Low dose magnesium sulphate regimen and maternal outcome of patients with eclampsia

Background: Preeclampsia, a serious pregnancy complication which is commonly characterized by high blood pressure, presence of protein in the urine and sometimes swelling in women's feet, legs and hands. With this condition, patient’s high blood pressure often results in seizures. Generally, the outcome remains good, however, eclampsia can be life threatening and disastrous.Methods: This cross-sectional study considered 114 patients who meet inclusion criteria and agreed to will-fully participate in the study were evaluated for different parameters. Patients who developed eclampsia during intra-natal and postnatal period were included in the study. The aim of the study was to evaluate the maternal outcome among all patients of eclampsia treated with low magnesium sulphate dosage therapy. Results: The present study revealed, very low fit recurrence rate, low mortality rate, zero treatment failure rate, no toxicity and (99.12%) success rate.Conclusions: Apart from zero percent treatment failure rate, Low maternal mortality and fit recurrence rate encouraged us to continue the treatment with low dose MGSO4 regimen. Thus, low dose magnesium sulphate has been found very effective in treating the eclmpsia and at the same time maintains the high safety margin.

Study of feto-maternal outcome in patients with hepatitis E infection during pregnancy

Background: Hepatitis E is considered as a common cause of high maternal morbidity and mortality particularly in third trimester and also high perinatal morbidity and mortality. Thus, this study is conducted to evaluate the feto-maternal outcome in patients infected with hepatitis E during pregnancy.Methods: It is a retrospective observational study conducted in department of obstetrics and gynecology at L. G. hospital. Fifty pregnant women with clinical hepatitis in third trimester of pregnancy were included in this study and thorough investigation were carried out. Patients were monitored till postpartum period and fetal monitoring data were collected from neonatal ICU.Results: In this study, majority of pregnant patients with hepatitis B were admitted during monsoon season suggests that HEV outbreaks are more common during monsoon months. Majority of the patients (70%) were emergency cases. Majority of these patients (82%) were belonged to lower socio-economic class. Co-infection with HAV was in 2% and with HBV in 4%. S. bilirubin >15 mg/dl in 16% of patients. PT and APTT were raised in 28% of patients. FDP was raised in 70% of patients. 76% were delivered vaginally and 22% were delivered by LSCS. Most common complication in HEV infected pregnant women was disseminated intravascular coagulation (DIC) (26%). Maternal mortality rate is 14%. Out of 50 patients, 88% delivered live baby, out of which 72% needed NICU admission. Perinatal mortality rate was as high as 28%.Conclusions: Hepatitis E infection and pregnancy is a deadly and fatal combination. Specifically, in 3rd trimester of pregnancy, acute hepatitis E has a grave prognosis with high maternal morbidity and mortality. Prevention is the mainstay of controlling HEV especially in developing countries.

Frequency and Fetomaternal Outcome in COVID 19 Positive Pregnant Women

Objective: To determine the frequency and outcome in pregnant women with COVID-19 infection. Study Design: This is a observational cohort study. Setting: Study carried out at Department of Obstetrics & Gynecology, Civil Hospital, Dow University of health sciences Karachi, from July 2020 to November 2021. Materials & Methods: The study was conducted in a tertiary care hospital in Karachi. Women having COVID-19 positive status during any stage of their pregnancy having antenatal visits in our hospital were included in our study. Maternal demographics, race, maternal outcome, and neonatal complications were noted on a self-made Performa. Statistical analysis was done by SPSS version 21 and descriptive statistics with frequencies were mainly calculated. Results: During the defined time of 14 months, we had 143 women visiting antenatal outpatient department and were tested positive for COVID-19. Majority of the women were tested for COVID-19 due to symptoms like fever, flu, cough and diarrhea. The mean age of women in our study was found to be 30 ± 6.7 years. The most frequent maternal outcome with SARSCOV-2 was preterm delivery. Out of 143, 27 cases had emergency lower segment C-section.PCR testing of neonates was carried out and 8.39% (n=12) neonates tested positive for SARSCOV-2. Conclusion: Infection with Covid-19 during pregnancy is associated with adverse pregnancy outcomes. Covid-19 infection can be transmitted to the fetus during pregnancy or childbirth. Neonatal has a high chance of being admitted to the ICU, and women also faces other complications of Covid 19, such as the risk of miscarriage and premature delivery.

