Study of risk factors in patients with postpartum hemorrhage- an observational study

Background: In both developed and developing countries, postpartum haemorrhage (PPH) can occur in 1-5% of deliveries, and it is still the leading cause of maternal morbidity and mortality. Clinicians must be aware of PPH risk factors and should consider them when counselling women about where to birth. The goal of this study was to assess risk factors in patients with postpartum hemorrhage.Methods: This study comprised 50 pregnant patients with PPH. Their maternal age, parity status, GA, and mode of delivery were recorded. Other associated co-morbidities with PPH such as anaemia, H/O LSCS, hypertensive status, abruptio placentae, premature rupture of membranes, and prolonged labour were also recorded. The morbidity rate and intervention employed were also recorded.Results: In the present study, significant risk factors for PPH were 20-24 years of age, primipara, severe anaemia (Hb<7 gm%), previous LSCS, hypertensive disorders of pregnancy, premature rupture of membranes, abruptio placentae and prolonged labor.Conclusions: Monitoring these identified risk factors could enable extra vigilance during labor, and preparedness for managing PPH in all women giving birth

Prevalence of glucose tolerance test abnormalities in women with polycystic ovarian syndrome

Background: PCOS is the most frequent endocrine disorder, often complicated by chronic anovulatory infertility and hyperandrogenism. High prevalence of impaired glucose tolerance and type 2 diabetes is observed due to peripheral insulin resistance. Holistic approach to the disorder to prevent long-term complications is required. The objective of the study was to study the prevalence of oral glucose tolerance test abnormalities (OGTT) in PCOS women and to study the significance of risk factors contributing to glucose intolerance in women with PCOS.Methods: Hospital based analytical cross sectional study was conducted for 1 and ½ years among 200 women with PCOS. Women diagnosed as PCOS according to Rotterdam’s criteria. Women with other causes of anovulation, premature ovarian failure and women already diagnosed to be diabetic.Results: Abnormal glucose tolerance was observed in 32 (16 %) of the 200 PCOS women. Among them 14.5% had impaired glucose tolerance (IGT) and 1.5% had diabetes. There was a significant trend towards increasing prevalence of IGT and diabetes in females with higher BMI, waist circumference, clinical and biochemical hyperandrogenism and patients with metabolic syndrome.Conclusions: High prevalence of IGT and Non-Insulin Dependent Diabetes Mellitus (NIDDM) in women with PCOS was observed than expected. They have accelerated conversion from IGT to NIDDM. IGT is often asymptomatic and is a known risk factor for type 2 DM and cardiovascular disease. OGTT with 75 gms of glucose is the best screening method for glucose intolerance and a good measure to diagnose type 2 DM in PCOS women

Study of risk factors associated with ectopic pregnancy: an observational study

Background: Any pregnancy in which the fertilised ovum implants outside the intrauterine cavity is an ectopic pregnancy. Since none of the extrauterine areas can support placental attachment or a developing embryo, it invariably risks rupture and haemorrhage. It is thus considered a life-threatening emergency. Lower abdominal pain with vaginal bleeding in women of reproductive age raises the suspicion of an ectopic pregnancy. However, this is not always the case; some may present vague symptoms, oblivious to the underlying pathology. Hence this study aimed to document the potential risk factors for ectopic pregnancy.Methods: This prospective study was carried out at a tertiary care hospital and included 60 women diagnosed with ectopic pregnancy. Detailed history, menstrual and obstetric history, clinical examination, urine pregnancy test, and ultrasonography were obtained for each patient. Their clinical profile was noted, including their name, age, marital status, socioeconomic status, parity, and last childbirth. A list of potential risk factors was compiled. The general, systemic, abdominal and vaginal examination was done. Data were collected and evaluated.Results: 60 cases of ectopic pregnancies were diagnosed during the study period. The highest number of patients were noted in the 20-24 years age group (n=21) and the least in the 35–39 years age group (n=1). Pain in the abdomen was the most commonly noted symptom at 88.3%, followed by bleeding per vaginum (76.7%), vomiting (73.3%), fainting (58.3%), shock (30.0%), and abdominal distention (21.7%). While 18.3% of cohorts did not present with any risk factor, pelvic inflammatory disease (n=13) was the most commonly noted risk factor.Conclusions: Ectopic pregnancy is a life-threatening medical emergency which requires a keen eye for detail. A comprehensive narrative of clinical history, signs and symptoms aided by appropriate diagnostic tools will help side-step fatalities.

Prevalence of gestational diabetes mellitus in antenatal women and its associated risk factors

Background: Gestational diabetes mellitus (GDM) is an important public health problem in India and its prevalence is steadily increasing. It is one of the common complications during pregnancy affecting both maternal and fetal outcome. The increased prevalence is due to the aging population structure, urbanization, obesity epidemic and physical inactivity. Among the South Asian ethnic groups, Indian women mainly south Indians are developing GDM in highest frequency which emphasizes the significance of universal screening in South Asians. The main objective was to find out the prevalence of Gestational diabetes mellitus according to ADA criteria and to examine its association with a number of risk factors in the pregnant population.Methods: Hospital based analytical cross sectional study was conducted for 1 year among 500 antenatal women. Fasting blood glucose was measured after which they were given 75 g oral glucose and plasma glucose was estimated at 1hour and 2hour. GDM was diagnosed according to ADA criteria. Inclusion criterion was pregnant women attending outpatient department between 24-28 weeks gestation. Exclusion criteria were known diabetic women (pre gestational)/diagnosed having GDM before 24 weeks.Results: Prevalence of GDM was found to be 11.8%. Gestational diabetes mellitus was found to be significantly associated with age, BMI, past history of PCOS, family history of diabetes, excess weight gain in present pregnancy, GDM in previous pregnancy and previous poor fetal outcome.Conclusions: Prevalence of GDM is progressively increasing and it was significantly associated with multiple risk factors. Universal screening should be done for all pregnant women for better maternal and fetal outcom

Prevalence of subclinical and overt hypothyroidism in infertile women

Background: Hypothyroidism has a significant effect on fertility causing anovulatory cycles, luteal phase defect, hyperprolactinemia and sex hormone imbalances. To identify potential and overt hypothyroidism, thyroid screening should be done for all infertile women. The objective of the study was to find the prevalence of subclinical and overt hypothyroidism among infertile women, to find the correlation of hypothyroidism with hormonal and metabolic parameters associated with infertility.Methods: Hospital based analytical cross sectional study was conducted for one and half years among 300 infertile women with primary and secondary infertility. Women with primary and secondary infertility. All hypothyroid women on thyroxine supplementation, male factor infertility, female factor infertility like tubal factor, anomalies of the urogenital tract, obvious organic lesions in the pelvis and women unwilling to participate or sign the informed consent.Results: The prevalence of hypothyroidism in infertile women was 27%. Among them, 25% were subclinical hypothyroid and 2.33% overt hypothyroid. Menstrual dysfunction was observed in 52% of subclinical and 51.15% of overt hypothyroid women, predominant type being oligomenorrhea. We found a negative correlation of hypothyroidism with the family history of thyroid disease. 91.4% of hypothyroid infertile women were obese and the association was strongly significant. Prevalence of hyperprolactinemia in infertile women was 24.67%. The association of hyperprolactinemia with hypothyroidism was 23%. Raised LDL levels were observed in 80% of subclinical and 100% overt hypothyroidism infertile women.Conclusions: Hypothyroidism alters the Hypothalamo-Pituitary ovarian axis and is one of the important etiological factors of female infertility. Most of the women were asymptomatic. Hence every infertile woman should be screened for thyroid profile to open better prospects of conception