Role of serum LDH in preeclampsia as a prognostic factor – a cross sectional case control study in tertiary care hospital

Background: LDH is an intracellular cytoplasmic enzyme. It is ubiquitous to all the major organ systems. Cellular enzymes in extracellular space have no metabolic function, although they serve as indicators of disturbances in cellular integrity. Serum LDH is abnormal in many disorders, therefore total serum LDH is highly sensitive but nonspecific test. In preeclampsia also LDH may be elevated and can indicate the prognosis for both mother and fetus. We conducted this study to examine the relationship between lactate dehydrogenase concentration and the severity of the disease and the occurrence of its complications.Methods: 200 pre-eclamptic women (121 with mild and 79 with severe pre-eclampsia) and 200 healthy normotensive controls were studied prospectively at Government Kilpauk medical college and hospital between January and December 2015. Demographic, hemodynamic, and laboratory data were compared among the three groups. The symptoms and complications of severe pre-eclampsia along with fetal outcome were analyzed according to the levels of LDH.Results: Severely pre-eclamptic patients were significantly younger, with low gravidity and parity. On the other hand, they had significantly increased systolic and diastolic pressure and liver enzymes, uric acid, urine albumin, and LDH levels. The symptoms and complications of pre-eclampsia along with perinatal mortality were increased significantly in patients with LDH >800 IU/l compared with those who had lower levels.Conclusions:  Lactate dehydrogenase is a useful biochemical marker that reflects the severity of pre-eclampsia. In our study, LDH has been evaluated as a biochemical marker for preeclampsia and as a prognosticator of the disease severity. Detection of high-risk patients with increased levels of LDH mandate close monitoring and management to prevent maternal and fetal morbidity and mortality

Critical analysis of surgical difficulties and postoperative morbidities of caesarean deliveries: a rural teaching hospital experiences in silk city, South India

Background: Caesarean section is the delivery of a fetus through a surgical incision on the uterine wall after 28 weeks of gestation. Objectives of present study were to determine the caesarean section rate, to analyse surgical difficulties and post-operative morbidites in caesarean deliveries and to formulate modalities to reduce morbidity and to ensure safe motherhood.Methods: Retrospective analysis of caesarean deliveries in Shri Sathya Sai Medical College and Research Institute, Ammapettai from January 2015-2017. Total number of delivery in these two year were 494.Total vaginal delivery-210, Total caesarean delivery-284. Case records of women who had cesarean deliveries were analysed for intra operative complications and post-operative morbidity within the period of their hospital stay.Results: Total no of deliveries in 2 years were 494. Vaginal delivery was 210 (42.5%). Total caesarean section is 57.5% (n=284). Primary caesarean section rate 33.1% (n=94) and secondary cesarean section rate 66.9% (n=190). 60% of our subjects were un-booked emergency admissions. Majority were between 21-30 years. Youngest is 16yr old with imminent eclampsia, oldest 35yr with previous 3 LSCS with central placenta previa. Non-closure of peritoneum in previous caesarean has increased the risk of adhesions, plastered rectus muscle and bladder adhesion which caused difficulty in reaching lower segment in 62 women. In present study, vertical incision was put on uterus in 4 cases due to adhesions. Difficulty in entering uterine cavity, extension of uterine angle due to thick lower segment and excessive bleeding was seen in cases of repeat caesarean section. Scar dehiscence has increased due to single layer closure of uterus. Scar dehiscence was noted in 41 cases. Bladder injury in 3 cases, adherent placenta over the scar was seen in 5 cases.Conclusions: Caesarean section rate is increasing. Intraoperative complications and postoperative morbidity is comparatively less in primary caesarean section. More than one morbidity was seen in 60% women who had repeat section. With the growing rate of cesarean deliveries worldwide, women should be counselled that the repeat cesarean are bound with surgical difficulties and complications. If available, it’s imperative to take the senior obstetricians help for better surgical outcome. Anticipation of complications, early decision and active intervention reduces morbidity and prevent mortality as most of the women report for admissions late in labour

Adolescent gynaecology problems in rural South India: a review of hospital admission in a tertiary care teaching hospital in Ammapettai, Tamil Nadu, India A review of hospital admission in a tertiary care teaching hospital in Ammapettai

Background: Adolescent girl’s knowledge about sexual abuse and awareness of health services is poor. The study is conducted to analyse the gynaecological problems mandating hospitalization and to formulate modalities to improve their health and to ensure safe motherhood. The objectives of this study were to evaluate gynaecological problems in adolescent girls, and to analyse gynaecological emergencies, and to develop modalities to improve adolescent health and for safe motherhood.Methods: Retrospective hospital based observational study of hospital records regarding health issues and awareness of health services among girls in the age group of 13-19 years hospitalized for various medical and surgical problems during the period of January 2015 to January 2016 at Shri Sathya Sai medical college and Research Institute, Ammapettai, Kancheepuram, Tamil Nadu, India. 50 age, education, social background, knowledge of available health services, contraception and detailed history of menstruation regarding duration, quantity and previous medication prior to admission and their present cause of admission were analysed.Results: Total admission in the year were 50, medical 34 (including 5 girls who had check curettage for postabortal bleeding with severe anemia) and surgical 16. Early adolescent group were 34 (68%)and late adolescent group were 16 (32%), married were 5 (10%) and unmarried 45 (90%). All 50 girls were from low socioeconomic class, with rural background. 84% were school dropout and 40% were unemployed. 20 % of our study subjects were admitted with unsafe abortion with postabortal bleeding with no knowledge about Health services.16% were sexually abused and were raped. Abnormal uterine bleeding(menorrhagia) is the most common gynaecological problem in adolescent girls in our study. DUB (52%) is the most common cause. Second most common cause for abnormal bleeding is postabortal bleeding (40%). The most common surgical procedure done was check curettage for postabortal bleeding in 10%. Next common surgery was laparotomy for ovarian cyst in 6% cases and for torsion adnexal cyst in 6%.Conclusions: The most important cause for admission was anemia following abnormal excessive bleeding P/V due to DUB or postabortal bleeding. Second most important cause was ovarian tumours. Unprotected coitus, sex abuse and repeated unsafe abortions have increased the rate of PID and ectopic pregnancies. The study emphasizes the need to sensitize these young girls on the issue like excessive menstruation, gender relationships, and sex abuses. Create awareness and promote knowledge regarding medical issue, available health services and contraception to prevent unsafe abortion and its sequelae. Active implementation of projects like ARSH - adolescent friendly reproductive services, where confidentiality is maintained and proper counseling regarding contraception and supplementation of iron and folic acid is given to all adolescent girls who are future mothers and to ensure safe motherhood