The Journal of Obstetrics and Gynecology of India

To evaluate nulliparous breech delivery so as to determine prognostic factors for an unsafe vaginal delivery (VD). This retrospective and descriptive study was carried out in the University Teaching Hospital Yaoundé–Cameroon, from January 1, 2005 to December 31, 2009. Files of 126 women with singletons in breech presentation and normal fetal heart beats at a gestational age ≥32 weeks were reviewed with a trial of VD ordered in 104. The parameters recorded were mother’s age, gestational age, mode of delivery, birth weight, 5th minute Apgar scores, neonatal outcome, and use of episiotomy. The results showed that 84 (66.7 %) had a successful VD. Failure of VD or poor Apgar score after VD were observed if fetal weight ≥3,500 or <1,800 g, footling breech, maternal age >28 or <19 years, post term, and rigid cervix. Elective cesarean section should be systematic if the unsafe circumstances above mentioned are present.

The present study was conducted to compare the gravidogram and ultrasound in the detection of intrauterine growth restriction. This study was conducted in the Department of Obstetrics and Gynecology, Voluntary Health Services, Chennai (TN) from August 2007–May 2009. The study included 321 women with singleton pregnancy in a longitudinal lie. These women underwent serial symphysio-fundal height measurements and ultrasound. Birth weights of the newborns were noted at the time of delivery. Gravidogram and ultrasound findings were correlated with the birth weights. The sensitivity of the ultrasound in the detection of IUGR was higher (85.2 vs 74.1 %) than the gravidogram, but the specificity was almost the same (96.6 and 95.9 %). The gravidogram is a simple and inexpensive screening tool and as useful as an ultrasound in detection of intrauterine growth restriction. Both gravidogram and ultrasound, when used together, have higher detection rates.

To assess the predictive value of cerebroplacental ratio (i.e., S/D ratio of middle cerebral artery to S/D ratio of Umbilical artery) in detection of perinatal outcome in high-risk pregnancies. This retrospective study was conducted on 150 patients between 28 and 40 weeks of gestation (25 low risk and 125 high risk) who attended OPD and indoor wards of Teerthanker Mahaveer medical college and research center, Moradabad. All patients had serial color Doppler ultrasounds done after taking informed consent which was repeated at 2 weeks interval, and data were collected with regard to perinatal outcome. Cerebroplacental ratio is having higher sensitivity and negative predictive value in detection of IUGR, Meconium aspiration syndrome, operative interference for fetal distress, and NICU admissions in comparison to its components. So, better prediction of neonatal outcome can be done by C/U ratio.

Peripartum cardiomyopathy (PPCM) is a disorder of unknown etiology in which symptoms of heart failure occur between the last month of pregnancy and 5 months post-partum. These findings prompted us to carry out a more detailed study aimed at correlating plasma levels of C-reactive protein TNF-α and IL-6 as prognostic value for major clinical in-hospital events and 6-month follow-up in patients with PPCM. After ethical clearance, in the present prospective case–control study, a total of 86 subjects were enrolled [patients (n = 46) and controls (n = 40)]. After checking for the inclusion and exclusion criteria, informed consent was obtained and patients were enrolled. The details of history of pre-eclampsia and mode of delivery were obtained from the patients. The history of onset of symptoms and signs was recorded at the first presentation and at 6 months. Clinical assessment, echocardiography, and blood analysis were done at baseline and after 6 months of standard therapy. All patients received treatment with diuretics and the ACE inhibitor (ramipril), Carvedilol if not contraindicated, and inotropic support inj-Dobutamine. Inflammatory markers (C-reactive protein, TNF-α, and IL-6) were measured at baseline and at 6 months. Data were analyzed using the SAS version 9.1 statistical program. The characteristics of the study population at first presentation to the cardiac clinic are similar (compared with controls): 0.91 % of the study patients were diagnosed as PPCM patients for the first time and 49 % patients presented within one month after delivery. C-reactive protein (22 vs 08 mg/dl, p < 0.05), TNF-α (9.6 vs 3.2 pg/dl, p < 001), and IL-6 (73.19 ± 34.4 vs 31.52 ± 8.83 pg/dl, p < 0.005) were significantly abnormal, and these patients showed significantly higher LV dimensions, LV EDD (61.6 ± 7.1 vs 46 ± 9 mm p < 0.004) LV ESD (53.1 ± 7 vs 32 ± 8, p < 0.005), and significantly lower echocardiographic left ventricular ejection fraction (LVEF) (25.9 ± 8.2 vs 55 ± 12 p < 0.001) and correlate well with NYHA FC and death. LVEF improved from 25.9 ± 8.2 to 42.9 + 13.6 % at 6 months (p < 0.0001). Patients who completed 6 months of standard care showed a significant reduction of heart rate, LV dimensions, and NYHA FC (p < 0.001). However, normalization of LVEF (>50 %) was only observed in 11 (35 %) patients. Seven patients died within 6 months of diagnoses and eight patients were lost to follow-up. Plasma markers of inflammation were significantly elevated in PPCM patients and correlated with increased LV dimensions and lower EF at presentation. Baseline CRP, IL-6, TNF-α, and higher NYHA FC were the only predictors of mortality. These results contribute to inflammation which may contribute to the pathogenesis of PPCM and its complications and predictors of mortality.

