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

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

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

Single hadron response measurement and calorimeter jet energy scale uncertainty with the ATLAS detector at the LHC

The uncertainty on the calorimeter energy response to jets of particles is derived for the ATLAS experiment at the Large Hadron Collider (LHC). First, the calorimeter response to single isolated charged hadrons is measured and compared to the Monte Carlo simulation using proton-proton collisions at centre-of-mass energies of sqrt(s) = 900 GeV and 7 TeV collected during 2009 and 2010. Then, using the decay of K_s and Lambda particles, the calorimeter response to specific types of particles (positively and negatively charged pions, protons, and anti-protons) is measured and compared to the Monte Carlo predictions. Finally, the jet energy scale uncertainty is determined by propagating the response uncertainty for single charged and neutral particles to jets. The response uncertainty is 2-5% for central isolated hadrons and 1-3% for the final calorimeter jet energy scale.Comment: 24 pages plus author list (36 pages total), 23 figures, 1 table, submitted to European Physical Journal

Measurements of Higgs boson production and couplings in diboson final states with the ATLAS detector at the LHC

Measurements are presented of production properties and couplings of the recently discovered Higgs boson using the decays into boson pairs, H →γ γ, H → Z Z∗ →4l and H →W W∗ →lνlν. The results are based on the complete pp collision data sample recorded by the ATLAS experiment at the CERN Large Hadron Collider at centre-of-mass energies of √s = 7 TeV and √s = 8 TeV, corresponding to an integrated luminosity of about 25 fb−1. Evidence for Higgs boson production through vector-boson fusion is reported. Results of combined fits probing Higgs boson couplings to fermions and bosons, as well as anomalous contributions to loop-induced production and decay modes, are presented. All measurements are consistent with expectations for the Standard Model Higgs boson

Standalone vertex finding in the ATLAS muon spectrometer

A dedicated reconstruction algorithm to find decay vertices in the ATLAS muon spectrometer is presented. The algorithm searches the region just upstream of or inside the muon spectrometer volume for multi-particle vertices that originate from the decay of particles with long decay paths. The performance of the algorithm is evaluated using both a sample of simulated Higgs boson events, in which the Higgs boson decays to long-lived neutral particles that in turn decay to bbar b final states, and pp collision data at √s = 7 TeV collected with the ATLAS detector at the LHC during 2011

Expected Performance of the ATLAS Experiment - Detector, Trigger and Physics

A detailed study is presented of the expected performance of the ATLAS detector. The reconstruction of tracks, leptons, photons, missing energy and jets is investigated, together with the performance of b-tagging and the trigger. The physics potential for a variety of interesting physics processes, within the Standard Model and beyond, is examined. The study comprises a series of notes based on simulations of the detector and physics processes, with particular emphasis given to the data expected from the first years of operation of the LHC at CERN