Arterial Resistance in Late First Trimester as a Predictor of Subsequent Pregnancy-Related Hypertension

Objectives: This study aimed to examine the association between indicators of arterial resistance occurring late in the first trimester and the subsequent development of pregnancy-related hypertension. Methods: This study took place between May 2014 and August 2015 and included 329 consecutive women with singleton pregnancies attending the antenatal clinics of a medical college in Karnataka, India, during this period. Pulse pressure (PP) and uterine artery Doppler parameters were recorded between 11–14 gestational weeks. Consequently, women were followed-up until after delivery for subsequent hypertension. Results: Hypertension occurred more frequently if PP was high (17.6% versus 14.4% of pregnancies without high PP; P = 0.713), if a diastolic notch (DN) was present (15.1% versus 12.8% of pregnancies with an absent DN; P = 0.612) and if the resistive index (RI) was raised (22.2% versus 14.3% of pregnancies without raised RI; P = 0.366). A raised pulsatility index (PI) was significantly associated with hypertension (P = 0.013). The risk of hypertension was approximately seven-fold higher if two or more arterial resistance indicators were used, except with a present DN plus a raised RI or a present DN plus high PP. All arterial resistance indicators showed negative predictability (>85.6%) and good specificity (≥95.0%), except for the presence of a DN. A population-specific cut-off PI value of 1.72 had high negative predictability (92.8%) and good sensitivity (70.8%) and specificity (65.1%). Conclusion: Raised PI in the late first trimester was a significant predictor of hypertension later in pregnancy. A combination of arterial resistance indicators may enhance prediction of subsequent hypertension

Prediction of mode of delivery in term pregnancies: development of scoring system

Background: The objective of the study was to develop and to validate a scoring system to predict the mode of delivery.Methods: The study involved 835 term pregnancies in labor. Backward multiple logistic regression analysis was carried out in 600 women to identify the factors independently associated with vaginal or caesarean delivery and logistic coefficients were determined to provide weightage for each of the factors. The total score was calculated for each subject. Sensitivity and specificity for vaginal/ cesarean delivery were calculated for different total scores. The validity of the scoring was studied by applying to the same data provider group retrospectively, and on other 235 laboring women prospectively recruited after the development of score.Results: Of 600 women, 61.2% had vaginal deliveries. The significant facilitating factors for vaginal delivery were found to be maternal age of 20-25 years (p=0.02), multiparity (p=0.002), unscarred uterus (p=0.05), rhesus positivity (p=0.05), expected baby weight of 2.5-3.5 kg (p=0.004), and with cephalic presentation, Bishop status> 4, spontaneous onset of labor, clear liquor, and no FHR abnormality (p=0.00).A cut off score of 21 predicted the vaginal delivery with sensitivity , specificity, positive predictive value and negative predictive values of 80%, 65%, 70% and 76%, respectively.Conclusions: The composite score of 21 suggests that woman will most probably have vaginal delivery and that a higher score does not always mean a caesarean delivery

Antenatal umbilical cord parameters and perinatal outcome

Background: The objective of the study was to study the association between antenatally determined umbilical cord thickness and coiling index at/after 34 weeks of gestation and the measures of perinatal outcome.Methods: Umbilical cord thickness and coiling index were determined sonographically at or after 34 weeks of gestation in 100 singleton pregnancies. The influence of the antenatal cord findings was analyzed for their associations with measures of perinatal outcome in high and low risk pregnancies. Intrapartum fetal heart rate abnormalities, meconium staining of liquor, birth weight, Apgar score and the need for neonatal intensive care (NICU) admission were considered as measures of perinatal outcome.Results: Mean cord thickness was 1.62 ± 0.26 cm and the coiling index was 0.42 ± 0.08 in the present observation of 100 cord sonographies. There were 39 pregnancies with high risk attributes. High risk pregnancies were found to have higher proportion of cases with lean (<1.3 cm; p = 0.04) and hypercoiled cord (>0.5; p = 0.00). Among individual associations thicker cord (>1.9 cm) and macrosomia (p = 0.01), hypercoiled cord and polyhydramnios (p = 0.02) were significant. More number of primigravidas were seen to have hypercoiled cord (p = 0.04). Association between cord parameters and meconium stained amniotic fluid, low Apgar score or NICU requirement could not be established.Conclusions: No association between antenatal umbilical cord characteristics and perinatal outcome was found in pregnancies at high risk for poor perinatal outcome

