Role of Elaborate Cardiotocography (CTG) in Pregnancy Management

Background: Elaborate Cardiotocography (CTG) is the most commonly used test for antepartum and intrapartum fetal surveillance because it gives information via the cerebro-cardiac response of fetal cerebral activity, which is modified by the hypoxia. Objective: This study was designed to compare the perinatal outcomes among the normal and abnormal CTG groups. Method: It was a prospective observational study carried out in the Department of obstetrics, BSMMU during the period July 2006 to July 2008. Hundred consecutive normal and hundred consecutive abnormal CTC tracings were collected from patients who were advised to perform CTG after admission. Both labour and non-labour patients were included. Interpretation of CTG was done based on FlGO recommendation (1987). Pregnancy and neonatal data were obtained and the findings were correlated with the FHR tracing. Statistical analysis was carried out by student's unpaired t-test, X2 and Z-test. Level of significance was set at P value < 0.05. Results: Out of 100 abnormal CTG, 30% had tachycardia, 42% had deceleration, 38% was non reactive, 4% had absence beat-to-beat variability and 4% had fetal bradycardia. There was significantly higher caesarean delivery, lower apgar score, higher requirement of neonatal resuscitation and admission at neonatal unit and higher perinatal death among the abnormal CTG group. The abnormal fetal outcome was found highest in heart rate deceleration group. Conclusion: CTG can be continued as a good screening test of fetal surveillance but it is not the sole criteria to influence the management of high-risk pregnancies. Abnormal CTG should be supplemented with other test before intervention. Key words: CTG; Perinatal outcome.DOI: 10.3329/bsmmuj.v2i1.3706 BSMMU J 2009; 2(1): 18-2

Pregnancy with Invasive Carcinoma of the Cervix- A Case Report

Carcinoma of the cervix is a preventable female malignancy. Recently, a 30 years old 5th gravid lady was referred to Bangabandhu Sheikh Mujib Medical University (BSMMU) from Jahurul Islam Medical College & Hospital, Bajitpur, Kishorganj after diagnosing as a case of 32 weeks pregnancy coupled with invasive carcinoma of the cervix. Histopathology of cervical tissue showed moderately differentiated squamous cell carcinoma. Her cervical growth was confined in the anterior lip of the cervix and clinical stage was 1B. She was severely anemic. Her anemia had been corrected by blood transfusion. Injection dexamethasone was given for fetal lung maturity. Renal function tests and all other investigations for surgical fitness were done. At her 34th weeks of pregnancy caesarean section followed by Wertheim's hysterectomy was performed. Baby was alive, birth weight was 2.3 kg, Apgar score was good. Postoperative period was un-event full. At her 23rd postoperative day she was discharged from Obs and Gynae department and referred to Oncology institute for further management. At the time of discharge her baby was healthy. Key Words: Cervical cancer, pregnancy, Wertheim's hysterectomy.DOI: 10.3329/bsmmuj.v2i1.3712 BSMMU J 2009; 2(1): 47-4

The evaluation between vitamin D level and pelvic organ prolapse in post-menopausal women

Background: Vitamin D is important for skeletal integrity and optimal muscle function. The high incidence and prevalence of vitamin D deficiency and pelvic organ prolapse have been found in postmenopausal women, raising the question of whether the entities are related. The aim of the study was to evaluation between vitamin D level and pelvic organ prolapse in post-menopausal women. Methods: This case control study has been designed and conducted in the Department of Obstetrics and Gynecology, BSMMU to investigate the level of vitamin D in patients with and without pelvic organ prolapse to explore the association of vitamin D with pelvic organ prolapse. After taking informed written consent the serum vitamin D level of all participants was measured by CMIA technology with flexible assay protocols at Biochemistry and Molecular Biology department of the same institute. Statistical analysis of the results was obtained by using window-based computer software devised with Statistical Packages for Social Sciences (SPSS-24). Results: The study population was divided into two groups, a case group (n=74) consisting of patients with pelvic organ prolapse and a control group (n=74) comprising of women without pelvic organ prolapse. A total 148 participants of 52 years or older attending the out or inpatient department were enrolled in the study. Mean±SD level of Vitamin D in the case group was 13.96±5.18 ng/ml and in the control, group was 21.08±5.77 ng/ml respectively. The difference was statistically significant (p<0.05). Moreover, the vitamin D levels were inversely proportionate with the severity of pelvic organ prolapse. Conclusions: Vitamin D deficiency may be an important systemic factor associated with pelvic organ prolapse. Measuring vitamin D levels in postmenopausal women and replenishing deficiencies may also be important for the pelvic floor

56 Pregnancy with Invasive Carcinoma of the Cervix- A Case Report

Carcinoma of the cervix is a preventable female malignancy. Recently, a 30 years old 5th gravid lady was referred to Bangabandhu Sheikh Mujib Medical University (BSMMU) from Jahurul Islam Medical College & Hospital, Bajitpur, Kishorganj after diagnosing as a case of 32 weeks pregnancy coupled with invasive carcinoma of the cervix. Histopathology of cervical tissue showed moderately differentiated squamous cell carcinoma. Her cervical growth was confined in the anterior lip of the cervix and clinical stage was 1B. She was severely anemic. Her anemia had been corrected by blood transfusion. Injection dexamethasone was given for fetal lung maturity. Renal function tests and all other investigations for surgical fitness were done. At her 34th weeks of pregnancy caesarean section followed by Wertheim’s hysterectomy was performed. Baby was alive, birth weight was 2.3 kg, Apgar score was good. Postoperative period was un-event full. At her 23rd postoperative day she was discharged from Obs and Gynae department and referred to Oncology institute for further management. At the time of discharge her baby was healthy