Viable Pregnancy Research Articles

Plasma and amniotic fluid concentrations of nitric oxide: Effects on uterine artery and placental vasculature in women who underwent voluntary pregnancy termination and in women with missed and threatened abortion. A pilot study

ObjectivesFirst trimester miscarriage is a multifactorial event. Various angiogenic factors have been proposed as possible early markers of non-viable pregnancies. The aim of the present study was to evaluate the systemic nitric oxide (NO) production in healthy early pregnancy and its possible role in first trimester miscarriage. Study designWe prospectively enrolled women referred to our Unit for elective termination of pregnancy, threatened abortion or missed abortion. Blood samples were taken for testing circulating NO plasma levels. Subsequently, all patients underwent 2-D ultrasonographic analysis and Color Doppler imaging to assess the pulsatility index of the uterine arteries. 3-D ultrasonographic and power Doppler analysis allowed a volumetric and vascular reconstruction of the placenta. During dilatation and vacuum aspiration, amniotic fluid was collected. ResultsSeventy-two patients were enrolled: 25 with elective termination of pregnancy (Group I); 17 with threatened abortion (Group II); 30 with missed abortion (Group III). Group II showed greater placental volume and lower uterine arteries PI than others. The plasma NO concentration resulted statistically higher in women with threatened abortion, while amniotic fluid NO concentration were higher in the viable pregnancies (Group I) than in the aborted fetuses (Group III). Plasma NO was inversely correlated with both mean arterial pressure and uterine artery PI and was positively correlated with amniotic fluid NO and CRL; amniotic fluid NO was positively correlated with placental Vascularization Index and Vascularization-Flow Index. ConclusionAmniotic NO concentration was higher in viable pregnancies and positively related to Doppler 3D indices of vascularization and blood flow within the placenta. Further studies are needed to elucidate its role in first trimester miscarriage.

Evaluation of Pregnancy Outcome in Women with First Trimester Vaginal Bleeding: A Longitudinal Study at a Tertiary Care Hospital, Kolkata, India

Introduction: First trimester vaginal bleeding, a serious obstetric challenge to developing embryo, occurs in 15-25% of all pregnant women. It is a matter of great concern to both mother and obstetrician for its increased association of adverse maternal and foetal outcome. Aim: To measure the prevalence of patients with first trimester vaginal bleeding, to evaluate factors associated with it and to assess foeto-maternal outcome in those pregnant women. Materials and Methods: This was a prospective, hospitalbased, longitudinal study carried out among 120 women with first trimester vaginal bleeding having normal bodyweight, and regular cycles and agreeing to follow-up, at Department of Obstetrics and Gynaecology in a tertiary teaching hospital, Kolkata, West Bengal, India, from January 2019 to June 2020. The incidence of vaginal bleeding in first trimester, its risk factors, foeto-maternal outcome in terms of Pregnancy Induced Hypertension (PIH), abortions, preterm deliveries, Antepartum Haemorrhages (APH), birth weight of baby, low APGAR (Appearance or colour of the baby, Pulse, Grimace, Activity, and Respiration) score at birth were assessed. The descriptive statistics to calculate percentage and mean and Chi-square-test with significance value considered at p-value <0.05. Results: Out of 4716 pregnant women attending in Obstetric clinic at their first trimester, 332 had vaginal bleeding, incidence being 7.04%. Out of 332 women, 120 study participants met inclusion criteria. Of 120 cases, 79 (65.8%) were from age group of 21-30 years. Highest incidence was 74 (61.7%) in primigravida. Incidence was high in poor socio-economic status (upper lower and lower) ie., 57 and unplanned cases, 87 (72.5%). On followup of 120 participants, 66 (55%) had threatened abortion, of them 51.5% (34/66) led to term pregnancy followed by preterm labour 39.39% (26/66) and only few, 9.09% (6/66) ended up with incomplete miscarriage. Spotting was most common nature of bleeding per vagina 41.66%, (50/120). On follow-up of 60 (90.9%) viable pregnancies, PIH was in 12 (20%) cases and abruption was seen in one (1.6%). Majority of preterm babies 65.4%, (17/26) Needed Neonatal Intensive Care Unit (NICU) admission. Conclusion: Vaginal bleeding in first trimester is an indicator of the maternal and foetal adverse consequences and results of this study can enrich our knowledge to plan and manage these pregnant women adequately.

