Reproductive Concerns Among Women with Disability: A Host of Opportunities for Reproductive Health Care Professionals.

Background: Maternal health in India is likely to move towards an obstetric transition, wherein there is sustained reduction of maternal mortality and focus shifts towards improving quality of care. In such a context, reproductive concerns of special populations gain prominence. One such population group is women with disability. What this review contains: This mini-review examines the incremental importance given to people with disabilities and the sparse data available on the topic of reproductive concerns among women with disability. The attitudes of the women with disability towards childbearing and the association between disability and obstetric problems are discussed. The limited available data on specific medical and obstetric problems among women with disability are reviewed. Conclusions: The article calls for all obstetricians to display increased sensitivity and heightened cognizance towards the reproductive concerns among women with disability.

Comparison of EPDS Scores Among Women with Good Neonatal Outcomes and Adverse Neonatal Outcomes.

A comparative, questionnaire-based study among postpartum patients was conducted using the Edinburgh Postpartum Depression Scale. 80 women who had good neonatal outcomes were compared with 80 women who had adverse neonatal outcomes. Demographic characteristics were similar between the groups. The average EPDS score in those with good neonatal outcomes was lesser than that of those with adverse neonatal outcome (10.07 vs11.04, p 0.045). Using the cut-off value of 9, the proportion of women who tested positive (higher chance of PPD) was statistically significantly higher (p value 0.0488) in adverse neonatal outcomes group (45% vs 28.75%). This result showed that women who have experienced stillbirth/ neonatal mortality or had neonates who needed NICU care have a higher propensity for PPD. This implies that women who have experienced stillbirth/neonatal mortality should be considered for prioritization in screening for PPD. PPD screening, even if not done routinely, should be done in this selected group (adverse perinatal outcomes group) on priority.

Double Trouble: A Case Report of Abnormal Uterine Bleeding due to Both Central and Peripheral Pathology.

A 46-year-old female came to the gynecology outpatient department with heavy and prolonged menstrual bleeding. The examination revealed a thyroid mass and tachycardia. Systemic and gynecological examinations were insignificant. Laboratory tests revealed a deranged thyroid profile which was further explored by performing magnetic resonance imaging. This revealed a functioning pituitary microadenoma producing thyroid-stimulating hormone (TSH). This entity is known as a TSHoma. Ultrasonography of the abdomen and pelvis showed increased endometrial thickness. The patient was treated with antithyroid medication and has undergone Mirena intrauterine contraceptive device insertion. The patient is planned for a hysterectomy when the thyroid profile is normalized.

Neonatal Effects of Maternal Magnesium Sulphate in Late Preterm and Term Pregnancies.

AIM: To compare the clinical, obstetric and neonatal parameters between patients with > 34-week gestation having severe preeclampsia receiving magnesium sulphate and those with > 34-week gestation with preeclampsia but not receiving magnesium sulphate. MATERIALS AND METHODS: Single-centre prospective study studied 60 patients in each of the two groups. Magnesium sulphate was administered by Pritchard regimen as per standard protocol. Standard obstetric management was followed for both groups. In the severe preeclampsia/eclampsia group, maternal blood sample was analysed for serum magnesium levels. The duration of exposure, the amount of magnesium sulphate received and time elapsed between last dose of magnesium sulphate and delivery were all noted. Neonatal assessment was done. The various parameters including age, parity, blood pressure, mode of termination of pregnancy, NICU admission rate, incidence of hypotonia in the newborn and other neonatal parameters were tabulated and compared. RESULTS: The two groups were comparable with respect to age and parity. Need for induction of labour was higher in the group with severe preeclampsia/eclampsia. Rate of LSCS and birth weights were comparable between the two groups. NICU admission rate and incidence of hypotonia were higher in those who received magnesium sulphate. Amount of magnesium sulphate received and total duration of magnesium sulphate did not correlate with NICU admission rates. CONCLUSIONS: Neonatal morbidity, in terms of higher NICU admission rates and hypotonia, is higher in patients receiving magnesium sulphate.

Outcome of Pregnancy with Hemoglobinopathy in a Tertiary Care Center.

PURPOSE: The objective was to observe the characteristics among pregnant patients with a diagnosed hemoglobinopathy and to study the obstetric and medical morbidity patterns during the antenatal and the perinatal periods in this group of patients. METHODS: A prospective observational study was conducted in a tertiary care center. RESULTS: Sixty patients were studied in 11 months. Primigravidae (43.3%) formed the highest percentage of patients. ß Thalassemia trait was the most common hemoglobinopathy, seen in 81.66% of study subjects. The hemoglobin value ranged from 5.7 to 13.0, with an average of 9.2 g/dl. Thyroid problems were the most common associated medical disorder. Though IUGR and placenta previa were common, there were no major obstetric problems. There were 57 live births and 1 fresh stillbirth. Two patients had spontaneous abortion for which uterine curettage was done. LSCS was the most common obstetric outcome. Patients with sickle-cell disease required more blood transfusion than those with beta-thalassemia trait. There were 2 maternal mortalities, and both the patients were the diagnosed cases of sickle-cell disease. CONCLUSIONS: While the perinatal outcomes among women with sickle-cell disease are poor, the outcomes in pregnant patients with beta-thalassemia trait were not a cause of major concern.

Novel FSH receptor mutation in a case of spontaneous ovarian hyperstimulation syndrome with successful pregnancy outcome.

The objective is to study the FSH receptor (FSHR) for mutations in a case of spontaneous ovarian hyperstimulation syndrome (sOHSS). This is a single case study and it examined patient who presented with spontaneous critical OHSS in early pregnancy and had successful good obstetric outcome. Intervention of this study was analysis of blood for genetic analysis of FSHR postdelivery. The main outcome measure noted was FSHR mutation. The study resulted in a novel, here though unreported, heterozygous mutation in FSHR gene at nucleotide position 1346 (AC(1346)T to AAT) in exon 10 yielding a threonine to asparagine (Thr(449)Asn) substitution in the transmembrane domain helix 3 of the FSHR. To conclude FSHR gene analysis can add to our understanding of sOHSS.