VITAMIN D DEFICIENCY IN PREGNANCY AND ITS ASSOCIATION WITH MATERNAL COMPLICATIONS

Introduction: Vitamin D de?ciency and insuf?ciency have been associated with a variety of adverse maternal and fetal outcomes, ranging from Gestational hypertension, preeclampsia, gestational diabetes, preterm delivery, intrauterine growth restriction, and cesarean section. The study was done to determine whether vitamin D de?ciency in pregnant women was associated with complications. In this prospective observational study, Methods: vitamin D levels were estimated in 100 pregnant women from gestational age 32 to 40 weeks in a teaching hospital in Delhi, India. All the subjects were further followed up for the appearance of pregnancy associated complications mostly focusing on the appearance of Gestational Hypertension, Pre-eclampsia, Gestational Diabetes, IUGR, Preterm labour or landing up in Caesarean section. 84% had suboptimal vitamin D level i.e serum vitamin D < 30ng/ml. Common complications were Results: gestational hypertension (47%), caesarean section (47%) and gestational diabetes (41%). Signi?cantly low vitamin D levels were found in women with obstetric complications as compared to controls with no complications. Also, signi?cant association was found between suboptimal vitamin D levels and complications. The routine measurement of vitamin D in Conclusion: pregnancy can be of great help in identifying patients at risk for development of these complications, early intervention and prevention of occurrence of these complications. Cost effective and timely treatment can prevent the complications in expecting mothers.

Case series on obstetrical outcomes in patient with uterine malformations

Congenital uterine anomalies occur due to abnormal fusion of mullerian duct during embryonic life. It is associated with high incidences of reproductive failures and adverse obstetrical outcomes. It may be associated with malpresentation, preterm labour, or recurrent pregnancy losses. Authors report a case series of 7 patients which were admitted in obstetrics and gynaecology department of SP medical college and associated group of hospitals between time period of March 2019 to July 2019. Among 7 cases 6 cases were associated with malpresentation, 1 with abortion, and 1 with preterm labour. This series shows that uterine anomalies are associated with different obstetrical outcomes varying from totally uneventful antenatal and postnatal period to abortion or preterm labour. Prenatal diagnosis of uterine anomaly may help in improving the obstetrical outcome in these patients.

Vaginal progesterone after tocolytic therapy in threatened preterm labour

Background: Currently preterm labour is one of the most challenging problem faced by both obstetricians and perinatologists, this episode in the course of woman’s pregnancy takes a heavy tool for perinatal mortality which accounts for approximately 50-75%. The incidence of preterm labour is estimated to be 5-10% of all pregnancies.Methods: It was a prospective randomize control trail over a period of 3 year at department of obstetrics and gynecology, tertiary care hospital Pune, Maharashtra, India. Total 100 subjects were randomized into two groups with group one receiving vaginal micronized progesterone and group two control group receiving only tocolytics and steroids. Subsequently authors compared the safety and efficacy of vaginal micronized progesterone versus placebo as a maintenance therapy in preventing preterm labour.Results: This analysis showed that women who randomized to progesterone prophylaxis had a significantly increase in duration of pregnancy. The mean of birthweight in Group A and Group B was 2963±36 gm and 2567±49 gm and respectively which confirmed the positive effects of progesterone on increasing infants’ weights at birth.Conclusions: Authors concluded that progesterone therapy had acceptable efficacy in the prevention of preterm labor in terms of prolongation of delivery and by increasing gestational age at delivery.

