Aims To evaluate the feto-maternal outcome, identify the adverse outcome predictors and test the applicability of modified WHO (mWHO) classification in pregnant women with heart disease (PWWHD) from Tamil Nadu, India. Methods and results One thousand and five pregnant women (mean age: 26.04 ± 4.2) with 1029 consecutive pregnancies were prospectively enrolled from July 2016 to December 2019 in the Madras medical college pregnancy and cardiac (M-PAC) registry. Majority (60.5%; 623/1029) had heart disease (HD) diagnosed for the first time during pregnancy. Rheumatic HD (42%; 433/1029) was most common. One third (34.2%; 352/1029) had pulmonary hypertension (PH). Maternal mortality and composite maternal cardiac events (MCEs) were the primary outcomes. Secondary outcomes were foetal loss and composite adverse foetal events (AFEs). MCEs occurred in 15.2% (156/1029; 95% CI: 13.0–17.5) pregnancies. Heart failure was the most common MCE (66.0%; 103/156; 95% CI: 58.0–73.4). Maternal mortality was 1.9% (20/1029; 95% CI: 1.1–2.8), with highest rates in patients with prosthetic heart valves (PHVs) (8.6%; 6/70). Left ventricular systolic dysfunction (LVSD), PHVs, severe mitral stenosis, PH and current pregnancy diagnosis of HD were independent predictors of MCE. The c-statistic of mWHO classification for predicting MCE and maternal death were 0.794 (95% CI: 0.763–0.826) and 0.796 (95% CI: 0.732–0.860). 91.2% (938/1029; 95% CI: 89.392.8) of pregnancies resulted in live births. 33.7% (347/1029; 95% CI: 30.8–36.7) of pregnancies reported AFEs. Conclusion Maternal mortality is high in PWWHD from India. Highest death rates occurred in women with PHVs, PH and LVSD. The mWHO classification for risk stratification may require further adaptation and validation in India.

The first female sterilisation was performed in North America by S.S.Lungren at the time of caesarean section in 1880. For the next few decades all tubal sterilisation were performed at the time of laparotomy as concurrent procedure because the risk of mortality was too high to perform this procedure alone. In 1970, tubal sterilisation became widespread due to introduction of minilap and laparoscopy methods. Sterilisation is the most commonly used method of family planning in the world. 1-2 Physical and mental health of a child depends on responsible and planned parenthood which is possible only by adopting any of the contraceptive methods available. This Study on permanent tubal sterilisation in a semi-urban based medical college hospital throws light on various parameters influencing the acceptance. Undergoing tubal sterilisation with two living children irrespective of the sex of the child will help in reducing high order birth and its complications which in turn reduces the maternal and perinatal mortality and morbidity. 3-8 METHODS This is a retrospective study conducted at Government Vellore Medical College Hospital which is a semi urban based hospital at Adukkamparai, Vellore, Tamilnadu, India from April 2015 to March 2016 for a period of one year. Source of data was collected from maternity department and family planning department is our hospital.

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Background Cardiac disease in pregnancy is a major contributor to maternal mortality in high, middle and low-income countries. Availability of data on outcomes of pregnancy in women with heart disease is important for planning resources to reduce maternal mortality. Prospective data on outcomes and risk predictors of mortality in pregnant women with heart disease (PWWHD) from low- and middle-income countries are scarce. Methods The Tamil Nadu Pregnancy and Heart Disease Registry (TNPHDR) is a prospective, multicentric and multidisciplinary registry of PWWHD from 29 participating sites including both public and private sectors, across the state of Tamil Nadu in India. The TNPHDR is aimed to provide data on incidence of maternal and fetal outcomes, adverse outcome predictors, applicability of the modified World Health Organization (mWHO) classification of maternal cardiovascular risk and the International risk scoring systems (ZAHARA and CARPREG I & II) in Indian population and identify possible gaps in the existing management of PWWHD. Pregnancy and heart teams will be formed in all participating sites. Baseline demographic, clinical, laboratory and imaging parameters, data on counselling received, antenatal triage and management, peripartum management and postpartum care will be collected from 2500 eligible participants as part of the TNPHDR. Participants will be followed up at one, three and six-months after delivery/termination of pregnancy to document study outcomes. Predictors of maternal and foetal outcome will be identified. Discussion The TNPHDR will be the first representative registry from low- and middle-income countries aimed at providing crucial information on pregnancy outcomes and risk predictors in PWWHD. The results of TNPHDR could help to formulate steps for improved care and to generate a customised and practical guideline for managing pregnancy in women with heart disease in limited resource settings. Trial registration The TNPHDR is registered under Clinical Trials Registry-India (CTRI/2020/01/022736).

INTRODUCTIONPre-eclampsia is a pregnancy-specific condition with a multifactorial etiology associated with proteinuria and hypertension.1,2 It is one of the common causes of maternal and perinatal morbidity and mortality.Berg and colleagues stated that around 50% of these preeclampsia related deaths are preventable. 3The exact etiology of preeclampsia is not known. But there are risk factors predisposing to development of preeclampsia. Genetic factors include family history of preeclampsia. 4 Obstetric factors include primiparity, previous history of pre-eclampsia, new paternity, multiple pregnancy, hydrops fetalis with large placenta, hydatidiform mole, triploidy. ABSTRACT Background:The study aimed to determine whether dyslipidemia in the second trimester of pregnancy is associated with pre-eclampsia and to investigate and compare the levels of serum lipids among preeclampsia and normal pregnant women. Methods: This prospective cohort study was done between March 2016 to February 2017. Fasting lipid profile was taken for about 200 selected antenatal women between 18-20 weeks of gestation. The patients who developed preeclampsia were grouped as preeclampsia group and the rest of the patients were grouped as normal group. The maternal characteristics compared between two groups were age, parity, BMI and socioeconomic class according to modified Kuppuswamy scale. Results: There is statistical significance among the two groups with respect to BMI and parity whereas no significance with age distribution. Mean total cholesterol in Preeclampsia was 240.24±46.63 mg/dl and normal pregnancy was 186.10±28.02 mg/dl. Mean HDL in preeclampsia was 47.49±4.40mg/dl and normal pregnancy was 52.11±8.918 mg/dl. Mean LDL in preeclampsia was 140.43±36.92 mg/ dl and normal pregnancy was 94.6±24.5 mg/dl. Mean VLDL in preeclampsia was 64.48±15.76mg/dl and in normal pregnancy was 33.54±9.38 mg/dl, Mean Triglycerides in preeclampsia was 291.95±82.33 mg/dl and normal pregnancy was 166.78±48.83 mg/dl. Total cholesterol, Low density lipoprotein, very low-density lipoprotein, triglycerides were increased in preeclampsia when compared to normal pregnancy, which is statistically significant. Conclusions: Detecting dyslipidemia before 20 weeks of gestation helps to recognise pregnancies at high risk for preeclampsia and to detect and treat the disease earlier for a better maternal and perinatal outcome.