Introduction: Pregnancy, complicated by coronavirus disease 2019 (COVID-19), results in higher hospitalization and mortality rate. Pathogenesis of COVID-19 is similar to any other systemic inflammatory condition but results in a cytokine storm of higher magnitude causing severe acute respiratory distress syndrome and multiorgan failure. Tocilizumab, a humanized monoclonal antibody, targets soluble and membrane-bound IL-6 receptors and is used in the treatment of juvenile idiopathic arthritis, rheumatoid arthritis, and cytokine release syndrome. However, studies exploring its role in pregnancy are minimal. Hence, this study was done to study the effect of tocilizumab on maternal and fetal outcomes in critical COVID-19 pregnant women.Methodology: A retrospective study was conducted on 28 pregnant women with critical COVID-19 who received tocilizumab. Clinical status, chest x-ray, biochemical parameters, and fetal well-being were monitored and documented. The discharged patients were followed up through telemedicine.Result: On treatment with tocilizumab, improvement was seen in the number of zones and patterns of chest x-ray, along with 80% reduction in the c-reactive protein (CRP) levels. Based on the WHO clinical progression scale, 20 patients improved by the end of first week, and by the end of first month, 26 patients became asymptomatic. Two patients died during the course of the disease. No fetal adverse effects were noted.Conclusion: Based on the encouraging response and as tocilizumab did not impart any adverse effects on the pregnancy, tocilizumab may be administered as an adjuvant to critical COVID-19 pregnant women in their second and third trimesters.
Original research article studies have stated prevalence from 5-15% (2). Sufferers make up a sizeable proportion of those attending gynecologic practices, whether seeking help for infertility, or because the condition has become chronic with disabling effects. Although it is not easy to determine how prevalent the disease is among the general population (at present, it can only be confirmed by laparoscopy or laparotomy), there are indications that it is increasing. One factor in this could be the considerable delay between the onset of pain and the surgical diagnosis, as well as the change in family planning, with a shift among young females towards professional rather than personal ambition. In addition to the physical effects of the disease, the psychological impact of endometriosis is also a cause for concern. Every practicing primary care provider and gynecologist should be aware of the feelings of frustration and consequent depression experienced by women with endometriosis. The definitions of endometriosis have changed over time, contributing to biases in the literature. In the mid-1980s, the
Congenital uterine anomalies are an uncommon type of female genital malformations caused by abnormal development of müllerian ducts during embryogenesis. Patients with an obstructive uterine anomaly have a higher risk of developing gynecological and obstetric complications that may present at menarche or later in life. We present a case of severe dysmenorrhea in a young teenager caused by obstructive hematometra in a noncommunicating horn of the unicornuate uterus. A differential diagnosis of a possible anomaly was made using 2-dimensional pelvic ultrasonography, which was later confirmed using MRI that revealed an anomalous uterine cavity with a single left-sided cornua communicating with the cervix and a distended right-sided rudimentary horn. She underwent a right salpingectomy with rudimentary horn excision, which was successfully managed laparoscopically. This case emphasizes the importance of physicians being cognizant in identifying patients with uterine anomaly to provide appropriate treatment and prevent adverse reproductive outcomes.
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