Good Apgar Scores Research Articles

Pregnancy with recurrent Sertoli- Leydig cell tumour

Sertoli -Leydig cell tumor (SLCT) is a rare variety ovarian tumor that belongs to the group of sex-cord stromal tumors. These constitute less than 0.5% of malignant ovarian tumors. A recurrence of Sertoli-Leydig cell tumor of right ovary in a 21-year-old pregnant woman with twenty weeks pregnancy is reported. Oligo-menorrhoea, obesity, mild hirsutism and other features of virilism were associated with the condition. Normal level testosterone and alpha-fetoprotein (AFP) were found preoperatively.Exploratory laparotomy and right sided salpingo- ovariotomy was performed in fifth month of pregnancy, under general anaesthesia. There were no pelvic or peritoneal metastatic deposits. Histopathology and immuno-histo chemistry confirmed the diagnosis of poorly differentiated Sertoli- Leydig cell tumour. Onco-surgeon and physician were consulted for tumor surveillance and further management during pregnancy. It was decided to start cancer chemotherapy after the delivery of baby. After the laparotomy ,patient had uneventful antenatal period .She was delivered by an elective caesarean section at the completion of 38 weeks. A healthy male baby with 3 kg birth weight was born with good Apgar score and without any congenital malformation. Peritoneal metastatic deposit of 3 to 4 cms in size were found in the pelvic region during caesarean section .These tumour deposits were removed during caesarean section and sent for histopathology .Histopathology report was suggestive of poorly differentiated Sertoli- Leydig cell tumour. Patient was treated with paclitaxel and carboplatin regemen in the postpartum period. This is one of the rare reports on a Sertoli- Leydig cell tumor which showed recurrence and rapid growth during pregnancy.

Ultrasound Assessment of Low Risk versus High Risk Pregnancy and Perinatal Outcome

Objective: To determine the maturational changes in the placenta by ultrasonography at various gestational ages in low risk vs. high risk pregnancies and their correlation with perinatal outcome.
 Subjects: Study was conducted in 100 patients with singleton pregnancies, divided into two groups: Group A (control group) having no medical or obstetrical complications in the current pregnancy and Group B (study group) having medical or obstetrical complication. All the patients were subjected to ultrasonography between 28-31 weeks, 32-37 weeks and after 37 weeks of gestation. All cases were followed till pregnancy outcome and neonates followed up to 7 days after birth. Perinatal outcome of group A and group B was compared.
 Results: It was observed that placental maturity increased with GA in both groups but placenta matured earlier in high risk cases. 8% patients in group A and 26% in group B showed earlier placental maturation. Patients of diabetes mellitus showed delayed maturity and lower grades were found even at termination. Incidence of LSCS was 44%in group B and 20% in group A. Good apgar score was shown when placental maturity was of higher grade. Respiratory distress syndrome was seen in only 4% neonates in group A and 8% in group B at termination with grade III placenta. 19% neonates in group A required admission to an ICU as compared to 37% in group B. Perinatal mortality was high in patients who had placental grade 0 and 1 at termination in both the groups. There was 10% perinatal mortality (4% still births and 6% neonatal deaths) in group A and 14% (4% still births and 10% neonatal deaths) in group B as high risk patients were there in group B.
 Conclusion: Placental grading by ultrasonography is a reliable index of foetal pulmonary maturity and it can assist the obstetrician in the management of high risk patients, thus making ultrasonography a useful tool for predicting the perinatal outcome and planning treatment modalities for termination of pregnancy. JMS 2014;17(1):6-10

Seropositivity of dengue antibodies during pregnancy.

