Spectrum of neurological disorders in pregnancy in a neurology clinic in eastern Uttar Pradesh

Background: Pregnancy-induced endocrinal and physiological changes increase the risk of neuropathy and musculoskeletal problems in pregnancy. The purpose of this study is to provide a comprehensive look at the neurological and musculoskeletal disorders occurring during pregnancy.Methods: A total of 202 antenatal women with neurological and musculoskeletal problems were enrolled for study. Their demographic characteristics were noted. Detailed clinical history and neurological examination was done. Radiological investigations including x-ray, CT head, MRI brain, MRA, MR Venography with electrophysiological NCS studies were performed accordingly.Results: Among musculoskeletal symptoms most prevalent was LBA (50%), cramps (15.7 %) followed by pelvic girdle pain (10%) and wrist pain (8,5). Among peripheral neurological disorders most common was CTS (12.37%) followed by bells palsy. Among Central neurological disorders most common was headache (26.23%), seizures (12.37%), eclampsia (2.47%), followed by Cortical venous thrombosis CVT, BIH, PRES.Conclusions: Among musculoskeletal complaints the most frequent symptoms during pregnancy were low back pain, hip joint pain, cramps and wrist pain. Among neuropathies CTS prevalence was relatively higher in pregnant women especially in third trimester and was mostly bilateral. Among central neurological symptoms headache especially migraine without aura and seizures were common while eclampsia, CVT, BIH, PRES were less common

Assessment of health related quality of life in patients with cervical dystonia and writer’s cramp

Background: There is paucity of literature regarding data about clinical and demographic factors affecting HRQoL with assessment with validated specific tool in patients with CD and WC especially from India.Methods: Demographic, clinical details, SF-36 and BDI score were noted in included patients. CD and WC severity scale were assessed by TWSTRS and BFM scale respectively. Disease specific quality of life in patients with CD was assessed by CDQ-24.Results: All 32 patients with CD scored significantly worse in all the eight domains of the SF-36. Patients with CD had significantly worse (mean BDI 12.14±6.7 versus 5.09±4.8; P<0.001) score. In CD group 15.62% have no depression, while 34.37% had mild and 34.37% had moderate to severe depression. Patients with CD had significantly worse CDQ-24 score (mean 50.96±20.47 versus 6.89±6.33); (P<0.001). TWSTRS score had negative correlation with BDI and CDQ-24. All 60 patients with WC scored significantly worse in all domains of the SF-36 except 3 domain physical functioning (p =0.80), bodily pain (p=0.122) and vitality (p=0.97).Among WC patients 45% have no depression, 21.67% had mild and 23.35% had moderate to severe depression. BFM had significant negative correlation with all SF-36 subscale except role emotional (p=0.059).Conclusions: Patients with CD and WC suffered from significant impairment in HRQoL with moderate to severe depression .The validated specific scale provides further evidence for profound impact of above mentioned dystonias on physical, psychological and social aspect of quality of life.

Practice of contraception in this modern world: still a myth?

Background: Objective: To assess the attitude, knowledge and practice of contraception among MTP seekers women attending Family Planning OPD.Methods: 150 women attending family planning clinic and requesting for Medical Termination of Pregnancy (MTP), were interrogated on a pre- structured questionnaire and their knowledge, attitude and practice about contraception were assessed.Results: Of the women 80% women had some or the other knowledge of contraception but still 92 (61.3%) were not using any contraception 92 (61.3%), 54 (36%) were using barrier method and only 4 (2.6%) were used OCP’s. The request for MTP was mainly on grounds of unplanned pregnancy and completed family in 57.3% cases followed by previous child small 42 (28%). Of the women, only 38 (25.3%) had heard about emergency contraceptives and only few had used them off and on. The various methods of contraception accepted by the women post abortion were IUDs by 91 (61.3%) and female sterilization by 55 (36.6%). Statistical analysis was done using SPSS software 15.Conclusions: Practice of contraception is still a myth. There is a great need to strengthen the awareness among people by various programmes and the target group should be both males and females

Impact of Janani Suraksha Yojana on institutional delivery rate, incidence of rupture uterus and feto-maternal outcome related to uterine rupture

