2-hour 75 gm OGTT for screening and Rescreening at 32-34 weeks for diagnosing gestational diabetes-evaluation of maternal and neonatal outcomes

Background: Gestational diabetes mellitus, most of which progress to type-2 diabetes mellitus is increasing worldwide. Identification of gestational diabetes and control of glucose can reduce such complications and improve maternal and neonatal health.Methods: A hospital based cross sectional study was conducted to find out maternal and fetal outcome of gestational diabetes from January 2014 to September 2015. Data were collected from 500 antenatal women screened out of which 25 had gestational diabetes and 35 women had intermediate hypergylcaemia attending Sriram Chandra Medical College and Hospital Cuttack for delivery.Results: In our study out of 500 patients, 25 mothers were diagnosed as GDM; its prevalence is 5% in our hospital. In GDM group 10 patients out of 25 had history of risk factors, which constitutes 40 % of the patients. The age group at risk of getting gestational diabetes in this study was between 20-35 years in 98.5%of cases. All the mothers with gestational diabetes were of low parity. In this study, nearly 56% of mothers with gestational diabetes had a body mass index of greater than 25. Significant numbers of cases were detected by rescreening at 32 to 36 weeks who are screen negative during the initial screening procedure (i.e. 10% in GDM group). Caesarean section rate was more in GDM group, mostly due to obstructed labour, fetal distress, hypertension, big baby. Complications like trauma to the baby, congenital anomaly, still birth of the baby were infrequent in this study.Conclusions: Pregnancy thought to be the most vulnerable stage of women's life and protecting her health along with her fetus during this period yields a positive impact on the health of future generation. Particular attention should be given during antenatal period to initiate screening programme and treatment protocol for gestational diabetic mothers

A rare case report of rupture uterus with full fetus in bladder

Uterine rupture is the primary concern when a patient chooses a trial of labour after a caesarean section. Bladder rupture accompanied by uterine rupture should be taken into consideration if gross haematuria occurs. We report the case of a patient with uterine rupture during a trial of labour after cesarean delivery. Her course of labour went into obstructed labour and failed forceps delivery for which she was referred to our tertiary care hospital. Intra -operatively she was found to be a case of rupture uterus with rupture of bladder and full fetus lying in the bladder which was delivered by giving incision on the anterior bladder wall. Patient had subtotal hysterectomy with repair of bladder done with suprapubic cystostomy. Her postoperative recovery was uneventful.  Bladder injury and uterine rupture can occur at any time during labour. Gross haematuria immediately after delivery is the most common presentation. The incidence of rupture uterus and associated bladder injury is on increase due to higher rates of caesarean section. But there are no case reports on full fetus inside the bladder, so it is justified to report this case

The effect of low dose aspirin and low molecular weight heparin (enoxaparin) in recurrent pregnancy loss associated with antiphospholipid antibody syndrome

Background: Recurrent miscarriage affects 1–2% of women. Recurrent pregnancy loss (RPL) is the loss of three or more consecutive pregnancies before or during the 20th week of gestation. The most important association between gestational loss and autoimmune phenomena is the presence of antiphospholipid antibodies represented by the lupus anticoagulants and or anticardiolipin antibodies (Antiphospholipid Antibody Syndrome). The antiphospholipid syndrome is an acquired autoimmune. The clinical features are thrombosis (venous, arterial and microvascular) and/or pregnancy complications; the most prominent of which is recurrent abortion.Methods: Twenty-two selected patients during pregnancy with clinical and/or serological findings of antiphospholipid syndrome had received low dose aspirin (75 mg once daily orally) plus LMWH enoxaparin (40 mg subcutaneously/day).Results: There are live born in 86% cases compared to abortion (37 weeks) and 50% cases are at preterm (<37 week) on which 9%) is spontaneous preterm and 41% is iatrogenic preterm due to preeclampsia, IUGR, PPROM and APH.Conclusions: Use of low dose aspirin (75mg) and enoxaparin 40 mg subcutaneously daily in patients with RPL due to antiphospholipid syndrome resulted in higher live birth rates. Combination treatment with aspirin and LMWH leads to a high live birth rate among women with recurrent abortion and antiphospholipid antibodies.

