Objective: To evaluate the maternal and fetal risks in women with various types of congenital heart disease.
Methods: 348 women with various types of heart disease delivered during a period of 4 years 8 months from January 2003-August 2007. This is a prospective study of pregnancy outcome in 112 women with congenital heart disease. The ratio of CRHD:CHD was 1.91:1.
Results: The various common cardiac lesions were ASD-33, VSD-28, PS-9, co-arctation of aorta-8, PDA-7, TR-6, myxomatous mitral valve-6, bicuspid aortic valve-4, TGA-3 and TOF-3. We had more Muslim women with CHD in our study. 96.43% were in NYHA class-I, 53.13% were diagnosed in the index pregnancy, 20.54% had prior surgical correction, 62.39% delivered vaginally and 37.62% had Cesarean section. Live births were 98.18%.
Conclusions: PNM was 1.81%. MMR was 1.78%. A high rate of PIH-23.63%, LBW–44.54% and IUGR-38.18% were noted. We have routinely advocated IE prophylaxis in CHD. PPH which causes hypotension should be avoided at all costs.
congenital heart disease (CHD), pregnancy with ASD, VSDObjectives: To evaluate the role of umbilical artery Doppler in growth restricted fetuses.
Methods: In a prospective observational study, 100 pregnant women with growth restricted fetuses confirmed by ultrasound were evaluated by umbilical artery Doppler velocimetry after 28 weeks of gestation. Outcome of the pregnancy was recorded for the normal Doppler group (n=54) and abnormal Doppler group (n=46). Abnormal Doppler group consisted of low end diastolic flow group (n=29) and absent or reversed end diastolic flow (REDF) group (n=17).
Results: Fetuses with abnormal umbilical flow velocimetry had higher incidence of oligohydramnios and abnormal NST compared to the fetuses with normal umbilical flow. The average birth weight and gestational age at delivery were lower in the abnormal Doppler group. Neonates with abnormal umbilical artery velocimetry had increased incidence of caesarean delivery, low apgar scores at birth, increased NICU admissions, increased requirement of positive pressure ventilation, and higher perinatal morbidity and mortality.
Conclusion: Umbilical artery Doppler velocimetry should be used in the management of the intrauterine growth restricted fetuses, as it helps in differentiating fetus with pathological growth restriction at risk for perinatal complications from small and healthy fetuses.
perinatal outcome, intrauterine growth restriction, Doppler, umbilical artery velocimetry,Objectives: To study the place of visual inspection of cervix with acetic acid in screening for CIN and cancer cervix and to compare and correlate the efficacy of VIA with cervical cytology in early detection of cancer cervix.
Methods: This cross sectional study took place in the Gynaecology out patient department (GGOPD) of NSCB Medical College, Jabalpur between June 2005 and September 2006. Out of the total 16,400 women who attended GOPD during this period, 750 women were screened for CIN and early cancer cervix. VIA and pap smears were done concurrently and their sensitivity and specificity compared. For ethical reasons all those who were found positive were subjected to colposcopy and further management as per standard guidelines.
Results: Out of the 750 women screened VIA was positive in 122 (16.26%) women and cytology was positive in 39 (5.2%) cases of the true positive (27 cases). The difference between the two tests was statistically significant (P=0.000001) VIA being highly sensitive (93.1%) buy less specific than cytology.
Conclusion: The high sensitivity of VIA shows that the test could be valuable in detection of precancerous lesions of the cervix.
cervical carcinoma, screening, VIA cytologyObjective: Carcinoma cervix is the commonest cancer seen in our department. The purpose of this study is to discuss the unique problems we have encountered and address our concerns.
Materials and methods: A retrospective analysis was done on 257 patients with carcinoma cervix seen between 1998 and 2005. A descriptive analysis was done wherein the proportion of patients coming from rural areas, the results of treatment and complications were brought out.
Results: More than 50% (140/ 257) of the patients were from the rural areas. Sixty (23%) were defaulters and 197 (77%) completed the scheduled treatment. Forty four out of 197 (22%) received palliative RT and 153/197 (78%) who received curative treatment were analyzed. Status of 54 patients were unknown because 24 patients were from the camp and 30 patients were lost to follow-up. Thus, 78/99 (79%) patients were NED.
Conclusion: A similar disease pattern and patient characteristics are expected in future. Communication with referring doctors, effective counseling of patients and relatives during treatment will hopefully bring down the default rates and the number of cases lost to follow up.
carcinoma cervix, concurrent chemoradiationObjectives: To evaluate the efficacy of in vitro fertilization (IVF) and intra-uterine insemination (IUI) in couples with unexplained and mild male factor infertility.
Methods: One hundred fifty couples were allocated to treatment with IVF and IUI, both following the same protocol (clomiphene citrate and follicle stimulating hormone (FSH) injection) depending upon their hormonal response. The mild male factor patients were included in the study because we observed that their rate of failed fertilization was not different from those in couples with unexplained infertility. They had ovulatory cycles confirmed by recent ovulatory mid luteal phase progesterone measurement and bilateral tubal patency, which was confirmed by laparoscopy or hysterosalpingography. Men with unexplained infertility had semen analysis with a sperm concentration >25x106/ml, motility (grdel + 2) >40% and normal forms >25%. Men with mild male factor infertility had semen analysis where only one of the above parameters was below the normal range.
Results: Among the 150 couples, 75 were treated with IVF and 75 were treated with IUI. The mean age of women allocated to IVF was 32.9 years compared to 33.2 years for the IUI treatment group. Cycle day 2 basal plasma estradiol, LH and FSH concentrations were also not different (geometric means; Estradiol 244 and 245 pmol/1, LH 4.9 and 5.3 IU/1, FSH 7.5 and 7.7 IU/1 in the IVF and IUI treatment groups, respectively).
Conclusion: IUI is the first choice of treatment for unexplained and mild male factor infertility 1 with a lower cost and the equal efficacy as IVF. Treatment delivered within the context of a specialized IVF center will be more efficient and safer because of the potential to salvage over-responding cycles by conversion to IVF.
unexplained infertility, male factor, IVF, IUI