Clinical characteristics, obstetric and perinatal outcome of COVID-19 Infection in pregnant women.

OBJECTIVE: To determine clinical characteristics, obstetrics and perinatal outcome of coronavirus disease 2019 infection in pregnant women. METHODS: The cross-sectional study was conducted at the Department of Obstetrics and Gynaecology of the Ruth Pfau Civil Hospital, Karachi, and Dow University of Health Sciences, Karachi, from August 2020 to July 2021, and comprised pregnant women with suspicion of coronavirus disease 2019 infection, who underwent recommended testing, and were found to be positive. Oral swabs for the presence of infection were also taken from the neonate within 24 hours of delivery. Data was analysed using Stata 11. RESULTS: There were 41 women with a mean age of 27±5 years, a mean gestational age of 35±3 weeks, and mean parity 1.2±1.01. Of them, 3(7.3%) women died. Medical complications found along with coronavirus disease 2019 infection were pregnancy-induced hypertension 2(4.8%), eclampsia 4(11%) and diabetes mellitus 2(4.8%). Fever was the most common symptom seen in 12(30%) women, followed by cough 7(20%) and shortness of breath 6(14%). Majority 32(82%) of the women underwent caesarean section. The most common maternal complication was postpartum haemorrhage 6(20%). Also, 36(86%) women required intensive care unit stay for a mean 5±9 days. CONCLUSIONS: Fever, followed by cough and breathlessness, were the most common clinical features. Most common maternal and foetal complication was postpartum haemorrhage and low birth weight, respectively.

Physicians' Migration: Perceptions of Pakistani Medical Students.

OBJECTIVE: To study the perceptions of medical students about factors responsible for physicians'migration. STUDY DESIGN: Cross-sectional survey. PLACE AND DURATION OF STUDY: Dow Medical College and Civil Hospital, Karachi, from April to May 2015. METHODOLOGY: Aself-administered structured questionnaire was used including demographic details, attitudes about push and pull factors of migration, and reasons for migrating or not migrating abroad. Final year students and interns were included. Likert scale from 1 to 4 (1=strongly disagree to 4=strongly agree) was used to assess attitudes. Data was analyzed by SPSS version 16. RESULTS: Atotal of 240 medical students, mostly females (n=181, 75%) (60% final year and 40% interns), participated in the study. Majority wished to go abroad (n=127; 54%) with United States being the favourite destination (n=80; 66.1%) and internal medicine fields being the preferred choice for specialization (n=126; 54%). The major pull factors were better quality of postgraduate education abroad (n=110; 48.2%) and economic prospects (80; 35.2%); while the push factors were a weak healthcare system (n=219; 94.3%), inadequate salary structure (n=205; 88.3%), insecurity (n=219; 93.9%) and increasing religious intolerance in Pakistan (n=183; 78.5%). CONCLUSION: This survey highlights the continuing trend of physician migration from Pakistan owing to an interplay of various push and pull factors. Majority of our medical students wish to migrate, mainly due to low salaries, poor job structure, and insecurity. Urgent interventions are required to reverse this trend of medical brain-drain.

Spot urine protein-creatinine ratio and 24-h urine protein excretion: Diagnostic accuracy in women with pre-eclampsia.

OBJECTIVE: To compare the efficacy of spot urinary protein/creatinine ratio with 24h urinary protein excretion in women with pre-eclampsia. METHODS: A total of 85 women with hypertensive disorders during pregnancy were prospectively studied. Urine protein/creatinine ratio in spot urine sample was compared with 24h urinary protein. Sensitivity and specificity for urinary spot P/C (protein/creatinine) ratio was assessed, and receiver operating curve was used to determine the value against the gold standard of >300mg proteinuria in 24h urinary sample. RESULTS: Of 85 women, complete data were available for 81 women. There was a strong correlation between spot urinary P/C ratio and 24h urine protein excretion (r=0.81, P value <0.000). The optimal spot P/C ratio cut-off point was 0.14 for 300mg/24h of protein excretion (preeclampsia) with a sensitivity of 82% and specificity of 79%. CONCLUSION: We found a strong correlation between spot urinary P/C and 24h urinary protein. Spot urinary protein/creatinine ratio is a good predictor of proteinuria for pre-eclampsia.

Transfusion of blood and blood component therapy for postpartum haemorrhage at a tertiary referral center.

OBJECTIVE: To determine the practice of transfusion of blood and blood products in cases of postpartum haemorrhage, at a tertiary referral center. METHODS: A retrospective study was conducted where medical records were reviewed for women, who either delivered or were admitted in labour suite with diagnosis of postpartum haemorrhage. The study period extended from Jan 2008 to Oct 2009. During a period of 22 months, records were reviewed for transfusion of blood and blood products in above group of women. Data were analyzed for descriptive statistics. RESULTS: During the study period, a total of 4744 patients were admitted in the labour suite. A total of 113 (2.36%) women were diagnosed with Post partum haemorrhage. Uterine atony was the commonest cause of PPH, followed by genital tract trauma. A total of 81 (71%) women received transfusion of blood and blood components (1.6%). The mean blood loss was 1088 ml (+/- 584 ml). Transfusion of blood and blood component therapy was significantly more in women who underwent caesarean section, compared to those women who delivered vaginally. There was one case of acute tubular necrosis due to PPH, and seven maternal deaths. The mean hospital stay was of +/- 3 days. CONCLUSION: In this hospital based study, the prevalence of PPH was 2.36%, and the rate of transfusion of blood and blood products was 1.6%.

High prevalence of vitamin D deficiency in Pakistani mothers and their newborns.

OBJECTIVE: To determine the prevalence of vitamin D deficiency in Pakistani parturients and their newborns and to assess the correlation between maternal and newborn serum levels of the vitamin D metabolite 25-hydroxy vitamin D3. METHODS: A prospective study of parturients presenting to the labor suite with a singleton pregnancy. Maternal and cord blood were collected for estimation of serum 25-hydroxy vitamin D3. RESULTS: In total, 89% of the gravidae were deficient in vitamin D (serum 25-hydroxy vitamin D3 <30 ng/mL). There was a positive correlation between maternal and cord blood 25-hydroxy vitamin D3 levels(r = 0.68; P < 0.001). Inverse correlations were noted between cord blood 25-hydroxy vitamin D3 and a longer duration of gestation (r = -0.33; P = 0.003) and with the newborn's birth weight (r = -0.23; P = 0.048). Maternal 25-hydroxy vitamin D3 levels were inversely correlated with maternal mean arterial pressure (r = 0.029; P < 0.020). CONCLUSION: There was a high prevalence of vitamin D deficiency in the Pakistani parturients and their newborns. There was a correlation between higher maternal vitamin D levels and lower blood pressure in the mothers.