Unbooked Cases Research Articles

Trends in Maternal Mortality in a Tertiary Care Hospital of Khyber Pakhtunkhwa

Background: Maternal mortality is an extremely devastating event for family, surviving children, hospital staff and community. Aim: To analyse the rate, demography, causes and timing of maternal deaths in a tertiary care hospital of Mardan. Methodology: This retrospective study was conducted in Gynaecology Department, Mardan Medical Complex, Mardan from January 2016 to December 2020. All patients received in the study period were included and counted and causative factors of maternal deaths were recorded. A predesigned proforma was used for collection of data from the medical records. SPSS 23.0 was employed for data analysis. Results: MMR of 657.7/100,000 live births was recorded. Most of the deaths (50%) were in 21-30 years age group, followed by 31-40 years age group (26%).34(39%) patients were multigravidas,27(31%) were primigravidas and 26(30%) were grand multigravidas.72(82.7%) were booked and 15(17%) were unbooked cases. Haemmorhage was responsible for 39(45%) maternal deaths, Hypertensive disorders ±HELLP caused 21(24%), Sepsis and thromboembolism caused 7(8%) each, cardiac diseases 5(5.7%), anesthesia complicated 3(3.4%), Anaphylaxis and hepatic encephalopathy lead to 2(2.2%) each, and epilepsy caused 1 maternal death. Most (44%) maternal deaths occurred in 6-12 hours of admission. Conclusion: The common causes of maternal mortality are haemmorhage, hypertensive disorders, sepsis and thromboembolism. Improvement of the maternity units in tertiary care facilitiesis need of the day and awareness of the general population is strongly favored to reduce or prevent maternal mortalities. Keywords: Maternal Mortality, Eclampsia, Postpartum Haemmorhage, Hypertension, Thromboembolism, Sepsis.

To study the incidence of rheumatic heart disease and congenital heart disease with pregnancy

The aim of the study is to study the incidence of rheumatic heart disease and congenital heart disease with pregnancy. Patients with heart Diseases either booked or unbooked cases who were admitted in OBGY during study period, were recruited. The booked cases were seen by obstetrician in outpatient department and by cardiologist in the respective O.P.D.to check their cardiac status. Maximum no. of cases were in age group 21-25 yrs. Followed by equal no. of cases in age group <20 yrs. and 26-30 yrs. 30 cases, 30(90%) cases were suffering from rheumatic heart disease while only 03 (10%) cases had congenital heart disease. The distribution of cases according to period of gestation in weeks. The maximum no. 14 (46.6%) of cases had come with the pregnancy of 33-40 weeks. Only 01 cases were postmature. 23.3% of cases delivered spontaneously. L.S.C.S. done in 16.6%. ventouse applied in 03 cases & forceps in 1 case. Premature deliveries in 20% cases. We conclude an incidence of 0.2%. Mostly cases were rheumatic heart disease (90%). Out of which 32% had mitral stenosis as commonest lesion. 8.9% cases were of congenital heart disease. Maximum cases 4.3% were between age group 21-25 but mostly belong to low risk category. 23.3% cases had spontaneous vaginal delivery. LSCS was done only in 16.6% cases, with mostly because of obstetrics and foetal causes.Pre-conception counseling should be offered to all women with heart disease with the aim of avoiding risks and helping them to plan their future.

Preterm Labour Pain & Its Outcome in 50 pts attending at a Tertiary Care Hospital-ICMH

