Maternal Mortality Due to an Undiagnosed Large Thymoma in Puerperium: A Case Report

Introduction: Delayed or avoided medical care due to coronavirus disease 2019 (COVID-19) related concerns may increase morbidity and mortality associated with both acute and chronic health conditions. Thymoma is uncommon in pregnancy, although it could be accompanied with unfavorable outcomes. We report a puerperal woman presented with dyspnea and cardiac arrest with a recent diagnosis of thymoma that led to maternal mortality. Case Presentation: A 38-year-old woman with occasional dyspnea during pregnancy without medical referral was admitted to the hospital with severe dyspnea and orthopnea three days after cesarean section. Spiral computed tomography (CT) angiography showed a 64 × 84-centimeter mass with soft tissue density in the left perivascular that was originated from the anterior mediastinum; in biopsy, thymoma was suggested. She died shortly after due to severe dyspnea and cardiac arrest. Conclusions: Prenatal care during COVID-19 pandemic should not be postponed. Indeed, any symptom similar to the physiologic changes in pregnancy needs to be evaluated for optimal clinical management.

Feto-placental Changes in Pregnancy Induced Hypertension

Aims: To study if there is any difference in the foetus and placenta of pregnant women who are normotensive and those of of hypertensive patients of different severity. Study Design: Prospective study. Place and Duration of Study: Department of pathology, Saveetha institute of medical and technical sciences, between June 2017- June 2018. Methodology: Pregnant women with hypertension attending obstetrics and gynecology department, Saveetha Medical College, Chennai was studied during the study period. The study was conducted in accordance with the guidelines approved by the institutional review board of our Institution. The study population was divided into two groups namely normotensive and hypertensive patients. The hypertensive groups patients were further divided into two groups of mild (BP ≥140/90 mm Hg with proteinuria) and severe (BP ≥ 160/100 mm Hg with proteinuria). The placental specimens after expulsion were collected in 10% neutral buffered formalin solution. Informed consent was obtained in all patients and clinical data were obtained from the case notes. In the histopathology laboratory biopsy was taken from the insertion point of umbilical cord for light microscopy. P-values less than 0.05 were considered statistically significant. Data was entered in MS excel sheet and analysed using SPSS software version. Results: The placental weight, birth weight of baby and APGAR score was decreased in PIH patients than normal pregnant women. Conclusion: The diagnosis and treatment of PIH is very important to prevent complications in mother and baby.

Community Changes in Pregnancy Services during the Covid-19 Pandemic

This article will discuss how to adjust and the condition of services in health facilities, especially for pregnant women during the pandemic. The method used is literature study to obtain data and finally it will be condensed into a conclusion. The theory of behavior change is the basis for analyzing changes in community behavior in health services during the Covid- 19 pandemic. The purpose of this paper is to provide an understanding of how the actual situation in society, especially in the health sector of pregnant women during the Covid-19 pandemic is. The results showed that in the health sector there were considerable changes. This change is not only carried out by medical personnel, but also needs to be balanced by public awareness. Due to this pandemic, people must pay more attention to themselves, especially for pregnant women. For pregnant women, it can be done through online examinations and consultations with medical personnel or face to face with strict health protocols. In addition, monitoring can also be carried out independently from home by referring to the MCH handbook. Understanding and knowledge of pregnant women is needed in addition to reducing the intensity of pregnancy checks. For this reason, pregnant women need to behave in a healthy way by referring to the policies issued by the Indonesian Ministry of Health. Optimizing the health of pregnant women is very much needed in reducing the incidence of Covid-19 and reducing maternal anxiety during the Covid-19 pandemic.

A prospective observational study to analyse the relationship between fundus changes in pregnancy induced hypertension with visual impairment and its reversibility

Background: Irreversible visual impairment and morbidity are associated with pregnancy induced hypertension. It causes pathological changes in vascularity of placenta, kidney and brain along with two major pathological types of changes in fundus namely arteriolar vasospasm and permeability changes in vascular endothelium. The aim of our study was to analyse the relationship between fundus changes in pregnancy induced hypertension with visual impairment and its reversibility.Methods: A prospective observational study done on pregnant women with any grade of pregnancy induced hypertension with recent visual impairment from 24 completed weeks of pregnancy.Results: Out of 75 patients with PIH, all the patients had varying degree of fundus changes in one or both eyes. In 150 eyes of the 75 patients, 86 (57.30%) eyes had isolated arteriolar vasospasm, 14 (9.33%) had grade III hypertensive retinopathy, 4 (2.66%) had grade IV hypertensive retinopathy, 30 (20%) had macular oedema, 4 (2.66%) had central serous chorioretinopathy, 2 (1.33%) had vascular occlusion, 2 (2.66%) eyes had normal fundus with cortical blindness, 2 (2.66%) had exudative retinal detachment, 6 (4%) eyes had normal fundus with changes in the other eye.Conclusions: Out of 75 patients, 7 (9.3%) patients had irreversible loss of vision, 3 (42.85%) due to arteriolar vasospasm, and 4 (57.15%) due to choroidal ischemia. Among the 4 patients with choroidal ischemia, 3 (75%) were in the group of eclampsia and 1 (25%) in gestational hypertension.

Influence of Pregnancy on Neuromyelitis Optica From an Ophthalmological Point of View: a Case Report and Literature Review

Neuromyelitis Optica (NMO, Devic’s disease) is a rare demyelinating disease of the central nervous system leading to optic neuritis and transverse myelitis. The clinical course of the disease and ocular changes in pregnancy is still not well known. Here, we present the subclinical ophthalmological changes which are evaluated by spectral domain optical coherence tomography (SD-OCT) during the 39 weeks gestation and postpartum period in a pregnant woman with a diagnosis of NMO. Additionally, we present the obstetric and neurologic course of our patient and review the literature. A 30-year-old female with a history of NMO had been ophthalmologically examined and performed SD-OCT every trimester periodically to observe the effects of pregnancy on the disease course. No ophthalmological changes were observed during the pregnancy and postpartum period. Cesarean delivery was preferred due to obstetric indication. The patient was discharged on the second day of postpartum period.

A Study on Fundus changes in Pregnancy-induced hypertension: A Four-year Observation

Introduction: Hypertensive disorders complicate 5-10% in all pregnant and together form the deadly triad and hemorrhage and heart disease that contribute greatly to maternal morbidity or mortality. This study aims to identify retinal changes in pregnancy-induced hypertension and analyze the association between retinal changes and hypertension severity. Method: A total of 100 pregnant admitted with pregnancy-induced hypertension(PIH) were included. Patients with pre-existing hypertension, diabetes mellitus, and renal diseases were excluded from the study. The vision, anterior segment, and Fundus were examined. Result: Higher number of PIH were recorded in the 21-30 years age group. Fifty-four pregnant women suffered from mild preeclampsia, 40 pregnant women with severe preeclampsia, and six pregnant women with eclampsia with seizures. 41% of pregnant had normal fundus, and 24% of pregnant had hypertensive retinopathy. Whereas grade 2,3, and 4 retinopathy was observed in 22%, 6%, and 2% of pregnant women. Two percent of pregnants had macular edema, and 3% had central serous retinopathy. No association was observed between the fundus findings with age/gravida. Whereas a significant positive correlation was observed between the fundus findings and hypertension severity (P < 0.001). Conclusion: Overall, 54% of pregnants were recorded with hypertensive retinopathy. A positive correlation was observed between fundus changes with the hypertension severity. This study reports the importance of routine fundus examination in pregnant with hypertension. Retinal change during pregnancy is an important indicator to decide the pregnancy termination or any other opt.