Frequency of anti-HCV, HBsAg and related risk factors in pregnant women at Nishtar Hospital, Multan.

BACKGROUND: Viral hepatitis is a global issue. Among the hepatitis viruses hepatitis B and C are important in South Asia including Pakistan. There are various modes of transmission of these viruses. Vertical transmission is also gaining importance. Antepartum screening for HBV and HCV would help the infected women for appropriate antiviral therapy at appropriate time as well as for taking proper care of the newborns. The present study was designed to see the frequency of HBsAg and anti-HCV in pregnant women at Nishtar Hospital, Multan. METHODS: This was a cross-sectional study carried out using non-probability purposive sampling technique. The period of the study was from June 2006 to August 2007. Five hundred (500) pregnant women attending outpatient department of Gynaecology and Obstetrics were included. Informed consent was taken. A specially designed proforma was filled in. Anti-HCV and HBsAg were tested by device method. Data were analysed on SPSS-11. RESULTS: Out of 500 pregnant women 35 (7.00%) were found to be anti-HCV positive and 23 (4.60%) were positive for HBsAg. Mean age was 26.7 +/- 4.8 years. Majority of the patients 263 (52.60%) were in the age group 26-35 years. 138 (27.60%) women were nulliparous and 282 (56.40%) were para 1-4 and anti-HCV and HBsAg were common in this parity group. Only 80 (16.00%) women were para 5 or more. All anti-HCV and HBsAg positive women were house-wives. Most of them were belonging to rural areas having poor socio-economic status. Among 35 anti-HCV positive women, 20 (57.14%) had history of previous surgery, while 13 (37.14%) had history of multiple injections, 5 (14.28%) received blood transfusion, 4 (11.42%) had ear/nose piercing while tattooing was seen in only 2 (5.71%). Among 23 HBsAg positive women, 10 (43.47%) had history of previous surgery. History of multiple injections was present in 6 (26.08%) patients, 4 (17.39%) patients had history of blood transfusion, tattooing, ear/nose piercing, history of dental procedure, history of sharing needles was observed in 1 each. CONCLUSION: Frequency of anti-HCV is more common than HBsAg in our study population. Previous history of surgery, multiple injection therapy and blood transfusion were observed as risk factors among anti-HCV and HBsAg positive pregnant women.

Herpes gestationis.

Herpes gestationis, also known as Pemphigoid gestationis, is a rare autoimmune disease of pregnancy. It is characterized by itching and skin lesions. The disease causes prominently maternal discomfort but fetal and neonatal complications have been reported. There are only scattered reports of cutaneous neonatal herpes gestationis in the literature; however, the frequency and severity of fetal illness are still debated. We describe 2 cases of herpes gestationis diagnosed and managed at the King Khalid University Hospital, Riyadh, Kingdom of Saudi Arabia.

Pregnancy and valvular heart disease.

OBJECTIVE: To review all cases of valvular heart disease during pregnancy in a regional Saudi-Arabian population between 1993-1997, determine its incidence, contributing factors and its effect on the outcome of pregnancy. METHODS: A retrospective study of 33,200 cases between 1993-1997 performed over a period of 5 years in the Department of Obstetrics and Gynecology in King Khalid University Hospital, Riyadh, Kingdom of Saudi Arabia. Most patients were Saudi nationals (83.4%). Evidence of heart disease was detected in 166 pregnant women, an incidence of 0.5%. Valvular heart disease was present, either as a single valve involvement or in combination, in 76% of the patients. The remaining 24% were a miscellaneous group including patients with cardiomyopathies, or pulmonale and septal defects. The data collected was analyzed using Gold Stat Software Package. RESULTS: As a single valve disease, mitral valve involvement was predominant (94.5%), compared to aortic valve (5.5%). The most common condition involving mitral valve was the valve prolapse (39.2%), followed by mitral regurgitation (19.9%) and mitral stenosis (16.9%). Twenty-four percent of the pregnant women with valve disease had multiple valve involvement. Forceps were applied in 8.4% of the patients and ventouse deliveries in 1.2%. Cesarean section was performed in 3.6% of the cases, out of which 2.4% were emergency lower segment cesarean section and 1.2% were elective. No maternal or infant mortality occurred. All infants were normal and healthy with mean infant weight of 3.24 +/- 0.52 kg. Prophylactic antibiotics were administered in 83% of the patients. None of the patients, whether treated with antibiotics or not, developed infective endocarditis. CONCLUSION: Presence of valvular heart disease in our study did not appear to affect the outcome of pregnancy, but its accurate diagnosis and management demand a greater understanding of cardiovascular physiology and its pathophysiology in pregnancy, labor and the puerperium. The successful management of the woman with valvular heart disease in pregnancy required complete cooperation between the patient herself, the obstetrician, cardiologist, anesthetist and other supporting medical staff, to optimize the outcome for both the mother and her baby.

