External cephalic version in breech presentations at term: comparison of maternal and perinatal outcome with normal pregnancies

Background: To study the maternal and perinatal outcome after successful external cephalic version in term breech pregnancies and to compare the same with normal deliveries with cephalic presentation.Methods: Singleton term breech pregnancies were included in Group I; in which ECV was attempted. Out of this, pregnancies with successful ECV (Subgroup I) were compared with Group II comprising of two term normal pregnancies delivering in labour room immediately after delivery of every woman who had successful ECV. Maternal, labour and perinatal parameters were compared between Subgroup and Group II. Results: The two groups were comparable with respect to maternal age and gestational age. There were more multigravidae in both groups. There were more labour inductions in Subgroup. 83.3% women in study group and 95.8% women in control group had spontaneous vaginal deliveries. There were no perinatal deaths in either group. No serious maternal complications related to version were noted.Conclusions: This study shows that ECV does not adversely affect the maternal and perinatal outcome; although larger studies are required to confirm this. ECV may be more successful in multigravidae with flexed breech presentations. The procedure should probably be practiced regularly to improve the success rate

Serum activin B levels as predictive biomarker for ectopic pregnancy

Tubal Ectopic pregnancy remains to be a diagnostic dilemma with high morbidity and mortality. Identification of serum biomarkers for diagnosis of the above condition is warranted. Decidualization of endometrium is expected to be low in tubal ectopic pregnancy due to limitation of space in the fallopian tube.  Hence tubal ectopic pregnancy is likely to have less serum levels of decidualization markers and activin B is one such marker. In the present study, we explored the utility of activin B in discriminating tubal ectopic pregnancy from intrauterine miscarriages and normal viable intrauterine pregnancy. The study included 28 in tubal Ectopic pregnancy (tEP), 31 intrauterine miscarriages (IUM) and 29 normal intrauterine pregnancies (IUP) confirmed both by clinical examination and ultrasonography. Serum activin B levels were measured at the time of admission using commercial ELISA kit. The median serum activin B levels were found to be significantly decreased in both tEP (P value=0.004) and IUM (P value =0.022) compared to normal IUP.  When compared between tEP and IUM, activin B levels did not differ significantly (P value =0.648). Receiver operating curve analysis demonstrated AUC of 0.722 to discriminate ectopic pregnancy from viable IUP with levels less than 23.3 pg/ml delivering a sensitivity of 82.14%, specificity of 62.07%, negative predictive value of 77.7% and positive predictive value of 68.4%, with 95% confidence interval between 0.588 to 0.833. ROC analysis of activin B and free β-hCG demonstrated AUC of 0.722 and 0.805, respectively to discriminate tEP from viable IUP. The model including both activin B and free β-hCG improved the discriminating potential with greater AUC (0.824), and specificity (93%) than individual one.  To discriminate tEP from IUM, activin B, free β-hCG and combination of both performed poorly. We conclude that serum activin B concentration is lower in tubal ectopic pregnancy, and can discriminate it from normal pregnancy with moderate accuracy. It also shows improved diagnostic potential along with free β-hCG, but cannot distinguish tEP from IUM reliably

Markers of Oxidative Stress in Pregnant Womenwith Sleep Disturbances

Objective: The quality and duration of sleep is impaired during pregnancy. Our study aimed to determine whether maternal sleep deprivation occurring during the second and third trimester of pregnancy could alter fetal well-being with respect to birth weight and APGAR score by altering the inflammatory status and oxidative stress in the mothers. Methods: Sleep adequacy was assessed using the Pittsburgh Sleep Quality Index (PSQI). We investigated the inflammatory status and oxidative stress at term in the blood of pregnant subjects with and without sleep deprivation by measuring the levels of protein-bound sialic acid (PBSA), high-sensitivity C-reactive protein (hsCRP), malondialdehyde (MDA) and protein carbonyl (PCO). Homocysteine (Hcy) and its vitamin determinants were also measured. Fetal outcome with respect to birth weight and APGAR score were compared between study subjects. Results: A significant increase was observed in the levels of hsCRP, PBSA, Hcy, MDA, and PCO, in the sleep-deprived group when compared to the control group. Fetal outcome at birth showed a significant difference between the cases with high sleep deprivation and those with low sleep deprivation. Conclusion: Sleep deprivation in pregnancy leads to an increase in the inflammatory parameters, oxidative stress, and Hcy levels. Fetal outcome at birth was affected more in mothers with high sleep deprivation than those with low sleep deprivation. Follow-up in these babies are needed to reveal any differences in their growth and development

Markers of Oxidative Stress in Pregnant Womenwith Sleep Disturbances

Objective: The quality and duration of sleep is impaired during pregnancy. Our study aimed to determine whether maternal sleep deprivation occurring during the second and third trimester of pregnancy could alter fetal well-being with respect to birth weight and APGAR score by altering the inflammatory status and oxidative stress in the mothers. Methods: Sleep adequacy was assessed using the Pittsburgh Sleep Quality Index (PSQI). We investigated the inflammatory status and oxidative stress at term in the blood of pregnant subjects with and without sleep deprivation by measuring the levels of protein-bound sialic acid (PBSA), high-sensitivity C-reactive protein (hsCRP), malondialdehyde (MDA) and protein carbonyl (PCO). Homocysteine (Hcy) and its vitamin determinants were also measured. Fetal outcome with respect to birth weight and APGAR score were compared between study subjects. Results: A significant increase was observed in the levels of hsCRP, PBSA, Hcy, MDA, and PCO, in the sleep-deprived group when compared to the control group. Fetal outcome at birth showed a significant difference between the cases with high sleep deprivation and those with low sleep deprivation. Conclusion: Sleep deprivation in pregnancy leads to an increase in the inflammatory parameters, oxidative stress, and Hcy levels. Fetal outcome at birth was affected more in mothers with high sleep deprivation than those with low sleep deprivation. Follow-up in these babies are needed to reveal any differences in their growth and development