Publications by authors named "Anuja Abraham"

18 Publications

  • Page 1 of 1

Spinal haemangioma with cauda equina syndrome in pregnancy.

BMJ Case Rep 2022 Jun 27;15(6). Epub 2022 Jun 27.

Department of Neurosciences, Christian Medical College and Hospital Vellore, Vellore, Tamil Nadu, India.

The true incidence of haemangiomas, which are the most common benign tumours in the spine, is not known as they are most often asymptomatic and are detected at autopsy. It can become symptomatic due to the haemodynamic and hormonal changes in pregnancy which cause sudden expansion of the lesion. In this paper, we present a case of a woman in her 30s, primigravida at 31 weeks' gestation with acute urinary retention and neurological features suggestive of cauda equina syndrome. Imaging confirmed the diagnosis of vertebral haemangioma involving T12 vertebra encroaching the posterior dural space and abutting the cord. She underwent surgical excision of the haemangioma with complete recovery of neurological symptoms on postoperative follow-up.
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http://dx.doi.org/10.1136/bcr-2022-250306DOI Listing
June 2022

Breast milk contains red cell isohaemagglutinins: An observational study of 176 mothers.

Vox Sang 2022 Jun 26;117(6):847-852. Epub 2022 Jan 26.

Department of Transfusion Medicine and Immunohaematology, Christian Medical College, Vellore, India.

Background And Objectives: Maternal antibodies are transferred to the child, predominantly IgG, via the transplacental route, and mostly IgA through breast milk. Cases reported by us and others have shown the transfer of red cell allo-antibodies through breast milk. This study was conducted to assess the presence of isohaemagglutinins in breast milk, the range of titres, and the correlation between breast milk and maternal plasma titres.

Materials And Methods: A total of 176 mothers were recruited in this study. Breast milk was collected after sufficient feeding was established and within 2-5 days of delivery in a sterile container without any anticoagulant. Antibody screen, identification and titres were performed on maternal plasma as well as breast milk.

Results: Anti-A and anti-B in breast milk corresponding to their respective maternal blood groups were found in all the samples. This study has shown titres in the breast milk of anti-A and anti-B ranging from 2 to 1024 in both saline and Coombs phases. There was no association between plasma and breast milk titres, thus making it impossible to predict which mother may potentially transfer a larger amount of these haemagglutinins. Isotypes of anti-A and anti-B were evaluated in both plasma and breast milk of 11 samples, which showed predominantly IgG in 7 (63.63%) and predominantly IgA in 4 (36.36%) samples.

Conclusion: Our study demonstrates the presence of a wide range of titres for IgG antibodies of the ABO blood group system in breast milk. The clinical impact of this finding needs to be studied further, as it assumes great relevance in developing countries where anaemia continues to challenge young infants.
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http://dx.doi.org/10.1111/vox.13253DOI Listing
June 2022

Biliary cystadenoma masquerading as an adnexal cyst in pregnancy.

BMJ Case Rep 2021 Dec 14;14(12). Epub 2021 Dec 14.

Department of Hepato Pancreato Biliary Surgery, Christian Medical College Vellore, Vellore, India.

The aetiological diagnosis of cystic masses detected on routine ultrasound during pregnancy can be challenging. Unless approached cautiously with a detailed history and adequate use of imaging techniques, misdiagnosis of these cystic masses are not uncommon. Cystic masses diagnosed during pregnancy are mostly of ovarian origin; however, other non-ovarian cystic masses are also detected incidentally or at laparotomy/laparoscopy. We report a rare case of ruptured biliary cystadenoma in a pregnant woman diagnosed at emergency laparotomy. She was taken up for surgery with a provisional impression of ruptured adnexal cyst. However, the cyst was found to be arising from the liver and the histology of the cyst wall was reported as biliary cystadenoma.
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http://dx.doi.org/10.1136/bcr-2021-246392DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8671909PMC
December 2021

Placenta percreta presenting as uterine rupture following previous B-Lynch suture.

BMJ Case Rep 2021 Oct 1;14(10). Epub 2021 Oct 1.

Department of Obstetrics and Gynecology, Unit III, Christian Medical College and Hospital, Vellore, Tamil Nadu, India.

