Quadruple Term Gestation of Quadri-Chorionic Quadri-Amniotic Pregnancy After Artificial Insemination: A Case Report

Background: To solve infertility, modern science has promoted assisted reproduction techniques such as in vitro fertilization, ovulation induction, and artificial insemination. Quadruple-type multiple pregnancies occur in 1 of every 500,000 pregnancies, and it is estimated that 90% occur due to assisted reproductive techniques, which often lead to numerous complications. Case presentation: Here we present a case of a 33-year-old woman, who desired pregnancy, but had a history of primary infertility diagnosed by hysterosalpingography, and endometriosis, which was treated by fulguration and medical management. Concomitantly, the patient was anovulatory. To fulfill her wish, she underwent homologous artificial insemination, after treatment, she successfully conceived quadri-chorionic quadri-amniotic infants, who were born at 37.2 weeks, without perinatal or maternal complications.Conclusion: This paper presented the parameters of prenatal care, appropriate management approach, and successful resolution without maternal-fetal complications despite the inherent risks of this type of pregnancy.

Serum Lactate Dehydrogenase Level in Pregnancy Induced Hypertension and Fetomaternal Outcome

Hypertensive disorders complicate 5-10% of all pregnancies and associated with potentially dangerous maternal and fetal complications. Studies have shown that pre-eclamptic patients with higher levels of lactate dehydrogenase (LDH) are at high risk of developing subsequent complications with poor maternal and fetal outcome. So with the aim to correlate serum LDH level in pregnancy induced hypertension (PIH) with fetomaternal outcome this hospital based observational descriptive study was done at Tribhuvan University Teaching Hospital (TUTH) for the duration of 1 year from 15th May, 2018 to 14th May, 2019. Women with PIH fulfilling inclusion criteria were enrolled in the study. Serum LDH level was measured and severity of PIH, maternal and perinatal outcome were studied according to the levels of LDH. Results were analyzed using SPSS 18. The incidence of hypertensive disorder in pregnancy was 4.74% in this study and total 180 cases were enrolled. The mean serum LDH level increased with increase in severity of PIH. Thirty two (17.7%) cases had maternal complications and hemolysis elevated liver enzymes and low platelet (HELLP) syndrome was most common complication. More than 2/3rd (62.5%) of cases with LDH level >800 IU/L had complications. The most common perinatal complication was intrauterine growth restriction (IUGR). The perinatal morbidity and mortality were significantly high in patients with PIH with LDH level >800 IU/l. As with the increase in serum LDH level increase in maternal and fetal complications was observed, LDH can be a useful biochemical marker that reflects the severity of PIH.

Effect of obesity on pregnancy, childbirth and postpartum among Moroccan women

Background: Overweight and obesity among Moroccan adults is continually growing affecting one in three adults from which 63.1% are women. Obesity during pregnancy increases the risk of maternal and fetal complications. The conditions of delivery are also more difficult. Objective: we aimed to describe the complications of obesity occurring in pregnancy, childbirth and postpartum among obese women in Morocco. Material and methods: It is a cross-sectional study conducted, in 2017, in two Hospital maternities in Marrakech. A sample of 200 women, who had just given birth, and have a Body Mass Index more than 30 was recruited. Women sociodemographic conditions and data about complications occurring during pregnancy, childbirth and postpartum, were collected meaning a structured interview and from participants' birth records. We used The SPSS software to realize descriptive analysis of data. Results: we noticed more than 37% of severe obesity and morbid obesity among participants. Several complications were noticed. Gestational diabetes occurs first (23%), followed by preeclampsia (14%). More than 38% of women gave birth by cesarean section. Almost 33% of participants had postpartum complications, the most common being infection (13%) and hemorrhage (12%). Conclusion: the high incidence of complications in obese women during pregnancy, childbirth and post partum emphasizes the need of a women nutritional management in preconception and during pregnancy to minimize complications.

