Normal Term Delivery Research Articles

Comparison of Standard Conservative Treatment and Early Initiation of Renal Replacement Therapy in Pregnancy-related Acute Kidney Injury: A Single-center Prospective Study.

Introduction and objectivePregnancy-related acute kidney injury (PRAKI) is one of the most important cause of maternal and fetal morbidity and mortality. Some of the reasons behind PRAKI may be due to sepsis, postpartum hemorrhage, preeclampsia, thrombotic microangiopathies (TMA), and acute fatty liver of pregnancy (AFLP). The timing of initiation of renal replacement therapy (RRT) for better patient outcome is still debatable. We conducted this study to establish whether earlier initiation of RRT in PRAKI improves fetomaternal survival compared to a more conservative approach.Materials and methodsThis is a prospective study, where patients were screened at a multispecialty tertiary care hospital in north India for 1 year. The patients were divided into two groups: early RRT and standard AKI treatment. The demographic profile and clinical characteristics of the patients in terms of age, parity access to antenatal care, fetal outcome, urine output, hematological and biochemical profiles, RRT, duration of hospitalization, recovery of renal function, and patients survival were recorded.ResultsThis prospective study conducted included 13 patients in the early RRT group and 23 patients in the standard group. Considering the fetal outcome, the number of fetal deaths in early RRT group were 14.29%, whereas for the standard group it was 85.71%. In all, 75% of early RRT group and 25% of standard group had normal term delivery. Probability test applied showed they were statistically significant. One maternal mortality was there in the standard group. The indices of maternal outcome in PRAKI patients were found to be statistically insignificant.ConclusionThe planning of RRT whether early or late does not make a difference in maternal mortality or morbidity. The fetal outcome is significantly better for patients with early RRT than conservative treatment in PRAKI.How to cite this articleBanerjee A, Mehrotra G. Comparison of Standard Conservative Treatment and Early Initiation of Renal Replacement Therapy in Pregnancy-related Acute Kidney Injury: A Single-center Prospective Study. Indian J Crit Care Med 2020;24(8):688–694.

Primary complete colporrhexis

Primary spontaneous colporrhexis is rare a condition characterised by rupture of the upper one third of the vaginal wall without extension from uterus or cervix in a parous women with an unscarred uterus. In our case the colporrhexis was also a complete one with rupture of the entire vaginal wall layers.A 31-year old, second gravida was booked in our hospital at 36 wks of gestation. She had no comorbities. She had previous full term normal vaginal delivery of an alive baby weighing 2.75kg.At 39 weeks and 4 days gestation she was admitted for induction of labour as she had borderline liquor. Induction was done with 2 doses of misoprostol 25mcg kept vaginally 4 hrs apart. 2 hours after placing the 2ndmisoprost she had spontaneous rupture of membranes with clear liquor draining PV. With strong uterine contractions. She delivered within 45 minutes a live healthy baby of 3kg weight. Placenta was delivered by AMTSL. Bleeding per vagina was within normal limits. During visualization of cervix and vagina prior to closure of episiotomy, omentum was seen coming out of upper part of posterior fornix of vagina. An irregular transverse rent was found and felt behind the cervix. Cervix was intact Uterus had contracted well. There was no excessive bleeding from vagina. Patients vitals were stable. Vagina was immediately packed and patient was shifted to OT after explaining about the unexpected complication and obtaining informed consent from patient and her relatives. Under anaesthesia, Visualisation of cervix and Examination of uterus was done. They were found to be intact. No extension of episiotomy seen. There was a transverse tear of 5 cm involving the posterior fornix. The left edge of the tear was found to be extending slightly upwards for about 2 cm. Omentum was seen protruding through the rent. The edges were dilineated, omentum was pushed inside. The delineated edges of the rent were sutured with 1-0 vicryl with intermittent sutures in two layers. Complete hemostasis was ensured.

