Clinical profile and obstetric outcome in pregnancies complicated by heart disease: a five year Indian rural experience

Background: Cardiac diseases are a major cause of morbidity and mortality in pregnant women in the developing world. This study illustrates the problem in rural India focusing on patterns of diseases, clinical features, and pregnancy outcome in these women.Methods: A retrospective analysis of five year data, from 2006 to 2010 for all patients admitted with cardiac disease in pregnancy.Results: Past history of heart disease was present in 70%. Rheumatic heart disease was predominant type in 83% and the chief complaint at admission was breathlessness in 44%.   Mitral stenosis was the commonest lesion in 55% and mitral regurgitation with or without stenosis in 48%. Preeclampsia was seen in 20% and preterm labor in 10%. Spontaneous vaginal delivery was seen in 41% and cesarean in 20.6%.Conclusions: Heart disease in pregnancy is a high risk condition has a major impact on pregnancy. Associated obstetric complications along with lack of knowledge and ignorance regarding the pathology lead to unpleasant obstetric outcomes

Do women with benign versus malignant ovarian masses demonstrate variable clinical presentation?

Background: Early diagnosis of ovarian tumors is a challenge due to variable presentation. Early diagnosis of ovarian cancers aids in timely management and better clinical outcomes. Aim of study was to determine the different clinical presentations of ovarian tumors and compare those in benign tumors versus malignancies.Methods: Clinical data of all women operated for ovarian masses was extracted from case files at a tertiary care centre and evaluated and clinical features compared in women with benign versus malignant tumors.  Results: We found 50 cases of ovarian tumors with 26% malignancies. The mean age was 38.48+14.9 years. Malignancies were significantly common in menopausal than menstruating (χ2=13.57, p=0.001, fishers exact). Pain was the commonest symptom and combined lumbar and iliac pain was reported in 67% cases. The location of pain was not significantly different in women with malignancy compared to those with benign tumors (likelihood ratio χ2=7.93, p=0.24). The odds of reporting a mass in abdomen were significantly greater in women with cancers than benign tumors (OR= 4.9, 95%CI 1.07-24.06, p=0.01). More women with cancer had history of distension of abdomen compared to women with benign tumors (χ2=9.43, p=0.002).Conclusions: Lumbar pain is most frequent complaint in women with ovarian pathology. Symptoms of distension in abdomen or presence of lump in abdomen are a significant guide to alert the physician regarding possibility of malignancy must be evaluated without delay

Prevalence and genotype distribution of human papilloma virus in cervical samples of young married women: a hospital based prospective cross-sectional study

Background: The aim of the study was to determine the prevalence and genotypes of human papillomavirus (HPV) infection in the cervical samples of young married women at a tertiary care hospital in Chhattisgarh. A prospective cross-sectional observational study was performed in married women, aged 18 to 30 years.Methods: Relevant history was noted and cervical samples were collected and tested for HPV deoxyribonucleic acid (DNA) by polymerase chain reaction (PCR). Data was compiled to calculate the prevalence of HPV and the genotypic distribution.Results: The overall prevalence of HPV in this study was 22.73% and that of type 16 and 18 either alone or in combination with other subtypes was 17.26%. They were the commonest subtypes. HPV positivity was inversely related to education levels (Chi square, p=0.05). There was a significant difference in parity of women testing positive for HPV versus those negative for HPV (one tailed Pr (t<t)=0.03, 95% CI=1.445 to 1,865 at 108 degrees of freedom). No difference was observed between education and socio economic levels of positive versus negative women. Type 16 and 18 accounted for 76% of all HPV subtypes detected.Conclusions: The prevalence of HPV infection is high in Indian women. The high risk oncogenic types are the commonest subtypes. There is an urgent need to screen for the presence of high risk HPV infections in younger women so that they may be followed up more closely to prevent cervical cancers

Status of Maternal Serum Vitamin D Levels in Rural India

Background: The role of Vitamin D during pregnancy and its effect on maternal and fetal health is just beginning to be understood. What is clear, however, is that Vitamin D deficiency during pregnancy is rampant throughout the world. Vitamin D deficiency is prevalent in India, a finding that is unexpected in a tropical country with abundant sunshine. Various studies have shown an intrinsic relation between various parameters of maternal and fetal wellbeing with maternal Vitamin D status during pregnancy.Aim: To determine the status of Vitamin D levels in pregnancy among rural mothers.Methods: A total of 60 pregnant females, aged 20-35 years were studied during the third trimester of pregnancy. Serum Vitamin D was measured by chemiluminescent immunoassay.Results: 65% subjects were found to have Vitamin D deficiency and 26.67% were found to have Vitamin D insufficiency whereas 8.33% had normal Vitamin D levels. Mean maternal serum Vitamin D level was 15.97±9.216 ng/mL.Conclusions: We observed a high prevalence of physiologically significant hypovitaminosis D among pregnant women attending rural hospital. As mentioned in literature, Vitamin D deficiency is associated with adverse fetomaternal outcome, the magnitude of hypovitaminosis D in antenatal period warrants public health intervention

Domestic violence as an unfortunate cause of splenic injury, fetal demise, and maternal morbidity

Abuse of pregnant women is a serious health problem with the potential to cause life-threatening injuries to the mother and her baby. This is a case of domestic violence leading to splenic injury and massive intraperitoneal hemorrhage leading to fetal demise. Fortunately, timely interventions saved the mother′s life