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  • ISSN: 2333-6439
    Volume 9, Issue 1
    Research Article
    David Ruiru, Simon Byonanuwe*, Benson Oguttu, and Emmanuel Nzabandora
    We established the severity patterns and determinants of thrombocytopenia among women delivering at Kampala International University Teaching Hospital (KIUTH), to guide us on future interventions. This was a three months cross-sectional study conducted in the months of May 2019 to August 2019 at KIUTH. A total of 386 participants were consecutively enrolled. Interviewer administered questionnaires and laboratory result forms were used to collect data. Binary logistic regression was conducted to identify the determinants of thrombocytopenia. All data analyses were conducted using STATA version 14.2. Majority of the women had mild thrombocytopenia 34 (55.7%), followed by moderate thrombocytopenia 23 (37.7%), and then severe thrombocytopenia 4 (6.6%). The determinants of thrombocytopenia at this hospital were hypertension in pregnancy (aOR: 18.9, 95% CI: 8.8-43.13, p<0.001), HIV positive status (aOR: 21.2 95% CI: 5.15-87.56, p< 0.001), young age (aOR: 4.3, 95% CI: 1.17–15.94, p=0.028) and anaemia in pregnancy (aOR: 4.48, 95% CI: 1.3-15.5, p=0.018). Majority of the women who deliver at KIUTH have mild-to-moderate thrombocytopenia. Early recognition and treatment of the above determinants could go a long way towards preventing thrombocytopenia at this facility.
    Sneha Mishra* and Krishna Agarwal
    Introduction: SGA foetuses with normal Dopplers are not at risk of IUD .However, there is lack of consensus about timing of delivery of SGA foetuses. Clinicians commonly induce all SGA pregnancies at 37 weeks. Expectant management of SGA foetuses beyond 37 weeks is not well studied.   
    Methods: We followed up women with clinically suspected growth restriction with foetal biometry, doppler and biophysical profile. Pregnancies with foetal AC between 10 th to 3 rd centile with normal Dopplers were recruited in the study group. The women were allowed to go in spontaneous labour till 39+6/7 weeks or were induced at 39+6/7 weeks. The outcome of such cases was compared with controls who were induced at 37+0/7 weeks. 
    Results: Spontaneous labour occurred in 42% subjects in study group whereas in control group all were induced. Mean gestation at delivery in the study group was increased (39.57 ± 0.71 vs 37.0 ± 0.0, p value<0.001). Almost 81% of the subjects in study group delivered after 39 weeks. The rate of caesarean section was significantly lower in study group (3% vs 22%, p value-0.024). Also, the risk of intrapartum foetal distress was lower in study group (3/36 vs 1/36).The mean birth weight in the study group was higher (2426.5 ± 154.1gms vs 2297.9 ± 101.4gms, p value<0.001). 
    Conclusions: Expectant management of SGA pregnancies with normal Doppler parameters leads to a significant increase in gestational age at birth and the mean birthweight and a significant reduction in caesarean section rate.
    de Kruijf P*, Naji S, Krijnen C, Jespersen J, and Kluft C
    The use of combined oral contraceptives has been associated with an increased risk of thromboembolic disease. Current in vitro tests are focusing on one or some sets of multiple factors but are not really pharmacodynamic tests. In this report we present thrombodynamics, which are an elegant in vitro analysis that resembles in vivo coagulation on a prothrombotic surface and gives insight in the spatial dynamics of the formation of a fibrin clot and thrombin generation. The effect of the use of three different types combined oral contraceptives, belonging to either the 2nd or 3rd generation, on the thrombodynamic parameters have been investigated. Data show that fibrin clot formation and thrombin generation are increased after 6 months treatment of combined oral contraceptives. Furthermore, with thrombodynamics it is possible to identify the ‘high hemostatic responders’ including multiple factors, which may have the highest risk to develop thrombogenic effects while using combined oral contraceptives.
    Victoria R. Greenberg*, Olga Grechukhina, Jennifer Cate, Marie-Louise Landry, Christian M. Pettker, and Katherine H. Campbell
    Objective: To evaluate relationships between cycle threshold values and COVID-19 presentations and clinical courses in women presenting for childbirth. Cycle threshold values from polymerase chain reaction (PCR), testing are inversely proportional to viral burden and may be important predictors of disease state and infectivity risk.
    Design: Retrospective cohort study.
    Setting: Three Yale-New Haven Health Hospitals between 4/2/2020-5/14/2020.
    Population: Women presenting for childbirth who underwent SARS-CoV-2 PCR testing.
    Methods: Electronic health records were reviewed for socio-demographics, medical comorbidities, pregnancy and postpartum course, and COVID-19 symptoms and exposures. Records of SARS-CoV-2 positive women were reviewed for symptom onset, duration, and relation to test timing, disease course, and neonatal SARS-CoV-2 results.
