Accuracy of Fetal Weight Estimation by Ultrasonographic Evaluation in a Northeastern Region of India

Background and Objectives. Fetal weight evaluation in utero is a significant component in obstetric practices. The present study aims to estimate the fetal weight (EFW) by evaluating two available formulas using ultrasound parameters and comparing them with actual birth weight (ABW) after delivery. The accuracy and efficacy of both EFW formulas in detecting intrauterine growth retardation (IUGR) and macrosomia were also compared in our local sample of the population. Methods. The cross-sectional study included 100 pregnant women aged 20–45 years from the Kamrup district admitted to Guwahati Medical College and Hospital, Guwahati, Assam. The data were analyzed using Microsoft Excel and SPSS version 16. The EFW at term was calculated using Shepard’s formula and Hadlock’s formula. Differences in means are compared using the one-way ANOVA or Kruskal–Wallis test and paired t-test. The accuracy of the two procedures was evaluated using mean absolute error (MAE) and mean absolute percentage error (MAPE). A p value<0.05 was considered significant. Results. The present study included 100 pregnant women aged 21–38 years with term or postterm pregnancies subjected to ultrasonographic evaluation within 72 hours of delivery. The mean (±s.d.) EFW by Shepard’s formula was 2716.05 (±332.38) g and Hadlock’s formula was 2740.44 (±353.23) g, respectively. For Hadlock’s formula, MAE ± s.d. was found to be higher (overall 84.59 ± 76.54) specifically in the weight category less than 2500 (106.42 ± 88.11) as compared to Shepard’s (overall MAE ± s.d = 79.86 ± 64.78, and among ABW < 2500 g, MAE ± s.d = 65.04 ± 61.02). The overall MAPE of Hadlock’s formula was 3.14% and that for Shepard’s formula was 2.91%, and the difference was not statistically significant. Both Shepard’s formula and Hadlock’s formula had a sensitivity of 92.85% in detecting IUGR, but Hadlock’s method had higher specificity (66%), higher PPV (86.67%), and higher NPV (80%). Conclusion. The ultrasonographic evaluation of fetal weight helps predict fetal birth weight precisely and can influence obstetric management decisions concerning timing and route of delivery, thus reducing perinatal morbidity and mortality.

Maternal and perinatal outcomes of pregnancies complicated by cardiac disease at a tertiary level hospital

Heart disease in pregnancy is one of the leading non-obstetric causes of maternal mortality and is the leading cause of maternal intensive care unit admissions in the world. To study the prevalence of heart disease in antenatal mothers and fetal outcome with obstetric management. The presence of comorbidities and the occurrence of obstetric, fetal, and cardiovascular complications during delivery among women with heart disease hospitalized for delivery were studied in 35 women at GSL Medical College, Rajahmundry for a period of 1 year from 01/01/2019 to 1/1/2020: Over a period of 12 months, 35 subjects were recruited. During this period, there were 5005 deliveries. The majority of women were aged between 20-25yrs and were unbooked cases belonging to NYHA class I or II. Cesarean section and operative vaginal delivery were more common. Despite the multidisciplinary approach, 3 women succumbed to the disease of which one was a case of severe rheumatic heart disease with valve failure, the second was a case of postpartum cardiomyopathy and the third was a case of severe pulmonary arterial hypertension. Fetal outcome in cardiac patients is usually good and only a little different from those patients who do not suffer from heart disease. Pregnant women with heart disease were more likely to experience adverse events during delivery. These women require a multidisciplinary team for optimal maternal and foetal outcomes.

Gynecologic and obstetric management of women with von Willebrand disease: summary of 3 systematic reviews of the literature

Von Willebrand disease, (VWD) disproportionately affects women due to potential issues with heavy menstrual bleeding (HMB), delivery complications, and postpartum hemorrhage (PPH). To systematically synthesize the evidence regarding first line management of HMB, treatment of women requiring/desiring neuraxial analgesia, and management of PPH. We searched Medline and EMBASE through October 2019 for randomized trials, comparative observational studies, and case series comparing the effects of desmopressin, hormonal therapy, and tranexamic acid (TXA) on HMB, comparing different von Willebrand factor (VWF) levels in women with VWD undergoing labor and receiving neuraxial anesthesia and the effects of TXA on PPH We conducted duplicate study selection, data abstraction, and appraisal of risk of bias. Whenever possible, we conducted meta-analyses. We assessed the quality of the evidence using the GRADE approach. We included 1 randomized trial, 3 comparative observational studies and 10 case series. Moderate certainty evidence showed that desmopressin results in a smaller reduction of menstrual blood loss (difference in mean change from baseline, 41.6 [95% CI, 16.6 to 63.6] points in pictorial blood assessment chart score as compared to TXA. There was very low certainty evidence about how first line treatments compare against each other, the effects of different VWF levels in women receiving neuraxial anesthesia, and the effects of TXA administration postpartum. Most of the evidence relevant to the gynecologic and obstetric management of women with VWD addressed by most guidelines is very low quality. Future studies addressing research priorities will be key when updating such guidelines.

