Weeks Period Of Gestation Research Articles

Pregnancy with Post Inferior Vena Cava Balloon Angioplasty with Uterine Arterio-Venous Malformation

Venous thromboembolism (VTE) complicates one in 1000 pregnancies. The standard therapy in venous thromboembolism are anticoagulants, heparin, or warfarin. Uterine artery malformation is rare but can result in life-threatening bleeding which needs immediate intervention. A 33-year-old female, G2A1 at 36 weeks period of gestation, with h/o inferior vena cava (IVC) thrombus and uterine arterio-venous (AV) malformation, which was treated with uterine artery embolisation and Inferior vena cava (IVC) balloon angioplasty 3 years back, was successfully managed during her antenatal, intrapartum and postpartum period with anticoagulants at therapeutic doses. Both mother and baby were discharged in stable condition. The balance between prevention of thrombus formation and bleeding complication with the use of anticoagulants is critical in such patients. Successful management of both VTE and bleeding uterine artery malformation needs intensive monitoring and requires both anticoagulant and haemostatic therapy under close supervision of multidisciplinary team.

EVALUATION OF RISK FACTORS, CLINICAL PRESENTATION AND MANAGEMENT OF ECTOPIC PREGNANCY

INTRODUCTION: Ectopic Pregnancy is dened as implantation and development of the blastocyst at a site other than the uterine cavity. In a normal pregnancy, the zygote enters the uterine cavity in the form of Morula 4 days after fertilization and implantation in the endometrium begins 6-7 days after fertilization. In a small percentage of pregnancies, however, the embryo implants in extra uterine locations leading to an ectopic pregnancy. The most common site of ectopic pregnancy is the fallopian tube. Ectopic pregnancy is one of the main cause of maternal death in early pregnancy. In an ectopic pregnancy, as the pregnancy continues, it can cause the tube to rupture with internal bleeding. This situation is life threatening and needs to be treated as a medical emergency. AIM: The present study is undertaken to determine the incidence, risk factors, clinical presentation, diagnosis, and management of ectopic pregnancy in Obstetrics and Gynaecology department at Patna Medical College & Hospital, Patna. Type of study: Prospective study Study period: 2 years (November 2019 to October 2021) MATERIALS AND METHODS: This is a prospective study conducted in Obstetrics and Gynaecology department at Patna Medical College & Hospital,Patna.Medicalrecords of allwomenwith an ectopic pregnancy betweenNovember 2019 andOctober 2021 are analyzed.The total number of admissions and deliveries during the study period, details of age characteristics, symptoms and signs, gravida, gestational age at presentation, site of ectopicpregnancy,riskfactorsfor ectopicpregnancy,diagnosticmodality, andtreatment(whethersurgicalormedical) are recorded. RESULT: A total of 12,316 admissions and 9740 deliveries are conducted in the study period. 77 patients are diagnosed with ectopic pregnancy during the study period of 2 years. The incidence of ectopic pregnancy is 3.1 per 1000 patients-year. 62.34% of the patients are in the range of 21-30 years of age. In the present study, ectopic pregnancy is found more in multigravida and only 11.69% of the patients are primigravida. The mean gestational age at presentation is 7.25 weeks period of gestation with majority of the patients (46.75%) presenting at 6-8 weeks. The most common risk factor is previous history of ectopic pregnancy followed by history of Pelvic Inammatory Disease. 75 patients out of total of 77 patients presented with features of ruptured ectopic pregnancy. The most common site of ectopic pregnancy is ampulla of fallopian tube with 69.74% of the patients falling in this. Medical Management with single dose Methotrexate was done in 2 patients who presented with un-ruptured ectopic pregnancy. CONCLUSION: Patient with risk factor for ectopic pregnancy should be encouraged to visit her obstetrician for an early diagnosis. PMCH being a tertiary care centre, most of the cases are referred, hence in the present study most of the patients presented very late with ruptured ectopic pregnancy. This being a medical emergency, immediate resuscitation and laparotomy is done in them.

