Mifepristone alone versus mifepristone-misoprostol combination regimen for management of intrauterine fetal death

Background: Early pregnancy failure is a common complication of pregnancy. If women do not abort spontaneously, they will undergo medical or surgical treatment in order to remove the products of conception from the uterus. Curettage, although highly effective, is associated with a risk of complications; medical treatment with misoprostol is a safe and less expensive alternative. Unfortunately, after 1 week of expectant management in case of EPF, medical treatment with misoprostol has a complete evacuation rate of approximately 50%. Misoprostol treatment results may be improved by pre-treatment with mifepristone; its effectiveness has already been proven for other indications of pregnancy termination. The study objective was to compare the outcome of Mifepristone alone with the Mifepristone- Misoprostol combination regimen for the management of IUFD.Methods: This was a Prospective clinical trial at the department of obstetrics and gynecology, Chittagong Medical College Hospital, Chittagong. From March 2016 (Actual patient enrolment started after obtaining ethical clearance i.e. March 2018) to September 2018.Results: A subjects delivered earlier than group B and the mean induction delivery interval in Group A is significantly less in comparison to Group B (p=<0.001). Out of 50 women, 2(4%) and 10(20%) women in Groups A and B required oxytocin infusion to establish good contractions, and completion of termination who regarded as a failure. In the mifepristone alone group, the success rate is significantly higher than in the combination group.Conclusions: The efficacy of mifepristone alone was found superior to that of the mifepristone misoprostol combination regimen in the present study.

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 & Obstetrics and Fetomaternal Medicine OPD, BSMMU from September 2020 to August 2021. Results: Respondents were divided into two groups. Low PAPP-A group (<0.5MoM) and normal PAPP-A group (>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<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 (<0.5 MoM) in 11-14 weeks of pregnancy is associated for development of GDM

Disease characteristics and serological responses in patients with differing severity of COVID-19 infection: A longitudinal cohort study in Dhaka, Bangladesh.

BackgroundCOVID-19 caused by SARS-CoV-2 ranges from asymptomatic to severe disease and can cause fatal and devastating outcome in many cases. In this study, we have compared the clinical, biochemical and immunological parameters across the different disease spectrum of COVID-19 in Bangladeshi patients.Methodology/principal findingsThis longitudinal study was conducted in two COVID-19 hospitals and also around the community in Dhaka city in Bangladesh between November 2020 to March 2021. A total of 100 patients with COVID-19 infection were enrolled and classified into asymptomatic, mild, moderate and severe cases (n = 25/group). In addition, thirty age and sex matched healthy participants were enrolled and 21 were analyzed as controls based on exclusion criteria. After enrollment (study day1), follow-up visits were conducted on day 7, 14 and 28 for the cases. Older age, male gender and co-morbid conditions were the risk factors for severe COVID-19 disease. Those with moderate and severe cases of infection had low lymphocyte counts, high neutrophil counts along with a higher neutrophil-lymphocyte ratio (NLR) at enrollment; this decreased to normal range within 42 days after the onset of symptom. At enrollment, D-dimer, CRP and ferritin levels were elevated among moderate and severe cases. The mild, moderate, and severe cases were seropositive for IgG antibody by day 14 after enrollment. Moderate and severe cases showed significantly higher IgM and IgG levels of antibodies to SARS-CoV-2 compared to mild and asymptomatic cases.Conclusion/significanceWe report on the clinical, biochemical, and hematological parameters associated with the different severity of COVID-19 infection. We also show different profile of antibody response against SARS-CoV-2 in relation to disease severity, especially in those with moderate and severe disease manifestations compared to the mild and asymptomatic infection