Case series on mullerian anomalies incidence during caesarean section over one year period

Congenital uterine anomalies occur due to abnormal fusion of Mullerian duct during embryonic life. It is associated with high incidences of reproductive failures and adverse obstetrical outcomes. It may be associated with malpresentation, preterm labour or recurrent pregnancy losses. The association of congenital anomalies and early pregnancy loss has been well established but its adverse effect on late pregnancy in form of malpresentation, preterm deliveries has not yet been elaborated. Hence, this case series aimed to summarize the incidence and perinatal outcome of pregnancy in women with congenital uterine anomalies undergoing cesarean section. This was a case series which was conducted on women who underwent cesarean section at P. C. Sethi hospital, Indore between time period of October 2020 to September 2021. Out of total 1835 cesarean undergoing patients, 12 patients were found to have uterine anomalies. Out of 12 patients, 9 (75%) patients were associated with malpresentation, 4 (33.3%) patients had preterm delivery and 6 (50%) patients had low birth weight babies. Hence it can be said that women with congenital uterine anomalies were at higher incidence of malpresentation and preterm deliveries. Presence of congenital uterine anomalies were associated with adverse obstetrical outcome. This knowledge warrants the need for a larger case control study to extrapolate these findings to the general population and also to recommend the need for universal prenatal screening for uterine anomalies to improve the obstetrical and perinatal outcome in patients with uterine anomalies.

Prevalence and Maternal Effects of Hypothyroidism in Pregnancy

Background: 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 prevalence of thyroid dysfunction in pregnancy and its impact on obstetrical outcome. Materials and methods: It is an observational study done in a Combined Military Hospital (CMH) Chattogram during the period from February to December 2020 on 130 hypothyroid mothers to observe maternal effects of hypothyroidism. Patients were collected as per inclusion and exclusion criteria after informed written consent. Data was compiled and analyzed and presented. Results: Among 1148 total patients,1018(89%) were normal and 130(11%) were diagnosed as hypothyroid.Among all the patients, 35% patientsare from inside the Chattogram and 65% are from outside. Among 130 hypothyroid cases age range revealed 20-45 years and 20 -30 years age group were 82(63.07%), 30-40 years age group was 40(30.76%) and >40 years age group were 8(6.15%). Primigravida was 48(36.92%) cases and multigravida was 82(63.08%) cases, anemia was present in 40(30.76%) cases, 10(7.69%) patients had hypertension, GDM and DM was found in 20(15.38%)and 3(2.30%) cases respectively, preconception hypothyroidism was found in 10(7.69%) and on Levothyroxine during ANC was 120(92.30%).Among all, 63(48.46%) cases were underwent vaginal delivery and 67(51.53%) cases underwent cesarean section. Untreated and irregular treatment in hypothyroidism are associated with pregnancy complications like spontaneous miscarriage 40(30.76%), maternal anaemia 55(42.30%), pre-eclampsia 4(3.07%), pre term birth 16(12.30%), postpartum haemorrhage 3(2.30%). Conclusion: Hypothyroidism is a common clinical condition during pregnancy and it causes variable pregnancy outcome Chatt Maa Shi Hosp Med Coll J; Vol.20 (2); July 2021; Page 18-21

Misoprostol vs dinoprostone vaginal insert in labour induction: comparison of obstetrical outcome

Induction of labour (IOL) is increasingly used in obstetric practice. For patients with unfavourable cervix, we are constantly looking for an optimal, in terms of effectiveness and safety, ripening of cervix protocol. It was retrospective cohort study. We analyzed obstetrical results in 481 patients undergoing IOL in one center using two different vaginal inserts that release prostaglandins at a constant rate for 24 h—misoprostol vaginal insert (MVI) with 200 µg of misoprostol (n = 367) and dinoprostone vaginal insert (DVI) with 10 mg of dinoprostone (n = 114). Full-term, single pregnancy patients with intact fetal membranes and the cervix evaluated in Bishop score ≤ 6 were included in the analysis. In the group of MVI patients, the labour ended with caesarean section more often (OR 2.71 95% CI 1.63–4.47) and more frequent unreassuring cardiotocographic trace indicating the surgical delivery occurred (OR 2.38 95% CI 1.10–5.17). We did not notice any differences in the percentage of vacuum extraction and patients in whom the use of oxytocin was necessary during labour induction. The clinical status of newborns after birth and the pH of cord blood did not differ between groups.The use of MVI 200 μg in patients with an unriped cervix is associated with a greater chance of completing delivery by caesarean section and increased chance of abnormal intrapartum CTG trace compared to the use of DVI 10 mg. These differences do not affect the clinical and biochemical status of the newborn.