International Journal of Reproduction, Contraception, Obstetrics and Gynecology
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A prospective observational study of demographic profile and maternal and neonatal outcomes in emergency obstetrics
Get PDFBackground: Emergency obstetric care (EmOC) is vital in reducing maternal and neonatal morbidity and mortality. Tertiary care centers serve as critical hubs for managing high-risk pregnancies and obstetric complications. Objectives were to evaluate the clinical profile, maternal morbidity, and neonatal outcomes of obstetric ICU admissions at a tertiary care center and assess associations with booking status and ICU stay duration.
Methods: A prospective observational study was conducted at Al-Ameen Medical College Hospital, Karnataka, from July 2023 to January 2025. A total of 160 obstetric ICU patients meeting inclusion criteria were enrolled. Data on age, booking status, ICU diagnosis, length of stay, delivery mode, maternal morbidity, and NICU admissions were collected and analyzed using SPSS v23. Statistical significance was set at p<0.05.
Results: Most patients were aged 31-40 years (43.8%) and unbooked (75%). Preeclampsia (25%), severe anemia (13.8%), and sepsis (12.5%) were the leading ICU admission causes. Maternal morbidity was significantly higher in unbooked patients (p=0.03). NICU admissions (27.5%) were significantly associated with ICU stay >7 days (p=0.001).
Conclusions: Unbooked status and preventable complications are major contributors to ICU admissions. Strengthening antenatal services and improving referral systems are essential for better maternal and neonatal outcomes
Knowledge, attitude and mis-conceptions regarding copper-T among women and ASHA workers in Bundelkhand region
Get PDFBackground: Population explosion is probably the most challenging issue India is facing currently. According to the factsheet of National Family Health survey -5 (NFHS-5), the total unmet need for family planning methods in currently married women aged 15-49 years is 9.4% and the total unmet need for spacing methods is 4.0%. Also, IUCDs hold 2.1% of total share of contraceptives being used.
Methods: 200 women coming to the hospital and 100 ASHA workers of Bundelkhand region accompanying them were included in this survey. They were asked to fill a questionnaire and results were analysed.
Results: 56% of women knew about Copper-T as a contraceptive and only 25.5% women perceived it as an effective contraceptive. Theyraised concerns like bleeding, pain, infection and infertility. 53% ASHA workers reported women have only partial knowledge about Copper T.
Conclusion: Copper T has low acceptance among women due to misconceptions and lack of awareness. Counselling, providing incentives to women, involving men and family members can improve its acceptance
Cesarean section delivery at a tertiary care center
Get PDFBackground: With the better surgical techniques, better anesthesia and with use of prophylactic antibiotics, cesarean sections are now considered a relatively common and safe operative procedures. Cesarean section is carried out with an incision on anterior abdominal wall and delivery of fetus by laparotomy. There may be an unambiguous association between cesarean delivery and fetomaternal morbidity and mortality. Rising trend in cesarean section deliveries need to be analysed and its effect on fetomaternal outcome at tertiary care centers.
Methods: This retrospective study was carried out with the aim to study the trends in cesarean section deliveries over the period extending from March 2022 to March 2024 has included all cesarean section delivery cases fulfilling the inclusion and exclusion criteria. The data were collected from the medical record department (MRD) and was kept confidential, and privacy of the patients were maintained, and data was analysed as per predefined proforma.
Results: The cesarean section rate was 49.11% out of 2596 deliveries, out of which most common indication being previous CS (37.89%) followed by fetal distress (18.24%). Majority of cases belonged to Robson group 5 followed by group 2. Emergency CS 61.72%, some neonatal complications were seen in which major cause was respiratory distress (9.88%). No fetomaternal mortality occurred during the study period.
Conclusions: Although with advent technology and medical advancement cesarean section is being a much safer and better operative procedure but its impact on future pregnancies and morbidity related to it should be kept in mind. The audit regarding the rate, indications and complications related to cesareans section should be analysed in all health care facilities
Evaluation of sepsis in obstetric score: a novel scoring system for obstetric population, a tertiary care centre study
Get PDFBackground: Sepsis remains the second leading cause of maternal mortality, affecting approximately 5.7 per 10,000 pregnancies. Delayed recognition and escalation of care contribute to preventable deaths. The Sepsis in Obstetrics Score (SOS), designed by Albright et al. to predict critical care needs in pregnant and postpartum women, has limited validation data. This study evaluates SOS in predicting maternal and neonatal outcomes in septic obstetric patients.
