Study the morphology and the morphometric measurements of placenta among normotensive and pregnancy-induced hypertension pregnancies

Background: Placental pathology has undoubtedly received very little attention by both the obstetricians and pathologist. The various indications for placental examination are essentially any maternal disease or disorders of the infant or any other clinically accepted placental abnormality. The aim and objectives of the present study were study of the morphology, mophometry and site of umbilical cord insertion in the placenta of women with normal and PIH pregnancy and correlation of the changes observed in morphology, morphometric measurements and sites of umbilical cord insertion. Materials and Methods: The cases were then divided into two main groups: pregnancy cases without any complication or normal pregnancy (n=50) and pregnancy cases with PIH (n=50). Each group comprised of patients having known LMP (last menstrual period), EDD (expected date of delivery), blood pressure and gestational period ranging from 35 to 40 weeks. At labour room placentae were collected as fresh specimen after delivery and then examination was carried out in the following way: morphological and morphometrical. In the morphological study, following facts were kept in mind while examining the gross anatomical features of placenta like placental completeness, placental shape, placental consistency, placental parenchyma and umbilical cord insertion. For morphometric study: placental weight, volume, thickness, diameter, circumference, cord insertion percentage/site and area were noted. The diameter of placenta was measured with a measuring tape twice. The average of maximum and minimum diameter is the diameter of the placenta. Results: In the present study the mean placental weight seen in case of PIH pregnancy series was 486.9 ± 37.08 grams with a maximum weight of 566 grams and a minimum weight of 382 grams. In PIH case studies the maximum volume of placenta was 515 cc and minimum 302 cc with an average of 406.4 ± 36.77 cc. Maximum placental area was recorded in our studies was 249 sq.cc and minimum was 102.7 sq.cc, with an average of 172.5 ± 24.76 sq.cc. In our studies maximum thickness of placenta was observed 2.2 cm and minimum thickness was 0.9 cm with an average of 1.48 ± 0.15 cm. In our cases the maximum diameter was observed 17.8 cm and minimum was 10.8 cm with an average of 14.76 ± 0.33 cm. In this PIH case series the maximum placental circumference was 52.5 cm and minimum circumference was 31.6 cm with an average circumference was 45.66 ± 2.09 cm. In this study we found maximum ratio of 5.58 and minimum ratio of 4.2 with the average ratio of 4.65 ± 0.35. In normal pregnancy groups- 50 placentae were studied of which 16 (32%) had central type insertion, 14 (28%) had medial, 5 (10%) had lateral type and 165 (30%) had marginal type of cord insertion. In PIH pregnancy groups- 50 placentae were studied of which 19 (38%) had central type insertion, 11 (22%) had medial, 4 (8%) had lateral type and 16 (32%) had marginal type of cord insertion. Conclusion: In our study we found that hypertensive placentae tend to be slightly smaller in size, weight, volume, area, thickness, diameter, circumference and feto-placental ratio than normal placentae. Placenta undergoes different changes in weight, volume, structure, shape and function continuously throughout the gestation to support the prenatal life. Pregnancy complications like hypertension reflected macroscopically and microscopically in the placenta

Comparative study of ropivacaine (0.5%) versus levobupivacaine (0.5%) as regional anesthesia in gynecological surgeries: A tertiary care hospital based study at Eastern India

Introduction: Most women experience moderate to severe pain during labor and delivery, often requiring some form of pharmacologic analgesia. The lack of proper psychological preparation combined with fear and anxiety can greatly enhance the patient’s sensitivity to pain and further add to the discomfort during labor and delivery. However, skillfully conducted obstetric analgesia, in addition to relieving pain and anxiety, may benefit the mother in many other ways. The aim of this prospective, randomized, double-blind study was to compare the block induced by ropivacaine (0.5%) plain and levobupivacaine (0.5%) plain in gynecological surgeries at the recommended dose range. These concentrations have provided equivalent block after epidural analgesia. Material and methods: This randomized, prospective, double blind study was conducted at a tertiary care hospital in Department of Anesthesia and Obstetrics & Gynaecology, Haldia, West Bengal between Jan 2019-December 2019. Fifty patients who were posted for gynecological surgeries were enrolled and randomly divided into two groups: Group R received 3.5 ml (17.5 mg) 0.5% ropivacaine plain and Group L received 3.5 ml (17.5 mg) 0.5% levobupivacaine plain. The onset and duration of sensory and motor block and any undesirable side effects were noted. Results: The mean sensory block onset time in levobupivacaine group was 6.23 ± 1.13 min, while it was 7.89 ± 2.74 min in ropivacaine group. The mean sensory onset time was higher in ropivacaine as compared to levobupivacaine group (P = 0.0073). The mean duration of sensory block in levobupivacaine group was 265.87 ± 79.67 min, while it was 239.89 ± 61.18 min in ropivacaine group. The mean duration of sensory block was higher in levobupivacaine group in comparison to ropivacaine group (P = 0.2021, NS). The mean motor block onset in levobupivacaine group was 5.29 ± 2.23 min, while it was 6.78 ± 2.67 min in ropivacaine group. The mean motor onset time was higher in ropivacaine group in comparison to levobupivacaine group (P = 0.0373). The mean duration of motor block in levobupivacaine group was 248.33 ± 78.18 min, while it was 209.29 ± 53.16 min in ropivacaine group. The mean duration of motor block was higher in levobupivacaine group in comparison to ropivacaine group (P = 0.0373). Conclusion: The mean duration of sensory block was higher in levobupivacaine group in comparison to ropivacaine group (P = 0.2021, NS). The mean motor onset time was higher in ropivacaine group in comparison to levobupivacaine group (P = 0.0373). The mean duration of motor block was higher in levobupivacaine group in comparison to ropivacaine group (P = 0.0373)