Placenta accreta spectrum disorder varies from minimally adherent placenta to deeply invasive placenta. Placenta percreta is a rare cause for uterine rupture and the incidence of morbidly adherent placenta is on the rise due to increase in the rates of caesarean section. We report a case of a 32-year-old, G2P1L1 who presented to us at 27 weeks in a state of haemodynamic shock with intrauterine fetal death. She had a history of prior caesarean section complicated by postpartum haemorrhage requiring B-Lynch suturing. With an initial diagnosis of caesarean scar rupture, she underwent an emergency laparotomy. Intraoperatively, the caesarean scar was found to be intact and uterine fundal rupture with placental protrusion identified. She underwent caesarean hysterectomy and was discharged in a stable condition. The histopathology report confirmed the diagnosis of placenta percreta.
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http://dx.doi.org/10.1136/bcr-2021-245593DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8488723PMC
October 2021

Maternal and Perinatal Outcomes of Influenza in Pregnancy after Treatment with Oseltamivir.

J Glob Infect Dis 2021 Jan-Mar;13(1):20-26. Epub 2021 Jan 29.

Global Health Center, Cincinnati Children's Hospital, Cincinnati, OH, USA.

Context: Influenza infection in pregnancy causes 4%-8% case fatality and five times more perinatal mortality. Influenza is a major contributor to mortality in developing countries; however, the morbidity has largely been underestimated. Public health interventions for prevention are also lacking.

Aims: This study aimed to determine the seasonality of influenza in pregnant Indian women and to estimate the maternal and perinatal morbidity after treatment with oseltamivir.

Settings And Design: This was a prospective observational cohort study, conducted in a tertiary hospital.

Subjects And Methods: Pregnant women with ILI (influenza-like illness) were recruited into Cohort 1 (polymerase chain reaction [PCR] positive) and Cohort 2 (PCR negative). Gestational age-matched asymptomatic controls formed Cohort 3. Women in Cohort 1 received oseltamivir for 5 days. The incidence of small-for-gestational age (SGA) and preterm birth were the primary outcomes. Maternal and neonatal morbidity formed the secondary outcomes.

Statistical Analysis: Unmatched (Cohort 1 and 2) and matched analysis (Cohort 1 and 3) were done. Student's -test and Chi-square test were used to compare between variables.

Results: Year-round incidence of influenza was recorded. Severe illness was more in Cohort 1 compared to Cohort 2 (36.2% vs. 6.3%; < 0.001). SGA was comparable in all the cohorts (13%). Preterm birth (7.8% vs. 3.3%; < 0.08; relative risk-2.75) was considerably high in Cohort 1. Secondary maternal and neonatal outcomes were similar between the groups.

Conclusion: Influenza in pregnancy showed year-round incidence and increased maternal and neonatal morbidity despite treatment with oseltamivir. We suggest the need for newer interventions to curtail the illness in pregnancy.
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http://dx.doi.org/10.4103/jgid.jgid_157_20DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8054794PMC
January 2021

Follow-up of offspring and mothers with gestational diabetes treated with metformin or glibenclamide: A randomized controlled trial.

Int J Gynaecol Obstet 2021 03 12;152(3):446-447. Epub 2020 Oct 12.

Department of Obstetrics and Gynecology, Christian Medical College, Vellore, Tamil Nadu, India.

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http://dx.doi.org/10.1002/ijgo.13380DOI Listing
March 2021

A prospective observational study of the follow-up of medical management of early pregnancy failure.

J Family Med Prim Care 2019 Dec 10;8(12):3998-4002. Epub 2019 Dec 10.

Department of Obstetrics and Gynaecology Unit - 5, Christian Medical College, Ida Scudder Road, Vellore, Tamil Nadu, India.

Background: Medical termination for missed miscarriage with the use of 800 μg of vaginal misoprostol as a single agent is recommended as a cheap option before 14 weeks of gestation in developing countries. A few studies have looked at its efficacy.

Methods: A prospective, observational study was done on women having medical termination with up to three doses of 800 μg vaginal misoprostol at 12 hourly intervals. The number of women who needed check curettage was collected. Ultrasound findings if done were collated. Follow-up was done telephonically at the end of first week, fourth week and sixth week.

Results: The cohort comprised 145 women. The primary outcome was the need for curettage after expulsion of products following medical management and this was 49/145 (37.8%) of women. The induction expulsion interval was 36 hours. The mean endometrial thickness of the 113/145 women who had an ultrasound was 11 mm. The mean endometrial thickness in women who had check curettage was 18 mm. Persistent spotting was the only significant symptom at follow-up. Resumption of cycle at the end of the sixth week was seen in 105/132 (80.15%) of women who were followed up.

Conclusion: Findings of our study showed the check curettage rate of 37.8%. However, the regime which we used, that is, 800 μg vaginal misoprostol at 12 hourly intervals had a long induction to expulsion interval of 36 hours. In all, 80% of women resumed normal cycles at the end of the sixth week. No significant complications were noted on follow-up.
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http://dx.doi.org/10.4103/jfmpc.jfmpc_585_19DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6924238PMC
December 2019

Randomized controlled trial of the effect of amniotomy on the duration of spontaneous labor.