Introduction: Preterm labor is the leading cause of neonatal morbidity all over the world. Over the past two decades despite major preventive efforts, the incidence of preterm birth has remained constant at about 5-10% of live births. The etiology is often multifactorial and poorly understood. Currently preterm labour is one of the most challenging problems confronting the obstetricians and perinatologists. With this background the present study was done to find out perinatal outcome in women presenting with preterm labour. Aims To study the fetal and maternal outcome in preterm labor cases. Materials and Methods: It was Prospective, single centered, observational study. A total of 50 women with preterm labor in the study period i.e. from June 2019 to May 2020 were included for the study sample. This study carried out at the department of Obstetrics and Gynecology, Institute of Child and Mother Health (ICMH), Matuail, Dhaka, Bangladesh. The data were collected personally through a structural questionnaire. Results: Out of 50 subjects, majority of mothers 32(64%) were in age group of 21-30 years followed by 12(24%) in age group of 20 years. Majority 26(52%) of study subjects were primigravida followed by 24(48%) multigravida. Majority 32(64%) of study subjects were in lower class followed by 15 (30%) cases in middle class, 3(6.0%) cases in affluent class. Maximum 31 (62%) cases were unbooked cases and rest 19 (38%) cases were booked. Out of 50 babies who were <2500 grams, maximum 29 (58.0%) were low birth weight followed by 11(22%) being VLBW babies. 5 cases were >2.5 kgs, which are not LBW babies according to WHO Classification of low birth weight. Majority 17 (47.2%) stayed for 1-10 days followed by 9 (25.0%) babies for 11-20 days. Also 7 (19.4%) babies stayed for 21-30 days. Conclusions: Preterm infants are at high risk of overall morbidity and mortality. Clinical suspicion, early detection and correction of risk factors, institutional delivery and good neonatal care back up facilities can improve the outcome of preterm labour and decrease the maternal complications as well. Medicine Today 2023 Vol.35 (2): 73-77

To study the correlation between severe oligohydramnios with perinatal outcome along with histopathology of placenta

The aim: To study the correlation between severe oligohydramnios with perinatal outcome and the placenta's histopathology.
 Materials and methods: comprised of 100 patients with oligohydramnios diagnosed after 28 weeks of gestation, admitted on an emergency basis, both booked / unbooked, who were willing to cooperate, were chosen. All patients with oligohydramnios (AFI<5 %) were included in the study.
 Results: 3 cases came with intra-uterine death. All three were totally unbooked cases. 2 preterm babies died neonatal intensive care unit after 4 days due to meconium aspiration syndrome. Thus the perinatal mortality was 5 %. 44 % of neonates required admission into the neonatal intensive care unit. In our study, it was found that neonatal mortality and morbidity increased significantly when oligohydramnios was associated with complications like IUGR and pregnancy-induced hypertension in mothers. All the cases associated with these histopathological changes had adverse perinatal outcomes. Hence estimation of the amount of liquor is important in the antenatal period because oligohydramnios gives insight into the associated maternal complications or fetal anomalies and has a significant bearing on the perinatal outcome. The placental examination will illuminate all the conditions affecting the perinatal outcome. Without associated complications, oligohydramnios does not have adverse perinatal outcomes.
 Conclusions: Thus, in cases of oligohydramnios with no associated complications, expectant management can be tried for a better fetal outcome. Only oligohydramnios may be the first sign of placental insufficiency and an independent manifestation of the placental-related complications spectrum.

Maternal Complications and Perinatal Outcome in The Booked and Unbooked Cases of Pregnancy at Manipal Teaching Hospital

Introduction: The use of prenatal care prevents maternal complications and perinatal adverse outcomes by early identification of high risk pregnancies, assessment of growth and well being of the fetus, prompt diagnosis and management of complications, with safe delivery.
 Objectives: This study aims at comparing the obstetrical complications and perinatal outcomes in delivered booked and unbooked mothers to determine the correlation of booking status and maternal and perinatal outcome.
 Methodology: In this prospective study, 350 patients admitted for delivery at Manipal Teaching Hospital, Pokhara during March 2014 to May 2015 were included. Antenatal complications of the mothers, postnatal complications, neonatal outcome and the mode of delivery were compared amongst the booked and unbooked cases.
 Results: There was an increased prevalence of preeclampsia (6.3% in unbooked vs. 1.6% in booked); eclampsia (2.5% in unbooked vs. nil in booked); antepartum haemorrhage (5.06% in unbooked vs. 2.1% in booked); Preterm premature rupture of membrane (5.1% in unbooked vs. 2.1% in booked); Rh-isoimmunization (06% in unbooked vs. nil in booked); Intrauterine growth restriction (5.7% in unbooked vs. 3.6% in booked ); and Intrauterine fetal death (7.6% in unbooked vs. 0.5% in booked) in unbooked mothers as compared to booked mothers. The unbooked mothers were prone to postpartum hemorrhage (6.9% vs 2.6% in booked mothers). Assisted breech delivery and ventouse delivery were recorded higher in unbooked cases than in booked case (3.2% vs. 0.5% and 3.8% vs. 3.1% respectively).
 Conclusion: The poorer maternal and fetal outcome in unbooked cases in comparison to booked cases can be reduced with the best utilization of the prenatal care.

