Acquired methemoglobinemia in a third trimester puerpera and her premature infant with sodium nitrite poisoning:A case report

BACKGROUND The common cause of sodium nitrite poisoning has shifted from previous accidental intoxication by exposure or ingestion of contaminated water and food to recent alarming intentional intoxication as an employed method of suicide/exit.The subsequent formation of methemoglobin(MetHb)restricts oxygen transport and utilization in the body,resulting in functional hypoxia at the tissue level.In clinical practice,a mismatch of cyanotic appearance and oxygen partial pressure usually contributes to the identification of methemoglobinemia.Prompt recognition of characteristic mismatch and accurate diagnosis of sodium nitrite poisoning are prerequisites for the implementation of standardized systemic interventions.CASE SUMMARY A pregnant woman was admitted to the Department of Critical Care Medicine at the First Affiliated Hospital of Harbin Medical University due to consciousness disorders and drowsiness 2 h before admission.Subsequently,she developed vomiting and cyanotic skin.The woman underwent orotracheal intubation,invasive mechanical ventilation(IMV),and correction of internal environment disturbance in the ICU.Her premature infant was born with a higher-than-normal MetHb level of 3.3%,and received detoxification with methylene blue and vitamin C,supplemental vitamin K1,an infusion of fresh frozen plasma,as well as respiratory support via orotracheal intubation and IMV.On day 3 after admission,the puerpera regained consciousness,evacuated the IMV,and resumed enteral nutrition.She was then transferred to the maternity ward 24 h later.On day 7 after admission,the woman recovered and was discharged without any sequelae.CONCLUSION MetHb can cross through the placental barrier.Level of MetHb both reflects severity of the sodium nitrite poisoning and serves as feedback on therapeutic effectiveness.

Plasma motilin concentration in the second and third trimesters of pregnancy and postpartum

Plasma motilin concentrations were measured in 135 women during the second and third trimesters of pregnancy and 3～5 d after delivery and the results were compared with those of 20 healthy nonpregnant women.The mean plasma motilin concentration (323.96± 125.10 ng/L) in women during the second trimester of pregnancy was lower than in healthy nonpregnant women (366.12±96.23 ng/L) (P<0.05),but that was significantly higher than in women during the third trimester of pregnancy (121.04±27.00 ng/L) (P<0.01);the plasma motilin concentration in women during 3～5d after delivery (443.05±140.79 ng/L) was significantly higher than that in pregnant women (P<0.01).The results showed that pregnancy appears to have a profound inhibitory effect on plasma motilin,and this may partly be responsible for the gastrointestinal hypomotility associated with pregnancy.

Obstetric Hemorrhage during the Third Trimester of Pregnancy: Experience in a University Hospital in Guinea

Aims: Obstetric hemorrhage, especially during the 3rd trimester of pregnancy, causes maternal, fetal and neonatal mortality and morbidity. We attempted to characterize its clinical features in Guinea. The objectives of this study were to describe the socio-demographic characteristics of the patients, identify the causes and contributing factors, describe the management and evaluate the maternal-fetal prognosis in such patients. Methods: We retrieved and analyzed patients with 3rd trimester hemorrhage whom we managed at Ignace Deen National Hospital, Guinea during 1-year period (1st of December 2019-30th of November 2020). Results: We experienced recorded 401 patients with 3rd trimester obstetric hemorrhage out of 5468 deliveries during the corresponding period;the rate being 7.33%. The main causes were as follows: placental hematoma (65.33%), placenta previa (27.68%) and uterine rupture (6.99%). The socio-demographic profiles were as follows: the age group of 25 - 29 years (28.42%), married (94.51%), uneducated (50.12%), and with a liberal profession. (43.64%) and pauciparous (30.42%). The conditions were considered to be preventable by managing risk factors during the prenatal consultation (PNC): 7.73% underwent no PNC. Cesarean accounted for 84.78% of patients. Prognosis was as follows: 14 maternal deaths (3.45% of a fatality), 34.66% of anemia, and 16.95% of hemorrhagic shock. Fetal/neonatal prognoses were poor. Conclusion: Obstetric hemorrhage during 3rd trimester remains the main cause of poor outcomes in Guinea. This study identified that this type of hemorrhage still represents an important cause of maternal and fetal morbidity and mortality in developing countries.

