Changing Facets of Hyderabadi Tehzeeb: Are we missing anything?

In its historic evolution and development, the Hyderabad city has experienced many changes since its foundation as the capital of the medieval Kingdom of Golconda in the 16th century to its present status as the metropolis of a modern state. Each historic phase of development has significantly influenced its physical, social, economic and cultural growth. Hyderabad, under the influence of Deccan, Persian and indigenous culture, synthesised and evolved its very own Hyderabadi Tehzeeb. It truly represented the assimilation (yet uniqueness) of diverse cultures which inhabited Hyderabad. More than four hundred years later, HITEC city Hyderabad today presents a different picture. Whether it is its structural and spatial expansion, infrastructural development or its socio-cultural ethos, contemporary Hyderabad has evolved phenomenally and for many natives beyond recognition. Using ethnographic approach and secondary data, the paper introspects whether the City of Pearls has retained its unblotted tolerance and Hyderabadi Tehzeeb or has given up to the challenges of modern and globalizing times. Culturally, what is it that the natives of ‘Bhagyanagar’ irrespective of their caste, creed, gender, region and religion miss in modern Hyderabad

Fetal Doppler for prediction of adverse perinatal outcome in preeclampsia in a low resource setting

Background: To assess the usefulness of fetal Doppler in predicting adverse perinatal outcome in preeclampsia.Methods: All the women with preeclampsia from 30 weeks onwards were enrolled in the study. The umblical artery (UA) Systolic-diastolic (S/D) ratio>2standard deviation (SD) or UA-Pulsatility Index (PI) and UA-Resistive Index (RI) >2SD were taken as abnormal. The middle cerebral artery (MCA) was visualized and cerebroumblical PI ratio calculated. MCA-RI2SD (RR 4.46, 95% CI 1.40-14.17) and RI>2SD (RR 3.36, 95% CI 1.03-10.61) and MCA RI2SD predicted acute fetal distress in labour (RR 2.33, 95% CI 1.21-4.47), there was no association on multivariate regression analysis.Conclusions: This study showed UA-S/D ratio and UA-RI>2SD are significant predictors of perinatal deaths and immediate neonatal resuscitation in preeclampsia. Acute fetal distress in labour or neonatal nursery admission could not be predicted

Fetal growth and its correlation with level of glycemic control in pregnancy with diabetes: an observational study in tertiary care centre of North India

Background: Diabetes in pregnancy is a known risk factor for macrosomia and intensive glycemic control is a well-known strategy to prevent this macrosomia. However, does this tight glycemic control is actually beneficial or is it one of the reasons for small for gestational age babies in these women? Is a clinical enigma. We planned this study to see effects of glycemic control on fetal weight and to answer if tight control is always better.Methods: This prospective observational study was conducted in the department of obstetrics and gynaecology in a tertiary care centre (King George medical university) over a period of one year (June 2017-June 2018). All pregnant women with GDM and pre-gestational diabetes with singleton pregnancy were registered in the study after proper consent, followed up for glycemic control, fetal weight. Antepartum risk factors and complications of diabetes were also noted in these women.Results: Total 88 patients included in the study. Five with pre-gestational diabetes, 83 with GDM. Small for gestational age neonates were seen in 54.1% cases, large for gestational age were seen in 2 cases and rest of neonates were appropriate for gestational age. 89.4% had good glycemic control, 7% had over-zealous glycemic control and 3.5% had under-controlled sugars.Conclusions: The results in the study strongly supported the efficacy of good glycemic control in prevention of LGA/macrosomia. However, optimal glycemic control in third trimester does not guarantee appropriate weight of fetus as incidence of SGA/FGR neonates was fairly high (53.9%) even in good glycemic control group

Decoding the effect of time interval between hCG and IUI and sperm preparation and IUI

Background: The study was aimed to assess the difference in IUI outcome depending on the interval between hCG trigger and IUI and sperm preparation and IUI.Methods: The study was conducted in the Department of Obstetrics and Gynecology in Infertility unit at King George’s Medical University, Lucknow from January-December 2016. All the women eligible for IUI were included in the study. Once the follicle attained size of 17-18 mm, IUI was planned 36-48 hours after Inj. hCG 10,000 IU im. Semen processing was done in laboratory and time noted between sperm preparation and IUI. Outcome was confirmation of pregnancy by urine test. Cases were women in whom IUI was done 36-40 hours after hCG as against controls (>40 hours). Interval between sperm preparation and IUI was <30 minutes in cases and ≥30 minutes in controls.Results: A total of 624 cycles were included in the study. Clomiphene was used in 582/624 cycles (93.3%) gonadotropins used in 42/624 cycles (2.7%). There was a total of 23 conceptions in study (3.7%). Of these 8/98 (8.2%) were seen when the interval between ovulation trigger and IUI was 36-40 hours and 15/526 in cycles (2.9%) when the interval was more than 40 hours (p=0.023; OR-3.028 95% CI -1.247-7.352). Of a total of 23 conceptions in the study, 18/324 conceptions were seen when IUI was done within 30 minutes of sperm preparation as compared to 5/300 when interval was more than 30 minutes (p=0.01).Conclusions: IUI with ovarian stimulation is a simple and effective procedure and its outcome can be maximized keeping in consideration the availability of gametes. IUI performed within 36-40 hours of hCG trigger and within 30 minutes of sperm preparation can increase conception rates