Unusual and delayed presentation of chronic uterine inversion in a young woman as a result of negligence by an\xa0untrained birth attendant: a case report

BackgroundUterine inversion is a rare but known complication following parturition and may prove fatal due to neurogenic shock or postpartum hemorrhage if not corrected immediately. The incidence is variable, occurring in 1 in 2000 to 1 in 50,000 deliveries, as reported in the past. Nowadays, the incidence is declining due to better antenatal care and increasing institutional deliveries. However, in a developing country such as India, due to cultural and financial reasons, most of the deliveries are still being conducted by untrained birth attendants (“dais”) who have sparse knowledge of oxytocic drugs. Hence, proper education and training should be imparted to the traditional birth attendants and local village health practitioners about the management of labor, placental delivery, timely diagnosis, and proper management of uterine inversion to avoid this grave complication. We report this case because only a limited number of such cases have been reported so far with delayed presentation of chronic uterine inversion 8 months after delivery as a result of the negligence of an untrained birth attendant.Case presentationWe report a case of a patient with chronic uterine inversion presenting 8 months after childbirth as a result of ignorance at the time of delivery. A 22-year-old P1L1 (Para 1 Live 1) Asian woman of Punjabi ethnicity presented to our institute with a progressively increasing painless vaginal mass along with blood-stained vaginal discharge for the last 6 months and progressive dyspareunia (pain during intercourse) for the last 5 months that had worsened with time. She had experienced a full-term normal vaginal delivery at home 8 months earlier with the assistance of an untrained birth attendant (dai). Her history revealed that she had an unduly prolonged second stage of labor and was given aggressive fundal pressure due to inadequate bearing-down efforts and had collapsed after delivery but was managed conservatively by an untrained birth attendant. A provisional diagnosis of chronic uterine inversion was made on the basis of vaginal findings of a globular mass protruding from the cervix and approaching the vagina with thinning of the cervix around the mass, forming a tight constriction ring, in addition to ultrasound findings. The patient’s condition was corrected surgically using Haultain’s approach. She had a satisfactory outcome and was discharged symptom-free.ConclusionAwareness of this complication with timely diagnosis and prompt management can significantly minimize maternal morbidity and mortality, especially in a low- and middle-income country such as India, where 70–80% of deliveries still occur in a rural setting with untrained birth attendants.

Increased homocysteine expression associated with genetic changes in the folate pathway as a key determinant of preeclampsia: A prospective study from lower Assam, India

Lacunae exist in the scientific understanding of preeclampsia (PE) pathogenesis, which is a global issue and a clinical challenge during pregnancy and contributes to both maternal and fetal morbidity and mortality. We aim to understand the significance of homocysteine levels and folate pathway parameters in PE pathogenesis involving pregnancy cases from lower Assam, India. PE cases {N = 145, mild-PE (n = 108), severe-PE (n = 37)} and 192 normal full-term delivery cases were evaluated for Hcy expression and Vitamin B12 levels and evaluated for association with MTHFR and TYMS polymorphisms in PE pathogenesis. Hcy level was significantly higher in PE cases with negative pregnancy outcomes (p = 0.003) and was higher in PE-preterm delivery compared to PE-term delivery cases (p = 0.301). The VitaminB12 levels were not associated with higher tHcy concentration. Distribution of MTHFRC677T variant genotype was significantly higher in severe-PE cases compared to mild-PE cases (p = 0.050) and was associated with an increased risk of severe PE. The combined variant genotype of MTHFR and TYMSdel6 polymorphism resulted in significant increase (p = 0.014) in the risk of severe-PE compared to mild-PE. Within the PE delivery group, the combined variant genotypes showed association with higher homocysteine levels both in live birth cases as well in the PE cases with negative pregnancy outcomes. Increased homocysteine levels were associated with combined variant genotypes and were consistent in both term and preterm delivery in PE cases. The study points out the prognostic significance of MTHFR C677T, TYMS 1494del6 genotype and tHcy levels as a risk factor for PE, negative pregnancy outcome and preterm delivery.

Relationship between preterm birth and post-partum periodontal maternal status: a hospital-based Romanian study.

This cross-sectional case-control study of post-partum women aimed to estimate whether maternal periodontitis was a predictive contributor to preterm birth and to identify other risk factors associated with preterm birth in our target population. The case group included women who delivered preterm (74 cases) and the control group included women who had a normal term delivery (120 controls). Medical records, a 16-item questionnaire, and a full-mouth periodontal examination were used to collect information about socio-demographic characteristics, general health problems, birth-related information, behavioral factors and periodontal status. Logistic regression analysis was used to estimate the strength of the relationship between predictors and the categorical outcome variable, preterm birth. The bivariate analysis revealed the significant associations between preterm birth and socio-demographic factors (educational level, p = 0.003), antepartum smoking habit (p = 0.001) and birth weight lower than 2500g (p < 0.001). The multivariate analysis highlighted that the presence of post-partum maternal periodontitis and its severity remained independent risk factors of preterm birth in the presence of antepartum smoking habit and route of delivery [adjusted OR 2.26, 95% CI (1.06; 4.82), respectively, OR 3.46, 95% CI (1.08; 11.15)]. Post-partum maternal periodontal disease and its severity might, in part, be considered as contributor to preterm deliveries before 37weeks of gestation.