Study of risk factors for preterm deliveries in a tertiary hospital

Background: Preterm labour and preterm deliveries are very challenging obstetric complications. Early identification of risk factors may help identify women at risk for preterm deliveries.Methods: A one-year observational study was conducted in the department of obstetrics and gynecology, IGMC Shimla, Himachal Pradesh from 1st August 2017 to 31st July 2018. All mothers who delivered between 24 to 37 weeks were subjected to a detailed history with respect to age, parity, previous pregnancy outcomes and to identify the presence of any risk factors. A thorough obstetric and systemic examination was done. Parametric and non-parametric test of significance were used to find the association between different quantitative and qualitative variable.Results: Incidence of preterm deliveries was 11.4%. Maximum cases were of age group 25-30 years. 71.7% belonged to lower socio-economic status. 54% cases were seen in multigravida. History of previous abortion was seen in 18.4% and 9.7% had history of preterm deliveries. 12% cases had history of 1st trimester bleeding.  Spontaneous onset of preterm labour was seen in 55.1%. The significant risk factors associated were PIH and genitourinary infections.Conclusions: The risk factors of preterm birth to a large extent can be identified in antenatal period. Adolescent health education including good nutrition, good hygiene, counselling for contraception to reduce unintended pregnancies and birth spacing can lower the preterm birth rate. Better prenatal care, early identification of risk factors and complicated cases, regular follow up and proper management can help us in reducing preterm births.

Study of obstetric and perinatal outcome of twin pregnancy

Background: Multifetal pregnancy constitutes a significant portion of high-risk pregnancies. This is due to the increasing obstetric and perinatal morbidity and mortality rates associated with it. Maternal and perinatal outcome of twin pregnancies has been evaluated in this study.Methods: Total 30 patients with twin pregnancy and having gestational age more than 28 weeks were included in this observational study.Results: Incidence of twins in the study was found to be 2%. Twin pregnancies were more common in multiparous women aged between 20 and 30 years. Most common foetal presentation was vertex- vertex presentation. Most common maternal complication was preterm labour seen in 67% women, followed by anaemia seen in 50% women. Most of the women were delivered by caesarean section (63.3%). Most common perinatal complication was birth hypoxia (41.6%). Other perinatal complications were jaundice, septicemia, intrauterine growth restriction. 71% of the neonates had birth weight less than 2.5 kg. Perinatal mortality was found to be 11.6%.Conclusions: Twin pregnancies are high risk pregnancies associated with higher obstetric and perinatal morbidity. Perinatal morbidity was more common for the second coming twin. Regular antenatal visits, planned delivery and better NICU facilities can help combat these complications. A team of skilled obstetricians and pediatricians along with a multidisciplinary approach is essential for the effective management of twin pregnancies.

Microbiological study of cervical flora in preterm labour

Background: Preterm labour occurs due to various causative factors. Genital infections contribute significantly to the preterm labour. Ours is a prospective, observational study looking at the cervical microbiota involved in the preterm labour. The cervical flora contributing to the occurrence of preterm labour was studied. The results were analyzed based on the microbiological study of cervical swabs. The primary objectives of this study were to determine the association of cervical microbiota of pregnant women with spontaneous preterm delivery. To characterize the effect of cervical microbiota on birth gestation. The secondary objective of this study was to analyse the role of cervical microbiota and its relationship between social and behavioural factors.Methods: It is a prospective, observational study, which includes 193 patients, studied over a period of one and a half year. It was conducted at our tertiary care centre after the approval by ethics committee, and the results were analysed. As this is a purely observational study, management decisions of treating obstetrician were not interfered with. No additional cost, intervention or injury was caused to the study subject.Results: In our study, cervical swab culture shows growth in 2.07% which is statistically insignificant. Though, it was found that preterm labour is more common with leucocytosis, i.e. WBC > 11000 cmm, which is found to be statistically significant (p value = 0.023).Conclusions: In our study, we found that there was no significant association of cervical flora with preterm labour, though we found an association with leucocytosis.

