Abstract

In today’s world, evil appears to be all pervading. Medical publication is no exception. Scientific misconduct in medical writing is slowly becoming a global concern, especially over the last few decades. While the occurrence of such events is certainly rare, every researcher and reader should be aware of this entity. The researcher should ensure that no inadvertent error is construed as misconduct, and should take every effort to guard against it, and the reader should have a critical eye for the same. This article looks into various aspects of scientific misconduct and encourages awareness regarding the same.

Abstract

Cesarean section rate has been on the rise. It is commonly perceived as a simple and safe alternative to difficult vaginal birth. However, there are situations during C section where delivery of fetus may be difficult. This can cause maternal and fetal complications. To avoid such mishaps, anticipation of potential difficulties and planning in advance can be fruitful. This amounts to mobilization of a good team of anesthetist, assistant and skilled neonatologist. Proper technical skills are needed not only to use the equipment but to deal with such situations for safe delivery of the fetus. The training in technical skills can be imparted through drill protocols under C section skills. This way, one should try and accomplish safe atraumatic fetal delivery.

Abstract

Background: Polycystic ovarian syndrome (PCOS), a commonly prevalent endocrinopathy among reproductive age group women, is most often associated with obesity. Increased insulin resistance appears to be the central pathophysiologic mechanism responsible for various complications of PCOS. This makes ‘weight loss’ as the first-line treatment approach in PCOS. So various trials have tried to compare metformin (an insulin-sensitizing agent) and orlistat (an anti-obesity drug) aiming to achieve weight loss and hence higher ovulation rate for the group of obese PCOS patients. Keeping an eye on all these background facts, we designed this systematic review and metaanalysis to compare the effects of metformin andorlistat on various aspects of PCOS and to pick the better among the two drugs.

Materials and Methods: This is a systemic review of randomized control trials that studied the effectiveness of orlistat versus metformin in terms of improvement in ovulation rate, weight loss, lipid profile, etc. Systematic literature search over the period January 2000–December 2016 was performed in the following electronic databases: Medline, embase, google scholar, pubmed and The Cochrane Library and only randomized controlled clinical trials were included in our study. All authors carefully went through all sources of information independently.

Results: According to this study, weight loss, testosterone level after 4 weeks of treatment, total serum cholesterol and triglyceride level showed significant fall in orlistattreated group.

Conclusion: Our review shows that orlistat is a more effective drug than metformin and should be the preferred drug in obese PCOS in combination with weight loss.

Abstract

Background Information: Placenta is the connecting organ between the mother and the fetus. It supplies oxygen and all the necessary elements for the growth and development of the fetus. In normal pregnancy, the growth of the placenta remains concordant with the growth of the fetus. The sonographic assessment of placenta can give information about the nutritional status of the fetus. It is known that normal placental thickness approximately equals gestational age. It is historically documented that placental weight is one-fifth of the fetal weight and abnormally thin or thick placenta is associated with increased incidence of perinatal morbidity and mortality. However, there are very few studies correlating placental thickness with Neonatal outcome.

Objectives: To correlate ultrasonographic placental thickness at 32 and 36 weeks pregnancy with neonatal outcome. To propose placental thickness as a simple test for prediction of neonatal outcome.

Methods: Placental thickness at 32 and 36 weeks was measured by ultrasound, in 130 pregnant mothers with confirmed dates and uncomplicated singleton pregnancy. Placental thickness was categorized as normal (10th–95th percentile), thin (\10th percentile) and thick ([95th percentile) at each stage and was correlated with birth weight and neonatal outcome.

Results: Neonatal outcome was good in women with normal placental thickness (10th–95th percentile) at 32 and 36 weeks and was compromised in women with thin (\10th percentile) and thick ([95th percentile) placentae.

Conclusion: Placental thickness at 32 and 36 weeks corresponds well with gestational age and is a good prognostic factor in assessing neonatal outcome. Therefore, placental thickness should be measured in addition to biometric parameters in antenatal women undergoing ultrasound

Abstract

Background and Objectives: Hepatitis B is a major health concern in Asia. Chronic hepatitis B virus (HBV) infection may cause hepatic cirrhosis and liver cancer. HBV is transmitted horizontally through blood and blood products and vertically from mother to infant. Perinatal infection is the main route of transmission in regions with high prevalence of hepatitis B surface antigen (HbsAg) carriage, and perinatal transmission leads to high rates of chronic infection. Therefore, it is important to prevent mother-tochild transmission (MTCT) of HBV1. The present study aims at comparing the use of antivirals (lamivudine vs tenofovir) in reducing MTCT

