European Journal of Cardiovascular Medicine

Background: Caesarean section is the most common done obstetric emergency and the outcome of surgery differs depending on various factors. Maternal and fetal outcome depends on proper follow up during antenatal period. Aims: To study the maternal and fetal outcome of emergency caesarean delivery between unbooked rural referrals and booked cases. Materials and methods: This is a Comparative cross sectional study was conducted in the Department of Obstetrics and Gynaecology in Gestational age > 37 weeks, Unbooked cases handled outside and referred, who underwent caesarean delivery on emergency, Booked cases admitted in our hospital and underwent emergency caesarean delivery and Singleton pregnancy. Results: This study included 980 antenatal patients who underwent emergency caesarean section, among them 420 were booked cases and 560 were unbooked cases. The incidence of emergency caesarean section was more in unbooked group compared to booked group.  This comparison of age, Teenage pregnancy, parity, socioeconomic status had  statistical significance with p value < 0.05. The major indication of emergency caesarean section in booked cases was previous caesarean section (29.26%), where as it was fetal distress (22.6%) in unbooked group. Septicaemia in unbooked group (4.6%) was more than booked group(1%).66 cases (11.8%) of unbooked group and only 21 cases (4.9%) of booked group had wound infection. Postpartum haemorrhage, Perinatal mortality, NICU admission rate statistically significant among the two groups. Maternal intrinsic factors such as nutrition socioeconomic status and lack of antenatal care have been suggested as the causative factors in the unbooked patients. Conclusion: Poor utilization of antenatal care is associated with adverse feto-maternal outcome. Most maternal deaths are preventable if complications are diagnosed early and managed effectively in time .Early admission and management of critical obstetric patients decreases maternal morbidity and mortality

Labour and delivery are focus and climax of the reproductive process. They are both physical and emotional challenge for the mother and a hazardous journey for the fetus. Labour is a dynamic phenomenon characterized by a progressive increase in the frequency, intensity and duration of uterine contractions with progressive dilatation and effacement of the cervix and the  fetal  descent  through  the  birth  canal.   This physiological process may lead to pathology and failure to recognize this would result in prolonged labour resulting in increased morbidity and mortality of mother and baby.2 Material And Methods A hospital-based prospective study of 100 pregnant women with high-risk pregnancy  attending  the  department  of  Obstetrics  and  Gynaecology, Gayatri vidyaparishad medical college, Vishakhapatnam, from December 2021- November 2022. The study groups randomly selected a hundred primigravida with high-risk pregnancy fulfilling the inclusion and exclusion criteria. Informed and written consent was taken from all the women participating in the study. The study's primi pregnant women fulfilling inclusion and exclusion criteria were divided into the PARTOGRAM GROUP (P) and the other NO PARTOGRAM (NP). Each group consists of 50 primi  pregnant  women.  In the partogram group,  the progress of labour was documented on MODIFIED  WHO PARTOGRAPH and the notes on the progress sheet of case record file while standard notes only in no partogram group. Results In our study, 80% of pregnant women gestational age was below 39 weeks. In the NP group, 34% of women at 38 weeks, followed by 32% at 39 weeks. In the P group, 54% were at 38weeks, followed by 18% at 39 weeks and 18% at 40 weeks. Oligohydramnios  was  predominantly  observed  in  women  presented  in  39 weeks  (48%)  gestational  age.  Gestational  hypertension  (38.6%)  and  gestational diabetes mellitus(18.1%) was commonly observed in women in 38 weeks of gestation as both conditions are delivered at 38 weeks. Hypothyroidism was predominantly observed in women at 37 weeks(36.3%) and 39 weeks(24%) of gestation.  In individuals' groups, among the NP group, most pregnant women were delivered by FTNVD (60%) followed by 30% cases by LSCS. In P group out of 50 deliveries, 78% of cases delivered by FTNVD, followed by 14% undergone LSCS.  Conclusion: Partogram is an excellent tool for reflecting quick and consistent review of labour events, handing over the patient in changing shift duties, especially in low resource settings. It leads to earlier decision making in labour management and shown to reduce cesarean section rates.

