Gestational diabetes (GDM) is a state of intolerance to glucose that initiates or is first diagnosed during gestation. About 1-14% of all pregnancies are complicated by GDM. The pregnancy-related morbidity and mortality in gestational diabetes is lower than in overt diabetes; however, if left untreated, it is significantly higher than in nondiabetic women. Treating GDM is important because appropriate treatment reduces side effects on the mother and newborn. GDM during pregnancy has a number of adverse short- and long-term consequences for both the mother and the fetus. Aim: To establish the relationship between gestational diabetes and complications related to pregnancy and childbirth. Study Design: A prospective cohort study. Place and Duration: The study was conducted at the Karachi Aga Khan University Hospital in the Department of Obstetrics and Gynecology from 22 November, 2018 to 22 May 2019, six months after the approval of the study. Methods: 130 patients, 65 patients in the GDM group and 65 patients in the non-GDM group were enrolled in the study. Demographic data were presented as standard deviation and mean as well as simple descriptive statistics, while qualitative variables as percentage and frequency. Chi-square test was applied for comparison of the incidence of complications related to pregnancy and childbirth. P<0.05 was considered statistically significant. Relative risk was calculated. Results: 130 total patients, including 65 patients in GDM group and 65 patients in non GDM group were included. Mean age in GDM and non GDM group was 29.27±2.79 years and 28.49±3.40 years. Outcome of pregnancy in GDM and non GDM group showed that 27 (41.5%) and 18 (27.7%) had pregnancy induced hypertension, 07 (10.8%) and 03 (4.6%) had pre-eclampsia, 29 (44.6%) and 07 (10.8%) had polyhydramnios, 04 (6.2%) and 02 (3.1%) had antepartum hemorrhage, 01 (1.5%) and 06 (9.2%) had premature rupture of membrane, 11 (16.9%) and 09 (13.8%) had preterm labour, 13 (20%) and 04 (6.2%) had urinary tract infection. Outcome of pregnancy in GDM and non GDM group showed 51 (78.5%) and 33 (50.8%) had induction of labour, 17 (26.2%) and 14 (21.5%) had low birth weight, 14 (51%) and 03 (4.6%) had macrosomia, 02 (3.1%) and 01 (1.5%) had birth injury and 10 (15.4%) and 11 (16.9%) had NICU admission. Conclusion: Gestational diabetes (GDM) is the utmost communal medicinal complication of pregnancy. It has negative consequences for the mother and the newborn baby. Maintaining glycemia in GDM decreases the morbidity of both baby and mother. Keywords: Gestational diabetes mellitus, delivery outcome, pregnancy outcome, maternal and fetal outcomes.
Objective: To determine the outcomes following induction of labor in nulliparous women presenting to tertiary care facility. Study Design: Case Series Place and Duration: Department of Obstetrics & Gynaecology, Aga Khan University & Hospital Karachi. Duration was Six months from 15thJanuary 2016 - 15th June 2016. Methadology: Admitted women was selected, women were induced with PGE2 3mg vaginal tablet, inserted in the posterior vaginal fornix. This was repeated at 4-hour intervals, if contractions are not initiated. Maximum 6 mg was given. Decision was taken for cesarean section 4 hours post second dose by the consultant having more than 2 years of post-fellowship experience. Results: 100 women enrolled in this study, mean age of the patients was 26.9±3.9 years. BMI of the patient were 30.4±4.5 kg/m2. Stratification analysis was performed and observed that statistically significant association in MOD in nulliparous women with age and dose of PGE2. MOD of delivery in nulliparous women was not associated with height weight BMI gestational age and baby NICU admission. Conclusion: Elective induction of labour at term gestation can reduce perinatal mortality and morbidity in Pakistan with increasing the risk of operative delivery. Keywords: Induction of labour, Nulliparous women, Unfavorable cervix.
Objective: To determine the frequency of adverse perinatal outcome in women undergoing emergency lower segment cesarean section at term due to non–reassuring CTG at Tertiary Care Hospital. Study Design: Descriptive case series-longitudinal. Study Setting: Study was conducted at Department of Gynaecology and Obstetrics, Aga Khan University Hospital. Duration of Study: Six months from 1st July, 2018 till 31st December 2018. Subjects and Methods: Data was prospectively collected from patients after taking a consent. A total of 211 patients were included. Demographic data was presented as simple descriptive statistics giving mean and standard deviation and qualitative variables were presented as frequency and percentages. Post stratification chi square test was applied taking p-value of ≤ 0.05 as significant. Results: Mean age in group A and B was 33.56±3.91 and 34.71±4.01 years respectively. Adverse fetal outcome showed that birth weight < 2500 gm (20.4% vs 12.3%), APGAR score < 7 (16.6% vs 12.3%), Umblical cord ph < 7.1 (14.2% vs 9%), NICU admission (11.8% vs 8.5%) and still birth patients (4.3% vs 1.9%) who were in decision to delivery group of < 30 minutes and > 30 minutes respectively. Conclusion: This study showed that there are still avoidable delays in emergency caesarean section. Improving health care delivery so as to eliminate the identified causes would go a long way in reducing these delays. But given the results of this study, adverse fetal outcomes appears to be less in DDI > 30 minutes group when compared with DDI < 30 minutes group. Keywords: Elective lower segment cesarean section, decision to delivery time, birth weight, APGAR score, NICU admission, umbilical ph and still birth.
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