OBJECTIVES - To find the incidence of abnormal blood sugar and gestational diabetes mellitus (GOM) in the Indian population and to correlate the abnormal results with maternal and fetal outcome.
METHODS - Universal screening for GOM was performed on 3JOpregnant women with 50 gm 1 hour oral glucose challenge test (OGCT). Those with abnormal results were subjected to 100gm 3 hour oral glucose challenge test (OGTT). All women were followed till delivery and maternal and fetal outcomes were noted
RESULTS - Out of 300 women's, 61 (20.3°/,,) were found to have positive screening. Out of them, 12 (4% of 300) were diagnosed as GOM. A higher incidence of LSCS and preterm delivery was found amongst the positively screened and GOM cases. Adverse fetal outcome was found in gestational diabetics.
CONCLUSION - The increased morbidity in GOM is preventable by meticulous antenatal
care. All pregnant women should be screened for GOM at teast once during pregnancy and all detected GDMs
should be closely monitored for strict glycemic control for good maternal and fetal outcome.
OBJECTIVE - To evaluate the clinical profiles, and maternal and perinatal outcomes in women who sustained significant trauma during pregnancy.
METHODS - A total of 27 pregnant women were hospitalized with significant trauma over a span of 5 years (1999-2003). They were prospectively analyzed in respect of nature of injury, various complications arising out of it, and maternal and perinatal outcomes.
RESULTS - Burns remained the commonest type (48.14%) of injury, followed by physical assault and abuse (11.11%). Motor vehicle accident was less common(7.40%). Spontaneous abortion (22.22%), preterm labor (44.44%) and abruptio placentae (7.4%) we re notable complications. Maternal mortality was 25.92%. Fetal and perinatal loss together was 59.25%.
CONCLUSION -
Trauma in pregnancy is not an insignificant contributory factor to maternal, fetal and perinatal loss. In reducing the
maternal and perinatal mortality and morbidity a multidisciplinary team approach plays the pivotal role.
OBJECTIVES - To assess the role of antepartum amnio infusion in raising the amniotic fluid index and prolonging the pregnancy, and its effect on perinatal outcome in cases with preterm oligohydramnios.
METHODS - Seventeen singleton pregnancies from 24 to 34 weeks of gestation with amniotic fluid index of S5, were randomly allocated to two groups controls (nine women) and subjects (eight women). Transabdominal amnio infusion was performed in subjects under ultrasonic guidance and repeated weekly till deliver y if oligohydramnios recurred or persisted. Comparison was made with Chi-Square and t-test.
RESULTS - Amnio infusion succeeded in five of the eight subjects. A total of eight successful amnio infusions were performed. Th e rise in amniotic fluid index of 3.67 em was significantly higher in the subjects compared to controls (p<O.01). The perinatal outcome was generally poor with only five out of 17 babies surviving . There were no maternal complications.
CONCLUSIONS - Transabdominal amnioinfusion is a safe procedure. It significantly raises the amniotic fluid index. However perinatal outcome remains poor
amnioinfusion, oligohydramniosOBJECTIVE - To find out if low amniotic fluid index (AFI) has any clinical significance in low-risk pregnancies
METHODS - A case controlled prospective study was done. Fiftyfive consecutive subjects with term pregnancy and low amniotic fluid index (AFI) of ms attending the labour room having no known high risk factor were matched with equal number of controls admitted immediately after the indexed cases with normal AFI. In both the groups the exclusion and inclusion criteria were matched except the AFI. The following outcomes were assessed 1) CTC changes 2) Need for LSCS due to CTC changes 3) Presence of meconium 4) Apgar score at 5 minutes 5) Need for admission of neonate to neonatal in tensive case unit (NICU) and 6) perinatal mortality.
RESULTS - There was no statistically significant difference between the two groups as regards the fetal heart rate abnormalities. However, subjects with variable decelerations were more in the group with AFI ≤ 5 than in the controls. But this difference too was statistically not significant. There was no significant difference in cesarean section rates in the two groups. Instrumental vagina l deliveries with vacuum extractor and forceps were also not significantly different in the two groups. There were no subjects with meconium stained liquor amnii. None of the babies in either group were severely asphyxiated. None of the babies required an admission to NICU and there was no perinatal mortality in either group.
