A study on the perinatal outcome in cases of oligohydramnios

Background: Amniotic fluid has an important role in the fetal growth and development. It provides the fetus, with a protective low resistance environment which is suitable for the growth and development. With normal amount of amniotic fluid index ranging from 5 to 24 cms, Amniotic fluid index of 5 cms were taken. AFI >10 cms was considered to be normal. Various outcome measures recorded were, induced Vs spontaneous labor, gestational age at delivery, nature of amniotic fluid, FHR tracings, mode of delivery, indication for cesarean section or instrumental delivery Apgar score at one minute and five minutes, birth weight, admission to neonatal intensive care unit, perinatal morbidity and perinatal mortality.Results: Normal quantity of liquor amnii is essential for normal and successful outcome of pregnancy, as it provides a safe milieu interior for the foetus in utero. Deprivation of required quantity, will adversely affect the neonatal outcome. Oligohydramnios, in itself is enough to cause such damage, by creating chronic hypoxic situation.Conclusions: The fetal morbidity and mortality increases if additional antenatal complications of   preeclampsia and post-term pregnancy are present along with oligohyrdramnios

A study to evaluate accuracy of gestational age, comparing conventional method against duration of intermenstrual interval consideration

Background: Most methods of calculating gestational length are based upon 28 day cycle. If a woman has a cycle which is significantly shorter than 28 days and she delivers before her due date calculated by her LMP, this arises an anticipation of a premature baby, but the fetus is mature by all criteria of maturity assessment. Dr. Modi (Text Book of Medical Jurisprudence) stated, ‘duration of pregnancy in homo homosapiens is 10 times the inter-menstrual interval’. Keeping this in mind we undertook this study.Methods: The study was done for a duration of 1 year. The gestational age of patients was calculated from the routine Naegele’s formula and inter-menstrual interval. The maturity of neonate was assessed by using Ballard’s score. This data was co-related for further evaluation.Results: Although 39 (19.5%) neonates were expected to be preterm, 24 (12%) actually turned out to be preterm according to Ballard’s score. Rest 15 neonates, premature by Naegele’s formula, should be in “premature” group, turned out to be well developed, by Ballard’s score, almost 37.5% of early delivery group, (significant at P<0.05)Conclusions: This showed that the baby attained maturity at a lesser gestational age which corresponded to 10 times the inter-menstrual interval

A comparative study of evaluate dose related feto-maternal effects of syntocinon during labor

Background: In times, Active management of Third stage is a gold standard rule, to reduce third stage complications. In the same tradition, we conceived the idea of “Active management of Labor”, as a whole, to reduce all the problems, maternal and fetal, to a minimum possible level. With this motto, and aim in mind we devised the protocol of study I present forthwith. Methods: This study was done in Dhiraj Hospital in Obstetrics and Gynaecology department. The study duration was 1 year. It was a comparative study comprising of patients who came in labor room under unit 3 included in group 1 and under other units included in group 2 and 3. In this study, those patients were augmented who came to labor room. These patients were studied after screening inclusion and exclusion criteria & its outcome was assessed.Results: Augmentation-delivery interval in primigravida was 4.5 hours in group 1, in group 2 it was 3 hrs, where as in group 3 active phase delivery interval was 8.1 hours, Augmentation-delivery interval in multigravida was 3.5 hours in group 1, in group 2 it was 3 hrs, where as in group 3 active phase delivery interval was 6 hours. The incidence of spontaneous vaginal delivery was higher in group 1 than in group 2 and 3. There was very less or absent of maternal complications observed in group 1 than in other 2 groups. Incidence of NICU admissions was only 1 % in group 1, whereas in other groups it was higher. There was no neonatal mortality noted in either group.Conclusions: There is significant reduction in the duration of labor by augmenting labor with slow low regulated dose of syntocinon drip, thus reducing the maternal exhaustion and morbidity due to prolonged labor. There is significant reduction in the operative interference like LSCS, vacuum and forceps delivery, thus reducing maternal morbidity associated with operative interference and anesthesia. It also reduces the cost of medical services. The incidence of fetal distress and LSCS for the same does not increase in the augmentation group, indicating that syntocinon can be safely used for the augmentation. At this time, much attention in the field of obstetrics is focused on attempting to reduce the rate of cesarean section, not only to reduce maternal morbidity, but to lower the cost of medical care. Our finding is that syntocinon administration can significantly reduce the cesarean section rate

