Abstract

Introduction: Skin changes occur in about 90 % pregnant women in one form or the other. The various skin changes maybe either physiological (hormonal), changes in preexisting skin diseases or development of new pregnancyspecific dermatoses. All of these dermatoses can be attributed to the profound hormonal, vascular, metabolic, and immunological changes occurring during pregnancy.

Classification: Pregnancy-specific dermatoses have now been classified into dermatoses which are definitively associated and dermatoses with uncertain association with pregnancy. Though most of these skin dermatoses are benign and resolve in postpartum period, a few can risk fetal life and require antenatal surveillance. Most of the dermatoses of pregnancy can be treated conservatively but a few require intervention in the form of termination of pregnancy.

Conclusion: Careful history taking and examination will help us to identify each condition clinically and appropriate management can be instituted for the well-being of the mother and the fetus.

Abstract

Objective: To perform analyses of maternal and fetal complications in overweight and obese women.

Methods: Eighty-seven women with singleton pregnancies with BMI[25–29.9 kg/m2 and 83 women with singleton pregnancies with BMI[30 kg/m2 were studied for maternal and fetal complications at Nehru Hospital, B.R.D. Medical College, Gorakhpur during June 2007–October 2008. Forty-five women with BMI 20–24.9 kg/m2 were selected to serve as control.

Results: Compared with women with normal BMI, the outcomes which were more common in overweight and obese women were gestation hypertension (p\0.05); preeclampsia (p\0.001); preterm delivery (p\0.05); induction of labor (p\0.05); instrumental vaginal delivery (p[0.05); cesarean section (p\0.01); increased operative time (p\0.01); still births (p\0.05); early neonatal deaths (p\0.05); Apgar score\7 at 5 min (p\0.05); and admission to NICU (p\0.001). No significant differences were noted among groups regarding hypoglycemia hyperbilirubinemia and respiratory distress.

Conclusion: Overweight and obesity are definite risk factors for adverse pregnancy outcomes. This may be due to altered metabolic state in obesity.

Abstract

Objective: The present study was undertaken to assess the impact of intravenous iron sucrose (Feronia IV) in the treatment of iron deficiency anemia observed in gynecological and obstetrical practice.

Methods: Seventy-seven practicing gynecologists and obstetricians throughout India collaborated in the recruitment of 145 women over a period of 1 year, of which 143 were analyzable cases.

Results: The overall mean rise in hemoglobin level was observed to be 2.43 gm % at the end of 4 weeks. The dose of iron sucrose administered ranged from 100 to 1,050 mg. In women who received 200 mg of the drug, and the mean Hb rise was found to be 2.21 ± 1.06 gm %. The highest observable rise in hemoglobin level was 5.5 gm % with 800 mg of iron sucrose. No serious adverse reactions were reported during the observation period.

Conclusion: Intravenous Iron sucrose is a safe and effective treatment for the rapid reversal of iron deficiency anemia, in obstetric and gynecological settings.

Abstract

Objective: To determine if community-based, low-cost interventions during third trimester of pregnancy can reduce the incidence of low birth weight babies.

Methods: In a case control study, 290 pregnant women from a slum area were registered in the beginning of third trimester of pregnancy and provided full antenatal care comprising fortnightly check up, one IFA tablet daily, counseling for minimum one-and-a-half hour post-lunch rest in left lateral position, additional diet to ensure minimum 2,200 kcal per day, and management of clinical conditions, if any. An equal number of pregnant women belonging to the same slum area were registered as control who received routine antenatal services from the existing health care facilities. The birth weight of the babies in the two groups were recorded and compared. Test of significance and correlation coefficient were applied to the data.

Results: Mean birth weight of the babies of the Subjects was 2.76 kg (SD 0.39) compared to mean birth weight of 2.57 kg (SD 0.36) of the babies in the Control group. Incidence of low birth weight babies among subjects who consumed minimum 2,400 kcal per day, had one-and-ahalf hour post-lunch rest in left lateral position and who consumed one tablet of IFA (100 mg iron and 5 mg folic acid) per day during the last trimester of pregnancy was lower (17.6 %) as compared with women in the Control group (36.2 %). The difference in the mean birth weight of newborns of the two groups was statistically significant (t = 2.52, p\0.01).