Laproscopic Management of Large Ovarian Cyst with Pregnancy: A Case Report

Background: Before a pregnant woman's baby birth, the incidence of cyst is the most common. Due to availability of quality antenatal ultrasound, ovarian cysts in the pregnant woman are diagnosed more frequently. The large (&gt;5 cm) and complex cysts are symptomatic and it required to be managed by surgical intervention. Cyst might rupture, twist, or even cause problems during childbirth.&#x0D; Aims and objective: To bring relief to a primigravida with 16 weeks pregnancy after spontaneous conception, presented with complain of hugely distended abdomen with marked discomfort and to preserve her pregnancy.&#x0D; Case Report:&#x0D; Materials and Methods: A 26 year old pregnant woman with ovarian cyst was enrolled and treated through laparoscopic management.&#x0D; Results: After the laparoscopic removal of cyst the post-operative period of the pregnant woman was found uneventful. The pregnancy of the woman was progressed smoothly and there was no any complications during the pregnancy. Full term normal delivery (FTNVD) was occurred and the baby was healthy with weight of approximately 2.55 Kgs.&#x0D; Conclusion: Large ovarian cyst can be managed without disturbing the pregnancy and a complicated case can be transformed into a normal ante natal check-ups (ANC).

SAT-200 INCREASED RISK OF LONG-TERM RENAL DISEASE IN WOMEN WHO DELIVER PRETERM INFANTS: A POPULATION-BASED COHORT STUDY

Chronic kidney disease (CKD) is a major cause of global morbidity, with estimated prevalence of 7-12% among women. Preterm delivery is a common adverse pregnancy outcome, and an independent risk factor for maternal cardiovascular disease. Little is known about the association between preterm delivery and subsequent maternal renal function, and whether any association is independent of preeclampsia or intra-uterine growth restriction. We aimed to determine whether women who deliver preterm infants are at increased risk of CKD and end-stage renal disease (ESRD). Using data from the Swedish Medical Birth Register, singleton live births from 1973-2012 were identified and linked to data from the Swedish Renal Register and National Patient Register (up to 2013). Women with pre-pregnancy renal disease, cardiovascular disease, diabetes, hypertension, systemic lupus erythematosus were excluded. Preterm delivery was the main exposure, and treated as a time-dependent variable. Primary outcomes were maternal CKD or ESRD. Cox regression was used for analysis, adjusting for maternal age, year of delivery, country of origin, parity, inter-pregnancy interval, smoking, BMI, gestational diabetes. Adjusted hazard ratios (aHR) and 95% confidence intervals (CI) were estimated. Models were stratified by history of preeclampsia or small for gestational age (SGA) delivery. The sample comprised 1,943,716 women with 3,760,429 live-births. Overall, 162,918 women (8.4%) delivered preterm. The mean (±SD) follow-up was 20.3 (±11.6) years. 18,001 women (0.9%) developed CKD, and 1,268 (0.07%) developed ESRD. Women with history of preterm delivery were at increased risk of CKD (aHR 1.46, 95% CI 1.39-1.53) and ESRD (aHR 2.52, 95% CI 2.17-2.93) compared with women who delivered at term (≥37 weeks). Women with history of extremely preterm delivery (<28 weeks) were at particularly high risk of CKD (aHR 1.94, 95% CI 1.60-2.34) and ESRD (aHR 3.99, 95 %CI 2.25-7.06). The risk of renal disease was greatest in women who experienced preterm delivery complicated by preeclampsia (vs. normal term deliveries, for CKD, aHR 2.81, 95% CI 2.46-3.20; for ESRD, aHR 6.70, 95% CI 4.70-9.76). However, spontaneous preterm delivery was also associated with significantly increased risk of CKD and ESRD independent of all other factors. Women who deliver preterm infants are at higher risk of CKD and ESRD, particularly those with very/extremely preterm deliveries. This association persists independently of preeclampsia or SGA. Preterm delivery warrants consideration as part of overall CKD risk prediction models. Women and clinicians should be informed of this heightened risk to plan for appropriate preventive interventions.

