Effect of elective cerclage versus rescue cerclage in pregnancy and its pregnancy outcome

Prolongation of the pregnancy in cases of incompetence of cervix or short cervix can be done by prompt diagnosis at the correct time with a decision on encirclage taken at the right time. An observational retrospective study conducted over a period of 6 months in a tertiary care centre enrolling 14 pregnant women who had various risk factors like multiple gestation, short cervix, cervical incompetence, bad obstetric history, anomalous uterus, in vitro fertilization technique, history of primary infertility ,recurrent abortions and mid-trimester losses or preterm delivery, and the results were interpreted with various tables and charts showing the benefits of elective versus emergency encirclage. Through the study, it was found that there wasn't any significant difference in the incidence of a patient who underwent cervical encirclage whether the patient had a prior antenatal registration or not. 71% of the patients enrolled for encirclage were primigravida and the most common gestation age was between 12-24 weeks. The most common age group was 21-30 years of age. Cervical incompetence and short cervix were the most important risk factor needed for cervical cerclage. Most of the patients delivered at around 34-37 weeks of gestation. 21.4% patient underwent rescue cerclage and delivered between 34-37 weeks of gestation. 57.14% underwent elective cerclage and delivered near term. Elective cerclage has a better outcome of pregnancy to reach near term than rescue cerclage.

Serum lactate dehydrogenase as a biochemical marker for maternal outcome in pre-eclampsia

Background: LDH is a cytoplasmic intracellular enzyme present in the heart, kidney, muscle, leukocytes and erythrocytes, of all major organ systems. The presence of LDH in extracellular space points towards cellular damage, endothelial dysfunction. Preeclampsia is a multisystem disorder during pregnancy causing cellular damage or death. Hence, serum LDH levels can be helpful in determining the extent of cell damage and the seriousness of this disease. The present study aimed to correlate the maternal serum lactate dehydrogenase levels with maternal and perinatal outcomes in women with pre-eclampsia.Methods: It was a prospective observational study. A total of 120 antenatal patients diagnosed with hypertensive disorder of pregnancy were included in this study. Serum LDH levels were estimated by enzymatic method on the autoanalyzer. Patients were grouped into 3 categories according to serum LDH levels: a) 800 IU/l. Clinical manifestation of development of complications of hypertensive disease and its relation with serum LDH in respective patients were analyzed.Results: An LDH level of more than 800 IU/l was seen in 19.2% while between 600 to 800 IU/l was seen in 16.7% cases. A significant association was observed between incidence of maternal complications with high LDH levels (p<0.01). High LDH levels were observed to be associated with development of ante-partum haemorrhage, eclampsia and requirement of ICU admission. No significant association was found between different categories of LDH and deep tendon reflexes, levels of proteinuria at the time of admission in these preeclamptic women.Conclusions: Close monitoring and early intervention of the preeclampsia patients with elevated serum LDH levels can help avoid adverse effects of the disease and thereby help improve maternal and perinatal outcomes in pregnant women with preeclampsia

Efficacy of MgSO4 to prevent eclampsia in women with severe pre-eclampsia and impending eclampsia

Background: Preeclampsia is a multi-system disorder that is frequently accompanied by proteinuria and new-onset hypertension. Poor placental perfusion and a general disease process that may affect multiple organ systems are the hallmarks of the syndrome. While eclampsia is a complicated condition brought on by cerebral dysrhythmia due to various pathogenesis steps that include abnormal trophoblastic invasion which led to vasospasm, endothelial dysfunction, and platelet aggregation. Maternal complications of severe preeclampsia/eclampsia can lead to maternal, fetal, and neonatal morbidity and mortality. One of the anticonvulsants MgSO4 is known to reduce the risk of eclampsia. The present study was conducted with the aim to analyse the effect of MgSO4 to reduce the incidence of eclampsia in pregnant women with preeclampsia and impending eclampsia. Methods: A total of 114 women with preeclampsia and impending eclampsia were included in present study. Mgso4 was given as a loading dose and the Zuspan regimen as required. Women were categorised based on raised blood pressure (&gt;140/90 mmHg), deranged lab parameters which includes renal function tests (urea, uric acid, creatinine), coagulation profile (PT, APTT, INR, LDH, platelet count), liver function tests (total bilirubin, SGOT/SGPT) and clinical symptoms which include headache, blurring of vision, epigastric pain.  The incidence of eclampsia even after a dose of MgSO4 was calculated. Results: The mean age of the women was 28.17±4.69 years. The diagnosis of pre-eclampsia was made based on systolic and diastolic blood pressure. Out of 114 pregnant women with severe preeclampsia or impending eclampsia who were given a dose of MgSO4, only 2 women have developed eclampsia. Conclusions: The incidence of eclampsia after the dose of MgSO4 among women with preeclampsia or impending eclampsia was reported to be only 1.75% which confirms MgSO4 therapy as an effective tool in preventing perinatal morbidity and mortality

