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Introduction Misoprostol (prostaglandin E1 analog) is being used for the induction of labor by vaginal, oral, and sublingual routes. Oral misoprostol is the preferred route for induction of labor, but the use of sublingual misoprostol appears promising due to a faster onset of action. This study was done to compare the efficacy and safety of oral and sublingual misoprostol for induction of labor in term pregnancy. Materials and methods One hundred and sixty patients were randomly allocated to one of the two groups to receive 50 micrograms of oral and sublingual misoprostol four hourly for a maximum of six doses. Primigravida at 37-42 weeks of gestation with singleton pregnancy, cephalic presentation, Bishop score (<5), and reassuring fetal heart rate were included in the study. Misoprostol dose was withheld if the active phase of labor was reached or if the cervix was favorable for amniotomy (Bishop score greater than or equal to eight). The change in the Bishop score with misoprostol was studied along with adverse effects and neonatal outcomes. Results The mean number of 50 mcg misoprostol doses required was significantly less in the sublingual group (2.94±0.97 versus 2.13±0.92; p<0.0001). The rate of change of the mean Bishop score was faster in the sublingual group. After four hours of the first dose, the mean Bishop score changed to 3.52±2.14 versus 4.68±2.34 (p=0.001), and, similarly, after eight hours, it was 10.48±2.59 versus 11.39±2.06, and this difference was statistically significant (p=0.015). The mean induction delivery interval was significantly lower in the sublingual group. The need for labor augmentation, mode of delivery, and adverse effects were similar in both groups. The incidence of meconium-stained liquor and NICU admission was also similar in both groups. Conclusion Sublingmisoprostolstol has a short induction delivery interval and comparable side effects when compared to omisoprostolstol. Sublingmisoprostolstol is recommended for induction of labor at term.
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Introduction Dengue is caused by a virus from the Flaviviridae family. Although the literature on this disease is sparse, some studies have shown the effects of dengue in the first trimester of pregnancy. However, the sample size in these studies is limited. Aims and objective The current study aimed to compare foetomaternal outcomes in pregnant patients with dengue in early (< 24 weeks) and late (> 24 weeks) pregnancy and find the prevalence and predictive factors for abortion in pregnant patients with dengue. Material and methods This retrospective study included all pregnant patients (n = 62) admitted to the labour room over a period of six years from April 2016 to February 2022 and who were diagnosed with dengue anytime during pregnancy. Data were collected from their medical records and analysed. Differences between the two groups were assessed by the Chi-square test, Fisher's exact test, and Mann-Whitney U test. A p value of less than 0.05 was considered significant. Results Out of a total of 62 patients, those with dengue at a gestational age of less than 24 weeks (n = 15) had more incidence of intrauterine growth restriction (55.6 vs 12.9%) (p value = 0.012) and oligohydramnios (66.7 vs 17.9%) (p value = 0.007). The incidence of abortion was 33.3%; among the patients at a gestational age of less than 12 weeks, 71.4% had an abortion. When the patients who had abortions were compared with those who did not, the factors predicting abortion were found to be a history of previous abortion (p value = 0.004), gestational age of less than 12 weeks (p value = 0.003), and decreased platelet count (p value = 0.03). Conclusion The effect of dengue infection in early pregnancy includes abortion, intrauterine growth restriction, and oligohydramnios, and these patients should be managed in a tertiary care hospital.