Comparison between Oral and Intravenous Iron Supplements in the Management of Anemia in Pregnancy

Aim: To compare the efficacy of oral and intravenous iron supplements in the management of anemia in pregnancy. Materials and Methods: Antenatal women between 24 to 34 weeks period of gestation (POG) with mild to moderate anemia were included. They were randomly divided into two groups where Group A - supplemented with oral iron (ferrous sulfate 300mg) and Group B - supplemented with intravenous iron sucrose 200mg. Where Intravenous iron sucrose of 200mg of 4 doses 2 weeks apart (i.e. 24 weeks POG, 26 weeks POG, 28 weeks POG, 30 weeks POG) were infused. Whereas oral iron ferrous sulfate 300mg per day (i.e. from 24 weeks POG – 34 weeks POG) in mild to moderate anemia patients were administered. Results: The mean difference of the haemoglobin between before and after administration of the intravenous iron supplements was observed to very high (2.13 g/dl) when compared to the mean difference of the haemoglobin between before and after administration of the oral iron supplements (0.97 g/dl). The mean difference of the ferritin between before and after administration of the intravenous iron supplements was observed to very high (46.9 ?g/L) when compared to the mean difference of the ferritin between the before and after administration of the oral iron supplements (21.24 ?g/L). Conclusion: In this study, we observed an increase in the mean values of haemoglobin and ferritin after the administration of both intravenous and oral iron supplements. When comparing the mean differences of haemoglobin and ferritin of intravenous iron supplements with oral iron supplements, a significant increase in the values of haemoglobin and ferritin was observed among the pregnant women who were administered with intravenous iron supplements when compared to the pregnant women who were administered with oral iron supplements.

A study of primary cesarean section-its rate, indications, and complications in a tertiary healthcare in Sikkim

Background: The indication of performing lower uterine section caesarean section has been changing a lot in recent year and they are expected to go on changing on basis of continuing trials. Aims and Objectives: The aims to study are to assess rate, frequency along with complications of primary cesarean section. Along with to study the incidence and indications of primary cesarean section and causes maternal as well as fetal morbidity and mortality in these cases. Materials and Methods: This prospective study included all pregnant women after 28 weeks period of gestation who underwent caesarean section for the 1st time between December 2016 and June 2018 at Central Referral Hospital of Sikkim Manipal Institute of Medical Sciences (SMIMS), Gangtok, Sikkim – India. Over a period of 1.5 years, 750 women at Central Referral Hospital, SMIMS, Sikkim, India, underwent primary cesarean section. Results: The percentage of primary lower uterine section cesarean section was 27.38% and total cesarean section rate was found to be 49.59% which is far more than the expected rate of 15% as proposed by the world health organization. Elective lower uterine section cesarean section was done in 341 cases (45.47%) and emergency lower uterine section caesarean section was done in 409 cases (54.53%). Patient’s desire was the most frequent indication for elective lower uterine section cesarean section (38.40%). Conclusions: There is tremendous rise in rate of primary cesarean section with patient’s request being the most common indication of elective lower uterine section cesarean section.

Fetal Outcome of Term Pregnancy with Non-Reactive Non-Stress Test at Birat Medical College Teaching Hospital