Osteoprotegerin,interleukin and hepatocyte growth factor for prediction of diabetes and hypertension in the third trimester of pregnancy

BACKGROUND Gestational diabetes mellitus(GDM)raises the risk of high blood pressure and may cause a series of life-threatening complications in pregnant women.Screening and management of GDM and gestational hypertension(GH)in pregnancy helps to control and reduce these risks and prevent adverse effects on mothers and their fetuses.Currently,the majority criteria used for screening of diabetes mellitus is oral glucose tolerance tests,and blood pressure test is usually used for the screening and diagnosis of hypertension.However,these criteria might not anticipate or detect all GDM or GH cases.Therefore,new specific predictive and diagnostic tools should be evaluated for this population.This study selected three biomarkers of osteoprotegerin(OPG),interleukin(IL)and hepatocyte growth factor(HGF)for GDM and GH predication and diagnosis.AIM To explore the feasibility of changes in placental and serum OPG,IL and HGF as tools for prediction and diagnosis of diabetes and hypertension in pregnant women.METHODS From January 2018 to January 2019,44 pregnant women with GDM and GH were selected as an observation group,and 44 healthy pregnant women were selected as a control group in the same period.Serum OPG,IL and HGF were compared between the two groups.RESULTS The levels of OPG and HGF in the observation group were lower than in the control group,and the level of IL-1βwas higher in the observation group than in the control group(all P<0.05).Furthermore,OPG and HGF were negatively associated with gestational diabetes and gestational hypertension,while IL-1βwas positively associated with GDM complicated with GH(all P<0.05).CONCLUSION The evaluation of serum OPG,HGF and IL-1βlevels in patients with coexistent gestational diabetes complicated with hypertension can predict the degree of disease and play an important role in the follow-up treatment and prognosis prediction.

Serum Magnesium Levels in Second and Third Trimesters of Pregnancy in Patients That Developed Pre-Eclampsia and Feto-Maternal Outcome

Introduction: Pregnancy is a physiological process that may be complicated by a number of clinical conditions. Gestational diabetes and pre-eclampsia are known complications in pregnancy. Pre-eclampsia is a disease of hypothesis in which the pathogenesis is yet to be fully explained. The role of magnesium in the pathogenesis of pre-eclampsia has been suggested by studies and it is being investigated all over the world. The study aimed to compare serum magnesium levels in pre-eclampsia and control groups from second trimester of pregnancy and assessed maternofetal outcome. Materials and Methods: This was a nested case control study in which consenting three hundred and sixty (360) normal pregnant women were enrolled. These women were recruited in their second trimester of pregnancy. Blood samples for serum magnesium estimation were obtained from subjects and controls at recruitment and after development of pre-eclampsia. Results: Thirty seven pregnant women that developed pre-eclampsia were nested as cases and were matched with 37 controls (apparently healthy pregnant women). The mean serum magnesium at recruitment was 0.75 ± 0.028 mmol/l (cases) and 0.76 ± 0.036 mmol/l (controls) (P = 0.123);this became significant when diagnosis of pre-eclampsia were made with mean of 0.53 ± 0.06 mmol/l (cases) and 0.69 ± 0.08 mmol/l (controls), (P 0.001). There was significant statistical relationship between preterm delivery, low birth weight and need for special care baby unit (SCBU) admission in newborn of mothers with low serum magnesium level (P = 0.001, 0.002 and 0.035 respectively). Conclusion: Findings from this study revealed that hypomagnesaemia appears to be a complication of pre-eclampsia. Serum levels of magnesium were normal until the development of the disease. Serum level of this biomarker affects maternofetal outcome significantly.

