Role of mRNA expression of interleukin-6 and interleukin-10 in idiopathic preterm birth

Background: India is one of the nation’s leading in number of preterm births (PTB), as reported by WHO. Despite extensive research the exact cause of PTB remains elusive. The present study was designed to study the effect of inflammatory genes (proinflammatory IL-6 and anti-inflammatory IL-10) in etiopathogenesis of idiopathic PTB.Methods: Maternal blood and placental tissue samples of PTB cases (n=263) and equal number of term delivery controls (n=263) were collected at the time of delivery. mRNA expression of IL-6 and IL-10 gene was analysed using Real-time PCR.Results: mRNA expression of IL-6 gene (pro-inflammatory) was 11.73 folds high in maternal blood and 2.60 folds higher in placental tissue in PTB compared to term birth cases. mRNA expression of IL-10 gene (anti-inflammatory) was 25 folds lower in maternal blood and 10 folds lower in placental tissue of PTB compared to term deliveries.Conclusions: Interleukins have been identified to have a major role in etiopathogenesis of idiopathic preterm birth

Role of nutrition in pre-eclampsia and eclampsia cases, a case control study

Background: Preeclampsia and eclampsia during pregnancy contribute to maternal and fetal morbidity as well as mortality. The identification of the role of maternal nutrition during pregnancy will help in reducing morbidity and mortality. Aims & Objective: The objective of this study is to find out the role of nutrition, in the form of total calorie, protein, fruits, iron, folic acid and calcium intake in the development of preeclampsia and eclampsia among pregnant women in a tertiary level hospital. Material Methods: After ethical approval and informed consent, 122 women who delivered beyond 22 weeks of gestation and diagnosed as preeclampsia or eclampsia were selected. Simultaneously, 122 controls with no diagnosis of preeclampsia or eclampsia were selected from the post natal ward. Cases and controls were administered the same pre-tested questionnaire containing questions related to food and micronutrient intake by cases and control. Results: Logistic regression was applied in the statistical analysis. The factors that were found to be significant predictors of risk for development of preeclampsia and eclampsia were higher calorie intake (adjusted Odds Ratio (OR) 14.12 [6.41-43.23] P < 0.001), less protein intake (adjusted OR 3.87 [1.97-8.01] P < 0.001) during pregnancy. Fruits intake in both cases and controls were similar. 77.9% of cases and 84.4% of controls had taken iron tablets during their antenatal period. 75.4% of cases and 82.8% of controls had taken calcium tablets during their antenatal period. Iron and calcium intake is not significantly associated with development of preeclampsia and eclampsia. Conclusion: Higher calorie intake and less protein intake during pregnancy were associated with development of preeclampsia and eclampsia. Fruits intake, iron and calcium intake were not associated with development of preeclampsia and eclampsi

Factor V Leiden mutation and acquired activated protein C resistance in Indian women with recurrent fetal loss

Objectives: To study the prevalence and association of factor V Leiden (FVL) mutation and acquired APC resistance (APCR) in women with recurrent fetal loss (RFL).Patients and Methods: Fifty women with two or more RFLs and 50 age‑matched controls with no history of fetal loss and at least one live birth were included in the study. Complete blood counts and screening tests for coagulation (PT, APTT), APCR, and FVL (PCR) were done in all women.Results: Age of the patients ranged from 20–42 years with a mean ± SD of 27.4 ± 4.8 years. Prolonged PT and APTT were observed in 2% and 8% cases, respectively. None of the controls had prolonged PT/APTT. APCR was observed in 8% cases and 2% controls. The prevalence of APCR was higher in women with first‑trimester fetal loss (24.2%) as compared to women with the second trimester (13.3%) fetal loss. FVL was not observed in any of the cases or controls.Conclusion: This study indicates that FVL mutation is not associated with RFL in the Indian population while APCR is observed in Indian women with RFL. Key words: Activated protein C resistance; factor V Leiden; recurrent fetal loss; thrombophilia

Nations within a nation: variations in epidemiological transition across the states of India, 1990–2016 in the Global Burden of Disease Study

18% of the world's population lives in India, and many states of India have populations similar to those of large countries. Action to effectively improve population health in India requires availability of reliable and comprehensive state-level estimates of disease burden and risk factors over time. Such comprehensive estimates have not been available so far for all major diseases and risk factors. Thus, we aimed to estimate the disease burden and risk factors in every state of India as part of the Global Burden of Disease (GBD) Study 2016

