Journal of South Asian Federation of Obstetrics and Gynaecology

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Volume 13, Number 4, July-August 2021

From the Editor\'s Desk

Jaideep Malthora

From the Editor's Desk

[Year:2021] [Month:July-August] [Volume:13] [Number:4] [Pages:1] [Pages No:00 - 00]

PDF  |  DOI: 10.5005/jsafog-13-4-iv  |  Open Access |  How to cite  | 

Original Article

Preeti F Lewis, Amita S Budhewar, Nitin Bhimrao Bavdekar

Fetomaternal Outcome of Pregnant Women Infected with Tuberculosis: An Analytical Study

[Year:2021] [Month:July-August] [Volume:13] [Number:4] [Pages:5] [Pages No:197 - 201]

Keywords: Antenatal women, Maternal death, NICU admission, Perinatal outcome, Preterm birth, Stillbirth, Tuberculosis

PDF  |  DOI: 10.5005/jp-journals-10006-1948  |  Open Access |  How to cite  | 

Abstract

Background: Tuberculosis (TB) remains a major global public health problem, despite that maternal TB remains an obscure and underestimated issue. The prevalence of TB in pregnancy is not well known. The present study is aimed to determine the prevalence of TB and assess the obstetrical and perinatal outcomes of TB in antenatal women. Materials and methods: A prospective observational study was done in a tertiary care center over a period of 1 year from January 2019 to January 2020. Pregnant women in the age-group of 18–42 years diagnosed with TB in the antenatal period were included in our study for evaluating maternal and fetal outcomes. We excluded those antenatal women with a history of TB and adequately treated and cured and those women with TB who did not deliver during the study period. Data collected from individual case record included age, parity, socioeconomic status, time of diagnosis, and complication in antenatal, intrapartum, and postpartum period. The mean birth weight of infants and frequency of small for gestation, stillbirth, neonatal depression, neonatal intensive care unit (NICU) admission, and neonatal death were noted, and perinatal outcome was seen. Results: Five-thousand and two hundred patients delivered during the study period; among those, 70 diagnosed with TB in the antenatal period were included, making a prevalence rate of 1.34/1,000 per pregnant woman. There was a significant increase in the incidence of preterm delivery, anemia, and intrauterine growth restriction in TB. In our study, we found that maternal and perinatal outcomes in pregnant women with TB depend on site, the severity of disease, gestation at diagnosis, and complication of TB. Conclusion: The prevalence of TB in antenatal women at our institute was 1.34/1,000 per pregnant woman. A high suspicion is required to acknowledge the varying disease spectrum and thus complications of TB in antenatal women and initiate treatment early for better outcomes.

Original Article

Rasika S de Silva, Hemantha Perera

Serial Measurements of Fetal Head Circumference and Abdominal Circumference to Predict Fetal Growth Restriction in a Sri Lankan Study Population

[Year:2021] [Month:July-August] [Volume:13] [Number:4] [Pages:5] [Pages No:202 - 206]

Keywords: Fetal growth restriction, Noncommunicable diseases, Ponderal index, Serial ultrasound scans, Thrifty phenotype

PDF  |  DOI: 10.5005/jp-journals-10006-1933  |  Open Access |  How to cite  | 

Abstract

Aim and objective: Prediction of fetal growth restriction (FGR) by serial ultrasound measurement of head circumference (HC) and abdominal circumference (AC) of the fetus applied routinely to all mothers irrespective of risk status for FGR and small for gestational age. Materials and methods: A prospective study was done of 508 pregnant women who underwent two successive growth scans 4 weeks apart at Sri Jayewardenepura General Hospital, Sri Lanka. FGR was identified by graphically plotting serial fetal AC and HC. Postnatally, growth restriction was diagnosed based on ponderal index (PI). Sensitivity, specificity, positive predictive value, and likelihood ratio of predicting FGR by successive serial ultrasound measurements of fetal AC and HC were calculated. Results: Based on fetal AC and HC, FGR was present in 223 of 508 fetuses (43.89%). Based on PI, 224 of 508 (44.1%) neonates were growth-restricted. Sensitivity, specificity, positive predictive value, positive likelihood ratio, and negative likelihood ratio of predicting FGR by serial fetal AC and HC were 82.59, 86.62, 82.59%, 6.2, and 0.2, respectively. Conclusion: Serial ultrasound measurements of fetal AC and HC plotted on a fetal growth centile chart routinely carried out in all mothers irrespective of risk status for FGR increases the detection of FGR.

Original Article

Shweta A Khade, Shriya P Pandya, Meenal S Sarmalkar, Arun H Nayak

Fetomaternal Outcome in Referral Obstetric Patients in Tertiary Care Hospital

[Year:2021] [Month:July-August] [Volume:13] [Number:4] [Pages:5] [Pages No:207 - 211]

Keywords: Fetomaternal outcome, Maternal morbidity, Maternal mortality, Referral cases

