: Hypothyroidism during pregnancy has an adverse effect on both mother and child. The maternal and foetal risk is higher in TPOAb (Thyroid peroxidase antibody) positive women compared to women with negative TPO Ab. The recent ATA (American Thyroid Association) guidelines recommend that pregnant women with TSH (Thyroid Stimulating Hormone) concentration above 2.5mU/L should be evaluated for TPOAb status and LT4(levothyroxine) treatment should be considered with TSH values between 2.5mU/L and 4.0mU/L only when TPOAb status is positive.: All the pregnant women booked in first trimester underwent testing for TSH levels and subsequently for anti TPO Ab if TSH levels were between 2.5-4 mIU/ml. The hospital based prevalence of women with anti TPO Ab positive status was determined. These pregnancies were followed till term and the maternal and foetal complications associated with TPO Ab positive and negative status were compared. Total of 400 pregnant women were included. The hospital prevalence of women with anti TPO antibodies in first trimester of pregnancy with TSH values between 2.5- 4 mIU/ml was found to be 23.5%. Anti TPO antibody positive status was significantly more associated with antenatal complications especially GDM and IUGR as compared to patients with anti TPO antibody negative status (47.8% v/s 23.2%, p value 0.001).: Women with TPO Ab positive status are to be vigilantly monitored for early detection and management of various antenatal complications. Determining anti TPO Ab status helps in avoiding unnecessary treatment of the women with TPO Ab negative status and TSH between 2.5-4mIU/ml.
Introduction: Abnormal Cerebro-Placental Ratio (CPR) is associated with a substantial risk of adverse perinatal outcomes and the test seems to be particularly useful for follow-up of foetuses with sonographically diagnosed Foetal Growth Restriction (FGR). Aim: To determine the usefulness of doppler velocimetry, especially CPR at 35 weeks of gestation or later, in predicting intrapartum foetal heart rate abnormalities and adverse neonatal outcomes in low-risk term pregnancies. Materials and Methods: The present prospective cohort study was conducted at the Department of Obstetrics and Gynaecology in Bangalore Baptist Hospital, Bangalore from September 2019 to September 2020. A total of 60 pregnant women between the ages of 18 and 35 years with low-risk pregnancies, who present for the obstetrical ultrasound at 35 weeks of gestation or later with planned delivery at the hospital were included. All lowrisk pregnant women with estimated foetal weight (EFW) >10th centile and abnormal Cerebro-Placental Ratio (CPR) <10th centile were compared with those with normal CPR i.e., >10th centile. An adverse obstetric outcome, like foetal distress, meconium aspiration syndrome or respiratory distress syndrome, mode of delivery, admission to Neonatal Intensive Care Unit (NICU), and perinatal mortality was analysed in the study population using chi-square test or Fischer’s-exact test. Results: In this study, there was a significant association between foetal distress and CPR with Odds Ratio (OR) of 4.21 i.e., foetal distress was 4.21 times higher in the abnormal group compared to the normal group. Among 20 cases with abnormal CPR, 11 had foetal distress i.e., 55% and among 40 cases with normal CPR, nine had foetal distress i.e., 22.5%. Among those with abnormal CPR, 15% had Amniotic Fluid Index (AFI) <8 and among those with normal CPR, 0% had AFI <8, showing a significant association. Conclusion: In low-risk patients with EFW >10th centile and abnormal CPR, there was a significant association with adverse obstetric outcomes, requiring vigilant intrapartum monitoring.
Acute abdomen in pregnancy remains one of the most challenging situation in regard with the diagnosis and management. Pregnancy is a unique state in which the female body undergoes both anatomical and physiological changes which can pose a challenge in diagnosis. This may result in delay in management and increase in maternal and fetal morbidity and mortality. This study was to identify the spectrum of causes, the clinical presentation and diagnostic dilemma of acute abdomen in pregnancy. It was an observational study was done over a period of 3 years which included all the pregnant women who presented with acute abdomen. In this study, eighteen pregnant women presented with acute abdomen. Among the study group, 5.5%, 50% and 44.5% presented in first, second and third trimester respectively. The diagnosis included acute appendicitis in 11.1%, acute cholecystitis in 16.6%, acute pancreatitis in 16.6%, malrotation in 11.1%, uterine rupture 11.1%, rudimentary horn rupture in 22.4% and ovarian cyst torsion in 11.1%. The clinical presentation included pain abdomen (16.6%), pain abdomen and vomiting (44.4%), pain abdomen in shock (39%) and abdominal tenderness (33.3%). The diagnosis was confirmed with ultrasonography in 55.6%, 11.1% women required higher imaging like magnetic resonance imaging (MRI) and 33.3% women were diagnosed on table. Majority of them had good outcome, but there was one maternal mortality (6%). Diagnosis and treatment of acute abdomen in pregnancy should be individualized. Good clinical acumen is essential for ordering early diagnostic test in acute abdomen in pregnancy. Appropriate intervention should be undertaken at the earliest to reduce the maternal and fetal complications.
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