Effect of COVID -19 pandemic on still births.

Introduction: The COVID-19 pandemic is testing the strength of the strongest medical management in the globe. In developing countries, this contagious disease is quickly spreading in the midst of various endemic medical conditions like HIV, tuberculosis, jungle fever, lack of healthy sustenance, and incessant episodes of rampant contaminations. This happens especially in a setting of frail healthcare systems which may scarcely adapt to the previously mentioned existing medical challenges. Purpose: The objective of this research is to examine the impacts of pandemic of COVID-19 on the stillbirth rates. Methodology: Study was conducted at department of obstetrics and gynecology Unit Gynae C Lady Reading Hospital Peshawar from 1st January 2019 to 31st August 2020. This comparative cross sectional study was carried out at using non probability consecutive sampling technique. Findings: A large number of patients admitted with the diagnosis of stillbirth during 2019 and 2020 were multiparas 57% and 62% respectively. Booking status was 64% during 2019 and dropped to 52% in pandemic year 2020.Percentages of stillbirth due to abruption, placenta previa, gestational diabetes mellitus(GDM), type II diabetes, malpresentation, intrauterine growth restriction (IUGR),obstructed labor, eclampsia, postdates and unknown causes in 2019 and 2020 have been given in the table.

Prevalence of microcephaly: the Latin American Network of Congenital Malformations 2010–2017

ObjectiveThe Latin American Network of Congenital Malformations: ReLAMC was established in 2017 to provide accurate congenital anomaly surveillance. This study used data from ReLAMC registries to quantify the prevalence of microcephaly from 2010 to 2017 (before, during and after the Zika virus epidemic).DesignNine ReLAMC congenital anomaly registries provided case-level data or aggregate data for any live births, still births or terminations of pregnancy with microcephaly. Births to pregnant women infected with Zika virus first occurred in Brazil in 2015, and in the remaining registry areas in 2016 with the exception of Chile that did not experience Zika virus. Therefore the prevalence of microcephaly for 2010–2014 and individual years 2015, 2016 and 2017 was estimated using multilevel random effect Poisson models. Clinical classification and characteristics of the cases were compared pre and post Zika for all centres providing individual case-level data.ResultsThe prevalence of microcephaly for all registries excluding Brazil was 2.3 per 10 000 (95% CI 2.0 to 2.6) for 2010–2014 rising to 5.4 (95% CI 4.8 to 6.0) in 2016 and 5.9 (95% CI 5.3 to 6.6) in 2017. Brazil had a prevalence of 0.6 per 10 000 (95% CI 0.5 to 0.6) in 2010–2014, rising to 5.8 (95% CI 5.6 to 6.1) in 2015, 8.0 (95% CI 7.6 to 8.3) in 2016 and then falling in 2017. Only 29 out of 687 cases of microcephaly were reported as congenital Zika syndrome in countries excluding Brazil.ConclusionsThe prevalence of microcephaly was influenced both by Zika causing congenital Zika syndrome and by increased reporting awareness.

Frequency of Stillbirths in Obese Pregnant Women

Objective: To determine the frequency of stillbirths in obese pregnant women. Design of the Study: It’s a descriptive cross-sectional study. Study Settings: This study was carried out at Department of Obstetrics and Gynecology, Lady Reading Hospital Peshawar from January 2018 to July 2018. Material and Methods: In this study a total of 289 patients were observed. Detailed history was taken from each patient, period of gestation was calculated from 1st trimester scan, conducted by a person having at least 2 years post-graduate training experience in his/her respective field. Height/Weight measurements were done by the same standardized equipment’s for all enrolled patients and BMI calculation done by standard WHO formula before delivery. Baby after delivery was examined and looked for presence/absence of vital signs by the designated obstetrician. Outcome of pregnancy either alive or stillborn baby was recorded for each patient in order to fulfill the objective of study. To control bias and confounding, exclusion criteria had strictly followed. All the data was recorded on a pre-designed Proforma and subjected to analysis. Results of the Study: Our study shows that mean age of 28.87 +3.92 years Forty two percent patients were primi gravid and 58% patients were multi gravida. Forty three percent patients were primi para while 57% patients were multi para. Ninety percent babies were alive while 10% babies were still birth. Conclusion: Our study concludes that the frequency of still births was 10% in obese pregnant women. Keywords: still births, obese, pregnant women, primi para, WHO.