Purpose. Malaysia a dengue endemic country with dengue infections in pregnancy on the rise. The present study was aimed at determining dengue seroprevalence (IgG or IgM) during pregnancy and its neonatal transmission in dengue seropositive women. Methods. Maternal with paired cord blood samples were tested for dengue antibodies (IgG and IgM) using an enzyme-linked immunosorbent assay (ELISA). Maternal age, parity, occupation, ethnic group, and gestational age were recorded. Data on neonatal Apgar score and admissions to the Neonatal Intensive Care Unit (NICU) were analyzed. Results. Out of 358 women recruited, about 128 (35.8%) patients were seropositive. Twelve patients (3.4%) had recent infections (IgM positive) and another 116 women (32.4%) were with past infections (IgG positive). All babies born to seropositive mothers had positive IgG paired cord blood; however, no IgM seropositivity was observed. All neonates had good Apgar scores and did not require NICU admission. Conclusion. In this study, 35.8% pregnant women were found to be dengue seropositive. However, transplacental transfer of IgG antibodies had no detrimental effect on the neonatal outcomes.

Surgical Excision of Left Atrial Chondrosarcoma and Mitral Valve Repair in a 30 Weeks Pregnant Female

This case report is regarding a 32 years old female with 30 weeks gestation, presented to the obstetric department first time with gestational amenorrhoea. She has history of exertional dysponea, orthopnoea and attacks of syncope on and off from last three years. On further work up, she has got left sided intra atrial mass of about 41×36 mm in size attached to the lateral wall of left atrium, protruding into left ventricle through mitral valve, during diastole causing severe obstruction. Left ventricular systolic function was normal, estimated ejection fraction of 58% and no regional wall motion abnormality. Fetal heart rate and other parameters of fetal wellbeing was assessed, they were within normal limits. Patient and her family were counseled about her critical condition. In the presence of obstetrician within the operating room, cardiac surgery was started with all essential monitoring. A successful excision of atrial mass and mitral valve repair was done with a cross clamp time of 45 minutes and total cardiopulmonary bypass time of 105 minutes. Postoperatively, patient was shifted to cardiac ICU and extubated when met the criteria of extubation and she was kept in cardiac ICU for 48 hours. In CICU, fetal cardiac activity was assessed continuously. All parameters regarding fetus were remained within normal limits and Obstetrician decided to plan for Caesarian section vs. spontaneous vaginal Delivery after four to six weeks, with regular weekly visits to labor suit. At 36th week, patient was admitted for induction of labor or possible caesarean section. The whole of the labor went uneventful and she delivered a male baby with good APGAR score. There were no postpartum complications. Histopathology of the excised mass showed a very rare intra cardiac tumor i.e. Chondrosarcoma.

PM.48 A Case of Haemoglobin Sun Prairie in Pregnancy

We describe a case of Haemoglobin Sun Prairie, a rare form of alpha thalassemia, caused by an unstable alpha-2-globin variant created by a point mutation in the gene coding for...

Successful outcome from empirical use of heparin and aspirin in unexplained pregnancy loss

Abstract Success in pregnancy of a 42-years old woman with a history of unexplained recurrent miscarriages is described. She had a sub-septate uterus with free spillage bilaterally, based on hysterosalpingogram, and it was corrected by hysteroscopy in October 2009, which was followed by transcervical septal resection (TCRS). Clomiphene citrate was given ovulation. She was treated with folic acid supplementation, aspirin 75 mg, micronized progesterone 400 mg/d, and low molecular heparin 2500 IU/d, from the diagnosis of pregnancy at 5 weeks, until the delivery. However, at 28 weeks glucose tolerance test with 100 g glucose revealed mild derangement in first (159 mg/dL) and second (164 mg/dL) hour values; metformin was given for the control of sugar. Heparin injections were given to the patient continuously during the antenatal period. No major bleeding episode was noted during pregnancy or delivery. A male child weighing 3.2 kg with a good APGAR score was delivered at the end of the term. Both anatomical abnormality and advanced maternal age had determinative role in pregnancy loss, but TCRS and antithrombotic heparin and aspirin treatment had the blithesome effect.

W316 EFFECT OF INTRAPARTUM PETHIDINE ON THE NEONATAL OUTCOME: IS IT DURATION RELATED?

