OBJECTIVE(S) : To study the complications, mode of delivery and the outcome of pregnancy in women with sickle cell disease / trait.
METHOD(S) : This is a comparitive study. Study group (subjects) consisted of 118 pregnant women with sickle cell disease / sickle cell trait who were attending the antenatal clinic or were admitted in obstetric wards and followed up till 7th day after delivery. The control group consisted of 236 age and gravidity matched pregnant women who did not have sickle cell disease / trait recruited from the same hospital.
RESULTS : Statistically significant complications during pregnancy included anemia, crisis, and toxemia. Incidence of preterm deliveries, cesarean section, adverse fetal outcome in terms of still births, intrauterine deaths, early neonatal deaths, and low birth weight were significantly higher in the study group than in the control group.
CONCLUSION(S) : Incidence of toxemia was alarming among the women with sickle cell trait and was found to be more deleterious than previously thought. Complications of sickle cell disease-trait precipitate the onset of delivery (preterm deliveries 72% vs 30.10%) and significantly more cesarean sections were carried out to improve the pregnancy outcome (p=0.0257).
OBJECTIVE(S) : To study the role of prolactin in the development of respiratory distress syndrome (RDS) in newborns.
METHOD(S) : In this prospective study of 100 women, 20 with normal pregnancy and 80 with abnormal pregnancies (pregnancy-induced hypertension, gestational diabetes mellitus, premature labor, premature rupture of membranes, twins, jaundice and anemia), umbilical cord blood was taken at the time of delivery for serum prolactin (PRL) level estimation and newborns were observed for development of RDS.
RESULTS : Cord serum PRL level was directly proportional to gestational age and birth weight in normal and abnormal pregnancies but was not affected by maternal age, parity, socioeconomic status, geographical background and mode of delivery. Women with abnormal pregnancy had significantly lower (302.12± 103.02 vs 385.65 ± 85.01 ng/mL) prolaction level as compared to that with normal pregnancy. Newborns who developed RDS had significantly lower (147.92 vs 329.72 ng/mL) cord serum prolactin level. Out of 15 babies exposed to betamethasone in-utero 80% had higher prolactin level (279.66 ±138.30 vs 166.96 ± 14.43 ng/mL) and did not develop RDS as compared to babies who developed RDS (P = 0.013).
CONCLUSION(S) : Prolactin does play a role in fetal lung maturation.
OBJECTIVE(S) : To find out the effect of jaundice during pregnancy on fetomaternal outcome.
METHOD(S) : An analysis of fetomaternal outcome of 41 pregnant women admitted with jaundice during January 2002 to September 2003 is made.
RESULTS : Majority (80.55%) of the women were unbooked; 58.53% were from rural area and 95% were in their third trimester of pregnancy. Serum billirubin was > 10 mg in 48.48% of the women. SGOT, SGPT and alkaline phosphatase were raised in a majority of them. Out of 41 women, two aborted, 34 delivered and five remained undelivered. In 55.88% of women the onset of labor was spontaneous. 76.47% delivered vaginally. Perinatal mortality was 61.76% with 50%, stillbirths and 11.76% early neonatal deaths. 55.89% of women were discharged in improved condition. Four women were transferred to medicine department for further management and four left the hospital against medical advice. Maternal mortality was 30.3% (10/33) in the 33 patients who were managed in the department; 50% of them died within 24 hours, 20% on the second day and 20% on the third day of admission. Cause of death was hepatic encephalopathy with renal failure in 60%, disseminated intravascular coagulation in 20%, postparptum hemorrhage and congestivie cardiac failure associated with severe anemia in 10% each.
CONCLUSION(S) : Jaundice and pregnancy is a deadly combination resulting in a very high perinatal as well as maternal morbidity and mortality, and requires an early diagnosis and careful management.
OBJECTIVE(S) : To determine the incidence of bone morbidity in pregnant women with specific correlation to parity.
METHOD(S) : Two hundred and thirty three pregnant women were assessed for bone mineral density and the results were analysed in terms of T-score for the incidences of normal bone mass, osteopenia, and osteoporosis in primigravidas and multigravidas.
RESULTS : Out of 233 pregnant women, 23.6% had normal bone reserve, 41.6% were osteopenic and 34.8% osteoporotic. Results analysed in terms of T-score showed that multigravidas (n=183) had statistically significant higher incidence of osteopenia (P=0.0486) and of osteoporosis (P= 0.0077) as compared to primigravidas (n=50).
CONCULSION(S) : Significant number of pregnant women have low bone reserve even at first conception and the severity of bone loss increases with parity. Therefore good counseling regarding diet is a must for adolescent girls and early supplementation of calcium is mandatory during pregnancy.
OBJECTIVE(S) : To assess the prevalence of low back pain (LBP) in obstetricians and gynecologists and to study its association with other variables.