Methods: A prospective study was conducted on 50 pregnant, post-abortal, and postpartum women with sepsis at GSVM Medical College, Kanpur. Patients with pre-existing organ disease were excluded. SOS was calculated using clinical and laboratory parameters, with scores <6 classified as non-severe and ≥6 as severe sepsis. Outcomes assessed included ICU admission, organ dysfunction, maternal and neonatal mortality, and hospital stay. ROC analysis determined the optimal cutoff for predicting mortality.
Results: Mortality rose with higher SOS scores: 5.3% (0–2), 18.2% (3–5), 30% (6–8), and 71.4% (9–11). ICU admission and multi-organ failure were significantly more frequent in the ≥6 group. Neonatal outcomes were worse among high-score mothers, with more NICU admissions (5 vs. 1) and stillbirths (9 vs. 6). ROC analysis showed good predictive accuracy (AUROC 0.859, p<0.001). A cutoff ≥5 predicted mortality with 92.3% sensitivity, 62.2% specificity, and 70% diagnostic accuracy, outperforming the traditional ≥6 threshold by identifying high-risk women earlier.
Conclusions: SOS is a reliable triage tool for obstetric sepsis. A threshold ≥5 enables earlier ICU transfer, timely intervention, and improved maternal and perinatal outcomes, supporting its integration into routine obstetric care
Torsion of giant ovarian cyst in postmenopausal woman: a case report with review of literature
Get PDFTorsion of ovarian cyst, an acute gynecological emergency, needs attention not only for pain relief but to prevent its serious complications and in certain cases, to preserve the ovary. Though many factors predispose to the pathology, an enlarged ovary is the primary factor in the pathophysiology of torsion. It is rare in postmenopausal women. The Clinical presentation may be variable depending on the extent of pathology, as well as the investigation reports. Ultrasonography, using both grayscale and doppler imaging, and both transabdominal and transvaginal approaches, is the primary diagnostic investigation for patients with clinical suspicion. Surgery is both diagnostic and the treatment of choice. The earlier the treatment, the better the outcome, as it helps prevent complications. In certain cases, the ovary may be preserved through cystectomy and oophoropexy. Torsion of a benign giant ovarian cyst of 24 cm and weighing 3.5 kg in a postmenopausal woman is rare. In our case, a 46 years old postmenopausal parous lady presented with moderate pain abdomen and was found to have a giant ovarian cyst with mild tenderness, diagnosed as 7200 torsions of the right ovarian cyst of 24×20 cm on exploratory laparotomy. Total abdominal hysterectomy with right salpingo-oophorectomy and left salpingectomy was executed considering her age, healthy looking left ovary, and the benign features of the right ovarian cyst. Histopathology revealed a benign mucinous cystadenoma. Her post-operative period was uneventful, and she was found asymptomatic and healthy on follow up
Unveiling the role of pregnancy associated plasma protein-A in idiopathic preterm labour: a review
Get PDFIdiopathic preterm birth (IPTB) is birth before 37 weeks in the absence of any identifiable cause for preterm labour. Prediction and prevention of preterm birth can significantly reduce the burden of morbidity and mortality associated with under-five mortality across the world. Pregnancy-associated plasma protein-A (PAPP-A), a glycoprotein secreted by the placenta, which plays an important role in early placenta development through regulation of the IGF system, has emerged as an excellent biomarker for the prediction of preterm birth. This narrative review aims to understand the possible mechanism by which it is linked to preterm birth and its potential as a predictive biomarker for idiopathic preterm birth
A study on existing gaps in current antenatal care and new WHO model of routine antenatal care: need for implementation of new WHO guidelines on antenatal care
Get PDFBackground: Antenatal care is essential for ensuring good maternal and neonatal health outcomes, yet significant gaps remain in its delivery. In 2016, the WHO introduced new antenatal care guidelines increasing the number of antenatal contacts to 8, from the old 4 visit approach. The new model focuses on strengthening the connection between health care workers and pregnant women receiving antenatal care. However, utilization rate for the level of recommended antenatal care is still low especially in developing countries like India, thus further highlighting the need for identifying and bridging the gaps in antenatal care delivery. This study critically assessed the current challenges with antenatal care delivery by healthcare workers, aiming to identify gaps in existing practices and evaluate the need for implementing the New WHO antenatal care guidelines (2016).
Methods: A qualitative type of cross-sectional study was conducted at a tertiary care hospital in western Maharashtra, India among 128 mothers who were admitted to the post-natal ward of the hospital. Data collection was done using a pretested, prevalidated questionnaire, descriptive statistics were used to summarise the data.
Results: The study found that while 92% of women had recommended number of antenatal care contacts in the first and second trimester, while none had five antenatal care contacts in the third trimester. 50% of mothers had below recommended IFA consumption. Regarding nutritional counselling and non-pharmacological management of common pregnancy symptoms only 5.46% received guidance on nausea and 29.68% on heartburn management. All participants received respectful maternal care aligning with the WHO guidelines.
