A rare and successfully managed case of idiopathic thrombocytopenic purpura (ITP) with previous caesarean with splenectomy with hepatitis C positive

Rajshree Dayanand Katke

Abstract:

ITP occurs in approximately 2 of 1000 pregnant women. ITP may develop at any time during pregnancy, but is often initially recognized in the first trimester and is the most common cause of isolated thrombocytopenia in this time period. A 33 year old, married since 6 years, G2p1l1 with 33 weeks gestation referred to our tertiary centre. She was a known case of ITP with splenectomy done. She had a 5 year old male child, delivered by LSCS. She was diagnosed as having ITP at the age of 12 years. HCV antibody was weakly positive. ANA was positive. Emergency LSCS was done in view of scar tenderness. Post op she developed epistaxis, bleeding gums and per vaginum. Patient received multiple FFP, platelet transfusions and responded to treatment with methylprednisolone. The diagnosis and management of ITP in pregnancy is similar to that in the non-pregnant adult patient, but the risks to the developing fetus must be taken into account when choosing treatment and the maintenance of a safe platelet count, rather than prolonged remission, is the goal. Mode of delivery must be guided by obstetrical indications.

Key words: Idiopathic thrombocytopenic purpura, ITP with pregnancy.

For Full Article Link:

http://www.scopemed.org/?mno=167924

LSCS audit in a tertiary care center in Mumbai: to study indications and risk factors in LSCS and it’s effect on early peri-natal morbidity and mortality rate

Rajshree Dayanand Katke, Ashish N. Zarariya, Pranay V. Desai

Abstract:

Background: Caesarean section has become a relatively safer and so common procedure in the practice of modern obstetrics. Audit plays an important role in the analysis of changing trends in caesarean delivery. The present retrospective analytical study attempts to critically analyze 474 cases of caesarean deliveries performed in tertiary hospital over a span of six months with an aim to identify the indications and risk factors involved in early peri-natal morbidity and mortality.
Methods: The Cama and Albless hospital is a tertiary care center located in South Mumbai, which cares for over 3000 deliveries per year. In the present retrospective analytical study, all cases of caesarean delivery from August 2013 to January 2014 were analyzed regarding the indication, associated risks factors, and all NICU admissions were studied. The decision to perform a caesarean section in each of these patients was made by a consultant on duty in consultation with the unit head telephonically. The primary objective of the study was to do LSCS audit with the secondary objective to analyse relationship of early peri-natal morbidity with indication of LSCS and risk factors associated.
Results: In the present study we found that the overall incidence of LSCS is 25.7%, incidence of primary LSCS is 23.1 %, incidence of LSCS in Referred cases is 61.7 %. So overall high incidence of LSCS is justified as our’s is a tertiary care referral unit. 3.5% of total LSCS cases were elderly gravidas and teenage pregnancies each. In our study, 11.8% and 3.5% patients were less than 37 weeks and 34 weeks respectively. However 30.6 % of NICU admissions were due to low birth weight. So IUGR in near term patients is an important morbid factor. Previous LSCS was the leading indication in 35.2% of cases followed by foetal distress in 14.9% of cases and Previous 2 LSCS 10.5%. Two important relative indications we found were Previous 1 LSCS and PIH contributing for nearly half of the total cases. Average duration of surgery was 86 minutes in our study and average stay in hospital was 9 days. In our study early perinatal mortality was 1.6% and morbidity in the form of NICU admissions was 20.8%. Most common cause for NICU admission was LBW followed by Respiratory distress. After comparing high risks factors and indications with NICU admissions we found highest morbidity in neonates who underwent LSCS for fetal distress, multiple pregnancy and premature rupture of membranes.
Conclusions: Individualization of the indication and careful evaluation can help us limiting early peri-natal morbidity and mortality. Obstetric audits in the institution, following standardized guidelines and practice of evidenced-based medicine will help us a lot in reducing the peri-natal morbidity and mortality.

Key words: LSCS, Indications, Risk factors, Perinatal morbidity and mortality.

For Full Article Link:

http://www.scopemed.org/?mno=168620

Rising incidence of unwed mothers in India; associated social parameters & institutional guidelines for managing them

Rajshree Dayanand Katke, Mohit R. Saraogi, Priyanka Pagare

Abstract:

Background: Globally the incidence of unwed mothers is rising. While the incidence is higher in western countries, developing countries like India are soon catching up. 
Methods: Ours is a retrospective study from January 2009 to December 2013 analyzing 51 cases of unwed mothers for - changing incidence of unwed mothers in India, to look for predisposing social & family pressures which may have led to the pregnancy, to study neonatal outcomes in such mothers & to analyze the role of social worker intervention in the management of such pregnancies. 
Results: Our study showed a 50% rise in the incidence of unwed mothers in our institute over the years with a majority (49%) of them being teenaged girls. 68% unwed mothers were uneducated or had only primary education & 58.9% unwed mothers had some predisposing factor which might have contributed to the pregnancy. 52% unwed mothers (who delivered) opted for institutional admission till term and 35.4% of these underwent a caesarean section at term (higher than institute LSCS rates). 21.5% unwed mother united with father with social worker intervention. 
Conclusions: Social and demographic parameters play a significant role in the incidence of unwed mothers. Several of these parameters are subject to external regulation & can reduce incidence of unwed mothers. Also the role of a social worker is priceless in management of these patients.

For Full Article Link:

http://www.scopemed.org/?mno=168620

Thrombocytopenia during pregnancy: An Institutional based study

Rajshree Dayanand Katke, Dhruv Pravin Gohil.

Abstract:

Background: Thrombocytopenia affects 6% to 10% of all pregnant women and other than anemia is the most common hematologic disorder in pregnancy. All pregnant women with platelet counts less than 100000/mm3 require careful hematological and obstetric consultation to exclude more serious disorders. Objectives of the study were to study the number and percentage of cases, the various etiological factors associated, the effect and outcome of the mother and neonates borne.

Methods: The study was conducted in this tertiary institute over a period of two years and three months. 103 pregnant patients with a platelet count of or less than 100000/mL were included. The course of pregnancy was studied and the investigation profile was monitored.

Results: Out of 103 cases of thrombocytopenia, 73 (70.9%) patients had moderate, 30 (29.1%) patients had severe thrombocytopenia. In this study 35% cases were primigravidas, 32% cases were gravida 2, 33% cases were gravida 3 to 5. Gestational thrombocytopenia was the most common etiological factor with 30.1% cases, 27.2% cases due to hypertensive disorders, 18.4% cases due to malaria followed by 12.6% cases due to dengue. In the study group the mean gestational age was 33 ± 5.139, maximum cases belonged to gestational age 30 to ≥40. 14 patients (14.1%) had still births. 9 patients (8.7%) had Neonatal deaths (NNDs).

Conclusions: The challenge to the clinician is to weigh the risks of maternal and fetal bleeding complications against the benefits of diagnostic tests and interventions.

Key words: Thrombocytopenia, Pregnancy

For Full Article Link:

http://www.scopemed.org/fulltextpdf.php?mno=167914