Enema Administration During Labor: Pregnant Women's Perspective and Knowledge.

Current evidence does not support the routine use of rectal enemas (REs) because they have not been associated with reduced rates of puerperal infection, degree of perineal tear, or duration of labor. A recent literature review recognized knowledge gaps regarding the uses of RE during labor including women's perceptions, pain, and satisfaction. To report pregnant women's knowledge, attitudes, perceptions, pain, and satisfaction associated with the use of RE during labor. A prospective study was conducted between 20 October 2019 and 20 October 2020. Women were included if they were 37 weeks or more pregnant, had a viable pregnancy, were admitted in labor, and had an RE. Characteristic data and data about knowledge, perceptions, attitudes, pain, and satisfaction associated with its use were recorded. Women were regrouped based on their level of knowledge into low- and high-level groups. Attitudes, perceptions, inconveniences, pain, and satisfaction were regrouped into two categories: low and high on the Likert scale. A total of 300 women were recruited, with means (SD) for age and gestational age of 27.8 (4.8) years, and 40 (1.1) weeks, respectively, and 45.7% were knowledgeable or very knowledgeable, 76% had a positive attitude, and 88.7% perceived enemas as important. The mean scores (SD) for pain and satisfaction as measured on visual analogue scales were 1.5 (1.8) and 5.4 (1.8), respectively. Women with high knowledge about RE were older and multiparous. Recruited women were more likely to report lower inconvenience and pain scores and higher satisfaction scores (all P<.05). Most recruited women were knowledgeable about REs, perceived them as important, and expressed a positive attitude toward their administration. The low levels of inconvenience, pain, and complications and the high satisfaction rates may be used when counseling women about when an RE is required during labor.

Oral dydrogesterone in frozen-thawed embryo transfer cycles.

The aim of this study was to compare the use of micronized vaginal progesterone and oral dydrogesterone in the endometrial preparation for frozen-thawed embryo transfer. This was a randomized, controlled, open, two-armed clinical trial, with women undergoing frozen-thawed embryo transfer along with hormone replacement therapy for endometrial preparation, between September 2019 and February 2021. A total of 73 patients were randomly selected and orally administered 40 mg/day dydrogesterone (dydrogesterone group, n=36) or 800 mg/day micronized vaginal progesterone (micronized vaginal progesterone group, n=37), after endometrial preparation with transdermal estradiol. The main outcome was a viable ongoing pregnancy with 12 weeks of gestation as evaluated by ultrasound. The reproductive outcomes in frozen-thawed embryo transfer cycles were similar, with pregnancy rates in the dydrogesterone and micronized vaginal progesterone treatment groups being, respectively, 33.3 and 32.4% at 12 weeks pregnancy (confidence interval= -22.4-20.6, p=0.196). The use of oral dydrogesterone may be a more patient-friendly approach to endometrial preparation in frozen-thawed embryo transfer cycles, avoiding undesirable side effects and discomfort resulting from vaginal administration, while also providing similar reproductive results.

Value of fetal abdominal subcutaneous tissue thickness via ultrasound in prediction of birth weight

Background: Multiple interactions between maternal, foetal, and placental effects impact the development of the foetus. Numerous aspects of perinatology need that the foetal development rate correspond with its age. Abnormal foetal development can lead to prenatal and postnatal complications and is associated with an increase in infant morbidity and mortality, given that foetal weight is one of the most influential factors influencing newborn survival. The goal of this study was to evaluate the accuracy of fetal abdominal subcutaneous tissue thickness (FASTT) measured by ultrasonography at term and correlate it with the actual birth weight (BW) recorded at the time of delivery. Methods: This study prospective observational study was carried out on 60 singleton pregnant ladies and normal viable ongoing pregnancies at 37-39th week. Women underwent the following procedures: history taking, abdominal examination, abdominal ultrasonographic examinations (at 37-39 weeks), and follow-up after delivery for the recording of the post-natal fetal weight. Results: The mean resistive index was 0.61±0.01 among the participants while the mean FASTT was 6.8± 1.8 mm. Cut-off value of FASTT for large babies obtained by using ROC curve was 4.55 mm. Sensitivity for FASTT >4.5 mm for gestational age babies is 91.7% and specificity is 65.4%. There was statistically significant positive correlation between FASTT and weight at birth in grams. There were 44% had vaginal delivery and 56% had caesarean delivery. There were 14% had preterm labor. The mean weight at birth was 3227±642.7 g among the participants. Conclusions: The relationship between FASTT and BW is favourable. 4.55 mm was the FASTT cutoff threshold for large newborns. The sensitivity and specificity for FASTT >4.5 mm in newborns of gestational age are 91.7% and 65.4%, respectively. In addition to other well-established birth weight indicators, FASTT can be used to predict newborns who are big for their gestational age.

