Management of preterm premature rupture of membrane in a high-risk pregnancy

Preterm premature rupture of membranes (PPROM) usually has a multi factorial aetiology that is often unknown, although the most frequently reported cause is infection, others could be cervical insufficiency, over distention of uterine cavity, previous history of preterm labor, systemic inflammatory disease etc. This case report documented a rare incidence of preterm premature rupture of membranes, in a 35-year-old female with past history of 8 spontaneous abortions and 1 ectopic pregnancy. Patient had an IVF conception, amenorrheic for 7 months and 2 weeks, and came with a complaint of white discharge per vaginum. On per speculum examination, cervical os was found dilated. The patient was managed conservatively with protein and progesterone support along with prophylactic tocolytics and antibiotics, till early signs of chorioamnionitis were noticed. The decision of induction of labour and eventually preterm premature rupture of membranes lead to emergency cesarean section. Challenges faced in managing this high risk pregnancy are discussed, emphasizing the need of close monitoring and tailoring management in similar circumstances.

A prospective study of maternal and fetal outcome in patients with hypertensive disorders of pregnancy and COVID-19 infection in a tertiary care center

Background: During the current COVID-19 epidemic, managing pregnant patients is an issue. Pregnant women with coronavirus infection have an increased risk of miscarriage, preclampsia, caesarean delivery, and neonatal mortality. The additive effect of COVID-19 infection and preclampsia in pregnancy may affect the fetal and maternal outcome in a more complicated way. There have been only a few studies till now to observe the combined effect of both in pregnancy. Our study aims to observe and analyse the maternal and fetal outcomes in pregnancy complicated by preclampsia and COVID-19 infection.Methods: This is a prospective study at a tertiary referral facility. This research included women with hypertension who were hospitalized for delivery and screened for SARS-RTPCR using a nasopharyngeal swab from April 2020 to September 30, 2021. The maternal and neonatal outcomes were studied and analyzed.Results: In our study of 65 women with COVID-19 infection and hypertensive disorders in pregnancy, about 6 (9.2%) had eclampsia, 6 (9.2%) had abruptio placenta, 5 (7.6%) had DIC, 3 (4.6%) had HELLP, 2 (3.07%) had acute kidney injury, 2 (3.07%) had ARDS, and 1 (1.5%) had PRESS. 4 (6.1%) had chronic hypertension. Further, 12 (18.4%) of patients needed ICU admission with ventilatory support; about 5 (7.6%) was the rate of maternal deaths in our study. 43 (65%) of neonates were appropriate for gestational age, while 20 (32%) were low birth weight and 2 (3%) were extremely low birth weight. 45% of women with preclampsia develop complications.Conclusions: Our study concluded that complications from preclampsia are more common in women with COVID-19 infection, but a larger sample size is necessary for statistical significance

A survey on the impact of COVID-19 infection on menstrual cycle following second wave of COVID infection in a tertiary care centre in Mumbai

Background: The COVID-19 pandemic has led to poor mental health measures, with emerging evidence suggesting gender differences with poorer outcomes in women. It has also introduced many acute stressors in life of many women and thus, led to worse outcomes. This may have unintended consequences for women’s overall health and well-being, including disruptions to reproductive function as elevated stress is often associated with menstrual cycle irregularities. The objective of this study was to determine if and how the COVID-19 infection and its related stressors have impacted women’s menstrual cyclicity.Methods: An online survey was designed to capture self-reported information on menstrual cycle changes was distributed between April and September 2021. A total of 155 women who met stringent inclusion and exclusion criteria and completed the survey.Results: Of the 155 respondents, more than half (78%) reported changes in their menstrual cycles. These included changes in menstrual cycle length, the duration of menses, or changes in premenstrual symptoms.Conclusions: By uncovering a trend in increased menstrual cycle irregularities during the second wave of the COVID-19 pandemic, this study contributes to our understanding of the implications that the pandemic may have on women’s reproductive health.