A case series on successful pregnancy outcomes in patients with Apla syndrome

The antiphospholipid antibody syndrome (APS) is defined by the persistent presence of antiphospholipid antibodies in patients with recurrent venous or arterial thromboembolism or pregnancy morbidity. Obstetric complications such as recurrent pregnancy loss, oligohydramnios, preterm delivery, fetal growth restriction, preeclampsia, HELLP syndrome and fetal distress are frequently associated with antiphospholipid syndrome. Successful management of pregnancies with APLA syndrome is a huge challenge for treating obstetrician. Obstetric care is based on combined medical and obstetric high risk management and treatment with the association between aspirin and heparin. Here, we present 3 cases of pregnancy with APLA syndrome who were successfully managed and they had uneventful pregnancies with successful outcomes without any complication

Case series on obstetrical outcomes in patient with uterine malformations

Congenital uterine anomalies occur due to abnormal fusion of mullerian duct during embryonic life. It is associated with high incidences of reproductive failures and adverse obstetrical outcomes. It may be associated with malpresentation, preterm labour, or recurrent pregnancy losses. Authors report a case series of 7 patients which were admitted in obstetrics and gynaecology department of SP medical college and associated group of hospitals between time period of March 2019 to July 2019. Among 7 cases 6 cases were associated with malpresentation, 1 with abortion, and 1 with preterm labour. This series shows that uterine anomalies are associated with different obstetrical outcomes varying from totally uneventful antenatal and postnatal period to abortion or preterm labour. Prenatal diagnosis of uterine anomaly may help in improving the obstetrical outcome in these patients.

A prospective study to know the efficacy of short-term use of injectable depot medroxy progesterone acetate for contraception in tertiary care hospital from North West Rajasthan, India

Background: Population explosion is a major issue especially in our country with the second largest population in world next only to china starting the use of contraception in postpartum period is an effective method of increasing the gap between two pregnancies and hence reducing the family size. Objective was to study the efficacy of DMPA injection in postpartum period for contraception.Methods: The study was a prospective study conducted on 100 patients during June 2018 to May 2019 in the department of obstetrics and gynaecology, S. P. Medical College Associate A. G. H., Bikaner, Rajasthan, India.Results: In present study mild irregular bleeding was present in 21, 35 and 38 cases at initial visit, at 3 months and at 6 months follow up respectively. Moderate irregular bleeding was present in 8 cases at initial visit, 27 cases at 3 months and 18 cases at 6 months follow up while 37 and 43 cases had severe irregular bleeding at 3 and 6 months follow up respectively. At baseline, 89 and 10 and 1 cases had their blood sugar 120 respectively, at 3 months follow-up, 94, 6 and 0 cases had their blood sugar level 120 respectively while at 6 months follow-up 97, 3 and 1 cases had their blood sugar level 200 respectively.Conclusions: Injection DMPA use in postpartum period is safe, effective and reversible method with no deleterious metabolic effects and do not need special training to administer to it, so it is a good option of contraception for women who are lactating.

Chronic uterine inversion associated with uterine leiomyoma misdiagnosed as cervical fibroid: a case report

Chronic inversion of uterus is a rare clinical entity which is usually associated with obstetrics complication and rarely with gynaecological disorder like fibroid present at fundus of uterus. We here present a case of 40-year-old female P3L3 with chronic inversion of uterus with fundal fibroid which present with 3year history of abnormal vaginal bleeding. Ultrasonography and MRI revealed cervical fibroid. Due to AUB secondary to cervical fibroid decision of hysterectomy was taken. On laparotomy chronic uterine inversion was present which was corrected by haultain’s procedure. Then hysterectomy was done. Histopathology report suggestive of uterine leiomyoma at fundus of uterus. Chronic uterine inversion associated most commonly with fundal submucous leiomyoma. Other causes are leiomyosarcoma, endometrial carcinoma, cervical carcinoma, rhabdomyosarcoma, mixed mullerian sarcoma. It is an extremely rare gynaecological condition and can be misdiagnosed as cervical fibroid, advanced cervical malignancy or other causes of AUB in females. It could be labelled as gynaecological near miss so a high index of suspicion is necessary for it’s diagnosis

A prospective clinical trial to evaluate the role of very low dose mifepristone 10 mg in medical management of uterine leiomyoma in tertiary care hospital from North West India

