Good Feto-maternal Outcome Research Articles

Intra Cervical Foley’s Versus Combination Of Intra Cervical Foley’s And Extra Amniotic Saline Infusion As Cervical Ripening Agent For Induction Of Labor

Objective: To compare IntraCervical Foleys (ICF) and intracervical Foleys along with Extra Amniotic Saline Infusion (EASI) as a cervical ripening agent for Induction Of Labour(IOL). Methods: It was carried out at the Department of Obstetrics and Gynecology Holy Family Hospital, Rawalpindi. In this comparative study, we included 100 patients with singleton cephalic presentation, intact membranes and a BISHOP score ≤ 6. These were further subdivided into two groups, Group A (ICF) and Group B (ICF with EASI),50 in each group. In Group A, Foley’s catheter was placed cervically while in Group B extraamniotic saline infusion was also administered in the urine drainage port at midnight. PGE2/ Augmentation with syntocinon was considered according to the bishop score at 6 am. Improvement in BISHOP score, induction to delivery interval, and feto-maternal outcomes were noted in both groups. Results: Data analysis showed that the mean improvement in the BISHOP score of the patients in Group A was 3.78 ± 1.75 while that of Group B was 3.56 ± 1.79(pvalue = 0.508). The induction to delivery interval in group A patients was 14.6 ± 4.75 hours while that of group B was 13.22 ± 4.54 hours (p =0.103). Only 14/100 patients had failed IOL and underwent C- C-sections and 8/100 neonates had NICU admissions and were discharged later on. Conclusion: Both Intra Cervical Foley’s and a Combination Of Intra Cervical Foley’s And Extra Amniotic Saline Infusion are equally effective as cervical ripening agents for induction Of labour with high chances of successful vaginal delivery and good feto-maternal outcome. Keywords: Induction of labour, Intracervical folleys, Extra-amniotic saline infusion, BISHOP score.

A Report of Rare Case of Advanced Secondary Abdominal Pregnancy with Good Feto-Maternal Outcome Managed by Multidisciplinary Team

A Report of Rare Case of Advanced Secondary Abdominal Pregnancy with Good Feto-Maternal Outcome Managed by Multidisciplinary Team

Maternal and fetal outcomes in women undergoing induction of labor with low dose vaginal misoprostol.

To determine Maternal and Fetal outcome in women undergoing induction of labour with low dose misoprostol. A cross-sectional study was carried out to determine the efficacy of Misoprostol for induction of labor (IOL) in MTI, Lady Reading Hospital (LRH), Peshawar from 21st January to 31st December 2021. All pregnant women with singleton pregnancy and cephalic presentation admitted for Induction of Labor were included in the study. Maternal and Fetal outcome was noted. Induction of labor was started with 25 micrograms of Misoprostol, repeated every six hours depending on Bishop Score. Three hundred and thirty-seven women were included in this study. The majority of females (76%) were in 18-35 years age group. In 92.3% of females, the Bishop score was less than six. The maximum number of females (33.5%) delivered after eight hours of IOL. Sixty-six (66.46%) of females had gestational age of 37-40 weeks. Premature rupture of membranes was the most common indication (32.9%). Three doses of misoprostol were required in 31.2% of females. Only 5.6% of females required six doses of misoprostol for induction. With Misoprostol 85.1% of females delivered spontaneously, 2.37% required forceps delivery, 1.7% required vacuum delivery, and 10.68% delivered by Caesarean Section. APGAR score was 8 /10 in 84% of neonates at birth. Eighty-seven %(87.8%) of neonates did not require NICU admission. Misoprostol is a safe medicine to be used to induce labor in females. It can help shorten the duration of labor, with good fetomaternal outcome.

