LSCS Rate Research Articles

Evaluation of the Effects of Epidural Labour Analgesia on Mode of Delivery in 250 Bedded District Hospital, Bagerhat, Bangladesh

Background: Labor pain is intensely severe, often leading to hyperventilation and hormonal releases that can harm the fetus by reducing oxygen supply and causing metabolic acidosis. Effective pain management during childbirth is crucial for both physical and mental health. Various pharmacologic and non-pharmacologic methods are available, with epidural analgesia being a prominent choice. It is widely used in high-income countries, provides substantial pain relief, and benefits uterine contractions and placental perfusion. Epidural analgesia has potential side effects and controversies, such as delayed labor and higher intervention rates. Aim of the Study: The study aimed to examine the impact of epidural analgesia on the mode of delivery. Methods: This observational study, conducted from July 2021 to June 2022 at the Department of Gynecology and Obstetrics in a 250-bed District Hospital in Bagerhat, Bangladesh, included 50 participants divided into two groups of 25 each: Group A (with epidural analgesia) and Group B (without epidural analgesia). Approved by the Ethical Committee, the study included women aged 18-35 years, 37-41 weeks gestation, in labor with regular contractions, at least 4 cm cervical dilatation, and a regular fetal heart rate pattern. Excluded were women with medical or obstetrical complications, uterine scars, or spinal deformities. Data were collected via interviews, observations, and clinical examinations. Result: In this study of 50 participants (25 per group), most women were under 30 years old, with mean ages of 22.4±4.5 and 22.9±5.2 years in groups A and B, respectively. Gestational ages ranged from 37 to 40 weeks, and BMIs were 18.5-24.9 kg/m². Both groups had similar parity distributions. Normal vaginal births occurred in 84% (Group A) and 88% (Group B), with LSCS rates at 4%. Group A had 60% male neonates with average birth weights of 2.86±0.27 kg, and Group B had 56% males with weights of 2.88±0.26 kg. APGAR scores were high in both groups. Conclusion: Epidural labor analgesia is safe and does not increase instrumental deliveries or affect neonatal outcomes, making it a viable pain management option. Obstetric care providers can use this information to counsel women.

Maternal and fetal outcome in COVID 19 positive pregnant women with thyroid dysfunction

Background: Normally functioning thyroid glands are able to meet the increasing need for hormones during pregnancy and keep thyroid hormone levels within normal limits. However thyroid dysfunction in pregnancy can cause adverse maternal and fetal outcomes like pre-eclampsia and gestational hypertension, antepartum hemorrhage, anemia, preterm delivery, low birth weight and addition of SARS-CoV-19 infection can worsen the perinatal outcome. In present ambispective study, obstetric outcomes of 32 cases of COVID 19 positive pregnant women with thyroid dysfunction (Group A) were compared with 32 cases of COVID 19 negative pregnant women with thyroid dysfunction (Group B). Results: Pregnancy induced hypertension (PIH) was the most common antepartum complication noted in both the groups (28.1% vs 12.5%). Group-A had 40.6% LSCS rate whereas it was 37.5% in group-B. Average period of gestation at delivery was 38 weeks in both the groups. The most common neonatal complication was low birth weight (9.4%) in both the groups. Group A was also associated with meconium aspiration syndrome (MAS) (9.4%), neonatal sepsis (6.2%) and transient tachypnoea of newborn (TTN) (3.1%). NICU admissions were 37.5% in group A while only 6.25% in group B. (p value <0.01). Most common indication for NICU admission was MAS (9.4%) in group A. It was observed that incidence of pregnancy induced hypertension (PIH) and neonatal complications including NICU admissions were increased in presence of both COVID 19 and thyroid disorder as compared to only thyroid disorder in pregnancy. Multi-disciplinary approach with more vigilant monitoring can help reduce perinatal morbidity and mortality.