Methods and Material: A total of 60 HbsAg-positive pregnant women were enrolled in the prospective study to test the efficacy of antiviral (lamivudine vs tenofovir— category B drug) to reduce mother-to-child transmission and monitor hepatitis B viral status in infant. HbsAg-positive pregnant women aged 18–43 years at gestational age between 28 and 32 weeks were followed up. They were tested for HBsAg, liver function test and HBeAg. In whom HbeAg was positive, HBV viral load was tested. Sixty patients with high viral load ([6 log copies/ml) were recruited in the study. Alternate patients were randomized into two groups. Group A comprised 31 subjects treated with lamivudine 100 mg daily starting from 28 to 32 weeks of gestation (third trimester) and continued to 1 month after delivery. Group B comprised 29 pregnant women who were treated with tenofovir 300 mg daily from 28 to 32 weeks of gestation and continued to 1 month postpartum. The newborn babies were given HBIG within 24 h after delivery and HBV vaccines at 0, 1 and 6 months. HBsAg infectivity was tested in the infant at 1 year after birth.

Results: Antivirals, lamivudine/tenofovir treatment in HBV carrier mothers from 28 weeks of gestation along with active and passive immunization of new born may interrupt MTCT of HBV efficiently. Tenofovir, category B drug, is more effective in preventing transmission of HBV infection to infants (p = 0.004).

Abstract

Background: Purpose of study To assess the maternal and perinatal complications associated with meconium-stained amniotic fluid (MSAF) in low-risk women in labor.

Methods: This prospective cohort study was conducted at CMC Hospital, Vellore, India. Two hundred low-risk women who had artificial or spontaneous rupture of membranes after admission with MSAF were included in the study. Two hundred similar women with clear liquorwere taken as controls. The primary outcomes consideredwere the incidence of chorioamnionitis and endomy-ometritis in the mothers. The secondary outcomes includedpostpartum hemorrhage and retained placenta in themothers and respiratory distress, meconium aspiration,sepsis, and NICU admission in the newborn. Statisticalanalysis was done using Fischer exact test. Odds ratio, 95%confidence interval, andPvalue were estimated.

Results: Compared to controls, those with MSAF had sig-nificantly higher rates of chorioamnionitis (2 vs. 8%,P=0.006) and endomyometritis (3 vs. 9.5%P=0.007).Among the secondary end points, only neonatal respiratorydistress (8.5 vs. 1.5%;P=0.001) and meconium aspira-tion (4 vs. 0%;P=0.007) were found to be significantlyincreased in the meconium group.

Conclusion: Statistically significant increased incidence ofchorioamnionitis and endomyometritis in women with MSAF in labor established in our study strongly supports the use of prophylactic antibiotics in these women to prevent immediate and long-term consequences.

Abstract

Introduction and Objective: Fetal choroid plexus cysts(CPC) are often detected on prenatal ultrasounds and posea need to formulate protocol for management andcounseling.

Methodology: A total of 1024 unselected cases between gestational ages 11 and 20 weeks were sonologically screened for CPC in 1-year period. On ultrasound, CPC are seen as sonolucent spaces in the echogenic choroid plexus of lateral ventricles of brain measuring at least 2–3 mm indiameter. Those diagnosed with CPC were subjected to thorough anomaly scan. Prenatal karyotype was offered in cases of associated anomalies.

Results: The incidence of CPC is 1% (10/1024) in this study. Associated anomalies were found in 20% (2/10) of cases, which were offered invasive testing for fetal kary-otype. All the cases with isolated CPC had good outcome.

Conclusions: Isolated CPC with low-risk biochemical screening for a neuploidies are now considered normal variants rather than a pathology, need no invasive testing and carry a good prognosis. CPC associated with other anomalies warrant invasive testing and are more likely to be associated with Trisomy 18.

Abstract

Background: The umbilical cord is the lifeline of the foetus as it supplies water, nutrients, and oxygen. Protection of these blood vessels is needed and provided by Wharton’s Jelly, amniotic fluid and the helical pattern, or coiling, of the umbilical cord vessels.

Aim: To establish the relationship between antenatal umbilical cord coiling index (aUCI) measured at 18–20 weeks along with level II USG and adverse perinatal outcomes.
Methods A cross-sectional study was conducted on 408 antenatal women, enrolled at the time of fetal anatomic survey, and their cord coiling index (aUCI) was measured, and its association with perinatal outcomes was observed. Umbilical coiling index was classified as Hypocoiled if UCI \10th percentile, hypercoiled [90th percentile, normocoiled between 10th and 90th percentile.

