Efficacy and safety of oral mifepristone on preinduction cervical ripening at term pregnancy prospective randomized control study

Background: Cervical ripening is important prerequisite for induction of labour, induction is indicated when it is advantageous to mother and fetus. Successful induction of labour decreases caesarean rate. Beyond term pregnancy there will be placental insufficiency, it leads to complications such as oligohydramnios thereby cord compression, birth asphyxia, increased incidence of operative delivery. Induction at term pregnancy has the potential to improve the neonatal outcomes. Aim was to study the efficacy and safety of oral mifepristone on cervical ripening prior to induction of labor at term pregnancy and to compare the feto maternal outcome with control group.Methods: Total 112 pregnant women at term pregnancy, where pregnancy can be continued for another 48 hours with bishop score 4 or less were selected. Sample was equally divided into study group (56 women) to receive 200mg mifepristone and control Group group (56 women) to receive placebo orally. Bishop score was assessed at 24hours and 48hours. In women who did not enter labor spontaneously other modes of induction was done.Results: There is significant improvement in bishop score at 24 hr and 48hr in study group p value 0.001, 80.35% women in study group and 50 % women in control group delivered vaginally. 33.9% women of study group and 10.7% women of control group delivered spontaneously. Requirement of PGE2 gel and oxytocin was significantly lesser in study group, there was no significant adverse effect seen on mother and newborn compared to control group.Conclusions: Cervical ripening with mifepristone prior to induction of labour at term improves bishop score and decreases rate of failed induction and cesarean section rate, with good neonatal outcome.

Analysis of ectopic pregnancy in a tertiary care hospital

Background: Ectopic pregnancy is a life threatening obstetrics emergency in early trimester associated with increased risk of morbidity and mortality if not timely intervened. High index of clinical suspicion is required for early diagnosis specially in reproductive age group women presenting with history of amenorrhea. Aim was to analyse the incidence of ectopic pregnancy, its risk factors, clinical presentation and management of ectopic pregnancy.Methods: A retrospective observational study was conducted on ectopic pregnancy cases admitted in a tertiary care institute over a period of 5 years from January 2018 to December 2022. A total of 221 cases of ectopic pregnancy were analysed for parameters like age, parity, gestational age, clinical presentation, risk factors, intervention and outcome.Results: There were 221 ectopic pregnancy cases during the study period with incidence of 4.3/1000 deliveries. The mean age was 24 years with the mean gestational age of 6.83�25 weeks. The commonest risk factor identified was any previous pelvic surgeries (49.32%), PID (11.76%), history of abortion and use of IUCD (8.14%). The triad of ectopic pregnancy (pain abdomen, history of amenorrhoea, bleeding PV) was found in 35.29%. Ectopic pregnancy was ruptured in 148 cases (66.96%) and unruptured in 73 cases (33.03%). Majority of the ectopic pregnancy was tubal ectopic and most common site was Ampulla (47.06%) followed by isthmus (23.98%). 96% of the cases were managed by surgical intervention and two maternal deaths were found during the study period.Conclusions: Proper evaluation of risk factors9and early diagnosis will help in preserving fertility and also reducing8morbidity and mortality. Majority of the cases were in ruptured condition, rendering8conservative management was impossible. Therefore awareness of its determinants can aid in8early detection of more number of such cases8in unruptured condition especially in8peripheral center, leading to early referral.

Analysis of maternal near miss cases in a tertiary care hospital

Background: The study of maternal near miss (severe maternal morbidity) is an alternative to study of maternal death. To reduce maternal mortality ratio (MMR), analysis of maternal near miss cases provide valuable information, which helps in implementing strategies to prevent maternal death. Aims and objectives were to determine maternal near miss indices and to analyse the causes of maternal near miss and other associated factors.Methods: A retrospective analysis of health records of maternal near miss cases admitted to tertiary care hospital from October 2021 - September 2022 was done. Patient characteristics like age, parity, gestational age, risk factors, mode of delivery, lifesaving intervention were studied.Results: A total of 9,744 patient admitted for seeking obstetric care and out of which there were 8,791 deliveries. A total of 164 maternal near miss cases and 24 maternal deaths were found during study period. The maternal near miss incidence ratio 18.76/1000 live birth, maternal near miss to mortality ratio 6.8:1 and mortality index was 12.7%. Hypertension and its complications are the most common cause for maternal near miss cases. Women in late trimester, multiparity, low education status, lack of awareness are at increased risk of near miss cases.Conclusions: Hypertensive disorders in pregnancy and obstetric hemorrhage are leading cause for pregnancy specific obstetric disorder and anemia was found to be a leading cause for pre-existing condition aggravated during pregnancy. This study highlights the need for overall improvement in awareness among pregnant mothers and its timely accessibility with quality critical care management.

Pregnancy in sickle cell thalassemia: double trouble!

This is a case report of 20-year-old multigravida (G2P1L0) belonging to tribal community presented at 30 weeks of gestation with severe anemia, fever, arthralgia and jaundice with multiple blood transfusions in the past and with previous pregnancy outcome being stillborn and was not evaluated for the same. A diagnosis of sickle cell ?+Thalassemia (SCD crisis) was made and managed vigilantly by multidisciplinary approach and had full term vaginal delivery with good perinatal outcome and finally both mother and newborn were discharged in stable condition. This highlights the overall increase in maternal and fetal complications in pregnancy with sickle cell thalassemia. Thus health education, screening, early intervention with multidisciplinary approach and regular follow up prevents maternal morbidity and mortality.

