Academic literature on the topic 'Pregnancy Complications Victoria'

The relationship between maternal exposure to ambient air pollution and pregnancy complications is not well characterized. We aimed to explore the relationship between maternal exposure to ambient nitrogen dioxide (NO2) and fine particulate matter (PM2.5) and hypertensive disorders of pregnancy, gestational diabetes mellitus (GDM) and placental abruption. Using administrative data, we defined a state-wide cohort of singleton pregnancies born between 1 March 2012 and 31 December 2015 in Victoria, Australia. Annual average NO2 and PM2.5 was assigned to maternal residence at the time of birth. 285,594 singleton pregnancies were included. An IQR increase in NO2 (3.9 ppb) was associated with reduced likelihood of hypertensive disorders of pregnancy (RR 0.89; 95%CI 0.86, 0.91), GDM (RR 0.92; 95%CI 0.90, 0.94) and placental abruption (RR 0.81; 95%CI 0.69, 0.95). Mixed observations and smaller effect sizes were observed for IQR increases in PM2.5 (1.3 µg/m3) and pregnancy complications; reduced likelihood of hypertensive disorders of pregnancy (RR 0.95; 95%CI 0.93, 0.97), increased likelihood of GDM (RR 1.02; 95%CI 1.00, 1.03) and no relationship for placental abruption. In this exploratory study using an annual metric of exposure, findings were largely inconsistent with a priori expectations and further research involving temporally resolved exposure estimates are required.

Abstract Background Two strains of influenza B virus, B/Yamagata and B/Victoria, co-circulate in the USA, typically appearing in late March. This year, influenza B virus (FluB) co-circulated consistently with influenza A virus (FluA). We hypothesized that this could be explained by an increased use of influenza trivalent vaccine, which lacks the B/Yamagata strain, over the quadrivalent vaccine. Methods We performed a retrospective, observational cohort study of patients with laboratory-diagnosed influenza from October 2016 through April 2017. Age, comorbidity categories, pregnancy status, symptoms, The presence of opacity on chest film, ICU admission, death, and receipt of oseltamivir were reviewed for 256 patients. A subset of FluB specimens were subtyped for lineage using RT–PCR. Results Influenza was detected in 495 (10.4%) of 4,754 samples collected, including 305 FluA and 190 FluB. The H3 strain represented 97% of FluA cases. FluB subtypes were: 70, B/Victoria; 21, B/Yamagata; and 41, not subtyped. Chart review was conducted for 124 randomly selected FluA and 132 sequential FluB patients. Median age of patients with FluA was 44 compared with 27 with FluB (P < 0.001). Forty-three (34.7%) FluA patients had heart disease compared with 21 (15.9%) FluB patients (P < 0.001). Otherwise, there were no differences in comorbidities, pregnancy status, clinical symptoms, or infectious complications between FluA vs. FluB patients. Ninety-three (75%) FluA patients and 78 (59.1%) FluB patients received oseltamivir. ICU admission occurred in 15 (12.1%) FluA and 9 (6.8%) FluB patients (OR 1.414; 95% CI 0.83-2.4). Seventy-seven (30%) patients received flu vaccine, 39 with FluA, and 38 with FluB; 97 (37.9%) were not vaccinated and 82 (32%) were missing data. Of those vaccinated, 6 patients received trivalent vaccine, and 71 received quadrivalent. Only 24 patients with B/Victoria and 7 patients with B/Yamagata were vaccinated. Conclusion The proportion of infected patients who had received vaccination was low, limiting our ability to detect the effect of the trivalent vaccine on the incidence of infection with B/Yamagata. In contrast to conventional thought, when compared with influenza B, influenza A (predominantly H3N2) did not appear to disproportionally affect those with most medical comorbidities, and was not disproportionately associated with our identified clinical complications. Disclosures All authors: No reported disclosures.

Background: Ectopic pregnancy remains the most common cause of early pregnancy mortality, with management options differing according to clinical presentation and investigations. This audit aims to investigate the indications for medical and surgical management of ectopic pregnancy at a tertiary hospital network, in order to assess variances in practice and adherence to local hospital protocols. Methods: A retrospective audit of the management of women with a diagnosis of ectopic pregnancy was performed over 12 months from July 2018 to June 2019, at three hospitals in the largest healthcare network in Victoria, Australia. Information collected included patient demographics, risk factors for ectopic pregnancy, pathology and radiology results, documented indication for surgery, and any complications of treatment. A subgroup analysis of data was done to investigate changes and deficiency in management of ectopic pregnancy compared to local hospital protocol. Results: Over a 12-month period, 138 women were diagnosed with an ectopic pregnancy, of which 99 (72%) received surgical management and 39 (28%) received medical management. Four women within the medical group were excluded from analysis, one due to loss of follow-up and three patients who were diagnosed with nontubal ectopic pregnancies. About 94% (33/35) of women who received methotrexate were within hospital guidelines for medical management and 91% (32/35) were successfully managed without surgery. All women who received surgical management underwent a salpingectomy and 97% (96/99) had clear indications documented for surgery within local protocol. Conclusion: Overall, the majority of women with ectopic pregnancy were treated according to local guidelines. Expectant management and the option of salpingostomy as a surgical alternative could be considered in the local guidelines. The dissemination of this clinical audit data is aimed at continuing clinical governance and improvements in outcomes.

