The perinatal and maternal outcome in pregnancy with advanced maternal age 35 years and >35 years

Background: Purpose of this study is to evaluate maternal and perinatal outcome in advanced maternal age women. As numbers of pregnancies in advanced maternal age continue to grow, obstetric care provider would benefit from up to date outcome data to enhance their preconceptional and antenatal counseling.Methods: It is observational prospective analytic study, conducted in Nowrosjee Wadia maternity hospital, Parel, Mumbai. Total 100 patients were included in study, fulfilling inclusion criteria over period of 1 year.Results: In 100 patients, most common cause of delay conception is infertility (27%). 24% of patients conceived after treatment. out of 100 patients 23% of patients had pre-existing medical and surgical disorders, 50% developed complications in pregnancy. Out of 100 patient 58 patients undergone through biochemical study, 3 patients had high risk for chromosomal disorders. The rate of caeasarean section in our study is 68%. Perinatal mortality and morbidity is high in our study, rate of preterm delivery is 23.7%. Out of 105 babies (including multiple gestation), 42.8% babies are low birth weight out of which 9.5% babies are very low birth weight. Rate of NICU admission is 33%, perinatal mortality rate, neonatal mortality rate and still birth rate is 19.4 per 1000 births. Advanced maternal age is related to high maternal and perinatal morbidity and mortality rate.Conclusions: Pregnancies in women of advanced maternal age are considered high risk for Perinatal and maternal morbidity and mortality. A proper preconception consultation and intensive antenatal care assessment can individualize and potentially reduce the risks for women with advanced maternal age

The perinatal and maternal outcome in pregnancy with advanced maternal age 35 years and >35 years

Background: Purpose of this study is to evaluate maternal and perinatal outcome in advanced maternal age women. As numbers of pregnancies in advanced maternal age continue to grow, obstetric care provider would benefit from up to date outcome data to enhance their preconceptional and antenatal counseling.Methods: It is observational prospective analytic study, conducted in Nowrosjee Wadia maternity hospital, Parel, Mumbai. Total 100 patients were included in study, fulfilling inclusion criteria over period of 1 year.Results: In 100 patients, most common cause of delay conception is infertility (27%). 24% of patients conceived after treatment. out of 100 patients 23% of patients had pre-existing medical and surgical disorders, 50% developed complications in pregnancy. Out of 100 patient 58 patients undergone through biochemical study, 3 patients had high risk for chromosomal disorders. The rate of caeasarean section in our study is 68%. Perinatal mortality and morbidity is high in our study, rate of preterm delivery is 23.7%. Out of 105 babies (including multiple gestation), 42.8% babies are low birth weight out of which 9.5% babies are very low birth weight. Rate of NICU admission is 33%, perinatal mortality rate, neonatal mortality rate and still birth rate is 19.4 per 1000 births. Advanced maternal age is related to high maternal and perinatal morbidity and mortality rate.Conclusions: Pregnancies in women of advanced maternal age are considered high risk for Perinatal and maternal morbidity and mortality. A proper preconception consultation and intensive antenatal care assessment can individualize and potentially reduce the risks for women with advanced maternal age

Vitamin D and depression: A case series

Introduction: Over two-thirds of Canadians are deficient in vitamin D. Clinical overlap can compound diagnosis of depression in vitamin D deficient individuals. Citing high costs, the Ministry of Health has restricted routine vitamin D screening and hence is not feasible. Objectives: The current case series is an attempt to recognise the clinical overlap between depression and vitamin D deficiency in order to avoid unnecessary antidepressant prescriptions and to demonstrate the role of collaborative care in such patients. Method: After appropriate ethics approval 62 patients from an outpatient clinic were screened for the diagnosis of treatment resistant depression. Those who had predominant somatic complaints were further screened for organic factors and those with inadequate vitamin D levels were referred to family physicians for supplementation with vitamin D. Results: More than 50% were detected deficient in vitamin D after our evaluation. They showed subjective improvement with vitamin D supplements. No modification of antidepressants was needed. Conclusion: Vitamin D deficiency should be suspected in depressed patients with prominent somatic symptoms and their treatment resistance should be reconsidered to avoid unnecessary exposure to mood stabilisers. Collaborating with primary care is advocated. Limitation: Co-prescription of an antidepressant is a confounder in our case series, and we propose more organised studies with objective rating scales

Coronary Plaque Microstructure and Composition Modify Optical Polarization

Objectives: This study aimed to evaluate whether polarimetry, performed using a modified optical frequency domain imaging (OFDI) system, can improve the assessment of histological features relevant to characterizing human coronary atherosclerosis. Background: The microscopic structure and organization of the arterial wall influence the polarization of the infrared light used by OFDI. Modification of the OFDI apparatus, along with recently developed image reconstruction methods, permits polarimetric measurements simultaneously with conventional OFDI cross-sectional imaging through standard intravascular imaging catheters. Methods: The main coronary arteries of 5 cadaveric human hearts were imaged with an OFDI system capable of providing polarimetric assessment. Cross-sectional views of tissue birefringence, measured in refractive index units, and depolarization, expressed as the ratio of depolarized signal to total intensity, were reconstructed, together with conventional OFDI images. Following imaging, the vessels underwent histological evaluation to enable interpretation of the observed polarization features of individual tissue components. Results: Birefringence in fibrous tissue was significantly higher than in intimal tissue with minimal abnormality (0.44 × 10-3 vs. 0.33 × 10-3; p < 0.0001). Birefringence was highest in the tunica media (p < 0.0001), consistent with its high smooth muscle cell content, cells known to associate with birefringence. In fibrous areas, birefringence showed fine spatial features and close correspondence with the histological appearance of collagen. In contrast, necrotic cores and regions rich in lipid elicited significant depolarization (p < 0.0001). Depolarization was also evident in locations of cholesterol crystals and macrophages. Conclusions: Intravascular measurements of birefringence and depolarization can be obtained using conventional OFDI catheters in conjunction with a modified console and signal processing algorithms. Polarimetric measurements enhance conventional OFDI by providing additional information related to the tissue composition and offer quantitative metrics enabling characterization of plaque features