Serum biotin level during pregnancy is associated with fetal growth and preterm delivery.

Background : Biotin is a water-soluble vitamin that plays various biological roles through histone modification, such as immune functions and fetal growth. Mammalian maternal biotin deficiency during gestation induces fetal growth restriction. Preterm infants are known to be marginal biotin deficiency. However, studies on the biotin status of pregnant women under various conditions are lacking. Method : This was a retrospective case control study to analyze serum biotin concentration during pregnancy and cord blood in normal pregnancy, preterm delivery and small-for-gestational-age (SGA). Results : Twenty pregnant women with normal term delivery, 35 with preterm delivery, 24 with SGA, and 10 non-pregnant adult women were enrolled. Serum biotin concentrations of pregnant women remained low from first to third trimester. The levels of serum biotin in cord blood showed a significant positive correlation with gestational age, and that of pregnant women showed a weak positive correlation with gestational age. The maternal serum biotin levels during second and third trimester of SGA group were significantly lower than those of normal term delivery. Conclusion : This study suggests that maternal biotin deficiency during pregnancy might be the risk of preterm labor or fetal growth restriction. Further studies are required to clarify the roles of biotin in perinatal medicine. J. Med. Invest. 67 : 170-173, February, 2020.

Management of Peripartum Cardiomyopathy with Secondary Large Left Ventricular Apical Clot using Novel Oral Anticoagulants: A Case Report

Peripartum Cardiomyopathy (PPCM) is a major life-threatening complication of pregnancy, as only half of them or slightly more patients show improvement of Left Ventricular (LV) dysfunction. A 28-year-old woman with a history of gestational hypertension and diabetes during pregnancy, underwent full-term normal vaginal delivery. She started developing dyspnea, Class II which progressed to Class IV postpartum. Kidney and liver functions were found to be grossly deranged along with thrombocytopenia. Provisional diagnosis of Haemolysis, Elevated Liver Enzymes and Low Platelets (HELLP) was made. Electrocardiography (ECG) revealed the left anterior fascicular block. Eventually, bedside echocardiogram revealed severe LV dysfunction and the presence of a large soft LV apical clot with an Ejection Fraction (EF) of 30%. Adequate anticoagulation was achieved using Novel Oral Anticoagulants (NOAC). After six days and a 3-month follow-up, an echocardiogram demonstrated a significant improvement of LV function (EF-45%) and a complete resolution of LV apical clot, respectively.

A rare case of acute small bowel obstruction in immediate postpartum period: laparoscopic management

Background: Intestinal obstruction due to right paraduodenal hernia in early postpartum period is rare. There is only one published case report on left-sided paraduodenal hernia (PDH) in early postpartum period, which was treated by open surgery [1]. However, we would like to present first ever case of right-sided PDH causing acute small bowel obstruction in early postpartum period, which was treated laparoscopically. Case Presentation: Our patient was a 29-year-old female who had undergone full-term normal delivery 4 days prior. She presented with acute small bowel obstruction to the emergency ward. Right PDH was diagnosed on contrast-enhanced abdominal computed tomography. She underwent laparoscopic repair. Right PDH is a congenital condition caused by incomplete rotation of the midgut in early embryological developmental phase. In our patient, increased intra-abdominal pressure during gestation probably forced more and more bowel loops to enter and get entrapped into the pre-existing defect. Conclusion: Right PDH is a rare entity and can rarely cause acute intestinal obstruction in immediate postpartum period.

Pregnancy Outcomes in Chronic Myeloid Leukemia: A Single Center Experience.