Study Of Variations In Human Placental Attachment Of Umbilical Cord And Its Clinical Significance

Introduction: The word placenta comes from Latin - flat cake and Greek -”Plakous” which means “flat, slab like.”Only eutherian mammals possess placenta. The human placenta is discoid, hemochorial and deciduate whichfunctions as a fetomaternal organ. It is developed from chorion frondosum & decidua basalis. Abnormalities inthe development and site of insertion of the umbilical cord can affect maternal and fetal well-being. The umbilicalcord is usually attached near the centre of the placenta. The various types of umbilical cord attachment into theplacenta are: central, eccentric, battledore (marginal), velamentous (membranous) and furcate. Hence knowledgeabout the variations in the placental attachment of umbilical cord is important for clinicians.Aims and Objectives: The present study is undertaken to study various types of placental attachment of umbilicalcord.Materials and methods: The study was carried out on 10% formalin fixed 100 normal human placenta collectedfrom department of Obstetrics and Gynaecology, Cheluvamba Hospital for children & women, Mysore medicalcollege and research institute, Mysuru, Karnataka. The study was carried out in department of Anatomy, MMC&RI,Mysuru. Study of various types of placental attachment of umbilical cord was done by naked eye observation.The data obtained was tabulated & statistically analysed.Observations and Results: Out of 100 placenta observed 68 placenta had central attachment of umbilical cord,16 placenta had eccentric attachment, 12 placenta had battledore (marginal) attachment and 04 placenta hadmembranous (velamentous) attachment.Conclusion: Variation in the placental attachment of umbilical cord is associated with various congenitalanomalies. Therefore early prenatal ultrasonographic identification of anomalies helps in reducing risk inmaternal and perinatal outcome.

A prospective study of maternal factors and perinatal outcome of preterm birth

Background: Preterm birth (PTB) is a leading cause of perinatal morbidity and mortality, henceforth being a major concern for the obstetricians and paediatricians as well being a major health care issue. Preventing and treating the associated risk factors could play a major role in curbing the perinatal morbidity and mortality.Methods: A total 100 women with preterm labour or an indicated preterm termination of pregnancy were enrolled in the study. They were evaluated by history taking, clinical examination, and ultrasonography. Corticosteroids were given to all the patients. Maternal risk factors, obstetric outcome and perinatal outcome till discharge were studied.Results: Of the 100 women studied, mean age of the cases was 27 years, 60% of the cases belonged to lower socio-economic class, 74% of the cases were under 55 kgs weight group and 77% of cases were anaemic. 34% cases were below 34 weeks of gestation, 58% were multigravida, and 2% grand multipara with 35% labour being induced labour because of presence of various risk factors such as preterm premature rupture of membranes (PPROM), pre-eclampsia, eclampsia and chorioamnionitis. 6% cases had multiple pregnancies and 8% had history of preterm delivery in previous pregnancy. Out of 107 babies, 73% neonates required neonatal intensive care unit (NICU) admission and there was 12.14% neonatal mortality rate.Conclusions: Anaemia, malnutrition, infection, high order pregnancy are the preventable causes of preterm birth which can be prevented, screened and treated by specialised antenatal programs.

Prevalence and associated risk factors of abnormal pap smear in pregnant women

Background: The Papanicolaou test is a method of cervical screening used to detect pre-cancerous and cancerous processes. The incidence of cervical cancer in India is alarmingly high and is the leading cause of cancer in women in India accounting for 147 deaths per lakh women. Cervical cytological abnormalities are found in up to 5% of all pregnancies. In Indian settings, published data on abnormal Pap smear in pregnancy is lacking. The present study was designed to know the prevalence of abnormal Pap smear in pregnant women and its associated risk factors.Methods: This prospective study included 450 pregnant and 450 non-pregnant women who fulfilled the inclusion criteria. After a detailed history, clinical examination and investigations, Pap smear was collected as per conventional method and reported using 2014 Bethesda system.Results: 53.6% pregnant and 44.6% non-pregnant subjects had abnormal Pap smear. Out of the abnormal smears in pregnant women, 31.18% had inflammatory cytology, 15.37% had bacterial vaginosis, 4.01% had Trichomonal and 3.34% Monilial pathology. No epithelial cell abnormality was seen. Rural residence, lower class, age at first intercourse less than 21 years and having more than one sexual partner were important risk factors observed in our study and were statistically significant.Conclusions: Bacterial vaginosis, the most common infection detected on Pap smear is strongly associated with previos preterm labour and delivery. This opportunity for screening of cervical cancer and counselling should not be missed in the antenatal period.

