Pregnancy outcomes after spontaneous conception with previous spontaneous abortion preceding present pregnancy

Background: The objective of the present study was to study pregnancy outcomes in patients with Spontaneous conception with history of previous spontaneous abortion preceding present pregnancy.Methods: A prospective study included patients with spontaneous conception with history of previous spontaneous abortion preceding present pregnancy admitted in the department of obstetrics and gynecology, command hospital, Pune between October 2018 and April 2020. The patients were booked (minimum 3 visits in antenatal outdoor clinic) or admitted for the first time as an emergency. The detailed history about previous abortions was taken and routine as well as investigations for possible etiologies of previous abortions were done. Cases with history of mid-trimester abortion were investigated for cervical incompetence. All the patients were observed for complications during present pregnancy like threatened abortion, preeclampsia, preterm labour, intrauterine death and final outcome.Results: A total of 110 patients with history of previous spontaneous abortion were admitted, all patients were booked. Majority (51.8 %) of patients belong to the age group 25-30 years. All patients were with history of previous one abortion followed by pregnancy with spontaneous conception. The final outcomes were term live birth (86.4%), abortion (8.2%), preterm delivery (5.4%), and no still birth. Caesarian section was done in 32.7% patients for various indications.Conclusions: Previous history of spontaneous abortion is associated with adverse pregnancy outcome. There is increased risk of abortion, preterm delivery, need for caesarean sections and fetal loss in cases of previous spontaneous abortions. These complications and fetal loss can be reduced by booking the patients and giving due antenatal care.

Express method for determining the probability of developing congenital pneumonia in preterm infants with low body weight

Background. According to the World Health Organization, more than 2 million children under the age of five die from pneumonia every year, accounting for almost 1 in 5 deaths. Therefore, the aim of the study was to develop a mathematical model for determining the probability of developing congenital pneumonia in premature infants with low body weight by the express method. Materials and methods. A comprehensive examination of 171 newborns who stayed at the maternity physiology department, the department of anesthesiology and resuscitation (with wards for newborns) and the pediatric department for premature newborns of the State Institution “Republican Scientific and Practical Center “Mother and Child” was conducted. Results. A comparative analysis was carried out of more than 200 life history data, outcomes of previous pregnancies, complications of present pregnancy and clinical and laboratory methods of research in newborns in the first three days of life. Subsequently, the most significant factors associated with the development of congenital pneumonia in premature infants with low body weight were determined. The mathematical analysis of more than 380 million connections of variables is carried out. As a result of the survey, compared with the comparison group and the control group, the most significant factors were established: from the obstetric-gynecological and somatic history of the mother’s life — non-developing pregnancy (odds ratio (OR) = 13.46 (10.11–17.91); OR = 32.72 (24.76–43.22)) and spontaneous miscarriage (OR = 3.79 (2.69–5.35); OR = 19.19 (14.57–25.26)); from the complications of a present pregnancy — chronic fetoplacental insufficiency (OR = 3.47 (2.48–4.87); OR = 38.29 (28.78–50.91)), intrauterine growth restriction syndrome (OR = 11.56 (8.70–15.35)) and the threatened miscarriage (OR = 2.73 (1.76–4.23); OR = 3.96 (2.51–6.25)); according to the results of clinical manifestations in infant in the first three days of life — severe respiratory failure (OR = 6.90 (5.01–9.49)). Based on the obtained data, a mathematical model was developed with a sensitivity of 76.4 %, specificity — 83.0 %, and the area under the ROC curve = 0.840 ± 0.056 (0.76–0.91), p < 0.001. Conclusions. Using the model, threshold values were calculated: for non-developing pregnancy — 0.769, spontaneous miscarriage — 0.493, chronic fetoplacental insufficiency — 0.366, intrauterine growth restriction syndrome — 0.334, threatened miscarriage — 0.283, respiratory failure degree III — 0.703, which at the threshold values ≥ 0.49 allows us to single out a high-risk group for the development of congenital pneumonia among premature infants with low body weight.