PURPOSEThe aim of the current work was to report the effect of imatinib on pregnancy in patients with chronic myeloid leukemia (CML).METHODSData were collected between January 1998 and December 2014. One hundred four patients met inclusion criteria, and we report the results of 104 pregnancies—conceived by the participant or partner—while being on imatinib therapy for CML.RESULTSFifty-eight patients were male and 46 were female. Eighty-three patients, 20 patients, and one patient were had CML in the chronic phase, accelerated phase, or blast phase, respectively. Of 46 female patients, 21 underwent abortion (spontaneous, n = 36.9; elective termination, n = 8.6%). In the case of full-term pregnancy in the female partners of male patients with CML, all outcomes were uneventful. Of 46 female patients, 25 had full-term pregnancy outcomes. During the pre–imatinib era (total n = 6), patients were treated with hydroxyurea, interferon-alpha, and therapeutic leukapheresis. A total 10 of 19 pregnant patients continued on imatinib until their delivery and experienced the following outcomes: normal full-term deliveries (n = 7), preterm delivery (n = 1), omphalocele (n = 1), and craniosynostosis (n = 1). Of those who discontinued imatinib after counseling (n = 9), eight patients had full-term normal delivery, of which two patients required leukapheresis and one patient expired. All patients who continued on imatinib while pregnant were in complete cytogenetic response and major molecular response (MMR) before pregnancy, during pregnancy, and postpregnancy. Of nine patients who discontinued imatinib, two lost MMR during the third trimester and all of these patients were in complete cytogenetic response and MMR before pregnancy.CONCLUSIONIt is clear that there is no standard of care for the best treatment of CML in the case of pregnancy. Interferon and/or leukapheresis will be included as treatment options. Patients can have normal pregnancies even with the administration of imatinib at the risk of congenital anomalies, intervention for which can be done after birth.

The Effect of Video Education on Skin-to-Skin at the Time of Delivery [18T

INTRODUCTION: Skin-to-skin contact (SSC) is significantly associated with breastfeeding which continues to be below national goals. With a lack of research on how to overcome barriers to SSC, this trial examined the effect of video education upon admission for delivery on intent to, and actual participation in SSC. METHODS: Randomized control trial (June 2017-October 2017) of educational intervention in women (N=240) 18 or older admitted in anticipation of normal spontaneous term delivery. Alternate patients were randomized at the time of admission into video (N=120) and no video (N=120) groups. Both groups received a brief survey about SSC. The video group watched a patient education DVD and completed a post survey about SSC. IRB approval and patient informed consent were obtained. RESULTS: During the pre-intervention survey, 89.2% (107/120) of those in the video group compared to 83.3% (100/120) of those in the no video group indicated that they planned to use SSC (p=0.396). After the video, 98.3% (118/120) planned to do SSC after delivery (p<0.001). However, only 59.8% (55/92) started SSC within 5 minutes of delivery in the video group and only 49.4% (42/85) started SSC within 5 minutes of delivery in the no video group (p=0.17). CONCLUSION: Video education at the time of admission prior to delivery alters the intention of patients and trends towards preforming SSC within five minutes of delivery. Despite the plans for SSC there was no significant difference in rates of utilization between the two groups. These findings support that obstacles, other than prenatal education, may affect early SSC.

Influence of mode of delivery on cytokine expression in cord blood

The mode of delivery is a known risk factor for immune-related disorders. Normal term vaginal delivery is an inflammatory process and several cytokines are suggested to be involved. The purpose of the study was to evaluate differences in cord blood cytokine expression between modes of delivery in term-born children.Cord blood was collected from 49 elective Caesarean section (C-section) cases and from 49 normal vaginal term deliveries. Plasma was tested for 17 cytokines with Bio-Plex®-200-system. Mann-Whitney test was used for comparing the groups with Bonferroni correction for multiple testing.Four cytokines showed significant differences between the modes of delivery. Interleukin-6, Interleukin-8 showed a significantly higher expression in the vaginal delivery group, while Tumor-Necrosis Factor-a, Granulocyte-Colony Stimulating Factor showed a significantly higher level of expression in the C-section cord blood.Our study shows that there is differential expression of pro-inflammatory cytokines in elective C-section compared with normal term vaginal delivery.