Background: Uterine leiomyomas are the most common benign tumours of the uterus and also the most common benign solid tumor in female. It arises from the uterine smooth muscles (myometrium) but contain varying amount of fibrous connective tissue. Aim of study was to evaluate the efficacy of very low dose Mifepristone (10 mg) on leiomyoma volume and its related symptoms.Methods: This was a prospective clinical study. 30 women met with the inclusion criteria and giving informed consent for the study.Results: Mean myoma volume was 60.32±51.89 at initial visit and 36.13±48.54 at 3 months follow up visit with 40.1% reduction which was statistically significant difference (p < 0.001). Mean PBAC score in Group I was 155.53±21.70 at initial visit and 0.97±2.97 at 3 months follow up visit with 99.3% reduction which was statistically significant (p < 0.001).Conclusions: Mifepristone 10 mg is efficacious in term of control of bleeding, alleviation of pain related symptoms with few side effects. So low dose mifepristone can be used as a suitable option for women with symptomatic fibroids in perimenopausal periods or patients not willing or fit for surgery

A cross sectional study to evaluate serum calcium levels among pregnant women and it's association with preeclampsia and delivery outcomes at tertiary care Hospital Bikaner, Rajasthan

Background: Hypertensive disorders of pregnancy, including preeclampsia complicates about 10% of pregnancies worldwide. Preeclampsia is one of the major cause of maternal and perinatal morbidity and mortality worldwide. According to the National Health Portal of India, the incidence of preeclampsia is reported to be about 8-10% among pregnant women. The present study was aimed to compare mean serum calcium levels in preeclamptic and normotensive pregnant women at third trimester of gestation and assess relationship between maternal serum calcium levels, severity of disease and overall maternal and perinatal outcome.Methods: This was a cross sectional study conducted on 200 females divided into two groups (i.e. Study and Control Group) from 1st November 2019 to 31st October 2020. Informed consent was obtained for subjecting. Detailed history and clinical examination were performed. Serum calcium level was measured in both groups by spectrophotometric method.Results: Mean serum calcium level in study group (preeclamptic) was 7.84±0.74 mg/dl while in control group (normotensive) mean serum calcium level was 9.68±0.97 mg/dl. Serum calcium level was significantly lower in preeclamptic women than normotensive pregnant women (p<0.001).Serum calcium showed significant negative correlation with systolic and diastolic blood pressure.Conclusions: This study concludes that hypocalcaemia may have a role in aetiology of preeclampsia and adverse maternal and perinatal outcome. Thus intake of calcium supplements may help in reduction of incidence of preeclampsia especially in a population of a developing country

Blood cytokine, chemokine and growth factor profiling in a cohort of pregnant women from tropical countries

The immune status of women changes during and after pregnancy, differs between blood compartments at delivery and is affected by environmental factors particularly in tropical areas endemic for multiple infections. We quantified the plasma concentration of a set of thirty-one TH1, TH2, TH17 and regulatory cytokines, pro-inflammatory and anti-inflammatory cytokines and chemokines, and growth factors (altogether biomarkers), in a cohort of 540 pregnant women from five malaria-endemic tropical countries. Samples were collected at recruitment (first antenatal visit), delivery (periphery, cord and placenta) and postpartum, allowing a longitudinal analysis. We found the lowest concentration of biomarkers at recruitment and the highest at postpartum, with few exceptions. Among them, IL-6, HGF and TGF-β had the highest levels at delivery, and even higher concentrations in the placenta compared to peripheral blood. Placental concentrations were generally higher than peripheral, except for eotaxin that was lower. We also compared plasma biomarker concentrations between the tropical cohort and a control group from Spain at delivery, presenting overall higher biomarker levels the tropical cohort, particularly pro-inflammatory cytokines and growth factors. Only IL-6 presented lower levels in the tropical group. Moreover, a principal component analysis of biomarker concentrations at delivery showed that women from Spain grouped more homogenously, and that IL-6 and IL-8 clustered together in the tropical cohort but not in the Spanish one. Plasma cytokine concentrations correlated with Plasmodium antibody levels at postpartum but not during pregnancy. This basal profiling of immune mediators over gestation and in different compartments at delivery is important to subsequently understand response to infections and clinical outcomes in mothers and infants in tropical areas

Naturally Acquired Binding-Inhibitory Antibodies to Plasmodium vivax Duffy Binding Protein in Pregnant Women Are Associated with Higher Birth Weight in a Multicenter Study

