Gestational diabetes; sensitivity, specificity and diagnostic accuracy of glucose challenge test in diagnosis

To find sensitivity specificity and diagnostic accuracy of Glucose Challenge test in diagnosing Gestational Diabetes in Pregnant women. Due to poor socioeconomical and educational status, dietary habits and ignorance regarding pregnancy related problems probably increase the prevalence and burden of gestational diabetes mellitus [GDM] and its complications in pregnancy. Best and simple strategy to identify women with gestational diabetes is still lacking and unclear. Cross sectional study. This study was performed at Jinnah Hospital Lahore, from Nov 2005 to Dec 2006. A glucose challenge test [GCT] was performed on 500 selected pregnant women by giving 50-g glucose in water orally. A serum glucose level ?140 mg/dl after an hour was taken as positive test. To confirm GDM, 75 g glucose in 200 ml of water was given and sugar levels after 2 hrs by Glucometer, >200 mg/dl confirmed GDM. An increasing trend in age, gestational age and BMI and a significant difference regarding positive family history of diabetes and gravidity was seen in patients with GDM compared to normal pregnant. The maximum percentage of GDM 2 was noted in multigravida, between 25-29 years, BMI >28kg/m, and a gestational age of 28 weeks. The sensitivity of GCT was 80%, specificity 97.8%., and diagnostic accuracy was 96.4%. Screening is necessary to identify women with GDM. A 50-g glucose challenge test might be acceptable as a screening test for GDM as it has high sensitivity, specificity and diagnostic accuracy

Induction of labour; routive induction at 40 weeks of pregnancy

The aim of this study to justify induction of labour at 40 weeks of pregnancy in our population. Quasi experimental study. Combined Military hospital Attock, Obstetric and Gynaecology Department from 1.6.2011 to 1.2.2012. 100 patients were selected from outpatient department, and divided into two groups, group A, with 50 patients at 40 weeks and group B with 50 patients at 41 weeks. Booked or unbooked patients with singleton pregnancy with cephalic presentation, were selected by non propability consecutive sampling technique. Pregnancy with previous scar, medical disorder, polyhydramnios, multiple fetal and uterine abnormality and intrauterine death, placenta previa, were ruled out excluded from study. Postdate pregnancy was confirmed clinically by last menstrual period and early dating ultrasound. Patients were clinically followed for fundal height, presentations and FHR. Bishop scoring was done and patients were induced mechanically with cervical foley and vaginal pessary PGE2 according to bishop score. Amniotomy was done at bishop score more than 7. Labour was monitored with full protocol. Same procedure was repeated for group B of 50 patients who were selected according to criteria, for induction of labour at 40 weeks of pregnancy. Maternal and fetal outcome was analysed in term of mode of delivery and APGAR score respectively. Out of 100 patients, 50 patients with age 20 to 35 year, presenting at 40 weeks were included in group A. Spontaneous vaginal delivery was seen in 30 patients [60%], 4 by vaccum[8%], 3 by forcep delivery [6%], 13 patients ended up into emergency LSCS [26%]. In group B of 50 women, planned for induction at 41 weeks, emergency cesareans were 23 [46%]. MAS was in 9[18%] babies as compared to 2% in group A and, Fetal distress [type 2 dips] were found in 3[6%] cases. Neonatal outcome was assessed with help of APGAR score. Babies delivered with good APGAR were 47 in group A, as compared to 41 in group B. Rate of vaginal delivery was high in group A [74%] induced at 40 weeks. Results were analysed by using SPSS 10 and p-value was found to 0.024. No difference was found in the incidence of fetal outcome with APGAR SCORE 10, and fewer babies were with poor APGAR SCORE and p=0.051. Induction at 40 weeks may reduce perinatal mortality and incidence of MAS. It does not increase risk of caesarean section when compared with induction at or beyond 41 weeks

Induction at poor bishop is justified

Objectives: To prove that induction at poor bishop is not justified

Study design: A Prospective study

Place and duration: Obstetrics and Gynecology Department of Military Hospital Rawalpindi from September 2011 to Feb 2012

Methodology: Total of 1852 women were included by non-probability consecutive sampling technique, irrespective of parity at term with singleton healthy pregnancy in vertex presentation and were divided into two groups on basis of their bishop score. Health volunteers, cases of uterine rupture, previous cesareans, uncontrolled medical disorder and pregnancy with fetal anomaly for termination were excluded. Ultrasound for fetal wellbeing were done and strict feto maternal monitoring was done during labor. Medical and elective indications and Bishop Scores were recorded before labor induction. Cervical foley no 16 was used in patients with B/S >3. [Group - A] and tablet Prostin E2 was used in patients with B/S< 3 [Group - B] as an initial agent to induce labor. Outcomes like mode of delivery, mean parity and mean age was analyzed by spss11 and P value was found out Performas were attached with patient's case notes

