International Journal of Reproduction, Contraception, Obstetrics and Gynecology
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Maternal near miss and maternal mortality in a tertiary care centre of North Karnataka: a retrospective study
Get PDFBackground: Maternal near-miss cases and maternal deaths serve as crucial indicators of obstetric care quality. Analysis of these cases in tertiary care settings provides valuable insights for improving maternal healthcare services.
Objective of this study was to analyze the prevalence, causes, and outcomes of maternal near-miss cases and maternal deaths in a tertiary care center in North Karnataka.
Methods: This retrospective observational study was conducted at Karnataka Medical College and Research Institute, Hubli, during 2023. The study population comprised all pregnant women who were admitted to the Department of Obstetrics and Gynecology at KMCRI during 2023. The identification and classification of maternal near-miss cases were conducted in accordance with the Ministry of Health and Family Welfare (MoHFW), Government of India guidelines. Data was collected from multiple hospital records and analyzed using SPSS version 22.
Results: Among 11,658 live births, 113 maternal near-miss cases and 51 maternal deaths were recorded (maternal mortality ratio: 437.46 per 100,000 live births). The majority of cases occurred in the 20-25 years age group (near-miss: 43.4%, deaths: 54.9%). Primigravidae constituted 48.7% of near-miss cases and 43.1% of deaths. Most cases were referrals (near-miss: 76.1%, deaths: 70.6%) and booked outside the institution (near-miss: 94.7%, deaths: 82.4%). Hypertensive disorders were the leading cause of near-miss events (65.5%), and maternal deaths were also primarily attributed to hypertensive complications (31.4%), acute kidney injury (23.5%), and sepsis (19.6%). Mechanical ventilation was required in 90.2% of maternal deaths and 53.1% of near-miss cases.
Conclusions: The high proportion of referred cases and unstable presentations emphasizes the need to strengthen peripheral healthcare facilities and referral systems. Early recognition of complications, timely referral, and improved antenatal care at primary healthcare levels are crucial for reducing maternal morbidity and mortality
Study of primary caesarean section among multiparous women in tertiary care centre of Bastar region: a prospective study
Get PDFBackground: In this study was to know the incidence of primary Caesarean section in multigravidas, its indications among these patients.
Methods: Prospective observational study. All deliveries at Late Baliram Kashyap Memorial Hospital and Govt Medical college Jagdalpur, Bastar, Chhattisgarh, India. 8729 deliveries during the period of 2 year from January 2022 to December 2023. Multigravida women admitted to hospital with pregnancy of >28 weeks gestation (gravida 2 and above), each of whom has had a previous vaginal delivery of >28 weeks gestation were included. Women with previous abortions and previous section were excluded. Indication of caesarean section, obstetric history, antenatal history.
Results: A total of 8729 deliveries were conducted in the institute Lt shri BRKM Govt Medical College Jagdalpur Chhattisgarh among which 2709 (31%) were caesarean sections and 6015 (68.9%) were conducted vaginally. Total number of primary CS in multiparous women were 642 about 23.6% of the total CS rate. The mean age is 26±4 years ranged from 18 – 40 years. Most of the patients were in the age group of 26-30 years (45.01%) followed by 21-25 years (26.01%) Out of 642 primary cs in multipara, 316 (50.6%) cases underwent emergency CS whereas rest 326 went elective CS. Maternal and fetal indications contributed 21% and 79%.
Conclusions: Many unforeseen complications occur in women who previously had a normal vaginal delivery. With this study we came to the conclusion that fetal distress is the major contributor of primary CS in multigravida. Thus, preventive measures should be taken to decrease the fetal distress and non-progress of labour
Bacteriological assessment on urinary tract infection in preterm premature rupture of the membranes and preterm labour related to fetomaternal outcomes
Get PDFBackground: Urinary tract infection (UTI) is a health hazards risk during pregnancy of mothers, which leads to preterm premature rupture of the membranes (PPROM) following preterm labour (PTL). The objective was to investigate the most common bacteria causing UTI in cases presenting with PPROM following PTL and also their sensitivity profile to antibiotics and fetomaternal outcome in such cases at tertiary care hospital, Central India.
Methods: This research was conducted a hospital-based prospective and observational study among 60 pregnant women for the period of 01 July 2020 to 30 June 2021 in the tertiary care hospital at Bhilai, Chhattisgarh. Also studied urine for culture and sensitivity test for antibiotics related to fetomaternal outcomes.
