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Sukhpal Singh, Lakhwinder Singh, and Kamal Vatta (Eds.). 2021. Covid-19 Pandemic and Economic Development Emerging Public Policy Lessons for Indian Punjab. Palgrave Macmillan, xxvi + 309 pp., E93.08 (eBook), E109.99 (hardback). ISBN 978-981-16-4442-9 (eBook), ISBN 978-981-16-4441-2 (hardback).

Neurological manifestations, including raised intracranial pressures, are a hallmark of worsening pre‐eclampsia. Invasive methods for measuring intracranial pressure, though a gold standard, are not always a viable option. Maternal ocular sonography is a promising bedside tool, which serves as a noninvasive, cost‐effective means for measuring optic nerve sheath diameter (ONSD), a surrogate marker of raised intracranial pressures. We studied the ultrasonographically measured ONSD in severely pre‐eclamptic women, and the effect of magnesium sulfate therapy on its values. Thirty severely pre‐eclamptic women at ≥28 weeks gestation were included. We recorded baseline ONSD values, serum magnesium levels, neurological symptoms, vitals, and repeated them at 4 and 12 hours following magnesium sulfate therapy, and then at 24 hours postpartum. An ONSD value >5.8 mm was suggestive of raised intracranial pressure. Primary outcome measure was to evaluate changes in ultrasonographically measured ONSD following seizure prophylaxis with magnesium sulfate. Women, 73.3%, had baseline ONSD >5.8 mm, with mean diameter being significantly high (6.02 ± 0.77 mm). There was a statistically nonsignificant decline in mean ONSD values at 4 and 12 hours, as well as at 24 hours postpartum. Patients with neurological symptoms declined significantly (from 70 to 10%; pvalue <.001) following magnesium sulfate therapy. Majority of severely pre‐eclamptic parturients had high ONSD value suggestive of raised intracranial pressures, which persisted in the postpartum period and was unaffected by magnesium sulfate therapy. Ultrasound can thus serve as a point‐of‐care, cost‐effective, easily available bedside tool for indirectly measuring intracranial pressures in this high‐risk population.

Background: India plays an important role in global research on gestational diabetes mellitus (GDM), but a bibliometric assessment of this research is lacking. Objective: To provide a comprehensive analysis of Indian GDM research during the last 30 years using select bibliometric indicators. Methods: The Scopus international database was used to retrieve publication data, using a defined search strategy. The analysis focused on research output of Indian authors and organizations and their collaborations. The qualitative performance was assessed in terms of relative citation index and citations per paper (CPP). Results: Overall, 100 countries participated in GDM research producing 13,193 publications during 1990–2019. India ranked ninth in global output (1182 publications, 3.1% share) and CPP of 18.6. Only 21.3% of publications had international collaboration and 9.4% were funded. Of the 235 organizations and 544 authors that participated in India’s research on GDM, the top 50 organizations and authors contributed 53.8 and 36.4% to national publication share, respectively. The leading productive organizations were AIIMS, New Delhi, KEMH, Pune and PGIMER, Chandigarh, whereas the most productive authors were S. Kalra, V. Seshiah and C.S. Yajnik. Indian Journal of Endocrinology and Metabolism, Journal of Clinical and Diagnostic Research, Journal of Obstetrics and Gynecology of India and Diabetes Research and Clinical Practice were the most productive journals. Conclusions: Indian research on GDM is lagging behind other countries which have a similar disease burden. Increasing national and international collaborations, and active support of national and international funding agencies is urgently required to produce quality research on GDM.

Background: Hyperemesis gravidarum (HG) refers to intractable vomiting during pregnancy and is rarely associated with Wernicke’s encephalopathy (WE). HG-associated WE can lead to mortality and permanent cognitive impairment if left untreated. In this report, we present two cases of WE following HG occurring in the context of comorbid severe depression.Case Description: In the first case, a 29-year-old female developed HG and WE during the second month of pregnancy, followed by an episode of severe depression with catatonia. In the second case, a 23-year-old female with bipolar disorder presented with HG for two months during pregnancy, followed by an episode of severe depression and a fractured mandible due to a fall.Conclusion: Thiamine should be considered in women experiencing prolonged vomiting during pregnancy, and they should be closely monitored for features of WE.

Lakhwinder Singh and K. J. Joseph (Eds), 2024. Reimagining Innovation Systems In The COVID And Post-COVID World. Routledge, xxii+278 pp., £104 (hardback), £28.79 (paperback and e-book).

