Pregnancy outcome in women with heart disease at a tertiary referral teaching center in Northern India

Background: Pregnancy causes a significant burden on cardiovascular system due to hemodynamic changes therefore a diseased heart may not be able to adjust with extra load resulting in heart failure and even maternal mortality.Methods: A prospective study was done in 50 women with heart disease over a period of 12 months from 2010 to 2011 at G.S.V.M. Medical College, Kanpur. At the first antenatal visit baseline data is recorded included age, parity, gestational age, NYHA class, co-morbid conditions, prior cardiac events, cardiac lesion (if already diagnosed), prior surgery/interventions, cyanosis and medications. A thorough clinical examination and investigations were done.Results: Maximum numbers of patients (56%) were in the age group 20-24 years. 52 % of patients were primigravida and 48 % of patients were multigravida. Maximum numbers of patients (76.67%) were in the lower socioeconomic group. Chronic rheumatic heart disease (84%) was the most common type of heart disease followed by congenital cardiac disease (14%). Heart disease if diagnosed preconceptionally or during earlier period of gestation both maternal (8.9%) and foetal complications (22.8%) are lesser as compared to patients in whom diagnosis was made late. There is also the significant difference with majority of the foetal complications in group IV (80%) (preterm birth, IUGR and perinatal mortality) as compared to group I (14.2%).Conclusions: Maternal and perinatal outcome in women with heart disease depends mainly on the functional cardiac status during pregnancy, the risk being greater in NYHA III and IV. Our study shows that surgical intervention or medical management in pregnancy improves the functional class and also improves the maternal and fetal outcomes. Interventions can only be successfully done either before pregnancy or during 2nd trimester. When patients were diagnosed before pregnancy we have enough time for counseling and treatment. Counseling further increase the compliance and acceptance for medical and surgical interventions

Maternal morbidity due to unsafe medical abortion in rural practice is just the tip of the iceberg: is it really preventable?

Background: In India around 6.4 million abortions are performed annually, of which 3.6 million (56%) were unsafe abortions, account for 8-20% of all maternal deaths. Medical methods of abortion have been proven to be effective and safe option to save women’s lives when practiced under medical supervision. This study was carried out to determine the frequency of unsafe medical abortion, demographic profile of patients, reasons for seeking abortion, abortion providers, evaluation of significant adverse outcome and management.Methods: A 5 year retrospective observational study included 400 patients with history of unsafe medical abortion who were admitted with complications between June 2009 and May 2014, in the department of obstetrics and gynecology, government medical college (Chhattisgarh institute of medical sciences) and tertiary care hospital Bilaspur Chhattisgarh.Results: Unintended pregnancy was the main reason for the unsafe medical abortion in 378 (94.5%) women. Most frequent complains observed for admission were heavy bleeding and retained products (incomplete abortion). Major complications seen in 177 (44.25%) cases only, of which moderate to severe anaemia in 141 (35.25%), shock in 23 (5.75%), septicaemia in 11 (2.75%) and acute renal failure in 2 (0.5%) cases. Majority 206 (51.50%) required surgical intervention. However 5 (1.25%) patients could not survive despite of all resuscitative measures. Post-abortion family planning adopted by 27 (6.75%) cases only.Conclusions: Mostly unsafe abortions take place behind the scene, always remain unnoticed and never listed in government data. In Chhattisgarh state where majority of rural population are tribal, illiterate, living in difficult to reach areas, unaware of safe abortion and abortion rights and dependent on herbs, quacks or paramedics, due to unavailability of clinicians or lady medical officers in government facilities. Thus the best way remain to prevent unsafe abortion is the prevention of unwanted pregnancy

Comparative Study to Evaluate the Efficacy and Safety of Propranolol versus Amitriptyline for Prophylaxis of Migraine

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To evaluate diagnostic efficacy of maternal serum C - reactive protein to predict preterm labour

