Self home blood pressure monitoring in pregnancy: how reliable is it?

Background: The use of automated blood pressure monitors in pregnancy has become increasingly popular, as more women tend to get involved in their healthcare. Not only does it reduce clinician visits, it also helps to eliminate the white coat hypertension.Methods: We conducted a prospective study in the antenatal department of JSS Medical College and Hospital, Mysuru; over a period of one year, from July 2016 to June 2017. The blood pressures of 50 women were recorded at four different periods of gestation using the conventional ‘Diamond mercury Sphygmomanometer’ versus the automated ‘Omron HEM 7130’ home BP monitor and compared.Results: The recordings of systolic blood pressure at home were consistently less than the office measurements at all periods of gestation. However, the difference was not statistically significant. The comparison of diastolic pressures revealed minimal variations between the mean of the office and home blood pressure recordings. The mean arterial pressure also revealed a similar trend.Conclusions: Self-monitoring of blood pressure is a feasible and acceptable option to pregnant women. It might make antenatal care more effective, but we need further research to establish safety and efficacy, the impact on women and health professionals, and how best to use the results

Short term effects of maternal obesity on mother and fetus: a prospective study

Background: Obesity is such a common health care problem of female population that have major impact on pregnancy. The worldwide prevalence of obesity is more than doubled in between 1980 and 2015. The objectives of present study are to observe whether obese women have an increased risk of pregnancy related complications and adverse fetal outcome and also to compare pregnancy outcomes in different classes of BMI in obese group.Methods: A prospective observational study conducted in OBG department JSS Hospital, Mysore from November 2014 to July 2016. All pregnant women attending OPD and inpatients of antenatal wards were screened for pre-pregnancy BMI. Total number of singleton births were 5727 in our institution. Out of which 314 obese pregnant women were included in the study group, remaining 5413 non-obese pregnant mothers were taken as control group respectively. They are closely monitored in every antenatal visit for development of complications such as pre-eclampsia, gestational diabetes mellitus, increased rate of caesarean section and presence of macrosomia (B.wt >3.5kg).Results: In comparison to normal BMI pregnant women, obese mothers had an increased risk of gestational hypertension (16.9% versus 2.0%, OR-2.3) gestational diabetes mellitus (35.7% versus 3.1%, OR-2.84), preeclampsia (23.9% versus 5%,0R-1.64) cesarean sections (75.2% versus 65.4%), macrosomia (45.9% versus 22%, OR-1.64), it was also found that as BMI increases the incidence of these complications increase as seen in different classes of obese population.Conclusions: Pregnancy associated with obesity is considered as a high-risk pregnancy and obesity being a modifiable risk factor, educating women in early pregnancy and preconceptional counseling regarding harmful effects of obesity and information regarding appropriate gestational weight gain is essential.

Impact of socio demographic factors on the severity of maternal anaemia

Background: Anaemia in pregnancy is still a global problem and one of the leading causes for maternal mortality and morbidity in most of the developing countries. The aim and objective of the study was to know the role of various sociodemographic factors and its association with maternal anaemia.Methods: This is a retrospective observational study at a Community Health Centre in Chamarajanagar District. For the study purpose WHO categorization of severity of anaemia was used. All the delivered patients were divided into mild, moderate or severe degree of anaemia based on their hemoglobin (Hb%) levels at the time of delivery and the impact of the sociodemographic factors on the degree of anaemia was expressed as the percentage of severity.Results: A total of 1270 cases were included in the study out of which 270 (21.3%) of pregnant women had a normal hemoglobin level and 503 (39.6%) parturient were mildly anaemic, 460 (36.2%) with moderately anaemic and 2.9% (n=37) were severely anaemic. Patients who had an interpregnancy interval of >2 years, 60 % had normal Hb% and only 1.6% were severely anaemic. Moderate and severe anaemia was found more in women who were illiterates and an education level of less than high school level.Conclusions: Anaemia in pregnancy is associated with several social and demographic factors. Strategies must be taken from the conceptional level itself by providing proper antenatal counseling and women should be economically empowered and good antenatal care must be made available and accessible to all of them. Even with routine iron prophylaxis in pregnancy, still the prevalence of anaemia is high, so should we consider one or two doses of routine parenteral iron therapy for all pregnant women

Mixed germ cell tumour complicated by pulmonary thromboembolism: a case report

Malignant ovarian germ cell tumours (MOGCTs) are a heterogeneous group of tumours that have several histological different types derived from primordial germ cells of the embryonic gonad. They account for less than 5% of all ovarian malignancies, and are seen in the second and third decade of life. The majority of germ cell tumours are diagnosed in the early stages. Histology, FIGO stage and residual tumour after surgery are the most important prognostic factors. Recent multimodality therapy with staging laparotomy and conservative surgery, followed by platinum based chemotherapy, is associated with survival rates of 60 - 80%, even in patients with advanced disease. Mixed germ cell tumours are extremely rare and the prognosis depends on the size of each component of the tumour. The exact incidence of thrombo embolic events in patients with malignancy is difficult to determine. However ovarian malignancy is strongly associated with venous thrombo embolism. We report a case of a fourteen year old girl with a mixed GCT, with elements of yolk sac tumour and embryonal carcinoma, who succumbed to pulmonary thromboembolism

