Dipika Deka

Hematopoietic stem/progenitor cell harvesting from umbilical cord blood.

Umbilical cord blood contains hematopoietic stem cells from which mature, functional cells are derived w1x. These pluripotent stem cells form colonies in vitro in semi-solid culture medium, and colony-forming units–granulocyte-macrophage (CFU-GM) and burst-forming units– erythroid (BFU-E) are indirect indicators of the stem cell population. Another marker of hematopoietic stemyprogenitor cells is the CD34 antigen, a membrane glycoprotein that regulates the adhesion of stem cells to stromal cells w2x. To quantify stem cells (i.e. CFU-GM and CD34q cells) in cord blood, 27 gravidas with uncomplicated pregnancies who were in labor at term were enrolled after giving informed consent. After delivery, the umbilical vein was punctured and residual placental blood recovered in a modified blood collection bag containing 20 ml of citrate phosphate dextrose adenine as an anticoagulant (Terumo Penpol Ltd, Puliyarakonam, Trivandrum, India). Approximately 3 ml of collected cord blood was mixed with a triple volume of Iscove’s modified Dulbecco’s medium (IMDM)

Incarcerated pregnant uterus in an incisional hernia

This paper reports a case of incarcerated pregnant uterus in an incisional hernia which required operative reduction. A 20-year-old gravida 2 with previous lower segment cesarean section and early neonatal death was booked at 19 weeks of gestation for antenatal care at a hospital. However at 28 weeks of gestation the patient complained of severe abdominal pain. Upon examination the uterus was found incarcerated inside the incisional hernia. She was admitted for an emergency laparotomy for operative reduction of the incarcerated uterus. The ulcerated and redundant skin was removed the hernia ring excised and the uterus returned into the abdominal cavity. Such an obstetric situation is rare but serious. Its management protocol would largely depend upon the period of gestation. During the second trimester when the risk of incarceration inside the hernia is maximal conservative management by rest by use of abdominal binders and by avoiding undue straining is preferred. However when the hernia is so large that despite conservative management the uterus remains inside the hernia sac and is at increased risk of incarceration herniorrhaphy is considered during pregnancy. In the late second or third trimester herniorrhaphy is postponed until after the delivery.

Intravenous Immunoglobulin as Primary Therapy or Adjuvant Therapy to Intrauterine Fetal Blood Transfusion: A New Approach in the Management of Severe Rh‐Immunization

Maternal high dose intravenous immunoglobulin (IVIG) has shown promise in the management of severe Rh‐immunization. Intravenous immunoglobulin, blocks Fc mediated antibody transport across the placenta and blocks destruction of fetal red cells and reduces maternal antibody levels. We have tried this new therapy in 6 patients with severe Rh‐immunization, with high maternal antibody titres and previous hydrops and intrauterine deaths. Intravenous immunoglobulin was given from 13–18 weeks of gestation 3–4 weekly, till intrauterine transfusion (IUT) or delivery. Intensive fetal monitoring was done. No fetal hydrops or deaths occurred in any of the 6 cases. Only 2 cases needed intrauterine transfusion. IVIG delayed the onset of fetal anemia by 8–17 weeks thus deferring the need for IUT. All pregnancies continued till 32–36 weeks and all 6 babies did well in the neonatal period.

Levonorgestrel-releasing intrauterine system vs. transcervical endometrial resection for dysfunctional uterine bleeding.

Objective: To compare the acceptability, efficacy, adverse effects, and user satisfaction of a levonorgestrel intrauterine system (LNG‐IUS) and transcervical resection of the endometrium (TCRE) for the treatment of dysfunctional uterine bleeding.

Analysis of telomere length in couples experiencing idiopathic recurrent pregnancy loss.

PurposeTelomere length plays a significant role in various disorders; however, its role in idiopathic recurrent pregnancy loss (iRPL) is not known. The objective of this study was to assess telomere length in peripheral blood leukocytes in couples experiencing unexplained recurrent pregnancy loss (iRPL).MethodsThe study included 25 couples experiencing iRPL and 20 controls. The mean relative telomere length was measured by quantitative Real Time PCR (Q-PCR) based assay, which measures the average ratio of telomere repeat copy number to a single copy gene (36B4) copy number (T/S ratio) in each sample.ResultsThe relative leukocyte mean telomere length (T/S) in both men and women from iRPL group was significantly lower (p < 0.05) when compared to controls. A significant (P < 0.05) negative correlation was found between age and leukocyte telomere length (T/S ratio). Among the sperm parameters seminal volume was found to be negatively (r = −0.4679) associated with the telomere T/S ratio. The DNA fragmentation index of sperm showed positive correlation (r = 0.4744) with telomere length. In this preliminary study, we found that shorter telomere length in both men and women may be associated with early pregnancy loss.ConclusionIn conclusion, shorter telomere length in both male and female partners appears to play a role in the idiopathic recurrent pregnancy loss. Loss of telomeric DNA due to oxidative stress needs further analysis. Analysis of telomere length in germ cells are needed to further substantiate the findings of this study.

