Perinatal Services

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    Cushing's Syndrome missed in pregnancy.
    (Cureus part of Singer Nature, 2024-10-06) Koshy , Rayna M
    Cushing's syndrome (CS) is uncommon during pregnancy and often difficult to diagnose due to similar symptoms shared with normal pregnancy. This case report discusses a 26-year-old woman who developed CS while pregnant, underlining the importance of early detection and the diagnostic challenges involved. The patient presented with gestational diabetes and pre-eclampsia during pregnancy. Post delivery, she continued to experience hypertension and facial swelling, which led to a diagnosis of CS. The patient underwent a successful laparoscopic adrenalectomy, which normalized her blood pressure and improved her symptoms. This case highlights the need for heightened awareness of CS in pregnant women exhibiting both gestational diabetes and hypertension, as early diagnosis and treatment are essential to reduce maternofoetal complications.
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    COVID-19 vaccine safety during pregnancy and breastfeeding in women with autoimmune diseases: results from the COVAD study.
    (2024-05-02) Gupta, Latika
    Objectives: We investigated coronavirus disease 2019 (COVID-19) vaccine safety in pregnant and breastfeeding women with autoimmune diseases (AID) in the COVID-19 Vaccination in Autoimmune Diseases (COVAD) study. Methods: Delayed-onset (>7 days) vaccine-related adverse events (AE), disease flares and AID-related treatment modifications were analysed upon diagnosis of AID vs healthy controls (HC) and the pregnancy/breastfeeding status at the time of at least one dose of vaccine. Results Among the 9201 participants to the self-administered online survey, 6787 (73.8%) were women. Forty pregnant and 52 breastfeeding patients with AID were identified, of whom the majority had received at least one dose of COVID-19 vaccine (100% and 96.2%, respectively). AE were reported significantly more frequently in pregnant than in non-pregnant patients (overall AE 45% vs 26%, P = 0.01; minor AE 40% vs 25.9%, P = 0.03; major AE 17.5% vs 4.6%, P < 0.01), but no difference was found in comparison with pregnant HC. No difference was observed between breastfeeding patients and HC with respect to AE. Post-vaccination disease flares were reported by 17.5% of pregnant and 20% of breastfeeding patients, and by 18.3% of age- and disease-matched non-pregnant and non-breastfeeding patients (n = 262). All pregnant/breastfeeding patients who experienced a disease flare were managed with glucocorticoids; 28.6% and 20% of them required initiation or change in immunosuppressants, respectively. Conclusion: This study provides reassuring insights into the safety of COVID-19 vaccines administered to women with AID during the gestational and post-partum periods, helping overcome hesitant attitudes, as the benefits for the mother and for the fetus by passive immunization appear to outweigh potential risks.
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    Risk factors for labour induction and augmentation: a multicentre prospective cohort study in India.
    (Elsevier., 2024-05-07) Churchil, David
    Background: Guidelines for labour induction/augmentation involve evaluating maternal and fetal complications, and allowing informed decisions from pregnant women. This study aimed to comprehensively explore clinical and non-clinical factors influencing labour induction and augmentation in an Indian population. Methods: A prospective cohort study included 9305 pregnant women from 13 hospitals across India. Self-reported maternal socio-demographic and lifestyle factors, and maternal medical and obstetric histories from medical records were obtained at recruitment (≥28 weeks of gestation), and women were followed up within 48 h after childbirth. Maternal and fetal clinical information were classified based on guidelines into four groups of clinical factors: (i) ≥2 indications, (ii) one indication, (iii) no indication and (iv) contraindication. Associations of clinical and non-clinical factors (socio-demographic, healthcare utilisation and lifestyle related) with labour induction and augmentation were investigated using multivariable logistic regression analyses. Findings: Over two-fifths (n = 3936, 42.3%, 95% confidence interval [CI] 41.3-43.3%) of the study population experienced labour induction and more than a quarter (n = 2537, 27.3%, 95% CI 26.4-28.2%) experienced augmentation. Compared with women with ≥2 indications, those with one (adjusted odds ratio [aOR] 0.50, 95% CI 0.42-0.58) or no indication (aOR 0.24, 95% CI 0.20-0.28) or with contraindications (aOR 0.12, 95% CI 0.07-0.20) were less likely to be induced, adjusting for non-clinical characteristics. These associations were similar for labour augmentation. Notably, 34% of women who were induced or augmented did not have any clinical indication. Several maternal demographic (age at labour, parity and body mass index in early pregnancy), healthcare utilization (number of antenatal check-ups, duration of iron-folic acid supplementation and individuals managing childbirth) and socio-economic factors (religion, living below poverty line, maternal education and partner's occupation) were independently associated with labour induction and augmentation. Interpretation: Although decisions about induction and augmentation of labour in our study population in India were largely guided by clinical recommendations, we cannot ignore that more than a third of the women did not have an indication. Decisions could also be influenced by non-clinical factors which need further research.
