Prevalence of hypothyroidism in first trimester screening and its association with maternal and foetal outcomes

Background: Maternal hypothyroid is one of the common thyroid disorder. Hypothyroidism in pregnant women who are not treated can cause premature birth, low birth weight, and respiratory distress in the newborn. Objectives were to find out the prevalence of hypothyroidism in pregnant women during first trimester screening and its association with maternal and foetal outcomes. Methods: The present study was a hospital based study carried out in the department of obstetrics and gynaecology, Chettinad Hospital and Research Institute, Kelambakkam, Chennai, India between January 2021 and January 2023. The study was carried out among the pregnant women in the first trimester visiting the outpatient department of the OBG department during the study period. Based on the thyroid profile obtained, the participants were classified into normal, subclinical hypothyroidism and overt hypothyroidism. They were then followed up to record the maternal and foetal outcome. Results: A total of 2017 patients were included in the study. The prevalence of hypothyroidism was 15.3%. The distribution of type of delivery was found to be different between hypothyroid and normal groups with more number of women underwent Caesarean delivery (18.24%) in the hypothyroid group than those in normal group. The proportion of low birth weight was also statistically higher (45.28%) in the hypothyroid group than in the normal. Similar pattern was observed with birth asphyxia. The APGAR scores recorded were also significantly lower in the hypothyroid group than in the euthyroid group with p value of less than 0.05. Conclusions: The prevalence of hypothyroidism was 15.3%. In our study, women with hypothyroidism showed adverse maternal and foetal outcome such as more caesarean deliveries, low birth weight, and poor APGAR scores and were found to be statistically significant when compared to euthyroid women

Changing trends of causative factors in antenatal mothers with bad obstetric history: a retrospective study

Background: The death of an infant, in utero or after birth has been a devastating experience for parents and clinicians alike. Various efforts are being made to make an accurate diagnosis of such pregnancy losses at the earliest to prevent the emotional and physical stress that the woman undergoes. This study aims to assess the changing trends in risk factors and outcome of pregnancies in cases of bad obstetric history (BOH) and to identify the newly emerging maternal and fetal factors contributing to incidence of pregnancy loss.Methods: This study is a retrospective analysis of antenatal women with BOH attending the obstetrics and gynecology OPD at Chettinad hospital. The study was conducted during a time period of 1 year (May 2019 to May 2020).Results: The medical complications and underlying causes for BOH were analysed among the study group. Out of 41 women, 6 were diagnosed to have gestational diabetes mellitus (GDM), 8 were found to be hypertensive and 1 APLA positive. Neonatal mortality was encountered in 2 cases, attributing to Inborn error of metabolism. However, the cause for BOH remained unexplained in 3 individuals.Conclusions: A full work-up can be initiated after two consecutive losses to identify and treat the various causes responsible for BOH. Lot of further studies and research are being conducted to unravel the mystery in these cases. Despite these efforts, the male factors contributing to recurrent pregnancy loss have remained largely unexplored

Role of amniotic fluid index on maternal and neonatal outcomes among obstetric women with preterm premature rupture of membranes

Background: Preterm Premature rupture of Membrane (PPROM) is one of the major complications of a pregnant women with risk factors like low socioeconomic class, infections, STDs etc. Maternal complications such as Chorioamnionitis, Abruptio placenta, sepsis and neonatal complications like neonatal sepsis, RDS, intraventricular hemorrhage are common with those with PPROM. The objectives of the present study were to find the association between AFI values and maternal and fetal outcomes in patients with preterm premature rupture of membranesMethods: A cross sectional study was conducted in a Multispecialty Teaching Hospital, North Chennai, Tamil Nadu with the sample size of 100. The study participants included pregnant women with gestational age of 28 to 34 weeks presenting with PPROM. Maternal outcomes included clinical diagnosis of chorioamnionitis, placental abruption, meconium in liquor, fetal distress, prolapsed cord and mode of delivery. Neonatal outcomes include neonatal hospitalization in NICU, APGAR score at 1st minute and 5 minutes, early neonatal sepsis neonatal death. Significance of difference in means was calculated using independent t test.Results: Total study participants were divided into 2 groups with Amniotic Fluid Index (AFI) of >5 and <5. Latency period, Chorioamnionitis, placental abruption and mode of delivery were compared between the groups. Chorioamnionitis was present in 8% and 12% in group 1 and group 2 respectively. Neonatal outcomes like NICU admission, RDS and neonatal sepsis were also compared between the groups. NICU admission was required for 18% and 48% in group 1 and 2 respectively. APGAR scores at 1 and 5 minutes were found to be lower among those with Group 2. (p =0.000).Conclusions: PROM is associated with increased maternal and neonatal complications. AFI has been proven a role in predicting maternal and neonatal outcomes in PROM. Identifying the risk factor and its treatment remains the main mode of prevention for PROM

