Oligoamnios has a significant correlation with adverse perinatal outcome.
Vaginal hysterectomy is the gold standard in the era of minimal access surgery. Some of the contraindications to VH can be overcome by assistance of laparoscope and a potential abdominal hysterectomy can be converted to a vaginal procedure.
Background: Low birth weight is a socio, economic, cultural and community based health issue which reflects responsibility and commitment of local and national administrative authorities. It continues to be a cause of short and long term adverse perinatal outcome with a bearing on adult non communicable health risks.Methods: This is a prospective observational and analytic study to know the prevalence, risk factors and perinatal outcome of LBW, from July 2017 to December 2018 in department of Obstetrics and Gynecology, MIMS Medical College, Andhra Pradesh, India. Maternal risk factors and outcomes associated with LBW were defined through risk ratios.Results: 721 infants including 116 LBW and 605 NBW born during study period were included in the study. Prevalence of LBW was 16%. Preterm birth accounted for 35%, FGR for 13.8% and SGA for 51.2% of them. Maternal factors like age <20 years and >35years, social status II to IV, below higher secondary education, house maker, primi gravida, grand multi para, BMI <18.5kg/M2 or >24.9kg/M2, Hb<11 gm% were having higher RR for LBW. LBW infants showed frequent association with oligo or polyhydramnious and hemorrhagic or turbid amniotic fluid. They had higher risks for non reassuring fetal heart rate changes, for induced delivery or an elective caesarean section. More often they needed NICU care for longer duration and showed a higher risk for malformations and neonatal mortality. Overall perinatal mortality was 5.54 per 1000 live birth.Conclusions: LBW is a risk factor for neonatal morbidity and mortality; which can be minimised by institutional delivery. High prevalence PTB (35%) warrants obstetricians to be more vigilant about indentifying the risk factors and adequate management planning. Constitutionally small baby at birth probably needs redefining normal birth weight for different ethnicity.
To compare the maternal and fetal outcome in multiple versus singleton pregnancies in a private teaching hospital in India. Prospectively collected data on 50 twin deliveries from July 2018 to November 2021 were studied to determine its incidence; the maternal and foetal outcome, and compared with 50 singleton deliveries conducted on same day following the twin delivery who served as controls, the twins were also analysed on the basis of chorionicity. A total of 3415 deliveries were conducted during the study period, of which 50 were twin deliveries, giving an incidence of 14 per 1000 births or 1.4:100 deliveries. Six among 50 twins resulted following ovulation induction. Women with twin gestation had a mean maternal age of 24.7±3.71, same for the singleton mothers was 24.26±3.7years; mean gestational age at delivery for twins and singletons were 35.38±2.6 and 38.63±1.19 weeks; mean birth weight for twins and singletons were 2.193kgs and 2.85±0.46kgs, mean parity were 2.04± 1.0 and 1.72±0.7 respectively. Parity, gestational age, NICU stay characteristics showed p value < 0.05. Compared with singletons, women with twin gestations had a positive risk association with odds >1 for anaemia, preeclampsia, preterm labour, malpresentation and caesarean delivery. Twin Neonates suffered prematurity, low birth weight, congenital anomaly, prolonged NICU care and increased perinatal death. Neonatal risk was more among monochorionic twins than dichorionic twins. There were 3 cases with single fetal demise, and both fetuses IUD in another case, (total IUDs-5), one twin was still born, two had early neonatal death and there were two late neonatal (>7 Days) deaths. One twin mother threw fits on the 6th postpartum day. Another mother received 20 units of blood and component replacement and subtotal hysterectomy for PPH. Despite improvement in antenatal and neonatal care, twins pose a higher threat to MCH outcome. Hence, thorough counselling, patient awareness, more vigilance at interpretation of antenatal tests, intrapartum monitoring and bridging the gap between demand and supply at NICU facility can improve maternal and neonatal outcome; as well as can help parents cope with the psychological stress.
Background: If not detected early, ectopic pregnancy can result in a gynaecological emergency with significant abdominal bleeding, hypovolemic shock, and maternal death. The main objectives of this study are to find out the incidence of ectopic pregnancy, demographic profile of the women, risk factors and to study the clinical presentation, treatment modalities and outcome in our hospital. Methods: This prospective observational study was conducted in the department of obstetrics and Gynaecology, at a tertiary care centre, Andhra Pradesh from January 2021 to December 2022. A total of 62 cases of ectopic pregnancy were analysed for parameters like demographic characteristics, gravidity, risk factors, clinical presentation, treatment modalities and outcome. Results:The incidence of ectopic pregnancy in present study was 9.7 per thousand deliveries. Majority of cases belonged to age group of 21-25 years (67.7%) and were gravida 3 and above (49.1%). Commonest risk factors identified were tubal ligation (29%) and history of previous abortions (19.3%). The frequent presenting symptoms were abdominal pain (87%) and amenorrhea (38.7%). Most of the patients required surgical management (91.9%), medical management was done in 4 cases and expectant management was done in 1 case. Tubal ectopic pregnancy (87%) is more common. Anaemia was seen in 64.5% of cases that required multiple blood transfusions (72.5%) for resuscitation. There was no maternal mortality in the current study. Conclusions: Ectopic pregnancy is an emergency in which timely intervention will reduce the maternal morbidity and mortality. Clinical presentation varies from case to case and still there is a chance of missing the diagnosis in a small proportion of patients even with the availability of advanced imaging techniques. For early diagnosis a clinician should be aware about the various presentations and associated risk factors of ectopic pregnancy.
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