Introduction: The Coronavirus Disease-2019 (COVID-19), caused by the Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2), is a global public health crisis. Pregnant women are known to be disproportionately affected by respiratory illnesses, which are associated with increased infectious morbidity and high maternal mortality rates. Aim: To study the management of COVID-19 in pregnancy and its perinatal outcome. Materials and Methods: This prospective observational study was conducted in the Obstetrics and Gynaecology Department from March 2020 to September 2020. To evaluate the effects of COVID-19 in pregnancy and to determine the maternal and fetal outcomes in COVID-19 positive patients. In order to evaluate the pattern of caesarean and vaginal deliveries in COVID-19 and non COVID-19 patients, chi-square test was done. Results: A total of 150 COVID-19 positive patients were admitted to the COVID-19 labour room and out of them 142 (94.67%) were antenatal and 8 (5.33%) were postnatal. Total number of the deliveries in this period was 80 (53.33%) and out of them vaginal deliveries were 35 (23.33%) and caesarean section were 45 (30%). A 6 (7.50%) babies with poor Appearance, Pulse, Grimace, Activity, Respiration (APGAR) score were admitted to the Neonatal Intensive Care Unit (NICU) and 70 (87.50%) had good APGAR after delivery, four had Intrauterine Death (IUD). Conclusion: The pregnant women with suspected COVID-19 who need medical care should be transferred to a hospital equipped with sufficient health facilities and fully trained clinicians to take proper care of critically ill obstetric patients for effective management.
Objective: Lower limb fracture in pregnancy is a rare complication. Still, there is limited literature available on the management of these fractures, and perioperative obstetric and orthopedic management of these fractures is largely unclear. Trauma during pregnancy is a common cause of non-obstetrical maternal death and a significant public health burden. This study reviews the common causes of lower limb trauma during pregnancy, morbidity, mortality, and provides a management approach to pregnant patients with lower limb trauma. Methods: A prospective analysis was conducted in the orthopedics department of Government Medical College, Patiala from 2019–2022 on 30 pregnant patients admitted here with lower limb fractures.18 patients presented with femoral fractures and 12 patients with tibial fractures. Details of the type of fracture and site of fracture, along with the type of intervention, were recorded. Roadside accident was the most common cause of trauma, followed by fall and then assault. Results: The following observations were made from the data collected during this study in the treatment of 30 cases of lower limb trauma during pregnancy. The mean age of patients in the study was 27 years. The most common cause of trauma was traffic accidents, followed by fall and assault. In our study, 18 patients (60%) presented with femoral fractures, and 12 patients (40%) with tibial fractures. Operative intervention was done for all femoral fractures and 6 tibia fractures.6 tibial fractures were managed conservatively. Among 18 femoral fractures, 15 were operated with plating and 3 with interlocking femur nails. Among 6 operated tibia fractures, 2 were operated with plating and 4 with interlocking tibia nail. All cases were evaluated with risks and benefits of operative treatment, positioning of the patient, type of anesthesia used, use of c-arm, radiation dose, intraoperative fetal monitoring and the risk associated with anesthetic agents, antibiotics, analgesics, and anticoagulants. Conclusions: Orthopedic trauma during pregnancy is usually associated with significant morbidity and mortality to the mother as well as fetus. A multidisciplinary approach should be used for the successful management of lower limb fractures during pregnancy. The orthopedic surgeon must consider both operative and non-operative measures. Risk and benefits of operative treatment must be weighed carefully. Many fractures during pregnancy can be managed conservatively based on the fracture pattern and displacement. Also, we can delay the operative treatment until after delivery which is often a safe option. In fractures where surgical intervention is necessary, orthopedic surgeons must consider the physiologic changes that accompany pregnancy and the potential risks to the fetus. The surgeon must take care of the proper positioning of the patient, use of the c-arm, radiation dose, and intraoperative fetal monitoring. Furthermore, the risk associated with anesthetic agents, antibiotics, analgesics, and anticoagulants must be taken care of.
Emergency obstetric hysterectomy is a life saving procedure. Its incidence is on the rise as is the increasing incidence of caesarean sections and placenta accrete spectrum. Methods: This descriptive prospective study was conducted for a period of two years on patients who underwent emergency obstetric hysterectomy to determine the frequency, demographic characters, indications and fetomaternal outcomes from July 17 to June 19 at tertiary care institute of Punjab in Department of Obstetrics and Gynaecology, GMC Patiala. Results: There were 40 cases of obstetric hysterectomy out of 10859 deliveries giving an incidence of 3.6 per 1000 births, Most of the patients were unbooked (87.5%). 65% were multiparas. Maximum number of women (50%) were in age group 26 to 30 years. 75% patients were cases of previous caesarean. 80% among these had placenta accrete spectrum and these ended up in caesarean hysterectomy. There were five maternal deaths attributed to late referral, irreversible haemorrhagic shock and acute respiratory distress syndrome. Maternal death to maternal near miss ratio during study period was 1:6.4. Conclusion:Emergency obstetric hysterectomy is definitely life saving procedure but we should reduce its iatrogenic incidence by reducing the incidence of scarred uterus.
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