Introduction: Non-stress test (NST) in pregnancy helps to detect fetuses which are at risk of developing hypoxia. In general, reassuring NST indicates good fetal outcome while non-reassuring NST may result in abnormal perinatal outcome.
 Objectives: The objective of this study is to detect the fetal outcome among term uncomplicated pregnancies with Non-reactive NST in Birat Medical College Teaching Hospital.
 Methodology: A cross-sectional study conducted for 6 months in the department of Obstetrics and Gynaecology at Birat Medical College Teaching Hospital. Singleton pregnancies with longitudinal lie and cephalic presentation between 37 to 42 weeks Period of gestation were included in the study. All participants were advised for a NST as an institutional protocol for 20 minutes at the time of admission. Participants with Non-reactive NST were counselled and planned for emergency LSCS as per hospital protocol. Participants were followed up for intraoperative findings such as colour of liquor and umbilical cord abnormality and outcome of fetus were assessed for APGAR score and need for NICU. The collected data was entered in Microsoft Excel and analyzed by using SPSS version 22.
 Results: Out of 115 pregnant women, the mean age and standard deviation of 24.93±4.68 years. Decelerations was found in 35(30.4%), Decreased baseline variability was found in 33(28.7%), Persistent fetal tachycardia was found in 23(20%) and Decreased baseline fetal heart was found in 24(20.9%). Intraoperative meconium-stained liquor was found in 39(33.9%) of patients. All babies born were shown APGAR score > 7 at 5 minutes. 14(12.2%) babies were admitted to the Neonatal intensive care unit (NICU). Correlation of admission NST was not found statistically significant with fetal outcome.
 Conclusion: LSCS for abnormal NST does not show adverse fetal outcome.

Risk factors of early and late preterm birth

Preterm birth (PTB) is one of the major causes of morbidity in newborn. The aim of this study was to estimate the prevalence and to compare the associated risk factors of early and late PTB. This was a hospital-based cross sectional study conducted in 2016/2017. Women, 271, having PTB at 28-33+6 weeks period of gestation was taken as early PTB and 34-36+6 were taken as late PTB. Data was collected using semi-structured questionnaire, patients’ record book, adopting face- to - face interview technique and clinical examination. The annual prevalence of PTB was 7.25% of which 11% were <28+0 weeks, early PTB was 32% and late PTB was 57%. Mother with school education were 2.0 times more likely to have early preterm births than those having higher education (P-value: 0.005, COR: 2.061,95% CI:1.234-3.441). Mothers with positive history of PTB in any of previous pregnancy was 10.7 times more likely to have early PTB in current pregnancy (P-value: <0.001, COR: 10.677, 95% CI: 2.792 – 40.746). Both variables were found to have independent risk on early PTB in logistic regression analysis (education: P-value: 0.027, aOR: 2.973, 95% CI: 1.132- 3.047; previous history of PTB: P-value: 0.002, aOR: 9.191, 95% CI: 2.308 - 36.596). Early and late PTB have differential risk factors. Mothers with positive history of PTB and having lower level of education were more likely to have early PTB.

Pregnancy with Tubercular Pericarditis Presenting as A Cardiac Emergency: Review of A Rare Case

Pericardial effusion can present as one of the life threatening emergency requiring prompt diagnosis and immediate life-saving measures. We are presenting a case of a large pericardial effusion, tubercular in origin, in a pregnant woman with 31 weeks period of gestation. She presented with acute onset cough, dyspnea and hemodynamic instability. She was managed successfully with pericardiocentesis and antitubercular therapy and later she had a normal vaginal delivery. Prompt and correct diagnosis and team-based approach is the key in the management of such patients and a successful outcome. Keywords: Pericardial Effusion; Tubercular; Pregnant; Pericardiocentesis.

Clinical course of ectopic pregnancy in a tertiary center: Observational study

Objective: Ectopic pregnancy is a life-threatening obstetric emergency. The objective of the study was to highlight the incidence, clinical profile and the management of ectopic pregnancy. The study was conducted in Obstetrics and Gynecology department of ESIC PGIMSR Delhi over one year. It was an observational study. Materials and Methods: Pregnant women presenting in gynaecology emergency with pain abdomen or bleeding per vaginum or history suggestive of ectopic pregnancy in first trimester were assessed for intrauterine or extrauterine pregnancy. Written informed consent was obtained from each patient prior to the treatment. All pregnant women with intrauterine pregnancies were excluded. 77 pregnant women were found to have extrauterine pregnancy. All Hemodynamically stable cases were managed conservatively. Hemodynamically compromised cases were managed surgically. Surgical procedure performed was salpingectomy. These cases were followed with weekly beta hCG till it normalized. Outcome: Incidence, Age, Parity and the treatment given. Results: Incidence of ectopic pregnancy in the institution was 2.01%. 46.7% cases were among age group 20-30 years. Multigravida 46.7% were having more ectopic pregnancy. 99% of extrauterine pregnancy were located in the Fallopian tubes. 38.9% presented between 4-6 weeks period of gestation 10.3% managed conservatively. 11.6% were chronic ectopic pregnancies were operated. Salpingectomy was the main surgical procedure. Conclusion: Thus, high index of clinical suspicion of ectopic pregnancy must be kept in mind. Early diagnosis and prompt treatment can help in reducing maternal mortality and morbidity. Keywords: Ectopic pregnancy, Salpingectomy, Fallopian tube.

