Acute kidney injury in obstetrics: a five-year study in a tertiary centre

Background: Pregnancy Related Acute Kidney Injury (PRAKI) is a major cause of maternal and foetal morbidity and mortality in developing countries. The incidence has declined due to improvements in reproductive health but it is still associated with significant perinatal mortality and maternal morbidity. It may be due to decrease in renal perfusion or ischemic tubular necrosis from a variety of conditions encountered during pregnancy. Our study aims at determining the predisposing factors and causes of AKI during pregnancy and its impact on maternal and foetal outcome.Methods: A retrospective cohort study over a period of 5 years was conducted on pregnant women with AKI as per inclusion and exclusion criteria. The detailed history, events, mode of delivery, cause leading to AKI, management, hospital stay, maternal and foetal outcome were studied in detail and evaluated. These patients were classified according to RIFLE criteria and were followed up for hospital stay and residual morbidities.Results: The incidence of PRAKI in the study was 0.07% (36 out of 50,735 deliveries) and among obstetric ICU patients, it was 6.8%. Most of the majority of the cases were unbooked (66.7%) and multipara (61.1%). Maternal morbidity was seen in 66.7% and mortality was 27.8%. Poor foetal outcome was seen in 44.4%.Conclusions: Haemorrhage is the most common cause of PRAKI, followed by toxaemia of pregnancy and sepsis. Early detection and meticulous management of haemorrhage, hypertension and sepsis reduce the incidence of PRAKI and associated maternal mortality

Live-birth after transplantation of cryopreserved ovarian tissue

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A multicentric randomized clinical trial of homoeopathic medicines in fifty millesimal potencies vis-à -vis centesimal potencies on symptomatic uterine fibroids

Objective: The primary objective was to evaluate the effects of homoeopathic medicines in fifty millesimal (LM) potencies vis-à -vis centesimal (CH) potencies on symptomatic uterine fibroids. Materials and Methods: A multicentric randomized clinical trial was conducted at six centers under the Central Council for Research in Homoeopathy. Patients were screened for symptomatic uterine fibroids with the preset inclusion and exclusion criteria. A consultant specialized in obstetrics and gynecology was engaged at each center to screen and follow-up the enrolled patients. Homoeopathic physicians engaged in the study were responsible for prescription and follow up for 12 months. The primary outcome was changes in symptoms of uterine fibroid on a visual analog scale (VAS) of 0–10 and findings through ultrasonography (USG) between LM and CH potencies. The secondary outcome was to assess the changes in uterine fibroid symptom quality of life questionnaire (UFSQOL). Data analysis was done as per intention to treat (ITT) analysis. Results: Of 216 patients enrolled in the study (LM: 108 and CH: 108), 209 patients were analyzed under modified ITT (LM: 106, CH: 103). Both LM and CH potencies were equally effective in reducing the symptoms (percentage change) due to uterine fibroid on VAS scale after 1 year of treatment (P > 0.05). The health-related quality of life (HRQOL) and subdomains of UFSQOL also showed equal effectiveness in both the groups (P = 0.05). However, no difference was observed in all the USG findings except for uterine volume (P = 0.03). There was overall difference before and after homoeopathic treatment irrespective of assigned groups, i.e., LM or CH (P < 0.05) in all the above parameters. The medicines frequently prescribed were: Pulsatilla, Sulphur, Lycopodium, Sepia, Phosphorus, Calcarea carbonica, and Natrum muriaticum. Conclusion: LM and CH potencies are equally effective in giving symptomatic relief to patients suffering from symptomatic uterine fibroids