Conclusions: The findings demonstrate the need for active implementation of the new 2016 WHO’s guidelines on antenatal care to enhance the quantity and quality of antenatal care delivered. Ensuring that healthcare workers provide recommended education, immunization, supplementation, and maternal support throughout pregnancy. Identifying and bridging these gaps will help improve maternal and neonatal health outcomes, aligning practices with global standards and contributing to positive pregnancy experiences for pregnant women
A study to assess the knowledge regarding expressed breast milk among working mothers attending outpatient departments in a selected hospital at Mangaluru, Karnataka, India
Get PDFBackground: Breastfeeding is the gold standard for infant feeding. Breastfeeding is essential for child survival and health. Employment is one of the most common barriers to discontinue breast feeding after childbirth. Expressed breast milk (EBM) serves as a practical solution for mothers who cannot be physically present to breastfeed due to work commitments. The aim of the study was to assess the knowledge regarding EBM and find the association between knowledge and their sociodemographic variables among working mothers attending outpatient departments in a selected hospital at Mangaluru, Karnataka, India.
Methods: A non-experimental descriptive study. Purposive sampling technique was used to select 30 working mothers. Data was collected using a structured knowledge questionnaire. Data was analysed using descriptive and inferential statistics.
Results: The study findings showed that the mean knowledge score with standard deviation was 12.76±3.58 and the mean knowledge score percentage was 42.5% regarding EBM. There was no significant association between mother’s knowledge level and sociodemographic variables.
Conclusions: The study highlights the urgent need for educational programs and support systems to empower working mothers with the right knowledge regarding EBM and ensuring better nutrition and growth for their infants
A study of maternal near miss cases at tertiary care centre, Rajkot
Get PDFBackground: A maternal death is one of the most serious complications in obstetrics, with major impact on family members and staff involved. For every woman who dies from pregnancy or childbirth-related causes, it is estimated that twenty more suffer from pregnancy-related illness or experience other severe complications, these are considered as near-miss cases. The aim is to study the prevalence and clinical profile of maternal near miss in a tertiary care centre and assess the underlying socio-demographic variables, complications and contributing factors among near miss cases.
Methods: A hospital based prospective observational study was carried out at department of obstetrics and gynaecology at P.D.U medical college and hospital, Rajkot for the period of 18 months. The study population were the patients admitted in the department of obstetrics and gynaecology at P.D.U medical college and hospital, Rajkot. Selection of patients was according to WHO near miss criteria published in 2011. Demographic details, obstetric history along with past medical and surgical history were the main components in patient interview.
Results: 12916 live births occurred during the study period. Maternal near miss incidence was 15.79 per 1000 live births; Maternal near miss to mortality ratio was 4.34; Severe maternal outcome ratio was 19.43 per 1000 live births. Anaemia followed by hypertensive disorders in pregnancy were most common disorders seen in our study.
Conclusions: In order to decrease maternal mortality, awareness among general public, timely antenatal visits and early detection of complication and timely management is required
Non-stress test as an admission test to assess the outcome in all pregnant women attending tertiary care center
Get PDFBackground: Perinatal mortality remains high in developing countries, including India, where it is approximately 32 per 1000 live births. The non-stress test (NST) is a non-invasive, simple, and widely used method to assess fetal well-being after 30 weeks of gestation. A reactive NST usually indicates adequate fetal oxygenation, while a non-reactive result may suggest hypoxia or neurological depression.
Methods: This prospective study included 100 pregnant women (>30 weeks gestation) with singleton pregnancies admitted to the labour ward of Navodaya medical college, Raichur. NST was performed in the semi-recumbent or left lateral position for 20 minutes (extended to 40 minutes if non-reactive). Outcomes assessed included mode of delivery, birth weight, Apgar scores at 1 and 5 minutes, NICU admissions, maternal complications, and hospital stay duration.
Results: Reactive NST was recorded in 78% of participants, non-reactive in 16%, and suspicious in 6%. Non-reactive and suspicious NSTs were significantly associated with higher emergency caesarean section rates (50% vs 17.9%), increased NICU admissions (37.5% and 33.3% vs 5.1%), lower Apgar scores, and greater incidence of meconium-stained liquor and intrapartum fetal distress (p<0.05).
Conclusions: Admission NST is a reliable predictor of perinatal outcome. Reactive NSTs are associated with favorable outcomes, whereas non-reactive/suspicious results indicate higher perinatal risk, necessitating timely intervention