AHSG rs4918 Polymorphism poses a weak predisposition to insulin resistance during pregnancy

Objective: To identify the association between Fetuin-A levels and genetic polymorphism with gestational diabetes mellitus among pregnant women visiting a tertiary care centre. Methods: This cross-sectional case-control study was conducted at Aga Khan University Hospital, Karachi, from December 2015 to September 2016, and comprised pregnant women in their second trimester. Those with gestational diabetes mellitus were considered the cases while the rest acted as controls. The enzyme-linked immunosorbent assay was used to quantify Fetuin-A levels while genotyping for alpha-2-Heremans-Schmidglycoprotein rs4918 was performed using restriction fragment length polymorphism technique. Blood samples were collected and serum and deoxyribonucleic acid were extracted and stored at -80°C. SPSS 21 was used to analyse the findings. Results: Of the 88 subjects, there were 44(50%) in each group. Serum Fetuin-A concentration was higher in cases compared to the controls (p\u3c0.01). The genotype data for the cases was 0.668 and for the controls 0.840 (p\u3e0.05). However, the G allele showed a weak risk or predisposition towards gestational diabetes mellitus (p=0.038). Conclusion: Increased Fetuin-A levels were found to be related to the occurrence of gestational diabetes mellitus, indicating that Fetuin-A possibly contributes towards insulin resistance

Comparison of Materials used in Facilitating External Cephalic Version

Background External cephalic version (ECV) is a procedure to manipulate a fetus with breech presentation to cephalic presentation through maternal abdomen under ultrasound guidance. It is done to reduce number of assisted breech deliveries and caesarean sections for breech presentation . Talcum powder or aqueous gel is frequently used to facilitate ECV. We  compared powder with gel in attaining successful version and  level of practitioner satisfaction with powder versus gel use. Methodology This retrospective descriptive study was conducted by –removed for blind review---10th Oct 2015- 10th Oct 2019 . Total of 56  low risk gravid women underwent ECV after selection on the basis of inclusion and exclusion criteria. By using  convenient consecutive sampling, powder or gel during ECV was allocated accordingly . ECV was performed by the  single experienced practitioner in labour room with  cardiotocograph and emergency caesarean facilities . Powder and gel use was compared in attaining successful version . ECV was declared successful on confirming head of fetus in lower uterine segment on ultrasound. Unsuccessful ECV’s were reattempted with crossover use to the other aid. Practitioner satisfaction  was defined  as, ease experienced by the practitioner in performing ECV. It was graded as high, medium and low on the base of ease or difficulty experienced by the practitioner while  using powder or gel during ECV. The data was recorded  & analysed using SPSS software. Descriptive statistics with Chi-square test is applied to find out the association between successful version & practitioner satisfaction level with powder versus gel use.  Results In powder use group , 9  ECV’s were successful and 19 ECV’s  were unsuccessful. In gel use group , 12  ECV’s were successful and 16 were unsuccessful .There were more successful ECV’s in gel group but the association was not significant (P value .408). Practitioner satisfaction was  significantly high with gel than  the powder use(Pvalue .<.001). Conclusion Powder or gel is not superior over the other as an aid for achieving successful ECV though gel use is more satisfying for the provider than the powder use in performing ECV. More studies are required regarding aids used in performing ECV for recommendations in clinical practice

ANALYSIS OF DIFFERENT RISK FACTORS OF SURGICAL SITE INFECTION IN OBSTETRICS FEMALES IN PAKISTAN

Introduction: Infection is one of the most common causes of maternal mortality and morbidity in obstetrics. Surgical site infections (SSIs) are infections that occur at or near surgical incision within 30 days of operation or after 1 year if an implant is placed. Objectives of the study: The main objective of the study is to analysis of associated risk factors of surgical infection in obstetrics among females in Pakistan. Methodology of the study: The current study was conducted in the surgical department of Nishtar Hospital, Multan for a period of 9 months during March 2018 to December 2018. The information incorporates every one of those ladies who conveyed child through C-segment or by ordinary conveyance. Office based review observational study configuration was completed purposively to evaluate the prevalence of surgical site infections and related hazard factors among moms who had conveyance related medical procedure at obstetric ward of healing facility from the determined example estimate. Results: The socio-statistic estimations of the patients showed that these are reliant variables and SSI is likewise relying on these qualities. Socio statistic variable had no noteworthy relationship with SSIs aside from age, those ladies age under nineteen years were multiple times danger of creating surgical site infection as contrast with those ages run 20– 34. Conclusion: It is concluded that surgical site infection rate become high among young age women as compared to old age women. Duration of surgery and wound healing are not a dependent factor these are independent factors because it is not related to SSI. Key words: SSI, Infection, Pregnant, Women

