European Journal of Molecular & Clinical Medicine

Abruptio placenta is the complete or partial separation of the normally implanted placenta before delivery of the fetus. It is one of the commonest causes of antepartum hemorrhage affecting maternal and fetal outcomes. Early detection and timely intervention of abruptio placenta in daily clinical practice are important to improve maternal and perinatal outcomes. The objective of the study was to find out the prevalence of abruptio placenta among the pregnant women admitted to the Department of Obstetrics and Gynaecology in a tertiary care centre.
Methods: A cross-sectional study was done among the pregnant women admitted to the Department of Obstetrics and Gynaecology in a tertiary care centre where data from medical records was taken after taking ethical approval from the Institutional Review Committee. Demographic details of the patients including age and parity were recorded. Convenience sampling was done.
Results: The results of my studies are summarized as follows:Overall incidence of Antepartum hemorrhage is 3.6% with abruptio placenta about 1.2. Hypertension is the most common etiology recognized in all studies.The incidence in our study is 54.8%.
Conclusions: The prevalence of abruptio placenta among pregnancies was similar to the studies done in similar settings

Pregnancy adaptations are well tolerated in healthy women but it rapidly decompensate in pregnants with valvular heart disease resulting in maternal and perinatal morbidity². Multidisciplinary approach and proper guideline is a necessity to reduce the adverse outcome.
Aims and Objectives: Clinical and echocardiographic assessment of valvular heart disease during pregnancy, in south Indian population and its effect on maternal and fetal outcome. Thereby provide local layout of disease burden and help develop patient centric management plan.
Materials and Methods: 77 pregnant women admitted with valvular heart disease in Coimbatore Medical College Hospital were recruited during period of 2020-2021. Clinical  and Echocardiographic correlation with Maternal and fetal outcome were studied.
Results: In our study, 70.1% of pregnants had Rheumatic heart disease and 23.4% had Congenital heart disease, with ratio of 3:1; 70.3% were diagnosed during index pregnancy.
 Mitral valve was the most common valve involved (84.4%) with Mitral Regurgitation being the predominant lesion (62.3%); Aortic valve involvement (14.3%); Both Aortic and Mitral valve involvement (3.9%). Functional class deterioration were seen in pregnants with critical stenotic lesions and severe insufficiency. Increase in valvular gradient in stenotic lesions is associated with congestive failure. Maternal outcome:  63.6% had caesarean section; 31.7% had cardiac indications; 7.8% had instrumental delivery; 1 maternal death; 23.4% had Congestive Cardiac Failure. Fetal outcome: 71% had term delivery; 28.6% had preterm delivery; 11(14.3%) had fetal loss; 48% low birth weight; 5.2% Intrauterine growth retardation; Perinatal mortality was 7.5% in NYHA class I, II and 42.1% in class III, IV.
Conclusion: High transvalvular gradient, Depressed LV function and increased LV volume, especially in patients with stenotic lesion is associated with life threatening complications in the course of pregnancy. Regurgitant lesion have better tolerability and outcome as compared to obstructive lesion.  There was close association of NYHA class and maternal and fetal outcome, with higher risk in NYHA class III and IV.  

The concept of providing relief from pain has been tardy in acceptance, however experience has shown that providing pain relief during labour reduces maternal stress and results in shorter labours and improved maternal outcome.
Aim and Objectives : To compare the maternal and neonatal outcome of programmed labour protocol with the conventional labour.
Materials and Method : This was a prospective study done in the department of obstetrics and genecology of our tertiary care centre for period of one year,  50 uncomplicated primigravida at term (between 37-42 weeks) were included in the study and compared with 50 uncomplicated control group. The cases were selected at random from the women admitted in labour rooms for delivery. Cases were selected after following exclusion and inclusion criteria and approved by institutional ethical committee.
Results: The mean duration of active phase of I stage of labour in the study and the control group were 134.23 min (38.76hr) and 219.46 min (54.69 hr) respectively. Mean blood loss in the study group is 101.42ml, while in the control group it was 152.36ml and these variable were statistically significant. there was significant difference observed, in relief score between cases and controls. But we didn’t find any significant difference in the birth weight between the groups.
Conclusion : Programmed labour can be used as a safe and effective method of labour analgesia where there reduction in duration of labour and gives more relief to mother from pain.

