Cord blood parameters and fetal outcome in neonates with fetal distress due to meconium staining liquor- an observational study

Background: Meconium staining liquor (MSL) results from passage of meconium during labour and is used to diagnose fetal distress. Thick and granular meconium has been found to have a significant association with an abnormal cord pH and lactate and worst neonatal outcome. The aim of this study was to analyse and compare the mode of delivery, cord blood parameters and fetal outcomes in cases diagnosed with different degrees of meconium staining liquor.Methods: An observational study was carried out on 76 labouring patients presenting in the active stage of labour with term, singleton pregnancy with cephalic presentation diagnosed with either thin or thick MSL. The cases were followed up and compared in thin or thick MSL group for the mode of delivery (normal vaginal delivery, instrumental delivery or caesarean section), fetal cord blood parameter after birth (cord blood pH and lactate) and the neonatal outcome.Results: 39 cases were diagnosed with thin MSL. Of these, 74.4% delivered by a normal vaginal delivery. Maximum cases had normal cord blood parameters with a favourable neonatal outcome. 37 cases had thick MSL. Lower segment caesarean section (LSCS) rate was highest in this group (i.e. 48.6%). The neonatal outcomes were as follows- 24.3% had an APGAR score <7, 43.2% required assisted ventilation, 43.2% required NICU admission and 13.5% had an early neonatal death.Conclusions: Thin MSL should be closely monitored and can be followed up for normal vaginal delivery

Diagnostic accuracy of neutrophil to lymphocyte ratio in comparison with liver function tests for the diagnosis of intrahepatic cholestasis of pregnancy

Background: In this study, we aimed to find diagnostic accuracy of neutrophil to lymphocyte ratio in comparison with liver function tests for the diagnosis of intrahepatic cholestasis of pregnancy and adverse fetal-maternal outcomes.Methods: NLR and aminotransferase (AST/ALT) levels in the blood samples of pregnant women with complaint of pruritus. 90 women with elevated transaminase were taken as cases and same number of women with normal aminotransferase levels taken as control. All were examined in this prospective case-control study.Results: Not only was the mean NLR elevated in the pregnant women with cholestasis when compared to the controls, but it also predicted the severity of the cholestasis. The correlation between transaminase levels and NLR was significant.Conclusions: Although TBA is still the diagnostic standard, NLR can be used as an initial screening tool due to its high specificity

First trimester serum vitamin D, hs-CRP and second trimester uterine artery diastolic notching in predicting gestational hypertension and preeclampsia

Background: Gestational hypertension and preeclampsia is one of the leading causes of maternal and fetal morbidity and mortality. The objective of this study was to study prediction of gestational hypertension/preeclampsia by using first trimester serum vitamin D and hs-CRP and second trimester uterine artery diastolic notching.Methods: It was an observational study conducted in the departments of obstetrics and gynaecology, clinical biochemistry and radiology, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India. All pregnant women with 11 to 14 weeks gestational age attending antenatal clinic between October 2012 and June 2013 were enrolled in the study. A detailed history including history of the duration of sun exposure was taken and a general physical examination including obstetrical examination was done at every visit. Serum sample were taken for hs-CRP and vitamin-D levels at 11-14 weeks. Uterine artery colour doppler study was done between 22-24 weeks for uterine artery diastolic notching. The main outcome measures were development of gestational hypertension/ preeclampsia/ eclampsia.Results: The mean vitamin D levels were significantly lower and mean hs-CRP levels were significantly higher in the hypertensive group as compared to the normotensive group, p=0.001 and p=0.004, respectively. Significant number women who developed hypertension had unilateral (46.2%) or bilateral (20.4%) uterine artery diastolic notching, p=0.005 and p=0.000, respectively. Crude’s odds ratio of uterine artery diastolic notching for prediction of hypertension in pregnancy was high, 9.894, 95% CI, 3.273-29.907 as compared to vitamin D (9.15 mg/L), 2.859, 95% CI, 1.418-5.763 and 7.16, 95% CI, 3.33-15.397.Conclusions: Uterine artery diastolic notching in the early second trimester is found to be the best predictor of PE followed by first trimester hs-CRP and vitamin D

