Sheeba Marwah

Misoprostol for medical treatment of missed abortion: a systematic review and network meta-analysis

The efficacy and safety of misoprostol alone for missed abortion varied with different regimens. To evaluate existing evidence for the medical management of missed abortion using misoprostol, we undertook a comprehensive review and meta-analysis. The electronic literature search was conducted using PubMed, the Cochrane Library, Embase, EBSCOhost Online Research Databases, Springer Link, ScienceDirect, Web of Science, Ovid Medline and Google Scholar. 18 studies of 1802 participants were included in our analysis. Compared with vaginal misoprostol of 800 ug or sublingual misoprostol of 600 ug, lower-dose regimens (200 ug or 400 ug) by any route of administration tend to be significantly less effective in producing abortion within about 24 hours. In terms of efficacy, the most effective treatment was sublingual misoprostol of 600 ug and the least effective was oral misoprostol of 400 ug. In terms of tolerability, vaginal misoprostol of 400 ug was reported with fewer side effects and sublingual misoprostol of 600 ug was reported with more side effects. Misoprostol is a non-invasive, effective medical method for completion of abortion in missed abortion. Sublingual misoprostol of 600 ug or vaginal misoprostol of 800 ug may be a good choice for the first dose. The ideal dose and medication interval of misoprostol however needs to be further researched.

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.

Managing dyspnea in pregnancy-an errand uphill: an experience from the critical care obstetric unit of a tertiary care facility in India

Dyspnea or shortness of breath or difficult, labored, consciousness about taking breath is a common symptom during pregnancy that makes even simple everyday activities a major challenge. Around 50% of gravidas, even without history of cardiac or pulmonary disease, experience it sometime during their gestation. These symptoms may be related to physiological changes in cardio-pulmonary, hematopoietic system, increase in ABSTRACT

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.

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.