PDF  |  DOI: 10.5005/jp-journals-10006-1934  |  Open Access |  How to cite  | 

Abstract

Aim and objective: To identify indication and fetomaternal outcome of emergency obstetric referral to our hospital so as to reduce fetomaternal morbidity and mortality. Materials and methods: This retrospective observational study was done at the Department of Obstetrics and Gynecology, LTMMC and LTMGH, Sion, Mumbai, for a duration of 1 year from January 2020 to December 2020. All referred patients in emergency for obstetrics indications above 20 weeks were analyzed for fetomaternal outcome and their indication of referral. Results: In our study, of a total of 7,751 delivered patients, 2,233 (28.8%) cases were referred. Maximum 1,711 (76.6%) cases were in the 21–30 years age-group and (66.86%) cases referred from secondary centers. The most common referral indication was fetal, meconium-stained amniotic fluid, and fetal distress 432 (19.4%), followed by preterm labor 291 (11.1%) as maternal indication. One thousand seven hundred twenty-seven (77.4%) patients delivered by lower segment cesarean section. Maternal morbidity was seen in 370 (16.6%) patients, of which 41 (11%) patients required intensive care unit admission. Maternal mortalities were 12. Total 1,832 (80.8%) neonates were shifted to mother and 325 (14.3%) required NICU admission. Conclusion: To reduce unnecessary referrals and burden on tertiary care hospitals, first referral units (FRUs) should be strengthened and healthcare workers should be trained in essential and emergency obstetric care, which will help in reducing morbidity and mortality.

Original Article

Amrita Singh, Richa Yadav, Shipra Kunwar, Shweta Kumari, Kumkum Shrivastava

Comparative Evaluation of Diabetes in Pregnancy Study Group of India and International Association of Diabetes and Pregnancy Study Groups: Criteria for the Diagnosis of Gestational Diabetes Mellitus

[Year:2021] [Month:July-August] [Volume:13] [Number:4] [Pages:4] [Pages No:212 - 215]

Keywords: Diabetes in Pregnancy Study Group of India, Gestational diabetes mellitus, International Association of Diabetes and Pregnancy Study Groups

PDF  |  DOI: 10.5005/jp-journals-10006-1935  |  Open Access |  How to cite  | 

Abstract

Introduction: Gestational diabetes mellitus (GDM) is a glucose tolerance disorder that occurs or is diagnosed for the first time during pregnancy. GDM affects 1–14% of all pregnancies, and its incidence has been steadily rising. GDM is a major cause of perinatal morbidity and mortality, as well as maternal morbidity. It is therefore highly important that these mothers are diagnosed during pregnancy and that they have a regular postpartum follow-up for identification and treatment of any complications. Materials and methods: All antenatal women attending the antenatal clinic (ANC) at 24–28 weeks of pregnancy were included in the study. After obtaining history, detailed examination, and informed consent, 2 mL of blood sample was taken in fluoride vial under all aseptic precautions in nonfasting state and after giving 75 g oral glucose load. Blood sugar levels were assessed in the obtained samples. All those women having blood sugar levels >140 mg/dL were categorized as GDM as per the Diabetes in Pregnancy Study Group of India (DIPSI) criteria. Same women were called again after 3–4 days in fasting state. First, 2 mL of the sample was taken in fasting state and then after giving oral glucose load of 75 g. Samples were taken after 1 and 2 hours consecutively. All those women who are having any single plasma glucose values above or equal to the cutoff, fasting: ≥92 mg/dL, 1-hour: ≥180 mg/dL, and 2-hour: ≥153 mg/dL were categorized GDM as per the International Association of Diabetes and Pregnancy Study Groups (IADPSG) criteria 6: the data so collected were subjected to the analysis using SPSS version 21; power of the study was taken as 80%. Vitros GLU Slide method was used for blood sugar estimation. Chi-square test and Student\'s t-test were used to test the significance of two means. Level of significance was significant at p ≤ 0.05. Result: Sensitivity of DIPSI is quite low, hence to be used as screening and diagnostic tool at the same time is still questionable. A repeat DIPSI at 32–34 weeks may increase its sensitivity. Even if we are using DIPSI for the diagnosis of GDM, the 2-hour capillary blood glucose (CBG) cutoff should be lowered than 140 mg/dL for good sensitivity of the test. Conclusion: Doctor\'s counseling and motivation are the best drives to bring mothers in fasting state and can make IADPSG too a simple and cost-effective single-step method in our country. This is the dire requirement of our country to have a better sensitive method for diagnosing GDM so that healthcare facility does not crunch out because of additional false-positive cases detected by DIPSI.

Original Article

Shashikala Karanth, Christy Vijay, C Jaya Sibi Mol, Nirupama Vijaykumar, Uma Devaraj, Chaitanya Harita Balakrishnan

Study of Maternal and Perinatal Outcomes in Pregnant Women with Respiratory Complications

[Year:2021] [Month:July-August] [Volume:13] [Number:4] [Pages:5] [Pages No:216 - 220]