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    Awareness regarding venous thromboembolism and pulmonary embolism after pregnancy and cesarean section in female population in the Aseer Region, Saudi Arabia.
    (Springer nature Group., 2024-01-29) Nadeem, Mir
    Introduction A pulmonary embolism (PE) occurs when an embolus that has traveled through the venous system from another part of the body obstructs an artery in the lungs. Chest pain, especially while breathing in, coughing up blood, and shortness of breath are all possible signs of PE. There could also be signs of a blood clot in the leg, like a painful, swollen, red, and warm leg. As a high-risk group, particularly during childbearing age, the aim of this study is to evaluate the general awareness of females regarding PE and identify areas of knowledge deficit and factors contributing to their awareness level. Methods A cross-sectional descriptive survey of Saudi women in general over the age of 18 was carried out. Participants were asked to respond to a structured questionnaire that was used to gather data. The questionnaire was formulated in Google Forms with an Arabic translation of the form and the link generated and was sent to each participant for completion. In total, 827 respondents filled out the survey with accurate and complete information. Results The study comprised 827 female volunteers, with a mean age of 33.2 ± 9.4 years, ranging in age from 15 to 60. Additionally, 52.8% of the female sample had graduated from college, compared to about 4% who were illiterate. In general, 40.2% of the girls knew everything there was to know about PE. Conclusions According to the study's findings, the public female population knew less about PE overall - that is, about risk factors, symptoms, and preventive measures. As more knowledge about the dangers, causes, prevention, diagnosis, and treatment of PE becomes available, it is imperative that healthcare professionals translate and actively distribute this information to the public, particularly to women.
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    The complex relationship between iron status and anemia in pregnant and postpartum women in India: Analysis of two Indian study cohorts of uncomplicated pregnancies.
    (Wiley, 2023-11-01) Churchill, David
    Low hemoglobin is widely used as an indicator of iron deficiency anemia in India and other low-and-middle income counties, but anemia need not accurately reflect iron deficiency. We examined the relationship between hemoglobin and biomarkers of iron status in antenatal and postnatal period. Secondary analysis of uncomplicated singleton pregnancies in two Indian study cohorts: 1132 antenatal women in third trimester and 837 postnatal women 12–72 h after childbirth. Associations of hemoglobin with ferritin in both data sets, and with sTfR, TSAT, and hepcidin in the postnatal cohort were examined using multivariable linear regression. Multinomial logistic regression was used to examine the association between severity of anemia and iron status. Regression models were adjusted for potential confounders. Over 55% of the women were anemic; 34% of antenatal and 40% of postnatal women had low ferritin, but 4% antenatal and 6% postnatal women had high ferritin. No evidence of association between hemoglobin and ferritin was observed (antenatal: adjusted coefficient [aCoef] −0.0004, 95% confidence interval [CI] −0.001, 0.001; postnatal: aCoef −0.0001, 95% CI −0.001, 0.001). We found a significant linear association of hemoglobin with sTfR (aCoef −0.04, 95% CI −0.07, −0.01), TSAT (aCoef −0.005, 95% CI −0.008, −0.002), and hepcidin (aCoef 0.02, 95% CI 0.02, 0.03) in postnatal women. Likelihood of low ferritin was more common in anemic than non-anemic women, but high ferritin was also more common in women with severe anemia in both cohorts. Causes of anemia in pregnant and postpartum women in India are multifactorial; low hemoglobin alone is not be a useful marker of iron deficiency.