Patient safety in obstetrics and gynecology departments of two teaching hospitals in Delhi

Background: A healthy safety culture is integral to positive health care. A sound safety climate is required in Obstetrics and Gynecology to prevent adverse outcomes. Objective: The objective of this study was to assess and compare patient safety culture in two departments of Obstetrics and Gynecology. Materials and Methods: Using a closed-ended standard version of Hospital Survey on Patient Safety Culture (HSOPS), respondents were asked to answer 42 survey items, grouped into 10 dimensions and two outcome variables in two tertiary care teaching hospitals in Delhi. Qualitative data were compared using Fisher's exact test and chi-square test wherever applicable. Mean values were calculated and compared using unpaired t-test. Results: The overall survey response rate was 55%. A positive response rate of 57% was seen in the overall perception of patient safety that ranged from very good to acceptable. Sixty-four percent showed positive teamwork across hospital departments and units, while 36% gave an affirmative opinion with respect to interdepartmental handoffs. However, few adverse events (0-10) were reported in the last 12 months and only 38% of mistakes by doctors were reported. Half of the respondents agreed that their mistakes were held against them. There was no statistical difference in the safety culture between the two hospitals. Conclusions: Although the perception of patient safety and standards of patient safety were high in both the hospitals' departments, there is plenty of scope for improvement with respect to event reporting, positive feedback, and nonpunitive error

First Trimester Abortion: A Rare Cause of Intrauterine Bony Spicules

Bony fragments in the uterus occur after second trimester termination of pregnancy following retained fetal bones. Very rarely, they can form following first trimester loss. Clinical symptoms range from pain, menstrual symptoms, and infertility. Ultrasound shows a hyperechoic shadow, and treatment is by curettage or hysteroscopic removal

To evaluate the use of ProSeal laryngeal mask airway in patients undergoing elective lower segment cesarean section under general anesthesia: A prospective randomized controlled study

Background: Anaesthesia for caesarean section poses challenges unique to the obstetric patient due to changes in the airway and respiratory system. The choice of anaesthesia for caesarean section depends on various factors; however, general anaesthesia (GA) is necessary in certain situations. Supraglottic airway devices are an emerging method to secure the airway, especially in difficult situations. Of these devices, ProSeal laryngeal mask airway (PLMA) is designed to provide better protection of the airway. Use of PLMA has been reported to be successful as a rescue device in difficult intubation situations and in patients undergoing elective caesarean section without any complications. Hence, this prospective randomized study was designed to compare the use of PLMA with endotracheal tube (ETT) in patients undergoing elective lower segment caesarean section (LSCS). Material and Methods: Patients undergoing LSCS under GA belonging to the American Society of Anaesthesiologists (ASA) grades 1 and 2 were included. Patients with history of less than 6 h of fasting, known/predicted difficult airway, obesity, gastro-esophageal reflux disease, and hypertensive disorder were excluded. A standard anaesthesia protocol was followed. All patients received aspiration prophylaxis. The airway was maintained with either PLMA or ETT. The parameters including ease of insertion, adequacy of ventilation, hemodynamic changes at insertion and removal of device, and incidence of regurgitation and aspiration were noted. Statistical analysis: The data were analyzed by unpaired t-test, chi-square/Fisher′s test. Results: Findings of the study indicated that PLMA was easy to insert (20.67 ± 6.835 s) with comparable insertion time to ETT (18.33 ± 4.971, P = 0.136) and adequate ventilation was achieved with very minimal hemodynamic changes seen with PLMA as compared to ETT at the insertion and removal of devices (P = 0.01). There was no incidence of regurgitation with the use of PLMA. The incidence of postoperative sore throat was minimal (6.7%) with PLMA (P < 0.05). Conclusion: PLMA appears to be a safe alternative to ETT for selected obstetric patients undergoing elective LSCS. A further study with a large group of patients is required to establish the safety of PLMA in obstetric patients

Determination of risk factors for pre-eclampsia and eclampsia in a tertiary hospital of India: A case control study

