Fetomaternal outcome in COVID-19 infected pregnant women: a preliminary clinical study

Background: WHO has declared COVID-19 infection a health emergency of international concern on 11th March, 2020. It is not clear whether clinical characteristics of pregnant women with COVID-19 differ from those of nonpregnant women and whether it aggravates COVID-19 symptoms and whether antiviral therapy is necessary for COVID-19 infected pregnant women.Methods: This is prospective study of 125 cases based on the compiled clinical data for pregnant women with COVID-19 between 15th April 2020 and 10th June 2020. A laboratory confirmed positive case of COVID-19 infection in pregnant women were included.Results: The most common symptoms at presentation were cough in 61.6% (77/125) and fever in 46.4% (58/125). Other reported symptoms were sore throat in 13.6% (17/125), myalgia in 10.4% (13/125) while 38.4% (48/125) were asymptomatic. There were total 97 deliveries (including 2 twins’ deliveries) among which 3 cases had IUD. Present study reported 96 live births. The incidence of missed abortion was 2.4% (3/125). The incidence of preterm birth before 37 weeks was 8.2% (8/97). Ninety-six (96.9%) of neonates were tested for SARS-CoV-2 viral nucleic acid on nasopharyngeal and pharyngeal samples and 16.67% (16/96) were resulted positive.Conclusions: At present, there is no evidence regarding the greater risk of pregnant women to succumb to COVID-19 infection and experience severe pneumonia. The risks of spontaneous abortion and preterm birth are not increased as reported in this study but shows possibility of vertical transmission when it manifests during the third trimester of pregnancy.

Maternal outcome in pregnancy with thrombocytopenia

Background: Thrombocytopenia is second most common haematological abnormality in pregnancy after anemia. The aim of this study was to find out the prevalence, causative factor of thrombocytopenia and to observe the obstetrics outcome of pregnancies complicated with thrombocytopenia.Methods: This is prospective study of maternal outcome in pregnancy with thrombocytopenia carried out at tertiary care center from February 2019 to January 2020. Out of 350 antenatal screened women, 25 women who were diagnosed with thrombocytopenia, were included in the study.Results: The incidence of maternal thrombocytopenia in this study was 7.1%. 60% of the women had mild thrombocytopenia while 24% and 16% of women were moderate and severe thrombocytopenic respectively. Amongst 25 thrombocytopenic women 68% had gestational thrombocytopenia, 24% had gestational hypertensive disorder,4% had HELLP syndrome, 4% had immune thrombocytopenic purpura. 60% were delivered vaginally and 40% were delivered by LSCS. The most common indication of LSCS was acute fetal distress (40%) followed by failed induction (30%), breech (10%), and the rest (20%) for other obstetrical indications. The most common indication for induction was pre-eclampsia followed by IUGR, and post-date.Conclusions: In pregnancy with thrombocytopenia, gestational thrombocytopenia is the commonest and benign condition which does not alter the obstetrical management. Still a vigil 4 should be kept on maternal platelet count in antenatal period to prevent unfavorable outcome in serious conditions that may require specific and urgent management (HELLP syndrome, severe pre-eclampsia, ITP).

Changing trends in cesarean section: from 1950 to 2020

Caesarean section (C.S) is a part of the standard care in modern obstetrics. The indications for a caesarean section as an alternative to vaginal delivery have evolved over the centuries. Its practicality, disponibility, and apparent safety have placed caesarean section, a first-line procedure in many clinical scenarios. The awareness of perinatal mortality and morbidity associated with safety of caesarean, expert anaesthesia, potent antibiotics, blood transfusion facilities and better neonatal care have increased incidence of caesarean section very fast. Thus, there is fast, steady and definite rise in incidence of caesarean section everywhere. But the question is ‘Is a rising caesarean section rate is inevitable?’. Studies carried out to understand CS deliveries has adopted different framework. The issue treats elements of ethics in the medical profession, gender issues, choices of women, the quality of institutional services, etc. The findings of retrospective studies have suggested that the caesarean section rate could be reduced in certain categories. In this study, we discuss the various ways in which it can be achieved.

