Pregnancy Wastage Research Articles

Fungal endometritis associated with embryonic loss in a maiden mare

SummaryFungal endometritis and placentitis have been reported as a rare but important cause of infertility in the mare. There are no reported clinical cases of fungal endometritis causing embryonic loss in the mare. This case report aims to highlight the potential of fungal endometritis as an aetiological agent in embryonic loss in the mare; an incidental diagnosis of a case of fungal endometritis and embryonic loss while undertaking routine pregnancy assessments in a Standardbred mare. After a positive pregnancy diagnosis after 13 days post‐ovulation, a mare was diagnosed with endometritis and pregnancy loss associated with the growth of an unusual fungus, likely of the Acremonium spp., 28 days post‐ovulation. While fungal embryonic loss is rare, it should be considered a potential reason for pregnancy wastage in the mare.

IJCM_74A: Reproductive health problems and its determinants among the tribal women in Wayanad, Kerala; a cross sectional study.

Background: India has the largest proportion of tribal population, and there is a growing concern about the maternal and reproductive health of women, particularly those who are marginalized. In Kerala, the maternal and reproductive health indicators of tribal women exhibit notable variations compared to other social groups. Objectives: 1) To estimate the prevalence of reproductive health problems among the tribal women in Wayanad district. 2)To assess the factors associated with reproductive health problems. Methodology: A convenience sampling method was employed to conduct a cross-sectional study involving 300 tribal women aged 15-49 in Kalpatta, Wayanad district. The study gathered information on sociodemographic factors, reproductive health issues, hygienic practices, and anthropometric details through a pretested semi-structured questionnaire. The collected data were entered into MS Excel, and the analysis was carried out using SPSS 21.0. Results: The mean age of the participants is 30.4±10.3 years. The prevalence of reporting any reproductive health issue is 16.3%, with 10.7% reporting two symptoms and 14.7% reporting three or more while 58.3% had no symptoms. The most common symptom is abnormal vaginal discharge with itching (57.1%). Among the participants, 64.5% are currently married, with 41.7% having low BMI, 55% use smokeless tobacco products,93.7% maintain good hygienic practices and 18.7% experienced pregnancy wastage. Occupation status and hygienic practices were found to be significantly associated with reproductive health problems. Conclusion: Adhering to appropriate hygiene practices in daily life, including menstruation, can minimize prevalent reproductive health issues among women in tribal communities.

The outcome of cervical stitch in the prevention of pre-viable and preterm deliveries in Nigerian Tertiary Hospital

Background: Cervical incompetence, defined as the inability to sustain a pregnancy to term due to functional and anatomical defects of the cervix is a distressing cause of childlessness in Nigeria. Cervical cerclage, introduced into clinical practice by Shirodkar and McDonald in the 1950s still a time-tested intervention in the prevention of pregnancy wastages from cervical incompetence. Aim: The purpose of this study was to audit the outcome of the applications of cervical cerclages in the prevention of pregnancy wastages at the Maternity Complex of the Ekiti State University Teaching Hospital and Maternal and Child Specialists’ Clinic in Ekiti State, Southwest Nigeria. Methods: In this prospective observational cohort study, we included all pregnant women who had cervical stitches applied over ten years, (2010-2019). Information on sociodemographic biodata, risk factors, indications, and outcomes were collated. Statistical analysis was performed using the SPSS package, version 22 (SPSS Inc, Chicago, IL). Statistical significance of the categorical variables was tested using the chi-square or Fisher’s exact test, confidence level of 95%and P-value of 0.05. Results: The 134 pregnant women diagnosed with cervical incompetence had cervical stitches applied over the ten years. 15,037 deliveries giving a prevalence rate of 0.89% of cervical incompetence. 75% were multigravida, while 92.5% were of low parity. Risk factors found included recurrent mid-trimester abortions (55%), and prior cervical dilatation (20%). The cervical cerclages were history and physical examination indicated in 22.5% and 75% had ultrasound scanning confirmation. In the majority (82.5%), cervical cerclage was placed at 14-16 weeks using Mersilene tape in 92.5%. Spinal anesthesia and conscious sedation were administered in equal proportion. Majority had McDonald’s procedure (96.27%) whereas only 3.73% had Shirodkar’s. Placement to removal interval ranged from 10-20 weeks in 53%, while in 12.5% it lasted 4 weeks. The indications for removal included pregnancy carried to term at 72.5%, preterm labor at 7.5%, and vagina bleeding occurred in 7.5% of cases. Vaginal deliveries were achieved in 62.5% while 25% had cesarean delivery. 7.5% expelled pre-viable fetuses. Cervical cerclage placement was successful in 75%, while 25% had failed cerclage. 10% of those who had failed cerclage had live births. We achieved 85% of babies take home. There was no significant association between the overall outcomes of cervical cerclage (inevitable abortion, preterm delivery, term delivery) and certain defined co-variables (age, gravidity, and parity). On multivariate linear regression. Conclusion: We recommend that timely application of cervical stitches will rescue women from pregnancy wastages associated with cervical incompetence in Ekiti State.

