Acute pancreatitis in pregnancy: 5-year experience from a multidisciplinary centre

Background: Acute pancreatitis is rare in pregnancy, but it is associated with increased incidence of maternal and fetal mortality. It should be one of the differential diagnosis of upper abdominal pain with or without nausea or vomiting. S. amylase, lipase and ultrasound abdomen were the diagnostic methods. Conservative management is the main stay in mild cases. Severe cases have multiorgan involvement and needs multidisciplinary approach. The objectives of this study were to study the maternal and fetal outcome in pregnant women diagnosed with acute pancreatitis and to identify the risk factors for acute pancreatitis in pregnancy.Methods: Retrospective descriptive study of pregnant women diagnosed with acute pancreatitis in Amrita Institute of Medical Sciences, Kochi during the period of 5 years from January 2011 to December 2016. A proforma having patients age, parity index, gestational age, symptoms with duration, blood investigations, ultrasonography, interventions done, mode of delivery, supportive treatment, complications were developed. Fetal weight, Apgar score, fetal complications were also noted.Results: The mean gestational age of presentation was 30 weeks of pregnancy. Upper abdominal pain radiating to back, vomiting, fever was the commonest clinical presentation in majority of cases. The diagnostic methods were S.Amylase ,Lipase and Ultrasound abdomen. The mean age of the patients were 26 years and 66.7% were primigravidas in the present study. There were 4 patients in SAP and 5 in MAP groups. Complications in SAP group were ARF, ARDS, DIC, MODS, metabolic acidosis etc. SAP group had 3 maternal and 3 fetal loss.Conclusions: Severe acute pancreatitis has adverse maternal and fetal outcome due to multi organ failure and sepsis.

Download Full-text

Doppler ultrasound of umbilical artery in prediction of fetal outcome in pregnancy induced hypertension Sudanese population

International Journal of Research in Medical Sciences ◽

10.18203/2320-6012.ijrms20195890 ◽

2019 ◽

Vol 8 (1) ◽

pp. 96

Author(s):

Rihab A. Yousif ◽

Awadia G. Suliman ◽

Raga A. Aburaida ◽

Ibrahim M. Daoud ◽

Naglaa E. Mohammed

Keyword(s):

Flow Velocity ◽

Umbilical Artery ◽

Fetal Outcome ◽

Fetal Mortality ◽

Pregnancy Induced Hypertension ◽

Diastolic Flow ◽

Induced Hypertension ◽

The Mean ◽

Doppler Indices ◽

In Pregnancy

The pregnancy induced hypertension increase the fetal mortality and morbidity and the using of Doppler umbilical artery indices decrease the fetal mortality and morbidity however, there is few complete data about the most frequently altered Doppler US parameters to predict fetal outcome in pregnancy induced hypertension . Methods This ia cohort prospective study done in two hundred and six women of second and third trimester presenting to antenatal clinic in Soba University Hospital at the department of Obstetrics & Gynecology, in the fetus unit and critical pregnancy in the period From June 2008 to April 2013 to assess the Doppler indices of umbilical artery in pregnancy induced hypertension for prediction of prenatal outcome; 105 pregnancy induced hypertension patients and 101 women with uneventful pregnancies as normal control group included in this study . Baseline investigations and color Doppler of umbilical artery were done. Statistical analysis of data were done using SPSS, Receiver Operating Characteristic (ROC) curve analysis was performed and the area under the curve (AUC) used to determine sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of umbilical artery Doppler indices to predict fetal outcome.Results The study determine that there was significant difference in Doppler indices in PIH and control group ( p<0.01, the mean indices of umbilical artery is higher in PIH group compared with normal pregnancy group , the mean different of S/D ratio was 0.40, mean difference of RI was 0.06 and the mean different of PI index was 0.16, high percentage of adverse fetal outcome had been reported in in Pregnancy Induced Hypertension group than in control , which was more in absent and reversed flow velocity in umbilical artery in Pregnancy Induced Hypertension compared with group of Pregnancy Induced Hypertension with present end diastolic flow velocity. Systolic/Diastolic ratio was most accurate in predicting adverse outcome in pregnancy induced hypertension patients, followed by the Pulastility index then the Resistance index (75%, 66% and 57% respectively).ConclusionThis study concluded that pregnancy induced hypertension leads to worsen placental insufficiently, which appears on the higher Doppler indices of umbilical artery to PIH patients when compared with normal pregnancy. A low diastolic flow and higher indices characterized the pregnancies with abnormal outcomes. Doppler of the umbilical artery was useful to predict fetal well being in PIH patients, high percentage of adverse fetal outcome had been reported in absent and reversed end diastolic flow velocity in umbilical artery compared with group of present flow velocity.