The effect of preventive measures to reduce the decision to delivery interval in women undergoing emergency caesarean section

Background: Time interval between the decision to perform an emergency caesarean (ES) section and the actual delivery is known as decision delivery interval (DDI). A third phase delay in the delivery of emergency obstetric care is caused by prolonged DDI. In an effort to reduce maternal morbidity and neonatal morbidity and mortality, it is essential to implement interventions designed to reduce DDI. Methods: This study was carried out to reduce DDI by setting benchmarks for all categories according to Royal College of Obstetricians and Gynaecologists (RCOG) guidelines 2010, in our setup. The study carried out in 2 phases; first phase was a pilot study comprising of 143 women who underwent ES section. The deviation in DDI with possible causes were noted. The benchmarks were set to 8%, 30% and 20% for categories 1, 2, and 3 respectively. Corrective actions were taken including both hospital and patient causes for delay and were discussed at each level. Second phase included total 460 women from January to December 2021 and evaluated for DDI. Results: Out of 460, 87 (18.91%) women had deviated from the set DDI. The percentages in individual categories 1, 2 and 3 were 17.22%, 30.50%, and 29.50%, respectively. The deviation percentage of DDI in category 2, was achieved as per benchmark set in a pilot study, however, it was not achieved for other categories. Conclusions: Since the result that was obtained didn’t reach the set deviation percentage, we have observed that achieved deviation cannot be further reduced as our clinical setup is a teaching institute

Evaluation of clinico-epidemiological factors and outcome of COVID-19 disease in perinatal period

Background: The coronavirus disease 2019 (COVID-19) is caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). It is well accepted that pregnant women are at increased risk of infections, morbidity from known respiratory viruses like H1N1, varicella, influenza. COVID-19, a virus from the same family poses a greater and influential risk to the health of our mothers and their babies. Raised concerns of pregnant women, being physiologically immunocompromised with associated comorbidities like hypertension, diabetes, heart disease, anemia is very challenging for the obstetrician to conquer.Methods: We tested 405 pregnant women for PCR SARS CoV-2 during the pandemic out of which 59 pregnant women turned out to be positive, and were included in the study analysis. These women had singleton live pregnancy beyond 37 weeks and opted for in patient management. Study participants did not have any known obstetric complications.Results: 81% of women were delivered by cesearean section, indication being premature rupture of membranes and anhydramnios in 45 % of women reflecting the infective etiology of the disease. 60% women were asymptomatic, yet positive for the disease. Community spread was seen in 75% of the women. No ICU admissions were recorded.Conclusions: The substantial impact on the vulnerable groups like pregnancy has necessitated need for further studies and research and to build more service models as frontline obstetric COVID health care workers.

Long chain polyunsaturated fatty acids in mothers and term babies

Aim: To establish the levels of docosahexaenoic acid (DHA) and arachidonic acid (AA) in both plasma and erythrocytes of maternal and cord blood as well as in breast milk of mothers delivering babies at term. Methods: A total of 148 mothers delivering babies at term were recruited from Bharati Medical Hospital, Pune, India. Results: Levels of DHA and AA in both plasma and erythrocyte were higher in cord blood compared to levels in maternal blood (P&#60;0.001). Maternal plasma and erythrocyte DHA levels had a positive association with the respective levels in cord blood (P&#60;0.001). However, such an association was not seen for AA levels. Maternal plasma omega 3 and omega 6 fatty acids were positively associated with the respective milk fatty acids (P&#60;0.01). Conclusions: Our results indicate that milk long-chain polyunsaturated fatty acids (LCPUFA) status reflects the concentrations of maternal LCPUFA in women delivering babies at term. Improving the maternal LCPUFA status throughout pregnancy and lactation may improve the milk LCPUFA status and ultimately benefit the infant.Peer Reviewe