Maternal–Fetal Outcomes in Women with Endometriosis and Shared Pathogenic Mechanisms

The connection between endometriosis and pregnancy outcomes is trending among the research topics. Until recently, endometriosis and its painful symptomatology were considered to be alleviated by pregnancy. However, these beliefs have shifted, as emerging literature has demonstrated the role of this condition in affecting pregnancy evolution. The underlying pathogenesis of endometriosis is still poorly understood, all the more when pregnancy complications are involved. Debatable opinions on endometriosis associated with obstetric complications exist because of the potential bias resulting from the heterogeneity of preceding evidence. This review aims to evaluate the connection between endometriosis and adverse pregnancy outcomes and their shared pathogenic mechanisms. We searched PubMed and EMBASE and focused on the studies that include placenta praevia, premature rupture of membranes, spontaneous preterm birth, gestational hypertension, preeclampsia, obstetric hemorrhages (ante- and postpartum bleeding, abruptio placentae), miscarriage, stillbirth, neonatal death, gestational diabetes mellitus, gestational cholestasis, small for gestational age, and their association with endometriosis. Not only the risks of emergence were highlighted, but also the pathogenic connections. Epigenetic alterations of some genes were found to be mirrored both in endometriosis and obstetric complications. This review issues a warning for providing increased attention to pregnant women with endometriosis and newborns as higher risks of preeclampsia, placental issues, and preterm deliveries are associated.

Pregnancy and Birth Outcomes during the Early Months of the COVID-19 Pandemic: The MOACC-19 Cohort

The new coronavirus, SARS-CoV-2, is devastating for specific groups of patients, but currently there is not enough information concerning its effects on pregnant women. The purpose of this study is to identify the impact of SARS-CoV-2 infection on pregnancy and the consequences that it could cause. We studied a cohort of pregnant ladies who were tested for SARS-CoV-2 infection by RT-PCR and classified as infected or not infected. The recruitment was carried out in the HUMV hospital, a third-level hospital located in Santander, northern Spain. It started on 23 March 2020 and ended on 14 October 2020. Data from our cohort were compared to another cohort recruited in 2018 at the same hospital. We found that gestational hypertension, placental abruptio, and home exposure to an infected person, among other variables, could be associated with SARS-CoV-2 infection. In conclusion, we consider pregnant women a high-risk group of patients towards a possible SARS-CoV-2 infection, especially those who present with conditions such as gestational hypertension or obesity; moreover, we think that SARS-CoV-2 infection could increase the possibilities of having an abruptio placentae, although this result was found in only a few women, so it requires further confirmation.

Maternal death due to ruptured uterus consequent to abruptio placentae: 2 case reports

Background Abruptio placentae is a complication of pregnancy that can lead to uterine rupture, increasing maternal and fetal mortality, especially when there is a lack of medical outreach in remote areas. Case presentation We present two maternal deaths due to uterine rupture in a term pregnancy consequent to abruptio placentae. In one case, the uterus ruptured at the previous lower segment Caesarean section (LSCS) scar site and in another over the lateral wall of Couvelaire uterus. In both cases, the fetus was partially lying outside the uterus in the peritoneal cavity, and there was a massive retro-placental clot. Conclusions Early identification of high-risk factors, followed by institutional delivery, may reduce maternal and fetal mortality due to abruption followed by uterine rupture.

A CLINICAL STUDY OF EVALUATE THE CASES OF THIRD TRIMESTER BLEEDING PER VAGINA

Aims and Objectives: To nd out the incidence of third trimester bleeding in our institution. To evaluate the patients with full medical, surgical and obstetrical history clinical examination, relevant investigations and obstetrical management. Maternal and perinatal outcome. Evaluation of preventive measures to reduce the complications of third trimester bleeding and to improve perinatal and maternal outcome. Materials and methods: The present study was conducted among the patients admitted in the Department of Obstetrics and Gynaecology of DARBHANGA MEDICAL COLLEGE AND HOSPITAL, LAHERIASARAI, BIHAR. During this study from December 2018 to November 2020 a total number of 9334 mother were delivered among which 112 were diagnosed as having third trimester bleeding per vagina. Result: Perinatal and maternal mortality much higher in the third trimester bleeding per vagina cases. Majority of perinatal mortality occurs in abruptio placentae (47.5%) and only one maternal death occurred in abruption placental. 62.29% of cases were major degree of placenta praevia of which dangerous type II posterior variety was found in 19.67% cases. Conclusion: Blood transfusion facility and round the clock operative facility are very much needed. All efforts are to be made for motivating the mother for acceptance of family planning and to reduce unwanted pregnancy and to encourage small-family norms. The transportation system should be improved for referral of the patients to the next level of care. Liberal and judicious use of caesarean section is also important to achieve the goal of better maternal and perinatal outcome. Finally, the provision of a well equipped neonatal care unit should be available throughout the country

