Harsha Gaikwad

Evaluation of Hematological Parameters in Partial Exchange and Packed Cell Transfusion in Treatment of Severe Anemia in Pregnancy

Objectives. Anemia is a major public health problem throughout the world which assumes prominence in pregnant mothers. Patients with severe anemia continue to present themselves at term or in labor. This study was conducted to compare the improvements in hematological parameters of patients receiving partial exchange blood transfusion and transfusion of packed cells without exchange. Methods. One hundred and twenty-five severely anemic antenatal mothers were admitted from outpatient service. Partial exchange transfusion was given to sixty-six patients while fifty-nine received transfusion of packed cells with frusemide cover. Results. The two groups were comparable in terms of age, height, weight, religion, diet, education, occupation of self and husband, and income. Hemoglobin level in Group 1 was comparatively less than Group 2 at prelevel (5.2 ± 1.5 versus 6.6 ± 2.3, P = 0.001) and postlevel (7.2 ± 1.5 versus 8.6 ± 1.8, P = 0.001), respectively, but there was no significant difference between the two modes of transfusion (2.09 ± 1.6 versus 2.01 ± 1.5, P = 0.78). Conclusion. The study produced an equally significant improvement in hematological parameters in partial exchange and packed cell transfusion. Platelet counts were significantly less in partial exchange as compared with packed cell transfusion.

Psychosocial Implications of Stillborn Babies on Mother and Family: A Review from Tertiary Care Infirmary in India

BackgroundWhen a mother loses a baby after the period of viability, there is no way to fathom her grief, neither any words, nor an explanation. It is an unexpected event. Stillbirth presents a situation where the early activation of the grief process primarily in mother is exacerbated by the circumstances surrounding the loss. It thus becomes imperative for the healthcare providers to evaluate the significance of parent’s perception on the loss and the factors contributing to it before the initiation of therapy.ObjectiveTo evaluate the psychosocial impact of stillbirth among mothers and its contributing factors.Materials and MethodsA WHO-funded prospective study was conducted in VMMC and Safdarjung Hospital from September 2015 to August 2016 on all women who gave birth to a stillborn baby, using a questionnaire based on EPDS, after taking their written informed consent. Data were entered on the predesigned proforma and analyzed after applying Chi-square test, keeping a null hypothesis value of 15% for all the variables.ResultsOut of the 709 women who delivered stillborn babies, 645 respondents, who willingly consented to participate, were included in the study. There was a significant relationship between psychosocial impact after perinatal loss and support from caregiver and family.ConclusionMothers with stillborn fetuses should be screened for psychosocial impact and offered support when needed. Appropriate counseling by healthcare providers and continued psychosocial and emotional support by family members must be provided.

Takayasu’s Arteritis in Pregnancy: A Rare Case Report from a Tertiary Care Infirmary in India

Background. Takayasus 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.

Menopause: But Where’s the Pause?

Menopause which is defined as complete cessation of menstruation for twelve months or more is a normal physiological change. It is an important phase in a woman’s life and its association with psychosomatic symptoms is a growing cause of concern. Vasomotor symptoms, sleep disturbances and depressed mood affect a significant proportion of menopausal women. The most common explanation is oestrogen deficiency. Although hot flushes may be distressing, psychosocial factors, including stressful life events have more impact upon mood than does menopause itself. But often these menopause related problems are underreported as most of the women do not come up with their symptoms because of personal and social reasons. Clinicians who interact with women at the time of menopause have an invaluable opportunity that should be utilized. There is not much literature which is available highlighting this aspect. So, a study was undertaken at our tertiary care centre which is one of the Asia’s busiest hospitals to study the prevalence of various psychological, somatic and urinary symptoms in menopausal women. Material and Methods

Giant chorioangioma of placenta: an infrequent placental cause for adverse feto-maternal outcome -

Chorioangioma is a relatively rare benign tumor of placenta arising from chorionic tissue, with incidence being 1 in 100 cases. Giant vascular chorioangiomas render a challenge to obstetricians with their potential critical complications adversely altering feto-maternal outcome. Diagnosis is suspected antenatally by ultrasound and Doppler studies, and is corroborated by histopathology post-delivery. Here we report a pregnancy complicated by a giant placental chorioangioma with polyhydraminos in a young mother, diagnosed prenatally, and associated with deranged liver function tests, culminating into a preterm delivery of a plethoric stillborn fetus, followed by life-threatening postpartum hemorrhage in mother. Also clinical considerations and relevant literature review on prognostic factors affecting obstetric outcome are addressed. A case of giant chorioangioma placenta warrants close antenatal surveillance and institutional delivery as it may have untoward maternal complications as was seen. Vascularization of tumor is a pivotal determining factor of pregnancy outcome.

Analysis of prognostic factors for 5 year survival in surgically treated patients with carcinoma cervix stages IB1, IB2 and IIA

Aim:  To identify pathological and clinical prognostic factors that best predict 5 year survival among patients with early stage cervical carcinoma treated with radical hysterectomy.