PREGNANCY OUTCOME IN ADVANCED MATERNAL AGE IN COMPARISON WITH YOUNGER PREGNANT WOMEN – A COMPARATIVE STUDY IN CENTRAL REFERRAL HOSPITAL, GANGTOK, SIKKIM

Objectives: The aim of the study was to compare maternal and neonatal outcome in pregnancy in advanced maternal age (>35 years) in comparison with pregnancy outcome in younger mothers of age 20–34 years. Methods: This was a retrospective and comparative study conducted in the Department of Obstetrics and Gynecology of Central Referral Hospital, Gangtok, Sikkim. Institutional ethical committee approved the study. One thousand three hundred and thirty-five women were included in this study. Data of these mothers were retrieved from the MRD records and reviewed. Pregnancy outcomes were studied in terms of antenatal, intranatal, and postpartum complications. Each adverse obstetrical outcome was assessed if it has made a significant association with maternal age. Perinatal outcome was also compared. Results: The mean maternal age was significantly higher in Group A (38.2±0.66) as compared to Group Y (25.85±4.41) and the difference was found to be statistically highly significant (p<0.0001). LSCS rate was more in advanced maternal age group as compared to patients <35 years and the difference was statistically significant (p=0.0009). Comparison for both the groups for gestational diabetes, gestational hypertension, anemia, preterm labor, prelabor rupture of membranes, and postpartum hemorrhage shows these pathologies to be more common in Group A. In Group A, the common causes of LSCS were patient request (41.39%) followed by FGR with abnormal Doppler (26.01%) whereas in Group Y common indications for LSCS included previous LSCS (36.56%) patient request (27.56%). Group A had a higher incidence of low birth weight (52 vs. 65, p<0.0001), large-for-gestational-age babies (>4 kg) (15 vs. 12, p<0.0001), NICU admission due to low APGAR score (35 vs. 42, p<0.0001), and pre-term births (43 vs. 10, p<0.0001). Conclusion: Advanced maternal age pregnancies are associated with increased incidence of maternal medical disorders, cesarean section, and postpartum haemorrhage as well as adverse perinatal outcome.

First Trimester Maternal Body Mass Index and Ges-tational Weight Gain and Their Association with Feto-Maternal Outcomes

Introduction: Women of reproductive age have also been impacted by the significant rise in the prevalence of obesity. A significant predictor of poor outcomes for the health of the mother and the newborn is excessive gestational weight increase. The study was conducted with an objective to study first trimester maternal Body Mass Index and gestational weight gain and their association with maternal and perinatal outcomes.
 Methodology: This was a prospective observational clinical study conducted in 196 primigravida patients presenting in a tertiary care hospital in central India. BMI of women were recorded during the first trimester and followed up to assesses gestational weight gain. Early pregnancy BMI and gestational weight gain were compared with various feto maternal outcome.
 Results: The mean of First trimester BMI was 21.3 kg/m2. In Overweight category, 65.2% had high weight gain (WG) while in obese, 26.1% had High WG. Type of delivery and NICU admission rate significantly differ in BMI categories (p <0.05). LSCS rate were higher in overweight and obese category. Preterm babies and post-partum hemorrhage were higher in higher WG categories; however, the difference was non-significant (p>0.05).
 Conclusion: This study conclude that First trimester underweights and overweight/obesity is associated with higher antenatal, intra-natal and postnatal complications as well as neonatal complications. Caesarian rate and instrumental deliver are also common in First trimester overweight and obese women. Preeclampsia is associated with extreme of First trimester BMI.

Cardiovascular disease in pregnancy and its outcome: A prospective study.