Incidence of umbilical cord around the neck and its effects on mode of delivery and fetal outcome at tertiary care hospital

Background: Umbilical cord is one of the fetal membranes. It is developed from the yolk sac. Umbilical cord is tubular structure. Approximate length of the cord is 50 cm. Umbilical cord around the neck is called as the nuchal cord. The aim of the study is to find out the incidence of umbilical cord around the neck at the time of delivery and its fetal outcomes.Methods: It is a retrospective observational study. This study was conducted in the department of obstetrics and gynecology at a tertiary care hospital over a period of 6 months (Feb-Jul 2020). Out of 542 patients, 388 were enrolled in this study after the inclusion and exclusion criteria, of which 101 were delivered with umbilical cord and the remaining were 287 patients in control group.Results: Present study showed 38.4% incidence of umbilical cord at the time of delivery. Incidence is more among the primigravida and it is statistically significant. Both intrapartum and postpartum risks are not related to umbilical cord around the neck. Mean length of the cord in patients delivered with cord around the neck is more when compared to the control group and has significant p value.Conclusions: This study concludes that the presence of umbilical cord, alone is not an indication for caesarean section. Umbilical cord with 3 loops was associated with increased operative delivery and low Apgar score, proper intrapartum surveillance and portogram leads to good fetal outcome

Study of changes in non-stress test following antenatal corticosteroid therapy in preterm pregnancy

Background: Preterm birth is the largest unsolved problem in obstetrics and the single most significant cause of neonatal morbidity and mortality. Preterm labour constitutes 5-10% of pregnancies and is the leading cause of neonatal morbidity and mortality worldwide. It is a major public health problem in terms of loss of life, long term disability (cerebral palsy, blindness, deafness, chronic lung disease). The objectives of this study were to determine whether antenatal corticosteroid administration affects the non-stress test. To evaluate the effect of antenatal steroid on foetal movements. To assess the incidence of respiratory distress syndrome and neonatal mortality after antenatal corticosteroid administration.Methods: All antenatal cases between 28-32 weeks of gestation judged to be at risk for preterm delivery attending the outpatient department or admitted in a tertiary care hospital, Tamil Nadu during the study period of 3 years.Results: The present study was undertaken to evaluate the NST for a period of 3 days following antenatal corticosteroid administration and to study the immediate changes in the mother and the foetus. We found out that there was a statistically significant change (p <0.01) in non-stress test when compared with the pre-betamethasone assay.Conclusions: Corticosteroids can cause metabolic alterations in mother, short- and long-term effect in the foetus

Trends in ectopic pregnancy: a retrospective clinical study of 79 cases

Background: To know the age group, parity, risk factors, clinical features, modalities of treatment employed and their efficacies, morbidity and mortality associated with ectopic pregnancy.Methods: This is a retrospective study conducted in the department of Obstetrics and Gynaecology at Chettinad Hospital and Research Institute; Chennai over a period of 3 years from January 2014 to December 2016. A total number of 79 cases of ectopic pregnancies were reported during this period. Data were collected, tabulated and analyzed.Results: 79 cases were diagnosed as ectopic pregnancies during the study period giving an incidence of 3.49%. Incidence of cases was maximum in women between the age group of 26-30 years (40.50%), in multiparous women (72.15%) and also in women of gestational age between 6 to 10 weeks (81.01%).72% of the cases had one or more identifiable risk factors. Ruptured ectopic was observed in 45 (56.96%)cases while unruptured in 31 (39.24%) cases. Tubal abortion was found in 3 (3.74%) cases. 2.53% cases were expectantly managed. 34.17% cases were medically managed. 63.29% cases were managed surgically. Morbidity due to ectopic pregnancy included anaemia, wound infection, SICU admission. No mortality observed.Conclusions: A high index of suspicion is needed in the diagnosis of ectopic pregnancy especially in women with high risk factors to arrive at early diagnosis, followed with conservative management, thus reducing the morbidity. We can reduce the incidence of ectopic pregnancy by awareness on safe sexual practices and contraception. The lady’s future fertility can be improved by focusing on prevention, early diagnosis and conservative management of ectopic pregnancy

Clinical and hormonal profile of patients diagnosed with polycystic ovarian syndrome at tertiary care hospital in Tamil Nadu