Download Full-text

Factors Influencing Stress, Anxiety, and Depression Among Iranian Pregnant Women: The Role of Sexual Distress and Genital Self-image

10.21203/rs.3.rs-97765/v1 ◽

2020 ◽

Author(s):

Afsaneh Keramat ◽

Mina Malary ◽

Mahmood Moosazadeh ◽

Nastaran bagherian ◽

Mohammad-Reza Rajabi-Shakib

Keyword(s):

Risk Factors ◽

Pregnant Women ◽

Gestational Age ◽

Sexual Distress ◽

Self Image ◽

Factors Influencing ◽

Severity Of Depression ◽

The Mean ◽

Distress Scale ◽

In Pregnancy

Abstract Background: Pregnancy is a unique period with the increased likelihood of psychological changes and emotional disturbances such as depression, anxiety, and stress. In this study, we investigated the factors influencing depression, anxiety, and stress in pregnancy and identify their associations with Sexual Distress (SD) and Genital Self-Image(GSI). Methods: This was a descriptive, correlational, cross-sectional study performed between September 2019 and January 2020. Overall, 295 pregnant women completed a demographics and obstetric information checklist, Depression Anxiety and Stress Scale-21 (DASS-21), Female Genital Self-Image Scale (FGSI), and Female Sexual Distress Scale-Revised (FSDS-R).Results: The mean score of SD was significantly associated with the severity of depression, anxiety, and stress. Also, the mean score of GSI was negatively correlated with the severity of depression and anxiety. Multiple linear regression analysis revealed that the risk factors for depression include SD, fear of fetal abortion, bad experience in previous pregnancy, poor GSI, and advancing age, whereas satisfaction with income was a protective factor. SD, fear of fetal abortion, and increased duration of marriage were found to be associated with the development of anxiety symptoms, whereas satisfaction with income, positive body image, and increased gestational age had a protective effect against this variable. SD, adverse events in previous pregnancies, and advancing age were the risk factors, while planned pregnancy and increased gestational age were the protective factors against developing stress during pregnancy. Conclusion: Many factors influence the development of depression, anxiety and stress in pregnancy, which may be different or common. Some of these factors are avoidable and some are not. Therefore, considering all the factors comprehensively with emphasis on the improvement of preventable factors by screening and counseling can be useful for mothers and their fetuses.

Download Full-text

MATERNALAND FETAL OUTCOME OF BURNS DURING PREGNANCY IN A RURAL TEACHING HOSPITAL IN EASTERN PART OF INDIA

10.36106/ijsr/4231175 ◽

2021 ◽

pp. 42-44

Author(s):

Sabyasachi Ray ◽

Jagriti Pandey ◽

Barunabha Pal

Keyword(s):

Observational Study ◽

Maternal Death ◽

Gestational Age ◽

Fetal Death ◽

Burn Injury ◽

Mortality Rates ◽

Fetal Outcome ◽

Fetal Mortality ◽

The Mean ◽

Rural Teaching

Burns during pregnancy inuence maternal as well as fetal outcome. Keeping this in view this study was undertaken to evaluate the maternal and fetal outcome in relation to burn extent, gestational age and etiology of burns. This descriptive observational study was performed over three years period. Atotal of 16 cases of burn females with pregnancy were analyzed. There were 6 (37.5%) maternal death and 9 (56.25%) fetal deaths in our study. The mean percentage of total burn surface area (TBSA) was signicantly higher in cases of maternal or fetal death (p ≤0.0001 and 0.0001 respectively). The maternal and fetal mortality rates were also signicantly higher when the burn was suicidal (p≤0.001 and p=0.001, respectively). Gestational age appeared unrelated to maternal mortality and the rate of fetal mortality decreased with increasing gestational age. Percentage of TBSAburn, suicidal burn injury was correlated with a higher maternal and fetal mortality.

