Intrahepatic Cholestasis Of Pregnancy - A Review

Intrahepatic cholestasis of pregnancy (ICP) is a complex disease described by pruritus connected with elevated serum bile acid or amino transferase level. Usually,it occurs to the third trimester of pregnancy and improves itself after delivery.In 1970’s the prevalence was reported highest in Bolivia and Chile, however, the prevalence in United States (US) ranges in between 0.3 to 5.6%, whereas, in Europe it is 0.5 to 1.5%. The awareness campaigns of the disease showed an increase in incidence in the high-incidence regions because of more reporting of the cases.Ursodeoxycholicacid (dose) is the treatment of choice for ICP. This treatment provide improved liver function and relief in pruritus and is considered safe during pregnancy.At the molecular level, it offers cytoprotection against hepatotoxic effects of hydrophobic bile acids, improves hepatobiliary bile acid transport, and decreases plasma bile acids. Moreover, to alleviate the pruritus; hydroxyzine or an aqueous cream with 1% methanol were used.ICP is a unique hepatic disorder in pregnancy with possibly an interaction of genetic, hormonal, and environmental factors in its etiopathogenesis, although the definite etiology still remains obscure

Impact Of Emergency Obstetric Care Skill Training Workshops For Medical Students At Ziauddin University. Karachi. Pakistan

Background: Obstetric emergencies are usually sudden, unpredictable and may lead to maternal death and morbidity. Each year about 5,36,000 women die worldwide from complications of pregnancy and childbirth. Health professionals should be trained in emergency, life saving skills. Emergency obstetrics skills workshops for medical students were aimed to train them in providing care in emergency situations like antepartum and postpartum haemorrhage, eclampsia, shock, obstructed labour and abortion. Thus the purpose of our study was to evaluate the effect of emergency obstetrics workshop after providing training in team work in fourth year medical students to fulfil our future needs. We have evaluated the effect of hands-on training of emergency obstetrics skills in medical students in small groups and assessed the difference in their knowledge before and after the workshop. Methods: This cross-sectional study was conducted at Obstetrics and Gynaecology Department of Ziauddin University, Karachi, Pakistan from 2015 to 2016. Fourth year MBBS students (n=146) were included in the study with their informed consent. The knowledge regarding pre & post workshop was evaluated regarding various emergency situations with the help of a questionnaire. A pre-workshop test of 10 multiple-choice questions was administered to all the participants. At the end of the workshop, the same 10 questions were administered and the two scores compared using Paired sample t-test for paired data on SPSS statistical software version-21. A paired-sample t-test was for pre & post test score. Results: The results of pre test and post test showed profound improvement. We have been observed that the post test mean value of knowledge was higher than the pretest mean value of knowledge. Finally p-value <0.05 was considered statistically significance. Students were able to identify basic need of obstetric care that should be provided in obstetric emergency, compared with the situation before receiving the training. Conclusion: Well defined and structured hands-on training is an effective way of improving skills of medical students and may reduce maternal mortality in Pakistan

Plasminogen activator inhibitor-1: is it a risk factor for recurrent miscarriage?

Background: About 50% cases of recurrent miscarriages are idiopathic. The association of fibrinolytic defects with recurrent pregnancy failure is a novel research avenue and was first recommended in early 1990s. High Plasminogen activator inhibitor-1 (PAI-1) levels are found to be associated with recurrent miscarriage in various studies. The association of Plasminogen activator inhibitor -1 with recurrent pregnancy loss and its various variables are detrermined. Methods: This study was conducted at Ziauddin University Hospital Karachi, from Feb 2014 to Nov 2014. All non pregnant and non-obese women with history of consecutive two or more miscarriages, with no co-morbid diseases, visiting a gynecologist were included. Studied variables included were age, BMI, no. of miscarriages, time of miscarriage and plasma PAI-1 levels. The data was expressed in terms of median and percentages with a confidence interval of 95%. Analysis was done on SPSS version 20. Results: The median age of females was found to be 27.34± 5.09 years. Out of seventy five females with history of recurrent miscarriages, (81.3%) (n=61) women had Plasma PAI-1 levels within normal range whereas (18.7%) (n=14) had value greater than normal. The median plasma PAI-1 was found to be 29.6±22.16 ng/ml. Conclusion: PAI-1 was not found to be a risk factor for recurrent miscarriages in a local population of Karachi. Furthermore, studies on a large sample size need to be undertaken to assess the role of PAI-1in our population. Key Words: Recurrent pregnancy loss. Plasminogen activator inhibitor-1, Fibrinolysi