Cesarean section (CS) is a delivery method, which is used to avoid the complications of vaginal delivery, maternal and neonatal morbidity, and mortality. It has become the most applied surgical procedure both in Türkiye, and globally. In 2013, Robson et al. created the “Robson 10-Group Classification System” (TGCS) in Ireland to evaluate and standardize CS indications more easily. The data for this retrospective study were collected from the records of women, who gave birth between January 1, 2019 and July 31, 2022 at Muğla University Education and Research Hospital. These data were classified according to the TGCS. There were 4889 deliveries in our clinic between the specified dates. 3177 (64.98%) of these births were CS. When the CS ratio was evaluated as a percentage, the groups with the highest ratio were, respectively, Robson groups 9, 5, 7, and 8 (100%, 99.34%, 97.56%, and 96.92%). When the CS ratio was evaluated as a percentage, the group with the lowest ratio was Robson group 3 (21.5%). When numerically evaluated in terms of the effect on the CS number, the ranking was Robson groups 5, 1, and 2, respectively (1,053, 893, and 568). The CS ratio of our clinic is above the mean for that of Türkiye, and the highest acceptable CS ratio according to the WHO. Since our clinic is the only university hospital in the city, all complicated pregnancies are referred to our clinic, with births also taking place there. In addition, behavior change would be appropriate both with respect to active birth management and the action required to reduce the CS ratio.

The aim of this study was to investigate perinatal outcome and the rate of cesarean section (CS) following intrapartum amnioinfusion in women with meconium-stained amniotic fluid (MSAF). A total of 100 women at term in labor with meconium were randomized to infuse transcervical intrapartum amnioinfusion with saline (50) and routine obstetrical care (50). Perinatal outcome and obstetric outcome were recorded and analyzed in both groups by means of Chi-square test. The CS rate due to fetal distress was 40.0 % in the control group and 20.0 % in the study group. The difference was statistically significant (P < 0.01). Respiratory distress of the neonate was significantly less common in the study group than in the control group (4.0 % vs. 12 %; P = 0.0349). Amnioinfusion in cases of meconium-stained liquor significantly improved neonatal outcome and CS rate without increasing any maternal and fetal complications.

To determine the efficacy of tranexamic acid in decreasing blood loss in elective/emergency LSCS. A prospective randomised case control study was done in 200 pregnant women undergoing elective/emergency LSCS in the Department of Obstetrics and Gynaecology, at a tertiary care teaching hospital in Mysuru, from December 2018 to September 2019. Women in the age group of 18–35 years were included in the study. Those with anaemia (Hb < 10 gm%), hypertension in pregnancy, bleeding diathesis, GDM on insulin, polyhydramnios, oligohydramnios, cardiac and chronic liver disorders were excluded from the study. Two hundred women undergoing emergency/elective LSCS were divided into case (group 1) or control (group 2) groups using a computer-generated random number table. Tranexamic acid (10 mg/Kg) was given in 100 ml Normal Saline 10 mins prior to skin incision to women in the first group, along with routine care (10 Units of Oxytocin IM soon after extraction of the baby). Routine care, as per institutional protocol, was followed in the second group. The primary outcome was to estimate the intraoperative blood loss. Blood loss was measured by weighing pads, mops, drapes before and after surgery and blood in the suction container after surgery. Two separate suction catheters and containers were used, in order to minimise mixing of blood and amniotic fluid. Total blood loss was calculated as the difference in the weight of the pads, mops and drapes before and after surgery and the sum of the amount of blood in suction container. The difference between the pre-operative and post-operative haemoglobin and haematocrit was compared. The pre-operative, intra-operative and post-operative hemodynamics were also compared. Statistical analysis was done using MS Excel and R-3.5.1 software. Unpaired and paired t test were used. In our study, there was a significant decrease in intraoperative bleeding in women receiving tranexamic acid. Women in the control group had a significant fall in the postoperative hemoglobin when compared to women who received tranexamic acid. Also, women who received tranexamic acid did not develop any significant hemodynamic changes during or immediately after the surgery. Tranexamic acid can be safely used as a prophylactic agent to reduce bleeding during elective and emergency LSCS.