A rare case of paraneoplastic neurological syndrome with ovarian teratoma

Paraneoplastic neurological syndrome (PNS) is a neuropathological disorder of central nervous system, in this the patient presents with a tumor anywhere in the body with diverse neuropsychiatric symptoms. The clinical manifestation of the tumor may be preceded by PNS. We are reporting a case of a 23-year-old married nulliparous female who came to the gynaecology outpatient department (OPD) with the history of mass per abdomen for the past four months and also undergoing treatment for acute psychosis, memory loss and cognitive impairment for the past five months. Her symptoms were not relieved on treatment. After clinical, laboratory and radiological evaluation possibility of paraneoplastic neurological syndrome associated with ovarian teratoma was made. Patient was taken up for staging laparotomy with U/L salpingoophrectomy. After surgical treatment her psychiatric symptoms rapidly improved and her psychiatric medications doses was reduced. PNS should be suspected in female patients presenting with an acute history of neuropsychiatric symptoms. Tumor resection should be performed at the earliest to improve patient outcomes

Upright kneeling position during second stage of labor: a pilot study

Background: Women delivering in upright position have shorter labour due to efficient and stronger contractions with faster descent of foetal head. The present study aimed to find out effect of upright kneeling position in the second stage of labour on maternal and foetal outcome and assess patients’ satisfaction.Methods: The study was carried out in a tertiary care hospital of North India from October 2012 to February 2014. Low risk women admitted in early labour were divided into two groups, women delivering in kneeling position and in supine position. The outcome measures studied were, duration of second stage of labour, mode of delivery, 2nd degree perineal tears, Apgar scores at 5 minutes, NICU admission rate and patient satisfaction.Results: The mean duration of second stage of labour in kneeling group was shorter by 14.901 minutes. The rate of vaginal delivery was comparable for both primigravidas and multigravida in kneeling and supine groups, RR: 2.275, 95% CI (0.7872-6.5831) and RR: 1.633, 95% CI (0.393-6.775). Primigravidas had more 2nd degree perineal tears in kneeling group as compared to supine, RR 4.191, 95% CI (1.54 to 11.41). No difference in Apgar scores >7 at 5 minutes was observed in both groups, however, significantly lesser babies in kneeling group were admitted in NICU, RR 0.246, 95% CI (0.079 to 0.761). There was no difference on comparing satisfaction scores of primigravidas and multigravida in both supine and kneeling position.Conclusions: Kneeling position reduces the duration of second stage of labour and NICU admissions

Evaluation of cyclodextrins for enhancing corneal penetration of natamycin eye drops

A new group of pharmaceutical excipients called cyclodextrins can be introduced into ophthalmology for delivering such water insoluble drug. This group of excipients is able to solubilize many water insoluble drugs which were previously impossible to be formulated as aqueous eye drop solution by forming their inclusion complexes. Analysis of pure drug and excipients by physical test, melting point determination, chemical test and solubility determination were carried out in this study. It may be concluded that cyclodextrin complexes of Natamycin can lead to an aqueous formulation (Natamycin eye drop) having better trans corneal permeability and thus can be proved to have faster and better antifungal efficiency

A Clinical Study on Initial Experience of COVID-19 ARDS in Obstetric Patients at a Tertiary Care Centre in India

Coronavirus disease 2019 (COVID-19) is caused by a novel coronavirus (severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)) which causes severe viral pneumonia rapidly leading to acute respiratory distress syndrome (ARDS). Pregnant women are considered more vulnerable to severe viral respiratory infections owing to the physiological changes in pregnancy. In COVID-19, patient can present with a variety of symptoms of which dyspnoea is one that is also commonly seen in the late stages of pregnancy. The clinical presentation as well as response to therapy is highly variable, and since no conclusive proven treatment is available yet, prevention and symptomatic treatment remains the mainstay of management. Thus, we report a case series of four SARS-CoV-2-positive obstetric patients who presented with severe ARDS in a tertiary care hospital, posing diagnostic and therapeutic challenges to the clinician, and were managed with a holistic multidisciplinary stepwise approach. Through this, an effort has been made to sensitize the attending obstetrician on diverse presentation of COVID-19 disease and to emphasize the importance of prevention, early pick up, and timely optimal management of pneumonia in pregnant females with COVID-19. The clinical presentation of respiratory illness due to SARS-CoV-2 in pregnancy can be mistaken for exaggerated physiological changes of pregnancy leading to delay in seeking medical care. During the current pandemic, high suspicion for COVID-19 should be kept. If found symptomatic, immediate care should be sought in a designated facility and managed accordingly preferably with a multidisciplinary approach