Prevalence of Anaemia in Women with Unsupervised Medical AbortionAn Observational Study

Introduction: According to American College of Obstetricians and Gynecologists (ACOG) and other organisations such as the Society of Family Planning (SFP) and American Society for Reproductive Medicine (ASRM), abortion services are considered as an essential component of comprehensive healthcare. Such services are considered as a time-sensitive issue, as delay in getting comprehensive abortion services may be associated with significant impact on physical health, wellbeing and mental health of the individual. Aim: To determine proportion of women presenting to Gynaecologyy Outpatient Department (OPD) with unsupervised use of abortion pills and to estimate the percentage of anaemia among these women. Materials and Methods: The present observational study was conducted on 148 women attending the Gynaecology OPD in People’s Hospital and seeking treatment for complications due to unsupervised use of abortion pills during the study period of 18 months. A thorough history was obtained and a thorough physical examination was conducted. Haemoglobin estimation and Ultrasonography (USG) was done to determine complications. Data was compiled using MS Excel and results were expressed in terms of frequency and percentages and mean±SD. Results: During the study period, a total of 360 cases with abortions were registered, of them 150 cases were unsupervised attributing to 41.7% cases. Out of 150 females with unsupervised abortions, 2 females did not give consent to participate and thus a total of 148 females were enrolled. Consumption of unsupervised abortion pills resulted in incomplete abortion in 77 (52%) cases, while complete abortion was reported in only 22 (14.9%) cases. Other complications observed in a few cases were septic shock, in 7 (4.7%) haemorrhagic shock in 4 (2.7%), secondary infertility in 3 (2%), inevitable abortion in 3 (2%), ruptured ectopic pregnancy in 3 (2%) and chronic ovarian ectopic in 1 (0.7%). Missed abortion was documented in 20 (13.5%) cases after complete examination and in 8 (5.4%) cases viable intrauterine pregnancy was diagnosed. Mild, moderate and severe anaemia was observed in 19 (12.8%), 98 (66.2%) and 12 (8.1%) females respectively. Conclusion: The unsupervised use of abortion pills not only increases maternal morbidity but also has been associated with life threatening complications such as septic shock, haemorrhagic shock, ruptured ectopic pregnancy etc. Anaemia is one of the most common complication of unsupervised pill consumption and preventing the latter may obviate the need for blood transfusion.

Neonatal Outcome in Pregnant Women with Confirmed COVID-19 Infection during the Last Two Weeks of a Viable Pregnancy: A Retrospective Data Analysis

Neonatal Outcome in Pregnant Women with Confirmed COVID-19 Infection during the Last Two Weeks of a Viable Pregnancy: A Retrospective Data Analysis

Maternal determinants of gestation length in the rhesus monkey.

A gestation length of normal duration and natural delivery at term are considered to be important indicators of a healthy pregnancy, especially given the potentially adverse consequences for neonates of being born premature. While many have assessed the factors influencing gestation length in humans, and there has been considerable interest in the pregnancy duration of domesticated farm animals, this topic has not been re-assessed recently in rhesus monkeys, the most commonly used primate in biomedical research. In older articles, it's gestation length was typically reported to be 165 days, although most authors acknowledged that viable pregnancies could occur out to 180 days. Predicting the normal range of acceptable due dates has important veterinary implications for when to intervene in a prolonged pregnancy. Using archival records from a large, established breeding program, gestation lengths and infant birthweights were analyzed for 408 pregnancies across a 25-year period. The potential influence of maternal factors, including age and parity, was assessed. Familial concordance in gestation length within mother-daughter matrilines was examined, as well as similarity in length across repeat pregnancies for 84 multiparous females. Mean duration from mating to delivery was 168.8 days, longer than reported in most but not all previous articles. Many females birthed successfully at a longer duration that might have prompted consideration of a caesarian delivery. Gestation length for an individual female was fairly stable and significantly correlated across multiple pregnancies. There was not a pronounced transgenerational influence on gestation length even though familial propensities for birthing small and large infants were evident in the female descendants. Typical pregnancy lengths and birthweights are provided as reference norms to assist other breeding programs and to enhance our understanding of the natural reproduction of rhesus macaques that still live in many forested and urban locations across South Asia.