Prevalence estimates place maternal heart illness anywhere from 0.3 to 3.5 percent. Up to 20.5% of all maternal deaths of non-obstetrical cause are attributable to cardiovascular disease. The aim of the study was the management of patients with the multidisciplinary approach to maternal cardiovascular disease and its influence on maternal and fetal outcomes in a tertiary care centre. 1. To find out the prevalence and spectrum of heart disease in Pregnancy. 2. To find out the outcome of pregnancy with heart disease in a tertiary care centre. This prospective study of one year was done on pregnant with heart disease coming to the Obstetrics and Gynaecology department in collaboration with the cardiology department of IGIMS, Patna. A study was done on 65 pregnant with heart disease between the age group 20 to 35 years were compared to a control group of 65 pregnant women who were hospitalised during the same time period but did not have heart disease. All the pregnant women with heart disease were included in this study. Patients with medical disorders like Kidney disease, Liver disease, Pulmonary Disease, Diabetes Mellitus were excluded from the study. We used IBM's SPSS v23 to analyse the collected data. Prevalence of heart disease in pregnancy was 5.8% in present study and mostly of RHD (62.5%), followed by corrected CHD (12.5%) and CHD (10.9%). Patients of NYHA Class I and II (58.5%), Class III (26.2%), and Class IV (15.4%). The mitral valve was most often impacted by RHD (35.3% of all cases), followed by the tricuspid valve (15.0%). Eight (1.1%) people had cardiac surgery for therapeutic reasons. Six percent of all corrective surgeries included closing an atrial septal defect (ASD). The most common kind of congenital abnormality was a ventricular septal defect (VSD, 3%), followed by atrial septal defect (ASD, 1.5%) and pulmonary ductal atresia (PDA, 1.5%). Patients with heart disease had a higher rate of MTP, emergency LSCS and instrumental births than the controls. Deaths during pregnancy were 4 (6.2%) with cardiac disease and no maternal mortality in control group and all belonged to NYHA Class 4 were anaemic. In patients with a left ventricular ejection fraction of 45% or below, death was high. Two women died intrapartum from RHD, and two died postpartum from Peripartum cardiomyopathy. There were significantly more incidences of low-birth-weight infants (36.4%) compared to the control group (p = 0.001). Cases had a statistically significant greater frequency of obstetric problems, as well as an increased risk of developing anaemia, hypertension, hypothyroidism, cholestasis, FGR, and GDM (p-value 0.017). Multiparity, severe valvular lesion, NYHA function class III or IV, arrhythmia, and low ejection fraction were associated with poor maternal outcome in the current study. Maternal morbidity and mortality due to heart disease can be reduced appreciably by antenatal care, early diagnosis, and management with the help of cardiologists and surgery in selected cases.

Comparison of Maternal and Foetal Outcome between Normal and Abnormal Amniotic Fluid Index in the Third Trimester of Pregnancy - A Longitudinal Analytical Study in A Tertiary Level Medical College of Suburban West Bengal, India

Background: Amniotic fluid (AF) is the protective liquid present in the amniotic sac of a gravid uterus. Amniotic fluid has nutritive, protective and diagnostic functions. Amniotic Fluid Index (AFI) is most popular and reliable method for quantifying amniotic fluid, till date. AFI is one of the major parameters of foetal biophysical profile (BPP) that can predict perinatal and maternal outcomes. Periodical scanning of foetus is utmost essential during antenatal visits, especially in high-risk pregnancies, but there is no definite standard protocol regarding its frequency.Methods: This study was conducted in the department of Obstetrics & Gynaecology, College of Medicine & JNM Hospital, Kalyani, Nadia, India. This longitudinal analytical study included 356 patients, among whom 151 (42.4%) were in oligohydramnios group, 174 (48.9%) in normal group and 31 (8.7%) in polyhydramnios group.Results: The data revealed oligohydramnios was strongly associated with caesarean section (p = 0.0010). In oligohydramnios group, IUGR was found in 37 (24.5%) patients (p = 0.0297). Meconium-stained liquor was almost similar in all three categories i.e. 15 (10.0%) in oligohydramnios group, 18 (10.3%) in normal group and 5 (16.1%) in polyhydramnios group, respectively. There was higher SNCU admission among babies delivered by mothers with oligohydramnios (p = 0.0369). There was no statistically significant difference in 1 and 5 minutes APGAR scores among normal and abnormal AFI groups. Conclusions: It was inferred that LSCS, IUGR baby and SNCU admission rates were more in oligohydramnios group compared to other categories. The perinatal death was 3.3% with oligohydramnios compared to 1.7% with normal liqour. The results from this study emphasize on the importance of AFI among the various means of antepartum surveillance and predictors of foetal outcome. Keywords: Oligohydramnios, Polyhydramnios, Foetal Outcome, IUGR, AFI

