Vanita Suri

Maternal and perinatal outcome in rheumatic heart disease

Objectives: To study the maternal and perinatal outcome of pregnancies complicated by rheumatic heart disease. Methods: A retrospective study was carried out in the cardio‐obstetric clinic of the Postgraduate Institute of Medical Education and Research, Chandigarh (India) over a period of 13 years (1987–1999) involving 486 pregnant patients with rheumatic heart disease. Maternal and perinatal outcome was reviewed. Results: Three hundred and four patients (63.3%) had single valve involvement and mitral stenosis was the most predominant lesion (89.2%). One hundred and seventy one (38.6%) patients had undergone surgical correction prior to the onset of pregnancy. One hundred and thirteen patients (22.6%) were identified as NYHA class III–IV. Mitral valvotomy was performed during pregnancy in 48 patients. The incidence of preterm birth and small for gestational age newborns was 12% and 18.2%, respectively. There were 10 maternal deaths, of which eight patients were NYHA III and IV. Conclusions: Rheumatic heart disease in pregnancy is associated with significant maternal and perinatal morbidity in NYHA class III–IV patients.

Immunogenicity and safety of human papillomavirus‐16/18 AS04‐adjuvanted cervical cancer vaccine in healthy Indian women

Aim:  India has the highest number of annual incident cases and mortality rates for cervical cancer worldwide. This study was conducted to assess the immunogenicity and safety of human papillomavirus (HPV)‐16/18 AS04‐adjuvanted cervical cancer vaccine in healthy Indian women aged 18–35 years old.

Comparison of extraamniotic Foley catheter and intracervical prostaglandin E2 gel for preinduction cervical ripening

Background.  The success of induced labor depends on the degree of ripening of cervix. Pharmacological preparations are in widespread use for cervical ripening but are not free from side‐effects and complications. Mechanical methods, i.e. the use of Foley catheter balloon, though effective have not gained much popularity because of the fear of infection. Therefore, this study has been conducted to prove the efficacy and safety of extraamniotic Foley catheter balloon and to compare it with intracervical prostaglandin E2 (PGE2) gel.

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.

Tocolytic therapy in conservative management of symptomatic placenta previa

Objectives: To study the effect of ritodrine therapy on maternal and perinatal outcome in cases of symptomatic placenta previa being managed conservatively. Methods: A prospective, randomized controlled clinical trial was made of a total of 60 women whose pregnancies ranged from 28 through 34 menstrual weeks who were randomly allocated to the two study groups using Tippets random number table. Of these women, 30 were included in the study group where tocolysis with ritodrine was given whereas the other 30 in the control group did not receive tocolysis. Prolongation of pregnancy and birth weight of the newborn were evaluated. The unpaired t‐test and chi‐square test were used for statistical analysis. Results: Use of tocolysis in symptomatic placenta previa was associated with significant prolongation of pregnancy (25.33 vs. 14.47 days, P<0.05) and difference in birth weight (2270 g vs. 1950 g, P<0.05). There was no observed statistical difference between the two groups with regard to number of episodes of hemorrhage after admission, total amount of blood loss during stay in hospital, number of blood transfusions and maternal complications due to tocolysis in the study group. Conclusions: The present prospective study suggests that ritodrine hydrochloride in patients with symptomatic placenta previa tends to prolong the pregnancy and result in an increase in birth weight of the babies without causing any adverse effect on the mother and fetus.

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.

Pre‐induction sonographic assessment of the cervix in the prediction of successful induction of labour in nulliparous women

Objective:  To compare the efficacy of ultrasonographic cervical assessment with Bishop score before induction of labour in predicting the success of labour induction in nulliparous women.

Maternal and perinatal outcome in idiopathic thrombocytopenic purpura (ITP) with pregnancy.

Background. Idiopathic thrombocytopenic purpura commonly affects women of childbearing age and is associated with maternal and fetal complications. Management of a pregnant patient is difficult and requires combined care of obstetrician and a neonatologist. We report our experience of idiopathic thrombocytopenic purpura during pregnancy during the last 7 years. Method. A retrospective study over the 7‐year period 1997–2003 was carried out in the Department of Obstetrics and Gynaecology in the Postgraduate Institute of Medical Education and Research, Chandigarh, India. The course of pregnancy, disease and perinatal outcome of 19 pregnancies in 16 patients with idiopathic thrombocytopenic purpura was studied. Results. Out of 16 patients with idiopathic thrombocytopenic purpura, eight were already diagnosed while the other eight were diagnosed during pregnancy. Five patients diagnosed during pregnancy had severe thrombocytopenia, and four of them showed hemorrhagic manifestation. Nine patients required steroids during pregnancy. Two patients received immunoglobulin therapy. During the antenatal period one patient developed pre‐eclampsia and one patient had gestational diabetes mellitus. Both of these patients were on steroids. There was no postpartum hemorrhage or maternal death. None of the neonates had bleeding complication, irrespective of mode of delivery. Conclusion. Pregnant patients with idiopathic thrombocytopenic purpura have generally good maternal and perinatal outcomes.

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.