A Rare Case of Successful Management of Postpartum COVID-19-Related Coagulopathy

Pulmonary embolism, while a rare and life-threatening condition, is increasingly recognized in the context of pregnancy, particularly when compounded by infections such as coronavirus disease 2019 (COVID-19). This case report describes a 34-year-old pregnant woman, at 32 weeks of gestation, who developed COVID-19-related coagulopathy despite prophylactic treatment with low molecular weight heparin (LMWH). Admitted with symptoms of breathlessness, fever, and cough, she was diagnosed with COVID-19 and subsequently developed pulmonary embolism. This development was particularly unusual given her ongoing LMWH therapy. Diagnosis in such cases relies heavily on clinical assessment, evaluation of risk factors, and diagnostic tools, with computed tomography pulmonary angiography being pivotal for confirmation. This case highlights the complexities involved in managing COVID-19 among pregnant patients, especially the increased risk and diagnostic challenges associated with thromboembolic disorders. The successful resolution of the case, attributed to a multidisciplinary team's timely intervention and coordinated approach, emphasizes the critical need for prompt and individualized treatment strategies in similar clinical scenarios.

Changing Trends of Obstetric Hysterectomy Over Last 2 Decades: A Retrospective Analysis from a Single Center Tertiary Care Rural Teaching Hospital of Western India

Objective

The primary objective of our study to analyze the trend of obstetric hysterectomy (OH) over last 2 decade in rural tertiary care referral center of western India.

Design

Retrospective observational and comparative study from single rural tertiary care referral center of western India.

Method

A retrospective data collected of patients who underwent OH from Jan 2001 to Dec 2021. Each patient studied in detail for demographic and clinical profile, indication of OH, Intra operative and post operative complication and feto-maternal outcome. Patient of first decade (2001 to 2010) compared with second decade (2011 to 2021) to see the changing trend of OH.

Results

Total 19,666 patients delivered in study period.195 patient underwent OH. Incidence of OH is 0.9%. 171 out of 195 patients were referred (87%). If we see the trend of OH over 2 decades 2001 to 2010 and 2011 to 2021 incidence of OH slightly raised from 0.87% to 1.07% (p 0.16). Although Incidence of OH in cesarean delivery rises from 0.6 to 1.4% (p 0.6) but this change due to overall increase in cesarean section rate from 37 to 49%(p < 0.0001). Indication of OH significantly change as uterine rupture decrease significantly from 61 to 22%(p < 0.001) and morbidly adherent placenta increases from 7 to 23%(p 0.007). ICU admission and ventilator support increases from 54 to 79%(p 0.04) and 22% to 70% (p < 0.001), respectively, due to improved critical care services, but maternal death remains relatively same 15% & 20% (p 0.5).

Conclusion

Primary CS rates should be decreased to prevent adherent placenta spectrum disorders. Good antenatal care and development of a robust referral system can decrease maternal mortality. Greater utilization of skill laboratory and simulators will go a long way in developing the skills of aspiring doctors in operative vaginal deliveries.

Unilateral Pulmonary Fibrosis in Pregnancy: A Post-Tubercular Sequelae

Pulmonary tuberculosis (TB) is one of the top 10 leading causes of death in the world. Multi-drug resistant TB can lead to short-term and long-term sequelae causing clinical, psychosocial, and financial burden on the diseased. Pregnancy in a woman with compromised pulmonary function is a challenge for the treating obstetrician. A multidisciplinary approach involving a respiratory physician, pre-conceptional counseling, and delivery at a tertiary care center can reduce maternal morbidity and mortality. Compliance with anti-tubercular treatment with regular follow-up can minimize the long term effects of pulmonary TB.

We report a case of unilateral lung collapse due to multidrug-resistant pulmonary TB in pregnancy with good maternal and fetal outcomes.

Amelioration of drought tolerance in wheat by the interaction of plant growth-promoting rhizobacteria

Drought stress adversely affects the growth and yield of wheat. The present study was planned to investigate the effect of inoculation of plant-growth promoting rhizobacteria (PGPR) strains IG 3 (Klebsiella sp.), IG 10 (Enterobacter ludwigii) and IG 15 (Flavobacterium sp.) in improving drought tolerance in wheat. These PGPR strains were screened for drought tolerance in nutrient broth supplemented with different concentrations (0-25%) of polyethylene glycol (PEG6000). Effect of PGPR inoculation on various physiological, biochemical parameters and gene expression of stress responsive genes were studied under drought stress. Root colonization at the surface and interiors of roots was demonstrated using scanning electron microscopy (SEM) and tetrazolium staining, respectively. Drought stress significantly affected various growth parameters, water status, membrane integrity, osmolyte accumulation and stress-responsive gene expressions, which were positively altered by PGPR-inoculation in wheat. Quantitative real-time (qRT)-PCR analysis revealed the up regulation of some stress-related genes (DREB2A and CAT1) in un-inoculated wheat plants exposed to drought stress. PGPR-inoculated plants showed attenuated transcript levels suggesting improved drought tolerance due to interaction of PGPRs. The PGPR strain IG 3 was found to be the best in terms of influencing biochemical and physiological status of the seedlings under drought stress. Our report demonstrates the role of PGPRs Enterobacter ludwigii and Flavobacterium sp. in plant growth promotion of wheat plants under drought stress. The study reports the potential of PGPR in alleviating drought stress in wheat which could be used as potent biofertilizers.

Dissecting Aortic Aneurysm Complicating Pregnancy

Dissection of the aorta which is very rare in pregnancy usually occurs in the third trimester when blood volume and cardiac output rise to a maximum. We present here, a case of a 38-year-old pregnant woman with acute aortic dissection Type B. Management was conservative and after stabilization of vitals, obstetric hysterotomy was performed.

Vulval swelling: A diagnostic dilemma

Vulval swellings have always caused dilemmas in diagnosis and more so when they are huge in size. Sebaceous cysts are known to occur as a result of blocked pilo-sebaceous gland and duct or as a result of any injury to the skin. Face, neck, chest, back, scalp, and ears are known sites, however, they also occur over private parts. They are mostly asymptomatic but cause intense pain and discomfort if infected. Symptomatic cysts warrant removal.

Lifestyle and dietary factors determine age at natural menopause

A literature search was done using PubMed. The age at natural menopause (ANM) depends on various factors like genetic, environmental, socioeconomic, reproductive, dietary, and lifestyle of which some like nulliparity, vegetarian diet, smoking, high fat intake, cholesterol, and caffeine accelerates; while others like parity, prior use of oral contraceptive pills, and Japanese ethnicity delays the ANM. ANM is an important risk factor for long-term morbidity and mortality; and hence, the need to identify the modifiable risk factors like diet and lifestyle changes. Delayed menopause is associated with increased risk of endometrial and breast cancer, while early ANM enhances the risk for cardiovascular diseases and osteoporosis. The correlation between diet and ANM has not been extensively studied; however, whatever studies have been done till now point towards role of high intake of total calories, fruits, and proteins in delaying the ANM, while high polyunsaturated fat intake accelerates it. The role of dietary soy, total fat, saturated fat, red meat, and dietary fiber in determining the ANM has been controversial and needs further studies to substantiate it. The lifestyle factors like current smoking and vigorous exercise have been significantly associated with early menopause, while moderate alcohol consumption delays the ANM. Large prospective studies are needed to study the association of ANM and other modifiable factors like passive smoking fish consumption, soy, and various types of tea. The knowledge of modifiable determinants of ANM can help in setting up menopausal clinics and initiating health programs specially in developing countries.