An observational study on use of maternal risk factors, mean arterial pressure, mean uterine artery pulsatility index and serum placenta like growth factor for screening of preeclampsia in first trimester

Background: Preeclampsia (PE) affects 2-3% of all pregnancies and is a major cause of maternal and perinatal morbidity and mortality. In the last decade extensive research has been devoted to screening for PE with the aim of reducing the prevalence of the disease through pharmacological intervention in the high-risk group. In our study we used the combined screening method to evaluate the risk of developing preeclampsia in pregnant women. Our primary objective was to estimate the screen positivity rate for preeclampsia using the first trimester combined screening method (maternal risk factors and biophysical methods) in our population in a tertiary care hospital setting. Methods: Risk of preeclampsia was calculated using fetal medicine foundation algorithm accessed at https://fetalmedicine.org/research/assess/preeclampsia. Results: Using the combined screening method, 10 out of 75 women (13.33%) were found to be screen positive for risk of developing preterm preeclampsia (at <37 weeks) with a risk cut off of 1:100. Using the maternal risk factors approach only (as per NICE guidelines) again 10 out of 75 women (13.3%) were found to be screen positive. However, the subset of women who were screen positive by each method were not the same. There were only 4 out of 10 women who were screen positive by both methods. The screen positivity rate for preterm preeclampsia (<37 weeks) in our population using combined screening approach was 13%, which means aspirin would be advisable to 13/100 pregnant women to reduce the risk of preterm preeclampsia. Conclusions: Basis on our study we concluded that one cost effective method of screening could be, to offer aspirin to all women who are screen positive by the maternal risk factor approach (NICE guidelines approach). This approach does not require any extra blood test or skill to measure uterine artery pulsatility index

Comparative study of clinical and endocrinal profile between lean and obese patients of polycystic ovary syndrome

Background: Polycystic ovary syndrome (PCOS) is a common endocrine disorder having escalation in its prevalence. It is the most frequent cause of oligoanovulatory infertility. This study was conducted to compare the clinical and endocrinal profile of PCOS in lean PCOS (BMI<23 kg/m2) and obese PCOS (BMI>23 kg/m2) women. Methods: A prospective study was conducted for 6 months in department of obstetrics and gynecology, GMERS Medical college, Junagadh. 100 healthy women who were euthyroid with age range 20-38 years who presented to gynecology OPD and diagnosed to have PCOS according to ESHRE/ASRM criteria were included in the study. BMI (body mass index) was calculated by the formula weight in kg/height in meter square. BMI were calculated were divided into 2 groups. Lean PCOS found in patients with BMI<23 kg/m2 and overweight/obese PCOS found in patients with BMI>23 kg/m2. History of menstrual irregularity, hirsutism, acne, alopecia, infertility, history of weight gain, history of voice change, family history of PCOS, diabetes was taken and hormonal profile was done. Results: The findings showed a no significant correlation of clinical profile i.e., menstrual irregularities, acne vulgaris, acanthosis nigricans and hirsutism in both groups. The waist-hip ratio was higher obese PCOS women. High levels of serum testosterone were seen in obese women with PCOS, whereas there is no correlation between other hormone like FSH, LH, TSH and LH/FSH in both study groups. Conclusions: PCOS is a risk factor for endocrinal and metabolic derangements irrespective of the BMI status. More than half of women with PCOS were obese. Increased BMI in PCOS women is associated with increased WHR and raised serum testosterone with no difference in other endocrine parameters

A retrograde study to evaluate the maternal and fetal outcome of severe oligohydramnios in singleton term (37-40 weeks) gestation

Background: Oligohydromnios is a condition where there is very low or absent amniotic fluid and it demands intense antepartum, intrapartum care and fetal surveillance, as it is frequently associated with IUGR, fetal distress, PIH, PROM, fetal renal abnormalities as renal agenesis, bilateral cystic kidneys and obstructive uropathy. Methods: Total 124 antenatal patients delivered at Department of Obstetrics and Gynecology at GMERS Medical College and General Hospital, Junagadh. During Period of September 2022 to February 2023 with gestational age between 37-40wks with AFI<1cms with intact membranes were studied and analyzed retrospectively for perinatal and maternal outcome. Results: Out of 124 cases with oligohydramnios with AFI <1cm studied, about 115 cases underwent LSCS (92.7%). Most patients belong to age group of <25 about 85. Growth retardation seen in 38 (30.6 %), NICU admission seen in 35(28.2%) and new born with APGAR <7 @ 1 min seen in 30 cases (24.2%). Conclusions: According to our study on severe oligohydramnios, the common mode of delivery was caesarean section and indications for CS were PIH, FGR and poor BISHOP score with severe oligohydramnios. Growth retardation seen in babies who were born from severe oligohydramnios mother