A Prospective Study of Feto-Maternal Outcome Among Covid-19 Positive Women Delivered in a Level III Covid Hospital at Moradabad, Western UP

Background: The ongoing pandemic situation by a highly infective Covid-19 virus is a global health threat. Pregnancy related physiological changes of cardio- respiratory system and relative immunosuppression might cause more infectivity and worsening complications of this novel respiratory virus infection. Limited data availability on feto -maternal outcome of Covid 19 positive pregnant women necessitates the current study.Methodology: A prospective cohort study was conducted in a government designated level III Covid care hospital at Teerthankar Mahaveer Medical College & Research Centre to assess the feto-maternal outcome in Covid 19 RT- PCR test positive pregnant women delivered between April 2020 to September 2020. Mothers were evaluated in terms of asymptomatic status or predominant symptoms (fever, cough, sore throat, and breathlessness), complication if any including need for ventilatory support for extensive pneumonia, or mortality. Neonates were tested for presence of infection by RT-PCR test on day 2 & 5 of delivery, and also looked for any symptoms of the disease or it’s complication.Results: Total 33 women with Covid19 positivity delivered at term pregnancy in the said period of 6 months. The most frequent (45.45%) age group was 26 to 30 years. Asymptomatic Covid 19 positive cases were more (57.58%) prevailing over symptomatic patients. Fever was most frequent (33.33%) physical symptom. Emotional quotient was significantly affected by presence of anxiety amongst 36.36%. Caesarean delivery conducted maintaining all protocol in 60.6% women, but all were indicated for other obstetric reason. None of the mother had developed significant pneumonia or other complication. One case of maternal mortality noted, but was not related to Covid 19 infection. Vertical transmission was nil in our study and no neonate was affected by any complication.Conclusion: Course of disease was not different in pregnant women infected by Covid 19 virus in late pregnancy in comparison to non-pregnant adults. No case of vertical transmission noted, neither any neonatal morbidity nor mortality in present study, shows the importance of following optimum protocol. All pregnant women should be screened for Covid 19 infection in current scenario.

Case series on uterine rupture depicting the atypical presentations in the labour room

Uterine rupture is the complete division of all the three layers of uterus. Most uterine ruptures occur during labor in pregnant women, most commonly seen in previously scarred myometrium. Consequences of uterine rupture depend on the time between diagnosis of uterine rupture and intervention, and can be as grave as fetal and maternal death. Vigilance and avid action by the obstetrician can lead to better outcomes. Case 1 represented a 28-year-old moderately anemic G4P2L2A1 having previous 2 LSCS at POG 39 weeks 1 day presented in COVID emergency in active labour and was found to have a uterine scar rupture (5 cm rent) extending towards bladder wall with shoulder presenting on rent. A live female baby with thick meconium staining was delivered and uterine repair along with bilateral tubectomy was performed. Case 2 represented a 21-year-old primigravida with breech presentation at a gestation of 34 weeks 6 days with preterm labour pains who had been referred to our centre. Decision for LSCS was taken and on entering the abdomen rupture uterus with an inverted T-shaped rent in the upper segment extending up to the fundus was seen. A stillborn male fetus was delivered through the rent, followed by successful uterine repair. In spite of massive blood loss, the mother had survived. Case 3 represented a 30-year-old grand multipara at a gestation of 38 weeks 3 days with ultrasound documented fetal demise with fetal hydrocephalus and holoprosencephaly with labour pains was taken up for laparotomy due to suspicion of uterine rupture based on examination findings. Intra-operatively, baby was found lying in the peritoneal cavity with an unsalvageable uterus with a rupture in lower uterine segment and left lateral wall extending upto round ligament above and cervix below. A stillborn male fetus was delivered and peripartum subtotal hysterectomy with left salpingoophorectomy and right salpingectomy was done with a good maternal outcome. The above series suggest that the signs and symptoms of uterine rupture are usually variable and nonspecific, hence posing a challenge for the diagnosis. Early diagnosis and timely intervention by the obstetrician, can help us to improve the fetal and maternal outcome drastically.

