Iron deficiency is the most common nutritional deficiency worldwide. Anemia, defined by the World Health Organization as hemoglobin < 11 g/dl, is frequently seen in the antenatal period and affects 4-48% of women who give birth and severe anemia, with hemoglobin levels <9 g/dl .This study is to evaluate the efficacy and safety of intravenous Ferric Carboxymaltose. (FCM) in comparison with intravenous Iron sucrose complex (ISC) for treatment of iron deficiency anemia in pregnancy.: A comparative, interventional, prospective study was carried out in 100 antenatal patients with Anemia (hemoglobin level between 5 to 9.5 gm/dl) in the department of obstetrics and gynecology, Government Medical College, Baroda, Gujarat, India from September 2017 to August 2018. The subjects were randomized in two groups. First group receiving 1000 mg of intravenous iron sucrose divided in five doses on alternate days (200 mg each) and Second group receiving 1000 mg of intravenous ferric carboxymaltose.: Maximum number of patients in our study were belonged to low socioeconomic group, significantly higher number of women achieved rise of hemoglobin >2gm/dl in FCM group, which was highly significant (p value <0.001). Mean rise of hemoglobin was 1.9 g/dl for FCM group and 1.66gm/dl for iron sucrose group, which was also significant. Serum ferritin level in ferric carboxymaltose group was rises more as compared to iron sucrose group. Unpaired‘t’ test was used to test the significance of rise and compare the rise between two groups.Ferric carboxymaltose is an efficient and better alternative to Iron Sucrose in treating iron deficiency anemia of pregnancy. It has an added advantage of single dose regime with lower side effects.

Background: Ectopic pregnancy is defined as any intra or extra-uterine pregnancy in which the fertilized ovum implants at an aberrant site which is inconducive to its growth and development. It is a catastrophic and life-threatening condition and one of the commonest acute abdominal emergencies affecting approximately 2% of all pregnancies. The purpose of this study is to review cases of ectopic pregnancy and determine: incidence, high risk factors, types of clinical presentation, diagnostic methods, management, morbidity and mortality.Methods: The present study, conducted over a period of 2-year, total number of deliveries was 16,144 and total number of ectopic pregnancies was 116. More than half of the cases (56.04%) had one or the other identifiable risk factor. Results: Amongst the various risk factors studied, history of previous pelvic surgery (15.43%), history of Pelvic inflammatory disease (PID) (12.9%), use of Intrauterine contraceptive device (IUCD) (10.3%) and either spontaneous or induced abortion (7.76%) has been found. History of self-administered medical termination of pregnancy (MTP) pill was present in 3.45%. Repeat ectopic pregnancies were seen in 1.72%. There was no identifiable risk factor in 49.63% of cases.Conclusion: Ectopic pregnancy is a major challenge in obstetrical practice because of its varied clinical presentation. It can be diagnosed early by keeping a high index of suspicion. Undue delay in referral reduces significant morbidity and improves the chances of preserving future fertility. Mass education regarding safe abortion practices and post abortal care should be promoted. Unsupervised usage of MTP pill intake should be condemned.

Background: To analyse the requirement of high dependency unit (HDU)/intensive care unit (ICU) in an obstetric population in terms of utilization rate, indications for admission, interventions required and gestational outcome.Methods: Retrospective observational study was carried out from April 2015 to September 2018 at department of obstetrics and gynecology SSG Hospital, Vadodara India. Data related to indications for ICU admission, interventions required, length of stay and outcomes were collected, and results were analyzed.Results: Obstetric ICU utilization rate was 130 per 1000 deliveries.  The major obstetric indications for admission were hypertensive disorders of pregnancy (42%) followed by anemia (25%) and post-partum hemorrhage (3%). In the rest of the patient’s majority (50%) had cardiovascular problems. Maternal mortality among these critically ill women was 3.76%. The death rate in the present study was high among patients admitted for non-obstetric (74.54%) as opposed to obstetric indications (25.46%).Conclusions: Establishment of well managed high dependency and intensive care unit in health care facilities dealing with high volumes of high-risk maternity cases reduces the maternal mortality significantly and results in improved maternal outcomes.

IgA Nephropathy is a primary glomerular disease leading cause of primary glomerulonephritis and one of the important  leading cause of secondary hypertension. Pregnancy causes complex pathological changes in patients with IgA nephropathy affecting the renal function leading to secondary hypertension which in turn affects the prognosis of these patients. The association between chronic kidney disease and increased risk of adverse maternal and fetal outcomes which includes pre-eclampsia, accelerated decline in renal function, intrauterine growth retardation, preterm delivery and fetal death, is well recognised. Management of patients with IgA Nephropathy in pregnancy is challenging and thus authors are discussing here a case with successful outcome. Our patient was a known case of IgA Nephropathy and landed up with complications during pregnancy which was manged successfully.