Near miss maternal mortality cases generally occur more frequently than maternal deaths and therefore a more reliable quantitative analysis can be carried out, which can provide a more comprehensive profile of health system functioning. Present study was aimed to study clinical profile of maternal near miss cases at a tertiary hospital. Material and Methods: Present study was single-center, prospective, observational study, conducted in pregnant women who were pregnant or in labor or delivered or aborted; up to 42 days from termination of pregnancy, admitted and labelled as Maternal Near Miss. Results: In present hospital-based study, 220 near-missed cases were studied. Most of the patients are from the age group of 20-24 years (45.9 %), followed by 25-29 years (29.09 %) & 30-34 years (9.54 %). Majority of near-miss cases belonged to rural area (59.09%), were housewives (41.81 %), belonged to class III of socioeconomic class (29.09 %), were illiterate (55.90 %). Of 220 cases, 197 were registered (89.54 %), 95% of patients were immunized. Majority cases were referred from other hospitals (53.63 %) & were admitted in the antepartum period (87%). Majority cases were primigravida (40.9 %) followed by gravida two (20.45 %) & gravida three cases (19.09 %). 202 cases (91%) were delivered at a tertiary centre of which many were referred in antenatal period for high-risk management. 128 cases (58.18%) underwent LSCS, 88 cases (40%) delivered vaginally. Hypertensive disorders of pregnancy (53.18 %) contributed to the majority of near-miss cases, followed by anemia (19.09 %), heart disease (9.09 %), abruptio placentae (6.36 %) & respiratory disease (5.45 %). In 52% of near-miss cases, vascular and hematological dysfunction. Conclusion: Present study noted pregnant women from rural area, from lower socioeconomic class, low literacy were common among near miss cases.

Background: Cardiac disease in pregnancy is considered to be an important cause of maternal morbidity and mortality. Cardiac disease complicates 1-3% of all pregnancies and considered as leading cause of indirect maternal deaths. Cardiac disease in pregnancy is considered to be high risk and management of it in pregnancy is challenging. Aim: To evaluate fetomaternal outcome in cardiac disease complicating pregnancy. Objectives: To evaluate fetal and maternal outcome in pregnancy with cardiac disease. To measure the prevalence of cardiac disease in pregnancy. Materials & Methods: A retrospective observational study of all women who delivered at a tertiary care centre from 2011 to 2018 with heart disease complicating pregnancy were included in the study. Their details were collected from the case record and registers, using data collection proforma. The outcomes were studied. Results: The prevalence of cardiac disease was found to be 0.66%. Most common heart disease in pregnancy was found to Rhematic heart disease (72%). Among them the most common heart disease was found to be mitral stenosis (35%). Conclusion: Cardiac disease is a high risk pregnancy and has major effect on fetal and maternal outcome morbidity and mortality in pregnancy. Hence proper antenatal monitoring, involvement of multidisciplinary team and delivery in a tertiary care setup with ICU and Cardiac care facilities will definitely improve the fetal and maternal outcomes in cardiac disease complicating pregnancy.

Aims: To study of acute kidney injury in Antenatal mothers secondary to hypertensive disorders and Early detection to prevent the serious complications, Maternal morbidity and mortality and improve the perinatal outcome by early detection and treatment. Materials and methods: A hospital based prospective observational study was conducted in the Department of Obstetrics and gynaecology. Subjects were included in the study after written informed consent and data was collected by using pre structured questionnaire. Thorough obstetric, medical and surgical history was taken. the subjects were analysed for the following parameters. Results: 56% were antenatal presentations. Distribution of gravida shows that 56% had 2, 14% had 3, and 20% had 10% gravida. Induced delivery (48%) and Emergency LSCS (38%) were the main modes of pregnancy termination. 82% had medical treatment, 7% had ventilator support and 11% had dialysis. Nine patients died and 1 patient had chronic hypertension. 72% of the babies admitted to NICU, there were 32 fetal deaths and 1 abortion. Neonatal morbidity and mortality are very high because of AKI in pregnancy and with other complications. Pregnancy needs to be terminated immediately, irrespective of gestational age to prevent maternal complications and deaths. Mothers with hypertensive disorders who presented in early preterm (24-32 weeks) delivered babies with less than 1.5 kg and among them, 100% perinatal mortality is observed. For babies with>1.5 kg weight, most of them presented with intrauterine death due to abruption or fetal growth restriction. Conclusion: Knowledge of associated characteristics and outcomes presented in this study provides important prognostic information for patients, a framework for physicians to understand severe pregnancy- related AKI in the current era, and informed strategies to better identify women at risk. And also concluded from this study that prevention is always better than cure.