Subchorionic Haemaorrhage in First Trimester and Its Effects on Pregnancy Outcome

Background: Subchorionic haemorrhage which may or may not be associated with vaginal bleeding is definitely of concern as it predisposes to adverse pregnancy outcomes. This study is done with a aim to find how subchorionic haemorrhage affects pregnancy outcome.&#x0D; Methodology: The study was carried out from January 2020 till July 2020. 57 antenatal women with singleton viable pregnancy from 6 weeks to 12 weeks gestation having subchorionic haemorrhage on USG with or without bleeding were included in the study after informed consent. High risk pregnancies with any medical disorder were excluded. Size of Subchorionic haemorrhage was described as percentage involvement of gestational sac. Patient were closely followed for outcome as miscarriage, preterm delivery, abruption , intrauterine fetal death , IUGR or term delivery.&#x0D; Conclusion: 52.63% of the patients were less than 30 years of age , 57.89% of the patients were primipara and 42.10 % were multipara. 24.56% of females had previous abortion, 14.03 %, suffered an abortion. Maximum 5 patients with miscarriage had large subchorionic haemarrhage with more than 50 % gestational sac. Intra uterine fetal demise occurred in only one patient with size of subchorionic haematoma between 26%-50%. 6 patients experienced preterm delivery before 37 weeks .Term delivery was seen in 42 patients and maximum 19 patients had SCH 11%-25% of Gsac. Though the outcome is variable , size of SCH definitely affects the outcome.

Recurrent Implantation Failure-Is It the Egg or the Chicken?

Recurrent implantation failure (RIF) is an undefined, quite often, clinical phenomenon that can result from the repeated failure of embryo transfers to obtain a viable pregnancy. Careful clinical evaluation prior to assisted reproduction can uncover various treatable causes, including endocrine dysfunction, fibroid(s), polyp(s), adhesions, uterine malformations. Despite the fact that it is often encountered and has a critical role in Assisted Reproductive Technique (ART) and human reproduction, RIF’s do not yet have an agreed-on definition, and its etiologic factors have not been entirely determined. ART is a complex treatment with a variable percentage of success among patients and care providers. ART depends on several factors that are not always known and probably not always the same. When confronted with repeated ART failure, medical care providers should try to determine whether the cause is an embryo or endometrium related. One of the most common causes of pregnancy failure is aneuploidy. Therefore, it is likely that this represents a common cause of RIF. Other RIF potential causes include immune and endometrial factors; however, with a very poorly defined role. Recent data indicate that the possible endometrial causes of RIF are very rare, thereby throwing into doubt all endometrial receptivity assays. All recent reports indicate that the true origin of RIF is probably due to the “egg”.

Medical versus elective induction of labor resulted in comparably low cesarean rates in single center

Medical induction of labor (mIOL) is generally associated with high risk of Cesarean Delivery (CD) and performed under non ideal circumstances. We sought to compare the rate of primary CD in women requiring mIOL to women undergoing elective induction of labor (eIOL) at term in viable pregnancies.

Timing of initiation of cervical ripening and its effect on time of delivery

Increasing staff shortages despite a rise in patient numbers has led to congestion on our L&D unit resulting in delays in scheduled inductions. Our staffing model differs from day to night with regard to number of nurses, residents, attending physicians, and ancillary staff present. While staffing is more limited during nighttime hours, our patients undergoing daytime cervical ripening are more likely to deliver during the night. We sought to examine if shift of admission for cervical ripening impacted the time of delivery. We completed a retrospective cohort study of singleton pregnancies at our institution delivered January-December 2018. We included viable pregnancies with cephalic presentation requiring cervical ripening. Bishop score ≥6 was excluded. Cervical ripening was completed with misoprostol or foley balloon. We excluded history of prior cesarean section, gestational age < 37 weeks, multiple gestations, and contraindication to vaginal delivery. Primary outcome was shift of delivery. Multiple logistic regression was performed to evaluate the relative impact of BMI, parity, and cervical exam on time to delivery. Significance defined as P< .05. 450 patients met inclusion criteria. Patients were divided into those with day (7am-7pm) and night (7pm-7am) deliveries. The majority of our population was nulliparous (59%) with admission dilation of 1cm (44%). We found no statistically significant difference in time of delivery based on shift of admission for cervical ripening. We did find statistically significant differences in time from admission to delivery based on parity, cervical exam on admission, and BMI. Our data show shift of admission for cervical ripening does not impact shift of delivery. BMI, parity, and cervical exam on admission do influence length of induction to delivery. These patient characteristics may be used to predict the length of time a patient will be on L&D and help time inductions to optimize delivery to match staffing and improve L&D flow. Development of a predictive model for induction to delivery timing is currently being studied.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

