scholarly journals Monitoring Foetus and Neonatal Outcomes in Patients With Current or Previous History of Hyperthyroidism

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. A942-A942
Author(s):  
Lakshminarayanan Varadhan ◽  
Monzoor Quader ◽  
Ayat Mohamed ◽  
Julia Uffindell ◽  
Sa’adatu Usman ◽  
...  
Keyword(s):  
Gestational Age ◽  
Care Pathway ◽  
Previous History ◽  
Multidisciplinary Care ◽  
Thyroid Function Test ◽  
Large For Gestational Age ◽  
Third Trimester ◽  
Thyroid Status ◽  
Tertiary Referral Centre ◽  
History Of

Abstract Aim: Graves’ hyperthyroidism can be associated with persistent TSH-receptor antibody (TRAB) and need for anti-thyroid drugs (ATD) during pregnancy warranting careful monitoring during pregnancy and the neonatal period. The aim of this retrospective observational study was to assess the outcomes of babies born of women with current or previous history of hyperthyroidism. Method: All women with previous or current hyperthyroidism were reviewed in the joint antenatal-endocrine clinic. Neonatal alert was instituted for all patients with positive TRAB at 20 weeks and/or requiring ATD into third trimester and included serial growth scans in third trimester, fetal medicine(FM) scan, review of neonate by paediatrician, thyroid function test(TFT) for the neonate on day 2(D2) and further tests as needed. Results: Of the 56 patients treated over a 2 year period, 31 qualified for this study. Thyroid statuses of patients were: active hyperthyroidism at conception=20; Post radioactive iodine (RAI)=4; post thyroidectomy =2; hyperthyroidism in remission prenatally=5. 24 patients were TRAB positive at 20 weeks (Strongly positive(>3xnormal) =10) & 7 were TRAB negative. 16 patients required ATD into 3rd trimester, of whom 11 required until delivery. Presence of any TRAB positivity did not statistically predict continuation or withdrawal of treatment. FM scan was normal in all patients (one patient had hydronephrosis which was deemed not related to thyroid status and resolved spontaneously after birth). Growth Scans were normal in 26 patients. One patient had a large for gestational age fetus which was not related to thyroid status (patient in Graves’ remission, TRAB weakly positive, normal FM scan, normal D2 and D14 TSH in the neonate). 4 patients had small for gestational age fetuses -2 had weakly positive and 1 strongly positive TRAB; all had normal FM scans; 1 neonate had high TSH at D2 and others normal; all neonates had normal TFT at D14. None of the neonates had clinical or biochemical hyperthyroidism on D2. 12 had high TSH on D2 - 10 normalized at D14; the other 2 were discussed with tertiary referral centre, no further medical treatment was advised and normalized spontaneously. 22 had high T4 at D2; at D14, 14 normalized, 4 had persistent high T4 but normal TSH (T4 data not available on 4 but all had normal TSH). Neonates born to mothers who were using ATD at time of delivery had higher probability of having high TSH at D2 compared to those who were not (8/11 vs 4/20, p<0.005). This difference was not statistically significant based on use of ATD at onset of pregnancy (10/20 vs 2/11, p=0.08). Conclusion: Our study showed that no neonates developed overt hyperthyroidism. Use of ATD, especially in third trimester, could be associated with risk of transient biochemical hypothyroidism in neonate. A coordinated multidisciplinary care pathway is required to monitor and manage this complex cohort of patients and neonates.