Background: Thyroid gland is the power house of human body. It provides energy for the various biochemical processes of the body and helps to maintain basal metabolic rate. Objective: To estimate the prevalence of thyroid dysfunction in pregnancy and to evaluate the obstetric and perinatal outcomes in such pregnancies Setting: Department of Obstetrics & Gynecology, Bahawal Victoria Hospital Bahawalpur from 15 January 2021 to 15 JUNE 2021 Study Design: A Descriptive Case Series. Materials and Methods: A total of 292 cases of antenatal patients, irrespective of their period of gestation were enrolled in this study by random sampling method. Patients with multiple pregnancies and having bad obstetrical history were excluded. Detailed history and obstetrical examination, routine blood test and serum TSH were performed. These patients were followed during labour, delivery and puerperium and maternal outcome and neonatal outcomes were noted. Results: In this study we enrolled two hundreds and ninety two (292) antenatal women. Out of total 292 patients only 61 (20.9%) were nulliparous and rest of the patients were multiparous. The prevalence of thyroid dysfunction in pregnancy was 8.2%. Out of this, 2.74 % patients had sub clinical hypothyroidism (SCH). Overt hypothyroidism (OH) was seen in 2.40%, sub clinical Hyperthyroidism in 1.71% & the incidence of overt hyperthyroidism was 1.37%. Maternal complication included: abortion (5.5%), pre-eclampsia (3.4%), abruption-placentae (4.1%), preterm labour (4.5%), PPH (4.2%) and puerperal sepsis (2.8%). Neonatal outcomes included: preterm births (5.4%),LBW (5.1 %), IUGR (6.2%), still birth (4.4%), neonatal death (5.1%), low APGAR score ( <7 at 5 minutes ) (6.9%). Conclusion: Thyroid dysfunction in pregnancy, though has a low incidence, but is associated with adverse maternal and fetal complications. Thus thyroid screening should be done in antenatal period to improve fetomaternal outcome. Keywords: Thyroid dysfunction, Hypothyroidism, Hyperthyroidism, Fetomaternal outcome, Overt Hypothyroidism, Subclinical Hypothyroidism.

Many triplets are conceived as a consequence of assisted reproductive technology (ART). Concerns have been raised that triplet pregnancies conceived by ART are more complicated than those conceived spontaneously. The purpose of this study was to evaluate all triplet pregnancies managed over a 12-year period to determine if there were any differences in outcome based on the mode of conception. All triplet pregnancies between 1999 and 2011 that reached at least 20 weeks’ gestation and that were managed at the Royal Women's Hospital (RWH), Melbourne, Victoria were identified. Maternal and neonatal outcomes were compared between ART conceived and spontaneously conceived triplets. In the study period, 53 sets of triplets managed in our institution met the eligibility criteria. Twenty-five triplet sets were conceived by ART and 28 were conceived spontaneously. More ART conceptions resulted in trichorionic triamniotic (TCTA) triplets than did spontaneous conceptions (p= .015). There were no differences between ART and spontaneously conceived triplets for any of the maternal or neonatal complications studied. Trichorionic (TC) triplets delivered at a later gestation than other triplets: 32.1 (SD2.9) versus 30.4 (SD3.9) weeks (p= .08). TC triplets were significantly less likely to die than monochorionic (MC) or dichorionic (DC) triplets: 3/93 (3%) versus 13/66 (20%) (p= .025). In conclusion, triplets conceived by ART are more likely to have TCTA placentation and TCTA triplet sets had lower mortality rates than other triplet combinations. Outcomes for triplets conceived by ART were similar to those of triplets conceived spontaneously.

