Open Access Original Research Article

Retrospective Longitudinal Study on COVID-19 Pregnant Women, Management and Maternal Outcomes, in a Tertiary Care Hospital

B. K. Sujani, N. V. Manjula, . Urvashi, Jessica Fernandes, S. Gayatri Devi, B. M. Krupa, Nivedita Reshme, Varsha Ram

Asian Research Journal of Gynaecology and Obstetrics, Page 1-10

Background: The novel Coronavirus has established itself as the challenging pandemic of the 21st century.  Maternal-fetal medicine practice has had to evolve continuously to meet the demands of this pandemic.  Researchers all over the globe have been working on this novel viral infection to find effective preventive and treatment modalities, less progress has been achieved so far. The pathogen displays a wide range of severity, causing difficulty in determining infection outcome. It is of great importance to study the effects of this virus on pregnancy and its outcome. Unpredictable and exaggerated immune response with raised inflammatory markers are the cardinal laboratory features in COVID-19 infection which help in reflecting the disease severity.

Objectives: 1) To study the clinical manifestations and management of COVID-19 in pregnant women and 2) To study the maternal outcomes in confirmed cases of COVID-19 as compared to pregnant women who were COVID-19 negative during that time.

Methods: This is a retrospective longitudinal study to analyze the clinical manifestations and to study the maternal outcomes in confirmed cases of COVID-19 from June 1st 2020 to May 31st 2021. Data were collected from case records and patient details regarding obstetric history, preexisting comorbidities, clinical manifestations, investigations and interventions. Data were recorded and analyzed. 96 COVID-19 positive and 96 COVID-19 negative pregnant women were included in this study conducted at our tertiary care institution.

Results: In COVID-19 Positive group, mean Pulse rate was 98.0 ± 9.0 bpm, mean Temperature was 96.9 ± 1.2OF, mean SpO2 was 96.7 ± 4.3. Mean Pulse Rate, Temperature was high in COVID-19 positive group compared to COVID-19 negative group. Mean SpO2 was significantly lower in COVID-19 positive group compared to COVID-19 negative group. Total count, Neutrophil count, Eosinophil count was low in COVID-19 positive group and basophilic count was high in COVID-19 positive group compared to negative group. In COVID-19 positive patients, mean Serum Ferritin was 82.6 ± 156.4, mean serum LDH was 313.6 ± 230.0, mean D dimer was 1.2 ± 0.8, mean CRP was 2.0 ± 0.9. In COVID-19 negative patients mean Serum Ferritin was 46.1 ± 88.8, mean serum LDH was 227.7 ± 74.8, mean D dimer was 0.5 ± 0.4, mean CRP was 5.2± 7.0. There was significant difference in Serum Ferritin, serum LDH, D dimer and Serum CRP between two groups.  In COVID-19 positive mothers, 11.4% had HTN comparable to 4.2% in COVID-19 negative group. Distribution of mode of delivery: 57.9% delivered by LSCS, 30.6% by vaginal delivery and 11.6% were not delivered. 16.9% had Low birth weight, 1.2% had macrosomia, and 2.4% had IUD and 1.1% of mothers died in COVID-19 positive group. The inflammatory markers were statistically significant. There was a higher rate for LSCS in view of the COVID-19 pandemic.

Conclusion: COVID-19 infection was noted to have an impact on the cytokine profile of pregnant women, which can be correlated with the disease severity. The mode of delivery does not have much impact on the disease severity of pregnant women. The severe form of COVID-19 disease was seen in 1% of COVID-19 positive pregnant women and proved to be fatal. LSCS was done in this case to reduce the respiratory burden on the mother. Hypertension was found more significant in the COVID-19 positive group. 2.1% of the cases had abruption, 6.25% were found to have PPROM when compared to 3.1% in control group.

Open Access Original Research Article

Knowledge, Attitude and Practice of Contraception among Married Women Attending a Tertiary Hospital in Uttar Pradesh

Aditi Bhandari

Asian Research Journal of Gynaecology and Obstetrics, Page 11-23

Purpose of the Study: The main aim of this study was to assess the knowledge, prevalent attitude and practices about various contraceptives, regarding family planning, to study the factors affecting contraceptive use and to find out reasons for not adopting contraception.

Study Design & Methods: It is a cross sectional observational study conducted in the OPD of OBG, SMC&H, Ghaziabad where 408 married women between 18-45 years were randomly interviewed (after taking informed consent) with predesigned questionnaire about their knowledge, attitude and practice of contraception in order to understand the reasons for the wide gap between knowledge and practice of contraception.

Results: The study revealed a modest percentage of overall knowledge about methods of contraception, 73.3% women knew at least one method of contraception but only 54.4% were using some sort of contraception, the main source of knowledge being social interactions with friends/relatives. Maximum awareness (84.1%) was seen among females aged 31-35 years. Working women were more aware and used contraceptives more as compared to Non-working females. We found that contraceptive awareness and use increased with the increase in the parity, educational status, socio-economic status and employment of a woman. Common method preferred was barrier method (41%).

Conclusion: Although the participants were quite aware about family planning but sizeable proportions are yet to adopt a method. Effective counselling through extensive information, education and communication activities may help to remove some of the myths and misconceptions that may ultimately result in bridging the existing gap between the greater knowledge and lesser practice. An educational and motivational activity from doctors and health workers, regular supply of contraceptives and effective FP services is needed to promote the use of contraception.