Purpose: Etiological spectrum of fever in pregnant women and its impact on fetomaternal outcomes were studied. Methods: This was a hospital-based prospective study, conducted over 12 months. All pregnant women with fever were screened and detailed etiological evaluation carried out. Maternal and foetal outcomes were noted. Results: One hundred and eighty-one pregnant women with fever were included. Common causes were dengue 44 (24.3%), hepatitis E 26 (14.4%) and urinary tract infection (UTI) 22 (12.2%). Mosquito-borne diseases accounted for the highest burden 61 (33.7%). Second most common were diseases transmitted by feco-oral route 46 (25.4%). Maternal deaths occurred in 29 (16%) patients. Common causes of death were hepatitis E infection in 9 of 26 (34.6%) cases, dengue in 7 of 44 (15.9%) and tuberculosis in 5 of 11 (45.5%) cases. Conclusion: Dengue, hepatitis E and UTI were the most common causes of fever during pregnancy. Most cases were caused by vector- and water-borne diseases and thus potentially preventable. Overall maternal mortality was 16%.

Background: Near miss (NM) concept has led to a more comprehensive and better assessment of effect of care on maternal health. It indicates the degree of organ function failure in the wide spectrum of severity. Methods: This was a prospective observational study conducted from July 2015 to Feb 2016. Among women with potentially life-threatening conditions (PLTCs), those fulfilling one or more WHO NM criteria were included and followed up till the final outcome (NM or death). Various critical interventions done in them were associated with the final outcome. Standardized mortality ratio (SMR) was calculated for assessment of overall quality of health care provided. Results: One thousand seven hundred and thirty-nine patients had PLTCs of which 174 (10%) patients were identified as NM. Of 174 patients, 116 patients (66.66%) were discharged in stable condition (group A) and 58 patients (33.34%) died (group B). Hemorrhage (31.8%) was the most frequent complication in group A followed by hypertensive disorders (18.1%) and severe anemia (11.2%). The two most common causes of maternal mortality were hypertensive disorders (27.6%) and hemorrhage (24.1%). Only two critical interventions (assisted ventilation and massive blood transfusion) had significant association with the final outcome. SMR of our center was 1.187 indicating adequate quality of provision of care to the patients. Conclusion: Hemorrhage and hypertensive disorders were the two most common causes of NM and deaths highlighting the importance of their prompt diagnosis and vigorous management. Periodic SMR calculation can be used as an audit to guide us in improving the overall status of maternal health.

Background: Tetralogy of Fallot is a severe type of congenital heart disease (CHD) and one of the leading indirect causes of mortality & morbidity among women with CHD. We came across a rare case of an uncorrected Tetralogy of Fallot with pulmonary atresia and major aortopulmonary collateral arteries in pregnancy. Case presentation: We are reporting the challenges in managing a pregnancy of 25-years-old G3 P0110, previous one stillbirth and who was diagnosed to have congenital heart disease during pregnancy following spontaneous abortion. Conclusions: This case report highlights the role of multidisciplinary care in managing such a high risk case. It also emphasizes the role of cardiac examination of every woman before pregnancy so that definitive treatment or optimization can be done in time for a better outcome.

AbstractPregnancy in a woman with double outlet right ventricle, ventricular septal defect, and pulmonary stenosis is presented. Her previous two pregnancies ended in fetal losses. In the current pregnancy, she had thrombocytopenia, placenta previa, and severe fetal growth restriction. She underwent an emergency caesarean section followed by post-partum haemorrhage and COVID-19 infection. Literature review has been performed.

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Serous cystadenofibroma is a benign tumor usually misdiagnosed as malignant ovarian tumor due to its gross appearance as well as on imaging. In our case, 34-year-old primigravida at 18+ 3weeks diagnosed with ovarian tumor was also suspected and managed as malignant ovarian neoplasm preoperatively. Right salpingo-oophorectomy was done and final histopathology report came as cysadenofibroma—a benign tumor.

Pseudohypoparathyroidism is rare during pregnancy and poses multiple challenges related to its diagnosis and management during pregnancy. We hereby report a case of a young woman who was diagnosed to have type 1a pseudohypoparathyroidism. She was managed by multidisciplinary team and had good maternal and perinatal outcome. Management-related issues are discussed here in detail.