Pregnancy outcome after first trimester vaginal bleeding

Background: First trimester vaginal bleeding is one of the most common complications in pregnancy threatening its proper development and successful outcome.Methods: A case-control study was conducted from October 2016 to April 2018 in the department of obstetrics and gynecology SKIMS.200 cases with vaginal bleeding in first trimester were taken for study. Out of the cases, number of patients who had abortion, ectopic, molar pregnancy or continued their pregnancy beyond 20 weeks was noted. Those who continued their pregnancy were compared with 130 controls for complications developing later in pregnancy.Results: There was significantly higher incidence of PIH (15.4% of cases, 6.9% of controls, p value = 0.005) and abruption (7.7% and 1.5% among cases and controls respectively with p-value of 0.034) among cases than controls. Mean gestational age at delivery in cases was 35.6±3.63 weeks while in controls it was 38.5±1.94 weeks (p value <0.001). Mean birth-weight of the neonates in cases was 2.16±0.78 kgs while in controls was 3.05±0.53 kgs (p value <0.001). IUGR occurred in 9.2% of cases and 3.1% of controls (p value 0.039). There was significantly higher neonatal ICU admission rate in cases than controls (p value 0.019).Conclusions: Patients with first trimester vaginal bleeding are at increased risk for spontaneous loss and adverse pregnancy outcome

Blood urea nitrogen as an early predictor of severity in acute pancreatitis

Background: Acute pancreatitis presents as acute abdominal pain and is usually associated with raised pancreatic enzyme levels in the blood or urine. Aims and objectives of the study was to evaluate the role of serial BUN measurement as an early prognostic marker of acute pancreatitis.Methods: From each patient detailed history was taken, general and systemic examination were done and relevant investigations were conducted. BUN was repeated after 24 hours and the change in the level of BUN was noted. Imaging in the form of CT after 72 hours of admission were performed in each patient. The severity of acute pancreatitis was gauged by modified CTSI and the same was compared to the change in BUN values over first 24 hours of admission.Results: Mean BUN values at ‘0’ hour in severe acute pancreatitis and non-severe acute pancreatitis were 31.91±6.79 and 15.44±5.95 mg/dl, respectively. The difference between the two groups was statistically significant with p value of <0.001. Similarly, the difference in BUN values at ‘24’ hours between the two groups was statistically significant. BUN value ≥23 mg/dl at ‘0’ hour was found to be the optimal cut off for determining the severity of pancreatitis with sensitivity of 91.3%. BUN ≥25 mg/dl at 24 hours was found to be the optimal cut-off for determining the severity of acute pancreatitis with sensitivity of 95.7%.Conclusions: BUN as a single marker for acute pancreatitis can be useful as it is easy to perform and cheap marker to predict severity without the need for complex calculations.