A Study of Maternal Outcome of Booked and Unbooked Cases

Background: The provision of antenatal services is a matter of great importance because it not only enables women to receive appropriate healthcare, but it also ensures that any issues that may arise during childbirth are detected and managed effectively through timely consultations with specialists. Aim: The aim is to ascertain how often booked cases appear during childbirth and to contrast the outcomes for mothers in the local population who have pre-booked appointments with those who have not. Methods: A observational study was carried out for six months at Indus Medical Collage Tando Muhammad Khan, Pakistan. Non-probability consecutive sampling was used to select participants. Participants were asked to provide informed consent and were asked about their demographic information and obstetric history. The cases were classified as either "booked" or "un-booked" based on an operational definition, and their maternal outcomes were recorded in relation to delivery. Results: Pre-eclampsia, out of a total of 180 participants, 42 (23.33%) were diagnosed with the condition. Of those 42 cases, 18 occurred in the booked group and 24 in the unbooked group. preeclampsia, 8.33% of unbooked women from low SES groups had preeclampsia, compared to only 5.0% of unbooked women from middle SES groups (p-value = 0.003). Similarly, for preterm birth, 10.55% of unbooked women from low SES groups had preterm births, compared to only 2.77% of unbooked women from middle SES groups (p-value < 0.0001). Conclusion: The findings of our research indicated that most individuals who encountered unfavorable maternal consequences, such as surgical delivery, gestational hypertension, and premature delivery, belonged to the unregistered category. Conversely, the registered group demonstrated significantly lower occurrences of these complexities. Keywords: booked and unbooked, pregnancy complications, Preeclampsia, maternal outcome

Frequency of gestational diabetes mellitus & its responsible factors among pregnant women presenting at a tertiary care hospital, Karachi

Controlling the related factors implicated in the development of GDM may help to mitigate the sharp rise in the prevalence of GDM and its detrimental effects on maternal and newborn problems. Maternal age (over 30 years), prior history of gestational diabetes, increased BMI, family history of diabetes, parity, belonging to an ethnic group with a high correlation with GDM and prior birth of a large baby are the key related factors of GDM. Aim: The main goal is to determine the frequency of gestational diabetes mellitus among pregnant women and its causing factors. Place and Duration: This Descriptive, cross-sectional study was held in Department of Gynecology, Liaquat National Hospital, Karachi from 16th January 2017 to 15th July 2017. Methods: 250 pregnant women with gestational diabetes mellitus between the 18-45 years of age were included. Multiple gestations, unbooked cases, and cases of known DM were not included. Development of gestational diabetes is the primary outcome factor which was determined. Maternal age, parity, gestational age, grand multiparity, BMI (for obesity), prior GDM, prior experience of macrosomic infant, family history of DM & PCOS are additional study variables (responsible factors).