Objective: To analyse rising rates of caesarean section, its indications and effect on maternal and neonatal outcomes viz a viz vaginal deliveries with special focus on primary caesarean section.
Study design: This was a prospective observational study of 1000 deliveries after 28 weeks’ gestation. The different modes of deliveries were studied with respect to their antepartum, intrapartum and postpartum feto-maternal outcomes. A comparative analysis of caesarean and vaginal deliveries was carried out with particular focus on primary caesarean sections.
Results: The caesarean section rate was 47.1% out of which 66.2% were primary caesarean sections(PCS). The most common indication of PCS was found to be foetal distress (34.2%) and blood loss, febrile morbidity, SSI were more in caesarean sections compared to vaginal deliveries (VD). Neonatal outcomes too were relatively worse in caesarean sections compared to VD.
Conclusion: There has been an unacceptably high rise in caesarean section rates globally. It has been accepted that maternal and neonatal outcomes remain comparatively favourable with vaginal deliveries. Hence there is a need to have a closer look at the various indications of caesarean deliveries with regular caesarean audits at all levels of health care with a targeted focus on PCS, which is the genesis of the rising rates. CS should be resorted to only when there is an evidence based indication with the aim of improving the reproductive years of the mother and future development of the newborn.

Caesarean section can be performed before labour, during first and second stages of labour.Present study was aimed to compare fetomaternal outcome in women undergoing caesarean section in first stage vs second stage of labour at a tertiary hospital. Material and Methods: Present study was prospective, comparative study, conducted in pregnant women, between 21-35 years of age, Singleton, term pregnancies, low risk & fit for vaginal delivery underwent emergency LSCS. Pregnant women were divided into 2 groups as group 1 (LSCS in the first stage of labour) & group 2 (LSCS in the second stage of labour). Results: Maternal complications such as blood transfusions (4 % vs 7 %), bladder high up (1 % vs 10 %), hematuria (2 % vs 17 %), unintended extensions (2 % vs 14 %), wound dehiscence (3 % vs 11 %) & febrile morbidity (4 % vs 16 %) were more among women underwent LSCS in second stage of labour, difference was statistically significant. Neonatal morbidities such as Apgar Score <7 at 5 min (2 % vs 6 %), Neonatal septicaemia (2 % vs 10 %), Intubation not for meconium (1 % vs 7 %), NICU stay >24 hrs (2 % vs 19 %) were more in women underwent LSCS in second stage of labour, difference was statistically significant. Fetal injuries (2 %) were noted only in women who underwent LSCS in second stage of labour. Conclusion: Maternal complications (blood transfusions, hematuria, unintended extensions, wound dehiscence & febrile morbidity) & neonatal morbidities (Apgar Score <7 at 5 min, Neonatal septicaemia, Intubation not for meconium & NICU stay >24 hrs) were more in women underwent LSCS in second stage of labour.

High BMI is associated with an increased risk of preeclampsia, gestational hypertension, macrosomia, induction of labour, caesarean deliveries and poor perinatal outcomes^.Low BMI has been shown to be associated with an increased risk of preterm deliveries, low birth weight and anemia and a decreased risk of preeclampsia, gestational diabetes, obstetric intervention and postpartum haemorrhage. Aim & Objective: 1. To assess correlation between maternal Body Mass Index (BMI) and perinatal outcome. Methods: Study design: Prospective observational Study. Study setting: Department of Obstetrics and Gynaecology, Nowrosjee Wadia Maternity Hospital, Mumbai (NWMH), (Tertiary Health Centre). Study population: patients who delivered / underwent completion of pregnancy at the institute such cases were included in the study. Sample size: 100 Results: The highest number of patients belonged to the age group of 23-28 yr (61%%), followed closely by the age group of 29-35 yr (33%). Patient between age group 18-22 yr was only 6%. LSCS was performed in 48%, out of which Emergency LSCS constituted 40% & Elective LSCS constituted 8%. P-value for LSCS was 0.001 & for Emergency LSCS was 0.003 suggesting these are more common in BMI Group III & IV. Instrumental Deliveries were performed in 4% of patients out of which Forceps applied in 2% & Vacuum extraction done in 2% patients. Out of 90 patients, in 7 (7.78%) patients second stage of labour was prolonged. Meconium-stained liquor was found more commonly in BMI Group III with P-value for 0.028. Total of 25 patients were diagnosed to be suffering from gestational hypertension. 5 (20%) of them had postpartum haemorrhage & Blood Transfusion was needed in 3 (12%) them. Foetal Distress was found to be the most common complications affecting 18% of patients who participated in this study. P-value for Foetal Distress is 0.011 suggesting significant association being more common in BMI Group IV. Neonatal complications respiratory distress syndrome & Meconium Aspiration Syndrome were found in 4 % & 3% babies without any significant association in any of the BMI group. Conclusion: Vaginal Delivery was the most common obstetric outcome, Neonatal outcome was Live Birth among all the patients.