Download Full-text

TO REVIEW THE TIMING OF INTERVENTION WHICH WILL PROVIDE THE BEST OUTCOME IN HYPOTHYROIDISM IN PREGNANCY

International Journal of Medical and Biomedical Studies ◽

10.32553/ijmbs.v3i4.209 ◽

2019 ◽

Vol 3 (4) ◽

Author(s):

Dr. Archana Mohana ◽

Dr. Sujata Badoniya

Keyword(s):

Pregnant Women ◽

Thyroid Disease ◽

Fetal Outcome ◽

Thyroxine Therapy ◽

In Pregnancy

The Aim of this study is to Review the timing of intervention which will provide the Best Outcome in Hypothyroidism in Pregnancy. Hypothyroid pregnant women are appropriately managed with regular antenatal checkup and thyroxine therapy during pregnancy, a good maternal and fetal outcome can be achieved and congenital cretinism and other neuro developmental sequele in the offspring can be averted. Keywords: Intervention, Hyperthyroidism, Pregnancy & Thyroid disease.

Download Full-text

Overt and subclinical hypothyroidism among Bangladeshi pregnant women and its effect on fetomaternal outcome

Bangladesh Medical Research Council Bulletin ◽

10.3329/bmrcb.v40i2.25183 ◽

2015 ◽

Vol 40 (2) ◽

pp. 52-57 ◽

Cited By ~ 5

Author(s):

M Sharmeen ◽

PA Shamsunnahar ◽

TR Laita ◽

SB Chowdhury

Keyword(s):

Adverse Effects ◽

Pregnant Women ◽

Subclinical Hypothyroidism ◽

Thyroid Dysfunction ◽

Perinatal Outcomes ◽

Fetal Outcome ◽

Thyroid Stimulating Hormone ◽

Overt Hypothyroidism ◽

Adequate Treatment ◽

In Pregnancy

Objectives: Thyroid disorders are among the common endocrine problems in pregnant women. It is now well established that not only overt but subclinical thyroid dysfunction also has adverse effects on maternal and fetal outcome. There are few data from Bangladesh about the prevalence of thyroid dysfunction in pregnancy. With this background, this study aims to find out thyroid dysfunction (both overt and subclinical hypothyroidism) in pregnancy and its impact on obstetrical outcome.Methods: We studied the evaluation of 50 admitted pregnancies corresponding to 29 women with subclinical hypothyroidism and rest 21 was overt hypothyroidism. Detailed history and examination were performed. Apart from routine obstetrical investigations, Thyroid Stimulating Hormone (TSH) estimation was done. Their obstetrical and perinatal outcomes were noted.Results: Overt hypothyroidism was significantly (p<0.05) higher in 25 to 44 years age group. However two and three abortions were significantly (p<0.05) higher in overt hypothyroidism patients. In sub clinical hypothyroidism 86.2% conceived firstly within 2 years and 66.7% in overt hypothyroidism patients conceived firstly in between 3 to 5 years after marriage. Overt hypothyroids were prone to have pregnancy-induced hypertension 42.9%, intrauterine growth restriction (P=0.001) and gestational diabetes (38.1%) as compared to subclinical cases. Neonatal complications were significantly more in overt hypothyroidism group. Mean TSH level was significantly (p<0.05) higher in overt hypothyroidism patients but mean FT4 level was almost similar in both groups. Majority of the patient underwent caesarean section in both groups due to associated medical and obstetrical complications. None of the babies showed hypothyroidism by cord blood tests. In this analysis our results showed that overt hypothyroidism among Bangladeshi pregnant women are associated with more maternal complication & adverse parental outcome than subclinical hypothyroidism. The adequate treatment of hypothyroidism during gestation minimizes risks and generally, makes it possible for pregnancies to be carried to term without complications. Significant adverse effects on maternal and fetal outcome were seen emphasizing the importance of routine antenatal thyroid screening.Bangladesh Med Res Counc Bull 2014; 40 (2): 52-57

