Study of changes in levels of salivary estriol and progesterone in preterm labor in comparison to normal pregnancy

Background: This prospective research was designed to evaluate changes in levels of salivary Estriol and Progesterone in preterm labor in comparison to normal pregnancy. Spontaneous onset of labor at term is produced by definite increase in estriol and fall in progesterone. This rise in free estrogen should precede the onset of labor according with the known effect of estrogen and progesterone on myometrial activity. Concentration of steroid in saliva reflect unbound unconjugated and biologically active fraction.Methods: The present study was carried for duration of one year enrolling 115 antenatal women between 28 and < 37 weeks of gestation with or without labour pains attending the antenatal clinic in KGMU, Lucknow and those admitted in Queen Mary’s Hospital Lucknow. 5 ml of saliva was collected in cryovials from each patient to estimate estriol and progesterone. The estimation of saliva progesterone and estriol was done by immunoenzymatic colorimetric method of the supernatant of sample.Results: In our study mean value of saliva progesterone levels of pregnant women with preterm delivery (study group IIA) was lower than the control group (Group l) but the difference was not significant (3814.46±751.14 pg/ml versus 3945.16±577.11 pg/ml, p = 0.351). Mean value of estriol study group who delivered preterm (3512.85±586.16 pg/ml) was higher as compared to the mean value of control group (2691.72±681.08 pg/ml) and difference was significant (p value < 0.001).Conclusions: Thus, there is significant rise in level of saliva estriol, it can be used as a predictor for detecting symptomatic and asymptomatic women at risk for preterm birth

Assessment of serum lipid profile in early pregnancy and its relation with pre eclampsia: a prospective study

Background: Pathophysiology of pre eclampsia and atherosclerosis seems to be similar as a hyperlipidemic state, due to hormonal changes in pregnancy. We tried to assess the relationship between maternal plasma lipid concentration and risk of developing pre eclampsia.Methods: This is a prospective cohort study, for a period of one year from August 2009 to August 2010. Total no of subjects (N=270) were divided into two groups: Control group:  who remained normotensive during study and Study group: who developed pre-eclampsia.Results: The mean level of cholesterol in study group was (226.74±39.77 mg/dl) significantly higher as compared to control group (164±22.48 mg/dl). That was statistically significant (p=0.001). Mean levels of cholesterol in mild PET group was 216±28.90mg/dl and in severe PET group was 252.3±50.63 mg/dl respectively, that was also significantly higher as compared to control group (p=0.001). In our study mean levels of Triglyceride was 153.95±23.52 mg/dl in control group and 205.25±42.48 mg/dl in study group. There were statistically significant difference between the groups (p=0.001). In mild PET mean value of Triglyceride was 198.99±36.12 mg/dl and in severe PET it was 220.35± 53.13mg/dl. It was seen that both the study group had significantly higher mean value as compared to control group (p=0.001).Conclusions: In present study we have observed that maternal dyslipidemia in early second trimester is associated with increased risk of developing pre eclampsia. So dyslipidemia in early second trimester is a very good predictor of pre eclampsia

Role of hysterolaparoscopy in evaluation and management of infertility

Background: This study was conducted to evaluate the role of hysteron-laparoscopy in evaluation and management of infertility.Methods: Prospective observational study was conducted in department of obstetrics and gynaecology, LLRM medical college, SVBP hospital Meerut from May 2019 to June 2020. It included 58 women aged 22-40 years with primary and secondary infertility with normal hormone profile without male factor infertility.Results: Out of total 58 cases for infertility evaluated, primary infertility were 42 (72.41%) and secondary infertility were 67 (27.59%). In hysteroscopy deep seated ostium (12.06%), followed by endometrial polyp (6.89%) ,intrauterine synechiae (6.89%) were the most common pathologies while common abnormalities in laparoscopy were tubal pathology (20.68%), endometriosis (15.51%), and PCOD (12.06%) .Some of the diagnosed pathologies were dealt surgically in same sitting.Conclusions: Hystero-laparoscopy is a feasible and acceptable procedure and it can be used as “one time approach” in the assessment of female infertility caused due to pelvic and uterine pathology. It helps in diagnosis of certain factors causing infertility, which cannot be diagnosed by any other method such as by USG, HSG and reveals whether surgery is possible and if so the nature of surgery most suited for patient which can be performed in the same sitting

Individual and Group Level Antecedents of Team-Member Exchange (TMX) and its Associated Outcomes

