Prevalence, Pregnancy Outcomes and Treatment Modalities of Immune Thrombocytopenia Mothers Over 5-years in a Tertiary Health Care Hospital in South India | Chapter 15 | Achievements and Challenges of Medicine and Medical Science Vol. 11

Background: It has been proposed that thrombocytopenia is the most common haematological abnormality in pregnancy after anaemia. The incidence of severe immune thrombocytopenia (ITP) in pregnancy has been difficult to report because of the rarity of the disease. Treating pregnancy associated with ITP can be difficult.

Objective: The objectives were to determine the prevalence, pregnancy outcomes, and treatment modalities of ITP mothers over five years in a tertiary health care hospital in South India.

Methods: Our study was a retrospective record study, which looked into various aspects of obstetrical outcomes and complications in ITP mothers. Records of the in-patient medical record department (MRD) folders of patients with ITP who delivered at St. Johns Medical Hospital, Bangalore were studied. Patients with acute and chronic ITP were included as per the Vicenza consensus conference and the criteria for differentiating primary from secondary forms of ITP was followed, with consideration of a new entity of ITP associated with the presence of antiphospholipid antibodies.

Results: The study identified 53 patients with ITP with a mean age of 25.6+4.6 years, age of diagnosis of ITP at 21.1+5.9 years and gestational age of 36.2+3 weeks. In our study 17 (32%) were acute and 36 (67.1%) were chronic ITP. In our study, 39.6% had a history of at least one prior pregnancy loss. Patients with ITP at 35-37 weeks were induced with PGE1 (35.7%) in comparison to those with PGE2 (p≤0.001). Post-partum haemorrage (PPH) was seen in 7.5% of the pregnancies and all four were mothers with chronic ITP. Severe preeclampsia in ITP mothers was seen in 2 (66.7%).  All the findings showed that there is no reliable maternal parameter to predict the susceptibility and the need for intervention in mothers with life-threatening thrombocytopenia and the complications it poses to the foetus. Hence, constant vigilance is required to establish a safe pregnancy outcome in mothers with ITP.

Conclusions: Chronic ITP in pregnancy poses more risks to mother and foetus as seen with the higher chance of PPH etc. Mothers with ITP should be screened antenatally as the chances of anomalies are high in the foetus.

 

Author (s) Details

 

Shashikala Karanth
Department of Obstetrics and Gynecology, St. John’s Medical College and Hospital, Bangalore, Karnataka, India.

 

Christy Vijay
Department of Obstetrics and Gynecology, St. John’s Medical College and Hospital, Bangalore, Karnataka, India.

 

Chaitanya Harita
Department of Medicine, St. John’s Medical College and Hospital, Bangalore, Karnataka, India.

 

Jaya S. Mol
Department of Obstetrics and Gynecology, St. John’s Medical College and Hospital, Bangalore, Karnataka, India.

 

Please see the book here:- https://doi.org/10.9734/bpi/acmms/v11/3758

Study on Mifepristone for Cervical Ripening and Induction of Labor in Previous LSCS Cases-Experience from a Single Centre of North India | Chapter 10 | Highlights on Medicine and Medical Science Vol. 14

 Inducing labour in a previous caesarean operation presents a significant challenge for the doctor (CS). Induction of labour rates in women with past CS are falling globally. The tendency is toward elective recurrent caesarean procedures if a pregnancy must be ended for obstetric reasons. Vaginal birth had fewer difficulties than repeat CS, especially in a community like ours where multiparity is more common. As a result, there is a desire for an agent that has a superior vaginal birth outcome.

The study's goal was to see if Mifepristone could help with cervical softening and induction of labour in previous caesarean instances. It also had the goal of determining the induction delivery interval as well as mother and foetal outcomes.

Methods: This was a prospective research on fifty-two term pregnant females with one previous caesarean section referred for labour induction for various reasons in a tertiary care centre in North India. They were placed into two research groups of twenty-six people each at random. Females in Group A were given Mifepristone tablets, whereas females in Group B were given a placebo.

Age, gestational time, and Bishop score at induction were not different between the two groups. In both groups, the most prevalent reason for induction was a post-dated pregnancy. There was a statistically significant difference in induction to onset of labour with Mifepristone when compared to the control group. The time between induction and the commencement of labour in the mifepristone and control groups was 24 hours 7 minutes and 37 hours 3 minutes, respectively. The mean induction delivery interval in the cases and control groups was 33 hours and 1 minute and 46 hours and 9 minutes, respectively, however this was not statistically significant. In the mifepristone group, 21 patients (80.7%) delivered vaginally, compared to 15 patients (57.6%) in the control group.

Conclusions: This study found that Mifepristone is a simple and effective approach for IOL in term women who have had previous LSCS, with a favourable outcome, and that its usage offers an intriguing new alternative to traditional uterotonic drugs when induction is required in past LSCS patients.

Author (S) Details

Gagan Lata
Department of Obstetrics and Gynecology, Adesh Medical College & Hospital, Mohri, Shahbad, Haryana, India.

Sukhbir Pal Kaur
Department of Obstetrics and Gynecology, Adesh Medical College & Hospital, Mohri, Shahbad, Haryana, India.

Susmita Sharma
Department of Obstetrics and Gynecology, Adesh Medical College & Hospital, Mohri, Shahbad, Haryana, India.

View Book :- https://stm.bookpi.org/HMMS-V14/article/view/2561