Plasma Angiotensin-(1-7) Is Decreased in Preeclampsia

Hypertension ◽  
2000 ◽  
Vol 36 (suppl_1) ◽  
pp. 696-696
Author(s):  
K. Bridget Brosnihan ◽  
Michael Karoly ◽  
David Merrill
Keyword(s):  
Gestational Age ◽  
Previous History ◽  
Renin Angiotensin System ◽  
Normal Pregnancy ◽  
Ang Ii ◽  
Third Trimester ◽  
Bioactive Component ◽  
Plasma Angiotensin ◽  
History Of ◽  
Group A

P18 Angiotensin-(1-7)[Ang-(1-7)] is a bioactive component of the renin-angiotensin system (RAS), which has depressor, vasodilatory, and antihypertensive actions. In normal pregnancy we questioned whether the known rise in plasma Ang II is counterbalanced by an increase in plasma Ang-(1-7) and whether plasma Ang-(1-7)levels are decreased in preeclampsia and may thus be a factor involved in the development of hypertension. Nulliparous preeclamptic patients (PREE) and third trimester normotensive pregnant contols (NPC)(matched for parity, race, and gestational age) were enrolled (n=15/group). A nonpregnant group (CON)(n=15) was also included for comparison. PREE had no previous history of hypertension. Mean gestational age of preeclamptic subjects was 33.9±1.2 vs 33.7±1.2 weeks for normotensive pregnant subjects (n.s.,p=0.9). PREE subjects had significant hypertension (159±3/98±2 mmHg) and all had ≥3† proteinuria. Plasma Ang I, Ang II, and renin activity (PRA) were significantly elevated in normal pregnancy as compared to nonpregnant CON subjects; plasma Ang-(1-7) was increased by 51%(p<0.05). In PREE subjects all components of the RAS were reduced as compared to NPC; however, plasma Ang II remained elevated as compared to nonpregnant CON subjects. These studies confirm that the RAS is activated in the third trimester of normal pregnancy,including an increase in plasma Ang-(1-7)levels. In preeclampsia, the decreased levels of plasma Ang-(1-7)in the presence of persistent elevated plasma Ang II are consistent with the development of hypertension.

scholarly journals Prediction of large‐for‐gestational‐age neonate by routine third‐trimester ultrasound

2019 ◽  
Vol 54 (3) ◽  
pp. 326-333 ◽  
Author(s):  
N. Khan ◽  
A. Ciobanu ◽  
T. Karampitsakos ◽  
R. Akolekar ◽  
K. H. Nicolaides
Keyword(s):  
Gestational Age ◽  
Large For Gestational Age ◽  
Third Trimester

scholarly journals Ambispective study on Mac Donald suturing in pregnant ladies with cervical incompetence in Dhulikhel Hospital

2012 ◽  
Vol 8 (3) ◽  
pp. 321-324
Author(s):  
S R Tamrakur ◽  
C D Chawla
Keyword(s):  
Pregnant Women ◽  
Pregnancy Outcomes ◽  
Previous History ◽  
Cervical Length ◽  
University Teaching ◽  
Third Trimester ◽  
Cervical Cerclage ◽  
Trimester Abortion ◽  
Cervical Incompetence ◽  
History Of