Objectives: To study the effect of pethidine on the intrapartum fetal heart rate (FHR) pattern and to assess the neonatal outcome with regards to the interval between pethidine administration to delivery of the fetus. Materials: 73 healthy women intrapartum from labour suite hospital Tengku Ampuan Afzan, Kuantan, Malaysia Methods: This is a prospective observational study done on 73 healthy consented women with singleton pregnancy at term . All fetus were normal, vertex presentation with reactive FHR tracing before pethidine administration. FHR recording were performed for 40 minutes prior to and one hour post pethidine. Cervical dilatation of all patients ≤ 4 cm at time of pethidine administration. Intramuscular pethidine 1mg/kg was given as an intrapartum analgesia. The study sample was divided into two groups, first group delivered within 4 hours and second group delivered more than 4 hours after the pethidine administration. The data were analysed by SSPS 17.0. Results: the mean age of the recruited patients is 28.15 ± 6.15 years and mean gestational age of 39.14 ± 1.094 weeks. The mean duration from pethidine administration to delivery is 296.48 ± 173.65 minutes (4 hours and 56 minutes). Four (5.5%) cases had suspicious CTG 1 hour post pethidine, 1 with absence of acceleration for 45 minutes and 3 cases with early deceleration lasted for 60 to 90 minutes. Out of 73 patients, 38 babies delivered within 4 hours and 35 delivered after 4 hours of pethidine. All neonates delivered with good Apgar Score (AS), 8 at 1 minute and 9 at 5 minute except 1 with AS of 5 at 1 min and 7 at 5 min which delivered more than 4 hours after pethidine. Sixteen (21.9%) cases were admitted to the Neonatal Intensive Care Unit (NICU). Eleven (68.75%) cases were admitted due to neonatal sedation from the delivery group less than 4 hours after pethidine. Five (31.25%) cases from the delivery group more than 4 hours, 4 cases with a diagnosis of transient tachypnea of newborn and 1 secondary to meconium aspiration syndrome (MAS). All discharge to mother after 24 hours, non required ventilation apart from the one with MAS which required ventilation for one day and longer admission. Despite of the higher number of those require admission in the less than 4 hours group, it was not statistically significant with P value of 7.44. Conclusions: Pethidine can be used as an intrapartum analgesia which is safe, easily available without major effect on fetal heart rate pattern and neonatal outcome even if given in advance stage of labour.

Microcephalic osteodysplastic primordial dwarfism (MOPD) type I with lissencephaly and brain cyst

We are reporting a very rare case of primordial dwarfism associated with lissencephaly and brain cyst, in a full term (37weeks) girl, who had extreme low birth weight (580g), delivered vaginally with good APGAR score (6 and 7) at 1 and 5min, respectively. The mother was healthy, para 0+1, 20years old, had previous abortion and had no risk factors for severe intra uterine growth retardation (IUGR). Parents were non consanguineous. Although the baby had extreme low birth weight (ELBW) she did not need any ventilatory support till discharge from the hospital and was discharged home sucking well with weight on discharge 1.2kg. The baby had typical features of primordial dwarfism MOPD type I and to our knowledge this is the first time to report such a rare case from Kuwait. Also the patient had lissencephaly and brain cyst which were not reported previously.

A review of 93 cases of ruptured uterus over a period of 2 years in a tertiary care hospital in South India

