Study of maternal and fetal outcomes in patients with gestational diabetes mellitus

Background: Diabetes mellitus is the commonest medical problem complicating pregnancy, with possibility of grave consequences. With the present study, incidence, management and perinatal outcomes in the cases of GDM were studied.Methods: All the pregnant patients attending antenatal clinic at the study centre during study period of three years were studied. Those with positive history were screened for GDM as early as possible and rest screened at 24-28 weeks gestation. Carpenter and Coustan criteria were used for the diagnosis of gestational diabetes mellitus. All the diagnosed cases of gestational diabetes mellitus were followed up throughout the course of gestation and complications, if any, recorded.Results: A total of 39 patients were diagnosed as GDM. Majority were multigravida (69.3%, 27) and weighed over 75 kg (56%, 22). Patients were mostly diagnosed at the gestational age of 31-35 weeks (n-15) and 21-25 weeks (n-11). Fifteen patients (38.4%) had HbA1c values between 6-7%, 14 patients (35.8%) between 7-8% and 3 patients had HBA1c levels more than 10%. Twenty-three percent (9) patients had PIH, 13% (5) polyhydramnios and 7.6% (3) had PROM. Three mothers had babies suffering from IUGR. Sixteen (41%) had full term normal delivery while 2 (5.1%) patients had preterm labor and delivered normally. Twenty-one mothers (53.84%) had LSCS, out of which 3 had preterm LSCS.Conclusions: Diabetes during pregnancy is associated with risk factors as well as high maternal and foetal morbidity. GDM has good maternal and foetal outcomes depending upon how well the blood sugar levels are controlled

A study of evaluation of unhealthy cervix by various diagnostic modalities

Background: This study was carried out to evaluate cases of unhealthy cervix by using Pap (Papanicolaou) smear, colposcopy and cervical biopsy and to arrive at a definitive diagnosis. It correlated the findings of Pap smear, colposcopy and histopathology. It is important to strictly implement the screening program and spread awareness of the disease symptoms and its management to reduce the overall incidence of morbidity and mortality reported due to cervical cancer.Methods: A total 120 patients satisfying the inclusion/exclusion criteria were recruited for the study and informed consent was taken from all the participants. Pap smear was taken for all the cases. Then cases were subjected to colposcopy followed by biopsy. All the findings were correlated and analyzed. The findings of Pap smear and colposcopy were correlated with the gold standard of histopathology.Results: The sensitivity and specificity of Pap smear and colposcopy with respect to cervical biopsy were 53.1% and 98.7%, 87.87% and 72.72% respectively. Colposcopy had higher sensitivity and lower specificity than Pap smear for screening of cancer cervix.Conclusions: Cervical cancer is one of the preventable and highly curable conditions when diagnosed in the precancerous stage. The incidence of deaths resulting from cervical cancer can be brought down with adequate cervical cancer screening. Colposcopy and colposcopy directed biopsy should be done along with Pap smear in screening for early detection of cervical cancer since the accuracy of detection of cervical abnormalities is higher when these two methods are used complementarily

A prospective study of the study of maternal and perinatal outcome in cases of eclampsia

Background: This is an observational analytical study carried out in the department of obstetrics and gynecology, in a tertiary care center to determine the factors influencing fetal and maternal outcome, prognosis and complications in booked and unbooked eclamptic cases.Methods: The present study is a prospective study of perinatal and maternal outcome in 50 cases of eclampsia, above 32 weeks of gestation, from 1st May 2013 to 30th April 2014. Patients with medical complications like anemia, preexisting hypertension, diabetes, vascular or renal disease, multiple gestation, polyhydraminos, etc. are excluded from the study. Detailed history, physical examinations were carried out and appropriate management instituted as per individual patient need. Follow-up of mothers up to 6weeks postpartum and neonates in the early neonatal period was done.                Results: Incidence of eclampsia is 0.64%, incidence of maternal mortality is 0.4% and perinatal mortality is 24%. 36% of patients developed complications. Maternal mortality was significantly high in patients with 6 or more episodes of convulsions. The most common cause of perinatal mortality is prematurity. Antepartum eclampsia with gestational age less than 36 weeks, BP >160/100, preterm births, low birth weight babies, low apgar scores influenced adverse perinatal outcome.Conclusions: Eclampsia still remains a major problem in developing countries. It is one of the important causes of maternal and perinatal morbidity and mortality due to lack of proper ANC, low socio-economic status and lack of education

