Correction to: Postpartum Collapse Subsequent to Catatonia in a Female with COVID-19 Infection: A Rare Entity Visited.

[This corrects the article DOI: 10.1007/s13224-022-01737-5.].

SCOPE: Surveillance of COVID-19 in pregnancy- results of a multicentric ambispective case-control study on clinical presentation and maternal outcomes in India between April to November 2020.

OBJECTIVE: To determine the clinical manifestations, risk factors, treatment modalities and maternal outcomes in pregnant women with lab-confirmed COVID-19 and compare it with COVID-19 negative pregnant women in same age group. DESIGN: Multicentric case-control study. DATA SOURCES: Ambispective primary data collection through paper-based forms from 20 tertiary care centres across India between April and November 2020. STUDY POPULATION: All pregnant women reporting to the centres with a lab-confirmed COVID-19 positive result matched with controls. DATA QUALITY: Dedicated research officers extracted hospital records, using modified WHO Case Record Forms (CRF) and verified for completeness and accuracy. STATISTICAL ANALYSIS: Data converted to excel files and statistical analyses done using STATA 16 (StataCorp, TX, USA). Odds ratios (ORs) with 95% confidence intervals (CI) estimated using unconditional logistic regression. RESULTS: A total of 76,264 women delivered across 20 centres during the study period. Data of 3723 COVID positive pregnant women and 3744 age-matched controls was analyzed. Of the positive cases 56·9% were asymptomatic. Antenatal complications like preeclampsia and abruptio placentae were seen more among the cases. Induction and caesarean delivery rates were also higher among Covid positive women. Pre-existing maternal co-morbidities increased need for supportive care. There were 34 maternal deaths out of the 3723(0.9%) positive mothers, while covid negative deaths reported from all the centres were 449 of 72,541 (0·6%). CONCLUSION: Covid-19 infection predisposed to adverse maternal outcomes in a large cohort of Covid positive pregnant women as compared to the negative controls.

Postpartum Collapse Subsequent to Catatonia in a Female with COVID-19 Infection: a Rare Entity Visited.

Postpartum collapse is a life-threatening condition caused by obstetrical and non-obstetrical events. In this case report, we discuss a case of postpartum collapse in COVID-19-positive woman who required intensive care and mechanical ventilation for two days. After confusing collision of many provisional diagnoses soldiering for three days, she was ultimately diagnosed with malignant catatonia. Targeted therapy with lorazepam challenge resulted in drastic improvement, and she was discharged with her baby in healthy condition.

The placental pathology in Coronavirus disease 2019 infected mothers and its impact on pregnancy outcome.

INTRODUCTION: This study aims at observing placental pathologies in COVID-19 infected women, and analyzing its impact on pregnancy outcome. METHOD: This is a descriptive-analytical study done at a tertiary centre of Northern India. All COVID-19 positive pregnant women with gestational age ≥20 weeks, with placental histopathological reporting, were included in this study. A total of 173 COVID-19 pregnant women were included in the study. RESULTS: Placental abnormalities were noticed in 49·16% of total 179 placentae examined. Maternal vascular malperfusion (27·93%) was the most observed placental pathology followed by villous fibrin deposits (22·90%), fetal vasculopathy (16·75%), and acute inflammation (6·70%). Stillbirths were 22 and NICU admissions were seen in 50 neonates. Abnormal placental abnormalities led to higher stillbirths (p value 0·011) and lower Apgar scores at 1 and 5 min (p-value 0·028; p-value 0·002, respectively). Intervillous fibrin deposits had higher risk associated with lower Apgar score at 1 and 5 min [RR 2·05 (95% CI 1·21-3·48, p-value 0·010) and RR 5·52 (95% CI 2·58-11·81, p-value <0·001), respectively]. RP clot/hemorrhage was also associated with lower Apgar score at 1 and 5 min [RR 2·61 (95% CI 1·52-4·49, p-value 0·002) and RR 3.54 (95% CI 1·66-7·55, p-value 0·001), respectively]. DISCUSSION: Placental abnormalities in COVID-19 infection were associated with significant higher incidence of unexplained stillbirths, and lower Apgar scores. Although, this is the largest descriptive-analytical study done so far, comparative studies are required to draw a clear conclusion regarding the impact of COVID-19 infection on human placenta and its effect on pregnancy outcomes.

