PREGNANCY CARE IN COVID19 THROUGH AYURVEDA

The coronavirus disease 2019 (COVID-19) is a highly transmittable and pathogenic viral infection caused by se- vere acute respiratory syndrome coronavirus 2 (SARS COV-2) and Garbha-Kala is one of the most crucial and responsible stages in women's life. COVID-19 can produce a devastating effect on maternal wellbeing. Ayurveda has mentioned the pandemic situation under the term Janapadodhwamsa which spread through Vayu, Jala, Desha and Kala. The outbreak of Covid-19 is severely affecting the world. It is an infectious disease caused by severe acute respiratory syndrome coronavirus 2. It has mainly respiratory and systemic manifestations. People having diabetes, chronic diseases, pregnant women are more prone to this infection as they are more susceptible to path- ogens and the development of severe conditions like pneumonia. Due to the physiological changes during preg- nancy, pregnant women are the most vulnerable group in this pandemic situation because infection during preg- nancy can result in adverse outcomes. Much research is still in continuation because we are not sure of much evi- dence till now. Many preventive protocols suggested by Ayurveda can prevent the prevalence of disease up to some extent. Keywords: Ayurveda, Covid-19, Janapadodhwamsa, Pandemic, Pregnancy

Increased Homocysteine Level and Risk of Gestational Hypertension in South East Algerian population

The objective of this study is to target the effect, in the South East Algerian population, of homocysteine level on gestational hypertension (GH) in wom-en. We also aim to study if gestational hypertension and preeclampsia (PE), two types of hypertensive disorders, share the same risk factors. The case-control study has been undertaken in Ouargla maternity hospital. Homocys-teine (Hcy) levels have been measured using an automated chemilumines-cence method. Creatinine and total protein have been determined using a colorimetric method, while an enzymatic technique has been employed to estimate the aspartate aminotransferase (AST) and the alanine aminotrans-ferase (ALT). The mean concentration of homocysteine was significantly higher for PE (14.90±8.54 μmol/l) and GH (11.10±5.13 μmol/l) compared to that of normotensive women (6.85±3.23 μmol/l) p≤ 0.01. Besides, hyperho-mocysteinemia (Hhcy) was detected with 70% of mothers with PE and with 40% of mothers with GH compared to only 11.53 % of controls. These values show the correlation between the rate of Hcy and hypertension during preg-nancy aetiology and severity. The other metabolites showed a significant increase in total protein level in PE and GH women compared to controls (p≤0.01). A significant increase in creatinine level is observed for patients with preeclampsia (p<0.05). There were no differences among patients and controls concerning AST nor ALT. Results show that homocysteine is an im-portant risk factor as for gestational hypertension as for preeclampsia. Com-plications have similar biochemical profiles leading GH to be given as much attention as PE.

Hyperthyroidism in Pregnancy: the Delicate Balance between too Much or too Little Antithyroid Drug

Overt hyperthyroidism during pregnancy is associated with risk of maternal-fetal complications. The antithyroid drugs (ATD) have a potential risk for teratogenic effects and fetal&ndash;neonatal hy-pothyroidism. This study evaluated ATD treatment and thyroid function control during preg-nancy, and pregnancy outcome in women with hyperthyroidism. Patients and methods: retro-spective analysis of 36 single fetus pregnancies in 29 consecutive women (median age 30.3 &plusmn; 4.7 years) with hyperthyroidism diagnosed before or during pregnancy; a control group of 39 healthy euthyroid pregnant women was used. Results: 26 women had Graves&rsquo; disease (GD, 33 pregnan-cies), 1 had a hyperfunctioning autonomous nodule, 2 had gestational transient thyrotoxicosis (GTT). Methimazole (MMI) was administered in 22 pregnancies (78.5%), Propylthiouracil (PTU) in 2 (7.1%), switch from MMI to PTU in 4 (14.2%), no treatment in 8 pregnancies (3 with subclinical hyperthyroidism, 5 euthyroid with previous GD remission before conception). One spontaneous abortion at 5 weeks (3.4% of pregnancies) and 1 premature delivery at 32 weeks with perinatal death in 24h (3.4%) were recorded in 2 of the 8 pregnancies of GD patients diagnosed shortly before (&lt; 6 weeks) or during gestation. In women treated more than 6 months until conception (20 pregnancies): a) median ATD doses were lower than those in women diagnosed shortly before or during pregnancy; b) ATD was withdrawn in 40% of pregnancies in trimester (T) I, all on MMI &lt; 10 mg/day (relapse in 14.2%), and in up to 55% in TIII; c) TSH level was below normal in 37%, 35% and 22% of pregnancies in T I, II and III respectively; FT4 was increased in 5.8% (T I) and sub-normal in 11.75% in TII and III; d) one fetal death due to a true umbilical cord knot was recorded. Hyperthyroidism relapsed postpartum in 83% of GD patients (at median 3 &plusmn; 2.6 months). One child had neonatal hyperthyroidism (3.3% of live children in GD women) and a small atrial sept defect (4% of live children in ATD treated women). Mean birth weight did not differ from that of the control group. Conclusion. In hyperthyroid women with long-term ATD control before con-ception, drugs could be withdrawn in TI in a third of them, and fetal complications were rare. Frequent serum TSH and FT4 monitoring is needed in order to maintain optimal thyroid function during pregnancy.