This was a retrospective descriptive study carried out on cases in JIPMER between July 2008 and June 2010 among 32,080 deliveries. The study sample included 93 women who had a ruptured uterus. Outcome variables included maternal characteristics, risk factors, management and complications of ruptured uterus. The incidence of ruptured uterus was 0.28%. Most of these women were multiparous (95%), between 20 and 30 years (82%). The majority had a scarred uterus (77%) and 83% were at term gestation. Among women with a scarred uterus, 57 women (79%) had an unknown uterine scar type and 46 women (64%) had < 18 months’ duration from the last caesarean section. A total of 37 women (39.7%) presented with ruptured uterus and a dead fetus. Out of 71 women with previous caesarean section, 46 women (49.4%) were allowed trial of scar and developed a ruptured uterus in hospital. Among women with unscarred uterus, 14 presented with rupture and seven of these women were induced in hospital. Out of the 93 cases, 87% were managed with uterine repair and 12 women underwent hysterectomy. A total of 31 babies were born with good Apgar scores; 48 babies were stillborn. We conclude that the strongest association of ruptured uterus was with previous scarred uterus, multiparity and < 18 months’ duration from the last caesarean section. There were no maternal deaths. Maternal morbidity was seen in 17% of cases. Perinatal mortality was 60.6%. As a result of the study, we have implemented changes to improve patients’ care.

ST Analysis of the Fetal ECG, as an Adjunct to Fetal Heart Rate Monitoring in Labour: A Review.

ST Analysis of the Fetal ECG, as an Adjunct to Fetal Heart Rate Monitoring in Labour: A Review.

PRETERM LABOUR

Objective: To determine the effectiveness of transdermal patch of glyceryl trinitrate as tocolytic agent. Study design: Interventional- Quasi experimental study. Setting: Department of Obstetrics and Gynecology Unit- 1, Services hospital, Lahore. Duration with dates: One year (February 10, 2006 – February 10, 2007). Sample size: Fifty pregnant women with preterm labour were included in the study. Results: 54% of pregnant women were between G2 – G4. Majority (48%) of the women presented between 31 – 34 weeks of gestation. 46% of pregnant women had bishop score of 4 or more. 64% of patients found to have no risk factor for preterm labour. Majority (86%) responded after application of second patch (10 mg glyceryl trinitrate patch). 84% had no side effects. Local skin reaction (10%) and headache (4%) observed in few patients. 58% of pregnant women delivered after 48 hours and 78% of them delivered vaginally which was statically significant and majority of babies delivered weight more than 1.5 kg and with good Apgar score. Conclusions: It is concluded from the study that glyceryl trinitrate is a safer tocolytic, which has simple method of application; rapid onset of action with low cost, low risk from side effects and it does not require intensive monitoring.

Mitral valve replacement in a twin pregnancy

A 35-year-old female with twin gestation diagnosed with severe mitral stenosis and pulmonary hypertension was successfully treated with open heart surgery for mitral valve replacement (MVR). She gave birth to twins with good Apgar scores at 33 weeks of gestation by cesarean section. Cardiac surgery in singleton pregnancy has been reported extensively. However, there is only a single reported case of MVR following therapeutic abortion of a twin pregnancy in the second trimester. In contrast, we report the first case of mitral valve replacement for severe mitral stenosis and pulmonary hypertension in an ongoing twin pregnancy with successful outcomes.

Live Birth following Treatment of Metastatic Cerebral Choriocarcinoma

ABSTRACT Choriocarcinoma is a malignant tumor of trophoblastic tissue and constitutes about 30 to 40% of the trophoblastic neoplasia cases. Early hematogenous spread is characterstic of choriocarcinoma. We report a case of metastatic cerebral choriocarcinoma in a 23-year-old female with appearance of acute neurological signs following spontaneous intracerebral hemorrhage as the initial presentation. She underwent successful treatment of choriocarcinoma with chemotherapy (EMA-CO regime) and was able to have normal baby with good apgar score. The case emphasizes the importance of suspecting an underlying choriocarciroma in women of child bearing age group presenting with spontaneous cerebral hemorrhage and an uncomplicated term delivery can be expected after complete chemotherapy for GTN.