Post Caesarean Section Deep Pelvic Abscess: CT Guided Transgluteal Drainage.

Organ space surgical site infection (SSI), in itself, is a problematic condition for the surgeon and also adds pain and misery to the patient. If it happens along with deep pelvic collection, it further increases the risk of sepsis to the patient. Untreated abdominal or pelvic abscesses are associated with high mortality. This outcome is improved due to advances in image-guided percutaneous interventional techniques. The aim is to drain the collection with minimal morbidity to the patient. We report a case of deep surgical site infection following caesarean section in a COVID-19 positive patient managed with minimal intervention.

Characteristics and outcomes of parturients with COVID-19, admitted to a critical care unit: A single-center retrospective observational study.

Background: Data on outcomes of coronavirus disease 2019 (COVID-19) in pregnancy are scarce, although they represent a unique physiological state affecting both the mother and child. We present collated data from a tertiary care center in North India, encompassing the outcome, clinical characteristics, and management of these patients. Materials and Methods: Parturients ≥ 18 years old, with COVID-19 reverse transcriptase polymerase chain reaction positive for severe acute respiratory syndrome coronavirus 2, requiring intensive care unit (ICU) admission at a tertiary care hospital were included. Data were retrospectively collected from April 2020 to November 2021. Results: In all, 26 parturients were admitted to ICU with COVID-19. Five patients were admitted during the first wave, and all were asymptomatic. Twenty-one patients presented during the second wave (March 2021 onward), among which four were asymptomatic and 17 symptomatic (all with severe pneumonia). Three patients presented in the second trimester, all with critical disease, out of which one did not survive. Two patients had twin gestation, and others were singleton pregnancies. Seven patients (27%) were primigravida, and five patients (19.2%) had more than third pregnancy. Twenty critically ill women (77%) delivered during the hospital stay. Six patients died during the second wave, and four deaths (66.7%) were because of COVID-19 acute respiratory distress syndrome (ARDS). Conclusions: The number of admissions and mortality related to COVID-19 ARDS was higher in the second wave than in the first. We report the safe use of remdesivir and tocilizumab in our patients.

Ruptured Rudimentary Horn Pregnancy: Delayed Diagnosis.

Developmental anomalies of the genital tract result from defective fusion and absorption of various parts of Mullerian ducts in fetal life. Rudimentary horn pregnancy is a rare occurrence of one in 76,000 and one in 160,000. We present a case of a 24-year-old primigravida with ruptured rudimentary horn pregnancy initially managed in the line of an intrauterine pregnancy with severe anemia. Hemodynamic instability made us suspect ruptured rudimentary horn pregnancy and lifesaving laparotomy was performed for the same. A 1.5-liter hemoperitoneum was encountered with a right ruptured rudimentary horn. Multiple adhesions were present with necrotic tissue adherent and clumped together as tubo ovarian mass. Resection of the rudimentary horn was performed. We report this case to emphasize the need to consider rare uterine anomalies as a possibility in patients presenting with acute abdomen in early pregnancy. Obstetricians should consider these rare entities in the differential diagnosis to provide efficient management of these cases.

Prevalence and Pregnancy Outcome of Mullerian Anomalies in Infertile Women: A Retrospective Study.