Maternal outcomes of rheumatic heart disease in pregnancy

Background: Preexisting cardiac disease is seen in 1-3% of pregnancies. In developing countries, sequelae of rheumatic fever often constitute the majority of women with heart disease; whereas in developed countries, it is the congenital heart diseases. The aim of this study was to examine the changing trends and mode of care of women with Rheumatic heart disease in pregnancy over a period of five years in a tertiary care centre.Methods: Patient records over five years were retrieved and maternal and perinatal outcomes were documented. The present study reports the outcomes of 72 women with rheumatic heart disease.Results: The prevalence of heart disease in pregnancy in our study was 1.72%. The prevalence was higher among the rural population, and in lower socio economic strata. 30% of patients were diagnosed during pregnancy. The risk of complications co - related with their functional status at the onset of pregnancy. The mode of termination of pregnancy and indications for LSCS did not vary. However, the risk of complications was greatest during labour and post-partum period. The mean birth weight was 2.7 kg, however, 30% of term neonates were of low birth weight (<2.5 kg).Conclusions: Rheumatic heart disease continues to be a major cause of cardiac disease complicating pregnancy. However, early diagnosis, appropriate management prior to pregnancy, and good functional status at the time of entering pregnancy allowed for a good maternal and neonatal outcome

Central cervical fibroid with a typical Lantern on top of St. Paul’s cathedral appearance

Leiomyoma of the uterus in one of the common benign gynecological conditions and one of the rare locations of a fibroid is from the cervix with an incidence of upto 2%. We are reporting a case of a 46 year old patient who came with complaints of mass per abdomen and with a history of retention of urine twice in the past one and half months. Abdominal examination revealed a firm mass of 24 weeks size gravid uterus with restricted mobility arising from the pelvis and a speculum examination, showed a mass protruding through the vagina with all the walls ballooned out and it appeared as if a head of the baby was protruding out in second stage of labor. It was a 1.9kg central cervical fibroid with a typical "Lantern on top of St. Paul’s cathedral" appearance which was operated without any complications

Dengue fever presenting as acute pancreatitis

A 32-year-old non-alcoholic female was admitted with complaints of severe abdominal pain and was diagnosed with acute pancreatitis after blood investigations and USG of the abdomen. She had fever on the initial two days of admission, and serology tested positive for dengue. Treatment for dengue was instituted, leading to a good response and complete resolution of pancreatitis. The patient has been doing well and has had no recurrence of pancreatitis

Cardiovascular magnetic resonance with an MR compatible pacemaker

Abstract Magnetic resonance imaging (MRI) within FDA guidelines for the MRI-conditional pacemaker precludes placing the heart at the center of the magnet’s bore. This in effect appears to preclude cardiovascular MR. In this manuscript, we describe a protocol for cardiovascular MR of patients with a Revo pacemaker system while operating within FDA guidelines, and the first US case of cardiovascular MR in a patient with a Revo MRI-conditional pacing system despite position constraints.</p

Study of dengue outbreak in north west zone of Rajasthan, India

Background: Dengue is one of the most important mosquito-borne viral disease globally. The virus is the member of flavivirus group which typically is a single stranded RNA virus. It is 2nd most common arthropod borne disease in India. Due to its atypical presentation often, dengue missed out as a differential diagnosis. High clinical suspicion and proper investigation help in early diagnosis of dengue and its complications.Methods: A total of 200 patients were selected to be a part of study after applying inclusion and exclusion criteria. Only those patients were included in the study who had classical features of dengue- fever with chills, body ache, headache and thrombocytopenia and had a positive serology against dengue virus. Patients who had malaria, enteric fever, and negative serology were excluded from the study. Other causes of pancreatitis, pneumonitis, ascitis, cholangitis, pleural effusion and thrombocytopenia are rolled out. All patients were subjected to a detailed history and a thorough clinical examination. A complete blood count, liver function tests, renal function tests, chest X-ray and USG abdomen were also done.Results: Among 200 patients diagnosed as dengue fever,106 were male and 94 female. 78% patient were from urban and majority were from 20-30 years age group. Average duration of stay in hospital is 3.5 days. Along with fever and malaise, pain abdomen, bleeding diathesis, itching, cough were the major complaints in decreasing order. Different findings in the investigations are: Mean WBC counts - 4251, mean platelet counts - 41831, mean hematocret - 41.8, mean MPV- 8.55, number of patients with deranged ALT/AST- 88(44%). In USG ascitis and edematous gall bladder were the major findings followed by hepatomegaly, splenomegaly and pleural effusion. Number of patients required platelet transfusion were 60. Among these 60 patients average number of RDP transfused is 2 units.Conclusions: Present study concludes that clinical vigilance about various type of presentations is important as timely recognition can influence outcome and may prevent compilations