Wernicke’s encephalopathy: obstetric diagnostic challenge! (a rare complication of hyperemesis gravidarum): a case report and review of literature

Wernicke’s encephalopathy (WE) is an acute neurological disorder caused by a deficiency in thiamine. It is characterized by triad of altered mental status, ataxia and ophthalmoplegia. Most of the cases reported were secondary to long-term alcohol use. We reported a rare case of WE due to hyperemesis gravidarum in a 29-year-old P1L1A1 women at 22 weeks of gestation who had spontaneous abortion. Patient manifested with features of mental confusion, nystagmus, and gait ataxia. Diagnosis was established after MRI findings suggestive of WE in thalamus. Patient clinically improved after treatment with thiamine. We emphasize the importance of thiamine supplementation to women with hyperemesis to prevent life threatening complications.

Pregnancy in sickle cell thalassemia: double trouble!

This is a case report of 20-year-old multigravida (G2P1L0) belonging to tribal community presented at 30 weeks of gestation with severe anemia, fever, arthralgia and jaundice with multiple blood transfusions in the past and with previous pregnancy outcome being stillborn and was not evaluated for the same. A diagnosis of sickle cell β+Thalassemia (SCD crisis) was made and managed vigilantly by multidisciplinary approach and had full term vaginal delivery with good perinatal outcome and finally both mother and newborn were discharged in stable condition. This highlights the overall increase in maternal and fetal complications in pregnancy with sickle cell thalassemia. Thus health education, screening, early intervention with multidisciplinary approach and regular follow up prevents maternal morbidity and mortality

Analysis of ectopic pregnancy in a tertiary care hospital

Background: Ectopic pregnancy is a life threatening obstetrics emergency in early trimester associated with increased risk of morbidity and mortality if not timely intervened. High index of clinical suspicion is required for early diagnosis specially in reproductive age group women presenting with history of amenorrhea. Aim was to analyse the incidence of ectopic pregnancy, its risk factors, clinical presentation and management of ectopic pregnancy. Methods: A retrospective observational study was conducted on ectopic pregnancy cases admitted in a tertiary care institute over a period of 5 years from January 2018 to December 2022. A total of 221 cases of ectopic pregnancy were analysed for parameters like age, parity, gestational age, clinical presentation, risk factors, intervention and outcome. Results: There were 221 ectopic pregnancy cases during the study period with incidence of 4.3/1000 deliveries. The mean age was 24 years with the mean gestational age of 6.83±1.25 weeks. The commonest risk factor identified was any previous pelvic surgeries (49.32%), PID (11.76%), history of abortion and use of IUCD (8.14%). The triad of ectopic pregnancy (pain abdomen, history of amenorrhoea, bleeding PV) was found in 35.29%. Ectopic pregnancy was ruptured in 148 cases (66.96%) and unruptured in 73 cases (33.03%). Majority of the ectopic pregnancy was tubal ectopic and most common site was Ampulla (47.06%) followed by isthmus (23.98%). 96% of the cases were managed by surgical intervention and two maternal deaths were found during the study period. Conclusions: Proper evaluation of risk factors9and early diagnosis will help in preserving fertility and also reducing8morbidity and mortality. Majority of the cases were in ruptured condition, rendering8conservative management was impossible. Therefore awareness of its determinants can aid in8early detection of more number of such cases8in unruptured condition especially in8peripheral center, leading to early referral

Analysis of maternal near miss cases in a tertiary care hospital

Background: The study of maternal near miss (severe maternal morbidity) is an alternative to study of maternal death. To reduce maternal mortality ratio (MMR), analysis of maternal near miss cases provide valuable information, which helps in implementing strategies to prevent maternal death. Aims and objectives were to determine maternal near miss indices and to analyse the causes of maternal near miss and other associated factors. Methods: A retrospective analysis of health records of maternal near miss cases admitted to tertiary care hospital from October 2021 - September 2022 was done. Patient characteristics like age, parity, gestational age, risk factors, mode of delivery, lifesaving intervention were studied. Results: A total of 9,744 patient admitted for seeking obstetric care and out of which there were 8,791 deliveries. A total of 164 maternal near miss cases and 24 maternal deaths were found during study period. The maternal near miss incidence ratio 18.76/1000 live birth, maternal near miss to mortality ratio 6.8:1 and mortality index was 12.7%. Hypertension and its complications are the most common cause for maternal near miss cases. Women in late trimester, multiparity, low education status, lack of awareness are at increased risk of near miss cases. Conclusions: Hypertensive disorders in pregnancy and obstetric hemorrhage are leading cause for pregnancy specific obstetric disorder and anemia was found to be a leading cause for pre-existing condition aggravated during pregnancy. This study highlights the need for overall improvement in awareness among pregnant mothers and its timely accessibility with quality critical care management