Results: Among the marker of infection of total studied patients, a maximum for UCS positive (21.7%) and WBC count >15000 cumm (15.0%) while minimum for CRP (10.0%). Among the various microorganisms isolated in urine culture of participants, a higher value was observed on E. coli (11.67%) followed by Klebsiella sp. and Proteus sp. (3.33%) while lower value was observed for Pseudomonas sp. and CoNS (1.67%) among total studied patients. The association between urine culture and maternal complications, type of delivery, did not show significant association. No significant association was observed between urine culture and different parameters of neonatal complications and neonatal death. Only two deaths of babies were recorded.
Conclusions: UTI is significant causative factors of PTL and PPROM. It is always suggested to screen and monitor the antenatal mothers for the presence of asymptomatic or symptomatic UTI
When endometriosis returns: managing vault involvement after hysterectomy: a case report
Get PDFVault endometriosis is a rare but quite challenging condition occurring in post-hysterectomy patients. Minimally invasive surgery remains the gold standard for the diagnosis and management of such cases. We hereby present a case report of a 41-year-old lady who had undergone total laparoscopic hysterectomy 12 years ago and came with irregular vaginal bleeding since 7 to 8 years. She was thoroughly evaluated for the same and underwent biopsy of the growth over the vault, which was suggestive of endometriosis. Magnetic resonance imaging (MRI) was done to rule out involvement of the bladder and rectum. She underwent elective laparoscopic excision of an endometriotic nodule over the vault and bladder serosal shaving. Postoperatively patient was relieved of her signs and symptoms
Upshots of second stage lower segment caesarean section
Get PDFBackground: Second stage caesarean section is done at full dilatation of cervix with head deeply engaged in the pelvis. Indicated in dystocias, unsuccessful trial of instrumental deliveries, non-reassuring fetal CTG, second stage arrest, deep transverse arrest. This study aimed to evaluate the indications, intraoperative and postoperative complications and fetomaternal outcome in second stage lower segment caesarean section (LSCS).
Methods: This was a retrospective study conducted at Gandhi Medical College, Secunderabad from August 2022 to 2023.
Results: Total 180 cases underwent second stage LSCS during this period. Among them majority of the age group belonged to 26-30 years (37.8%), unbooked cases (88.9%) and primi gravida (73.3%). Most common indications were cephalopelvic disproportion (38.8%) and fetal distress (14.6%). The commonly used method was Patwardhan method 33.3% followed by vertex 37.7%. The common complications were PPH (55.8%) and extension of incision site (16.7%). Fetal complications were birth asphyxia (45%), mortality (10%). Postoperative complications were febrile illness (16.1%), prolonged stay (35%) and anemia (20%).
Conclusions: A proper judgement and skilled obstetricians are required to perform a second stage LSCS
Carbetocin in the prevention of postpartum hemorrhage
Get PDFBackground: Postpartum hemorrhage (PPH) is the most common and a potentially life-threatening complication of childbirth in both vaginal and caesarean deliveries. Carbetocin is a newer analogue of oxytocin with longer half-life and more heat stable. This study was aimed to assess the efficacy of carbetocin in the prevention of postpartum hemorrhage (PPH) in vaginal and caesarean deliveries, at a single tertiary care centre.
Methods: A total of 130 pregnant patients included in the study received a bolus of carbetocin 100 µg i.v./i.m. at the delivery of anterior shoulder. After patients received uterotonic agent (carbetocin), patients were observed for 24 hours. The change in hemodynamic and clinical variables such as drop in hematocrit than one obtained on admission was observed. Clinical signs such as pallor, cold clammy skin, hypotension and tachycardia were also noted. In addition uterine tone after receiving carbetocin was also noted.
Results: There were comparable hemodynamic parameters in terms of heart rate, SBP and DBP in the pre-labor and post-labor. Most of the patients 54.6% (n=71) had contracted uterine tone followed by well-contracted in 35.4% (n=46). There was no significant difference found in terms of hemoglobin concentration and hematocrit in pre-labor and post-labor. 3.1% (n=4) patients experienced PPH. 6.15% (n=8) needed blood transfusion. No adverse effects or complications or maternal mortality was observed in the present study.
