Cardiovascular disease in pregnancy

Background: Maternal cardiac disease is a major cause of non-obstetric maternal morbidity and mortality. The care of pregnant women with cardiac disease requires a multidisciplinary approach, involving obstetricians, cardiologists and anesthesiologist.Methods: A prospective analytical study of maternal heart disease and its fetomaternal outcome is carried out in the department of obstetrics and gynecology at tertiary hospital and teaching institute. The study was carried out on 50 cases belonging to age group 18-50 years with various cardiac diseases during their pregnancy and peripartum period.Results: In this study, 78% of the cases were registered with our hospital. The present study shows about 32% of the women having cardiac disease were in the age group of 20-25 years. 34% belonged to NYHA class II and had a relatively uneventful peripartum period. Among all forms of heart disease, RHD was common constituting 26% of cases. Most common condition associated with cardiac disease in pregnancy was preeclampsia (36%) in our study, with anemia being other one (10%). The common complications were congestive cardiac failure (12%) and pulmonary edema (8%). Combination of diuretics and beta blockers was used most commonly (22%). 56% of women delivered with caesarean section. 42 patients delivered after age of viability with 29 (69%) term deliveries and 13 (30%) preterm deliveries with 8 requiring NICU care.Conclusions: Valvular heart disease of rheumatic origin is the most common cardiac disease associated with pregnancy.The availability of adequate systems of early diagnosis of cardiac lesion, reference to tertiary care center & close monitoring of patient and delivery with multidisciplinary approach include specialized cardiologic care, high risk obstetric support and neonatology expertise that can minimize the serious consequences and helps to improve fetomaternal outcome. Pre-conceptional counseling and surgical correction of certain conditions improves maternal as well as fetal outcome. Awareness needs to be created about heart diseases during pregnancy and the importance of regular antenatal check-ups

Schwannian stroma poor calcified bilateral neuroblastoma of adrenal gland: a rare case report

Schwannian stroma poor calcified bilateral neuroblastoma of adrenal gland in 14 year old male patient is an exceptionally uncommon, malignant tumor that is derived from the primitive neural crest cells of the adrenal medulla. Neuroblastoma is the fourth most common malignancy of childhood up to five years of age, and very occasionally seen after that. It rarely occurs in the adrenal gland after ten years of age and bilaterally. The diagnosis was established based on clinical, radiological, histopathological and immunohistochemical features. At present, the patient is on chemotherapy and radiotherapy but the recent MRI is showing bilateral pubic bone and femur metastasis. Conclusion: Schwannian stroma poor calcified bilateral neuroblastoma of adrenal gland is a rare tumor at the age of 14 years which needs precise histopathological assessment and confirmation by Immunohistochemistry

Evaluation of abnormal uterine bleeding: role of diagnostic hysteroscopy and its correlation with histopathology

Background: The objective was to assess the accuracy of diagnostic hysteroscopy in evaluation of abnormal uterine bleeding and to correlate hysteroscopic findings with histopathology reports.Methods: A prospective study was carried out at our institute from January 2010 to December 2013. Ninety cases were included in this study. Patients’ age varied from 20 to 60. Those women with the history of abnormal uterine bleeding were admitted. In all cases diagnostic hysteroscopic examination and dilatation and curettage were carried out. Endometrium was sent for histopathology and correlation of hysteroscopic findings with histopathology reports was studied.Results: Various findings on hysteroscopy are as following: proliferative endometrium 36.66%, secretary endometrium 17.77% endometrial hyperplasia 24.44%, atrophic endometrium 5.55%, endometrial polyp 8.88%, submucous fibroid 4.44%, and endometrial carcinoma 2.22%.Conclusions: Hysteroscopy is an eye in uterus and it provides more accurate diagnosis than dilatation and curettage alone in patients with abnormal uterine bleeding.

