Study of the Vertical Transmission of COVID-19 by Using the World Health Organisation Protocol in a Tertiary Care Hospital in Eastern India.

BACKGROUND: The World Health Organisation (WHO) has established criteria to diagnose vertical transmission in severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). This study aimed to determine the incidence of vertical transmission of SARS-CoV-2 using WHO criteria in a tertiary care centre in eastern India. METHODS: A hospital-based prospective observational study was conducted from June 2021 to February 2022 on women admitted for delivery with a positive nasopharyngeal (NP) swab and a SARS-CoV-2 real-time reverse-transcriptase polymerase chain reaction (RT-PCR) test. Following the delivery, the amniotic fluid (AF) and swab from the placenta were tested for SARS-CoV-2 by the Truenat test. The umbilical cord and maternal blood were analyzed to detect immunoglobulin M (IgM) and immunoglobulin G (IgG). The nasopharyngeal swabs of the newborns were tested for SARS-CoV-2 by RT-PCR. RESULTS: Forty-eight SARS-CoV-2-positive asymptomatic women were included in the study. Twenty-eight (58.3%) were delivered via cesarean section. Preterm delivery occurred in 13 (27.1%) cases. In only one case, vertical transmission was confirmed as the neonate had a positive nasopharyngeal SARS-CoV-2 RT-PCR test and the cord blood was IgM positive (suggesting an immune response in the neonate). The placenta was positive in three cases, and amniotic fluid was positive in two. However, vertical transmission was deemed unlikely in these cases as there was no evidence of immune response or viral persistence according to the WHO criteria. There was one stillbirth, and it tested negative for SARS-CoV-2. CONCLUSION: This study strengthens the evidence of vertical transmission in COVID-19-positive asymptomatic mothers. The data suggest a low transmission rate.

A Curious Case of Parasitic Fibroid in a Postmenopausal Woman.

Parasitic fibroids or leiomyomas are rare extrauterine benign tumors in women of reproductive age. Often, they are named wandering fibroids or ectopic fibroids. They lack any myometrial connection and obtain their nourishment from other abdominopelvic structures to which they are attached. Clinicians often find it difficult to diagnose these fibroids preoperatively due to their atypical presentations and locations. Recent studies have suggested that the development of parasitic fibroids is iatrogenic. Inadvertent seeding of fibroid fragments during the morcellation procedure in a previous laparoscopic myomectomy surgery could be the pathogenesis. However, in rare scenarios, they may develop spontaneously with no history of surgery or a coexistent uterine fibroid. In this report, we present a case of parasitic fibroid in a 75-year-old postmenopausal woman. She had no surgical history, and she had a normal uterus. Radiological investigations had initially suggested the mass to be a subserous fibroid. However, it was diagnosed as parasitic fibroid intraoperatively, confirmed later by histopathological examination.

Central Placenta Previa With Coexisting Central Cervical Fibroid in Pregnancy: An Obstetrician's Nightmare.

Pregnancy with central placenta praevia and a coexistent cervical fibroid is infrequently encountered in clinical practice. A patient with this unusual combination is a nightmare for any clinician, especially if she presents with obstetric emergencies. In this scenario, there is a high chance of catastrophic obstetric hemorrhage during the peripartum period leading to a fatal outcome. We report a case of a 27-year-old lady at term pregnancy, who was brought to emergency in labor pain with antepartum hemorrhage. Subsequently, she was diagnosed to have central placenta praevia along with a large central cervical fibroid. An emergency cesarean section was performed to deliver the child. Intraoperatively, she had a major postpartum hemorrhage which was successfully managed with intrauterine balloon tamponade, hemostatic sutures, and uterine artery ligation. We could avoid cesarean hysterectomy by precise anticipation, meticulous planning, and step-wise protocol-driven management.

Pregnancy With SARS-CoV-2 Infection Complicated by Preeclampsia and Acute Fatty Liver of Pregnancy.