Background: Placentation abnormalities such as placenta previa, placenta accreta and vasa previa are associated with antepartum and postpartum haemorrhage, which makes them an important cause of serious fetal and maternal morbidity and even mortality in India. In spite of the significant improvement in obstetric care and management and modern transfusion service, antepartum and postpartum bleeding continues to be a significant cause of very high-risk pregnancy.Methods: This is a retrospective study conducted in department of obstetrics and gynecology, Sir Sayaji Hospital, Baroda, for a period of 2 years from January 2018 to December 2019. All cases of placenta previa and morbidly adherent placenta admitted during pregnancy in this period were included in the study. All case records were obtained and carefully analysed to find out the incidence, various types of placenta previa and adherent placenta, its clinical presentation and its outcome in relation to mode of delivery, birth weight, maternal and perinatal morbidity and mortality.Results: The prevalence of placenta previa was 0.87% and was more commonly present among multigravida women (80.3%). Most common type of placenta previa was type 1 in 51 cases (35.9%) cases followed by type 2 in 33 cases (23.2%). 29 cases (20.4%) were of complete placenta. Morbidly adherent placenta comprised 4.2%. Single case (0.7%) was of vasa previa. Out of 142 cases, 12 (8.4%) had atonic PPH and 8 (5.6%) cases underwent peripartum hysterectomy, (12.6%) 18 patients had hemorrhagic shock due to severe blood loss. All cases of perinatal mortality were between 28 to 30 weeks weighing between 1-1.2 kg associated with complete placenta previa in 14 cases and type 3 (incomplete) in 8 cases. There was no maternal mortality in this studyConclusions: Abnormal placentation carries a very high-risk for maternal and fetal outcome. Anticipation, prevention, early detection and appropriate management will result in favorable outcome and will boost the present scenario of management of high-risk pregnancies.

Background: This study was conducted to compare the safety and effect on maternal and perinatal outcome of expectant versus interventional management in women with preterm severe preeclampsia with gestational age between 28 to 34 weeks. Methods: This was a non-blinded prospective analytical study carried out in the department of obstetrics and gynaecology, SSG hospital, Vadodara from January 2021-December 2021. 40 women diagnosed with severe pre-eclampsia remote from term meeting the inclusion criteria were divided in two groups (20 in each). First group comprised of women undergoing interventional management i.e. prompt delivery and the second group comprised of women undergoing expectant management till 34 completed weeks. The women in the expectant management underwent pregnancy termination before 34 weeks if any complication arises (e.g. anhydramnios, abruption, eclampsia etc). Results: The mean prolongation of pregnancy in the expectant management group was 11.45 days (range: 4-35 days). There was no increase in incidence of maternal complications (p value: 0.003). The fetal outcome was favourable in the expectant management group in terms of higher gestational age at delivery (33 versus 31 weeks; p value: 0.001), higher birth weight (1.7 versus 1.5 kg; p value: 0.05), higher APGAR score at 1 minute (7.5 versus 7; p value :0.05), lesser incidence of neonatal complications (55% versus 95%; p value 0.003). Conclusions: Considering the results of this study, it can be concluded that expectant management is recommended in patients with severe preeclampsia remote from term with intensive monitoring.

Background: Caesarean section is the most common obstetrical procedure performed worldwide. Sometimes oxytocin alone is not sufficient to prevent postpartum haemorrhage and additional uterotonics may be required. We attempted an additional uterotonic misoprostol by sublingual route to evaluate the role of it to reduce blood loss at caesarean delivery.Methods: This prospective clinical study was done on patients of S. S. G. Hospital, Baroda; 138 patients who underwent lower segment caesarean section (elective or emergency). The primary outcome was less intra/peri operative blood loss, need for additional uterotonic agents and perioperative haemoglobin (Hb) fall. The secondary outcomes studied were incidence of shivering, pyrexia, nausea, vomiting, operating time, blood transfusion, endomyometritis and hospitalization period. Average blood loss after normal vaginal delivery is 500 ml and after caesarean delivery is around 1000 ml.Results: Mean postoperative Hb was high with misoprostol group and perioperative Hb fall was less. Perioperative Hb fall of 1 g or more was lesser in this group.Conclusions: Sublingual misoprostol reduces intraoperative blood loss, perioperative blood loss and the need for additional uterotonic agents and blood transfusions at caesarean delivery.

Objective To study the relationship between midtrimester cervical length measurement on transvaginal ultrasonography and timing and mode of delivery. Materials and methods A total of 200 asymptomatic antenatal women at 20 to 24 weeks gestation were recruited. Cervical assessment with transvaginal ultrasound was performed using a 5 MHz transvaginal probe. Findings of cervical assessment were then correlated with the timing and mode of delivery. Chisquare test and Odd's ratios with 95% confidence intervals were used. Results Sixteen percent women delivered preterm. A cervical length of ≤ 30 mm had good specificity and NPV. At the cut-off value of 25 mm or less, sensitivity was 31.3%, specificity was 100%, PPV was also 100% and NPV was 88.4%. Increased cervical length on TVS (>40 mm) was associated with higher rate of cesarean section as compared to <40 mm (66% vs 34%) and this observation was statistically significant. Conclusion Cervical length measured by TVS at midtrimester is a useful and significant predictor of the gestational age at delivery and the mode of delivery. The high negative predictive value avoids unnecessary interventions, such as tocolysis or cerclage in high-risk pregnancies. How to cite this article Arora P, Maitra NK, Agarwal S. Cervical Length Measurement by Transvaginal Ultrasound at 20 to 24 Weeks Gestation and the Timing and Mode of Delivery. J South Asian Feder Obst Gynae 2012;4(1):22-24.