FETAL BIOPHYSICAL PROFILE

To evaluate fetal Biophysical Profile as an effective technique for the assessment of fetal condition and to improve fetal outcome by early detection of fetal hypoxia. Design: Co relational study: Place and Duration of Study: The study was carried out for a period of one year from Oct 2004-Oct 2005 at Obstetrics and Gynecology Department of Fatima memorial hospital Lahore. Patients and Methods: All patientswith history of sluggish fetal movements and clinical suspicion of IUGR, were underwent BPP from 32-42weeks. 100 patients were selected and their BPP score was recorded and were followed till delivery. Those who went into spontaneous labor and who were induced monitored during labor and at any sign of fetal distress immediate caesarean section performed. APGAR score of newborn was noted at one and five minutes and those having poor APGAR score were resuscitated and were followed till one week after delivery. APGAR score was compared with BPP score. Results: During this study 100 BPP were performed. 34patients were primigravidas and 66 were multigravidas. Among 100 patients 73had a BPP score of 9-10/10, 21 patients had a score of 7-8/10 and 6 patients had 4-6/10.In 2 patients with 4/10score emergency caesarean section led to the delivery of neonates with APGAR score of 8 at 5 minutes. Majority of patients with normal BPS of 8-9/10 had good APGAR score of 7- 8/10.Only 8 patients having BPP of 9-10/10 had poor APGAR score 6/10 or &lt;6/10. Conclusion: The fetal BPP appears to be an effective technique for assessment of fetal condition.

Inevitable Caesarean Myomectomy: A Case Report.

The traditional teaching in obstetrics is to avoid myomectomy during caesarean section because of increased risk of hemorrhage. When a lower segment uterine fibroid is present, a classical incision is prescribed.We present a 32year old booked nullipara who had an emergency classical caesarean section for huge lower segment fibroids, transverse lie and premature rupture of fetal membranes at 37 weeks of gestation and was delivered of a live male baby who weighed 3.6kg with good APGAR scores. The intramural fibroids, enchroaching into the uterine incision, made closure impossible, necessitating a caesarean myomectomy under a high dose oxytocin infusion before successfully closing the incision. She did remarkably well and was discharged home on the 7th post-operative day. Caesarean myomectomy can safely be done in situations where fibroid nodules enchroach on the incision line or in cases of pedunculated subserous fibroids, using good surgical technique and high dose oxytocin infusion.Key words: uterine fibroids, classical incision, inevitable, caesarean myomectomy.

Pregnancy outcome in women with autoimmune hepatitis

Autoimmune hepatitis (AIH) is a chronic disease of unknown cause, characterized by progressive hepatocellular inflammation and necrosis, frequently leading to cirrhosis. AIH usually affects young women and may influence fertility and pregnancy in them. Nearly 200 pregnancies have been reported so far in the world literature in women with AIH, and no definite guidelines have been established. We hereby report our experience of four pregnancies in women with definite diagnosis of AIH. We studied the maternal and perinatal outcome of four women with AIH. The medical history was recorded in detail. The pregnancies were allowed to continue with careful fetal and maternal surveillance. Antenatal complications, disease course during pregnancy, intrapartum maternal fetal events, mode of delivery, and perinatal outcome were noted. All four patients had preterm labor: three had vaginal delivery and cesarean was done in one due to breech presentation with preterm rupture of membranes. All the infants were live born with birth weight appropriate for gestational age and were born with good Apgar scores and no congenital malformation. The incidence of post partum hemorrhage was 25% and so was the maternal mortality. Successful pregnancy outcome in patients with well-controlled AIH seems to be a realistic expectation with careful monitoring jointly by the Obstetricians and Hepatologists, especially in the post partum period. Steroids seem to be the safe alternative as immunosuppressant therapy although azathioprine has also been seen to be generally safe for mother or baby.