Background: The purpose of this study was to compare fetomaternal outcome of twin pregnancies with singleton pregnancies
Material and method: This was the prospective study done on patients coming to antenatal clinic and labour room emergency of Nalanda Medical College And  Hospital, Patna. Consecutive sampling was done till sample size reached 50 for both twin pregnancies and singleton pregnancies >28 weeks of gestation. Patients fulfilling the inclusion criteria were divided into two groups:
GROUP A: 50 patients of twin pregnancies
GROUP B: 50 patients of singleton pregnancies
Result: The incidence of twin in this study was1.9%, mean maternal age 27.6±3 years for twin pregnancies and 22.5±3years  for singleton pregnancies, twin were seen more in multigravida (60%). Anaemia(50%), preterm labour (30%), hypertensive disorder(10%), APH(2%)were the common complications of twin pregnancies. Mean weight of first twin was2.12±0.35 kg kg and that of second twin was1.97±0.3 kg. Caesarian section occurred in 60% of twin pregnancy and the most common indication being malpresentation (24%). Significantly higher incidence of IUGR(10%), birth weight discordance (20%), early neonatal death(5%) and higher rate of NICU admission in twins were recorded
Conclusion: Despite improvement in antenatal and neonatal care, twin pregnancy posses a higher threat to maternal and child outcome than singleton pregnancies.

Background: Anemia in pregnancy is defined as hemoglobin levels less than 11gm/dL. Severe anaemia is responsible for 20-40% of direct and indirect maternal deaths because of increased susceptibility to cardiac failure, sepsis and association with preeclampsia, antepartum haemorrhage, postpartum haemorrhage and thrombo-embolism. Present study was carried out to fetomaternal outcome in pregnant women with severe anemia at a tertiary hospital.
Material and Methods: Present study was single-center, prospective, observational study, conducted in pregnant women with Hb < 7gm/dL, with gestational age > 28 weeks, delivered at our hospital.
Results: Total 72 women with severe anemia were studied, majority were from 19-25 years age group (52.78 %), mean age was 25.4 ± 3.5 years, had completed primary education (70.83 %), from lower Socio-economic status (84.72 %). Though Un-booked (13.89 %) pregnancies were less than booked cases (86.11 %), majority had less than 4 antenatal visits (75 %). Majority of patients were Para 2 (34.72 %), Para > 2 (31.94 %), had spacing between pregnancy was < 2 years (71.93 %). Vaginal (70.83 %) was most common Mode of delivery, followed by LSCS (26.39 %) & Instrument delivery (2.78 %). In present study, maternal complication/ high risk factors noted were premature delivery (52.78 %), postpartum hemorrhage (34.72 %), preeclampsia (20.83 %), prolonged labor (19.44 %), congestive cardiac failure (16.67 %), puerperal pyrexia (15.28 %).  One maternal mortality (1.39 %) was noted. We noted total 7 deaths (3 Intrauterine fetal death/ Stillbirth & 4 Early neonatal deaths), while Low birth weight (<2500 gm) (65.28 %), NICU admission (48.61 %), Apgar score <7 (at 5 minute) (8.33 %).
Conclusion: Anemia in pregnancy is a major health problem in developing countries. Severe anemia during pregnancy is associated with maternal and fetal health outcomes fetomaternal morbidity and mortality.