Disgerminom u trudnoći - prikaz slučaja

Introduction: Malignant germ cell tumors (MGCTs), as a subtype of rare non-epithelial ovarian cancers (NOEC), are most commonly found in pregnancy. Of all MGCTs, 38% are dysgerminoma. Considering the rarity of these entities, the aim of this paper is to show a rare case of ovarian dysgerminoma presented in pregnancy and its influence on course and outcome of the pregnancy. Patient Review: Patient aged 26, gravida 2, para 1, with one vaginal delivery five years before, was admitted to the Clinic for Gynecology and obstetrics in term pregnancy because of uterine contractions accompanied by left thigh pain and tingling sensation in the left leg. Solid hypoechogenic mass with regular borders, 125x90 mm in diameter adjacent to the left side of the uterus was seen by ultrasound, without free fluid in pelvic cavity. Since regular uterine contractions started, the decision was made to terminate pregnancy by Caesarean section (CS) because of tumor previa. Histopathological examination confirmed ovarian dysgerminoma, but after staging operation which was performed two months after CS, following imaging diagnostics, ovarian dysgerminoma was confirmed with FIGO stage IA, meaning that patient's specific oncological treatment was finished. Conclusion: Diagnosis of ovarian dysgerminoma is in general challenging since up to 50% are asymptomatic or symptoms are non-specific. The management of ovarian cancer in pregnancy should be multidisciplinary and individualized in the best interest of the mother and the fetus. The overall five-year survival rate for ovarian dysgerminoma is favorable in more than 90% of cases. Women diagnosed with dysgerminoma in pregnancy are young and in general have good feto-maternal outcome.

Previable Premature Rupture of Membranes in Dichorionic Diamniotic Twin Gestation, Loss of Leading Twin, Emergency Cervical Cerclage and Ceaserean Delivery at Term

Introduction: Multiple pregnancies have a higher risk of premature delivery and a weakened cervix has been associated with it. In most cases, emergency cerclage has proved to be beneficial as the birth of the first twin is usually followed by the unavoidable delivery of the second twin and most fetus dies shortly after delivery. Studies have noted that delayed delivery of the second fetus in a twin pregnancy is an effective management choice and the use of cervical cerclage after the first delivery is associated with a longer inter-delivery interval. We present a case of previable premature rupture of membrane of a dichorionic diamniotic twin gestation leading to the loss of the leading twin and subsequently having emergency cervical cerclage for the second twin and caesarean delivery at term. Case Presentation: She was a case of a 29 years old, G6P1+4 with 1 living child at a gestational age of 17 weeks plus 5 days who initially was diagnosed with dichorionic diamniotic twin gestation following an early ultrasound but presented with a history of bleeding and passage of liquor per vaginam. Ultrasound done on admission showed cervical funneling and a stable state of the second twin. She subsequently had emergency cervical cerclage after stabilization on account of previable premature rupture of membrane of a dichorionic diamniotic twin gestation with the loss of the leading twin. A repeat ultrasound done prior to discharge showed closed cervical os and a good state of the fetus. She then had elective caesarean delivery at term with a good feto-maternal outcome. Conclusion: Emergency cervical cerclage should be part of the options of management after stabilization in cases of previable premature rupture of membrane in a dichorionic or multichoronic gestation so as to save the viable once.

DIAGNOSIS AND MANAGEMENT OF SYSTEMIC LUPUS ERYTHEMATOSUS IN PREGNANCY: A CASE REPORT

Systemic lupus erythematosus (SLE) is a heterogenous autoimmune disorder with a complex pathogenesis that results in interactions between susceptibility genes and environmental factors. Almost 90 percent of SLE cases are in women; especially in child bearing age. It is a chronic inammatory disease with multisystemic involvement in which immune complex deposition causes damage to the tissues involved. Maternal and fetal mortality and morbidity are still signicantly high despite improvements in outcomes. Maternal morbidity includes higher risk of disease ares, preeclampsia and other pregnancy-related complications. Fetal issues include higher rates of preterm birth, fetal growth restriction, and neonatal lupus syndromes. Management option is limited to few safer drugs. A multidisciplinary approach, with close medical, obstetric and neonatal monitoring, is essential for optimal outcomes. This case report describes a 27 years old primigravida diagnosed with SLE for the rst time in pregnancy, evaluated and managed with a good fetomaternal outcome.

