Maternal and foetal outcome of pregnancy in women with connective tissue diseases

Introduction. The majority of patients diagnosed with systemic connective tissue diseases are women of childbearing age. Aim. The analysis of obstetric results and exacerbation rates in the pregnancies involving systemic connective tissue diseases. Material and Methods. We retrospectively reviewed perinatal outcomes of fourteen women with systemic connective tissue diseases hospitalised in the Department of Reproduction in the period between September 2019 and July 2021. Results. Median duration of a pregnancy was 37 weeks. One pregnancy ended in a stillbirth in week 28. Of the 13 live births, preterm delivery occurred in 5 cases. Of the 13 live-birth neonates, preterm delivery occurred in five cases. The Caesarean section rate was 57.1% and vaginal delivery rate was 42.9%. The mean birth weight of the live neonates was 2787g (SD 892), and the median Apgar score in the 1st and the 3rd minute was 10. In total, all 4 patients with the active disease at the time of conception and 1 who did not decide to undergo the recommended mitral valve surgery prior to pregnancy experienced symptoms indicating a disease flare-up in the course of pregnancy. None of the patients who planned their pregnancy experienced an exacerbation of the disease. Conclusions. All patients diagnosed with systemic connective tissue diseases should receive multidisciplinary care prior to conception, during pregnancy and in the postpartum period. Furthermore, they should be monitored by a team of specialists, due to the risk of a disease exacerbation and high rates of maternal and foetal complications resulting from the underlying condition.

Maternal and Foetal Outcome in Pregnancy with Heart Disease Admitted in Chalmeda Anand Rao Institute of Medical Sciences, Karimnagar

BACKGROUND Heart disease complicating pregnancy is considered as a high-risk condition. Increased cardiac demands during the course of pregnancy potentially increase morbidity and mortality in women with underlying heart disease. Fifty percent increase in volume of plasma and increase in the risk of thrombosis by 6 times strikes a challenge to pregnant woman with heart disease. Pregnancy state is more prone to risk of infection as it is an immunocompromised condition which can result in increased heart rate eventually deteriorating the cardiac function. We wanted to determine maternal and foetal outcome in pregnant women with heart diseases in terms of foetal complications, maternal complications, and mode of delivery. METHODS A prospective clinical study conducted in Chalmeda Anand Rao Institute of Medical Sciences, Karimnagar for delivery was carried to find out the maternal and foetal outcomes in about 30 cases of pregnancy complicated heart disease. Taking prevalence to be 4 % (P) with confidence interval of 95 % (Z = 1.96) and allowable error (d) 7 %, sample size was calculated using formula 𝑍 2𝑃𝑄/𝑑2 RESULTS Present study revealed heart disease in pregnancy as about 0.48 %. Rheumatic heart lesions constituted 56.6 % of the cases. Eleven (36.7 %) women delivered spontaneously vaginally at term. Caesarean section was performed in 12 cases (41.2 %). There were 2 maternal deaths. No perinatal deaths were reported. CONCLUSIONS Pregnancy and cardiac lesions affect mutually. Compliance of patient and her family to regular follow up will ensure a safe outcome for mother and foetus and avoid complications by regular checkups with obstetrician and cardiologist. KEY WORDS Cardiomyopathy, Pregnancy, Rheumatic Heart Disease, Maternal Morbidity, Maternal Mortality

A STUDY OF MATERNAL PERCEPTION OF DECREASED FOETAL MOVEMENT AND PERINATAL OUTCOME

BACKGROUND: Fetal movement is described as motion of the fetus perceived by the mother and is considered as a sign of foetal wellbeing. A reduction of foetal movements causes concern and anxiety, both to the mother and obstetrician.Decreased foetal movements are regarded as a marker for suboptimal intrauterine conditions,possibly of placental dysfunction and intrauterine stress. Evaluation of maternal perception of decrease foetal movement is done by taking proper history,daily foetal movement count (DFMC),non-stress test (NST) and ultrasonography. AIM AND OBJECTIVES: The aim of this study was to find out perinatal outcome among women with decreased foetal movements. The rational for the study is that our findings should contribute to maternal understanding of foetal wellbeing in utero,and possible ways to work with mothers to prevent intrauterine foetal deaths and stillbirths. MATERIAL AND METHODS: This is a hospital based descriptive study conducted at Obstetrics and Gynaecology department, Srimati Heera Kunwar Ba Mahila Chikitsalaya,Jhalawar Medical College Jhalawar from November 2018 to October 2019. Ethical approval was taken from ethical committee and written informed consent was taken from the participants.Total 192 women were included in the study with complain of decreased foetal movements.To ev aluate the foetal well-being daily foetal movement count (DFMC),non-stress test (NST) and ultrasonography was done. RESULT: There was no statistically significant association between DFMC and foetal outcome, but reactive NST is associated with good foetal outcome. CONCLUSION: W rd e conclude that reduced foetal movement during 3 trimester could be ominous sign. Our study suggests that NST,sonography and DFMC may be used to evaluate the women complaining of decrease foetal movement and may identify the women at risk for adverse perinatal outcome.