Keywords: ARDS, Asthma, Bronchitis, Pregnancy

PDF  |  DOI: 10.5005/jp-journals-10006-1936  |  Open Access |  How to cite  | 

Abstract

Introduction: The frequency and significance of acute and chronic respiratory disorders in pregnant women have increased in recent years. Clinicians must have an understanding of cardiopulmonary physiology to promptly recognize and treat pregnant women with respiratory conditions ranging from asthma to adult respiratory distress syndrome. Significant changes are seen in respiratory parameters as pregnancy progresses. Materials and methods: Our study was a retrospective record study, which analyzed various respiratory diseases in pregnancy and its effects on the perinatal outcome. Hospital documents of pregnant women who delivered in the institution during the years 2015–2019 was studied. Pregnant women with respiratory complications in pregnancy including new onset/or exacerbations of preexisting respiratory disease like asthma, acute bronchitis, acute respiratory distress syndrome (ARDS), and pneumonia were noted. Results: We identified 214 pregnant women with respiratory complications over a period of 5 years. The overall incidence was 2.3%; 94.4% were 20–35 years of age, and 82.2% delivered at term gestation (37–40 weeks). Respiratory complications like infective, restrictive, and obstructive lung diseases were seen. Bronchial asthma exacerbations in 155 (72%), respiratory tract infections (upper and lower respiratory tract infections) in 23 (10.7%), acute bronchitis in 16 (7.5%), ARDS in 8 (3.7%), pleural effusion in 3 (1.4%), tuberculosis in 2 (0.9%) and OSA in 1 (0.5%) were seen. A total of 3.2% had intensive care unit (ICU) admissions, and there was 1.4% maternal mortality. The following were observed in those with respiratory complications: a higher chance of preeclampsia in 31 (14.4%), increased rates of lower segment cesarian section (LSCS) in 99 (46.2%), intrauterine death (IUD) in 12 (5.6%), and poor appearance, pulse, grimmace, activity, respiration (APGAR) and neonatal intensive care unit (NICU) admissions of 99 (46.3%) women. Conclusion: Respiratory illnesses in pregnancy poses more risk to the mother than to the fetus. Close monitoring of the antenatal period with pulmonary function testing increases the chance of a good pregnancy outcome. Mothers with respiratory diseases should be screened antenatally as the chances of preterm and inrauterine growth restriction (IUGR) are high in the fetus.

Original Article

Rajat Sharma, Shyamkumar Shankarrao Sirsam, Prachi S Koranne, Aparna R Wahane

Balloon Tamponade—A Novel Innovation in the Management of Refractory Postpartum Hemorrhage at Tertiary Care Center: A Study from Central India

[Year:2021] [Month:July-August] [Volume:13] [Number:4] [Pages:5] [Pages No:221 - 225]

Keywords: Compression sutures, Refractory PPH, Rescue hysterectomy, Stepwise devascularization, UBT, Uterotonics

PDF  |  DOI: 10.5005/jp-journals-10006-1930  |  Open Access |  How to cite  | 

Abstract

Background: Postpartum hemorrhage (PPH) is the leading cause of maternal mortality in low-income countries and the primary cause of nearly one-quarter of all maternal deaths globally. Refractory PPH is defined as PPH failed to respond to the medical line of management and requiring second-line treatment in the form of balloon tamponade, compression sutures, stepwise devascularization, or hysterectomy. Aim and objective: To assess the effectiveness of balloon tamponade in the management of refractory PPH and reduction in surgical interventions with the use of uterine balloon tamponade. Materials and methods: Prospective data of all 53 women with refractory PPH who underwent balloon tamponade after failed medical management that were collected over a period of 1.5 years were analyzed. Results: The study includes women from 20 to 35 years of age. The mean age of the study population was 24.81 ± 4.468 years. The estimated amount of blood loss in this study ranges from 700 to 2000 mL, and the mean estimated amount of blood loss was 1260.38 ± 333.02 mL. The success rate of balloon tamponade alone was 84.90%, while when combined with additional surgical intervention—compression sutures and stepwise devascularization—overall success rate increased up to 98.11% in this study, while one patient underwent rescue hysterectomy despite balloon tamponade. The failure rate was 1.89%. Conclusion: UBT is novel innovation for the management of refractory PPH, and real-time blood loss assessment through Bakri balloon alerts and guides the surgeon in major decisions before proceeding to rescue hysterectomy. Our study recommends the use of balloon tamponade as a primary tool before proceeding for surgical interventions in case if uterotonics fail to manage PPH. Clinical significance: Balloon tamponade is simple, easy, and cost-effective intervention, especially in low resource setting for reducing maternal morbidity and mortality due to refractory PPH.

Original Article

Sunita Mishra, Shilpa Sapre, Nootan Chandwaskar, Roshni Sahu

Assessment of Maternal and Fetal Outcomes of Burn in Pregnancy

[Year:2021] [Month:July-August] [Volume:13] [Number:4] [Pages:4] [Pages No:226 - 229]

Keywords: Burns in pregnancy, Fetal outcomes, Gestational age (trimester), Maternal outcomes, Total body surface area (TBSA)