Audit of Maternal Near Miss Cases in A Tertiary Care Hospital of Mardan

Aim: To determine the frequency and causes of maternal near miss events at a tertiary care hospital of Mardan. Methodology: This descriptive cross sectional study was conducted at Gynaecology department of Mardan Medical Complex from January 2018 to December 2019.Cases of maternal near miss events were collected from the records of women who met the WHO criteria for near miss. All the data was entered into structured proforma and analysis done. Results: Total near miss cases were 215 and totallive births were 9,228. The near miss rate was 23/1000 and maternal near miss to maternal mortality ratio was 3.7:1.Mean age was 26±3.2 years.Age group of 21-30 years was the high risk group with 112(52%) cases, followed by 31-40 years age group with 81(38%) cases. 89(41%) patients were multigravidas and 77(36%) were grand multi gravidas. Gestational age of more than 28 was seen in 146(68%) women and less than 28 weeks in 17(8%) whereas 52(24%) were postnatal.184(86%) were unbooked cases. Regarding the causes of near miss events, haemmorhage was seen in 96(45%), hypertension in 53(24.6%), Sepsis in 26(12%), cardiac disease in 10(4.6%), anaphylactic shock in 8(4%), anesthetic complications in 6(3%), epilepsy and hepatic encephalopathy in 4(2%) each and 8(4%) were due to indirect causes. Conclusion: Near miss cases have many similarities with maternal deaths and give us knowledge about the issues that need to be solved in order to reduce the grave situations where a maternal death can be prevented. Keywords: Near miss, Mortality, Morbidity, Haemmorhage, Hepatic Encephalopathy, Sepsis

Comparison of Fetomaternal Complications in Women of High Parity with Women of Low Parity among Saudi Women.

High parity is associated with the risk of fetomaternal complications such as gestational diabetes mellitus, hypertensive disorders, maternal anemia, preterm labor, miscarriage, postpartum hemorrhage, and perinatal and preterm mortality. The objective of the study was to compare fetomaternal complications in women of high parity with women of low parity. This involved a cohort study on a sample size of 500 women who had singleton births. Data were collected from the Maternity and Child Hospital, Ha'il, Kingdom of Saudi Arabia. Participants were classified into two groups according to parity, i.e., women of low parity and women of high parity. Socio-demographic data and pregnancy complications, such as gestational diabetes, hypertension, preeclampsia, intrauterine growth restriction, etc., were retrieved from participants' files. Participants were followed in the postnatal ward until their discharge. The results revealed that women of high parity mostly (49%) were married before 20 years of age, less educated, obese, and were of un-booked cases. Premature babies and fetal mortality are significantly high (0.000) in this group. There is a significant difference between the two groups with respect to maternal anemia, gestational diabetes mellitus, joint pain, perineal tear, miscarriage, postpartum hemorrhage, preeclampsia, vaginal tear, and cesarean section. Determinants responsible for high parity should be identified via evidence-based medicine. Public health education programs targeting couples, weight control, nutrition, and contraception would be a cost-effective strategy for reducing the risk of possible fetomaternal complications.

Risk Factors, Indications and Outcome of Emergency Obstetric Hysterectomy: A study performed at Tertiary Care Hospital

Background: Emergency obstetric hysterectomy is the life-saving surgical intervention when all other available measures are unable to control obstetric hemorrhage. In addition to the known indications and risk factors for globally increasing this near miss event, home deliveries by untrained birth attendants is irrefutable cause of obstetric morbidity and mortality Aim: To identify the risk factors and indications for EOH like Pakistan. Study design: Retrospective descriptive study. Settings: OB/GYN department of Lahore General Hospital, PGMI. Duration: Two years, from start of 2020 to the end of 2021. Methodology: All patients having emergency obstetric hysterectomy in Gynae Unit 3, were included in this study. Risk factors and indications for the procedure were recorded. Outcome in the form of morbidity and mortality was reviewed. Results: Out of total 6809 deliveries, 48 patients had EOH and majority were multiparous with age ranging from 20 to 35 years. Complicated home deliveries ending in EOH were 8.32% of the cases. Two third of the patients had one or more previous caesarean sections and 70.8% underwent Caesarean section in the index pregnancy. Most of the women, 81.25%, were un-booked cases. Most common indication for EOH (50%) in our study was uterine atony and 45.81% of the cases had morbidly adherent placenta. Conclusion: Rising trend of caesarian sections leading to placental issues, lack of proper antenatal care and deliveries at inappropriate places are the contributing factors in morbidity and mortality associated with EOH. Keywords: Uterine atony, morbidly adherent placenta, emergency obstetric hysterectomy.