On the cutting edge: key findings on maternal and neonatal outcomes in women with COVID-19 in a study by the World Association of Perinatal Medicine

The World Association of Perinatal Medicine (WAPM) study on the COrona VIrus Disease 2019 (COVID-19) was an international, retrospective cohort study that included pregnant women tested positive with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection between February and April 2020. The study involved 73 centers from 22 countries. The WAPM study included 388 singletons, viable pregnancies, positive to SARS-CoV-2 at real-time reverse-transcriptase-polymerase-chain-reaction nasal and pharyngeal swab. The majority of the included women were symptomatic. The occurrence of maternal adverse events was significantly higher in symptomatic, compared with asymptomatic pregnant women. Women carrying high-risk pregnancies (either preexisting chronic medical conditions in pregnancy or obstetrical disorders occurring in pregnancy) were at a higher risk of hospital admission, presence of severe respiratory symptoms, admission to the intensive care unit, and invasive mechanical ventilation. As per maternal outcomes, the occurrence of fetal and neonatal adverse events was significantly higher in symptomatic, compared with asymptomatic pregnant women. The incidence of a composite adverse fetal outcome was significantly higher when the infection occurred in the first trimester, and in fetuses with lower birthweight.

Outcome of Pregnancies Associated with Fibroids

Objectives: To evaluate the behaviour of uterine leiomyoma, their frequency and impact on the course of pregnancy Design: It was a descriptive study. Setting: Gynaecology and Obstetric Unit, Hayatabad Medical Complex, PGMI, Peshawar. Subjects: All the patients presenting to antenatal clinic or emergency having a pregnancy associated with fibroids from 1st July 2001 to 30th June 2002. Subject and Methods: Women diagnosed with leiomyoma during pregnancy were evaluated clinically and the findings were confirmed by ultrasound. Detection of leiomyoma during caesarean section also made the patient eligible for the study. In all there were 76 patients in the study. The size of leiomyoma, the type of leiomyoma, their effect on pregnancy outcome and complications were noted. Patients obstetric, and fertility history was recorded on a questionnaire. The concerned doctors were required to fill a performa regarding the outcome and complications the delivery of such patients. Data Analysis: After data collection, the data was analyzed using various statistical tests like percentage, relative risk (R.R), ods ratio (O.R), mean, standard deviation (S.D) confidence interval (C.I), using software SPSS version 8.0 and Epi-Info 6. Main Outcome Measures: The main outcome measures were noted down as the frequency of spontaneous pregnancy loss, vaginal delivery or the caesarean section. Results: Out of 76 patients (1.9%), 16 underwent spontaneous pregnancy loss (21 %, O.R 1.16. R.R 1.13, P 0.59), 31 had vaginal delivery (40.8%, O.R 0.21, R.R 0.62, P 0.0000) and 29 had caesarean section (38.2%. O.R 4.71, R.R 2.91, P 0.0000). The frequency of complicated deliveries was 73.3%. The different complications occurring were antepartum haemorrhage, acute abdomen, laparotomy, preterm labour, dysfunctional labour, retained placenta and retained products of conception. Conclusion: Although abortions, preterm delivery, dysfunctional labour and cesarean sections were common, the neonatal outcome in viable pregnancies was fairly good in women with uterine leiomyomas. Because of increased risk of complications all the patients with leiomyomas having pregnancy should be considered as high-risk cases.

