The comparative study of fibrin degradation products in normal pregnancy and pregnancy induced hypertension

Background: Pregnancy induced hypertension is a multisystem disorder and is characterized by changes in haemostatic system. The assessment of the coagulation parameters of the patients of pre-eclampsia and eclampsia is important because it helps to diagnose the severity of the disease, and to predict the outcome. There is no universal agreement as to the need for further investigations if the platelet count comes normal. Hence in such cases it is always prudent to get the coagulation profile. D dimer of such patients is done to diagnose the cases of coagulation failure early and to manage it efficiently. The objectives of the study to compare the Fibrin Degradation Products in term normal pregnancy, pre eclamptic and eclamptic patients, to assess the severity of pregnancy induced hypertension and to detect coagulation failure early and manage before it worsens.Methods: This study was conducted in the Department of Obstetrics and Gynaecology at Karnataka Institute of Medical Sciences, Hubli during the period of March 2014 to February 2015 on 100 patients between 37-42 weeks of gestation. 50 controls were well matched with the study population which included a total of 50 patients with pre-eclampsia and eclampsia. Pregnant women with known bleeding disorders, on anticoagulant therapy, with abruptio placentae, with IUD, in labour and with established DIC were excluded.The blood coagulation parameters which were compared between the control and the study population were Bleeding time (BT), Platelet Count, Clotting time (CT), Prothrombin time (PT), Activated partial thromboplastin time (aPTT) and D-dimer.Results: The BT, CT, PT, aPTT values were nearly identical in all the groups. The platelet count showed a decreasing trend from normal control to eclampsia group. The D dimer showed an increasing trend from the normal control to eclampsia group. D dimer level was raised in all patients who were in sub clinical and clinical coagulation failure.Conclusions: This study shows that even with the normal routine coagulation parameters, D dimer was significantly elevated in both subclinical and clinical DIC. So, D dimer can be used as a specific tool in early diagnosis and deciding appropriate management of PIH

Subclinical hypothyroidism in pregnancy and outcomes

Background: Screening for subclinical hypothyroidism is essential in all pregnant women, especially in the Indian context, as Indian women have increased risk of developing iodine deficiency during pregnancy. Hence this study was undertaken to study the prevalence of subclinical hypothyroidism. Emphasis was put to know the need for universal screening and also the obstetric outcome in terms of perinatal morbidity and mortality and maternal morbidity were assessed.Methods: It was a prospective analytical study. Sample size consisted of 200 pregnant women attending antenatal OPD. Thyroid profile (serum TSH, FT3 and FT4) was done during first visit and in subsequent trimester of each pregnant woman. The results were analyzed taking into consideration recent endocrine society guidelines. Patients with normal thyroid levels were taken as controls. Detailed history taken, physical examination and routine laboratory investigations were done. Patients with SCH were started on Levothyroxine and serial monitoring of TSH done until delivery. The patients were followed up to assess the mode of delivery, maternal and fetal outcome and any associated co-morbidities to serve the secondary objective of the study. Babies of SCH mothers were screened as well to rule out congenital hypothyroidism.Results: Incidence of SCH was found to be 9.5% in the patients studied. Pregnant women with SCH had increased risks of developing anemia (31.5%), preeclampsia (15%), GDM (5%) and prematurity (10%), higher cesarean section rate (36.8%). Neonates of women with SCH had higher incidence poor APGAR score (47.36%), LBW (15%), NICU admission (10%), IUGR (5%). Increased maternal age and more BMI were associated with higher incidence of subclinical hypothyroidism.Conclusions: Prevalence of subclinical hypothyroidism among pregnant women is fairly high among Indians. Screening for subclinical hypothyroidism has to be included as a routine screening test and should be treated accordingly to improve maternal and fetal outcomes

Managing aplastic anaemia in pregnancy: a unique obstetric challenge

Aplastic anaemia during pregnancy poses a unique obstetric challenge due to its rarity and potential life-threatening consequences. This article explores the intricate management of aplastic anaemia in pregnancy through a detailed case report of a 23-year-old primigravida. Despite the absence of clear guidelines, the patient successfully navigated pregnancy with multiple transfusions, presenting a compelling example of obstetric and neonatal success. The discussion digs into the complex relationship between pregnancy and aplastic anaemia, emphasizing the need for a multidisciplinary approach and careful decision-making to balance maternal and foetal well-being. The conclusion highlights the importance of a comprehensive strategy, including vigilant transfusion techniques, foetal growth monitoring, and delivery planning at tertiary centres

Drotaverine to improve progression of labour among parturient women- a case control study

Background: Prolonged labour contributes to increased perinatal and maternal morbidity. Pharmacological interventions can hasten cervical dilation and help obstetrician to accomplish the delivery in the shortest possible time without compromising maternal and fetal safety. Aims and objectives were to evaluate the acceleration effect of drotaverine on the dilatation of the cervix in both primigravidae and multigravida and compare it with control group. Methods: A total of 70 patients were studied (35 in drotaverine group and 35 in control group). The inclusion criteria were pregnancy with at least 37 weeks completed, cervical dilatation 3-4 cm, regular uterine contractions and cephalic presentation. The study group received 40 mg drotaverine hydrochloride i.m. in active phase of labour, control group received standard delivery care. Parameters such as duration of first and second stage of labour, mode of delivery, neonatal outcome and side effects to drug was recorded. Results: 6 subjects from the study group and 4 from the control group developed complications in first stage of labour and were taken up for operative delivery and hence they were excluded from calculation of various labour parameters. The mean rate of cervical dilatation with drotaverine was 2.26 cm/hour, while it was 1.67 cm/hour without any intervention (p value <0.05). Mean duration of active phase of first stage of labor was 3.09 hours in drotaverine group against 4.98 hours in study group (p value <0.05). There were no significant untoward effects noted in either of the groups. Conclusions: Drotaverine was found to be an effective and safe drug in shortening the duration of the first stage of labor without any significant detrimental effects on the mother and newborn. Drotaverine did not interfere with uterine contractility and there was no increased incidence of operative deliveries.

Remnants of Greenstone sequence from the Archaean rocks of Rajasthan

An interesting association of granitoid-amphibolite-metasediments occurs around Jagat, southeast of Udaipur in Rajasthan. Lying a little south of the area from where 3.3-billion-year-old gneisses have been reported, these rocks compare well with the known greenstone associations of Archaean age. The mafic and granitoid rocks show chemical affinity with the modern volcanic arc rocks