METHODS(S) : Members of local obstetric and gynecological society were approached with a pre-designed questionnaire to obtain demographic details and issues related to their practice.
RESULTS : Completed questionnaires were obtained from 77 members. The lifetime prevalence of LBP was 53%. The occurrence of LBP was significantly correlated with the body weight (pain vs no pain; 65+10 kg. vs 59+10 kg; p<0.01). We found no correlation of occurrence of low back pain with other variables like age, height, years in practice and number of surgeries performed per month.
CONCLUSION(S) : A large number of obstetricians and gynecologists suffer from LBP and it can be a cause of significant disability. To reduce this incidence particular attention should be given to good ergonomic practices and to maintaining proper body weight.
OBJECTIVE(S) : To study the role of surgery and effect of cisplatinum and cyclophosphamide (C+P) regimen in epithelial ovarian malignancy, both as neoadjuvant and in post-operative setting.
METHOD(S) : This is a prospective analysis of 50 patients having epithelial ovarian malignancy studied over a period of 2 years (1st February, 2000 to 31st January, 2002). Twenty-eight patients underwent primary surgery and then received C+P chemotherapy post-operatively. Twenty-two patients were given C+P as neoadjuvant chemotherapy followed by interval laparotomy.
RESULTS : Mean age was 42.6 years. Out of the 28 patients who had primary surgery, 13 (46.4%) had optimal debulking. Thirteen patients had interval surgery after neoadjuvant chemotherapy of whom 10 (76.9%) had optimal debulking. Thirty-two percent of the patients has FIGO Stage-III disease. Seventy-eight percent of the patients has serous type tumors. Commonest toxicity was nausea and vomiting. Disease status was evaluable in only 41 patients since 9 were lost to followup. 30.4% of the patients with optimal debulking surgery were disease-free while 17% with suboptimal surgery were disease-free.
CONCLUSION(S) : Management of epithelial ovarian cancer requires optimal surgery and effective combination chemotherapy. Neoadjuvant chemotherapy, improves resectibility rates without compromising on survival.
OBJECTIVE(S) : To evaluate the use of 4x magnification for tuboplasty.
METHOD(S) : Tuboplasty under 4x magnification was carried out on 28 women who underwent tubectomy reversal for various reasons.
RESULTS : Loss of a male child was the commonest (64.28%) reason for tubectomy reversal. All the women had an interval of less than 6 years between tubectomy and its reversal. Fifty percent of the women who conceived had become pregnant within one year of tuboplasty and 94.12% of them had either bilateral or unilateral isthmo-isthmic or isthmo- ampullary anastomosis. All those who conceived had residual tubal length of more than 6 cm. Of the 23 previously laproligated women 17 (73.91%) conceived. Fifteen of these 17 had term pregnancies, one had ectopic pregnancy and one had early abortion.
CONCLUSION(S) : Tuboplasty under 4x magnification gives good success rate for reversal of tubal ligation and is recommended for use at peripheral centers where operating microscope facilities are not available.
OBJECTIVE(S): To assess the efficacy of medical abortion in the Indian setting and to assess the efficacy of manual vacuum aspiration for early pregnancy termination.
METHOD(S): A case control study of 324 pregnant women < 56 days gestation undergoing voluntary elective abortion (MTP) was carried out. They were divided into 3 groups; 30 women for medical abortion (received 200 mg mifeprostone followed 48 hours later by 400 mg misoprostol orally), 194 women for manual vacuum aspiration, and 100 women for electric vacuum aspiration. Clinical data were collected from medical records. We compared electric vacuum aspiration (EVA) to medical abortion and to manual vacuum aspiration (MVA) with regards to certain variables viz., need for pain control medication, time needed for the procedure, patient satisfaction, and complications (incomplete abortion, hemorrhage, perforation, infection).
RESULTS: Medical abortion was more commonly opted for by women belonging to urban areas (96.67%) as against either EVA (62%) or MVA (61.34%), (P < 0.0001). In early pregnancy of 35-48 days women prefered medical abortion to surgical abortion (86.67% vs 46.6%; P < 0.0001). Complication rates were almost similar in the two groups (5.1% in the surgical group vs 6.66% in the medical group). Time taken for surgical procedures was 18.14 + 1.72 minutes for MVA and 27.01 + 2.71 minutes for EVA. Complete abortion rate was highest for EVA (98%) followed by that for MVA (96.91%) and medical abortion (96.67%).
CONCLUSION(S): Medical abortion is a relatively new, safe, and non-invasive technic of voluntary abortion which is preferred by urban and educated population in the upper socio-economic strata. The study also establishes an efficacy of MVA similar to that of EVA for early pregnancy termination. MVA is simpler, needs less resources, is equally efficient, and has lower complication rates.
