Background: Pregnant women with type 2 diabetes mellitus (T2DM) pose an important public health problem, because diabetes not only affects the maternal and the fetal outcome but the women suffering with DM, their fetuses are also at an increased risk of developing diabetes and related complications later in their life. Case description: A 28-year-old woman with the diagnosis of G3P1L1A1 with 32 weeks' gestational age with previous vaginal delivery and known case of chronic T2DM and hypothyroidism since 4-5 years. On admission, she was having altered sensorium, breathlessness, and palpitations. She was in latent phase of labor. Fetal heart sound was not heard on Doppler. Ultrasonography (USG) revealed intrauterine death of fetus. Her investigation reports suggested severe diabetic ketoacidosis (DKA). She was managed in medicine intensive care unit (ICU) where her labor progressed spontaneously and delivered a male dead baby, weighing 1500 g. It was sent for autopsy. Patient had postpartum hemorrhage and managed medically. But medical management did not suffice for her and so decision of laparotomy was taken with the plan of obstetric hysterectomy. Objectives: We examined the precipitating factors, laboratory abnormalities, treatment strategies, and clinical recovery in pregnancies complicated by DKA. Conclusion: Diabetes during pregnancy is associated with higher maternal and fetal morbidity. Early screening, detection of complications, close monitoring, and intervention are essential to reduce maternal and fetal short-and long-term adverse effects, especially in high-risk pregnancies. Pregnancy provides an opportunity to clinician to control the disease process and inculcate healthy lifestyle practices in these patients.
Hypertensive Disorders of Pregnancy affect growth of fetus, birth weight too. However all babies are not small. This might have something to do with lipids.Objective: Present study was to study serum lipid levels in normal pregnant, women with HDsP, specially lipid abnormalities in HDsP and birth weight of baby. Materials and methods:Prospective study was carried out with singleton pregnancy, gestational age more than 20 weeks with HDsP. Normotensive pregnant women, matched for age, (+2) parity (+1), gestational age (+2 weeks) were controls. Fasting serum lipids, cholesterol, triglycerides, high density lipoproteins (HDL), low density lipoproteins (LDL), very low density lipoproteins (VLDL) were estimated at entry, repeated 7 days. Criterion for small for gestation weight was less than 2500 gms birth weight of >37 weeks babies. Preterm were excluded for analysis.Results: During study there were 7233 births, 964 had HDsP (13.32%), 635 (66%) term (>37 weeks) pregnancy. Of 451 women with mild gestational hypertension (GH), 425 had abnormal lipids, 117 (27.52%) of them, of 26 with normal lipids, 23.07% had SGA babies, more babies SGA with higher LDL, VLDL, Tri glycerides, lower HDL. Among 58 term cases with severe GH, 50 had abnormal lipid levels, 8 (16%) and of 8 with normal lipids, one (12.5%) had SGA baby, more babies SGA with abnormal lipids. Among 65 of term gestation with mild PE, 48 had abnormal lipids, 17 (35.41%) and of 17 with normal lipids 4 (23.52%) had SGA babies with abnormal lipids, more SGA babies with abnormal lipids. With severe PE, all 44 had some lipid abnormality, 59% had SGA babies. All 17 with eclampsia at term had abnormal lipids, 16 (94.11%) had SGA babies. However in all categories difference was statistically insignificant. Conclusion:Lipid abnormalities were present in quite a few cases of HDsP and when present affected baby weight. A lot of more research is needed.
Ectopic pregnancy is the most common cause of maternal death in early pregnancy and its incidence is rising. Most of the ectopic pregnancies occur in the young age group and subsequent fertility is an important issue. There is no consensus in the literature regarding conservative laparoscopic versus radical treatment of tubal pregnancy in terms of future reproductive performance. There are no randomized controlled trials of sufficient power, and meta-analysis of studies has shown different results with different investigators. But in certain studies laparoscopic surgery has advantages over open surgery and results in higher rates of subsequent intrauterine pregnancies and a lower rate of ectopic pregnancy.
Umbilical cord (UC) represents the “life source”, or the “entry and exit” point of humans which is the only source of energy. It is essential for the development, well-being, and survival of the nourishing baby. The characteristic of the coiling of the umbilical cord makes the cord a structure that is both flexible and strong and provides resistance to external forces which could compromise the blood flow to the foetus. UC is vulnerable to kinking, compressions, traction, and torsion, which may affect the intrauterine life and perinatal outcome due to coiling. One complete spiral of 360º of the umbilical vessels around each other is defined as Umbilical Coil. Abnormal coiling is defined as UCI less than the 10th percentile (i.e., Hypocoiled cord), UCI more than the 90th percentile (i.e., Hypercoiled cord), and the UCI between 10th and 90th percentile is Normocoiled cord. According to the literature studies, hypercoiled cords are usually associated with intrapartum foetal acidosis and asphyxia, foetal growth restriction, vascular thrombosis, and cord stenosis while the increased incidence of foetal demise, intrapartum FHR deceleration, low APGAR scores, preterm delivery, chorioamnionitis, structural and chromosomal abnormalities, and operative delivery have been associated more with hypocoiled cords. Hence, if the umbilical coiling index can be measured reliably in utero by ultrasound antenatally, then in future, it might become a promising prognostic marker for a better pregnancy and adverse foetal outcome.
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