A rare case of secondary live advanced abdominal pregnancy

A 25-year-old gravida 2 para one with a history of 8 months lactational amenorrhoea presented to labour room with pain in abdomen since, 20 days in shock. Fundal height of uterus corresponded to 34 weeks size with unstable lie and uterus was relaxed. Fetal parts were palpable more easily than usual. Fetal heart sound was good. Pelvic examination revealed uneffaced and undilated cervix. Antenatal ultrasonography showed a single, viable fetus with gestational age of 33 weeks 6 days with oblique lie with head in right lower quadrant. Placenta was located in lower uterine segment covering internal os with AFI – nil with normal fetal cardiac activity and fetal movement. On opening the abdomen there was a boggy mass in the lower pelvic cavity with fetus with intact membrane lying in the abdominal cavity. Baby was delivered by breech extraction Baby weighed 2.2kg with no congenital anomaly. Placenta with membrane was in the left non-communicating horn of uterus with feeding vessels from omentum which were clamped, cut and ligated. The non-communicating horn with placenta was resected and left salpingo oophorectomy was done. Examination of intraabdominal viscera confirmed no injury. There was no torrential haemorrhage intraoperatively and abdomen was closed in layers after achieving proper hemostasis

Neuro-imaging study in eclampsia

Background: Eclampsia is associated with increased risk of maternal death varying from 1.8 % in developed countries to 14 % in developing countries. Cerebral complications are the major cause of death in eclampsia patients. Eclampsia along with hypercoagulopathy of pregnancy is a high risk fact for patient in respect of development of cerebrovascular thrombosis/haemoorhage. Eclampsia patients have been found to have various CNS pathological conditions amenable to the medical treatment. The aim of the study is to know the neuropathophysiology behind an eclamptic seizure to reduce the morbidity associated with it.Methods: Prospective study design included 50 patients for the study. All patients were admitted in the eclampsia room with h/o convulsions. All patients were put on MgSO4 therapy and anti-hypertensive. Cranial CT scan examinations were performed for all patients within 24hours of last convulsion without intravenous contrast material injection. Time taken to recover from all the clinical symptoms like altered consciousness, defective vision, headache and seizure and the maternal outcome are compared.    Results: 62% of patients with eclampsia had detectable pathological changes in CT scan. Cerebral edema was the most common CT scan finding with parietal lobe was the most common site (90.32%) of pathological changes. Mortality rate was high among eclamptic patients with cerebral hemorrhage.Conclusions: CT scan was found to be effective in detecting cerebral pathology in more than half of the eclamptic patients. The most common pathological changes detected are cerebral edema and cerebral infarction. CT scan may not be required for the diagnosis of eclampsia, but it must be used in certain complicated patients to detect cerebral pathology at the earliest so that specific management could be provided to reduce the maternal mortality

Diagnostic and therapeutic laparoscopy in the management of endometriosis

Background: Endometriosis associated with a variety of symptoms, primarily produces dysmenorrhea and infertility. Three classes of techniques have been used to diagnose women with endometriosis beside the history and the clinical picture: biochemical markers, radiological imaging and laparoscopic examination of peritoneal cavity.Methods: All 52 patients were evaluated clinically, biochemically, and radiologically and laparascopically to find out the abnormalities.Results: Most common complaint in a patient with endometriosis is dysmenorrhea affecting 67.6% population in this study group. 20% patients presented with infertility. Diagnostic laparoscopy of the patients in the study group show ovarian endometrioma in 67.3% population. Stage II endometriosis was seen in maximum number of cases in the study group comprising 46.2% patients. Ovarian cystectomy was the most common therapeutic procedure done in 51.9% of patients, out of which 40.4% cases treated with unilateral cystectomy and rest by bilateral cystectomy.Conclusions: This study concludes that endometriosis predominantly affects the women of reproductive age group and causes dysmenorrhea and infertility in majority of the patients. A laparoscopic finding marks as a standard tool in diagnosis and treatment of endometriosis

