The predictive role of color doppler sonography in evaluating hypoxia and acidosis in intrauterine growth restriction fetuses: correlation with arterial blood gas analysis

Background: Doppler is an ultrasound technique allowing non-invasive measurement of artery blood flow velocities. Objective of this study was to evaluate the role of umbilical artery (UA) and middle cerebral artery (MCA) Doppler study in predicting fetal hypoxia and acidosis in IUGR fetus and a population subjected to hematologic fluctuations.Methods: In this study 100 subjects with IUGR fetuses was evaluated for comparison of Doppler sonography analysis of fetal middle cerebral arteries and umbilical arteries and cord blood samples (pCO2, pO2) that was collected at the time of delivery.Results: Among the 100 subjects (between 28-32 gestational week) of IUGR showed a high risk of hypoxia and acidosis type condition. The observations were recorded in terms of MCA/UA ratio, the abnormal MCA/UA ratio was observed in significant (p<0.05) number of patients growth restricted fetuses (n=96), as compared to normal. There is a direct correlation found in the pH and pCO2 values. The results of arterial blood gases with respect to pH were found to be less than 7.3±1.6 in 96 subjects with abnormal MCA/UA ratio as compared to normal, that relates to the increase in the relative pCO2 (61.66%) [Acid increase] and decrease in pO2 arterial gases (Hpoxia increase).Conclusions: The study provides an insight that shows IUGR fetuses have a relatively higher risk of hypoxia (less oxygen) and acidosis (low pH and high pCO2), showed the most important determinants variations

Cardiac disease and pregnancy: hyper vigilance and extreme caution for optimal outcome

Cardiac disease in pregnancy is a leading cause of maternal death in more so high-income countries. The armamentarium for winning this difficult battle involves shared decision-making with communication across the clinical team and the patient. There is limited clinical evidence concerning effective approaches to managing such complex care and moreover involvement of different specialists makes coordinated care challenging. Bicuspid aortic valve (BAV) is the most common congenital cardiac malformation, occurring in 1-2% of the population whereas a single ventricle is a rare congenital heart disease that accounts for less than 1% of all congenital heart diseases. We had two cases of pregnancy with bicuspid aortic valve in one case and the other with single ventricle. The involvement of multidisciplinary team involving cardiologist, cardiothoracic anaesthetist and fetal maternal medicine specialist resulted in good maternal and fetal outcome in both the cases

Post partum headache: a case series

Postpartum headache is the complaint of head, neck, or shoulder pain occurring during the first 6 weeks following delivery. Among the women who underwent neuraxial aneasthesia Post Dural puncture headache is one of the most common presentations. However, physicians should be aware that post Dural puncture headache is not the only cause of postpartum headache. Authors present a series of four cases that had varied presentation of post partum headache with varied diagnosis, the first case was of subdural haematoma where CT scan revealed an acute on chronic SDH. The second case was diagnosed as meningitis and the CSF for culture sensitivity grew Streptococcus Pneumoniae .In our third case of cortical vein  thrombosis , NCCT followed by MR venogram  revealed left transverse venous sinus thrombosis and our last case in the series was of posterior reversible encephalopathy syndrome where MRI confirmed the findings of typical findings are symmetric edema involving the white matter of the posterior regions of the cerebral hemispheres. The diagnostic dilemma was resolved by neuroimaging because the clinical presentation was not making us reach a satisfactory diagnosis of the cause of headache. Early resort to neuroimaging and multidisciplinary team effort paved way to early diagnosis and appropriate recovery of the patients

The impact of maternal body mass index on maternal and perinatal outcome

Background: The incidence of obesity has increased to pandemic proportions over the last 20 years. Obesity is a chronic illness which is associated with metabolic disease, nutritional deficiency, musculoskeletal complications and carcinomas. The aim of the study was to evaluate and compare the maternal and perinatal outcome in patients with BMI 20-24.9 kg/m2 (normal), with BMI 25-29.9 kg/m2 (overweight) and with BMI >30 kg/m2 (obese).Methods: This cross-sectional study was conducted on 300 singleton pregnant women with gestational age>37 weeks with cephalic presentation. The selected women were categorized into three groups of 100 each according to their BMI: Category I included normal women (BMI 20-24.9 kg/m2), Category II included overweight women (BMI 25-29.9 kg/m2) and Category III included obese women (BMI >30 kg/m2).Results: There was increased incidence of antepartum complications in obese women. The difference in the occurrence of pre-eclampsia among the three categories was statistically significant (p=0.001). Similarly, more obese women had eclampsia (5%) and gestational diabetes mellitus (6%) as compared to overweight and normal women and the difference was statistically significant in both these complications (p=0.02 for each). The risk of induction of labour was highest in obese women and so was the incidence of caesarean and instrumental deliveries and the difference was statistically significant. The difference in the onset of labour as well as mode of delivery among the three categories was statistically significant (p4 kg) among babies of three BMI categories was statistically significant (p<0.05). The difference in the incidence of NICU admissions was statistically significant (p=0.02).Conclusions: Obesity is an independent risk factor for adverse pregnancy outcomes and hence preventable steps should be taken for reducing the maternal and perinatal morbidity and mortality

Challenges in involvement of male spouse in family planning program in rural areas of Varanasi

