Obesity in pregnancy: maternal and perinatal outcome

Background: The objective of this study was to find out the spectrum of complications during pregnancy due to maternal obesity with incidence and to assess the neonatal outcome.Methods: Retrospective study of antenatal patients was done in Sardar Vallabhbhai Patel Institute of Medical Sciences and Research (SVPIMSR), Ahmedabad from June 2019 to December 2019. Antenatal patients were categorized into 3 classes based on body mass index (BMI): class I=30-34.9 kg/m2, class II=35-39.9 kg/m2, and class III ≥40 kg/m2. The maternal and perinatal outcome of the patients was evaluated in relation to BMI.Results: A total of 61 women were included in the study, with 44 belonging to class I, 15 women to class II and 2 women to class III. In class I, 27% women had pre-eclampsia and its incidence increased with class II (69.2%) and class III (100%). The incidence of gestational diabetes mellitus (GDM) increases with increase in BMI (class I=5.4%, class II=7.6% and class III=50%). Incidence of fetal growth restriction (FGR) (7.6% and 2.7%) and post term pregnancy (38% and 16.2%) more in class II compared to class I respectively. Lower segment caesarean section (LSCS) rates are seen to be highest in class III (100%) as compared to class II (53%) and class I (50%). Class III (50%) women were more likely to have macrosomic babies than class II (40%) and class I (34.1%).Conclusions: Interventions directed towards weight loss and prevention of excessive weight gain must begin in the preconceptional period. Obese mothers must be counselled regarding risk and complications of obesity and importance of weight loss

Eye Movements, Perceptions, and Performance

Due to the ever growing amount of information, individuals often face high cognitive loads when making decisions. Thus, understanding user reactions to high cognitive loads can help to improve a user’s ability to make good quality decisions under high cognitive load. Prior decision making and user experience research suggest that eye tracking may provide a more complete picture of user reactions under high cognitive loads. Thus, through an exploratory study we investigate the relationship between fixation, perceptions of cognitive load and performance. Our analysis shows that fixation can predict both perception of the load as well as performance of a cognitively demanding online game

Study of metformin in polycystic ovary syndrome

Background: Objective of the study was to measure the efficacy and safety of insulin sensitizing drug metformin in reversing the metabolic and endocrine disturbances in fifty women with polycystic ovarian disease.Methods: The study was performed on 57 women with polycystic ovarian syndrome (PCOS) in the outpatient department of obstetrics and gynaecology, V. S. General Hospital, Ahmedabad. Metformin 500 mg thrice daily was given until the cysts disappeared which was taken as the end point of the study. Follicular studies were done to check the effect of metformin on ovulation. Significance was tested by paired t test and p value calculated.Results: Metformin was found effective in regressing polycystic changes in ovary, regularization of menstrual cycles and improving ovulation.Conclusions: The present study shows that metformin has a beneficial role in effective management of PCOS.

A comparative study of single versus repeat instillation of intravaginal prostaglandin E2 gel for induction of labour

Background: The aim of induction was to achieve successful vaginal delivery where continuation of pregnancy is not desirable. Unfavourable cervix is one of the main causes of failed induction. Introduction of intravaginal prostaglandins E2 has revolutionised the method of cervical ripening. More than one dose of prostaglandin E2 (PGE2) gel may be necessary to facilitate cervical ripening and increase the chances of vaginal delivery.Methods: This retrospective study was done to find the efficacy of repeat instillation of intravaginal PGE2 gel and to compare the maternal and fetal outcome between the single instillation group and repeat instillation group. The women who went into labour or achieved cervical ripening with a single instillation of PGE2 gel forms Group A. Those who required repeat instillation of PGE2 gel forms Group B. Both groups were compared for specific parameters.Results: Primigravidas required repeat instillation. Postdated pregnancy was the most common indication for induction of labour. 45.2% of primis required only single dose and 54.8% required repeat dose. About two third (77.8%) of multipara required only one dose and a third of multipara needed repeat dose. In Group A 90.7% had vaginal delivery, 9.3% had Caesarean section. Group B 95.7% had vaginal delivery and 4.3% had Caesarean section.Conclusions: Prostaglandins PGE2 (0.5 mg) gel is recommended to be used intravaginally. We applied 2 doses of intravaginal PGE2, 24 hours apart and no complications like uterine hyperstimulation was seen. There is no increased fetal risk with repeat instillation of intravaginal PGE2 gel