BACKGROUND: Uterine anomalies arise if there is agenesis of one or two mullerian ducts, or absence of fusion or reabsorption of the septum between these ducts. The process may be partial or total and affect one or multiple parts of the tract. AIMS: This study was done to assess the distribution of various types of mullerian anomalies in infertile women, their classification based on ESHRE and AFS, associated anomalies, types of diagnostic modalities used, surgical interventions done(if any), various types of infertility treatment used and their outcomes. SETTING AND DESIGN: A retrospective analysis in a tertiary level hospital. MATERIALS AND METHODS: This was a retrospective study in which the women found to have mullerian anomalies were recruited from infertility clinic from July 2019 to March 2020. They were classified according to ESHRE and AFS criteria and their records were analyzed after taking various factors like age, ovarian reserve, duration of infertility, treatment given , associated ovarian and tubal factors and pregnancy outcomes. STATISTICAL ANALYSIS: Analysis was performed in Excel. RESULTS: There were 30 women with mullerian anomalies. Unicornuate uterus was most common anomaly. Four women required septoplasty in view of septate uterus. Five women had associated renal anomalies in form of shrunken kidney and ectopic kidney. Most of these women were considered for controlled ovarian stimulation followed by intrauterine insemination. In our study 16.6% women had successful pregnancy outcome. CONCLUSION: Mullerian anomalies continue to attract infertility specialist as they pose challenge in making clear diagnosis and its management as obstetrics outcomes are excellent after septum resection in women with septate uterus and conservative management in women with other anomalies. Proper work up of infertility and its management varies from case to case and associated factors like endometriosis, male factor, polycystic ovarian syndrome etc.

Wound complication among different skin closure techniques in the emergency cesarean section: a randomized control trial.

OBJECTIVE: Cesarean section is the most commonly performed obstetrical surgical procedure; however, there are no standard guidelines on appropriate skin closure techniques and materials. Only few comparative studies have been conducted on different skin closure techniques, and they have shown conflicting results. Therefore, we compared different skin closure techniques during emergency cesarean section to identify the best technique with minimal wound complication rates. METHODS: Patients were randomized into 3 groups (group A, n=100; group B, n=102; and group C, n=98). In group A, the skin was closed using staples; in group B, via the subcuticular technique using monocryl 3-0; and in group C, using mattress suture nylon (2-0). The primary outcome was a composite of wound complications, including infection, seroma, gaping, and need for resuturing and antibiotic administration. The secondary outcome included closure time, pain perception, patient satisfaction, and cost. Analyses were performed in accordance with the intention-to-treat principle. RESULTS: The composite wound complication rate in the entire cohort was 16.6% (n=50); the complication rate was significantly higher in group A than in the other groups. Infection was the most common wound complication observed in the entire study group (86%) and was significantly higher in group A than in groups B and C (P≤0.001). CONCLUSION: The use of staples for cesarean section skin closure is associated with an increased risk of wound complications and prolonged hospital stay postoperative visits.

Advanced abdominal pregnancy: a search for consensus. Review of literature along with case report.

BACKGROUND: Advanced abdominal pregnancy is a highly morbid form of extrauterine gestation that demands skilled management. Despite advancement in antenatal care and imaging modalities, undiagnosed cases of advanced abdominal pregnancies are still reported. We report a case of asymptomatic abdominal pregnancy with healthy fetus advanced till 40 + 4 weeks period of gestation. Her diagnosis was not established even after obstetrical evaluation and cesarean section at primary care hospital. To the best of our knowledge, less than 10 postdated cases of abdominal pregnancy have been reported so far in the literature. This case emphasizes the need to re-awaken awareness and high index of suspicion to diagnose such cases. Details of all the cases pertaining to advanced abdominal pregnancies reported after 2013 were reviewed and summarized. METHODOLOGY: We searched electronic medical database in English using keywords related to abdominal pregnancy. Bibliographies of the relevant articles of advanced abdominal pregnancy published from 2013 onwards were reviewed and then cross searched to identify further relevant studies. RESULTS: A total of 26 cases of advanced abdominal pregnancy including index one were reviewed. All preoperatively diagnosed cases of abdominal pregnancy at earlier gestation were given conservative management and resulted in live births. The incidence of malformations in live births was 24%. CONCLUSION: We are of considered opinion that conservative strategy is a feasible option in selected cases of advanced abdominal pregnancy yet there is a need of standardization of treatment principles for such cases to optimize fetomaternal outcome.

