A RARE CASE REPORT ON EISENMENGER’S SYNDROME WITH PREGNANCY : A GLIMPSE OF LIFE IN OCEAN OF DEATH

Pregnancy complicated with Eisenmenger syndrome is associated with high risk to the fetus as well as the mother. There is approximately 50% risk of sudden maternal death, frequently occuring a few days postpartum and the overall fetal wastage is reported to be up to 75%. Patients with Eisenmenger syndrome are advised to refrain from pregnancy or to terminate pregnancy by the end of rst trimester itself. Management of these patients requires a co- ordinated multi-specialist care when such pregnancies reach a stage where safe termination is not advisable. However, in spite of all the risks, a few patients deliver successfully with a good maternal and neonatal outcome. We present 2 cases reported till third trimester and delivered a healthy baby and were subsequently discharged on the 10th postpartum day without any serious complications.

Advantages of Screening for Glucose Tolerance in the Sequential Weeks of Gestation

Prelife exposure relates to development during the time preceding the first appearance of life, a time course from “conception to confinement.” From single cell zygote to finally formed fetus at confinement, a remarkable change occurs due to maternal fuels and hormonal influence on the fetal development. The crucial period in the fetal development is the first trimester. Early exposure to aberrant maternal metabolism in the embryonic developmental stage would result in congenital malformation and fetal wastage. Maintaining maternal glucose at the recommended level of fasting 80 to 90 mg and 2 hours postprandial plasma glucose 110 to 120 mg/dL during preconceptional period and throughout pregnancy is the assurance for the healthy offspring with ideal birth weight of 2.5 to 3.5 kg and prevention of noncommunicable diseases in the future.

Preconceptual Priming Overrides Susceptibility to Escherichia coli Systemic Infection during Pregnancy

ABSTRACT Maternal sepsis is a leading cause of morbidity and mortality during pregnancy. Escherichia coli is a primary cause of bacteremia in women and occurs more frequently during pregnancy. Several key outstanding questions remain regarding how to identify women at highest infection risk and how to boost immunity against E. coli infection during pregnancy. Here, we show that pregnancy-induced susceptibility to E. coli systemic infection extends to rodents as a model of human infection. Mice infected during pregnancy contain >100-fold-more recoverable bacteria in target tissues than nonpregnant controls. Infection leads to near complete fetal wastage that parallels placental plus congenital fetal invasion. Susceptibility in maternal tissues positively correlates with the number of concepti, suggesting important contributions by expanded placental-fetal target tissue. Remarkably, these pregnancy-induced susceptibility phenotypes are also efficiently overturned in mice with resolved sublethal infection prior to pregnancy. Preconceptual infection primes the accumulation of E. coli-specific IgG and IgM antibodies, and adoptive transfer of serum containing these antibodies to naive recipient mice protects against fetal wastage. Together, these results suggest that the lack of E. coli immunity may help discriminate individuals at risk during pregnancy, and that overriding susceptibility to E. coli prenatal infection by preconceptual priming is a potential strategy for boosting immunity in this physiological window of vulnerability. IMPORTANCE Pregnancy makes women especially vulnerable to infection. The most common cause of bloodstream infection during pregnancy is by a bacterium called Escherichia coli. This bacterium is a very common cause of bloodstream infection, not just during pregnancy but in all individuals, from newborn babies to the elderly, probably because it is always present in our intestine and can intermittently invade through this mucosal barrier. We first show that pregnancy in animals also makes them more susceptible to E. coli bloodstream infection. This is important because many of the dominant factors likely to control differences in human infection susceptibility can be property controlled for only in animals. Despite this vulnerability induced by pregnancy, we also show that animals with resolved E. coli infection are protected against reinfection during pregnancy, including having resistance to most infection-induced pregnancy complications. Protection against reinfection is mediated by antibodies that can be measured in the blood. This information may help to explain why most women do not develop E. coli infection during pregnancy, enabling new approaches for identifying those at especially high risk of infection and strategies for preventing infection during pregnancy.

