Maternal outcome in pregnancy with sickle cell trait haemoglobinopathie

Background: Sickle cell trait, the heterozygous state for sickle cell disorders (SCD), which is associated with various obstetrical and non- obstetrical complication. Our objective was to study the pregnancy outcome in women with sickle cell trait.Methods: A prospective observational study was conducted collecting data from medical records of around 40 consecutive consenting subjects admitted in a tertiary health care center of south Gujarat over a period of May 2020 to April 2021 after Human Research Ethics Committee (HREC) approval.Results: In our study majority of the subjects (52.5%) belonged to age group of 18-25 years, majority (62.5%) of subjects were belonged to tribal population. Majority (92.5%) of subjects in our study diagnosed as sickle cell trait post -conceptional. 67% of subjects had various antenatal maternal morbidity among them anemia (45%); preterm labour (12.5%); hypertensive disorder (7.5%) and respiratory failure (2.5%). 65% of our subjects were delivered vaginaly. 5% of subjects had post- partum complication.Conclusions: Though sickle cell trait is considered as a low risk factor during pregnancy, expansion of SCT screening and educational efforts, the availability of reproductive technologies, and the increasing research on clinical complications of SCT have important implications for reproductive and genetic counselling guidelines

A prospective observational study of foetal outcome in twin pregnancy delivering at a tertiary health care center of South Gujarat

Background: Worldwide increased incidence of twin gestation. The rates of twin gestation have a direct effect on the rates of preterm birth and its co-morbidities. Importantly, this increased risk applies to each fetus and is not simply the result of more foetuses.Methods: This prospective study was carried out in department of obstetrics and gynaecology. 100 consecutive subjects fulfilling inclusion criteria   admitted to labour room and obstetrics intensive care enrolled over a period of around 1 year.Results: In this study twin delivery accounted for 1.3% of all delivery at our institute. On analysing neonatal morbidities Prematurity was commonest 65%, VLBW (23% first twin, 30% second twin), RDS (9% first twin, 13% second twin), birth asphyxia (7% first twin, 12% second twin), neonatal hyperbilirubinemia (7% first twin, 8% second twin). 34% of first twin and 40% of second twin required NICU admission. Early neonatal death observed in 6% of first twin and 8% of second twin. It was observed that proportion of neonatal complications was more in MCDA as compared to DCDA and in un-booked subjects as compared to booked subjects. This difference is statistically significant among both twin (p value<0.05).Conclusions: Twin pregnancy is associated with high perinatal morbidity. Specialized obstetrics and Intensive Neonatal care can decrease neonatal morbidity and mortality in twin gestation. We need to be extra vigilant in monochorionic twins and twin pregnancy with inadequate antenatal care

Comparison of transvaginal sonography and saline infusion sonohysterography for the diagnosis of causes of abnormal uterine bleeding: a diagnostic accuracy study

Background: Abnormal uterine bleeding (AUB) is one of the frequently observed gynecological problems in outpatient settings. Diagnosis of the cause of AUB is important and hysteroscopy with biopsy is considered is best method for diagnosis of the same. Recent studies suggest the role of transvaginal sonography (TVS) and saline infusion sonohysterography (SIS) for the diagnosis of AUB though data about accuracy and comparison of these techniques with gold standard is not available. The study was designed with the aim of comparison of TVS and SIS for the diagnosis of abnormal uterine bleeding in reference to microscopical examination after hysterectomy.Methods: 100 consecutive patients of AUB were included in the study on the basis of inclusion and exclusion criteria. TVS and SIS were performed on each patient before the surgery for hysterectomy. The findings of TVS and SIS were compared with microscopical examination of the specimen after the hysterectomy. Sensitivity, specificity, positive predictive and negative predictive values were measured.Results: For sub mucosal myoma sensitivity , specificity, positive predictive value, negative predictive value and kappa statistics of SIS were 100%, 100%, 100%, 100%, 1 respectively while for TVS It were 18.1%, 98.8%, 66.6%, 90.7% and 0.25 respectively.Conclusions: SIS has superior diagnostic accuracy and compared to TVS. These findings need to be confirmed by randomized studies with more sample size

Radiotherapy for Benign Diseases

Radiotherapy mainly involves treatment of patients with malignant tumors. Even with recognition of the risks of late skin injury, carcinogenesis, leukemogenesis, and genetic damage from all ionizing radiation; radiation therapy also continues to be accepted treatment for benign diseases. Before initiation, the quality of irradiation, total dose, overall time, underlying organs at risk, and shielding factors should be considered. Children should be treated with ionizing radiation only in very exceptional cases and after weighing the pros and cons of the therapy. Direct irradiation of skin areas overlying organs that are particularly prone to late effects (e.g. thyroid, eye, gonads, bone marrow and breast) should be avoided. Radiation protection techniques should be used in all instances. The depth of penetration of the x-ray beam should be chosen according to the depth of the pathologic process. Choice of beam energy usually depends on the depth of the target volume; every effort is made to spare normal underlying tissue in superficial lesions. There are a number of other benign conditions that can be treated with radiotherapy; we present a brief overview of some of the commonly encountered conditions. JNMA J Nepal Med Assoc. 2008 Jul-Sep;47(171):151-155