CONCLUSION - Reduced AFI in the absence of any known high-risk factor has no clinical significance.
amniotic fluid index, low risk pregnancyOBJECTIVE - To study the blood rheology of otherwise uncomplicated rVeR pregnancies and its comparison with that in normal pregnancies.
METHOD - The present study is a cross-sectional study in which the lipoprotein profile of 25 women with rVeR pregnancies was compared with that in 25 women having normal pregnancies. Serum lipid profile estimations were performed by enzymatic method using infinite lipid kits from Accurex Biomedical Pvt. Ltd. Results were analyzed using standard statistical methods.
RESULTS - Serum cholesterol, serum triglycerides, serum LOL cholesterol and VLOL cholesterol were observed to increase with increasing gestational age in normal pregnancies while all these decreased with increasing gestational age in pregnancies with intrauterine growth retardation. HOL cholesterol decreased with increasing gestational age (at sampling) in normal pregnancies as compared to an increase in pregnancies complicated with rveR but there was no statistically significant correlation between increasing gestational age and HOL cholesterol values in both study and control group. Serum cholesterol and LOL cholesterol of women with rveR were significantly lower as compared to those in normal women.
CONCLUSION - Pregnancies
having rVeR are associated with an abnormal lipid profile, particularly decreased levels of serum cholesterol, serum
triglycerides, LOL cholesterol and HOL cholesterol. This may be responsible for abnormal substrate availability to
and utilization by the fetus.
OBJECTIVE - To assess the advantages of Misgav Ladach cesarean section in comparison with routine Pfannenstiel cesarean section.
METHODS - Randomized controlled study was done over 15 months on 200 elective and emergency caesarean sections.
RESULTS - The duration of surgery, blood loss and post - operative pain were significantly less in the Misgav Ladach group (P ≤ 001).
CONCLUSION - Misgav Ladach technique
of cesarean section has many advantages and should be used routinely.
OBJECTIVES - To study various causes of near-misses, and their incidence and influence on overall maternal mortality and to search the level of delay.
METHODS - A 'near-miss' describes a patient with acute organ system dysfunction which if not treated appropriately could result in death. A prospective study was conducted on such cases treated from January 2001 to June 2001. Their sociodemographic features, causes, modes of management and ultimate outcome were evaluated and all maternal deaths during that period were analysed and compared.
RESULTS - One hundred near-misses and 16 maternal deaths were identified. The commonest reason for near-miss were: severe hypotension (42%), pulmonary edema (23%) and emergency hysterectomy (10%).The most common initiating obstetric conditions were hemorrhage (60%), acute severe hypertension (34%) and sepsis (4%). The primary obstetric factors amongst the maternal death were: hemorrhage (43.75%),maternal disease (25.09%)and hypertension (18.79%).
CONCLUSION - The definition of near-miss identified nearly six times as many cases as maternal deaths. The
review of near-miss mortality helps delineate continuing threats to maternal health and types of support services
most commenly required.
OBJECTIVE - To evaluate the use of anganwadi workers in the screening program they being an important link between the health providers and the community.
METHODS - Only 33.2% of the workers had some knowledge of the established risk factors and tests for cancer. Hence they were trained and then used to organize cancer screening camps.
RESULTS - Attendance to the camps improved from 24 women to 82 women . 87.8% women were now ready to undergo Pap smear as com pared to only 33.3% women earlier. 85.7% women with abnormal smears were followed and given definitive treatment. 1.1% women with breast cancer and 1.5% with cervical cancer were diagnosed. Approximately 5.5 % of precancerous cervical lesions and 5.9 % breast lumps were brought under evaluation. Camps were repeated in the same area after 3 years at 12 places. Attendance increased from 74 women to 90 women.The genital hygiene had improved and number of abnormal smears decreased from 10.8% to 6.7%.
CONCLUSION - Reaching out to the community with the help of an anganwadi worker is a simple, cost effective
and easily implimentable model for cancer screening among Indian women.
OBJECTIVES - To study and analyze the cases of ruptured corpus luteum retrospectively.
METHODS - All women of reproductive age group who presented with severe pain in abdomen and hemoperitoneum, to the gynecological emergency over a period of 5 1/2 years (September 1997- February 2003) were included in the study. All patients with a diagnosis of ruptured corpus luteum were analyzed retrospectively with regards to presenting complaints, examination findings, investigations and mode of treatment.