A CASE REPORT OF PREGNANCY WITH EISENMENGER SYNDROME, A RARE CASE

Pregnancy complicated with Eisenmenger syndrome is associated with high risk to the mother and the fetus. There is approximately 50% risk of sudden maternal death, frequently occurring a few days postpartum and the overall fetal wastage is reported to be up to 75%. Patients with Eisenmenger syndrome are advised to refrain from pregnancy or to terminate pregnancy by the end of rst trimester itself. Management of these patients requires a coordinated multi-specialist care when such pregnancies reach a stage where safe termination is not advisable. However, inspite of all the risks, a few patients delivered successfully with a good maternal and neonatal outcome. Here we report a case of a 20 years old primi patient with 36 weeks gestational age and known case of Ventricular Septal Defect with Eisenmenger syndrome and Tricuspid Regurgitation and Pulmonary Hypertension. Her doppler study suggestive of utero placental insufency with reversal of umbilical artery ow. Patient was delivered normally with full support of oxygen with good neonatal outcome. Patient and her baby were transferred to cardiology department and patient was discharged on post partum day 5 from cardiology hospital

SLAUGHTER OF THE SINGLE-HUMPED CAMEL (Camelus dromedarius) FOR MEAT AT THE SOKOTO ABATTOIR, NIGERIA.

Daily records on camels Camelus dromedarius) slaughtered for meat at the Sokoto abattoir in Nigeria, were collected for a period of 12 months (January to December 1992) and analysed to determine the rate and seasonal trend in slaughter and to acertain the accompanying fetal wastage. There was no significant (P>.01) seasonal variation in the number of camels slaughtered. A total of 3798 camels (estimated carcass yield of about 1077.7t of camel meat) were slaughtered during the period under investigation. One thousand, six hundred and seventy-seven (44.2%) of the camels sluaghtered were mates whilst 2121 (55.8) were females. Of the female animals slaughtered, 522 (24.06%) were pregnant.

Undiagnosed cyanotic heart disease - A challenge to emergency medical professionals

Cyanotic heart disease characterized by pulmonary hypertension with reversal or bidirectional shunt associated with atrioventricular septal defects or patent ductus arteriosus is known as Eisenmenger syndrome. Pregnancy-associated decreased systemic vascular resistance increases the degree of right to left shunting and hypoxemia, thereby increasing substantially both the maternal mortality and fetal wastage which is reported to be as high as 70%. Ideally, this is a contraindication for conceiving but if there is strong desire of pregnancy, it should be a supervised antenatally by multidisciplinary team. We present a case of a young primigravida who had cesarean delivery under subarachnoid block at 37 weeks of gestation and was referred after fall in oxygen saturation. It can be a challenge to manage these cases at a peripheral unit if the condition is undiagnosed.

RECIPROCAL TRANSLOCATION t (6; 8) (q25-27; q23): CASE REPORT

Reciprocal translocations are the most common structural chromosomal abnormalities in humans. In this study, the results of cytogenetic analysis performed on a couple with a reproductive history of three abortions and one intrauterine death referred to our laboratory are presented. Normal karyotype (46, XY) in male and reciprocal translocation 46XX t (6; 8) (q25-27; q23) in female were determined. In about 4% of couples with recurrent miscarriages, one of the parents is either a balanced reciprocal translocation or a robertsonian translocation carrier. Therefore, cytogenetic analysis should be recommended to couples with recurrent miscarriages. Keywords: Recurrent Abortions, Fetal Wastage, Reciprocal Translocation

Study of intrauterine fetal death cases in a tertiary care center

Background: The death of a fetus is a tragic event not only for the parents but also a great cause of stress for the caregiver. It is thus vital to identify specific probable causes of fetal death to determine the risk of recurrence, prevention or corrective action.Methods: This retrospective observational study was carried out in department of obstetrics and gynaecology, Jhalawar Medical College, Jhalawar, from July 2019 to October 2019. Intrauterine fetal death was confirmed either with ultrasound or on clinical examination. The details of complaints, obstetrics history, examination findings, mode of delivery, fetal outcomes and investigation reports were recorded.Results: A total of 114 intrauterine fetal deaths were reported amongst 2982 deliveries conducted during the study period. The incidence rate of IUFD was 38.22/1000 live births. 85.96% deliveries were unbooked. 59.64% belonged to rural population. 59.64% fetal deaths occurred in women between 20 to 25 years of age. 45.61% women were primigravida. 41.2% IUFD occurred between 26 to 31 weeks of gestation. Among the identifiable cause’s hypertensive disorders (23.68) and placental causes (19.29%) were most common.Conclusions: Unexplained causes, PIH and abruptio placentae were major causes of IUFD. Majority of fetal wastage can be prevented with universal and improved antenatal care.