MANAGEMENT OF INFERTILITY DUE TO HYDROSALPINX WITH BOH BY AYURVEDIC REGIME: A CASE STUDY

We report a case of a 33 years old female patient anxious for issues since 2 years. Patient was having Bad Obstetric History (BOH) in her previous 2 pregnancies with history of Ectopic pregnancy in her last preg-nancy for which linear salpingostomy was done. Patient underwent diagnostic investigations and proce-dures to rule out the cause. She was found to have Bilateral Hydrosalpinx in her HSG findings. So, the treatment was planned accordingly, and she was treated with Ayurvedic regimen consisting of Shodhana and Shamana therapy. HSG was repeated 6 months after treatment which was found to be normal with Bi-lateral patent tubes and she was managed to conceive successfully after treatment. Though she was a K/C/O BOH also, so she was provided all the necessary advice and examinations in her Antenatal period including Masanumasika Garbhini Paricharya and she delivered healthy female child of 2.8 kgs on 21.11.2020. So, implementation of Ayurvedic approach with X ray HSG resulted in successfully treating this case without tubal corrective surgery.

OPERATIVE TREATMENT OF ECTOPIC PREGNANCY: FEATURES OF VARIOUS TYPES OF SURGICAL INTERVENTIONS

Ectopic pregnancy is one of the most pressing prob-lems associated with reproductive problems all over the world. Unfortunately, so far, impaired ectopic pregnancy in some cases leads to maternal mortality. Suspicion of ectopic pregnancy requires a full clinical and diagnostic examination and hospitalization of the patient in the gynecological Department. In most cas-es, ectopic pregnancy is localized in the fallopian tube. Most often, according to the literature, patients with ectopic pregnancy are subjected to surgical treatment, which subsequently negatively affects the reproductive function of women, since the removal of ectopic pregnancy leads to both the removal of the tube and its injury, which increases the risk of repeat-ed ectopic pregnancy. The choice of the type of surgi-cal intervention on the fallopian tube in ectopic preg-nancy should be personalized and appropriate to the specific clinical situation. This paper analyzes various types of surgical interventions on the fallopian tubes in ectopic pregnancy.

POSSIBILITIES OF THE USE OF INTRAUTERINE CONTRACEPTION IN WOMEN OF DIFFERENT AGE GROUPS

Currently, the problem of family planning is not only medical, but also social. The reason for this is the widespread use of artificial termination of pregnancy in our country. Moreover, the majority of women in Russia resort to the extremely dangerous method of abortion - acute curettage, which is associated with a high risk of further infertility and the development of long-term adverse consequences. It is necessary to inform all patients of reproductive age about the neg-ative consequences of artificial termination of preg-nancy and the possibilities of modern methods of con-traception. One of the most popular in our country (in second place after combined oral contraceptives) and highly effective (Pearl index is 0.1-0.5) methods of contraception is the intrauterine device. Intrauterine systems (IUDs) are reversible long-term contraception, which makes them easy to use and affordable. The IUD is installed for 5 years and does not require constant monitoring by the patient. If necessary, the device can be removed at any time. Another positive aspect is that fertility is restored after 12 months in 80-96% of cas-es. Also, intrauterine contraceptives have the thera-peutic effect, since the local action allows you to nor-malize the menstrual cycle, which is especially im-portant for women suffering from hyperpolymenor-rhea and chronic anemia. It has been proven that IUDs do not increase the risk of developing endome-trial and cervical malignant tumors and, in addition, have antiproliferative and antimitotic effects, which makes it possible to use them in patients with complex atypical hyperplasia and highly differentiated stage IA endometrial adenocarcinoma.

Prevalence and factors associated with the consumption of folic acid and iron in pregnant women in the BRISA cohort

Objectives: to describe the prevalence and factors associated with the consumption of folic acid and iron among puerperal women in the city of São Luís, Maranhão. Methods: a cross-sectional study with 4,036 puerperal women through a standardized questionnaire. The dependent variables (outcomes) were: the consumption of folic acid during pregnancy, iron and folic acid before pregnancy. The independent variables: age; schooling; skin color; marital status; income; planned pregnancy; place and number of prenatal consultations. Statistical analyzes were performed on STATA 14.0. For the first two outcomes, Poisson model with a robust variance was used. And for the last one, logistic regression. Results: the prevalence of consuming folic acid and iron during pregnancy were, respec-tively, 77.27% and 84.98%. However, only 0.37% reported the consume of folic acid and iron before pregnancy. In the adjusted analysis, the variables associated with the consumption of folic acid during pregnancy were: schooling and income; the consume of iron during preg-nancy, age only; and for those who consumed folic acid before pregnancy, no variable was statistically significant. Conclusions: high percentage of puerperal women who consumed folic acid and iron supplements during pregnancy, however, the recommended consumption of folic acid before pregnancy was low and maternal, social and economic factors influence the consumption of these supplements.