Evaluation of clinical efficacy and safety of natural micronized progesterone in prevention of preterm labor: a prospective study at tertiary care teaching hospital in India

Background: Uterine relaxants (UR) are used in management of in Preterm labour (PTL), which is responsible for considerable morbidity and mortality in mother as well as preterm infant. Author are yet to discover an ideal UR which is highly effective yet safe. Literature supports the use of natural micronized progesterone (NP) during threatened PTL. However, little data exists for Indian population. Therefore, present study becomes imperative.Methods: A comparative clinical study was carried out on 78 patients (aged 19 to 35 years with singleton pregnancy and gestational age between 28 and 37 weeks with cervix ?4 cm dilated) who were diagnosed with threatened PTL were included. Those who refused treatment were allocated to control group (n= 29) and received only bed rest. NP was given orally 200 mg twice a day to 21 patients and 200 mg intra vaginal twice a day to 28 patients and was continued until delivery or 37 weeks of gestation whichever occurred first. The efficacy was proven if PTL was prevented and patient did not require an alternative UR for ?48 hours.Results: The mean age of patients was 23±3.2 years, majority being multipara. Author observed that both oral and vaginal formulation of NP was found to be highly effective (p <0.05) as primary UR and maintenance therapy in preventing PTL as compared to the control group. However, difference between them was not statistically significant. None of the patients were lost to follow-up and no adverse events linked to the treatment were reported.Conclusions: Although, the data obtained from this study was limited and the sample size was small, findings of this study support the use of NP in prolonging threatened PTL.

Study of outcome of pregnancy in patients with first-trimester bleeding per vaginum.

To assess pregnancy outcome in women with threatened miscarriage in the first trimester. To study various maternal complication and outcome of labor in pregnancy affected by first-trimester bleeding. Methods: This prospective study was carried out by institute from May 2013 to April 2014. 100 patients were included with a history of amenorrhea and urine pregnancy test positive with bleeding per vaginum in the first trimester. Results: In this case series, 100 cases of first-trimester bleeding were studied. Majority of patients were multigravida (66%). In the present study, 40 patient (40%) had a history of previous abortion out of these 16 (40%) had non-viable outcome and 24 (60%) continue with the pregnancy beyond 20 weeks. Majority of patients (68%) presented with spotting, among those 59 (86.7%) had a favorable outcome and only 9 (13.3%) out of 68 patients were aborted. All 10 patients of heavy bleeding category aborted. 5 out of 22 patients of bleeding of moderate category aborted. First-trimester bleeding associated with pain has a poor outcome. Conclusion: First-trimester bleeding is not only associated with miscarriage but also with a higher rate of pregnancy complications. First-trimester bleeding is associated with an increased risk of certain pregnancy-related complications namely placental abruption, preterm labor, delivery of low birth weight infants and preterm premature rupture of membrane.

Analytical study of 50 cases of fetal growth restriction.

The objective of the study is to earlier diagnose the cases of FGR (Fetal growth restriction) and to identify the possible causes and management option to prevent further damage and to study the fetomaternal outcome and improve fetomaternal outcome in FGR cases. Methods: This is an analytical study of 50 cases of FGR pregnancies done during the period of 1st April 2013 to 31st March 2014. Data was collected from the OPD books and indoor case papers of patients attending routine antenatal care and emergency services provided by obstetrics and gynaecology department of our institute. Results: 50 cases of FGR were studied. Various possible etiological factors were studied like presence of anaemia, hypoproteinemia and PIH, maternal pre-pregnancy weight, and average weight gain during pregnancy. Among them, malnutrition (64%) was the commonest aetiology of FGR followed by PIH (44%). Ante partum surveillance was done by serial fundal height measurement, maternal weight gain monitoring and serial ultrasound. 40% patients were having severe oligoamnios and 30% were having altered Doppler waveforms. Operative interference was required in 44% cases. 30 babies out of 50 were admitted to NICU. And perinatal mortality was 13.72%. Conclusion: Timely diagnosis, proper management at all levels in well-equipped centre can definitely prevent morbidity and mortality from FGR. Improving pre-pregnancy health, ensuring better antenatal care, effective use of contraception, preventing teenage pregnancies, stop smoking are some preventive measures.