Cross-Sectional Study of Placental Surface Area and Umbilical Cord Attachment on Placenta in Normal and PIH Pregnancy and Its Effects on Foetal Weight

Introduction: Pregnancy-induced hypertension (PIH) is one of the risk factor in pregnancy leading to placental insufficiency which in turn is responsible for maternal and foetal morbidity and mortality. PIH causes morphological changes in placenta. Decreased placental surface area and variation in the attachment of umbilical cord on placenta are more commonly noted in PIH which hampers the uteroplacental perfusion resulting in foetal mortality and morbidity. Hence afforts were made to study the incidence of reduced placental surface area and mode of cord attachment on placenta. Materials and methods: The study was conducted in the Department of Anatomy, Sri Siddhartha medical college and Hospital, Tumakuru, Karnataka. A total of 100 (50 normal and 50 PIH) human placentae were studied. Placental surface area and mode of attachment of umbilical cord in normal and PIH pregnancy were measured and noted. This study was analysed statistically by using Unpaired t-test and Chi-square test. Results: The study revealed significantly decrease in placental surface area and also there is increased incidence of central and marginal attachment of umbilical cord in PIH cases. Conclusion: Study reveals, PIH cause morphological changes in placenta, it decreasing the uteroplacental blood flow which reduces foetal nutrition ultimately decreasing the neonatal weight.

Importance of Doppler study of Umbilical Artery and FoetalMiddle Cerebral Artery in PIH and IUGR

Background: PIH is associated with increased vascular resistance and decreased utero -placental perfusion resulting in an increased incidence of foetal hypoxia and impaired foetalgrowth.The objective of this study was to assess the diagnostic performance of S/D ratio, resistance index(RI), pulsatility index (PI) and cerebro-placental ratio (CPR) in the prediction of adverse perinatal outcome in PIH and IUGR. Objective: is to determine S/D ratio, RI, PI, CPR and asses their diagnostic values in the prediction of adverse perinatal outcome.Material& Methods:50 pregnant patients with PIH and IUGR, beyond 28 weeks of gestation, were prospectively studied at P k das institute of medical college,vaniyamkulamand subjected for Doppler study of the umbilical artery and foetal middle cerebral artery. The abnormality of above parameters was correlated with the major adverse perinatal outcome.Results:Patients with abnormal Doppler parameters had a poor perinatal outcome, compared to those who had normal Doppler study. The cerebro-placental ratios(CPR) had the sensitivity and specificity, positive and negative predictive values of 95%,76%,73%,95% respectively with Kappa value of o .68(good agreement) and p value of .000 which was statistically significant, for the prediction of major adverse perinatal outcome.Conclusions:This study shows that Doppler study of umbilical and foetal middle cerebral artery can reliably predict the neonatal morbidity and helpful in determining the optimal time of delivery in complicated pregnancies. The CPR is more accurate than the independent evaluation of S/D, RI, PI, in identifying foetus with adverse perinatal outcome.

Adaptación cultural y validez del instrumento pih para medir comportamientos de automanejo en cáncer / Cultural adaptation and validity of the instrument to measure self-management behaviors in cancer / Adaptação cultural e validade do instrumento pih para medir comportamentos de auto-gestão em câncer

Resumen Objetivo: Adaptar culturalmente al español y validar, en Colombia, el instrumento de comportamientos de automanejo para personas con cáncer. Metodología: Estudio transversal de validación de instrumento, en el que a partir de la versión original de la escala pih [Patterns in Health scale, Patrones en salud], que mide los comportamientos de automanejo, se desarrolló su versión adaptada culturalmente al español y se adelantó la evaluación de la validez de constructo a partir de la aplicación de la escala a 182 adultos con diagnóstico de cáncer, para lo que se acudió a análisis factorial exploratorio y confiabilidad, mediante consistencia interna con el alfa de Cronbach. Resultados: Se obtiene un instrumento adaptado culturalmente al español en Colombia, para su uso en personas con cáncer. El análisis factorial arrojó cuatro factores con vector propio: conocimiento, reconocimiento y manejo de síntomas, alianza personal de salud/médico-paciente y afrontamiento. La consistencia interna es aceptable, con una alfa de Cronbach de 0,728. Conclusiones: La escala pih adaptada al español evalúa integralmente los comportamientos de automanejo de una persona con cáncer, y demostró validez de constructo y consistencia interna para su uso en el contexto colombiano en adultos con cáncer.

