Prevalence of Chlamydia pneumoniae seropositivity in early pregnancy and its association with preeclampsia among primigravidae in Indian population

Background: Preeclampsia (PE) is a multifactorial disease that might be caused by a concurrent or preceding inflammatory stimulus. Inflammatory changes similar to those reported in chronic Chlamydia pneumoniae infection are seen in PE. It is suggested that persistent or chronic Chlamydia pneumoniae infection might have a role in the pathogenesis of PE and antichlamydial treatment in early pregnancy may prevent reactivation of infection and hence the development of preeclampsia.Methods: This randomized interventional study was conducted to determine the prevalence of C.pneumoniae IgG seropositivity in early pregnancy, its association with PE and the effect of treatment with oral azithromycin. A total of 330 primigravidae included in the study were followed up till delivery. C.pneumoniae IgG antibodies measured by ELISA technique at 14-20 weeks of gestation revealed seropositivity in 32.4%. These women were at higher risk of developing severe PE (odds’ ratio 3.2) as compared to the C. pneumoniae seronegative cases.Results: Treatment with oral azithromycin resulted in reduction in the occurrence of PE amongst the C.pneumoniae seropositive cases; as well as significant reduction in the incidence of low birth weight babies in the C.pneumonie seropositive group (p<0.001, ARR= 0.204).Conclusions: Pregnant women who were C.pneumonia IgG seropositive are at higher risk of developing severe preeclmapsia as compared to the C.pneumoniae seronegative cases. This association needs to be further evaluated

Intravenous oxytocin bolus and infusion versus infusion alone on the blood loss during caesarean section

Background: PPH is one of the leading causes of maternal mortality in the world. In India >30% maternal mortality is because of PPH.Methods: 250 females posted for LSCS were randomised into 2 groups. Group A: 5U oxytocin bolus + 40U oxytocin infusion @125 ml/hour in 500 ml saline. Group B: 5 ml Saline bolus + 40 U oxytocin infusionPrimary outcome was to measure blood loss (objective and subjective). Secondary outcomes were time for uterine hardening, additional uterotonic agents, hemodynamic changes, side effects and need for blood transfusion within 24 hours of LSCS.Results: Blood loss was significantly less in Group A in objective as well as subjective assessment (p0.05). However, during the postoperative period increase in heart rate was noted in Group B (p<0.05). Vomiting was the only major side effect observed, which was higher in Group A (5.6% versus 3.2%).Conclusions: Combination of 5U oxytocin bolus followed by an infusion of 40 U oxytocin given over 4 hours routinely in ASA grade I and ASA grade II parturient significantly decreases the operative blood loss during LSCS without causing any hemodynamic variability. This regimen provides better uterine contractility, lesser need for additional utero-tonic agents and lesser requirement of blood transfusion

Emergency contraception: knowledge, attitude and practices among women in South Delhi, India

Background: Objective of the study was to assess the awareness of emergency contraception (EC) amongst women attending the routine antenatal outpatient services.Methods: It was a hospital based cross sectional study for one year. 550 women were enrolled in the study after written informed consent. Socio demographic characteristics, knowledge, attitude and practice towards EC were analyzed.Results: Majority of the women were between 20 to 29 years, and had a basic level of education. 60.4% women were housewives, and 70.5% of them had an urban place of residence. 94% women knew about some method of contraception. Only 34.5% women knew EC; amongst them 54.2% knew about EC pills and 12.5% had used it at least once. 40.5% women knew that there are methods of EC but did not know how what these methods were. 67.9%of women did not know how long after unprotected intercourse EC should be taken.Conclusions: Majority of the women were between 20 to 29 years, and had a basic level of education. 60.4% women were housewives, and 70.5% of them had an urban place of residence. 94% women knew about some method of contraception. Only 34.5% women knew EC; amongst them 54.2% knew about EC pills and 12.5% had used it at least once. 40.5% women knew that there are methods of EC but did not know how what these methods were. 67.9% of women did not know how long after unprotected intercourse EC should be taken