Conclusions: This study concludes that using carbetocin in the third stage of labour resulted in decreased incidence of post-partum hemorrhage, decreased blood transfusion as well as decreased use of additional uterotonics
Evaluation of vaginal and sublingual routes of misoprostol in induction of labor
Get PDFBackground: Labor induction is used to initiate uterine contractions. Various misoprostol administration routes demonstrate differing pharmacokinetics and efficacy. Optimal route is selected considering factors like onset of action, side effects, patient comfort, and neonatal outcomes. Objectives were to study the response of sublingual and vaginal routes of misoprostol for induction of labor and compare both the routes for induction of labor.
Methods: A randomized prospective study was conducted from May 2023 to October 2024 at Shri Ram Murti Smarak Institute of Medical Sciences, Bareilly, UP. Participants were assigned to either sublingual or vaginal misoprostol (25 mcg every 4 hours, up to five doses), stopped at 4 cm dilation or if adverse effects occurred. Oxytocin was given if needed. Labor progress, induction-to-delivery time, doses, patient preference, and side effects were recorded.
Results: The present study on labor induction with sublingual and vaginal misoprostol showed no significant differences in demographic factors, gravidity, parity, or gestational period between the groups. Bishop scores improved significantly after three doses of misoprostol. The sublingual group had a shorter labor duration and required fewer doses, supporting its quicker induction efficiency. No significant differences were found in adverse effects, mode of delivery, failure rates, or neonatal outcomes but individualized care is essential.
Conclusions: This study highlighted that both sublingual and vaginal misoprostol are effective for labor induction, with sublingual route offering faster results but higher risks, suggesting that the choice of route should be based on patient-specific factors
Spontaneous uterine rupture masquerading as intestinal perforation in a primigravida with polyhydramnios
Get PDFSpontaneous rupture of an unscarred uterus in a primigravida is an exceptionally rare and life-threatening event. We report the case of a 26-year-old primigravida at 36 weeks who was referred as a suspected case of intestinal perforation. Cross-sectional imaging revealed a uterine fundal rent with hemoperitoneum. Intraoperative findings included dense pelvic adhesions, fat stranding, and a ruptured dilated vessel over the uterine rent, suggestive of chronic pelvic inflammation possibly due to endometriosis or prior subclinical pelvic inflammatory disease. This case highlights the importance of considering uterine rupture in unscarred uteri, particularly when atypical presentations occur
A study on the pattern of non-communicable diseases and their effects on pregnancy outcomes in Kashmiri women
Get PDFBackground: Non-communicable diseases (NCDs), such as chronic hypertension, diabetes, thyroid disorders and cardiovascular diseases, pose significant risks during pregnancy, contributing to adverse maternal and fetal outcomes. This study aims to examine the pattern of NCDs among pregnant women in Kashmir and evaluate their effects on pregnancy outcomes.
Methods: A prospective observational study was conducted over 12 months at Lalla Ded Hospital, Srinagar, involving 450 pregnant women diagnosed with NCDs either before or during pregnancy. Data were collected on maternal demographics, type of NCD and pregnancy outcomes. Maternal and fetal complications were assessed, including APGAR scores, NICU admissions, delivery modes and maternal morbidity and mortality.
Results: The most prevalent NCD was chronic hypertension (33.7%), followed by thyroid disorders (19.1%) and diabetes mellitus (15.1%). Of the 450 women, 250 (55.5%) had no complications, 176 (39.1%) had non-life-threatening complications, 20 (4.4%) experienced maternal near-miss events and 4 (0.8%) succumbed to their conditions. Regarding fetal outcomes, 84.8% were live births, 10.2% abortions, 3.1% intrauterine deaths and 1.7% stillbirths. APGAR scores were ≥8 in 73.2% of babies, while 31.2% required NICU admission.
Conclusions: NCDs during pregnancy are prevalent and significantly impact both maternal and fetal health. Chronic hypertension was the most common condition, associated with increased rates of complications, caesarean delivery and NICU admissions. Early diagnosis, multidisciplinary management and improved antenatal care are crucial for optimizing fetomaternal outcomes in pregnancies complicated by NCDs
Monoamniotic twin pregnancy in a previous caesarean with placenta accreta spectrum: a rare case report
Get PDFMonoamniotic twin pregnancy with placenta accreta spectrum is a rare condition. We are presenting a case of 36-year-old, G4P1021 at 27 weeks 1 day period of gestation with previous cesarean with monochorionic monoamniotic twin pregnancy with placenta previa with placenta accreta spectrum who underwent classical cesarean section with peripartum hysterectomy under general anaesthesia at 33 weeks and 2 days of period of gestation. This case gives an insight on the grey area of appropriate management in such cases with multiple high-risk factors and possible interventions to prevent complications