Conclusions: Incidence of low birth weight babies can be significantly reduced by providing simple, low-cost care to pregnant women during the last trimester of pregnancy in the community setting.

Abstract

Objective: To evaluate factors contributing to obstetric emergencies, analyze the fetomaternal outcome and role of obstetric drill in facing these emergencies effectively.

Material and Method: Out of 10,892 deliveries, a total of 520 women were included in this prospective study. Analysis of emergency obstetric conditions was done by evaluating incidence, various contributing factors, and fetomaternal outcome. Obstetric drill was conducted among residents repetitively. Pre drill and post drill assessment of confidence in clinical, knowledge, and team work skills were compared by v2 test. Impact of drill on severe obstetric morbidities was noted.

Observations: Incidence of obstetric emergencies was found to be 4.88 %. Maternal and perinatal mortality was seen in 4.23 and 37.11 %, respectively, of these emergency obstetric women. Impact of drill showed an increase in score in knowledge (p\0.019), confidence (p, 0.001), and team work (p\0.001).

Conclusion: Active implementation of emergency obstetric care and incorporation of obstetric drill lays a strong foundation for safe fetomaternal outcome.

Abstract

Objective: To observe the role of uterine arteryDoppler flow velocimetry at midtrimester in prediction of preeclampsia.

Method: 179 women carrying \16 weeks of pregnancy, with singleton fetus and without any fetal anomaly were recruited and were divided in high-risk and low-risk group. Doppler velocimetry of uterine artery was done at 24–26 weeks. Any notch in uterine artery, unilateral or bilateral, or RI[0.6, was considered abnormal. Women were followed up and development of preeclampsia noted.

Result: Sensitivity and specificity of abnormal uterine artery Doppler study for prediction of preeclampsia were 73.33 and 86.48 % in high-risk and 57.14 and 95.83 % in low-risk group, respectively. Relative risk with 95 % confidence interval was 5.427 (2.272–12.958) in high-risk and 13.65 (5.669–32.865) in low-risk women.

Conclusion: Doppler velocimetry of uterine artery at 24 weeks can be used as a reliable screening test for prediction of preeclampsia in both high-risk and low-risk women.

Abstract

Objectives: To study maternal heart disease in an Indian setting for: (1) different etiological factors, (2) different types of lesions, and (3) maternal and perinatal outcome.

Methods: 281 women with heart disease who delivered C28 weeks of gestation at different teaching institutions (tertiary care centres) in India were studied.

Results: Rheumatic heart disease (n = 195; 69.4 %) with isolated mitral stenosis (n = 75; 26.7 %) were the commonest. Septal defect (n = 27; 9.6 %) was the predominant lesion among the congenital heart disease (n = 60; 21.3 %) patients, whereas in the miscellaneous group (n = 26; 9.2 %), ischemic heart disease (n = 10; 3.6 %) was the leading cause. Multiple cardiac lesions were also diagnosed in 100 (35.58 %) women. In 87 (31 %) women, diagnosis was made first time in labor. Majority n = 131, (46.6 %) had spontaneous vaginal delivery and few (n = 9; 3.3 %) required induction of labor. Cardiac complications were noted in 72 women (25.6 %). There were three (1.06 %) maternal deaths and perinatal mortality was 4 % (n = 11).

Conclusion: In this study, rheumatic heart disease in pregnancy is still predominant though acquired cardiac lesions are rising. In rheumatic heart disease, mitral valve involvement was the commonest and multiple valve lesions were a major observation. Most common obstetric complication was small for gestation baby. Maternal morbidities in the unbooked women are high and congestive cardiac failure was the major cardiac complication.