Epilepsy and pregnancy: identifying risks

Pregnancy is a time of physical, physiological and psychological challenge. For women with epilepsy, as well as its potential for joy and fulfilment, pregnancy may bring additional risks and difficulties. Clinicians must anticipate and prevent these complications, ensuring that pregnancy, delivery and motherhood proceed without obstetric or medical complications, using available evidence to balance individual risks of undertreatment and overtreatment. Here we review epilepsy management in pregnancy, identifying some of the known effects of epilepsy and its treatment on gestation, fetal malformation, delivery, and neurocognitive and behavioural development. We outline strategies to reduce obstetric and fetal complications in women with epilepsy, while recognising the sometimes competing need to maintain or improve seizure control. We reinforce the importance of identifying those at highest risk, who may require additional measures or safeguards.

Epigenetic: New Insight in Gestational Diabetes Mellitus

Gestational diabetes mellitus (GDM) is the more frequent metabolic complication of pregnancy with a prevalence that is significantly increased in the last decade accounting for 12–18% of all pregnancies. Recent evidences strongly suggests that epigenetic profile changes could be involved in the onset of GDM and its related maternal and fetal complications. In particular, the unfavorable intrauterine environment related to hyperglycemia, a feature of GDM, has been evidenced to exert a negative impact on the establishment of the epigenome of the offspring. Furthermore the adverse in utero environment could be one of the mechanisms engaged in the development of adult chronic diseases. The purpose of this article is to review a number of published studies to fill the gap in our understanding of how maternal lifestyle and intrauterine environment influence molecular modifications in the offspring, with an emphasis on epigenetic alterations.

Risks and challenges in multiple pregnancy

Because of breakthroughs in reproductive medicine, multiple pregnancies have become more common in the industrialized world. As a result, obstetric care for women with multiple pregnancies and neonatal care for the same has become more demanding. Multifetal pregnancies are linked to an elevated risk for both the mother and child. There is increased incidence of obstetric complications such as spontaneous abortion, hypertensive disorders, placenta previa, and fetal malformations. Perinatal outcome is also affected which is attributable to increased incidence of fetal complications like prematurity, congenital malformations, growth discordance and cord accidents. We are presenting 2 cases, one of MCMA twin pregnancy with fetal congenital anomaly and another of a triplet pregnancy and their perinatal outcomes.

Obstetric hysterectomy: a retrospective study

Background: Obstetric hysterectomy (OH) is last resort usually opted to save life of a mother in critical obstetric conditions compromising her reproductive potential. With increasing caesarean deliveries incidence of morbidly adhered placenta is increasing, thus increasing need of OH. We aimed to study socio-demographic factors, incidence, indications, complications and feto-maternal outcomes associated with obstetric hysterectomy. Also, we aimed to study factors which affect the maternal and fetal outcome in obstetric hysterectomy case so as to minimize maternal and neonatal mortality and morbidity.Methods: We conducted a retrospective analytical study of 2 years 6 months in Department of Obstetrics and Gynecology at a tertiary and teaching institute of western Maharashtra.Results: The incidence of obstetric hysterectomy was 0.4%. Majority of women were between 25-35 years age group and parity two or more. Most common indication was postpartum haemorrhage (PPH) (41.1%) followed by uterine rupture (29.4%) and adhered placenta (23.5%). Most common risk factor found was previous caesarean delivery. Most common complication was need of intensive care unit (ICU) and vasopressor support.Conclusions: Proper antenatal care, screening for high-risk obstetric cases and registration of those patients at a well-equipped hospital and early referral and delivery at tertiary hospital by expert surgeon with timely decision, timely and adequate transfusions can prevent maternal and fetal complications.

Successful maternal and fetal outcome in an uncorrected case of tetralogy of fallot

Tetralogy of Fallot (ToF) is the most common congenital heart defect which is associated with systemic cyanosis. Pregnancy and delivery cause dramatic alterations in cardiovascular physiology and pregnancy in women with unrepaired TOF may have a worsening in right to left shunt with an increase of the cyanosis. This possesses an elevated risk of maternal and foetal morbidity and even mortality. We report and discuss a case of a 24 years old Primigravida with uncorrected ToF. A multidisciplinary team was involved in the management of the case with the aim to minimize maternal and foetal complications. The target of the management was to perform adequate maternal surveillance by maintaining an adequate oxygen saturation and good haemoglobin levels and perform timely foetal surveillance tests in the form of Obstetric doppler. A caesarean section was performed at 35 weeks and 5 days of gestation without any maternal or fetal complications. Without optimal obstetrical or medical management, prognosis of pregnancy in patient with uncorrected ToF is poor.