Study of implications of thyroid status over feto-maternal outcomes in pregnancy

Background: Thyroid disorders are reported at clinically significant prevalence during pregnancy, affecting ~5% of all pregnancies. Maternal thyroid status during pregnancy purportedly affects fetal as well as maternal outcomes. The objective of present study was to analyse the relationship of thyroid status in pregnancy and various maternal and fetal outcomes.Methods: In this hospital based observational study, a total of 913 pregnant women were enrolled as per fixed criteria and all the study participants were screened for thyroid disorders. Further, they were followed up throughout pregnancy and puerperium and evaluated for various maternal and fetal complications by predefined outcome measures. The results were compared by subgroup analysis.Results: Of the 913 patients screened, 105 were diagnosed with thyroid abnormality and followed up till delivery, with newborn thyroid profile on day 7. Total 49 patients were diagnosed with anaemia (46.66%), of which 46 (43.80%) had subclinical hypothyroidism (p <0.05); along with pregnancy induced hypertension in 42 (40%) cases of which 40 (38.09%) had subclinical hypothyroidism were observed to have statistically significant associations. Intrauterine growth restriction (IUGR) (37, 35.23%) and prematurity (19, 18.1%) were the most common fetal occurrences; the association of IUGR and subclinical hypothyroidism being statically significant.Conclusions: Thyroid disorders during pregnancy are commonly associated with maternal and fetal complications and thyroid profile is recommended as universal screening method in early pregnancy to diagnose and start required treatment early.

Pregnancy Outcome According To Elapsing Time After An Immediate Administration Of Antibiotics In A Rabbit Model For The Intrauterine Infection / 대한산부인과학회잡지

OBJECTIVE: In a pregnant rabbit model using hysteroscopy-guided inoculation of E. coli, we investigated pregnancy outcome according to elapsing time with immediate antibiotic treatment after E. coli inoculation, and in turn determined which of the maintenance of pregnancy with antibiotic and tocolytic administration or prompt delivery in the management of preterm labor complicated with intrauterine infection offered the improvement of pregnancy outcome. METHODS: Timed-pregnant rabbits underwent hysteroscopy at 20-21 days of gestation(70%). Animals were inoculated with either E. coli(0.2 ml containing 10' cfu/ml) or saline, and administered ampicillin-sulbactam(100 mg/kg/day; Unasyn; Pfizer) in divided doses every 8 hours beginning 30 minutes after microbial inoculation until euthanasia with one of the following; 3 days(n 10), 5 days(n 8), or 7 days(n-8) after hysteroscopy. In the first study, which performed in animals with inoculation of E. coli, pregnancy outcome including fetal survival rate and results of microbial studies and placental pathology were compared among three groups. In second study, which performed in animals with inoculation with saline, pregnancy outcome were compared among three groups for the purpose of elucidating effects of antibiotic administration during inoculation-to-euthanasia interval on pregnancy outcome. RESULTS: Of rabbits inoculated with E. coli and receiving antibiotics immediately, the rate of fetal survival and positive intrauterine cultures in total and live fetuses decreased significantly, and the rate of placental inflammation in total and live fetuses increased significantly with time from intracervical inoculation with E. coli to euthanasia(p<0.05, respectively). Of rabbits inoculated with saline and receiving antibiotics immediately, the rates of fetal survival, positive intrauterine cultures in total and live fetuses, and placental inflammation in total and live fetuses have no difference with time from intracervical inoculation with saline to euthanasia. CONCLUSION: Fetal complications including fetal death could be induced in utero if persistent subclinical intrauterine infection was present in spite of earlier antibiotics administration initiated after inoculation of E, coli. Therefore, when treating with antibiotics in intrauterine infection, it is needed to observe and monitor the presence of persistent intrauterine infection, and if it is persistent, prompt delivery may be better than maintenance of pregnancy with antibiotic and tocolytic administration for the improvement of pregnancy outcome.

A Clinical Experience in 16 Pregnancies with Hemolysis, Elevated Liver Enzymes, and Low Platelets (HELLP Syndrome) / 대한산부인과학회잡지

OBJECTIVE: Our purpose was to describe the clinical progress and the maternal and fetal outcome in 16 pregnancies complicated by the HELLP(hemolysis, elevated liver enzymes, low platelet). Material: We reviewed the maternal and neonatal charts from 16 consecutive pregnancies complicated by the HELLP syndrome among 302 pregnancies complicated by preeclamsia and eclamsia managed at our hospital during the period of 4 years from June 1994 through June 1998. The HELLP syndrome was defined by previously published laboratory criteria. We assessed the time of onset, presenting symptom, laboratory finding, mode of delivery, fetal and maternal complication in each case. We also reviewed the clinical finding in detail in the case resulted in maternal death. RESULTS: In regards to the time of onset, 15 cases (93.7%) occurred at antepartum period and only 1 case (6.2%) occurred at postpartum period. Among the 15 cases occurred at antepartum period, 13 cases (81.25%) developed at 27 to 36 weeks gestation and 2 cases (12.5%) developed at near term. In regards to the presenting symptom, twelve patients (75%) complained of right upper quardrant or epigastric pain. Of 16 patients, 12 patients (75%) experienced headache and 10 patients (62.5%) complained of nausea, or vomiting and 5 patients (31.2%) had visual disturbance. The laboratory finding of all 16 cases were as follow; the mean level of platelet: 68700/mm3 (range: 48000 to 91700), the mean level of serum asparate aminotransferase: 335 IU/L (range: 62 to 135), the mean level of lactic dehydrogenase: 910 IU/L (range: 558 to 5794), and the mean level of total bilirubin: 2.6 mg/dl (range: 0.7 to 10.4). To review the mode of delivery, cesarean sections were done on 10 patients (62.5%) including 7(43.7%) emergency and 3(18.7%) elective operations. However, 6 patients (37.5%) delivered vaginally. Maternal complications were as follow; abruptio placenta in 1 case (6.2%), DIC in 2 cases (12.5%), pulmonary edema in 3 cases (18.7%), pleural effusion in 4 cases (25%), renal failure in 4 cases (25%), and 1 case of death. Fetal and neonatal outcome was assessed; 9 cases of intrauterine growth retardation (56.2%), meconium stained in 3 cases (18.7%), 2 stillbirth (12.5%), and 2 neonatal death (12.5%). CONCLUSION: HELLP syndrome is associated with serious maternal and fetal morbidity and mortality.