Effects of the WHO Labour Care Guide on cesarean section in India: a pragmatic, stepped-wedge, cluster-randomized pilot trial

Cesarean section rates worldwide are rising, driven by medically unnecessary cesarean use. The new World Health Organization Labour Care Guide (LCG) aims to improve the quality of care for women during labor and childbirth. Using the LCG might reduce overuse of cesarean; however, its effects have not been evaluated in randomized trials. We conducted a stepped-wedge, cluster-randomized pilot trial in four hospitals in India to evaluate the implementation of an LCG strategy intervention, compared with routine care. We performed this trial to pilot the intervention and obtain preliminary effectiveness data, informing future research. Eligible clusters were four hospitals with >4,000 births annually and cesarean rates ≥30%. Eligible women were those giving birth at ≥20 weeks' gestation. One hospital transitioned to intervention every 2 months, according to a random sequence. The primary outcome was the cesarean rate among women in Robson Group 1 (that is, those who were nulliparous and gave birth to a singleton, term pregnancy in cephalic presentation and in spontaneous labor). A total of 26,331 participants gave birth. A 5.5% crude absolute reduction in the primary outcome was observed (45.2% versus 39.7%; relative risk 0.85, 95% confidence interval 0.54-1.33). Maternal process-of-care outcomes were not significantly different, though labor augmentation with oxytocin was 18.0% lower with the LCG strategy. No differences were observed for other health outcomes or women's birth experiences. These findings can guide future definitive effectiveness trials, particularly in settings where urgent reversal of rising cesarean section rates is needed. Clinical Trials Registry India number: CTRI/2021/01/03069

Arterial Resistance in Late First Trimester as a Predictor of Subsequent Pregnancy-Related Hypertension

Objectives: This study aimed to examine the association between indicators of arterial resistance occurring late in the first trimester and the subsequent development of pregnancy-related hypertension. Methods: This study took place between May 2014 and August 2015 and included 329 consecutive women with singleton pregnancies attending the antenatal clinics of a medical college in Karnataka, India, during this period. Pulse pressure (PP) and uterine artery Doppler parameters were recorded between 11–14 gestational weeks. Consequently, women were followed-up until after delivery for subsequent hypertension. Results: Hypertension occurred more frequently if PP was high (17.6% versus 14.4% of pregnancies without high PP; P = 0.713), if a diastolic notch (DN) was present (15.1% versus 12.8% of pregnancies with an absent DN; P = 0.612) and if the resistive index (RI) was raised (22.2% versus 14.3% of pregnancies without raised RI; P = 0.366). A raised pulsatility index (PI) was significantly associated with hypertension (P = 0.013). The risk of hypertension was approximately seven-fold higher if two or more arterial resistance indicators were used, except with a present DN plus a raised RI or a present DN plus high PP. All arterial resistance indicators showed negative predictability (>85.6%) and good specificity (≥95.0%), except for the presence of a DN. A population-specific cut-off PI value of 1.72 had high negative predictability (92.8%) and good sensitivity (70.8%) and specificity (65.1%). Conclusion: Raised PI in the late first trimester was a significant predictor of hypertension later in pregnancy. A combination of arterial resistance indicators may enhance prediction of subsequent hypertension

Ovarian Crescent Sign and Sonomorphological Indices in Preoperative Determination of Malignancy in Adnexal Masses

Objective :To compare the value of ovarian crescent sign (OCS) and various sonomorphologic scoring systems in consolidating pre-operative suspicion of ovarian malignancy in adnexal masses. Materials and Methods :A prospective study was carried out in 60 consenting women with an undiagnosed adnexal mass requiring operative intervention. OCS was considered to be present if normal ovarian tissue was seen adjacent to the tumor area on ultrasound. Various other sonological parameters were noted to calculate five morphological scoring systems. Doppler velocimetry study values were available in 27 cases. The results were compared for correctness of suspicion with histopathologic examination report of the tumor obtained at surgery. Results :Eleven of 60 specimens showed histopathologic diagnosis of malignancy. OCS was identified in 97% of the benign masses. The sign was not seen in 10 of the 11 cases with malignancy. Sensitivity and negative predictive value of crescent sign was better than values obtained for the compared sonomorphological indices and Doppler velocimetry studies. Conclusion :Ovarian crescent sign is a reliable and simple sonographic indicator comparable to sonomorphological indices and Doppler flow velocimetric studies for the preoperative detection of malignancy in adnexal masses