Background: The aim of the study was to describe epidemiological aspects and clinical characteristics of these patients, as well as diagnostic work-up, comprehensive management and updated follow-up. Methods: In a 4-years’ period, 6 female and 4 male fetuses were diagnosed with NTD in Department of OBG at Victoria Hospital, BMCRI, Bangalore. Analyzed data were related to familiar and/or maternal risk factors (consanguinity, maternal preexisting and/or gestational diseases, exposure to teratogen/infectious agents, lack of preconception folic acid supplement), demographic (ethnicity/origin, residence) and clinical features (eventual use of assisted reproduction techniques, prenatal diagnosis, gestational age, fetal presentation, type of delivery, birth weight, preoperative imaging, antibiotics and analgesics use, description of the surgery intervention, length of hospital stay, comorbidities, complications), and follow-up. Results: Among 10 cases, 6 female and 4 male fetuses were diagnosed with NTD. All 10 fetuses had Anencephaly and other associated anomalies. The diagnosis was made by prenatal ultrasonography. Among ten mothers one was over-aged. Medical history revealed that only 2 mothers used folic acid (FA), -tablets containing 5 mg folic acid, once daily, beginning after being aware of the pregnancy- neither initiated preconceptionally, nor consumed regularly. The remaining 8 mothers did not use any supplements. No mothers used any kind of drugs during pregnancy, and 2 were diabetic. All patients had normal thyroid, liver and renal function tests. Abdominal ultrasonography revealed no abnormality.

ObjectiveTo analyse yearly rates of pelvic inflammatory disease (PID) and ectopic pregnancy (EP) diagnosed in hospital settings in Australia from 2009 to 2014.MethodsWe calculated yearly PID and EP diagnosis rates in three states (Victoria, New South Wales, Queensland) for women aged 15–44 years using hospital admissions and emergency department (ED) attendance data, with population and live birth denominators. We stratified PID diagnoses as chlamydial-related or gonorrhoeal-related (Chlamydia trachomatis (CT)-related or Neisseria gonorrhoeae (NG)-related), acute, unspecified and chronic, and analysed variations by year, age and residential area using Poisson regression models.ResultsFor PID, the rate of all admissions in 2014 was 63.3 per 100 000 women (95% CI 60.8 to 65.9) and of all presentations in EDs was 97.0 per 100 000 women (95% CI 93.9 to 100.2). Comparing 2014 with 2009, the rate of all PID admissions did not change, but the rate of all presentations in EDs increased (adjusted incidence rate ratio (aIRR) 1.34, 95% CI 1.24 to 1.45), and for admissions by PID category was higher for CT-related or NG-related PID (aIRR 1.73, 95% CI 1.31 to 2.28) and unspecified PID (aIRR 1.09, 95% CI 1.00 to 1.19), and lower for chronic PID (aIRR 0.84, 95% CI 0.74 to 0.95). For EP, in 2014 the rate of all admissions was 17.4 (95% CI 16.9 to 17.9) per 1000 live births and of all ED presentations was 15.6 (95% CI 15.1 to 16.1). Comparing 2014 with 2009, the rates of all EP admissions (aIRR 1.06, 95% CI 1.04 to 1.08) and rates in EDs (aIRR 1.24, 95% CI 1.18 to 1.31) were higher.ConclusionsPID and EP remain important causes of hospital admissions for female STI-associated complications. Hospital EDs care for more PID cases than inpatient departments, particularly for young women. Updated primary care data are needed to better understand PID epidemiology and healthcare usage.

Background and Aim: The prevalence of acute pancreatitis is still high with a mortality rate of 10-20% for the past two decades. Acute pancreatitis can be prognosis with computed tomography (CT) which correlates clinical outcomes, complications, and associated mortality rate. The current study aims were to evaluate the clinical outcomes and prognostic significance of early vs. late computed tomography in acute pancreatitis. Methodology: A cross-sectional study was carried out on 136 consecutive acute pancreatitis patients in the department of Gastroenterology and Radiology, Bahawal Victoria Hospital, Bahawalpur for duration of one year from August 2020 to July 2021. Patients with no abdominal CT due to pregnancy and CT performed after 14 days of pain onset were excluded. All the patients were categorized into two groups; Group-I where CT was performed after 4-5 days of pain onset and Group-II CT performed after 6-14 days of pain onset. The CT findings such as prognostic information, CT severity index and local complications were compared in both group. For data collection and analysis, SPSS version 21 was used. Results: Of the total 136 acute appendicitis patients, 92 (67.6%) were male and 44 (32.4%) were females with an age range of 18 to 60 years. The overall mean age was 42.45± 11.62 years. Group-I had 72 patients (early CT performed) and Group-II had 64 (47.1%) patients of late CT performed. The mean severity index of CT performed in early and late was 5.43±2.31 and 6.59±2.6; p=0.005). The severity index of CT was higher in late-performed computed tomography compared to early perform CT. The persistent organ failure had an almost similar incidence in both early and late CT performed (37.4% versus 48.7%; p<0.125). Late CT performed group majority patients had local complications 82.6% compared to 67.4%; p<0.021. No significant variance was found in surgery, percutaneous drainage need, and mortality (p>0.05). Conclusion: Our study found that early CT does not have a negative impact on the outcome of acute pancreatitis. However, local complications were detected with the onset of symptoms in computed tomography after 5-days. Performing computed tomography before the hospitalization sixth day does not result in earlier intervention. Keywords: Computed tomography, Acute pancreatitis, Clinical outcomes

