Serum β HCG and lipid profile in early second trimester as predictors of hypertensive disorders of pregnancy

Background: Hypertensive disorders complicating pregnancy are common (5-10%) and form one member of the deadly triad, along with haemorrhage and infection that contribute greatly to maternal morbidity and mortality rates. Although overt illness rarely appears until third trimester, there are multiple indications that the disease process begin early in the pregnancy. Since years there has been a search for an early predictor of PIH so that special antenatal care can be given to these patients. This prospective study was one of the efforts to predict preeclampsia by measuring serum beta HCG levels and lipid profile in 2nd trimester of pregnancy.Methods: This was a prospective study carried out on 200 pregnant women attending the outpatient antenatal clinic and estimating serum beta HCG and lipid profile in early second trimester.Results: Most of the women who entered the study were in the age group of 21-30 years. Out of 200 patients, 164 remained normotensive and 36 turned out to be hypertensive. 50% of patients in the normotensive group and 75% in the hypertensive group were primigravidas indicating that primigravidas have a higher risk of developing PIH compared to multiparas. No correlation was found between the residence and occurrence of hypertension. Among 45 patients with beta HCG >40,000mIU/mL, 30 developed hypertensions, whereas, among 155 patients who had levels 200 mg/dl. Among the hypertensive group, 83.4% cases had levels >250 mg/dl. A significantly higher number of hypertensive cases i.e.75% had serum VLDL >40 mg/dl. 83.4% of hypertensive patients had serum LDL >140 mg/dl. In our study, 5.5% of the cases among normotensive group had serum HDL <40 mg/dl whereas, 16.6% of cases among the hypertensive group had serum HDL <40 mg/dl.Conclusions: Women with raised serum beta HCG and/or dyslipidemia should be carefully followed up to achieve a more favourable outcome for both mother and the fetus

Analysis of caesarean section rate according to modified Robson’s classification at tertiary care centre in Uttarakhand, India

Background: High caesarean section rate worldwide including India is matter of concern. The aim of this study is to analyse caesarean section rate at tertiary care centre according to Modified Robson’s classification.Methods: This retrospective study was conducted at Shri Guru Ram Rai Institute of Medical and Health Sciences (SGRRIMHS) and Shri Mahant Indiresh Hospital at Dehradun from April 2018 to September 2018. All women delivered during this period were classified according to modified Robson’s classification using their maternal characteristics and obstetric history. For each group, authors calculated the caesarean section rate within the group and its contribution to overall caesarean section rate.Results: Out of total 1302 women delivered, 395 underwent CS (30.3%).The major contribution to overall caesarean section rate was 33.4% by group 5 (Previous CS, singleton, cephalic, >37weeks) followed by 16.7% by group 1 (nullipara, singleton, cephalic, >37 weeks, spontaneous labour), 12.4% by group 3 ( multipara, singleton, cephalic, >37 weeks, spontaneous labour ).CS rates among various group ranges from 100% among women with abnormal lie (group 9) to 77.5% in nulliparous breech (group 6), 73.7% in previous CS (group 5) and least 11.2%  in multipara induced or pre labour CS (group 4).Conclusions: Modified Robson classification is simple, systematic, reproducible and can be effectively utilized in analyzing delivering women. Major contribution to overall caesarean section is made by previous CS

Epidemiology of MTP in a tertiary care center over a period of 3 years

Background: Medical termination of pregnancy was legalized in India under the MTP act of 1971 which states that all the women can legally have an abortion up to 20 weeks of gestation if indicated. This study is a retrospective analysis of incidence, indication, the age group availing the facility, socio-demographic and obstetric profile of MTP seekers and the method of contraception followed after MTP.Methods: A retrospective 3-year data was analyzed by MTP register of the hospital as a reference.Results: The incidence rate of MTP is 96/1000 live births in the institute. The main reason for MTP is failure of contraception which highlights the unmet need of contraception and counselling. Majority of the age group availing MTP belonged to 16-20 years. Most of the women were   from urban slums, were illiterate and belonged to class IV and V according to Prasad’s classification. Mostly MTP seekers were parous, having ≥2 living children, and maximum no. of them went to private hospitals for their previous MTP. Medical method was the most favoured method of the care giver as well as of the patient. OCP was the choice of contraception after MTP. Religious difference is still very evident in availing   MTP services which can be minimized by tactful counselling. Conclusion: MTP act of 1971 opened new horizons for the unwanted pregnancies. Young population opting for MTP indicates the unmet need of contraception and counselling suggesting that implementation and integration of MTP services should be at the root level

Intrahepatic cholestasis of pregnancy: maternal and fetal outcome and its correlation with serum bile acid levels

Background: Maternal, fetal, and neonatal outcomes in parturients with intrahepatic cholestasis of pregnancy (ICP) have been retrospectively documented. We aimed to present pregnancy outcomes of parturients with ICP who underwent delivery. The study was conducted during a 1-year period in a tertiary care centre.Methods: Data from 1 January to 31 December 2017 were collected to identify parturients with ICP.Results: Almost 3/4th of births came to a vaginal delivery (76.74%) and only 10 parturients had cesarean delivery. 4 of 10 parturients underwent nonelective cesarean section, while 6 had elective cesarean delivery. 15.15 % vaginal deliveries were instrumental. The most common indications for emergency LSCS and instrumental deliveries was fetal distress followed by failure to progress of labour. Most births occurred at or after 37 weeks of gestation (65%).  Regarding neonatal outcomes in terms of birth weight and Apgar scores at 1 and 5 min, they were positive, as well.  None of the babies had Apgar score < 7 at 5 minutes. No case of perinatal death was observed.Conclusions: Although the results were generally positive, larger studies need to be conducted to evaluate the maternal and fetal outcomes in ICP and correlation with serum bile acid levels

