Spontaneous uterine rupture in primigravida at 15 weeks

This is a very rare and interesting case of primigravida with sonographic evidence of intrauterine pregnancy presenting with acute abdomen at 15 weeks. With the diagnosis of uterine rupture, emergency laparotomy was done. The defect was repaired and post-operative recovery was good. This shows that spontaneous uterine rupture can occur in primigravida and should be kept in mind during diagnosis of acute abdomen

Maternal and foetal outcome of eclampsia in a referral hospital

Background: Eclampsia is a life-threatening condition, common in developing countries with high fatality rate. It is a cause of maternal and foetal mortality and morbidity. The aim of the study is to determine the maternal and foetal outcome in Tata Main Hospital, Jamshedpur, Jharkhand, India.Methods: All cases of eclampsia were analysed from January 2012 to December 2014 from admission to discharge or death of the patient.  Age, parity, antenatal care, interval between attack and admission, blood pressure on admission, gestational age and mode of delivery were  taken into account. There were 135 cases of eclampsia out of 14572 deliveries. Only singleton pregnancies were analysed.Results: The incidence of antepartum eclampsia was 84.4%, intrapartum 3% and postpartum 12.5 %. 83% patients were primigravida, 33% less than 20 yrs,42% had no antenatal checkup and 45% had < 4 visits. Only 15% patients received magnesium sulphate before referral to the hospital. There were four maternal deaths and twenty-one perinatal deaths. Eleven patients needed ventilatory support, four developed pulmonary oedema,  two patients had respiratory depression and three patients had renal failure.Conclusions: Hypertensive disease in pregnancy requires proper antenatal care, early recognition and referral, adequate treatment and timely delivery

Fetal Doppler for prediction of adverse perinatal outcome in preeclampsia in a low resource setting

Background: To assess the usefulness of fetal Doppler in predicting adverse perinatal outcome in preeclampsia.Methods: All the women with preeclampsia from 30 weeks onwards were enrolled in the study. The umblical artery (UA) Systolic-diastolic (S/D) ratio>2standard deviation (SD) or UA-Pulsatility Index (PI) and UA-Resistive Index (RI) >2SD were taken as abnormal. The middle cerebral artery (MCA) was visualized and cerebroumblical PI ratio calculated. MCA-RI2SD (RR 4.46, 95% CI 1.40-14.17) and RI>2SD (RR 3.36, 95% CI 1.03-10.61) and MCA RI2SD predicted acute fetal distress in labour (RR 2.33, 95% CI 1.21-4.47), there was no association on multivariate regression analysis.Conclusions: This study showed UA-S/D ratio and UA-RI>2SD are significant predictors of perinatal deaths and immediate neonatal resuscitation in preeclampsia. Acute fetal distress in labour or neonatal nursery admission could not be predicted

Fetal growth and its correlation with level of glycemic control in pregnancy with diabetes: an observational study in tertiary care centre of North India

Background: Diabetes in pregnancy is a known risk factor for macrosomia and intensive glycemic control is a well-known strategy to prevent this macrosomia. However, does this tight glycemic control is actually beneficial or is it one of the reasons for small for gestational age babies in these women? Is a clinical enigma. We planned this study to see effects of glycemic control on fetal weight and to answer if tight control is always better.Methods: This prospective observational study was conducted in the department of obstetrics and gynaecology in a tertiary care centre (King George medical university) over a period of one year (June 2017-June 2018). All pregnant women with GDM and pre-gestational diabetes with singleton pregnancy were registered in the study after proper consent, followed up for glycemic control, fetal weight. Antepartum risk factors and complications of diabetes were also noted in these women.Results: Total 88 patients included in the study. Five with pre-gestational diabetes, 83 with GDM. Small for gestational age neonates were seen in 54.1% cases, large for gestational age were seen in 2 cases and rest of neonates were appropriate for gestational age. 89.4% had good glycemic control, 7% had over-zealous glycemic control and 3.5% had under-controlled sugars.Conclusions: The results in the study strongly supported the efficacy of good glycemic control in prevention of LGA/macrosomia. However, optimal glycemic control in third trimester does not guarantee appropriate weight of fetus as incidence of SGA/FGR neonates was fairly high (53.9%) even in good glycemic control group

Diosmin versus tranexamic acid in heavy menstrual bleeding: a randomized controlled trial

