Maternal and neonatal outcome in cases of premature rupture of membranes beyond 34 weeks of gestation

Background: Preterm premature rupture of membrane (PPROM) and premature rupture of membrane (PROM) are associated with various maternal and neonatal complications. Management guidelines regarding rupture of membrane before labour is still controversial. The study was carried out to determine the various maternal and neonatal outcomes associated with rupture of membranes beyond 34 weeks of gestation.Methods: It was a prospective observational study carried out in a tertiary care teaching hospital for a period of one year. All the pregnant women with rupture of membrane beyond 34 weeks are included in the study. After establishment of diagnosis of rupture of membranes, antibiotics were started and all of them were induced after 6 hours if they did not have spontaneous labour. Various maternal and neonatal outcomes were noted and statistical analysis carried out.Results: Incidence of rupture of membrane in our study was 4.2%. 92% of patients delivered within 24 hours of rupture of membrane and 18% of them required caesarean section. 5 neonates had respiratory distress syndrome and 1 neonate had sepsis.Conclusions: Induction of labour and delivery within 24 hours of rupture of membranes associated with low incidence of maternal and neonatal adverse outcome

Cervical ectopic pregnancy: a rare complication

Cervical ectopic gestation is a rare site and frequently confused with neoplastic process. Profuse bleeding can occur if the placenta is mistaken for a tumor and a biopsy is taken which may lead to hysterectomy. Cervical gestation also can be mistaken for an incomplete abortion where Products Of Conception (POC) are retained within the cervical canal may lead to diagnostic dilemma. We are presenting a case of cervical ectopic which was successfully managed conservatively

Association of first trimester serum level of placental growth factor (PlGF) and cervical length with onset of preterm labour

Background: Preterm labour (PTL) or premature labour is defined as one where labour starts before the 37th completed week.  The incidence of preterm birth is around 5-10% and it is the leading cause of perinatal morbidity and mortality. Diagnosis and treatment of PTL is challenging. However, owing to the availability of effective strategies for prevention of preterm birth, risk identification and early prediction is even more essential. This may provide opportunity for intervention and better obstetric care. Various biochemical markers were studied for prediction of preterm labour, but the sensitivity and specificity were found to be low. This study focuses on determining whether serum level of PlGF and ultrasound measure of cervical length at 10 – 14 weeks period of gestation can be used for early prediction of preterm labour.Methods: 296 antenatal women participated in this prospective observational study carried out from Dec 2015 to Sep 2017 at a tertiary care hospital. Serum level of PlGF was determined at 10-14 weeks. In the same sitting, cervical length was measured by transvaginal sonography. All these patients were followed up in antenatal OPD for monitoring the onset of preterm labour.Results: Incidence of preterm labour was 6.76 %. Maternal characteristics and obstetric factors were comparable in cases and controls. Serum PlGF level and cervical length values were lower in preterm labour group than term deliveries. But this result was not statistically significant.Conclusions: Lower levels of PlGF and cervical length were seen in preterm labour group, although it was not found to be statistically significant

Outcome of singleton pregnancy following in-vitro fertilization: a prospective study

Background: It is observed that any spontaneous pregnancy does not always result in healthy baby and healthy mother. The aim of the study was to study the obstetrical outcome of singleton pregnancies following in vitro fertilization and embryo transfer (IVF-ET).Methods: All cases undergoing IVF-ET at ART Centre were followed up after Day18 (of ET) for estimation of serum beta HCG and trans-vaginal ultrasound done on day 21 and 5th week. The selected singleton pregnancies were followed for the various parameters to be studied and the data was statistically analyzed. A resultant 73 patients with single intrauterine gestational sac was followed up.Results: In our study population of 73 post IVF-ET singleton pregnancies, 13.69% underwent first and second trimester abortions. They had increased risk of developing hypertensive disorders in pregnancy. Study also showed increased incidence of gestational diabetes mellitus. Yet another important outcome also included pregnancy with intrauterine growth restriction. Preterm birth was noted in 10 singleton pregnancies. Out of 73 followed up patients one third underwent caesarean delivery and another few underwent instrumental delivery. One in four babies accounted for weight more than 2.5 kgs. Out of followed up 73 cases of singleton IVF-ET pregnancies, 5 cases had congenital anomalies. Most common indication for NICU admission was respiratory distress. The incidence of small for gestational age came out to be significant.Conclusions: Outcome of singleton pregnancy after IVF-ET is associated with adverse pregnancy outcomes. Couples should be made aware that even singleton pregnancies resulting from ART are at increased risk for obstetric complications

Maternal and fetal factors associated with non detection of fetal growth restriction at term: a retrospective study

Background: Fetal growth restriction (FGR) is one of the major factors of perinatal morbidity and mortality. Aim was to study the maternal and fetal risk factors associated with non- detection of fetal growth restriction.Methods: A retrospective analysis was done at a tertiary care hospital. 280 term newborn cases weighing <2.5 kg were selected and they were divided into two groups, Group I- FGR detected cases by ultrasound, and group II- FGR non detected cases. Data was collected from the labour room registers.Results: Incidence of FGR found to be 6.8%.The maternal biological factors found to be significantly associated with fetal growth restriction were gestational hypertension, chronic hypertension and anemia. Fewer ANC visits was associated with non-detection of FGR cases. Detection of FGR cases were more if the birth weight found to be <2 kg when compared to non detection of FGR cases.Conclusions: Anaemia and fewer ante natal visits were associated with non detection of FGR at term when compared with antenatally detected FGR patients