Age related effect on pregnancy rate and pregnancy wastage in thoroughbred mares bred during different heat cycles postpartum under subtropical conditions

This investigation reports the correlation of age and heat cycles on the pregnancy rate and pregnancy wastage in Thoroughbred mares bred during foal heat (FH), second heat (SH) and third heat (TH) in a commercial stud farm in Kunigal, Karnataka, India. The pregnancy rate was not influenced by the different heat cycles post partum. The correlation of mare’s age on the pregnancy rate and heat cycles showed that the age of the mares significantly influenced the conception rate in mares bred during FH and TH postpartum, while it was not significant in SH. The mare’s age did not influence the pregnancy wastage significantly in mares bred during FH, SH or TH, but the FH bred mares showed significantly higher early embryonic mortality rate than SH and TH bred mares. While the abortion rate was not influenced by the different heat cycles postpartum. In conclusion, the reproductive efficiency with respect to pregnancy rate was age dependent, while pregnancy wastage looked independent of age in Thoroughbred mares bred on FH, SH and TH. The optimum age for better pregnancy rate was between 6 and 13 years in all the heat cycles and aged mares (>18 years old) showed reduced pregnancy rate due to increased pregnancy losses.

Review: Some challenges and unrealized opportunities toward widespread use of the in vitro-produced embryo in cattle production.

The embryo produced by in vitro oocyte maturation, fertilization, and embryonic development is an important resource for genetic improvement and has the potential to improve female fertility and to be programmed to produce offspring with superior ability for health and production. The cultured embryo is also an important component of several realized and potential technologies such as gene editing, somatic cell nuclear cloning, stem cell technologies and gamete generation in vitro. Full realization of the opportunities afforded by the in vitro-produced embryo will require overcoming some technical obstacles to cost-effective implementation of an embryo transfer program. Among the research goals for improving the penetration of embryo transfer in the cattle industry are development of methods to increase the supply of oocytes from genetically elite females, enhance the proportion of oocytes that become transferrable embryos, improve the fraction of embryos that establish pregnancy after transfer, reduce pregnancy wastage after pregnancy diagnosis, and identify culture conditions to optimize postnatal phenotype.

A Retrospective Analysis of Cervical Cerclage Outcomes in a Low-Income Country

Background: Cervical incompetence (CI) is a common cause of mid-trimester pregnancy loss. Clinical evidence has demonstrated the role of cervical cerclage in reducing preterm births alongside engendering successful maternal and foetal outcomes in carefully selected women with cervical incompetence. This study aimed at determining foetal and maternal outcomes in women with cervical incompetence after elective cervical cerclage. Methods: A retrospective analysis of 88 patients who had elective cervical cerclage at the University College Hospital, Ibadan (UCH), Ibadan, Nigeria between January 2015 to December 2017. Data from the case records of these patients were analysed using the Statistical Package for Social Sciences version 22. Descriptive analysis was generated and summarized with the aid of pie chart, bar chart and frequency tables. Chi-square statistic was used in testing for associations between categorical variables. Results: The mean age was 32.5 ± 4.2 years. Most of the women (78%) had cervical cerclage performed between 14 -16 weeks’ gestation. The most observed complication was pre-term contractions (76.2%). Eighteen women (20.5%) had a miscarriage and 50 women (56.8%) had term deliveries. The mean gestational age (GA) at delivery was 34.1 ± 5.8 weeks. Maternal complications, use of tocolytics and duration of hospital stay had a significant influence on the gestational age at delivery (p<0.005). Conclusion: Cervical cerclage is an effective surgical procedure for preventing and delaying preterm births in women with cervical incompetence evidenced by a successful outcome in 56.8% of cases depicted in this study. Its use in a low-income country with high rates of preventable pregnancy wastages cannot be over-emphasized.