Int J Gynaecol Obstet 2017 Aug 2;138(2):152-157. Epub 2017 Jun 2.

Department of Obstetrics and Gynaecology, Christian Medical College, Vellore, Tamilnadu, India.

Objective: To investigate the effect of amniotomy on the duration of spontaneous labor.

Methods: In the present randomized controlled trial, women in spontaneous labor with singleton pregnancies presenting at a tertiary teaching hospital in South India between August 1, 2014, and October 31, 2015, were randomized in a 1:1 ratio to undergo amniotomy or conservative management. The primary outcome was the duration of labor. Per-protocol analyses were performed and the duration of labor was compared between the groups of patients.

Results: There were 144 patients randomized to each group. The median duration of labor was 235 minutes (interquartile range 117-355) in the amniotomy group and 364 minutes (interquartile range 201-580) in the conservative management group (P<0.001).

Conclusion: Amniotomy was associated with a shorter duration of labor in comparison with conservative management in patients with singleton pregnancies experiencing spontaneous labor. Clinical Trials Registry-India: (CTRI) (CTRI/2014/12/005264).
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http://dx.doi.org/10.1002/ijgo.12203DOI Listing
August 2017

Digital stretching of cervix in the active phase of labour to shorten its duration: a randomised control trial.

Trop Doct 2017 Oct 14;47(4):312-316. Epub 2017 Apr 14.

4 Professor, Department of Obstetrics and Gynaecology, Christian Medical College, Vellore, Tamil Nadu, India.

An assessment of the efficacy and satisfaction of women in active labour having digital cervical stretching compared to women who did not have this intervention. Ours was a randomised controlled trial at a tertiary centre in India. Low-risk women at term with vertex presentation in active labour with ruptured membranes and cervical dilation of 4-6 cm were included. Stretching to delivery interval was 247.5 ± 158.2 min in the intervention group and 265.5 ± 158.4 in the control group. The mode of delivery, incidence of cervical tear, and maternal, fetal and neonatal complications were similar in both groups. The Labour and Delivery Satisfaction Index (LADSI) was similar in both groups. While no significant discomfort was perceived with stretching, it does not appear to expedite labour.
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http://dx.doi.org/10.1177/0049475517703279DOI Listing
October 2017

Randomized double-blind placebo controlled study of preinduction cervical priming with 25 µg of misoprostol in the outpatient setting to prevent formal induction of labour.

Arch Gynecol Obstet 2017 Jan 26;295(1):33-38. Epub 2016 Aug 26.

Department of Obstetrics and Gynaecology Unit V, Christian Medical College, Ida Scudder Road, Vellore, 632 004, India.

Objective: To compare the efficacy of preinduction outpatient use of a single dose of 25 μg vaginal misoprostol between 38 and 40 weeks with that of placebo, to decrease the interval from intervention to delivery after stretch and sweep in low-risk gravid women with Bishop's score <4.

Method: Sixty three women received 25 μg vaginal misoprostol and 63 women received placebo after stretch and sweep.

Results: The duration from intervention to delivery was 3.35 (1.12-9.46) days in the misoprostol group and 5.42 (2.39-10.11) days in the placebo group which was statistically significant (p = 0.029). Spontaneous labor was seen in 39 women (61.9 %) in the misoprostol group and 35 women (55.6 %) in the placebo group (p = 0.531). Eight women in the misoprostol group and 18 in the placebo group had Lower Segment Caesarean Section (LSCS) and this difference was also statistically significant (p = 0.027). There were no major maternal and neonatal complications in both groups.

Conclusion: Preinduction use of 25 μg vaginal misoprostol after stretch and sweep in the outpatient setting decreased the intervention to delivery interval when compared to placebo.
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http://dx.doi.org/10.1007/s00404-016-4173-zDOI Listing
January 2017

Umbilical Cord Haematoma Causing Still Birth- A Case Report.

J Clin Diagn Res 2015 Dec 1;9(12):QD01-2. Epub 2015 Dec 1.

Associate Professor, Department of Obstetrics and Gynaecology, Christian Medical College , Vellore, Tamil Nadu, India .