The obstetric outcome following treatment in a cohort of patients with antiphospholipid antibody syndrome in a tertiary care center

BACKGROUND Antiphospholipid antibody syndrome (APAS) is regarded as the most frequently acquired risk factor for thrombophilia. The obstetric manifestations of APAS include early or late pregnancy losses and complications like preeclampsia and fetal growth restriction. Its timely diagnosis and treatment can improve maternal and neonatal outcome. AIMS To study the pregnancy outcome of patients with APAS treated with heparin and aspirin. SETTINGS AND DESIGN This was a retrospective study of pregnancy outcome in 42 consecutive women with APAS, treated with heparin and aspirin. MATERIALS AND METHODS The case records of 42 diagnosed cases of APAS with pregnancy, over a 3-year period, were studied. The pregnancy outcome in this group was compared before and after treatment with heparin and low-dose aspirin in terms of abortions, intrauterine deaths and live birth rate. The outcome of the present pregnancy in terms of fetal and maternal complications was analyzed. RESULTS The mean age and average parity of women with APAS were 30.1±4.1 years and 3.2±1.2, respectively. Among the treated patients of APAS, 13 (30.9%) had preeclampsia and 9 (21.4%) had intrauterine growth restriction (IUGR). There were 2 (4.7%) intrauterine deaths, 4 (9.5%) missed abortions and 3 (7.1%) abruptio placentae. Women with APAS had a live birth rate of 4.6% before treatment and 85.7% in the index pregnancy after treatment. CONCLUSION Treatment of pregnant women with APAS results in marked improvement in the live birth rate (4.6-85.7%). However, complications like preeclampsia and IUGR occur even after treatment, requiring strict monitoring and timely delivery.

Role of maternal oral hydration in increasing amniotic fluid volume in pregnant women with oligohydramnios

The patho-physiology of decreased amniotic fluid volume is not well understood. Although fetal congenital anomalies such as renal malformations are associated with oligohydramnios, quite often the fetus is structurally normal. Intrauterine growth restriction, post-maturity syndrome, chronic fetal hypoxia are associated with oligohydramnios. It may be responsible for fetal malpresentations, umbilical cord compression, meconium staining, dry labor, increased perinatal mortality and morbidity, and increased operative delivery 1 . Maternal hydration with intravenous fluids have been reported to increase amniotic fluid 2 . A non-invasive method of increasing amniotic fluid would be very useful in the conservative management of such cases during pregnancy and labor. We evaluated the effect of maternal hydration with oral water intake in a prospective study carried out on 50 pregnant women with oligohy-

Society of Fetal Medicine Practice Guidelines for the Second Trimester Anomalies Scan

Ultrasound is now an established tool in the clinical management of pregnancy. Consequent to its major role in clinical decision-making and its remarkable operator dependence, it is necessary to have guidelines for minimum standards of performance of this modality in each area of obstetric ultrasound. The Society of Fetal Medicine guidelines have been developed for use by all the practitioners performing antenatal ultrasound scans. They are intended to provide the entire medical community with standards for the performance of quality ultrasound examinations. Practitioners are encouraged to go beyond these standards in relevant clinical situations. Each guideline in this document has undergone extensive discussion followed by a consensus. In a rapidly evolving technological and research environment, it is imperative to constantly re-evaluate and update these guidelines. Practitioners are advised to be aware of these updates and incorporate these into their daily practice.

First trimester 'retained abortion'--can it be termed 'placenta accreta'?

Morbid adhesions of the placenta-accreta, increta and percreta are very rare before 20 weeks of pregnancy and rarer still in the first trimester. They are usually diagnosed when difficulty is encountered at curettage and are termed ‘retained abortion’. Though hysterectomy is the treatment of choice, attempts at uterine conservation are worthwhile in patients who want to become fertile. Two extremely rare and challenging cases of first trimester missed abortion in nulliparous women, complicated by several unsuccessful attempts at uterine evacuation are described.

Can amniotic fluid distribution predict fetal outcome

Objective: This study was designed to determine whether the distribution pattern of amniotic fluid (AF) within the uterine cavity is related to perinatal outcome. Study design: One‐hundred women in labor with intact membranes underwent a real time ultrasound examination to measure the AF index. Patients were divided into two groups based on liquor distribution. Those with>50% liquor distributed in upper quadrants formed the ‘upper greater’ group whereas the rest of the patients constituted the ‘lower greater’ group. Pregnancy outcome was assessed with respect to incidence of fetal heart rate (FHR) abnormalities, operative delivery, meconium stained liquor, Apgar score<7 at 1 and 5 min and neonatal intensive care unit admissions. Results: A total of 100 patients were evaluated. The ‘upper greater’ group had a higher incidence of cesarean for non‐reassuring FHR (40.74% vs. 9.6%, P<0.001), persistent variable deceleration (14.8% vs. 0%, P<0.001) and bradycardia (25.9% vs. 4.1%, P<0.001). There was no statistically significant difference in the Apgar score<7 at 1 min and neonatal intensive care unit admissions in the two groups. Conclusions: Distribution of less liquor in the lower quadrants of the uterus predisposed to abnormalities in FHR and hence, cesarean section. The distribution pattern did not have a predictive value for the perinatal outcome.