MATERNAL AND PERINATAL OUTCOME IN BORDERLINE OLIGOHYDRAMNIOS: A HOSPITAL-BASED STUDY

Introduction: Amniotic fluid index (AFI) between 5.1 to 8 is termed as borderline oligohydramnios. Oligohydramnios has been linked with perinatal morbidity and mortality, however there are paucity of data on the effect of outcome of pregnancy among the isolated borderline oligohydramnios. This study studied the outcome of borderline oligohydramnios.
 Methods: Pregnant women after 30 weeks period of gestation, with AFI 5-8 were included in the study. Pregnancy with hypertension, diabetes, heart disease, congenital anomalies in fetus, previous cesarean section or any uterine surgery were excluded from the study. Collected data were analyzed using descriptive statistics.
 Results: 140 pregnancy were enrolled. The mean age(SD) of study population was 24.7(4.0) years. 60%. The mean(SD) gestational age at the presentation was 38.8(1.6) weeks, with range from 35.3 weeks to 42.5 weeks. Induction of labour was done in 80.2%, normal delivery was possible only in 42.1%. Meconium-stained liquor was present in 27.1%. The most common indication of cesarean section was Non-reactive Non-Stress Test (NRNST) among 51.9%. Postpartum Haemorrhage(PPH) was observed in 11.4%. There was no perinatal depression, the mean(SD) of birth weight was 2.9(0.4) kgs. 6.4% of the cases required nursery admission, among them the common causes of nursery admission were neonatal sepsis (45%) and various causes of respiratory-distress (55%. There was no neonatal or maternal death.
 Conclusions: Borderline oligohydramnios was more among nulliparous with higher rate of caesarean section. However, adverse outcome like PPH, neonatal infection and respiratory distress are less frequent findings and there was no perinatal mortality.
 Keywords: Borderline oligohydramnios, perinatal, maternal, neonatal, outcome.

A Cross-sectional Study to Evaluate Causes of Maternal Mortality in Rural Areas of Punjab, India

Introduction: Maternal mortality is an index of reproductive health of the society. In India illiteracy, late referrals, low socio-economic status of the community and direct causes are responsible for high incidence of maternal deaths which contributes to one-fifth of the global burden. Aim: To evaluate the causes of maternal death in rural areas of Punjab. Materials and Methods: The present retrospective cross-sectional study was conducted in 10 districts of Punjab, India chosen from five different zones i.e., east, west, north, south and central zone for a period of one year from 2016 to 2017. Information of all the deaths was taken from the civil surgeon office of the chosen district and then data of maternal deaths occurring within 42 days of delivery was collected by visiting patient’s residence and verbal autopsy was conducted. The data was collected and entered in predesigned proforma and percentages were calculated in Microsoft Excel version 2016. Results: A total of 67 maternal deaths were noted from above five zones, out of total rural population of 94,59,553. Maximum (n=51) maternal deaths were between age range of 20-30 years. Of these 67, majority 29 (43.28%) were illiterate, 66 (98.5%) women belonged to middle and low socio-economic status, 55 (82.1%) deaths occurred in the postnatal period, 33 (49.25%) occurred at more than 37 weeks period of gestation and 51 (76.12%) were due to direct causes. Out of 67 deaths, haemorrhage (n=29) was the most common cause. Anaemia contributed to 16.7% (11) as an indirect cause of maternal death. Conclusion: The maximum maternal deaths were contributed by illiterate women from middle and low socio-economic status. The most common cause was postpartum haemorrhage followed by pre-eclampsia/eclampsia.