Background: In pregnancy, anaemia has a significant impact on the health of fetus as
well as that of mother. It is one of the leading causes responsible for maternal and
perinatal morbidity and mortality. The objectives of the study are to find out the effect
of severe anaemia on women in labour affecting maternal and fetal outcome.
Materials and Methods: This a prospective case control study undertaken in the
Department of Obstetrics and Gynaecology, Govt Maternity Hospital, Petlaburz
attached to Osmania Medical College, Hyderabad. The period of study was from 1st
December 2019 to 31st December 2021.There were a total of 160 study subjects, 80 cases
of severe anaemia (Hb<7gm %) and 80 non anaemic controls (Hb≥ 11gm %).
Results: Low socio economic status (86.25%), inadequate antenatal care (38.75%),
multiparity (71.25%) and no iron supplementation (52.5%) were associated with severe
anaemia cases. Microcytic hypochromic anaemia was more prevalent (76.25%),
suggesting nutritional inadequacies as a cause of anaemia. It was seen that the incidence
of preterm labour (22.5%), atonic PPH (2.5%), sub involution of the uterus (2.5%),
CCF (1.25%), abruptio placentae (1.25%) and maternal mortality (1.25%) was more in
cases of severe anaemia than in the control group. Adverse fetal outcome in the form of
preterm birth (22.5%), low birth weight babies (41.25%), IUGR (13.75%), birth
asphyxia (11.25%), and perinatal mortality (11.25%) was more in the anaemic group
than the controls.

Background: To find correlation of clinical, hematological and biochemical parameters
in women with severe preeclampsia and maternal outcome and to study the maternal
and perinatal outcome in severe preeclampsia and.
Materials and Methods: The study was done in the Department of Obstetrics and
Gynaecology, Raichur Institute of Medical Sciences, Raichur. 140 patients with blood
pressure ≥ 160/110 mm of hg with proteinuria or Blood pressure ≥ 140/90 mm of hg
with proteinuria of ≥ 2+ were involved in the study. Statistical analysis was done by
applying chi-square.

Background: Pre-pregnancy obesity is strongly associated with certain pregnancy
complications and perinatal conditions. Placental structure and function are important
for maternal and fetal health both during and after pregnancy. The aim of this study to
evaluate the effect of prelabour body mass index on the mode of delivery.
Materials and Methods: An hospital-based prospective study involving pregnant women
at term (33-37 weeks) admitted to gynaecology ward in district hospital Dholpur,
Rajasthan, India during one-year period. A total of 120 cases in the age group of 18-40
years included in the study. Patients were classified into 3 categories based on their first
trimester BMI. Category I included normal women (BMI 20- 24.9 kg/m2), Category II
included overweight women (BMI 25-29.9 kg/m2) and detailed history and clinical
examination including general physical, obstetrical and systemic examinations.
Category III included obese women (BMI >30 kg/m2). Data were analysed statistically
by Chi-square test of the dependence of variables and a p-value of less than 0.05 was
considered as statistically significant.
Results: Under anthropometric parameters, the differences in mean age, mean weight,
mean height and mean BMI among the three categories women were statistically
significant (p<0.001**), In this study, it was observed that overweight and obese women
were slightly older and short in stature when compared with women with normal BMI.
There was increased incidence of antepartum complications in Category III women as
compared to Category II and Category I women. The difference in the onset of labour
as well as mode of delivery among the three categories was statistically significant
(p<0.05*).
Conclusion: As obesity is a modifiable risk factor all attempts should be made to
maintain a normal BMI in women of childbearing age. Pre–pregnancy counselling,
health programme and appropriate multidisciplinary management should be done.

To evaluate the maternal, fetal and neonatal complications in pregnant women with Covid-19 infection. Setting and design: A prospective descriptive study was carried out in Basrah Teaching Hospital, Iraq during the period 15/3/2020 till 1/11/2020. There were 135 infected pregnant women with Covid-19. The maternal information's were obtained included Age, parity, residence, travel history, gestational age at time of diagnosis. The pregnancy measures of interest were evaluated according to the severity of the disease, medical disease, history of antepartum hemorrhage, mode of delivery, type of delivery, post-natal complication and admission to
intensive care unit and maternal death. The neonatal outcomes of interest were fetal weight, neonatal Apgar
score, admission to neonatal intensive care unit and neonatal death. Results: The mild type of the disease was common (41.48%) in comparison to severe conditions (17.77%).