ISOLATED UNILATERAL LEFT FETAL VENTRICULOMEGALY: CASE REPORT

ntroduction: Ventriculomegaly is dened as dilation of the fetal cerebral ventricles (>10mm). (1) The incidence of mild to moderate fetal ventriculomegaly on prenatal ultrasound is 1 percent.(2) It is characterized into mild, moderate and severe. Ventriculomegaly maybe associated with genetic, structural or neurocognitive disorders and outcome maybe normal or it may result in severe impairment. The case being described is of mild unilateral ventriculomegaly wherein the patient was diagnosed at 21 weeks of gestation followed by prenatal testing to rule out structural, genetic and infectious causes. After ruling out structural genetic and infectious causes the pregnancy was continued till term giving due consideration to prognosis. Patient was delivered at term by Caesarean-section with good fetomaternal outcome.

TO DETERMINE THE EFFICACY AND SAFETY OF MIFEPRISTONE USE FOR CERVICAL RIPENING AND INDUCTION OF LABOUR VS EXPECTANT MANAGEMENT IN TERM AND POST TERM PREGNANCY IN NMCH PATNA, BIHAR

Background :To study the effect of mifepristone in cervical ripening and induction of labour to facilitate normal vaginal delivery. Aims and objectives: This study was done on use of mifepristone for pre induction cervical ripening and labour induction in terms of safety, efcacy and feto maternal outcome. Material and method: 100 women near term and post term pregnancy with poor bishop score less than 4 were randomised in study group and 100 women were kept in control group (expectant management) and augmentation was done in both groups after improvement in Bishop's score. Observation and result: preinduction cervical ripening was successful in76% of patients receiving mifepristone. Induction delivery interval was reduced and vaginal delivery was more in mifepristone group. Conclusion: Mifepristone can be used for pre induction cervical ripening in term and post term pregnancy with reduced induction delivery interval and good fetomaternal outcome.

A Study on Management of Premature Rupture of Membranes (PROM)

Background: Premature rupture of membranes (PROM) is a common obstetric complication. Knowledge of etiopathogenesis, diagnosis, complications & management of PROM has increased due to extensive research in the recent past. Yet, there is no unanimous opinion regarding optimum management of PROM. The aim of the study was to observe the patients during labor and compare the latent period, duration of first stage of labor, modes of deliveries and the use of oxytocin and its outcome in PROM cases with controls.
 Materials and methods: In this study, the definition of PROM used is – rupture of fetal membranes before the onset of true labor pain. The minimum gestational age was taken to be 28 weeks. Diagnosis of PROM was mainly clinical. A cohort study was conducted in the Dept. of Obs & Gynae of KPL Medical College & Hospital, Kolkata on 100 cases of PROM and 100 cases of comparison group, over a period of one year.
 Results: It was observed that onset of labor was more rapid with increasing gestational age, use of oxytocin for induction & augmentation of labor & operative deliveries were higher in PROM cases.
 Conclusion: Individualized management of PROM cases depending on the gestational age and risk of complications is the best way to achieve a good feto-maternal outcome.
 Bangladesh J Obstet Gynaecol, 2017; Vol. 32(2) : 94-98

Autoimmune Haemolytic Anaemia in Pregnancy: A Case Report With Literature Review

Autoimmune Haemolytic Anaemia (AIHA) results from increased red cell destruction due to red cell autoantibodies. Pregnancy associated AIHA is a very rare condition with unexplained entity, but can be dangerous for both fetus and mother. A case of multipara lady who developed haemolyticanamia during pregnancy, with a wide range of differential diagnosis. She was responded well to moderate dose of steroid with good feto-maternal outcome. Autoimmune haemolytic anaemia in pregnancy has rarely been reported in literature, which deserve its presentation.
 JCMCTA 2019 ; 30 (1) : 61-63

A comparative study to evaluate oral iron and intravenous iron sucrose for treatment of anemia in pregnancy in a poor socioeconomic region of Northeast India.

