Maternal Near Miss Cases in Medical College Ambikapur Running in Tribal Zone of Chhattisgarh: A Retrospective Study

MMR being an important index for evaluation of obstetric care of that area has a little information regarding actions to be taken to negotiate the maternal health issues of that area. Hence more number of cases who were moribund and critical but fortunately escaped death grouped as near miss was being studied to find out the shadowed causes of maternal mortality. Methods: All 312 near miss cases women were evaluated out of total 6040 admissions in obstetric ward of this institute during a period of one year from April 2017 to March 2018 to know the steps to be taken for improvement of maternal health in tribal and low resource newly started medical college. Result: Hypertensive disorders of pregnancy are the main culprit of maternal mortality whereas hemorrhage and its aftereffects are proved to be the most important cause of near miss. Incomplete abortion is the most common cause of hemorrhage and over the counter sell and misuse of Mifegest is found mainly responsible for incomplete abortion. Conclusion: To improve the obstetric care we have to educate the public for proper antenatal checkup. It will help health workers to identify the high risk pregnancies and their timely management. Apart from public awareness program there is necessity of well-equipped government health set ups where the poor tribal and also the other needy ones can report easily with all faith and confidence. Scarcity of skilled staff is also a subject to be noticed.

The role of apolipoprotein C4 in vascular endothelial cell injury in hypertensive disorder of pregnancy / 中华检验医学杂志

Objective Find abnormal changes of plasma lipid metabolism-related proteins before 20 weeks of gestation in patients with hypertensive disorder of pregnancy(HDP), and preliminarily investigate the role of plasma apolipoprotein C4 elevation in HDP. Methods A nested case-control study was used. The plasma were collected from pregnant women who underwent routine prenatal examination in Guangzhou Women and Children's Medical Center from November 2014 to March 2017. Label-free mass spectrometry was used to detect the differences in plasma lipid metabolism-related proteins before 20 weeks of gestation between 12 pairs of HDP patients and normal controls, and different 48 pairs of samples were used for verification. The protein with the most significant difference multiples was screened to study its effects on monolayer permeability and nitric oxide secretion of endothelial cells. One-way ANOVA was used for comparison between groups, and P<0.05 was considered as statistically significant difference. Results Compared with the control, the lipid metabolism-related proteins, APOC4, Fatty acid-binding protein 4 (FABP4), Apolipoprotein E (APOE), Apolipoprotein C3 (APOC3) and Beta-2-glycoprotein 1(APOH) raised to 1.94, 1.82, 1.59, 1.55 and 1.38 times, phospholipid transfer protein (PLTP) decreased to 0.78 times in plasma before 20 weeks of pregnancy of patients with HDP (t value were 2.499, 2.497, 2.081, 2.098, 2.426 and 2.564, respectively, P<0.05). Cell experiments results showed that 50 ng / ml APOC4 significantly increased 20％ HUVEC single layer cell permeability to FITC-labeled dextran (F=455.4, P<0.01), and significantly decreased the level of nitric oxide in the supernatant of HUVEC culture by 25％ (F=61.92, P<0.01). Conclusions Before diagnosis, plasma protein levels involved in lipid metabolism in HDP patients have been changed, resulting in abnormal lipid metabolism. APOC4 can increase the permeability of vascular endothelial cells, inhibit endothelial source of NO secretion, cause endothelial dysfunction.

