Obstetric emergencies during COVID-19 pandemic pose an enormous challenge to the concerned obstetrician. Risk stratification during obstetric triage will guide in the initial assessment & planning of further management to reduce maternal and fetal morbidity and mortality rates. As the health system adapts to cope with this pandemic, special attention needs to be given to the several moral and ethical dilemmas that may occur during patient care.
Background: Pre-eclampsia is one of the leading causes of maternal and perinatal morbidity and mortality in India. Objective of this study was to establish whether a spot urinary albumin/creatinine ratio (ACR) measured between 18-28 weeks of gestation can predict subsequent pre-eclampsia in asymptomatic pregnant women.Methods: A prospective observational study involving 50 registered antenatal cases visiting the obstetrics outpatient department between 18-28 weeks of singleton pregnancy with nil proteinuria upon dipstick measurement were included. ACR was determined from random single midstream urine sample. Statistical analysis was performed using Chi square test and Student’s t-test.Results: Of the study group, 10 patients had high ACR value, with 8(80%) developed pre-eclampsia and 2(20%) remained normotensive. ACR had a sensitivity of 80%, specificity 97.56%, positive predictive value of 88.89%, diagnostic accuracy of the test being 94.12%.Conclusions: The spot urinary protein creatinine ratio is a reliable predictor for pre-eclampsia in pregnancy.
Background: Over the last 50 years, extensive research has been conducted with the objective of preventing, predicting and optimizing the outcome of patients with preterm labour. Currently, the therapeutic foundation for treating preterm labour involves the use of tocolysis. An attempt is made to study the tocolytic effect of Isoxsuprine and nifedipine in suppression of preterm labour.Methods: This is a prospective study, carried out in the department of Obstetrics and Gynaecology of S S institute of medical sciences and research centre, Davangere, over a period of 15 months- from October 2014 to January 2016.Results: 60 antenatal cases with 28-36 weeks of gestation with painful intermittent uterine contractions were considered for the study. Subjects were randomly allotted into two groups - Group A (Isoxsuprine) and Group B (Nifedipine) 30 patients each. Main outcomes include prolongation of pregnancy, maternal side effects and neonatal outcome were compared. Baseline characteristics were well matched in both study groups. Mean prolongation of pregnancy was 31.68 days in Nifedipine and 27.54 days in Isoxsuprine group which was statistically significant. Success rate with Nifedipine was found to be 96% as compared to Isoxsuprine which was 75%. Maternal side effects like hypotension (13.33%) and tachycardia (6.66%) were common in Isoxsuprine group, while facial flushing was seen in16.66% patients in Nifedipine group. Neonatal outcome was similar in the both groups.Conclusions: Nifedipine is a safe and effective tocolytic agent than Isoxsuprine with less maternal complications.
Background: Covid-19 presents with plethora of symptoms & signs, whereas pregnant people might be at increased risk for severe illness from COVID-19 compared to non-pregnant people probably due to changes in anatomy, endocrine, and immune factors during pregnancy. Additionally, there may be an increased risk of adverse pregnancy outcomes, such as preterm birth, intrauterine fetal demise. Case report: A 35yr old G3P2L2 with 33 weeks 1 day of gestation with prev 2 lscs with COVID-19 positive with severe respiratory distress admitted to ICU for ventilator support. She required an emergency caesarean section in view of deteriorating medical condition. 14 days postnatally, both mother & baby were discharged with no complications. Conclusion: Covid-19 in pregnancy pose a imperative aspect in its management as we do not have set guidelines on management of pregnant women & her baby in critical care setup during this pandemic. Decision making for delivery should highlight the balance of risk & benefit for maternal status & fetal status.
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