Maternal outcome in accreta cases. Conservative surgery and hysterectomy in Cipto Mangunkusumo Hospital, Jakarta, Indonesia, from January 2017 to January 2018

HIGHLIGHT1. As the incidence of placenta accreta is increasing which seems to parallel the increasing cesarean delivery rate, advance planning should be made for the management of delivery. 2. Maternal outcome of placenta accreta cases in a national hospital was reported based on the surgical technique performed.3. No significant results of maternal outcome undergoing conservative surgery and conventional hysterectomy in managing accreta cases in the national hospital.ABSTRACTObjectives: To report maternal outcome based on surgical technique on the management of accreta. The study was conducted in Cipto Mangunkusumo Hospital, Jakarta, Indonesia from January 2017 to January 2018.Case Report: There were 1609 cases of pregnant women delivered during the study period. From these, the prevalence of previous caesarean section was 73 cases, including 20 cases of accreta. Total maternal mortality for 1 year in Cipto Mangunkusumo Hospital, Jakarta, Indonesia, was 11, and accreta contributed 3 cases. We reported 20 cases of accreta in pregnancy The maternal outcomes, including bladder injury, duration of operation, intraoperative bleeding, length of hospitalization, and mortality, were evaluated. From 20 cases, 8 patients had one previous caesarean history, 11 had second previous caesarean section, while 2 patient had third previous caesarean section history. Of women with placenta accreta, about 7 patients (35%) had delivery in fullterm pregnancies, while 13 (65%) had delivery in preterm pregnancy. Surgical technique in accreta management mostly was hysterectomy to override bleeding complication along the delivery. From 20 cases, 16 caesarean sections were followed-up with hysterectomy. Four cases were with conservative management. From all the hysterectomy performed, four were complicated with bladder injury. The mean intraoperative bleeding was 600 - 5500 cc of blood, while the mean of post-operative transfusion was 1000 -3000 cc. There were 2 maternal deaths in this study. Thirteen patients were admitted to the ICU after the procedure.Conclusion: Accreta increases morbidity due to massive bleeding. It is important to have algorithm for managing abnormal implantation of the placenta. Our cases revealed no significant results of maternal outcome between conservative surgery and conventional hysterectomy in managing accreta cases in Cipto Mangunkusumo Hospital, Jakarta, Indonesia.

Maternal Outcome of Anemic Pregnant Mother at Private Hospitals in Dhaka City

Introduction: The study carried out among the pregnant women who had anemia during pregnancy with the objectives to determine their maternal outcome at private hospitals in Dhaka city. Materials and Methods: The total sample size was 110. Data was collected by interviewing the respondents with a structured pre-tested questionnaire. The study was conducted in pregnant women with anemia at or after 28 weeks of gestation and had delivered at Obstetrics Department of Ad-Din Barrister Rafique ul-Huq Hospital, Jurain and Bashundhara Ad-Din Medical College Hospital South Keranigonj. Results: Most of the respondents (38.2%) belonged to the age group between 16-20 years. The mean age was 23.74±5.127 years. Almost (49.1%) up to primary & (38.2%) were up to secondary/higher secondary level. Most of the respondents were homemaker (87.3%); Monthly income means was 19340.91±12459.647. Most (90.9%) of the respondents had received ANC and 79.1% respondent’s hemoglobin level was below 10 gm. /dl. Among them 90.9% of the respondent’s fetal outcome were healthy & alive baby. More than half (51.8%) of the respondent’s baby were _ 2.5 kg birth weight. Study also shows that 55.5% respondents had anemia after delivery, 28.2% had sickness and 22.7% were sulfured with complications after delivery. There was a significant relationship with low birth weights (LBW) to less high education. Conclusion: All women should be given advice regarding diet in pregnancy with details of foods rich in iron. Dietary changes alone are not sufficient to correct an existing iron deficiency in pregnancy and iron supplements are necessary. Medicine Today 2021 Vol.33(2): 102-107