Objectives: To note the changes in calcium excretion in women with pre-eclampsia (PE), eclampsia and its role as its predictor, and to correlate the changes with renal function.
Methods: A prospective study was conducted over a period of 1 year, on 60 women by 4 weekly clinical follow up and 24 hour urinary calcium and creatinine estimation Thirtythree remained normotensive (Group I), while 27 developed PE in the later weeks (Group II).
Results: . Twentyfour hour urinary calcium and calcium: creatinine ratio (Ca:Cr) decreased progressively in Group 2 from around the 32nd to 40th week and this was statistically significant. Urinary calcium excretion indices in Group II showed a steady decline in midtrimester.
Conclusions: Hypocalciuria is a very good tool for prediction of PE and is independent of renal function. Ca:Cr and calcium excretion index are better than only calcium measurement.
Objectives: To identify various social and practical causes, contributing to the well-known medical causes of stillbirths.
Methods: Over a period of 4 years (from January 2002 to December 2005), 96 stillbirths occurred. They were studied for knowing the medical as well as social and practical causes behind it.
Results: Among the total 2728 deliveries during the study period, 96 stillbirths (including three twins) occurred giving a still birth rate of 35.2/1000 births. Of the 93 women having stillbirths, 14 (15.1%) were registered for antenatal care, while 79 (85%) were unregistered. The causes for stillbirth could be identified in 82.3% of cases. Pregnancy induced hypertension, eclampsia, abruptio placenta, birth asphyxia, and preterm labor were common causes contributing to stillbirths. Inadequate antenatal care and suboptimal intrapartum care due to various reasons were the causes behind the preventable medical causes.
Conclusions: Most of the stillbirths were preventable by improving patient’s education and compliance to antenatal care. Adequate antenatal care, timely referral of high-risk cases and prompt tertiary care will help us achieve the goal of reducing stillbirth rate.
Objectives: To evaluate the efficacy of bilateral ligation of uterine and ovarian arteries simultaneously for the management of atonic post partum hemorrhage (PPH) during cesarean section.
Methods: Out of 4936 cesarean sections, 42 atonic PPH mothers were selected for bilateral uterine and ovarian arteries ligation while medical management failed. Inclusion criteria: Those cases of LSCS who developed PPH due to atonicity of the uterus and who failed to respond to medical therapy such as injection oxytocin upto 40 units added to 1 L of iv. fluid in 30-40 minutes, injection methyl ergometrine 0.2mg given IM and injection 15 methyl prostaglandin F2a 250 mcg IM for 3 doses in 15-20 minutes interval along with bi manual uterine compression and massage. Exclusion criteria were post partum hemorrhage arising after vaginal delivery and traumatic PPH.
Results: Out of 42 women 26 (61.90%) were multigravid and 16 (38.10%) primigravid. Eighty percent were unbooked and referred from remote health centers. 35.72% had cesarean section due to prolonged labor with fetal distress. Other indications were postcesarean pregnancy in labor (19.05%), severe pregnancy induced hypertension (PIH) (14.29%), obstructed labor (9.52%) and accidental hemorrhage (9.52%) and placenta previa (11.90%). Uterine and ovarian artery ligation were performed in all the 42 cases. In 39 (92.85%) cases PPH was controlled successfully but two mothers with placenta previa and one mother with placental abruption required cesarean hysterectomy.
Conclusion: Based on the result of the study we can conclude that the uterine devascularization by bilateral uterine and ovarian artery ligation is an effective, simple, rapid and safe method for controlling PPH during cesarean section.
Objectives: To find out the feasibility and yield of endometrial sampling as an OPD procedure using a suction curette device for evaluating abnormal uterine bleeding in pre and post menopausal women.
Methods: Endometrial biopsy was done in the OPD without anesthesia, on 50 consecutive patients of pre and post menopausal age group, presenting with symptoms of abnormal bleeding, using a suction curette device (Endorette).
Results: Endometrial sampling using a suction curette device, as an OPD procedure was safe with 98% procedural success and could pick up adenocarcinoma endometrium (3/50 patients), simple hyperplasia without atypia (33/50 patients), complex hyperplasia without atypia (6/50 patients), complex hyperplasia with atypia (2/50 patients) and TB endometritis (1/50 patient). It missed one case of adenocarcinoma located at the fundus. Patients tolerated the procedure well with no procedure related complications.
Conclusions: Endometrial sampling using suction curette device, is a simple, inexpensive and minimally invasive technique to evaluate endometrium in pre and post menopausal bleeding.
Objectives: To analyze the role of MIB-1 immunostaining for grading of cervical intraepithelial lesions (CIN) and microinvasive carcinoma as an index of cellular proliferation of dysplastic lesions and neoplastic progression. Methods: One hundred and fifty three cases of paraffin sections were stained by streptavidin - biotin method after antigen retrieval. Statistical analysis was done by using SPSS 10.0 package and comparisons were done by ANOVA method and independent sample ‘t’ test.
Results: MIB-1 labeling index (LI) increased from dysplasia to carcinoma group. Statistical analysis showed that MIBLI was significantly higher in diseased group as compared to normal group (P<0.0001 for all the groups) but few cases of CINI lesion showed high proliferative index. The mean values present linear progression from normal to metaplastic to dysplastic to cancerous lesion. A significant positive correlation was present between intensity of marker and labeling index of MIB-1 in all the groups (P=0.05) except nonSCC group. Statistically no important correlation was found with age and menopausal status.
Conclusion: This marker may be useful in grading CIN lesions and identifying low-grade CIN cases with high proliferative index.
Objectives: To find out the role of intrauterine contraceptive device (IUCD) in pelvic inflammatory disease (PID).
Method: Chi-square test was used statistical analysis. Results : The odds ratio for PID with IUD as risk factor was 2.19 with 95% confidence interval (CI) being 1.13 to 4.23. Among 140 cases IUD was present in 29 cases (19.33%) while in 150 controls it was in 16 cases (10.66%). The difference was statistically significant (p=0.027). (See Graph I). This suggests etiological fraction of 54.3% (CI 11.6% to 76.4%) among IUD uses.
Conclusion: IUCD is a risk factor for PID.