Upright kneeling position during second stage of labor: a pilot study

Background: Women delivering in upright position have shorter labour due to efficient and stronger contractions with faster descent of foetal head. The present study aimed to find out effect of upright kneeling position in the second stage of labour on maternal and foetal outcome and assess patients’ satisfaction.Methods: The study was carried out in a tertiary care hospital of North India from October 2012 to February 2014. Low risk women admitted in early labour were divided into two groups, women delivering in kneeling position and in supine position. The outcome measures studied were, duration of second stage of labour, mode of delivery, 2nd degree perineal tears, Apgar scores at 5 minutes, NICU admission rate and patient satisfaction.Results: The mean duration of second stage of labour in kneeling group was shorter by 14.901 minutes. The rate of vaginal delivery was comparable for both primigravidas and multigravida in kneeling and supine groups, RR: 2.275, 95% CI (0.7872-6.5831) and RR: 1.633, 95% CI (0.393-6.775). Primigravidas had more 2nd degree perineal tears in kneeling group as compared to supine, RR 4.191, 95% CI (1.54 to 11.41). No difference in Apgar scores &gt;7 at 5 minutes was observed in both groups, however, significantly lesser babies in kneeling group were admitted in NICU, RR 0.246, 95% CI (0.079 to 0.761). There was no difference on comparing satisfaction scores of primigravidas and multigravida in both supine and kneeling position.Conclusions: Kneeling position reduces the duration of second stage of labour and NICU admissions

Fragile X screening for FRAXA and FRAXE mutations using PCR based studies: Results of a five year study

Background: Fragile X syndrome is the most common cause of inherited X-linked mental retardation. It is due to a mutation in a gene on X chromosome leading to hyper-expansion of a trinucleotide repeat sequence. The two most common Fragile sites with clinical significance are FRAXA at Xq27.3 comprising CGG repeat and a more distal FRAXE associated with amplification of a GCC repeat, located at Xq28. The frequency of occurrence of Fragile X syndrome is estimated to be 1/4000 male births. Screening of referrals for the mutations associated with the Fragile X syndrome constitutes a significant workload in many genetic laboratories. Aims: The aim of the present study was to establish the use of PCR based simple and rapid method of initial screening of samples, so that only a minority of samples tested positive with the above methods need to be screened by Southern blotting which is more time consuming and involves use of radioactive material. Materials and Methods: Study includes 294 patients with mental retardation. DNA extracted from blood was used for simultaneous amplification of the triplet repeat sequences at the FRAXA and FRAXE loci. Secondly samples from females were analyzed for heterozygosity of normal FRAXA allele. For confirmation of the presence of an expanded FRAXA allele in all the male positive cases, Southern blot hybridization was carried out. PCR based assay was done to detect methylation of the CpG island upstream of the FMR-1 gene. Results: Out of the 294 cases 23 (7.8%) were found to be having full mutation (FM) for FRAXA (21 males, 1 female & 1 male with mosaic FM/PM) and 13 females as having premutation (PM). All these 36 cases were confirmed by Southern blotting using appropriate probes. Among the females the heterozygosity for FRAXA allele was found to be 46%. Conclusion: Non-radioactive PCR methods are efficient and rapid test for intial screening of samples for the presence of FRAXA and FRAXE mutations. Since a large majority of referrals do not have Fragile X, this economical and reliable method reduces the number of samples needing Southern blotting