The impact of interpregnancy interval on occurance of preterm births in the present pregnancy

Background: The pregnancy outcomes are influenced by the inter pregnancy intervals. Both short and long inter pregnancy intervals are known to adversely affect the mother and the baby. The main aim of birth spacing was to achieve ideal inter pregnancy intervals and thus to decrease maternal, neonatal morbidity and mortality.Methods: It is a prospective observational study. In this study, about 500 gravida 2 women who has delivered vaginally in the index pregnancy, with gestational age more than 28 weeks of gestation and with known interpregnancy interval were included in the study. They followed up to to delivery and occurance of preterm births in relation to maternal characteristics and interpregnancy interval were analysed.Results: Our study showed that Inter pregnancy intervals of 18-24 months were found to have the least number of preterm births when compared to intervals <18 months and >24 months. This association was found to be statistically significant (p value, Pearson chi square 0.0008). This relationship between inter pregnancy intervals and preterm births persisted when stratified according to maternal age, education, residence and BMI.A previous preterm birth was associated with increased risk of recurrent preterm birth (p value -0.034) and was statistically significant. The history of PROM in present pregnancy associated with preterm birth (p value -0.001) and association was statistically significant.Conclusions: From this study it was found that the 18-24 months birth to pregnancy interval is associated with the least incidence of preterm births.

Modified Laparoscopic Transabdominal Cervicoisthmic Cerclage for the Surgical Management of Recurrent Pregnancy Loss due to Cervical Factors

This study aimed evaluate the feasibility of modified laparoscopic transabdominal cervicoisthmic cerclage (LTCC) and its impact on recurrent pregnancy loss (RPL) and is a retrospective observational cohort study of patients who underwent modified LTCC from 2003 to 2018 (n = 299). The surgery was performed at a mean gestational age of 12.5 weeks (range 10.5–17.5 weeks). Of the 299 patients, 190 were reported as having undergone abortion (one abortion: 91 (47.9%), two: 59 (31.1%), three or more: 40 (21.1%)) before the present pregnancy and prior to the surgery. The mean operation time was 47.4 min (range 15–100 min). We followed up with 205 of 299 patients and recorded their obstetric outcomes. There were 176 successful deliveries via cesarean section, and the fetal survival rate was 85.9% (176/205). The results of this study suggest that modified LTCC is a safe and feasible surgical option during pregnancy for patients with a history of RPL due to cervical factors.

Attitude of pregnant women towards institutional delivery: a study in Khaag block-a tribal area of the Kashmir valley

Background: Motherhood is often a positive and fulfilling experience but for many women it is associated with suffering, ill health, and even death. Improving maternal health is one of the thirteen targets for the sustainable development goal 3 (SDG-3) on health adopted by the international community in 2015. Objective of the study was to find out the attitude of pregnant women towards institutional delivery in Khaag block of district Budgam.Methods: A cross-sectional, community-based study was conducted, in February 2018 to March 2018, to assess attitude of pregnant women towards place of delivery in a tribal area of Khaag area of district Budgam. For this study, 99 pregnant women were approached. Informed consent was obtained from the participants and the registered pregnant women were interviewed by a pre-designed questionnaire. Results: Mean age at the time of contact was 28 years with a standard deviation of 3.87 years. The maximum years of schooling were 10 years. It was found that the last delivery was conducted at hospital for about 76% of women but for the present pregnancy 88% of the women had decided to have it conducted at the hospital. Thus, the attitude of women towards institutional deliveries has changed positively (p=0.001).Conclusions: Percentage of institutional deliveries is still less in rural area of Khaag is Kashmir. For decreasing the maternal and infant mortality rates further, much is still to be done. Awareness needs to be generated among common masses for promoting institutional deliveries. Educating women folk will make them confident in decision making.

Prenatal diagnosis of spinal amyotrophy

The first regional case of pregnancy management in a patient with a child with spinal muscular atrophy is presented. In the present pregnancy for the purpose of prenatal diagnosis of spinal amyotrophy at 12 weeks transabdominal aspiration of chorion villi was performed, followed by molecular genetic research, which revealed the deletion of exons 7–8 of the SMN 1 gene (survival motor neuron) in the homozygous state. Due to the unfavorable prognosis abortion was performed for medical reasons. Thus, to reduce the risk of having a child with spinal muscular atrophy in families with identified mutations in the SMN 1 gene, prenatal DNA diagnosis of this hereditary pathology is recommended.