A rare case of procidentia with rectal prolapse: A revolutionary change needed in the delivery practices in rural India

A rare case of procidentia with rectal prolapse: A revolutionary change needed in the delivery practices in rural India - IJOGR- Print ISSN No: - 2394-2746 Online ISSN No:- 2394-2754 Article DOI No:- 10.18231/2394-2754.2019.0028, Indian Journal of Obstetrics and Gynecology Research-Indian J Obstet Gynecol Res

Analysis of obstetric «near miss» cases in the Ryazan region

Although maternal mortality cases in Russia have become rare, the problem of their prevention remains relevant. To enforce the preventive measures, an analysis of critical conditions and «near miss» cases in obstetrics is commonly used. As a result, the quality of medical care in obstetric institutions improves. Aim: to assess the character and incidence of critical situations in obstetrics practice over the Ryazan region in 2015-2017 and to analyze the failures in medical care that led to such situations. Materials and methods. We analyzed 46 «near miss» cases and 1 case of maternal death recorded in the Ryazan region in 2015-2017. Results. The leading cause of critical conditions in obstetrics found in the Ryazan region was hemorrhage following an emergency caesarean section delivery. In most cases, bleeding was caused by pregnancy complications, although extragenital conditions also contributed to the development of the «near miss» situations. The main indication for emergency delivery was the premature detachment of a normally located placenta; in the normal term delivery, it was an inconsistent uterine scar after cesarean section and the accompanying pathology, such as placenta accreta. Conclusion. Considering the «near miss» cases as a separate group of obstetrics conditions contributes to the prevention of maternal mortality and improves the healthcare standards in obstetric institutions.

Long-Term Clinical Outcomes of Transcervical Radiofrequency Ablation of Uterine Fibroids: The VITALITY Study.

Objective: The aim of this research was to learn the long-term (> 5 years) clinical outcomes of transcervical radiofrequency ablation of uterine fibroids.Materials and Methods: For this retrospective, single-arm, long-term data-collection study, 23 women with heavy menstrual bleeding secondary to fibroids were treated with transcervical radiofrequency ablation guided by integrated intrauterine sonography (using the Sonata® System, Gynesonics, Redwood City, CA). This study was within the 12-month Fibroid Ablation Study-EU clinical trial in Mexico. Symptoms were assessed using the Uterine Fibroid Symptom and Quality-of-Life's Symptom Severity Score (SSS) and Health-Related Quality of Life (HRQoL) subscales. Patients were queried regarding pregnancy and surgical reinterventions.Results: Seventeen women (73.9%) provided long-term follow-up information, with a mean of 64.4 months ±4.5 months (range: 57–73 months). From baseline, mean SSS decreased significantly from 64.9 ± 16.9 to 27.6 ± 36.1, and mean HRQoL improved significantly from 27.2 ± 22.4 to 76.0 ± 32.6 (p = 0.002, and p = 0.0001, respectively). There were no surgical reinterventions through the first 3.5 years post-treatment. There was an 11.8% incidence of surgical reinterventions over 5.4 years of average follow-up, with 2 hysterectomies occurring after 3.5 and 4 years postablation, respectively (event rate: 2.2% per year; 95% confidence interval; 0.3%, 7.9%). Freedom from surgical reintervention at 1, 2, and 3 years was 100%, and, at 4 and 5 years, was 88.2% ± 7.8%. There was a single pregnancy occurring within the first year of treatment leading to a normal-term delivery by elective repeat cesarean section.Conclusions: Transcervical radiofrequency ablation with the Sonata System produced substantial durable clinical benefits beyond 5 years with a low reintervention rate.

Impact of K-Taping on sacroiliac joint pain in women after full-term normal delivery

Background: This study will help to plan the treatment protocol for reducing immediate sacroiliac joint pain with the help of K-tape in women after full term normal delivery and provide better quality of life to get back their activities of daily living more comfortably.Aim and Objectives: Aim of the study is to find out the impact of k-taping in sacroiliac joint pain in women after full term normal delivery. With following objectives 1) To study the impact of kinesiological taping in Sacroiliac joint pain in women after full term normal delivery. 2) To study the quality of life (QOL) in women with sacroiliac joint pain after full term normal delivery. Materials and Methods: study population: women with sacroiliac joint pain after full term normal delivery. Outcome measures- (A) Numeric pain rating scale (NPRS), (B)Roland Morris Disability Questionnaire (RMDQ). Intervention: The intervention period was of 72 hours where K-tape done in experimental group with exercise and only exercise in control group and both the outcome measures were documented. Result: Statistical analysis was done by using descriptive and inferential statistics using student's paired and unpaired t test and software used in the analysis was SPSS 22.0 version and p

