Successful pregnancy outcome in a case of Takayasu’s arteritis with recurrent pregnancy loss with low dose heparin

Takayasu's arteritis (TA) is a well-known yet rare form of large vessel vasculitis. TA commonly effect women in childbearing age of Asian origin. The etiology remains speculative but current literature supports autoimmune basis for TA. Suppression of inflammation and preservation of vascular competence form the basis of the treatment. The basic disease appears to be unaffected by pregnancy, inflammatory activity and haemodynamic status improves with pregnancy, but the high arterial pressure and the pre-eclampsia constitute main maternal complications. The fetal complication is intrauterine growth. Therefore, obstetricians are faced with the dilemma of optimal management in pregnancy. The optimum management of these women involves conception during the remission period, antenatal care provided by multidisciplinary team, early detection, treatment of hypertension and curtailing the second stage of labour for better maternal and fetal outcome. In our case, the patient was managed with low dose heparin which was started as soon as the patient visited us (14 weeks) and continued till one day before surgery. No steroids were given at any time during the course of pregnancy and post - one year follow - up the patient is doing fine

A comparative study of coagulation profile and platelet indices at term in pre-eclamptic, eclamptic and normal pregnancy along with fetomaternal outcome

Background: Hypertensive disorders of pregnancy is reported to cause about 60-80% of maternal deaths. Platelet indices are biomarkers of platelet activation. Among these platelet indices, mean platelet volume (MPV), and platelet distribution width (PDW), platelet large cell ratio (PLCR) is a group of platelet parameters. When platelets are activated, they become larger in size which causes increased platelet indices such as MPV, PDW and PLCR. So, platelet indices can give an idea of platelet activation. A comparative study of coagulation profile and platelet indices at term in pre-eclamptic, eclamptic and normal pregnancy along with fetomaternal outcome.Methods: This study was carried out in department of obstetrics and gynaecology in collaboration with department of pathology, Rabindranath Tagore Medical College (RNTMC), Udaipur. Cases were selected by systematic random sampling. Bleeding time (BT), clotting time (CT), prothrombin time (PT), mean platelet volume (MPV), platelet distribution width (PDW), and activated partial thromboplastin time (aPTT) to analyse hypertensive disorders in pregnancy (HDP) during the period January 2021 to December 2021.Results: Significant difference was seen in bleeding time (seconds), prothrombin time (seconds), aPTT (seconds) between normal pregnancy as compared to pre-eclampsia and eclampsia. (p value <0.05). Patients’ admission in neonatal intensive care unit (NICU) was significantly higher in eclampsia (p<0.0001) and pre-eclampsia (p<0.0001) as compared to normal pregnancy (66.67%, 43.24% versus 2% respectively).Conclusions: We conclude that coagulation profile like (BT, CT, PT, and aPTT), platelet counts along with platelet indices- MPV, PDW are useful markers, which were significantly raised in patients with preeclampsia and eclampsia. Platelet indices along with coagulation profile emerges as an important, simple, cost effective and effortless tool for predicting severity of pregnancy induced hypertension (PIH).

Comparative study of combination of misoprostol with Foley’s bulb compared with misoprostol alone for termination of second trimester pregnancy

Background: Second trimester abortion is termination of pregnancy in a period from 13 to 28 weeks of gestation. Second trimester losses may be due to maternal factors such as uterine malformation, growths in the uterus (fibroids), or cervical problems. These conditions also may contribute to premature birth.  Aims and objectives were to compare the efficacy, safety and suitability of combination of misoprostol with intracervical Foley’s catheter v/s misoprostol alone for termination of second trimester pregnancy.Methods: This randomized controlled trial study was conducted on 100 study subjects who passed our inclusion and exclusion criteria. Group A: received misoprostol with intracervical Foley’s catheter. Group B: received misoprostol alone. The groups were compared with respect to the patients’ characteristics, gestational age, indication for termination of pregnancy, rate of complications, etc.Results: Mean value of age (years) of study subjects was 27.12±4.5. Mean induction to delivery time (hours) in P0 was 17.73±6.46 and in P1-P2 was 14.78±4.9 which was significantly higher as compared to ≥P3 (11.46±3.82). (p=0.0004). Mean induction to delivery time (hours) in 14 to 18 weeks was 15.25±5.4 and >18 weeks was 15.02±5.84. (p=0.854). Distribution of side effect between group A and B. (6% vs 20% respectively) (p=0.041).Conclusions: We conclude that intracervical Foley catheter and vaginal misoprostol is a safe and effective method for second trimester abortion as compared to misoprostol alone group with no additional risks.