    Main Outcome Measures: SARS-CoV-2 real-time PCR cycle threshold values from positive tests were compared between asymptomatic and symptomatic women and in relation to disease severity. In women with symptomatic COVID-19, cycle threshold values were evaluated as a function of time since symptom onset.
    Results: 1,210 women gave birth during the study period with 84 (6.9%), positive for SARS-CoV-2. Higher cycle threshold values were seen in asymptomatic SARS-CoV-2 positive patients (8/38 (21.1%), of asymptomatic women had cycle threshold <30 compared to 22/32 (68.0%), of symptomatic women, p<0.0001). In symptomatic women, values increased as time from symptom onset increased.
    Conclusion: This study demonstrates higher cycle threshold values in asymptomatic patients and symptomatic patients tested remote from symptom onset, signifying older infections and detection of lower levels of viral RNA. Assessment of standardized cycle threshold values may help to understand disease characteristics and progression.
    Case Report
    Nagashree Undinti* and Vasanthi D
    Pregnancy is a hyper coagulable state due to increased procoagulant factors. Almost 50% of them with thrombotic event have congenital or acquired thrombophilia. APLA- Antiphospholipid antibodies found in 2.2 to 4% of normal pregnancies. Presence of additional prothrombotic risk factors in APLA positive individuals influences thrombosis risk. In pregnancy, risk of deep venous thrombosis increases 5-10 times that of normal and in case of cesarean section, risk increases to 5-10 folds. We here by present a known case of primigravida with prior history of deep venous thrombosis, Antiphospholipid antibodies borderline with postpartum thrombosis after 8 weeks. The aim to highlight this case report is that patients with thrombosis always need proper follow up. Pregnancy is associated with complications due to its hypercoagulable state. The importance of antenatal, postpartum thrombosis and their follow up should be highlighted. Patient should be educated about the importance of compliance of the medication.
    Research Article
    Gabkika Bray Madoué*, Foumsou Lhagadang, Souam Nguele Sile, and Essomba Jacques Serge Zamé
    Intrauterine fetal death is the spontaneous cessation of fetal heart activity from gestational term ≥ 14SA.
    Objective: To analyze the risk factors in order to improve the prognosis of patients.
    This was a descriptive and prospective study for a period of one (1) year, from 16 October 2018 to 15 October 2019, performed in N’Djamena Mother and Child University Hospital about intra uterine fetal death: epidemiological aspects and maternal prognosis. All patients admitted intra uterine death (term ≥ 14 SA) who agreed to participate in the study were included.
    The frequency of IUFD was 2.6%. The age group of 20-24 years was the most represented with 31%. The majority of patients (67.3%), was referred. Main consultation’ reasons was absence of fetal movement with 21%. Malaria was the main etiology of IUFD with31%. The majority of patients had had induced labor (84.5%), versus 15.5% with spontaneous labor. Means used for induction were: misoprostol (63.6%), ocytocin (17.3 %,), Balloon (3.6%). The majority of patients (94.6%) delivered by the vagina. Main complications of IUFD noted were: anemia (11.8%), amniotic infection (9.1%), Hemorrhage (4.5%), Clot disorder (3.6%). The maternal lethality rate was 3.6%.
    Intra uterine fetal death is a frequent pathology in our regions. Main cause of IUFD is malaria. The treatment is often based on induction of labor with misoprostol.
    Anshul Pahwa*, Sushma Gore, Nishant D. Goyal, and Vrushali Nandre
    Cancer of the cervix is an increasing health problem and an important cause of mortality in women worldwide.
    Aims: To screen women for cervical cancer with help of PAP smear for early detection.
    Materials and methods: The study was conducted on 320 women attending Gynaecology OPD for different reasons over period of six months from June 2019 to November 2019. Patient were provided appropriate information regarding the pap smear test and its implications, Consented patient underwent Pap smear followed by cytological evaluation,
    Results: None of the participant had pap smear test done earlier in their life. Mean age of participants was 36.2 years with most common presenting complain being leucorrhea. Cytological examination was done in all the 320 women who were included in the study, 92 (28.7%), smears were reported as NILM,110 (34.37%), were reported as inflammatory smear, 20 (6.25%), were reported as LSIL and 12 (3.75%), were reported as HSIL.
    Conclusion: Pap smear is simple, safe, effective and economical screening tool for cancer cervix. Detection of abnormal epithelial cells at an early stage helps in better patient management and reduce morbidity and mortality. In low resource settings where women are not compliant for regular clinical visits, every patient should be made aware about the availability of test which can detect cancer cervix in its precursor stage. Moreover, PAP smear test should be offered to every patient attending gynaecology of age group 21-65 years.
    Hiwot Berhanu, Muluneh Ayele, and Daniel Geleta*
    Background: Cesarean section, the most frequent abdominal surgery among adults, is rapidly growing and currently occurs in 20 million of deliveries worldwide each year. The indications and complications of cesarean section are unevenly distributed and unpredictably change. Therefore, this study aims to identify the contemporary cesarean section indications and complications among mothers and their newborns in Durame General Hospital.
