Electrocardiographic profile of patients with hypertensive disorders in pregnancy

Background: Preeclampsia in pregnancy is a frequently encountered entity. Recent evidence suggests that preeclampsia can be considered as a screening test for future cardiovascular problems and abnormalities in pregnancy may help in counselling patients regarding future risk of cardiovascular problems. Electrocardiography (ECG) is a simple tool for detecting cardiovascular problems. While physiological changes in the ECG in pregnancy have been documented, the pattern of ECG in hypertensive disorders of pregnancy is not adequately studied in India. This formed the basis of the study.Methods: 140 patients who have been diagnosed as gestational hypertension and pre-eclampsia during the pregnancy were studied in the antenatal period. An ECG (non-portable, standard, 12 lead) available in the hospital was done, and the ECG was reported by the physician on-call.Results: The average age distribution of the patients was 28.26 years. Majority of the patients in the study were primigravidae. 35% of the patients were more than 37 weeks of gestation. 20 patients showed electrocardiographic abnormalities. The most common abnormality was sinus tachycardia and left axis deviation.Conclusions: ECG abnormalities are seen in 14.2% of preeclamptic women. ECG abnormalities in preeclamptic women studied had no relation to the maternal age, gestational age; parity and use of antihypertensives

Comparison of obstetric outcomes with use of two different standard doses of oxytocin for induction of labor

Background: The interventions used in a suspected abnormal labor include amniotomy (artificial rupture of membranes), oxytocin infusion, forceps application and caesarean section. No study is available for individualised treatment with oxytocin. Considering the literature review, many unanswered questions remain regarding the use of oxytocin and definite improvements are possible. All this led us to choose this as the topic for study.Methods: This study was conducted over a duration of 18 months (January 2017 to June 2018) where ninety (90) laboring patients admitted in a tertiary care hospital were included. They were categorized into two groups, one group (30 patients) received the low dose and the other group (60 patients) received high dose oxytocin infusions. The labor outcomes including the maternal and fetal outcomes were observed.Results: The average age in the study population was 26 years and the average gestation was 38 weeks. The overall rate of cesarean section in this study was 16.67% (23.33% in the low dose group and 13.33% in the high dose group). Gravidity and parity have an association with the vaginal delivery.Conclusions: It is safe to use oxytocin infusion either in the low dose or the high dose for induction of labor as both the regimens are equally effective and comparable in terms of outcomes. The low dose oxytocin regimen can be safely recommended in a patient requiring oxytocin infusion for induction of labor and the treating doctor should consider starting with low dose oxytocin.

Comparison of dermabond adhesive glue with skin suture for repair of episiotomy

Background: The objective of the study was to compare perineal skin closure of episiotomy with cyanoacrylate adhesive glue with standard skin closure.Methods: A prospective randomized controlled study was conducted in a tertiary care hospital. 100 primigravidae undergoing normal vaginal delivery were assigned to study and control groups. After completion of vagina mucosa and muscle suturing; in study group, skin closure was done with adhesive glue and in control group, conventional suturing done. Time taken to complete skin closure, pain perceived during and after procedure and postoperative wound healing and cosmesis of perineal area were studied.Results: The mean time for skin closure with adhesive glue (1.16 minutes) was lesser than conventional skin suturing (3.52 minutes). 84% of study group patients perceived no pain (VAS score of 1) while 72% of patients in control group perceived mild pain during suturing. In all time intervals (during and after the procedure), pain intensity was lower in the study group (p value <0.05). The time for healing was around 4 days in the study group and around 8 days in the control group. There was no statistically significant difference in the rate of wound complications and cosmesis between the groups.Conclusions: Findings of the study support the safe and efficacious usage of cyanoacrylate adhesive glue for episiotomy skin closure. Cyanoacrylate adhesive glue is a superior alternative to conventional skin suturing shorter time, less pain during and after the procedure. Wound healing and cosmesis are comparable with both adhesive glue and suturing

Primary cesarean section in multigravidae: a case control study

Background: Primary Cesarean Section (CS) is defined as CS in a patient who has not had a prior CS. While primigravidae contribute to the bulk of those undergoing primary CS, multigravidae (with only prior vaginal delivery) can also contribute. The purpose of this article is to examine the contribution of the group of multigravidae (with only prior vaginal delivery) and how they differ from primigravidae.Methods: A review of records was conducted for one year period. The confinements which were first or second para (which had undergone CS in either index pregnancy or previous pregnancy) were divided into primipara: primary CS and second para: primary CS. Various parameters were compared between the primipara undergoing primary CS and multipara undergoing primary CS.Results: Out of 1154 births, the number of CS was 401. Primary CS in primiparas was 266 (66.3%) and primary CS in multipara (with only prior vaginal deliveries) was 61(15.2%). Booking status, baby weights and NICU admission rates did not different significantly. Preterm deliveries, higher number of prior abortions; malpresentations, deep transverse arrest, antepartum hemorrhage was more common among the multipara group and the difference was statistically significant (p value &lt; 0.05).Conclusions: Multipara (with prior vaginal delivery only) definitely contribute to primary CS rate and cannot be neglected. The profile of patients and the indications of CS in multipara appear to differ from those in primipara