The Genetic and Genomic Landscape of Human Reproductive Disorders: An Overview with Our Experience

Genetics and genomics play a role in the causation of various human diseases. A large number of human reproductive disorders also arise as a result of genetic and genomic abnormalities. Reproductive disorders associated with predominantly genetics and genomic abnormalities are infertility, early pregnancy loss, congenital malformations, difference or disorder of sex development and reproductive cancers. The genetic etiology of human reproductive disorders is increasing with improved molecular biology techniques such as DNA microarray and next-generation sequencing. Infertility is one of the significant areas of reproductive disorders where genetics/genomics plays a substantial role and may result from chromosomal, copy number variation, Yq & pseudo autosomal region microdeletion/microduplication, gene mutation (monogenic, oligogenic, polygenic), multifactorial, epigenetic, mitochondrial, etc. abnormalities. All idiopathic infertile couples should be screened for genetic disorders before assisted reproduction to prevent transmission, if any, in offspring. Pregnancy wastage in early pregnancy is very high (about 70%) and is mainly related to chromosome number, copy number variation, and some monogenic or epigenetic abnormalities. Therefore, all early pregnancy loss cases should also be tested for genetic causes. Congenital malformations are structural defects in embryo, fetus, or newborns and affect about 3% (major malformations) of all births. The malformations could be due to the abnormalities of chromosomes, copy number variation, monogenic, oligogenic, multifactorial, or environmental. Array CGH &/or NGS should be used as the first step to screen congenital malformations. Differences/disorder of sex development is a developmental defect in which the determination and/or differentiation of chromosomal, gonadal, or phenotypic/anatomic sex is abnormal. It is a common disorder and is primarily related to genetic abnormalities. Therefore, a precise diagnosis, mainly through an array CGH and/or NGS, is crucial for the proper management to prevent future psychosexual problems and another birth with the disorder. Cancer is a genomic disorder characterized by genomic instability (due to a defect in DNA repair mechanism), uncontrolled replication (due to lack of response to inhibitory factors/loss of contact inhibition), neo-angiogenesis, invasion and metastasis. All cancer cases should be investigated for genomic markers (both hereditary and somatic) for precise diagnosis, prognosis, and genetic counseling. In this review, we will try to evaluate the role of genetics and genomics in the above-mentioned reproductive disorders, along with genetic & genomic techniques used and reproductive counseling in addition to our experiences.

Consanguinity, Fertility and Reproductive Outcomes: An International Review

Consanguineous marriages have been common throughout human history, and remain so even today in many parts of the world. Many Arab countries display some of the highest rates of consanguinity and, specifically, first cousin marriages which may encompass 25 to 30 percent of all marriages. The effects of inbreeding on reproductive outcome have been extensively studied. It used to be generally believed that inbreeding contributed to increased mortality and morbidity with detrimental effects on reproductive outcome; however, some studies have shown only a moderate to slight impact. The fertility of consanguineous couples and infant and childhood morbidity and mortality in their progeny have also been extensively studied and numerous studies have concluded that consanguinity is not associated with either a significant positive or negative effect on fertility. The majority of studies found that first cousin couples produce more children. In many cases the mean number of live births to women in consanguineous marriages has been reported as being higher than that in non-consanguineous unions, although several studies found that mean fertility rates may be lower in consanguineous couples. In general, higher total fertility rates have been reported in consanguineous marriages. Reports regarding the association of consanguinity and fetal wastage are conflicting, with some reporting that the total prenatal losses were essentially the same for consanguineous and non-consanguineous. Congenital malformations have long been established to be higher in consanguineous couples about the background rate (4.5% vs 1%). Due to the principle of the existence of a common ancestor. Consanguinity is most commonly associated with inborn errors of metabolism, most of which are autosomal recessive. Consanguinity also increases the incidence of multi-factorial disorders such as diabetes, cardiovascular disorders, obesity and certain types of cancers, which may in turn affect reproductive outcomes. Pregnancy outcomes, such as increased pregnancy wastage and preterm labor have been reported with consanguineous marriages. The most significant effects on reproductive outcomes are mostly due to autosomal recessive inherited conditions and inborn errors in metabolism. In the future, with completion of the study of the whole human Genome and current advances in pre-implantation diagnosis and screening it may be possible to mitigate some of the adverse reproductive outcomes associated with consanguinity.