RESULTS - Twenty-six patients were diagnosed as ruptured corpus luteum with hemoperitoneum. Most ruptures occurred between is- and 28th day of menstrual cycle. There was an association between coitus and corpus luteum rupture. Ruptured corpus luteum was more common on the right side. A sensitive urine pregnancy test was important in differentiating ruptured corpus luterum with hemoperitoneum from ectopic pregnancy. All the patients who had positive pregnancy test with ruptured corpus luteum were pregnant - three had ectopic pregnancy with ruptured corpus luteum and two had intrauterine pregnancy.
CONCLUSION - A diagnosis of ruptured corpus luteum can be made with reasonable
certainty with negative urine pregnancy test in women of child bearing age group presenting in secretory phase of
menstrual cycle with abdominal pain and hemoperitoneum. Patients with positive urine pregnancy test with
associated ruptured corpus luteum should be looked into for the evidence of pregnancy and managed at the same
sitting
OBJECTIVE - To analyse the diagnosis and management of androgen insensitivity syndrome from January 1992 to December 2001.
METHOD - Ten cases of androgen insensitivity syndrome identified by detailed clinical, cytogenetic and hormonal evaluation from January 1992 to December 2001 were analysed with reference to their clinical presentation, management and outcome.
RESULT - Complete androgen insensitivity syndrome was diagnosed in seven individuals, two of whom were sisters. All presented at puberty with primary amenorrhea and female phenotype. They were managed successfully by psychological counseling, gonadectomy and hormone replacement therapy with graded vaginal dilatation. Laparoscopic gonadectomy was done in the two sisters. Incomplete androgen insensitivity syndrome was diagnosed in three in dividuals who presented with virilization at puberty. Feminizing genitoplasty was done in all. Only one case required vaginoplasty. All were followed up with detailed psychological counseling. Satisfactory vaginal length could be achieved in all patients. Five women (three of complete variety and two of incomplete variety) subsequently got married and are having successful coitus. Significant recession of hirsuitism, change of voice and breast development were noted in the three cases of incomplete androgen insensitivity syndrome two years after surgery.
CONCLUSION - Excellent quality of life can be achieved in individuals with androgen insensitivity syndrome by a combination
of psychological counseling, individualized surgery and hormone replacement therapy.
OBJECTIVES - To find out whether study of LH or LH:FSH ratio by clomiphene citrate challenge test can explain poor response to clomiphene citrate and to find out the FSH level indicative of adequate ovarian reserve status.
METHODS - Ninety-nine cases of primary infertility having dysovulation (by basal body temperature charts and serum progesterone levels) underwent clomiphence citrate challenge test and their FSH and LH levels were studied on day 10 of the cycle. Serum progestgerone level was studied in each case on day 22 or 23. A serum progesterone level of less than 10 ng / mL was considered as poor response to clomiphene citrate dosage.
RESULTS - Out of the 99 patients, 13 conceived in the tested cycle and these acted as controls. Out of the remaining 86 cases, 38 showed poor response. Patients who showed poor response did not differ from the control group having adequate ovarian reserve in their LH and LH:FSH ratio. FSH level above 13.32 mlU / mL indicated diminished ovarian reserve status.
CONCLUSIONS - Study of LH or LHFSH ratio by clomiphene citrate challenge test in a general infertility clinic
does not help in predicting adequate ovulatory response to clomiphene citrate. FSH level less than 13.32 mIU / mL
may be considered as indicative of adequate ovulatory reserve status.
OBJECTIVE - To find out the feasibility of hysteroscopic tubal cannulation in proximal tubal obstruction and the incidence of pregnancy following achievement of tubal patency.
METHODS - Hysteroscopic tubal cannulation was performed along with concomitant laparoscopy in 24 cases (age 23 to 35 years) of proximal tubal obstruction between January 2000 and December 2002. Successful cases were followed up for pregnancy.
RESULTS - Out of 24 cases, 18 had secondary and 6 primary infertility. Cannulation of at least one tube was achieved in 20 (83%) cases. Two patients had tubal perforation with no serious consequence. Successful intrauterine pregnancy was achieved in 5 (21%) cases.
CONCLUSION - Hysteroscopic tubal
cannulation is an effective and safe form of treatment for proximal tubal obstruction
