Abstract

Objectives: 1. To study the pregnancy outcome in chronic rheumatic heart disease (CRHD) 2. To evaluate the perinatal outcome of percutaneous balloon mitral valvuloplasty (PBMV) done during pregnancy.

Methods: Three hundred sixty three women with cardiac disease were admitted and evaluated, 330 delivered from 2003-2007 at GMH, Nayapul, Hyderabad. Among them, 60.6% women had CRHD and 32.1% had congenital heart disease.

Results: 80.5% of the women had single value involvement with predominant mitral stenosis (MS) in 48.5% and 28% were in New York Heart Association (NYHA) class III and IV. 66.5% (133/200) were diagnosed during index pregnancy. 73.5% had vaginal delivery – 30 (15%) had induced labor. Out of the 32 women who had PBMV, 25 underwent surgery during pregnancy. The perinatal mortality rate (PNMR) was 8.31% in this group and 27.2% in women with severe MS without PBMV (n=11). In NYHA class I & II, the perinatal mortality was 3.4% and in class III & IV it was 14.28%.

Conclusions: PNMR was 6.4% and maternal mortality was 0.89%. PBMV in pregnancy reduced the perinatal mortality in severe MS.

Abstract

Objectives: To evaluate the cerebral and umbilical arterial blood flow velocity and its various indices during 3rd trimester of pregnancy and to compare these indices in normal and growth retarded pregnancies.

Method: In this study, 50 women with normal singleton pregnancy and 50 women with intrauterine growth retarded (IUGR) pregnancy with expected birth weight <10th percentile of the normal for the gestational age were studied by doppler evaluation of their umbilical artery and middle cerebral arteries (MCA). Pulsatility index(PI), resistance index (RI), S/D ratio, and C/U of the control group were calculated and reference range constructed. Values of doppler indices of IUGR group were compared with those of the control group. Perinatal outcome was evaluated in relation to the indices.

Results: Umbilical artery showed elevated indices in 47 out of 50 cases of the study group showing its high sensitivity in diagnosing hemodynamically compromised growth retarded fetuses. Absent end diastolic velocity (AEDV) and reversed end diastolic velocity (REDV) were seen in 2 and 1 case respectively and were associated with poor perinatal outcome. MCA values were decreased in 18 cases of the study group and had poor perinatal outcome in terms of need for lower segment cesarean section (LSCS) for fetal distress, apgar <7 at 1 minute, and admission to nursery. Cerebroumbilical (C/U) ratio of <1.08 was similarly associated with poor perinatal outcome.

Conclusions: In normal pregnancy there is gestational age related fall in impedance in umbilical and middle cerebral arteries. Doppler study of umbilical artery is highly sensitive in the detection of IUGR while MCA doppler is very useful for the prediction of adverse perinatal outcome in small for gestational age.

Abstract

Objectives: To find the incidence of bacterial vaginosis (BV) in idiopathic preterm labor and check its association with an adverse outcome in patients of idiopathic preterm labor.

Methods: This is a comparative study, with the study group comprising 75 pregnant women admitted with preterm labor, without any obvious cause i.e. idiopathic preterm labor and a control group consisting of 75 pregnant women carrying singleton pregnancy to term. Both the controls and subjects were tested for BV by gram stained vaginal smear. All patients were followed till delivery.

Results: Significantly more number of women in the study group tested positive for BV on gram stain of vaginal discharge as compared to the control group (18.7% vs 80%). In the study group, an adverse outcome in the form of preterm delivery (<37 weeks) was noted in 92.9% women testing positive for BV and only in 49.3% of the women testing negative for BV. Also, women with BV were more likely to deliver before 34 weeks (57.1% vs 14.8%).

Conclusions: BV infection is commonly seen in patients of idiopathic preterm labor. Presence of BV in women admitted with idiopathic preterm labor is associated with preterm delivery. It is even more strongly associated with very preterm delivery (i.e. < 34 weeks).

Abstract

Objectives: Current contraceptive prevalence in Kerala is 64 percent and tubal sterilization (TS) dominates the methods mix, 76 percent. Many recent researches have reported an association between tubal sterilization and abnormal menstrual bleeding pattern. Hence the objective of this study was to analyze the menstrual diary data to look into the association of tubal sterilization with menstrual bleeding pattern and dysmenorrhea.

Methods: A prospective cohort of 480 TS acceptors and 155 non-acceptors selected from a community were followed up over a period of 18 months to compare menstrual diary data, clinical and laboratory findings. Menstrual diary was analyzed by reference period method. We used multivariate logistic regression to identify independent predictors.

Results: Among the sterilized women, 71% had acceptable menstrual pattern whereas in the control group this was 73%. Reduced/infrequent pattern was estimated in 21%, frequent/prolonged bleeding in 12% and dysmenorrhea in 24%. In the control group, respective percentage of the above three conditions were 16,13 and 20. In multivariate analysis, unacceptable menstrual bleeding pattern and dysmenorrhea were not statistically significant amid the two groups. Lower reproductive tract infections and menstrual hygiene were identified as independent predictors for unacceptable menstrual bleeding. The risk for dysmenorrhea is high by minilaparotomy procedure.

Conclusion: Tubal sterilization is safe, as it involves no augmented risk for unacceptable bleeding pattern, and cycle related pain. Early treatment of reproductive tract infections and health education to improve menstrual hygiene are of prime importance to reduce menstrual morbidities.

Abstract

Objectives: To evaluate the diagnostic value of polymerase chain reaction (PCR) in female genital tuberculosis and to study conception rate after antituberculosis chemotherapy (ATT) in positive cases.

Method: Sixty infertile patients were investigated for the presence of mycobacterium tuberculosis (MTB) by PCR of endometrial curettings. PCR demonstrated MTB DNA in 28 patients. ATT was started in diagnosed cases which were followed up for two years for conception.

Results: All patients with laparoscopy suggestive of tuberculosis, more than 50% of those with a probable diagnosis and significant number of those with incidental findings were found positive for TB by PCR. Six PCR positive cases conceived within two years after taking ATT for 9 moths. Four patients conceived spontaneously and two patients with intrauterine insemination.

Conclusion: PCR offered increased sensitivity in determining tuberculosis in female infertility and significant number of patients conceived after regular ATT.