NULLIPAROUS WOMEN: EXAMINING FETAL AND MATERNAL OUTCOMES IN INDUCED VERSUS SPONTANEOUS LABOR

Introduction: The goal of modern obstetrics is to enhance feto-maternal health. In certain cases, interventions are required to safe-guard it. The most frequent interventional procedure is currently in-duction of labour. This study was conducted to assess feto-maternal outcome in induced women in comparison to spontaneous labour in nullipara. Methodology: This was a prospective study conducted among 55 nulliparous pregnant women at or beyond 37 weeks of gestation who were in need of induction. Progress of labour was monitored with modified WHO partograph. All consecutive patients who entered into spontaneous labour (n=55) were also included. Results: Mean cervical dilatation in ‘spontaneous labour’ group was 4.48 (± 0.65) cm and in ‘induction labour’ group was 4.4 (± 0.62) cm. In ‘spontaneous labour’ group, 36.4% required augmentation whereas in ‘induction labour’ group 67.3% required. In former, 81.8% had normal vaginal deliveries, whereas 63.6% in the later group. Mean du-ration of first stage of labour in ‘spontaneous labour’ group was 11.42 (± 2.32) hours and in ‘induction labour’ group was 10.36 (± 2.78) hrs. The rate of maternal complication was significantly more in ‘in-duction labour’ group compared to ‘spontaneous labour’ group. There was no significant difference in neonatal outcome in new-born in both the study groups. Conclusion: Induction of labour is associated with higher rate of LSCS. Duration of first stage of labour is significantly shorter in in-duced women, however duration of second and third stage of labour was almost similar to spontaneous labour. Induction of labour is a safe procedure.

Antenatal Care - How to ensure quality!

Antenatal Care - How to ensure quality!

MODIFIED BIOPHYSICAL PROFILE IN HIGH RISK PREGNANCY AND ITS FETAL OUTCOME

Background: High risk pregnancies are at increased risk of maternal and neonatal morbidity and mortality. Modied biophysical prole (MBPP) is one of the best method used in antepartum fetal surveillance which comprises of Non stress test (NST) and Amniotic uid index (AFI). Our main aim is to evaluate the efcacy of modied biophysical prole in predicting perinatal outcome in high risk pregnancy & to prevent perinatal morbidity & mortality by intervention done in time. Methods: A prospective cohort study was conducted in our hospital from February 2021 to January 2022. In this study 200 high risk pregnant women with term pregnancy, attending the antenatal outpatient clinic or admitted in the ward were evaluated with the modied biophysical prole consisting of NST recording for 20 minutes, followed by ultrasound assessment of amniotic uid volume, using four quadrant technique. Results:Among 200 high risk pregnant women, Modied biophysical prole in high risk pregnancy showed amniotic uid index < 5 in 4.5% cases, 26 % cases had AFI 6 to 8 and 69.5 % cases had AFI 8 to 24 ; CTG showed 23 % cases were found to have non-reactive & 77% cases were reactive. When AFI & CTG was combined, non-reactive CTG is more among cases with AFI < 5 and it was statistically signicant (P Value =0.05). The rate of LSCS, Neonatal resuscitation and Admission was increased when there was abnormal MBPP. Conclusion: Modied biophysical prole is the best method for antepartum fetal surveillance. It can be used to predict perinatal outcome and provide timely intervention in high risk pregnancies

Study of fetomaternal outcome of teenage pregnancy in a tertiary care hospital

Background: The objective is to study the fetomaternal outcome in teenage pregnancy at Government Maternity Hospital, S V Medical College, Tirupathi for the study period of 1 year from June 2021 to May 2022. Teenage pregnancy is a worldwide health problem. WHO defined adolescence as the period from 10-19 years? It is a serious health problem in a developing country like India. Teenage pregnancy is associated with high risk of prematurity, low birthweight, preeclampsia and anaemia.Methods: It is a retrospective study conducted in a tertiary care hospital at GMH, SVMC, Tirupathi over a period of 1 year. 1325 teenage pregnant women were included in the study out of 12992 pregnant women admitted for delivery during the study period. Results: Study showed the incidence of teenage pregnancies as 10.1%. Among these teenage pregnant women 87% had anemia, 21.6% had gestational hypertension, 7% had eclampsia, 6% had intrauterine death and malpresentations were noted in 4%. Intrapartum complications noted in the study are preterm labor (41.9%), cephalopelvic disproportion(25.8%), fetal distress(22.4%) and obstructed labor(0.3%). 52 cases were complicated with postpartum hemorrhage, 2 with puerperal sepsis and 6 with retained placenta. 2 cases of maternal deaths occurred due to antepartum eclampsia and pulmonary edema. LSCS rate was 27%, 65.9% had normal vaginal deliveries and 11.9% had instrumental deliveries. Among the total births 57.8% were low birth weight.Conclusions: Teenage pregnancy is associated with increased incidence of anemia, pre-eclampsia, eclampsia, preterm delivery, instrumental delivery, low birth weight and perinatal death. The healthcare provider should consider teenage pregnancy as high risk pregnancy and should emphasise for more number of antenatal visits to identify the risk as early as possible.