Abstract Objective: Culturally adapt to Spanish and validate in Colombia the instrument of self-management behaviors for people with cancer. Methodology: Cross-sectional study of instrument validation in which, from the version of the pih scale [patterns in health] that measures self-management behaviors, its culturally adapted version was developed in Spanish, construct validity was advanced from the application to 182 adults diagnosed with cancer. Exploratory factor analysis and reliability were used through internal consistency with Cronbach's alpha. Results: An instrument culturally adapted to Colombian Spanish is obtained for use in people with cancer. The factor analysis revealed four factors with its own vector: knowledge, recognition and management of symptoms, alliance between health personnel / doctor-patient and coping. Internal consistency is acceptable with a Cronbach's alpha of 0.728. Conclusions: The pih scale adapted to Spanish comprehensively evaluates the self-management behaviours of a person with cancer, demonstrated construct validity and internal consistency for use in the Colombian context

Resumo Objetivo: Adaptar culturalmente o espanhol e validar na Colômbia o instrumento de comportamentos de autogestão para pessoas com câncer. Metodologia: estudo transversal de validação de instrumento, no qual, a partir da versão da escala pih [padrões em saúde] que mede comportamentos de autogestão, sua versão culturalmente adaptada foi desenvolvida em espanhol, a validade de construto foi avançada a partir do aplicação a 182 adultos diagnosticados com câncer. A análise fatorial exploratória e a confiabilidade foram utilizadas através da consistência interna com o alfa de Cronbach. Resultados: Um instrumento culturalmente adaptado ao espanhol colombiano é obtido para uso em pessoas com câncer. A análise fatorial revelou quatro fatores com seu próprio vetor: conhecimento, reconhecimento e manejo dos sintomas, aliança entre equipe de saúde / médico-paciente e enfrentamento. A consistência interna é aceitável com um alfa de Cronbach de 0,728. Conclusões: A escala pih adaptada ao espanhol avalia de forma abrangente os comportamentos de autogestão de uma pessoa com câncer, demonstrou validade de construto e consistência interna para uso no contexto colombiano.

Comparison of placental grading at different periods of gestation in PIH patients and their outcome

Background: The current study follows grannum grading of placenta. It is well known that there is accelerated placental maturation in PIH patients and the ultrasonic appearance of grade 3 placenta before 37 weeks may signify placental dysfunction and is associated with development of low birth weight babies, IUGR meconium stained liquor, low APGAR score. Hence this study was conducted to emphasize on placental grading at different periods of gestation to predict and prevent increased obstetric and fetal compromise and to compare the outcomes.Methods: Obstetric scans were performed in all PIH patients attending antenatal OPD and inpatients at ESIC and PGIMSR medical college, Bangalore to know the placental grading and biophysical profile. These women were followed till their delivery for obstetric and fetal outcomes.Results: Grade 3 placenta is seen in 17 patients in group 1(50%) and 39 patients (59%) in group 2. For statistical analysis grade 1 and 2 were combined and compared with  grade 3. P-value 0.198 which was not statistically significant. There was no statistically significant difference in age and gravidity between two groups. The medical disorders were more in group 2 i.e., between 37 - 40 weeks. The complications of PIH were also more in group 2. There were more number of LSCS (n=19 versus 14) in 34-36 weeks group which was not statistically significant. Fetal outcomes like IUGR and IUD were more in group 2 which was not statistically significant. The mean birth weight in group 1 was 2 kg as compared to 2.7 kg in group 2. All associated medical disorders were more in group 2.Conclusions: In hypertensive women there is accelerated placental maturation leading to maternal and fetal complications. Hence women with accelerated placental maturity in ultrasound should be closely monitored and appropriately managed. However, we recommend larger randomized studies are necessary.