Background: Preeclampsia and eclampsia (PE) are pregnancy specific syndromes that contribute to maternal and fetal morbidity and mortality. The identification of its predisposing factors in the pre-pregnancy and initial stage of pregnancy will help in reducing the morbidity and mortality. Aim: The aim of this study is to determine the risk factors for PE among pregnant women in a tertiary level hospital. Materials and Methods: In this study, 122 women who delivered beyond 22 weeks of gestation and diagnosed as preeclampsia or eclampsia were selected. Simultaneously, 122 controls with no diagnosis of preeclampsia or eclampsia were selected from the post natal ward. Cases and controls were administered the same pre-tested questionnaire containing different risk factors. Results and Conclusion: Logistic regression was applied in the statistical analysis. The factors that were found to be significant predictors of risk for development of PE were family history of preeclampsia (adjusted odds ratio [OR] 18.57 [1.93-178.16], P = 0.011), higher calorie intake (adjusted OR 14.12 [6.41-43.23] body mass index (adjusted P < 0.001), employment (adjusted OR 6.35 [1.56-25.82] P = 0.010], less protein intake (adjusted OR 3.87 [1.97-8.01] P < 0.001), increased OR 5.86 [02.48-13.8] P < 0.001), mild physical activities (adjusted OR 3.46 [1.06-11.24] P = 0.039). Past history of hypertension and diabetes mellitus were also associated with development of PE

Maternal and foetal outcomes of preeclampsia and eclampsia patients in a tertiary level hospital in Delhi

Background: Preeclampsia and eclampsia (PE) are diseases that occur due to pregnancy.PE affects the mother and foetal health throughout pregnancy. This leads to poor outcome of mother and newborn in the postpartum period. This study determined the maternal and foetal outcomes of preeclampsia and eclampsia patients from a tertiary level hospital were determined. Methods: One hundred twenty two women of preeclampsia or eclampsia, delivered beyond 22 weeks of gestation were allocated as cases. Simultaneously 122 women were selected as controls with no diagnosis of preeclampsia or eclampsia. The study was designed as a case control study. Foetal and maternal outcome of pregnancy was asked by using a pre-tested questionnaire. The data was collected from over two year period and statistically analyzed. Results: The percentages of preeclampsia and eclampsia cases were 2.54%and 0.79% respectively during the study period. Proportion of preterm deliveries was more in PE patients (32.0%) than controls (27.9%). Intra uterine death and still birth were reported more among PE cases (7.8% and 3.8% respectively) than controls (1.6% and 0.8% respectively). Two neonatal deaths were reported among PE cases. Incidence of low birth weight babies was more in PE cases (55.4%) than controls (43.1%). Bad obstetric history reported more in PE cases (30.3%) than controls (22.1%). Conclusion: Adverse foetal outcome in the form of intrauterine death, still birth, low birth weight, preterm delivery and neonatal deaths were observed more among PE cases. Bad obstetrics history was detected more in PE cases

Role of nutrition in pre-eclampsia and eclampsia cases, a case control study

Background: Preeclampsia and eclampsia during pregnancy contribute to maternal and fetal morbidity as well as mortality. The identification of the role of maternal nutrition during pregnancy will help in reducing morbidity and mortality. Aims & Objective: The objective of this study is to find out the role of nutrition, in the form of total calorie, protein, fruits, iron, folic acid and calcium intake in the development of preeclampsia and eclampsia among pregnant women in a tertiary level hospital. Material Methods: After ethical approval and informed consent, 122 women who delivered beyond 22 weeks of gestation and diagnosed as preeclampsia or eclampsia were selected. Simultaneously, 122 controls with no diagnosis of preeclampsia or eclampsia were selected from the post natal ward. Cases and controls were administered the same pre-tested questionnaire containing questions related to food and micronutrient intake by cases and control. Results: Logistic regression was applied in the statistical analysis. The factors that were found to be significant predictors of risk for development of preeclampsia and eclampsia were higher calorie intake (adjusted Odds Ratio (OR) 14.12 [6.41-43.23] P < 0.001), less protein intake (adjusted OR 3.87 [1.97-8.01] P < 0.001) during pregnancy. Fruits intake in both cases and controls were similar. 77.9% of cases and 84.4% of controls had taken iron tablets during their antenatal period. 75.4% of cases and 82.8% of controls had taken calcium tablets during their antenatal period. Iron and calcium intake is not significantly associated with development of preeclampsia and eclampsia. Conclusion: Higher calorie intake and less protein intake during pregnancy were associated with development of preeclampsia and eclampsia. Fruits intake, iron and calcium intake were not associated with development of preeclampsia and eclampsi