Effect of Third Interstitial Fluid on Adverse Outcomes in Patients with Severe Pre-eclampsia and Twin Pregnancy:A 5-year Single-center Retrospective Study

Objective This study aims to identify the effect of third interstitial fluid on adverse outcomes in twin pregnancies with severe pre-eclampsia,and explore the differences in bad ending between twins and singletons.Methods The present retrospective cohort study was conducted on patients with severe pre-eclampsia,who delivered in Tongji Hospital,Wuhan,China,between 2017 and 2022.The adverse outcomes in singleton and twin pregnancies with severe pre-eclampsia were initially investigated.Then,the diverse maternal and fetal consequences between singleton and twin pregnancies in patients with severe pre-eclampsia were compared after merging with the third interstitial fluid.Results A total of 709 patients were included for the present study.Among these patients,68 patients had twin pregnancies,and 641 patients had singleton pregnancies.The rate of postpartum hemorrhage(2.81%vs.13.24%,P<0.001),and admission rate to the Neonatal Intensive Care Unit(NICU)after birth(30.73%vs.63.24%,P=0.011)were significantly higher in twin pregnancies.The neonatal weight of twins was statistically lower than singletons(1964.73±510.61 g vs.2142.92±731.25 g,P=0.008).For the groups with the third interstitial fluid,the delivery week(P=0.001)and rate of admission to the NICU after birth were significantly advanced in twin pregnancy group,when compared to singleton pregnancy group(P=0.032),and the length of hospital stay was shorter(P=0.044).Furthermore,there was no statistically significant difference between the twin pregnancy group and the singletony pregnancy group without the third interstitial fluid.Conclusion The maternal and fetal adverse outcomes of patients with severe pre-eclampsia increased in twin pregnancies,when compared to singleton pregnancies.Thus,when patients develop the third interstitial fluid,twin pregnancies would more likely lead to adverse fetal outcomes,when compared to singleton pregnancies,and there would be no significant difference in maternal adverse outcomes.More attention should be given to patients who merge with the third interstitial fluid.

Cervical Ripening in the Third Trimester of Pregnancy with Intravaginal Misoprostol: A Double-blind, Randomized,Placebo-controlled Study

To evaluate the safety and efficacy of intravaginal misoprostol for cervical ripening in the third trimester, a randomized, double-blind, placebo-controlled trial was conducted in 85 patients indicated for induction of labor and with unfavorable cervices. They were randomly assigned to receive either intravaginal misoprostol (100 mg) or placebo placed in the posterior vaginal fornix. The Bishop score, fetal heart rate and Doppler blood flow velocity waveforms were measured before and 12 h after drug administration. Placenta and decidu were histopathologically observed in some cases. Among 85 patients enrolled, 43 received misoprostol and 42 received placebo. Whereas the mean initial Bishop scores were not significantly different between the two growps, the mean Bishop score in misoprostol group was significantly better than those in placebo group.The mean change in Bishop score was also significantly different (4. 4 for misoprostol versus 1. 0 for placebo, P<0.01 ). The prevalence of spontaneous onset of labor within 12 h after drug insertion in misoprostol group (67. 4%, 29/43)was significantly higher than that in placebo group (14. 3%, 6/42), P<0.01.The average DOppler velocity systolic to diastolic (S/D) ratios of umbilical artery,middle cramal artery, renal artery were not significantly different before and 12 h after drug insertion between both groups. There was no significant difference in frequency of abnormal fetal heart rate tracings or fetal distress and in the mean Apgar scores between the two groups. Except the presence of vasodilation in villi vessels in the misoprostol group, the placental and decidual histopathological changes had no significantly difference between two groups. It is concluded that intravaginal misoprostol may be an effective and safe cervical ripening agent in the third trimester of pregnancy.

Contribution to the Study of Hemorrhages in the Third Trimester of Pregnancy, Etiology and Management

