A study of predisposing factors and microbial flora in puerperal sepsis

Background: Puerperal sepsis is the third or fourth leading cause of maternal death worldwide with maternal mortality due to infections being as high as 15%6 with maternal morbidity being 8.1%7. Meticulous aseptic techniques, modern investigative tools and use of prophylactic antibiotics have reduced the incidence of puerperal sepsis in the developed countries however it still continues as a major cause of maternal morbidity and mortality in the developing countries.Methods: This was a retrospective study over a period of 18 months from July 2010 to December 2011 which included all the post natal patients admitted in the obstetrics ward of our hospital. All the patients who fulfilled the ICD 10 criteria of puerperal pyrexia were studied for the booking status, parity, mode of delivery, maternal anemia, number of PV examinations and duration of rupture of membranes. In addition vaginal swab culture and sensitivity of these cases was analysed. The results were calculated by statistical analysis and odds ratio calculated with 95% confidence interval.Results: The incidence of puerperal sepsis was 8.68% and was responsible for 60.29% of cases of puerperal pyrexia. The common predisposing factors were unbooked status, primiparity, caesarean section, anaemia, frequent PV examination and prolonged rupture of membranes. The most common microorganisms in vaginal swab culture and sensitivity were S. aureus (36%) and E. coli (29.8%).Conclusions: Puerperal sepsis is by and large a preventable cause of maternal morbidity and mortality. From our study and review of literature we conclude that early booking of all the antenatal cases, correction of maternal anemia, better aseptic conditions, deferring undue PV examinations, recognition of all the high risk cases and prophylactic administration of ampicillin and gentamycin can go a long way in preventing puerperal sepsis

Prenatal presentation of a rare genetic disorder: a clinical, autopsy and molecular correlation

Walker Warburg syndrome (WWS) lies at the severe end of the spectrum of the congenital muscular dystrophies. WWS is a congenital disorder of the O-glycosylation that disrupts in the post-translation modification of dystroglycan proteins. WWS is characterized by the involvement of the central nervous system and rarely by multisystem involvement. Next-generation sequencing discovered that multiple genes are associated with this disorder. FKTN is the rarest cause of WWS. We describe a clinical-autopsy report of a molecularly- confirmed WWS case presenting with ventriculomegaly, agenesis of the corpus callosum with a novel phenotype of Dandy-Walker malformation and unilateral multi-cystic kidney. The whole-exome sequencing confirmed a homozygous variant (c.411C>A) in the FKTN gene with a premature termination codon. This case emphasizes the importance of detailed postnatal phenotyping through an autopsy in any pregnancy with antenatally identified malformations. Obstetricians, pediatricians as well as fetal medicine experts need to counsel the parents and focus on preserving the appropriate sample for genetic testing. WWS, though rare deserves testing especially in the presence of positive family history. Dandy-Walker malformation is a novel feature and expands the phenotypic spectrum

Clinico-biochemical correlation with special reference to oxidized LDL and small dense LDL in Indian women with CAD

In women with coronary artery disease (CAD), clinical presentation is different enough from men which lead to missed or delayed diagnosis of CAD. We therefore assessed the major risk factors and biomarkers in female subjects with CAD. Venous sample of control, unstable angina (UA) and myocardial infarction (MI) patients were taken. In Both UA and MI patients, predominant risk factor was menopause (76.7% UA, 86.7% MI) followed by hypertension (56.7% UA, 60% MI), central obesity (56.7% MI, 56.7% UA), dyslipidemia (50% UA, 50% MI) and diabetes mellitus (50% UA, 33.3% MI). Total serum cholesterol and LDL cholesterol were highly significant (p<0.001) in MI and UA as compared to controls. LDL cholesterol was significantly increased (p<0.05) in MI as compared to UA. Triglycerides and HDLCholesterol were also increased but not at the significant level (p>0.05). Apolipoprotein (ApoB), small dense LDL and oxidized-LDL (Ox-LDL) were highly significant (p<0.001) in MI and UA as compared to controls. Based on discriminate analysis ox-LDL is a potential marker to discriminate cases of UA from controls while ApoB is the reliable marker which can discriminate the cases of MI from UA and controls