A vaccine to eliminate malaria would need a multi-stage and multi-species composition to achieve robust protection, but the lack of knowledge about antigen targets and mechanisms of protection precludes the development of fully efficacious malaria vaccines, especially for Plasmodium vivax (Pv). Pregnant women constitute a risk population who would greatly benefit from a vaccine preventing the adverse events of Plasmodium infection during gestation. We hypothesized that functional immune responses against putative targets of naturally acquired immunity to malaria and vaccine candidates will be associated with protection against malaria infection and/or poor outcomes during pregnancy. We measured (i) IgG responses to a large panel of Pv and Plasmodium falciparum (Pf) antigens, (ii) the capacity of anti-Pv ligand Duffy binding protein (PvDBP) antibodies to inhibit binding to Duffy antigen, and (iii) cellular immune responses to two Pv antigens, in a subset of 1,056 pregnant women from Brazil, Colombia, Guatemala, India, and Papua New Guinea (PNG). There were significant intraspecies and interspecies correlations for most antibody responses (e.g., PfMSP119 versus PfAMA1, Spearman's rho = 0.81). Women from PNG and Colombia had the highest levels of IgG overall. Submicroscopic infections seemed sufficient to boost antibody responses in Guatemala but not antigen-specific cellular responses in PNG. Brazil had the highest percentage of Duffy binding inhibition (p-values versus Colombia: 0.040; Guatemala: 0.047; India: 0.003, and PNG: 0.153) despite having low anti-PvDBP IgG levels. Almost all antibodies had a positive association with present infection, and coinfection with the other species increased this association. Anti-PvDBP, anti-PfMSP1, and anti-PfAMA1 IgG levels at recruitment were positively associated with infection at delivery (p-values: 0.010, 0.003, and 0.023, respectively), suggesting that they are markers of malaria exposure. Peripheral blood mononuclear cells from Pv-infected women presented fewer CD8+IFN-gamma+ T cells and secreted more G-CSF and IL-4 independently of the stimulus used in vitro. Functional anti-PvDBP levels at recruitment had a positive association with birth weight (difference per doubling antibody levels: 45 g, p-value: 0.046). Thus, naturally acquired binding-inhibitory antibodies to PvDBP might confer protection against poor outcomes of Pv malaria in pregnancy

Microsatellite Genotyping of Plasmodium vivax Isolates from Pregnant Women in Four Malaria Endemic Countries

Plasmodium vivax is the most widely distributed human parasite and the main cause of human malaria outside the African continent. However, the knowledge about the genetic variability of P. vivax is limited when compared to the information available for P. falciparum. We present the results of a study aimed at characterizing the genetic structure of P. vivax populations obtained from pregnant women from different malaria endemic settings. Between June 2008 and October 2011 nearly 2000 pregnant women were recruited during routine antenatal care at each site and followed up until delivery. A capillary blood sample from the study participants was collected for genotyping at different time points. Seven P. vivax microsatellite markers were used for genotypic characterization on a total of 229 P. vivax isolates obtained from Brazil, Colombia, India and Papua New Guinea. In each population, the number of alleles per locus, the expected heterozygosity and the levels of multilocus linkage disequilibrium were assessed. The extent of genetic differentiation among populations was also estimated. Six microsatellite loci on 137 P. falciparum isolates from three countries were screened for comparison. The mean value of expected heterozygosity per country ranged from 0.839 to 0.874 for P. vivax and from 0.578 to 0.758 for P. falciparum. P. vivax populations were more diverse than those of P. falciparum. In some of the studied countries, the diversity of P. vivax population was very high compared to the respective level of endemicity. The level of inter-population differentiation was moderate to high in all P. vivax and P. falciparum populations studied

A Clinical study of amniotic fluid index at or beyond 28 weeks of gestation and its relation to perinatal outcome

Background: Amniotic fluid plays a major role in the development of fetus. It provides a medium in which fetus can readily move, cushions the fetus against injuries, helps to maintain even temperature. Objective of present study was to investigate the perinatal outcome of ultrasonographically detected normal and decreased (Oligohydramnios) amniotic fluid index, at or beyond 28 weeks of gestation.Methods: During this study 200 patients with singleton pregnancy were selected at or beyond 28 weeks of pregnancy and AFI was evaluated. On the basis of AFI measurement patients were divided in two groups. Perinatal outcome in pregnancies with AFI of &lt;5cm were compared with those with normal AFI.Results: There was significant correlation (p&lt;0.001) between oligohyramnios and poor perinatal outcome. Incidence of LSCS, meconium stained liquor and low apgar score has significant correlation in patients with oligohydramnios. Incidence of low birth weight babies, NICU admissions and perinatal death was more were more are more in oligohydramnios cases. This is statistically significant (p&lt;0.001).Conclusions: AFI &lt;5 cm at or beyond 28 weeks of gestational age in an indicator of poor perinatal outcome. AFI measurement in antepartum or intrapartum period can help to identify women who need increased antepartum surveillance for pregnancy complications and such women should be managed in a special unit to combat the complications effectively