Evaluation of causes of still birth in a tertiary care teaching hospital

Background: Whenever pregnancy occurs there is an expectation that every pregnancy will end with the birth of a healthy baby, yet in a developing country like India 22 in every 1000 births are stillborn. The objective of this study was to evaluate the rate and causes of still birth in a tertiary care teaching hospital, Queen Mary, King George Medical college and university, Lucknow, Uttar Pradesh, India.Methods: Present study was an observational study in a tertiary care hospital. 7024 births occurred in the institution over a period of 1 year out of which 550 were stillbirths. Stillbirths which weighed over 500 grams were included in the study. After informed consent, details of history about epidemiological factors, obstetric history and medical history were obtained. Antenatal investigations including imaging, delivery details and stillborn morphological characteristics were analyzed to identify the cause of stillbirthResults: Out of 7024 deliveries, stillbirth rate was 78.30/1000 total births. Cause of intrapartum stillbirth showed statistically significant correlation with patient’s place of residence (rural>urban), distance of health centre from her house, time taken to reach first point of contact and her parity. The major obstetrical causes of stillbirth identified were APH 22.36%, hypertensive disorders of pregnancy 19.27%, IUGR 15.27%, unexplained causes 11.09%, mal-presentations 9.64%, rupture uterus 9.09% and obstructed labour 6.36%. Severe anemia was found in 24.91% as an associated obstetrical cause of stillbirth.Conclusions: The rate of stillbirth is higher as compared to the Indian data (22/1000 total births). Antepartum obstetric complications (APH, hypertensive disorder of pregnancy, IUGR) were the most common. 15.45% cases showed intrapartum causes of stillbirth (obstructed labour and rupture uterus) which was significantly higher than developed countries where such cases are negligible. The higher number of intrapartum deaths indicate that better healthcare services can drastically reduce stillbirth rates in developing countries

High rate of caesarean section in cases of intrauterine fetal demise in a low resource setting: Why?

Background: Stillbirth as an obstetric complication is emotionally devastating for the women as well as the clinician and having a caesarean section for stillbirth is even more catastrophic. The aim of the present research was to study the indications of caesarean section in women with intrauterine fetal demise in a low resource setting.Methods: This was an observational study for assessing the indication of caesarean section among 222/ 550 stillbirths from June 2013 to May 2014 in a tertiary care teaching hospital of North India. 7024 births occurred in the institution over a period of 1 year out of which 550 were stillbirths. Stillbirths which weighed over 500 grams were included in the study. Details of women with intrauterine fetal demise in which caesarian section was done were noted and analyzed.Results: Out of 550 stillbirths, 222 women underwent caesarean section. Rate of caesarean section among women with stillbirth was 40.36%.  Placenta previa (23.87%), Rupture uterus (22.1%), obstructed labour (10.8%), transverse lie (9.45%), failed induction (7.20%), massive abruption (5.86%), non-progress of labour (5.40%), eclampsia/pre-eclampsia related causes (4.95%), acute fetal distress (4.95%), were leading indications of caesarean sections. Out of 222 women, 162 (73%) women had anaemia (Hb <11g%). Severe anaemia (haemoglobin less then 7gm/dl) was present in 51 cases (23%).Conclusions: Caesarean section done for intrauterine death in present study were mostly inevitable. Reducing intrapartum stillbirths by improving essential obstetric services will ultimately result in reducing caesarean section rates in stillbirths in developing countries. Further studies are needed both in developing and developed countries to strategize the management of intrauterine dead fetus to prevent such high rate of caesarean section

Hyperhomocysteinemia and MTHFR gene 677 C>T polymorphism: questionable role in female infertility

Background: Homocysteine is an intermediate in methionine metabolism required for the biosynthesis of nucleic acids. Hyperhomocysteinemia affects various organ systems and also has been implicated as a risk factor for infertility. Elevated levels result either from genetic mutations of the enzymes catalyzing the metabolic pathway or deficiency of micronutrients required as co-enzymes for the same. The aim of this cohort study was to evaluate serum homocysteine levels and MTHFR gene 677C&gt;T mutation and to establish a possible relation between hyperhomocysteinemia, genetic polymorphism and female infertility.  Methods: Ninety-five infertile women were enrolled over a period of one year and categorized as unexplained, anovulatory and male partner factor infertility according to the etiology. Thirty-one age-matched fertile women were enrolled as controls. Serum homocysteine levels were evaluated and genetic analysis for MTHFR gene mutation 677C&gt;T was done.  Results: Mean homocysteine levels for the women in three infertile groups were comparable (group I - 16.21 ± 3.39 µmol/l, group II - 16.36 ± 3.56 µmol/l, group III - 16.98 ± 3.14 µmol/l) within the groups as well as with the fertile group (15.85 ± 9.3 µmol/l) with no statistically significant difference (P = 0.573). Prevalence of hyperhomocysteinemia was 86.3% for infertile group and 90.3% for fertile group. Nineteen heterozygous (CT) and 3 homozygous (TT) mutations were noted among infertile subjects and 8 heterozygous (CT) mutations among fertile subjects prevalence being similar for both the groups.  Conclusions: Significant prevalence of hyperhomocysteinemia and MTHFR polymorphism was observed in the studied population. The study did not establish a positive role of hyperhomocysteinemia and MTHFR mutation in female infertility.