Potential innate immunity-related markers of endometrial receptivity and recurrent implantation failure (RIF)

The successful implantation of the embryo into a receptive endometrium is essential for the establishment of a viable pregnancy while recurrent implantation failure (RIF) is a real challenge in assisted reproduction. The maternal innate immune system, specifically the Toll-like receptors (TLRs), are involved in maintaining immunity in the female reproductive tract (FRT) required for fertility. In this study, we aimed to investigate the importance of innate immunity-related gene expression in the regulation of human fertility and as a prediction of potential outcome of in vitro fertilization - embryo transfer (IVF-ET), thus, we assessed the gene expression levels of TLR signalling molecules using quantitative real-time PCR between endometrial biopsies of healthy fertile women, and the patients experiencing RIF. Interestingly, our results showed that, TRIB2 and TLR9 genes were differentially expressed between the endometrial biopsies of healthy women and those with RIF. However, comparing expression levels of same genes between pre-receptive and receptive healthy endometrial biopsies showed different genes (ICAM1, NFKBIA, VCAM1, LIF, VEGFB, TLR5) had significantly altered expression, suggesting their involvement in endometrial receptivity. Thus, further investigations will enable us to better understand the role of these genes in the biology of FRT and as a possible target for the improvement of infertility treatments and/or development of non-hormonal contraception.

Abstract 9402: Venous Thromboembolism During Pregnancy is Associated with Elevated Tricuspid Regurgitation Velocity in Sickle Cell Disease

Introduction: In patients with sickle cell disease (SCD), a tricuspid regurgitation velocity (TRV) &gt; 2.5 m/s by echocardiogram is a non-invasive marker for underlying pulmonary hypertension (PH), and associated with increased mortality. During pregnancy, maternal and fetal adverse events are increased in women SCD, and in women with PH. Data on pregnancy outcomes in women with both SCD and elevated TRV are sparse; we hypothesized increased adverse events in this group. Methods: We retrospectively compared pregnancy outcomes in women with SCD and elevated TRV (&gt;2.5 m/s) to those with SCD and normal TRV (≤ 2.5 m/s). Results: We identified 59 pregnancies in 43 women (mean age 28 ± 5 years at delivery) with SCD (31 pregnancies in women with elevated TRV, 28 with normal TRV). There was a trend towards more lifetime transfusions, and significantly lower hemoglobin in women with elevated TRV ( Figure A-B ). As expected, right ventricular systolic pressure was different between the groups, however other baseline characteristics, including SCD genotype, left ventricular systolic function, and pre-pregnancy venous thromboembolism (VTE) were similar ( Figure C-F ). No maternal deaths occurred in pregnancy or 1-year postpartum. VTE occurred in 7 (12%) pregnancies, only in women with elevated TRV; and postpartum readmission was more common in women with elevated TRV ( Figure G ). Other cardiac and hematologic outcomes occurred with similar incidence between the groups ( Figure G ). In viable pregnancies, preterm birth was more common in women with elevated TRV, while other adverse obstetric and fetal outcomes did not differ between the groups ( Figure G ). Conclusion: In conclusion, we identified a higher incidence of VTE, preterm birth and postpartum readmission in pregnant women with SCD and elevated TRV. These complications may be associated with worse SCD burden; however, the potential mechanistic link between pregnancy, VTE and PH as assessed by elevated TRV requires further study.

Advanced extra-uterine pregnancy: A review of the literature

Advanced extra-uterine pregnancies, although uncommon, are associated with significant morbidity and mortality. Early diagnosis is essential. A high index of suspicion is necessary and ultrasound examination is probably the most suitable investigative tool to date. Conservative management with the aim of fetal viability in pregnancies &gt;24 weeks’ gestation is an appropriate form of management and does not adversely affect maternal morbidity and mortality.