Determination of pregnancy wastage and its financial implication in slaughtered cows using pregnancy-specific protein B

Determination of pregnancy wastage and its financial implication in slaughtered cows using pregnancy-specific protein B

Pregnancy and parturition in dromedary camels III. Incidence, timing and factors affecting abortions and perinatal mortality under intensive management

In this study, the incidence, timing and risk factors associated with abortion and perinatal mortality (PM) were described in dromedary camels under intensive management. In addition, overall pregnancy losses were also summarized and weekly risk of pregnancy wastage was determined throughout gestation. Data were collected over 11 breeding seasons from September 2006 through June 2017 at the world's largest camel dairy farm. A total of 229 abortions were observed (5.05%) out of 4533 pregnancies after 60 days (d) of gestation. Most abortions were singleton (n = 199, 86.9%), but twin abortions were also recorded in 30 cases (13.1%). Abortions showed a pronounced seasonal distribution, with a peak in August. The age category (P < 0.01), breed or ecotype of the female (P < 0.05) and bull influenced the occurrence of singleton abortions. Dromedaries with twins tended to abort earlier than those with a singleton fetus (median = 232.5 d vs. 257 d, P = 0.053). Perinatal mortality was observed in 174 cases (3.84%) out of 4533 pregnancies after 60 d of gestation. The condition included the premature birth of non-viable calves after shorter than normal gestation (330–350 d, n = 26, 14.9%), the birth of well-developed but dead calves after normal gestation length (n = 120, 69.0%) and neonates that died within 48 h after delivery (n = 28, 16.1%). The frequency distribution of PM was parallel with that of parturitions. The most important predisposing factor for PM was difficult calving. Thirty-nine percent (68 out of 174) of these losses were associated with dystocia. In addition, age category (P < 0.05) and parity of the female (P < 0.01), month of delivery (P < 0.05) and breeding season (P < 0.05) also affected the incidence of PM. The cause of 60 cases of PM (1.4% of all deliveries) could not be determined and was considered idiopathic. In conclusion, one-third of total pregnancy losses occurred during mid to late gestation. Approximately 10% of pregnancies after Day 60 failed, and 90% resulted in the birth of a live calf that survived beyond 48 h. More than half of these pregnancy losses were abortions before 330 d of gestation, and approximately 40% were classified as PM. The weekly mean risk of pregnancy loss after 100 d of gestation remained only a fraction of that observed during the first 2–3 months.

Characteristics of Holstein cows predisposed to ketosis during the post-partum transition period.

Ketosis is a common metabolic disorder during the post-partum transition period of dairy cattle. How the method of reproduction, parturition time, and calf birth weight affect the occurrence of ketosis on dairy herds remains elusive. This study investigated factors associated with the severity of ketosis. We divided 186 Holstein cows into three classifications based on the highest β-hydroxybutyrate (BHBA) concentration during the post-partum transition period, namely non-ketosis (<1.2mmol/L, n = 94), subclinical ketosis (1.2-2.9mmol/L, n = 58), and clinical ketosis (≥3.0mmol/L, n = 34). We evaluated characteristics of cows associated with the severity of ketosis. Ketosis was not associated with the method of reproduction, parturition time, pregnancy wastage, premature delivery, retained placenta, and type of calf. Cows calving in spring and especially summer were at higher risk of severe ketosis (p < 0.01). Cows with increased body condition score (BCS) at parturition, age, lactation number, and calving interval were more likely to develop severe ketosis (p < 0.05). Cows with clinical ketosis produced most milk (29.9 ± 1.0kg) from days four to six, whereas cows without ketosis produced the least (21.3 ± 0.8kg) (p < 0.001). Heavier calf birth weight resulted in high risk of severe ketosis (p < 0.01), due to increased milk yield during the early lactation. The severity of ketosis is associated with the calving season, BCS at parturition, age, lactation number, calving interval, milk yield in the early lactation period, and calf birth weight. Nonetheless, it was not associated with the method of reproduction, parturition time, pregnancy wastage, premature delivery, retained placenta, and type of calf. This study is the first to investigate the associations between ketosis and calf birth weight. Our findings could help predict cows at risk of ketosis and take precautions.