Analysis of still births in a tertiary care system and changed scenario over six year period

Background: In India, the maternal and infant mortality rates have been steadily decreasing in recent years, but there has been no corresponding decrease in the perinatal mortality. Hence, there is need to evaluate the factors leading to this unfortunate event. The objective of this study was to find out various factors (especially preventable) responsible for perinatal stillbirths.Methods: An analytical comparative study in a tertiary care hospital comparing fresh and macerated still births over a period of one year in 2011 and 2017 and responsible factors were analysed.Results: Amazingly, despite improvement in the antenatal services, more institutional deliveries, there is no change in the incidence of still birth rate. However, there was decrease in the rate of still births due to extreme prematurity and congenital malformations. There was no change in incidence of PIH/ Eclampsia, IUGR and placental causes but there was substantial increase in the incidence of GDM.Conclusions: Perinatal mortality can definitely be reduced by strengthening and improving quality of antenatal services, early identification of high risk pregnancies, timely referral and appropriate intervention.

Clinical Study of Serum Uric Acid Level on Outcome of Pregnancy in Cases of Pregnancy Induced Hypertension (PIH)

Background: Hypertensive disorder is one of the commonestmedical complications of pregnancy. It is assumed that serumuric acid elevation is a specific laboratory finding for thedisease.Objectives: To assess the effect of raised Serum uric acidlevel on outcome of pregnancy in cases of PIH (PregnancyInduced Hypertension).Methods: A Prospective study was conducted to pregnantpatients (between 28-40 weeks of pregnancy with PIH). Total100 patients were selected, who were separated into twogroups. Those who had Serum uric acid level more than6mg/dl (67 participants) are classified as Group A and thosewho had Serum uric acid level less than 6mg/dl (33participants) are classified as Group B.Results: Age of PIH patients were within 16-40 years. Theserum uric acid was significantly elevated in all the patients.Concentration of Serum uric acid is much higher in Eclampsiagroups, which is 4.5-12.0 mg/100ml (7.36 ± 2.17), incomparison to Preeclampsia patients, which is 2.6-9.6mg/100ml (6.28 ± 1.64). Comparing maternal outcome withSerum uric acid level between group A and group B patients,percentage of PPH and Abruptio placenta was higher in groupA than group B. In addition, Postpartum eclampsia, HELLPsyndrome and Pulmonary oedema were present in group A(each 2 in number); but these complications are not found ingroup B. In perinatal outcome, the better consequence wasobserved in group B in case of birth weight, intrauterine growthretardation, still birth and neonatal death rate. There wasstatistical significant association between Serum uric acid andbirth weight of group A & B (p= 032).Conclusion: The degree of hyperuricemia increases with theseverity of preeclampsia. Perinatal mortality was markedlyincreased when maternal serum uric acid concentration wereraised. Serum uric acid was an important indicator for maternalcomplications and prognosis of fetus.

Maternal serum βhCG level and uterine artery doppler studies as predictors of pregnancy induced hypertension and intra uterine growth restriction: a prospective study

Background: PIH, a pregnancy-specific disorder, is one of the major causes of maternal and perinatal morbidity and mortality worldwide.PIH and fetal growth restriction are important causes of perinatal and maternal morbidity and mortility.Methods: Hundred Indian pregnant women in their second trimester (13-20 weeks) and in their late second trimester (24-28 weeks) investigated for their serum β-hCG level and uterine artery Doppler studies respectively, attending OPD/IPD in Sir T. hospital, Bhavnagar from June 2014 to June 2015.Results: There is no clinical significance between parity and occurrence of PIH (p=0.2) and FGR (p=0.7). Out of 77 patients with their β hCG level ≤2 MoM, 2 patients (2.59%) developed PIH and FGR. And from 12 patients with their β hCG level ≥2 MoM 10 patients (80%) developed PIH and FGR which is highly significant (p<0.001). The study establishes the validity of beta HCG as a predictor of PIH and FGR with the sensitivity of 83.3%, specificity of 97.5%.Conclusions: This study can be concluded by there is a strong association between high maternal serum ß-hCG level, abnormal uterine Doppler studies with predicting adverse outcome of pregnancy like PIH and FGR. There is also a good association between high maternal serum ß-hCG level and rising severity of the disease.