Results: 408 antenatal women were enrolled for the study. Mean aUCI was 0.43 ± 0.30 (normocoiled group),0.18 ± 0.4 (hypocoiled), and 0.53 ± 0.05 (hypercoiled group). The average gestational age at delivery in hypocoiled group was 36.8 ± 2.34 weeks, and it was shorter than 38.3 ± 1.82 weeks of the normocoiled group and 38.9 ± 1.72 weeks of the hypercoiled group. Mean birth weight observed was 2055 ± 744 (hypocoiled group), 3049 ± 564 (hypercoiled), and 3102 ± 564 (normocoiled) p\0.001. Preterm births 52 (59%) and low birth weight 76 (69%) were significantly associated with hypocoiling. Conclusion Abnormal umbilical cord coiling index, detected at the fetal ultrasound anatomic survey in the second trimester (18–20 weeks), can be used potentially as a screening or as a predictive tool for adverse antenatal or perinatal events.

Abstract

Background: There is no consensus about the better intravenous drug between Hydralazine and Labetalol to control hypertension in cases of severe hypertension in pregnancy. Both drugs have their own advantages and disadvantages.

Methods: This is a prospective randomized controlled trial comparing the efficacy and safety of intravenous Labetalol versus Hydralazine for management of severe hypertension in pregnancy. A total of 152 eligible subjects were randomised in two groups consisting 76 subjects each by envelope method. Both the groups were comparable with respect to systolic, diastolic and mean arterial blood pressure at admission. One group received Labetalol and the other Hydralazine. The number of drug doses, the time taken to achieve target blood pressure and side-effects were noted.

Results: With a single dose, Labetalol (81.5%) was able to achieve target blood pressure in a significantly higher number of cases as compared to Hydralazine (69.5%). Labetalol could help in achieving the target blood pressure faster than Hydralazine. The incidence of maternal adverse effects was comparable between the groups. Fetal outcome was comparable in both groups.

Conclusion: Hydralazine and Labetalol both were found to be equally efficacious in reducing blood pressure in cases of severe hypertension in pregnancy. Labetalol achieved the target blood pressure faster than Hydralazine. The adverse effects of both the drugs were comparable.

Abstract

Background: Preeclampsia is a heterogeneous disorder prevalent in 3–10% of pregnant women globally. The etiology is multifactorial. There is a initial stage of endothelial dysfunction and placental ischemia (Stage 1); this leads to maternal syndrome of hypertension, edema, and proteinuria (Stage 2). Drugs acting on immunomodulatory, anti-inflammatory, antioxidant and proresolving pathways can minimize the complications of preeclampsia. The therapeutic effect of aspirin is based on acetyl group and salicylate group. Both components have independent therapeutic effects on anti-inflammatory pathway and proresolving pathway.

Aims and Objectives: This study was designed to assess the effectiveness and safety of aspirin in prevention and treatment of symptoms and complications of preeclampsia in women at high risk of preeclampsia.

Methods: This is a prospective experimental study to evaluate the effectiveness of aspirin versus placebo in the prevention of maternal syndrome of preeclampsia in women with high risk of preeclampsia (G1 = 97, G2 = 92). Patients with age C 34, chronic hypertension, multiple pregnancies, gestational diabetes, and high pulsatility index of uterine artery were enrolled between 12 and 20 weeks of gestation and prescribed 75 mg aspirin daily till 34 weeks of gestation. Control group was not prescribed aspirin.

Observations and Results: There was a reduction in relative risk of preeclampsia in aspirin group as compared with control group. There was no significant increase in the number of cases of abruption placenta, preterm delivery, neonatal intraventricular hemorrhage, patent ductus arteriosus, and postpartum hemorrhage following aspirin therapy.

Conclusion: In patients with high mean pulsatility index of uterine arteries, low dose aspirin can be a useful intervention. Uterine artery Doppler is a simple and noninvasive test which can be used safely for the prediction of preeclampsia. Aspirin is safe, economical, and easily available commercially.

Abstract

Objective: Study was planned to know vitamin D status in mothers and their newborns and effect of vitamin D deficiency on pregnancy outcome.

Study design: Two hundred consecutive pregnant women with singleton pregnancy admitted to the labor ward of a tertiary care center were recruited for the study. Maternal and cord blood samples were taken and analyzed for 25(OH) D level. Maternal and fetal outcomes were studied.