Measurement of serum C-reactive protein levels in early second trimester as a predictor of preterm delivery

Background: Preterm labour is the leading cause of perinatal morbidity and mortality. Infection plays a major role in preterm labour. Elevation of CRP, an inflammatory biomarker has been associated with spontaneous preterm birth. This study was aimed at evaluating the relation of C-reactive protein in early second trimester with preterm labour and neonatal morbidity.Methods: It is a prospective cohort study, 200 pregnant women of singleton pregnancy between the gestational age of 14 to 20 weeks were enrolled. After detailed history taking, maternal serum CRP levels were estimated by ELISA method. These women were divided into two groups according to CRP levels. Incidence of preterm delivery and incidence of neonatal morbidity was compared in both groups to ascertain if measured maternal CRP levels has any association with preterm labour and neonatal morbidity.Results: In this study 42 patients (21%) had preterm delivery. Of these 30 patients had CRP > 1.5mg/dl; 12 had CRP < 1.5 mg/dl. In CRP increased group, 30 patients (57.7%) delivered preterm, 22 patients (42.3%) had term. It was found that increased levels of maternal serum CRP in early pregnancy were associated with increased incidence of preterm delivery. According to this study if the CRP value 1.5 the sensitivity will be 71.4% and specificity will be 86% to predict the preterm. Of the total 42 preterm babies, 1 from Group A (8.3%) and 12 from Group B (40%) developed sepsis. So increased CRP has association with neonatal sepsis.Conclusions: Elevated maternal serum CRP concentration in early second trimester was associated with increased incidence of preterm delivery and showed a positive correlation with neonatal sepsis.

Study of changes in levels of salivary estriol and progesterone in preterm labor in comparison to normal pregnancy

Background: This prospective research was designed to evaluate changes in levels of salivary Estriol and Progesterone in preterm labor in comparison to normal pregnancy. Spontaneous onset of labor at term is produced by definite increase in estriol and fall in progesterone. This rise in free estrogen should precede the onset of labor according with the known effect of estrogen and progesterone on myometrial activity. Concentration of steroid in saliva reflect unbound unconjugated and biologically active fraction.Methods: The present study was carried for duration of one year enrolling 115 antenatal women between 28 and < 37 weeks of gestation with or without labour pains attending the antenatal clinic in KGMU, Lucknow and those admitted in Queen Mary’s Hospital Lucknow. 5 ml of saliva was collected in cryovials from each patient to estimate estriol and progesterone. The estimation of saliva progesterone and estriol was done by immunoenzymatic colorimetric method of the supernatant of sample.Results: In our study mean value of saliva progesterone levels of pregnant women with preterm delivery (study group IIA) was lower than the control group (Group l) but the difference was not significant (3814.46±751.14 pg/ml versus 3945.16±577.11 pg/ml, p = 0.351). Mean value of estriol study group who delivered preterm (3512.85±586.16 pg/ml) was higher as compared to the mean value of control group (2691.72±681.08 pg/ml) and difference was significant (p value < 0.001).Conclusions: Thus, there is significant rise in level of saliva estriol, it can be used as a predictor for detecting symptomatic and asymptomatic women at risk for preterm birth.

A clinical study of preterm labour

Background: There has been a rising incidence of preterm labour in India. Preterm labour poses greater risks of morbidity and mortality of the preterm neonates. Various factors contribute towards risk of preterm labour and its outcome. Addressing these factors appropriately improves the outcome in pregnant women.Methods: This prospective observational study was conducted in department of obstetrics and gynaecology from the period of July 2017 to July 2018.Results: The present study was in 98 patients admitted in our hospital with preterm labour. Clinical profile of those patients was studied. Statistically significant association was found between administration of antibiotics and tocolysis in prolongation of pregnancy (p value=0.00). There was an association found between gestational age at birth and immediate neonatal outcome (p value=0.00). Preterm labour was more common in multigravidae (62.4%) and women with cervical length less than 3 cm (85.17%).Conclusions: Preterm labour can be expected more commonly in multigravidae, pregnant women with cervical length less than 3 cm and in presence of high-risk factors. Anticipation of preterm labour, judicious use of antibiotics, tocolytics can improve the outcome of preterm labour.