PDF  |  DOI: 10.5005/jp-journals-10006-1932  |  Open Access |  How to cite  | 

Abstract

Background: Burn injuries in pregnancy are often associated with a high rate of maternal and fetal mortality. They are considered relatively rare, but they affect the fate of the mother and the developing fetus. Aims and objectives: • To study the maternal and fetal outcomes in pregnant women with burns. • To evaluate the predictors of maternal and fetal mortality due to burns. Materials and methods: A retrospective study was conducted in the Department of Obstetrics and Gynaecology at Sri Aurobindo Institute of Medical Sciences and Postgraduate Institute, Indore (MP). The duration of this study was 2 years (March 2015 to February 2017). A total of 15 pregnant women with thermal injuries were included in this study. Data were obtained from the Medical Records Department of all the cases of burns during pregnancy, who were admitted into the hospital. The obtained data were analyzed regarding the age, duration of hospital stay, percentage of total body surface area (TBSA) burned, gestational age, and the maternal and fetal outcomes. Result: The mean age was 24.6 ± 5.26, median hospital stay 12.5 days, median gestational age 22.5 weeks, and burn size 59%. Eleven (73.4%) patients of accidental and four (26.6%) of suicidal cases were found. There were five (33.3%) cases in the 20–39% TBSA group, two (13.4%) cases in 40–59% TBSA, five (33.3%) cases in 60–79% TBSA, and three (20%) cases in >80% TBSA, respectively. There was a significant difference between fetal death and aliveness according to the first five (100%) and zero (0%), second five (83.4%) and one (16.6%), and third trimester one (25%) and three (75%), p = 0.001. The first trimester was associated with the highest incidence of fetal death. We found that TBSA (positive predictive value [PPV] = 0.607; p = 0.001) and trimester (PPV = 0.638; p = 0.001) were positive predictors for abortion/fetal deaths. Conclusion: The rate of fetal mortality was highest in the first and second trimesters. Maternal and fetal morbidity and mortality were directly proportional to TBSA.

Original Article

Hemraj Narkhede, Mahesh R Asalkar, Surkyant Munload, Y Vipulachandra, Tushar V Patil

Vertical Transmission of SARS-CoV-2 to Newborns in COVID-19 Infected Mothers: A Cross-sectional Study

[Year:2021] [Month:July-August] [Volume:13] [Number:4] [Pages:6] [Pages No:230 - 235]

Keywords: Coronavirus, COVID-19, Intrauterine transmission, Perinatal, Pregnancy, SARS-CoV-2, Vertical transmission

PDF  |  DOI: 10.5005/jp-journals-10006-1917  |  Open Access |  How to cite  | 

Abstract

Aim and objective: To establish the presence or absence of vertical transmission of SARS-CoV-2 in patients who delivered during the study period. Study design: Cross-sectional study was conducted from May 2020 to October 2020 at dedicated COVID hospital. During the study period, all SARS-CoV-2-positive patients who delivered at the study institution were studied to find SARS-CoV-2 infection in newborn by intrauterine transmission. Newborns were screened within 60 minutes of delivery for vertical transmission of SARS-CoV-2 infection by nasopharyngeal swab test for RT-PCR. Results: Two hundred one COVID positive pregnant women enrolled in the study. Two newborns tested SARS-CoV-2 positive by RT-PCR test: One was delivered by vaginal route and other by caesarian section. Both babies who were tested SARS-CoV-2 positive by RT-PCR test were born after EDD (>40 weeks) to low-risk mothers. Time interval between maternal test positivity and delivery interval was 7–14 days. Conclusion: The rate of VT is 0.99% in our study. The possibility of vertical transmission is more in postdated pregnancy. There was no relation seen in our study with the severity of disease or symptoms of infection at the time of admission and vertical transmission, but it needs to be further studied. We did not notice the association of high-risk obstetrics conditions and vertical transmission.

Original Article

Divya Dwivedi, Uma Pandey, Sarah McDonell, Mark Hehir, Stephen W Lindow

Intention to Vaccinate against SARS-CoV-2 amongst Healthcare Workers in India: A Multicenter Cross-sectional Study

[Year:2021] [Month:July-August] [Volume:13] [Number:4] [Pages:4] [Pages No:236 - 239]

Keywords: Attitudes, Beliefs, COVID-19, Healthcare workers, Herd immunity, Hesitancy, Intention to vaccinate, SARS-CoV-2, Vaccine acceptability

PDF  |  DOI: 10.5005/jp-journals-10006-1912  |  Open Access |  How to cite  | 

Abstract

Aim and objective: The high fatality rate of the corona virus disease-19 (COVID-19) pandemic has led to the development of vaccines over a very short period of time. This is a study to assess the vaccine acceptability among Indian healthcare workers (HCWs) and to evaluate the knowledge, fears, and intentions among them regarding COVID-19 vaccination and to estimate the number of HCWs who will accept or refuse vaccination. Materials and methods: A multicenter cross-sectional study on COVID-19 vaccination was done in three tertiary hospitals by an anonymous online questionnaire. Doctors, nurses, students, and laboratory and administration staff were invited to take part. Results: A total of 314 HCWs participated voluntarily in the survey. Among the participants, 75.1% of them would definitely/probably accept the vaccination, and 24.8% would definitely/probably refuse if it were made available. Significant factors in the refusal were skepticism in the efficacy and safety of a vaccine. Conclusion: The majority of the respondents (75.1%) in our study were willing to receive and accept the vaccine against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) virus However, concerns about efficacy and safety of the vaccine need to be addressed to increase the uptake and ensuring coverage of large population in order to attain herd immunity against COVID-19.