Obstetric Management in Maternal with Covid-19

Coronavirus disease-19 (COVID-19) is caused by severe acute respiratory syndrome coronavirus-2 (SARS- CoV-2). Covid-19 pandemic began in the end of 2019 and spread all over the world in a short duration of time. Like two other notable beta coronaviruses, severe acute respiratory syndrome coronavirus-1 (SARS-CoV-1) and Middle East respiratory syndrome coronavirus (MERS-CoV), SARS-CoV-2 can lead to severe contagious respiratory disease. Due to impaired cellular immunity and physiological changes, pregnant women are susceptible to respiratory disease and are more likely to develop severe pneumonia.

Case Of NAIT Causing Severe Thrombocytopenia due to Anti-HLA Class I

Neonatal alloimmune thrombocytopenia (NAIT) is the leading cause of thrombocytopenia in otherwise healthy new-born. (1,2) Maternal antibodies raised against paternally inherited alloantigen carried on fetal platelet causing NAIT. Maternal IgG antibodies passed through to the fetal via the placenta, attack and cause the destruction of the fetal platelet. (3) We present a case of NAIT without any complications in a premature baby (35 weeks) with VACREL association, G6PD deficiency, left calcified cephalohaematoma, cardiomegaly and hypospadias with severe thrombocytopenia (platelet counts is 23 109/L) at day two of life and received twice platelet transfusion. Platelet count initially 123 109/L at birth but significantly drop and persistently less than 50 109/L until day 10 of life before it normalized. Maternal serum antibody screening was negative, but platelet immunology test detected maternal platelet-reactive antibody Anti-HLA Class I and correlates with incompatible parental crossmatch indicating that parent had “platelet-antigen incompatibility”. The goal of obstetric management is to identify pregnancies at risk and prevent intracranial haemorrhage. (4) There is no evidence to support routine screening for pregnancies as per current practice. (2, 5) The latest treatments include maternal administration of intravenous immunoglobulin to suppress maternal antibody production and or to reduce placental transfer of antibodies; with or without steroids during antepartum period besides planning of mode, timing and method of delivery. (2, 5, 6, 7) This is a rare and unique case of NAIT secondary to Anti-HLA Class I antibody and hence clinician should be au fait with the diagnosis and management as it is infrequent among Malaysian.International Journal of Human and Health Sciences Supplementary Issue-2: 2021 Page: S21

Obstetric Management in Maternal with Covid-19

Coronavirus disease-19 (COVID-19) is caused by severe acute respiratory syndrome coronavirus-2 (SARS- CoV-2). Covid-19 pandemic began in the end of 2019 and spread all over the world in a short duration of time. Like two other notable beta coronaviruses, severe acute respiratory syndrome coronavirus-1 (SARS-CoV-1) and Middle East respiratory syndrome coronavirus (MERS-CoV), SARS-CoV-2 can lead to severe contagious respiratory disease. Due to impaired cellular immunity and physiological changes, pregnant women are susceptible to respiratory disease and are more likely to develop severe pneumonia.

Evaluation of Prenatal Central Nervous System Anomalies: Obstetric Management, Fetal Outcomes and Chromosome Abnormalities

Objective: To study the prognostic outcomes of fetuses with prenatally diagnosed central nervous system (CNS) anomalies and describe the obstetric management for those fetuses.Methods: In this retrospective study, fetuses who were detected to have central nervous system by prenatal ultrasound from January 2010 to December 2019 were recruited. Data regarding prenatal diagnosis and obstetric outcome were retrieved from maternal and paediatric records. Prognosis of children who survived till delivery was classified based on their neurodevelopmental outcome within 2 years of life.Results: 365 fetuses were prenatally diagnosed with CNS malformations within the 10-year study period, at a mean gestational age of 24.65±7.37 weeks at diagnosis. Ventriculomegaly (23.36%) was the commonest CNS anomalies diagnosed antenatally. 198 (54.20%) fetuses has associated extra-CNS anomalies, with cardiovascular system being the most common organ system involved with CNS anomalies. Karyotyping was performed in 111 pregnancies, with chromosomal aberrations detected in 53 (49.07%) cases and culture failure in 3 cases. Edward syndrome and Patau syndrome were commonly associated with CNS anomalies. Fetuses with congenital CNS anomalies and abnormal chromosomal karyotyping more likely to be diagnosed earlier by prenatal ultrasound and tend to have poorer obstetric and neurocognitive prognosis. Among the 279 cases whom their pregnancy outcomes were available, 105 (37.63%) pregnancies were electively terminated, 35 (12.54%) pregnancies ended in spontaneous loss while the remaining 139 (49.82%) cases resulted in live births. The decision of TOP largely depends on mean diagnostic gestational age, presence of chromosomal aberrations and abnormal amniotic fluid volume in those fetuses. Ruling out 21 (15.11%) cases which were lost to 2-year follow-up, only 75 (53.96%) infants were still alive by the age of 2 years. Only 32 (23.02%) children with prenatally diagnosed CNS anomalies had normal neurodevelopmental outcome. The presence of multiple CNS anomalies and involvement of extra-CNS anomalies indicated a poorer neurodevelopmental prognosis.Conclusion: Less than 50% of fetuses with prenatally diagnosed CNS anomalies resulted in live births. Even if they survive till delivery, majority passed away within 2 years or had neurodevelopmental disability.