Third trimester bleeding is a common concern in obstetrics. The main objective of this work was to study the management of hemorrhages in the third trimester of pregnancy in the maternity ward of the Sominé Dolo hospital in Mopti. Our prospective descriptive cross-sectional survey type study conducted at the maternity ward of Sominé Dolo hospital in Mopti over a period from January 1, 2017 to December 31, 2017 included 94 cases collected. During this period we had performed 1485 deliveries including 94 cases of pregnancies complicated by 3rd trimester hemorrhage, a frequency of 6.33%. The main cause of hemorrhage in the third trimester was represented by placenta preavia 42.6% followed by retroplacental hematoma 28.7%, uterine rupture 26.6% and association Placenta preavia and retroplacental hematoma 2.1%. The type of intervention depended on the cause of the hemorrhage and the maternal and fetal condition. More than half of the cases of uterine rupture 52% had benefited from a hysterorrhaphy during a laparotomy (n = 13/25) against 48% from hysterectomy (n = 12/25). Caesarean section was performed in 87.5% (n = 35/40) against 12.5% vaginal delivery (n = 5/40) in case of placenta preavia. In the end, in 74% of cases (n = 20/27) of retroplacental hematoma, first-line cesarean section was performed. The maternal prognosis was represented by a mortality rate of 12% (n = 11/94) and morbidity dominated by hypovolemic shock 48.9% (n = 22/94), infections 28.8% (n = 13/94) and coagulopathy 11.1% (n = 5/94). The fetal prognosis was very poor. More than half (55%) of the newborns had succumbed against 45% of the newly born. In 55.3% of cases neonatal mortality occurred antenatally. Neonatal morbidity was represented by prematurity, i.e. 20.2% (n = 19/94) and low birth weight, i.e. 22.3% (n = 21/94).

Acute Onset Pancreatitis in the Third Trimester of Pregnancy in HBV Carrier Women Taking Telbivudine for Blocking Mother-to-Infant Transmission

Acute pancreatitis in pregnancy(APIP) is rare and the reasons for APIP are biliary disease and congenital or acquired hypertriglyceridemia, which could occur during any trimester but more than 50% cases happened during the third trimester. In this report, one case of a young pregnant woman, a HBV carrier in her 37 th week + 5 d of gestation, was admitted to Emergency Department due to acute abdominal pain, vomiting and diarrhea. The patient was in antiretroviral treatment with telbivudine from 28 weeks of gestation to prevent motherto-child transmission of HBV. Laboratory tests demonstrated hypertriglyceridemia, abdominal computed tomography scan revealed peripancreatic edema. Hyperlipidemic pancreatitits was primary diagnosed and the patient was admitted to the intensive care unit. Considering the possible role in the pathogenesis of pancreatitis, telbivudine was interrupted after birth giving. After supportive treatment, her condition gradually improved. Since it is the first description of APIP during treatment with telbivudine, the association between pregnancy, hyperlipidemia, telbivudine and acute pancreatitis has been well investigated.

Bochdalek hernia masquerading as severe acute pancreatitis during the third trimester of pregnancy: A case report

BACKGROUND The occurrence of a diaphragmatic hernia during the third trimester of pregnancy is rare;to our knowledge,there has only been a single case report related to congenital Bochdalek hernia complicated with mild acute pancreatitis during pregnancy.Nonspecific symptoms and lack of experience due to its rarity make the diagnosis of this condition very challenging.We report a case of diaphragmatic hernia accompanied by mild acute pancreatitis in the third trimester of pregnancy,which was misdiagnosed as severe acute pancreatitis.CASE SUMMARY A 19-year-old woman presented at gestation of 31+2 weeks with continuous distension pain for 3 d in the left lumbar region of no obvious cause.Ultrasonographic findings of left ureterectasis,with nonspecific lumbago and abdominal pain,led to the misdiagnosis of renal colic.Increased serum amylase and/or lipase levels indicated acute pancreatitis.Following the treatment of pancreatitis,her condition deteriorated.The patient was finally diagnosed with a diaphragmatic hernia complicated with mild acute pancreatitis on magnetic resonance imaging at our hospital.Caesarean section was performed at gestation of 31+6 weeks,followed by hernia repair,and the pancreatitis was treated sequentially.The patient was discharged in good condition 20 d after the surgery.CONCLUSION In this case,surgical treatment was not the same as that for non-pregnant diaphragmatic hernia repair.It is important to first perform a cesarean section before commencing the therapy.