App for Resume-Based Job Matching with Speech Interviews and Grammar Analysis: A Review

Through the advancement in natural language processing (NLP), specifically in speech recognition, fully automated complex systems functioning on voice input have started proliferating in areas such as home automation. These systems have been termed Automatic Speech Recognition Systems (ASR). In this review paper, we explore the feasibility of an end-to-end system providing speech and text based natural language processing for job interview preparation as well as recommendation of relevant job postings. We also explore existing recommender-based systems and note their limitations. This literature review would help us identify the approaches and limitations of the various similar use-cases of NLP technology for our upcoming project.Comment: 4 pages, 2 figures, literature revie

The role of foetal assessment by ultrasound at 11-13+6 weeks of gestation

Background: The prevalence of congenital anomalies has been increasing over the years, and it is estimated that every year 1 in 33 infants are affected by some sort of congenital anomaly. At 12 weeks of intrauterine gestation, most of the major foetal structures complete their development and also proper delineation of the foetal anatomy is possible by the time of routine NT scan at 11-13+6 weeks. Methods: This was a prospective study of 110 cases who underwent a first trimester 11-13+6 weeks scan for congenital foetal abnormalities. The eligibility criteria for selection of cases were first trimester pregnancy between the 11-13+6 weeks gestation and CRL between 45 mm and 84 mm. Results: The study found that the detection rate of foetus abnormalities was 15.4% in mothers over 35 years old. Total 2.7% of the present study population were detected to be high risk for trisomy 21. All the 110 cases in present study were followed up till delivery/ termination. MTP was performed in 8.1% cases with lethal anomalies and in 1 cases of structural anomaly with missed abortion, D and E was done. 91% delivered live and healthy babies. There was no intrauterine foetal death or still born in present study. Conclusions: Ultrasound at 11-13+6 weeks must be mandatory, not only for the detection of major foetal anomalies but also for diagnosis of multiple pregnancy and abnormal pregnancy like missed abortion, molar pregnancy and ectopic pregnancy

Fetomaternal outcome in COVID-19 infected pregnant women: a preliminary clinical study

Background: WHO has declared COVID-19 infection a health emergency of international concern on 11th March, 2020. It is not clear whether clinical characteristics of pregnant women with COVID-19 differ from those of nonpregnant women and whether it aggravates COVID-19 symptoms and whether antiviral therapy is necessary for COVID-19 infected pregnant women.Methods: This is prospective study of 125 cases based on the compiled clinical data for pregnant women with COVID-19 between 15th April 2020 and 10th June 2020. A laboratory confirmed positive case of COVID-19 infection in pregnant women were included.Results: The most common symptoms at presentation were cough in 61.6% (77/125) and fever in 46.4% (58/125). Other reported symptoms were sore throat in 13.6% (17/125), myalgia in 10.4% (13/125) while 38.4% (48/125) were asymptomatic. There were total 97 deliveries (including 2 twins’ deliveries) among which 3 cases had IUD. Present study reported 96 live births. The incidence of missed abortion was 2.4% (3/125). The incidence of preterm birth before 37 weeks was 8.2% (8/97). Ninety-six (96.9%) of neonates were tested for SARS-CoV-2 viral nucleic acid on nasopharyngeal and pharyngeal samples and 16.67% (16/96) were resulted positive.Conclusions: At present, there is no evidence regarding the greater risk of pregnant women to succumb to COVID-19 infection and experience severe pneumonia. The risks of spontaneous abortion and preterm birth are not increased as reported in this study but shows possibility of vertical transmission when it manifests during the third trimester of pregnancy

Evaluation of complication during third stage of labour at tertiary care center

Background: The objective of the present study was to determine the maternal outcome of complications of third stage of labour and to determine the risk factors and evaluate the management protocols for these complications.Methods: This is retrospective study of maternal outcome with complications of third stage of labour carried out at tertiary care centre from June 2016 to December 2019. Patients who developed any complications of third stage of labour after vaginal delivery or caesarean section were included.Results: Complications observed during third stage of labour were atonic PPH 0.82% (74 cases), traumatic PPH 0.55% (50 cases), retained placenta (including placenta accreta spectrum) 0.21% (19 cases), secondary PPH 0.03% (3 cases), uterine inversion 0.03% (3 cases) and amniotic fluid embolism 0.01% (1 case). Maximum cases were seen in 18-24 years of age group. Only 36% patients having atonic PPH responded to medical treatment, 46% patients having atonic PPH responded to conservative surgery, 18% of patients required radical surgery.Conclusions: Third stage complications are potentially life threatening. Associated conditions for third stage complication are high parity, anemia, hydramnios, multiple pregnancy, malpresentation, placenta previa, and adherent placenta. Early anticipation and early intervention with proper planning is required to reduce the maternal morbidity and mortality in third stage complication

