To find the association between intrapartum amniotic fluid lactate level and labour outcome

Background: Inspite of good monitoring in labour, there are still adverse labour outcomes. There is a need for supplementary test for early prediction of prolonged labour and fetal hypoxia. This study was undertaken to find to find the association between intrapartum amniotic fluid lactate level and labour outcome.Methods: 103 antenatal patients low risk at term, who entered into active labour either spontaneously or induced between September 2012 to August 2013 were included. Amniotic fluid was collected after doing ARM and lactate level was measured. Chi square test was used to find correlation between lactate level and duration of labour, mode of delivery and Apgar score.Results: In our study, patients with duration of labour between 8-<20hours 88 % had lactate level <10mmol/l, thus intra partum amniotic fluid lactate levels had a good negative predictive value when it was compared with the duration of labour. When the mode of delivery was analysed using Chi square test there was no statistically significant correlation (p<0.825) with amniotic fluid lactate. Spearman Rank correlation was done to observe correlation between lactate levels and Apgar which showed a correlation of 0.20 with p<0.05.Conclusions: Amniotic fluid lactate levels had better correlation with duration of labour and Apgar score. The lower the amniotic fluid lactate level, the better is the Apgar at birth. Better correlation could have been observed if amniotic fluid lactate levels were repeated every 3-4 hours during active labor. However, this was not possible due to practical difficulty in collection of sample

To find the association between intrapartum amniotic fluid lactate level and labour outcome

INTRODUCTION: The most important cause for operative delivery in the obstetric practice is when the patient is in labor mainly dysfunctional labor. The major cause for perinatal mortality and morbidity is the birth asphyxia secondary to abnormalities during the labor. many trails have been done since many years in the past for detection of the abnormalities in labor, so that early intervention will reduce the adverse perinatal outcome. The introduction of the terminology abnormal labor or dysfunctional labor dates back to the time of Friedman, when he introduced the use of Partogram in active labor. Many modifications are being done till date, while the first partogram was based on the cervical dilatation against the descent of the fetal presenting part. The modern partogram has got many components like fetal heart rate, maternal contractions, usage of drugs, intravenous fluids, color of the liquor, presence of moulding and caput, maternal pulse, blood pressure, temperature and urine output. The most important part being the alert line and the action line, the alert line is drawn from the starting of active phase of labor i,e from 3 to 4 cm dilatation upto 10 cm and an action line is drawn 4 hours after the alert line, x axis will plot time and y axis shows the cervical dilatation and descent of the presenting part. Any measurements which crosses the action line indicates prolonged labor which demands for active intervention. However the use of partogram alone for assessing the dysfunctionl labor was not sufficient. Many labors which was shown as abnormal had normal parturition without any adverse perinatal outcome, so there is a need for supplementary test for early prediction of adverse labor outcome. So trials and research are being carried out in this direction. AIM OF THE STUDY: To find the association between intrapartum amniotic fluid lactate level and labour outcome. OBJECTIVES: 1. To find the association between intrapartum amniotic fluid lactate level and labour outcome. 2. Mode of delivery. 3. Need of instrumentation / LSCS. 4. Apgar score at birth. MATERIALS AND METHODS: The study was conducted in the department of Obstetrics and Gynaecology, PSG Hospitals, Coimbatore from September 2012 to September 2013. STUDY DESIGN: Prospective study. STUDY POPULATION: Study group consisted of low risk pregnant women at term admitted to PSG Hospitals who entered into active labour either by spontaneous/ induced SELECTION CRITERIA: 1. Women in active labour without any obstetrical complications. 2. Vertex, Breech presentation. 3. Term, Postdated pregnancy. EXCLUSION CRITERIA: 1. < 37 Weeks not in active labour 2. Obstetrical complication 3. Biohazard 4. Multiple gestation 5. Absent/Ruptured Membranes METHODOLOGY: Women in active labour without any obstetrical complications are selected who may be either a Term/Postdated. This a Prospective study involving all low risk antenatal patients who entered into active labour were selected for the study. Basic assessment for risk factors is done in antenatal patients with spontaneous onset of labour and induced labour and if the patient comes under uncomplicated term and post dated gestation, she is included in the study. Women were included in the study group if their gestational age was atleast 37 weeks at admission to labour, who carried a singleton pregnancy either a vertex or breech presentation who were without any other obstetrical or medical complications. Both spontaneous and induced labour were chosen. CONCLUSION: 1. The uterine myometrium has an increased propensity for anaerobic metabolism when compared with other types of mucles. 2. The myometrial capillary blood lactate increases in women following prolonged labour. 3. The amniotic fluid lactate is 4-6 times higher when compared with fetal and maternal blood, which occurs mainly during dysfunctional labour. 4. The traditional partogram is a good tool used for diagnosing dysfunctional labour. The combination of intrapartum amniotic fluid lactate levels along with WHO partogram could be used as a better tool in diagnosing dysfunctional labour. 5. According to our study, the intra partum amniotic fluid lactate levels had a good negative predictive value when it was compared with the duration of labour. 6. Of the patients whose duration of labor were 8-<20 hours, 88% had amniotic fluid lactate levels < 10. In lactate levels 5-<8 – 9.1% had apgar < 7. In lactate levels 8-<10 - 15.6 % had apgar score < 7. But in lactate levels > 10- 35.7 % had low apgar score <7. 7. Amniotic fluid lactate levels had better correlation with duration of labour and apgar score. 8. The lower the amniotic fluid lactate levels, the better is the apgar score. 9. Better correlation could have been observed if amniotic fluid lactate levels were seen every 3-4 hours during active labor. However this was not possible due to practical difficulty in collection of sample. 10. Lactate analysis is a simpler, easier method of analyzing the labour outcome and the results of this test can be obtained very fast since its analyzed with auto analyzer. 11. The laboratory results are also standard since its done with the auto analyzer. 12. The intrapartum amniotic fluid lactate levels can be correlated with umbilical cord blood lactate and fetal scalp blood lactate for further analysis

