Background: The outcome of first trimester vaginal bleeding is a matter of debate. This study sought to determine the maternal and perinatal outcome in patients presenting with first trimester vaginal bleeding.Methods: This prospective observational study was done on 1007 women with first trimester vaginal bleeding at a tertiary care hospital in Mumbai over a period of one year. A detailed history was taken and USG was done to confirm diagnosis. All these patients were evaluated for the outcomes including threatened abortions, spontaneous, complete or incomplete abortions, sub-chorionic hematoma, Intra-uterine Fetal Demise, missed abortions, second and third trimester bleeding, Intra-uterine Growth Restriction, premature rupture of membranes and preterm deliveries.Results: Out of the 11835 confinements 1007 patients presented with first trimester vaginal bleeding. The incidence was highest (52.3%) in the age group of 21-30 years. 63.9% primigravidas presented with first trimester bleeding as compared to 36.1% of multigravidas. It was seen that 76.9% patients who presented before 6 weeks aborted whereas only 7% patients who presented after 10 weeks aborted. Out of the 163 patients that continued pregnancy after first trimester vaginal bleeding 1.8% had a second trimester abortion, 15.3% went into preterm labour 6.75% has premature rupture of membranes and 1.8% had antepartum hemorrhage.Conclusions: According to the results of present study, first trimester vaginal bleeding predicts auxiliary maternal and fetal complications. Also, as the clinical intermediation has an important role in continuance of pregnancy and in reducing the fetal complications precise management and planning by physician is important.
Background: Cardiac disease is a leading cause of maternal mortality and morbidity. Timely diagnosis and appropriate management can significantly improve the maternal and perinatal outcome.Methods: This prospective observational study was performed over a period of 18 months at a tertiary care centre in Mumbai. A total of 100 women with heart disease were included in the study. The subjects were followed up during the antenatal, intrapartum and postpartum period to study the maternal and perinatal outcome.Results: Out of 14791 confinements 100 consenting patients were included in the study. The incidence of heart disease came out to 0.9%. Rheumatic heart disease (RHD) was seen more commonly as compared to congenital heart disease (CHD) and peripartum cardiomyopathy. 64% patients delivered vaginally out of which 8% had instrumental delivery and 28% underwent a lower segment caesarean section (LSCS). 21% patients had cardiac complications like pulmonary edema, arrhythmias, sepsis, DIC etc. and there were 3 maternal mortalities. 58% of the babies were born low birth weight, 90.9% of the babies had an Apgar score of >7. 60% of the babies were born at term whereas 26% had a preterm delivery.Conclusions: Patients of cardiac disease with pregnancy need to be managed at a tertiary care centre by a multidisciplinary team of doctors. Early diagnosis of heart disease and stringent management of complication is of utmost importance. Vaginal delivery is favourable and LSCS should be performed for an obstetric indication. Maternal heart disease leads to an increased incidence of preterm delivery and hence a joint care of neonatologist is mandatory in managing these patients.
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