Pregnancy with Hypoparathyroidism - A Case Report

There is no established therapeutic regimen for treatment of hypoparathyroidism during pregnancy. This is particularly due to uncertainty about the use of vitamin D or its analogues, as in animal experiments teratogenic side-effects have been reported. Nevertheless, vitamin D or its analogues are required to control tetany predisposing to abortion and preterm labour. I herein report the pregnancy in a hypoparathyroid woman treated with calcitriol. A 20 years old hypoparathyroid woman receiving chronic treatment with calcitriol(0.5μgm/day) and calcium (1gm/day) was admitted in BSMMU with primi 41 weeks of pregnancy with chronic hypoparathyroidism. She had an cesarean section and delivered a healthy female baby of 3.4kg. Both the mother and baby were healthy. Key words: Hypoparathyroidism; pregnancy. DOI: 10.3329/bsmmuj.v3i2.7062BSMMU J 2010; 3(2): 107-10

Pregnancy with Legg Calve Perthes Disease A Case Report

Legg Calve Perthes’ Disease (LCPD) is a hip deformity most common in newborns and children, however it can also affect adults. It is a condition in which the femoral head softens and breaks down. It tends to get better with the age, so in most cases a childhood Perthes’ sufferer will not suffer at all into adulthood apart from the obvious of being significantly short in height for their age. A 25yrs old primigravid lady was admitted at 36+wks pregnancy with Gestational Diabetes Mellitus(GDM) with H/O Bronchial asthma with old Perthes’ Disease. She had pain in left hip which increases on movement. This pain and restricted movement of hip increases as pregnancy advances. Her left lower limb was shortened by 0.5cm.Elective caesarean section was done under spinal anaesthesia. A healthy baby was delivered. Her postoperative period was uneventful. The patient was discharged on 6th postoperative day(POD). Key words: Legg calve Perthes’ Disease; Pregnancy DOI: http://dx.doi.org/10.3329/bsmmuj.v4i2.8645 BSMMU J 2011; 4(2):125-12

Rupture of primigravid uterus and recurrent rupture

Uterine rupture is a deadly obstetrical emergency endangering the life of both mother and fetus. In Bangladesh, majority of deliveries arc attended by unskilled traditional birth attendant and maternal mortality is still quite high. It is rare Ln developed country but unfortunately it is common in a developing country like Bangladesh. We report a case history of a patient age 32yrs from Daudkandi, Comilla admitted with H/0 previous two rupture uterus and repair with no living issue. We did caesarean section at her 31+ weeks of pregnancy when she developed Jabour pain. A baby of 1.4 kg was delivered. During cesarean section, focal rupture was noted in previous scar of rupture. Unfortunately the baby expired in neonatal ICU after 36 hours

Outcome of Pregnancy in Lupus

Background: Pregnancy in patients with SLE is associated with a high risk of maternal disease exacerbation in active disease state and adverse fetal outcome. Objective: To analyse maternal and fetal outcome in pregnant lupus patients as well as to identify influence of disease activity on it. Methods: This retrospective observational cross sectional study was done on 27 pregnant lupus patients in feto-maternal medicine wing of the department of Obstetrics and Gynaecology, BSMMU from April 2007 to March 2011. For statistical analysis z test of proportion and students t test was used. Results: Mean age of the patients was 26.6 years. At booking, 8 (29.63%) had active lupus while 19 (70.37%) was in remission. As complications of SLE, lupus flare was found in 11.1%, lupus nephritis in 25.9% and skin rash in 7.4%. Regarding obstetric complications, PIH was developed in 3.7% and preeclampsia in 11.1% of the patients. Average gestational age at delivery was 34.8 weeks. Birth weight was <2.5kg in 45.8% of neonates. There was IUGR in 33.3% of the cases and 25% of the neonates needed admission in neonatal ICU. There was no neonatal death and none of the 24 neonates had neonatal lupus. In this study there was no maternal mortality. Patients who were in active disease state, most (55.5%) delivered preterm, spontaneous abortion occurred in two and IUD in one of the patients. Average birth weight was lower (1.9+.47kg) in patients with active SLE than those of with remission (2.3+.68kg). Lupus flare developed in 66.6% with active disease, while in 33.3% with remission. Conclusion: Pregnancy is relatively safe with SLE in remission but considered as high risk in terms of fetal loss and spontaneous abortion. Disease activity influences pregnancy outcome.DOI: http://dx.doi.org/10.3329/bsmmuj.v5i1.10995 BSMMU J 2012; 5(1):18-2

Variants of Conjoined Twins - Two Case Reports

Conjoined twins are identical twins whose bodies are joined in utero. Parasitic twins occur when a twin embryo begins developing in utero, but the pair does not fully separate, and one embryo maintains dominant development at the expense of the other which becomes vestigial. Vestigial twin appears as parasitic because it is incompletely formed or wholly dependent on the body function of the complete fetus. The independent twin is called the autosite. In conjoined twins both remain healthy. In this study we have presented one parasitic twin and another conjoined twin. In 1st case a 28 yrs old lady delivered a female parasitic twin by caesarean section due to failure of induction of labour. Unfortunately the baby died on 3rd postoperative day. In 2nd case, a 25years old lady diagnosed as a case of conjoined twin by ultrasonography for the first time at her 35wks of pregnancy. Emergency caesarean section was arranged on the day of admission as she started labour pain. A conjoined twin was delivered which were joined at thorax and abdomen and both were alive. Parents were offered surgical separation but they refused it and take the babies home.DOI: http://dx.doi.org/10.3329/bsmmuj.v5i1.11027 BSMMU J 2012; 5(1):65-68