Multidrug-Resistant Tuberculosis during Pregnancy: Two Case Reports and Review of the Literature.

Multidrug-resistant tuberculosis (MDR-TB) is identified from the time of introduction of antituberculosis treatment and is a known worldwide public health crisis affecting women of reproductive age group. Management issues raised by pregnant women with MDR tuberculosis are challenging due to the limited clinical experience available with the use of second line drugs. We hereby report two cases of MDR-TB during pregnancy: one patient was on second line drugs, while another one was evaluated and diagnosed to have MDR-TB in last trimester. At 6 months of follow-up both mothers and babies are doing well. The approach to such cases along with review of the literature is discussed.

Prevalence of metabolic syndrome in pre- and post-menopausal women: A prospective study from apex institute of North India.

BACKGROUND: The metabolic syndrome (MS) (syndrome X, insulin resistance syndrome) is a constellation of metabolic abnormalities and a complex predisease state that predicts future development of type 2 diabetes mellitus and cardiovascular disease. Menopausal transition and postmenopausal state are considered as a vulnerable period for developing MS, and this increased risk has been attributed to decreasing estrogen levels with an increasing risk of insulin resistance following menopause. AIMS AND OBJECTIVES: This study aimed to determine the prevalence of MS and its components in pre- and post-menopausal women from North India. METHODOLOGY: This is a cross-sectional study of 350 women in the age group of 45-55 years attending gynecology clinic in a tertiary center of North India. Details of sociodemographic data, menopausal history, reproductive, and medical profile were obtained. Then, waist circumference, body mass index (BMI), and blood pressure were recorded. A venous blood sample was collected for fasting blood glucose, triglycerides, total cholesterol, low-density lipoprotein cholesterol, and high-density lipoprotein cholesterol. MS was defined according to the modified National Cholesterol Education Program Adult Treatment Panel III criteria. RESULTS: The mean age was 49.09 ± 2.2 years in premenopausal and 49.54 ± 2.8 years in postmenopausal women. The prevalence of MS in the study group was 62.6%. Occurrence of MS was higher in older and obese women. Abnormal waist circumference was the most prevalent component (87%) of MS and in terms of odd ratio, correlation was highest for BMI followed by total cholesterol and waist-hip ratio. CONCLUSION: We should target obesity and deranged lipid profile by bringing out changes in lifestyle and dietary habits to decrease the higher prevalence of MS and the risk of cardiovascular diseases.

Chylocolporrhea or chylous vaginal discharge: diagnostic conundrum with therapeutic challenge.

BACKGROUND: Chylocolporrhea or chylous vaginal discharge is an extremely rare manifestation of chylous reflux syndrome. Continuous loss of chyle adversely affects quality of life and results in increased morbidity due to the chronic loss of nutrients. Diagnosis and management of this condition is very challenging. CASE HISTORY: A 35-year-old multiparous lady presented with the chief complaints of excessive milky vaginal discharge for 10 years. Microscopic and biochemical analysis of vaginal discharge along with hysteroscopy confirmed diagnosis of chylocolporrhea. Lymphoscintigraphy along with magnetic resonance imaging revealed site of leakage from the right external iliac lymphatics. She was started on medium-chain triglycerides-rich diet and meticulous ligation of all visible megalymphatics with tension-free lymphovenous anastomosis was done to right external iliac vein. CONCLUSION: Chylocolporrhea can be managed successfully using operative and nonoperative modalities.

Distinguishing Myasthenia Exacerbation from Severe Preeclampsia: A Diagnostic and Therapeutic Challenge.