Abruptio placentae: impact of early treatment on maternal and fetal outcomes

Background: Haemorrhage is the leading cause for maternal mortality in India as well as the world. Abruptio placenta is the second most common cause of antepartum haemorrhage and it is associated with sudden, severe and devastating maternal and fetal complications. The main objective of this study is to study the impact of early treatment on maternal and fetal outcomes.Methods: This single center retrospective study includes all patients admitted at Lokmanya Tilak Municipal General Hospital, a tertiary referral hospital, diagnosed to have abruptio placenta (grade II and grade III) from 01 July 2019 to 31 December 2019. In this study a total of 48 cases were included and data regarding time duration between onset of symptoms and initiation of treatment, clinical course and maternal and fetal outcomes was noted.Results: A total of 5059 deliveries occurred over six months. The incidence of placental abruption was found to be 0.94%. Patients receiving early care (30 cases, 62.5%) were found to have significantly better maternal outcomes (p=0.006, Chi square test) as well as fetal outcomes (p=0.007, Fischer’s exact test) than patients who received delayed care (18 cases, 37.5%).Conclusions: Abruptio placentae is an obstetric emergency and early diagnosis as well as initiation of treatment plays an important role in curbing complications. Strengthening of peripheral centers, availability of multi-disciplinary approach and educating health care staff as well as patients form the cornerstones of improved maternal and fetal outcomes.

A STUDY OF ANTEPARTUM HAEMORRHAGE AND ITS MATERNAL AND NEONATAL OUTCOME AT TERTIARY CARE HOSPITAL

Antepartum haemorrhage (APH) is an obstetric emergency contributing to a signicant amount of perinatal & maternal morbidity and mortality (1). It is dened as bleeding from or into the genital tract after 28 weeks of gestation (2). It occurs in 2-5% of pregnancies and is an important cause of fetal and maternal mortality (3). Thirty percent of maternal deaths are caused by antepartum haemorrhage of which 50% are associated with avoidable factors (4). In India, the prevalence of antepartum haemorrhage is reported to be 18.8 % (5). The main causes of APH are placenta previa, abruptio placentae, indeterminate cause or local causes of genital tract.

Study of Maternal and Foetal Outcome in Abruptio Placentae

Study of Maternal and Foetal outcome in Abruptio Placentae Introduction: Abruptio placentae (AP) is a significant obstetrical emergency and as per WHO 2009 maternal mortality rates reported due to AP worldwide was 2.1% and fetal perinatal mortality rate was 15%. AP cannot be prevented but maternal and perinatal morbidity and mortality due to AP can be reduced significantly by aggressive management. Methods: The present prospective study was conducted to evaluate the outcome of treatment on the perinatal and maternal outcome in Abruptio Placentae patients in a tertiary care hospital from January 2015 to January 2016 amongst 54 pregnant women diagnosed to have abruptio placentae from 28 weeks of gestation and above and all babies delivered. Face-to-face interviews was conducted. Results: Maximum no. of abruptio placentae were unbooked - 37 (69%) and 85% of patients belonged to the less than 30 years of age group. An abruptio placenta was more common in multipara. Anaemia was seen in 21 patients (38%). Anaemia and PIH was seen in 12 patients (23%). 7 patients had fetal distress at the time of admission (13%). Regarding mode of delivery, 50% of patients delivered vaginally by artificial rupture of membrane (ARM) and oxytocin augmentation and 50% underwent caesarean section. Conclusion: It was concluded that abruptio placentae is still a leading cause of maternal morbidity and mortality that can be reduced with modern management of abruptio placentae, but timely diagnosis and intervention is necessary. Key Words: Abruptio placentae, maternal mortality, fetal distress, anaemia

Placental Pathology in a COVID-19 Positive Patient with Abruptio Placentae- A Case Report

The effects of Severe Acute Respiratory Distress Syndrome-Associated Coronavirus-2 (SARS-CoV-2) on the placental tissue are still being explored. Whether these placental changes result in adverse foeto-maternal outcome is an aspect that needs to be understood. This is a report of 32-year-old pregnant woman who presented with Antepartum Haemorrhage (APH) and decreased foetal movements. She was also diagnosed to be positive for the SARS-CoV-2. The patient had abruptio placentae unrelated to pre-eclampsia. On histopathological examination, the umbilical cord showed funisitis with increased perivillous fibrin deposition on section from foetal and maternal surface of the placenta. Though the foetus was stillborn, with timely management the maternal outcome was not compromised.