Fetal transverse cerebellar diameter measurement in intrauterine growth restriction: a more accurate parameter for gestational age assessment at term

Background: Assessment of fetal gestational age (GA) is an essential part of obstetric USG. Accurate knowledge of fetal GA is important to facilitate the best possible prenatal care and successful pregnancy outcome.  For the estimation of GA the commonly used parameters in third trimester are:- BPD, HC, AC and FL. As all these parameters are affected by fetal growth disorders and fetal position. TCD can be used as another parameter for the estimation of GA in growth restricted fetuses.Methods: This study was conducted at Mahila Chikitsalaya Sanganeri Gate; SMS Medical College Jaipur from July 2005 to September 2006. A total of 80 pregnant women in third trimester with singleton pregnancy including 40 pregnant women with known cases of IUGR and 40 AGA fetuses were studied for TCD measure.Results: Correlation coefficient between TCD and gestational age was highly significant and no significant difference was found in TCD of AGA and IUGR fetuses.Conclusions: TCD measurement can be used as more reliable parameter for accurate estimation of gestational age in IUGR fetuses in third trimester.

Role of IV administered Iron sucrose with recombinant erythropoietin in the treatment of moderate and severe iron deficiency anemia in the third trimester of pregnancy

Background: Iron deficiency Anemia in pregnancy is one of the most common and intractable nutritional problems in the world today. The objective of this study was to investigate the therapeutic efficacy and safety of rHuEPO combined with IV iron sucrose, in the treatment of pregnant women in third trimester with moderate and severe iron deficiency anemia and whether addition of erythropoietin will increase the rate of rise of Hb without compromising on the safety of the therapy.Methods: 60 pregnant women in the third trimester, diagnosed as cases of moderate and severe iron deficiency anemia were enrolled in this study with 30 subjects in each of the 2 groups. Recombinant Erythropoietin 2000 IU s/c and Inj Iron sucrose 100 mg slow intravenously in 100 ml 0.9% NS over 1 hr on alternate days was administered to the case group and the control group was administered only iron sucrose slow IV in the same dose on alternate days till target Hb (11gm%) was reached. Efficacy measures were reticulocyte count, increase in Hb/week, time to target Hb level and need for continued therapy after 4 weeks.Results: In the case group, the increases in Hb were greater after 1 week of treatment and this was found to be significant (P < .01), the median duration of therapy was shorter in the case group (22 versus 34 days), with more patients reaching the target hemoglobin level by 4 weeks as opposed to 7 weeks in the control group. Average rise in Hb/week was much more in the case group. The groups did not differ with respect to maternal and fetal safety parameters.Conclusions: Iron sucrose plus rhEPO is an effective treatment for iron deficiency anemia in pregnancy probably because of a synergistic action, with rhEPO stimulating erythropoiesis and iron sucrose delivering iron for hemoglobin synthesis.

Effect of eclampsia on pregnancy outcome at tertiary care center, Gujarat, India

Background: Eclampsia, a common medical emergency of pregnancy mainly seen in 5% to 10% of all pregnancies. The objective of the present study was to study the effect of eclampsia on maternal and perinatal outcome.Methods: This cross-sectional study was conducted among 50 clinically diagnosed women with eclampsia in their third trimester of pregnancy. Inclusion criteria for the study was; females with singleton pregnancy, all in the third trimester which were diagnosed to have PIH based on the development of hypertension for the first time, proteinuria with or without edema, with no history of previous urinary tract troubles and no evidence of UTI.Results: Almost 84.0% participants were belonged to age group of 20 to 30 years age, 54.0% were belonged to rural area and 92.0% were belonged to lower socio-economical class, 88.0%% participants were registered as emergency case, 34.0% participants were stayed more than 10 days at hospital and 36.0% were completed ANC visit. Almost 24.0% participants were anemic, 6.0% pre-eclampsic and 4.0% have tween pregnancy. Severe hypertension at the time of admission were noted in 50.0% participants followed by absent knee jerk (12.0%), proteinuria (78.0%) and edema (62.0%) respectively. Maternal mortality and still birth observed in 2.0% and 18.0% cases respectively.Conclusions: Early age, lower socio-economic class, anemia, less ANC clinic visit, higher hospital stay and primigravida observed more among study participants and these factors may play an important role in the pathogenesis of eclampsia.

Influence of the ultrasound examination duration using supine position on umbilical artery blood flow parameters and fetal heart rate in the third?trimester pregnant women / 中国综合临床

