A new indication for elective induction of labor COVID-19 pandemic effect

Background: Induction of labour is performed in certain circumstances which involve greater risks of waiting for the onset of spontaneous labour than the risks due to shortening the duration of pregnancy by induction. The objective of this study was to evaluate the maternal and fetal outcome in patients undergoing elective induction during COVID-19 pandemic.Methods: This prospective observational study was conducted on 60 ANC patients with singleton pregnancy and POG >39 weeks coming to OPD with negative COVID-19 RT-PCR report. To avoid the burden of repeat testing after one week and risk of exposure to COVID-19 virus from community, patients were induced. All the data was recorded and analyzed.Results: Most of the patients were in age group of 20-25 years (50%) and only 6.7% of the patients were older than 30 years. 32 (53.3%) patients were multiparous and 50% of the patients were having Bishop score between 2-5 and only 8.3% had bishop score of more than 5. 47 patients (78.3%) underwent normal vagina delivery whereas 12 patients (20%) underwent LSCS. Failure of Induction was the indication for LSCS in 5 patients (41.7%).Conclusions: Elective induction was found to be better option in COVID-19 negative patients. All pregnant women should be monitored for development of symptoms and signs of COVID-19 particularly if they have had close contact with a confirmed case. Pregnancy and childbirth generally do not increase the risk for acquiring SARS-CoV-2 infection but may worsen the clinical course of COVID-19 compared with nonpregnant individuals of the same age.

Steroid receptor coactivator 3 (SRC-3/AIB1) is enriched and functional in mouse and human Tregs

A subset of CD4 + lymphocytes, regulatory T cells (Tregs), are necessary for central tolerance and function as suppressors of autoimmunity against self-antigens. The SRC-3 coactivator is an oncogene in multiple cancers and is capable of potentiating numerous transcription factors in a wide variety of cell types. Src-3 knockout mice display broad lymphoproliferation and hypersensitivity to systemic inflammation. Using publicly available bioinformatics data and directed cellular approaches, we show that SRC-3 also is highly enriched in Tregs in mice and humans. Human Tregs lose phenotypic characteristics when SRC-3 is depleted or pharmacologically inhibited, including failure of induction from resting T cells and loss of the ability to suppress proliferation of stimulated T cells. These data support a model for SRC-3 as a coactivator that actively participates in protection from autoimmunity and may support immune evasion of cancers by contributing to the biology of Tregs.

Study of maternal and fetal outcome in pregnancy beyond 40 weeks: a prospective observational study at a tertiary institute

Background: Prolonged pregnancy is one that exceeds 42 0/7weeks. Management of prolonged pregnancy is very challenging in modern obstetrics.Methods: It is prospective observational study in department of Obstetrics and Gynecology, Shri B.M Patil medical college and Research center, deemed to be University, Vijayapur, North karnataka. Study period was from January 2018 to January 2019.Results: Total of 186 pregnant women were included in the study. Results in terms of age, gravidity, gestational age, time of induction, mode of delivery, neonatal outcome and maternal complications.Conclusion: Pregnancies beyond 40 weeks require early detection, effective fetal monitoring and proper planning of labour. In pregnancies beyond 40 weeks, decision of induction should be taken cautiously as early induction leads to failure of induction and increased rates of lower (uterine) segment Caesarean section (LSCS), while delayed induction leads to increased fetal complications.

Study of caesarean section at tertiary care centre: a retrospective study

Background: Caesarean section (C-section) is one of the most widely performed surgical procedure in obstetrics worldwide. The WHO guidelines revised in 1994 states that the proportion of C-section birth should range between 5-15% but both in developed and developing countries C-section rate is on the rise. This study was conducted to analyse the frequency and indications for C-section and associated maternal morbidity and mortality.Methods: This retrospective study was conducted over a period from January 2018 to May 2019 at the department of obstetrics and gynecology, NKP Salve Institute of Medical Sciences and Research Centre and Lata Mangeshkar Hospital, Hingna, Nagpur, Maharashtra, India. Data of patients who delivered by C-section in our hospital during the defined study period were studied and statistically analysed according to various parameters namely, the frequency of caesarean section, its indications, age, parity and gestational age of the patient.Results: The total number of women delivered over the study period were 2811. Out of which C-sections were done in 1461 women (51.97%). Previous C-section was the leading indication in 35.72% women followed by fetal distress 14.09%, failure of induction 12.93%, arrest of labour 7.93%, PIH 7.18%, oligo/IUGR 6.50%, breech 4.44%, refusal of vaginal birth 4.24%, CPD 1.71%, bad obstetrics history (BOH) 1.43%, malpresentation 1.30%, prematurity 1.23%, and multifetal gestation in 1.09% women. Two women had classical C-section 0.07. 14.09% women had various complications. There was no maternal mortality.Conclusions: A high rate of caesarean deliveries was observed. Individualization of the indication and careful evaluation, following standardized guidelines can help us to limit C-section. Audit and feedback are the best way to judge clinical practice and to reduce the frequency of caesarean section in any tertiary setup.