Background: To study the impact of janani suraksha yojana (JSY) on institutional delivery rate, incidence of rupture uterus in pregnant women, maternal and fetal mortality rate related to rupture uterus.Methods: 33 cases of rupture uterus which occurred before -implementation of JSY in our hospital in one year duration i.e Jan 2007-Dec 2007 (group 1) were studied and compared with 41 cases which occurred after implentation of JSY in one year i.e. July 2014-Jun 2015 (group 2). This is a retrospective observational study. Information were collected regarding number of institutional deliveries, incidence of rupture uterus ,previous history of unscarred and scarred uterus, maternal and fetal mortality rate related to uterine rupture.Results: there was 125% proportional increase in the institutional deliveries, significant decrease in the incidence of rupture uterus (Z=2.5963, P<0.05) and maternal mortatility (Chisquare at 1 df=4.326, P<0.05) after implementation of JSY.Conclusions: JSY is working excellently and need to be extended until we achieve the goal of 100% institutional deliveries and 0 % maternal mortality rate related to rupture uterus

Comparison of maternal outcome in COVID-19 positive and negative antenatal women: a comparative study

Background: Coronavirus is an RNA virus causing respiratory and gastrointestinal infections. It caused SARS and MERS epidemics. In late 2019, a mutation called SARS-CoV-2 caused COVID-19, a severe respiratory illness. Pregnant women are at risk, but information is limited. The second wave affected pregnant women more. Maternal COVID-19 can lead to preterm births and caesarean sections. Vertical transmission to neonates is possible. Ongoing research is crucial to understand COVID-19's impact on mothers. Methods: A comparative prospective hospital-based study was conducted, including antenatal women with COVID-19 symptoms in the case group. The control group consisted of antenatal women who tested negative for COVID-19. The study analyzed 150 COVID-19-positive antenatal women and 350 COVID-19-negative antenatal women, excluding those who left the study prematurely or tested positive during the study period. Results: In the case group, no abortions were reported (0%), while in the control group, there was 1 abortion (0.29%). PROM occurred in 5.78% of cases and 1.43% of controls, with a significant difference. PPROM occurred in 2.31% of cases and 2.57% of controls, showing no significant difference. Preterm labor was observed in 11.53% of cases and 3.71% of controls, with a significant difference. Conclusions: Pregnant women with COVID-19 experience diverse symptoms, highlighting the importance of vigilant monitoring. Adverse maternal outcomes, including preterm labor and ICU admission, are more common in infected individuals. Managing comorbidities, such as diabetes, is crucial

Maternal and perinatal outcome in obstetric cholestasis- a prospective observational study

Background: The objective of this study was to study the maternal and perinatal outcome of pregnancy complicated by obstetric cholestasis.Methods: This prospective observational study included 80 cases, diagnosed as obstetric cholestasis on the basis of symptoms of persistent pruritus (generalized or localized), biochemical evidence of altered liver function test and excluding other liver and skin disorder. Medical treatment and active management (fetal surveillance and termination of pregnancy at 37-38 weeks) were offered to all. Maternal and perinatal outcome were studied.Results: Incidence of obstetric cholestasis was 1.9%. Majority of women (55%) were primigravida and recurrence rate was 61.1% among multiparous women. Pruritus (generalized) was the cardinal symptoms in 90% patients and mostly (88.7%) presented and diagnosed after 28 weeks i.e. in third trimester. A total of 43.7%women had caesarean section (CS) which was quite high incidence. Most common pregnancy complications included preterm labor (25%), post-partum haemorrhage (13.75%) and preterm premature rupture of membrane (11.25%). Perinatal outcome revealed meconium aspiration (20%), preterm birth (30%), low birth weight (35%), fetal distress (18.75%) and intrauterine fetal death (2.5%). 43.75% neonates required NICU (Neonatal intensive care unit) admission. Serum transaminase levels tended to be higher in patients with poor perinatal outcome such as still birth, fetal distress and meconium stained amniotic fluid. LFT (liver function test) returned to normal in 95% of women and 100% women became symptom free after 6 weeks postpartum.Conclusions: Obstetric cholestasis has an adverse effect on the fetal outcome and hence early diagnosis with careful clinical examination and biochemical testing is essential. Serum abnormality in liver function test (transaminases) tended to be higher in women with poor perinatal outcome

Comparison of obstetric outcomes of pregnancies after donor oocyte IVF: Three-arm age-matched retrospective cohort study