Clinical presentation of autoimmune disorders in pregnancy

Background: Autoimmune disorders have a significant impact over the health of an individual. This heterogenous group of disorders affects pregnancy in a multitude of ways. Pregnancies with autoimmune disorders are usually cared for by a multidisciplinary team of doctors.Methods: Pregnancies with autoimmune disorders were studied over a one-year period in one unit of a medical college teaching hospital set up. Obstetric and neonatal outcomes were studied.Results: Ten patients were studied. Average age was 29.9 years. Majority presented in early second trimester. Eight patients were ANA positive. Two patients had antiphospholipid antibody syndrome, for whom low molecular weight heparin was helpful. Hypothyroidism was seen in two patients. Bad obstetric history was seen in most patients. Successful neonatal outcome was seen in six patients. One patient had Evans syndrome. There were no maternal mortalities. There was one perinatal mortality.Conclusions: Autoimmune disorders in pregnancy when managed in a tertiary care centre with multidisciplinary approach can result in good obstetric and neonatal outcomes

Pregnancy in breast cancer survivor with anthracycline induced cardiomyopathy

With earlier diagnosis and improved treatment modalities and management of breast cancer patients, survival is improving. An increasing number of survivors are in the reproductive age group; however a neglected medical area is contraceptive advice, failure of which can result in unwanted pregnancy and further medical complications. An undiagnosed pregnancy in a breast cancer survivor with known anthracycline- induced cardiomyopathy is presented here

Clinical outcomes among pregnant patients with cardiac disease only and those with co-existing pregnancy-associated hypertension

Background: Impact of cardiac disease on pregnancy is significant. Impact of hypertension on pregnancy is also significant. “Does occurrence of hypertension along with cardiac disease worsen the outcomes?” forms the crux of this study. The aim of the present study was to determine the impact of pregnancy-associated hypertension on the clinical outcomes of pregnant patients with cardiac disease.Methods: Retrospective, observational, comparative, case control study of one and half year duration conducted in a tertiary care referral hospital. The various medical and obstetric parameters were studied and compared.Results: Among 143 patients studied, 36 were hypertensive and 107 were non-hypertensive. Non-severe hypertension was seen in 17%, severe hypertension in 4% and eclampsia in 4%. Average age was 26 years and majority were first or second gravida. Valvular heart disease was the most common cardiac disease encountered. Gestational age at delivery, perinatal outcome and occurrence of pulmonary hypertension were all similar in both the hypertensive and non-hypertensive groups.  The most common mode of delivery was vaginal delivery. The cesarean section rate was 29% and was similar among both hypertensive and non-hypertensive groups. Requirement for induction of labor, occurrence of small-for- gestational age among the newborns, intensive care unit admission due to heart failure and maternal death was higher (statistically significant (p<0.05) among the hypertensive group.Conclusions: Presence of hypertension worsens outcomes among pregnant patients with cardiac disease. The coexistence of hypertension and cardiac disease should alert the obstetrician and specialist physician towards a more vigilant management. The findings of this study may help risk stratification (development of pregnancy associated hypertension) while counseling patients with heart disease.

A case of strongyloidiasis in pregnancy

Helminthic infections such as Strongyloides stercoralis occurs commonly in immunocompromised states. However, they can rarely occur in normal individuals also. A 23 year old multigravida presented at 39 weeks gestation with watery diarrhoea. She was evaluated and diagnosed of strongyloidiasis. Medical management was given and pregnancy outcome was successful. This case is reported because strongyloidiasis is a rare and underreported occurrence in pregnancy, which can occasionally be fatal

Study of congenital fetal malformations among antenatal women in a tertiary care centre

Background: Congenital malformations are morphological or functional anomalies that occur in the prenatal period as a result of genetic mutation, chromosomal abnormalities and adverse intrauterine environment. Early recognition is important. If congenital malformations are detected beyond the period of legal limit for medical termination of pregnancy, it carries immense burden on the pregnant woman.Methods: A descriptive observational study was conducted as a retrospective analysis of patient-records, over a span of 9 consecutive months in the Department of Obstetrics and Paediatric Surgery, at a tertiary care centre, Mumbai. The project was carried out to study demographic profiles, risk factors and system-wise distribution of pregnant women carrying malformed fetus.Results: The average annual incidence rate was 29 per 1000 deliveries. Of 151 patients, renal malformations were the commonest accounted for 40% of all congenital malformations. This was followed by central nervous system 32%, cardiovascular 14%, gastrointestinal 8% and musculoskeletal 3%. Congenital malformations were more common in multigravida than primigravida. 92% of congenital malformations were detected beyond 20 weeks of gestation. Previous abortions, hypothyroidism and raised sugars were associated high risk factors.Conclusions: The diagnosis of congenital malformation using ultrasonography occurs at a later gestational age than 20 weeks. For these patients a combined approach of the obstetrician/neonatologist/paediatric surgeon allows better counselling of parents and to permit preparation of the team to optimize neonatal outcomes

Conventional laparotomy for management of caesarean scar ectopic pregnancy: a case report

Increase in the rates of caesarean deliveries has led to a concurrent rise in the number of caesarean scar ectopic pregnancies (CSEP). With recent advances, diagnosis can be made at an early gestational age, hence facilitating a prompt intervention. With the varied treatment options available, choosing the right one may possess a clinical dilemma. However, in a low resource setting, conventional laparotomy may be the only option feasible. A case of CSEP managed with laparotomy is presented