Myasthenia gravis is an acquired, autoimmune neuromuscular disorder characterized by voluntary muscle weakness. Pregnant patients may have disease exacerbation, respiratory failure, crisis, adverse drug reaction, surprisingly enough remission at any trimester or postnatal period. Concurrence of myasthenia gravis with severe preeclampsia is a dreadful condition raising diagnostic and management issues. We hereby discuss a case of myasthenic woman who developed severe preeclampsia during pregnancy and presented in last trimester with clinical features mimicking signs of impending eclampsia. Keeping in mind the history of myasthenia gravis, urgent neurology review taken and diagnosis of myasthenic exacerbation was entertained. She responded well to injection neostigmine and in this way inadvertent use of magnesium sulphate was avoided.

A prospective randomized controlled comparison of immediate versus late removal of urinary catheter after abdominal hysterectomy.

OBJECTIVE: Indwelling transurethral catheter is frequently used after gynecological surgeries in order to prevent urinary retention. There is controversy about the ideal time to remove the catheter after surgery. This randomized controlled study was undertaken to determine whether the immediate removal of urinary catheter after abdominal hysterectomy affects the rate of symptomatic urinary tract infection (UTI), recatheterization, subjective pain perception and febrile morbidity. STUDY DESIGN: This prospective randomized controlled trial included 70 women undergoing abdominal hysterectomy with or without salpingoophrectomy for benign diseases. Patients were divided into two equal groups on the basis of timing of removal of urinary catheter (Group I - Immediate removal after surgery, Group II - Removal after 24 h and evaluated for benefits versus risks of immediate catheter removal. The results were compared by the Chi-square test. RESULTS: Recatheterization was required in three patients of immediate removal group and none in late removal group (P = 0.07). Higher incidence of positive urine cultures (25.9%) and febrile morbidity (10%) was found in Group II when compared to immediate removal group (8%). Pain perception was not statistically different in both groups (P = 0.567). CONCLUSIONS: The early removal of an indwelling catheter after surgery was not associated with an increased rate of febrile events, UTI. Pain perception was also lower in early removal group. Although need of recatheterization was higher in early removal group, but not statistically significant.

Obstetrical catastrophe averted: successful outcome of an abdominal pregnancy.

Abdominal pregnancy is defined as an implantation in peritoneal cavity, exclusive of tubal, ovarian, or intraligmentary pregnancy.These pregnancies are rarely encountered and can go undiagnosed until advanced period of gestation [1]. Frequency of abdominal pregnancy has been directly related to the frequency of ectopic gestation as constituting 2% of ectopics and nearly 0.01% of all pregnancies [2-4]. These pregnancies are seen more commonly in developing countries and poses special challenges to the clinician. Advanced abdominal pregnancy is life-threatening condition and carries high risk of hemorrhage, disseminated intravascular coagulation, bowel injury, and fistulae [5]. The perinatal outcome is mainly influenced by the availability of blood supply and site of implantation [6]. Most of the fetus die in utero because of compromised environment, and those who survive face problems due to congenital malformations [3,7]. Patients of abdominal pregnancy can have variable clinical presentation, and physical examination may be inconclusive for making diagnosis [7,8]. Clinical features like irregular bleeding per vaginum, abdominal pain, dyspepsia, altered bowel habits, malpresentation, and extremely anteriorly placed cervix should raise the suspicion [2,3,8,9]. Diagnostic challenge with oxytocin stimulation, abdominal x-ray, hysterosalpingography, and ultrasonography has been used as tools to assist in diagnosis [10,11]. Magnetic resonance imaging is found to complement sonography in making accurate diagnosis and can be useful to demonstrate the relationship between fetus, the cervix, and the myometrium [12]. We hereby report a successful operative delivery of a live baby after a term extrauterine abdominal pregnancy in a multigravida in whom the diagnosis was made after laparotomy.