Serum β HCG as a predictor and potent marker for pregnancy induced hypertension

Background: Hypertensive disorders are also responsible for perinatal mortality and morbidity. Preeclampsia is a risk factor for stillbirth, IUGR, LBW, Preterm delivery, Respiratory distress syndrome, and admission in the neonatal intensive care unit. Hypertensive disorders account for 8-10% of all preterm births. Aim of the study: This study was conducted to predict gestational hypertension by using serum beta HCG and thereby to follow up the risk patients and to reduce both maternal and perinatal morbidity and mortality. Materials and methods: A prospective study was done to determine the role of βHCG in 100 pregnant women in their second trimester (13-20) weeks, attending Tirunelveli medical college OPD. Duration of study was from March 2018- January 2019. Routine antenatal investigations were done. 5 ml of venous blood sample was collected and tests were carried out. Estimation of serum beta HCG level was done by enzyme-linked fluorescence immunoassay. In the antenatal clinic, the patients were followed up. Results: From the study, it was found, women who have elevated βHCG values in 13-20 weeks were at increased risk of developing PIH. For any test to be used as screening test it should have good sensitivity, specificity, and positive predictive value. In this study, β HCG had Sensitivity – 71.4%, Specificity - 87.1%. Conclusion: While comparing patients with normal BP and pre-eclampsia - βHCG values are elevated in patients with preeclampsia. The sensitivity and specificity of βHCG are very low to be Sheba Rosatee Victor, D Jayalakshmi. Serum β HCG as a predictor and potent marker for pregnancy induced hypertension. IAIM, 2019; 6(3): 38-43. Page 39 useful as a mass screening marker on its own and therefore it should be combined with other serum markers and ultrasound parameters like Doppler study of uterine vessels, which will help in improving its role as a screening tool.

Comparative study on maternal outcomes between normal and PIH mothers with serum albumin level

Background: Perinatal outcome is strongly influenced by gestational age and the severity of hypertension as expressed by the need for antihypertensive treatment, irrespective of the underlying syndrome. Severe preeclampsia is associated with different degrees of fetal injury. The main impact on the fetus is under nutrition as a result of uteroplacental vascular insufficiency, which leads to growth retardation. There are short and long-term effects. The immediate impact observed is altered fetal growth resulting in greater fetal liability. Fetal health, as well as its weight, is highly compromised, leading to various degrees of fetal morbidity, and fetal damage may be such as to cause fetal death. Aim of the study: To compare maternal outcomes between normal and PIH mothers in correlation with a serum albumin level. Materials and methods: The study was conducted in Obstetrics and Gynecology OPD of Tirunelveli Medical College. Duration of study was from March 2018 to November 2018. Routine antenatal investigations were done. The maternal outcomes were analyzed between two categories Results: The normal, forceps and LSCS deliveries among the total mothers were 42.4%, 2.0%, and 55.6% respectively. The difference between PIH and normal mothers was not statistically significant (P>0.05). The pre and term among the total mothers were 12.1%, and 87.9% respectively. The difference between the pre and term babies among the PIH and normal was very highly statistically significant (P>0.001). The pre and term among the total mothers were 11.1%, and 88.9% respectively. The difference between the APO and NPO of babies between the PIH and normal mothers was very D Jayalakshmi, Sheba Rosatee Victor. Comparative study on maternal outcomes between normal and PIH mothers with serum albumin level. IAIM, 2019; 6(3): 32-37. Page 33 highly statistically significant (P>0.001). The complicated and normal outcome among the total mothers was 4.0%, and 96.0% respectively. The difference between the complicated and normal outcome between the PIH and normal mothers was very highly statistically significant (P>0.001). Conclusion: Perinatal outcome is strongly influenced by gestational age and the severity of hypertension as expressed by the need for antihypertensive treatment, irrespective of the underlying syndrome. Severe preeclampsia is associated with different degrees of fetal injury. The main impact on the fetus is under nutrition as a result of uteroplacental vascular insufficiency, which leads to growth retardation. There are short and long-term effects. The immediate impact observed is altered fetal growth resulting in greater fetal liability. Fetal health, as well as its weight, is highly compromised, leading to various degrees of fetal morbidity, and fetal damage may be such as to cause fetal death.

Epidemiología y manifestaciones neurológicas asociadas a eclampsia en un hospital de referencia del Perú. Serie de casos / Epidemiology and neurological manifestations associated with eclampsia in a Peruvian reference hospital. A case series

