Background: Pregnancy is a serious burden to women with sickle cell disease (SCD). Our centre is the only tertiary care referral centre in the public sector which caters to the districts of Wayanad and the Nilgiris which has the maximum prevalence for SCD in South India. Hence this study was conducted to assess complications in pregnancy and maternal and perinatal outcome among women with SCD.Methods: A retrospective observational study was conducted by reviewing the medical records of all the pregnant women with SCD who had delivered in the Department of Obstetrics and Gynecology, Government Medical College, Kozhikode from January 2014 to December 2016.Results: There were 72 antenatal women with SCD during the study period with a prevalence of 0.15%. 54.17% (n = 39) patients were HbSS (sickle cell anemia), 44.44% (n = 32) were HbAS (sickle cell trait) and 1.39% (n = 1) were HbS-β thalassemia trait. There was increased risk of obstetric complications like gestational hypertension (16%), preeclampsia (11.11%), eclampsia (5.56%), HELLP syndrome (4.16%), intrauterine growth retardation (38.89%), and oligohydramnios (18.06%). Medical complications observed were mainly anaemia (76.38%), vasoocclusive crisis (18.05%), acute chest syndrome (5.56%) and infections like urinary tract infection (8.33%) and pneumonia (5.56%). The incidence of low birth weight babies (56.94%), low Apgar score (14.49%) and neonatal ICU admissions (31.88%) were high. There was no maternal mortality, but perinatal mortality was high (6.94%).Conclusion: Pregnancy in SCD is associated with an increased maternal morbidity and high perinatal mortality due to obstetric and medical complications.

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Background: Congenital anomalies have emerged as an important cause for neonatal morbidity and mortality. The prevalence as well as pattern of anomaly varies from place to place. Literature search reveals that India has the highest number of children with birth defects. Methods: This is a cohort study conducted in the Department of Obstetrics and Gynecology during the period [2009][2010][2011][2012][2013][2014][2015]. All mothers admitted with congenital structural defects to the fetus diagnosed by imaging and those who delivered anomalous babies were included in this study. The anomalies were classified based on ICD-10 system. Results: There were a total of 911 anomalous babies born during the study period of which 554 were males and 338 were females.19 babies had ambiguous genitalia. Anomalies were more common in multigravidae and in mothers of age group 20-29 years. Maximum number of babies were born between 37-40weeks. Maternal diabetes was associated with increased incidence of anomalies. Most common system involved was urinary system followed by musculoskeletal system. Conclusions: The prevalence of structural anomalies in the present study is 0.84%. Patients with risk factors for anomalies should undergo pre-pregnancy counselling. Routine antenatal anomaly screening with ultrasound before viability should be done for all patients so that early termination of lethal anomalies can be done. Jayasree S et al. Int J Reprod Contracept Obstet Gynecol. 2018 Mar;7(3):864-869 International Journal of Reproduction, Contraception, Obstetrics and Gynecology Volume 7 · Issue 3 Page 865 rate as well as cause of infant mortality. Immunization and use of broad spectrum antibiotics along with improvement in nutritional status have reduced the problem in low and middle income countries also. In this scenario birth defects will begin to emerge as one of the major contributor of infant morbidity and mortality. 7 A large number of congenital malformations are incompatible with life. But children with congenital defects may develop long term disability which can cause a significant impact on individuals, families, healthcare system and societies. Keywords4 40% of pediatric surgery admissions are contributed by structural birth defects.8 As the healthcare facilities improves life expectancy of children with congenital anomalies also increases with all its consequences.The birth prevalence of congenital anomalies in the developing countries is actually underestimated due poor registry, lack of diagnostic techniques and their reliability.9 Like other low and middle income countries, still congenital anomalies are not considered as a major problem in India. But literature search reveals that India has the highest number of children with birth defects. 10About 2.5% neonates at birth are affected by birth defects which accounts for 8-15% of perinatal deaths and 13-16% of neonatal deaths in India. 11,12About 60% of major malformations have no recognized aetiology. They can occur as an inherent genetic condition, poor diet, ...

Aim: To assess the maternal mortality ratio (MMR), epidemiological aspects, and the causes of maternal mortality according to the International Classification of Diseases, 10th Revision (ICD-10). Materials and methods: This is a retrospective observational study of maternal deaths that occurred at Government Medical College, Kozhikode. The data were collected from patients' records and maternal mortality register maintained by the medical records library of the hospital. Maternal deaths during the period of January 2011 to December 2015 were analyzed with emphasis on sociodemographic profile and deliveryrelated characteristics. Identification and classification of the cause of maternal deaths-direct and indirect, along with further subdivisions (nine subgroups), were done according to World Health Organization (WHO) application of ICD to deaths during pregnancy, childbirth, and the puerperium [ICD-Maternal Mortality (ICD-MM)], which is based upon the 10th revision of ICD. Results were analyzed using percentage and proportion. Results: There were 77,065 live births and 90 maternal deaths during the study period. The average MMR was 117 per 1 lakh live births. Maximum maternal deaths were in the 20 to 24 years age group and in multigravida. Total 40% of the deaths occurred in term patients and following vaginal delivery. The direct causes constituted 61.11%, the indirect causes constituted 34.44%, and unknown cases constituted 4.44%. Conclusion: The ICD-MM Group VI (nonobstetric complications), composed of numerous common and uncommon diseases, is the single largest cause of maternal mortality. "Hypertensive disorders of pregnancy" is the leading direct cause of maternal mortality closely followed by obstetric hemorrhage, embolism, and sepsis. Improvement of general health of the women and also having a planned pregnancy especially in those with preexisting medical disorder is advisable.

The prevalence of elderly primigravidae is on an increasing trend due increasing infertility and delay in child bearing. These women with advanced age are considered to be at high risk of pregnancy complications and adverse obstetric outcome. This has led to increasing antepartum surveillance and increased interventions including induction of labour and caesarean section. OBJECTIVESTo analyse the maternal and foetal complications and obstetric outcome in primigravidae above 30 years with those between 20 and 29 years of age. MATERIALS AND METHODSA one-year retrospective case control study where the birth outcome of elderly primigravidae above 30 years was compared with younger primigravidae (20-29 years) delivered at the Govt. Medical College, Kozhikode. RESULTSDuring the study period there were 13459 deliveries of which 392 patients were above the 30 years of age. Antepartum complications like hypertensive disorders, GDM, placenta praevia and preterm labour were increased in elderly patients. The caesarean section rate and low birth weight was found to be high with increasing age. CONCLUSIONIn spite of increased risk of maternal and neonatal complications in elderly primigravidae, the obstetric outcome was good.

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