Balancing and Lucas-Balancing Numbers and their Application to Cryptography

It is well known that, a recursive relation for the sequence  is an equation that relates  to certain of its preceding terms . Initial conditions for the sequence  are explicitly given values for a finite number of the terms of the sequence. The recurrence relation is useful in certain counting problems like Fibonacci numbers, Lucas numbers, balancing numbers, Lucas-balancing numbers etc. In this study, we use the recurrence relations for both balancing and Lucas-balancing numbers and examine their application to cryptography

Maternal and perinatal outcome of eclampsia in a tertiary care centre

Background: Eclampsia is associated with devastating maternal and fetal complications. The main objective was to study the perinatal and maternal outcome and the causative factors for the mortality and morbidity in eclampsia patients admitted to this hospital and to explore the factors contributing to the alarming situation.Methods: 218 eclampsia cases admitted to the labour room in Department of Obstetrics &amp; Gynaecology, SCB Medical College Cuttack, Odisha, India from Jan 2013 to Sept 2014 enrolled for the study.Results: In this study 218 eclampsia cases were studied. The incidence of eclampsia in S.C.B.MCH during study period was 1.39%. Most of the patients were primigravida accounting 83.48% out of which 74.31% were antepartum, 14.22% were intrapartum and 11.47% were postpartum. 44.04% of cases had no ANC and 40.36 irregular ANC. Occurrence of onset of eclampsia at &lt;34 weeks GA 27.53%, 35-37 weeks 43.12 % and &gt;38 weeks 29.35%. Most of patients were from rural area (97.50%) and having low socioeconomic status (83.94%) and illiterate. Out of 218 cases 46.33% patients had vaginal delivery, 3.21% patients had vaginal delivery with instrumentation.Conclusions: There is a need of proper antenatal care to prevent eclampsia and the need for intensive monitoring of women with eclampsia throughout hospitalization to improve both the maternal and perinatal outcome

Review of Some Transaction Models used in Mobile Databases

Mobile computing is presently experiencing a period of unprecedented growth with the convergence of communication and computing capabilities of mobile phones and personal digital assistant. However, mobile computing presents many inherent problems that lead to poor network connectivity. To overcome poor connectivity and reduce cost, mobile clients are forced to operate in disconnected and partially connected modes. One of the main goals of mobile data access is to reach the ubiquity inherent to the mobile systems: to access information regardless of time and place. Due to mobile systems restrictions such as, for instance, limited memory and narrow bandwidth, it is only natural that researchers expend efforts to soothe such issues. This work approaches the issues regarding the cache management in mobile databases, with emphasis in techniques to reduce cache faults while the mobile device is either connected, or with a narrow bandwidth, or disconnected at all. Thus, it is expected improve data availability while a disconnection. Here in the paper, we try to describe various mobile transaction models, focusing on versatile data sharing mechanisms in volatile mobile environments

Review of Some Transaction Models used in Mobile Databases

Mobile computing is presently experiencing a period of unprecedented growth with the convergence of communication and computing capabilities of mobile phones and personal digital assistant. However, mobile computing presents many inherent problems that lead to poor network connectivity. To overcome poor connectivity and reduce cost, mobile clients are forced to operate in disconnected and partially connected modes. One of the main goals of mobile data access is to reach the ubiquity inherent to the mobile systems: to access information regardless of time and place. Due to mobile systems restrictions such as, for instance, limited memory and narrow bandwidth, it is only natural that researchers expend efforts to soothe such issues. This work approaches the issues regarding the cache management in mobile databases, with emphasis in techniques to reduce cache faults while the mobile device is either connected, or with a narrow bandwidth, or disconnected at all. Thus, it is expected improve data availability while a disconnection. Here in the paper, we try to describe various mobile transaction models, focusing on versatile data sharing mechanisms in volatile mobile environments