Objectives : To evaluate the variations and potential clinical use of second trimester serum markers as predictor of preeclampsia.
Methods : In a prospective study β HCG, α feto protein and inhibin A levels were estimated in 50 antenatal women in the second trimester (12-24 weeks) by ELISA technique. Results were noted in terms of development of preeclampsia, mean serum levels of all three markers, mode of delivery and fetal outcome.
Results : Out of 50 women, 10 developed preeclampsia (20%). A significant rise of mean serum β HCG level (16130.2 MIU/ml, >2.5 MoM,p <0.001), mean serum AFP level (161.7 ng/ml, >2.5 MoM, P<0.001) and mean inhibin-A level (1248.49 pg/ml, >2.0 MoM, P<0.001) was present in those who developed preeclampsia. Out of 10 preeclamptic women one had IUD, four fetuses were growth retarded, two babies were born before term and six were low birth weight babies, whereas out of 40 normotensive women only five had IUGR, three preterm delivery and 32 delivered at term without and complication.
Conclusions : A significant positive correlation between
second trimester serum markers and development of preeclampsia was observed (p<0.001). Thus with the second trimester
serum marker study, prediction of preeclampsia is possible at incipient stage and its adverse pregnancy outcome can be
minimized.
Objectives : To compare the efficacy of epidural and I/V Tramadol for painless labor and effect on perinatal outcome.
Material and methods : A total of 90 parturients admitted in S.N. Medical College, Agra were selected for study. Thirty parturients received intravenous tramadol, thirty received epidural tramadol and thirty were kept as controls by the method of randomization. In the intravenous group, tramadol in doses of 1mg/Kg body weight IV bolus and 100mg in 500ml Ringer lactate at the rate of 8-24 drops/min was given. In the epidural group tramadol 1mg/kg body weight with 8-10 ml of 0.25% bupivacaine was given.
Results : In the epidural group, pain relief was excellent in 36.67%, good in 50% and average in 13.33%. In intravenous group, pain relief was excellent in 10%, good in 26.67% and average in 63.33%. In both the groups there was no significant effect on duration of 1st & 3rd stage of labor. Second stage of labor was prolonged in the control group. There were no significant changes in APGAR scoring.
Conclusion : Epidural tramadol is a safe and effective method for labor pain relief better than I/V tramadol.
Objectives : To assess the short term morbidity of non-closure of the visceral and parietal peritoneal at caesarean section as compared to suture peritonization.
Methods : A prospective randomized controlled trial of 200 women undergoing cesarean section was done; randomized into non-closure and closure groups. Perioperative, intraoperative and postoperative details were recorded in the proforma. Chi-square/student t-test were used to compared outcome between the two groups.
Results : Operating time, anesthesia time and time of ambulation were significantly shorter in non-closure group (p<0.0001). There was less postoperative pain, analgesic requirement and febrile morbidity in non-closure group; however it was not statistically significant.
Conclusion : Avoiding the closure of visceral and parietal peritoneum at cesarean is associated with lesser operating
time, decreased febrile morbidity and lesser need for postoperative analgesics. Hence routine closure of peritoneum at cesarean
can be avoided.
Objectives : The present study compares MVA and EVA as the method for 1st trimester MTP in terms of effi7acy, blood loss, duration, acceptability and complications.
Method : The present study was conducted in the Department of Gynecology and Obstetrics, Eden Hospital, Medical College, Kolkata. Medical College, Kolkata is also a Government of India recognized center for MVA training programme. A total number of 200 patients were studied; out of which 100 patients underwent MVA and remaining 100 EVA. Cases were compared with respect to age, parity, blood loss, time taken and complications.
Results : In the present study MVA was effective in 98% and EVA in 97% cases as 2% and 3% respectively of the 2 groups required reevacuation for incompleteness. Thus the two procedures did not show much difference as far as their effectiveness was concerned.
Conclusion : MVA has a safety and efficacy profile similar to that of EVA. Also, MVA is a simple, safe, effective procedure, portable
and low cost technique. Hence, MVA is a promising method compared to EVA which can be practiced widely in rural areas where
the access to medical facilities are limited, high tech equipments are not available, power supply erratic and maintenance of instruments not up to the mark. The judicious use of MVA comes with a promise to make early abortions safe and easily accessible
to women of both rural and urban societies belonging to any socioeconomic strata.
Objective : To assess the prevalence & incidence of biliary sludge and stones during pregnancy and to measure the changes in gallbladder volume.
Method and Material : The study was on 276 healthy pregnant females. Questionnaires were obtained at entry & gallbladder ultrasounds were done in each trimester & 2-4 weeks postpartum. Gallbladder volume was measured at each ultrasound.
Results : The incidence of biliary sludge and gallbladder stones during pregnancy was found to be 14.4% and 6.67% respectively. The prevalence of gallstone disease increased with advancing gestational age and the increase in gallbladder volume was also statistically significant (p<<0.001). At 2-4 weeks postpartum gallstones have disappeared in 15% while sludge disappeared in 38.7%. Amongst antenatal women with gallstone disease most were asymptomatic while itching was the commonest presenting symptom. A statistically significant correlation was found between gallstone disease and advanced age, high parity, prolonged breast feeding & raised BMI.
Conclusion : Biliary sludge and stones develop frequently during pregnancy and are
usually asymptomatic.
