STUDY OF PREGNANCY OUTCOME IN VARIOUS HIGH-RISK PREGNANCIES IN TERTIARY CARE HOSPITAL

Abstract

Introduction: In normal married couple or married women pregnancy is normal physiological condition and not a high-risk condition. Most of the pregnancies have happy outcome with good health of both foetus and mother whereas some pregnancies are complicated by problems with mother’s health, the health of the foetus or complications unique to pregnancy. Like these kinds of complicated pregnancies are group as “high risk” for developing problems and having a poor outcome. In comparing to the normal pregnancy High-risk pregnancy is one of greater risk to the mother or her fetus. A High risk (at risk) pregnancy cases there is increased in risk of morbidity or mortality before or after delivery where the mother, fetus, or neonate. At the time of pregnancy, a high-risk pregnancy is grouped in which past reproductive performance or maternal environment presents a significant risk to foetus such as premature birth, small for date infant, full term with low reservoir or still births and early neonatal death. For pregnant women identification of at high risk for these complicated pregnancies with poor outcome is fundamental to antenatal care. The risk factors which include high risk pregnancy are existing medical conditions such as HIV positive, Diabetes mellitus and BP as well as maternal obesity, multiple births and young or old age. A number of biological and social factors such as age, social class, parity and past obstetric history, occupation and psycho social factors and nutritional status that influence the perinatal outcome during pregnancy.
 Aim: The main aim of this study is to pregnancy outcome in various high-risk pregnancies.
 Material and Methods: This study was prospective study in which total 100 high risk and 100 low risk caesarean cases were done. In all the cases married women were included with the age from 20 to 40 years old having gestational age of more than 28 wks and underwent Caeserian section (Emergency/elective). In this study both IPD and OPD patients were included. In IPD cases in general had minimum of two antenatal check-ups. At the time of admission detail history of patients was taken including age, address and occupation, menstrual history, obstetrical history regarding gravity, parity abortion, number of term & preterm labours, any history of previous CS, indication for CS and intra-operative complication. For all the patients scoring was done as low risk and high risk cases by modified Coopland’s Scoring System. In the case of cesarean section Breast feeding was stated after 4 hours. Detailed information and history of neonatal complication and perinatal outcome was also recorded using predesigned and pretested proforma.
 Result: In this study to total 100 high risks as a study group and 100 low risks as a control group caesarean case with perinatal outcome was recorded. 42% and 30% of the study and control group respectively had low birth weight baby. In the high risk group, 3% had neonatal death while in control group there was 0% respectively. 38% babies in this study group and 17% babies in the control group had mild to severe depression and Apgar score below 6-4.
 Conclusion: This study showed pregnancy complications and related perinatal morbidity as risk factors impacting on neonatal outcome. If mother had access to appropriate and timely healthcare during pregnancy majority of maternal morbidities could be prevented. Hence proper care and timely referral can have a positive impact in lowering the perinatal mortality and morbidity and possibly better maternal outcome.
 Keywords: Pregnancy outcome, High risk pregnancy, Perinatal outcome, Coopland scoring, Caesarian section