Indian Journal of Obstetrics and Gynecology

Background: HELLP syndrome is a serious obstetric complication in pregnancy characterised by hemolysis, elevated liver enzymes and low platelet count. Incidence is 9.7% and prevalence ranges from 0.5-0.9%. The aim of the study was to study the incidence, different clinical presentations and diagnosis of HELLP syndrome in Pre eclampsia and eclampsia and to analyse the severity, complications, maternal and perinatal outcome.

Aim & Objective: To determine perinatal outcome in patients diagnosed with HELLP syndrome.

Methodology: The clinical trial was conducted for a period of two years OBGY department of Bharati Vidyapeeth University, Pune. It is an prospective observational study where a total number of 30 cases of HELLP syndrome above 28 weeks of gestational age were admitted in Bharati hospital during the study period of 24 months. Data analysis was done and appropriate statistical tests were used.

Results: A total of 30 females with HELLP syndrome visiting tertiary care teaching hospital were included in the study. The mean age of the patients was ranging between 21 to 43 years. The mean gestation age was ranging between 28 to 38 weeks. Majority 13 (43.3%) of women were primigravida, followed by G2A1 7(23.3%), G2P1L1 3(10.0%), G3P1L1 and G3P1L1A1 2(6.7%) each, G3A2, G4P1D1A2 and G2P2L1 1(3.3%)each. There were total 8 (26.6%), 7 (23.4%) of HELLP syndrome patients had pre eclampsia and GDM, respectively, one and 2 of these patients were also having hypothyroidism respectively. 2 (6.7%) each patients had hypothyroidism, anemia and chronic hypertension. While, eclampsia, epilepsy, IVF and gestational hypertension were reported in 1 (3.3%) patient each. Majority of women with HELLP syndrome had brisk (24 (80%) type of deep tendon reflexes, followed by exaggerated 3 (10%) and there were 3 (10%) women with normal reflexes. Majority of women the mode of delivery was emergency LSCS (60%), mean of the APGAR score at 1 minandat 5 minutes was recorded among 25 (83.33%) patients.

The NICU admission was require damong 14/30 (46.7%) of new born, while it was not required in 16 (53.3%) of new born.

Conclusion: This study was done to intensify our efforts to reduce pre eclampsia with HELLP syndrome by undergoing regular antenatal care, early detection of pre eclampsia and its prompt management and early detection of complications with timely intervention.

Introduction: Labour pain is one of the most severe types of pain ever to be experienced. Entonox is a nitrous oxide (N2O), a self administered patient controlled inhalational analgesia. Our research is focused to study about this aspect of Entonox that is reduction in the duration of labour by making cervical dilatation faster. The aims and objectives of our study was to determine the effect of entonox on duration of first stage of labour and to determine the effect of entonox on rate of cervical dilatation.

Methodology: A prospective observational study was carried out Pushpagiri Institute of Medical Sciences and Research Centre in Kerala, India, for a period of 6 months consecutive sampling: sample size obtained is 20 per group, grouped them into two groups depending upon the analgesic of choice. The study tool was a Performa and variables entered into Microsoft excel spreadsheet and analysed SPSS 18.0 software package. Results presented as frequency and percentages for categorical data and descriptive statistics for continuous data. The duration of labour was presented as mean and SD and cervical dilatation rate is calculated as cm in dilatation divided by duration of first stage and this also was presented as mean and SD. These two outcome variables was compared between entonox and control Mann-Whitney U Test.

Results: There was 20 study participants each in the two groups. 10 primigravidas and 10 multigravidas, with mean age was 28.15 ± 2.66 years and majority of them belong to normal BMI. Although there was no difference with respect to the cervical dilatation at the onset of usage of Entonox, it was observed that there was significant reduction in the duration of labour and usage of Entonox as there was a increase in cervical dilatation rate when compared to women who chose other analgesics. All these factors also found to be statistically significant.

Conclusion: A part from analgesic effect nitrous oxide also is shown to decrease the duration of active phase of labour by making cervical dilatation faster and lowering the duration of usage of labour analgesics, which makes labour a pleasant experience for woman.

Background: Maternal perception of reduced fetal movements (RFM) is associated with increased risk of still birth, preterm labor & fetal growth restriction. RFM is thought to represent fetal compensation to conserve energy due to insufficient oxygen & nutrient transfer resulting from placental insufficiency. Intrauterine fetal death is preceded by RFM for 24 hours in up to 50% cases. In infants who are alive at presentation, RFM is associated with increased incidence of still birth, fetal growth restriction & feto-maternal hemorrhage. However RFM is may also occur in non pathological conditions such as anterior placental site, increased maternal activity & standing position. Inadequate clinician response to complaint of RFM is important contributory factor to still birth.

Aims and objectives: To assess association between maternal perceptions of reduced fetal movements and fetal outcome.

Methodology: Study was conducted in Department of Obstetrics and Gynecology at Bharati hospital, Pune. It was a prospective observational study of fetal outcomes in mothers perceiving reduced fetal movements. Women after 28 weeks of pregnancy presenting with reduced fetal movements out of that 202 pregnant women were included. Study was conducted from October 2020 to October 2022.

Results: Majority of the fetuses were healthy. There was strong association between reduced fetal movements and Oligohydramnios. We found significant association between NICU admission, birth weight, APGAR, and RFM category, while no significant association between RFM category and status at birth and type of delivery. There were 2 IUD’s noted.

Conclusion: Fetal movements monitoring is necessary during antenatal period, after 28 weeks of pregnancy, it is a good predictor of fetal outcome, and helps in timely intervention.

Aim & Objective: Demographic datas like the patients age, gestational age, admission BP, blood and urine investigation, neuroimaging, Management, mode of delivery, neonatal and maternal outcomes were analysed in patients presenting with eclampsia in a tertiary care centre.

Introduction: The onset of convulsions in a woman with pre eclampsia that cannot be attributed to other causes is termed eclampsia. Eclampsia is a major cause of maternal and neonatal morbidity and mortality. Magnesium sulfate is the drug of choice for reducing the rate of eclampsia and also to prevent recurrent convulsions in eclampsia.

Materials and Methods: The study was conducted retrospectively on cases presenting with eclampsia in the OBG department, Government Rajaji Hospital for a period of 6 months from July 2019 to December 2019.

Results: During the 6 month study period, total 26 cases of eclampsia was reported out of 5843 deliveries (0.4%). Total 657 cases of hypertensive disorders of pregnancy (11.2%) was reported out of which 65 cases were severe pre-eclampsia (9.8%). 65% (11) of eclampsia presented as Antepartum eclampsia, 30.7%(11) cases presented as postpartum eclampsia, 3.8%(1) case as intrapartum eclampsia. One case presented as both antepartum and postpartum eclampsia. No case of maternal mortality was reported during the study period.

Conclusion: Early detection of cases of pre-eclampsia and imminent eclampsia, proper evaluation and treatment with anti-hypertensives and Magnesium sulphate will reduce the occurrence of eclampsia. Multidisciplinary approach in a tertiary care centre can reduce the maternal mortality and morbidity. Proper knowledge of management of eclampsia can reduce the mortality. IV labetalol and its careful use is mandatory. Perinatal mortality is high mainly because of prematurity.