Background. Takayasu's arteritis (TA) is a rare, chronic, inflammatory, progressive, idiopathic arteriopathy, afflicting young women of reproductive age group, causing narrowing, occlusion, and aneurysms of systemic and pulmonary arteries, especially the aorta and its branches. During pregnancy, such patients warrant special attention. An interdisciplinary collaboration of obstetricians, cardiologists, and neurologists is necessary to improve maternal and fetal prognosis. Here a case is reported where a patient with diagnosis of TA, complicated by neurological sequelae, successfully fought the vagaries of the condition twice to deliver uneventfully. Case. 25-year-old G2P1L1 presented at 34 weeks of gestation, with chronic hypertension, with TA, with epilepsy, and with late-onset severe IUGR. Following a multidisciplinary approach, she delivered an alive born low birth weight baby (following induction). Her postpartum course remained uneventful. Conclusion. Pregnancy with TA poses a stringent challenge to an obstetrician. Despite advancements in cardiovascular management and advent of new-fangled drugs, the optimal management for pregnant patients with this disease still remains elusive.
Labor and delivery-related complications being the largest contributors to India's high maternal mortality rate, optimizing labor and delivery are of utmost importance. This study analyses the safety and efficacy of active management of labor at a secondary hospital using the protocol proposed by Daftary [1].Women in labor with a term pregnancy who consented to the protocol formed the study group. The control group was managed expectantly. The 2 groups of 700 participants each were similar regarding parity, age, and pregnancy-related complications such as pregnancy-induced hypertension, intrauterine growth retardation, and postdatism.A gel preparation containing 0.5 mg of prostaglandin E2 was instilled intracervically in women with a Bishop score of 6 or less, and oxytocin was administered for labor augmentation if necessary. The partogram was then started, and amniotomy performed [2]. At the onset of the active phase of labor, 6 mg of pentazocin (an opioid analgesic) and 2 mg of diazepam (a tranquilizer) were diluted in distilled water and administered intravenously, and 50 mg of camylofin dihydrochloride (a smoothmuscle relaxant) was administered intramuscularly. Three hours later an injection of tramadol hydrochloride (an analgesic) or drotaverine hydrochloride (an antispasmodic) was given, the latter being repeated every 2 h depending on the partogram and the patient's pain score. An injection of 125 mg of carboprost tromethamine was given intramuscularly after delivery to promote contraction and retraction of the uterine musculature. The remainder of the pentazocine and diazepam mixture was injected while the episiotomy was being sutured. The pain score was tabulated, and the total duration of labor and labor outcomes were analyzed. P b.05 was considered significant in determining the effect of active management of labor on the rate of cesarean deliveries. An attempt was made to identify the indications that could benefit from this protocol.
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