Background: Globally, men have not shared equally with women the responsibility for fertility regulation. While family planning efforts have been directed almost toward women, the lack of male involvement may also reflect the limited options available to men. Current methods for men are condom, withdrawal, or permanent, such as vasectomy. The success of family planning depends on the involvement of couples but this hardly happen especially in rural areas. It is the belief, though erroneously among most males that the practice of family planning should be the sole responsibility of the female. The present study was a community based cross sectional study with the objective to assess challenges in involvement of male spouse in family planning program in rural areas.Methods: This is a community based and cross-sectional study was undertaken in randomly selected 4 villages of Kashi vidyapeeth block, Varanasi. Total enumeration of women from the selected villages delivered within last 3 years was done and their husbands were interviewed by using a pre-designed, pre-tested interview schedule. Chi-square test was applied to find out any association between the variables. P<0.05 was considered to be statistically significant, data was analyzed with statistical package for the social sciences (SPSS) 20 trial version.Results: These preliminary findings are part of thesis shows that out of 130 interviewed respondents, majority (89.5%) had aware about family planning and two third (66.2%) of the respondents said that either they or their wives are using family planning. More than half of the respondents were aware about male sterilization but none of them were using male sterilization. Majority (77.7%) of the respondents said that human immunodeficiency virus-acquired immune deficiency syndrome (HIV-AIDS) and 45.4% were said that sexually transmitted diseases or sexually transmitted infections (STDs/STIs) can be prevented by use of condom. More than half (53.8%) of the respondents were sole of the decision maker regarding the use of family planning.Conclusions: The present study concludes that the majority of the respondents were awareness about the family planning but practices of family planning is low in the study area. Health workers should educate the eligible couples for use of contraceptive methods. Promotion of male contraceptive usage should be done by intense awareness campaigns

Pregnancy and delivery of a women with Von Willebrand disease type 3: a case report

Von Willebrand disease (VWB) is the most common inherited bleeding disorder, found in approximately 1% of the general population, without ethnic differences. A multidisciplinary team ensuring readiness of availability of blood and blood products, perfect intraoperative hemostatis and administration of timely Von Willebrands factor are essential to prevent complications and improve perinatal outcome

Increased nuchal translucency: it’s not just aneuploidy

Nuchal translucency (NT) measurement between 11- and 14-weeks’ gestation is an established and consistently performing marker for chromosomal abnormalities, including trisomy 21. Even in the absence of aneuploidy in the event of normal conventional karyotyping or microarray analysis, increased NT is prognosticative of adverse pregnancy outcome, because it is associated with miscarriages, congenital heart defects, several fetal malformations, many genetic syndromes, skeletal dysplasia’s, intrauterine death; the majority of these structural anomalies are undetectable before birth. The parents should be reassured that in the absence of any abnormality detected the fetus will have a normal uneventful outcome and postnatal development when compared to the general population outcome

Changing indications of prenatal diagnosis in molecular era: experience of single centre in North India

Background: About 3-5% of pregnancies are complicated by chromosomal aberrations and birth defects. In the past prenatal genetic testing is identified to be largely restricted to the detection of chromosomal abnormalities like aneuploidy. With advances in the field of medical genetics, there has been substantial rise in use of prenatal genetic testing and we wanted to find out the same in our cohort of patients.Methods: Study design was retrospective, single-center observational study. Pregnant patients who underwent invasive testing for prenatal genetic disorder at fetal medicine specialty were considered for inclusion in the study. The invasive procedures that were performed in our study were amniocentesis, chorionic villous sampling (CVS) and cordocentesis.Results: Total 515 pregnant women underwent prenatal testing. Amniocentesis was the most common procedure to be performed accounting for about 74% of total cases. In our cohort, abnormal aneuploidy screening was the most common indication for performing prenatal diagnosis (64% of cases), while 12.8 % underwent prenatal diagnosis due to abnormalities/genetic disorder in previous child. Abnormalities in antenatal ultrasonography accounted for 16% of cases. Quantitative fluorescene polymerase chain reaction, rapid aneuploidy testing (QFPCR) was performed in all the cases. Karyotype was performed in 273 cases while chromosomal microarray was performed on 92 samples. Multiplex ligation dependent probe amplification (MLPA) was done for 15 patients. Targeted mutation testing (Sanger sequencing) was done on 121 prenatal samples. Exome sequencing was performed on 14 fetuses. Out of 515 a total of 79 fetuses (15.3%) were found to have genetic disorder.  Aneuploidies were identified in 11 fetuses (2.1%), 12 fetuses (2.3%) were found to have pathogenic CNVs (Copy number variants). Single gene disorders were found in 56 fetuses (10.8%). Conclusions: We have moved very rapidly from Karyotyping to chromosomal microarray to exome sequencing. There has been rapid change in the indications for prenatal Diagnosis from yesteryears with coming of new era of genetics

Big Data Analytics

The basic of this dissertation is the rise of "big data" and the use of analytics to storehouse the data. Big data is mainly used to analyze the large amount of data. The Big data store large amount of data and provide helpful information in an efficient manner leads a system toward a serious computational challenges, like to analyze, mixture, and store, where information are remotely collected. In the recent times, data warehousing, data repository and data mining are mostly used for Bid data. Big data warehouse known as terabytes which mean data collect in warehouse was terabytes in storage but in recent time it is petabytes, and the data built at a high speed. The progress in companies and organization is mainly because it store and analyze the data at greater levels and in greater details, as well as meta data , Web data and code-generated data, to build better relationship between customer and market behavior. Big data provide helpful information to achieve a goal. A lot of companies in recent time use big data to improve their quality. Growth of big data increase at higher speed in recent time, even trend going in coming year