CURRENT STATUS OF IMMUNOGLOBULIN M AND IMMUNOGLOBULIN G SEROPREVALENCE OF TORCH INFECTIONS IN PREGNANT WOMEN WITH BAD OBSTETRIC HISTORY AT A TERTIARY CARE HOSPITAL

Introduction: TORCH stands for Toxoplasma gondii, Rubella virus, Cytomegalo virus (CMV) and Herpes simplex virus2 (HSV-2). These infections are transmitted to the foetus through transplacental route at any time during gestation or sometimes at the time of delivery. The infection may be asymptomatic or mild in mother but associated with inadvertent outcomes for the foetus. One of the causes of BOH is maternal infection. TORCH infection is asymptomatic in pregnant women and on clinical basis it is difficult to diagnose. To study the TORCH infection (IgM and IgG a Aim: ntibodies) prevalence in pregnant women with Bad Obstetric History. A hospital based cross-sectional Materials And Methods: study conducted in Department of Microbiology in collaboration with Department of Obstetrics and Gynecology, SHKM GMC, Nalhar, Nuh, Haryana over a period of one year (February 2020 - January 2021). A total of 90 samples were included in the study including control group. The IgM seroprevalence of TORCH in participants with bad obste Results: tric history was found to be 11.11%. In cases with Bad obstetric history prevalence of IgM Toxoplasma, Rubella, Cytomegalovirus &amp; Herpes Simplex Virus was found as 4.44%, 0%, 2.22% &amp; 4.44% respectively and prevalence of IgG Toxoplasma, Rubella, Cytomegalovirus, &amp; Herpes Simplex Virus was found as 53.33%, 91.11%, 88.89% &amp; 66.67% respectively. This study concluded that a previous history of pregnancy wastage and the serological Conclusion: screening for TORCH infections during current pregnancy must be considered while managing BOH cases to reduce the adverse fetal outcome.

Pregnancy wastage and its socio-demographic determinants in Maharashtra: Analysis of a DistrictLevel Household Survey-4, 2012-13

Background: Stillbirth is a major contributor to perinatal mortality, and abortion is one of the important causes of maternal mortality. Understanding the true magnitude and associated factors is important to devise appropriate public health strategies to curb the issue. Objective: To determine the magnitude of pregnancy wastage (abortion and stillbirth) and socio-demographic factors associated with the study population. Methods: The secondary data analysis was performed on DLHS-4 data of 45,690 women in the reproductive age group in Maharashtra. Magnitude of lifetime pregnancy wastage and last pregnancy wastage was estimated as proportion and rates per 1000 pregnancies. Univariate and bivariate analysis were performed using Statistical Package for the Social Science (SPSS). The last pregnancy wastage indicator was cross-tabulated with socio-demographic indicators to understand the correlation. Results: Lifetime pregnancy wastage among the study population was found to be 12.4% (1.5% stillbirth, 3.8% induced abortion, and 7.1% spontaneous abortion). The magnitude of pregnancy wastage for the last reported pregnancy was 3.9% (0.7% stillbirth, 1.5% induced abortions, and 1.7% spontaneous abortion). Stillbirth was significantly associated with place of residence and woman remunerated in the last 12 months. Induced abortion was significantly associated with the age of woman, education, place of residence, caste, age at marriage, and husband education. Spontaneous abortion was significantly associated with age, literacy status, and remunerated in the last 12 months. Conclusion: The study finding indicates a higher number of stillbirths and abortions that emphasizes the urgent need of formulating appropriate strategies to reduce pregnancy wastage.