Background Cervical incompetence is one of the main contributors to repeated pregnancy loss, accounting for approximately 25% of the cases. Typically it results in progressive cervical dilatation, leading to a painless second- or early-third-trimester abortion. Objectives The main objective of the study was to explore the benefit from cervical cerclage in pregnant women with anatomical cervical incompetence Methods In a review of the operation and labour registers from January 2006 till January 2010, a total of 38 cervical cerclage procedures were performed at Dhulikhel Hospital (DH). In the study caste, parity, gestational age, diagnostic criteria, postoperative complications and pregnancy outcomes of the cases were analyzed. Results Two of the 38 cases didn’t come for delivery at Dhulikhel Hospital (Kathmandu University Teaching Hospital). Four women haven’t delivered at the time of data analysis. So pregnancy outcomes were analyzed among 32 cases while rests of the variables were analyzed among 38 cases. Of them 18 cases (47%) were Brahmin, 22 cases (58%) were between 20-25 years old and 32 cases (84%) were from Kavre district.  All cases were booked cases (they had antenatal care in the hospital) and 14 patients (37%) were third gravida. Most cases had 2 to 4 antenatal visits prior to suturing. Two cases were diagnosed with a bicornuate uterus. 21 cases (55%) had a previous history of at least one dilatation and evacuation.  33 cases (87%) were diagnosed with cervical incompetence clinically and confirmed by ultrasound. The remaining 13% were assessed, in the absence of a history of mid-trimester abortion, of having a high suspicion of cervical incompetence after mid-trimester scan with measurement of cervical length. In 18 cases (47%), cervical cerclage were done at 15 to 20 weeks of gestation. The postoperative period was uneventful in all 38 cases.  All cases (32) delivered in DH were assisted by consultant obstetricians. 19 out 32 cases (59%) were delivered vaginally at term. Conclusions38 cases were included in the study. Pregnancy outcomes were analyzed among 32 cases while rests of the variables were analyzed among 38 cases. 31 out 32 cases were delivered with good foetal weight. It clearly shows pregnant women with anatomical cervical incompetence were benefitted from cervical cerclage. The authors recommend an early trans vaginal scan in any patient with a history of mid trimester abortion or preterm labour. The cervical cerclage procedure therefore should be available more widely to benefit those patients with proven or strongly suspected cervical incompetence.DOI: http://dx.doi.org/10.3126/kumj.v8i3.6222 Kathmandu Univ Med J 2010;8(3):321-24 

Hemostatic Parameters in Newborn - I. Effect of Gestation and Rate of Intrauterine Growth

1986 ◽  
Vol 55 (01) ◽  
pp. 047-050 ◽  
Author(s):  
B Dube ◽  
R K Dube ◽  
V Bhargava ◽  
J K Kolindewala ◽  
V L N Kota ◽  
...  
Keyword(s):  
Gestational Age ◽  
The Other ◽  
Plasma Fibrinogen ◽  
Large For Gestational Age ◽  
Term Neonates ◽  
Intrauterine Growth ◽  
Appropriate For Gestational Age ◽  
History Of ◽  
Preterm Babies ◽  
Preterm Newborns

SummaryThe present study comprises of 208 term, 159 preterm and 18 post-term neonates born to mothers with no history of drug intake or any disease likely to effect coagulation of the newborn. PT, TT and KCCT were relatively prolonged and plasma fibrinogen reduced to varying degree in newborns (as compared to adults). There was further prolongation of TT and reduction in plasma fibrinogen levels amongst preterm newborns as compared to term babies; TT was more prolonged amongst post-term babies also. PT was significantly more prolonged till 30 weeks of gestation, after which a near plateau was formed. KCCT showed significant improvement after 33 weeks and a further trend to normalisation after 38 weeks of gestation. Serum FDP values showed too much of variation for any meaningful statistical analysis but generally FDPs were higher in preterm babies. Intrauterine growth rate had no significant effect on these parameters amongst preterms -similar values for SGA (small for gestational age), AGA (appropriate for gestational age) and LGA (large for gestational age). On the other hand, amongst term babies SGA neonates had significantly prolonged PT and low plasma fibrinogen as compared to AGA; LGA babies also showed more prolongation of TT as compared to AGA.

scholarly journals Preterm Prelabour Rupture of the Membrane & Feto-Maternal out come: an Observational Study

1970 ◽  
Vol 28 (1) ◽  
pp. 17-23 ◽  
Author(s):  
S Akter ◽  
R Akter ◽  
M Rashid
Keyword(s):  
Risk Factors ◽  
Antenatal Care ◽  
Gestational Age ◽  
Previous History ◽  
Time Interval ◽  
Premature Rupture ◽  
Genital Tract Infection ◽  
College Hospital ◽  
Study Results ◽  
History Of

