The role of anti-Mullerian hormone and other correlates in patients with polycystic ovary syndrome.

BACKGROUND: Anti-Müllerian hormone (AMH) has recently emerged as a promising biomarker for the detection of polycystic ovarian morphology. In polycystic ovary syndrome (PCOS), an elevated level of AMH has been suggested to add value to the Rotterdam criteria in cases of diagnostic uncertainty. In this study, we evaluated the correlation between AMH and PCOS, and the potential role of AMH in PCOS diagnosis. METHODS: A case-control study was performed on a total of 200 females, 100 of which were diagnosed with PCOS as per Rotterdam revised criteria (2003) and 100 as the control (non-PCOS group). Patient medical records were therefore retrieved for clinical, biochemical and ultrasound markers for PCOS diagnosis. Sensitivity, specificity, area under receiver operating characteristic (AUROC) curve, and multivariate linear regression models were applied to analyze our data. RESULTS: Mean serum levels of LH and AMH, and LH/FSH ratio were significantly different between compared groups. In the PCOS group, the mean serum AMH level was 6.78 ng/mL and LH/FSH ratio was 1.53 while those of controls were 2.73 ng/mL and 0.53, respectively (p < .001). The most suitable compromise between 81% specificity and 79% sensitivity was obtained with a cutoff value of 3.75 ng/mL (26.78 pmol/L) serum AMH concentration for PCOS prediction, with an AUROC curve of 0.9691. CONCLUSION: Serum AMH cutoff level of 3.75 ng/mL was identified as a convenient gauge for the prediction of PCOS and an adjuvant to the Rotterdam criteria.

Amp-CKlebsiella-Induced Chorioamnionitis and Associated Abnormalities in Cardiotocography: A Case Report with a Narrative Review.

Introduction: Infections caused by multidrug-resistant organisms are on the rise in obstetric patients. Chorioamnionitis is associated with adverse pregnancy outcomes. If caused by multidrug-resistant organisms, chorioamnionitis is associated with high maternal and fetal morbidity. Due to the paucity of the literature and the challenges associated with their diagnosis, the diagnosis is usually delayed. This often leads to delays in management, and hence, adverse maternal and neonatal outcomes are noted. Important Clinical Findings. The patient presented with prelabour rupture of membranes for three days. She developed chorioamnionitis in labour, which was refractory to broad spectrum antibiotics. Persistent tachycardia with variable decelerations followed by prolonged fetal deceleration was observed in cardiotocography. Delivery of baby was done by cesarean section in the view of pathological findings in cardiotocography. The primary diagnoses, interventions, and outcomes. Based on the placental culture results, Amp-C Klebsiella-induced chorioamnionitis was diagnosed. Ertapenem was commenced after the sensitivity results. Good feto-maternal outcomes were observed. The neonate was admitted to the neonatal intensive care unit and discharged home in stable condition. Conclusions: Cases of multidrug-resistant organisms-induced chorioamnionitis are rarely reported, though they are associated with maternal morbidity and poor neonatal outcome. In cases of chorioamnionitis, caution should be taken in cases that are refractory to broad-spectrum antibiotics, and multidrug-resistant organisms should be suspected and managed to improve pregnancy outcome.

Impact of Early Tracheostomy on Weaning From Ventilation and Sedation in COVID-19 Pregnant and Early Postpartum Patient: Two Case Reports.

Pregnant women are at high risk of coronavirus disease 2019 (COVID-19) complications, including acute respiratory distress syndrome (ARDS) and the need for mechanical ventilation. There is no literature on the optimal strategy for the management of difficult-to-wean pregnant and early postpartum patients. We report two cases of pregnant women with COVID-19 pneumonia and ARDS, who required mechanical ventilation and high doses of analgesia, and sedation with neuromuscular blocking agents to facilitate ventilation and oxygenation. Both patients had a tracheostomy procedure to facilitate weaning from mechanical ventilation and sedation. Shortly after tracheostomy, sedation and analgesia, along with ventilatory support were weaned off. Both patients were discharged home. These cases propose early tracheostomy as a strategy to facilitate weaning from mechanical ventilation and sedation in pregnant and early postpartum patients.

Euglycemic diabetic ketoacidosis in pregnancy with COVID-19: A case report and literature review.

