A correlation of lactate dehydrogenase enzyme levels in pregnancy induced hypertensive disorders with severity of disease, maternal and perinatal outcome

Background: A spectrum of hypertensive disorders in pregnancy contribute to maternal and perinatal morbidity and mortality. For prediction and early diagnosis of preeclampsia various biochemical markers, vascular function test and renal markers have been developed. The objective of the study is to measure the lactate dehydrogenase enzyme (LDH) levels in pregnant women with pregnancy induced hypertensive disorders and correlate the levels with the severity of condition, maternal and the perinatal outcome.Methods: In this prospective observational study, a total of 150 pregnant women were studied. Out of these 150 women, 30 women had normal blood pressure, 30 women had gestational hypertension, 30 women had mild preeclampsia, 30 women had severe preeclampsia and 30 women had eclampsia. The serum LDH levels were measured in third trimester and patients followed up until early postpartum period and babies were followed up till early neonatal period to assess the maternal and neonatal outcomes.Results: Higher lactate dehydrogenase enzyme (LDH) levels were observed in pregnant women with severe form of hypertensive disorder and those who had a poor maternal and perinatal outcome. This is statistically significant (p<0.001).Conclusions: Lactate dehydrogenase enzyme (LDH) level is a useful biochemical marker to assess and predict the severity of disease, maternal and perinatal outcome as higher levels of the enzyme are associated with worsening severity of disease, a poor maternal and perinatal outcome

To study and compare the obstetric and neonatal outcome of pregnancies complicated with hypothyroidism amongst antenatally detected and treated hypothyroid patients and patients found to be hypothyroid at the time of labor

Background: To evaluate pregnancy outcome in women with elevated serum thyroid stimulating hormone (TSH) values as compared to those in whom hypothyroidism was treated.Methods: A prospective interventional comparative study was conducted in the department of obstetrics and gynaecology in King Edward Memorial Hospital, Mumbai, India from 2014 to 2015. A cohort of 60 hypothyroid patients was divided into two groups of 30 each. Group 1, euthyroid (treated hypothyroid) and group 2, hypothyroid at the time of labor and pregnancy outcomes were compared.Results: All patients in group 1 delivered at term; whereas in group 2, 9 (30%) patients had preterm deliveries and 21 (70%) delivered at term, amongst which 5 patients delivered babies with severe intrauterine growth restriction (IUGR). Neonatal intensive-care unit (NICU) admission were required for 3 neonates in group 1 and 11 (36.67%) neonates in group 2. Group 1 delivered 5 (16.67%) low birth weight babies (weight <2.5 kg) whereas 16 (53.34%) babies had low birth weight in group 2.Conclusions: Treatment of patients diagnosed with hypothyroidism during pregnancy significantly (p value <0.05) reduced the risk of preterm labor, low birth weight, need for NICU admission

Vaginal birth in singleton breech:revisited

Background: The purpose of the study was to analyze maternal and perinatal outcome according to mode of delivery in singleton breech presentation retrospectively in a tertiary care center.Methods: This was a retrospective observational study done in KEM Hospital, during 2012 to 2013. Maternal and perinatal outcome was studied retrospectively. The data was collected from the mother's medical records. The neonatology records were also examined. Primary outcomes included neonatal mortality, morbidity and maternal morbidity.Results: Out of 100 selected patients; 27 delivered vaginally and 73 underwent lower segment caesarean section (LSCS). Perinatal mortality was 3%. Two out of 3 were delivered vaginally and 1 underwent LSCS. Perinatal morbidity was 1% in vaginal delivery. Maternal morbidity was 2%, both patients underwent emergency LSCS. There was no maternal mortality in the study.Conclusions: Delivery of breech fetus when labor and delivery is supervised and or conducted by experienced obstetrician lowers maternal morbidity, neonatal morbidity and mortality

Combined protein C and protein S deficiency with pregnancy

A 35 year old female patient, married since 8 years, G6P1L1SA4 was registered with our unit since 8th week of gestation. She was a known case of protein C and protein S deficiency diagnosed 7 years ago (thrombotic profile- protein C: 70% normal: 70-100%, protein S: 55% normal: 70/140%, AT-III: 116% normal 70/140%, factor V leiden: no mutation detected) which was detected on evaluation for her bad obstetric history. ACLA was also positive. She was started on injection low molecular weight heparin 0.6 mg s/c OD, in addition to continuing Tb. Aspirin 75 mg which had been started when the pregnancy was registered. Foleys induction was done at 39 weeks of gestation in view of previous LSCS with pre-eclampsia. Emergency LSCS was done in view of previous LSCS with non-progress of labour. Male child weighing 2.4 kg was born which is doing well. A patient having combined deficiency of both factors protein C and protein S is very rare. Anticoagulation therapy is the cornerstone in the management of patients with inherited coagulation defects