Study of transcerebellar diameter to abdominal circumference ratio in prediction of foetal growth restriction in high risk pregnancies

Background: The high incidence of IUGR and its low recognition lead to increasing perinatal morbidity and mortality for which prediction of IUGR with timely management decisions is of paramount importance. Many studies have compared the efficacy of several gestational age independent parameters and found that TCD/AC is a better predictor of asymmetric IUGR. Aims: To study the trans cerebellar diameter / abdominal circumference ratio values in clinically suspected FGR and high-risk cases of pregnant women after 28 weeks. Materials and methods: A prospective study consisting of 100 antenatal women was conducted in pregnant women with clinically suspected FGR and high risk pregnancies after 28 weeks. Results: The most common gestational age group taken for evaluation of TCD/AC ratio was in between 30-36 weeks. Preeclampsia is the major predisposing factor of FGR i.e. 46%, and 30 % of cases were under unknown cause. The mean TCD/AC ratio in FGR cases is 17 .33 +/- 0.23. The cut-off value of TCD/AC ratio was 15.77. TCD/AC ratio has 98% positive predictive value when compared to FL/AC and HC/AC. LSCS rate is high in FGR cases (58 %).

Comparision of intra cervical PGE2 gel and transcervical Foley’s catheter for pre-induction cervical ripening

Introduction: Induction of labour is a common obstetric intervention, occurring in approximately 25% of term pregnancies in developing countries. Pharmacological and mechanical methods commonly used are prostaglandin preparations (PGE1 and PGE2) and various intracervical catheters (single or double balloon), respectively. Material and methods: Study was conducted in Siliguri District Hospital, Siliguri, Darjeeling, west Bengal. 100 antenatal woman admitted in obstetrics ward with pog more than 37 weeks were taken for study after applying inclusion and exclusion criteria. 50 were induced with cerviprime gel and 50 with intracervical foley catheter. Statistical analysis done. Results: Mean interval between treatment initiation and delivery was not statistically significant, tachysystole was more common in group B women, rate of LSCS and NVD was similar in both groups. Conclusion: It can be concluded from the present study that Foley’s catheter (mechanical) and prostaglandin E2 gel [pharmacological] both are effective agents for preinduction cervical ripening which substantially improve the bishops score and increase the chances of successful labour induction. There is no significant difference in their efficacy, mode of delivery and perinatal outcome.

The Impact of the COVID‐19 Lockdown on Obstetrics Practice at a Rural Based Tertiary Care Centre: An Analytical Crossectional Study

Objective: To evaluate the impact of the COVID‐19 lockdown on obstetrics practise in a tertiary care centre. Methods: Analytical Crossectional observational study was conducted in the obsgyn department from Jan 2020 to June 2020.There were two groups pre lockdown (Group B) and post lockdown (Group A) of 180 women in each group. Results were analysed using Epi info software version 7. Results: There was significant (p < 0.001) rise in LSCS rates (80%) in post lockdown period as compared to prelockdown (50%). Emergency LSCS (87.5%) was seen more during pandemics as compared to elective LSCS (12.5%). Elective LSCS was seen more prior to lockdown. The gestational age during admission in lockdown was more in <37 weeks gestation group with complications or >40 weeks. Significant rise (p< 0.001) in IUD (13.3%), NICU admissions (23.3%) were noted during lockdown as compared to prelockdown (6.6%), (10%). Hospital stay was reduced from 4 days to 3 days during the lockdown. Conclusion: Lockdown affects obstetrics outcome adversely. There is an urgent need to sensitize antenatal women as well as health care workers to continue the routine obstetrics care, especially in the second half of pregnancy with covid appropriate behaviour.

