Obs Gyne Review: Journal of Obstetric and Gynecology

Comparative Study Between Normal Pregnancy Outcome with Pregnancy with Diabetes Mellitus in Rangpur Medical College & Hospital, Rangpur, Bangladesh

Mst Ahsana Akter — 2024-09-30

Background: Diabetes mellitus is one of the common medical diseases with pregnancy. Increasing maternal age, overweight, life style change and family history of diabetes are all risk factor for diabetes mellitus. Objectives: To evaluate the foeto-maternal outcome in pregnancy and to compare with the patients having no DM/GDM and any medical disease. Materials and Methods: This is a cross sectional descriptive study which includes both the booked case having pregestational diabetes or newly diagnosed GDM cases admitted directly through the emergency or OPD with or without labour pain. Study period: From February 2015 to August 2015. Results: During the study period total 5075 obstetrics patients were admitted out of them 32(0.63%) were diabetes mellitus with pregnancy. Both age & parity matched study were done between diabetic & control group. Among them 12 (40%) had pregestational diabetes mellitus and 18(53.33%) above the age of 30 years, majority were multipara 15(50%) patients were with the gestatinal age of 38-40 weeks. Majority patients of diabetic group 18(60%) belongs to average socioeconomic status where as in control group 7(23.33%). 11(36.67%) patients diabetic group were secondarily educated in comparison to 06(20%) in control group those are statistically highly significant (p=0.008). Regarding BMI 40% were overweight in diabetic group compare to 16.67% control group that is statistically significant as a whole (p=0.007). There was no significant difference in the rates of foetal birth asphyxia but macrosomic baby in diabetic group in 7.4% caessarean section were 27(90%) in diabetic group compare to 09(30%) in control group that is statistically highly significant (p=0.000). Successful vaginal delivery had done in 10% patients in diabetic group under supervision. Conclusion: In our country DM is not uncommon and it is often associated with higher incidence of maternal and perinatal mortality due to lack of proper antenatat, intranatat and emergency obstetric care.

Evaluation of Pregnancy Outcome in Severe Preeclampsia

Salma Sultana — 2024-09-30

Background: Hypertensive disorder represent the most common medical complication of pregnancy affecting between 7 to 15 percent of all gestation and account for approximately a quarter of all antenatal admission. In Bangladesh the incidence of this killer disease is still high and it is third major cause of maternal death in our country. Objective: To evaluate pregnancy outcome in severe preeclampsia. Study design: Observational cross sectional study. Place of study: In Obstetrics & Gynaecology ward of BSMMU, Dhaka. Period of study: March, 2015 to August, 2015. Sample size: 30 patients were selected by purposive sampling. Methods: The data were collected by the active participation of the patients' interview by the preformed proforma of data collection sheet and then data were gathered, decorated, tabulated after data cleaning and edition. Then the results were found and they were tested by the student's unpaired t test (quantitative data) and chi-square test (qualitative data) to see their level of significance i,e p-value which was set as the cut off level at <0.05. So if p-value is >0.05 the results are no significant.Results: The mean age of 30 mothers were 27.65 (± 5.85) years. The maximum 19 (63.33%) patients were from 20-34 years age group. Among the 30 mothers with severe preeclampsia, 12(40%) were primiparous and rest 18 (60%) were multiparous. To ensure safe delivery 14(46.67%) mothers adopted LSCS whereas 10(33.33%) adopted vaginal delivery with episiotomy. The rest 6 (20%) underwent VD. Regular ANC ensured only 6 (20%) respondents whereas rest 80% replied that they were either irregular ANC or no ANC. The most common complications mothers faced was abruptio placenta (28.57%) followed by convulsion (14.28%) and HELLP syndrome (9.52%). Amo. Neonatal mortality was found in 4 cases out of 30. 60% neonate experienced low birth weight. 45% babies required neonatal ward admission whereas 62% required resuscitation. Conclusion: In conclusion, it may be assumed that though various fetal and maternal morbidities may occur in case of severe preeclampsia but mortality is seen only in case of neonates. Maternal mortality has been almost disappeared in our perspective in case of severe pre-eclampsia.

Placenta Previa in Scarred and Nonscarred Uterus and Its Effect on Maternal Fetal Outcome

Fatima Wahid — 2024-11-07

Introduction: Placenta, the life support system of foetus, when implants in lower uterine segment affects fetomaternal outcome adversely. Placenta previa when diagnosed in 2^nd or 3^rd trimester is associated with series of complications. Placenta previa is a major cause of vaginal bleeding in late 2^nd and 3^rd trimester.

Objective: To compare feto-maternal outcomes in cases of placenta previa occurring in scarred versus non-scarred uteri.

Methods: This study was prospective observational study, conducted in department of fetomaternal Medicine, BSMMU from January 2023 to June 2024. 60 casesanalyzing of placenta previa managed at a tertiary care center. Patients were categorized into two groups: scarred uterus (n=46) and non-scarred uterus (n=14). Maternal outcomes including hemorrhage, hysterectomy rates, and perioperative complications were compared. Fetal outcomes such as gestational age at delivery, birth weight, and NICU admission rates were also evaluated.