Neuroimaging in eclamptic patients and its clinical implications

Background: Aim of the study is to assess the utility of neuroimaging (CT/MRI) in eclamptic patients and correlating their clinical implications and to study the role of Injection Mannitol in case of Eclampsia who did not respond to injection magnesium sulphate alone. Methods: This prospective study was conducted in Pannadhay Mahila Chikitsalya Udaipur, RNT Medical College Udaipur, Rajasthan. 50 eclamptic patients fulfilling the inclusion and exclusion criteria were subjected to neuroimaging CT/MRI from August 2021 to August 2022. Injection Mannitol was added in eclamptic patients who did not respond to injection magnesium sulphate alone. Results: In this study neuroimaging were normal in 42% cases while 58% cases had pathological changes; PRES, haemorrhage, infarction, ischemia etc. Out of these PRES was seen in 48% cases. Mannitol was given in 14% patients and only one patient did not respond to mannitol. Conclusions: This study revealed that PRES was the main neurological component among patients. Neuroimaging helps in better management of eclampsia. Mannitol holds utility in managing the patients unresponsive to injection magnesium sulphate.

Modified biophysical profile in high-risk pregnancy and its correlation with perinatal outcome

Background: Aim of the present study was to evaluate the perinatal outcome in high-risk pregnancy with modified biophysical profile (MBPP). Methods: The study is observational study,65 high risk pregnant women fulfilling the inclusion criteria participated in the study. The study subjects were subjected to MBPP. Then perinatal outcomes were assessed in view of mode of delivery, maternal and neonatal morbidity and mortality. Results: Out of 65 cases, 78.5% had normal NST, 80% had normal AFI.3 neonates got admitted in NICU. 13 women underwent LSCS, 9 had instrumental delivery and rest delivered vaginally normal. Conclusions: The study showed that HRPs with MBPP abnormal or any of MBPP parameter abnormal have higher chances of perinatal morbidity and mortality

Correlation between ultrasonography measured transcerebellar diameter of foetus with early and late gestational age

Background: Traditionally, the gestational age of the foetus is determined from the date of the last menstrual period. Prediction of gestational age (GA) based on sonographic foetal parameters is perhaps the cornerstone in modern obstetrics and continues to remain an important component in the management of pregnancies with foetuses who have growth disturbances. The objective of the study was to study the correlation between foetal transcerebellar diameter (TCD) and pregnancy age, addressing early and late gestation periods.Methods: This prospective observational study was conducted in the 100 pregnant women. Ultrasound examination for TCD and gestation age was done between 20-28 weeks of gestation and between 30-36 weeks of gestation. For the measurement of TCD transverse view of the foetal intracranium was obtained. Statistical analysis was performed using suitable tests.Results: Mean age of the women was 24.82+3.31 and 85% women were in age group 21-30. The mean TCD in early gestational age i.e. 20-28 weeks was 24.7 ± 3.86 and in late gestational age i.e. 30-36 weeks was 39.31 ± 2.51. Median TCD increases from 20.35 mm at 20 weeks to 41.7 mm at 36 weeks of gestation. The correlation coefficient between gestational age and TCD was 0.971, which indicated high degree of relation with p value <0.0001.Conclusions: This study shows linear relationship between TCD and gestational age at 20-28 weeks & 30-36 weeks. So, TCD is a reliable method of gestational age determination in early as well as in late pregnancy