Centchroman use in dysfunctional and abnormal uterine bleeding after D and C

Background: Incidence of DUB is more in the age group of 30-35yr and is about 35%-40%. Medical management (Centchroman) can be the treatment of preference, after excluding any organic pathology in uterus. To evaluate efficacy and side effects of Saheli (Centchroman) in case of dysfunctional uterine bleeding will depend upon the type of endometrium as determined histologically after minor procedure, D&C (Dilatation and Curettage). This drug will be used only in the presence of Proliferative Endometrium on Histopathological Examination.Methods: The study was carried out at Dhiraj Hospital, Piparia. It was an Interventional Study. 50 patients were studied in 6 months of period, 25 each of DUB and AUB. A total of 50 patients were enrolled in this study, who were attending or were admitted in the hospital. Patients who meet the inclusion criteria were included in this study, after taking prior written and informed consent.Results: Most of the patient were in the age group 39-45 years. The common complaint was excessive uterine bleeding, for which they were prescribed Centchroman. Most of the DUB patients were relieved on medication. However, few of them who had poor response to drug went for hysterectomy. It was observed that patients with early proliferative phase on HPE had better response to this drug as compared with late proliferative phase. All the patients with late proliferative phase underwent hysterectomy. Most patient with AUB including Fibroid, Adenomyosis, Endometrial hyperplasia had little or no response went for hysterectomy sooner or later on after therapy in 50% cases. Centchroman is relatively a safe drug. The most common side effect encountered was breakthrough spotting in 15 patients. 4 patients complained of amenorrhoea after 3 months of taking this drug and 1 patient complained of itching and rash over the body. No major complications were noted.Conclusions: Centchroman can be an effective non hormonal drug used for menorrhagia with proliferative endometrium with early changes in patients of DUB. This drug can also be used to control menorrhagia in patients with fibroid. This is also beneficial in patients with menorrhagia with medical illness to avert hysterectomy

Preterm birth and its outcome

Background: Preterm birth is a major challenge in perinatal health care. Most perinatal deaths occur in preterm infants, and preterm birth is an important risk factor for neurological impairment and disability. Preterm birth not only affects infants and their families-providing care for preterm infants, who may spend several months in hospital, has increasing cost implications for health services. This study aims at to study the causes of preterm birth, perinatal outcome, identify the cases which need intervention.Methods: This is a retrospective study done at the Department of Obstetrics and Gynecology, Dhiraj General Hospital from May 2012 to May 2013. Total 272 preterm deliveries were enrolled for the study.Results: According to our study, preterm birth percentages 51% in low socio economic status, 58% in severe anaemia, 55% in unregistered, 37% in h/o previous preterm birth, 41% b/w 28-32 wks of gestational age, 46% b/w 32-36 wks of gestational age.Conclusions: In our population preterm birth is more common in poor socio economic status, women with anaemia, malnutrition and these factors can be eliminated by proper nutrition and health education by health workers

Association of ABO and Rh incompatibility with neonatal hyperbilirubinaemia

Background: 60% of term new-born have clinical jaundice, in the first week of life. ABO incompatibility is the most common cause of haemolytic disease of the new-born. So early intervention, at proper time, is mandatory to prevent these sequelae.Methods: This study was done at Dhiraj Hospital in Obstetrics and Gynecology Department. It was prospective observational study. 200 new-born with ABO incompatibility and 20 new-born with Rh incompatibility, causing clinically significant neonatal hyperbilirubinemia, were recruited for the clinical study noted.Results: The incidence of ABO incompatibility in our study was 13.79% and of Rh incompatibility was 1.37%. In ABO incompatibility group, 90% new born developed clinical jaundice. In treated group, out of 88 new born, 82 were from O-A and O-B incompatibility group. In ABO incompatibility DCT was positive in only 9%, whereas in Rh incompatibility it was 25%. In ABO incompatibility group, majority, 56% did not require treatment, whereas in Rh incompatibility group 65% required treatment. In ABO incompatibility group only 1% required exchange transfusion whereas in Rh incompatibility, it was required in 10%. In ABO incompatibility, all new-born treated well except, 0.5% developed kernicterus. In Rh incompatibility group, 10% new-born developed kernicterusConclusions: In ABO incompatibility, if jaundice develops, it remains in physiological limits. In presence of some aggravating conditions may present as pathological jaundice. It results in significant morbidity but no mortality. So prevention of aggravating factors is very important, in case of ABO incompatibility.