A Five Year Study on Maternal Mortality in The Maternity Ward of Government General Hospital, Siddhartha Medical College, Vijayawada

Introduction: Maternal health is important for the development of any country in terms of increasing equity and reducing poverty and is important in their own right and is central to solving economic, social and developmental challenges. Hence, maternal mortality is the key indicator of health and socio economic status and development of a community and the whole national system. Aim: To study the factors responsible for maternal mortality and to analyse the causes and trends in maternal mortality. Materials and Methods: A retrospective study on maternal deaths that occurred in the maternity ward of Government General Hospital, Siddhartha Medical College, Vijayawada during the period of five years from January 2017 to December 2021. Covid related deaths excluded. Results: Total 137 maternal deaths occurred during the study period. 121 maternal deaths (88.32%) were unbooked cases, 16 (11.67%) were booked cases. 58 women (42.33%) were primiparous, 76 (55.47%) were multiparous and 3 (2.18%) were grand multiparous. 76 women (55.47%) were of 20-24 years age, 38 women (27.73%)were of 25-29 years age. Maternal deaths due to direct causes were 89 (65.92%) and due to indirect causes were 47 (34.07%). Hypertensive disorders complicating pregnancy was the leading cause of death followed by hemorrhage in pregnancy. 105 (76.64%) maternal deaths occurred after delivery, 14 deaths (10.21%) during 3rd trimester of gestation. Type 1 delay (20.74%), type 2 delay (57.7%) type 3 (21.48%) delays contributed to the maternal deaths. Conclusion: Health education regarding adolescent health, pregnancy, abortion and contraception. Regular antenatal checkup, early identification of risk factors, awareness, timely intervention and referral to higher institute, proper intra natal and post natal care, multispecial team management in high risk cases are needed to reduce the maternal mortality.

To study the role of serum lactate dehydrogenase in prediction of adverse outcomes of pre-eclampsia and eclampsia

The present study was carried out in the Department of Obstetrics and Gynaecology, with an aim to study the role of Serum Lactate Dehydrogenase in prediction of adverse outcomes of pre-eclampsia and eclampsia. The patients were selected from patients who were admitted to as emergency cases in labour room patients were irrespective of age and parity. On a specially designed proforma for this study, the patient particulars like detailed obstetric history, examination and laboratory findings were studied.Among the cases studied 76% preeclampsia and 96% eclampsia patient were unbooked case and most of them resided in rural areas while the remaining were from urban slums. Hyperbilirubinemia was seen in small groups of pre-eclampsia and eclampsia patients. Deranged level of liver enzyme were also found in small group of pre-eclampsia and eclampsia patients. LDH level was found significant higher (more than 600 IU/L) in pre-eclampsia and eclampsia patients. Eclampsia is associated with significant maternal and perinatal morbidity and mortality. The higher mortality is due to high percentage of the patient being unbooked and majority received no therapeutic intervention until admission. Among the cases studied 76% preeclampsia and 96% eclampsia patient were unbooked case and most of them resided in rural areas while the remaining were from urban slums. Hyperbilirubinemia was seen in small groups of pre-eclampsia and eclampsia patients. Deranged level of liver enzyme were also found in small group of pre-eclampsia and eclampsia patients. LDH level was found significant higher (more than 600 IU/L) in pre-eclampsia and eclampsia patients.

An outcome of acute kidney injury during pregnancy: An observation and prospective study from tertiary care hospital

To study the management and outcome of Pregnancy-related Acute Kidney Injury (PRAKI) in obstetrics. This observational and prospective study was conducted in 9270 deliveries including 79 cases of AKI in pregnancy at a tertiary medical college and hospital for the duration of one year. All pregnant and postpartum women attending out patient department (OPD) and emergency as booked and unbooked cases were included in our study. A detailed analysis of all investigations, management and outcome were recorded. Diagnostic criteria of AKI include (a) sudden in onset oliguria (24hrs urine output <400 ml) or anuria (b) serum creatinine level >1.5mg/dl. In the present study the creatinine values during admission or during diagnosis ranged between 1.5 to 18.2 mg/dl with a mean of 4.53±3.24 mg/dl. Majority (51.9%) of the patients have values less than 4 mg/dl. Out of 79 cases, 38 patients required hemodialysis that comes up to 48.1%. Most of the sepsis patients (17 out of 32) required hemodialysis. Case fatality rate due to AKI was 16.46% in our study. Sepsis was responsible for more maternal death, 15.6% in this study. Total 59 patients (74.68%) were discharged in stable conditions.