Prevalence and risk factors for urinary incontinence in pregnant women during late third trimester

Background: Urinary incontinence (UI) is defined as any involuntary urinary leakage by the International continence society (ICS). The objective of this study was to analyze the prevalence and risk factors of urinary incontinence in pregnant women in late third trimester.Methods: A questionnaire based survey done on 400 pregnant women in third trimester beyond 34 weeks of gestation. A pretested, semi structured questionnaire was used to enquire about demographic and personal information regarding age, parity, education, occupation, type of delivery, weight, height, smoking, constipation and coffee consumption, regular physical activities, family history of UI, history of UI pre-pregnancy and during the previous pregnancy. Detailed history was taken regarding urgency, urge urinary incontinence (UUI), nocturia, bed wetting, dysuria, stress urinary incontinence (SUI) and sensation of incomplete emptying.Results: Prevalence of urinary incontinence was found to be 75.25%. Majority (72.7%) of the women complained of stress urinary continence. History of urinary tract infection was present in 35.75 % of women during pregnancy. 81.25% complained of increased frequency and 89% complained of nocturia. Significant association was found between the urinary incontinence and pregnancy (p=0), multiparity (p=.007) and smoking (p=0).Conclusions: High prevalence of UI among apparently healthy women. Major risk factors were urinary tract infection, sedentary lifestyle, constipation, multiparity and smoking

Effect of timing of cord clamping on iron stores of infants born to anemic mothers

Objective: To study the effect of timing of cord clamping on the iron stores of infants born to anemic (hemoglobin [Hb] 7-10 g/dl)mothers, and if late clamping leads to polycythemia. Design: Randomized comparative trial. Setting: Tertiary care hospital in ametropolitan city. Participants: Term, healthy, and vaginally delivered neonates without any congenital malformations or birth asphyxia,born to booked anemic (Hb 7-10 g/dl) mothers having no medical or pregnancy-related complications were included in the study.Interventions: The pregnant mothers were randomized into three groups, and their umbilical cords were clamped at 1, 2, and 3 min.Neonatal hematocrit was estimated by the capillary method at 24 h of life, and infant’s (Hb) and ferritin were obtained at 3 monthsof life. Main Outcome Measures: Hematocrit at 24 h of life and serum iron and ferritin levels at 3 months of age. Results: Theoutcome variables significantly associated (p&lt;0.05) with hematocrit were cord clamping time, maternal Hb and cord Hb, and ferritin.That associated with infant’s Hb were cord clamping time and cord Hb and ferritin. Whereas, only cord clamp time was significantlyassociated with infant’s ferritin. None of the neonates had polycythemia, and Hb and ferritin were found to be the highest in those whosecord was clamped at 3 min. Conclusion: In resource-constrained countries, where iron deficiency anemia is a major public healthproblem, delaying the umbilical cord clamping by up to 3 min will reduce the incidence of infantile anemia. It will serve as an additionalcost-effective intervention in anemia control program without any adverse effect of polycythemia

Randomized Comparison of Isosorbide Mononitrate and PGE2 Gel for Cervical Ripening at Term including High Risk Pregnancy

Aims. Prostaglandin E2 is the most commonly used drug for cervical ripening prior to labour induction. However, there are concerns regarding uterine tachysystole and nonreassuring fetal heart (N-RFH). Isosorbide mononitrate (IMN) has been used successfully for cervical ripening. The present study was conducted to compare the two drugs for cervical ripening at term in hospital. Methods. Two hundred women with term pregnancies referred for induction of labour with Bishop score less than 6 were randomly allocated to receive either 40 mg IMN tablet vaginally (n=100) or 0.5 mg PGE2 gel intracervically (n=100). Adverse effects, progress, and outcomes of labour were assessed. Results. PGE2 group had significantly higher postripening mean Bishop score, shorter time from start of medication to vaginal delivery (13.37 ± 10.67 hours versus 30.78 ± 17.29 hours), and shorter labour-delivery interval compared to IMN group (4.53 ± 3.97 hours versus 7.34 ± 5.51 hours). However, PGE2 group also had significantly higher incidence of uterine tachysystole (15%) and N-RFH (11%) compared to none in IMN group, as well as higher caesarean section rate (27% versus 17%). Conclusions. Cervical ripening with IMN was less effective than PGE2 but resulted in fewer adverse effects and was safer especially in high risk pregnancies