A study of serum lipid profile in normal pregnancy and pregnancy induced hypertensive disorders: a case-control study

Background: Pregnancy induced hypertensive disorders are one of the commonest complication of pregnancy which accounts for 12% of the maternal and perinatal mortality and morbidity. Dyslipidemias are associated with endothelial dysfunction that may result in proteinuria and hypertension which is a clinical hallmark of PIH. It affects both maternal health as well as fetal growth. Hence, this study was done to assess the role of altered lipid profile in the development of PIH.Methods: A Case Control study was conducted at the Department of Biochemistry, Kurnool Medical College and Govt General Hospital, Kurnool in collaboration with its Obstetrics Dept during the period of November 2015-2017. A total of 300 pregnant women, primigravida /multigravida with singleton pregnancy, in the age group of 18‐ 35 years with >20 weeks of gestation were included in the study. Subjects were divided into gestational hypertensives, n=39 (BP ≥140/80) and preeclamptic women, n=111 (≥140/80 and proteinuria) as cases. Age matched normotensive pregnant women, n=150 (BP 120/80) were recruited as Controls. Subjects with history of multiple pregnancies, pregnancy with congenital anomalies, chronic hypertension, diabetes mellitus, cardiac/thyroid/hepatic/renal disease, dyslipidemia were excluded. Total cholesterol, TG, HDL, LDL, VLDL were performed.Results: A comparison of these values between hypertensive and normotensive women showed a significant rise in TC, TG, LDL and VLDL. HDL-C showed a significant decrease in hypertensive women compared to normal pregnant women. LDL: HDL and TG:HDL ratios were higher in PIH group.Conclusions: The results of this study suggests an abnormal lipid metabolism, predominantly high TG concentrations and low HDL-C, which may add to the promotion of vascular dysfunction and oxidative stress seen in PIH. This association is significant in understanding the development of hypertension during pregnancy and is useful in early diagnosis and prevention of PIH.

A comparative analysis of serum lipid profile between normotensive and hypertensive pregnant women

Background: The pregnancy results in the development of the placenta which is characterized by the hormonal changes in the women body, which results in the alteration of lipid profile, diabetic state of the pregnant mothers and many others. Objective of this study was to compare the of serum lipid profile between normotensive and hypertensive pregnant women.Methods: A hospital based cross sectional study was conducted by the department of OBG, Hassan Institute of Medical Sciences, Hassan from July 2018 to December 2018. A total of 6 months the study was conducted. A total of 50 pregnant mothers who were more than 20 weeks of gestation and suffering from Preeclampsia were include in the study group and 50 Pregnant mothers who were more than 20 weeks of gestation and normotensive were included in the controls.Results: Majority of the study subjects in both the groups were less than 25 years of age. The mean age of mothers in study group was 23.19 years and 24.19 years in the control group. The mean HDL level was more among the normotensive group than the pre eclamptic group and the p value was found to be statistically insignificant. The VLDL, LDL and triglyceride level was more in the pre eclamptic group than the normotensive group and the association was also found to be statistically significant.Conclusions: Hormonal changes in pregnancy results in physiological Hyperlipidemia, in conditions like pre-eclampsia triglyceride are elevated more than the normal rise seen in normal pregnancy. Increased lipid profile with raised TG, VLDL, LDL levels leads to the development of Preeclampsia by increasing the oxidative stress and the endothelial dysfunction.

Comparison of Basement Membrane in Normotensive and Pregnancy Induced Hypertensive Placentae

Introduction: Placenta is related to mother and foetus viaindirect interaction with maternal blood that spurts out ofuteroplacental vessels. By study of placental bed newinformation has come to light, especially for pre – eclampsiaand intra uterine fetal growth retardation.Aim: To study changes in basement membrane in pregnancyinduced hypertensive and normotensive placentae.Materials and Methods: The present study was conducted inthe Department of Anatomy, MMMCH, Kumarhatti, Solan tostudy the histological changes in placenta in pregnancyinduced hypertensive parturients as compared to normotensivesubjects. It was based on 100 cases, 25 from normotensivesubjects (control group) and 75 from clinically proven cases ofpregnancy induced hypertension (study group).An attempt was made to see any changes in histologicalfeatures of placentae of pregnancy induced hypertensive casesand compare it with normotensive placentae.Results and Conclusion: The microscopic study showedsignificant thickening of basement membrane in PIH placentae.As compared to normotensive placentae (control) and are dueto occlusion or narrowing of utero placental vasculaturesuggesting thereby compromised foeto – placental circulation.