Diabetic ketoacidosis (DKA) is a life-threatening complication of diabetes and is considered a medical emergency. Euglycemic DKA (EKDA) is a variant of DKA with a normal or minimally elevated glucose level <200 mg/dl. The condition can be difficult to diagnose due to the relatively normal glucose levels. Pregnancy, infection, and a low-calorie intake are some of the contributing common etiologies of EDKA. Despite a rapid increase in scientific publications on COVID-19, there are still knowledge gaps regarding the course of COVID-19 in some patient subset. This is especially the case for pregnant women. In this case report, we discuss the course of COVID-19 infection in a pregnant woman with gestational diabetes who developed severe euglycemic diabetic ketoacidosis triggered by various precipitating factors, including starvation, caused by COVID-19 infection and its gastrointestinal effects.

Impact of maternal nationality on caesarean section rate variation in a high-income country.

BACKGROUND: Caesarean section (CS) rates have been reported to differ between immigrants and native-born women in high-income countries. OBJECTIVE: We assessed the CS rate and its relationship with the CS rate in country of nationality and other explanatory factors among women of different nationalities including Qatari women who underwent deliveries at our hospital to generate evidence that will quantify and help explain the observed CS rates in our hospital. METHODS: In this retrospective cross-sectional study conducted at the second-largest public maternity hospital in Qatar, Al-Wakra Hospital (AWH), data for all births delivered in 2019 were retrieved from the hospital's electronic medical records. The CS rates and the crude and adjusted risks of Caesarean delivery for mothers from each nationality were determined, and the common indications for CS were analyzed based on nationality. The association between nationality and Caesarean delivery was examined using binomial logistic regression analysis, with Qatari women as the reference group. The correlation between CS rate in country of nationality and observed CS rates in Qatar was also examined using Pearson's correlation. RESULTS: The study population consisted of 4816 births by women of 68 nationalities, of which 4513 births were by women from 25 countries. The highest proportion of deliveries (n-1247, 25.9%) was by Indian women. The frequency of CS was the highest and lowest among Egyptian (49.6%) and Yemeni women (17.9%), respectively. Elective CS was predominantly performed in women of Arab nationalities; the most common indication was a history of previous multiple CSs. Emergency CS was primarily performed in women of Asian and Sub-Saharan African nationalities; the most common indications were failure to progress and fetal distress. For most nationalities, the CS rate in Qatar was associated with those of the countries of nationality. CONCLUSIONS: The observed CS rates varied widely among women of different nationalities. The variation was influenced by maternal factors and medical indications as well as the CS rates in the country of nationality. We posit that cultural preferences, acculturation, and patient expectations influenced observed findings. More efforts are required to reduce primary CS rates and to help women make the most informed decisions regarding modes of delivery. Key Message: CS rates varied widely among women of different nationalities. The variation was influenced by medical indications, maternal preferences, and CS rate in countries of nationality. The solution to reducing CS rates should be a culturally informed response.

Chorioamnionitis and neonatal sepsis due to extended-spectrum beta-lactamase-producing Escherichia coli infection: a case report.

Chorioamnionitis is an acute inflammation of the membranes and chorion of the placenta typically due to ascending polymicrobial infection in the setting of membrane rupture. It is a common complication of pregnancy associated with significant maternal, perinatal, and long-term adverse outcomes. We present a case of placental infection leading to preterm delivery, severe neonatal sepsis, maternal wound infection, postnatal readmission, and prolonged hospital stay. This virulent infection was caused by multidrug-resistant extended-spectrum beta-lactamase (ESBL)-producing Escherichia Coli (E. Coli), which represent a major worldwide threat according to the Centre for Disease Control and Prevention (CDC). It was managed with appropriate antibiotic therapy, patient-centered approach, and multidisciplinary team involvement that led to favourable maternal and neonatal outcome.

Endometrial polyps and subfertility.

Endometrial polyps are a relatively common finding in infertility patients. They can distort the endometrial cavity, may have a detrimental effect on endometrial receptivity and increase the risk of implantation failure. Although treatment seems to be safe and easy, this may not always be the case if endometrial polyps are diagnosed after starting an in vitro fertilization cycle. This paper reviews the medical literature to provide an evidence-based approach for management of endometrial polyps in subfertile women.