Acute Aortic Dissection in Third Trimester Pregnancy with Well Controlled Hypertension

We describe a 32-year-old pregnant woman at 31 + 6 weeks of gestation who presented to a tertiary-care hospital with headache and back pain. She was found to have a sign of tear about 1.3 cm away from the aortic valve, and the torn intima extended upward to the ascending aorta and the descending part of the aortic arch. She delivered a live male neonate via cesarean delivery. She had a history of hypertension with oral Labetalol 50 mg twice times daily. At the very beginning of the onset, physicians in the emergency room wouldn’t be aware of the symptoms of aortic dissections, as well as atypical presentations which include anterior chest pain or chest pain radiating to the back. She was only received anti-hypertension management, until her symptoms of back pain aggravated, and an aortic dissection was confirmed by ultrasound and CT angiography. Then she received a mechanical aortic valve replacement. After 51 days of treatment, she was discharged and recovered without any complications. Aortic dissection in pregnancy is a rare disease. We recommend transthoracic echocardiography every 1 to 2 months to monitor the diameter of the ascending aorta during pregnancy in which patients with hypertension problems or other risk factors of aneurysm and perform the CT angiography scan to confirm aortic dissection in a pregnant or postpartum woman with suspicious pain symptoms. It is essential that multidisciplinary approach in which teams must urgently collaborate to ensure the protection life of both mother and baby.

The Effects of Fetal Movement Counting on Mental Health of Mother in Third Trimester A Randomized Controlled Trial

Anxiety is one of the psychological problems in pregnant women that sometimes takes the form of pathological and affects the mental health of mother. The aim of this study was to determine the effects of fetal movement counting on mental health of mother. In a randomized-controlled trial, 208 nulliparous women were randomly divided into two groups. At 28th weeks, both groups completed the GHQ-28. Then the intervention group started to count fetal movements from 28th to 37th weeks of gestation and the control group received routine prenatal care. Again, both groups completed the questionnaire at 37 weeks＇ gestation and the results were compared. Analysis was performed by SPSS and a P value 〈 0.05 was considered significant. The mean scores of mental health of mothers in 28th and 37th of pregnancy was respectively 23.52 ± 10.23 and 21.09 ± 10.12 in the intervention group and the difference was significant （P = 0.025）. The mean in the control group was 23.69 ± 9.43 and 23.88± 8.60 respectively, and the difference was not significant （P = 0.52）. In comparing the mean scores between the two groups, it was found that the difference was not significant at 28th weeks of gestation （P = 0.37）, but it was significant in 37th week （P = 0.002） and the counting of fetal movements could improve the mental health of mothers compared to control group. The women who had fetal movements counting at weeks 28 to 37 Of gestation reported better mental health than the control group. The mother renorted concerns about decreased fetal movement was similar in the two grouns.

Antenatal anxiety in the first trimester: Risk factors and effects on anxiety and depression in the third trimester and 6-week postpartum

Objective: Anxiety is common among pregnant women. However, research attention in the area of reproductive mental health has mainly focused on postpartum depression in past decades. Given adverse outcomes of antenatal anxiety, there is an urgent need to fill the research gaps. The objectives of the present study were to determine the prevalence of antenatal anxiety symptoms and examine the risk factors and effects of anxiety symptoms in early pregnancy on anxiety and depressive symptoms in later pregnancy and early postpartum period. Methodology: A prospective longitudinal design with quantitative approach was adopted. A consecutive sample of 1470 Chinese pregnant women from hospitals in Hong Kong was invited to participate in the study and was assessed using standardized instruments on 3 time points including first and third trimesters of pregnancy and 6-week postpartum. Results: The results showed that 17.7% of pregnant women manifested anxiety symptoms in the first trimester of pregnancy. Single mothers, younger mothers, mothers who smoked before pregnancy and mothers who received low education level reported significantly higher levels of anxiety symptoms in the first trimester. Unwanted pregnancy, low self esteem, low marital satisfaction and perceived low social support were significant psychosocial risk factors for anxiety symptoms in the first trimester. Anxiety symptoms in the first trimester were independent predictors for anxiety symptoms in the third trimester ( QUOTE β = 0.26, t = 5.74, p < 0.001), however anxiety symptoms in the first trimester no longer significantly predicted anxiety and depressive symptoms in 6 weeks postpartum after adjusting for the effects of potential confounders. Discussions: The present study points to the need for greater research and clinical attention to antenatal anxiety given that antenatal anxiety is a prevalent problem and has serious impacts on maternal well-being. Such findings also contribute to the understanding of maternal anxiety and have implications for the design of effective identification, prevention and treatment of these significant clinical

