Study of fetomaternal outcome in eclampsia

Background: Eclampsia is a life-threatening emergency that continues to be a major cause of maternal and perinatal mortality. The purpose of our study was to analyse the trend of eclampsia in a tertiary care teaching institute and to find out the fetomaternal outcomes of eclampsia.Methods: A retrospective epidemiological study was undertaken in the department of Obstetrics and Gynaecology, Jhalawar medical college, Jhalawar during the period ‘September 2018 to August 2019’. Women who presented as eclampsia or developed eclampsia during hospital stay were included in the study. Data analysed included various maternal parameters, fetal parameters, and the outcome of the pregnancy.Results: The incidence of antepartum eclampsia was (0.92%). High risk associated factors were primigravida (65.90%), low maternal age (21-30 years), illiteracy, and inadequate antenatal care. Caesarean section was the mode of delivery in 48 cases (54.54%) most common indication was unfavourable cervix, 80.6% women had antepartum eclampsia and 68.18% women had severe preeclampsia. There was 6.8% maternal mortality, attributed to pulmonary edema and acute renal failure. Perinatal mortality was 14.77% with 8 still births and 5 neonatal deaths. Prematurity complicated 46.66% pregnancies. Thirty neonates were admitted to NICU.Conclusions: Eclampsia is one of the important causes of maternal and perinatal morbidity and mortality due to lack of proper antenatal care, low socio-economic status, and lack of education. It can be concluded that better antenatal care, early recognition of disease, timely referral, early initiation of treatment and termination of eclamptic patients improves outcome. Management of eclamptic patients should be performed at tertiary care centres, where ICU facilities, NICU facilities, and multidisciplinary units are available

A cross sectional study to assess the pattern of maternal mortality in a tertiary level government hospital of a city in north India

Background: The index of the quality of health care delivery system of a country is reflected by its maternal mortality rate (MMR). Epidemiological data pertaining to maternal mortality is valuable in each set up to design interventional programs to favourably reduce the same. The objective of our study was to evaluate the maternal mortality rate in a tertiary care hospital, to assess the epidemiological aspects and causes of maternal mortality.Methods: A retrospective study of hospital records and death summaries of all maternal deaths over the period from January 2010 to December 2012 was carried out. Maternal mortality rate, epidemiological factors and causes affecting maternal mortality were assessed.Results: A total of 45 maternal deaths occurred per 7,266 live births out of which unbooked and late referrals accounted for 75.55 % of maternal deaths. Most maternal deaths occurred in the age group of 20–30 years, multiparous women (73.33%) and women from rural areas (71.11%). Direct obstetric causes accounted for 82.22% of maternal deaths where as 15.55% of maternal deaths were due to indirect causes. Maternal mortality rate (MMR) came out to be 627.79 per 100,000 live births. Hemorrhage was the commonest cause of death (37.33 %), followed by pregnancy-induced hypertension including eclampsia (15.55 %) and sepsis (11.11%).Conclusions: Hemorrhage, sepsis, and pregnancy-induced hypertension including eclampsia were found to be the direct major causes of death. There is a wide scope for improvement as a large proportion of the observed deaths are preventable

The role of cerebro placental ratio as a predictor of adverse perinatal outcome in uncomplicated term pregnancies

Background: Aim of the study was to study role of cerebro placental ratio (CPR) as a predictor of adverse perinatal outcome in uncomplicated term pregnancies. Methods: This prospective observational study took place at the Department of Obstetrics and Gynecology in SNMC Agra. We enrolled 140 uncomplicated antenatal cases with gestational age between 37 to 41 weeks, based on specific inclusion and exclusion criteria. Each participant underwent comprehensive assessments, including history-taking, examinations, and ultrasound color Doppler evaluations. We then analyzed perinatal outcomes in correlation with CPR. Results: Adverse perinatal outcomes i.e., asphyxia and NICU admissions were found to be significantly higher in patients with CPR<1. We also observed APGAR<7 at 1 and 5 minutes, cord blood ABG with pH<7.3, pO2<50, PCO2>45 in patients with CPR<1. Conclusions: CPR serves as a noninvasive means to identify fetal compromise in seemingly healthy pregnancies, aiding in the decision-making process regarding the mode of delivery. Clinical significance-CPR can assist in stratifying at risk pregnancies, subsequently influencing decisions regarding the mode and place of delivery.

