COVID-19 Quarantine is a Risk Factor for Poor Pregnancy Outcomes in GDM Patients: A Retrospective Study

Aims: This study was to evaluate the effects of the home quarantine on pregnancy outcomes of gestational diabetes mellitus (GDM) patients during the COVID-19 outbreak.Methods: Thecomplete electronic medical records of GDM patients with home quarantine history were collected and classified into the home quarantine group from 24 February 2020 to 24 November 2020. The same period of GDM patients without home quarantine historywas included in the control group from 2018 and 2019.Results: A total of 1358 GDM patients were included in the analysis, including 484 in 2018, 468 in 2019, and 406 in 2020. GDM patients with home quarantine in 2020 had higher glycemic levels and worse pregnancy outcomes than 2018 and 2019, including higher cesarean section rate,lower Apgar scores, and higher incidence of macrosomia and nuchal cord. More importantly, the second trimester of home quarantine had brought a broader impactto pregnant women and fetuses.Conclusion: Home quarantine has aggravated the condition of GDM pregnant women and brought more adverse pregnancy outcomes during the COVID-19 outbreak. Therefore, we suggested that governments and hospitals should strengthen lifestyle guidance, glucose management, and antenatal care for GDM patients with home quarantine during public health emergencies.

A study of fetomaternal outcome in singleton pregnancies with cord around neck

Background: Entanglement of umbilical cord around the foetal neck is a common finding at ultrasonography. A nuchal cord occurs when the umbilical cord becomes wrapped around the foetal neck by 360°. Nuchal cord is very common, with the prevalence rates of 6-37%. Up to half of nuchal cords resolve before delivery.Methods: This study was conducted on 100 women irrespective of parity with healthy singleton term pregnancies with cephalic presentation in the department of obstetrics and gynaecology, SMS Medical College Jaipur. They were included in study after applying inclusion criteria and a written informed consent was taken. Strict fetomaternal monitoring was done during labour and data was interpreted in terms of percentage.Results: Out of 100 cases 71% delivered vaginally, 29% underwent caesarean section. None of the caesarean was done for cord around neck as the only indication. The indications for caesarean section were previous caesarean (34.4%), preeclampsia (13.7%), severe oligohydramnios (31%) and non-reassuring foetal heart rate (20%). Among the women who delivered normally, 53% had single loop, 29.5% had two loops, 14% had three loops and 2% had more than 3 loops. Among women who underwent caesarean section, 65% had single loop, 31% had two loops and 14% had more than two loops. Regarding neonatal outcome 9% neonates were admitted in NICU for reasons like meconium aspiration (33.3%), preterm (44%) and preeclampsia (22%).Conclusions: Cord around neck per se is not an indication for caesarean section and these cases can be delivered vaginally if careful intrapartum monitoring is done.

Correlation of Cardiotocography with Intraoperative findings and neonatal outcome in caesarean section for non-reassuring fetal status

Aims: To demonstrate the correlation of cardiotocography with intraoperative findings and neonatal outcome undergoing emergency cesarean section for non-reassuring fetal status. Methods: It is a hospital based cross sectional study at maternity ward of Shree Birendra Hospital in Kathmandu with non-reassuring CTG who underwent cesarean section in a period of one year. Their CTG were correlated with their intraoperative findings and neonatal outcome such as meconium stained liquor, nuchal cord, Apgar score at birth, NICU admission, perinatal mortality and stillbirth. Results: Fifty four patients were recruited. Most common operative finding was meconium stained liquor (35.2%); and cardiotocographic abnormality was variable Deceleration (37%). Variable deceleration and late deceleration had significant correlation with meconium stain liquor and nuchal cord. Apgar score ≤ 7 at 5 minute was 7.4%. NICU admission was 13% with common abnormality as late Deceleration. Conclusion: CTG pattern of variable and late deceleration had correlated with the meconium stained liquor and nuchal cord only. There was no relation with neonatal outcome in terms of Apgar score and admission rate.

Perinatal outcome in pregnancies with nuchal cord: prospective cross-sectional study at tertiary care institute

Background: The umbilical cord around the neck of fetus at the time of birth is nuchal cord (NC). NC is blamed as a major cause of fetal distress and perinatal mortality. The present study was undertaken to found out the incidence of nuchal cord at delivery and its perinatal outcomes in babies born with NC.Methods: Total 500 low risk women delivered either vaginally or abdominally after 34 completed weeks of gestation were included in the study. Cases with NC at the time of delivery were taken as study group and the cases which did not have NC served as control group. Various obstetric characteristics and perinatal outcome were studied.Results: The frequency of NC found was 35.6% of all the deliveries. Women with age between 21-25 years showed the maximum presence of NC (11.4%) and NC mostly seen between 38-40 weeks of gestation (24.8%). Presence of NC had no statistical significance on the maternal age, parity, period of gestation, mode of delivery, presence of meconium stained amniotic fluid and fetal distress. Prolonged duration of labour was seen in the presence of NC. The presence of NC was directly proportional to the length of cord and umbilical cord coiling. Perinatal outcome of babies in terms of Apgar score and seen as NICU admissions rate were not statistically significant. Tight NC had a poor Apgar score needed more intensive care.Conclusions: NC is a common finding at the time of delivery. The present study suggests that NC is not associated with significant perinatal outcome.