The Third Trimester Bleeding at the Department of Obstetrics and Gynecology of the Teaching Hospital Souro Sanou of Bobo Dioulasso. About 105 Cases and Review of Literature

Objective: To learn the epidemiological, clinical, paraclinical, therapeutical aspects and prognosis of haemorrhage of the third trimester during pregnancy. Methodology: It is about a transversal and descriptive study, realized at the department of obstetrics and gynaecology from January 1st to June 30th 2020. Was included in the study any pregnant patient showing the third trimester bleeding (≥28 Weeks gestation) received for bleeding during our study period and has been taken in charge in our department. The parameters studied were on the socio-demographic characteristics, the clinical and para clinical aspects, the noted diagnosis, the therapeutic aspects, maternal and perinatal prognosis. The information was collected from an inquiry document, the clinical files, the register of delivery room and childbirth, surgery protocols. The type and the analysis of the data were done by the softwares Word, Excel 2013 and Epi Info version 7.2.3. Results: We registered 2159 deliveries and 105 cases of third trimester bleeding, so a frequency of 4.86%. The average age was 30.14 ± 6.57 [16 - 49 years old] and the average parity was 3 [0 - 10]. Married women represented 87.62% of all. They were in a bad condition in 41.90% of cases. Fetal heart-sound was absent in 65.76% of cases. The diagnosis checked was abruptio placenta, placenta previa and the uterus rupture. A blood transfusion of concentrated red blood cells Isogroup and Isorhesus was performed to 45.72% of cases. Caesarean section was performed in 54.29% of cases. Complications were observed in 74.28% of cases. The maternal lethality rate was 13.33% with a perinatal mortality of 74.77%. Conclusion: The third trimester bleeding is frequent in developing countries because of poor obstetric coverage in this country. The perinatal prognosis is often bad because of late diagnosis, difficult access to Health Center with adequate technical platforms, miss of blood products and miss of qualified staff to take in charge these emergencies.

Transplacental haemorrhage in women having third trimester bleeding and perinatal outcome

Objectives: Present prospective study was carried out to know the frequency of transplacental fetomaternal hemorrhage in pregnancies complicated by third trimester vaginal bleeding and it’s correlation with fetoneonatal outcome. Material methods: One hundred, out of 170 Rh-positive primigravida/multigravida with singleton pregnancy of more than 28 weeks gestation, admitted with third trimester vaginal bleeding with no other obstetric disorder, were the study subjects and 100 controls were women with no bleeding, admitted immediately after the study case with same inclusion and exclusion criteria. Maternal peripheral blood was collected at admission and at 2 hours of delivery and volume of FMH was calculated by Kleihauer’s formula. Results: Statistically significantly more perinatal deaths occurred in women with FMH, 35% in study subjects compared to 2.7% amongst controls. Conclusion: In the cases of third trimester bleeding and fetomaternal hemorrhage, chances of perinatal deaths are more.

Accuracy of Ultrasound to Determine Gestational Age in Third Trimester

Rapid and accurate determination of gestational age (GA) may be vital to the appropriate care of the critically ill pregnant patient and improve obstetric care through allowing the optimal timing of necessary interventions and the avoidance of unnecessary ones. Ultrasound scans are considered to be the most cost-effective, accurate and safe methods for measurement of various fetal parts in pregnant women. The aim of this research is to explore the accuracy of ultrasound in determining gestational age of fetus in third trimesters. Data collected for all pregnant women referred to the Maternity & Children’s Hospital in Jeddah. Only women with single live fetus were included in this study. Women who participated in the study were selected on following criteria: Regular menstrual cycles, known date of last menstrual period and previous live normal neonates in multipara. All scans were performed by a single ultrasonologist on one ultrasound machine. From collected data, it was found that out of 53 (100%) patients, 44 (84.62%) pregnant woman have different gestational age from US and last menstrual period (LMP). From this study we can conclude that the main method to follow fetus growth in third trimester not biparietal diameter (BPD) measurement only. The BPD in third trimester is not reliable and be useless when the patient pass 30 weeks and the BPD has to be side with other measurements when we take it in later trimesters to emphasize the normal growth of fetus and avoid wrong measurement of ultrasound.