Results: Women with scarred uteri had significantly higher estimated blood loss (1850 ± 950 mL vs 1200 ± 650 mL, p=0.012), increased need for blood transfusion (76.1% vs 42.9%, p=0.021), and higher rates of peripartum hysterectomy (39.1% vs 7.1%, p=0.025) compared to those with non-scarred uteri. Placenta accreta spectrum disorders were more common in the scarred uterus group (37.0% vs 7.1%, p=0.038). After adjusting for confounding factors, having a scarred uterus remained an independent risk factor for peripartum hysterectomy (aOR 6.2, 95% CI 1.8-21.5, p=0.004) and for requiring blood transfusion (aOR 3.8, 95% CI 1.2-12.1, p=0.023). Fetal outcomes showed a trend towards being poorer in the scarred uterus group, but these differences did not reach statistical significance.

Conclusion: Placenta previa in the context of a scarred uterus is associated with significantly worse maternal outcomes, particularly in terms of hemorrhage, transfusion requirements, and hysterectomy rates. These findings highlight the importance of strategies to reduce primary cesarean section rates and emphasize the need for specialized care in managing pregnancies complicated by placenta previa in women with previous cesarean deliveries.

Comparative Study Between Tab. Labetalol and Methyldopa In Treatment Of Pregnancy Induced Hypertension

Afroza Sultana — 2024-11-07

Background: Pregnancy induced hypertension is one of the most significant health problem in pregnancy. This is the 2^nd most common obstetrics cause of maternal death in Bangladesh. It is the leading cause of infant morbidity and mortality. Objective: To compare the efficacy of two drugs, labetalol and methyldopa as an antihypertensive to control of blood pressure.

Methodology: A randomized controlled trial carried among 100 pregnant women pregnancy induced hypertension (PIH) attending Obstetrics & Gynaecology Department Dhaka Medical College & Hospital during the period of November 2010 to April 2011. 50 patients treated with tab. Labetalol (Group A) and 50 treated with tab. Methyldopa (Group B). Results: Finding of the study showed mean age, gestational age and occupation did no differ significantly variation between Labetalol (group A) and Methyldopa (group B). Among 36% had gestational HTN, 62% had preeclampsia and 2% had eclampsia in group A. On the other hand in group B 32% had gestational HTN, 64% had preeclampsia and 4% had eclampsia. Among 23 patients in group A (46%) went in normal whereas (32%) went in normal vaginal delivery in group B. Maternal morbidity was more in group B than group A. The most common morbidity were pulmonary oedema (6%) in group A and 14% had pulmonary oedema in group B. At the time of discharge, in group A 85.41% patients had normal blood pressure and 95.83% patients had no protenuria. Whereas in group B 80.43% had normal blood pressure and 91.30% had no proteinuria. Incidence of still birth was more in methyldopa group (group B). Low birth weight was lower with labetalol group (group A).

Conclusion: It concluded that labetalol is more advantageous than methyldopa in terms of better and quicker control of blood pressure. The chances of normal vaginal delivery were greater in the labetalol group than in the methyldopa group.

Study Of Fetomaternal Outcome In Cases Of Placenta Previa At Tertiary Care Hospital, Dhaka, Bangladesh

Umme Kulsum — 2024-11-08

Background: Placenta previa remains a significant obstetric challenge associated with substantial maternal and fetal morbidity. The increasing incidence of placenta previa and its associated complications, particularly in the context of rising cesarean section rates, necessitates ongoing evaluation of management strategies and outcomes.

Objective: To assess the fetomaternal outcomes in cases of placenta previa managed at a tertiary care hospital and to identify risk factors associated with adverse outcomes.

Methods:This retrospective observational study analyzed 60 cases of placenta previa managed at FetomaternalMedicine Dept., BSMMU, Dhaka, Bangladesh between June 2023 to June 2024.Data on maternal characteristics, obstetric factors, management strategies, and fetomaternal outcomes were collected from medical records. Statistical analysis included descriptive statistics and multivariate logistic regression to identify risk factors for adverse outcomes.

Results: The mean maternal age was 29.2 ± 4.3 years, with 75% of patients having a history of previous cesarean sections. Placenta previa was diagnosed in 76.7% of cases, andlow lying placenta were present in 23.3%. Peripartum hysterectomy was performed in 41.7% of cases. The preterm delivery rate was 70%, with a mean gestational age at delivery of 35.6 ± 2.8 weeks. Neonatal intensive care unit admission was required for 36.7% of newborns, and the perinatal mortality rate was 3.3%. Multivariate analysis identified previous cesarean sections (≥2) (adjusted OR 3.8, 95% CI 1.7-8.5) and placenta accreta spectrum disorders (adjusted OR 12.5, 95% CI 4.2-37.1) as significant risk factors for peripartum hysterectomy.

Conclusion: This study highlights the significant maternal and fetal morbidity associated with placenta previa, particularly in cases with previous cesarean sections and placenta accreta spectrum disorders. The findings underscore the importance of early diagnosis, multidisciplinary management, and the need for specialized care in tertiary centers for high-risk pregnancies. Strategies to reduce primary cesarean section rates and careful counseling for women with a history of cesarean delivery are crucial in addressing this growing obstetric challenge.