Background. Birth of a fetus with no signs of life after a predefined age of viability is a nightmare for the obstetrician. Stillbirth is a sensitive indicator of maternal care during the antepartum and intrapartum period. Though there has been a renewed global focus on stillbirth as a public health concern, the decline in stillbirth rate (SBR) has not been satisfactory across the nations, with a large number of stillbirths occurring in the low- to middle-income countries (LMICs). Hence, the study was carried out to analyze maternal and fetal risk factors and their association with stillbirths in a tertiary care center in South India. Methods. This observational prospective study included pregnant women with stillbirth beyond 20 weeks of gestation or fetal weight more than 500 grams. Stillbirths were classified according to the simplified causes of death and associated conditions (CODAC) classification. Association between the risk factor and stillbirths was calculated with chi-square test and odds ratio with 95% confidence interval. Results. There were 171 stillbirths (2.97%) among total 5755 births. The SBR was 29.71/1000 births. Risk factors such as preterm delivery (OR: 22.33, 95% CI: 15.35–32.50), anemia (OR: 21.87, 95% CI: 15.69–30.48), congenital malformation (OR: 11.24, 95% CI: 6.99–18.06), abruption (OR: 10.14, 95% CI: 6.43–15.97), oligohydramnios (OR: 4.88, 95% CI: 3.23–7.39), and hypertensive disorder (OR: 3.01, 95% CI: 2.03–4.46) were significantly associated with stillbirths. The proportion of intrapartum stillbirths was found to be 5 (3%) among the study population. Conclusion. Highest prevalent risk factors associated with stillbirth are anemia and prematurity. Intrapartum stillbirths can be reduced significantly through evidence-based clinical interventions and practices in resource-poor settings. There is a need to provide and assure access to specialized quality antenatal care to pregnant women to control the risk factors associated with stillbirths.
Background: Hypertension is associated with a myriad of confounding factors, out of which elevated serum uric acid (SUA) profile is of interest as a biomarker. Despite a handful of studies alluding to the seminal relationship between the two, its prevalence and correlation in the Indian context have not been adequately investigated. Hence, the present study was aimed to evaluate the relationship between SUA levels and primary hypertension (HTN). Materials and Methods: This 1-year hospital-based cross-sectional study comprised 100 patients who were recently diagnosed with primary HTN and had not received antihypertensive medications, SUA levels and severity of HTN among patients were assessed along with their age, sex, body mass index, total cholesterol, and lipid profile. Results were statistically analyzed by Chi-square test, logistics regression, t-test/Welch t-test/Mann–Whitney U-test, and Pearson–Spearman rank correlation. Results: A strong correlation between SUA level with systolic blood pressure (SBP) in patients with primary HTN (r = 0.5046; P < 0.0001) was observed. The mean SBP (163.89 ± 9.99 mmHg) was significantly high (P < 0.001) in hyperuricemic patients, and raised SUA was noted in 38% of the cohort. Stage II hypertensive subjects of the 58–66 years age group were found to be a particularly vulnerable group (odds ratio of 32). History of diabetes mellitus, tobacco, and alcohol consumption showed a significant association with elevated SUA levels in males (P < 0.05). Conclusion: One in every three primary hypertensive patients is likely to present with hyperuricemia, and there exists a pertinent association between elevated SUA levels with SBP.
Introduction and Aim: Globally, rising caesarean section rates have become public health concern. Cesarean section analysis and audits using Robson ten group classification system have identified the main drivers of Cesarean section rates (CSR) are the gravidas with previous CS and the nulliparous with term singleton foetus with vertex presentation (NTSV). [1][2][3][4][5][6][7][8][9][10] Given the low rates of vaginal birth after a cesarean section, once a woman undergoes her first CS, she is extremely likely to have repeat CS in subsequent pregnancies. This increases the burden of high risk pregnancies and increased CS rates subsequently. Reducing primary cesarean sections in NTSV is the key for improving overall health statistics of the institutions. Hence, this one year prospective study was conducted to know the factors contributing to CS in NTSV population in a tertiary care hospital in South India. Materials and Methods:The study is prospective observational study which is conducted in labour wards of department of Obstetrics & Gynaecology at teaching hospital attached to KLE Academy of Higher Education's Jawaharlal Nehru Medical College, Belagavi, from January 2016 to December 2016. Results: Total number of gravidas who delivered during study period, were 6236, out of which 2494 (40%) were NTSVs. The CS among NTSVs were found to be 849(34.01%). The main indications for emergency cesarean sections in NTSV were fetal distress, non-progress of labour, failed induction i.e. 44.76%, 16.65% and 15.31%, respectively. Conclusion:The primary cesarean sections among the NSTV is an important contributor to the overall cesarean sections of the health institute. The main indications of CS were fetal distress, non-progress of labour and failed induction. There is a need to develop standard clinical protocols for management of these conditions and emphasise vaginal delivery in NTSVs. Also strategies like training the obstetricians in interpretation and management of suspicious and non-reactive CTG traces, use of cervical ripening agents prior to induction, use of partogram in monitoring patients in labour, should be included in routine practice to improve vaginal birth rates in this low risk population.
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