Original Article

Esha G Chainani

Incidence of Postpartum Depression in a Tertiary Care Hospital in Navi Mumbai amid COVID-19 Pandemic

[Year:2021] [Month:July-August] [Volume:13] [Number:4] [Pages:5] [Pages No:240 - 244]

Keywords: COVID-19, Edinburgh postnatal depression scale, Maternal morbidity, Pandemic, Postpartum depression

PDF  |  DOI: 10.5005/jp-journals-10006-1918  |  Open Access |  How to cite  | 

Abstract

Introduction: Coronavirus disease-2019 (COVID-19) pandemic has changed health care drastically, especially looking at how obstetrics functions. This places mothers in a situation of greater psychological vulnerability and heightens the risk of postpartum depression and disrupted mother–infant bonding, which may be weighted or worsened by the balance of the couple. We expect this impact to be even greater in vulnerable mothers in the context of dysfunctioning social services. This study intends to identify the incidence of postpartum depression in women delivering during COVID-19 pandemic among lockdown protocols in a tertiary center in Navi Mumbai and identify its sociocultural triggers so that strategies may be evolved to reduce the morbidity costs attributable to the mother and child in the future. Materials and methods: This study was a cross-sectional study, performed over a period of 2 months from June 2020 to August 2020 at DY Patil School of Medicine and Dr DY Patil Hospital, a teaching hospital in Western India. Two hundred postnatal mothers were recruited for the study in the postpartum period from 1 to 6 weeks after delivery. A specially designed questionnaire was used to record various determinants to assess the risk factors, which could contribute to postpartum depression. A predesigned and pretested questionnaire (EDPS—Edinburgh Postnatal Depression Scale) was used to detect the depressive symptoms in postnatal mothers. The results for qualitative data were presented in frequency and percentage. Binary logistic regression was used to predict the contribution of each independent risk factor to arrive at the depression level, which happens to be the dependent risk factor in this study. The statistical analysis was done by using SPSS 21.0. The significant level was used at p <0.05. Results: A total of 200 cases were studied. The average age of the study group was 27.5, with the average duration of postpartum period being 8 days. The total score obtained using EDPS was less than or equal to “8” in only “92” cases (46%). However, 20% of the cases studied had a score between 9 and 12, suggesting the possibility of depression. Thirty-four percent of the cases had a score of more than 12, indicating the presence of postpartum depression. Of the 200 women, 49% were primigravida, while 51% were multigravida. Fifteen percent of the women had a history of infertility. Forty-four percent of the women had a history of miscarriage. Six percent of the women had a history of intrauterine fetal demise. Forty-nine percent of the women had one living child. Of the 200 women, 55.5% of the women were living in a nuclear family setup (with husband and any existing children). One hundred percent of the women studied were aware of the prevalence of COVID-19. Sixty-seven percent were aware that their newborns were at risk of infection by this disease and 72.5% said they were worried about them and their newborns contracting COVID-19. Sixty-five percent said they were feeling significantly more anxious about their postpartum period due to COVID-19 pandemic. Discussion: In the current study, the prevalence of postpartum depression was noted in 34% of the women studied. A prevalence of 20.4% was found in a study conducted in Western India by Modi et al. A rural study conducted in South India showed a prevalence of 19.8%. A study conducted in a military hospital in North India had a prevalence of 21.5%. The prevalence in our study was comparable, if not a little higher to these studies; however, the factor of a pandemic and the anxiety associated with it confirms our suspicions about COVID-19 and a worldwide lockdown causing widespread psychological problems as well as physical ones. Conclusion: COVID-19 pandemic has had a significant impact on human history, especially that of medical history. Countless women with both planned and unplanned pregnancies have been thrown into a state of extreme fear and stress due to the unpredictability of the virus. Doctors should be concerned that if this disease was common before the pandemic, now it can affect even more women. A support system, plenty of transparent medical advice, and compassion must be applied to doctor visits—may they be in person or virtual. Doctors also need to familiarize themselves with postpartum depression scoring systems and also clinical symptoms to be able to reassure and diagnose women ahead of severe maternal morbidity.

Original Article

Anupama Dave, Sanjay Avashia, Dharmendra Jhavar, Kirti Sinha, Shivam Gupta

Characteristics and Outcomes of COVID-19 (SARS-CoV-2)Positive Pregnant Women Admitted to a Dedicated COVID Hospital in Central India: A Single-center Observational Study

[Year:2021] [Month:July-August] [Volume:13] [Number:4] [Pages:6] [Pages No:245 - 250]

Keywords: COVID-19, COVID-19 infection in pregnancy, Maternal and neonatal outcome, Maternal outcome, SARS-CoV-2

PDF  |  DOI: 10.5005/jp-journals-10006-1919  |  Open Access |  How to cite  | 

Abstract

Aim and objective: To identify characteristics of coronavirus disease-2019 (COVID-19) infection in pregnancy, maternal, and fetal outcomes and study changes in inflammatory markers and chest imaging findings. Materials and methods: This study is an observational study on pregnant COVID positive women admitted for treatment in the Maharaja Tukojirao Holkar Dedicated COVID Hospital, Indore, Madhya Pradesh, India from April 17, 2020, to April 30, 2021. There were two notable peaks of infection with different clinical characteristics. Group A included data from April 17, 2020, to February 28, 2021, and group B from March 1, 2021, to April 30, 2021. A detailed comparative analysis was done, comparing clinical parameters, investigational findings, and outcomes in both groups. Results: The incidence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in pregnant women based on admissions in our hospital was 1.26/1,000 maternities. Group A had 94 cases, while group B that included the second wave of infection had 103 cases. The demographic profile of women was comparable in both groups. About 84.04% of women in group A were asymptomatic. In group B, 27.18% were asymptomatic. Laboratory parameters were deranged more so in group B. In group A, 41.49% of women reported in labor and there were no mortalities. In group B, 25.24% reported in labor, those <31 weeks were 60.64%, and there were 12 mortalities. Cesarean section was done in 56.52% of group A, 39.06% of group B, and there were 12.5% of abortions. All of the babies who delivered by vaginal route or cesarean section tested negative within 12 hours of delivery irrespective of maturity. Conclusion: In our study, we noticed two notable peaks of SARS-CoV-2 infection, first onset was from April 2020 which gradually declined till February 2021 but majority of pregnant women remained asymptomatic, those at term delivered, others recovered within 8 to 14 days, and majority did not require any advanced treatment or oxygen support. Starting from April 2021, there was a resurgence of cases with moderate-to-severe disease, morbidities, and even deaths. All novel management options were given on individualized basis including remdesivir, IVIG, and bevacizumab, which proved to be lifesaving in some. All babies delivered tested were SARS-CoV-2 negative and there was a good neonatal outcome.