Maternal and fetal factors observed with late preterm births

Backround: Although neonatal morbidity and mortality rates are fallen in recent decades, the prevalence of preterm deliveries has increased especially late preterm births. Late preterm deliveries are at increased risk of various neonatal complications compared to term deliveries.This study was carried out to identify the maternal characteristics and co-morbidites found with late preterm births and feto-maternal outcome in terms of indication of delivery, route of delivery, Apgar score and NICU admissions.Methods: A retrospective study was conducted in a tertiary care teaching hospital of Indian armed forces between Jan 2011 to Dec 2012 where 248 late preterm deliveries were analysed.Results: 56% women had spontaneous late preterm births and 44% women were induced. 23% of patients had history of 1 or more prior abortion and 13% patients had previous fetal deaths among the patients had late preterm delivery. Common maternal morbidities in mother delivering late preterm were hypertensive disorders of pregnancy (20.6%), anaemia (14.5%) and preterm premature rupture of membrane (13.7%). 4.8% newborns had Apgar ≤ 7 and 10% newborns required NICU admissions.Conclusion: Higher incidences of hypertensive disorders of pregnancy, anaemia and preterm premature rupture of membrane were found with late preterm birth and 10% of newborns required NICU care.

Choriocarcinoma: a rare case of stomach metastasis

Choriocarcinoma is a rare form of cancer which commonly occurs in women of reproductive age, rarely in post-menopausal women and in women under 20 years of age. We report a rare case of uterine choriocarcinoma with stomach metastasis in a 29 year-old woman who presented with upper gastrointestinal symptoms. The presented case report emphasizes the need for innovative treatment approach and appropriate diagnostic technology to enable early diagnosis and correct treatment. Furthermore the case highlights the need for healthcare workers to consider rare causes of gastrointestinal signs and symptoms

Evaluation of the incidence and outcome of gestational diabetes mellitus using the current international consensus guidelines for diagnosing hyperglycaemia in pregnancy

Background: GDM is defined as carbohydrate intolerance of variable severity with onset or first recognition during pregnancy. It may be appropriate to screen pregnant women belonging to high-risk populations during the first trimester of pregnancy in order to detect previously undiagnosed Diabetes Mellitus. Formal systematic testing for Gestational Diabetes is usually done between 24 to 28 weeks of gestation. Even though there are many diagnostic criteria and guidelines for management of GDM, there still exists lack of consensus regarding diagnosis and management of patients with GDM. After HAPO study, IADPSG has formulated a new consensus guideline for diagnosing hyperglycaemia in pregnancy which has formed the back bone for this particular study.Methods: This prospective observational study was carried out for a period of one year from July 2014 to Jun 2015 at AFMC, Pune in Dept. of Obstetrics & Gynaecology. To determine if gestational diabetes is present in pregnant women, a standard OGTT was performed with 75 g glucose. The incidence of GDM in antenatal population visiting AFMC, Pune was calculated. Maternal and neonatal outcome was observed and was compared with those of euglycaemic antenatal population.Results: The incidence of GDM in the antenatal population visiting AFMC, Pune was found to be 12.4%. Family history of Diabetes among first degree relatives is the commonest risk factor associated with GDM. It was found that, with adequate glycaemic control, most of the maternal as well as neonatal complications associated with GDM can be reduced to a level comparable with euglycaemic antenatal population.Conclusions: The new international consensus guideline in diagnosing GDM has shown an incidence of GDM comparable with other criteria for diagnosing GDM. Ensuring an adequate glycaemic control throughout the antenatal period alleviates most of the maternal and neonatal complications associated with GDM

Relation of endometrial thickness and pregnancy rates in intrauterine insemination following ovulation induction

Background: Controlled ovarian hyper stimulation (COH) using different agents with intrauterine insemination (IUI) are known treatment for infertility. Endometrial thickness (ET) is one of the predicting factors for clinical pregnancy along with other parameters. Many studies have been done in the past to find factors affecting the growth and maturity of the endometrium in women in IUI, but indigenous Indian studies regarding its relation with pregnancy were either limited or the results were unclear.Methods: A Prospective observational study was undertaken for assessing effects of clomiphene citrate (CC) and human menopausal gonadotropin (hMG) stimulated cycles on the ET and clinical pregnancy in single IUI cycle. Infertility cases were studied in two groups; Group A [ovulation induction (OI) with CC and IUI; n=101] and Group B (OI with hMG and IUI; n=103) after randomization using random number table as per standard protocol.Results: Comparable data obtained in mean age, duration of infertility, female and male factors in both groups. Mean ET on day of IUI in Group A and B was 8.35+2.08mm and 10.87+2.54mm respectively (p value <0.001). Range of ET in clinical pregnancies in Group A (n= 15) were 8.0- 12.9mm and 9.0- 12.9mm in Group B (n= 26). Ongoing pregnancies beyond 1st trimester were higher in Group B (n= 25) than Group A (n= 14).Conclusions: Mean ET and clinical pregnancy rate both were higher in hMG group compared to CC. This study identified an ‘optimum endometrial thickness’ (9.0-12.9mm) for achieving clinical pregnancy in hMG group