Objective: The aim of this study was to see the maternal and fetal outcome of preterm pre labor rupture membrane and to identify the risk factors for preterm pre labor rupture membrane. Methods and Material: This was a cross-sectional descriptive type study carried out in Dhaka Medical College Hospital, Dhaka, during April to September, 2005 (6months) in the Department of Obstetric and Gynecology. 50 pregnant women with preterm premature rupture of the membrane (gestational age 29-0 to 36-6 weeks) were included in this study. Results: The mean age of the women was 27.24±6.28years and 36% of them more than 30 years old. Sixty two percent women were multi gravid .Socio-economic condition, level of education and antenatal care of the women was low. Median gestational age of the patient was 35 weeks. Fifty six percent had previous history of PROM, preterm delivery, abortion, MR and dilatation and curettage. Sixty two percent women had history of sexual activity between 2 to 7days. Seventy two percent women had UTI, anaemia, and lower genital tract infection. Mean duration of the latent period was 18.87 ±16.17hours and time interval of rupture membrane and delivery was 27.60 ± 21.127 hours. Eighty four percent patient delivered by vaginal route and Fifty four percent delivered within 24 hours of ruptured membrane. Forty two percent newborn suffered from neonatal asphyxia, respiratory distress syndrome, neonatal jaundice and neonatal sepsis. Thirty two percent women suffered from chorioamnionitis, abruptio placent and endometritis.Conclusion: PPROM is malnutrition and poverty related disease. Antenatal care is an important tool to prevent PPROM by identifying the risk factors and its management. Steroid for fetal lung maturity, antibiotics to prevent fetal and maternal infection and induction and /or augmentation of labor will speeded delivery and reduce hospital stay and infection. Key words: Premature rupture of the membrane; maternal and neonatal outcome; risk factors. DOI: 10.3329/jbcps.v28i1.4639 J Bangladesh Coll Phys Surg 2010; 28: 17-23

scholarly journals PRETERM PRE LABOUR RUPTURE OF MEMBRANES;

2013 ◽  
Vol 20 (05) ◽  
pp. 765-771
Author(s):  
SAADIA YASIR, ◽  
BUSHRA KANT, ◽  
TAHIRA JABBAR
Keyword(s):  
Birth Weight ◽  
Gestational Age ◽  
Post Partum ◽  
Previous History ◽  
Latency Period ◽  
Study Objective ◽  
Gestational Age At Delivery ◽  
History Of ◽  
One Year ◽  
Foetal Lung

Study Objective: The objective of this study is to describe the maternal and perinatal outcome of conservative managementin PPROM. Design: Descriptive prospective study. Period: One year from August 2006 to August 2007. Setting: Maternal and child health(MCH) Centre PIMS Islamabad. Material and Methods: 50 patients between 28-36 weeks of gestation presenting with PPROM. Results:The mean age was 27+5.1 years, 14(28%) were having gestational age between 28to 32 weeks and 36 (72%) were between 33 to 36weeks of gestation. 34 (68.0%) of the mothers had no history of abortions while 10 (20.0%) had 1-2 abortions and 6 (12.0%) had 3 ormore abortions. Sixteen (32.0%) women had previous PRROM while 10 (20.0%) had previous history of preterm labor. Inversecorrelation was observed between latency period and gestational age. Among 14(28%) women with gestational ages between 28 to 32weeks 10 delivered within 48 hours and 4 after 48 hours. Among 36(72%) women with gestational ages between 33-36 weeks 31(62%)delivered in less than 48 hours and 5 (10 %) women delivered after 48 hours.14(28%) of the 50 babies were admitted in NICU withsepticemia, 7(14.0%) with RDS, hypoglycemia in 2(4.0%) and necrotizing enterocolitis in 3(6.0%). 3 neonates died from septicemia and2 from RDS. On first follow-up 34.0% mothers had infections and 8.0% had post-partum hemorrhage. Conclusions: Expectantmanagement till 36 weeks is a suitable option as gestational age at delivery and birth weight both affect neonatal survival and offer time toadminister corticosteroids to allow foetal lung maturity. Foetal deaths occurred due to septicaemia and RDS with direction co-relationshipwith low birth weight.

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