Altered Interleukin 6 level in Gestational Diabetes across Eastern India

Background: Gestational diabetes mellitus (GDM) is the most common pregnancy-associated metabolic disorder that is steadily increasing worldwide. Early diagnosis of pregnant women susceptible to GDM is the first step for deploying effective preventive treatment to reduce maternal, fetal, and neonatal complications. Materials & Methods: The cross-sectional study consists of 52 pregnant females routinely examined for GDM with a 75 g 2 hour oral glucose tolerance test (OGTT) at the gynecological out-patient clinic were taken as cases whereas 48 women with normal glucose tolerance (NGT) were taken as control subjects in ICARE Institute of Medical Sciences and Research, Haldia. The cases as well as controls were matched for age, gestational age as well as BMI for this study. Overnight fasting venous blood samples were obtained from all participants by arm venous puncture to assess serum IL-6 levels and other biochemical parameters in the second trimester (24–28th weeks of gestation) during GDM screening. The samples were primarily stored at room temperature for 30 min to allow the blood to clot, followed by centrifugation at 2500 rpm for 15-20 min to separate serum. Serum specimens were aliquoted and stored at −80 °C until IL-6 levels were analyzed. Glucose levels were measured with the hexokinase method using a commercially available kit whereas Insulin levels were determined using a chemiluminescent assay (Beckman Coulter, CA). Serum IL-6 levels were assayed using a commercially available enzyme-linked immunosorbent assay (ELISA) kit (Raybiotech, USA). Results: There was no significant difference in age and BMI in either of the two groups between GDM cases and control subjects (Table 1). OGTT levels were elevated in GDM cases as compared to controls which were found statistically significant. Serum IL-6 levels were increased in GDM cases as compared to controls and were statistically significant (7.85 ± 4.71 vs 4.27 ± 1.85 pg/ml; p < 0.0001). It was also observed that serum Insulin levels were higher in GDM cases as compared to controls which was statistically significant (17.14 ± 7.53 versus 9.61 ± 3.97 μ IU/ml; P < 0.0001). However, no correlation was observed between serum insulin with serum IL 6 level (r = 0.141; P = 0.398) among GDM subjects. Conclusion: Despite correlation has not been established between IL-6 and insulin in GDM cases there is a sharp rise in their levels indicating early screening of these markers could be of diagnostic importance in the prevention of the pathogenesis of Gestational diabetes. Moreover, a large longitudinal study needs to be done to conclude the fact

Role of resistin in gestational diabetes in Eastern India

Background: Gestational diabetes leads to complications due to glucose intolerance whereas resistin induces insulin resistance concerned in the pathogenesis of obesity and type 2 diabetes commonly associated with GDM. Thus the aim of the study is to investigate the relationship between resistin levels and GDM and the possible benefits of the metabolic profile. Methods: The cross-sectional study consists of 36 pregnant females routinely examined for GDM with a 75 g 2 hour oral glucose tolerance test (OGTT) at the gynecological out-patient clinic were taken as cases whereas 32 women with normal glucose tolerance (NGT) were taken as control subjects. The cases as well as controls were assayed for serum resistin as well as serum insulin after matched for age, gestational age as well as BMI for this study. Results: Serum resistin levels were increased in GDM cases as compared to controls and were statistically significant (36.24 ± 14.62 vs 15.29 ± 8.51 ng/ml; p < 0.0001). Moreover, serum Insulin levels were higher in GDM cases as compared to controls which were statistically significant (16.92 ± 8.23 versus 8.84 ± 4.11 μ IU/ml; P < 0.0001). Conclusion: Our study reveals higher serum resistin and higher serum insulin values in GDM cases may be used for screening tests in the diagnosis of the disease