Torsion of the gravid uterus: A rare cause of abdominal pain

Uterine torsion in pregnancy is a rare clinical entity with a non-specific clinical presentation. Here, we present a case of uterine torsion,which was diagnosed at laparotomy done for the lower segment cesarean section (LSCS) in a case of central placenta previa with thefetus in transverse lie. At 36.4 weeks period of gestation, the patient complained of severe left-sided abdominal pain which was notsuggestive of labor. This abdominal pain was refractory to analgesics. Emergency LSCS was done which confirmed uterine torsion aswell as anterior sacculation.

Rupture of Non-communicating Rudimentary Horn Pregnancy at 15 Weeks with Previous Normal Pregnancies: A Case Report

Rudimentary horn is a mullerian anomaly that is a variant of unicornuate uterus. Rudimentary horn pregnancies are rare and associated with increased maternal morbidity and mortality. Diagnosis of rudimentary horn pregnancy and its rupture in a woman with previous vaginal delivery is challenging. Although ultrasonography is an important diagnostic tool, it has low sensitivity in making diagnosis of ruptured rudimentary horn pregnancy. Therefore, clinicians should have high index of suspicion in such cases. We report a case of G3P2L2 at 15 weeks period of gestation referred to our centre as a case of intrauterine pregnancy with acute abdomen. She underwent emergency laparotomy and was found to have ruptured rudimentary horn intraoperatively. Excision of the ruptured rudimentary horn and ipsilateral salpingectomy was done and the patient had an uneventful postoperative recovery.

Acute Fatty Liver of Pregnancy: A Life Threatening Condition

Acute Fatty Liver of Pregnancy (AFLP) is a rare but catastrophic disease affecting women in pregnancy. It usually occurs in the third trimester or post-partum period. Delay in diagnosis is associated with morbid complications with high morbidity and mortality. We report a case of 24 years old female at 38 weeks period of gestation who presented with jaundice, vomiting for 3 days and deranged liver function test. She was diagnosed as acute fatty liver of pregnancy and was delivered by instrumental delivery but required cesarean hysterectomy due to postpartum hemorrhage. She started improving with supportive care and discharged after 4 weeks of hospital stay.
 Key words: AFLP, Hysterectomy, Postpartum hemorrhage

Acute fatty liver of pregnancy: a case report

Introduction: Acute fatty liver of pregnancy (AFLP) is rare but potentially lethal complication. AFLP characterized by microvascular fatty infiltration of hepatocytes without any inflammation or necrosis.Case Presentation: A 37-year-old multigravida with 29 weeks period of gestation came with chief complains of acute jaundice, nausea, malaise and anorexia since 7 days ago. On examination, her eyes were icteric and her motor power was decreased on both extremities. Abdominal examination showed fetus in cephalic presentation with normal fetal heart rate. There was no opening and effacing of cervix. The ECG result showed prolonged QT interval. She had elevated liver enzyme, decreased renal function, electrolyte imbalance, hypoalbuminemia and hypercholesterolemia. Abdominal ultrasound was within normal limit. Patient was then assessed with differential diagnosed of AFLP, acute hepatitis and HELLP syndrome. She was treated conservatively with ferrous sulfate, high carbohydrate diet, KSR once daily, CDR once daily and Bisoprolol 1.25mg once daily. Â Three months later patient delivered a healthy baby boy via caesarian section due to premature rupture of membrane.Conclusion: Since AFLP is a medical and obstetric emergency, early recognition and prompt treatment improves both maternal and fetal survival.