Background: Heavy menstrual bleeding (HMB) is defined as cyclical bleeding at regular intervals but excessive in amount which affect the physical, social and mental aspects of life of a woman. The prevalence is 10-30% in reproductive age women and 50% in perimenopausal women. HMB is not just a clinical burden but also a huge social and economic burden. The aims and objective of my study is to compare the efficacy of diosmin and tranexamic acid in acute HMB in terms of average duration of menstrual cycle, PBAC/PABC score, endometrial thickness, hemoglobin concentration and finally need for other modes of treatment.Methods: The study was a randomized control trial in which the patients (sample size-72) were divided into two groups- group D (n=36) and group T (n=36). Group D was treated with tab diosmin 500 mg thrice daily from day 1 to day 5 of menstrual cycle. Similarly group T was treated with tab tranexamic acid 500 mg thrice daily from day 1 to day 5 of menstrual cycle. The PBAC score was taken at the end of three months along with endometrial thickness and hemoglobin concentration. The results were compared with values obtained before initiating treatment.Results: In this study after 3 months of treatment; the patients in group D had an initial PBAC score of 423.52 and at the end of treatment it was decreased to 149.89 (p<0.0001). Reduction was 60.5%. Group T patients had an initial PBAC score of 441which was reduced to 177.94 (p<0.0001) after treatment. The reduction in this group was 59.6%.Conclusions: In this study it was found that both tranexamic acid and diosmin were effective in reduction of HMB, in terms of PBAC score, average duration of menstrual cycle and endometrial thickness. But the in reduction in PBAC score was similar in both the groups. The failure rates were also similar in both the groups, but improvements in hemoglobin concentration were only margina

A near miss case of placenta percreta in a patient with post myomectomy scar

The term placenta accreta or placenta accrete syndrome is used to describe a spectrum of an abnormal placental implantation and firm adherence which are classified according to the depth of invasion into the uterus. A 28-year-old elderly primigravida presented AIIMS OPD to for the 1st time at 13+2 weeks of gestation with brownish discharge per vaginum. Ultrasonography done showed 12 weeks single intrauterine pregnancy with subchorionic haemorrhage of 3.7×2.52 cm with placenta being fundoanterior. She underwent myomectomy 2 years back and during her antenatal care in 3rd trimester growth scan at 30+2 weeks of gestation placenta was fundoanterior with loss of retroplacental hypoechoic in the upper margin of placenta at the myomectomy scar site with small extra uterine collection seen measuring 7.6×2.3 cm and hence possibility of placenta accreta was suggestive by the above findings confirmed by MRI. Emergency cesarean section done at 36+6 weeks of gestation for leaking per vaginum. Manual removal of placenta was tried but it failed and soon atonic PPH developed. Seeing no response with uterotonics internal iliac artery ligation was also attempted but failed. Immediate decision for hysterectomy was taken as a life-saving method. On adhesiolysis in the fundal region placental tissue perforating uterine serosa was visible on the surface of uterus, hence diagnosis of placenta percreta was confirmed which was further confirmed on histopathological report. Currently hysterectomy or local resection is preferred over conservative management with methotrexate

A Rapid and Efficient Luminescence-based Method for Assaying Phosphoglycosyltransferase Enzymes

Phosphoglycosyltransferases (PGTs) are families of integral membrane proteins with intriguingly diverse architectures. These enzymes function to initiate many important biosynthetic pathways including those leading to peptidoglycan, N-linked glycoproteins and lipopolysaccharide O-antigen. In spite of tremendous efforts, characterization of these enzymes remains a challenge not only due to the inherent difficulties associated with the purification of integral membrane proteins but also due to the limited availability of convenient assays. Current PGT assays include radioactivity-based methods, which rely on liquid-liquid or solid-liquid extractions, multienzyme systems linked to lactate dehydrogenase and NAD+ generation, and HPLC-based approaches, all of which may suffer from low sensitivity and low throughput. Herein, we present the validation of a new luminescence-based assay (UMP-Glo) for measuring activities of PGT enzymes. This assay measures UMP, the by-product of PGT reactions, in a sensitive and quantitative manner by measuring the luminescence output in a discontinuous coupled assay system. The assay is rapid and robust in nature, and also compatible with microtiter plate formats. Activity and kinetic parameters of PglC, a PGT from Campylobacter jejuni, were quickly established using this assay. The efficacy of the assay was further corroborated using two different PGTs; PglC from Helicobacter pullorum and WecA from Thermatoga maritima.National Institutes of Health (U.S.) (GM-039334

Decoding the effect of time interval between hCG and IUI and sperm preparation and IUI