Open Access Original Research Article

Attenuation of Reproductive Dysfunctions by Hydroethanolic Leaf Extract of Fleurya aestuans in Diabetic Rats

Green I. Kinikanwo, Charles C. Nwafor, Weleh I. Iyke

Asian Research Journal of Gynaecology and Obstetrics, Page 24-31

Diabetes mellitus produces excessive reactive oxygen species (ROS) in the male gonads resulting to impairments of steroidogenesis and spermatogenesis. Fleurya aestuans is an extremely basic plant with therapeutic properties but it’s frequently viewed as a weed in Nigeria. The present study therefore attempts to examine the effects of the hydroethanolic leaf extract of Fleurya aestuans on reproductive dysfunctions of diabetic rats. The rats were randomly assigned into seven groups of five rats each. Diabetes was induced in all the test groups 2-7 by intra-peritoneal injection of 150mg/kg bwt of alloxan monohydrate. Rats of the first group served as control and were only allowed rat feed and tap water ad libitum. Rats of the second group served as alloxan only group (ALXOG) and received 150mg/kg bwt of alloxan monohydrate. The third, fourth and fifth groups served as low dose extract group (LDEG), medium dose extract group (MDEG) and high dose extract group (HDEG) and received 50, 75 and 200mg/kg bwt of the extract respectively. Rats of the sixth group served as positive control group 1 (PCG1) and received 600mg/kg bwt of glibenclamide while rats of the seventh group served as positive control group 2 (PCG2) and received 100mg/kg bwt of tetrahydroxyflavone. Both extract and drugs were administered orally using oral gavage. The results indicated that the extract significantly reduced (p<0.05) blood glucose levels (203.10±0.10, 136.06±0.06, 111.01±0.01, 106.01±0.08) in contrast to group 2 (399.02±0.02, 277.02±0.02, 291.02±0.02, 383.01±0.00). In addition, the extract significantly improved (p<0.05) conceptive hormones, sperm parameters, SOD, CAT and GSH parameters. Our study confirmed that the leaf extract of Fleurya aestuans can be utilized in the correction of male reproductive dysfunction mediated by diabetes.

Open Access Original Research Article

Utilization of Reproductive Health Services among Adolescents at Maternal and Child Health Hospital, Kumasi, Ghana

Doris Hagan, Albert Opoku, Laurenda Fafa Anani-Adzoe

Asian Research Journal of Gynaecology and Obstetrics, Page 32-45

Aim: To explore and describe the factors that influence utilization of reproductive health services among adolescents seeking for services at the Child and Maternal Health Hospital (MCHH) in Kumasi, Ghana.

Sample: Adolescents between ages 15 to 19 years receiving health services at MCHH.

Study Design: Qualitative exploratory design was used to explore and describe the factors influencing utilization of reproductive health services among 10 selected adolescents through interviewing method.

Place and Duration: District hospital in Kumasi metropolis, Ghana over a period of one week.

Methodology: Interview guide was used to collect responses. Content analysis was used to analyze their responses.

Results: The study found that, most adolescents knew about reproductive health and their sources of information were their mothers and health care staffs. However, most of them have specific information needs such as, information on sex, preventive services such as family planning and how to avoid pregnancy. Majority of them were aware that, reproductive health services were provided in health facilities but did not know about specific services provided. Most of them will access services only when they are involved in risky sexual act, when they want to check for pregnancy or treat STIs and not for preventive services such as family planning and health education.

Conclusion: The above findings show that utilization of reproductive health services among the youth is low. Low levels of awareness on existing reproductive health services among the youth and staff attitude towards adolescents contributed to poor utilization of reproductive health services. Hence, factors that were found to influence utilization of reproductive health services among adolescents were; source of information on reproductive health and awareness on the type of reproductive services provided at the facility. This has serious implications on adolescents' reproductive health.

Open Access Original Research Article

Risk Factors for Placenta Praevia in the Niger Delta Region of Nigeria: A Case Control – Study

I. J. Abasi, E. H. Ikobho

Asian Research Journal of Gynaecology and Obstetrics, Page 46-54

Background: Placenta praevia remains a major cause of antepartum haemorrhage contributing significantly to maternal and perinatal mortality especially in developing countries including Nigeria. This study sought to determine the risk factors for placenta praevia among parturients in Niger Delta University Teaching Hospital, Okolobiri, in the south-south region of Nigeria.

Methods: The study was a retrospective case control study comprising 62 parturients with placenta praevia (cases) and 64 parturients without placenta praevia serving as control. Using a self-designed proforma data which include sociodemographic characteristics, past obstetric and gynaecological history and history of index pregnancy was extracted from patients’ medical records. Difference between cases and controls was explored using Chi-square test of proportion, while risk factors for placenta praevia were identified using a multivariate binary logistic regression analysis. Level of significance was set at pValue < 0.05.

Results: The women with placenta praevia (33.4±4.9years) were significantly (t=4.88;p-0.001) older than women in the control group (29.3±4.67years). Parity significantly differs between the case and the control group(X2–40.64;p-0.001). Risk factors for placenta previa identified in our locality include grandmultiparity[OR=14.65,(95%CI:1.50–143.45)], age≥35years[OR = 4.96,( 95% CI:1.45–16.93)], previous caesarean section[OR=3.66(95%CI:1.13–11.81)], and history of previous abortion[OR=2.68,(95% CI 1.13 – 7.24)].

Conclusion: From this study, the risk factors for placenta praevia were grandmultiparity, maternal age ≥35 years, previous caesarean section and history of previous abortion. Caregivers should be aware of this to ensure a high index of suspicion and thereby have good knowledgeable anticipation in the management of these patients.