Prevelence and economic inference of small ruminant foetal wastage at the Kumasi Abattoir Ltd (Kaase)

Postmortem survey of small ruminant pregnancy wastage was conducted at Kumasi Abattoir Ltd, Kaase. Abattoir visits and investigations were conducted on 16 randomly selected abattoir working days. All mature ewes and does slaughtered on selected abattoir working days (mean = 71.69 animals/day) were included in the study, giving a total of 1,147 animals (301 ewes and 846 does). The reproductive tracts of study animals were collected at slaughter line and the uterus were grossly inspected for pregnancy. Thereafter, uterine body and horns were longitudinally incised to check the lumen for a visible fetus. The type of pregnancy (single or twin) was recorded and crown-rump length (CRL) of the largest fetus was demarcated on a piece of string and measured on a standard measuring tape. The length of gestation was estimated using the formula; Developmental Age (Days) = 2.1(Y+17), where Y = the CRL in “cm”. A survey was conducted within the premises of the Kumasi abattoir to estimate the average prices of matured small ruminants to calculate the prevailing market value of small ruminants. The potential economic impact of small ruminant abattoir fetal wastage was estimated by calculating the gross economic value and net economic value forgone due to loss of potential offspring. Kumasi Abattoir Annual Off-take was estimated to be 26,095 small ruminants where 73.8% were does and 26.2% were ewes. Pregnant does slaughtered had 37.2% of them carrying single foetus and 12.5% carrying twin foetus whereas pregnant ewes slaughtered had 28.9% carrying single foetus and 9.3% carried twin foetus. Total pregnancy wastage recorded had 3.7% early pregnancy and 96.3% mid-pregnancy with no late pregnancy recorded. Economic losses due to pregnancy wastage was estimated to be from GHS 2,755,140.80 to 3,534,791.80. The greater amounts of foetal waste encountered, places a substantial risk not only to the livestock production sector, but also to the economy of the nation.

Factors Influencing the Magnitude of Menstrual Problems among Married Pre-menopausal Women of Rural Puducherry District

Among rural women of India, the magnitude of menstrual problems is fairly large. Such problems will be still large enough among those who are at pre-menopausal ages. In view of this, we made an attempt here to understand the magnitude of menstrual problems among rural women and tried to identify the key factors influencing the same. The data has been collected from 780 married pre-menopausal women (aged 35–49 years), who are selected from 30 villages of five communes in Puducherry district. Descriptive and inferential statistics as well as linear regression technique adapted. Around 63.5 per cent of sample women perceived to be suffering from one or the other menstrual problems. Results of multiple linear regression analysis suggest that the likelihood of women suffering from menstrual problems is positively associated with current age, pregnancy wastage and ever used oral contraceptive pills or IUCD. Conversely, such probability is found to be negatively associated with years of schooling, family monthly income, grading of occupational status, menstrual hygiene and extent of freedom of movement. Efforts may be taken to improve the socio-economic conditions and imparting good menstrual hygienic practices among rural women though the Government resources, NGOs and Voluntary Organizations.

Maternal characteristics and infant and young child feeding in Benghazi

Two hundred [200] mothers consecutively attending Al-Fateh Paediatric Hospital, Benghazi in 1992 were interviewed. The majority of women were under 30 years of age, had primary or no education, were housewives, had no experience of pregnancy wastage or child loss, used no contraception, had one to three living children, had information about breast-feeding from the mother-in-law, a relative or a neighbour, considered breast-feeding a natural way, nutritionally superior and hygienic, and practised mixed feeding. The reasons for introducing artificial feeding were maternal in 49.7% of cases, filial [related to the baby] in 36.5% and due to social pressure in 13.8%. Measures for successful breast-feeding are emphasized

Pregnancy Wastage Due to Fetal Congenital Malformations

OBJECTIVES: To study the pattern of various congenital anomalies in rural Haryana.STUDY DESIGN: This was a retrospective study conducted over 1 and ½ years (from January 2015 to June 2016) in a tertiary care center in Haryana, India.RESULTS: Out of 11,178 births, 227 babies had gross congenital malformations 2.03%. In literature, the most common birth defect reported in western countries is cardiovascular anomalies while in India and eastern countries, it’s the neural tube defect. In our study also, neural tube defects were the most common congenital anomalies accounting for 64.31% of total anomalies. They were more common in unbooked patients (70%) and the rural population. So, the main cause appears to be a lack of awareness and illiteracy.CONCLUSION: There is a need for increased awareness and folic acid supplementation routinely in the periconceptional period to decrease the incidence of congenital anomalies.

