Biochemical parameter and feto-maternal outcome in preeclampsia: a hospital based observational study

Background: Preeclampsia is one of the maternal diseases that cause detrimental effects on to the maternal, fetal, and neonatal health. The objective of the present study was to analyse maternal, perinatal outcome and investigation parameter in preeclampsia.Methods: This is an observational study and total of 90 consecutive patients were enrolled who has blood pressure ≥ 140/90 mmHg after 20 weeks of gestation with proteinuria (1+ by dipstick).Results: Among enrolled patients, 52 (58%) were in age group of 25-35 year and 51 (57%) were primigravida. Mean systolic and diastolic blood pressure of patients was 148±3.8 mm of Hg and 95±1.4 mm of Hg respectively. Most common presenting symptom was labor pain in 65 (72%) patients followed by edema in 61 (68%) patients. Most common complication was CNS symptom including seizure (Eclampsia) in 13 (15%) patients followed by vaginal bleeding (including abruption) in 12 (13%) patients. Mean hemoglobin level was 9.12±0.9 gm/dl. Mean urea and creatinine values were 34±4.6 mg/dl and 1.5±1.1 mg/dl respectively. Out of total 90 patients, 18 (20%) had elevated liver enzymes. Most common neonatal outcome was low birth weight 63 (70%) and 40 (44%) were preterm. APGAR score was less than 7 in 11 (12%) patients and more than 7 in 79 (88%) patients. Five (5.5%) newborn were still born.Conclusions: Preeclampsia is associated with multiple maternal and neonatal complications. Hence, there is a need for regular antenatal checkup to detect early and strengthening of neonatal intensive care units

Treatment outcome in patients with severe acute malnutrition managed with protocolised care at malnutrition treatment corner in Rajasthan, India: a prospective observational study (quasi-experimental)

Background: Malnutrition is rampant in paediatric age group. It is responsible for high morbidity, mortality and serious long term sequelae. In addition to critical care, a nutritional therapy followed by nutritional rehabilitation is a very important aspect for these children. Optimal management of these acutely ill children and a good outcome depends on an evidence based regimen of care.Methods: Total 75 cases were enrolled in the study and nursed in malnutrition treatment corner and were fed in appropriate composition and quantity as per Indian academy of pediatrics guidelines (initial and rehabilitation phase; F75, F100 and staple food). All children were assessed daily for weight gain, improvement in clinical status, feeding problem, compliance with the treatment and improvement in the appetite.Results: Out of 75 patients 63 (84%) patients were discharged. Dropout rate and mortality rate was 16% and 1.3% respectively. Majority patients were admitted for two weeks with mean duration of stay being 14.13 ± 9.1 days. Weight gain was good in 45, moderate in 22 and poor in 4 patients while 4 patients had weight loss during malnutrition treatment corner stay. Rate of weight gain was good in initial two weeks but as stay increased, rate of weight gain decreased in 3rd and 4th week with mean weight gain of 12.12±7.67 gm/kg/day. Twenty nine patients came for follow up after discharge and among them, 15(51.7%) patients had poor rate of weight gain, 9(31%) had moderate and 2 (6.89%) patients had good rate of weight gain whereas 3 patients had weight loss on follow up.Conclusions: Severely malnourished children have a better weight gain and improvement in nutritional status while receiving protocolised care in malnutrition treatment corner, which results in faster recovery because it is well accepted and better tolerated. Hospital based management of these children in specialised feeding centre is very important for regaining lost weight.

ETIOLOGICAL PROFILE OF CHILDREN ADMITTED WITH FEVER WITHOUT FOCUS FOR LESS THAN 7 DAYS DURATION AT TERTIARY CARE CENTER

Objective: The objective of the study was to know about the etiology of acute undifferentiated febrile illness (AUFI) or fever without focus in children admitted at tertiary care hospital. Methods: A study was conducted at medical college, Jhalawar, for a period of 3 months. Pediatric patients presenting with fever for less than or equal to 7 days duration without focus, who required hospitalization were included in this study. Results: A total of 200 children enrolled in study. Male-to-female ratio was 1.9:1. Mean age of children was 7.21±4.2 years. About 142 (71%) patients presented after 3 days of fever. Average duration of fever before admission was 4.62±1.78 days. The most common cause of fever of short duration (less than 7 days) was dengue fever 74 (37%) followed by malaria 58 (29%) and typhoid fever 36 (18%). About 26 (13%) patients had mixed infection. Out of 200 patients, 70 (35%) patients had splenomegaly, 66 (33%) had hepatomegaly, and 26 (13%) patients had both hepatosplenomegaly. Conclusion: The common etiology of AUFI with short duration in children was dengue, malaria, and typhoid. Vector control measures, drinking water supply, and sanitation should be improved to prevent vector-borne and water-borne diseases

A rare case of fourth consecutive fallopian tube ectopic pregnancy

We present a case of consecutive fourth tubal ectopic in a patient which was managed by emergency laparotomy and salpingectomy. The first two tubal ectopic pregnancies occurred on the right side while the subsequent two occurred on the contralateral side. The patient was planned for IVF-ET