A clinical study of maternal outcome among pregnant mothers suffering from preeclampsia with thrombocytopenia

Background: The thrombocytopenia in preeclampsia is mild to moderate, but severe thrombocytopenia can occur. Patients with eclampsia were at even greater risk for developing severe thrombocytopenia. And more likely to have HELLP syndrome, which is a subset of preeclampsia. Thrombocytopenia is a key and necessary component of this syndrome. The objective of the present study was to observe a clinical study of maternal outcome among pregnant mothers suffering from preeclampsia with thrombocytopenia.Methods: A Hospital based Study was conducted at Mysore Medical College from January 2018 to December 20180 in the department of Obstetrics and gynecology. A total of 100 cases of Pregnancy from the records / case sheets of pregnant women with pregnancy induced hypertension admitted in the labor ward of the department of obstetrics and gynecology, Mysore Medical College, Mysore, Karnataka, India.Results: Majority of the study subjects in present study were aged between 21-25 years (42%) followed by <20 years (26%). Nearly 55% of the study group were prim parous. In the above table out of 100 cases included in the study, 28 and 40 cases presented with mild and severe pregnancy induced hypertension, 8 cases were diagnosed as eclampsia and 24 cases presented with HELLP syndrome. The association between the mode of delivery and the variants of PIH was found to be statistically not significant. The Association between Mode of delivery and gestation weeks among the eclampsia cases was found to be not significant.Conclusions: Thrombocytopenia in pregnancy induced hypertension carries a risk for both the mother and her fetus. The associated causes like abruption, retain dead fetus, septicemia and disseminated intravascular coagulation aggravates the complication for thrombocytopenia.

A prospective randomized comparative study of Misoprostol and balloon tamponade using condom catheter to prevent postpartum hemorrhage at M. Y. H., Indore, India in vaginal delivered patients

Background: PPH is responsible for quarter of maternal deaths occurring worldwide and its incidence is increasing in developed world. According to Confidential Enquiries into Maternal and Child Health (CEMACH) report obstetric hemorrhage occurs in around3.7 per 1000 births. The objective of the study is that it was a prospective randomized comparative study of misoprostol and balloon tamponade via condom catheter to prevent postpartum hemorrhage in normal delivered patients at MYH.Methods: A sample size of 200 normal delivered patients between age group 18 and 45 years is chosen with excessive bleeding after third stage of labour and after administration of oxytocics. These 200 patients are divided into two groups: First group receiving Misoprostol and applying condom catheter in other group. Both groups are evaluated for PPH.Results: It was found that CG balloon condom catheter was a much better and more effective alternative in controlling PPH than Misoprostol as the failure rate with CG balloon condom catheter were  much less than that  with misoprostol. Due to its cost effectiveness and being easily available at primary health center and due to absence of any drug reactions and easy technique of formation makes it a better modality in controlling PPH even at PHC.Conclusions: Patients with condom catheter in situ must show better result than patients receiving misoprostol.

A Spot Urine Protein Creatine Ratio Is An Alternative To 24 Hours Urinary Protein For Detection Of Pih And Its Severity

Protein/creatinine ratio of a single voided urine specimen may have a role in the management of ambulatory women with suspected PIH, which necessitates further research in the field. We did a systematic review of the literature and multivariate meta–analysis with the objective of determining the diagnostic accuracy of the protein to creatinine ratio compared with 24 hour urine collection for the detection of significant proteinuria in patients with suspected pre–eclampsia and to look at their ability to predict adverse outcome for mother and baby & to find out its co–relation with disease severity. The spot urinary protein /creatinine ratio can be used as an alternative to 24–hours urinary protein excretion in patients with PIH.

Study of Acute Kidney Injury Associated with Pregnancy

Background: Pregnancy related acute kidney injury(PRAKI) is common in developing countries like India. The aim of the study was to identify the etiology, prognosis, management and to have preventable measures, to improve the maternal and fetal outcome. Methods: The study was conducted in S.P. Medical College& Hospital – Obstetrics and Gynecology Department from July 2017 to December 2017.A total of 22 cases has been studied. Results: The incidence of PRAKI was 1.3% in our hospital. Pregnancy induced hypertension, pre-eclampsia, eclampsia was found to be commonest cause. Incidence of PRAKI was high in third trimester. The outcome was favorable with complete recovery in 45.47% patients. Conclusion: The low incidence of PRAKI was probably due to improved obstetric practices. Future research is further needed, to decrease the incidence.