Introduction: Cardiac disease is a leading cause of maternal morbidity and mortality during pregnancy. Effective management strategies are crucial for improving outcomes in this high-risk population. Aim: This study aimed to evaluate the outcomes of pregnant women with cardiac disease managed at the Rajendra Institute of Medical Sciences (RIMS), Ranchi, to refine treatment protocols. Methods: A prospective cohort study was conducted over one year, enrolling 35 pregnant women with either congenital or acquired heart diseases. Participants underwent regular monitoring with echocardiography, and data were collected on maternal and perinatal outcomes, including delivery methods and postpartum complications. Results: The study highlights significant maternal and perinatal complications in pregnant women with cardiac disease, with anemia (31.4%) and preterm birth (25.7%) as prevalent issues. The findings underscore the need for careful monitoring and management tailored to the severity of cardiac dysfunction to improve outcomes for both mothers and newborns. Conclusion: Effective cardiac and obstetric management in a tertiary care setting allowed for predominantly vaginal deliveries and highlighted the importance of echocardiography in monitoring. Recommendation: Tailored antibiotic prophylaxis and comprehensive postpartum contraceptive counseling should be integrated into care protocols for pregnant women with cardiac disease

Background: Postpartum hemorrhage (PPH) is a leading cause of maternal morbidity and mortality globally. This study aimed to determine the prevalence, associated risk factors, severity, and management outcomes of PPH in a tertiary care hospital. Methods: An observational analysis was conducted on 100 postpartum cases. Data on demographics, obstetric history, labor characteristics, and management approaches were collected. The prevalence and risk factors of PPH were analyzed, and the severity of cases was categorized based on blood loss volume. Management strategies were evaluated for their effectiveness. Results: The prevalence of PPH was 23%. Significant risk factors included maternal age ≥35 years (65%), grand multiparity (48%), cesarean delivery (56%), prolonged labor (>12 hours, 60%), antepartum anemia (67%), placenta previa/placental abruption (30%), macrosomia (5%), and pre-eclampsia (70%). Mild PPH (500–1000 mL) accounted for 65% of cases, moderate PPH (1001–1500 mL) for 26%, and severe PPH (>1500 mL) for 9%. Management was primarily medical, effectively controlling 83% of cases, while surgical interventions were required in 17%. Conclusion: PPH remains a significant obstetric challenge, with multiple risk factors contributing to its occurrence and severity. Effective management, predominantly through medical interventions, is critical in reducing complications. Preventive measures focusing on high-risk groups, such as those with antepartum anemia or pre-eclampsia, may mitigate PPH prevalence and severity.

Background: Cesarean section (CS) is a widely performed obstetric procedure, with variations in surgical technique aimed at improving maternal and fetal outcomes. This study compares exteriorization of the uterus versus in situ repair during CS in terms of surgical and postoperative outcomes. Methods: A prospective interventional study was conducted at the Department of Obstetrics and Gynecology, Konaseema Institute of Medical Sciences, Amalapuram, involving 200 patients undergoing CS. Participants were randomized into two groups: exteriorization (n=100) and in situ repair (n=100). Demographic data, intraoperative parameters, postoperative recovery, and neonatal outcomes were compared using statistical analysis. Results: The exteriorization group had a significantly shorter surgical duration (59.09 ± 10.46 min vs. 66.15 ± 11.72 min, p < 0.0001) and less blood loss (postoperative hemoglobin: 10.28 ± 1.28 g/dl vs. 9.76 ± 0.89 g/dl, p = 0.001). However, postoperative pain scores were higher on day 1 (6.69 ± 0.84 vs. 5.43 ± 0.74, p < 0.0001), with increased analgesic use. Hospital stay, febrile morbidity, and infection rates were similar between groups. Neonatal outcomes were comparable, with no difference in 1-minute APGAR scores, though the 5-minute APGAR score was slightly higher in the in situ group (p = 0.005). Conclusion: Exteriorization of the uterus offers reduced surgery time and blood loss but is associated with higher immediate postoperative pain. Given the similar maternal and neonatal outcomes between techniques, the choice of approach should be tailored to individual patient conditions and surgeon preference.