Hypertriglyceridemia Induced Acute Pancreatitis in Pregnancy: A Case Report

Introduction: Acute pancreatitis is a rare event in pregnancy. Hypertriglyceridemia induced acute pancreatitis accounts for the second most common cause in pregnancy. This rare event has a high maternal and fetal mortality of 20% and 50% respectively. Case report: A 21-year-old woman, G2P0+1 at 26 weeks period of gestation presented to OBGYN emergency in a state of shock with history of sudden onset of severe epigastric pain and multiple episodes of vomiting for one day and absent fetal movement for six hours. Immediate fluid resuscitation was done. Her reports showed increased hematocrit, leukocytosis, serum lipase and amylase elevated to > 200U/L. Ultrasonography showed bulky pancreas with intrauterine fetal death. With the diagnosis of acute pancreatitis with fetal demise, she was managed conservatively in intensive care unit by fasting, nasogastric aspiration, intravenous fluids, antibiotics, analgesics and heparin. She was intubated on the third day for increasing tachypnea. Her lipid profile showed elevated triglyceride> 1000 mg/dl and was started on oral hypolipidemic drugs. Pregnancy was terminated vaginally by misoprostol and was discharged on 19th day. Conclusion: Hypertriglyceridemia induced acute pancreatitis in pregnancy has an increased maternal and fetal complication.

Laparoscopic Cervical Encerclage in Pregnancy in 6 Steps

Cervical insufficiency occurs in 0.1% to 1 % of all pregnancies and is associated with a high risk of second-trimester abortion and/or preterm delivery [1]. Laparoscopic encerclage is highly recommended for a previous failed vaginal encerclage and is superior to the laparotomy approach in terms of low morbidity and faster recovery [2].Laparoscopic encerclage in pregnancy is more challenging than that in the nonpregnant state. This is because of the enlarged uterine size, engorged uterine vessels, and infeasibility of using a uterine manipulator. The standardization and description of the technique are the main objectives of this video (Video 1). We have described the surgeryin6 steps that could make this procedure easier and safer. A step-by-step video demonstration of the technique. Paul's Hospital, Centre for Advanced Endoscopy & Infertility Treatment, Kochi, India. A 29-year-old pregnant woman, gravida 3 abortions 2, at 13 weeks period of gestation, with a history of 2 second-trimester abortions owing to cervical insufficiency. The patient had a failed vaginal cervical encerclage at 18 weeks in the second pregnancy. This is a step-wise laparoscopic approach for successful cervical encerclage in pregnancy. In this video, we demonstrate our technique for laparoscopic cervical encerclage in a pregnant woman's uterus in 6 steps using a Mersilene tape (Ethicon US, LLC, Somerville, NJ) as follows: (1) Opening the uterovesical fold and dissecting the bladder, (2) opening the left broad ligament and creating a window, (3) opening the right broad ligament and creating a window, (4) placing the Mersilene tape on the left side medial to the uterine vessels at the cervicoisthmic junction, (5) placing the Mersilene tape on the right side medial to the uterine vessels at the cervicoisthmic junction, (6) tying the Mersilene tape anteriorly. The standardization of laparoscopiccervical encerclage in pregnancy using the above 6 steps could make this procedure easier and safer to perform. Moreover, the standardization of the surgical technique could shorten the learning curve.

An Incidental Ultrasonographic Diagnosis of Partial Hydatidiform Mole in a Old Primigravida: A Case Report

Hydatidiform mole is an abnormal pregnancy common in Asian populations compared to western countries; however, a partial hydatidiform mole is relatively uncommon and very challenging to diagnose on ultrasound. We reported a 24 years old female visited our clinic whose first antenatal visit was regular with normal viable fetus on ultrasonographic scan. However, an uneventful scan at 12 weeks period of gestation revealed a large irregular gestational sac with the disproportionately small embryo corresponding to 6+6 weeks with no cardiac activity. Additionally, there was markedly thickened placenta measuring 30mm in thickness without cystic spaces within the placenta. Further, her beta-human chorionic gonadotrophin level was very high and suction evacuation sample showed hydropic chorionic villi lined by trophoblastic cells with cistern formation and scalloped border. In conclusion, partial hydatidiform mole is an uncommon molar pregnancy rarely diagnose on ultrasonography. Late first-trimester scan and excessively high beta-human chorionic gonadotrophin levels confirm the diagnosis. Keywords: Hydatidiform mole; molar pregnancy; partial hydatidiform mole.