Still Birth classification: Application of Relevant Condition at Death (ReCoDe) classification system in a tertiary care hospital of Pakistan.

ABSTRACTObjectives:To determine the cause of stillbirth after application of relevant condition at death (ReCoDe) classification system.Methods:This was a retrospective cross sectional study of 207 women diagnosed with stillbirth after 24 completed weeks of pregnancy at the Aga Khan University Hospital (AKUH), Karachi between 1st January 2015 and 31st December 2019. The primary objective was to find the cause of stillbirth according to the new classification of relevant condition at death (ReCoDe).Results:There were a total of 32413 live births and 207 stillbirths during the study period thus stillbirth rate of 6 per 1000 live births. In this study, 80% of women were in the age group of 20-35 years, 16% had advanced maternal age while 3.8% of women accounted for less than 20 years. Among the maternal factors; 54.5% cases were booked and the remaining were were un-booked cases. Pre-eclampsia was the most common associated maternal condition (14.9%).Fetal cause accounted for 34.7% of stillbirths and the fetal growth restriction (FGR) was the most common; 23.6%. After application of ReCoDe classification, in 81% of stillbirth cases associated condition were found and only 18.8% of cases were categorized unexplained.Conclusion:Application of ReCoDe classification is easy to understand and applicable, especially in low resource settings with associated causes identified in vast majority of cases.

ASSESSMENT OF NEONATAL OUTCOME IN BOOKED AND UNBOOKED PREGNANCY CASES IN A TERTIARY CARE CENTRE

Majority of neonatal deaths occurs in low and middle income countries indicating poor quality of health services provided by the government of the respective countries.In a developing country like India , a high morbidity and mortality serves as an sensitive indicator reecting the poor maternal and child health care services of the country.Most of the neonatal deaths can be attributed to avoidable factors which can be minimized by the effective utilization of antenatal services , early detection of high risk pregnancy and timely referral of these cases.The current study was conducted to determine the neonatal outcomes in booked and unbooked pregnancy cases in the tertiary care centre ,Assam Medical College and Hospital, Dibrugarh. METHODS: Close ended structured questionnaires were used to collect information from the parents (150 booked and 150 unbooked).Neonatal outcomes were categorised under groups of term and preterm ,live birth and stillbirts, birthweight, Gestational age, iugr, large for gestational age APGAR score ,NICU admissions and clinical course during hospital stay,course during rst 28 days of life along with complications,if any are all taken into consideration. RESULTS: During the study period 28.67% had low birth weight in booked cases and 41.33% had low birth weight in unbooked cases.The incidence of stillbirth and early neonatal deaths were 2%,4% respectively in booked cases and 4.67% , 6% respectively in unbooked cases.Higher incidence of MSL,prematurity ,birth asphyxia ,respiratory problems ,birth injuries,congenital malformations,infections and hyperbilirubinemia were seen in unbooked cases. CONCLUSIONS: The inference derived from the study ,showed that availability of antenatal care is directly proportional to the neonatal outcome .Thus unavailbility or lack of proper medical attention during the pregnancy results in unfavourable neonatal outcomes which can be prevented by increasing the range of availability , utilization and effectiveness of maternal and child health services alongwith ensuring booking of all the pregnancy cases in our country.