Towards a common etiopathogenesis: Periodontal disease and endometriosis

Context: Periodontal disease and endometriosis are seen to share a common pathogenesis. There is only one report suggesting the possible association between the two conditions. Aims: To study the association between endometriosis and periodontal disease. Settings and Design: This was a case–control study. Subjects and Methods: Periodontal screening was carried out in 25 women with endometriosis and 25 women without endometriosis. Severity of periodontal disease was classified based on the extent of loss of attachment. Statistical Analysis Used: Student's t-test, Mann–Whitney U test, and Karl Pearson correlation coefficient tests were used for statistical analysis. Results: The proportion of women with severe periodontitis was seen to be higher among women with endometriosis (70%). Conclusions: The results of the present study indicate the existence of a relationship between endometriosis and periodontal disease. However, further studies among larger cohorts of endometriosis may provide evidence about the association

Antenatal umbilical cord parameters and perinatal outcome

Background: The objective of the study was to study the association between antenatally determined umbilical cord thickness and coiling index at/after 34 weeks of gestation and the measures of perinatal outcome. Methods: Umbilical cord thickness and coiling index were determined sonographically at or after 34 weeks of gestation in 100 singleton pregnancies. The influence of the antenatal cord findings was analyzed for their associations with measures of perinatal outcome in high and low risk pregnancies. Intrapartum fetal heart rate abnormalities, meconium staining of liquor, birth weight, Apgar score and the need for neonatal intensive care (NICU) admission were considered as measures of perinatal outcome. Results: Mean cord thickness was 1.62 +/- 0.26 cm and the coiling index was 0.42 +/- 0.08 in the present observation of 100 cord sonographies. There were 39 pregnancies with high risk attributes. High risk pregnancies were found to have higher proportion of cases with lean (<1.3 cm; p = 0.04) and hypercoiled cord (>0.5; p = 0.00). Among individual associations thicker cord (>1.9 cm) and macrosomia (p = 0.01), hypercoiled cord and polyhydramnios (p = 0.02) were significant. More number of primigravidas were seen to have hypercoiled cord (p = 0.04). Association between cord parameters and meconium stained amniotic fluid, low Apgar score or NICU requirement could not be established. Conclusions: No association between antenatal umbilical cord characteristics and perinatal outcome was found in pregnancies at high risk for poor perinatal outcome. [Int J Reprod Contracept Obstet Gynecol 2016; 5(4.000): 1211-1215

A study on awareness and perception about perinatal death auditing among health care workers in two districts of Karnataka State, India

Background: To start perinatal death auditing, doctors should have good knowledge about it. Objectives: To know the awareness and perceptions of doctors about different aspects of perinatal death auditing like 1) different types of contributors; 2) high-risk approach; 3) consequences; 4) documentary requirements; and 5) existing system of mortality meeting/child death reviews. Methodology: The perinatal death auditing project was implemented in two districts of Karnataka state. As a part of the pre-intervention survey, awareness and perceptions of doctors and a few health care administrators were explored. They were requested to participate in the study. Those who consented were approached in their hospitals and interviewed. Trained medical social workers conducted the interviews. Awareness was scored from 0 to 3 with 0 being no knowledge and 3 being good knowledge. Perceptions were scored from 0 to 3 with 0 being no negative perceptions and 3 being fear of legal consequences. The responses were documented, scored, and described. Results: Though 22 doctors were eligible, only 16 consented to participate in the study. Knowledge of doctors about different contributors was inadequate. They were apprehensive about legal consequences. They knew that documentation could protect them and be useful in a court of law. They were not clear about the conduct of mortality meeting/existing system of child death reviews. Conclusion: Knowledge was inadequate. They were apprehensive about legal consequences. Training of doctors and allaying apprehensions are required for starting perinatal death auditing

Protein profile study of clinical samples of ovarian cancer using high-performance liquid chromatography-laser induced fluorescence (HPLC-LIF)

New techniques for the early detection of cancer are fast emerging. This is essential for more effective diagnosis and control of the disease. We have used a High Performance Liquid Chromatography-Laser Induced Fluorescence (HPLCLIF) technique to record chromatograms of proteins in serum and ovarian tissue samples. The recorded chromatograms of normal, benign and malignant samples were analyzed using statistical (Principal Component Analysis) methods. It is shown that chromatograms of the samples can be classified into sets, and a model based on such a classification can be used to analyze protein profiles of test samples of serum and ovarian tissue for the detection of malignancies