The predictive role of color doppler sonography in evaluating hypoxia and acidosis in intrauterine growth restriction fetuses: correlation with arterial blood gas analysis

Background: Doppler is an ultrasound technique allowing non-invasive measurement of artery blood flow velocities. Objective of this study was to evaluate the role of umbilical artery (UA) and middle cerebral artery (MCA) Doppler study in predicting fetal hypoxia and acidosis in IUGR fetus and a population subjected to hematologic fluctuations.Methods: In this study 100 subjects with IUGR fetuses was evaluated for comparison of Doppler sonography analysis of fetal middle cerebral arteries and umbilical arteries and cord blood samples (pCO2, pO2) that was collected at the time of delivery.Results: Among the 100 subjects (between 28-32 gestational week) of IUGR showed a high risk of hypoxia and acidosis type condition. The observations were recorded in terms of MCA/UA ratio, the abnormal MCA/UA ratio was observed in significant (p<0.05) number of patients growth restricted fetuses (n=96), as compared to normal. There is a direct correlation found in the pH and pCO2 values. The results of arterial blood gases with respect to pH were found to be less than 7.3±1.6 in 96 subjects with abnormal MCA/UA ratio as compared to normal, that relates to the increase in the relative pCO2 (61.66%) [Acid increase] and decrease in pO2 arterial gases (Hpoxia increase).Conclusions: The study provides an insight that shows IUGR fetuses have a relatively higher risk of hypoxia (less oxygen) and acidosis (low pH and high pCO2), showed the most important determinants variations.

Pregnancy and delivery of a women with Von Willebrand disease type 3: a case report

Von Willebrand disease (VWB) is the most common inherited bleeding disorder, found in approximately 1% of the general population, without ethnic differences. A multidisciplinary team ensuring readiness of availability of blood and blood products, perfect intraoperative hemostatis and administration of timely Von Willebrands factor are essential to prevent complications and improve perinatal outcome.

Cardiac disease and pregnancy: hyper vigilance and extreme caution for optimal outcome

Cardiac disease in pregnancy is a leading cause of maternal death in more so high-income countries. The armamentarium for winning this difficult battle involves shared decision-making with communication across the clinical team and the patient. There is limited clinical evidence concerning effective approaches to managing such complex care and moreover involvement of different specialists makes coordinated care challenging. Bicuspid aortic valve (BAV) is the most common congenital cardiac malformation, occurring in 1-2% of the population whereas a single ventricle is a rare congenital heart disease that accounts for less than 1% of all congenital heart diseases. We had two cases of pregnancy with bicuspid aortic valve in one case and the other with single ventricle. The involvement of multidisciplinary team involving cardiologist, cardiothoracic anaesthetist and fetal maternal medicine specialist resulted in good maternal and fetal outcome in both the cases.

Clinical study comparing outcome of post in vitro fertilisation triplet pregnancy reduced to twins versus non reduced in vitro fertilisation triplet pregnancies

Background: There has been an upsurge in the number of multiple pregnancies with its attributability to increasing use of artificial reproductive techniques. To study clinical outcome of post IVF triplet pregnancy reduced to twin pregnancies   compared to those without triplet reduction.Methods: Hospital designed comparative study. 31 subjects were studied for comparative study design with triplets obtained after infertility treatment (assisted post-IVF). Out of 31, 15 subjects were expectantly managed who refused reduction while 16 subjects chose reduction to twins. Outcomes like prematurity, complications in neonate, birth weight discordance, neonatal mortality and maternal complications were studied.Results: The fetal (triplet) reduction group was associated with significant (p<0.002) higher neonatal birth weight as compared to non-reduced group. The fetal reduction group had significantly lower incidence of prematurity and neonatal complications like hyperbilirubinemia, respiratory distress syndrome and neonatal sepsis. The maternal complications were also higher in nonreduced in terms of PPROM, gestational hypertension, gestational diabetes mellitus, intrahepatic cholestasis of pregnancy and gestational hypertension.Conclusions: It is indicated that the reduction of triplet to twins is effective considering more complications with non-reduced group and hence reduction improves favorable pregnancy outcomes.

Post partum headache: a case series

Postpartum headache is the complaint of head, neck, or shoulder pain occurring during the first 6 weeks following delivery. Among the women who underwent neuraxial aneasthesia Post Dural puncture headache is one of the most common presentations. However, physicians should be aware that post Dural puncture headache is not the only cause of postpartum headache. Authors present a series of four cases that had varied presentation of post partum headache with varied diagnosis, the first case was of subdural haematoma where CT scan revealed an acute on chronic SDH. The second case was diagnosed as meningitis and the CSF for culture sensitivity grew Streptococcus Pneumoniae .In our third case of cortical vein  thrombosis , NCCT followed by MR venogram  revealed left transverse venous sinus thrombosis and our last case in the series was of posterior reversible encephalopathy syndrome where MRI confirmed the findings of typical findings are symmetric edema involving the white matter of the posterior regions of the cerebral hemispheres. The diagnostic dilemma was resolved by neuroimaging because the clinical presentation was not making us reach a satisfactory diagnosis of the cause of headache. Early resort to neuroimaging and multidisciplinary team effort paved way to early diagnosis and appropriate recovery of the patients.

Ferricarboxy maltose to treat iron deficiency anemia in pregnancy: is it a feasible option?

Background: Iron deficiency is a common cause of anaemia in pregnancy which influences the health of mother and developing fetus. Intravenous (IV) iron preparations are considered, when oral iron therapy is ineffective or intolerant. Ferric carboxymaltose is an IV preparation that can be given with ease of administration and better tolerated. The aim of this study was to assess the efficacy and safety of IV ferric carboxymaltose in pregnant mother with all grades of anemia in the second and third trimester.Methods: This is a prospective observational study where 44 pregnant women with iron deficiency anemia [IDA] received ferric carboxymaltose up to 15mg/kg in second and third trimester. The parameters that were taken into account, to assess the effectiveness of the treatment was repeat haemoglobin [Hb] measurements and the subjective sense of wellbeing in the patient. The safety of the drug was analysed by continuous fetal heart rate [FHR] monitoring during the infusion and observation of any adverse reactions.Results: Ferric carboxymaltose intravenous infusion significantly increased Hb levels above baseline values in all women. The Increase in Hb levels were observed at 3- and 6-weeks post infusion therapy. FHR monitoring did not show any drug related unfavourable effect on the fetus. Of the 44 women interviewed, 33 (75%) women reported sense of well-being, 7 (15.9%) women could not feel any difference after the infusion and 4 (9.1%) patients could not comment. No serious adverse effects were noticed but minor side effects occurred in 3 (6.8%) patients.Conclusions: This prospective study showed safety and efficacy of ferric carboxymaltose in pregnancy with IDA which is consistent with available observational data.