A study of critically ill obstetric patients admitted to intensive care unit of a tertiary care hospital.

Objectives: To evaluate characteristics, indications, complications and outcome of obstetric patients admitted to ICU of tertiary care hospital in KPK, Pakistan. Methods: This descriptive study was conducted in department of OBGYN of Lady Reading Hospital, Peshawar from January 2021 till December 2021. A total of 62 patients were enrolled into the study using nonprobability consecutive sampling technique. Their data were collected on a proforma. All patients were followed till their death or discharge home from hospital. Results: The mean duration of ICU stay of patients, was 6.85 ± 4.82 days. Out of 62 patients 17 (27.41%) expired in ICU, while 45 (72.58%) patients survived and were discharged. Pre-eclampsia and Eclampsia was the commonest primary diagnosis, accounting for 28 cases (45.2%) with a case fatality rate of 25%, followed by 13 cases (21%) of primary postpartum hemorrhage (PPH) as the second commonest reason for ICU admission and a case fatality rate of 38%. The underlying primary diagnosis had no statistically significant association with outcome of the patient. Acute Renal failure had statistically significant association with outcome of the patient with adjusted OR 4.79, CI:1.17-19.66, p-0.02. Similar positive association with mortality existed for patients having DIC (aOR:6.59; CI:1.34-32.34, p-0.02). Conclusion: Pre-eclampsia/Eclampsia is the commonest reason for intensive care admission, however PPH has the highest case fatality rate. The outcome of critically ill obstetric patients is dependent on complications and not primary underlying diagnosis.

Association of high pre-pregnancy body mass index with adverse maternal and perinatal outcomes.

Background & Objectives: Obesity is an epidemic of the 21st century with its rates doubling in both developed and developing countries. It raises concerns for both maternal and fetal well-being and needs altered care throughout pregnancy and in postnatal period. Raised BMI prior to conception is associated with adverse feto-maternal outcomes. Limited data is available about its association with adverse maternofetal outcome in this region of the world. Our objective was to find out association of high pre-pregnancy BMI with adverse maternal and perinatal outcomes. Methods: This cohort study of 390 patients was conducted in Gynae department of Lady Reading Hospital Peshawar. Study duration was from June 2021 to March 2022. Patients enrolled in third trimester of gestation (≥ 37 weeks) were divided into two groups based on BMI i.e., Group-A with BMI <25 and Group-B with BMI ≥ 25. Both groups were followed until their delivery and discharge. Results: The mean age of 390 women was 28.2 ± 4.8 years. There was statistically significant association between raised pre pregnancy BMI and maternal risks like postpartum hemorrhage (p-0.0001), genital tract (p-0.0002) and perineal trauma (p-0.04). Neonatal risks significantly associated with high pre-pregnancy BMI were macrosomia (p-0.0001), and one minute APGAR score of < 8/10(p- 0.01). Both groups had no statistically significant difference for different modes of delivery i.e normal vaginal/ instrumental delivery and cesarean section (P-value 0.9). Conclusion: Maternal pre-conception BMI of ≥ 25 leads to poor maternal and perinatal outcomes.

Causes and outcome of pregnancy related acute kidney injury.

Objective: To determine frequencies of causes and renal outcomes of pregnancy related acute kidney injury. Method: This descriptive case series study was conducted in Nephrology unit of a tertiary care hospital of Peshawar, from 1st August 2021 to 31st July 2022.A total of 100 patients with acute kidney injury secondary to obstetric conditions were enrolled via non-probability consecutive sampling technique. While patients with pre-existing renal disease, those with renal stones, or having bilateral small kidneys on ultrasound were excluded from the study. Patients were followed till 12 weeks postpartum period. Underlying obstetrical causes and outcome at 12 weeks postnatal period were determined. Results: The mean age of sample of 100 cases was 29.29 ± 6.45. Mean serum creatinine at presentation was 6.5± 3.13. Majority of patient, 89% were multigravidas. Seventy eight percent patients required hemodialysis. Primary postpartum hemorrhage remained the commonest underlying cause of pregnancy related acute kidney injury in this study. The frequency of persistent renal failure in Pr-AKI (pregnancy related acute kidney injury) in this study was 14%. In about 66% of cases complete recovery occurred. All the underlying obstetrical causes, when adjusted for age, gravidity, place and mode of delivery, had no association with persistent renal failure. Conclusion: Primary postpartum hemorrhage is the predominant cause of pregnancy related acute kidney injury. By the end of 12 weeks postpartum, two third patients recover completely from pregnancy related acute renal injury.

Relationship of placental edge thickness and cervical length to gestational age at delivery in patients with placenta previa.

Background & Objective: Placenta previa and its accompanying fetomaternal complications are increasing day by day because of globally increasing rates of cesarean deliveries, trends of assisted reproductive techniques, and delaying pregnancies to later ages. Placenta previa is an important contributor to iatrogenic and mostly emergent preterm deliveries, which add to increased neonatal morbidity and mortality. The predictors of preterm deliveries can help clinician make necessary preparations for optimal fetomaternal outcome. The aim of the current study was to determine relationship of placental edge thickness and cervical length with gestation at delivery in patients having placenta previa. Methods: It was a descriptive case series study conducted in the department of obstetrics and gynecology, Medical Teaching Institute Lady Reading Hospital Peshawar from January 2020 till January 2021 .Seventy five patients fulfilled the inclusion criteria and were included in the study. Already diagnosed cases of placenta previa, with singleton alive pregnancies and gestation of 28 weeks or more were enrolled. Trans vaginal ultrasound was done to determine placental edge thickness and cervical length. Patients data on gestation at delivery were collected from hospital records. Results: A significant negative correlation between the placental edge thickness and gestational age at delivery was seen (r= -0.566, P= 0.001). The correlation between length of cervical canal and gestation at delivery was positive (r= 0.362, P=0.001). Also thick placental edge of > 2cm had significant association with birth before 37 weeks(P=0.023). A short cervix of less than 2.5 cm had also statistically significant association with birth before 37 weeks (P=0.022). Conclusion: There is linear inverse relationship of placental edge thickness with gestation at delivery. The relationship of cervical length with gestation is positive linear. Patients with thick placental edge are more likely to deliver preterm than those having thin placental edge.