Methods of efferent therapy in prolongation of pregnancy in the isthmic-cervical insufficiency (two clinical observations)

The report presents two clinical observations of pregnancy outcome in patients with isthmic-cervical insufficiency of functional (first observation) and functional-organic (second observation) origin. In both cases, previously treated cervical erosion by laser (in the second observation – carried out excision of the cervix). In secundiparous women in the present pregnancy were noted recurrent urogenital (first observation) and genital (second observation) infection with a threatened miscarriage and the need for re-hospitalizations. Complex therapy with the introduction of obstetric discharge pessarium was not effective enough, there were manifestations of the inflammatory response of the body, isthmic-cervical insufficiency progressed, up to prolapse of the fetal bladder into the cervical canal (first observation). When entering the perinatal center, the treatment of pregnant women included methods of low-volume membrane plasmapheresis and photomodification of blood with ultraviolet and laser rays (alternated). In both cases, it was possible to stop the manifestations of inflammatory response, to improve the condition of the cervical canal, to prolong pregnancy to the term of normal childbirth. In the first observation, the birth occurred naturally, in the second case cesarean section was performed due to organic changes in the cervix. Childbirth, the postpartum period in women proceeded normally. Children were born healthy, full-term, develop normally, receive breastfeeding.

A case of foetal macrosomia

Fetal macrosomia is an upcoming challenge in the field of obstetrics due to its rising incidence. The incidence varies according to ethnicity, genetic differences and anthropometric discrepancies between populations. Obesity, previous history of macrosomia, multiparity, diabetes and post-dated pregnancy are few risk factors associated with macrosomia. Management of macrosomia is a big challenge as no precise guidelines have been set. Macrosomia is associated with multiple maternal and foetal complications like operative delivery, post partum haemorrhage, perineal trauma, shoulder dystocia, brachial plexus injury, skeletal injury, birth asphyxia etc. We report a case of foetal macrosomia, weighing 5.5kg which was delivered by LSCS to a woman having BMI - 26.6kg/m² with 39 weeks of pregnancy with history of previous LSCS. There was no maternal or foetal complication. There was no history of diabetes in present pregnancy and inter conception period. Because of rarity of this condition we report this case of foetal macrosomia with a short review of literature.

Anamnestic and microbiological predictors of miscarriage

Hypothesis/aims of study. Miscarriage is a significant medical and social problem. The etiology of pregnancy losses is diverse and depends on many factors. It is believed that dysbiotic disorders of the vagina are one of the main causes of this pathology. While the etiopathogenesis of miscarriage is actively studied, many questions still remain open. The aim of the study was to investigate anamnestic and microbiological predictor factors of miscarriage. Study design, materials, and methods. In a prospective cohort study, 159 pregnant women were examined in the first trimester of pregnancy: the anamnesis, course of pregnancy, vaginal microflora, and present pregnancy outcome were studied. The vaginal microflora was analyzed using microscopic, bacteriological and quantitative real-time PCR methods. Depending on the present pregnancy outcome, the patients were divided into two groups: those delivered at term and women with early and late miscarriage. The analysis of predictors of miscarriage of the ongoing pregnancy was performed depending on the period of delivery. Results. The rate of miscarriage in women was 13%. The independent predictors of early miscarriage were chronic endometritis (OR 10.54; 95% CI 2.54 to 43.64), the dominance of Lactobacillus iners in the vaginal microflora (OR 8.52; 95% CI 2.07 to 35.05), and the prevalence of non-Lactobacillus species in microscopy of vaginal preparations (OR 4.50; 95% CI 1.02 to 19.69). The dominance of Lactobacillus crispatus was a significant protective factor of late miscarriage (OR 0.20; 95% CI 0.04 to 0.99). Conclusion. The undertaken analysis revealed significant associations of a number of anamnestic and microbiological predictor factors with miscarriage, which will enable to substantiate approaches for predicting pregnancy outcomes at different gestational age and to develop methods of pre-conception care and treatment in women with different risk of miscarriage.

Effects of interpregnancy interval and outcome of preceding pregnancy on present pregnancy outcome

Background: The objective of the present study was to estimate the effects of interpregnancy interval and outcome of preceding pregnancy on present pregnancy outcome.Methods: This study was undertaken as observational study. 1000 women were included in this study then interpregnancy interval categorized in 4 groups. Outcome of preceding pregnancy were included in term of induce abortion, miscarriage, still birth and live birth.Results: For each group the highest rate of IA occur for woman whose previous pregnancy ended with an IA. For pregnancy after an IA the rate of subsequent IA is 16.6%, 11.6%, 5% for IPI of <6 month, 6-14 months and 27-50 months respectively. Overall lowest rate of IA found for IPI of 27-50 months following live birth i.e. 1.25% and for group III 2% only. Rate of miscarriage was higher for IPI of <26 months began with a miscarriage 15.6% and 13.6% for following live birth.Conclusions: Outcome of present pregnancy not only depend upon interpregnancy interval but also depend upon outcome of preceding pregnancy. So, outcome of previous pregnancy will also determine outcome of present pregnancy.