PD-1/PD-L1 regulates Treg differentiation in pregnancy-induced hypertension

Pregnancy-induced hypertension (PIH) causes significant maternal and fetal morbidity and mortality. A decreased number of regulatory T (Treg) cells is associated with the pathogenesis of PIH. The programmed cell death-1 (PD-1)/PD-ligand 1 (PD-L1) pathway is critical to normal pregnancy (NP) by promoting Treg cell development. However, the relationship between PD-1/PD-L1 and Treg differentiation in PIH has not been fully elucidated. In this study, venous blood was obtained from 20 NP and 58 PIH patients. Peripheral blood mononuclear cells (PBMCs) were isolated from venous blood. The levels of Treg-related cytokines (TGF-β, IL-10, and IL-35) in serum and PBMCs were measured by ELISA. The percentage of Treg cells in PBMCs was assessed by flow cytometry. The mRNA levels of Treg-specific transcription factor Foxp3 in PBMCs, and PD-1 and PD-L1 in Treg cells were detected by qRT-PCR. The protein levels of PD-1 and PD-L1 in Treg cells were evaluated by western blot. The serum levels of TGF-β, IL-10, IL-35, and Foxp3 mRNA expression and CD4+CD25+ Treg cell percentage in PBMCs were decreased in PIH. Furthermore, a significant increase of PD-1 in Treg cells was found in PIH compared with NP. In addition, PD-L1 Fc, an activator of PD-1/PD-L1 pathway, increased Treg cell percentage, enhanced Foxp3 mRNA expression, and elevated levels of TGF-β, IL-10, and IL-35 in PBMCs. However, anti-PD-L1 mAb exerted a reverse effect. These findings revealed that PD-L1 Fc had a favorable effect on Treg cell differentiation, indicating a potential therapeutic value of PD-1/PD-L1 pathway for PIH treatment.

Study of Risk Factors for Preterm Births in a Teaching Hospital: A Prospective Study

Preterm birth is a leading cause of perinatal mortality and long term morbidity as well as the long term health consequences and neurodevelopmental outcome

Predictive Value of Detecting Serum L-Arginine Levels in Pregnant Woman with PIH / 现代检验医学杂志

Objective The evaluate action of serum L-arginine levels for predicting development of pregnant women with PIH,and analyze its effectiveness as clinical predictor.Methods Collecting 186 patients was performed a retrospective study.The PIH pregnant women was the experiment group,and the health pregnant women was the control group.In order to analyse the effect,the levels of L-arginine were measured in the early,middle and late period of pregnant women.Compared with the serum L-arginine in different groups with x2-test and t-test based on data type.Results Experimental group and control group subjects in age (x2 =2.426,P=0.119;t=1.218,P=0.229) and smoking before pregnancy (x2 =2.088,P=2.088),there was no significant differences,but the two groups of patients with BMI (x2 =8.772,P=0.003) and parity (x2 =6.083,P=0.014) was statistically.In different stages of pregnancy,the concentration of serum L-arginine had no statistical differences,and in the concentration of umbilical cord blood,serum L-arginine also had no statistical difference.There was a statistical differences in the serum L-arginine concentration of the cord blood for different number of pregnancies,but the concentrations of L-arginine in cord blood and in serum L-arginine.There were no significant difference in age,BMI and smoking pregnant.According to ROC curve analysis,for the diagnostic of concentration in serum L-arginine and in umbilical cord blood,the results indicate low efficiency to the diagnosis of pregnancy hypertension during pregnancy.Conclusion L-arginine level and the development of PIH and body mass index and maternal correlation for the pregnant women.Because the sample size limitations,L-arginine in the diagnosis of PIH also needs to be further research to determine the effectiveness of predicting.

A Cross Sectional Morphometric Study Of Hypertensive With Normal Placentae And Its Correlation With Fetal Outcome.