A cross-sectional study on factors influencing caesarean section rates in a tertiary care hospital, Jhansi (Uttar Pradesh)

Background: Worldwide rise in caesarean delivery (CD) rates during the last three decades has been a cause of alarm. The rates of such delivery have increased dramatically in recent years from 12% in 1990 to 24% in 2008. Tertiary care centers have high caesarean section rates but areas where health care facilities are not available may have maternal deaths due to lack of C-section facilities. The present study was conducted to determine the prevalence of caesarean section, to assess the association between caesarean section with socio-demographic determinants and maternal risk factors.Methods: Cross-sectional study was conducted during January 2016 to April 2016. A total of 288 pregnant females admitted in obstetric ward of medical college Jhansi formed the study population, a simple random sampling technique was adopted for the study. A study tool was pre-designed and pre-tested interview schedule. The data collected was entered in MS excel and analyzed using SPSS 24 version.Results: The study showed that 73 (25.34%) of our study participants have delivered by caesarean section. Caesarean section was significantly associated with literacy, place of residence, education status, socio-economic status and occupation of the husband. Caesarean section was significantly associated with maternal risk factors like obesity, pregnancy induced hypertension, gestational diabetes mellitus and polyhydromnios.Conclusions: Present study found a high caesarean section rate as compared to the WHO standard. Utilization of antenatal care, better doctor patient communication, doctor’s commitment to reduce the rate of LSCS, may help to reduce the increasing rate of caesarean delivery.

RISK FACTORS AND PREGNANCY OUTCOME OF ABRUPTIO PLACENTA: A RETROSPECTIVE STUDY

Background: Abruptio placenta is the most common cause of antepartum haemorrhage which is defined as separation of normally situated placenta after 20 weeks of gestation and before birth of fetus. Obstetrical haemorrhage accounts for almost half of all postpartum deaths in developing countries. Aim of study was to determine maternal and fetal outcome in pregnancy complicated by abruption.
 Methods: This was a retrospective study conducted at Gopinath maternity home, Sir T. Hospital, Bhavnagar. From MAY 2020 –APRIL 2021.all pregnant women came to labour room with diagnosis of abruptio placenta were included.
 Results: Total patients of abruption Identified Are 33 out of 2683 deliveries giving incidence of 1.1% In this study. Most of them are found at 26-35 years of age with 33-36 weeks of gestation. It is associated with multiparity in 57.5%. Vaginal bleeding is the most common presenting complain followed by absent fetal movement. 72.7% cases had association with preeclampsia. There is higher LSCS rates (61%) as compared to vaginal deliveries (39%). Most common complication found is DIC (30.3%) and next common is ARF (24.2%). case fatality rate of 6.06%. In our study 60.6% still birth and 39.3% live birth. Many of them required NICU admission.
 Conclusion: Abruption is continued to be responsible cause of maternal and foetal adverse outcome. early detection and proper management prevents morbidity associated with it. Combined care is required for it.
 Keywords: Abruptio placenta, risk factors, feto-maternal outcome.

Evaluation of Perinatal Outcome in Women with Impaired Glucose Homeostasis During Pregnancy