Still birth continues to be one of the many challenges that an obstetrician has to face. Still births that occur in the antenatal period are more difficult to explain than that which occurs intrapartum. The latter is most often due to intrapartum asphyxia, medical complications or infections; however a cause for antenatal still birth is difficult to ascertain. A thorough examination of the case along with necessary investigations might not necessarily reveal any cause and this leads to considerable anxiety for both the mother and the treating obstetrician. In the investigation of a case of still birth a detailed examination of the placenta and cord has to be emphasised as a considerable number of still births that are thought to be unexplained may be attributable to placental or cord pathologies. Here we present one such case where an umbilical cord haematoma resulted in intrauterine foetal death.
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http://dx.doi.org/10.7860/JCDR/2015/16106.6856DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4717679PMC
December 2015

A randomised double-blind placebo-controlled trial comparing stepwise oral misoprostol with vaginal misoprostol for induction of labour.

Trop Doct 2016 Oct 19;46(4):198-205. Epub 2016 Jan 19.

Professor, Department of Obstetrics and Gynaecology, Christian Medical College, Vellore, Tamil Nadu, India

A comparison of induction of labour (IOL) using three doses of 25 µg vaginal misoprostol inserted at intervals of 4 h or more with a stepwise oral regime starting with 50 µg followed by two doses of 100 µg was studied in a double-blind placebo-controlled trial in a tertiary centre in South India. Primary outcome was vaginal delivery in 24 h. Significantly more women in the first group required oxytocin augmentation and a third dose of the drug than women in the second group. Uterine tachysystole and other maternal and neonatal complications were similar. Thus it is concluded that women induced with oral, as compared to vaginal misoprostol are more likely to labour without oxytocin.
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http://dx.doi.org/10.1177/0049475515624856DOI Listing
October 2016

A randomised controlled trial comparing 30 mL and 80 mL in Foley catheter for induction of labour after previous Caesarean section.

Trop Doct 2016 Oct 15;46(4):205-211. Epub 2016 Jan 15.

Professor, Department of Obstetrics and Gynaecology, Christian Medical College, Vellore, Tamil Nadu, India

Inducing labour with a Foley balloon catheter rather than using oxytocin or prostaglandins is considered to be less risky if the uterus is scarred. It is not known if more fluid in the balloon is more effective without being more dangerous. Volumes of 80 mL and 30 mL were compared in 154 eligible women. Mode of delivery, duration of labour and delivery within 24 h were similar in both groups. However, the second group required oxytocin more frequently. Though more scar dehiscences occurred in the first group, the difference was not significant.
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http://dx.doi.org/10.1177/0049475515626031DOI Listing
October 2016

Risk Factors for Stress During Antenatal Period Among Pregnant Women in Tertiary Care Hospital of Southern India.

J Clin Diagn Res 2015 Oct 1;9(10):QC01-5. Epub 2015 Oct 1.

Assistant Professor, Department of Biostatistics, Christian Medical College Hospital , Vellore, Tamilnadu, India .

Background: The well-being of an infant may be affected when the mother is subjected to psychosocial stress during her pregnancy. Mothers exposed to stressful conditions were more prone for preterm birth than those without any stress. In this study perceived stress has been used as an indicator of levels of stress. There are very few studies published from developing countries on the levels of perceived stress and its causes in pregnant women.

Materials And Methods: This study employed a cross-sectional assessment of pregnant women attending the outpatient services of a tertiary care hospital for regular antenatal check-up. Women not known to have any risk factors at 28 weeks to 34 weeks of pregnancy who agreed to participate in the study were interviewed to assess the perceived stress score.

Results: Among the total patients 57.7% were primigravida and the mean score on perceived stress scale was 13.5±5.02. The majority of the group (102; 65.4%) scored higher than the mean value of total score on the perceived stress scale. Unplanned pregnancy and husband's employment status were associated with high levels of perceived stress in multivariate analysis in this set of women.

Conclusion: Individual as well as pregnancy related factors can contribute to perceived stress in pregnant women. With the established relationship between maternal mental health, pregnancy outcome and infant growth, the assessment and management of stress early in the pregnancy is crucial.
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http://dx.doi.org/10.7860/JCDR/2015/13973.6580DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4625287PMC
October 2015

Comparison of neonatal outcomes in women with gestational diabetes with moderate hyperglycaemia on metformin or glibenclamide--a randomised controlled trial.

Aust N Z J Obstet Gynaecol 2015 Feb;55(1):47-52

Department of Obstetrics and Gynaecology, Christian Medical College, Vellore, India.

Background: Two oral hypoglycaemic agents, metformin and glibenclamide, have been compared with insulin in separate large randomised controlled trials and have been found to be as effective as insulin in gestational diabetes. However, very few trials have compared metformin with glibenclamide.