    Methods: A three year retrospective cross-sectional study was conducted by reviewing maternity data at Durame General Hospital from July 1, 2015, to July 1, 2017. The data were obtained from records of mothers who underwent caesarian-section during the specified period. A total of 255 samples were estimated using a single proportion formula and randomly selected using a serial number of the registration log. Data were abstracted using a semi structured and pretested questionnaire. The collected data were entered into Epi info software and transported to SPSS software version 22 for analysis, and finally, the descriptive outcomes of the study were displayed by figures, tables & graphs.
    Result: The study has enrolled a total of 255 study participants whose mean age was 26.87 (SD ± 6.3) years. Cephalo-pelvic disproportion was the leading indication for cesarean-section (40.0%), followed by fetal distress (29.9%) and Mal-presentation (17.2%). After cesarean delivery, 16.1% of neonates and 6.7% of mothers were reported to suffer complications. The most complication of the neonates and mothers in the area were Birth Asphyxia (6.3%), and wound infection (2.7%), respectively.1.4. Conclusion and recommendations
    The incidence of caesarian delivery was higher in this hospital particularly for CPD leading to either maternal or newborn complications. Therefore, health care service providers jointly with the community & government should work to recognize the status of pregnancy at the early stage of labor to anticipate problems early.
    Nidhi Sharma*
    Aims and objectives: This study was to done to find the feto-maternal outcome when universal screening for COVID -19 was done in pregnancy. The effects of COVID-19 on placental histology and any evidence of vertical transplacental transmission were also investigated.
    Materials and Methods: A total of 850 pregnant women were screened from April 2020-July 2020 Eighty nine mothers were found positive for covid-19 with RTPCR. All pregnancies with covid 19 positive screen were admitted. 30 women were referred to labour room for intrapartum care and their feto maternal outcome was studied.
    Results: Covid -19 pregnancy is associated with miscarriages, preterm labour and intrauterine deaths. Placental lesions commonly observed are perivillous fibinous exudates, microthrombi and microinfracts. All newborns were covid negative tested by RT-PCR and hence transplacental transfer is not recorded in this preliminary report.
    Conclusion: The placenta acts as a barrier against transmission of COVID -19, though placental affection with microthrombi, infarcts and perivillous fibrosis were evident in almost all placenta in Pregnancy with Covid -19.
    Anshul Pahwa*
    Background: Amniotomy is one of the most commonly performed obstetric procedure with conflicting results.
    Aim: To evaluate and compare the effect of amniotomy with spontaneous rupture of membranes on labour, maternal and perinatal outcome.
    Methods: 200 Primipara at term with singleton uncomplicated pregnancy with spontaneous onset of labour were enrolled under the study. Cases were randomized by the chit box system to either the study group (ARM group) or control group (SRM group).Study group were offered amniotomy at cervical dilatation of 4 cm. Prior to Amniotomy, fetal lie, presentation, engagement of head, fetal heart sounds were noted. Labour progress of both the groups were monitored with the help of the partogram.
    Results: The mean duration of labour from randomization to delivery in amniotomy group was 3.24± 2.17 hours as compared to 4.4 ± 1.07 hours in the control group, the difference being statistically significant(p value<0.001). 22% of the patients in the amniotomy group required augmentation with oxytocin as compared to 38% in the control group (P value<0.05). Both the groups were comparable with respect to mode of delivery, indications of ceaserean section, mean birth weight, APGAR score at 5 mins, NICU admissions.
    Discussion: Amniotomy reduces the duration of first stage of labour, with no impact on second and third stage of labour and neonatal outcome.
    Conclusion: Though Amniotomy is effective in reducing the length of labour and requirement of oxytocin augmentation, it confers no added advantages with respect to other maternal and neonatal outcomes. Selective rather than routine amniotomy might prove to be more beneficial.
    Research Article
    Amal Alsalamah*, and Sajida Ajjawi
    Introduction: The management of women with pregnancy of unknown location (PUL), can vary significantly and often lacks a clear evidence base. This study aims to improve the diagnosis and management of PUL by evaluating ultrasound images using specific criteria describing the gestation sac.
    Method: Retrospective study. Data collected from the medical records for pregnant patients at initial visit to EPU. Data underwent specific ultrasound image criteria in reporting empty GS and describing deciduae signs.
    Result: A total of 69 cases were reviewed and 68 showed empty GS in the initial visit. There were three reports that described GS with DD signs sufficiently. After the image review process, GS DD signs were noted in 25 (69%), cases, one DD sign in 12 (85%), whilst 4 (44%), cases did not demonstrate any DD signs. Moreover, the sensitivity rate of the presence of DD signs and viability as the final outcome was 87.5% whereas specificity was 22.2%.
    Conclusion: A well written ultrasound report considering specific criteria in describing intrauterine sac would help in decreasing numbers of PUL from initial visits and subsequently reduce the number of un-necessary laparoscopy and βHCG tests.
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