Retrospective Analysis of Hematological Parameters in Covid Positive Pregnancy

The newly identified SARS-CoV-2 virus and its ongoing implicated COVID-19 pandemic started off as pneumonia of unknown aetiology in Wuhan, China, in December 2019. Certain laboratory values that may be considered deranged in non pregnant states are normal physiological changes in pregnancy. An understanding of the normal haematological and immunologic parameters in pregnancy is necessary for the interpretation of COVID-19 severity. Considering the COVID-19 infection is still new, little is known about the clinical course of the disease in pregnancy. This is a retrospective observational study undertaken in the Department of Obstetrics and Gynaecology, Saveetha Medical College Hospital, Chennai, India, from April to November 2020. Out of the 50 women in the study, 19 women were anaemic with haemoglobin <11, accounting for 38% of the study population. A neutrophil to lymphocyte ratio greater than 4.5 was observed in 44% of the population. Thrombocytopenia was present in 12% of the population. D-dimer greater than 1000 was found in 12% of the study population. All of our patients were asymptomatic, had good maternal and fetal outcomes even though derangement of inflammatory markers were noted. The immunological changes of pregnancy make pregnant women more susceptible to pathogens. Though our patients had instances suggestive of critical prognosis like an increased neutrophil-lymphocyte-ratio and affirmative acute phase reactants and inflammatory markers, they were asymptomatic (category BNH) and stable in room air. However, further analysis of laboratory parameters and their correlation to clinical scenarios in the second wave of COVID19 infection is warranted.

Trends in Faecal Calprotectin Levels During Pregnancy in Non-IBD Patients

Background and Aims: No optimal marker exists to assess activity of inflammatory bowel disease (IBD) during pregnancy, though faecal calprotectin (FCP) is the most commonly used test. However minimal data exists on what a normal calprotectin level is during pregnancy and post-partum in healthy individuals. Objective: Our aim is to determine normal FCP levels during pregnancy and post-partum in a healthy population. Methods: We performed a prospective analysis of FCP levels from pregnant women at 16- and 34-weeks’ gestation and 4- and 12-weeks post-partum. Patient demographics were collected. FCP concentrations were measured with a quantitative ELISA assay. Results: 98 patients were included in our study. 172 maternal stool samples were collected in total; 62 samples at 16-weeks’ gestation, 48 samples at 34-weeks’ gestation, 38 samples from 4-weeks post-partum and 24 samples from 12-weeks post-partum. Median age was 33.0 years. 41 patients had a BMI > 25 (41.8%). 16 patients were ex-smokers (16.3 %). The median FCP levels at 16-weeks’ gestation was 29.5 µg/g (range 10–476 µg/g), median level from 34-weeks’ gestation was 25.6 µg/g (range 10–259 µg/g), from 4-weeks post-partum was 23.4 µg/g (range 10–318 µg/g) and 12-weeks post-partum was 29.4 µg/g (range 10–216 µg/g). There was no significant change in median FCP levels over the course of pregnancy and post-partum (p = 0.294). Conclusion: Faecal calprotectin levels are not affected by physiological changes in pregnancy or post-partum in normal healthy individuals without IBD. This suggests FCP is a useful tool for identifying flares of colitis during pregnancy.

Pregnancy Outcome in First 50 Sars-Cov-2 Positive Patients At Our Center

OBJECTIVES: Suppressed immune system and physiological changes in pregnancy put pregnant women vulnerable to various viral diseases. Various studies have reported adverse pregnancy outcomes in SARS-CoV-2 infection. This study aimed to evaluate the maternal and fetal outcomes in SARS-CoV-2 affected pregnancies at our set up. STUDY DESIGN: It was a prospective cohort study conducted at a tertiary care Army Hospital, India. The first 50 cases of SARS CoV-2 positive pregnant women and 144 suspected cases that were found SARS-CoV-2 negative, received and managed at separate set up, during a period extending from 01 April 2020 to 15 Sep 2020 were included in our study. Their obstetric and neonatal outcomes along with the demographic and other clinical data were compared. RESULTS: Total RT-PCR positivity rate of SARS-CoV-2 infection in pregnant women was 2.7%. 96% of our patients were asymptomatic for SARS-CoV-2 infection. Premature rupture of membrane, preterm delivery, and NICU admission was similar in both groups. There were increased incidences (70%) of cesarean section in SARS-CoV-2 positive pregnant women. CONCLUSION: The study reported comparable maternal and fetal outcomes in SARS-CoV 2 positive pregnant women when compared with SARS-CoV-2 negative pregnant women.

Transmediastinal Gunshot Wound in a Pregnant Patient with Stable Hemodynamics

Transmediastinal gunshot wounds (TGWs) may lead to life-threatening injuries of vital organs such as large vessels, the esophagus, and lungs. Although they are not commonly encountered in pregnant women, additional caution should be given to these patients. Physical examination for the diagnosis and the choice of treatment modality contain controversial points in hemodynamically stable patients, and resuscitation has excessive importance due to physiological changes in pregnancy. We present a hemodynamically stable 26-week pregnant woman brought to the emergency department for TGW. She had a 1-cm diameter of bullet entrance hole on the right anterior 4th intercostal space, 2 cm lateral to the sternum, and a 3-cm diameter exit hole on the right posterior 12th intercostal space on the midscapular line. With our conservative approach, she had an uncomplicated pregnancy period, and gave birth to a healthy baby at term.

Evaluation of physiological changes and therapeutic approaches of hypertension in pregnancy

There are various physiological and pharmacokinetic changes occur in pregnancy to nurture the developing foetus, avoid toxicities, resistance to infections and prepare the mother for labour and delivery. Some of these changes influence normal biochemical values while others may mimic symptoms of medical disease and alter the kinetic parameters of the drugs. It is important to differentiate between normal physiological changes and disease pathology. This article highlights the important changes that take place during normal pregnancy, development of common conditions and pharmacokinetic variations. This review also will describe basic concepts in pharmacokinetics and their clinical relevance and highlight the variations in pregnancy that may impact the pharmacokinetic properties of medications, different treatment approaches, contraindications and drugs used in pregnancy Key words: Physiological changes in pregnancy, Hypertension, pregnancy disorders.

Изменения тиреоидного статуса и оценка функции щитовидной железы при нормально протекающей беременности

The article discusses the change in the functioning of the thyroid gland during physiological changes in pregnancy, as well as the effect of manifest and subclinical thyroid dysfunction on fertility and adverse pregnancy outcomes. Thyroid function assessment questions are considered during planning and pregnancy.