AN ASSESSMENT INTO THE DIAGNOSTIC VALUE OF ULTRASOUND IN THE FIRST TRIMESTER OF PREGNANCY BLEEDING

Background: One of the most prevalent obstetric issues is vaginal bleeding in the first trimester. It's also one of the most prevalent reasons for emergency admissions, as well as a reason for ultra-sound evaluation in the first trimester. In the first trimester, over a quarter of all pregnant female experience bleeding.&#x0D; Aims and objective: The purpose of this research was to determine the diagnostic value of ultra-sonography in first-trimester haemorrhage.&#x0D; Materials and method: All pregnant female who experienced per vaginal bleeding during the first trimester were included in this research. A semi-structured questionnaire was used to assess all of the selected instances. To arrive at a clinical opinion, a full history and comprehensive clinical evaluation were undertaken, including general, systemic, per abdominal, and per vaginal evaluations. In all of the cases that were chosen, ultra-sonography was used. The results of the clinical evaluation and ultra-sonography were documented.&#x0D; Results: On clinical evaluation, 164 cases of threatened abortion were identified, whereas ultra-sonography verified 102 cases of impending abortion. In 62 cases, there was a discrepancy in opinion. Complete abortion had a 16 percent inconsistancy, while incomplete abortion had a 4 percent inconsistancy. In 20 cases of Blighted ovum, there was a inconsistancy. Out of 214 occurrences of first trimester bleeding, abortion was diagnosed in 200 cases (93.46 percent), ectopic pregnancy in 10 cases (4.67 percent), and hydatiform mole in four cases (1.87 percent). Clinical opinion had a 100% sensitivity in diagnosing a viable intrauterine pregnancy, but only a 44.6 percent specificity. Clinical opinion has a poor statistical correlation in diagnosing nonviable pregnancies, with a sensitivity of 39%.&#x0D; Conclusion: Ultra-sonography has thus been established as a critical diagnostic tool in obstetrics. It is a readily available diagnostic tool that aids in the early detection of problems associated with first-trimester haemorrhage. It was established in the aforementioned research that it had an essential role in the opinion of first trimester haemorrhage.&#x0D; Key Word: first trimester bleeding, ultasonography, diagnostic importance

Neuraxial to general anesthesia conversion has equitable intraoperative and improved post-operative outcomes compared to general anesthesia in cesarean hysterectomy for placenta accreta spectrum (PAS)

Objective Placenta Accreta Spectrum (PAS) represents a series of placental disorders with an estimated incidence of 1:1000. Delivery and subsequent cesarean hysterectomy for PAS is associated with significant maternal morbidity and mortality. Neuraxial anesthesia may be utilized initially with subsequent conversion to general anesthesia after delivery of the fetus as an alternative to initiating with general anesthesia. Methods We performed a case–control study and analyzed 85 cases of pathology-confirmed PAS patients who underwent a cesarean hysterectomy in singleton, non-anomalous, viable pregnancies. All patients were delivered at our institution’s established Placenta Accreta Program from 2005 to 2020. Results Fifty-two (61%) patients underwent general anesthesia and 33 (39%) patients underwent neuraxial anesthesia (collectively spinal, epidural, and combined spinal-epidural) converted to general anesthesia after cesarean delivery. Baseline demographics between groups were similar. Pre-operative ASA airway assessment of III/IV was equivalent between groups (94 and 82%, p = .08). Intraoperatively, neuraxial conversion and general anesthesia were equal with respect to operative time (241 vs. 261 min, p = .47), estimated blood loss (6039 vs. 8134 mL, p = .51), and composite maternal morbidity (84.6 vs. 75.8%, p = .40). Post-operatively, ICU admission (47 vs. 46%, p = 1.0) and intensive care length of stay was equivalent (p = .07), yet the total post-operative length of stay was significantly reduced in patients who underwent neuraxial anesthesia (3.76 vs. 6.35 days, p = .02). In addition, while general anesthesia was associated with a greater sonographic suspicion for placenta percreta (40 vs. 12%, p = .007), final pathology was equivalent (52 vs. 60%, p = .5). Conclusions Taken together, our data show neuraxial conversion to general anesthesia has equivalent intra-operative parameters with improved post-operative outcomes when compared to general anesthesia alone in the case of cesarean hysterectomy for Placenta Accreta Spectrum disorders.

The Pregnant Surgical Patient

The most vulnerable time for a fetus is during embryogenesis in the first 8 to 10 weeks of pregnancy, when women may be unaware of their pregnancy. Once pregnancy is established, a standard approach to the pregnant patient is the optimal way to ensure medical and surgical decisions are made within the context of maintaining the safety of both mother and fetus. This review describes the approach to the pregnant patient for surgical conditions within the context of physiologic changes of the patient and fetus at each trimester, anesthesia and critical care in pregnancy, imaging and drugs safe for use in pregnancy, and nongynecologic surgery in the pregnant patient and specific surgical conditions. Tables outline the classification of abortion, the assessment of pregnancy viability, physiologic changes in pregnancy, laboratory changes in pregnancy, imaging modality and radiation dose, and antibiotics and safety in pregnancy. Figures include a diagram of types of hysterectomy, respiratory changes in pregnancy, and enlargement of the uterus. Algorithms outline the approach to abdominal pain in the pregnant patient and diagnosis and management of ectopic pregnancy. This review contains 5 figures, 6 tables, and 85 references.