ABSTRACT
Background: Perinatal mortality still continues to be high in India. The most important reason is that 60% of perinatal deaths are constituted by stillbirths and reducing stillbirth rate has always been a challenge to obstetricians for decades. In order to reduce the stillbirth rate it is mandatory to ascertain the various determinants of it. Studies regarding this in the north-eastern part of India are almost non-existent. Objectives: The objectives of the current study were to estimate the magnitude of stillbirth and also to ascertain the association between stillbirth and maternal and foetal factors. Methods: A hospital-based prospective study was done in the Department of Obstetrics and Gynaecology of RIMS, Imphal, Manipur in the year 2003. Data regarding socio-demographic backgrounds, detailed obstetric history, examination and investigative findings and pregnancy outcome was collected from 5,588 mothers who gave to 5,672 deliveries. Results: The stillbirth rate was found to be 17.6 per 1,000 births. The statistically significant determinants of stillbirth were rural residency, low educational level, age than 40 years, high parity, un-booked cases, anaemia, hypertension, high parity, twin delivery, presence of risk factors, breech delivery, preterm delivery and low birth weight. Conclusion: Stillbirth rate continues to be high in the north-eastern part of the country. And many of the determinants of stillbirth found out were preventable factors.
ABSTRACT
Background: Stillbirth constitutes about 60% of the perinatal deaths. And this is an event which has always challenged the obstetricians for decades. Various maternal, foetal and placental factors may result to stillbirths. Yet, in spite of the modern facilities available and advances made in the medical field, many times no contributing factors can be attributed to the exact cause of stillbirth and refusal of autopsy examination seals the chapter, with the cause of stillbirth remaining unexplored. Objective: The objective of the current study was to explore the maternal, foetal and placental conditions associated with stillbirth and to ascertain the common causes of stillbirth. Methods: A hospital-based prospective study was conducted in the Department of Obstetrics and Gynaecology, Regional Institute of Medical College, Imphal, Manipur in the year 2003. At the time of admission, after obtaining informed verbal consent, a detailed history was taken followed by thorough physical examination and routine investigations were dome for all the admitted patients in the antenatal ward. After delivery, all the women who had stillbirth were approached again to undergo special investigations like blood sugar estimation, VDRL test, urine examination for culture and sensitivity, ELISA for HIV and TORCH antibodies, Widal test, liver function tests and kidney function test. Based on the above findings, the stillbirths were analysed as macerated stillbirths and fresh stillbirths. Results: Only 43 women out of all the 100 women who had stillbirths could be investigated for TORCH antibodies. Out of these 43 women, 4 (9.3%) women were positive for Ig M toxoplasma antibody, 3 (7.0%) women were positive for Ig M Rubella antibody, 10 (23.3%) women were positive for Ig M CMV and 9 (20.9%) women were positive for Ig M HSV I & II indicating present infection. Ig G antibody alone was positive in 25 (58.1%) women for toxoplasmosis, 29 (67.4%) women for Rubella, 31 (72.1%) women for CMV and 20 (67.4%) women for HSV I & II indicating past infection (Table 1). Forty-eight women underwent VDRL testing and 08 (20%) women were found to be positive. Only 20 women gave consent for their placenta to undergo histopathological examination. Among these the commonest histological finding was syncytial knots (70%). Maternal anaemia (78%) was by far the commonest medical condition associated in women who either had macerated or fresh stillbirth. And accidental haemorrhage with or without placenta previa and prolonged/obstructed labour were the common conditions associated with stillbirth. The most probable causes of stillbirth assigned for all the 100 stillbirths, made after careful clinical consideration were intra-partum asphyxia (59%), foetal asphyxia (19%), unexplained intra-uterine deaths (15%) and congenital malformations (7%). Conclusion: Proper antenatal care for screening high risk factors and management thereof and educating the women to overcome the fear for hospital delivery are the needs of the hour. Also, a constant supervision by the senior staffs and their availability for consultation while conducting deliveries in the medical institutions may prevent a sizeable number of stillbirths. Vaginal delivery of difficult and breech delivery may be avoided as far as possible. Instead, Caesarean section should be opted.
ABSTRACT
Penicillium marneffei is a dimorphic fungus causing infection mainly in immunocompromised individuals, especially those with HIV infection. Penicillium marneffei is an important opportunistic pathogen of HIV infection in South East Asia including Manipur. Common clinical manifestations are fever, cough, weight loss, generalised lymphadenopathy, and papulonodular eruptions. We report an unusual case of HIV patient with Penicillium marneffei infection presenting as hoarseness
ABSTRACT
Penicillum Marneffi is the third leading opportunistic pathogen in HIV endemic areas. We report a case, with a rare clinical presentation as lump abdomen with newly diagnosed HIV -1 antibody reactive status. A diagnosis was made by endoscopic biopsy of growth in second part of duodenum which on histopathology and culture detected Penicillum Marneffi. He was treated with intravenous amphotericin B for 2 weeks followed by oral itraconazole. This case is reported for its unusual presentation to sensitize clinicians to consider this as an etiology in patients in HIV endemic areas who present as lump abdomen.