RESEARCH ARTICLE

Lakshmidevi Muralidhar, Shreedhar Venkatesh, Madhva Prasad, Anusha Chandra Poojari, Farha Bilal

Clinical Study on Spectrum of Dengue Morbidity in Pregnancy and Its Impact

[Year:2021] [Month:July-August] [Volume:13] [Number:4] [Pages:3] [Pages No:251 - 253]

Keywords: Dengue fever, Neonatal transmission, Platelet transfusion, Postpartum hemorrhage

PDF  |  DOI: 10.5005/jp-journals-10006-1937  |  Open Access |  How to cite  | 

Abstract

Introduction: Dengue is a mosquito borne viral disease transmitted by Aedes. Dengue infection in pregnancy carries the risk of hemorrhage for both the mother and the newborn. In addition, there is a serious risk of premature birth and fetal death. In case of infection close to term, there is a risk of vertical transmission. Timely intervention can improve the maternal as well as fetal outcome. This study was aimed to assess the presentation, maternal and fetal outcome of dengue fever (DF) during pregnancy. Materials and methods: The study was carried out on 35 pregnant females diagnosed and serologically confirmed to have DF and who were admitted in Vydehi Institute of Medical Sciences and Research Centre. Patients were included irrespective of the period of gestation. Serological testing for dengue virus-specific antigen and antibody was done for the diagnosis. Proforma was designed accordingly and used to collect data. Informed written consent was obtained. Result: In the present study on 35 patients suffering with DF, they are presented as the following in each trimester: 9 patients in the first trimester, 8 of them in the second trimester, and maximum, i.e., 18 patients, in the third trimester. About 13 cases were diagnosed by the nonstructural protein 1 (NS1) antigen, 17 by the immunoglobulin M (IgM) antibody, and 5 by the immunoglobulin G (IgG) +IgM antibody. Only two cases were febrile at delivery, but there was no case of dengue in infants. Platelet transfusion was required in four patients who had platelet <30,000. Term delivery was in 19 (54%) patients, preterm in 6 (17%) patients, lost to follow up 5 (14%) patients, and abortions in 5 (15%) patients. Out of 25 deliveries, 13 (52%) of them were full term normal delivery (FTND), 12 (48%) were lower segment cesarean section (LSCS), and none were complicated by postpartum hemorrhage. No cases of neonatal transmission were noted. Conclusion: Dengue infection in pregnancies need multimodal approach and treatment for potential fetal and maternal complications. Early detection and appropriate fluid administration and monitoring can decrease the mortality and morbidity associated with dengue infection.

RESEARCH ARTICLE

Deepika Gurnani, Preeti F Lewis, Sana T Bijapur

A Study of Maternal and Perinatal Outcomes in Pregnancy with Heart Diseases: Validation of CARPREG II Risk Prediction Index

[Year:2021] [Month:July-August] [Volume:13] [Number:4] [Pages:5] [Pages No:254 - 258]

Keywords: CARPREG II risk prediction index, Heart disease, Maternal outcome, Perinatal outcome, Pregnancy

PDF  |  DOI: 10.5005/jp-journals-10006-1941  |  Open Access |  How to cite  | 

Abstract

Aim and objective: The aim of the study was to assess efficacy of CARPREG II risk prediction index in predicting poor maternal outcomes in pregnancies with heart diseases. Materials and methods: This study was conducted in the department of obstetrics and gynecology at a tertiary care center in Mumbai. This was a retrospective study of 66 pregnant women with structural heart diseases. CARPREG II score was calculated for each patient as per history, clinical examination, specific lesion through echo findings, and delivery of antenatal care. Primary and secondary adverse cardiac outcomes were noted during antepartum and postpartum periods. Obstetric and perinatal outcomes were also recorded. Results: Mean age of the study population was 27.36 years. A total of 51.5% (n = 34) patients were primigravidae. Majority of the subjects about 59.09% (n = 39) had rheumatic heart diseases (RHDs) and 25.75% (n = 17) had congenital heart diseases (CHDs). Overall, vaginal delivery was the most common route with an increased rate of Cesarean section (41.07%) and instrumental vaginal delivery (16.6%). There was no significant difference in observed and expected values of primary maternal outcome (p value = 0.9). All the maternal adverse clinical events were more common in groups of patients with CARPREG II index of 4 or more, but in score <3, the risk index overestimated maternal adverse cardiac events. Perinatal complications did not show any correlation with CARPREG II score. Conclusion: Pregnancy with cardiac disease is associated with high maternal and fetal morbidity and mortality. CAREPREG II risk prediction index predicts maternal outcomes effectively and can be used routinely in clinical practices to assess the maternal risks. Clinical significance: Integration of general cardiac factors and disease-specific factors along with delivery of care predictor emphasizes the role of skilled antenatal care in improving outcomes in pregnancy with cardiac diseases.

