RESUMO
Background: Hypertensive disorders of pregnancy are an elusive group of diseases with multifactorial etiopathologies and varied manifestation. Abnormal pre pregnancy lipid profile is shown to have a positive correlation with endothelial dysfunction which in turn leads to development of hypertensive disorder of pregnancy.Methods: A total of 222 pregnant women who were aged between 18-35 years, with no obstetric and medical risk factors and less than 16 weeks of gestation who gave informed written consent were recruited for the study. Their baseline demographics and fasting blood samples were collected, blood samples were centrifuged, and serum was stored at -80-degree celsius. Patients were followed up till delivery and those with hypertensive disorders in pregnancy (n=22) was identified, defined as case. Control was selected after matching for body mass index and frozen serum samples were analyzed.Results: Overall incidence of hypertensive disorders in pregnancy in the study group was 12.4%. The mean early trimester fasting lipid values were higher in patients who developed hypertensive disorders, difference in mean between cases and controls was TC - 16.25 mg/dl (p-0.061), TGL- 21.45 mg/dl (p-0.143), LDL- 2.4 mg/dl (p-0.82) and for HDL 4.55 mg/dl (p-0.25). However, on stratification of early trimester fasting lipid level based on National Cholesterol Education Program (NCEP) criteria, Total cholesterol level greater than 160 mg/dl showed an odds ratio of 12.66 (p-0). Patients with early trimester fasting total cholesterol levels greater than 160mg/dl has a higher risk of developing hypertensive disorder in pregnancy.
RESUMO
The aim of this study was to study the outcomes of all patients who presented with breech presentation at term (≥37 weeks), to assess what percentage of patients were offered External cephalic version (ECV), the rates of success of the procedure and the rates of vaginal delivery following successful ECV. It was a retrospective study of 669 patients diagnosed with breech at term, their clinical records were retrieved and data like age, BMI, parity, type of breech and scan findings noted. ECV was done in 256 patients and was successful in 35.5% of women with 51.1% being multigravidas and 26.8% in primigravidas. 76.9% of women with successful ECV delivered vaginally. There was no significant fetal or maternal morbidity documented as a result of ECV in this study.
RESUMO
Caesarean hysterectomy (CH) is considered the gold standard for management of morbidly adherent placenta, now termed as placenta accreta spectrum (PAS). If bleeding is not controlled following removal of uterus, it is sometimes necessary to pack the pelvis and continue monitoring with correction of bleeding and physiological parameters in operating room and intensive care unit. This now comes under the damage control approach, being driven primarily by abnormal physiology rather than anatomical reconstruction. The pelvic packs are removed after about 48 hours. This retrospective study was done in patients with antenatal diagnosis of PAS who required CH, comparing those who required pelvic packing with those who did not. The variables compared were pre-operative (clinical and radiological), intra-operative (duration of surgery, blood loss and transfusion requirements of whole blood and blood products), and the final histopathological diagnosis. Outcome variables in terms of duration of hospital stay, re-admissions, re-laparotomy and complications were also compared. Over two years, three of eight patients with PAS required pelvic packing following CH. There were no differences between the two patient groups with any of the predictor variables or outcomes other than requirement of blood products. This suggests pelvic packing is a safe and efficacious procedure in intractable haemorrhage following CH for PAS. Pelvic packing needs greater awareness amongst obstetricians as the incidence of PAS is likely to increase.