Download Full-text

Factors influencing stress, anxiety, and depression among Iranian pregnant women: the role of sexual distress and genital self-image

BMC Pregnancy and Childbirth ◽

10.1186/s12884-021-03575-1 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Afsaneh Keramat ◽

Mina Malary ◽

Mahmood Moosazadeh ◽

Nastaran Bagherian ◽

Mohammad-Reza Rajabi-Shakib

Keyword(s):

Pregnant Women ◽

Multivariate Linear Regression Analysis ◽

Depression And Anxiety ◽

Sexual Distress ◽

Self Image ◽

Factors Influencing ◽

Severity Of Depression ◽

The Mean ◽

Distress Scale ◽

In Pregnancy

Abstract Background Pregnancy is a unique period with the increased likelihood of psychological changes and emotional disturbances such as depression, anxiety, and stress. In this study, we investigated the factors influencing depression, anxiety, and stress in pregnancy and identify their associations with Sexual Distress (SD) and Genital Self-Image (GSI). Methods This was a descriptive, correlational, cross-sectional study performed using the two-stage cluster sampling method between September 2019 and January 2020. Overall, 295 pregnant women completed a demographics and obstetric information checklist, Depression Anxiety and Stress Scale-21 (DASS-21), Female Genital Self-Image Scale (FGSI), and Female Sexual Distress Scale-Revised (FSDS-R). Results Analysis of Variance (ANOVA) showed significant differences in the mean scores of SD between the groups with varying degrees of depression, anxiety, and stress (P < 0.001) and in the mean score of GSI between the groups with varying degrees of depression (P = 0.01) and anxiety (P < 0.001). In multivariate linear regression analysis, higher (worse) depression, anxiety, and stress scores were found in women with more advanced age and higher SD scores; however, these scores were lower (better) in those with increased gestational age. Lower depression and anxiety scores were associated with moderate satisfaction with income, moderate satisfaction with BI in pregnancy, and lower stress and depression scores were linked to planned pregnancy. Higher (better) GSI score was a predictor of lower depression score, complication in a previous pregnancy was a predictor of higher stress score, and finally, fear of fetal abortion and being a housewife were predictors of a higher anxiety score. Conclusion Various factors contribute to the development of antenatal depression, anxiety, and stress. A positive correlation was found between SD and the severity of depression, anxiety, and stress, while a negative correlation was noted between GSI and the severity of depression and anxiety. Therefore, raising awareness regarding SD and GSI through screening and counseling sessions can have beneficial effects for mothers and their fetuses.

Download Full-text

Fish Oil Supplementation in Pregnancy Increases Gestational Age, Size for Gestational Age, and Birth Weight in Infants: A Randomized Controlled Trial

Journal of Nutrition ◽

10.1093/jn/nxy204 ◽

2018 ◽

Vol 149 (4) ◽

pp. 628-634 ◽

Cited By ~ 8

Author(s):

Rebecca Kofod Vinding ◽

Jakob Stokholm ◽

Astrid Sevelsted ◽

Bo L Chawes ◽

Klaus Bønnelykke ◽

...

Keyword(s):