Cesarean section in a parturient with giant lung cyst

Asymptomatic lung cysts in prepregnant state can have its first manifestation during pregnancy due to altered respiratory physiology. They offer special challenge due to difficult diagnosis and definite treatment during pregnancy. We report case of a 26 years old parturient, G2P1L0 at 36 weeks period of gestation who presented as non resolving pneumothorax which was later diagnosed as a giant lung cyst for cesarean section.

Altered cerebro-placental ratio is an early marker of adverse pregnancy outcome–a prospective study

Background: Fetal growth restriction (FGR) is a complex and common obstetric problem. It is associated with perinatal morbidity and mortality which accounts for about 10-15%. The diagnosis of FGR is made by clinical evaluation and ultrasonography. Objectives: To investigate the role of the efficacy of the cerebroplacental ratio as a marker of reduced fetal growth rate. To establish a relationship between Cerebro placental ratio at term with reduced fetal growth velocity and adverse pregnancy outcome. Methods: A Prospective study, in which study participants were subjected for Ultrasonography at 20 to 25 weeks for Abdominal Circumference and Ultrasonography above 35 weeks period of gestation were subjected to fetal biometry and Doppler studies. All Doppler indices will be converted into multiples of the median (MoM), correcting for gestational age using reference ranges, umbilical & middle cerebral arteries and birthweight values are converted into centiles. Results: Among 80 % of participants low cerebroplacental ratio were associated with low abdominal circumference and low growth velocity. The low cerebroplacental ratio risk is associated with the need for operative delivery. Conclusion: Altered Cerebroplacental ratio is the earlier marker of adverse fetal outcome than the biophysical profile. Low Cerebro placental ratio(<1) is associated with impaired fetal growth velocity and adverse pregnancy outcomes.

A Study of the Association of Early Pregnancy Serum Levels of Pregnancy-Associated Plasma Protein-A with Adverse Pregnancy Outcome

Background: Decreased levels of pregnancy-associated plasma protein-A (PAPP-A) in maternal serum can be a marker not only for some chromosomal disorders and anomalies in the fetus but also specific for adverse pregnancy outcomes too, such as preeclampsia, spontaneous preterm birth, gestational diabetes, and fetal growth restriction (FGR) and to the extent of stillbirth. Hence, measurement of early pregnancy PAPP-A levels may help identify the areas of intervention for reducing the adverse outcome in later gestations. Materials and Methods: This was a prospective observational study. A total of 250 antenatal cases fulfilling the inclusion criteria were taken in the study. Early pregnancy serum levels of PAPP-A were measured for antenatal cases visiting outpatient department of tertiary level teaching hospital between 10 and 14 weeks period of gestation, and these cases were followed up for development of adverse pregnancy outcome. Results: Two hundred and thirty-five patients had normal outcomes, among which 24 patients had PAPP-A values ≤0.4 multiples of the median (MoM) and 211 patients had PAPP-A level >0.4 MoM. Twenty-nine patients out of 250 in our study group had PAPP-A level <0.4 MoM, 1 patient developed preeclampsia (P = 0.211) but underwent normal vaginal delivery at term, and 1 had FGR (P = 0.513). Three patients had preterm delivery and the PAPP-A values in preterm group were lower as compared to term group, and this result was statistically significant (P = 0.005). Conclusion: The study concludes that the patients with low early pregnancy PAPP-A levels may be deemed to develop preterm labor subsequently and effective measures may be taken to prevent the same. However, it would be prudent to replicate the study in a wider and more representative sample over multiple centers to see if the results hold true.