In recent years, teams have become a popular and efficient way of managing and performing work tasks. The idea behind teams is that if they are structured to maximize communication density, connectivity, and minimize hierarchy, there will be greater flexibility in communicating, cooperating, and collaborating on work-related tasks. Human resources  are growing concern for today’s competitive organizations. Therefore it is very essential to focus on this issue seriously. In this review paper, we have integrated empirical research regarding the antecedents and consequences of Team-Member Exchange (TMX). An exchange relationship between team members is very critical but relatively unexplored phenomenon in the field of organizational behaviour. We have proposed a theoretical model to study certain selected antecedents (or predictor) and consequences of team-member exchange (TMX) process, both at the individual and group level. The individual level antecedents included in this paper are organizational justice, emotional intelligence, workplace friendship and group level antecedents are collectivistic orientation, team similarity, team identification, team-member affect, team reflexivity and group potency. Likewise, individual level outcomes associated with high quality team-member exchange are organizational citizenship behaviour, job performance, mental health and group level outcomes associated with high quality team-member exchange are team conflict, team climate, team commitment, team performance and team innovativeness. Further, several preliminary propositions have been offered to guide future research and the role of team-member exchange (TMX) within a broad theoretical and empirical context is discussed.Finally, we have discussed the gaps in the relevant literature, major issues for future research on team-member exchange (TMX) along with implications and interventions about how management can develop good interrelationships between co-workers.

Clinical significance of unexplained elevated maternal serum alpha feto-protein in second trimester of pregnancy

Background: Alpha-fetoprotein (AFP) is the major serum protein in the embryonic stage and in the early fetal stage. The aim of this study was to measure maternal serum AFP levels in second trimester between 15-20 weeks of gestation and to determine whether unexplained elevated MSAFP levels is an effective predictor of adverse pregnancy outcome among Indian population.Methods: This study was a prospective observational study, carried out on 400 pregnant women. Maternal serum alpha-fetoprotein (MSAFP) was measured between 15 and 20 weeks of gestation after excluding congenital malformation or birth defects. MSAFP level was determined by using a radio-immunoassay technique. Women with MSAFP level >2.0 MoM was considered as abnormal while MSAFP level≤ 2.0 MoM was considered as normal. All women were followed up till delivery and pregnancy outcomes were noted and compared between two groups.Results: Women with elevated MSAFP had significantly higher adverse pregnancy outcomes (75.4%) compared to women with MSAFP ≤2.0 MoM (26.1%) (p<0.0001 with relative risk of 2.89, 95% confidence interval 2.276 -3.667).Conclusions: Unexplained elevated MSAFP has high sensitivity, specificity, positive predictive value and negative predictive value in predicting adverse pregnancy outcomes. It would, therefore be worthwhile screening pregnant women in second trimester for maternal serum alpha-fetoprotein levels as it would help to identify high risk pregnancies and allow close antenatal survillence for better pregnancy outcome

Impact of vitamin A supplementation in anaemia during pregnancy: a randomized double blind controlled clinical trial

Background: To study the impact of Vitamin A supplementation in anaemia during Pregnancy and thus improving maternal and fetal outcome a Randomized double blind controlled clinical trial was conducted in Department of Obstetrics and Gynaecology, L.L.R.M. Medical college Meerut involving 250 pregnant women in late pregnancy 18-28 weeks with haemoglobin levels <11 g% (7-11 g%)..Methods: The study subjects were divided into two groups: Group A (n=125): Received daily supplement containing Iron (60 mg elemental iron) + Folate (500 mcg) + Vitamin A 20,000 IU weekly for a minimum of 12 weeks. Group B (n=125): Received daily supplement containing iron (60 mg elemental iron) + Folate (500 mcg) for a minimum of 12 weeks.Results: Maximum patients were uneducated belonging to low socioeconomic status. The mean haemoglobin values in Group A and Group B increased from 9.674±1.05 and 9.53±1.04 to 12.2±0.89 and 10.82±1.06 respectively after supplementation. Similarily Serum Ferritin levels increased from 15.96±2.94 and 15.70±2.83 to 78.40±17.82 and 58.64±11.93. Mean corpuscular volume, packed cell volume and red blood cell counts also increased significantly. Maximum haemoglobin levels were achieved with both vitamin A and iron supplementation. The proportion of women who became non anaemic was 97.17% in Group A vs 68.69% in Group B.Conclusions: Vitamin A supplementation improves anaemia and also dramatically improves iron stores in anaemic pregnant women