Ultrasound guided fine needle aspiration cytology of space occupying lesions of liver

Background: The liver is a common site for primary and secondary tumors; most often from malignant tumors within the abdomen and from extra-abdominal primary malignant neoplasm, but also for sarcomas and lymphomas. The main indication of fine-needle aspiration cytology (FNAC) of the liver is diagnosis of single or multiple space occupying lesions. This study aims to evaluate the cyto-morphology of primary and secondary neoplasms of liver and non-neoplastic conditions in the smears of ultrasound guided fine needle aspiration of SOL of liver, to evaluate the cytomorphologic features and to evaluate the erroneous diagnosis when compared with cell block preparation of aspirate (tissue diagnosis).Methods: This study is hospital-based prospective study including 57 patients with space occupying lesion of the liver mass. FNAC were carried out under the guidance of sonography and/or computed tomography. The staining performed were conventional for smears of the aspirate. The cell blocks were prepared from the aspirates by the established procedures. The values of correlation were bought out.Results: Males predominated over females. The distribution of cases for cyto-diagnosis were as follows; cirrhosis with hepatic granulosa (3 cases),pyogenic abscess (3 cases), hepatic adenoma (2 cases), Focal nodular hyperplasia (2 cases), hepatoblastoma (1 case), hepatocellular carcinoma (17 cases), adenocarcinoma deposits (20 cases), deposits of small cell carcinoma (3 cases), deposits of ductal carcinoma (2 cases) and 1 case each of deposits of squamous cell carcinoma, non-Hodgkin’s lymphoma, neuroendocrine tumor and adeno-squamous carcinoma. Values of correlation were as follows: sensitivity 97.61%, specificity 100%, PPV 100%, NPV 97.82% and diagnostic accuracy of 98.85%.Conclusions: FNAC is concluded to be first rank diagnostic procedure in diagnosis of SOL of liver of varied etiology with high values of NPV and PPV. It is also concluded that it helps in staging of metastatic malignancies

Effect of triple drug antiretroviral therapy on CD4+ count in pregnant women with HIV and prevention of parent to child transmission

Background: India has moved from single drug Antiretroviral Therapy (ART) in 2002 to triple drug ART in 2013 to prevent parent to child transmission of HIV. The aim of the study was to know the effects of triple drug ART on maternal CD4+ count and prevention of HIV transmission to baby along with its adherence, side effects and pregnancy outcome.Methods: A prospective study wsas done in Safdarjung Hospital, New Delhi on 40 HIV positive pregnant women who received single dose combination of triple drug ART. CD4+ count, LFT and KFT were done before beginning of ART and repeated after 6 months of ART. The infants received nevirapine prophylaxis and HIV status was determined by DBS PCR at 6 weeks.Results: The median CD4+ count was 317 and 397 pre and post ART for 6 months respectively (p value<0.001. Low birth weight (LBW) was seen in 43.59% which was statistically significant but confounded as 76.4% of these babies were preterm. 23.08% of babies had an APGAR of < 7 at 1 minute, out of which 77.7% were preterm. Nine out of 39 infants (one had abortion) needed NICU admission. Only one baby (2.56%) was HIV positive who died at 4 months of age due to pneumonia. There was no defaulter and no statistically significant changes in LFT and KFT after 6 months of ART.Conclusions: Triple drug ART offers greater convenience improves fetomaternal outcome and minimize the risk of HIV transmission from mother to child

Comparative efficacy of topical minoxidil alone against combination of topical minoxidil and platelet rich plasma in women with female pattern hair loss—A pilot, open randomised trial

Background: Female pattern hair loss (FPHL) affects a significant proportion of population and poses a major therapeutic challenge. Aims and Objectives: To compare the efficacy and safety profile of combination of topical minoxidil 2% plus platelet rich plasma (PRP) (group 1) and topical minoxidil 2% solution alone (group 2) in women having FPHL. Materials and Methods: 26 females with FPHL were randomised into two treatment groups. They were evaluated for increase in hair density, reduction in hair pull test (HPT), patient satisfaction score (PSS) and side effects. Results: Mean change of 34.92 ± 8.39 hairs/cm2 in group 1 (P < 0.001) and 31.21 ± 8.30 hair/cm2 in group 2 (P < 0.001) was seen. 16.7% and 28.6% patients in Group 1 and 2, respectively, had PSS of highly satisfied. The reduction in HPT was significant with P = 0.0123 (group 1) and P = 0.0128 (group 2). There was no statistically significant difference between the two groups. No major side effects were reported. Conclusion: Minoxidil—PRP combination therapy is an effective modality for FPHL but is not superior to topical 2% minoxidil therapy alone. PRP is a promising option in patients with minoxidil related compliance issues

Cutaneous Tuberculosis: A Diagnosis Too Common, Yet Too Far

Background: Cutaneous tuberculosis (TB) is a rare disease seen by the pediatrician on an outpatient basis. It has a varied presentation and is classified on the basis of the source of infection and host's immune response to mycobacteria. Lupus vulgaris (LV) is a paucibacillary manifestation of cutaneous TB. It can mimic other infectious skin diseases such as TB verrucosa cutis and chromoblastomycosis. Clinical Description: We hereby present a case report of an adolescent female with a serpiginous, nodular, and warty hyperpigmented skin lesion over her buttock. The lesion had started following incidental injury 7 years back as a papule and continued to expand despite multiple medications. Management: A skin biopsy was done which was suggestive of cutaneous TB, but the absence of systemic features confounded the diagnostic type. She was finally diagnosed as having LV after a detailed review with a dermatologist and pathologist. The patient responded well to antitubercular treatment. Conclusion: Although cutaneous tuberculosis is well described, it is often not recognized by the primary care physician. Diagnostic dilemmas may arise due to clinical-histopathological mismatch