Pregnancy Outcome of Rh D Alloimmunized Pregnancies: A Tertiary Care Institute Experience of a Developing Country.

To determine the socio-demographic characteristics and pregnancy outcome of Rh D alloimmunized women monitored with MCA PSV (middle cerebral artery peak systolic velocity). In total, 363 Rh D alloimmunized women attended antenatal clinic or obstetric emergency between January 2006 and December 2014. MCA PSV was the screening method for detection of fetal anemia. Intrauterine blood transfusion (IUT) was given when MCA PSV was > 1.5 MOM. Totally, 162 women (164 fetuses) received 492 transfusions. Forty-eight women had fetal hydrops at presentation. Five women (three received IUT) were lost to follow-up. Pregnancy outcome of 358 women and socio-demographic characteristics of 363 women were analyzed. The perinatal mortality was 421, 66 and 87 per 1000 live births in hydrops group, non-hydrops IUT group and non-IUT group, respectively. Rh alloimmunization is still a major cause of perinatal morbidity and mortality. The higher gravidity, previous history of pregnancy wastage, still births and hydrops increase the requirement of intrauterine transfusion. MCA PSV is an excellent tool for monitoring of Rh alloimmunized pregnancies to detect fetal anemia. Early detection and monitoring by MCA PSV improve its outcome.

Seroprevalence of TORCH infection and adverse reproductive outcome in women with bad obstretic history

Aim of the study was to know the seroprevalence of TORCH infection in antenatal women with bad obstetric history and to co relate the same with different clinical presentations. IgM antibodies for TORCH infection were analyzed in the serum samples of 172 Bad obstetric history (BOH)cases attending Ante Natal clinic by using ELISA according to manufacturer’s instructions. Seroprevalence for , Rubella, CMV and HSV-2 was found to be 12.79%, 11.62%, 04.65% and 02.32% respectively. Highest seropositivity in spontaneous abortions (16.25%)and early neonatal deaths (8.33%) cases was seen with infection. In cases with history of IUD (09.37%) and congenitally malformed babies (22.22%) maximum seropositivity was found for Rubella. History of still births (25%) was equally associated with and Rubella infection. There is a need of screening programmes during antenatal visits to reduce repeated pregnancy wastages in our country. Early detection of IgM by Enzyme-linked immunosorbent assay is useful for diagnosis of TORCH infection to reduce adverse fetal outcome.

Seroprevalence of low avidity anti-Toxoplasma IgG in pregnant women and its relationship with their age and contact with cats.

Toxoplasma gondii is a protozoan parasite that can infect all mammals, serving as intermediate hosts. The cause of congenital toxoplasmosis is transplacental transmission of the parasite to the foetus, resulting in wide range of manifestations from mild chorioretinitis to miscarriage. Its frequency can be reduced by early screening of pregnant women which is based mainly on tests for anti-Toxoplasma antibodies. We collected serum samples of 594 pregnant women (subjects) after taking their consent over a period of two years (2016-2018) and analyzed them for anti-Toxoplasma IgG by ELISA. The positive samples were then analyzed for IgG avidity test which could differentiate between recent and past infections. The seroprevalence was also correlated with the age of the subjects and their contact with cats. 162 subjects were found positive out of which only three showed a recent infection. After following up until delivery, one of them delivered a baby who had jaundice and was diagnosed with anti-Toxoplasma IgM at birth. The foetus of the second subject died in-utero, while the third woman delivered a normal baby after being given spiramycin when diagnosed with toxoplasmosis in the first trimester. It was found that most of the positive subjects had frequent contact with cats. Invasion of the parasite during third trimester resulted in death in-utero and jaundice. Most common cause of pregnancy wastage during our study was spontaneous abortions while pregnancy loss due to congenital anomalies was rare.