Background: The study was aimed to assess the difference in IUI outcome depending on the interval between hCG trigger and IUI and sperm preparation and IUI.Methods: The study was conducted in the Department of Obstetrics and Gynecology in Infertility unit at King George’s Medical University, Lucknow from January-December 2016. All the women eligible for IUI were included in the study. Once the follicle attained size of 17-18 mm, IUI was planned 36-48 hours after Inj. hCG 10,000 IU im. Semen processing was done in laboratory and time noted between sperm preparation and IUI. Outcome was confirmation of pregnancy by urine test. Cases were women in whom IUI was done 36-40 hours after hCG as against controls (>40 hours). Interval between sperm preparation and IUI was <30 minutes in cases and ≥30 minutes in controls.Results: A total of 624 cycles were included in the study. Clomiphene was used in 582/624 cycles (93.3%) gonadotropins used in 42/624 cycles (2.7%). There was a total of 23 conceptions in study (3.7%). Of these 8/98 (8.2%) were seen when the interval between ovulation trigger and IUI was 36-40 hours and 15/526 in cycles (2.9%) when the interval was more than 40 hours (p=0.023; OR-3.028 95% CI -1.247-7.352). Of a total of 23 conceptions in the study, 18/324 conceptions were seen when IUI was done within 30 minutes of sperm preparation as compared to 5/300 when interval was more than 30 minutes (p=0.01).Conclusions: IUI with ovarian stimulation is a simple and effective procedure and its outcome can be maximized keeping in consideration the availability of gametes. IUI performed within 36-40 hours of hCG trigger and within 30 minutes of sperm preparation can increase conception rates

Evaluation of causes of still birth in a tertiary care teaching hospital

Background: Whenever pregnancy occurs there is an expectation that every pregnancy will end with the birth of a healthy baby, yet in a developing country like India 22 in every 1000 births are stillborn. The objective of this study was to evaluate the rate and causes of still birth in a tertiary care teaching hospital, Queen Mary, King George Medical college and university, Lucknow, Uttar Pradesh, India.Methods: Present study was an observational study in a tertiary care hospital. 7024 births occurred in the institution over a period of 1 year out of which 550 were stillbirths. Stillbirths which weighed over 500 grams were included in the study. After informed consent, details of history about epidemiological factors, obstetric history and medical history were obtained. Antenatal investigations including imaging, delivery details and stillborn morphological characteristics were analyzed to identify the cause of stillbirthResults: Out of 7024 deliveries, stillbirth rate was 78.30/1000 total births. Cause of intrapartum stillbirth showed statistically significant correlation with patient’s place of residence (rural>urban), distance of health centre from her house, time taken to reach first point of contact and her parity. The major obstetrical causes of stillbirth identified were APH 22.36%, hypertensive disorders of pregnancy 19.27%, IUGR 15.27%, unexplained causes 11.09%, mal-presentations 9.64%, rupture uterus 9.09% and obstructed labour 6.36%. Severe anemia was found in 24.91% as an associated obstetrical cause of stillbirth.Conclusions: The rate of stillbirth is higher as compared to the Indian data (22/1000 total births). Antepartum obstetric complications (APH, hypertensive disorder of pregnancy, IUGR) were the most common. 15.45% cases showed intrapartum causes of stillbirth (obstructed labour and rupture uterus) which was significantly higher than developed countries where such cases are negligible. The higher number of intrapartum deaths indicate that better healthcare services can drastically reduce stillbirth rates in developing countries

High rate of caesarean section in cases of intrauterine fetal demise in a low resource setting: Why?

Background: Stillbirth as an obstetric complication is emotionally devastating for the women as well as the clinician and having a caesarean section for stillbirth is even more catastrophic. The aim of the present research was to study the indications of caesarean section in women with intrauterine fetal demise in a low resource setting.Methods: This was an observational study for assessing the indication of caesarean section among 222/ 550 stillbirths from June 2013 to May 2014 in a tertiary care teaching hospital of North India. 7024 births occurred in the institution over a period of 1 year out of which 550 were stillbirths. Stillbirths which weighed over 500 grams were included in the study. Details of women with intrauterine fetal demise in which caesarian section was done were noted and analyzed.Results: Out of 550 stillbirths, 222 women underwent caesarean section. Rate of caesarean section among women with stillbirth was 40.36%.  Placenta previa (23.87%), Rupture uterus (22.1%), obstructed labour (10.8%), transverse lie (9.45%), failed induction (7.20%), massive abruption (5.86%), non-progress of labour (5.40%), eclampsia/pre-eclampsia related causes (4.95%), acute fetal distress (4.95%), were leading indications of caesarean sections. Out of 222 women, 162 (73%) women had anaemia (Hb <11g%). Severe anaemia (haemoglobin less then 7gm/dl) was present in 51 cases (23%).Conclusions: Caesarean section done for intrauterine death in present study were mostly inevitable. Reducing intrapartum stillbirths by improving essential obstetric services will ultimately result in reducing caesarean section rates in stillbirths in developing countries. Further studies are needed both in developing and developed countries to strategize the management of intrauterine dead fetus to prevent such high rate of caesarean section