Association of high Body Mass Index and postdates pregnancy.

Background and Objective: Obesity with its growing prevalence is a major public health problem influencing gestational age at delivery. Raised Body Mass Index (BMI) has been shown to be associated with significantly increased risk of prolonged pregnancy; which is an important contributor to perinatal morbidity and mortality. Obesity needs modified antenatal, intrapartum and postpartum care by obstetrician. Limited data is found regarding association of obesity with prolonged pregnancy and the same fact led us to search for this association. Methods: This cohort study was carried out in Gynecology and Obstetrics department, MTI Lady Reading Hospital Peshawar from March 2020 to April 2021. Patients were enrolled in third trimester at 37 weeks of gestation with primary exposures of interest being either self-reported pre-pregnancy weight or obtained from first trimester antenatal record. Patients were divided into two classes based on BMI i.e., one with BMI <25 and other with BMI ≥ 25. Patients in both classes were followed till their delivery to determine outcome of gestational age at delivery. Results: Statistically significant difference between the two groups was seen at lower age range of 18-21 years(p-0.04) and higher age range of 39-42 years (p-0.0001). Statistically significant association was found between high pre pregnancy BMI and postdates pregnancy (OR: 4.93 ;95% CI: 1.98-12.26, p-0.001). Association of induction of labor with high pre pregnancy BMI was not significant. (OR 0.56, 95% CI: 0.21-1.48, P < 0.001). Higher rates of Instrumental deliveries(p-0.0005) and cesarean sections (p-0.0001) were seen in higher BMI group. Conclusion: Higher pre-pregnancy BMI is associated with increased risk of postdates pregnancy.

Relationship between immediate postpartum umbilical cord pH, fetal distress and neonatal outcome.

OBJECTIVES: To determine relationship between immediate postpartum umbilical cord pH, fetal distress and neonatal outcome. METHODS: This descriptive cross-sectional study was conducted in the department of Gynaecology, Lady Reading Hospital Peshawar, Pakistan, from January 2019 to July 2019. This study included 27 full-term pregnant women who had abnormal CTG during the active or latent phase of labour. Data were analyzed by IBM SPSS Statistics for Windows, Version 23.0. RESULTS: Out of 27, most patients 13 (48.14%) were in the age group 20-25 years,11 (40.74%) to 26-30 years and 3 (11.11%) belonged to 31-35 years of age group. CTG abnormalities were severe bradycardia, late deccelerations and persistent variable deccelerations with loss of baseline variability. Of all delivered babies, 21 (77%) babies had birth weight<3.5 kg and 6 (22%) had >3.5 kg birth weight. 20 (74.07%) had acidosis (pH <7.2) at the time of birth, of which one had severe hypoxemia and acidosis with pH 6.85. APGAR score at 0 minutes showed a strong positive correlation (r=0.818, p= <0.001) with cord pH, while APGAR at five minutes was also strongly correlated (r= 773, p=<0.001). Of all babies 18(66.66%) with PH less than 7.2 were admitted in NICU while only 2 babies with PH more than 7.2 were admitted. (p value= 0.005). CONCLUSION: Low umbilical cord pH values of babies born by cesarean section (for fetal distress) are strongly correlated with low APGAR score at birth and higher rates of NICU admission.

Efficacy Of Preoperative Misoprostol In Reducing Hemorrhage During Abdominal Myomectomy.

BACKGROUND: Uterine myomas are most common non-cancerous tumours in reproductive period. The fertility preserving surgery, i.e., myomectomy as compared to hysterectomy, is associated with massive blood loss due to dissection of huge fibroids making it technically difficult procedure. Misoprostol (a uterotonic) is an effective option amongst different interventions used to reduce intraoperative blood loss during myomectomy. This randomized control trial investigated effectiveness of single dose of rectal misoprostol given preoperatively in reducing intraoperative blood loss during abdominal myomectomy.. METHODS: Fifty Patients undergoing abdominal myomectomy were selected for the study. Twenty-five patients were given 800 micrograms misoprostol per rectally half an hour before surgery while rest received placebo, i.e., control group. Number and weight of surgical packs were recorded both Pre and post operatively to assess blood loss. Preoperative and 24 hrs postoperative haemoglobin was also recorded. Data analysed by SPSS-20. RESULTS: Mean of age, parity and myoma size were not statistically different between the two groups. However intraoperative blood loss (as measured by weighing and counting number of swabs used) and postoperative haemoglobin after 24 hours were significantly different between two groups with p-value <0.01. CONCLUSIONS: Single dose of misoprostol given preoperatively via rectal route is effective in reducing intraoperative blood loss during abdominal myomectomy. Misoprostol must be used in different doses and routes in order to investigate its effectiveness in reducing intraoperative blood loss.