Background: Anaemia in pregnancy, particularly iron deficiency anaemia, is a significant global health concern associated with adverse maternal and perinatal outcomes. This study aims to compare the maternal and fetal outcomes in anaemic pregnancies with iron deficiency and non-anaemic pregnancies. Methods: A prospective randomized case-control study was conducted involving 200 pregnant women (100 anaemic and 100 non-anaemic) at KIMS & RF, Amalapuram. Anaemia was classified into mild, moderate, and severe based on hemoglobin levels. Maternal and fetal outcomes were assessed and compared between the two groups. Results: The anaemic group had significantly higher rates of preterm birth (8% vs. 2%), postpartum hemorrhage (7% vs. 1%), and maternal morbidity (17.5% vs. 2%) compared to the non-anaemic group. Fetal outcomes were worse in the anaemic group, with higher rates of stillbirth (3% vs. 0%), early neonatal death (4% vs. 0%), low birth weight (22% vs. 3%), and neonatal morbidity (17.5% vs. 6%). Neonatal complications such as respiratory distress syndrome (3% vs. 1%) and meconium aspiration syndrome (10% vs. 1%) were also more prevalent in the anaemic group. Conclusion: Anaemia, particularly iron deficiency anaemia, significantly impacts maternal and fetal health, leading to higher maternal morbidity, preterm births, and adverse fetal outcomes. Early diagnosis and treatment of anaemia in pregnancy are crucial to improve both maternal and neonatal health

Background: Ectopic pregnancy remains a significant obstetric challenge, contributing to maternal morbidity and mortality. Despite advancements in diagnostic modalities, the condition continues to pose a serious threat due to its unpredictable nature and potential for life-threatening complications. This study aimed to assess the risk factors, clinical presentations, and outcomes of ectopic pregnancies in a tertiary care hospital in Kashmir. Methods: A retrospective observational study was conducted over a 20-month period (January 2022–August 2023) at the Department of Obstetrics and Gynecology, GMC Srinagar, Jammu & Kashmir. A total of 153 cases of ectopic pregnancies were identified through a records review. Data on sociodemographic characteristics, clinical presentations, risk factors, management modalities, and outcomes were collected. Statistical analysis was performed using SPSS v.22, with Chi-square and t-tests applied to assess associations. Results: The highest incidence of ectopic pregnancy was observed in women aged 25–30 years (52.9%), with a majority being multiparous (56.2%). The most common risk factors included previous lower segment cesarean section (39.2%), prior abortions (14.4%), and prior ectopic pregnancy (9.2%). Abdominal tenderness (89.5%) and vaginal bleeding (57.5%) were the most frequent clinical presentations. Surgical management was required in 61.5% of cases, while 11.8% were managed medically. Rupture was observed in 39.2% of cases, with significant associations found with adnexal mass (p < 0.001), cervical motion tenderness (p < 0.001), and bleeding per vaginum (p = 0.004). Conclusion: Ectopic pregnancy continues to present significant diagnostic and therapeutic challenges. Previous cesarean section and abortions emerged as major risk factors. The findings highlight the importance of early diagnosis and tailored management strategies to reduce morbidity and improve patient outcomes.