Prévalence de l’hypoglycémie cétosique chez les enfants d’âge scolaire dans le village d’Ahoué en Côte-d’Ivoire

To determine the prevalence of ketotic hypoglycemia among schoolchildren, a descriptive cross-sectional study was conducted in preschools and schools in rural areas that involved 102 schoolchildren, from 4 to 7 years old, comprised 51 girls and 51 boys. Index WHZ was used to evaluate the children's nutritional status. The sampling was obtained by a drop of capillary blood in the pulp of the finger. The determination of glucose was realized by glucose oxidase method using an ultra sensitive and fast (One Touch Ultra) glucometer, and ketonuria was detected by dipstick "Ketodiastix." The clinical results revealed that most of children had a normal birth weight with an average of 2.885 g, a good Apgar's score superior to 7, and then the nutritional index WHZ revealed 3% of severe malnutrition and 34% of moderate malnutrition. Ten children (9.8%) had a hypoglycemia with a median of 0.51 g/l and extreme values going from 0.42 to 0.59 g/l. Seven children had a hypoglycemia associated with ketonuria. The prevalence of ketotic hypoglycemia was 7% in this study, and more frequent in the children between 4 and 5 years with 57% of cases in this age group. Thus, this condition, found in Western countries is a reality in Côte d'Ivoire, where the diathesis of malnutrition (37% of the population of the study) is a favorable factor. Therefore, it is useful to prevent protein-energy malnutrition by a balanced food by avoiding fasting before school by diet management.

P02.17: High risk first trimester combined test is a better predictor of abnormal pregnancy outcome than abnormal PAPP-A concentration alone

be identified and the pericardial effusion resolved by 28 weeks of gestation. The patient had a spontaneous vaginal delivery at 38 weeks of gestation. The newborn weighed 2810gr, had good Apgar scores and uncomplicated postnatal course. At 2 months of age an echocardiogram demonstrated normal ventricles and a small patent foramen ovale. Our case supports a favorable outcome in cases of isolated cardiac diverticulum and large pericardial effusion diagnosed early in pregnancy in the setting of normal NT and normal cardiac function.

Disseminated Intravascular Coagulation Following Induction of Labour with Misoprostol:

Disseminated Intravascular coagulopathy (DIC) has been reported following use of Misoprostol which is an old drug with new indications in Obstetrics and Gynecology. Its effectiveness, low cost, stability in tropical conditions and ease of administration as well as side effects like gastrointestinal effect, uterine rupture and post partum haemorrhage (PPH) have been documented. This is to report a case of disseminated intravascular coagulopathy (DIC) associated with use of misoprostol for induction of labour and to call for extra vigilance in its use. This was a case of 22-year old gravida 2 para 1 at 42 weeks gestation that was induced with 100 microg of misoprostol and delivered a live female baby with good Apgar score. She subsequently developed PPH and epistaxis simultaneously, then conjunctival haemorrhage 30 minutes later. She was managed with fresh whole blood and had a satisfactory recovery. Life threatening complication could result from use of Misoprostol. More research and high index of suspicion are needed to establish the association of prostaglandins with DIC.

Prenatal Diagnosis of Isolated Fetal Hydrocolpos Secondary to Congenital Imperforate Hymen

A 32-year-old primigravida was referred to our hospital at 36 weeks of gestation with a fetal pelvic mass. Ultrasonography showed the fluid-filled area to be a 9 x 4 x 5-cm pear-shaped retrovesical mass with a funnel-shaped blind pouch at the distal end of the fetal vagina. Marked left hydronephrosis resulting from mass compression was also detected. Fetal magnetic resonance imaging further defined a pelvic lesion extending cephalically into the abdomen and caudally into the vagina. Membranal protrusion of the introitus was clearly identified. Therefore, the diagnosis of congenital imperforate hymen with hydrocolpos was established. At 38 weeks of gestation, a 2,966-g female infant was delivered vaginally with good Apgar scores. Physical examination of the neonate revealed a bulging membrane covering the vaginal opening. The presence of syndromic disorders (McKusick-Kaufman, Ellis-van Creveld or Bardet-Biedl syndromes), genitourinary and anorectal anomalies were excluded. The karyotype was 46,XX. A hymenotomy was performed on the second day of life. The infant recovered fully after hymenotomy.