Publication:

A prospective observational study of maternal outcomes in very high-risk pregnancies in a tertiary care centre of South Gujarat

Background Very high-risk pregnancy (VHRP) is associated with increased maternal morbidity and mortality. Early identification and appropriate management are essential to improve outcomes. This study aims to study maternal outcomes and complications in very high-risk pregnancies up to 7 days postpartum.

Methodology This prospective observational study was conducted in the Department of Obstetrics and Gynaecology at a tertiary care center in South Gujarat. A total of 150 pregnant women fulfilling VHRP criteria as per Government of Gujarat guidelines were included. Detailed history, clinical examination, and investigations were recorded. Maternal outcomes, complications, and OBICU admissions were analyzed.

Results Majority of women belonged to the 18–25 years age group (52%). Common VHRP conditions included Low BMI (25.3%), Previous 2 caesarean sections (23.3%) and Severe PET (21.3%). OBICU admissions were noted in a significant proportion of patients. OBICU admissions were commonly seen in severe PET (40.8%), Sickle cell disease (25.9%) and prev 2 caesarean sections (11.1%) while no OBICU admissions in low BMI criteria. Maternal complications commonly included puerperal pyrexia (20%) and sepsis (8.7%). Mortality rates were higher in severe PET (62.5%) and sickle cell disease (37.5%), however reduction in rates after implementation of VHRP criteria were seen.

Conclusion VHRP is associated with significant maternal morbidity. Early identification, timely referral, and management at tertiary care centres significantly improve outcomes and reduce mortality.