Results: The cesarean section rate was 32.6% [n=605], SVD were [n=1247]. Induction for medical reasons were 14.8% [n=275], with PROM 12.7% [n=237], women with fetal compromise were 11.7% [n=218], with macrosomia 9.07% [n=24], with mild pains 15.3% [n=285], with postdate pregnancy 16.4% [n=340], post term 18.4% [n=305] and patients with oligohydramnios were 1.2% [n=168]. Among 1852 from 38 week to 41 week, 1372 patients in group A, with bishop score >3. Rest of 480 were in group B, induced at bishop score <3. In group A, who were induced at B/S >3, total CS were 215, [150 with failed trial of labour] and 1157 were SVD. 65 CS were due to fetal distress. Total CS in group B, with failed trial were 300, C-Section due to fetal distress n=90. SVD were 90 and p=0.001. Mean age was 33.8 years. Mean parity found to be was 2.8 para. Difference in no of CS and SVD in both groups on basis of their bishop score was statically significant and was = 0.001

Conclusion: Bishop Score at time of induction should be >3 and induction at poor bishop should be avoided to control the rate of cesarean section

Gestational hypertension; maternal and fetal outcome in women with role of hyperurecemia

Aim of the study was to ascertain prospectively the prognostic value of serum uric acid for fetal and maternal outcomes in women with gestational hypertension. This prospective study was conducted at department of Gynae and Obs, Maternal and Child Health Center, PIMS Islamabad, from January to December 2003. A total of 200 women with a gestational age >20 weeks, and blood pressure >130/90 mmHg were inducted in the study. At presentation serum uric acid, creatinine, hemoglobin, and platelets were measured along with blood pressure. All patients were divided into group A [uric acid <4.5 mg/dl] and group B [>4.5 mg/dl] and were followed for one month after the delivery to record pregnancy and neonatal outcome. A significant difference [p<0.05] in the levels of uric acid, hemoglobin, platelet count, creatinine and blood pressure was noted between patients of group A and B. A significant decrease [p<0.05] in preterm delivery, baby birth weight and increase in fetal mortality was noted in patients of group B as compared to those of group A. Regarding maternal outcome preeclampsia [p=0.005, CI: 0.143-0.689], deranged liver functions [p=0.000, CI: 0.062-0.397], and disseminated intravascular coagulation [p=0.005; CI: 0.049-0.626] was noted in patients of group B as compared to group A. The patients of Group B showed a significant low birth weight, increased fetal mortality rate [p=0.005, CI: 0.030-0.622] and more chances of shifting neonates to NICU [p=0.002, CI: 0.164-0.667] as compared to those of group A. Hyperuricaemia in setting of gestational hypertension was associated with adverse fetal and maternal outcome

Emergency contraception: knowledge, attitude and practices among doctors of a tertiary care hospital

In Pakistan maternal mortality rate [MMR] is very high and more than one in five women die from pregnancy related causes; solution to this is to have low fertility rate. The emergency contraceptives [ECs] can be used to prevent unwanted pregnancies. The aim of this study was to assess the knowledge, attitude and practice about ECs among doctors. Institution-based crosssectional descriptive study on knowledge, attitude and practice of ECs was conducted at Rawal Hospital from Feb to May, 2012. Data was collected using structured questionnaire and analysed using SPSS-16. Fifty-seven percent of the respondents were >30 years of age, 94% were Muslim, 81% were married and 51% were women. Ninety-seven percent had heard of ECs before, only 17% knew Intra-uterine contraceptive device [IUCD] a method of EC. Sixty-one percent responded that IUCD should be removed if patient gets pregnant [p=0.007] and according to 31% ECs were not abortifacient [p=0.045]. Regarding attitude, 55.5% of the participants supported its use [p=0.027] and agreed to its easy accessibility [p=0.004]. Thirty-eight percent responded an increased dose of birth control pills as a form of EC [p=0.008], while 40% did not agree that ECs are effective when taken before intercourse [p=0.011]. Knowledge and practice of ECs is very low among doctors but a positive attitude is there. Evidence-based knowledge to family physicians regarding emergency contraception is strongly recommended to reduce the chances of MMR