Broad ligament term pregnancy in an unscarred uterus: misdiagnosis and the challenges

A broad ligament pregnancy is a rare condition, but full term broad ligamnet pregnancy especially in an unscarred uterus is extremely rare. It is often misdiagnosed and usually finally diagnosed during surgery. Here is case of full term broad ligament pregnancy, which remained undiagnosed throughout her pregnancy, unfortunately had IUFD. Patient was referred to our hospital in view of failure of induction with increased BP records. No ultrasound was available on admission. On clinical assessment it appeared as transverse lie with IUFD. So cesarean was decided as a mode of delivery. Emergency ultrasound could just confirm IUFD with pelvic mass? Fibroid (actually deviated uterus). On laparotomy the broad ligament pseudosac had occupied entire abdomen. After delivery of baby, anatomy was found completely distorted. Highly vascular omental adhesions on fundus with difficulty in placental removal. Placenta could be traced reaching abdomen posteriorly. The first clinical impression was suspicion of placenta percreta. Uterus appeared non salvageable and hysterectomy was decided. Placenta was found lying in abdomen, adhered to bowel, omentum and fundus of uterus. The final diagnosis of broad ligament pregnancy could be made after the cut section of the uterus and anatomic evaluation. Patient required blood transfusions preoperatively .She remained stable and discharged on postoperative day nine. This case holds importance because may be outcome was different if it was a booked and investigated pregnancy. May be baby and uterus were salvageable with better outcome.

Assessment of maternal and perinatal outcome in cases of prolonged pregnancy in a tertiary healthcare institute: a cross sectional observational study

Background: Prolonged pregnancy has always been regarded as a high‑risk condition because perinatal morbidity and mortality is known to rise. The interest in postdatism (just beyond expected date of delivery) has been recent and the management is controversial, more so with the advent of sonography providing information about placental aging and amount of amniotic fluid. The aim of the present retrospective study was to analyze the outcome of pregnancies which crossed the expected date of delivery.Methods: The present study was a cross sectional observational study, conducted between April 2018 to September 2018, among 90 cases presented with post dated pregnancy under the department of obstetrics and gynecology, in a tertiary medical teaching institute in Maharashtra.Results: Maximum number of cases, i.e., 22.22% indications were meconium stained liquor with fetal distress, in 18.51% cases indications were failure of induction, in 22.22% indications were nonreactive NST, in 17.61% cases indications were CPD.Conclusions: It was concluded that prolonged pregnancy was associated with significant risk of perinatal complications such as fetal distress, meconium aspiration syndrome and IUGR.

Efficacy of vaginal Misoprostol versus transcervical Foley’s catheter and vaginal Misoprostol in induction of labor

Background: The objective is to compare the efficacy of vaginal Misoprostol versus transcervical Foley’s catheter and vaginal Misoprostol.Methods: A prospective study analyzing the comparative efficacy of intravaginal instillation of Misoprostol in two groups (tablet Misoprostol 50mg alone and combination of intracervical Foley’s catheter and tablet Misoprostol 50mg) carried out in the labour room on 300 subjects (150 subjects in each group), from May 2013 to November 2015.Results: The common gestational age at the time of induction was 36-40 weeks and the most common indication was premature rupture of membrane. In both the groups, most of the cases delivered within 12 hours. present results show that statistically significant number of cases delivered vaginally within 12 hours with the group using Misoprostol plus Foley’s catheter as compared to the group using Misoprostol alone. Cesarean section rate was 12.67% in Misoprostol group and 10.67% in Misoprostol plus Foley’s catheter group. Incidence of failure of induction was similar in both the groups. The incidence of babies with Apgar score less than 8/10 at 5 minutes and incidence of early neonatal death were similar in both the groups.Conclusions: Addition of intracervical Foley’s catheter to vaginal Misoprostol for induction of labor in subjects with unfavorable cervices reduces the Induction-Delivery interval without added side effects or complications to the mother and fetus.

The Argument from Simplicity and (M) The Argument from Induction

This chapter presents a new thermodynamic argument for the existence of God. Naturalistic physics provides evidence for the failure of induction, because it provides evidence that the past is not at all what you think it is, and your existence is just a momentary fluctuation. The fact that you are not a momentary fluctuation thus provides evidence for the existence of God—God would ensure that the past is roughly what we think it is, and you have been in existence for roughly the amount of time you think you have. There is no definitive way for the atheist to refute this argument, but one suggestion is given that relies on physics-based simplicity considerations. The chapter closes with an epistemological discussion of self-undermining arguments.