Pattern of prophylactic antibiotics usage in caesarean section: An observational study

Background: Caesarean section is the most important factor associated with postpartum bacterial infections, with a infection rate reported to be 1-25%, which is 5-20 times higher than that of vaginal delivery. Materials & Methods: It was a prospective observational single centre study. The data was collected from the patient’s file in the nursing station within the hospital premises. The hospital was a tertiary care hospital, West Bengal. The prospective study was conducted at a tertiary care hospital with all pregnant women undergoing elective and emergency caesarean section. The study was designed to assess the type of antibiotics was used prophylactically before undergoing a caesarean section. Interval between the time of administration of antibiotic & time of delivery was assessed. Data on the use of antibiotic prophylaxis in caesarean sections was collected using a customized proforma. Other data included were indication for caesarean section, route of administration of antibiotics, type of antibiotics, dosage of antibiotics, time of incision, and duration of operation. All the methods were compared to Hospital protocol and NICE protocol. Results: The maximum no.of patients were administered the combination of inj. cefotaxime & inj. metronidazole that is 49.8%. The mean time interval between administration of antibiotic and delivery (mean± s.d.) of the patients was 44.99±16.83 minutes with range 5-90 minutes and the median was 45 minutes. Most of the time interval 209 (68.5%) were as per hospital protocol which was statistically significant (Z=5.79; p=0.0001). Conclusion: Antibiotic prophylaxis significantly reduces the postpartum infection rate & thus reduces maternal morbidity & mortality in caesarean section. In this study conducted at a tertiary care hospital, the prophylactic antibiotic usage data showed that combination of cefotaxime & metronidazole is most frequently used. The study describes that the usage of prophylactic antibiotic combination cefotaxime & metronidazole are most appropriate & have compliance with hospital protocol & NICE protocol. Keywords: Antibiotic prophylaxis, postoperative infection, caesarean section, surgical site infection (SSI

A Study of the indications of caesarean section in a tertiary care hospital at West Bengal: An observational study

Background: In recent decades, we have observed a remarkable increase in the rate of caesarean section (CS) in both developed and developing countries, especially in India.  Its prevalence has increased alarmingly in the last few years, which has motivated this research to identify the indications and determinants, influencing cesarean section delivery in the study area and determine the associated correlates for emergency and elective cesarean sections. Materials & Methods: The prospective study was conducted at a tertiary care hospital with all pregnant women undergoing elective and emergency caesarean section. Interval between the time of administration of antibiotic & time of delivery was assessed. Data on the use of antibiotic prophylaxis in caesarean sections was collected using a customized proforma. Other data included were indication for caesarean section, route of administration of antibiotics, type of antibiotics, dosage of antibiotics, time of incision, and duration of operation. All the methods were compared to Hospital protocol and NICE protocol.  Its prevalence has increased alarmingly in the last few years, which has motivated this research to identify the indications and determinants, influencing cesarean section delivery in the study area and determine the associated correlates for emergency and elective cesarean sections. Results were expressed as proportions, percentages & as averages +/- standard deviation (SD) with corresponding ranges. Results: The mean age (mean ± s.d.) of the patients was 28.94±3.88 years with range 19 - 42 years and the median age was 29 years. Test of proportion showed that proportion of single gravidity 216(70.8%) was significantly higher than that of multi-gravidity 89(29.2%) (Z=8.74;p=0.000001).  Most of the caesarean section 26(8.5%) were underwent as per maternal wish (Z=1.21;p=0.47). Most of the patients 280(91.8%) had intact membrane as compared to ruptured membrane 25(8.2%) (Z=10.19;p=0.000001). The mean duration of surgery (mean± s.d.) of the patients was 75.13±16.96 minutes with range 35-148 minutes and the median was 75 minutes. Most of the surgeries 250 (82%) were performed between 60-89 minutes which was significantly higher (Z=8.04;p=0.00001). Conclusion: Caesarean sections are effective in saving maternal and infant lives, but only when they are required for medically indicated reasons. Unnecessary cesarean section may have an adverse impact upon maternal, neonatal, and infant morbidity and mortality. The high cost of cesarean section may result in catastrophic health expenditure for families and additional pressure upon health systems, especially in low- and middle-income countries