A rare case of genital myiasis in genital prolapse

Genital myiasis is an infestation by fly larvae in genital organs, where they feed and develop as parasites. They can cause severe infection, inflammatory reaction and can be linked to psychiatric disturbances. Commonly cutaneous, ophthalmic, auricular and nasopharyngeal myiasis are seen, with genital myiasis being a rare condition. We reported a case of an 82-year-old postmenopausal female who presented with the complaint of intense pain in genital region. After clinical evaluation she was clinically diagnosed as a case of genital myiasis of prolapsed uterus. Myiasis of the genital organ is a rare clinical entity. Good personal hygiene and proper sanitary conditions are very crucial for prevention of myiasis

An observational study to assess feto-maternal outcome in severely ill COVID-19 positive pregnant females admitted at dedicated COVID care center of southern Rajasthan

Background: COVID-19 infection is caused by corona virus SARS-COV2. the aim of the study is to assess feto-maternal outcome in severely ill covid positive pregnant females.Methods: An observational study was conducted at dedicated covid care center, RNT medical college Udaipur from Jan 2021 to May 2021 among pregnant females. In this study out of 236 total covid positive pregnant patients, 54 patients which could not maintain oxygen saturation, according to NIH criteria were included in our study.Results: Out of 54 pregnant women, 24 women delivered with 2 twin pregnancies. Out of this 67% underwent cesarean section and 33% were delivered by vaginal route. Postpartum hemorrhage seen in 29% of patients. Maternal death reported in 39% of patients. Out of 54 patients 38 patients were admitted in ICU. Invasive ventilation received by 26% of patients while oxygen received by non-invasive ventilation (15%), Bains (18%) rest by NRBM and venturi mask (41%). Remdesivir were given in 26 (48%) patients.Conclusions: Our study suggests there may be increased risk of adverse pregnancy outcome for mother and fetus. COVID-19 in pregnancy was associated with risks of pre-eclampsia, stillbirth, preterm birth, PPH. Similar to general population comorbidities do play a role in the outcome of disease in pregnancy. Further studies are needed for effective strategies to prevent adverse outcomes in pregnant females with COVID-19.

Correlation of non-stress test with fetal outcome in term of Apgar score- a prospective observation study

Background: Non-stress test (NST) is a graphical recording of changes in fetal heart activity and uterine contraction along with fetal movement when uterus is quiescent. The objectives of antepartum fetal surveillance are to prevent fetal death and avoidance of unnecessary intervention. This study using NST as a tool for routine antepartum fetal surveillance was trying to catch up those fetuses who might be at risk in womb and provide prompt intervention in otherwise considered normal pregnancies without any obvious high risk factor thus giving the best outcome in mothers.Methods: The objective of this study was to evaluate the correlation of the non-stress test with fetal outcome in pregnancies from 37-42 weeks of gestation.  This was a prospective observational study at Pannadhaya Rajkiya Mahila Chikitsalya Udaipur (Rajasthan) from February 2022 to July 2022. This study included 100 normal pregnant mothers from 37 weeks to 42 weeks who were subjected to NST.Results: The parameters of poor fetal outcome like Apgar score <7 at 5 minutes had increased incidences in the non reactive group.Conclusions: NST tells about acute fetal hypoxia and decision to delivery time can be made for those patients with fetal distress so that a major improvement in the outcome among parturient can be achieved with abnormal NST results. So This study suggested that the NST was found to be a good predictor of the healthy foetus even in normal pregnancies between 37-42 weeks of gestation and the probability of an adverse outcome such as poor Apgar score increases with a non reactive strip

A rare case of giant condyloma acuminata during pregnancy

Genital warts (Condyloma acuminata) are a benign lesion caused by human papillomavirus (HPV) type-6 or type-11 and are usually transmitted sexually. During pregnancy, condyloma has a tendency to proliferate and may have recurrence. We have a case of G2P1L1 38 weeks previously normal vaginal delivered patient in our hospital with extensive genital warts. Patient was successfully managed by surgical excision and after that in follow up after 2 months for podophyllin resin application on remaining lesions. HPV infection presentation can range from asymptomatic to cervical cancer. Small genital wart lesion may become extensive and cumbersome during pregnancy and again regress after delivery in due course of time. HPV vaccination, sex education and early treatment of condyloma lesions should prevent and, in any case, improve the prognosis of this disease