Maternal and Perinatal Outcomes Amongst Nulliparous Singleton Pregnancies Electively Induced at 39 Weeks: A Prospective Observational Study.

Introduction: Given the uncertainty of inducing beyond 39 weeks, we intended to study the maternal and neonatal mortality and morbidity associated with planned elective induction of labour (eIOL) at 390/7 to 396/7 weeks. Objectives: To study the maternal and perinatal outcomes, after eIOL, at 390/7 to 396/7 weeks, amongst nulliparous singleton pregnancies, followed up for the duration of their hospital stay. Methods: All consecutive nulliparous, singleton gestations, undergoing eIOL, at 390/7 to 396/7 weeks, with no plan for caesarean section (CS) or contraindication for vaginal delivery were prospectively recruited. The primary outcome studied was the incidence of CS and neonatal intensive care requirement, and the secondary outcomes studied were induction-delivery interval, incidence of chorioamnionitis, postpartum haemorrhage, meconium aspiration syndrome (MAS), APGAR ≤ 7 at 1 min and neonatal mortality. Results: Amongst the total 304 mothers electively induced at 390/7 to 396/7 weeks, 80 (26.3%) mothers underwent CS and 48 (15.8%) neonates required intensive care. Fifteen (4.9%) babies required respiratory support at birth. The mean induction-delivery interval was 19 h 42 min ± 10 h. There were 9(3%) cases of PPH and no reported cases of chorioamnionitis. Eleven (3.6%) babies had an APGAR < / = 7 at 1 min and 9 (2.9%) had MAS, but there was no maternal or neonatal mortality. Conclusion: Induction of labour at 39 weeks in low-risk nulliparous women did not result in a lower frequency of CS or adverse perinatal outcomes.

Mutation analysis of WNT4 gene in SRY negative 46,XX DSD patients with Mullerian agenesis and/or gonadal dysgenesis- An Indian study.

Developmental disruption of the Mullerian duct and gonads in females leads to Mullerian agenesis and gonadal dysgenesis, respectively. These two structural abnormalities are coming under the 46,XX DSD (Disorders of Sexual Development) classification, the majority of cases the aetiology remains elusive. Without the SRY gene, WNT4 plays a key role in female reproductive structure development. Since there are no studies that explored the involvement of the WNT4 gene in Indian 46,XX DSD patients, we analysed the role of WNT4 in Indian 46,XX DSD patients with Mullerian agenesis and/or Gonadal dysgenesis. In our study, we recruited 103 adolescent girls with primary amenorrhea. After the cytogenetic and SRY gene analysis, we included thirty-two 46,XX DSD patients with Mullerian agenesis and/or gonadal dysgenesis for WNT4 gene mutation analysis. PCR sequencing was performed for all the coding exons of the WNT4 gene. Bioinformatic tools like Mutation Taster, Human Splicing Finder, and miRDB were used. We observed single nucleotide variations in three patients. One patient showed a known synonymous polymorphism (c.861C > T; p.G287G, rs544988174). miRDB data revealed the absence of microRNA regulatory sites in this region. The other two cases carried a nucleotide substitution in intronic regions and did not affect the normal splicing mechanism. In conclusion, we could not find any indication about WNT4 involvement in the disease condition. In the future, WNT4 promoter analysis in these patients and molecular characterization of the WNT4 coding and promoter region in more patients are needed to link WNT4 variants with these structural abnormalities.

Radiotherapy for successful symptom control in recurrent refractory endometriosis: A case report.

ABSTRACT: Endometriosis is a benign gynecological condition which induces a chronic inflammatory process, characterized by the presence of endometrium-like tissue outside the uterus. Treatment options for endometriosis include medical, surgical, or both. Irrespective of the treatment approach, recurrence of symptoms is not rare. We report the use of radiotherapy in a patient with recurrent refractory endometriosis, not responding to conventional treatments. At lower doses, radiotherapy can modulate the inflammatory cascade and can also does ovarian ablation. She was treated using 6MV photons with a four-field box to a total dose of 30Gy in 10 fractions. The pelvic radiotherapy field also included the ovarian remnant. Her symptoms regressed within one week of radiation treatment and is now symptom free for six months, with good quality of life.

Afibrinogenemia Diagnosed During Pregnancy Successfully Managed with Targeted Cryoprecipitate Transfusion: A Case Report.

BACKGROUND: We report a case of afibrinogenemia in a lady, which was detected for the first time during her pregnancy. CASE: A 24-year-old G4A3 was referred as a case of vaginal bleeding, after a cervical cerclage at 14 weeks of gestation. Elastometry targeted correction of coagulopathy was done initially, and targeted cryoprecipitate transfusion was done to maintain her gestation. She underwent induced vaginal delivery at 34 weeks of gestation. Fourteen days postpartum, the mother and child were discharged home well. CONCLUSION: Coagulation factor deficiency should be considered as a rare cause for RPL. Serum fibrinogen level of 50-100 mg/dl during pregnancy seems to be a safe and adequate target to maintain in pregnant patients with afibrinogenemia.

A case of refractory immune thrombocytopenia in pregnancy managed with elthrombopag.

Immune thrombocytopenic purpura is a common acquired autoimmune disorder defined by a low platelet count secondary to accelerated platelet destruction or impaired thrombopoesis by anti-platelet antibodies. Thrombopoietin (TPO)-mimetic drugs such as eltrombopag and romiplostim have been used successfully in many nonpregnant individuals with immune thrombocytopenia (ITP) but studies based on its effects in pregnancy are limited. A 27-year-old multigravida who is a known case of ITP with bad obstetric history was referred to the Department of Obstetrics and Gynecology at 26 weeks of gestation with complaints of mucosal bleeding and recurrent abortions. After 2 weeks of hospital stay, the patient did not respond to treatment with steroid and immunosuppressant. There was a rapid decline in platelet count with mucosal bleeds for which she required frequent platelet transfusions. Due to high costs, short action periods, and other potential maternal and fetal side effects of intravenous immunoglobulin (IVIgG) and anti-D, it was decided that TPO-mimetic drug eltrombopag would be given. After starting treatment with eltrombopag, the patient's platelet count could be maintained between 30,000/µl and 50,000/µl. At 36 weeks of gestation following preterm-induced vaginal delivery, she delivered a male active baby weighing 1.86 kg with an Apgar score of 8/10. After delivery, her platelet count was 60,000/µl. Eltrombopag is a thrombopoietin receptor agonist. It has been assigned to pregnancy category C by the Food and Drug Administration (FDA). There are no adequate and well-controlled studies of use of eltrombopag in pregnancy. In our case, the drug was given in the last trimester of pregnancy and the mother and baby were in good health at the time of discharge from the hospital and during follow-up.

Magnetic resonance imaging of placenta accreta.

Placenta accreta (PA) is a severe pregnancy complication which occurs when the chorionic villi (CV) invade the myometrium abnormally. Optimal management requires accurate prenatal diagnosis. Ultrasonography (USG) and magnetic resonance imaging (MRI) are the modalities for prenatal diagnosis of PA, although USG remains the primary investigation of choice. MRI is a complementary technique and reserved for further characterization when USG is inconclusive or incomplete. Breath-hold T2-weighted half-Fourier rapid acquisition with relaxation enhancement (RARE) and balanced steady-state free precession imaging in the three orthogonal planes is the key MRI technique. Markedly heterogeneous placenta, thick intraplacental dark bands on half-Fourier acquisition single-shot turbo spin-echo (HASTE), and disorganized abnormal intraplacental vascularity are the cardinal MRI features of PA. MRI is less reliable in differentiating between different degrees of placental invasion, especially between accreta vera and increta.