Publications by authors named "Ashima Taneja"

8 Publications

  • Page 1 of 1

Clinicobiochemical Parameters and Predictors of Liver Disease in Hospitalized Asian Indian Pregnant Women in a Tertiary Care Center in Northern India.

Cureus 2021 Feb 17;13(2):e13405. Epub 2021 Feb 17.

Medicine, C U Shah Medical College, Surendranagar, IND.

Introduction  During pregnancy, liver dysfunction is more frequent than expected and may require specialized care. For the early diagnosis, it is important to determine if changes in liver physiology may develop into liver disease. Liver disease during pregnancy may require intervention from a hepatologist for adequate monitoring of mother-fetus health outcomes. This study was aimed to evaluate the clinical profile and predictors of maternal mortality in patients with liver diseases among Asian-Indian-females. Methods We conducted a prospective, open-label, consecutive all-comers study of 2,663 pregnant Asian Indian women admitted in the hospital, which included 92 with liver dysfunction. The medical aspects of the pregnancy were then followed prospectively with laboratory and clinical data during the hospital stay and analyzed. The current study was approved by the Institutional Ethical Committee. Results We found that 92 out of 2,663 patients had liver dysfunction with a prevalence of 3.45%. Fifty-four (58.7%) patients had icterus followed by fever in 23 (25.0%), hypertension in 22 (23.9%), central nervous system manifestations in 21 (22.8%), abdominal pain in 19 (20.6%), vomiting in 19 (20.6%), and pruritus in six (6.5%). Predictors of maternal mortality were icterus (p = 0.04), hepatomegaly (p = 0.04), presenting serum-bilirubin greater than 10 milligram% (mg%) (p = 0.008). The most common etiology was acute viral hepatitis (45.6%), followed by a hypertensive disorder of pregnancy (29.3%), acute fatty liver of pregnancy (1.1%), cholestatic jaundice (9.8%), hyperemesis gravidarum (2.2%), septicemic hepatitis (3.3%), dengue immunoglobulin M (IgM), and plasmodium vivax malaria antigen positive in (2.2%) each. Four patients (4.3%) were leptospira IgM reactive and had co-infection with hepatitis E virus. There was one patient (1.1%) with underlying chronic liver disease. Idiopathic liver disease was present in 5.4% of patients. Conclusion Liver disease is relatively common in Indian pregnant women. It is associated with high maternal and perinatal mortality, even in a tertiary referral center. When managing pregnancy in a tertiary care center, for adequate follow-up of the disease and to prevent adverse consequences for mother and child, it is important to discard liver alterations early. For this purpose, liver disease during pregnancy needs early diagnosis for proper management. Furthermore, it is difficult to manage patients with preexisting liver disease, and it may require specialized intervention from a hepatologist and a gastroenterologist.
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February 2021

A rational approach to manage surgical procedures in COVID Era - A perspective based on experience in a private referral hospital.

J Anaesthesiol Clin Pharmacol 2020 Jul-Sep;36(3):325-330. Epub 2020 Sep 15.

Department of Medicine, Dayanand Medical College and Hospital, Ludhiana, Punjab, India.

Background And Aims: COVID-19 disease has imposed challenges in caring for non-Covid elective surgical patients. As elective surgeries become essential, we propose to evaluate our approach and outcomes of surgical procedures performed during the initial period of COVID-19 pandemic so as to provide a road-map for safer approach.

Material And Methods: We retrospectively evaluated outcomes in patients who underwent essential elective and emergency surgeries during the 5-week period between April 18, 2020 and May 28, 2020. All patients were screened at the front desk on their arrival to identify possible exposure to SARS- CoV-2. Nasopharyngeal swab of patients requiring hospital admission was tested for COVID-19 by quantitative RT-PCR. Patients needing essential elective surgery were taken up for surgery if they tested negative for COVID-19. Emergency procedures were undertaken in a demarcated theatre for COVID after taking level-3 protection without delay. The clinical data was reviewed and analysed.

