Fetal Surveillance in Pregnancies with Myasthenia Gravis

Myasthenia gravis (MG) is an autoimmune condition, that commonly impacts adult women of reproductive age. Myasthenia gravis in pregnancy is rare, but the incidence is higher in different geographical areas. Pregnancies in mothers with MG can have an unfortunate outcome. Acetylcholine receptor antibodies may pass into the fetal circulation and can affect the fetal neuromuscular junction, generating transient MG or even fetal arthrogryposis. The 2016 and 2021 International Consensus Guidance for Management of Myasthenia Gravis issued by Myasthenia Gravis Foundation of America is lacking in recommendation for fetal surveillance for pregnancies in women with MG. The aim of this paper is to highlight fetal and neonatal complications in mothers with MG and to offer antenatal care insights. Close maternal and pregnancy monitoring can improve pregnancy outcome. Patients with MG should be encouraged to conceive, to avoid triggers for exacerbations of the disease during pregnancy and a multidisciplinary team should be established to ensure the optimal support and therapy.

Feto-maternal outcome of oligohydramnios in tertiary care hospital

Background: The importance of amniotic fluid volume as an indicator of fetal wellbeing has made its assessment an important part of antenatal fetal surveillance. Oligohydramnios complicates 0.5% to 8% of pregnancies and the prognosis for pregnancies complicated by oligohydramnios is dependent on the gestational age and the underlying aetiology. This study aims to determine the feto-maternal outcome of oligohydramnios in a tertiary care hospital.Methods: In this study, we included 100 patients of oligohydramnios, with AFI ≤5 cm with a singleton pregnancy with intact membranes. The maternal outcome was accessed by mode of delivery and maternal complications and the neonatal outcome was studied by birth weight, APGAR score, NICU admission and perinatal mortality.Results: PIH was the most common risk factor in 38% of cases followed by IUGR in 29%, doppler changes in 24%. The reduced diastolic flow was the most common abnormal doppler finding in the 23% abnormal doppler cases, from which 39% underwent cesarean section, 9% required NICU admission and 61% had neonatal death. 53% delivered by cesarean section of which 13% had neonatal death. NICU admission is required in 64% of cases.Conclusions: We conclude that oligohydramnios is a high-risk pregnancy and proper antepartum care, intensive fetal surveillance and intrapartum care are required in a patient with oligohydramnios. Every case of oligohydramnios needs careful antenatal evaluation, parental counselling, individualization, decisions regarding time and mode of delivery. Continuous intrapartum fetal monitoring and good neonatal care are necessary for a better perinatal outcome.

Fetal heart rate tracing interpretation in cases of fetal heart block: A case series

Simple assessment of FHR baseline variability can differentiate second degree heart block (SHB) from complete heart block (CHB). In cases of SHB, antepartum NST can be reliably used for fetal surveillance. Intrapartum assessment of FHR variability as well as accelerations is useful to select cases for safe vaginal delivery

To evaluate the tests of antepartum fetal surveillance for predicting adverse perinatal outcome in pregnancy with IUGR

IUGR is one of the most common pregnancy complications which substantially increase risk of adverse neonatal outcome. The sequelae of IUGR include stillbirth, neuro-developmental delay in childhood and high risk of diseases like hypertension, diabetes in adulthood. Therefore, IUGR in pregnancy warrants intensive antepartum fetal surveillance to ensure optimal perinatal outcome.To evaluate the tests of antepartum fetal surveillance like AFI, BPS and Doppler ultrasound, alone and in combination for predicting adverse perinatal outcome in pregnancy with IUGR.This was a prospective observational study done on 100 pregnant IUGR women > 34weeks of gestation, at a tertiary care centre in Karnataka, from June 2017 till December 2018. They were monitored by tests of fetal surveillance like Amniotic Fluid Index (AFI), Bio Physical score (BPS) and Doppler ultrasound. Tests done within 48 hours before labour and its relation to perinatal outcome were assessed. Continuous data such as age, height, weight were described by mean and standard deviation. The sensitivity specificity, positive and negative predictive value were calculated for each test.The statistical difference between the normal and abnormal tests of antepartum fetal surveillance in relation to perinatal outcome was significant. Diagnostic accuracy of Doppler was 67%, BPS and AFI was 69%. In case of combination of findings of BPS and Doppler, the accuracy rose to 75%.Biophysical profile was most reliable diagnostic method than Doppler in predicting adverse outcome. Sensitivity increased when BPS and Doppler was combined which is beneficial in predicting perinatal outcome.