Abstract:Objective-Preeclampsia is one of the leading cause of maternal mortality and morbidity worldwide.
BackgroundUnintended pregnancies have a negative impact on the health and economy of a nation, which can be prevented by effective family planning (FP) services. Postpartum intrauterine device (PPIUCD) is a safe and effective FP method which allows women to obtain long-acting contraception before discharge from the point of delivery. We observed poor coverage of deliveries with PPIUCD at our facility. This was the trigger to initiate a quality improvement (QI) initiative to increase the PPIUCD coverage from current rate of 4.5%–10% in 3-month period.MethodA fishbone analysis of the problem was done and the following causes were identified: lack of focused counselling for FP, lack of sensitisation and training of resident doctors and inconsistent supply of intrauterine contraceptive devices (IUCDs). A QI team was constituted with representatives from faculty members, residents, interns, nursing officers and FP counsellors. The point of care quality improvement methodology was used.InterventionsDaily counselling of antenatal women was started by the counsellors and interns in antenatal wards. A WhatsApp group of residents was made initially to sensitise them; and later for parking of problems and trouble shooting. The residents were provided hands-on training at skills lab. Uninterrupted supply of IUCDs was ensured by provision of buffer stock of IUCDs with respective store keepers.ResultThe PPIUCD insertion rates improved from 4.5% to 19.2% at 3 months and have been sustained to a current 30%–35% after 1 ½ years of initiation of the project tiding through the turbulence during the COVID-19 pandemic using QI techniques.ConclusionSensitisation and training of residents as well as creation of awareness among antenatal women through targeted counselling helped improve PPIUCD coverage at the facility. QI initiatives have the potential to facilitate effective implementation of the FP programmes by strategic utilisation of the resources.
Morbid adherent placenta (MAP) is an abnormality of placental implantation that is an important cause of maternal and fetal mortality. The maternal mortality may reach up to 7% and is associated with multiple maternal morbidities e.g. massive transfusions, infections, urologic injuries and fistula formation. The present study was a retrospective observational study done to evaluate the profile and outcome of pregnancies diagnosed with MAP over three years. Forty nine patients were diagnosed with MAP. The incidence was 1.21 per 1000 pregnancies. A majority of patients were multi gravidas and had a history of previous caesarean section(CS). Placenta previa was present in 61.2% patients. Forty seven patients had to undergo a hysterectomy and 75% of patients had to undergo the internal iliac artery ligation to achieve hemostasis. 31 patients (63.2%) required intensive care admission and monitoring. There was one death in our cohort. MAP is an important cause of maternal morbidity and mortality and its incidence has been on the rise due to increased CS deliveries. CS and placenta previa are important risk factors for MAP. Early recognition of at risk pregnancies and subsequent risk based counselling and management can help optimise the outcomes in MAP.
Background: Hypertensive disorder of pregnancy affects both mother and fetus, leading their high morbidity and mortality and a major killer of women in developing country. The etiologic of preeclampsia is still not clear. It seems that placenta plays main role in path-physiology of preeclampsia, but there is strict relationship between hypertensive disorder of pregnancy and elevated β-hCG level, indicating there should be an abnormal placental secretary function in patients with severe preeclampsia.Methods: 245 patients were recruited from our institute (OPD) and Prospective analytical study was started with 16-20 weeks pregnant women. Cases were subjected to detailed history and thorough physical examination including baseline blood pressure. β-hCG measurement was done between 16-20 weeks and cases were followed at regular interval for the development of hypertensive disorder of pregnancy. Statistical testing was conducted with appropriate tests.Results: Total 245 women were enrolled in the study, only 208 were followed till delivery, 24 were developed hypertension. On analysis of data, maximum cases were younger, primigravida and of lower class. β-hCG levels (Mean ± SD) were also significantly higher (30100±16250 V/S 74700±23790; p<0.001) in subjects who later developed hypertension. Cut off value of β-hCG was 45755 mIU/ml, and analysis establishes validity of β-hCG as predictor of hypertensive disorder of pregnancy with sensitivity, specificity, positive and negative predictive value for β hCG were 87.5, 83.2, 70.4 and 83.7% respectively.Conclusions: Present study shows that elevated serum β-hCG in early second trimester can be considered as predictor of subsequent hypertensive disorder of pregnancy.
Stevens-Johnson syndrome (SJS) is a group of toxic necrolytic group of disorder of skin and mucous membrane with significant morbidity and mortality. It is a highly serious allergic reaction to medications affecting the skin and mucous membranes. Pregnant women with SJS or toxic epidermal necrolysis (TEN) are a unique subset, and both conditions can simultaneously affect the mother and fetus. It is a rare condition with a reported incidence of one case per million people per year. Till date, few cases of pregnancy with SJS/TEN have been reported. We are reporting a case of 20-year-old primigravida with 31+3 weeks of gestation presenting with extensive toxic epidermal necrosis. Attack of SJS developing in pregnancy can be fatal because immunity is compromised. This patient was managed in our institute with involvement of multidisciplinary team and had a successful pregnancy outcome. Perinatal outcome was also good in this case.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.