Los ‘síntomas premonitorios’ de la eclampsia se pueden ver englobados como verdaderos síntomas de afectación cerebral dentro del síndrome de leucoencefalopatía posterior reversible, y la eclampsia como un síntoma severo. Objetivo. Revisar las características epidemiológicas de los casos con eclampsia, enfatizando el análisis de las manifestaciones neurológicas asociadas, en un hospital nacional. Diseño. Serie de casos. Institución. Hospital Nacional Daniel A. Carrión (HNDAC), Lima, Perú. Pacientes. Mujeres con eclampsia. Metodología. Estudio de todas las pacientes con eclampsia en un periodo de 5 años y 6 meses. Se excluyó aquellas con eclampsia extrainstitucional o con datos insuficientes. Principales medidas de resultados. Características generales, síntomas asociados, complicaciones y valores laboratoriales en pacientes eclámpticas. Resultados. Se halló 39 casos. La incidencia fue 0,19% del total de gestantes. La edad media fue 21 años, 75,8% fueron primíparas, 44,4% por debajo de las 34 semanas y en 69,7% ocurrió antes del parto; 51,5% tuvo presión arterial mayor a 160/110 mmHg y 12,1% no presentó hipertensión arterial; 93,9% tuvo síntomas, siendo los más frecuentes cefalea (87,9%), alteraciones visuales (27,2%) y auditivas (12,1%). Hubo dos casos de pacientes con cefalea y presión arterial normal, y 2 casos sin sintomatología. Las complicaciones fueron trastorno de sensorio, desprendimiento prematuro de placenta (15,2%), síndrome HELLP (15,2%) e HTA de difícil control (39,4%). No hubo casos de mortalidad materno perinatal. Conclusiones. La sintomatología neurológica que antecede a la eclampsia en la gestante con preeclampsia es muy variable y su correlación con la severidad de la hipertensión arterial materna no es constante.

The “premonitory symptoms” of eclampsia can be interpreted as actual symptoms of cerebral involvement within the posterior reversible leukoencephalopathy syndrome, and eclampsia as a severe symptom of the same syndrome. Objective: To review the characteristics of women with eclampsia in a national hospital, with emphasis on the associated neurological manifestations. Design: Case series. Institution: Hospital Nacional Daniel Alcides Carrion (HNDAC), Lima, Peru. Patients: Women with eclampsia. Methodology: Study of all patients with eclampsia over a period of 5 years and 6 months. Eclampsia cases that occurred outside the institution or with insufficient data were excluded. Main outcome measures: General characteristics, associated symptoms, complications and laboratory values in eclamptic patients. Results: Thirty-nine cases were reported. The incidence of eclampsia in pregnant women was 0.19%. The mean age was 21 years; 75.8% of the women were primiparous and 44.4% were less than 34 weeks pregnant. 69.7% of them were diagnosed before delivery; 51.5% had blood pressure above 160/110 mmHg and 12.1% had no hypertension. 93.9% presented symptoms, mainly headache (87.9%), as well as visual (27.2%) and auditory (12.1%) disturbances. Two patients had headache and normal blood pressure, and 2 cases were asymptomatic. Complications were: sensory alterations, abruptio placentae (15.2%), HELLP syndrome (15.2%) and difficult-to-control hypertension (39.4%). There were neither maternal nor perinatal deaths. Conclusions: The neurological manifestations that precede eclampsia are variable and do not have a constant correlation with the severity of maternal hypertension.

Maternal and fetal factors observed with late preterm births.

Backround: Although neonatal morbidity and mortality rates are fallen in recent decades, the prevalence of preterm deliveries has increased especially late preterm births. Late preterm deliveries are at increased risk of various neonatal complications compared to term deliveries. This study was carried out to identify the maternal characteristics and co-morbidites found with late preterm births and feto-maternal outcome in terms of indication of delivery, route of delivery, Apgar score and NICU admissions. Methods: A retrospective study was conducted in a tertiary care teaching hospital of Indian armed forces between Jan 2011 to Dec 2012 where 248 late preterm deliveries were analysed. Results: 56% women had spontaneous late preterm births and 44% women were induced. 23% of patients had history of 1 or more prior abortion and 13% patients had previous fetal deaths among the patients had late preterm delivery. Common maternal morbidities in mother delivering late preterm were hypertensive disorders of pregnancy (20.6%), anaemia (14.5%) and preterm premature rupture of membrane (13.7%). 4.8% newborns had Apgar ≤ 7 and 10% newborns required NICU admissions. Conclusion: Higher incidences of hypertensive disorders of pregnancy, anaemia and preterm premature rupture of membrane were found with late preterm birth and 10% of newborns required NICU care.