Objective:The prevalence of anemia during pregnancy is as high as 80% in some sections of the Indian population. Iron therapy in different forms has been found to alleviate anemia and yield good fetomaternal outcome. This study aims to evaluate the efficacy of intravenous iron sucrose (IVIS) versus oral iron in treating anemia among the antenatal mothers attending a tertiary care center of Northeast India.Materials and Methods:One hundred women between 18 and 28 weeks of gestation with diagnosed iron-deficiency anemia and hemoglobin (Hb) of 7–10.9 g/dL were enrolled to be administered either oral ferrous sulfate 200 mg twice daily or requisite dose of IVIS 100 mg in 100 ml normal saline on alternate days. Hb and hematocrit were measured at the time of enrollment, 4th week, and 8th week of therapy. Acceptability of both the drugs based on like and dislike after interviewing the study participants was recorded. Adverse drug reactions, gestational age at delivery, and neonatal birth weight were also noted in both the groups. The results were analyzed by Student's t-test and Chi-square test.Results:Hb and hematocrit values were found to be increased in both the groups at 4th and 8th weeks. When both the groups were compared, the rise in the values was higher in the iron sucrose group (at 4th week P = 0.01 and at 8th week P = 0.00). The number of participants who reached target Hb levels at 4 weeks was 41 (82%) with oral iron and 48 (96%) with iron sucrose. In the iron sucrose group, no adverse effects were observed, suggesting its safety, and the acceptability and newborn birth weight were noted to be higher.Conclusion:IVIS was found to be more effective than oral iron therapy in treating antenatal anemia with no serious adverse drug reactions.

CERVICAL CERCLAGE;

Introduction: In Pakistan, cervical incompetence has been recognized as the leading cause of recurrent abortions in mid trimester. The elective cerclage based on history and clinical findings applied in second trimester overcomes the risk of emergency procedure. This problem is quite common in patients visiting IUH Faisalabad. Objectives: Assess gestational age at delivery after elective cervical cerclage application in mothers with recurrent mid trimester abortions. List the immediate and late complications of cerclage. Assess the fetal outcome after cerclage. Outcome Measures: 1. Percentage of mid trimester abortion in current pregnancy. 2. Frequency of prolongation of gestational age at delivery. 3. Complications of the procedure. 4. Birth weight of the baby. 5. Percentage of live births. 6. Fetal survival rate. Study Design: Interventional: Quasi experimental study. Setting: Department of Obstetrics and Gynaecology, Teaching Hospital IUH FSD. Period: Oct 2016 to July 2018. Subjects: Fifty patients with recurrent mid trimester miscarriage due to cervical incompetence. Methods: Patients were admitted through outdoor with history of previous mid trimester abortions possibly due to cervical incompetence. USG evidence of normal pregnancy with no obvious congenital anomaly was a pre requisite for cervical cercalge. Technique used was MCDonald’s suture under general anaesthesia. Results: Effectiveness of cerclage was 90%; 78% had term deliveries, 12% preterm delivery and 5 spontaneous mid trimester abortions. There were 81% live births. The complications included cervical trauma after delivery (2%), spontaneous abortions (10%), pre term delivery (13%) and pre prom (2%). Conclusion: Elective cerclage at 12-14 wks of gestation in recurrent mid trimester abortions results in good fetomaternal outcome with almost no complications.

Non-blood management of severe anaemia in pregnant human immunodeficiency virus positive Jehovah's Witness patients in the University of Port Harcourt Teaching Hospital, Port Harcourt, Nigeria

Background: Blood transfusion is clinically used to treat severe anaemia, but some people refuse it for its adverse effects and religious reasons. Aim: To present two Jehovah's Witness pregnant human immunodeficiency virus (HIV) positive women who were managed successfully without blood at the University of Port Harcourt Teaching Hospital. Methods: Case series - The first case, a 27-year-old Jehovah's Witness woman was found to be retropositive with severe anaemia. She had a packed cell volume (PCV) of 14% in her second trimester in pregnancy. She was treated with oral haematinics, and the PCV rose to 34% before an elective caesarean section. The second case was a 29-year-old Jehovah's Witness woman who was admitted for chronic cough and fever in her second trimester. On further investigation, she was found to have pulmonary tuberculosis, septicaemia and severe anaemia with a PCV of 17%. She declined blood transfusion and was managed with parenteral iron and erythropoietin. Both cases had safe deliveries with good fetomaternal outcome. Conclusion: Pregnant patients who decline blood transfusion can be adequately managed if they register in the first trimester or the early second trimester and such cases need good team management and cooperation between the patient and the teams for a good outcome.