The role of pregnancy-associated plasma protein-a level in the first trimester of pregnancy and clinical outcome in an urban referral centre

Background: Estimation of serum PAPP-A levels studied predictability for adverse perinatal outcome. This case control study tries to establish the association between low PAPP-A levels among the pregnant woman and adverse maternal foetal outcome.Methods: This is an case-control study during 2017-2018 in the women delivered at Department of OBG at Mehta Hospitals. Women delivered in the labour room  had a first trimester screening of PAPP-A level were explained, taken informed consent, questionnaire which include detailed antenatal history, mode of delivery and baby data.  Depending upon outcome, the subjects are classified as case group or control group, out of the study sample of 264 subjects, 88 patients who had complications were taken as cases and 176 patients with no complications taken as control were undertaken.Results: Low PAPP-A level (<0.5 MoM) showed high incidence of PIH and preeclampsia, followed by IUGR and Preterm. PAPP-A level >0.5 MoM, normal outcome is more than the adverse outcome. The difference in the PAPP-A levels is statistically significant. In women with low PAPP A level, low birth weight found statistically significant when compared with <0.5 PAPP A level. The sensitivity of PAPP A levels in identifying the complicated outcomes was 17.04%.The specificity was 98.85%. The positive predictive value of predicting the complications was 88.23% and negative predictive value of 70.44%.Conclusions: The low PAPP-A levels confirmed during first trimester of pregnancy is associated with adverse maternal and foetal outcome such as PIH, preeclampsia, preterm, IUGR and LBW.

The study of association between maternal serum magnesium levels and preterm labour in a tertiary care hospital

Background: Serum magnesium level in pregnancy is a valuable tool to find out preterm onset of labour. In the asymptomatic group, greater surveillance and administration of steroids, tocolytics and transfer to a higher centre wherever necessary has to be done with mothers with low serum magnesium level. The objective of the study is to find association between serum magnesium levels and women with preterm labour, and to compare these values with those patients who have a term delivery.Methods: The subjects included 100 pregnant women with preterm labour (cases) between 28 and 37 weeks gestation (Group A) and similar number of pregnant women with term labour (controls) between 37 and 40 weeks (Group B). Inclusion criteria for cases was singleton pregnancy, painful uterine contractions more than two in 30 minutes, intact fetal membranes, cervical dilatation (at least 1 cm) and effacement (80%). Serum magnesium levels were done in both the groups. Patients were followed until delivery. Routine antenatal investigations were done. Serum levels of magnesium were estimated by Erba’s semi auto-analyser.Results: 62% patients in Group A were from rural areas. More patients in Group A (70%) were from low socioeconomic class. More women in Group A were anaemic (44%). Mean value of hemoglobin in Group A was 9.93gm/dL. More patients in Group A had muscle cramps (89%). VLBW (<1500gm) neonates were more in Group A (21%). Also, LBW (1500-2499gm) neonates were more in Group A (60%). Mean neonatal birth weight in Group A (1907.3gm) was less. Neonatal morbidity and mortality was observed significantly more in Group A. Mean serum magnesium was less in Group A. Mean serum magnesium levels in primi and multigravida patients were less in Group A. Moreover, mean serum magnesium levels were less in urban and rural patients in Group A. Mean serum magnesium levels were less in normal and overweight patients in Group A. Also, mean serum magnesium levels were less in patients with cervical dilatation <3cm and >3cm in Group A.Conclusions: Low maternal serum magnesium level is associated with preterm labour. Patients with preterm labour have significantly low serum magnesium level when compared with labour at term.

