A STUDY TO DETERMINE MATERNAL AND FETAL OUTCOME IN HIGH RISK PREGNANCIES

Background: High risk pregnancy is any pregnancy in which there is a maternal or fetal factor that may adversely affect the outcome. In India, about 20-30 % pregnancies belong to high risk category, which is responsible for 75 % of perinatal morbidity and mortality. In order to improve the outcome of a high risk pregnancy, we must identify high risk factors and attempt to mitigate care to all these patients with high risk factors. Methods: The present study is an observational study focusing on maternal and fetal outcome in high risk pregnancies in a tertiary centre over 2 years, conducted in Dr DY Patil Medical College, Hospital and Research Centre, Pimpri, Pune. A pre designed semi structured, patient friendly questionnaire was prepared based on review of literature on high risk pregnancies. Results: In our study it was observed that patients of 20-25 years and 26-30 years were in reproductive age group and accounted for majority of the cases i.e. 42.1% and 36.9% respectively. A total of 1264 patients were admitted to our hospital between 34 to 40 weeks of gestational age, of which 384 patients were recognized as to have a high risk factors. The incidence of high risk pregnancy in our study was 30.37%. In our study, severe anaemia was the leading high risk factor, accounting for 23.4% .These patients were those with haemoglobin <7g/dl who required blood transfusion . Maternal outcome was the mainstay of our study. Anaemia being the single largest high risk factor, needed correction and therefore the use of parenteral iron and blood transfusion together accounted for 61.35% of patients. Blood transfusion was given to patients who were severe anaemic i.e. Hb was <7 g/dl, which accounted for 23.2%. This was followed by other morbid end organ disease like hypertension in pregnancy (16.1%), preterm labour (13.5%), previous LSCS (10.4%).Among the maternal outcome measures Post-partum haemorrhage accounted for 11.4% in our study which was a dangerous morbid factor anytime in obstetrics. Wound infection accounted for 10.5% among woman who underwent LSCS in our study, of these 5.2 % required secondary resuturing for both LSCS and episiotomy wound gape. Sudden blindness and acute renal failure were one of the end organ damage was seen in 1.75 % of patients who had hypertension and severe antepartum haemorrhage. Amongst the fetal outcome ,our study showed, preterm births which was 12.9 % followed by preterm with IUGR i.e. 11.9% and severely growth restricted babies accounted for 8.9%.The commonest cause for preterm labour , preterm with IUGR and IUGR babies was maternal anaemia and hypertension. Our study showed 45.2% of low birth weight babies which was significantly associated with high risk pregnancy.Of the total 402 babies born in our study, 258 babies required NICU (64%) for different causes are like preterm labour, IUGR and low birth weight. Conclusions: The key to reduction in high risk pregnancy is its early identification. Ours being a tertiary care centre most of the patients were referred from semiurban, rural set ups and primary health care centres. From the results of our study, we conclude that the key to management of high risk pregnancy is supervised and regular ANC and establishment of high risk dependency units in tertiary care hospitals like ours helps in better and protocol wise clinical management.