Maternal and Fetal outcome in Multiple pregnancy

Background:The incidence of multiple pregnancy increasing day by day.Twin pregnancy is the most common type of multiple gestation. Multiple gestation is problematic both for the mother as well as for her fetuses during ante-natal, intranatal and postnatal periods. The prognosisis worse both for the mother and the fetus inmultiple gestation as compared to a singleton pregnancy. Aim and objectives: To study maternal and fetal outcome in multiple fetal gestations. Material and methods: Retrospective observational study was carried out in antenatal women with multiple gestations after 24 weeks of gestation at a tertiary teaching hospital in Punjab over a period of one year. Maternal and Fetal outcomes were analyzed. Results:The incidence of multiple gestation in our study was 30.5 per1000 deliveries.There were 1673 deliveries out of which 51 women had delivered multiple gestation.One woman had triplet pregnancy. There were 103 babies delivered to 51 women. Majority of women were unbooked (64.71%) and in the age group of 21 -25 yrs(43.13%). Multiple gestation was more commonly seen in Multigravida (66.67%).Preterm labor (72.55%) was the most common complication observed with majority of the women delivering between 35-37 weeks. Higher rate of LSCS (58.82%)was seen in multiple gestation with most common indication being malpresentation. Majority of fetuses namely 70.59% of first twins and 74.51% of second twins were LBW(1.5-2.5kg). Fetal complications were FGR(14.56%) single fetal demise (1.94%), birth asphyxia (19.42%).There were 20.38% NICU admissions and 17.48% perinatal deaths in our study.Conclusion: Incidence of multiple gestation was 30.5 per 1000 deliveries , more seen in younger age group.Preterm labor was the most common complication. Good antenatal care , early detection and treatment of maternal complications and good NICU care can improve both maternal and fetal outcome

Plane strain consolidation of a compressible clay stratum by surface loads

An analytical solution of the fully coupled system of equations governing the plane strain deformation of a poroelastic medium with anisotropic permeability and compressible fluid and solid constituents is obtained. This solution is used to study the consolidation of a poroelastic clay layer with free permeable surface resting on a rough-rigid permeable or impermeable base. The stresses and the pore pressure are taken as the basic state variables. Displacements are obtained by integrating the coupled constitutive relations. The case of normal surface loading is discussed in detail. The solution is obtained in the Laplace-Fourier domain. Two integrations are required to obtain the solution in the space-time domain which are evaluated numerically for normal strip loading. Consolidation of the clay layer and diffusion of pore pressure is studied for both the bases. It is found that the time settlement is accelerated by the permeability of the base. Initially, the pore pressure is not affected by the permeability of the base, but has a significant effect, as we move towards the bottom of the layer. Also, anisotropy in permeability and compressibilities of constituents of the poroelastic medium have a significant effect on the consolidation of the clay layer

There is such a thing as too many daughters, but not too many sons”: a qualitative study of son preference and fetal sex selection among “It’s a girl!”— could be a death sentence All editorial matter

a b s t r a c t In response to concerns from feminists, demographers, bioethicists, journalists, and health care professionals, the Indian government passed legislation in 1994 and 2003 prohibiting the use of sex selection technology and sex-selective abortion. In contrast, South Asian families immigrating to the United States find themselves in an environment where reproductive choice is protected by law and technologies enabling sex selection are readily available. Yet there has been little research exploring immigrant Indian women's narratives about the pressure they face to have sons, the process of deciding to utilize sex selection technologies, and the physical and emotional health implications of both son preference and sex selection. We undertook semi-structured, in-depth interviews with 65 immigrant Indian women in the United States who had pursued fetal sex selection on the East and West coasts of the United States between September 2004 and December 2009. Women spoke of son preference and sex selection as separate though intimately related phenomena, and the major themes that arose during interviews included the sociocultural roots of son preference; women's early socialization around the importance of sons; the different forms of pressure to have sons that women experienced from female in-laws and husbands; the spectrum of verbal and physical abuse that women faced when they did not have male children and/or when they found out they were carrying a female fetus; and the ambivalence with which women regarded their own experience of reproductive "choice." We found that 40% of the women interviewed had terminated prior pregnancies with female fetuses and that 89% of women carrying female fetuses in their current pregnancy pursued an abortion. These narratives highlight the interaction between medical technology and the perpetuation of this specific form of violence against women in an immigrant context where women are both the assumed beneficiaries of reproductive choice while remaining highly vulnerable to family violence and reproductive coercion