A retrospective study of obstetric hysterectomy cases at tertiary care centre

Background: Postpartum haemorrhage (PPH) is a life-threatening condition. The objective of this study was to determine the incidence, demographic characteristics, indications, and feto-maternal outcomes associated with obstetric hysterectomy in a tertiary care centre.Methods: This is a retrospective analytical study conducted over a period of six years, from March 2014 to April 2020. A total of 68 cases of obstetric hysterectomy were studied at tertiary care centre in Ahmedabad, Gujarat, India.Results: Present study reported 68 obstetric hysterectomies per 44663 total deliveries (incidence - 0.15%), out of them 20 following 26446 vaginal deliveries (0.07%) and 48 following 18217 caesarean section (0.26%). Morbidly adherent placenta (29.41%) was the most common indication followed by atonic postpartum haemorrhage (25.00%) and uterine rupture (17.64%). The most frequent sequelae were disseminated intravascular coagulation (26.47%) and febrile morbidity (10.29%), maternal mortality was 16.17% whereas neonatal mortality was 26.47%.Conclusions: The incidence of obstetric hysterectomy has been found to be more following caesarean sections. There is a change in the indications of obstetric hysterectomy in the past two decades with placenta accreta spectrum being the commonest in present study. This is because of rising number of caesarean sections. Patients who underwent emergency obstetric hysterectomy due to atonic PPH had a higher mortality

A retrospective analysis of ectopic pregnancies in tertiary care hospital of Western India: two year study

Background: Ectopic pregnancy (EP) is the leading cause of maternal morbidity and mortality in the first trimester and major cause of reduced reproductive potential. Early detection of EP by improved ultrasonography modalities has decreased the rate of rupture and consequent maternal morbidity. Aim was to study the predisposing risk factors in modern scenario and choose the appropriate management available.Methods: A retrospective study on clinical diagnosis and management of EP of patients was carried out between January 2018 to February 2020. Investigations included CBC, UPT, serum β-hCG and TVS. Management was decided after thorough evaluation.Results: Out of 7,780 deliveries, 70 were EP (0.9%). Women with age 21-30 year had highest incidence (85.7%). Common symptoms were abdominal pain (94%), amenorrhea (87%), bleeding per vagina (48%). Most common risk factor associated with EP was PID (28.5%). Tubal EP was most common (84.2%) involving ampulla (66%), isthmus (15%), fimbria (12%), interstitial (7%). Scar ectopic was reported in 10% of cases and ovarian, rudimentary horn and abdominal pregnancy in 1.4% each. About 52.8% of ectopic was ruptured and salpingectomy was done in 74.3% and salpingo-oophorectomy in 2.8%. Five cases of scar EP required hysterotomy and 1 case was managed by methotrexate (MTX).Conclusions: EP remains a major challenge to the obstetrician worldwide. A high index of suspicion is required for early diagnosis and timely intervention in the form of medical or surgical treatment will definitely help in reducing the morbidity and mortality

Fetomaternal outcome in pregnancy with HELLP syndrome

Background: HELLP Syndrome is a serious complication of pregnancy induced hypertensive disorders. It is defined as a triad of hemolysis, elevated liver enzymes, and low platelet count (HELLP). Objectives of this study was to find out incidence of HELLP syndrome in pre-eclampsia, eclampsia and its overall incidence. To analyse the clinical profile of HELLP syndrome. To study maternal and perinatal outcome including morbidity and mortality.Methods: A retrospective study was conducted from July 2017 to September 2019 at a tertiary care center with inclusion criteria of abnormal peripheral blood smear, elevated liver enzymes (LDH, aspartate aminotransferase), and low platelet count.Results: HELLP syndrome was more common in younger age group (45%) and in primigravida (52.5%). Most of the patients presented at >36 weeks of gestation (40%) and most of the patients delivered by caesarean section (67.5%). Maternal complications were acute renal failure (27.5%), DIC (22.5%), maternal mortality (7.5%). Neonatal complications associated were intrauterine death (27.5%), prematurity (25%) and intrauterine growth retardation (15%).Conclusions: Thus, HELLP syndrome requires an early diagnosis and early initiation of treatment at tertiary care center with all the medical facilities available