Objective To investigate the influence of the length of time of supine ultrasound examination on the parameters of umbilical artery blood flow in the late pregnant fetus. Methods From February 2019 to June 2019,the ultrasound data of 93 pregnant women with the third-trimester pregnant were analyzed retrospectively. Fetal umbilical artery systolic／diastolic ( S／D ) ratio, resistance index ( RI ), pulsatility index ( PI ) and fetal heart rate ( HR ) were acquired at the beginning of the ultrasound examination and those after the routine ultrasound examination ( the examination of fetal, placenta and amniotic fluid). Forty-seven pregnant women from 29 to 31 weeks of gestation were assigned to around 30-week gestation group,while 46 pregnant women from 35 to 37 weeks of gestation were assigned to around 36-week gestation group. Sixty-five pregnant women with normal S／D ratio at the beginning were assigned to the initial normal group,while 28 pregnant women with abnormal S／D ratio at the beginning were assigned to the initial abnormal group. Fetal umbilical artery S／D ratio,RI,PI and HR at the beginning of the ultrasound and after the routine ultrasound examination were compared using paired sample test within around 30-week gestation group, around 36-week gestation group, initial normal and initial abnormal group, respectively. Results There was no significant difference in fetal umbilical artery S／D,RI PI and HR in the pregnant women at around 30-week gestation(all P＞0. 05). RI before the 36 week pregnant group was 0. 56 ±0. 05,and increased to 0. 58±0. 05 after the routine examination (t＝－2. 190,P＝0. 034). The S／D,RI and Pi of umbilical artery increased from 2. 36±0. 31,0. 57±0. 06,and 0. 84±0. 11 to 2. 50±0. 42,0. 59±0. 06, and 0. 88±0. 14 in the initial normal group ( t＝－3. 087,－3. 002,－2. 287,respectively; P＝0. 003,0. 004, 0. 025,respectively),of which 16 S／D increased to abnormal; the RI of umbilical artery increased from 0. 67 in the initial abnormal group ( 28 women ) after routine examination ) . The difference was statistically significant (t＝2. 616,P＝0. 014) . The ratio of S／D decreased to normal after routine examination in the initial abnormal group ( 14／28), which was higher than that in the initial normal group ( 16 ／ 65) . The difference was statistically significant ( χ2 ＝5. 771, P＜0. 05) . Conclusion Umbilical artery blood flow parameters should be measured at the beginning of the ultrasound examination in the third-trimester pregnant women. Umbilical artery Doppler ultrasound should be performed repeatedly if the pregnant woman has abnormal S／D ratio at the beginning of the examination.

Clinical treatment of acute aortic dissection in late pregnancy and puerperium / 中国胸心血管外科临床杂志

@#Objective    To study the clinical characteristics, therapy strategies and the outcomes of female patients with acute aortic dissection during late pregnancy and puerperal period. Methods    We retrospectively analyzed the clinical data of 7 patients with acute aortic dissection during late pregnancy and puerperal period in Shanghai Changhai Hospital between August 2012 and June 2017. Five of the 7 patients were late stage pregnancy, 2 were puerperal period (1 at the postpartum night, 1 in 18 days after delivery). There were 6 patients of Stanford type A aortic dissection (85.7%), and 1 patient of type B aortic dissection (14.3%). The age of the patients ranged from 26 to 34 (30.8±3.1) years. Cardiac ultrasonography of patients with type A showed that the maximum diameter of the ascending aortas was 4.2–5.7 (4.7±0.6) cm, of which 2 patients were aneurysm of aortic sinus, 3 patients were with Marfan syndrome. Bentall procedure was conducted in 1 patient, Bentall+Sun’s surgery in 2 patients, ascending aorta replacement+Sun’s+coronary artery bypass grafting surgery in 1 patient, aortic root remodeling+ascending aorta replacement+Sun’s surgery in 2 patients. One patient with Stanford type B acute aortic dissection was performed with thoracic endovascular aortic repair (TEVAR) after cesarean section. Results     Aortic blocking time ranged from 51 to 129 (85.5±22.9) min.  Cardiopulmonary bypass time was 75–196 (159.0±44.0) min. Moderate hypothermic circulation arrest with selective cerebral perfusion time was 20–30 (23.8±3.5) min. All maternal and fetuses survived. The infant whose mother received aortic repair in early stage and then received cesarean section was diagnosed with cerebral palsy. Maternal and fetuses were followed up for 9 months to 4 years. During the follow up period, all the fetuses grew well except the cerebral palsy one, and all maternal recovered well. The patient who received aortic repair in the early stage, had a sigmoid rupture during cesarean section and was treated with sigmoid colostomy. Another patient with Stanford type A dissection was diagnosed as left renal vein entrapment syndrome after 2 years. Conclusion    Type A aortic dissection is more common in late pregnancy and puerperal patients. And Marfan syndrome is a high-risk factor for acute aortic dissection in pregnancy women. Early and appropriate surgical treatment strategy based on the type of aortic dissection and gestational age are the key points to achieve good outcomes both for maternal and fetus.

Change of S/D Value in the Third trimester Pregnancy with Hypothyroidism / 医学研究杂志

Objective To observe the change of umbilical artery S/D value in the third trimester pregnant women with overt hypothyroidism(OH) or subclinical hypothyroidism(SCH).Methods We collect the data of 37-42 weeks pregnancy from January 2014 to December 2015.We devided them into OH group,SCH group and contral group.We compared the umbilical artery S/D value in these three groups and analyzed the relativity between S/D value and thyroid hormone.Results The S/D value was 2.46 ± 0.31 in OH group,2.48 ± 0.27 in SCH group and 2.32 ± 0.17 in control group.The differences were statistically significant between OH group and contral group (P =0.000),SCH group and contral group (P =0.000).There was no statistically significant between OH group and SCH group (P =0.907).The proportion of cases number during different S/D value range in these three groups had difference (P =0.000).The S/D value was positively correlated to TSH in OH group (r =0.186,P =0.037) and SCH group (r =0.146,P =0.015).There was no correlation between FT3 and S/D value(P ＞ 0.05) or FT4 and S/D value(P ＞ 0.05) in both OH and SCH group.There was no correlation between thyroid hormone and S/D value in the contral group either.Conclusion Both OH and SCH can effect umbilical artery S/D value in the third trimester pregnancy.