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Background The ongoing coronavirus 2019 (COVID-19) pandemic is the most devastating health care crisis of our times. Pregnant women with COVID-19 infection belong to a vulnerable group with concerns about the effect of the disease on maternal and neonatal health. As we are dealing with a new disease, we must study the changing trend of disease presentation, diagnosis, and treatment to successfully manage such pregnancies. Objective The purpose of the present study was to evaluate the differences in presenting features, comorbidities, the fetal and maternal outcomes in COVID-19 positive pregnant women in the first and second wave of the pandemic in a tertiary care institute in eastern India. Methodology This study was a retrospective observational cohort study conducted at Tata Main Hospital, Jamshedpur, a tertiary care hospital in eastern India. All COVID-19 positive by reverse transcription-polymerase chain reaction or rapid antigen (RTPCR) test pregnant women (249 women) admitted to the hospital from May 2020 to August 2021 were included in this study. Out of the total, 139 women were admitted during the first wave (May 2020 to February 2021), and 110 women were admitted during the second wave (March 2021 to August 2021) of the pandemic. Data like baseline characteristics, clinical presentation, associated co-morbidities, management modalities, the maternal and neonatal outcomes were analyzed and compared. Results The peak of the first wave of COVID-19 was found during the months of August-October 2020, while the second wave was in April-May 2021. The majority of women had the asymptomatic or mild disease during both waves, but 14 women had moderate to severe disease during the second wave as compared to two women during the first wave. There was a significant increase in maternal deaths in the second wave (3.64%) as compared to the first wave (0.00%). During the second wave, out of 85 women who delivered, 78.8% (n=67) women had a cesarean section which was significantly higher than the first wave (64.6%). Hypertensive disorders (pre-eclampsia, gestational hypertension, and chronic hypertension) were the most common associated comorbidity, followed by diabetes (gestational diabetes, diabetes mellitus type 2) and anemia during both waves of the pandemic. The rate of preterm delivery was 27.78% (n=35) and 24.71% (n=21) during the first and second waves, respectively. Two babies tested positive within 24 hours of delivery during the first wave and one during the second wave. Conclusion A significantly higher number of moderate to severe disease and maternal deaths were reported during the second wave of the pandemic. A higher incidence of severe oligohydramnios and cesarean section was seen during the second wave. The frequency of preterm deliveries and low birth weight remained high during both waves. Neonatal COVID-19 infection was seen during both waves, but the incidence remained low.
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Background and objective The global health care system is facing the challenge of diagnosing and treating the ongoing coronavirus disease 2019 (COVID-19) pandemic. Pregnant women belong to a vulnerable group, and the effect of the virus on the mother and fetus is not well established. The aim of the study was to understand the maternal and fetal outcomes after recovery from antenatal severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Methods This was a retrospective observational study conducted at Tata Main Hospital, Jamshedpur, India. It included all COVID-19-negative pregnant women who had delivered between 1st January 2021 and 31st August 2021 and had tested positive in the antenatal period (by reverse transcription-polymerase chain reaction (RT-PCR)), the details of which are available in the hospital database. Results A total of 53 women were included in our study who had tested positive in the antenatal period and had turned negative during delivery. Out of the 53 women, 5.7% were infected in the first trimester, 34% in the second trimester, and 60.3% were positive in the third trimester. We found an asymptomatic subgroup in 52.8% of women and mild symptoms in 41.5% of women. Two women were admitted in their antenatal period with moderate COVID-19 disease and one with severe. Preterm births between 34 weeks and 37 weeks were seen in 26.4% of women. Vaginal delivery accounted for 30.2% of cases. The most common indications for cesarean section were fetal distress (17%), previous cesarean section (17%), and unwillingness for vaginal delivery. Out of the 53 pregnant women included in the study, acute respiratory distress syndrome (ARDS) was seen in two women- one diagnosed intraoperatively during cesarean section and the other was diagnosed on the first postoperative day. Conclusion The study showed that pregnant women infected with SARS-CoV-2 usually have no/mild symptoms, and they recover well and have favorable maternal and neonatal outcomes. However, perinatal vigilance is advisable in these cases, as there is a risk of developing respiratory morbidity.
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Torsion of the gravid uterus is very rare in obstetric practice. We report a case of torsion in the uterus didelphys at term which is rare and a lifetime experience for an obstetrician. The patient, a 25-year-old gravida 2 para 1 was admitted to the labor ward at 37 weeks and six days of gestation with abdominal pain. Her previous delivery was a caesarean section performed four years back. She was taken to the operating room for an emergency caesarean section for fetal distress and the lie was transverse. On entering the peritoneal cavity, we found an engorged infundibulopelvic ligament with the fallopian tube and ovary covering the lower segment of the uterus. The baby was successfully delivered by breech extraction. Due to uterine torsion of more than 180 degrees, the posterior surface of the uterus was placed anteriorly, and the incision was made on the posterior surface of the uterus. There was a hemi uterus on the left side of the pelvic cavity with the fallopian tube and ovary attached to it; a diagnosis of uterus didelphys was made. The diagnosis of uterine torsion is intraoperative and prompt and timely decision by surgeons is crucial. We had favorable maternal and fetal outcomes in this rare and interesting case. The diagnosis, though rare, should be kept in mind in all cases of abdominal pain during pregnancy, especially in those with malpresentation.