Pathogenic antibodies induced by spike proteins of COVID-19 and SARS-CoV viruses

This study, using a virus-free mouse model, explores the pathogenic roles of certain antibodies specific to the spike proteins of highly pathogenic coronaviruses such as the COVID-19 and the SARS-CoV viruses. Our data showed that these pathogenic antibodies, through a mechanism of Antibody Dependent Auto-Attack (ADAA), target and bind to host vulnerable cells or tissues such as damaged lung epithelium cells, initiate a self-attack immune response, and lead to serious conditions including ARDS, cytokine release, and death. Moreover, the pathogenic antibodies also induced inflammation and hemorrhage of the kidneys, brain, and heart. Furthermore, the pathogenic antibodies can bind to unmatured fetal tissues and cause abortions, postpartum labors, still births, and neonatal deaths of pregnant mice. Novel clinical interventions, through disrupting the host-binding of these pathogenic antibodies, can be developed to fight the COVID-19 pandemic. In addition, the new concept of ADAA explored by this study may be applicable to other infectious diseases, such as the highly pathogenic influenza infections. It should be noted that the majority of anti-spike antibodies are non-pathogenic, as only 2 of 7 monoclonal antibodies tested showed significant pathogenic effects.

Pathogenic antibodies induced by spike proteins of COVID-19 and SARS-CoV viruses

This study, using a virus-free mouse model, explores the pathogenic roles and novel mechanism of action of certain antibodies specific to the spike proteins of highly pathogenic coronaviruses such as the COVID-19 and the SARS-CoV viruses. These pathogenic antibodies, induced during a highly pathogenic infection such as the COVID-19 infection, target and bind to host vulnerable cells or tissues such as damaged lung epithelium cells, initiate a persistent self-attack immune response, and lead to serious conditions including ARDS, cytokine storms, and death. Moreover, the pathogenic antibodies may also be responsible for infection-related autoimmune diseases, including those experienced by COVID-19 long haulers. Furthermore, the pathogenic antibodies can bind to the unmatured fetal tissues and cause abortions, postpartum labors, still births, and neonatal deaths of pregnant females. Novel clinical interventions, through disrupting the binding of these pathogenic antibodies, can be developed to fight the COVID-19 pandemic. In addition, the new concept explored by this study may be applicable to other infectious diseases, such as the highly pathogenic influenza infections.

‘THOSE WE CARRIED BUT NEVER HELD’-A REVIEW OF CAUSES OF STILLBIRTH AT TERTIARY CARE CENTRE.

Background: In order to reduce perinatal mortality, better understanding of aetiology of antepartum still births is very essential. Stillbirth rate according to the future years will be decided and UNICEF's goal of 'making every baby count' can be achieved only if; contributing factors of stillbirth are reviewed and assessed Aim:To estimate the incidence, factors related and delays responsible for still birth at tertiary care center. Method: A prospective observational study was conducted in Government medical college and hospital, Aurangabad from 2018 to 2020 after Institution Ethics Committee approval. Data of 1211 still birth cases were analysed and also classied as per CODAC classication system. Results: The incidence of still birth was found to be 3.09 %. As per CODAC classication, Intrapartum factors were observed in 13.21% cases, maternal factors in 40.21%, fetal factors in 26.34% and placental factors in 18.66%, cord related in 4.38% and unexplained factors in 11.72% of cases. Conclusion: In addition to disorders during pregnancy, low socioeconomic condition, poor referral services and suboptimal intrapartum care in referring facilities responsible for majority of still births which could have been prevented. We speculate that upgrading the existing health system performance, particularly high quality intrapartum care by skilled health personnel, will reduce stillbirths substantially.

