ABSTRACT
Background: Maternal serum biomarkers assist in identifying various maternal and foetal complications. In this manner, the present study was conducted to assess the birth of high-risk infants using ß-hCG level and neutrophil lymphocyte ratio and their correlation with the development of low birth weight and poor APGAR score. Methods:A tertiary hospital-based prospective observation study was conducted among primi gravida attending the Department of Obstetrics & Gynaecology of Vardhaman Mahavir Medical College and Safdarjung Hospital, New Delhi, India. Written informed consent was obtained from prim gravida who met the eligibility criteria. Basic details on socio-demographics and selective blood investigations, i.e., ß-hCG and neutrophil-to-lymphocyte ratio (NLR), were examined and followed-up until postdelivery to assess the neonatal outcome. Data was analysed using SPSS version 21.0 with appropriate statistical methods. Sample size: The contamination rate was calculated by dividing the total number of contaminated blood cultures by the total number of cultures multiplied by 100. Results:The mean (±SD) age of participants (N=440) was 23.7 (±1.6). Overall, the mean (±SD) of birth weight and APGAR score at five minutes were 2.6 (±0.6), and 8.8 (±1.2), respectively, within the normal limits. Maternal values of NLR and ß-hCG (IU/mL) were negatively correlated to neonatal outcomes, i.e., low birth weight and poor APGAR score. The mean values of NLR were significantly high in neonates with poor outcomes (LBW, poor APGAR). The sensitivity and specificity of ß-hCG as a predictor for poor APGAR score was 83% and 66% at 16-18 weeks (AUC -0.82, cut-off 22721) and 83%, and 90%, respectively at 32-34 weeks (AUC-0.79, cut-off 14825). The sensitivity and specificity of NLR as a predictor for poor APGAR score were 78% and 61% at 16-18 weeks (AUC-0.76, cut-off 4.5), and 89% and 53%, respectively at 32-34 weeks (AUC-0.74, cut-off 4.5). Conclusion:High levels of maternal NLR and ß-hCG resulted in low birth weight neonates and poor APGAR score. The negative impact of these biomarkers should be further explored on a larger scale basis. Ascertaining this would lead to reduction in poor fetal outcomes.
ABSTRACT
Term, live abdominal pregnancy secondary to rupture of a uterine rudimentary horn is a rare condition. Pregnancies conceived in the rudimentary horn of the uterus usually rupture during early gestation and present as a catastrophic event. However, rarely, after rupture of the uterine horn the foetus may continue to grow in the abdominal cavity and reach term gestation. A primigravida with a term pregnancy was referred to our centre for caesarean section with ultrasonography findings of transverse lie and placenta previa. During surgery, a live baby was extracted from the abdominal cavity, revealing a bicornuate uterus with rupture of the rudimentary horn. The early peroperative diagnosis and prompt control of the bleeding with excision of the rudimentary horn and transfusion of multiple blood products saved the patient's life. The case is presented for its rarity and to highlight the importance of a high index of suspicion in cases presenting with abnormal foetal presentation.