Introduction: Placenta “the vital organ” for maintaining healthy pregnancy is unique in its development, being derived from both mother and fetus. Thus hypertensive disorder affecting mother has a deleterious impact on placenta which may lead to poor fetal outcome. Aim: A cross-sectional descriptive study was undertaken to analyze and assess the morphological changes in hypertensive placentae and to clinically correlate it with fetal and maternal parameters. Materials and Methods: 50 placentae were freshly collected from pregnancy induced hypertension (PIH) cases (study group) and 50 from normal pregnancy (control group). Study group was divided into three categories depending upon severity of the disease. Observations and Results: 70% in study group were primigravida and were from rural area.46% were in age group of 15 – 20yrs.50% under low socio-economic status and 60% were without any regular antenatal checkup. Preterm, IUGR, still birth and neonatal death accounted to 10%, 12%, 18% and 10% respectively in study group. The average diameter, thickness, volume and number of cotyledons in study group were 15.91±2.11cm, 2.39±.54cm, 297.64±67.90ml and 10.02±4.13respectively. Mean placental weight was 376.41±17.198gm (mild PIH), 330.72±2.90gm (severe PIH), 329.73±3.19gm (eclampsia) and mean birth weight was 2680.29±198.46gm (mild PIH), 2212.06±36.41gm (severe PIH) and 2073.60±9.47gm (eclampsia) respectively in study group. Various pathological changes like retro placental hematoma, infarction and calcification had been noticed. Conclusion: Placental morphometric parameters were significantly reduced (<.001) in study group as compared to control group. Decreased placental weight was associated with reduced birth weight and feto-placental ratio with increase in severity of hypertension significantly (<.001). A significant increase (<.05) in incidence of preterm, IUGR, still birth and neonatal death were found in study group. Assessment of morphological changes and its clinical relevance can be correlated with transactional study so as to provide the safe confinement and reducing the fetal morbidity and mortality.

Serum magnesium in pregnancy induced hypertension.

Background: PIH is a major cause of maternal & perinatal morbidity & mortality worldwide because of its complications. The etiology of PIH is uncertain but appears to be related to uteroplacental ischaemia. Magnesium is one of the principle macronutrients, regulates vascular tone, causes relaxation of muscles of uterus and decreases excitability of nerves & muscles. Hence the study was planned to estimate and compare the levels of magnesium between women with PIH and normal pregnant women. Methods: The study comprised of thirty clinically diagnosed PIH patients and thirty gestational age-matched controls. Serum magnesium was estimated spectrophotometrically. Results: Significant decrease was observed in magnesium levels in women with PIH as compared to normal pregnant women. Conclusion: The decreased serum magnesium levels may indicate its possible role as one of the risk factors in the development of PIH in pregnant women. Hence the screening of clinically diagnosed cases of PIH for hypomagnesemia may help in minimizing the complications of PIH. Hypomagnesemia could be treated with magnesium supplementation and follow up of the patients for complications would be necessary to comment further.

Comparative evaluation of antihypertensive drugs in the management of pregnancy-induced hypertension.

Background: Pregnancy-induced hypertension is associated with various adverse fetal and maternal outcomes. The use of anti-hypertensive drugs in pregnancy is controversial. We conducted a prospective study to evaluate the comparative effectiveness and safety of nifedipine, methyldopa and labetalol monotherapy in patients with pregnancy-induced hypertension. Methods: A total of 60 pregnant women with blood pressure of 140/90 mm Hg or more with ≥1+ proteinuria between 20 and 38 weeks of gestation were randomly allocated to receive nifedipine (n=20), methyldopa (n=20) or labetalol (n=20). Blood pressure was measured at 0, 6, 24, 48 and 72 h of initiation of antihypertensive drugs. Patients were also followed up for development of adverse drug effects during this period. Results: Antihypertensive treatment with methyldopa was associated with reduction in systolic blood pressure (SBP) by 50 mmHg and diastolic blood pressure (DBP) by 30 mmHg at 72 h. For the same period treatment with nifedipine was associated with reduction in SBP by 54 mmHg and DBP by 30 mmHg. Treatment with labetalol was associated with reduction in SBP by 70 mmHg and DBP by 36 mmHg at 72 h. Conclusions: Labetalol was more effective than methyldopa and nifedipine in controlling blood pressure in patients with pregnancy-induced hypertension while methyldopa and nifedipine are equally effective in controlling blood pressure.