Comparison of Materials used in Facilitating External Cephalic Version

Background External cephalic version (ECV) is a procedure to manipulate a fetus with breech presentation to cephalic presentation through maternal abdomen under ultrasound guidance. It is done to reduce number of assisted breech deliveries and caesarean sections for breech presentation . Talcum powder or aqueous gel is frequently used to facilitate ECV. We  compared powder with gel in attaining successful version and  level of practitioner satisfaction with powder versus gel use. Methodology This retrospective descriptive study was conducted by –removed for blind review---10th Oct 2015- 10th Oct 2019 . Total of 56  low risk gravid women underwent ECV after selection on the basis of inclusion and exclusion criteria. By using  convenient consecutive sampling, powder or gel during ECV was allocated accordingly . ECV was performed by the  single experienced practitioner in labour room with  cardiotocograph and emergency caesarean facilities . Powder and gel use was compared in attaining successful version . ECV was declared successful on confirming head of fetus in lower uterine segment on ultrasound. Unsuccessful ECV’s were reattempted with crossover use to the other aid. Practitioner satisfaction  was defined  as, ease experienced by the practitioner in performing ECV. It was graded as high, medium and low on the base of ease or difficulty experienced by the practitioner while  using powder or gel during ECV. The data was recorded  & analysed using SPSS software. Descriptive statistics with Chi-square test is applied to find out the association between successful version & practitioner satisfaction level with powder versus gel use.  Results In powder use group , 9  ECV’s were successful and 19 ECV’s  were unsuccessful. In gel use group , 12  ECV’s were successful and 16 were unsuccessful .There were more successful ECV’s in gel group but the association was not significant (P value .408). Practitioner satisfaction was  significantly high with gel than  the powder use(Pvalue .<.001). Conclusion Powder or gel is not superior over the other as an aid for achieving successful ECV though gel use is more satisfying for the provider than the powder use in performing ECV. More studies are required regarding aids used in performing ECV for recommendations in clinical practice

To determine the rate of success of external cephalic version in low risk breech presentations and possible factors affecting its success in POF hospital, Wah Cantt.

Abstract   Background The caesarean section rate  is on the rise for various reasons. One of the reason is breech presentation . External cephalic version is a procedure to manipulate the baby from breech to cephalic presentation externally through the maternal abdomen under USG guidance . Success in ECV decreases the breech presentation and  hence caesarean section rate . Methods This retrospective study was conducted by Wah Medical College in POF hospital from10 Oct 2015- 10 Oct 2019 after approval from the ethical committee .  It included 56 low risk singleton  breech presentations from 36 wks- 40 wks after taking their informed consent  While those with < than 36 wks (primis) and >40 wks gestation, refusal to ECV , with absolute contraindication to ECV& with medical and obstetric complications (ie scarred uterus, liquor <than 8 cm & > than 17 cm, fetal growth restriction, preclampsia, gestational diabetes & abnormal cardiotocography) were excluded  from the study. ECV was performed by single obstetrician in labour room with facilities  of cardiotocograph and emergency caesarean section. Cardiotocography of the fetus  for 30-40 min was done just before & after the procedure of ECV. ECV was declared successful on cofirming head of the fetus occupying the lower uterine segment on ultrasound.  .Number  of successful ECVs & specific factors  of the women & the baby (age . parity, amniotic fluid index ,type of breech, engagement of breech, position of back of baby)  were chosen to observe their effect on success of  ECV. Results External cephalic version was successful in 27 (48.2%)  & unsuccessful in 29 (51.8%)of women .Multiparity , unengaged breech & type of breech (complete flexed) ( with p values .001, .000 & .001 respectively) had statistically significant positive association with successful external cephalic version. Conclusion ECV should be offered to all  women with low risk breech presentations. Knowledge of factors predictive of ECV success can be utilized in selecting cases for ECV &counselling the women regarding the success and failure of ECV.   &nbsp

Comparison of efficacy and safety of zinc gluconate versus placebo for treatment of Primary Dysmenorrhea