Background: Preterm birth is a major challenges faced by obstetricians worldwide. Globally, an estimated 13 million babies are born before 37 completed weeks of gestation annually. Preterm birth is the leading direct cause of neonatal death (27%); more than one million preterm newborns die annually. According to report ‘India is among the top 10 countries that account for 60 per cent of the world’s preterm births. Methods to detect preterm labour early include ultrasound examination of the cervix and detection of biochemical markers of preterm labour in blood (include serum C - reactive protein level) and cervicovaginal secretions. The objective of the study was evaluate diagnostic efficacy of maternal serum C - reactive protein (CRP) to predict preterm labour.Methods: A prospective study comprised of a total of 132 pregnant women with singleton fetus with symptoms of preterm labour. Serum CRP values was taken in all patients. Out of which 17 patients were lost during follow up, 3 patients develop PPROM. Hence study was conducted over 112 patients. Among these 62 patients went in preterm labour and 50 patients delivered at term.Results: For predicting preterm delivery sensitivity, specificity, positive and negative predictive value for serum CRP were 70.9%, 70%, 74.5% and 66% respectively.Conclusions: Serum CRP is good predictor to differentiate the women who were likely to deliver preterm. CRP positivity in early pregnancy is associated with nearly a twofold increased risk of preterm delivery

Phytochemical screening, antioxidant activity and estimation of quercetin by HPLC from Caesalpinia bonducella

Caesalpinia bonducella is an important medicinal plant for its traditional uses against different types of diseases. The aim of the present study was to evaluate in vitro antioxidant activities, phytochemical analysis and HPLC analysis of ethanol extract of leaves of Caesalpinia bonducella collected from Bhopal region of Madhya Pradesh. Qualitative analysis of various phytochemical constituents and quantitative analysis of total phenolics flavonoids and alkaloids were determined by the well-known test protocol available in the literature. The in vitro antioxidant activity of ethanolic extract of the leaves was assessed against DPPH and Nitric oxide scavenging activity using standard protocols. Quercetin was detected in ethanolic extract of Caesalpinia bonducella under study by using RP-HPLC analysis. Phytochemical analysis revealed the presence of phenols, flavonoids, tannins, saponins, alkaloids. The total phenolic, flavonoids and alkaloids content of ethanolic leave extract of Caesalpinia bonducella was found to be 0.647, 0.941and 0.369mg/100mg respectively. Caesalpinia bonducella extracts showed effective DPPH radical scavenging and nitric oxide scavenging activity. Quercetin content was found in Caesalpinia bonducella extract, was quantified as 0.285µg/ml. HPLC analysis of plant extracts indicated the presence of the most abundant dietary flavonol, Quercetin. The results of this study revealed that the bioactive compound content differences could be determinant for the medicinal properties of this plant especially for antioxidant activities with potential applications in food and pharmaceutical industries. Keywords: Caesalpinia bonducella, Phytochemical analysis, Antioxidant, HPLC analysi

Study of pregnancy outcome in women with cardiac disease: a retrospective analysis

Background: Cardiac disease complicates 1% of all pregnancies. It is one of the 3 major indirect causes of maternal mortality in India. Objective of the study is to evaluate the maternal and fetal outcome in patients with cardiac disease in pregnancy.Methods: A retrospective analysis was carried out in 117 pregnant women with known or newly diagnosed heart disease from January 2013 to December 2015 at a tertiary care hospital.Results: In the present study, the incidence of cardiac disease was 0.8%. Majority 66 (56.4%) were of 23-27 years of age, 72 (61.5%) were primigravida. Mostly 84 (71.8%) belonging to New York Heart Association (NYHA) Class I and II. Rheumatic heart disease seen in 96 (82.1%) and congenital heart disease in 17.9% subjects. Among RHD Mitral stenosis was the most common, seen in 51 (53.1%) cases. Majority 78 (66.6%) had vaginal delivery and caesarean section in 28 (23.9%) cases. Most common maternal complication was anaemia seen in 54 (46.2%) cases, congestive cardiac failure complicated 23 (19.6%) cases. 18 patients required ICU care and maternal mortality in 6 cases (5.12%). The live births in (94.8%) cases, 33 (28.2%) babies required NICU admission and perinatal mortality was 7.7%.Conclusions: Heart disease in pregnancy is a high risk condition and has a major impact on pregnancy outcome. Rheumatic heart disease being the prominent cardiac lesion. Fetomaternal mortality and morbidity can be reduced with proper antenatal, intrapartum and postnatal care in conjunction with cardiologist and neonatologist