Background: Oocyte donation has become widely used as a treatment option for infertile couples. The few available studies report conflicting evidence about the risk of hypertensive disorders in donor oocyte pregnancies after adjusting for maternal age and it is unclear whether pregnancy complications and obstetric risks are due to oocyte donation or to confounding factors such as maternal age. The aim of the present study was to evaluate and compare obstetric complications between women who conceived after oocyte donation and age-matched control women with spontaneous conception and self oocyte IVF conception.Methods : The present study comprised of women aged 20-45 years conceived from oocyte donation (n=104) between 1/12/2010 to 15/10/2017. Two age-matched control groups—Self oocyte IVF (n=150) and the other containing women who conceived spontaneously (n=312) were used for comparison of obstetric and perinatal outcomes.Results: Mean maternal age was statistically significantly higher in the Donor oocyte IVF group as compared to  self oocyte ivf and spontaneous conception group. Miscarriage, first trimester bleeding, pregnancy induced hypertension and gestational diabetes mellitus was significantly higher in Donor oocyte IVF group as compared to self-oocyte and spontaneous conception group (p=0.001). Using multiple logistic regression analysis age class adjusted PIH and GDM  incidence was significantly higher in donor oocyte group as compared to spontaneous conception (P=0.010).There was significant variation in perinatal outcomes between the three groups.Conclusion: Oocyte donation should be treated as an independent risk factor for miscarriage, first trimester bleeding, hypertensive disorder and gestational diabetes mellitus in pregnancy

The outcome of preterm births in pregnant women with hypertensive disorders: an observational study

Background: Hypertensive conditions occurring during pregnancy are linked to heightened chances of severe consequences, including preterm birth, intrauterine growth restriction, perinatal mortality and morbidity, acute kidney failure, sudden liver malfunction, excessive postpartum bleeding, HELLP Syndrome, disseminated intravascular coagulation, and seizures. Methods: A prospective hospital-based study was conducted in a tertiary care hospital of eastern Uttar Pradesh, over the period of one year. The total sample size calculated was 235. Data was collected using the structured questionnaire. This study recruited the hypertensive pregnant women with a blood pressure reading of 140/90 mmHg or higher, irrespective of the timing of the blood pressure elevation, who visited the hospital for delivery over the course of one year. Various maternal variables were examined, including age, gestational age, number of previous deliveries, the status of the mother's blood pressure, and the type of delivery. Results: In the present study, the births revealed the following distribution among different hypertensive disorders: chronic hypertension preterm: 100.0% 06 vs. term: 0% 0, eclampsia, preterm: 60.4% 64 vs. term: 39.6% 42, mild preeclampsia, preterm: 55.3% vs. term: 44.7%, severe preeclampsia, preterm: 48.5% vs. term: 51.5%, and gestational hypertension, preterm: 23.5% vs. term: 76.5%. Conclusions: Based on the findings of this study, it was determined that hypertensive disorders play a pivotal role in influencing both the frequency of preterm delivery and the associated complications in infants resulting from premature birth

Identifying the risk factors of antepartum haemorrhage and to evaluate the feto maternal outcome in antepartum haemorrhage cases

Background: Antepartum haemorrhage is an obstetric emergency contributing to a significant percentage of perinatal and maternal morbidity and mortality. Approximately 30% of maternal deaths are caused by ante-partum haemorrhage. In spite of a lot of improvement in antenatal care and intrapartum surveillance, antepar-tum haemorrhage has not reduced. Present study was conducted to assess the causes of APH and to compare the fetomaternal outcome among placenta previa and abruptio placenta group.Methods: The study was conducted in BRD medical college Gorakhpur, over a period of 1 year (October 2019 to September 2020) in which 100 cases of APH were taken and classified into placenta previa and abruptio placenta group and their fetomaternal outcome were compared.Results: In our study, out of 100 cases of APH 69% cases were of placenta previa followed by abruptio placen-ta in 29% cases and rest 2% cases were unclassified APH. Multigravida is the major risk factor in both placenta previa and abruptio placenta group. Second major risk factor in placenta previa group was h/o LSCS and in abruptio placenta group was HDP. Stillbirth was significantly seen in abruptio placenta group whereas Low birth weight babies (1.5-2.5 kg) were more in placenta previa group. Though the maternal outcome is poor in placenta previa group but the fetal outcome is worse in abruptio placenta group.Conclusions: APH neither can be reliably predicted nor can be prevented but only a comprehensive focused experienced team work can reduce maternal and perinatal morbidity and mortality