Cardiac diseases in pregnancy: clinical profile and feto-maternal complications

Background: Pregnancy in woman with heart disease increases the risk of maternal and fetal complications. About 1% of pregnant women have concomitant cardiac disease. The present research was conducted to study the profile of cardiac diseases in pregnancy and its associated complications.Methods: A prospective analysis was carried out of 55 pregnancies of women with cardiac disease from at a tertiary care center. Standard Ante-natal care was furnished to all patients subjective to their requirements. Condition of patient during labour as well as the progress of labour was closely monitored. Fetal and maternal outcome after delivery as well as development of any complication was noted and treated accordingly. Data was analyzed using SPSS software ver. 21.0.Results: In present study, RHD constituted 71% cases while CHD constitutes 11% of all cases of heart disease. Other etiologies were dilated cardiomyopathies (DCM) (12.7%), IHD (3.6%) and arrhythmias (18%). Most common anomaly associated with RHD cases was mitral stenosis (75%) either isolated or along with other valvular pathologies. Most common CHD was atrial septal defect seen in 4 out of 6 cases. A total of 8 patients (16%) developed complications of which, 4 had postpartum hemorrhage, 2 developed pulmonary oedema, 1 had arrhythmia and 1 patient developed septic shock and multi organ failure. A total of 74% babies were healthy while IUGR and intrauterine deaths were seen in 22% cases and 4% cases respectively.Conclusions: Rheumatic heart disease is the predominant type of cardiac disease in pregnancy. Maternal and perinatal outcome can be improved by team approach at tertiary care center. Counselling for contraception and family planning and follow up during subsequent pregnancies is mandatory

Outcome of pregnancy in gestational diabetes as compared to overt diabetes

Background: Diabetes mellitus is a chronic metabolic disorder characterised by polyuria, polyphagia, polydipsia and glycosuria. Diabetes in pregnancy can be defined as pregestational (pre-existing) diabetes or gestational diabetes have type 1 (T1DM) or type 2 (T2DM) diabetes mellitus. Present study was carried to compare the maternal and perinatal outcome of overt diabetes mellitus as compared to gestational diabetes mellitus (PGDM) with that of gestational diabetes (GDM).Methods: An observational study was conducted at obstetrics and gynaecology department of a tertiary care center from July 2010 to October 2012 among 23 diabetic women. Seven of them were cases of overt diabetes while 16 were diagnosed during pregnancy. Maternal and fetal outcome were studied. All patients were followed from time of admission to discharge from hospital.Results: mean age of the participants were 26.71±4.89 in overt diabetes as compared to 27.56±4.41 among gestational diabetes. Illiteracy, low socio-economic status, rural residence, family history of diabetes was also high in overt diabetes mellitus as compared to GDM but none of them was statistically significant (P < 0.05). Intrauterine fetal death was more among GDM (37.5%) as compared to overt diabetes (28.57%). Prematurity and LBW were also high in overt diabetes as compared to GDM but none of them were statistically significant. Oligohydramnios, polyhydramnios and premature rupture of membrane were higher in gestational diabetes mellitus as compared to overt diabetes among women. Rate of LSCS were higher in gestational diabetes.Conclusions: Diabetes whether over or gestational is responsible for the poor outcome of the pregnancy so tight control is needed.

Comparative study of efficiency of vaginal versus oral misoprostol along with mifepristone for first trimester medical termination of pregnancy

Background: Authors estimate that 15.6 million abortions (14.1 million-17.3 million) occurred in India in 2015. Incomplete abortion is a known disadvantage of medical method of abortion reported in 0.2-3% of cases. Though Misoprostol can be used with different routes including oral, sublingual and vaginal, few evidences are available in drug effectiveness as well as its related side effects when used through different routes and more so in India. The present study is aimed to compare the efficacy of misoprostal in first trimester abortion when taken vaginally as compared to orally. Thus, whichever route results in lower rates of incomplete abortions, can be employed in our health set up, minimizing the complications of failed first trimester MTP.Methods: An experimental study was conducted on 74 women seeking termination of pregnancy within 9 weeks of amenorrhea during the period of 9 months in a tertiary care institute. Tablet mifepristone 200 mg was given to all participants. After 48 hours, 37 women were given 800 mcg tablet of Misoprostol for oral consumption while other 37 women were given 800 mcg Misoprostol for self-administering vaginally. Abortion status and complications were checked.Results: The complete abortion rates in vaginal group and oral group were 97.3% and 86.49 % respectively. Satisfaction was more in case of vaginal misoprostol, while side effects were similar in both groups.Conclusions: Mifepristone with vaginal misoprostol was more effective as compared to oral misoprostol for first trimester abortion

Gum chewing stimulates early return of peristalsis after caesarean section

Background: The aim was to evaluate the efficacy and safety of postoperative gum chewing on the recovery of peristalsis after caesarean section. Study design was a randomized controlled study. Settings were at GMERS medical college and hospital, Sola, Ahmedabad. Population was total of 200 pregnant women who underwent caesarean section under spinal anaesthesia.Methods: Women were randomized into two groups. Group A who received 1 chewing gum for 15 minutes every 2 hours post-surgery. Group B had traditional management (oral intake of clear fluids after 12 hours).Results: The study group showed shorter mean interval time for return of bowel sounds, passage of flatus, passage of bowel motion and shorter hospital stay as compared to the control group. Conclusions: Chewing gum is safe post-CS, well tolerated and associated with rapid return of intestinal motility and shorter hospital stay.