Postpartum Septic Pelvic Thrombophlebitis in a Tertiary Maternity Hospital in Dubai, UAE.

Septic pelvic thrombophlebitis (SPT) is a well-known condition, yet it remains a rare postpartum complication. It can be divided into two types: deep septic pelvic thrombophlebitis (DSPT) and ovarian vein thrombosis (OVT). In this case series, we present three cases diagnosed with ovarian vein thrombosis that were managed in our tertiary care hospital, Latifa Women and Children Hospital (LWCH), in Dubai, UAE. It is a 440-bed public tertiary care center that specializes in maternal and neonatal services, with a range of 3500 to 4000 deliveries per year. The three cases represent the total number diagnosed with this condition in the period between 2018 and 2022 among the total obstetric population during this period. The three cases developed a fever in the postpartum period, which for several days did not respond to the standard antibiotics used for endometritis. Two cases were following a cesarean section, and the third case was following vaginal delivery complicated with severe postpartum hemorrhage and hysterectomy. The clinical suspicion and awareness of the condition paved the way to reach the proper diagnosis and initiate the therapeutic dose of anticoagulants, along with broad-spectrum antibiotics, in a timely manner. The prompt diagnosis with early intervention led to optimal patient outcomes and prevented the morbidity and mortality associated with this condition.

Takotsubo Syndrome (Broken-Heart Syndrome or Stress Cardiomyopathy) in an Epileptic Pregnant Woman: A Case Report.

Stress cardiomyopathy (Takotsubo syndrome) is a rare and transient cardiac dysfunction that has been reported in pregnant women with multiple triggering conditions. In general, those cases recovered from the acute cardiac insult within a few weeks. We report a 33-year-old 22 weeks pregnant woman, who presented with an episode of status epilepticus and subsequently developed acute heart failure. She had full recovery within three weeks and continued her pregnancy till term. She became pregnant again two years after this initial insult, remained asymptomatic with stable cardiac function and had normal vaginal delivery at term.

Maternal and Fetal Outcome in Pregnant Women With Critical COVID-19 Treated With Tocilizumab in a Tertiary Care Hospital in Dubai.

INTRODUCTION: Pregnancy, complicated by coronavirus disease 2019 (COVID-19), results in higher hospitalization and mortality rate. Pathogenesis of COVID-19 is similar to any other systemic inflammatory condition but results in a cytokine storm of higher magnitude causing severe acute respiratory distress syndrome and multiorgan failure. Tocilizumab, a humanized monoclonal antibody, targets soluble and membrane-bound IL-6 receptors and is used in the treatment of juvenile idiopathic arthritis, rheumatoid arthritis, and cytokine release syndrome. However, studies exploring its role in pregnancy are minimal. Hence, this study was done to study the effect of tocilizumab on maternal and fetal outcomes in critical COVID-19 pregnant women. METHODOLOGY: A retrospective study was conducted on 28 pregnant women with critical COVID-19 who received tocilizumab. Clinical status, chest x-ray, biochemical parameters, and fetal well-being were monitored and documented. The discharged patients were followed up through telemedicine. RESULT: On treatment with tocilizumab, improvement was seen in the number of zones and patterns of chest x-ray, along with 80% reduction in the c-reactive protein (CRP) levels. Based on the WHO clinical progression scale, 20 patients improved by the end of first week, and by the end of first month, 26 patients became asymptomatic. Two patients died during the course of the disease. No fetal adverse effects were noted. CONCLUSION: Based on the encouraging response and as tocilizumab did not impart any adverse effects on the pregnancy, tocilizumab may be administered as an adjuvant to critical COVID-19 pregnant women in their second and third trimesters.

Utility of oral glucose tolerance test in predicting type 2 diabetes following gestational diabetes: Towards personalized care.

BACKGROUND: Women with gestational diabetes mellitus (GDM) are at a seven-fold higher risk of developing type 2 diabetes (T2D) within 7-10 years after childbirth, compared with those with normoglycemic pregnancy. Although raised fasting blood glucose (FBG) levels has been said to be the main significant predictor of postpartum progression to T2D, it is difficult to predict who among the women with GDM would develop T2D. Therefore, we conducted a cross-sectional retrospective study to examine the glycemic indices that can predict postnatal T2D in Emirati Arab women with a history of GDM. AIM: To assess how oral glucose tolerance test (OGTT) can identify the distinct GDM pathophysiology and predict possible distinct postnatal T2D subtypes. METHODS: The glycemic status of a cohort of 4603 pregnant Emirati Arab women, who delivered in 2007 at both Latifa Women and Children Hospital and at Dubai Hospital, United Arab Emirates, was assessed retrospectively, using the International Association of Diabetes and Pregnancy Study Groups (IADPSG) criteria. Of the total, 1231 women were followed up and assessed in 2016. The FBG and/or the 2-h blood glucose (2hrBG) levels after a 75-g glucose load were measured to assess the prevalence of GDM and T2D, according to the IADPSG and American Diabetes Association (ADA) criteria, respectively. The receiver operating characteristic curve for the OGTT was plotted and sensitivity, specificity, and predictive values of FBG and 2hrBG for T2D were determined. RESULTS: Considering both FBG and 2hrBG levels, according to the IADPSG criteria, the prevalence of GDM in pregnant Emirati women in 2007 was 1057/4603 (23%), while the prevalence of pre-pregnancy T2D among them, based on ADA criteria, was 230/4603 (5%). In the subset of women (n = 1231) followed up in 2016, the prevalence of GDM in 2007 was 362/1231 (29.6%), while the prevalence of pre-pregnancy T2D was 36/1231 (2.9%). Of the 362 pregnant women with GDM in 2007, 96/362 (26.5%) developed T2D; 142/362 (39.2%) developed impaired fasting glucose; 29/362 (8.0%) developed impaired glucose tolerance, and the remaining 95/362 (26.2%) had normal glycemia in 2016. The prevalence of T2D, based on ADA criteria, stemmed from the prevalence of 36/1231 (2.9%) in 2007 to 141/1231 (11.5%), in 2016. The positive predictive value (PPV) for FBG suggests that if a woman tested positive for GDM in 2007, the probability of developing T2D in 2016 was approximately 24%. The opposite was observed when 2hrBG was used for diagnosis. The PPV value for 2hrBG suggests that if a woman was positive for GDM in 2007 then the probability of developing T2D in 2016 was only 3%. CONCLUSION: FBG and 2hrBG could predict postpartum T2D, following antenatal GDM. However, each test reflects different pathophysiology and possible T2D subtype and could be matched with a relevant T2D prevention program.