Fetomaternal outcome in eclampsia

Background: Eclampsia is the third most common cause of maternal mortality, after haemorrhage and infection in the developing countries. Majority of cases of eclampsia are young primigravidas. The reduction in both maternal and perinatal morbidity and mortality remains the yard stick of success in the management of eclampsia.Methods: A hospital based analytical cross-sectional study was conducted among the pregnant women with eclampsia admitted in the department of Obstetrics and Gynecology in Regional Institute of Medical Sciences, Imphal. The study was conducted for a period of one and half years from September 2018 to March 2020.Results: Fifty-five (55) patients in the age group between 21 and 25 years constitute the maximum percentage of eclampsia (67.3%). Forty-five (81.8%) cases were antepartum eclampsia, 2 (3.6%) were intrapartum eclampsia and 8 (14.5%) cases were postpartum eclampsia. Majority (78.2%) of the cases were primigravidae, which is comparable to other studies. As much as 23 (41.8%) of the cases presented at 32-37 weeks period of gestation. There were two maternal deaths (3.6%) due to eclampsia related complications. There were 13 (21.7%) perinatal deaths in this study, out of which 10 (16.7%) were still births and 3(5%) were early neonatal deaths.Conclusions: Eclampsia is still an important obstetric emergency in the community contributing to significant maternal and perinatal morbidity and mortality. Eclampsia may not develop de novo and as such, it is not always a preventable condition. Early detection and prompt intervention of complications is vital to ensure a healthy outcome for both mother and baby.

PREVALENCE AND RISK FACTORS FOR STILL BIRTH IN CHENGALPATTU

This study aimed to determine whether maternal age, maternal education , socio-economic status are factors for still births and identify the high risk age group which are likely to get affected , determine the signicant maternal medical conditions which are attributed to stillbirths and signicant obstetrics causes which are attributed to stillbirths. A cross-sectional hospital based study in government medical college hospital, chengalpattu was conducted. Data relating to socio- demographic information , passed obstetric history, associated medical conditions, index pregnancy characteristics where collected . economic classication was based on B.G.prasad's recommendation. medical and obstetric causes classied based on ReCoDe classication. Out of 11023 births from june 2016- may 2017 121 still births incidents were recorded at chengalpattu amounting to 11\1000 still birth incidents. The study showed mothers age between 19 and 21 is high risk group, literacy level has a positive impact in preventing stillbirths, economic status is a inuencing factor for stillbirth and placenta related complications remains a major causative factor of still birth followed by clinical conditions of the mother. The study could not establish any cross dependency on the variables and most of the factors have an independent inuence on the outcome.It is recommended that importance of antenatal care need to be communicated to the society especially to young mothers and practiced efciently

EFFECT OF WEATHER ON MATERNALAND FETAL OUTCOMES

Weather-related public health problems are most signicantly manifested by health effects due to extreme temperature, which are also the most direct and well-understood impact of climate change on human health. This is a retrospective study conducted in department of Obstetrics and Gynaecology at a tertiary health centre. Study period was 4 years 4 months.All the data regarding number of patients per month, delivered, undergone LSCS (Lower segment cesarean section), mortality, still births, live births were reviewed and arranged on Microsoft excel 2010·Ink , and calculations were done on this spreadsheet. Still birth rate and mortality rate was increased during Hot climate. Rate of total deliveries was lower in Hot climate group (62.8%) and higher in Cold climatem(78.6%) with respect to Whole sample(68.7%).

Performance of the Indigenous Pigs of Nigeria Under Intensive Management Conditions

OBSERVATIONS on some reproductive traits were made on 63 litters of indigenous pigs obtained from pigs selected from an initial group of 60 pigs purchased from local farmers around Ibadan between April 1972 and February 1976. Studies on the growth rate, feed intake and feed efficiency, as well as the proportion of separable tissue in carcass at different terminal weights, rate and efficiency of tissue growth were also carried out with a total of 394 pigs obtained from these litters. For the observations on performance, tissue proportions, tissue growth rate and efficiency of tissue deposition, Large White x Landrace pigs of the same age group were used for comparison at each stage. Litter size averaged 6.7 piglets per sow with a range value of between 4 and 13 piglets. Mean litter birth weight was 6.10 kg, while mean litter weaning weight was 29.4 kg. A preweaning mortality of 15.8% and 4.79% still births were recorded for these indigenous pigs. Daily gain, feed intake and feed conversion efficiency were lower for the indigenous compared to Large White X Landrace pigs. Maximum growth rate for these pigs occured in the growth phase between 45.5 and 56.8 kg. liveweights. Tissue growth rates were lower and the efficiency of tissue deposition poorer in the indigenous compared to the Large White x Landrace pigs. The basic factor underlying the differences in performance of these two breeds would appear to be the inherently different patterns of growth of the respective tissue. The rate and efficiency of tissue growth as well as growth and efficiency of feed utilisation, together indicate that the indigenous pigs should not be reared beyond liveweights between 45.5 and 56.8 kg.