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Introduction The COVID19 pandemic raises a major concern about its severity in pregnancy, fetomaternal outcomes and risk of vertical transmission.The Cycle threshold indicating the viral load can be a contributory factor towards modifying the management of such pregnant women. We report a retrospective descriptive study regarding the clinical course, fetomaternal outcomes of pregnant women with COVID19. Methodology This is a single-center, retrospective study performed in a tertiary care hospital for pregnant women with COVID-19 in India. The medical records of the all women who delivered in the Covid facility from May 5th 2020 to June 5th 2020 were reviewed independently. Data extracted from the records included demography, obstetric details, co morbidities, disease severity, investigations, management and information on neonates (birthweight, Apgar score, and perinatal complications).Statistical analysis was performed by the SPSS program for Windows, version 17.0(SPSS, Chicago, Illinois) Results Amongst 348 women(suspects) tested for SARS-CoV-2, 57 women ( 57/348,16.3%) were confirmed positive based on qRT-PCR of nasopharyngeal specimen. Most women (45 /78.9 %) had mild infection with favourable fetomaternal outcomes. Three maternal mortalities were associated with co morbidities. Five neonates tested positive for SARS-CoV-2, remained haemodynamically stable and were subsequently discharged. Conclusions Majority of pregnant women with Covid-19 had mild disease and recovered subsequently with good perinatal outcomes. Women with co morbidities may have increased risk of severe morbidity and mortality.The Cycle threshold signifying the viral load and degree of infectivity can modify the management during pregnancy.Long-term outcomes and the potential mother-to-child vertical/horizontal transmission needs further study.

BackgroundInflammatory response during urinary tract infection (UTI) is mediated by innate immune defense. Nod like receptors (NLRs) have been proposed to work simultaneously beside TLR pathways to mediate pro-inflammatory response and maintain tissue homeostasis. Some in vitro reports have showed the involvement of NLRP3 inflammasome during uropathogenic Escherichia coli (UPEC) mediated UTI. So we have sought to determine the status of various inflammasomes and their components in UPEC mediated UTI.MethodsA total of 186 females experiencing the first episode of UTI were recruited for the study and forty were found to be positive for UPEC (≥105 CFU/ml) in their urine (N = 40). Further, we analyzed the expression of NLRP3, NLRC4, NAIP, AIM2, ASC, CASPASE-4, and CASPASE-1 gene at mRNA and protein level in the blood of UPEC confirmed study subjects through real time qPCR and immunoblotting. Healthy females (N = 40) visiting the OPD for health checkups, family planning advice and subjects undergoing routine medical examinations, were recruited as healthy control subjects. Pro-inflammatory cytokines (IL-6, IL-8, IFN-γ, TNF-α and MCP-1) were measured in the plasma of patients and controls through ELISA. For investigation of the involvement of NLRC4 and NLRP3 inflammasome, in vitro studies were performed using co-immunoprecipitation and confocal microscopy.ResultsMost of the inflammatory regulators studied (i.e., NLRP3, NAIP, NLRC4, ASC, and CASPASE-1) were found to be up-regulated at both mRNA and protein levels in the UPEC infected UTI patients. Also, pro-inflammatory cytokines (IL-6, IL-8, IFN-γ, TNF-α, and MCP-1) were found to be up-regulated in the patients group. However, no significant difference was observed in the expression of AIM2 and CASPASE-4 genes at both mRNA and protein levels. Further, in vitro studies have shown the involvement of NLRC4 inflammasome in UPEC infected THP1 derived macrophages.ConclusionInvolvement of NLRP3 and NLRC4 inflammasomes in UPEC infected UTI is evident from our findings. This is the first report showing levels of inflammasome and its components in UTI patients suggesting a possible role during UPEC mediated UTI. We have also reported the involvement of NLRC4 inflammasome for the first time during UTI infection.

Early SWL (within 48 hours of onset of colicky pain) is feasible, safe, and highly efficacious in the management of symptomatic proximal ureteral stones <1 cm, resulting in a lesser requirement of number of SWL sessions, time taken for stone clearance, auxiliary procedure rate, and fewer complications in comparison with delayed SWL.

INTRODUCTIONThere is no ideal position for labour and delivery, the standard recommendation is to encourage and support the parturient to deliver in the position she feels most comfortable in.1,2 Although international guidelines advice against being recumbent or supine for long periods of time during labour, women are motivated to deliver in the supine position at most delivery centres in India. Women delivering in the supine position experience comparatively painful prolonged labors with increased incidence of foetal distress due to more aortocaval compression by the gravid uterus.1-5 However, supine position in the second stage of labour is favoured by most obstetricians as they are trained to take delivery in this position. It allows them to monitor the labour process better with ease of providing anaesthesia, enables them to give proper perineal support in the second stage of labour, and conduct operative vaginal deliveries.Upright labour positions have several physiological advantages over the supine position. Historically women were instinctively adopting upright positions for delivery as they experienced stronger, more efficient and less ABSTRACT Background: Women delivering in upright position have shorter labour due to efficient and stronger contractions with faster descent of foetal head. The present study aimed to find out effect of upright kneeling position in the second stage of labour on maternal and foetal outcome and assess patients' satisfaction. Methods: The study was carried out in a tertiary care hospital of North India from October 2012 to February 2014. Low risk women admitted in early labour were divided into two groups, women delivering in kneeling position and in supine position. The outcome measures studied were, duration of second stage of labour, mode of delivery, 2 nd degree perineal tears, Apgar scores at 5 minutes, NICU admission rate and patient satisfaction. Results: The mean duration of second stage of labour in kneeling group was shorter by 14.901 minutes. The rate of vaginal delivery was comparable for both primigravidas and multigravida in kneeling and supine groups, RR: 2.275, 95% CI (0.7872-6.5831) and RR: 1.633, 95% CI (0.393-6.775). Primigravidas had more 2 nd degree perineal tears in kneeling group as compared to supine, RR 4.191, 95% CI (1.54 to 11.41). No difference in Apgar scores >7 at 5 minutes was observed in both groups, however, significantly lesser babies in kneeling group were admitted in NICU, RR 0.246, 95% CI (0.079 to 0.761). There was no difference on comparing satisfaction scores of primigravidas and multigravida in both supine and kneeling position. Conclusions: Kneeling position reduces the duration of second stage of labour and NICU admissions.

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