinary tract infection affecting perinatal outcome. Ureteric stenting and percutaneous nephrostomy (PCN) during pregnancy are safe, requiring no intra-operative imaging, and inserted under local anaesthesia. It provides good symptom relief, low complication rate, efficient and safe modality for women with refractory symptoms.Methods: A retrospective study of pregnant women admitted under obstetric units with acute hydronephrosis requiring DJ stenting and/or PCN. Aim was to evaluate the course and pregnancy outcomes in a tertiary center of Southern India over a period of five years.Results: Descriptive statistical analysis was done in 12 women with acute hydronephrosis in pregnancy. 66.7% were nulliparous and mean gestational age at admission was 31 weeks. Diagnosis was done by USG. One-fourth had pyelonephritis and calculus being the main pathology (n=9;75%).Women requiring DJ stent and PCN were 41.6% and 58.4% respectively. 41.7% had preterm labour. 66.7% delivered vaginally, birth weight was more than 2.5kg in 50%.Conclusions: Maternal and neonatal outcome mainly depends on the early diagnosis. In this study we emphasize on the importance of multidisciplinary team approach in the management of women with acute hydronephrosis. DJ stent and PCN are efficient and safe modalities in women with refractory symptoms.
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