The effect of the maternal vitamin D level on the risk of spontaneous pregnancy loss in the first trimester

Background: Pregnancy loss in the first trimester is one of the most disappointing matters for a mother. But spontaneous pregnancy loss in the first trimester is the most common negative outcome of pregnancy. It's estimated that about 10% of known pregnancies are lost in the first trimester whereas fewer than 4% of pregnancies miscarry in the second trimester. Aim of current study was to assess the effect of the maternal vitamin D level on the risk of spontaneous pregnancy loss in the first trimester.Methods: It was a case-control study conducted in the department of obstetrics and gynecology, Sir Salimullah medical college Mitford hospital, Dhaka, Bangladesh during the period of September 2018 to August 2019. A total of 100 patients were included in this study. Statistical analyses of the results were obtained by using window-based computer software devised with SPSS version 22.0.Results: In analyzing the association of serum vitamin D status with first-trimester pregnancy state it was observed that more than half (52.0%) patients had severe deficiency (<10 ng/ml) in the case group and 14 (28.0%) patients in the control group. In total 24 (48.0%) patients had deficiency (10-20 ng/ml) in case and 35 (70.0%) in control group. Only 1 (2.0%) patient had insufficiency (21-29 ng/ml) in control group. The difference was statistically significant (p<0.05) between the two groups.Conclusions: Maternal serum vitamin D deficiency was significantly associated with early spontaneous pregnancy loss in the first trimester

Association of serum pregnancy associated plasma protein: a with gestational diabetes mellitus

Background: Gestational diabetes mellitus is defined as diabetes diagnosed during pregnancy that is not clearly overt diabetes. GDM has many adverse consequences on the health of mother and fetus. Methods: This cohort study was carried out involving 77 women of 11 to14-week pregnant attending in the Gynecology &amp; Obstetrics and Fetomaternal Medicine OPD, BSMMU from September 2020 to August 2021. Results: Respondents were divided into two groups. Low PAPP-A group (&lt;0.5MoM) and normal PAPP-A group (&gt;0.5MoM). In low PAPP-A group, out of 16 respondents, 8 (42.1%) developed GDM and remaining 8(13.8%) were euglycemic. Whereas, in normal PAPP-A group, out of 61 respondents, majority 50 (86.2%) were euglycemic and only 11 (57.9%) women developed GDM. A total 19 (24.68%) respondents developed GDM from both low and normal PAPP-A group. ROC analysis of PAPP-A level for detection of GDM, a AUC value of 0.889 (95% CI 0.818-0.960) found which was statistically significant. A cut off value of ≤16.80 showed the highest Youden index (0.652) with 89.4% sensitivity and 81% specificity, the accuracy was 83.35. Moreover, a cut off value ≤16.80 showed PPV and NPV of 62.1% and 95.9%, respectively. PAPP-A level of GDM detected (10.32±5.56) µg/ml was significantly lower from non GDM mothers (25.08 ±9.85) µg/ml, where p&lt;0. 001. Conclusions: Study finding revealed that maternal serum PAPP-A level was lower in 11-14 weeks of pregnancy who subsequently developed GDM. So, a low PAPP-A level (&lt;0.5 MoM) in 11-14 weeks of pregnancy is associated for development of GDM

Birth of a healthy baby from abdominal pregnancy, a rare event: A case report

Abdominal pregnancy is a rare form of ectopic pregnancy with very high morbidity and mortality for both the mother and the fetus. Diagnosis and management can pose some difficulties especially in low resource centres. High index of suspi­cious is vital in making prompt diagnosis in such situations. A young lady of 30 years presented with 2nd gravida at 31 wks pregnancy with pain in the whole abdomen having loose motion admitted in Dept of Obs and Gynae BSMMU. She was diagnosed as a case of 31 wks pregnancy with gastroenteritis. She was treated conservatively according to advice of gastroenterologist and was discharged after improvement. Patient was readmitted again with pervaginal watery discharge. Decision for cesarean section was taken because of transverse lie, fetal growth restriction with severe oligohydramnios. After opening the abdomen, abdominal pregnancy was diagnosed. Following delivery of the baby significant bleeding started which was secured with ligature. Placenta was kept in situ. Mother and baby were discharged healthy on fourteenth postoperative day

Association of antithrombin (antithrombin III) gene mutation with unexplained recurrent pregnancy loss

Background: Recurrent pregnancy loss (RPL) is an emotionally painful occurrence for couples and presents Obstetricians with a difficult clinical problem. Because a primary etiology cannot be determined in roughly half of the instances, it is irritating for both patients and obstetricians. The present study aimed to determine the association of the antithrombin III gene (SERPINC1) mutation with unexplained RPL.Methods: This case-control observational study was conducted at the out-patient department of feto-maternal medicine, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh, with a total sample size of was 68, with 34 in the control group and 34 in the case/RPL group.Results: The mean±standard deviation (SD) age of the RPL group was 28.44±5.25, and in the control group it was 29.15±4.72. The mean±SD body mass index (BMI) was 24.95±3.48 and 23.69±4.07 in RPL and control groups respectively. Among the RPL group patients, 68% (23) had the primary RPL, and 32% (11) had a second pregnancy loss.Conclusions: 5.88% of the cases have a heterozygous mutation which might be the cause of their RPL. There was no homozygous mutation was found for G878A in the case group. The allele for G878A was also higher in the case group. But these differences were statistically non-significant. So, to clarify this association with unexplained RPL, further research is necessary including multi-centre and large sample sizes