Maternal outcome in pregnancy with thrombocytopenia

Background: Thrombocytopenia is second most common haematological abnormality in pregnancy after anemia. The aim of this study was to find out the prevalence, causative factor of thrombocytopenia and to observe the obstetrics outcome of pregnancies complicated with thrombocytopenia.Methods: This is prospective study of maternal outcome in pregnancy with thrombocytopenia carried out at tertiary care center from February 2019 to January 2020. Out of 350 antenatal screened women, 25 women who were diagnosed with thrombocytopenia, were included in the study.Results: The incidence of maternal thrombocytopenia in this study was 7.1%. 60% of the women had mild thrombocytopenia while 24% and 16% of women were moderate and severe thrombocytopenic respectively. Amongst 25 thrombocytopenic women 68% had gestational thrombocytopenia, 24% had gestational hypertensive disorder,4% had HELLP syndrome, 4% had immune thrombocytopenic purpura. 60% were delivered vaginally and 40% were delivered by LSCS. The most common indication of LSCS was acute fetal distress (40%) followed by failed induction (30%), breech (10%), and the rest (20%) for other obstetrical indications. The most common indication for induction was pre-eclampsia followed by IUGR, and post-date.Conclusions: In pregnancy with thrombocytopenia, gestational thrombocytopenia is the commonest and benign condition which does not alter the obstetrical management. Still a vigil 4 should be kept on maternal platelet count in antenatal period to prevent unfavorable outcome in serious conditions that may require specific and urgent management (HELLP syndrome, severe pre-eclampsia, ITP)

Role of diagnostic hysterolaparoscopy in the evaluation of infertility

Background: Infertility has become nowadays not only a medical, but a social problem as well. None of the laboratory findings alone is conclusive in diagnosing infertility. Diagnostic hysterolaparoscopy is an accurate method of assessing and treating infertility. Direct visualization of abdominal and pelvic organs in hysteroscopy and laparoscopy allows a definite diagnosis where clinical examination and less invasive techniques such as ultrasound, SSG and HSG fail to identify the problem. The main objective of study was to determine the role of diagnostic hysterolaparoscopy in the evaluation of infertility in tertiary care centers.Methods: A prospective hospital based study was carried out in two tertiary care centers (Sheth V.S. General Hospital and Smt. S.C.L. Municipal Hospital) over a period of 2 years from July 2013 to June 2015. Hysterolaparoscopy was done in 300 patients. Women aged 20-40 years with normal hormone profile without male factor infertility were included.Results: Out of 300 cases, 206 (69%) patients had primary infertility. While laparoscopy detected abnormalities in 35% of the cases, significant hysteroscopy findings were noted in 17% of cases. Together, diagnostic hysterolaparoscopy detected abnormalities in 26% of the infertile patients in both groups. While the most common laparoscopic abnormality was endometriosis (14%) and adnexal adhesions (12%) in primary and secondary infertile patients respectively, on hysteroscopy, intrauterine septum was found as the commonest abnormality in both the groups.Conclusions: Hysterolaparoscopy is an effective diagnostic tool for evaluation of certain significant and correctable tubo-peritoneal and intrauterine pathologies like peritoneal endometriosis, adnexal adhesions and subseptate uterus, which are usually missed by other imaging modalities

The management of hot flushes for men treated with androgen deprivation therapy for prostate cancer: a survey of UK practice

Androgen deprivation therapy (ADT) is one of the main treatments for prostate cancer. Short-term ADT of between 6 months and 3 years is often used in combination with radiotherapy to treat localised and locally advanced prostate cancer. Permanent or intermittent ADT is used to treat metastatic disease. Hot flushes affect 44-80% of men undergoing ADT for prostate cancer, with around 27% saying they are the most distressing side effect.1 A recent UK survey found 30.7% of men treated with ADT reported moderate or major problems with hot flushes.2 Low testosterone levels are thought to cause dysfunction in thermoregulation in the hypothalamus, resulting in peripheral vasodilatation.3 Symptoms include a feeling of warmth, flushing of the skin, perspiration, chills, anxiety and palpitations. A variety of treatments have been evaluated and there is evidence of efficacy for several of them, however they all have additional side effect profiles. The National Institute for Health and Care Excellence (NICE) and European Association of Urology recommend offering medroxyprogesterone or cyproterone acetate.4-5 NICE has said there is currently a lack of evidence to support the use of complementary therapies. Addressing the side-effects of cancer treatment is one of the top ten Living with and Beyond Cancer research priorities established by the National Cancer Research Institute. However, there is little evidence on the standard of care that UK clinicians offer to men suffering with hot flushes