Spontaneous Abortions in the Second Trimester of Pregnancy: Research and Analysis of Factors Associated at Laquintinie Hospital in Douala

Introduction: Spontaneous abortion of the second trimester is an interruption of pregnancy with complete expulsion or not of the product of conception between 15 and 28 weeks of pregnancy without any maneuvers. The objective of our study was to determine the factors associated with second trimester spontaneous abortions at Laquintinie Hospital in Douala. Methodology for this purpose: We conducted a case-control study from January to May 2019 on pregnant women who may or may not have had spontaneous second trimester abortions. Results: In total we recorded 1609 pregnancies and recruited 184 patients, including 46 cases and 138 controls;which gave a frequency of spontaneous abortion in the second trimester of pregnancy of 2.85%. A correlative analysis showed that spontaneous abortions in the second trimester were associated with housewife status (OR = 2.89;CI = 1.21 - 6.79;p = 0.010), gestation > 5 (OR = 4.09;CI = 1.02 - 17.66;p = 0.040), multiparity (OR = 3.81;CI = 1.59 - 9.16;p = 0.002), history of endouterine maneuvers (OR = 5.64;CI = 2.43 - 13 .03;p = 0.000), malaria in pregnancy (OR = 3.99;CI = 1.1 - 14.76;p = 0.030), incompleteness on the second trimester ultrasound (OR = 2.37;CI = 1.18 - 4.70;p = 0.010), jolts when traveling (OR = 46.04;CI = 17.29 - 123.66;p = 0.000), long car journeys (OR = 7.05;CI = 1.99 - 27.77;p = 0.000). After logistic regression eliminating the confounding factors, only the following were associated with abortions: Multiparity (OR = 13.90;CI = 2.96 - 65.18;p = 0.000), endo uterine maneuvers (OR = 3.69;CI = 1. 01 - 13.44;p = 0.047), jolts when traveling (OR = 72.63;CI = 19.47 - 270.96;p = 0.000), long car journeys (OR = 15.41;CI = 2.7 - 85, 95;p = 0.000). Conclusion: Our study reveals that a set of factors contribute to the occurrence of spontaneous abortions in the second trimester of pregnancy in our context.

Predictive Value of the Neutrophil to Lymphocyte Ratio (NLR) to Predict the Development of Preeclampsia and Pregnancy Induced Hypertension at 1st Trimester

Introduction: Hypertensive disorder in pregnancy affects 4 to 6 percent of all pregnancies and carries risks for the both baby and the mother. Only a few groups of women who are at high-risk pregnancies are received prophylaxis Aspirin, more than 15 percent of women develop pre-eclampsia with a single minor risk factor. Methods: This descriptive cross-sectional study was conducted to compare the 1st trimester NLR value of normotensive, pregnancy induced hypertensive and pre-eclamptic pregnant women. The study was conducted with a sample of 416, antenatal patients who were admitted to ward 25, at Colombo North Teaching Hospital Ragama. Data was collected as separated three groups. NLR value was calculated separately and ANOVA test was used to analyze the 3 categorical data. Post HOC test was done to assess the multiple comparison. Results: The prevalence rates of pregnancy induced hypertension and pre-eclampsia among the pregnant women were 8.6% and 5.7%. The mean NLR values of normotensive group was 2.708, pregnancy induced hypertensive group was 2.650 and pre eclamptic group was 3.789. There was a significant difference in NLR value between pre eclamptic group and other two groups with P value of Conclusion: The 1st trimester NLR value of pre eclamptic patients significantly increased compared to normotensive women.

Normal pregnancy outcome after first-trimester exposure to semaglutide in an overweight woman: a case report

We reported a case of an overweight 34-year-old woman who unexpectedly became pregnant while undergoing semaglutide in early pregnancy and delivered a healthy male infant by caesarean section at 37 weeks and 4 days of gestation.Until now,the safety of semaglutide for use during pregnancy was unknown.This report may contribute to the limited knowledge available on pregnant women exposure to semaglutide.