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Lymphatic filariasis is a major health problem in tropical regions especially in India. A large number of patients tend to be asymptomatic. Ovarian filariasis is an extremely rare manifestation of lymphatic filariasis. This is a case report of bilateral ovarian filariasis presenting as ovarian mass with associated lower abdominal pain, weight loss and chyluria. This is a very rare diagnosis, more so as it was diagnosed preoperatively by ultrasound and managed with anti-filarial drugs and confirmed by biopsy. Most cases of ovarian filariasis reported in literature are incidental diagnosis on histopathological examination of postoperative specimen.
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The thalassemias are the most common single-gene disorders of hemoglobin synthesis. The salient features of beta thalassemia major, in which both alleles of the HBB gene are affected, are transfusion dependency and iron overload. Although with advances in treatment, the life expectancy in such patients has increased, they have difficulty in conceiving. We report a case of pregnancy in a beta thalassemia major patient who was transfusion independent and had no iron overload. Genetic analysis revealed IVS 1-5 (G-C) mutation in the homozygous state which usually manifests in severe disease and blood transfusion dependency. On the contrary, she did not need blood transfusion, had a smooth antenatal period and a vaginal delivery at term with a favorable childbirth experience. This case report highlights complex genetic interplay and the role of fetal hemoglobin (HbF) enhancer loci which modulates HbF levels thereby raising total hemoglobin levels.
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BACKGROUND: The current coronavirus disease 2019 (COVID-19) pandemic is one of the most challenging healthcare crises faced globally. Adequate information and understanding of the clinical presentation and impact of the disease on maternal and neonatal outcomes is the key to successfully manage a pregnancy with COVID-19. OBJECTIVE: The purpose of the present study was to evaluate the clinical presentation of COVID-19 in pregnancy, its course during pregnancy and its effects on maternal and neonatal outcomes. STUDY DESIGN AND SETTING: This study was a retrospective observational study conducted at Tata Main Hospital, Jamshedpur, a tertiary care hospital in Eastern India. Population and study period: All COVID-19-positive (by reverse transcription polymerase chain reaction or rapid antigen test) pregnant women admitted to the hospital from 15th May 2020 to 15th November 2020. Results: A total of 132 COVID-19-positive pregnant women were included in the study. Eighty-six women (65.15%) were asymptomatic, 45 women (34.09%) had mild symptoms and one woman had severe disease. Major co-morbidities seen were hypertensive disorders (pre-eclampsia, gestational hypertension and chronic hypertension) in 18 (13.64%) and diabetes (gestational diabetes, diabetes mellitus type 2) in 14women (10.60%). The rate of preterm delivery was 28.69% (n=35). Caesarean section was done for 78 women (63.93%) and 44 (36.07%) delivered vaginally. Average birth weight reported was 2.59 kilograms. Forty babies (33.06%) were admitted to the neonatal intensive care unit. Two babies (1.65%) tested positive for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) within 24 hours of delivery. Conclusion: COVID-19 in pregnancy commonly presents as an asymptomatic or mild disease. It is associated with high rates of preterm births and neonatal admissions to the intensive care unit. Intrauterine and neonatal death rates remain low. Vertical transmission is possible; however, the incidence is low, and the majority of these neonates are asymptomatic.
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There has been a consistent rise in ectopic pregnancies due to increase in maternal age, infertility treatment, cesarean sections, smoking among women, and use of contraceptives. With the extratubal ectopic pregnancies accounting for only 4% of the total ectopic pregnancies, scar pregnancies are even more of a rare entity with their incidence being less than 1%. We hereby present two cases of ectopic pregnancies, which though managed successfully presented a huge diagnostic challenge in the first case while the diagnosis was completely missed in the second case, hence, emphasizing the need for ectopic mindedness when dealing with early pregnancies.
