Pregnancies in chronic liver disease are associated with high rate of abortions. Live birth rates are better and complications such as variceal bleeding or decompensation of liver disease are less common than previously reported.
To study the maternal and foetal outcomes in pregnancies complicated by congenital hemolytic anaemias. Material and Methods: A retrospective descriptive study was carried out on pregnant women with hemolytic anaemias who delivered at SJMCH between January 2011 and January 2016. Antenatal and labour records were reviewed. Demographic variables like maternal age, parity, booking status, consanguinity, cause of haemolytic anaemia and time of diagnosis were noted. The primary outcome measures studied were -severity of anaemia, obstetric and medical complications, transfusion of blood and blood products and mode of delivery. Neonatal outcomes, need for ICU admission and duration of hospital stay were the secondary outcome measures studied. Data are presented as descriptive statistics, including means and percentage. Results: Prevalence of congenital hemolytic anaemias was 0.3% (38/12420). 20 had Beta-Thalassemia; 9 Sickle cell anaemia, 7 Hereditary Spherocytosis, and 2 had enzyme defects. 13% had mild, 55% moderate, 23% severe and 5% very severe anaemia. The obstetric complications noted were pre-eclampsia (7.8%), abortions and preterm labour in 10% each, oligohydramnios and puerperal sepsis in 13% each, IUGR (23%), infections (29%), and foetal distress (31.5%). 47% had vaginal deliveries, and 52% caesarean deliveries. 42% required antenatal, 13% intrapartum and 36% postpartum transfusion of blood products. The mean birth weight of babies was 2.65 kg. 5% had PPH, none required ICU care. Conclusion: Successful pregnancy outcomes can be achieved with prompt diagnosis, patient education, screening, genetic counselling and prenatal diagnostic testing of foetus and management in a tertiary care hospital by a multidisciplinary approach.
Pregnancy in patients with pulmonary hypertension and cor pulmonale is associated with high morbidity and mortality. The timing of termination of pregnancy, mode of delivery, labour analgesia and anaesthesia and management during puerperium are challenging issues which need to be resolved. Authors report a case of a 30-year-old primigravida with cor pulmonale and severe pulmonary artery hypertension secondary to past pulmonary tuberculosis, who delivered a healthy baby vaginally, due to its rarity and good outcome. Early diagnosis, effective management of aggravating factors like anaemia and hypertension, informed choice by the couple regarding route of delivery and multidisciplinary approach are the keys to successful outcomes in patients with cor pulmonale.
: Mother to child transmission (MTCT) is the most important mode of acquisition of hepatitis B. MTCT is dependent on HBeAg status and HBV DNA levels. There is lack of information about HBeAg status and HBV DNA levels in HBsAg pregnant women in India.We aimed to determine the frequency of Hepatitis B infection, HBeAg positive status, its association with HBV viral load and compared the differences in clinical and laboratory characteristics between HBeAg positive and negative cohort.: We extracted demographic, laboratory and virological characteristics from case records of pregnant women with HBV seen by department of Obstetrics and Gynaecology and Gastroenterology between January 2011 and December 2018. Patients were stratified into HBeAg positive and negative groups. Descriptive statistics were carried out. : The prevalence of HBsAg positive pregnancy was 0.63% (130/20624 deliveries). Of the 89 patients in whom e antigen results were available, 14 (15.7%) were HBeAg positive and 73 (82%) were HBeAg negative. HBeAg positive women were younger (24y vs 27y), had higher AST (36 vs 18), ALT (56 vs 23) and HBV DNA level (1.3x10 vs 54 IU/ml) levels compared to HBeAg negative women. 12/14 HBeAg positive women received antivirals to prevent MTCT.: Hepatitis B prevalence in our cohort is 0.63%. HBeAg positive status was seen in 15.7% of pregnant women and was associated with high viral load of >10/copies/ml. 82% were HBeAg negative and associated with low viral load. HBeAg can be used as a surrogate marker for viral load and has immunoprophylaxis and treatment implications.
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