Background: Glucose tolerance testing in pregnancy identifies many women with glycaemic responses that exceed normal range but that do not meet the threshold required to diagnose Gestational Diabetes Mellitus. It is controversial whether maternal hyperglycemia less severe than in diabetes is associated with increased risk of adverse pregnancy outcome or not. Materials and methods: All women were subjected to Glucose Challenge Test(GCT) with 50 gram glucose either at first visit or between 24-28 weeks on the basis of risk profile. High risk cases were screened at first visit and the rest between 24-28 weeks. Patients with a GCT value ≥200mg/dl were not subjected for GTT and were diagnosed as GDM.Value of GCT <140 mg/dl was taken as normal. Irrespective of GCT result, women were subjected to Oral Glucose Tolerance Test (OGTT) as recommended by WHO with 75 gram glucose using WHO criteria. Study group was identified with 4 categories with abnormal glucose homoeostasis as defined by the following criteria: 1. Abnormal GCT (>140 mg/dl) with normal OGTT; 2. Normal GCT with only Impaired Fasting Glucose(IFG) in OGTT; 3. Normal GCT with Gestational Glucose Intolerance(GGI); 4. Patients diagnosed as GDM: a. If fasting is >126mg/dl; b. If 2hr OGTT ≥ 140mg/dl & ≤ 199 mg/dl; c. If value of either GCT or OGTT >200 mg/dl. The control group comprised of women with normal GCT and normal OGTT. In all the above groups, adverse prenatal outcome and maternal outcomes were evaluated by the primary and secondary outcome measures. Results: There were 10 cases (15.3%) of hypertensive disorder of pregnancy in the study group (3 cases of gestational hypertension in abnormal GCT, 3 cases of pre eclampsia in each GGI and GDM and 1 antepartum eclampsia in GGI category) and 2 cases in control group (3%) (p=0.03). There were 2 cases of Fetal Growth Reduction (FGR) and 5 cases of Premature Rupture Of Membranes(PROM) in both study and control group. There was 1 case of cholestasis of pregnancy in study group. Term inductions were 11 and 13 in the study and control group respectively.Within the study group number of cases induced were more in GGI(n=7) and GDM(n=4) category. There were 14 caesarean sections (21.5%) and 2 (3%) instrumental deliveries among the study group. However there were 6 caesarean sections (9.2%) and no instrumental deliveries among control groups. The rate of elective LSCS is more in GDM (n=5) vs other 3 categories and the difference is significant (p=0.04) The overall number of LSCS (14 cases) was significantly higher in GDM. Conclusion: Cases with abnormal glucose homeostasis of lesser degree than GDM, like only abnormal GCT, IFG and GGI also were observed to have adverse maternal outcomes than controls, in form of hypertensive disorders of pregnancy, significantly higher LSCS rates, and increased risk of macrosomia. Instead of 2 step procedure, single step screening cum diagnostic test with 75 gm OGTT for diagnosing GDM could be an option to be universally practiced.

A PROSPECTIVE AND OBSERVATIONAL STUDY ON FETOMATERNAL OUTCOME IN POSTDATED PREGNANCY

Background: Postdated pregnancy is gestation longer than 40 weeks or 280 day. Prolonged pregnancy is defined as any pregnancy that last 294 days or more. Reported frequency of post term pregnancy range from 3 - 1 4 percent with an average of about 10 percent. Several studies have concluded that these pregnancies are accompanied by a rise in perinatal morbidity and mortality. The presumed etiology for this rise is placental insufficiency. Abnormalities such as congenital anomalies, oligohydramnios, meconium aspiration, fetal asphyxia, fetal dysmaturity, macrosomia and shoulder dystocia are commonly observed in these pregnancies
 Materials and Methods: This study was conducted in the Department of Obstetrics and Gynecology, after approval from the Ethics Committee, from January 2019 to September2020 on 150 patients in the department of Obstetrics and Gynaecology, willing to participate and fulfilling the inclusion and excliusion criteria in the study period.
 Results: Of the total 150 women, 122 (81.34%) were in 40 weeks group; 28 (18.66%) in 41 weeks group and 0 (0%) were in > 42 weeks group. Most women (89.3%) were between 20-35 years of age. Among 150 women, 40 (26.6%) went into spontaneous labor, 87(8.0%) were induced andn23 (15.34%) was taken for caesarian section. Misoprostol, Dinoprostone gel and oxytocin were the different modes of induction (Table 7). Misoprostol was used in the majority of inductions followed by Dinoprostone gel. The success rate between these two is almost similar (92.45% & 95.1%).Lscs rate was 15.33%.Most of the newborn had weight between 2.5-3.5kg in 68.25% of women in gestational age >40 weeks.
 Conclusions: The present study, we conclude that postdated pregnancy can be considered as a high risk factor from the point of fetal outcome as there is more fetal morbidity.
 Keywords: High risk pregnancies, maternal mortality, Outcomes, Perinatal mortality, postdated pregnancy.