Association of serum uric acid and C-reactive protein levels in prediction of pre-eclampsia

Background: Hypertensive disorders during pregnancy increase maternal and infant risk. The greatest impact is associated with the pregnancy-specific syndrome, preeclampsia, a consistently clinically worsening situation. PE is a complication of pregnancy, constituting a major cause of maternal and foetal morbidity, and mortalityHyperuricemia and increased CRP level, in pre-eclamptic patients need to be confirmed, in a designed strategy, in which uric acid and CRP level are  measured before the development of preeclampsia, or early in pregnancy, in order to identify and monitor the patients, “at risk of preeclampsia”, and thus  provide the best prenatal care for these women and their babies.Methods: The study was done in Dhiraj Hospital in Obstetrics and Gynecology Department. The study duration was 1 year. It is a prospective type of study comprising of patients, who were attending ANC clinic and were booked cases at Dhiraj hospital. Serum uric acid and C-reactive protein were estimated along with other routine investigations for all patients attending ANC clinic. All the subjects were divided into two groups: (i) Group-1 (Study Group): Fifty diagnosed pre-eclamptic patients in third trimester of pregnancy (37-40 weeks) whose serum uric acid and CRP levels were already raised during her antenatal visits in second trimester, (ii) Group-2 (Control Group): fifty two normal pregnant women of comparable gestational age.Results: The mean values of serum uric acid and CRP levels remain higher in study group than that of control group. This difference is statistically significant (p= 0.02).Conclusions: All the patients in study group whose measurement of uric acid and CRP levels were high, developed pre-eclampsia. So it can be fairly concluded, that the observed elevations in serum uric acid level or CRP level or both, preceded the development of pre-eclampsia

Influence of healthy candidate bias in assessing clinical effectiveness for implantable cardioverter-defibrillators: cohort study of older patients with heart failure

Objective: To assess the potential contribution of unmeasured general health status to patient selection in assessments of the clinical effectiveness of implantable cardioverter-defibrillator (ICD) therapy. Design: Retrospective cohort study. Setting: Linked data from an ICD registry, heart failure registry, and Medicare claims data for ICDs implanted in 2005 through 2009. Participants: 29 426 patients admitted to hospital with heart failure aged 66 years or older and eligible for ICD therapy for primary prevention. Main outcome measures Non-traumatic hip fracture, admission to a skilled nursing facility, and 30 day mortality—outcomes unlikely to be improved by ICD therapy. Results: Compared with 17 853 patients without ICD therapy, 11 573 patients with ICD therapy were younger and had lower ejection fraction and more cardiac admissions to hospital but fewer non-cardiac admissions to hospital and comorbid conditions. Patients with ICD therapy had greater freedom from unrelated events after adjusting for age and sex: hip fracture (hazard ratio 0.77, 95% confidence interval 0.64 to 0.92), skilled nursing facility admission (0.53, 0.50 to 0.55), and 30 day mortality (0.12, 0.10 to 0.15). Conclusions: Lower risks of measured outcomes likely reflect unmeasured differences in comorbidity and frailty. The findings highlight potential pitfalls of observational comparative effectiveness research and support physician consideration of general health status in selecting patients for ICD therapy

Role of Aspiration and Mechanical Thrombectomy in Patients With Acute Myocardial Infarction Undergoing Primary Angioplasty An Updated Meta-Analysis of Randomized Trials

Objectives This meta-analysis was designed to update data on clinical outcomes with aspiration thrombectomy or mechanical thrombectomy before primary percutaneous coronary intervention (PCI) compared with conventional primary PCI alone

An Important Role for Syndecan-1 in Herpes Simplex Virus Type-1 Induced Cell-to-Cell Fusion and Virus Spread

Herpes simplex virus type-1 (HSV-1) is a common human pathogen that relies heavily on cell-to-cell spread for establishing a lifelong latent infection. Molecular aspects of HSV-1 entry into host cells have been well studied; however, the molecular details of the spread of the virus from cell-to-cell remain poorly understood. In the past, the role of heparan sulfate proteoglycans (HSPG) during HSV-1 infection has focused solely on the role of HS chains as an attachment receptor for the virus, while the core protein has been assumed to perform a passive role of only carrying the HS chains. Likewise, very little is known about the involvement of any specific HSPGs in HSV-1 lifecycle. Here we demonstrate that a HSPG, syndecan-1, plays an important role in HSV-1 induced membrane fusion and cell-to-cell spread. Interestingly, the functions of syndecan-1 in fusion and spread are independent of the presence of HS on the core protein. Using a mutant CHO-K1 cell line that lacks all glycosaminoglycans (GAGs) on its surface (CHO-745) we demonstrate that the core protein of syndecan-1 possesses the ability to modulate membrane fusion and viral spread. Altogether, we identify a new role for syndecan-1 in HSV-1 pathogenesis and demonstrate HS-independent functions of its core protein in viral spread