The coronavirus disease 2019 (COVID-19) pandemic has spread across the world in a relentless and merciless way. As the pandemic escalates, varied presentations and complications of the disease have been reported from all over the world. Pregnant women fall into a vulnerable group who have been reported to have more severe disease and need of intensive care when compared to non-pregnant women of the same age group. Preeclampsia is one of the most common co-morbidity seen in pregnant women with COVID-19 infection. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection can lead to worsening of pre-existing co-morbidities and extra vigilance is required in such cases. Here we present a case of a pregnant woman with COVID-19 infection with preeclampsia complicated by acute fatty liver of pregnancy and acute kidney injury. Although a rare diagnosis, a prompt multidisciplinary approach helped in achieving a favorable maternal and neonatal outcome.

Maternal Near-Miss as a Surrogate Indicator of the Quality of Obstetric Care: A Study in a Tertiary Care Hospital in Eastern India.

Background Monitoring severe acute maternal morbidity or maternal near-miss is currently proposed by WHO as a valuable tool to assess the quality of obstetric care and implement new strategies for improving maternal health. Aim and objective The objective of this study was to assess and analyze the incidence of maternal near-miss (MNM) and maternal death (MD) at Tata Main Hospital, Jamshedpur, a tertiary care hospital in eastern India. Material and method This study was a prospective observational study conducted at Tata Main Hospital from November 2016 to October 2019. The study population included all the pregnant women who fulfilled the WHO near-miss criteria based on organ dysfunction or failure and all the maternal deaths that occurred during the study period. Results During the study period, there were 15,377 deliveries and 14,636 live births. The MNM cases were 153, and 38 were maternal deaths. The maternal near-miss ratio (MNMR) and severe maternal outcome ratio (SMOR) were 19.9 and 13.1 per 1000 live births, respectively. The maternal near-miss to mortality ratio (MNM: 1 MD) was 4:1, and the mortality index (MI) was 19.9%. Haemorrhagic disorders were the leading cause (40.5%) of MNM, followed by hypertensive disorders (25.5%) and cardiac diseases (14.4%). Similarly, both haemorrhage (23.7%) and sepsis (23.7%) were the leading causes of death followed by hypertensive disorders (15.8%). On reviewing patients, 62% of near-miss and 92% of mortality cases had shown organ dysfunction on admission. Conclusion MNM and MD cases share similar pathology with a different outcome. Hence, monitoring a larger volume of MNM cases helps in identifying the causes of maternal adverse events and finding out the gaps in the management more effectively than auditing only the maternal deaths.

A Rare Case of Pregnancy Complicated by Uterine Prolapse and Cervical Fibroid.

Uterine prolapse and cervical fibroid are two common gynecological conditions but relatively uncommon in pregnant women. However, these conditions can complicate normal pregnancy by significantly altering its course and outcome. Obstetricians should, therefore, familiarize themselves with the presentations, challenges, and outcomes of these unique situations to effectively manage the patient in the perinatal period. We report a rare case, where both uterine prolapse and cervical fibroid coexisted in a single pregnancy.

Vitamin D3 Level in Women with Uterine Fibroid: An Observational Study in Eastern Indian Population.

PURPOSE: Vitamin D deficiency has been proposed to be a risk factor in the pathogenesis of uterine fibroid in few recently published studies conducted in Europe and Africa. Nevertheless, no study has ever addressed similar query in Indian women where hypovitaminosis is very common. METHODS: A total of 144 women of age group 20-50 years belonging to Jamshedpur, Jharkhand, India, were included in the study. Out of which, 72 women had uterine fibroids and rest healthy women without fibroids served as controls. All women were subjected to ultrasound examination of uterus followed by measurement of serum FSH level (on 3rd day of menstruation) and serum vitamin D3. RESULTS: The mean serum concentration of vitamin D3 was significantly lower in women with uterine fibroids compared to controls (10.81 ± 6.18 vs. 22.91 ± 16.18, p < 0.0001). On further analysis, 62.5% of cases were found to be severely deficient (vitamin D3 < 10 ng/mL) as compared to 26.39% of controls (p < 0.0001). Besides that, only 2.77% of cases had sufficient vitamin D level as compared to 23.61% of controls (p = 0.0002). The odds ratio (OR) of occurrence of fibroid with serum vitamin D3 level of < 10 ng/dl compared to that of level > 10 ng/dl was 4.64 (95% confidence interval [CI] 2.28-9.44) (p = 0.0001). CONCLUSION: Serum vitamin D3 level inversely correlated with burden of uterine fibroid and possibly its deficiency is a risk factor for uterine fibroid occurrence in eastern part of India.