Term pregnancy with large anterior wall intramural fibroid: an intra-operative challenge

Leiomyomas are the most common benign smooth muscle tumors of the uterus. The incidence during pregnancy ranges between 1.6 to 10%. The management of fibroids encountered during caesarean section poses a therapeutic dilemma. We present a case of giant anterior wall lower segment leiomyoma complicating term pregnancy which posed a great surgical challenge. Myomectomy was performed before delivering the baby by lower segment caesarean section by locating the tumor free area using preoperative ultrasound. The tumor mass weighed 3kg. This case highlights the preoperative use of ultrasound in emergency caesarean section to avoid classical caesarean section and to prevent fetal mortality and morbidity by avoiding time consuming caesarean myomectomy before the delivery of the baby

Recurrent vaginal discharge: an unusual presentation of embryonal rhabdomyosarcoma of uterine cervix in an adolescent girl

Embryonal rhabdomyosarcoma (ERMS) is a rare tumor of the female genital tract. It tends to occur during childhood in the vagina and rarely it can arise in the uterine cervix, with a peak incidence in the second decade. We report a case of 15 year old adolescent girl who presented with recurrent vaginal discharge not responding to medical treatment. Examination under anesthesia showed friable growth arising from the cervix. Histopathological examination revealed embryonal rhabdomyosarcoma (botyroid variant) of the cervix. Patient underwent local excision of growth followed by IRS-4 protocol based chemotherapy and now patient is under follow up at our side and pediatric oncology and doing well. Young girls presenting with recurrent vaginal discharge not responding to medical treatment must undergo proper clinical examination and EUA and any suspicious lesions should be examined so as to avoid missing rare but aggressive etiology like rhabdomyosarcoma. Due to the young age of affected patients, embryonal rhabdomyosarcoma (sarcoma botyroides) poses a management challenge as the preservation of hormonal, sexual and reproductive function is essential. Awareness of such as uncommon lesion and its clinical implications is important for the counseling and management of the patient

Importance of examination under anaesthesia in adolescent age group for effective diagnosis and treatment in diagnostic dilemma: case series

Problems of the adolescent girls like discharge and bleeding per vaginum (BPV) are usually underestimated and under diagnosed and are considered as physiological. Often diagnosis not settled due to incomplete or absent examination. In such situations Examination under anaesthesia (EUA) is an invaluable method in the lower genital tract assessment of adolescent females. The aim of this study was to discuss Importance of EUA in adolescent age group with persistent complain of discharge and bleeding for aiding the diagnosis. Present case series discusses three cases of girls of adolescent age group who presented to tertiary care centre of Northern India over a period of six month with complain of discharge per vaginum and on and off bleeding p/v which was refractory to medical management. After initial examination and investigations they were planned for Examination under Anaesthesia. Gynecological complaints such as vaginal discharge, irregular BPV are common complains in adolescent age group. Many complaints can be dealt with by reassurance, whereas most others respond to medical therapy. To facilitate diagnosis in recurrent or unresponsive patients EUA is recommended. In diagnostic dilemma and in unusual presentation in young age EUA is invaluable

Review of hysterectomies in Department of Obstetrics and Gynaecology at tertiary care hospital in Northern India

Background: With the advancement of newer and conservative approach in the management of many gynaecological conditions, hysterectomy still remains the chief modality of treatment. The aim of this study was to analyze the various indications, clinical profile, and outcome of all the patients who underwent hysterectomy at premier teaching hospital in Northern India.Methods: This study involved all the patients who underwent hysterectomy from 1st Jan 2017 to 31st Dec 2017 in tertiary care hospital India.Results: Out of total 513 hysterectomies, 105 were obstetric and 408 were gynaecological hysterectomies. In obstetric hysterectomies 40% were due to rupture uterus, 38% were due to abnormal placentation. In gynaecological hysterectomies, 75.5 % abdominal & 24.5 % were vaginal.75.7 % were for benign conditions and 24.3% were for malignant conditions. Most common indication was AUB.Conclusions: Hysterectomy is commonly done to improve the quality of life but at the same time in obstetrics emergencies it’s a lifesaving procedure. So, its indications should be clearly evaluated, and patient should be clearly counselled about conservative options, risk and benefits of the procedure