Materials And Methods: Of 159 South Indian women with fasting glucose ≥5.5 mmol/l and ≤7.2 mmol/l and/or 2-h post-prandial value ≥6.7 mmol/l and ≤13.9 mmol/l after medical nutritional therapy consented to be randomised to receive either glibenclamide or metformin. 80 women received glibenclamide and 79 received metformin. Neonatal outcomes were assessed by neonatologists who were unaware that the mother was part of a study and were recorded by assessors blinded to the medication the mother was given. The primary outcome was a composite of neonatal outcomes namely macrosomia, hypoglycaemia, need for phototherapy, respiratory distress, stillbirth or neonatal death and birth trauma. Secondary outcomes were birthweight, maternal glycaemic control, pregnancy induced hypertension, preterm birth, need for induction of labour, mode of delivery and complications of delivery.

Results: Baseline characteristics were similar but for the higher fasting triglyceride levels in women on metformin. The primary outcome was seen in 35% of the glibenclamide group and 18.9% of the metformin group [95% CI 16.1 (2.5, 29.7); P = 0.02]. The difference in outcome related to a higher rate of neonatal hypoglycaemia in the glibenclamide group (12.5%) versus none in the metformin group [95% CI 12.5(5.3, 19.7); P = 0.001]. Secondary outcomes in both groups were similar.

Conclusion: In a south Indian population with gestational diabetes, metformin was associated with better neonatal outcomes than glibenclamide.
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http://dx.doi.org/10.1111/ajo.12276DOI Listing
February 2015

Misoprostol versus Foley catheter insertion for induction of labor in pregnancies affected by fetal growth restriction.

Int J Gynaecol Obstet 2015 May 29;129(2):152-5. Epub 2015 Jan 29.

Department of Obstetrics and Gynecology, Christian Medical College, Vellore, Tamil Nadu, India. Electronic address:

Objective: To compare 25μg of vaginal misoprostol with a Foley catheter for induction of labor (IOL) for fetal growth restriction.

Methods: A randomized controlled trial was conducted in a tertiary center in South India. Women with fetal growth restriction (n=100) were randomized to be induced with three doses of vaginal misoprostol (25μg) every 6hours or with an intracervical Foley catheter, inserted 12hours before rupture of membranes, and oxytocin if needed. The primary outcome was uterine tachysystole with fetal cardiotocography abnormalities. Secondary outcomes pertained to effectiveness, complications, and patient satisfaction.

Results: One woman in the misoprostol group and none in the Foley catheter group had uterine tachysystole. The duration of labor from IOL to delivery was similar in both groups (P=0.416). More women in the misoprostol group had a vaginal delivery within 12hours (26.1% versus 5.6%; P=0.005). Women induced with misoprostol were less likely to deliver by lower-segment cesarean delivery (15.2% versus 29.6%; P=0.168) and to require oxytocin augmentation (60.9% versus 85.2%; P=0.007). Complications were few in both group.

Conclusion: Few women had uterine tachysystole with cardiotocography abnormalities. Vaginal misoprostol at 25μg was more effective than a Foley catheter for IOL in fetal growth restriction. Clinical Trials Registry India:CTRI/2014/02/004411.
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http://dx.doi.org/10.1016/j.ijgo.2014.11.018DOI Listing
May 2015

A nested case-control study to evaluate the association between fetal growth restriction and vitamin B12 deficiency.

Aust N Z J Obstet Gynaecol 2013 Aug 25;53(4):399-402. Epub 2013 Feb 25.

Department of Obstetrics and Gynaecology, Christian Medical College, Vellore, Tamilnadu, India.

Objectives: To study the association between maternal vitamin B12 levels and fetal growth restriction.

Methods: In this nested case-control study, a cohort of low-risk women attending the antenatal clinic had their blood samples taken and stored at 28-31 weeks gestation. They were followed until delivery. Fifty-eight women delivering babies less than 2500 g were taken as cases and an equal number of controls delivering babies more than 2500 g were taken from the same cohort. Their B12 levels were assayed and studied for statistical significance.

Results: The baseline characteristics of both groups were similar. The number of women with serum B12 levels less than 200 pg/mL were similar in both groups: 33% versus 29% (P = 0.84). Type of kitchen fuel used was taken as a surrogate marker for socioeconomic status. More women in the cases used non-LPG (liquid petroleum gas) kitchen fuels such as kerosene and wood than in controls, 35% versus 19% (P = 0.06).

Conclusions: No association between maternal vitamin B12 levels and fetal growth restriction was found in this study. Low birth weight babies were more common in women of low socioeconomic status.
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http://dx.doi.org/10.1111/ajo.12057DOI Listing
August 2013
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