ASSESSMENT OF INDICATIONS OF LOWER SEGMENT CESAREAN SECTION AT TERTIARY CARE CENTER: A RETROSPECTIVE STUDY

Background: Cesarean section (CS) is one of the most common and widely performed surgical procedures in obstetrics in India and Worldwide. It is mainly evolved as a lifesaving procedure for mother and fetus during the difficult delivery. To study, various indications for the lower segment CS at our tertiary care center were the objective of the present study. Methods: This is a descriptive, retrospective study of all the patients who were underwent CS in the Department of Obstetrics and Gynecology, Jhalawar Medical College, Jhalawar from January 1, 2021, to March 31, 2021 for the duration of 3 months. Data of patients who delivered by C-Section in our hospital during the defined study period were recorded and a statistical analysis was done for various indications of the lower segment CS (LSCS). Results: The total numbers of women delivered by CS over the study period were 806 among these 339 (42.05%) patients were primiparous and 467 (57.95%) were multiparous. 550 (68.23%) cases were from age group 20–25 years and 153 (18.98%) were had age group 26–30 years, 20 (2.48%) were from age group below 19 years, and 76 (10.29%) patients were above 31 years age. The previous LSCS was the leading indication to the LSCS (31.14%) followed fetal distress (13.88%), malpresentation 95 (11.78%) (including breech presentation in maximum women (86), transverse and oblique lie (9 each), and face presentation (3)) (11.78%), meconium stained liquor with fetal distress 60 (7.44%), severe oligohydramnios 48 (5.95%), non-progress of labor 32 (3.97%), cephalopelvic disproportion 23 (2.85%), pre-eclampsia 20 (2.48%), obstructed labor 19 (2.35%), big baby 19 (2.35%), pregnancy-induced hypertension 18 (2.23%), maternal request and post-dated pregnancy 15 (1.86%) each, gestational hypertension and eclampsia 11 (1.36%) each, placenta previa 10 (1.24%), induction failure 8 (0.99%), and intrauterine growth retardation and antepartum hemorrhage 7 (0.86%) and 14 (1.73%). Patients had other indications such as Abruptio placentae, gestational diabetes, twin pregnancy, uterine rupture, and deep transverse arrest. Conclusions: In this study, CS rate (40.68%) is found to be higher as compared to other studies and the WHO guidelines. CSs rate is high probably because Jhalawar Medical College, Jhalawar acts as a government tertiary care center. The previous LSCS was a common indication in 31.14% of mothers in present study. Besides, previous LSCS, fetal distress, malpresentation (Breech presentation/transverse lie, oblique lie, and face presentation) MSL with fetal distress, and severe oligohydramnios were the common indications for LSCS, which are seen in the present study

Treatment outcome in patients with severe acute malnutrition managed with protocolised care at malnutrition treatment corner in Rajasthan, India: a prospective observational study (quasi-experimental)

Background: Malnutrition is rampant in paediatric age group. It is responsible for high morbidity, mortality and serious long term sequelae. In addition to critical care, a nutritional therapy followed by nutritional rehabilitation is a very important aspect for these children. Optimal management of these acutely ill children and a good outcome depends on an evidence based regimen of care.Methods: Total 75 cases were enrolled in the study and nursed in malnutrition treatment corner and were fed in appropriate composition and quantity as per Indian academy of pediatrics guidelines (initial and rehabilitation phase; F75, F100 and staple food). All children were assessed daily for weight gain, improvement in clinical status, feeding problem, compliance with the treatment and improvement in the appetite.Results: Out of 75 patients 63 (84%) patients were discharged. Dropout rate and mortality rate was 16% and 1.3% respectively. Majority patients were admitted for two weeks with mean duration of stay being 14.13 ± 9.1 days. Weight gain was good in 45, moderate in 22 and poor in 4 patients while 4 patients had weight loss during malnutrition treatment corner stay. Rate of weight gain was good in initial two weeks but as stay increased, rate of weight gain decreased in 3rd and 4th week with mean weight gain of 12.12±7.67 gm/kg/day. Twenty nine patients came for follow up after discharge and among them, 15(51.7%) patients had poor rate of weight gain, 9(31%) had moderate and 2 (6.89%) patients had good rate of weight gain whereas 3 patients had weight loss on follow up.Conclusions: Severely malnourished children have a better weight gain and improvement in nutritional status while receiving protocolised care in malnutrition treatment corner, which results in faster recovery because it is well accepted and better tolerated. Hospital based management of these children in specialised feeding centre is very important for regaining lost weight.

The Role of Uterine and Umbilical Arterial Doppler in High-risk Pregnancy: A Prospective Observational Study from India

Aim To study the role of Doppler imaging in prediction of high-risk pregnancies and their outcomes. Methods and Material This prospective study in a setup of tertiary-level care center includes 500 high-risk pregnant women from rural and urban sectors and evaluates the predictive values of various Doppler indices. Results Out of 500 patients, 110 patients had abnormal Doppler among them, 70 patients had abnormal uterine artery Doppler, and 50 patients had abnormal umbilical artery Doppler flow indices. In all, 10 patients had both umbilical artery and uterine artery abnormal Doppler indices. When uterine artery was abnormal (70 patients), 20 patients had preeclampsia, 10 patients had pregnancy-induced hypertension (PIH), and 25 patients had intrauterine growth restriction (IUGR). Systolic/diastolic (S/D) ratio and notch had sensitivity of 60% and positive predictive value of 33.3% and 37.5%, respectively. When umbilical artery was abnormal (50 patients), 10 had preeclampsia, 15 had PIH, and 15 had IUGR. S/D ratio had the highest positive predictive value of 40%; sensitivity is same for all. In uterine artery, combination of parameters had the best sensitivity of 80%, followed by notch and S/D ratio. In umbilical artery, combination of parameters, S/D ratio, and RI (resistance index) had sensitivity of 40%; specificity of all the indices was 91-96%. In all, 20 patients had bilateral notch, and among them 15 developed preeclampsia and 15 developed IUGR. When both uterine and umbilical artery Doppler were abnormal (10 patients), all patients had preeclampsia and IUGR. Conclusion Therefore, Doppler study may be used for the prediction of preeclampsia and IUGR to reduce the maternal and perinatal morbidity and mortality