A study on cardiac autonomic modulation during pregnancy by non-invasive heart rate variability measurement Purpose: Remarkable and uncontrollable changes with modifi cation during pregnancy are connected with the autonomic control and consequently with the heart rate variability (HRV). Heart rate variability is a sum of different mechanisms and if pregnancy is a state of change, these modifi cations could be extracted from HRV analysis. Objective: To assess the effect of pregnancy on heart rate variability among pregnant mothers during fi rst trimester of pregnancy and third trimester of pregnancy. Materials and Methods: HRV was measured for 5 minutes of continuous recording of electrocardiogram (ECG) lead II, using windows based HRV analysis system variowin-HR after obtaining permission from the Institutional Review Board of Government Medical College, Bhavnagar and written consent from 30 pregnant subjects and 30 non-pregnant control subjects at autonomic function lab, Dept of Physiology, Bhavnagar. Result: Frequency domain parameters, very low frequency (VLF), low frequency (LF), high frequency (HF) and HF normalized unit (nu) were signifi cantly decreased and LF (nu) and LF/HF signifi cantly increased in pregnant subject in 3 rd trimester as compared to their 1 st trimester of pregnancy. Time Domain parameters like SDNN, RMSSD, SDSD, NN50 count, pNN50, SD1/SD2, triangular HRV index and average R-R interval were signifi cantly decreased during 3 rd trimester of pregnancy. Conclusion: The inhibition of resting parasympathetic activity or vagal blockage and an increment of the sympathetic modulation during the 3 rd third trimester of gestation in pregnancy as compared to their 1 st trimester and healthy non-pregnant subjects. Sympathovagal imbalance and abnormally low HRV may more pronounce during later stage of normal pregnancy. Key words: Autonomic function test, gestation, heart rate variability, pregnancyOriginal Article INTRODUCTIONThe last three decades have witnessed the recognition of a signifi cant relationship between the autonomic nervous system and cardiovascular mortality, including sudden cardiac death.[1] Heart rate variability (HRV) is a non-invasive, easy and economical technique to assess the status of autonomic nervous regulation of cardio vascular system. Heart with a stable and regular heart beat periodically is now considered as the marker for a poor prognostic for longevity.[2] HRV studies enhance understanding of physiological phenomenon of heart activity especially during pregnancy. The changes in the function of every regulatory system during pregnancy are initiated by ovarian and placental hormones in the fi rst trimester, but may also be modifi ed by placental and fetal endocrine factors as gestational age advances. Pregnancy-induced effects on cardiovascular function are increases in heart rate (HR), stroke volume (SV), and cardiac output. [3,4] These changes result from the interactive effects of a primary reduction in peripheral vascular resistance, [5] cardiac autonomic modulati...

Introduction: Postpartum hemorrhage (PPH) is the leading cause of maternal mortality worldwide and PPH resulting in transfusion is the most common maternal morbidity in the United States. Literature demonstrates that tranexamic acid (TXA) can reduce blood loss in cesarean deliveries; however, there is little consensus on the impact on major morbidities like PPH and transfusions. Objective: We conducted a systematic review/meta-analysis of randomized controlled trials (RCTs) to evaluate if administration of prophylactic IV TXA prevents PPH and/or transfusions following low-risk cesarean delivery. Methods: PRISMA guidelines were followed. Five databases were searched: Cochrane, EBSCO, Ovid, PubMed, and ClinicalKey. RCTs published in English between January 2000 and December 2021 were included. Studies compared PPH and transfusions in cesarean deliveries between prophylactic IV TXA and control (placebo or no placebo). The primary outcome was PPH, and the secondary outcome was transfusions. Random effects models were used to calculate effect size (ES) of exposure in Mantel-Haenszel Risk Ratios (RR). All analysis was done at a confidence level (CI) of alpha=0.5. Results: Modeling showed that TXA led to significantly less risk of PPH than control (RR: 0.43, 95% CI: 0.28-0.67). The effect on transfusion was comparable (RR: 0.39, 95% CI: 0.21-0.73). Heterogeneity was minimal (I2 = 0%). Conclusion: Due to the large sample sizes needed, many RCTs are not powered to interpret TXA’s effect on PPH and transfusions. Pooling these studies in a meta-analysis allows for more power and analysis but is limited by the heterogeneity of studies. Our results minimize heterogeneity while demonstrating that prophylactic TXA reduces the risk for PPH and transfusion. This has the potential to address blood shortages, transfusion-associated risks, and healthcare costs. We suggest considering prophylactic IV TXA as the standard of care in low-risk cesarean deliveries.