Rare case of active lupus nephritis with mixed connective tissue disease in pregnancy

This was a case report of a 32 years old pregnant woman with 9+6 weeks of gestation presented with hyperemesis gravidarum who was diagnosed of lupus nephritis with mixed connective tissue disorder (MCTD) 7 months back. Renal biopsy-lupus nephritis class 4 with activity score of 9/24 and chronicity score of 0/12. She was advised contraception in view of active lupus nephritis with MCTD but she presented to us with 9+6 weeks gestation with conception being within 20 days of her last dose of cyclophosphamide. She was managed with oral immunosuppressants by constant supervision of obstetricians and nephrologist. The management of MCTD and lupus nephritis in pregnancy presents a diagnostic and therapeutic challenge for providers. Women with prior lupus nephritis and MCTD can have safe, successful pregnancies with excellent, immaculate, collaborative care between obstetricians, nephrologists, and multidisciplinary staff.

Wernicke抯 encephalopathy: obstetric diagnostic challenge! (a rare complication of hyperemesis gravidarum): a case report and review of literature

Wernicke抯 encephalopathy (WE) is an acute neurological disorder caused by a deficiency in thiamine. It is characterized by triad of altered mental status, ataxia and ophthalmoplegia. Most of the cases reported were secondary to long-term alcohol use. We reported a rare case of WE due to hyperemesis gravidarum in a 29-year-old P1L1A1 women at 22 weeks of gestation who had spontaneous abortion. Patient manifested with features of mental confusion, nystagmus, and gait ataxia. Diagnosis was established after MRI findings suggestive of WE in thalamus. Patient clinically improved after treatment with thiamine. We emphasize the importance of thiamine supplementation to women with hyperemesis to prevent life threatening complications.

Headache in pregnancy-a diagnostic dilemma: an unusual case of advanced glioblastoma multiforme in pregnancy: a case report and review of literature

This was a case report of a twenty year old patient with a obstetric score of G2P1L1 with 28 weeks of gestation presented with persistent intractable headache leading to a diagnostic conundrum. Magnetic resonance imaging of the brain revealed an advanced glioma in the right frontal lobe with a mass effect and a midline shift for which emergency surgical resection was sorted followed by chemoradiation which eventually lead to a satisfactory obstetric and perinatal outcome.Glioblastoma multiforme is a rare diagnosis during pregnancy which carries unique challenges to the mother, foetus and the health care providers. A combined effort from a multidisciplinary team is the key for a successful outcome.

A rare case of Nabothian cyst presenting as mass per vagina

Nabothian cysts are benign non neoplastic disorder rarely of any clinical significance usually appear as bumps on the surface of the cervix which may be single or in groups and they appear as a sequalae to chronic cervicitis, are asymptomatic unless they are sizeable presenting with rare and varied symptoms. Generally, Nabothian cysts do not require any therapy. The therapy is recommended when a patient becomes symptomatic with pain or when the lesion character is not clear and malignancy cannot be ruled out. Here we reported a case of 23-year young unmarried girl nulligravida with complaints of mass per vagina. On local examination an irregular polypoidal mass was seen protruding outside the introitus measuring about 4×4 cm soft to cystic in consistency. Ultrasound revealed a well-defined anechoic cyst of 3.6×5.7 cm noted in the right ovary with no evidence of internal septation/solid component and wall calcification suggestive of right ovarian simple cyst with left ovary and uterus being normal. Surgical management was planned. Diagnostic laparoscopy was performed which revealed right ovarian simple cyst of 6×4 cm which was punctured using cautery and drained. Following this vaginal exploration revealed a polypoidal structure of 5×4 cm cystic consistency seen arising from right upper anterolateral lip of cervix. Polyp was resected with cautery and haemostasis achieved. Post operative period was uneventful. Such rare presentations do pose a diagnostic dilemma and hence it should be kept in mind to ensure adequate treatment.

Large cervical fibroid: a rare case report

Although leiomyomas are the most common pelvic tumors presenting in the reproductive age group, cervical fibroids are rare accounting for 2% of all uterine fibroids. We report a case of 40 year old lady presenting with a firm, non-tender mass of 22-24 weeks size pregnant uterus with restricted mobility. Laparotomy showed a large mass arising from the anterior lip of cervix, with a small uterus pushed posteriorly. Enucleation followed by total abdominal hysterectomy was done. Large cervical fibroids are rare, presenting with surgical difficulties. Careful dissection by expert hands is needed in the management of such cases.

Study of maternal and perinatal outcome among twin pregnancies with one twin demise

Background: To study the incidence, management and to determine maternal and perinatal outcome in cases of twin pregnancy with one twin demise in the second half of the pregnancy.Methods: This retrospective study was carried out at Cheluvamba Hospital, a tertiary care hospital attached to Mysore medical college and research institute between September 2009 and 2014. 19 twin pregnancies complicated by single intrauterine fetal demise (IUFD) after 20 weeks of gestation were identified from the hospital records. Data collected included maternal age, parity, antenatal complications, cause of IUFD, gestational age at diagnosis, time interval between diagnosis of IUFD and delivery, mode of delivery, birth details, type of placentation and neonatal complications.Results: The incidence of twin with one twin demise was 2.056%. Mean gestational age at presentation was 33.86 weeks. Most common cause of death was growth discordance in 7 cases followed by placental insufficiency in 4 cases. 57.89% of cases had monochorionic placentation. Neonatal course was most commonly complicated by prematurity. Maternal course was uneventful in majority (63.15%) of cases with two maternal deaths due to intravascular coagulopathy sequelae.Conclusions: Single fetal death occurs more often in monochorionic twins. The main problem for the surviving twin is prematurity. It is very important to identify the chorionicity by ultrasound examination in early pregnancy and implement specific surveillance of monochorial pregnancies.