Results: High prevalence of hypovitaminosis D was found among pregnant women. Eighty-six percentage had vitamin D deficiency, 9.5% had insufficiency, and only 4.5% had sufficient vitamin D level. Women with preeclampsia had statistically significant vitamin D deficiency and insufficiency as compared to patients who had normal blood pressure levels (p = 0.04). Cesarean section rate was significantly higher in patients with vitamin D deficiency and insufficiency compared to sufficient group (p = 0.004). Cord blood 25(OH) D levels strongly correlated with maternal serum 25 (OH) D levels (p = 0.001, correlation coefficient r = 0.84).

Conclusions: This study showed a very high prevalence of hypovitaminosis D among pregnant women and excellent correlation between maternal and fetal 25(OH) D levels. Hypovitaminosis D was associated with preeclampsia, increased Cesarean rate, and low birth weight babies.

Abstract

Purpose: The objective was to observe the characteristicsamong pregnant patients with a diagnosedhemoglobinopathy and to study the obstetric and medicalmorbidity patterns during the antenatal and the perinatalperiods in this group of patients.

Methods: A prospective observational study was conductedin a tertiary care center.

Results: Sixty patients were studied in 11 months. Primi-gravidae (43.3%) formed the highest percentage ofpatients.bThalassemia trait was the most commonhemoglobinopathy, seen in 81.66% of study subjects. Thehemoglobin value ranged from 5.7 to 13.0, with an averageof 9.2 g/dl. Thyroid problems were the most commonassociated medical disorder. Though IUGR and placentaprevia were common, there were no major obstetric prob-lems. There were 57 live births and 1 fresh stillbirth. Twopatients had spontaneous abortion for which uterine curettage was done. LSCS was the most common obstetricoutcome. Patients with sickle-cell disease required moreblood transfusion than those with beta-thalassemia trait.There were 2 maternal mortalities, and both the patientswere the diagnosed cases of sickle-cell disease.

Conclusions: While the perinatal outcomes among womenwith sickle-cell disease are poor, the outcomes in pregnantpatients with beta-thalassemia trait were not a cause ofmajor concern.

Abstract

Background: Diabetes is the most common condition in pregnancy with a worldwide prevalence of 16.9%. Aim To determine the adequacy of the nutrient intake of pregnant women with diabetes mellitus. Methods This is a cross-sectional study of 85 pregnant women who met the diagnostic inclusion criteria for diabetes mellitus (gestational and pre-gestational diabetes mellitus) and who were being managed at the outpatient clinic of a tertiary care teaching hospital. Their demography, clinical characteristics (from updated medical records), anthropometric measures (using standard procedures), nutrient intake and meal pattern (obtained using 24 h recall, food frequency and their log diaries) were collected.

Results: The mean age of the group was 29.9 ? 4.5 years, 54% were in the second trimester of pregnancy with a mean glycosylated haemoglobin level of 6.3 ? 1.4%. The mean BMI indicated that 47% of them were in the obese grade 1 category. Insulin was used in one-third of the population. The overall macronutrient and micronutrient intakes of the population were below the recommended daily allowances for Indians (60–70% of RDA). There was a deficit in the intake of calories, fibre, proteins, iron, calcium, carotene, folic acid, thiamine, riboflavin and niacin. Between the two groups, the pre-GDM women had a significantly better nutrient intake and this could be attributed to a greater exposure to nutrition counselling that they have received during the earlier part of their diabetes care.

Conclusion: The gestational period should be viewed as a window of opportunity to modify dietary patterns and introduce healthy lifestyle practices for the woman and her family

Abstract

Background: To compare between the sequential and concurrent use of vaginal misoprostol plus Foley catheter for labor induction.

Methods: This single-center, non-blinded randomized study was conducted at the department of Obstetrics and Gynecology, Faculty of medicine, Zagazig University. A total of 160 women with full term singleton pregnancy, cephalic presentation and bishop score B 6 were randomized for labor induction with either concurrent or sequential use of vaginal misoprostol plus Foley catheter (80 cases in each group). The primary outcome measured was inductionto-delivery interval and secondary outcomes mesaured were vaginal delivery within 24 h, number of doses needed to induce labor, need of oxytocin for augmentation of labor, cesarean section rate, maternal or neonatal complications.

Results: The mean induction-to-delivery interval was 22.33 ± 13.28 h versus 18.45 ± 14.34 h (p = 0.041) in sequential and concurrent group, respectively. The percentage of women who completed vaginal delivery within 24 h was 51% versus 61% (p = 0.046) in sequential and concurrent group, respectively. Other maternal and neonatal outcomes were similar in both groups.

Conclusion: Concurrent use of vaginal misoprostol plus Foley catheter for labor induction was associated with shorter induction-to delivery interval compared to sequential use, and it increases the rate of vaginal delivery in the first 24 h.