Anemia in the first trimester is associated with anemia during pregnancy in Sidotopo Wetan Community Health Center, Surabaya

Objective: To analyze association between anemia in the first trimester and preeclampsia during pregnancy in Sidotopo Wetan Community Health Center Surabaya.Materials and Methods: This study was a analytic case control study. The samples were 49 women with preeclampsia as case group and 49 women non-preeclampsia as control group. The data were secondary data collected from medical record of pregnancy women on Sidotopo Wetan Community Health Center Surabaya from January 2016 – Desember 2017. The analysis was done by Chi Square Statistics.Results: 79,6% women in preeclampsia group and 93.9% women in non-preeclampsia group was not anemia in the first trimester. There is association between anemia in the first trimester and preeclampsia during pregnancy in Sidotopo Wetan Community Health Center Surabaya (p = 0.037; OR = 3.932 (CI 95% = 1.010 – 15.303)).Conclusion: There is association between anemia in the first trimester and preeclampsia during preg-nancy in Sidotopo Wetan Community Health Center Surabaya.

Dynamics of indicators of non-specific pro-tection of holstein black-and-white breeds of cows depending on the month of pregnancy

The article discusses the results of the dy-namics of indicators of innate immunity of cattle throughout pregnancy. The research topic is relevant, since receiving healthy offspring is certainly associated with the natural resistance of the cow. The aim of the study is to study the non-specific immunity of cows in different months of pregnan-cy. The work was performed on the farm of JSC Krasnoselskoye PZ (Leningrad Oblast). During the experiment, 2 groups of cows of Holstein black-and-white breeds were formed: the experimental group – 10 preg-nant cows and the control group-10 not steel cows. Blood was taken once a month throughout pregnancy. Indicators of phago-cytosis, bactericidal and lysozyme activities were determined in the blood. During the study, the authors noted a decrease in lyso-zyme, bactericidal activity relative to the indicators of the control group, however, the difference did not reach significant differences. Also observed a sig-nificant inhibition of the functional state of the number of blood neutrophils: a decrease in phagocytic activity reliably observed from 5 months by 27.02%, from 7 month by 41.9% to 9 month, the index decreased by 50,66% as compared to control; at the phag-ocytic number of reliable decrease was ob-served at 4 months 11.3% at 6 months had decreased by 24.86%, and the 9 month preg-nancy reduction made up 28.81%, the phag-ocytic index, starting with the 5th month of pregnancy was significantly decreased by 32.05%, to 8 month decreased by 48.31% and for 9 months had decreased by 50% compared to control. Therefore, in the period of pregnancy in the organism of cows, the development of sec ondary immunodeficiency is noted, which is directly associated with fetal gestation. The data obtained can be useful in correction factors of natural resistance during pregnancy of cows.

THE STATE OF ANTIOXIDANT SYSTEM AND CYTOKINE PROFILE AT DIFFERENT PERIODS OF A PHYSIOLOGICALLY ONGOING PREGNANCY

Pregnancy is accompanied by physiologically adaptive changes necessary for the normal vital functioning of preg- nant woman and for the growth and development of the fetus. During pregnancy, structural and functional changes in all body systems begin, including in the immune and antioxidant systems. In the normal course of pregnancy, the cytokine balance shifts toward the immunosuppressive Th-2 cytokines (IL-4, IL-10, TGF-β). Violation of an adequate restructuring cytokine balance can cause complications during pregnancy. It was noted that high levels of Th1 cyto- kines can significantly affect the course of pregnancy and that cytokines are sensitive markers of spontaneous abortion in women. Activation of metabolic processes, increased energy metabolism, the initiation of tissue respiration occurs in preg- nancy. Disruptions in the functioning of the mitochondrial respiratory chain, changes in hemodynamics and tissue oxy- genation induce the formation of reactive oxygen species (ROS) that often cause a violation of oxidative homeostasis and the formation of oxidative stress (OS). This requires activation of the antioxidant system and an additional amount of antioxidants to restore balance in the pro/antioxidant system. It should be noted that at different stages of pregnancy imbalance of pro/antioxidants and pro/anti-inflammatory cytokines systems are individual and the limits of physiological changes during normal pregnancy of particular indica- tors of these systems are poorly understood.