A study of feto-maternal outcome in case of premature rupture of membrane at a tertiary care center

Background: Premature rupture of membranes is the rupture of the fetal membranes in the absence of uterine contraction or before the onset of labor. When this occurs before 37 weeks of gestation, it is termed as preterm premature rupture of membranes. Management depends upon gestational age and the presence of complicating factors. An accurate assessment of gestational age and knowledge of the maternal, fetal and neonatal risks are essential to appropriate evaluation, counselling, and care of patients with PROM. The purpose of the study is timely diagnosis and appropriate management of the cases of PROM and PPROM to improve maternal and neonatal outcomes. Methods: A Prospective study was performed at the department of obstetrics and gynecology, at a tertiary care center from August 2020 to December 2021. A clinical data sheet was made for recording all information about the pregnant women after taking their consent. And their maternal and neonatal outcomes were recorded. Results: a total of 150 cases of PROM and PPROM were taken during our study out of which 53.33% belong to the younger age group, 43.33% were primi gravida, 66.66% belonged to the lower socioeconomic class, 25.33% had a previous history of abortion followed by dilatation and evacuation, rate of cesarean delivery was 34.66% and rate of NICU admission of neonates was 15.78% and 57.87% babies had low birth weight and rate of stillbirth was 1.97%. whereas 34.66% of cases had various complications related to PROM. Conclusions: Individualized management of PROM cases depending on the gestational age and risk of complications and antibiotic coverage is the best way to achieve a good fetomaternal outcome

GRFS and CRFS in alternative donor hematopoietic cell transplantation for pediatric patients with acute leukemia.

We report graft-versus-host disease (GVHD)-free relapse-free survival (GRFS) (a composite end point of survival without grade III-IV acute GVHD [aGVHD], systemic therapy-requiring chronic GVHD [cGVHD], or relapse) and cGVHD-free relapse-free survival (CRFS) among pediatric patients with acute leukemia (n = 1613) who underwent transplantation with 1 antigen-mismatched (7/8) bone marrow (BM; n = 172) or umbilical cord blood (UCB; n = 1441). Multivariate analysis was performed using Cox proportional hazards models. To account for multiple testing, P \u3c .01 for the donor/graft variable was considered statistically significant. Clinical characteristics were similar between UCB and 7/8 BM recipients, because most had acute lymphoblastic leukemia (62%), 64% received total body irradiation-based conditioning, and 60% received anti-thymocyte globulin or alemtuzumab. Methotrexate-based GVHD prophylaxis was more common with 7/8 BM (79%) than with UCB (15%), in which mycophenolate mofetil was commonly used. The univariate estimates of GRFS and CRFS were 22% (95% confidence interval [CI], 16-29) and 27% (95% CI, 20-34), respectively, with 7/8 BM and 33% (95% CI, 31-36) and 38% (95% CI, 35-40), respectively, with UCB (P \u3c .001). In multivariate analysis, 7/8 BM vs UCB had similar GRFS (hazard ratio [HR], 1.12; 95% CI, 0.87-1.45; P = .39), CRFS (HR, 1.06; 95% CI, 0.82-1.38; P = .66), overall survival (HR, 1.07; 95% CI, 0.80-1.44; P = .66), and relapse (HR, 1.44; 95% CI, 1.03-2.02; P = .03). However, the 7/8 BM group had a significantly higher risk for grade III-IV aGVHD (HR, 1.70; 95% CI, 1.16-2.48; P = .006) compared with the UCB group. UCB and 7/8 BM groups had similar outcomes, as measured by GRFS and CRFS. However, given the higher risk for grade III-IV aGVHD, UCB might be preferred for patients lacking matched donors. © 2019 American Society of Hematology. All rights reserved

Medication Complications in Extracorporeal Membrane Oxygenation.

The need for extracorporeal membrane oxygenation (ECMO) therapy is a marker of disease severity for which multiple medications are required. The therapy causes physiologic changes that impact drug pharmacokinetics. These changes can lead to exposure-driven decreases in efficacy or increased incidence of side effects. The pharmacokinetic changes are drug specific and largely undefined for most drugs. We review available drug dosing data and provide guidance for use in the ECMO patient population