Fetomaternal Outcome in Placental Abruption

Background: Placental abruption is a major contributor to obstetrical haemorrhage and a major cause of perinatal mortality in developing countries. This has been done to an attempt to recognize this condition at an earlier stage, prevent its complications and properly manage the complications if they do occur. Aim: To determine maternal and fetal outcome in females with placental abruption. Methods: Hundred patients with confirmed diagnosis of placental abruption were divided in three categories according to the grade of placental abruption. Their baseline investigations including blood group, haemoglobin and coagulation profile i.e. partial thromboplastin time, activated partial thromboplastin time, serum fibrinogen and FDP's were performed and recorded for each category separately. The effect of each grade of abruption was studied on maternal and fetal outcome as well as extent of coagulation disturbance. Results: The results of the study show that 66% babies were delivered alive and 34% were IUD/stillbirth. Gestational age at presentation was important in fetal outcome. Out of 30 babies presenting before 32 weeks of gestation 66% were IUD/stillbirth. 58% patients delivered vaginally and 42% had caesarean section. 32% patients had grade I abruption, 34% patients had grade 3 abruption. 18% patients had post-partum haemorrhage. Conclusion: All professionals working in labour ward must be aware of the causes, presentation and complications of disease and appropriate measures taken in time can help reduce the maternal and neonatal morbidity and mortality. Keywords: Placental abruption, maternal outcome, foetal outcome, coagulation disturbance

Clinical significance of ultrasonic placental grading during third trimester in hypertensive disorders in pregnancy and its correlation with fetal outcome in tertiary care centre

Background: Hypertension is one of the common complications in pregnancy and contributes significantly to maternal and perinatal morbidity and mortality. The aim of the present study was to study placental grading by grading by ultrasonography in pregnancy complicated with hypertension and normotensive gravidas. To compare the foetal outcome regarding placental grading and its correlation pattern of placental grade distribution, type of delivery, foetal distress, birth asphyxia, foetal maturity, perinatal morbidity and mortality.Methods: The present study was conducted for a period of 12 months, which included 200 patients who attended OPD at PDRMC, Udaipur. Inclusion criteria was hypertensive pregnant women with BP >140/90 mmHg. Exclusion criteria was Pregnancy associated with other medical disorders, twin gestation, renal and cardiovascular disease and diabetes mellitus.Results: 100 pregnant women with preeclampsia as study group. The most common age group in study group is 22-23 Years. The grade III placenta was found early third trimester in study group. Caesarean delivery was more common mode of delivery in grade III placenta. In foetal outcome small for gestational age was more among the grade III placenta. Foetal distress, birth asphyxia, perinatal mortality, morbidity more among the grade III placenta among the study group.Conclusions: Foetal complications were significantly more in study group compared to control group. Ultrasound placental grade III was statistically significant in correlating with foetal complications like foetal distress, birth asphyxia, perinatal morbidity and mortality.