A case report on IgA nephropathy in pregnancy

IgA Nephropathy is a primary glomerular disease leading cause of primary glomerulonephritis and one of the important  leading cause of secondary hypertension. Pregnancy causes complex pathological changes in patients with IgA nephropathy affecting the renal function leading to secondary hypertension which in turn affects the prognosis of these patients. The association between chronic kidney disease and increased risk of adverse maternal and fetal outcomes which includes pre-eclampsia, accelerated decline in renal function, intrauterine growth retardation, preterm delivery and fetal death, is well recognised. Management of patients with IgA Nephropathy in pregnancy is challenging and thus authors are discussing here a case with successful outcome. Our patient was a known case of IgA Nephropathy and landed up with complications during pregnancy which was manged successfully.

Evaluation of clinical efficacy and safety of natural micronized progesterone in prevention of preterm labor: a prospective study at tertiary care teaching hospital in India

Background: Uterine relaxants (UR) are used in management of in Preterm labour (PTL), which is responsible for considerable morbidity and mortality in mother as well as preterm infant. Author are yet to discover an ideal UR which is highly effective yet safe. Literature supports the use of natural micronized progesterone (NP) during threatened PTL. However, little data exists for Indian population. Therefore, present study becomes imperative.Methods: A comparative clinical study was carried out on 78 patients (aged 19 to 35 years with singleton pregnancy and gestational age between 28 and 37 weeks with cervix ?4 cm dilated) who were diagnosed with threatened PTL were included. Those who refused treatment were allocated to control group (n= 29) and received only bed rest. NP was given orally 200 mg twice a day to 21 patients and 200 mg intra vaginal twice a day to 28 patients and was continued until delivery or 37 weeks of gestation whichever occurred first. The efficacy was proven if PTL was prevented and patient did not require an alternative UR for ?48 hours.Results: The mean age of patients was 23±3.2 years, majority being multipara. Author observed that both oral and vaginal formulation of NP was found to be highly effective (p <0.05) as primary UR and maintenance therapy in preventing PTL as compared to the control group. However, difference between them was not statistically significant. None of the patients were lost to follow-up and no adverse events linked to the treatment were reported.Conclusions: Although, the data obtained from this study was limited and the sample size was small, findings of this study support the use of NP in prolonging threatened PTL.

Association of first trimester serum level of placental growth factor (PlGF) and cervical length with onset of preterm labour

Background: Preterm labour (PTL) or premature labour is defined as one where labour starts before the 37th completed week.  The incidence of preterm birth is around 5-10% and it is the leading cause of perinatal morbidity and mortality. Diagnosis and treatment of PTL is challenging. However, owing to the availability of effective strategies for prevention of preterm birth, risk identification and early prediction is even more essential. This may provide opportunity for intervention and better obstetric care. Various biochemical markers were studied for prediction of preterm labour, but the sensitivity and specificity were found to be low. This study focuses on determining whether serum level of PlGF and ultrasound measure of cervical length at 10 – 14 weeks period of gestation can be used for early prediction of preterm labour.Methods: 296 antenatal women participated in this prospective observational study carried out from Dec 2015 to Sep 2017 at a tertiary care hospital. Serum level of PlGF was determined at 10-14 weeks. In the same sitting, cervical length was measured by transvaginal sonography. All these patients were followed up in antenatal OPD for monitoring the onset of preterm labour.Results: Incidence of preterm labour was 6.76 %. Maternal characteristics and obstetric factors were comparable in cases and controls. Serum PlGF level and cervical length values were lower in preterm labour group than term deliveries. But this result was not statistically significant.Conclusions: Lower levels of PlGF and cervical length were seen in preterm labour group, although it was not found to be statistically significant.

