An interesting case series of Idiopathic thrombocytopenic purpura in pregnancy with an insight into its multimodality management Gauri Abhishek Prabhu, Shridevi Chidanand Metgud, Anita D Dalal, Chandana K R Indian Journal of Obstetrics and Gynecology Research, 2026 Immune thrombocytopenia (ITP) is an autoimmune disorder characterized by isolated thrombocytopenia, which can pose significant risks during pregnancy for both the mother and fetus. The management of ITP in pregnancy presents unique challenges due to physiological changes, potential complications, and the need for careful therapeutic balancing. All patients presented with varying degrees of thrombocytopenia, most commonly in the second trimester. Treatments included corticosteroids, intravenous immunoglobulin (IVIG), and in refractory cases, thrombopoietin receptor agonists. The majority achieved safe platelet thresholds for delivery. No major maternal bleeding complications were observed. Neonatal outcomes were favourable.ITP in pregnancy requires individualized management to optimize maternal and neonatal outcomes. This case series underscores the importance of early diagnosis, close monitoring, and multidisciplinary care in achieving favourable prognoses in pregnant women with ITP.
An Interesting Case of Medical Termination in a High-risk Pregnancy with Pre-existing Rheumatic Heart Disease Complicated by Arrhythmia and Severe Anemia Gauri A Prabhu, Anita Dalal, Shridevi Metgud, Mahasweta Das Journal of South Asian Federation of Obstetrics and Gynaecology, 2026 Aim and background: To emphasize the critical role of a multidisciplinary approach in managing medical termination of pregnancy (MTP) in high-risk cardiac patients, particularly those with rheumatic heart disease (RHD), coexistent severe anemia, and arrhythmias such as atrial fibrillation (AF).Case description: A 38-year-old G4P2L2A1 woman at 13 weeks and 4 days of gestational age presented with complaints of giddiness and generalized weakness for 2 days.She had a known history of RHD with severe mitral regurgitation (MR) and grade II atrial regurgitation (AR), diagnosed first during her initial pregnancy.The patient reported having taken medical termination pills 24 days prior at a local hospital, which led to the passage of clots the following day without subsequent vaginal bleeding.On evaluation, she was found to be in AF and had severe anemia (Hb < 7 gm/dL).A multidisciplinary team, including obstetricians, cardiologists, and anesthesiologists, managed her condition.She underwent stabilization with blood transfusions and rate control for AF before proceeding with further obstetric care and follow-up.Conclusion: Patients with pre-existing cardiac conditions like RHD face an elevated risk of morbidity during pregnancy termination.Complications such as anemia and arrhythmias further increase this risk and necessitate careful evaluation and coordination between specialties.Clinical significance: This case underscores the critical role of a multidisciplinary strategy in managing MTP in women with significant cardiac disease.Early identification, stabilization, and coordinated intervention are vital to ensuring favorable maternal outcomes in high-risk pregnancies.
A Rare Case Report of Guillain–Barré syndrome with COVID-19 in Pregnancy Shridevi C Metgud, Gauri A Prabhu, Shubhashree V Rao, Prasad M Renuka Journal of South Asian Federation of Obstetrics and Gynaecology, 2025 Aim: To describe a rare case of Guillain-Barr syndrome (GBS) triggered by COVID-19 infection in a full-term, fully vaccinated pregnant woman, emphasizing diagnostic complexity, ethical considerations, and multidisciplinary management.Case description: A 26-year-old second gravida at full-term, Rh-negative pregnancy with a history of previous cesarean section and full COVID-19 vaccination, presented with acute symmetrical flaccid quadriplegia, dysarthria, and respiratory distress.She tested positive for SARS-CoV-2.Neurological examination showed areflexia, facial weakness, and hypotonia.Nerve conduction studies (NCV) confirmed severe axonal sensorimotor polyneuropathy, consistent with GBS.A CT/MRI of the brain was deferred due to lack of surrogate consent, but systematic clinical evaluation excluded other neurological differentials.She underwent an emergency lower-segment cesarean section under general anesthesia as she went into spontaneous labor at 37 weeks.Informed written consent was obtained from her husband and mother.She was treated with intravenous immunoglobulin (IVIg) and tracheostomy, followed by a prolonged ICU course.Both the mother and the COVIDpositive neonate recovered fully.Conclusion: Guillain-Barr syndrome should be considered in pregnant patients with acute flaccid paralysis, even in the setting of COVID-19 vaccination.Timely clinical diagnosis, supported by NCV, can guide treatment when imaging is not feasible.Early immunotherapy and multidisciplinary collaboration ensure optimal outcomes.Clinical significance: Clinicians must maintain a high index of suspicion for post-infectious neuromuscular syndromes like GBS in pregnant women with recent or ongoing viral infections.This case illustrates that clinical and electrophysiological assessment can substitute for imaging in urgent scenarios and highlights the critical role of coordinated, ethics-conscious management in critical maternal care.
