Amreen Sharif

Abstract

Introduction: Post Partum Heamorrhage (PPH) is responsible for 47% of maternal mortality in India and one quarter of maternal deaths globally. Lack of expertise, lack of proper cold chain for oxytocin and cost limitations of heat stable carbetocin are major hurdles to prevent PPH. Restrained options for safer uterotonics in heart disease complicating pregnancy are a major concern. Materials and Methods: This study was conducted on 30 patients with heart disease complicating pregnancy who delivered at a tertiary care centre. All patients were administered single dose of carbetocin 100 mcg IM immediately after delivery and observed for development of PPH. Results: Carbetocin prevented PPH in 73.33% cases. Among 20% of COVID-19 positive patients, only one case had PPH. Major contributory factors in patients developing PPH include anemia before delivery, use of anticoagulant in antenatal period, instrumental delivery and high CARPREG 2 score. Less hemodynamic side effects even in patients with high CARPREG 2 score was appreciated. Conclusion: Carbetocin is a hemodynamically safer and effective uterotonic in heart disease complicating pregnancy. Increasing its availability and implementation in current guidelines is the way forward.   Keywords: Carbetocin, Post partum haemorrhage, Heart disease, COVID-19.

View Article

Abstract

Introduction: The novel coronavirus is a single stranded RNA virus with spike proteins triggering an immune response leading to cytokine storm and coagulopathy. Pregnancy is an immunocompromised and hypercoagulable state, with predis position to severe illness. An insight into impact of COVID-19 in pregnancy is essential to combat its future. Materials and Methods: This study was conducted at a tertiary care centre. Analytical study was conducted from the data collected regarding COVID-19 positive labour room admissions, deliveries and deaths during the second wave of pandemic. Results: There was a discharge rate of 88.14% after safe delivery. Among COVID-19 maternal mortalities, most deaths were due to ARDS. Quick SOFA score was a good predictor for morbidity and mortality. Deranged coagulation profile and D-Dimer levels more than 500 ng/ml were good predictors of mortality. Silent hypoxia needs to be identified and corrected at admission. Delay in seeking medical advice was a major contributory risk factor. Conclusion: Increasing awareness among public about seeking medical advice during early stages of disease. Early identification and treatment according to latest guidelines for a positive outcome. Making aware the policy makers regarding risk-benefits of vaccination in mothers can come a long way in changing the fate of COVID-19 in pregnancy.   Keywords: COVID- 19, Pregnancy, Second wave, Vaccination.

View Article