Effect of antibiotics on inflammatory marker (IL-6) and perinatal outcomes in women with preterm premature rupture of membranes

Background: The aim is to study the effect of antibiotics on inflammatory marker (IL-6) and perinatal outcomes in women with preterm premature rupture of membranes (PPROM).Methods: 60 women with PPROM at 28–34 weeks of gestation were enrolled in the study. All the women were given antibiotics as per hospital protocol and were subjected to blood sampling for Interleukin -6(IL-6) at admission, delivery and umbilical cord blood. IL-6 levels were assessed for associations with adverse perinatal outcomes and the effect of antibiotic treatment on IL-6 and perinatal outcomes were studied. The data were analyzed using t test and χ2 test.Results: Increased level of IL-6 was associated with chorioamnionitis and neonatal sepsis (p<0.001). High level of IL-6 led to early delivery and complete course of antibiotics suppressed IL-6 (p<0.001) and clinical chorioamnionitis in women with PROM. Full course of antibiotics also decreased the admission rate of babies to neonatal intensive care unit and suppressed respiratory distress syndrome, neonatal sepsis.Conclusions: Increased level of IL-6 is seen in women with chorioamnionitis and neonatal sepsis. Antibiotics suppress the IL-6 levels, chorioamnionitis and neonatal sepsis

Bandgap current reference using widlar current source

This paper has proposed a temperature insensitive current reference (CR) using Widlar current source. This CR has overwhelmed the direct relation of current to temperature present in Widlar current source. To obtain temperature insensitivity the proposed CR has been combined the complementary temperature behavior of current across MOSFET and BJT. Eldospice has supported the simulations of the proposed circuit using level 53, 0.18 µm CMOS technology with the help of EldoSpice. The proposed circuit has presented almost constant reference current of 63µA at a supply voltage of 1.8V for a temperature range of -30 to 100 °C. The proposed circuit has shown the maximum variation of 0.1µA as compared to 24.87µA in conventional Widlar current source

Bandgap current reference using widlar current source

934-938This paper has proposed a temperature insensitive current reference (CR) using Widlar current source. This CR has overwhelmed the direct relation of current to temperature present in Widlar current source. To obtain temperature insensitivity the proposed CR has been combined the complementary temperature behavior of current across MOSFET and BJT. Eldospice has supported the simulations of the proposed circuit using level 53, 0.18 µm CMOS technology with the help of EldoSpice. The proposed circuit has presented almost constant reference current of 63µA at a supply voltage of 1.8V for a temperature range of -30 to 100 °C. The proposed circuit has shown the maximum variation of 0.1µA as compared to 24.87µA in conventional Widlar current source

Evaluation of simple International ovarian tumor analysis ultra sound rules in differentiating between benign and malignant ovarian tumors and their histopathological correlation

Background: IOTA (International ovarian tumor analysis) study is considered one of the largest studies on ultrasound diagnosis of ovarian pathology conducted in literature till date. It was started in 1999 and included nine European countries. It is a standardized technique for preoperative classification of ovarian pathology defined by IOTA group.Methods: A retrospective study was analyzed from a period of January 2016 to December 2017 (2-year period). The records of all the patients operated for benign and malignant ovarian pathology in the gynae department of hospital were retrieved from medical record sections. USG findings were redefined as per IOTA simple rules by sonologist and its histopathological correlation was done using kappa statistical method.Results: In the present study, out of 61 patients IOTA was applicable to 57 patients. The sensitivity where IOTA simple rules were applicable was 92.8% and the specificity was 93%. The accuracy turned out to be 92.9%. If inconclusive results were taken as malignant then sensitivity increased to 94% and specificity decreased to 87%. Good level of agreement was found between sonological and histopathological findings with Kappa statistics application (K = 0.59).Conclusions: The IOTA simple rules can be considered as an important diagnostic modality in differentiation of benign and malignant ovarian tumors, it has an added advantage of abolishing the subjectivity of routine ultrasound. However inconclusive results demand further expertise in the field and need to be taken care of before interpretation of ovarian pathologies

Potential effect of Citrus decumana extract on stress induced peptic ulcer in rat

The present study was designed to investigate the antiulcer activity of ethyl acetate extract of Citrus decumana (grapefruit) peels. The antiulcerogenic activity was evaluated in water immersion and hypothermic restraint stress models at different doses (150, 250 and 350 mg/kg). The antiulcer potential of the extract was assessed by determining and comparing the ulcerative index and biochemical estimation was carried out using various oxidative stress markers i.e., TBARS, GSH, SOD and CAT in the blood and tissue samples. The highest dose (350 mg/kg) of the extract showed significant decrease in the ulcerative index and TBARS level, whereas there was increase in the GSH, SOD and CAT levels. Whereas the lowest and medium dose (150 mg/kg and 250mg/kg) did not produce any significant results. Therefore, our study indicate that the Citrus decumana peel extract may be used as a natural therapeutic agent in the treatment of peptic ulcers.Colegio de Farmacéuticos de la Provincia de Buenos Aire