Background: Placenta Accreta Spectrum (PAS) represents a range of severe obstetric complications characterized by abnormal placental adherence, leading to significant maternal morbidity. Early and accurate prenatal detection is crucial for optimal management. A low-lying placenta (LLP) is a known risk factor for PAS. This study aimed to investigate the correlation between maternal serum alpha-fetoprotein (MS-AFP) levels and the presence of PAS in pregnant women with LLP, and to evaluate its potential as a predictive marker. Methods: This was conducted at Lalla Ded hospital, a tertiary care centre in Srinagar, J&K, between August 2023 and January 2025. Pregnant women with gestation >=28 weeks, diagnosed with LLP via ultrasound , who underwent MS-AFP screening were included. MS-AFP levels were measured using and expressed as Multiples of the Median (MoM). An MS-AFP level of >=2.5 MoM was considered elevated. The diagnosis of PAS was confirmed by intraoperative findings and/or histopathological examination. Statistical analysis included descriptive statistics,, correlation analysis, and calculation of diagnostic accuracy metrics. Results: A total of 250 women with LLP were included. PAS was confirmed in 38 (15.2%) participants. The mean MS-AFP level was significantly higher in women with PAS (>=2.5 MoM) compared to those without PAS ( <2.5 MoM) (P<0.05). A significant positive correlation was observed between MS-AFP levels and the presence of PAS (P<[0.05]). Elevated MS-AFP (>=[2.5] MoM) demonstrated a sensitivity of [86.8]%, specificity of [72.1]% for the detection of PAS in this observational study.  Conclusion: Elevated second-trimester MS-AFP levels are significantly correlated with an increased risk of PAS in women with LLP. While not a standalone diagnostic tool, MS-AFP may serve as a valuable, non-invasive adjunct for risk stratification, prompting enhanced surveillance and timely referral for specialized management in this high-risk population.

Context/Background: The reproductive health of women is a crucial aspect of overall health and plays a key role in human development with services utilization playing a key role in reducing maternal morbidity and mortality. Despite global efforts to improve maternal health outcomes, the utilization of maternal health services remains suboptimal in many regions. Aims/Objectives: To assess the utilization of maternal and child health services and their children and factor influencing in the Chargawan block of Gorakhpur district. Methodology: A community based cross-sectional multistage study was conducted among recently delivered women in the Chargawan block of Gorakhpur district. The study participants were 400 recently delivered women and their children up to 24 months who reside in Chargawan block A pre-tested and pre-designed questionnaire was used to collect data on sociodemographic characteristics, and utilization of maternal and child health (MCH) services, including ANC, delivery, postnatal care (PNC), family planning, immunization, and childcare and factors influencing access utilization of MCH services. Statistical package for social sciences, version‑26 (SPSS‑26, IBM, Chicago, USA) was used for data analysis. P <0.05 was considered statistically significant. Results: The overall registration for ANC services in the study area was 96.50%. Most women who avail ANC services primarily visit the nearest Primary Health Center (36.50%), and 19.00% of RDWs prefer private clinics or hospitals for receiving ANC services. the majority (41.00%) had more than four ANC visits. The majority (95.75%) of RDWs opted for institutional deliveries. The family services availed by RDWs was 60.25%. the complete immunization by their children was 76.2%. The findings highlight the significant role of education, spouse’s occupation, and socio-economic status in shaping maternal health service utilization. Conclusions: To improve utilization addressing socio-economic disparities, enhancing awareness of maternal health, and improving healthcare access.

Background: Ectopic pregnancy is a potentially life-threatening condition in which a fertilized ovum implants outside the uterine cavity, most commonly in the fallopian tubes. It remains a major cause of maternal morbidity and mortality in the first trimester, particularly in resource-limited settings. Despite advancements in diagnostic imaging and laboratory support, delays in diagnosis are still common due to the variable and non-specific nature of its clinical presentation. Ectopic pregnancy accounts for 1–2% of all pregnancies globally, but the incidence may be higher in populations with limited access to early antenatal care or with high rates of risk factors such as pelvic inflammatory disease, tubal surgery, infertility treatments, or previous ectopic pregnancies.  In many cases, the classic triad of amenorrhea, abdominal pain, and vaginal bleeding may not be evident, making clinical suspicion essential. Without timely intervention, ectopic pregnancy can lead to tubal rupture, massive intra-abdominal bleeding, and maternal death. In low- and middle-income countries, the burden is further amplified due to late presentation, inadequate diagnostic facilities, and restricted access to emergency obstetric care. Understanding the clinical features and demographic patterns of ectopic pregnancy in a tertiary care setting is crucial to improve early diagnosis and outcomes. A hospital-based analysis provides valuable insight into real-world presentations and helps identify gaps in care that can be addressed through targeted interventions. Objective: To determine the clinical features of ectopic pregnancy among women presenting to a tertiary general hospital. During the study period, 50 subjects were chosen for the study. Conclusion: Strengthening clinical acumen and timely diagnostic protocols in emergency and obstetric care settings can significantly improve maternal outcomes in cases of ectopic pregnancy.