Medical termination of pregnancy in bicornuate uterus with twin gestation

The incidence of uterine anomalies in general population is about 3-5 %.abnormalities of fusion of mullerian duct during embryogenesis results in varied congenital abnormalities like arcuate, septate, uni-cornuate, bi-cornuate uterus. Majority of them are asymptomatic. The suspicion of uterine abnormalities is always considered when there is a history of recurrent abortions, intrauterine growth restrictions, preterm labour, mal-presentations. We are presenting a 31 year old pregnant women who came with history of urine pregnancy test positive at 56 days of amenorrhea and requested medical termination of pregnancy. On ultrasound examination a bi-cornuate uterus with pregnancy in both horns of the uterus was imaged. Her first pregnancy was a normal full term delivery one year ago. She was not diagnosed with bi-cornuate uterus in her previous pregnancy. She was given a combination of mifepristone and misoprostol for termination of pregnancy, which ended in a successful medical termination of pregnancy, confirmed by transvaginal ultrasound done two weeks later.

Congenital adrenal hyperplasia with maple syrup urine disease: An example of consanguinity impact.

Background: Maple syrup urine disease (MSUD) is a rare autosomal recessive metabolically inherited disorder, caused by an abnormal function of the branched-chain α-keto acid dehydrogenase complex in the mitochondria. Case Presentation: The proband was born after a full-term pregnancy and normal vaginal delivery, with a good Apgar score (8, 9 at 1 and 5 minutes) and the birth weight of 2.5 kg with ambiguous genitalia in the form of phallus-like structure (3 cm), the fusion of labio-scrotal folds and urogenital sinus. The third day after birth, the proband was lethargic and developed hyperkalemia and hyponatremia, which required intravenous fluid therapy and hormonal replacement with hydrocortisone and fludrocortisone. The treatment was based on the positive family history of congenital adrenal hyperplasia in an older male sibling. Laboratory tests, cytogenetic study, tandem mass spectroscopy, and surgery were performed for the affected individual (II-8) using standard procedures. The laboratory and the treatment revealed significant improvements. Follow-up tandem mass spectroscopy results were observed in the normal range. The affected individual was treated with prednisone (2.5 mg bid) and Florinef (Fludrocortisone) (0.1 mg OD). The subject had regular menses, while acne and hirsutism were not observed. Conclusion: We are reporting the first case of MSUD associated with CAH, 21-hydroxylase deficiency salt-losing type and suggest that glucocorticoids might have an important role in treating MSUD cases.

613: Assessment of Perinatal Outcomes of pregnant women with simple vs severe malaria

Malaria in pregnancy is associated with adverse perinatal outcomes. The aim was to compare outcomes of simple and severe malaria and whether they vary by trimester of infection. A prospective cohort study performed over a 10 month period in 3 hospitals in Rwanda. Both hospitalized and non-hospitalized pregnant patients with confirmed malaria were enrolled and followed until 7 days postpartum. Demographic, clinical manifestations and perinatal outcomes were recorded. There were 484 pregnant women with confirmed malaria: 446 had perinatal outcomes and 38 women were lost to follow up. In total, 361 (80.9%) had simple malaria. Patients were predominantly from rural areas (85.4%). Among the patients with severe malaria, 84.7% were rural and 34.5% were primigravidas. Severe anemia (hemoglobin < 7g/dl) and thrombocytopenia (<50K) were present in 11.7% and11.4%. Severe CNS complications were noted in 18 patients (4.04%). Severe malaria was more common as pregnancy progressed; out of 85 with severe malaria, 12.9% were in the 1st, 29.4% in the 2nd and 57.6% in the 3rd trimester (p<0.0001). Overall, a normal term delivery occurred in 59%, with preterm delivery (PTD) in 17.4% and abortion in 13.9%. Adverse perinatal outcomes increased with trimester of infection (p<0.0001) (Table 1). Two-thirds of the 9 early neonatal deaths had 3rdtrimester infection (p<0.0001). A significant difference in perinatal outcomes between simple and severe malaria was seen: 65.1% of women with simple malaria had a normal term delivery as compared to 32.9% with severe malaria (p=0.003). All complications were significantly greater with severe malaria. Overall poor perinatal outcomes are seen in malaria with significant differences in perinatal outcomes between simple and severe malaria and by trimester of infection. In addition to vector control and exposure prevention, efforts need to be made in screening, education and monitoring pregnancies affected by malaria.