Association of serum placental growth factor and pregnancy associated plasma protein A between 11 to 14 weeks and pre-eclampsia

Background: Pre eclampsia complicates around 5-10% of pregnancies worldwide. Many countries in the world are far away of having interventions to predict and prevent preeclampsia. A number of biochemical, biophysical and sonographic parameters are emerging as a potential tool which can help us in a long way. This study was aimed to study association of biochemical markers of preeclampsia in early pregnancy with the development of preeclampsia.Methods: This cohort study was conducted over a period of one year in the Department of Obstetrics and Gynecology at King George’s Medical University, Lucknow.Results: Total number of women enrolled at 11-14 weeks were 56. The mean age of women enrolled was 28±4.2 years. Out of total 44.6% women were nulliparous. Mean crown rump length at testing was 60.55±11.26mm. There was a significant correlation between the levels of Placental growth factors and development of PE (p<0.01) and especially severe early onset disease, however we did not found a significant correlation between Pregnancy associated plasma protein and Preeclampsia.Conclusions: Placental growth factor is an emerging marker which could be incorporated in essential bundle of care at 11 to 14 weeks testing in order to enhance the detection rates of preeclampsia

Correlation of serum homocysteine levels and pregnancy outcome: the dilemma continues

Background: Hyperhomocysteinemia has been implicated as a risk factor for complications in pregnancy including abortion, preeclampsia and placental abruption. The present study was designed to study the correlation, if any, of Hyperhomocysteinemia with pregnancy outcome.Methods: Pregnant women between 14 to 24 weeks of gestation were included as subjects. Serum homocysteine levels and MTHFR gene (Methylenetetrahydrofolate reductase 677C>T) polymorphism was estimated. The women were followed till delivery and obstetric & neonatal outcomes were noted.Results: A total of 81 women were followed till delivery. Out of these 42 women had an uncomplicated pregnancy and delivery and 39 women had at least one antenatal or perinatal complication. Difference between mean serum homocysteine in both the groups was not statistically significant (p=0.403).No significant difference was found in the occurrence of different genotypes in the 2 groups though women with TT genotype were found to have higher serum homocysteine levels as compared to other genotypes.Conclusions: Though the serum homocysteine levels were higher in the women with pregnancy complications as compared to women without complications but the difference was not statistically significant

Prediction of pre-eclampsia at 11-14 weeks of pregnancy using mean arterial pressure, uterine artery Doppler and pregnancy-associated plasma protein-A

Background: The possibility of prediction of preeclampsia (PE) at 11-14 weeks of pregnancy is a fairly new concept and in recent years, studies combining various parameters at 11-14 weeks of pregnancy have been undertaken, but an algorithm with a high predictive value is yet to be developed. The objective of this study was to develop such a protocol using mean arterial pressure (MAP), uterine artery Doppler and PAPP-A (pregnancy associated plasma protein-A) at 11-14 weeks of pregnancy (individually or in combination) for prediction of preeclampsia in a developing country like India.Methods: A prospective cohort study was done at the Department of Obstetrics and Gynecology, King George Medical University, Lucknow, Uttar Pradesh with pregnant women attending the antenatal OPD at 11- 14 weeks of gestation. A preformed questionnaire was filled for the enrolled women, MAP, blood pressure was recorded, uterine artery Doppler was done, serum sample for PAPP-A was drawn. Uterine artery Doppler pulsatility index (PI) at 11-14 weeks of pregnancy was found to be a good screening method (sensitivity-75.9%, specificity-79.6% at cut-off of 1.7) for prediction of preeclampsia and IUGR. The data was analyzed using SPSS (Statistical Package for Social Sciences) Version 15.0 statistical analysis software.Results: Out of the 78 women enrolled, 29 women (37.18%) developed complications. Uterine artery Doppler pulsatility index (PI) at 11-14 weeks of pregnancy was found to be a good screening method (sensitivity-75.9%, specificity-79.6%) for prediction of preeclampsia and IUGR. Presence of early diastolic notch on uterine artery Doppler was found predictive for IUGR. MAP and PAPP-A were not found to have a significant correlation with development of these complications.Conclusions: This study concluded that uterine artery Doppler alone was a good screening method at 11-14 weeks of gestation for women at high risk of developing preeclampsia and related complications