Absent endometrium due to balanced translocation [t(4;20)] presenting as primary amenorrhea

Primary amenorrhea is defined as the absence of menarche by 16-18 years of age in the presence of well-developed secondary sexual characters. An incidence of 1-3% has been reported in women of reproductive age group. The etiology varies with anatomical, genetic and hormonal factors implicated in the causation of primary amenorrhea. We present a case of absent endometrium due to balanced reciprocal translocation (RCPTR), 46 XX t (4;20)(q12;q13.1) as primary amenorrhea

Thyroid peroxidase antibody positivity among euthyroid pregnant women and its association with foeto-maternal outcome

Background: Thyroid peroxidase antibody (TPO-Ab) positivity is associated with increased risk of adverse pregnancy outcomes. The present study was planned to find out the prevalence of TPO-Ab and its association with adverse foeto-maternal outcome in euthyroid pregnant women.Methods: A total of 510 euthyroid pregnant women with &lt;20 weeks gestation were recruited from antenatal clinic. Serum TPO-Ab testing was done and women were divided into 2 groups. The study group comprised of TPO-Ab positive women and control group comprised of age and parity matched TPO-Ab negative women, double in number to that of the study group. Repeat Serum TSH was done at term/delivery and women were followed till delivery for foeto-maternal outcome.Results: The prevalence of TPO-Ab positivity in euthyroid pregnant women was 11.3%. A significant number of women in the study group developed hypothyroidism at term/delivery, 18.61% vs 7.61%, respectively, p=0.02. None of the women in the study or control group developed gestational diabetes or placental abruption, or had babies with NND or RDS. There was one IUD in the study group, rest of the maternal and foetal outcomes studied were not statistically significant between two the groups. The caesarean section rates in both groups was not statistically different, however, there were more caesarean sections done for foetal distress in the study group, p=0.04.Conclusions: Thyroid peroxidase positivity is present in 11.3% of euthyroid women and is associated with an increased risk of developing hypothyroidism during pregnancy. It is not associated with adverse foeto-maternal outcome

Thyroid peroxidase antibody positivity among euthyroid pregnant women and its association with foeto-maternal outcome

Background: Thyroid peroxidase antibody (TPO-Ab) positivity is associated with increased risk of adverse pregnancy outcomes. The present study was planned to find out the prevalence of TPO-Ab and its association with adverse foeto-maternal outcome in euthyroid pregnant women.Methods: A total of 510 euthyroid pregnant women with &lt;20 weeks gestation were recruited from antenatal clinic. Serum TPO-Ab testing was done and women were divided into 2 groups. The study group comprised of TPO-Ab positive women and control group comprised of age and parity matched TPO-Ab negative women, double in number to that of the study group. Repeat Serum TSH was done at term/delivery and women were followed till delivery for foeto-maternal outcome.Results: The prevalence of TPO-Ab positivity in euthyroid pregnant women was 11.3%. A significant number of women in the study group developed hypothyroidism at term/delivery, 18.61% vs 7.61%, respectively, p=0.02. None of the women in the study or control group developed gestational diabetes or placental abruption, or had babies with NND or RDS. There was one IUD in the study group, rest of the maternal and foetal outcomes studied were not statistically significant between two the groups. The caesarean section rates in both groups was not statistically different, however, there were more caesarean sections done for foetal distress in the study group, p=0.04.Conclusions: Thyroid peroxidase positivity is present in 11.3% of euthyroid women and is associated with an increased risk of developing hypothyroidism during pregnancy. It is not associated with adverse foeto-maternal outcome