RESEARCH ARTICLE

Papa Dasari, Sonal Garg, Rakhee Kar, Thyagaraju Chitra

Etiological Factors for First Single Early Pregnancy Loss: Are They Different from Recurrent Pregnancy Loss?

[Year:2021] [Month:July-August] [Volume:13] [Number:4] [Pages:6] [Pages No:259 - 264]

Keywords: Endocrine cause, Etiology, First early pregnancy loss, Miscarriage, Recurrent pregnancy loss, Thrombophilia

PDF  |  DOI: 10.5005/jp-journals-10006-1944  |  Open Access |  How to cite  | 

Abstract

Aim and objective: The recommendation for investigation of pregnancy loss is to test only after two or more pregnancy losses. But in practice, we find women with single pregnancy loss seeking explanation. The purpose of this study was to determine the identifiable causes and their proportion in women with first early pregnancy loss and to compare with that of women with recurrent pregnancy loss (RPL). Materials and methods: This cross-sectional analytical study was undertaken between 2018 and 2019. Group A included 105 women with first single pregnancy loss and group B included 105 women with RPL. The recommended investigations for etiological factors were done in both groups except karyotyping, and thrombophilia screening was done in those with unknown etiology. Statistical analysis: Etiological factors were expressed as proportions, and comparison between two groups was done by unpaired t-test and Mann–Whitney test. Results: Sociodemographic factors and gestational age were similar in both the groups. Significantly more number of women with first single pregnancy loss (58%) had known etiological factors than women with RPL (43%) (p = 0.038). Endocrine causes were commonest in both the groups (first pregnancy loss 36% vs RPL 21%; p = 0.023). Out of the women with unknown causes, 18% of women were positive for thrombophilia in each group and more than 50% of them were antiphospholipid antibodies (APLA) positive. Conclusion: Significant proportion of women with single first pregnancy loss have treatable etiological factors like those of RPL. Hence evaluation should be undertaken to achieve optimum outcomes during the next pregnancy and prevent RPL. Clinical significance: Evaluation of women with first pregnancy loss helps the clinician to prevent pregnancy loss in subsequent pregnancies by appropriate management as per the etiology.

RESEARCH ARTICLE

Sonu K Batham, Shaheen Anjum

Repeated Sweeping of Membranes at Term Pregnancy as Method of Induction

[Year:2021] [Month:July-August] [Volume:13] [Number:4] [Pages:4] [Pages No:265 - 268]

Keywords: Induction of labor, Membrane sweeping, Postterm pregnancy, Spontaneous labor, Term pregnancy

PDF  |  DOI: 10.5005/jp-journals-10006-1938  |  Open Access |  How to cite  | 

Abstract

Background: This study was aimed to determine the effectiveness of serial membranes sweeping in term pregnancy, and its effect on labor. Materials and methods: In this prospective study, 123 women with an uncomplicated pregnancy at 39 weeks or more gestation were recruited for the study; out of them, 38 were cases (serial sweeping group) and 85 were in the control (no sweeping group). The primary outcome measure was the occurrence of spontaneous labor and changes in Bishop\'s score after each sweeping. Other outcome measures included were interval of, occurrence of premature rupture of membranes, the total duration of active labor, mode of delivery, rate of cesarean section and its causes, and neonatal and maternal outcome. Results: There were no statistically significant differences between the two groups regarding maternal age, parity, and Bishop\'s score at recruitment. The onset of labor was not significantly different in both groups {(6.82 ± 1.967 days) (7.96 ± 3.63 days)} from the day of recruitment. A total of 27 (75.0%) patients of the cases group delivered in the second week whereas there were 40 (47.05%) patients of the control group. This showed a significant difference (p <0.05), and five (13.2%) patients went into postterm pregnancy, in comparison with 22 (25.88%) patients in the control group. There was no significant difference regarding the mode of delivery and maternal and fetal outcomes in cases and controls. Conclusion: Frequent membrane sweeping is not having any significant effect in the mode of induction of labor.

