Outpatient-based misoprostol to prevent prolonged pregnancy

Background: Prolonged pregnancy is defined as the one that persist at or beyond 42 weeks of gestation. Incidence of prolonged pregnancy is around 10%. Aim of the study was to evaluate the efficacy and safety of single dose vaginal misoprostol (25 µg) in preventing prolonged pregnancy when given on outpatient basis at 40 completed weeks of gestation. Objective was to compare number of women entering spontaneous labor between 40 to 41 weeks of gestation, time from enrolment in study till delivery, need for cesarean section and neonatal outcome in early neonatal age in study vs control group.Methods: Total no. of 130 subjects of uncomplicated singleton pregnancy with vertex presentation with bishop score ≤5 were recruited for the study. Patients were randomly allocated into two equal study and control groups. Women allocated to study group received intra-vaginal 25µg misoprostol and control group did not receive any intervention.Results: 92.3% (60/65) of women in the study group had onset of spontaneous labor in one week in comparison to only 72.3% (47/65) in the control group. Mean duration from enrolment to delivery was 1.33±2.03 days in study group and 4.98±2.74 days in control group, which is nearly four times less in women in study group. Women in study group did not have any side effects from single dose of misoprostol given. Mean birth weight, meconium stained liquor rate, NICU admission rate and neonatal morbidity were found to be comparable in both the groups. No neonatal or perinatal mortality was observed in either group.Conclusions: The present study supports the use of 25µg single dose vaginal misoprostol at 40 weeks of gestation to prevent prolonged pregnancy

Factors affecting “decision to delivery interval” in emergency caesarean sections in a tertiary care hospital: a cross sectional observational study

Background: The objective was to assess the waiting time and factors affecting the decision to delivery interval in an emergency caesarean section and to correlate it with neonatal and maternal outcomes.Methods: This study was conducted in the Department of Obstetrics & Gynaecology at UCMS and GTB Hospital, Delhi which is a government supported tertiary care hospital located in East Delhi. Data of 275 emergency caesarean sections was collected and analyzed for decision to delivery interval (DDI) along with the causes of delay and maternal and fetal outcomes.Results: The mean DDI was 183.24 minutes for all 275 cases and was 122 ± 89min for category I caesarean sections (crash caesareans). The major cause of delay was non availability of operation theatres due to long list of waiting caesareans sections. When the mean DDI exceeded 75 minutes, there was a 4.6 fold increase in the risk to the life of neonate while the maternal outcome was not significantly affected.Conclusion: DDI of 30 minutes is difficult to achieve even for urgent caesarean sections in government based set up of a developing nation, therefore a more reasonable time frame of 60-75 min may be justified for emergency caesarean sections under similar set up

Polymorphisms in renin-angiotensin-aldosterone system and vascular endothelial growth factor may cross talk in preeclampsia: a pilot study of maternal and fetal dyads in Indian population

Background: Preeclampsia (PE) is a multi-system disorder complicating 5-7% pregnancies and one of the leading causes of fetal/maternal morbidity and mortality worldwide.Methods: We have analyzed the association of common genetic polymorphisms of renin-angiotensin-aldosterone system (RAAS) and angiogenesis pathway in preeclamptic/eclamptic mother-fetal dyad samples, as we have hypothesized that there is a cross-talk between the maternal and fetal genotypes. Maternal venous and fetal umbilical vein blood of 50 primigravidae with preeclampsia /eclampsia and 100 matched normotensive controls of north Indian origin were collected.Results: A significant association was observed in the prevalence of VEGFA (vascular endothelial growth factor) polymorphism (rs25648 T>C) with PE. Moreover, difference in the prevalence of the AGT (rs7079 A>C) polymorphism was observed between mild vs. severe PE. Fetal genotypes showed a strong association with respect to RENIN (rs11240688 A>G) and AGT (rs11122576 G>A) to preeclampsia.Conclusions: Preeclamptic mothers and their fetuses have shown association with genes that are interacting partners in the regulation of angiogenesis and it would be interesting to expand the study to include more genes and connected pathways for the better understanding of the interplay of the biological process that goes dysregulated in this multi-systemic disorder.  

Bilateral Non-Hodgkin’s Lymphoma of the Temporal Bone: A Rare and Unusual Presentation

Primary lymphoma of the temporal bone is an unusual finding in clinical practice and bilateral affection is even more rare. To the best of our knowledge, there are no reports of bilateral primary temporal bone lymphoma without middle ear involvement in the English medical literature so far. We report, for the first time, a case of primary lymphoma involving both temporal bones which presented with left-sided infranuclear facial palsy. A combination of contrast enhanced magnetic resonance imaging (MRI) and high resolution computed tomography (HRCT) was used to characterize and to map the extent of the lesion, as well as to identify the exact site of facial nerve affection. An excision biopsy and immunohistochemistry revealed diffuse large B-cell non-Hodgkin’s lymphoma (DLBCL). Whole body fluorodeoxyglucose (FDG) positron emission tomography-computed tomography study (PET-CT) was performed to stage the disease. The patient was treated with chemotherapy and radiation therapy and is now on regular follow-up. The patient is alive and asymptomatic without disease progression for the last twenty months after initial diagnosis

Polymorphisms in renin-angiotensin-aldosterone system and vascular endothelial growth factor may cross talk in preeclampsia: a pilot study of maternal and fetal dyads in Indian population

Background: Preeclampsia (PE) is a multi-system disorder complicating 5-7% pregnancies and one of the leading causes of fetal/maternal morbidity and mortality worldwide. Methods: We have analyzed the association of common genetic polymorphisms of renin-angiotensin-aldosterone system (RAAS) and angiogenesis pathway in preeclamptic/eclamptic mother-fetal dyad samples, as we have hypothesized that there is a cross-talk between the maternal and fetal genotypes. Maternal venous and fetal umbilical vein blood of 50 primigravidae with preeclampsia /eclampsia and 100 matched normotensive controls of north Indian origin were collected. Results: A significant association was observed in the prevalence of VEGFA (vascular endothelial growth factor) polymorphism (rs25648 T>C) with PE. Moreover, difference in the prevalence of the AGT (rs7079 A>C) polymorphism was observed between mild vs. severe PE. Fetal genotypes showed a strong association with respect to RENIN (rs11240688 A>G) and AGT (rs11122576 G>A) to preeclampsia. Conclusions: Preeclamptic mothers and their fetuses have shown association with genes that are interacting partners in the regulation of angiogenesis and it would be interesting to expand the study to include more genes and connected pathways for the better understanding of the interplay of the biological process that goes dysregulated in this multi-systemic disorder. [Int J Res Med Sci 2016; 4(5.000): 1666-1672

Predictors and outcome of obstetric admissions to intensive care unit: A comparative study

This descriptive observational study was carried out in Guru Teg Bahadur Hospital to identify predictors and outcome of obstetric admission to Intensive Care Unit (ICU). Ninety consecutive pregnant patients or those up to 42 days of termination of pregnancy admitted to ICU from October 2010 to December 2011 were enrolled as study subjects with selection of a suitable comparison group. Qualitative statistics of both groups were compared using Pearson′s Chi-square test and Fisher′s exact test. Odds ratio was calculated for significant factors. Low socioeconomic status, duration of complaints more than 12 h, delay at intermediary facility, and peripartum hysterectomy increased probability of admission to ICU. High incidence of obstetric admissions to ICU as compared to other countries stresses on need for separate obstetric ICU. Availability of high dependency unit can decrease preload to ICU by 5%. Patients with hemorrhagic disorders and those undergoing peripartum hysterectomy need more intensive care