Abstract Background Gaps exist concerning the relationship between maternal exposure to air pollution and birth outcomes, including the importance of low-level exposure. We aimed to explore the association between maternal exposure to ambient nitrogen dioxide (NO2) and fine particulate matter (PM2.5) and selected birth outcomes in Victoria, Australia. Methods We included all births occurring in Victoria, Australia from 1st March 2012 to 31st December 2015 using routinely collected government data. Outcomes included birthweight, small for gestational age (SGA), term low birth weight (tLBW), large for gestational age, and spontaneous preterm birth. Annual ambient NO2 and PM2.5 was assigned to maternal residence at birth. Maternal, meteorological and temporal variables were included in final log-binomial models. Results There were 285,594 births. Average annual ambient NO2 exposure was 6.0 parts per billion (ppb, IQR 3.9 ppb) and PM2.5 was 6.9 µg/m3 (IQR 1.3). IQR increases in ambient NO2 and PM2.5 were associated with fetal growth restriction, including decrements in birth weight, increased risk of SGA and tLBW. Women with gestational diabetes and hypertensive disorders of pregnancy had greater decrements in birth weight associated with exposure. Conclusions Maternal exposure to low-level ambient air pollution at levels below national and international air quality guidelines was associated with fetal growth restriction. Key messages Exposure to low-level ambient air pollution was associated with fetal growth restriction and women with obstetric complications were more susceptible. These findings may inform iterative revisions of air quality guidelines.

Background: Unsafe abortions are the third leading cause of maternal mortality in India, close to 8 women die from unsafe abortion each day.(1) MMR in India is 103/100,000 live births (2017-2019),unsafe abortion account for 8% of the MMR. Both MTP act of 1971 and MTP amendment act 2021,which expanded the scope of the act and provides impetus for safer abortions, are progressive and encouraging. Each year 4.7-13.2%of maternal death attributed due to unsafe abortions (2). Unsafe abortion accounts for 13% of maternal deaths worldwide of which 19% occurs in South East Asia (3, 4).Medical methods of abortion has become preferable method with availability of prostaglandin analogue misoprostol and antiprogesterone mifepristone. There are many studies for both drugs and each study claims its schedule to be superior and safer than others.(5,6,7) AIM:This study mainly aims to compare efficacy of Mifepristone and Misoprostol combination versus Misoprostol alone in procuring complete abortions in first trimester by comparing their Need for Manual /electric vacuum aspiration. OBJECTIVES: Ÿ To compare efficacy in relation to gestational period. Ÿ To compare the Success rate of combination drugs with misoprostol alone. Ÿ To compare Induction to abortion time intervals. Ÿ To evaluate the Safety. This is a prospective observational study conducted at Government Victoria hospital, Department of Obstetrics & Gynaecology,Andhra Medical College,Visakhapatnam,and Andhra Pradesh Total no.of patients – 100 No.of women who were given Mifepristone & Misoprostol combination 50 No.of women received Misoprostol alone -50 Observations of this study 1.Maternal age was compared in both the groups.Majority of patients belongs to 21 to 25 years age group. 2.Majority are multigravida in both groups 3.Majority (64%) have opted for termination before 45days in mifepristone +misoprostol group,where as in misoprostol group 60% between 45-63 days 4.In both major indication for termination is unwanted pregnancy. 5. In mifepristone and misoprostol group 46 cases had complete abortion whereas 4 cases required electric vacuum aspiration 6.when comparing induction and abortion interval mifepristone and misoprostol group mean interval is 4.31 hours whereas misoprostol group is 16.18 hours and p value is <0.0001 showing induction abortion interval is less in mifepristone and misoprostol group 7.Unwanted symptoms were noted in both groups but significantly more with misoprostol only group but the p value was not significant. 8.There were no statistically significant major complications in both groups,none required blood transfusion 9. Although Mifepristone and Misoprostol combination is costly but more effective with higher rate of complete expulsion,should be preferred over Misoprostol alone where cost is not a restraining factor. CONCLUSION Based on findings from this study it can be concluded that 1. Mifepristone plus vaginal misoprostol combination group is associated with shorter induction abortion interval and 96% success rate when compared to misoprostol group alone. 2. Mifepristone plus vaginal misoprostol combination group is associated with complete abortion rate compared to misoprostol alone group.Vaginal misoprostol alone group is cost effective. 3. Routine use of Mifepristone-Misoprostol combination is an effective option for early MTP where cost is not a consideration and is ideal for home management. 4.Complication are less in Mifepristone-Misoprostol combination The only confounding factor is the cost involved which is about 20 times that of Misoprostol alone