Association of gestational weight gain and pre-pregnancy body mass index with adverse pregnancy outcome

To determine the association between gestation weight gain [GWG] and adverse pregnancy outcome in a Pakistani population. Analytical study. The Aga Khan University, Karachi, from February 2003 to 2007. This study used secondary data of 4,735 women from a large cohort study on fetal growth. Pre-pregnancy BMI was categorized according to the recommendations from the institute of medicine [IOM, 2009] and gestation weight gain [GWG] was noted. Chi-square test was used to find the association of GWG and pre-pregnancy BMI with low birth weight [LBW], preterm delivery, large for gestational age [LGA], and caesarean section. Logistic regression analysis was performed to control for confounders like age, parity, working status and ethnicity. The prevalence of LBW decreased with increasing BMI. GWG of the population was noted as 8.5 kg. LBW was observed to have an inverse relationship with GWG. Women below the age of 19 were twice more likely to have LBW than above 35 years of age. Weight gain above the recommended range were twice more likely to have large for dates. Overweight women were 1.5 times more likely to deliver preterm whereas obese women were 1.4 times more likely to undergo caesarean section than women with normal BMI. The optimal weight gain was estimated to be 8.5 kg to prevent low birth weight in our population. Obese women are more likely to have LGA, caesarean sections and pre-term deliveries

accuracy of ultrasound in the diagnosis of congenital abnormalities

To determine the accuracy of ultrasound in the diagnosis of congenital abnormalities at the Aga Khan University Hospital, Karachi. The data of congenital abnormalities was obtained from the obstetrical database and medical records of all cases complicated by congenital abnormalities, delivering from January 2001 to December 2003 and was reviewed. Antenatal ultrasounds had been performed by operators with different level of experience. In addition this data was retrieved from the termination and Congenital anomaly register. A structured data collection form was used to collect information of different variables of interest. Congenital abnormalities, complicated 2.8%[n=170], of all deliveries, including all cases of termination of pregnancy, stillbirth and live births. Out of the total, 11.6% occurred in women above the age of 35 years. Consanguinity was found in 18.2% cases. Prenatal diagnosis was made in just under half of the cases [48.8%]. Central nervous system and renal abnormalities were commonly diagnosed. However, facial defects, heart defects or skeletal defects were more commonly missed. Antenatal ultrasound successfully diagnosed foetal abnormalities in 48.8% of cases, and more than 90% Central Nervous system defects and renal abnormalities. In contrast about a quarter of Cardiac defects and none of the facial defects were detected. Based on these findings we recommend that the Sonologist should incorporate four chamber view of the heart and also look at the face carefully

Frequency and diagnosis of bacterial vaginosis

To determine the frequency of bacterial vaginosis [BV] in women with vaginal discharge, and to compare different diagnostic tests for its diagnosis. Cross-sectional study. The Aga Khan University Hospital from June 1998 to May 2000. All women attending the Obstetrics and Gynecology clinics at The Aga Khan University Hospital, with the complaints of vaginal discharge, were examined with the help of a speculum. The vaginal pH was measured, samples for bacterial cultures were obtained. A slide was prepared for the gram's stain and Whiff-test was also performed. BV was diagnosed, when the vaginal discharge fulfilled at least three of the composite clinical criteria [Amsel's criteria], a st and ard method for the diagnosis of bacterial vaginosis: homogenous [pasty] discharge, pH more than 4.5, positive Whiff-test and the presence of clue cells. The frequency of BV was observed to be 16.1%. The culture for Gardnerella vaginalis was compared with the composite clinical criteria. The sensitivity, specificity, positive and negative predictive values of the culture, calculated for the diagnosis of BV were 93.8%, 70%, 37.7% and 98% respectively. The use of laboratory tests in conjunction with clinical findings is necessary for diagnosis of BV. The composite clinical criteria for the diagnosis of BV are rapid, reliable and inexpensive method