Conservative management of single fetal death in a twin pregnancy

Intrauterine death of a single fetus in a twin pregnancy during the second or third trimester is an uncommon complication and poses management challenge to the obstetrician. It also causes psychological stress and concern for the patient and her partner. We report a case of single fetal demise in a twin pregnancy, managed conservatively with a favourable outcome. A 31 years old lady, Para 1+1, referred from a cottage hospital, at a gestational age of 27 weeks, on account of demise of the leading twin, made on ultrasonography, following complaint of reduction in fetal movement of one-week duration. The patient was counselled and admitted to hospital for close monitoring. However, at 33 weeks gestation, six weeks following admission, she went into spontaneous labour and was subsequently delivered vaginally of a dead female leading twin (papyraceus) and a live female second twin. They weighed 300g and 2100g respectively, with a diamniotic-dichorionic placentation. Mother and baby were discharged home in stable state. The primary concern for single fetal demise in a twin pregnancy is its effect on the surviving fetus and mother. Regular antenatal care and routine ultrasonography in pregnancy are needed to make a diagnosis. Close monitoring of the wellbeing of the surviving twin and coagulation profile of the mother are crucial to manage possible complications.  

Serum uric acid as a prognostic marker for preeclampsia at a tertiary hospital in Port Harcourt, Nigeria

Background: Preeclampsia is a recognized cause of maternal and perinatal morbidity and mortality. Some biomarkers such as uric acid are increased in the presence of the disease. This could serve as a marker of severity and provide a basis for making management decisions. This study sought to determine the association between elevated serum uric acid and adverse pregnancy outcomes in preeclampsia.Methods: A prospective case-control study was carried out on consenting preeclamptic (95) and normotensive (95) pregnant women in their third trimester of pregnancy. Blood samples were taken for serum uric acid estimation at recruitment and delivery. Their Socio-demographic information was collected through a structured proforma. Data were analyzed using Statistical package for social sciences (SPSS) version 23. A p<0.05 was considered statistically significant.Results: The mean serum uric acid level was higher in the preeclamptic than in the normotensive controls (400.0±105.27 versus 256.31±67.18; p=0.001). High serum uric acid levels were associated with a higher incidence of AKI (p=0.005), birth asphyxia (p=0.002), and low birth weight (p=0.006) compared to preeclamptics with normal uric acid levels. The sensitivity of high uric acid in predicting the outcomes was 78-81% while the specificity was 48%. Serum uric acid ≥334 µmol/l was the threshold for predicting adverse outcomes.Conclusions: Women with preeclampsia had significantly higher serum uric acid levels. Hyperuricaemia in preeclampsia was associated with a high incidence of acute kidney injury, Birth asphyxia, and low birth weight. Serum uric acid ≥334 µmol/l was the threshold for the prediction of adverse outcomes.

Maternal serum lactate dehydrogenase level as a predictor of adverse pregnancy outcome in women with severe preeclampsia

Background: Preeclampsia is a multisystem disorder causing vascular endothelial damage and leads to leakage of lactate dehydrogenase (LDH) into maternal serum. This study evaluated the serum LDH levels in severe preeclamptic women to detect any correlation with adverse pregnancy outcomes. Methods: A prospective cohort study compared LDH levels of 68 severe preeclamptic women with 68 normotensives in the third trimester, matched for age, parity, and gestational age. The preeclamptic women were followed up until delivery to assess the maternal and neonatal outcomes. Data were analyzed with SPSS for Windows version 23. The level of significance was set at p&lt;0.05. Results: Both groups were comparable in their characteristics. The mean LDH level for severe preeclamptic group (717.40 IU/L) was higher than for the normotensive group (162.90 IU/L) and this was significant (p=0.001). Cesarean delivery was less likely when LDH was &gt;600 compared to ≤600 (OR 0.31; p=0.049) indicating a potential protective effect. The likelihood of IUGR (OR 3.14; p=0.045), IUFD (OR 6.48; p=0.028), stillbirth (OR 7.06 p=0.007), perinatal mortality (OR 4.84; p=0.004) and low birth weight &lt;2500 gm (OR 3.77; p=0.025) were all significantly higher with LDH levels &gt;600 IU/L. Conclusions: Maternal serum LDH levels were found to be significantly increased in pregnant women with severe preeclampsia compared to their normotensive counterparts, and elevated levels &gt;600 IU/L in the third trimester was associated with adverse perinatal outcomes