Background: Ectopic pregnancy is defined as any intra or extra-uterine pregnancy in which the fertilized ovum implants at an aberrant site which is inconducive to its growth and development. It is a catastrophic and life-threatening condition and one of the commonest acute abdominal emergencies affecting approximately 2% of all pregnancies. The purpose of this study is to review cases of ectopic pregnancy and determine: incidence, high risk factors, types of clinical presentation, diagnostic methods, management, morbidity and mortality.Methods: The present study, conducted over a period of 2-year, total number of deliveries was 16,144 and total number of ectopic pregnancies was 116. More than half of the cases (56.04%) had one or the other identifiable risk factor. Results: Amongst the various risk factors studied, history of previous pelvic surgery (15.43%), history of Pelvic inflammatory disease (PID) (12.9%), use of Intrauterine contraceptive device (IUCD) (10.3%) and either spontaneous or induced abortion (7.76%) has been found. History of self-administered medical termination of pregnancy (MTP) pill was present in 3.45%. Repeat ectopic pregnancies were seen in 1.72%. There was no identifiable risk factor in 49.63% of cases.Conclusion: Ectopic pregnancy is a major challenge in obstetrical practice because of its varied clinical presentation. It can be diagnosed early by keeping a high index of suspicion. Undue delay in referral reduces significant morbidity and improves the chances of preserving future fertility. Mass education regarding safe abortion practices and post abortal care should be promoted. Unsupervised usage of MTP pill intake should be condemned.

Background: Placentation abnormalities such as placenta previa, placenta accreta and vasa previa are associated with antepartum and postpartum haemorrhage, which makes them an important cause of serious fetal and maternal morbidity and even mortality in India. In spite of the significant improvement in obstetric care and management and modern transfusion service, antepartum and postpartum bleeding continues to be a significant cause of very high-risk pregnancy.Methods: This is a retrospective study conducted in department of obstetrics and gynecology, Sir Sayaji Hospital, Baroda, for a period of 2 years from January 2018 to December 2019. All cases of placenta previa and morbidly adherent placenta admitted during pregnancy in this period were included in the study. All case records were obtained and carefully analysed to find out the incidence, various types of placenta previa and adherent placenta, its clinical presentation and its outcome in relation to mode of delivery, birth weight, maternal and perinatal morbidity and mortality.Results: The prevalence of placenta previa was 0.87% and was more commonly present among multigravida women (80.3%). Most common type of placenta previa was type 1 in 51 cases (35.9%) cases followed by type 2 in 33 cases (23.2%). 29 cases (20.4%) were of complete placenta. Morbidly adherent placenta comprised 4.2%. Single case (0.7%) was of vasa previa. Out of 142 cases, 12 (8.4%) had atonic PPH and 8 (5.6%) cases underwent peripartum hysterectomy, (12.6%) 18 patients had hemorrhagic shock due to severe blood loss. All cases of perinatal mortality were between 28 to 30 weeks weighing between 1-1.2 kg associated with complete placenta previa in 14 cases and type 3 (incomplete) in 8 cases. There was no maternal mortality in this studyConclusions: Abnormal placentation carries a very high-risk for maternal and fetal outcome. Anticipation, prevention, early detection and appropriate management will result in favorable outcome and will boost the present scenario of management of high-risk pregnancies.

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