CASE REPORT

Sadiq Unnisa Aman, Mehnaz Abdulla, Arshia Syed, Pavaman Sindgikar

Preeclampsia with Hemorrhagic Stroke: A Case Report of a Woman's Perilous Journey through Motherhood with a Miraculous Ending

[Year:2021] [Month:July-August] [Volume:13] [Number:4] [Pages:3] [Pages No:269 - 271]

Keywords: Maternal and perinatal outcome, Preeclampsia, Stroke

PDF  |  DOI: 10.5005/jp-journals-10006-1929  |  Open Access |  How to cite  | 

Abstract

Aim and objective: The aim of the study was to highlight the infrequent occurrence and timely multidisciplinary management of hemorrhagic stroke in preeclampsia (PE), thereby averting serious maternal and fetal morbidity and mortality. Background: Hemorrhagic stroke is a result of severe PE, which is a known but fortunately uncommon complication. In comparison with nonpregnant women, stroke rates are relatively rare during pregnancy. Despite the high maternal and fetal mortality rates in such a scenario, we report a case where the outcome for both mother and infant was excellent. Case description: We report the case of a 23-year-old primigravida who presented at 32 weeks 6 days period of gestation with sudden onset of right-sided hemiplegia associated with aphasia and blood pressure (BP) of 200/120 mm Hg. Cerebral computed tomography (CT) scan confirmed a left frontoparietal lobe parenchymal hemorrhage with intraventricular extension. Emergency Cesarean delivery was done followed by left frontotemporoparietal decompression craniotomy with intracranial hemorrhage (ICH)\'s evacuation. She recovered completely without any neurological deficit. Conclusion: Acute cerebrovascular accidents are a challenge in both diagnosis and management when it involves a pregnant woman. Early diagnosis using CT and a multidisciplinary approach will help reduce maternal mortality and morbidity in cases where the stroke is suspected. Clinical significance: The significance of optimal control of BP in patients with hypertensive pregnancy disorders cannot be overemphasized. As per the primary prevention, the patient\'s education at first contact with health care about the PE is a sine qua non, emphasizing antihypertensive compliance.

CASE REPORT

Kameshwarachari Pushpalatha, Bharti Singh, Anusha Devalla, Sashmi Sasidharan, Hemlata Panwar

Spontaneous Uterine Perforation in a Choriocarcinoma Presenting with Pyoperitoneum

[Year:2021] [Month:July-August] [Volume:13] [Number:4] [Pages:3] [Pages No:272 - 274]

Keywords: Acute abdomen, Choriocarcinoma, Laparotomy, Pyoperitoneum, Uterine perforation

PDF  |  DOI: 10.5005/jp-journals-10006-1946  |  Open Access |  How to cite  | 

Abstract

Aim and objective: Choriocarcinoma can have intricate presentations and pose challenges in management. We are presenting a rare case of spontaneous uterine perforation in a choriocarcinoma. Background: Choriocarcinoma is a rare neoplasm with varied incidence worldwide. It is a highly malignant tumor of trophoblastic tissue. Case description: We present a case of 29-year-old multiparous women admitted with fever and foul-smelling vaginal discharge. After 2 days of admission, she developed features of perforation peritonitis. She was taken up for emergency laparotomy. Hysterectomy was performed in view of perforation of uterus with extensive necrosis. Peritoneal cavity was filled with pus. The histopathological examination revealed choriocarcinoma. Her serum beta-human chorionic gonadotropin (hCG) was 2397 mIU/mL. She received multiagent chemotherapy (EMA/CO) for six cycles till the beta-hCG values came to normal. On 1 year follow-up, the beta-hCG values remained normal. Conclusion: Choriocarcinoma presenting with acute abdomen and pyoperitoneum is a rare clinical presentation and should be a kept as a diagnosis of exclusion. Clinical significance: Timely diagnosis and management can improve the clinical prognosis of the patients.

CASE REPORT

Shefali Tyagi, Swapnil Bhagat

Aneuploidy Presenting as Placental Thickness: A Case Report

[Year:2021] [Month:July-August] [Volume:13] [Number:4] [Pages:2] [Pages No:275 - 276]

Keywords: Aneuploidy, Thick placenta

PDF  |  DOI: 10.5005/jp-journals-10006-1947  |  Open Access |  How to cite  | 

Abstract

A normally functioning placenta is critical for normal fetal growth and development. The size of placenta increases during fetal growth to allow it to do its vital functions. Thus, a normal development of placenta is important for an uneventful embryonic and fetal development. The case described here is a case of aneuploidy of chromosomes 13,16, 21, and 22 diagnosed due to the detection of increased placental thickness.

Photo Assay

Richi Khandelwal, Manoranjan Mahapatra, Jita Parija, Agniv Sarkar, Smruti S Pattnaik

En Bloc Peritonectomy Specimen in a Case of Ovarian Cancer

[Year:2021] [Month:July-August] [Volume:13] [Number:4] [Pages:1] [Pages No:277 - 277]

Keywords: Adjuvant chemotherapy, Epithelial ovarian cancer, Peritonectomy

PDF  |  DOI: 10.5005/jp-journals-10006-1924  |  Open Access |  How to cite  | 

Abstract

This is a picture showing en bloc peritonectomy specimen during primary cytoreduction on a case of ovarian cancer.

Photo Assay

Agniv Sarkar, Manoranjan Mahapatra, Jita Parija, Richi Khandelwal, Smrutisudha Pattnaik

Para-aortic Area Dissection and Left Pelvic Space Dissection in a Case of Carcinoma Ovary

[Year:2021] [Month:July-August] [Volume:13] [Number:4] [Pages:1] [Pages No:278 - 278]

Keywords: CA 125, CA ovary, Ovarian carcinoma, Ovary

PDF  |  DOI: 10.5005/jp-journals-10006-1925  |  Open Access |  How to cite  | 

Abstract

A 52-year-old patient of carcinoma (CA) ovary was put for primary cytoreductive surgery. The two pictures depict para-aortic space and left pararectal space displaying hypogastric plexus.

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