Maternal and perinatal outcomes of pregnancies complicated by cardiac disease at a tertiary level hospital

Heart disease in pregnancy is one of the leading non-obstetric causes of maternal mortality and is the leading cause of maternal intensive care unit admissions in the world. To study the prevalence of heart disease in antenatal mothers and fetal outcome with obstetric management. The presence of comorbidities and the occurrence of obstetric, fetal, and cardiovascular complications during delivery among women with heart disease hospitalized for delivery were studied in 35 women at GSL Medical College, Rajahmundry for a period of 1 year from 01/01/2019 to 1/1/2020: Over a period of 12 months, 35 subjects were recruited. During this period, there were 5005 deliveries. The majority of women were aged between 20-25yrs and were unbooked cases belonging to NYHA class I or II. Cesarean section and operative vaginal delivery were more common. Despite the multidisciplinary approach, 3 women succumbed to the disease of which one was a case of severe rheumatic heart disease with valve failure, the second was a case of postpartum cardiomyopathy and the third was a case of severe pulmonary arterial hypertension. Fetal outcome in cardiac patients is usually good and only a little different from those patients who do not suffer from heart disease. Pregnant women with heart disease were more likely to experience adverse events during delivery. These women require a multidisciplinary team for optimal maternal and foetal outcomes.

Prevalence, Maternal Outcome, Placental Changes and It’s Correlation with Perinatal Outcome in Unbooked Patient’s of Iron Deficiency Anemia During Third Trimester

Background: Anaemia is the commonest medical disorder in pregnancy and severe anaemia is associated with poor maternal and perinatal outcome. Methods: The study was done to analyse the characteristics of hospitalized pregnant women with severe anaemia (Haemoglobin < 7gms %) at the time of delivery and to find out maternal outcome. It was a prospective study done at saraswathi institute of medical sciences,hapur,U.P, India over a period of one year from February 2019 to January 2020. Results: Results were analysed; out of 3784 deliveries 210 (5.54%) cases were severely anaemic at the time of delivery. Out of 210 women with severe anaemia 184(87.6%) patients belonged to low socioeconomic category, 177 (84.2%) were unbooked cases, 152 (72.4%) cases from rural area and 119 (57.6%) cases were multi gravidas. The maternal complications were Pre-eclampsia and eclampsia (16.1%), intercurrent infections (3%), abruptio placentae (3.3%), heart failure (1.4%), preterm labours (42.8%), intrauterine deaths (10.9%) and postpartum haemorrhage (10.4%). Conclusions: Severe anaemia during pregnancy is associated with maternal and perinatal morbidity and mortality so effective preventive measures in the form of regular antenatal check-ups and iron supplementation will prevent complications of anaemia in pregnant women.

A CLINICAL STUDY OF RISK FACTORS AND MATERNAL OUTCOME IN INTRA-UTERINE FETAL DEATH

Background: The objective of the present study was to examine the etiological factors, both maternal and fetal, that caused IUFD.
 Methods: It was a hospital based prospective observational study conducted in the Department of Obstetrics and Gynaecology at Jhalawar Medical College from January 2020 to December 2020. 120 cases of IUFD of ?24 weeks of gestation or foetuses weighing ?500 gramswere included in the study.
 Results: The incidence of IUFD was 37.8/1000 total birth. IUFD occurredmainly in 25-35yrs age group (55%), unbooked cases (70%),multigravida (59.2%), preterm (<37 weeks of gestation). The risk factors were PIH (49.2%), infections (9.2%), hypothyroidism (5%), Rh negative with hydrops fetalis (5%),GDM (4.2%), chronic hypertension (2.5%), previous H/O LBW (2.5%), H/O prior stillbirth (5%), hyperthyroidism (1.7%), oligohydramnios (46.7%), APH (20.8%) and congenital fetal anomalies (19.2%).
 Conclusion: IUFD rate still remains high. Therefore, regular ANC check up and early identification of risk factors like PIH, anaemia, infections, genetic counselling and timely referral to well equipped centre may help prevent IUFD and maternal mortality and morbidity.
 Keywords: IUFD, ANC, Preterm

Maternal and Perinatal Outcomes in Hypertensive Disorders of Pregnancy and Factors Influencing It: A Prospective Hospital-Based Study in Northeast India.