Background & Objectives: Dysmenorrhea is a common gynecological complaint in women of reproductive age. Primary dysmenorrhea is defined as painful menstruation in the absence of any pelvic pathology and occurs in response to increased prostaglandin release from the ischemic endometrium. Conventional treatments include NSAIDs and oral contraceptive pills.  Zinc is an essential micronutrient with anti-inflammatory properties. We conducted this study to evaluate the efficacy and safety of zinc supplementation in treatment of primary dysmenorrhea in our target population as it presents as very common gynaecological issue in young adolescents females.   Methods: 100 participants with primary dysmenorrhea were enrolled in study from outpatient department via non-probability consecutive sampling. They were randomized into two groups. The intervention group (Group A) received zinc gluconate 50mg once daily and the control group (Group B) received placebo drug once daily, for 5 days before and 2 days after onset of menstruation. After three and six months of treatment severity of primary dysmenorrhea was assessed and compared in both groups using visual analogue scale for pain, along with side effect profile. Results: The treatment with Zinc gluconate reduced the mean pain score in females with primary dysmenorrhea after 3months with a further reduction after 6 months of treatment (P<0.001) as compared to placebo. Very few (4% after 3 months & 6% after 6 months) participants experienced the side effects of Zinc supplementation. Conclusion: zinc gluconate 50mg daily for 5 days before and 2 days after onset of menstruation can effectively treat the primary dysmenorrhea. The drug has very few side effects at this dose and duration of use. Key words: Primary dysmenorrhea, zinc gluconate, pain severity, visual analogue scale. &nbsp

Feto-maternal Outcome of Reverse Breech Extraction versus Dis-impaction of Fetal Head in Caesarean Section for Obstructed Labour

Objectives: Obstructed labour is an obstetrical emergency with adverse feto-maternal consequences and caesarean delivery in such cases requires skillful handling of impacted fetal head. Objective of our study was to guide clinician about caesarean technique that facilitates the delivery with least complications for mother and baby. Methods: It was a randomized clinical trial with non-probability consecutive sampling conducted at –removed for blind review---from 1st july 2018 – 30th june 2020. Patients who underwent emergency cesarean section were randomized to undergo either push technique for delivery of impacted fetal head (Group A) or reverse breech extraction method (Group B) via lottery method. The data of 60 patients who fulfilled the inclusion criteria was analyzed using SPSS version 19. Maternal outcome measured were extension of uterine incision, blood transfusion, postpartum pyrexia, wound infection, postpartum hemorrhage and length of hospital stay. Fetal outcome measured were 5 minutes Apgar score, birth weight and NICU admission. Results: The results of our study showed statistically significant difference between extension of uterine incision(p-value=0.015), blood transfusion during surgery (p-value=0.021) and postpartum hemorrhage (p-value=0.020) in two groups with pull technique associated with less traumatic extension of uterine incision, less intraoperative transfusion and less PPH than push technique of fetal delivery. Length of hospital stay was also significantly less in reverse breech extraction group(p-value=0.001).More patients had postpartum pyrexia, wound infection, low 5-min Apgar score and NICU admissions in cephalic delivery group but results were not statistically significant. Conclusion: The results of our study recommend reverse breech extraction technique to be a safe alternative to conventional vaginal pushing of fetal head especially regarding maternal outcomes during caesarean section of patients with obstructed labour for fetal delivery. Key words: Obstructed labour, impacted fetal head, reverse breech extraction, caesarean sectio

Comparison of efficacy and safety of zinc gluconate versus placebo for treatment of Primary Dysmenorrhea

Background & Objectives: Dysmenorrhea is a common gynecological complaint in women of reproductive age. Primary dysmenorrhea is defined as painful menstruation in the absence of any pelvic pathology and occurs in response to increased prostaglandin release from the ischemic endometrium. Conventional treatments include NSAIDs and oral contraceptive pills.  Zinc is an essential micronutrient with anti-inflammatory properties. We conducted this study to evaluate the efficacy and safety of zinc supplementation in treatment of primary dysmenorrhea in our target population as it presents as very common gynaecological issue in young adolescents females.   Methods: 100 participants with primary dysmenorrhea were enrolled in study from outpatient department via non-probability consecutive sampling. They were randomized into two groups. The intervention group (Group A) received zinc gluconate 50mg once daily and the control group (Group B) received placebo drug once daily, for 5 days before and 2 days after onset of menstruation. After three and six months of treatment severity of primary dysmenorrhea was assessed and compared in both groups using visual analogue scale for pain, along with side effect profile. Results: The treatment with Zinc gluconate reduced the mean pain score in females with primary dysmenorrhea after 3months with a further reduction after 6 months of treatment (P<0.001) as compared to placebo. Very few (4% after 3 months & 6% after 6 months) participants experienced the side effects of Zinc supplementation. Conclusion: zinc gluconate 50mg daily for 5 days before and 2 days after onset of menstruation can effectively treat the primary dysmenorrhea. The drug has very few side effects at this dose and duration of use. Key words: Primary dysmenorrhea, zinc gluconate, pain severity, visual analogue scale. &nbsp