A RETROSPECTIVE STUDY ON EVALUATION OF CAESAREAN SECTION RATE USING THE ROBSON’S 10 GROUP CLASSIFICATION IN SARDAR PATEL MEDICAL COLLEGE, BIKANER

Introduction : Despite the lack of scientific evidence indicating any substantial maternal and perinatal benefits from increasing caesarean section rates, most of the studies are showing that higher rates could be linked to negative consequences in maternal and child health, still caesarean rates continues to increase worldwide, particularly in middle and high income countries, and have become a major and controversial public health concern. Therefore, we conducted this study to analyse the LSCS rate in the institute, to classify the indications of LSCS as per RTGCS and to find out strategy to decrease the prevalence of lower segment caesarean section.
 Material & Methods : This is a retrospective hospital based study at tertiary care centre. Data collection of one thousand pregnant females who delivered by caesarean section from the period of January 2018 onwards was assessed for the study. There are six parameters as per Robson’s classification to classify all pregnant females for caesarean section. Entire information was entered in Microsoft excel sheet and analysis were done to decrease caesarean section rate.
 Results : In the present study, a total of 1000 pregnant women delivered by caesarean section was taken from January 2018 onwards. The total number of deliveries during this study period was 2919 and the overall caesarean section rate was 34.25%. Most of the patients belonged to Robson’s group 1,2&5 which contributed to 65.6% to total.
 Conclusion : The overall CSR in the study is 34.25% which is high as compared to international studies, contribution of repeat CS is high. It is important that efforts to reduce the overall CS rate should focus on reducing the primary CS rate. More analytical studies based on Robson’s 10-group classification system are needed locally, to evaluate the indications of CS within each group.

Study of surgical site infection (SSI) in patients undergoing caesarean section (CS): A retrospective study

Background: Cesarean section (C-section) is one of the most commonly performed surgery in modern obstetrics. Due to this the worldwide continuous rise in the incidence of cesarean sections, the number of women with postpartum infection is expected to increase. Postpartum infections are a major cause of prolonged hospital stay and increase burden to our health care system. The objective of this study was to determine the incidence and risk factor for the of Surgical site infections (SSI).Methods: A Retrospective analytical study was conducted at Smt. Kashibai Navale medical college and general hospital, Pune. 1269 Patients undergoing LSCS from January 2017 to December 2017 were included after satisfying inclusion and exclusion criteria were included in the study.Results: Out of 1269 LSCS patient, 56(4.4%) of them had SSI, which represents the incidence rate of SSI post LSCS in our study. Anemia and previous caesarean were important risk factor for SSI in our study. Prolonged surgery was found to be statistically significant etiological factor in the study. MRSA (37.5%) was the commonest pathogen to produce SSI in our series, followed by sterile culture in 21% cases.Conclusion: Surgical site infection (SSI) following cesarean delivery was noted in 4.4% patients and it is a major cause of burden of disease both for the patients and the healthcare system in terms of the morbidity, and economic costs. Multidisciplinary team approach has proven effective for decreasing the incidence to minimal level. Reduction in incidence of SSI may be achieved by use of peri operative antibiotics, correction of anemia, use of proper surgical techniques and minimizing the duration of surgery.Pre-operative and post LSCS antibiotic policy should depend on types of bacteria isolated by culture and there resistance mechanism. This may effectively contribute in decreasing SSI after LSCS.

Comparison of active management of labour versus “traditional” approach

Background: Management of spontaneous labour is an important issue. Dystocia accounts for increased rate of LSCS. Prolonged labours are associated with higher maternal and neonatal morbidity. With active management, these complications could be reduced. Aims: To study outcome of labour, maternal & perinatal morbidity and mortality with active management of labour. Methods:100 primigravidas, at term were randomly assigned to 2 groups-study group-active management (N = 50) and control group (n=50). Women in active group were managed by early amniotomy and augmentation with Oxytocin at 6mIU/ml. In the control group, women received conservative care, amniotomy after 6cm dilatation and oxytocin at 1mIU/ml. In both groups labour was monitored using modified WHO partogram. Caesarean was done for standard obstetric indications. Results-In active management caesarean rate was 12 percent, as compared with 18 percent in control. Mean length of labour in study group was 5.6 hrs as compared to 7.1 in control group. The 6 percent reduction in the caesarean section rate was primarily due to a decrease in incidence of dystocia. With active management, the average length of labour was shortened by 1.5 hours, because of early amniotomy and oxytocin. No statistical difference was seen in both groups as regards to mortality and morbidity. Conclusions: Active management of labour reduces the incidence of dystocia, decreases duration of labour and increases the rate of vaginal delivery without increasing maternal or neonatal morbidity.