Abstract

Objective: To analyse the impact of Janani Suraksha Yojana (JSY) on Maternal Mortality Ratio (MMR). Design Retrospective analysis of maternal mortality.

Methods: Analysis of all maternal deaths between January 2001 and December 2009.

Results and Discussion: The total number of deliveries has been steadily rising from 1,685 in 2001 to 3,957 in 2009. TheMMRdoubled from 1,500/100,000 live births in 2001 to 3,000/100,000 live births in 2006, then declined to 2,464/ 100,000 live births in 2009. Implementation of the various maternity benefit schemes has had no significant impact on the profile of dying mothers—admission-to-death interval. Deaths due to anemia and eclampsia have significantly increased (P\0.05), whereas due to sepsis (P\0.001) and hemorrhage (P\0.05), deaths have significantly decreased. Almost 96 % of dying subjects received inadequate antenatal care. However, significantly less number (P\0.001) of women are delivering at home.

Conclusions: There is a need to stress the importance of good antenatal care in reducing MMR.

Abstract

Objectives: To assess the efficacy of calciuria as a diagnostic test for the prediction of preeclampsia, and also to determine the changes in urinary excretion of calcium in preeclampsia and normotensive women.

Methods: A prospective study was conducted on 60 primi mothers in the age group of 20–30 years, and all were enrolled at 16 weeks of gestation with clinical follow up by 4 weeks and 24 h urinary calcium and creatinine estimation. Ten mothers developed preeclampsia (study groups) and fifty remained normotensive (control groups). By means of Receiver-operator curve, a cut-off level of urinary calcium in 24 h was chosen for predicting preeclampsia.

Results: Preeclamptic women excreted significantly less total urine calcium (87.0 ± 3.59 mg/24 h) than normotensive women (303.68 ± 17.699 mg/24 h) (p\0.0001) at 40 weeks of gestation. Urinary calcium and calcium/ creatinine (Ca:Cr) ratio decreases progressively from 28 weeks to 40 weeks in the study group when compared to normotensive group.

Conclusions: Preeclamptic women excrete less calcium than normotensive women. This parameter would predict preeclampsia earlier in pregnancy.

Abstract

Objectives: The aim of this study was to compare the efficacy and safety of intravenous iron with oral iron in the treatment of iron deficiency anemia of pregnancy.

Methods: A randomized experimental study was conducted at K. J. Somaiya Hospital involving 200 pregnant women with iron deficiency anemia. In the intravenous group iron dose was calculated from: Total iron dose required (mg) = 2.4 9 weight kg 9 target hemoglobin - actual hemoglobin) g/dl ? 500. Target hemoglobin was set at 12 g/dl. In the oral group patients received 200 mg oral ferrous ascorbate daily. Hemoglobin and serum ferritin were reviewed at 2, 4, and 6 weeks. Paired and independent t test was applied.

Results: The change in hemoglobin and ferritin levels from baseline was significantly higher in the intravenous group than the oral group at each measurement (P = 0.000).

Conclusion: Intravenous iron elevates hemoglobin and restores iron stores faster than oral iron, with no severe adverse reactions.

Abstract

Objectives: To evaluate the clinico-pathological features, surgical procedures and postoperative treatment and their relation to survival in women with granulosa cell tumours.

Methods: Data of 37 women with granulosa cell tumours were collected and reviewed retrospectively. Mann–Whitney test, log rank test and Kaplan–Meier survival analysis were applied appropriately.

Results: Thirty-seven women of median age 48.6 years were diagnosed in stage Ia (45.9 %), stage Ic (27 %), stage III (16.2 %) and unstaged (10.8 %). The median follow up was 5 years. Overall survival was 93 % at 5 years. Disease- free survival at 5 years was 63 %. Tumour stage and residual disease were associated with poor prognosis (p\0.001). Mitotic rate and tumour grade were not of prognostic significance.

Conclusions: Stage of disease and residual disease are valuable prognostic factors. Prospective studies with large sample sizes and long-term follow up are needed to confirm our findings.