Time to shift from contemporary to high-sensitivity cardiac troponin in diagnosis of acute coronary syndromes

AbstractEarly rule-in and rule-out of non-ST-segment elevation myocardial infarction (NSTEMI) is a challenge. In patients with inconclusive findings on ECG, cardiac biomarkers play a crucial role in the diagnosis. The introduction of the new high-sensitive cardiac troponin test (hs-TnI assay) has changed the landscape of NSTEMI diagnosis.The new hs-TnI assay can detect troponin values at a lower level compared with a contemporary cardiac troponin (cTn) assay. The hs-cTnI assay has a coefficient of variation of ≤10%, well below the 99th percentile value. It reduces the time to diagnose acute myocardial infarction from 6h to 3h. A recent study has demonstrated that hs-cTnI can further reduce the time to 1h in 70% of all patients with chest pain.The European Society of Cardiology 2015 guidelines recommend including a second sample of hs-cTnI within 3h of presentation This increases the sensitivity of the hs-TnI assay from 82.3% (at admission) to 98.2% and negative predictive value from 94.7% (at admission) to 99.4%. Combining the 99th percentile at admission with serial changes in troponin increases the positive predictive value to rule in acute coronary syndrome from 75.1% at admission to 95.8% after 3h.The 2015 ESC Guidelines recommend the use of a rapid rule out protocol (0h and 1h) when hs-cTnI with a validated 0 to1h algorithm is available.Training and displaying the clinical algorithm depicting the role of hs-TnI assay in acute cardiac care units and in EDs are an efficient way to deliver the new standard of care to patients. Compared with contemporary troponin assays, the hs-cTn assay accelerates the diagnostic pathway to 0–1h, thus reducing the time for diagnosis of NSTEMI and hence, its management

Emergency Bilateral Internal Iliac Artery Ligation in Antepartum Haemorrhage with Complete Placenta Previa and Placenta Accreta at Previous Caesarean Scar Site: A Case Report

Implantation and placentation at the normal site are critical for a successful pregnancy. Many complications associated with pregnancy, which manifest late in pregnancy, such as preeclampsia and preterm labour, have been reported to have origins early during pregnancy with abnormalities in implantation and placental development. Placental abnormalities result from impaired embedding of the placenta in the endometrium, encompassing a wide range of placental pathologies associated with high maternal morbidity and mortality. Pregnancy-related complications such as Postpartum Haemorrhage (PPH) and hysterectomy have been closely linked to the Placenta Accreta Spectrum (PAS). PAS refers to the aberrant and invasive implantation of the placenta into the myometrium. Invasiveness in placenta accreta is marginal, followed by placenta increta (partial), placenta percreta (total), and placenta previa (covering the cervix). Here, the authors present a unique case report of an antenatal woman with antepartum haemorrhage, placenta previa, and placenta accreta at the previous Lower Segment Caesarean Section (LSCS) scar site, with massive PPH at 35 weeks, who benefited from an emergency LSCS with bilateral uterine and internal iliac artery ligation procedure, resulting in a life-saving outcome. The most common risk factors for PAS include prior caesarean section and curettage. The adhered placenta can lead to pelvic bleeding and necessitate an emergency hysterectomy. Therefore, it poses unique diagnostic and treatment issues, with the majority of cases requiring preterm termination of pregnancy

Abstracts of Scientifica 2022

This book contains the abstracts of the papers presented at Scientifica 2022, Organized by the Sancheti Institute College of Physiotherapy, Pune, Maharashtra, India, held on 12–13 March 2022. This conference helps bring researchers together across the globe on one platform to help benefit the young researchers. There were six invited talks from different fields of Physiotherapy and seven panel discussions including over thirty speakers across the globe which made the conference interesting due to the diversity of topics covered during the conference. Conference Title:  Scientifica 2022Conference Date: 12–13 March 2022Conference Location: Sancheti Institute College of PhysiotherapyConference Organizer: Sancheti Institute College of Physiotherapy, Pune, Maharashtra, Indi