First trimester serum vitamin D, hs-CRP and second trimester uterine artery diastolic notching in predicting gestational hypertension and preeclampsia

Background: Gestational hypertension and preeclampsia is one of the leading causes of maternal and fetal morbidity and mortality. The objective of this study was to study prediction of gestational hypertension/preeclampsia by using first trimester serum vitamin D and hs-CRP and second trimester uterine artery diastolic notching.Methods: It was an observational study conducted in the departments of obstetrics and gynaecology, clinical biochemistry and radiology, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India. All pregnant women with 11 to 14 weeks gestational age attending antenatal clinic between October 2012 and June 2013 were enrolled in the study. A detailed history including history of the duration of sun exposure was taken and a general physical examination including obstetrical examination was done at every visit. Serum sample were taken for hs-CRP and vitamin-D levels at 11-14 weeks. Uterine artery colour doppler study was done between 22-24 weeks for uterine artery diastolic notching. The main outcome measures were development of gestational hypertension/ preeclampsia/ eclampsia.Results: The mean vitamin D levels were significantly lower and mean hs-CRP levels were significantly higher in the hypertensive group as compared to the normotensive group, p=0.001 and p=0.004, respectively. Significant number women who developed hypertension had unilateral (46.2%) or bilateral (20.4%) uterine artery diastolic notching, p=0.005 and p=0.000, respectively. Crude’s odds ratio of uterine artery diastolic notching for prediction of hypertension in pregnancy was high, 9.894, 95% CI, 3.273-29.907 as compared to vitamin D (<13.5 ng/ml) and hs-CRP (>9.15 mg/L), 2.859, 95% CI, 1.418-5.763 and 7.16, 95% CI, 3.33-15.397.Conclusions: Uterine artery diastolic notching in the early second trimester is found to be the best predictor of PE followed by first trimester hs-CRP and vitamin D.

An unusual case of delivery with central rupture of perineum and intact introitus

Most women experience some degree of tear during childbirth and in some these can be extensive. Obstetrics injuries contribute 0.5-15% of vaginal deliveries. Here authors present a case of 23-year-old primigravida who presented at Safdarjung hospital New Delhi, Delhi, India with complaint of pain in perineum and excessive bleeding per vaginum. On examination, introitus was intact and there was central rupture of perineum which involved anal sphincter proximally and rectal mucosa distally. Patient was shifted to operation theatre for exploration and repair. She received 2 units of blood transfusion, antibiotics and laxatives. Patient was discharged on post-operative day 5 in satisfactory condition. Thus, authors emphasise the need of institutional delivery and prevention of perineal injuries which would further obviate the need for surgical repair and associated morbidity. In present era of easy communication and transport we still receive cases of unsupervised deliveries which gives us a strong motive to spread awareness for antenatal visits and care among this population.