Randomized Controlled Trial ◽

Birth Weight ◽

Pregnant Women ◽

Gestational Age ◽

Controlled Trial ◽

Growth Curves ◽

Vitamin D Supplementation ◽

Double Blind ◽

Randomized Controlled ◽

In Pregnancy

ABSTRACT Background Randomized trials have reported that supplementation with n–3 long-chain polyunsaturated fatty acids (LCPUFAs) in pregnancy can prolong pregnancy and thereby increase birth weight. Objective We aimed to examine the relations of n–3 LCPUFA supplementation in pregnancy with duration of pregnancy, birth weight, and size for gestational age (GA). Methods This was a double-blind randomized controlled trial conducted in 736 pregnant women and their offspring, from the Copenhagen Prospective Studies on Asthma in Childhood2010cohort. They were recruited between weeks 22 and 26 in pregnancy and randomly assigned to either of 2.4 g n–3 LCPUFA or control (olive oil) daily until 1 wk after birth. Exclusion criteria were endocrine, cardiovascular, or nephrologic disorders and vitamin D supplementation intake >600 IU/d. In this study we analyzed secondary outcomes, and further excluded twin pregnancies and extrauterine death. The primary outcome for the trial was persistent wheeze or asthma. Results The random assignment ran between 2008 and 2010. Six hundred and ninety-nine mother-infant pairs were included in the analysis. n–3 LCPUFA compared with control was associated with a 2-d prolongation of pregnancy [median (IQR): 282 (275–288) d compared with 280 (273–286) d, P = 0.02], a 97-g higher birth weight (mean ± SD: 3601 ± 534 g compared with 3504 ± 528 g, P = 0.02), and an increased size for GA according to the Norwegian population-based growth curves-Skjærven (mean ± SD: 49.9 ± 28.3 percentiles compared with 44.5 ± 27.6 percentiles, P = 0.01). Conclusion Supplementing pregnant women with n–3 LCPUFAs during the third trimester is associated with prolonged gestation and increased size for GA, leading to a higher birth weight in this randomized controlled trial. This trial was registered at clinicaltrials.gov as NCT00798226.

Download Full-text

Interactions between Vitamin D Status, Calcium Intake and Parathyroid Hormone Concentrations in Healthy White-Skinned Pregnant Women at Northern Latitude

Nutrients ◽

10.3390/nu10070916 ◽

2018 ◽

Vol 10 (7) ◽

pp. 916 ◽

Cited By ~ 3

Author(s):

Andrea Hemmingway ◽

Karen O’Callaghan ◽

Áine Hennessy ◽

George Hull ◽

Kevin Cashman ◽

...

Keyword(s):

Vitamin D ◽

Parathyroid Hormone ◽

Pregnant Women ◽

Calcium Intake ◽

Geometric Mean ◽

Vitamin D Status ◽

Metabolic System ◽

Cross Sectional ◽

The Mean ◽

In Pregnancy

Adverse effects of low vitamin D status and calcium intakes in pregnancy may be mediated through functional effects on the calcium metabolic system. Little explored in pregnancy, we aimed to examine the relative importance of serum 25-hydroxyvitamin D (25(OH)D) and calcium intake on parathyroid hormone (PTH) concentrations in healthy white-skinned pregnant women. This cross-sectional analysis included 142 participants (14 ± 2 weeks’ gestation) at baseline of a vitamin D intervention trial at 51.9 °N. Serum 25(OH)D, PTH, and albumin-corrected calcium were quantified biochemically. Total vitamin D and calcium intakes (diet and supplements) were estimated using a validated food frequency questionnaire. The mean ± SD vitamin D intake was 10.7 ± 5.2 μg/day. With a mean ± SD serum 25(OH)D of 54.9 ± 22.6 nmol/L, 44% of women were <50 nmol/L and 13% <30 nmol/L. Calcium intakes (mean ± SD) were 1182 ± 488 mg/day and 23% of participants consumed <800 mg/day. The mean ± SD serum albumin-adjusted calcium was 2.2 ± 0.1 mmol/L and geometric mean (95% CI) PTH was 9.2 (8.4, 10.2) pg/mL. PTH was inversely correlated with serum 25(OH)D (r = −0.311, p < 0.001), but not with calcium intake or serum calcium (r = −0.087 and 0.057, respectively, both p > 0.05). Analysis of variance showed that while serum 25(OH)D (dichotomised at 50 nmol/L) had a significant effect on PTH (p = 0.025), calcium intake (<800, 800–1000, ≥1000 mg/day) had no effect (p = 0.822). There was no 25(OH)D-calcium intake interaction effect on PTH (p = 0.941). In this group of white-skinned women with largely sufficient calcium intakes, serum 25(OH)D was important for maintaining normal PTH concentration.