Background: In recent years due to the changing sedentary life style, irregular periods and infertility has become a major concern. There are many causes for infertility out of which ovulatory disorders contribute to a great extend. The main objective of the study was to assess the clinical and hormonal profile of patients diagnosed with polycystic ovarian disease at tertiary care hospital in Tamil Nadu.Methods: This study was a cross sectional study and was carried out at the Department of Obstetrics and Gynaecology at a tertiary care hospital of Tamil Nadu. The study was done for a period of 6 months. For confirming polycystic ovaries, patients were interviewed thoroughly about their menstrual and fertility history. Blood investigations like LH, FSH were done on D2/D3 of menstrual cycle. 125 patients with PCOS were included in this study. The data was analysed with SPSS-IBM (V.22.0) software.Results: The patients having polycystic ovaries were higher in women of 21-30 years of age. BMI was more than 25. Infertility was found that 57%, hirsutism 45%,  oligomenorrhoea 21% and amenorrhea 20%. On day 2, mean serum LH was 5.9±3.6 and serum FSH was 3.9±2.3. This study showed that the proportion of menstrual complaints is reported more in higher age group. Likewise lower income group presented with menstrual complaints. This was found to be statistically significant (P value <0.05).Conclusions: The study showed that patients diagnosed to have PCOS overweight. PCO in obese women had more severe ovulatory dysfunction. Infertility was the most common complaint

Mifepristone: an alternate to dinoprostone in induction of labour

Background: To assess and compare the efficacy, safety and fetomaternal outcome of mifepristone versus dinoprostone in priming the cervix and in inducing labour in pregnant women at term.Methods: This is a prospective comparative study done in Chettinad health and research institute, over a period of one year from October 2015 to October 2016. 50 pregnant women (Group 1) in 3rd trimester with unfavorable cervix were given 200mcg of mifepristone orally. If labour did not start or if the Bishop score remained poor at the end of 24hrs, induction was continued with 0.5mg of dinoprostone gel at a maximum of 3 gels at 6th hourly interval. Another 50 pregnant women (Group2) in 3rd trimester underwent induction according to the routine dinoprostone gel regimen of maximum 3 gels at intervals of 6hrs.Results: Improvement in Bishop score was significant with mifepristone by the end of 24hrs.But, in comparison, there was statistically significant improvement in Bishop score in favour of dinoprostone (Mean 4.7) than mifepristone (Mean 4.0). Also, the induction delivery interval was significantly less (Mean 11.5 hrs) with dinoprostone than mifepristone (Mean 20.3 hrs). Number of cases undergoing LSCS for failed induction was less in mifepristone group (4%). The rate of vaginal delivery, Caesarean sections, instrumental delivery and overall fetal outcome was comparable in both groups.Conclusions: Mifepristone is a safe, effective and suitable alternate agent for cervical ripening and initiation of labour when given 24 h before onset of labour.

Efficacy and Safety of Tracnil™ Administration in Patients with Dermatological Manifestations of PCOS: An Open-Label Single-Arm Study

Myo-inositol’s role in improving acne by reducing hyperandrogenism has been demonstrated in PCOS patients. Inositol and associated molecules display inhibitory properties against 5-α reductase, COX-2, and lipase enzymes in addition to their antimicrobial and anti-inflammatory properties. However, the role of myo-inositol is not well established in women patients with normal hormone levels but with clinical manifestations of PCOS. In this study, we evaluate the efficacy of Tracnil™, a combination of myo-inositol with folic acid and vitamin D3, in resolving acne in overweight women of menstruation age displaying normal hormone levels. It is a single-arm study conducted at 2 centers including 33 women with acne, hirsutism, and menstrual irregularities. Acne and hirsutism were assessed by manual lesion count, modified Cook’s scale, and modified Ferriman–Gallwey hirsutism score (mFGHS). Hormone levels and safety parameters were assessed throughout the study. Our results show that Tracnil™ monotherapy could drastically reduce acne-related lesions of both inflammatory and noninflammatory types as quickly as 8 weeks. Additionally, it improves hirsutism and menstrual irregularities. Adverse reactions were negligible during the whole study period with no drastic side effects reflected by a modulatory effect on hormone levels. Despite the subjects having normal hormone levels, the acne treatment with myo-inositol and vitamin D3 shows improvement in hirsutism and regularization of menstrual cycle. Therefore, we attribute the mechanism of action of Tracnil™ to modulation of receptor sensitivity to sex hormones or other downstream processing events. Tracnil™ may be considered as a first-line treatment for dermatological manifestations of PCOS even in the absence of significant hormonal abnormalities. This treatment is practically implementable in a dermatologists’s office practise