Results of delivery in umbilical cord prolapse.

OBJECTIVE: To review the peripartum clinical course of patients whose pregnancies were complicated by umbilical cord prolapse and to evaluate its impact on neonatal outcome. METHODS: All cases of cord prolapse managed in King Khalid University Hospital, Riyadh, Kingdom of Saudi Arabia between 1990-2000 were identified. There were 111 patients identified among 55,789 deliveries. Each maternal and fetal chart was reviewed for parity, age, gestational age, fetal presentation, status of membranes, time from diagnosis to delivery, mode of delivery, baby weight, Apgar scores and cord blood hydrogen ion concentration (PH). The data collected was analyzed using Gold Stat Software Package, and statistical significance was established by using analysis of variance and Chi-square. RESULTS: The incidence of cord prolapse was found to be one in 503 cases (1.99 per thousand deliveries) in our study. Seventy-two (64.9%) of the fetuses were in vertex presentation and 39 (35.1%) were non-vertex, including breech and transverse presentations. Ninety one point nine percent were singletons and 8% were twins. At the time of diagnosis in 15 (13.5%) membranes were artificially ruptured and in 96 (86.5%), they were spontaneously ruptured. The cervix was fully dilated in 10% and minimally dilated in 100 (90%). Regarding mode of delivery, 7 (6.5%) were vaginal deliveries and 104 (93.5%) were cesarean sections. The interval from diagnosis to delivery ranged from 10 minutes to >20 minutes. Six (5.4%) of the babies were delivered in 10 minutes, 49 (44.1%) in 20 minutes and 56 (50.5%) in more than 20 minutes. Apgar score was less than 7 in 44 (39.6%) of the babies at one minute and in 5 (4.5%) of the babies at 5 minutes. Cord PH was less than 7 in 2 (1.8%) cases and more than 7 in 109 (98.2%). Forty-one (36.9%) of the babies were admitted in neonatal intensive care unit. There was no perinatal mortality in our study group. CONCLUSION: In our review, we found that cord prolapse is not associated with higher rates of perinatal mortality or morbidity and our study supports clinical management of cord prolapse by cesarean section. The interval from diagnosis to delivery may not be the only determinant of neonatal outcome.

A case of seven recurrent ectopic pregnancies.

If a woman with previous ectopic pregnancy ever gets pregnant again, the risk of a repeat ectopic pregnancy is said to be 4-fold. We present a rare case of 7 recurrent ectopic pregnancies in a 39-year-old Saudi woman, together with a literature review of the reproductive performance after recurrent ectopic pregnancy.

Transabdominal cervicoisthmic cerclage after multiple failed vaginal cerclages.

Cervical incompetence is a condition traditionally treated by cervical cerclage. We describe a patient who had 6 failed cervical cerclages and who was treated with transabdominal cervicoisthmic cerclage. There were no intra-operative or post-operative complications and the patient was regularly reviewed in the antenatal clinic by a senior physician and with a series of transvaginal ultrasounds. The patient went into labor at 36-weeks of gestation and had an emergency lower segment cesarean section, with a live male infant weighing 2.38 kg. Both mother and baby did well after delivery.