Rare Case Series of Non-malignant Perforated Pyometra in Postmenopausal Women Shridevi C Metgud, Ramadevi V Wani, Shrishail Metgud, Prashant Hombal Journal of South Asian Federation of Obstetrics and Gynaecology, 2024 A bstrAct Pyometra is the accumulation of purulent material in the uterine cavity. The most common cause of formation of pyometra in elderly women is obstruction to the natural drainage system, which may be caused by malignant or benign conditions. Uterine perforation in a postmenopausal woman with non-malignant etiology is a rare entity, with less than 100 cases reported in the literature. Here we present two cases of postmenopausal women who presented as acute abdomen with suspicion of hollow viscus perforation in one and preoperatively diagnosed uterine perforation in another.
A 5-years cross-sectional study of risk-factors feto-maternal outcomes in placenta accreta spectrum at single tertiary care centre in South India Shridevi Chidanand Metgud, Gauri Abhishek Prabhu, Prasad Murigendrappa Renuka Indian Journal of Obstetrics and Gynecology Research, 2024 : PAS is an abnormal placental trophoblastic invasion into the myometrium, serosa and surrounding structures causing severe maternal morbidity and mortality due to massive obstetric hemorrhage (MOH). The incidence of PAS is on the rise due to increasing rate of Cesarean Section (CS) worldwide. : This study aimed to assess the risk factors associated with Placenta accreta spectrum (PAS) and to compare the feto-maternal outcomes in elective and emergency delivery in PAS.This is a 5 years single centre cross-sectional study from 1st January 2018 to 31st December 2022. All diagnosed cases of PAS beyond 28 weeks of gestation were included. A total of 38 cases of PAS were studied. Chi-square test and T-test were used to compare the categorical variables with p value 0f &#60;0.05 as statistically significant.The incidence of PAS was 1.85/1000 deliveries. Advanced maternal age, previous CS, placenta previa in current pregnancy were major risk factors. MOH was the commonest complication. The blood loss, increased operative time and need for blood transfusions was mainly dependent on the placental location. Prematurity and low birth weight were the most important perinatal outcomes. Adequate blood and blood products prior to surgery is important as even in expert hands blood loss can be massive. Early referral and specialized regional team to manage PAS at tertiary care are needed. Future studies should emphasize on easy and early detection of PAS.
Safe infant feeding in healthcare facilities: Assessment of infection prevention and control conditions and behaviors in India, Malawi, and Tanzania Bethany A. Caruso, Uriel Paniagua, Irving Hoffman, Karim Manji, Friday Saidi, Christopher R. Sudfeld, Sunil S. Vernekar, Mohamed Bakari, Christopher P. Duggan, George C. Kibogoyo, Rodrick Kisenge, Sarah Somji, Eddah Kafansiyanji, Tisungane Mvalo, Naomie Nyirenda, Melda Phiri, Roopa Bellad, Sangappa Dhaded, Chaya K. A., Bhavana Koppad, Shilpa Nabapure, Saumya Nanda, Bipsa Singh, S. Yogeshkumar, Katelyn Fleming, Krysten North, Danielle E. Tuller, Katherine E. A. Semrau, Linda Vesel, Melissa F. Young, and Plos Global Public Health, 2023 Infants need to receive care in environments that limit their exposure to pathogens. Inadequate water, sanitation, and hygiene (WASH) environments and suboptimal infection prevention and control practices in healthcare settings contribute to the burden of healthcare-associated infections, which are particularly high in low-income settings. Specific research is needed to understand infant feeding preparation in healthcare settings, a task involving multiple behaviors that can introduce pathogens and negatively impact health. To understand feeding preparation practices and potential risks, and to inform strategies for improvement, we assessed facility WASH environments and observed infant feeding preparation practices across 12 facilities in India, Malawi, and Tanzania serving newborn infants. Research was embedded within the Low Birthweight Infant Feeding Exploration (LIFE) observational cohort study, which documented feeding practices and growth patterns to inform feeding interventions. We assessed WASH-related environments and feeding policies of all 12 facilities involved in the LIFE study. Additionally, we used a guidance-informed tool to carry out 27 feeding preparation observations across 9 facilities, enabling assessment of 270 total behaviors. All facilities had ‘improved’ water and sanitation services. Only 50% had written procedures for preparing expressed breastmilk; 50% had written procedures for cleaning, drying, and storage of infant feeding implements; and 33% had written procedures for preparing infant formula. Among 270 behaviors assessed across the 27 feeding preparation observations, 46 (17.0%) practices were carried out sub-optimally, including preparers not handwashing prior to preparation, and cleaning, drying, and storing of feeding implements in ways that do not effectively prevent contamination. While further research is needed to improve assessment tools and to identify specific microbial risks of the suboptimal behaviors identified, the evidence generated is sufficient to justify investment in developing guidance and programing to strengthen infant feeding preparation practices to ensure optimal newborn health.
