Seema Chopra

Pregnancy in Patients With Systemic Lupus Erythematosus

Summary: We reviewed the obstetrical performance and outcome of 15 pregnancies in patients with systemic lupus erythematosus (SLE) (study group) and compared them with 45 age and parity‐matched normal pregnancies (control group). Eleven women (73.8%) were in remission phase and 4 (26.7%) had active disease at the time of conception. The time interval between disease diagnosis and the index pregnancy was 4.2 ± 2.5 years. Two patients with renal involvement had lupus flare‐up during the antenatal period. There was no case of lupus flare‐up in the postpartum period. Gestational age at delivery was significantly lower in SLE patients (35.9 ± 2.5 weeks) compared to the control group (37.4 ± 2.2 weeks). The incidence of intrauterine growth retardation was significantly higher in the SLE patients (40%). There was no case of neonatal lupus or congenital heart block.

Severe anaemia in pregnancy: A tertiary hospital experience from northern India

Anaemia is a major health problem among woman of reproductive age group, particularly in developing countries. We undertook this study to determine the maternal and perinatal outcome in patients with severe anaemia in pregnancy, with a haemoglobin concentration of <7 g/dl. The in-hospital data were analysed for 12 months between January 2007 and December 2007 and 2.15% (n = 96) of women were found to have severe anaemia. Out of these, 18.75% had pre-term premature rupture of membranes and 5.12% of all deliveries were pre-term. Hypertensive diseases of pregnancy were seen in 17.7%; abruption in 3.12% and 9.37% had congestive cardiac failure. Postpartum haemorrhage was seen in 25.5% of the patients and 8.33% had puerperal pyrexia. Fetal distress was seen in 26% of and 33.33% had small for gestational age neonates; there were 16.66% stillbirths and 4.16% neonatal deaths. Of the 96 severely anaemic women, six died after admission. Our study shows that efforts must be taken towards safe motherhood and spreading awareness about the various consequences of anaemia, which is usually preventable with early correction.

Pregnancy and Takayasu arteritis: A single centre experience from North India

Aim:  Takayasus syndrome is a chronic inflammatory arteriopathy of unknown origin which primarily affects women of reproductive age. We report the course and outcome of 37 pregnancies in 15 women with Takayasu arteritis during the period 1999–2008.

Pregnancy Outcome in Hyperthyroidism: A Case Control Study

Background: Data comparing pregnancy outcome in hyperthyroid women with euthyroid women are scarce. Hence, this study was carried out to assess the maternal and fetal outcome in pregnant women with hyperthyroidism to ascertain the effect of disease on pregnancy. Methodology: This retrospective study was conducted over a period of 28 years. We compared the maternal and fetal outcomes of 208 hyperthyroid women with 403 healthy controls, between women with well-controlled and uncontrolled disease and amongst women diagnosed with hyperthyroidism before and during pregnancy. Results: Maternal outcome: women with hyperthyroidism were at increased risk for preeclampsia (OR = 3.94), intrauterine growth restriction (OR = 2.16), spontaneous preterm labor (OR = 1.73), preterm birth (OR = 1.7), gestational diabetes mellitus (OR = 1.8), and cesarean delivery (OR = 1.47). Hyperthyroid women required induction of labor more frequently (OR = 3.61). Fetal outcome: newborns of hyperthyroid mothers had lower birth weight than normal ones (p = 0.0001). Women with uncontrolled disease had higher odds for still birth (OR = 8.42; 95% CI: 2.01-35.2) and lower birth weight (p = 0.0001). Conclusions: Obstetrical complications were higher in women with hyperthyroidism than normal women. Outcome was worsened by uncontrolled disease. Women with pregestational hyperthyroidism had better outcomes than those diagnosed with it during pregnancy.

Pregnancy outcome in women with autoimmune hepatitis

IntroductionAutoimmune hepatitis (AIH) is a chronic disease of unknown cause, characterized by progressive hepatocellular inflammation and necrosis, frequently leading to cirrhosis. AIH usually affects young women and may influence fertility and pregnancy in them. Nearly 200 pregnancies have been reported so far in the world literature in women with AIH, and no definite guidelines have been established. We hereby report our experience of four pregnancies in women with definite diagnosis of AIH.Materials and methodsWe studied the maternal and perinatal outcome of four women with AIH. The medical history was recorded in detail. The pregnancies were allowed to continue with careful fetal and maternal surveillance. Antenatal complications, disease course during pregnancy, intrapartum maternal fetal events, mode of delivery, and perinatal outcome were noted.ResultsAll four patients had preterm labor: three had vaginal delivery and cesarean was done in one due to breech presentation with preterm rupture of membranes. All the infants were live born with birth weight appropriate for gestational age and were born with good Apgar scores and no congenital malformation. The incidence of post partum hemorrhage was 25% and so was the maternal mortality.ConclusionSuccessful pregnancy outcome in patients with well-controlled AIH seems to be a realistic expectation with careful monitoring jointly by the Obstetricians and Hepatologists, especially in the post partum period. Steroids seem to be the safe alternative as immunosuppressant therapy although azathioprine has also been seen to be generally safe for mother or baby.

Mechanical valve prosthesis and anticoagulation regimens in pregnancy: a tertiary centre experience

OBJECTIVE This study was undertaken to analyze the maternal and perinatal outcome in women with prosthetic heart valves on different anticoagulant regimens. STUDY DESIGN A retrospective chart review of pregnancies in 40 women with mechanical valve prostheses at a tertiary referral centre from 1997 to 2010. The main outcome measures were major maternal complications and perinatal outcome. RESULTS The valves replaced were mitral (67.5%), aortic (15.0%), or both (17.5%). Forty-nine pregnancies (72.1%) resulted in live births, 3(4.4%) had stillbirths, and 13(19.1%) had spontaneous abortions and 1(1.4%) underwent therapeutic abortions. The live birth rate was higher in women on heparin (78.3%) compared with those on warfarin (66.9%). There were 2 maternal deaths due to acute mitral valvular thrombosis while on acenocoumarol in the second trimester. Hemorrhagic complications occurred in 3 patients on heparin in the postpartum period, 2 of whom required transfusion. In addition one patient who was on acenocoumarol developed secondary hemorrhage. CONCLUSION No anticoagulant regimen can be said to be entirely safe for use during pregnancy as there is a degree of risk with each regimen. Further larger studies are needed to come up with sufficient evidence-based recommendations for the best possible management of such patients to reduce the maternal risks after mechanical heart valve replacement without compromising fetal outcome.

Maternal complete heart block in pregnancy: analysis of four cases and review of management.

Aim:  Maternal complete heart block (CHB), which manifests for the first time during pregnancy and peurperium, poses a challenge to treating physicians. We present here four cases that were diagnosed during pregnancy and peurperium, and we discuss their management issues.

Retrospective analysis of outcome of pregnancy in women with congenital heart disease: single-centre experience from North India.

Objective: To study maternal and perinatal outcome in congenital heart disease (CHD) and to compare outcome between cyanotic and acyanotic CHD.

Extra hepatic portal vein obstruction and pregnancy outcome: Largest reported experience

Aim:  Evaluate pregnancy outcome in women with extra hepatic portal vein obstruction (EHPVO).

Rudimentary horn pregnancy: Prerupture diagnosis and management

A unicornuate uterus with a rudimentary horn is a rare mullerian abnormality which may cause many gynecological and obstetrical complications. Rupture of pregnant rudimentary horn in the second trimester is the usual presentation, resulting in maternal morbidity and even mortality.