Management of pregnant women in times of COVID-19 our experience from Kashmir valley

Background: The coronavirus disease 2019, caused by severe acute respiratory syndrome coronavirus 2, is a global public health emergency. COVID-19 is a rapidly evolving situation, and there is limited data reporting its impact on pregnant women. Our study aimed to find the symptomatology, clinical courses and outcome of pregnant women with COVID-19 and to assess the vertical transmission potential of COVID-19 in pregnancy.Methods: This prospective observational study was conducted at Sher-i-Kashmir Institute of Medical Sciences (SKIMS), Medical College, Department of Gynaecology and obstetrics, Srinagar from May 2020 to September 2020. All COVID-19 positive pregnant patients admitted in our institution were included in our study.Results: The study included 100 Covid-19 positive pregnant women. Most of them were between 30 to 40 years of age. Median gestational age was 32.8 weeks. Comorbidity was present in 18 of our patients. 7 patients had gestational diabetes and 1 with overt diabetes, 5 were hypertensive, 3 had hypothyroidism, 1 with anti-phospholipid antibody syndrome (APLA) and 1 with asthma.44 patients were primigravidae and 56 were multigravidae. 27 patients delivered preterm and 44 with term pregnancy. 47 had undergone caesarean section and 24 normal vaginal delivery.88% of our patients were asymptomatic for covid-19 disease while as 12 patients had Covid-19 disease symptoms. The main complaints reported by patients related to covid-19 disease was mild dry cough and fever (9%). Two patients developed severe covid-19 pneumonia with ARDS and were put on ventilator, expired after 20 days of illness. All neonates were subjected to RT-PCR with none producing positive results.Conclusions: Appropriate and timely management of Covid-19 positive pregnant women is a principle for safe motherhood and healthy offspring in times of global pandemic. The present data do not suggest an increased risk of severe disease among pregnant women. We encourage the breast feeding immediately after delivery as benefits overweigh any potential risks of virus transmission if any

Role of IDH as a prognostic marker in preeclampsia/eclampsia: a comparative case control study

Background: Preeclampsia is a multisystem disorder which complicates 5-8% of all pregnancies. LDH is an intracellular enzyme and its level is increased in these women due to cellular death. Serum LDH levels can be used to assess the extent of cellular death and thereby the severity of disease in this group of women. Methods: It was a prospective case control study. Data was analysed using SPSS 16.0. The sample comprised of approximately 154 cases. All patients were of gestational age 28 weeks and above. They were divided into three groups 45 normotensives, 40 mild pre-eclamptics, 41 severe pre-eclamptics and 28 eclamptics. Results: Serum LDH levels consistently increased with increasing systolic and diastolic blood pressure, more so with diastolic blood pressure with a p value of <0.001. Most of the women with severe preeclampsia and eclampsia had severe proteinuria and serum LDH significantly increased with the severity of proteinuria (p<0.00). The incidence of operative delivery was moderately elevated with increased LDH level. The mean gestational age at the time of delivery in patients with serum LDH less than 600, 600 to 800 and more than 800 are 37.94 35.36 and 33.87 weeks. The mean baby weight in patients with serum LDH less than 600, 600 to 800 and more than 800 was 2.80, 2.62 and 1.81 kg. Conclusions: Serum LDH values were significantly high in pre-eclamptic patients depending on the severity of the disease. Serum LDH levels had a good correlation with all the diagnostic components of preeclampsia like SBP, DBP and proteinuria, similarly with maternal and fetal morbidity and mortality