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.
BACKGROUND Foetal macrosomia is defined as foetal growth above the 90 th percentile for a given gestational age or as foetal weight >4000 gms. In India, a baby weighing more than 3.25 kg would be greater than the 90 th percentile and therefore by definition has macrosomia. Foetal macrosomia is associated with increased risk of maternal and foetal complications. The aim of the study is to study the predictive power of clinical parameters and ultrasound foetal measurements in macrosomia. MATERIALS AND METHODS A case-control study was conducted in the Department of Obstetrics and Gynaecology at the Institute of Maternal and Child Health, Government Medical College, Kozhikode, during the period March 2014-April 2015. A comparison between a group of women delivering liveborn babies between 37-40 weeks weighing more than 4 kg and another group with similar inclusion criteria with less than 4 kg is done. 110 cases constituted the macrosomic group and 440 cases constituted the non-macrosomic group. Singleton pregnancy with regular cycles, known LMP and obstetric ultrasonography before 20 weeks to confirm the gestational age more than 37 weeks and less than 40 weeks were taken as the criteria for inclusion into the study. Obstetric ultrasonography must have been performed 2 weeks before delivery. Multiple gestation, stillbirth, gross or chromosomal abnormalities, small for gestational age, oligohydramnios and pregnancy in advanced labour were excluded from the study. Detailed clinical history is taken. Foetal ultrasound parameters measured are Biparietal Diameter (BPD), Head Circumference (HC), Abdominal Circumference (AC), Femur Length (FL), Femur Length/Abdominal Circumference (FL/AC), Intrauterine Ponderal Index (IUPI) and Estimated Foetal Weight (EFW). Data are expressed in its frequency and percentage. To elucidate the association and comparisons, chi-square test was employed. Risk of each parameter was assessed using binary logistic regression analysis and odds ratio was found out. For statistical evaluation, a two-tailed probability value less than 0.05 was considered significant. RESULTS 87% of the study population were less than 30 years. More than half were multigravida. Among them, 24.5% had macrosomic babies while among the primigravida only 14% had macrosomic babies. About 30% had gestational diabetes mellitus. Previous history of macrosomic foetus was present in 18.44%. Among 110 macrosomic babies, 74 mothers of those babies had BMI more than 25. In ultrasonography, 45 babies had BPD more than 96 mm (90th percentile), 40 had HC more than 354 mm (90th percentile), 92 had AC more than 346 mm (90th percentile) and 85 had FL more than 74 mm (90th percentile). Estimated foetal weight was more than 4000 grams in 86 patients. CONCLUSION Foetal macrosomia is more common among multigravida. There is significant association between the incidence of macrosomia and gestational diabetes mellitus. Previous macrosomic birth and high body mass index have influence over macrosomia. Biparietal diameter and head circumference ...
BACKGROUND Maternal mortality is used as a general indicator to gauge the health and even social status of an Indian mother. Reduction of maternal mortality ratio remains a challenge in India. The aim of the study is to compare the maternal mortality ratio in a tertiary care centre over a span of 10 years and to analyse the changes and trends in maternal mortality with reference to the causes of maternal mortality and sociodemographic factors. MATERIALS AND METHODS A retrospective facility based study was done at Government Medical College, Kozhikode. The detail of maternal death was analysed with respect to age, parity, gestational status of pregnancy and cause of death. Data from a period of 2007-2016 was compiled and compared as two five-year interval to enable a comparative analysis. Causes of death were classified according to World Health Organization application of International Classification of Diseases-Maternal Mortality (ICD-MM) classification. The results were compiled and statistical analysis done using Chi-square and unpaired t-test. RESULTS Over the first 5 years of our study, there were 80,217 livebirths and 87 maternal deaths. The next five years showed a similar trend with 77,473 livebirths and 88 maternal deaths. The maternal mortality ratio for 2007-2011 is 109 per 1 lakh livebirths, while maternal mortality ratio is 114 per 1 lakh livebirths in 2012-2016. There is a gross rise in deaths during antepartum period in 2012-16. The most common cause of mortality is still direct causes constituting 79% in 2007-11 and 56% in 2012-16. Indirect causes have risen from 21% to 37% during 2012-16. CONCLUSION Maternal mortality ratios for both 5 year periods during the 10 years study period are comparable. The sociodemographic profile has also remained constant. There is a definite decline in deaths due to haemorrhage while mortality due to other obstetric causes and non-obstetric causes are rising.
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.
Background: Gestational diabetes mellitus (GDM) and thyroid dysfunction are the two common endocrine disorders affecting pregnancy. Some association was hypothesized between GDM and thyroid dysfunction in the literature. The main aim of this study was to unveil this metabolic interplay as better understanding may facilitate early diagnosis and intervention thereby limiting major fetal and maternal adverse events. Here we estimated the prevalence of abnormal thyroid function and anti–thyroid peroxidase (anti-TPO) antibody and also studied the risk factors for thyroid disorders in patients with GDM. Materials and Methods: This cross-sectional study was conducted between February 2014 and January 2015. A total of 100 consecutive pregnant women diagnosed to have GDM as per the American Diabetes Association 2013 recommendations were recruited and thyroid stimulating hormone, free triiodothyronine (T3), free thyroxine (T4), and anti-TPO antibody assays were done. Details regarding pregnancy outcome and any complications if present were also obtained and analyzed. The prevalence is expressed as proportions, and the statistical significance of risk factors was assessed using the chi-square test and independent t-test. Results: Abnormal thyroid function was detected in 31 (31%) patients, which includes 17 cases of subclinical hypothyroidism (54%), 10 hypothyroidism (32%), 2 (6%) subclinical hyperthyroidism, and one case each of isolated low T3 and isolated low T4. Anti-TPO antibody was positive in 35 patients (35%). History of GDM in previous pregnancy, family history of diabetes mellitus, presence of clinically detectable thyroid gland enlargement, and presence of anti-TPO antibody in serum were found to increase the risk of thyroid dysfunction. Majority of the subjects had uneventful delivery, and no significant increase in maternal or fetal complications was reported. Conclusions: This study showed a high prevalence of thyroid dysfunction and anti-TPO antibody in GDM patients. The significant thyroid abnormalities detected were subclinical hypothyroidism and hypothyroidism. The risk of thyroid dysfunction is elevated in patients with the presence of anti-TPO antibody. This scenario provides a strong ground to recommend meticulous assessment of thyroid function in GDM patients.
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