Download Full-text

Acute Pancreatitis: An Atypical Presentation

Case Reports in Gastroenterology ◽

10.1159/000475920 ◽

2017 ◽

Vol 11 (2) ◽

pp. 359-363 ◽

Cited By ~ 1

Author(s):

Omar Nadhem ◽

Omar Salh

Keyword(s):

Acute Pancreatitis ◽

Abdominal Pain ◽

Case Reports ◽

Case Series ◽

Normal Serum ◽

Intravenous Fluids ◽

Serum Enzyme ◽

Serum Lipase ◽

Upper Abdominal ◽

Symptoms And Signs

Acute pancreatitis is an important cause of acute upper abdominal pain. Because its clinical features are similar to a number of other acute illnesses, it is difficult to make a diagnosis only on the basis of symptoms and signs. The diagnosis of acute pancreatitis is based on 2 of the following 3 criteria: (1) abdominal pain consistent with pancreatitis, (2) serum lipase and/or amylase ≥3 times the upper limit of normal, and (3) characteristic findings from abdominal imaging. The sensitivity and specificity of lipase in diagnosing acute pancreatitis are undisputed. However, normal lipase level should not exclude a pancreatitis diagnosis. In patients with atypical pancreatitis presentation, imaging is needed. We experienced two cases of acute pancreatitis associated with normal serum enzyme levels. Both patients were diagnosed based on clinical and radiological evidence. They were successfully treated with intravenous fluids and analgesics with clinical and laboratory improvement. The importance of this case series is the unlikely presentation of acute pancreatitis. We believe that more research is needed to determine the exact proportion of acute pancreatitis patients who first present with normal serum lipase, since similar cases have been seen in case reports.

Download Full-text

Evaluation of maternal and fetal outcome in pregnancies complicated by jaundice-an observational study

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20210995 ◽

2021 ◽

Author(s):

Ruchi Kishore ◽

Neha Thakur ◽

Mitali Tuwani

Keyword(s):

Mortality Rate ◽

Observational Study ◽

Maternal Mortality ◽

Viral Hepatitis ◽

Hellp Syndrome ◽

Fetal Outcome ◽

Maternal Outcome ◽

Fetal Mortality ◽

Maternal Mortality Rate ◽

In Pregnancy

Background: The spectrum of jaundice in pregnancy varies from a benign condition with good maternal and fetal outcome to a severe form resulting in liver failure and maternal and fetal mortality. Jaundice may complicate 3-5% of pregnancies. Present study was aimed to analyze the cause, course and impact of jaundice during pregnancy so as to have better understanding and hence better feto-maternal outcome. The present study aimed to analyze the various causes of hepatic dysfunction in pregnancy, maternal and fetal outcome in pregnancies complicated by jaundice and various hematological and liver function variables for predicting maternal and fetal outcome.Methods: The present study was an observational study conducted in the department of obstetrics and gynecology, Pt. JNM medical college and associated Dr. BRAM hospital, Raipur (CG) over period of 2 year from September 2018 to September 2020.Results: Total 0.72% pregnancies were complicated by jaundice. HELLP syndrome was the commonest cause of jaundice in pregnancy (36.7%), followed by viral hepatitis (32.7%). Hepatitis E was the most common type of viral hepatitis (91.8%). Hemolytic jaundice presented with best maternal outcome (maternal mortality rate 8.6%). Worst maternal outcome was seen in AFLP (maternal mortality rate 100%). Best fetal outcome was seen in viral hepatitis (live birth rate 67.6%), whereas worst noted with AFLP (fetal death rate 66.6%). Higher total serum bilirubin, higher serum AST, anemia and deranged INR had significant correlation with maternal mortality.Conclusions: HELLP syndrome and viral hepatitis are preventable causes of jaundice yet it contributed to significant proportion of maternal deaths in 26.5 and 18.5% cases respectively. AFLP is often under diagnosed and had a fulminant course in pregnancy causing maternal and fetal mortality.

Download Full-text