Association of hyperlipidaemia in preterm delivery

Background: Premature infant is the most important outcome of preterm delivery and is also the cause for infant mortality after congenital abnormality. Around the world, there are 3.6 million per year neonatal deaths, of which in developing countries, 99% deaths are observed. This study was conducted to evaluate the elevated triglycerides and cholesterol relationship on preterm labor risk.Methods: 350 healthy pregnant women were included in the study group in the age group of 18-36 years, their gestational age was confirmed either by last menstrual period or by ultrasound. This study was conducted in Department of Obstetrics  and Gynaecology at Osmania University, Hyderabad, Telangana India.Results: The good outcomes were observed in mothers with normal cholesterol values and preterm deliveries were observed in 32.14% of mothers with abnormal cholesterol values. 0.3% of mothers with normal triglyceride values and 75% of mothers with abnormal values had preterm delivery. P value difference was statistically significant (P<0.05).Conclusions: By measuring serum total cholesterol and triglycerides, along with serum screening of α-fetoprotein and inhibin A, it can be used to predict the preterm labour.

An observational study of effect of Mullerian anomalies on pregnancy

Background: Mullerian anomalies occur in approximately 3-4% of fertile and infertile women, 5–10% of women with recurrent early pregnancy loss, and up to 25% of women with late first or second-trimester pregnancy loss or preterm delivery. However, due to low prevalence rate and asymptomatic course of the anomalies, Mullerian anomalies remain underdiagnosed and often overlooked as a possible cause of recurrent pregnancy failures, preterm deliveries, IUGR and low birth weight.Methods: Total of 30 cases of Mullerian anomalies with pregnancy, prior diagnosed or incidental during LSCS, were studied for complications during pregnancy, history of gynecological complaints and rate of diagnosis with routine imaging technique.Results: Septate uterus was the most common anomaly seen in this study (36.6%).56.6% were diagnosed incidentally during LSCS despite the fact 26.6% of cases had history of 2 or more abortions and 30% had some or other gynecological complaints previously. 10% of pregnancies ended in abortions, 20% had preterm delivery, 36.6% had malpresentations and there was case of rupture uterus (03.3%).Conclusions: Mullerian anomalies are often asymptomatic or have subtle gynecological symptoms which are often missed by both patient and gynecologists. It is observed that due to the asymptomatic course of Mullerian anomalies, invasive nature of HSG and lack of 1.5 Tesla MRI at many institutes leads to low rate of diagnosis of Mullerian anomalies. Pregnancy with Mullerian anomalies often have preterm delivery, IUGR and malpresentation, so, require proper counselling and close monitoring during antenatal period.

Study of prevalence of bacterial vaginosis in preterm and term labour patients

Background: Bacterial vaginosis (BV) is a clinical condition caused by replacement of the normal hydrogen peroxide producing Lactobacillus species with high concentrations of aerobic and anaerobic bacteria. Studies have shown that spontaneous abortion, preterm labour (PTL), premature birth, preterm premature rupture of membranes, amniotic fluid infection, and postpartum endometritis are increased because of infection with BV. In India, not many studies have been done to estimate the prevalence and association of BV with preterm labour, hence this study is being taken up to know the prevalence of BV in preterm and term labour patients and its relationship with preterm delivery, low birth weight of baby and puerperal sepsis.The objective of the present study was to observe the prevalence of bacterial vaginosis in women presenting with preterm and term labour, its impact on preterm and term delivery and to analyze the maternal and fetal complications associated with BV.Methods: An observational study involving 100 patients with preterm and term labour (50 patients in each group) was conducted at a BNMCCC, Government Medical College, Amritsar. Women fulfilling the Amsel’s criteria and/or a score of 7 or more on gram staining of vaginal smears (Nugent’s score) was considered to have bacterial vaginosis.Results: The proportion of patients, who fulfilled Amsel’s criteria and/or a Nugent’s score of 7 or more for the diagnosis of BV, was more in PTL group versus term labour group, and the difference was statistically significant. Prevalence of BV in preterm labour and term labour patients was 18(36%) versus 4(8%) respectively. In PTL group, 27.8% of low birth weight neonates were born to BV positive mothers versus 3.1% were born to BV negative mothers. Maternal postpartum complications observed were 33.3% with BV versus 6.25% without BV in PTL group.Conclusions: BV is major risk factor for PTL. Therefore, the testing and prompt treatment of BV may reduce the risk of PTL. This will also go a long way in the prevention of maternal morbidity and neonatal complications due to prematurity.