IntroductionHypertensive disorders frequently complicate pregnancy and contribute substantially to maternal and perinatal morbidity and mortality. Identification of risk factors for hypertensive disorders of pregnancy (HDP) can help determine the particular patient group which requires appropriate intervention.MethodsThis prospective cross-sectional hospital-based study conducted from January 2016 to January 2019 included all pregnant women beyond 20 weeks of gestation complicated by HDP. The objectives were to determine the incidence of HDP and associated maternal and perinatal mortality and morbidity rates along with factors influencing it. Data collected were entered in Microsoft Excel (Microsoft Corporation, Redmond, WA) and analyzed with the Statistical Package for the Social Sciences (SPSS) software version 21 (IBM Corp. Armonk, NY).ResultsIn our study, out of 5460 deliveries, 402 (7.4%) cases had HDP, 27.6% had gestational hypertension, 27.6% had mild preeclampsia, 33.6% had severe preeclampsia, and 11.2% had eclampsia. Fifty-four (13.4%) cases required admission in the intensive care unit and 12 (2.9%) ended in maternal deaths. The cause of maternal mortality was cerebral hemorrhage in eight (66.6%) cases and pulmonary edema in four (33.3%) cases. All maternal deaths occurred in women with severe preeclampsia and eclampsia and eclampsia was significantly higher. Maternal deaths were more when systolic blood pressure (SBP) was ≥ 160mmHg, diastolic blood pressure (DBP) was ≥ 110mmHg, significantly more with 3+ proteinuria, but no association was found with age, parity, booking status, socio-economic status, gestational age, or mode of delivery. All mothers with HDP received treatment with antihypertensives. There were 60 (14.9%) cases of perinatal mortality. Perinatal deaths were more in unbooked cases and preterm HDP, significantly more with SBP ≥160 mmHg, DBP ≥110 mmHg and ≥2+proteinuria, but no association was found with parity or mode of delivery. Besides mortality, there was a significant burden of maternal and perinatal morbidity, which was more in women with severe preeclampsia and eclampsia.ConclusionRoutine antenatal screening for HDP in all pregnant women with appropriate and timely interventions in women at risk may help reduce HDP-related maternal and perinatal morbidity and mortality.

Maternal and fetal factors contributing to neonatal outcome in Al-Tibri Medical College and Hospital

Background: The study was done to identify the maternal and fetal factors contributing to neonatal outcome and to evaluate the correlation between risk factors and adverse neonatal outcome.
 Subjects and methods: This prospective observational study was conducted on 126 mothers and their neonates fulfilling the selection criteria at Al-Tibri Medical College and Hospital. A self-designed Performa was used to enter data of subjects. Sick neonates were referred to neonatal intensive care unit for admission and management. The results were analyzed by using SPSS version 22. A p-values <0.05 was considered as significant.
 Results: Out of 126 enrolled subjects, 81% mothers were multigravidas, 31% were unbooked, 13.5% had gestational comorbidities, 15% were drug addict, 2% were Hepatitis B positive. 22.2% underwent emergency LSCS while 31.7% delivered babies by elective LSCS. Regarding fetal factors contributing to sick babies, IUGR (20%), twin fetuses (15.4%), prematurity (47.7%) were significant. 65 were sick babies. Adverse neonatal outcomes observed were prematurity in 25.4%, IUGR in 11.1%, NICU admission in 33.3%, and neonatal death in 2%. Risk factors associated with adverse neonatal outcomes were positive maternal drug addiction (p-value = 0.028), preterm delivery (p-value<0.001), NICU admission (p-value<0.001) and low birth weight (p-value <0.001).
 Conclusion: Compromised maternal antenatal care has profound deleterious effect on fetus and neonate. Obstetricians, perinatologists and neonatologists need to work in concord to improve maternal antenatal care hence improving neonatal outcome. In our study adverse neonatal outcome was associated with unbooked cases, delivery by EmLSCS, addicted mother, preterm delivery, LBW and neonates requiring NICU admission.