Advanced live intra-abdominal pregnancy with good fetomaternal outcome: A case report

An incidence of abdominal pregnancy is 1 in 10,000 live births accounting for 1.4% of all ectopic pregnancies. Abdominal pregnancy occurs due to secondary implantation from an aborted tubal pregnancy or as a result of intra-abdominal fertilization. Case Report: This is a rare case report of a 20-year-old primigravida who presented to our hospital at 38 weeks of gestation with advanced live intra-abdominal pregnancy. After confirming the diagnosis, the patient was taken up for emergency laparotomy and a live baby was extracted. Mother and baby were discharged in good health without any perioperative complications. Conclusion: The management of advanced abdominal pregnancy remains controversial. Diagnosis and management of advanced abdominal pregnancy is still a challenge to today's medical world. But high index of suspicion aided with imaging studies can help in timely diagnosis of this rare obstetrical occurrence thereby preventing the associated life-threatening complications.

Multiple rib fracture at 33 weeks gestation

We report a case of multiple rib fracture at 33 weeks gestation, following a road traffic accident, in which the uterus and the fetus were not affected. Patient had spontaneous vaginal delivery at 41 weeks gestation, with good fetomaternal outcome. Mother and baby remained in satisfactory condition, and she was later discharged by the Orthopaedic team when she had fully recovered.Key-words: Multiple rib fracture, road traffic accident, spontaneous vaginal delivery.

Place of delivery among women who had antenatal care in a teaching hospital

The utilization of antenatal care services does not necessarily equate to delivery at the health facility. The objectives of this study were to determine the proportion of pregnant women who had antenatal care and delivered in the hospital and the reasons for delivery elsewhere. Pregnant women of low risk who initiated antenatal care at the University Teaching Hospital were recruited consecutively from January to June 2004 and longitudinally followed up until delivery. A two-part questionnaire was used to obtain information on biosocial data, place of delivery, accoucher, fetomaternal outcome, and reason(s) for delivery elsewhere. Of the 1,080 women studied, 740 (68.5%) delivered in the hospital while 340 (31.5%) delivered elsewhere. The majority (52) of the deliveries elsewhere were at the woman's home. There were more literate women amongst the hospital delivery group, while there were more women of high parity and with a previous home birth in the home delivery group (p<0.05). Fetomaternal outcomes were similar in both groups. Nurses/midwives conducted most (60%) of the home deliveries and the principal reasons for home births were privacy and lack of transport during labor. 68.5% of women who had uneventful antenatal care delivered in the hospital. Home delivery was the commonest site for delivery elsewhere and the main reasons were privacy and lack of transportation. Skilled attendants conducted most of the home deliveries with good fetomaternal outcome. There might be a need to encourage women during antenatal care to reach out for skilled attendants when home delivery becomes inevitable.

PREGNANCY INDUCED HYPERTENSION;

Objective: To assess the stress response in severe pregnancy induced hypertensive patients on different drug regimen during preoperative and postoperative period. Sample size: 40 patients. Study Design: Comparative study. Place: CMH Kharian and WT Obgyne (Pvt) Ltd.Multan. Duration: June 2004 to January 2005. Patients and Methods: 40 patients of severe pregnancyinduced hypertensives were induced in this study. 20 patients were placed on a single standard antihypertensivei.e. alpha methyldopa and 20 were put on a combination of alpha methyldopa with long actingnifedipine or amlodipine. Both these groups underwent caesarean section. The stress response in both thesegroups was carefully analyzed and compared with a special note on any untoward effect on the mother orfetus. Results: The results from this trial clearly demonstrated that patients on combined drug therapyshowed better stress response during perioperative and postoperative period. Conclusion: In severe PIHpatients undergoing caesarean section good feto-maternal outcome was obtained on combinationantihypertensive drug therapy as compared to patients receiving single anti-hypertensive drug.

Unexplained hemolytic anemia of pregnancy: Case report with review of related literature

We present a case of a multipara lady who developed hemolytic anemia during pregnancy with spontaneous remission after delivery. She was managed with low dose steroid for hemolysis during pregnancy with good feto-maternal outcome. Despite extensive investigations carried out to determine the cause, they remained in vain. Very few of such cases have been described in the literature, which merits its presentation. Key words: Hemolytic anemia, pregnancy doi:10.3126/njog.v3i1.1441 NJOG 2008 May-June; 3(1): 49 - 50