Results: A total of 764 surgical procedures were conducted, of which 70.7% were elective essential surgeries, with 95.4% of these patients being discharged in stable healthy condition. Approximately 23% of the elective and 26% of the emergency surgeries was categorised in the surgical difficulty category III and majority of these were performed under general anesthesia. Postoperative mortality was 1.04%, but the overall mortality rate was approximately 2.5%. Only two patients (0.3%) tested positive for COVID-19 in our series.

Conclusion: A robust preoperative screening and testing can enable safe scheduling of essential elective surgeries.
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September 2020

Vitamin D: Its Deficiency and Effect of Supplementation on Maternal Outcome.

J Assoc Physicians India 2020 Mar;68(3):47-50

Associate Professor, Department of Biochemistry, Dayanand Medical College and Hospital, Ludhiana, Punjab.

Objectives: Vitamin D deficiency is on a rise globally and so are the maternal complications related to it. This deficiency can be easily detected and corrected by simple oral supplementation for a better health outcome in pregnancy.

Methods: Antenatal women with no history of Vitamin D intake and first antenatal visit at our hospital between 26 to 28 weeks of gestation or after 34 weeks were tested for levels of Vitamin 25(OH)D. Deficient women (< 30 ng/ml) between 26 to 28 weeks were supplemented and tested again before delivery (Group A). Deficient women after 34 weeks who did not receive supplementation before delivery constituted Group B. Maternal outcome was noted and compared in both the groups.

Results: Out of the 189 Vitamin D deficient women included in the study; 105(55.5%) were enrolled in Group A and 84 (44.4%) in Group B. 24 (12.7%) women were severely deficient (<4 ng/ml), 134 (70.9%) were deficient (<20 ng/ml) and 28(14.8%) were vitamin D insufficient (20-30 ng/ml). A statistically significant reduction (<0.001) was observed in vitamin D deficient women after supplementation in group A. 5.7% women developed preeclampsia in group A as compared to 28.5% in group B (p<0.0001). Higher (13%) incidence of gestational diabetes mellitus was observed in group B as compared to group A (6.6%) though the difference was not significant. A significantly higher incidence of preterm labor was observed in group B (p=0.007).

Conclusion: Vitamin D deficiency is correlated with a higher incidence of preeclampsia, gestational diabetes mellitus and preterm birth. Maternal screening in targeted population and its supplementation is recommended to improve maternal outcome.
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March 2020

Successful management of abnormal uterine bleeding from uterine arteriovenous malformations with progesterone in postabortal patients.

J Obstet Gynaecol Res 2019 Jun 20;45(6):1114-1117. Epub 2019 Feb 20.

Department of Obstetrics and Gynaecology, Dayanand Medical College and Hospital, Ludhiana, India.

Aim: To study the feasibility of conservative management with progesterone as a treatment option for postabortal patients with uterine arterio-venous malformations (AVMs).

Methods: This prospective observational study was conducted in the tertiary care teaching hospital over a period of 2 years. Postabortal patients with abnormal uterine bleeding were enrolled. Diagnosis was made by history, clinical and radiological examinations. Oral norethisterone was used (10 mg twice daily for 3 weeks, maximum of three cycles). Descriptive statistics was used to present the data.

Results: A total of 30 patients were included. Majority (n = 17) had complete resolution of symptoms after a single 3-week course of progesterone therapy. Rest (n = 13) remained symptomatic and required second course. Of the later, only three remained symptomatic after 2 months, and underwent CT angiography followed by embolization. There was no report of any serious adverse events.

Conclusion: Oral norethisterone is a safe, effective and novel oral drug as an alternative to embolization or surgical therapy for patients with postabortal AVM bleed. Larger studies are required to confirm the findings of the present study.
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June 2019

Pregnancy Outcomes in Isolated Oligohydramnios during Second Trimester: A Case Series.