IMPACT OF COVID-19 ON PREGNANCY AND ITS OUTCOME IN ZONAL MILITARY HOSPITAL

Introduction :The corona virus disease 2019 [COVID-19] has rapidly spread worldwide and is now a global pandemic. It is matter of concern whether the COVID-19 affects the pregnancy and its outcome.In this study,investigation was done to determine the possibility of effects of COVID-19 on pregnancy and its outcome. Materials and Methods : A total of 1014 pregnant women were included in the study, from 1st April to 30 Nov 2020 at a zonal military hospital.There were 148 women who tested COVID-19 RT-PCR [reverse transcriptase polymerase chain reaction] positive and remaining 866 were COVID-19 negative.Findings of antenatal complications and perinatal outcome were compared in both the groups. Results :The incidence of COVID-19 positive pregnant women was found to be 14.59 %.No increase in rate of antenatal complications was seen in COVID-19 positive patients.Cesarean delivery rate was more in the COVID-19 positive group (52%) as compared to COVID-19 negative group (38%),(p > 0.05). Low APGAR score (0-3) was observed in 1 (0.67%) neonate of COVID-19 positive mothers and in 9 (1.03%) neonates of COVID-19 negative mothers.Overall 148 neonates were tested for the possibility of vertical transmission, 145 neonates were negative in RT-PCR, while 3 were positive.Conclusion : There is no significant effect of COVID-19 infection on maternal and foetal outcome in pregnancy and possibility of vertical transmission of the COVID-19 infection can not be ruled out.

THE STUDY OF MATERNAL AND FETAL OUTCOME IN PREGNANT WOMEN WITH THYROID DISORDER: A PROSPECTIVE STUDY IN INDORE REGION

BACKGROUND: Thyroid disorder is very common disorders in pregnancy. It is well established that overt and subclinical thyroid dysfunction has adverse effects on mother and the foetus like miscarriages, preterm delivery, preeclampsia, eclampsia, polyhydramnios, placental abruption, postpartum haemorrhage, low birth weight, fetal distress, NICU admission. With this background, we are conducting a study to know the effect of thyroid disorder on pregnancy and its maternal and foetal outcome. METHODS: The present study was carried out in Index Medical College, Indore, MP, India in Department of physiology in collaboration with Department of Obstetrics & Gynecology. It is a prospective random cross-sectional study done over 180 pregnant women (90 pregnant women with thyroid disorder and 90 with normal thyroid) which includes known cases of thyroid disorder. Serum thyroid stimulating hormone (TSH), fT3, and fT4 tests were apart from the routine blood sample investigations as per FOGSI-ICOG good clinical practice recommendation. Patients are followed up till delivery, and their obstetrics and perinatal outcomes are noted. RESULTS: In our study prevalence of thyroid dysfunction was 10.4%. Out of these 90 patients with thyroid dysfunction, complications associated were pre-eclampsia (14.4%), abortions (13.3%), maternal anaemia (11.1%), preterm labour (7.8%), still birth (5.6%), abruption placenta (4.4%). Out of 90 patients with thyroid dysfunction, foetal complications seen were low birth weight (22.2%), NICU admission (15.6%), hyperbilirubinemia (14.4%) and foetal distress (5.6%). CONCLUSIONS: Our result demonstrated that the thyroid disorders during pregnancy have adverse effects on maternal and foetal outcome emphasizing the importance of routine antenatal thyroid screening.

The Correlation between Placental Weight and Foetal Outcome in a Tertiary Health Facility in Southern Nigeria

Background: Placenta is a vital feto-maternal organ for promoting pregnancy, foetal growth and development. Placenta varies in weight, size, thickness, form and consistency. The weight of the placenta is functionally significant because it is related to villous surface area and foetal metabolism. Gross examination of placenta after delivery may provide a useful insight into foetal weight, newborn and maternal complications of pregnancy. Objectives: To determine the mean placental weight in our environment and also, to determine the correlation between the placental weight and neonatal outcome in term pregnancies in Calabar. Materials and Methods: This was a cross-sectional study of 300 women conducted at University of Calabar Teaching Hospital (UCTH). Participants in the study were women with singleton pregnancies who delivered either by vaginal delivery or caesarean section at term. Examination and weighing of placenta were done at delivery for placental weight. Foetal outcome that were recorded included birth weight, sex, length of the newborn and Apgar score at 5th minute. Maternal age, marital status and parity were also obtained. Data obtained were analyzed using the statistical package for Social Sciences (SPSS) version 20. Level of significance was set at p-value less than 0.05. Data were presented in tables and graph. Results: The mean placental weight was 652 ±152g and ranged from 250g-1,200g. The mean foetal birth weight was 3.309 ±0.522kg and ranged from 2.0-5.9kg. The mean placental weight to birth weight ratio was 1: 5.08. The mean gestational age at delivery was 38.94 ±1.33weeks while the mean length of the neonate was 49.79 ±2.66cm. There was a corresponding increase in placental weight with increase in neonatal birth weight and length of the neonate. Conclusions: Placental weight was positively correlated with birth weight and length of the neonate. Critical examination and weighting of the placenta immediately after delivery should be done to determine the well being of the newborn.