Prenatal and Obstetric Parameters of Late Terminations: A Retrospective Analysis

Background In Germany, the highly sensitive issue of late terminations of pregnancy and feticide is regulated in Sec. 218a para. 2 of the German Penal Code (medical indication). This study aimed to investigate the prenatal obstetric approach after feticide and the rate of maternal complications. Material and Methods All feticides of singleton pregnancies carried out at Leipzig University Hospital (n = 164) in the period between 01/2016 and 12/2019 were retrospectively analyzed. Selective feticides of multiple pregnancies were excluded from the study. Target indicators for the prenatal obstetric approach were sonographic accuracy of estimation, method used to induce feticide, time between feticide and delivery, and whether curettage was required. The rate of maternal complications was defined as blood loss of ≥ 500 ml. Results The number of feticides as a percentage of the total number of births during the investigation period was 1.6%. None of the terminations were performed primarily because of a serious risk to the motherʼs physical health; all of the indications to terminate the pregnancy were based on the psychosocial burden and the risk to the motherʼs mental health as outlined in Sec. 218a StGB (German Penal Code). The most common fetal diagnoses in the context of a maternal psychosocial emergency were central nervous system abnormalities (29.3%), numerical chromosomal aberrations (29.3%) and structural chromosomal aberrations/syndromes (21.3%). Sonographic measurements were used to estimate fetal weight and the weight of around half of the fetuses was underestimated (− 121.8 ± 155.8 g). The margin of estimation error increased with increasing gestational age (p < 0.001). Misoprostol was the most common drug administered to induce labor. No significant association was found between the method chosen for induction, parity, fetal birth position, fetal anomaly, fetal gender, birth mode or the number of previous cesarean sections and Δdelivery. However, a significantly higher loss of blood was observed with longer Δdelivery (p = 0.02). The likelihood of requiring curettage increased with increasing loss of blood. The number of maternal complications as a percentage of the total patient population was 10.4%. Only 11% of patients agreed to a postmortem examination. Conclusion Late terminations of pregnancy carried out in accordance with Sec. 218a para. 2 StGB are a reality and must be understood and accepted as a possible consequence of modern prenatal medicine. The complication rate after feticide and the subsequent obstetric procedure was 10% for the above-defined maternal complication. Late terminations and their obstetric management should be carried out in specialized perinatal centers which offer interprofessional expertise.

Neonatal alloimmune thrombocytopenia: two different neonatal manifestations of the same disease

Fetal and neonatal alloimmune thrombocytopenia is a rare disorder in which maternal alloantibodies cross the placenta and cause fetal thrombocytopenia. Most cases are mild but can be potentially fatal if there is an intracranial haemorrhage. Usually, the mother is asymptomatic during pregnancy and no screening is routinely recommended unless there is obstetric or family history. After birth, prompt identification is crucial so that the newborn is closely monitored and treatment is given, if needed, to prevent serious complications. In this article we present two clinical cases of fetal and neonatal alloimmune thrombocytopenia in first-born children, after uneventful pregnancies, with different outcomes and discuss the obstetric management and follow-up in future pregnancies.

Cervical cerclage or not in delayed delivery interval: obstetric management and outcomes

Objective The aim of this study is to explore the effectiveness of cervical cerclage in order to delay the delivery interval after delivery of the first fetus in dichorionic twin pregnancies. Study Design: Records of 11 twin pregnancies where delayed delivery was experienced for retained fetus(es), were collected retrospectively. Cases with cervical cerclage placed after the first delivery were evaluated as the cerclage group and cases without cerclage placement were evaluated as the non-cerclage group. Results The median duration of the delay 25.4 ± 8.1days (range, 4–50) in the cerclage group and 7.7 ± 2.0 days(range, 3–17) in the non-cerclage group (P = 0.045). Average gain birthweight of the second fetus in the cerclage group was 408.0 ± 160.2 g and 93.3 ± 25.5g in the non-cerclagegroup(P = 0.061). But other parameters were not different between the two groups. Conclusions Cervical cerclage after the first delivery is associated with a longer inter-delivery interval without increasing the risk of intrauterine infection.