J Clin Diagn Res 2017 Aug 1;11(8):QR01-QR02. Epub 2017 Aug 1.

Senior Resident, Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India.

Oligohydramnios is associated with increased maternal and foetal morbidities. However, some of the recent studies have shown no adverse effect of isolated oligohydramnios on perinatal outcome and recommends continuation of pregnancy. Pregnancies between 18-28 weeks with isolated Oligohydramnios were included. History and physical examination was recorded in a pre-designed proforma. All the cases received care as per the protocol. A total of seven patients were recruited of which one was a twin pregnancy with Oligohydramnios in both sacs. The mean age at presentation was 30 years. Three patients went into spontaneous explusion at an average gestational age of 22-24 weeks. One patient with twins delivered vaginally at 32 weeks. Rest were delivered by caesarean section between 34-35 weeks (indication in majority of the cases was foetal distress and cord compression). None of the babies suffered any complication and were discharged in good condition. Isolated oligohydramnios during second trimester does not increase adverse perinatal outcome significantly (but increases the caesarean section rate) and therefore, should not be an indication for termination of pregnancy.
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August 2017

Evaluating the Efficacy of Levonorgestrel Intrauterine System and Danazol for Relief of Postoperative Pain in Endometriosis.

J Clin Diagn Res 2017 Jul 1;11(7):QC10-QC12. Epub 2017 Jul 1.

Resident, Department of Obstetrics and Gynaecology, Dayanand Medical College and Hospital, Ludhiana, Punjab, India.

Introduction: Endometriosis is an oestrogen-dependent disorder, manifests during reproductive years and is associated with pain and infertility. There is considerable debate about the effectiveness of various interventions for pain relief.

Aim: To evaluate the efficacy of Levonorgestrel Intrauterine System (LNG-IUS) and Danazol in postoperative pain relief for patients with endometriosis.

Materials And Methods: Hundred patients with diagnosis of endometriosis, who were treated laparoscopically, entered the study to receive either danazol (600 mg once daily) or LNG-IUS (inserted during immediate post operative period) postsurgery, for pain relief. Patients were analysed for pain relief according to VAS score and recurrence of disease using ultrasonography at third and sixth months of follow up.

Results: There were 50% patients in stage IV of endometriosis. Majority of them presented with complaint of infertility (49%) and pelvic pain (43%). It was observed that LNG-IUS was significantly more effective in relieving pain compared to danazol (65.2% vs 38.0%, p<0.05). Recurrence rate was significantly lower in LNG-IUS users compared to other group.

Conclusion: LNG-IUS was found to be more effective in relieving pain compared to danazol.
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July 2017

Early medical abortion: a new regimen up to 49 days' gestation.

Aust N Z J Obstet Gynaecol 2005 Apr;45(2):137-9

Department of Obstetrics & Gynaecology, Dayanand Medical College & Hospital, Ludhiana, India.

Aim: To evaluate a new regimen of mifepristone and misoprostol in early medical abortion up to 49 days of amenorrhoea.

Methods: One hundred healthy women requesting pregnancy termination up to 49 days gestation received 200 mg mifepristone followed by 800 microg misoprostol orally 24 h later. Statistical analysis was carried out by unpaired t-test.

Results: Ninety-six percent of patients aborted completely 4.3 h after they were given misoprostol. No significant side-effects were noted. The duration of bleeding correlated with gestational age (P-value 0.009).

Conclusion: This new regimen of mifepristone-misoprostol is effective in terminating early pregnancy, with shorter induction to abortion interval and greater acceptability.
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April 2005

Incarcerated procidentia due to cervical fibroid: an unusual presentation.

Aust N Z J Obstet Gynaecol 2003 Jun;43(3):252-3

Department of Obstetrics and Gynecology, University College of Medical Sciences and Guru Teg Bahadur Hospital, Shahdara, Delhi, India.

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June 2003