Rare case of complete gonadal dysgenesis 46 XY, Swyer syndrome

Swyer syndrome also known as 46XY complete gonadal dysgenesis is a rare cause of primary amenorrhea. These patients are phenotypically females with female type of internal and external genitalia with absence of testicular tissues. They have streak gonads which have increased potential to turn into malignancy.  Bilateral gonadectomy should be done as soon as diagnosis is made. In present case, 20 years unmarried female came with complaints of menstrual bleeding only on taking medication. She never attained menarche, following which she was started on treatment outside, on withdrawal bleeding for the past 3 years. She was now evaluated and diagnosed as Swyer syndrome and bilateral gonadectomy was done laproscopically. Swyer syndrome patients can get married, have normal sexual life and can get pregnant through invitro fertilisation with donor oocyte if desired

Positive Evolutionary Selection of an HD Motif on Alzheimer Precursor Protein Orthologues Suggests a Functional Role

HD amino acid duplex has been found in the active center of many different enzymes. The dyad plays remarkably different roles in their catalytic processes that usually involve metal coordination. An HD motif is positioned directly on the amyloid beta fragment (Aβ) and on the carboxy-terminal region of the extracellular domain (CAED) of the human amyloid precursor protein (APP) and a taxonomically well defined group of APP orthologues (APPOs). In human Aβ HD is part of a presumed, RGD-like integrin-binding motif RHD; however, neither RHD nor RXD demonstrates reasonable conservation in APPOs. The sequences of CAEDs and the position of the HD are not particularly conserved either, yet we show with a novel statistical method using evolutionary modeling that the presence of HD on CAEDs cannot be the result of neutral evolutionary forces (p<0.0001). The motif is positively selected along the evolutionary process in the majority of APPOs, despite the fact that HD motif is underrepresented in the proteomes of all species of the animal kingdom. Position migration can be explained by high probability occurrence of multiple copies of HD on intermediate sequences, from which only one is kept by selective evolutionary forces, in a similar way as in the case of the “transcription binding site turnover.” CAED of all APP orthologues and homologues are predicted to bind metal ions including Amyloid-like protein 1 (APLP1) and Amyloid-like protein 2 (APLP2). Our results suggest that HDs on the CAEDs are most probably key components of metal-binding domains, which facilitate and/or regulate inter- or intra-molecular interactions in a metal ion-dependent or metal ion concentration-dependent manner. The involvement of naturally occurring mutations of HD (Tottori (D7N) and English (H6R) mutations) in early onset Alzheimer's disease gives additional support to our finding that HD has an evolutionary preserved function on APPOs

Successful pregnancy following single blastocyst transfer in a renal transplant recipient

Numerous spontaneous pregnancies have been reported in renal transplant recipients; however, only a few pregnancies after the use of assisted reproductive techniques. The authors report a case of renal transplant recipient with secondary infertility who delivered a healthy baby without any complications. The report highlights the importance of minimal stimulation protocol during ovarian stimulation, single embryo transfer, and the need for multispecialty care for these patients. To the best of the authors' knowledge, the present report is the first such case from India and also the second in the world to report a blastocyst transfer among renal transplant recipients