Prevalence and Determinants for Gestational Diabetes Mellitus (GDM) in Pregnant Females at high risk for GDM in a teritiary care center

Background: GDM represents a high risk factor in pregnancy. Prevalence of GDM is increasing globally. Aims & Objectives: To evaluate the prevalence and risk factors for gestational diabetes mellitus among pregnant females at high risk for GDM attending a tertiary care hospital. Methods: The present study was a prospective Observational study. Pregnant women between 24-28 weeks of gestation irrespective of the age and parity with risk factors like overweight, history of diabetes mellitus in first degree relatives, previous history of macrosomic baby or congenital malformations, history of difficult instrumental deliveries, polyhydramnios were included . Detailed history, physical examination and routine investigations were carried out. The screening was done by Glucose challenge test using 50gms of oral glucose .The women found positive on screening test were subjected to 3 hours, 100gm glucose tolerance test (GTT). Results: A total of 350 randomly selected pregnant females who met the inclusion criteria were included. Out of 350 women, 74 (21.1%) turned out to be positive for screening test. The screening test positive women when subjected to confirmatory test of GDM by oral glucose tolerance test, 22 (6.3%) women were found to have GDM. Factors associated with increased prevalence were increasing age(1.8% vs 5% vs 16% p=0.001 in age groups <25 , 25-29 and > 30 years respectively) , parity (10.6% vs 4.2% p=0.03 more than two children and less than or equal to two children respectively) , obesity(25% vs 2.6% p<0.05 Obese vs non obese ), those with history of previous abortion(5.2% vs 10.7% vs 25% p=0.013 ,no abortion, one abortion ,two or more abortion respectively), those with history of GDM in previous pregnancy( 57.1% vs 5.2 % p=0.001) and those with history of diabetes mellitus in first degree relatives(37.5 vs 5.6% p=0.001). Conclusion: The prevalence of GDM was 6.3%. GDM was found more commonly in those with higher age, parity, women with history of abortions during previous pregnancy, obese, those with history of GDM in previous pregnancy and those with history of diabetes mellitus in first degree relatives. Screening should be offered to all pregnant women especially women with risk factors.

Fetomaternal outcomes of mothers with detectable cytomegalo virus (CMV)-specific IgM antibodies

Background: Human cytomegalovirus (CMV) infection is the most common cause of perinatal viral infection. congenital CMV infection can produce varying degrees of neurodevelopmental disabilities. Aims and objectives were to study the fetomaternal outcome in CMV-Specific IgM antibodies.Methods: The study was prospective for a period of one and a half year. Hundred high risk patients with hundred controls were screened for CMV serology IgM. Maternal & fetal outcomes were noted.Results: Out of 100 cases in study group 27(27%) were positive for CMV IgM while in control group 6(6%) were positive(p<0.05). Primary CMV infection in mothers led to abortion in 2(7.4%) patients, pre-term labour in 5(18.5%), Postpartum hemorrhage in 6 (22.2%), fetal distress in 11(40.7%) while 37% had uneventful outcome. Among CMV positive cases 48.1% were born term live, 6(22.2%) were preterm, 1(3.7%) had IUD, Intrauterine growth restriction in 10 (37%), 6(22.2%) with congenital defect and 4(14.8%) with neonatal manifestations.Conclusions: CMV remains a significant public health concern. Education of young women in our community regarding hygienic and behavioral approaches that can help prevent CMV transmission is mandatory.

Prevalence of Viral Infections in High Risk Pregnancies

Introduction: Prevalence of viral infections in high riskpregnancies has not been studied so far in our population.Current research aimed to study the prevalence of viralinfections in high risk pregnancies.Material and methods: The Study was prospective fora period of one and a half year. Hundred high risk patientswith hundred controls were studied. The viral infectionsstudied included Rubella, Herpes Simplex Type 1 and Type 2,Cytomegalovirus (CMV), HBsAg, HCV, HIV-1 and 2Results: The mean age of the women in the study group was25.2+4 years and in the controls was 25.2+4 years Out of100 cases studied 29% were positive for CMV, vs 6% controlgroup (p < 0.05), 19% were positive for Rubella IgM, vs 1% incontrols. 21% cases were positive for HSV-1/ HSV-2 IgM, vs7% in controls, 5% were positive for HbsAg, vs nil in controls.7% were positive for HEV IgM, vs nil in controls. No case ofHCV IgM was found in study or control group. One case ofHIV IgM was found in study group and none in control group.Conclusion: The seroprevalence of viral infections issignificantly higher in high risk pregnancies as compared tocontrols. CMV infection was the most prevalent viral infectionin our studied population.

​Clinico-demographic Profile and Treatment Patterns of Ovarian Cancer in Kashmir

Introduction: Ovarian cancer is the fourth most common cause of cancer deaths world wide and also the commonest causeof death among all gynecological cancers.Aims and Objectives: To study the clinico demographic profile and treatment patterns of Ovarian Ca in our population.Material and Methods: We conducted an analytical, non-randomized, cross-sectional study on the Clinico-Demographic profileof 731` patients with Ovarian Carcinoma who reported to our OPD between 2008 to 2015.Results: The mean age of patients was 45±1. 49 years. Most common age group of our patients at presentation was 46-60 years.Majority of patients 70% in our study were from rural area. The major clinical presentation of ovarian in our study was pelvic pain(36%) followed by abdominal distention (34%) and ascites (22%). Most common type of ovarian cancer was of surface epithelialtype (94%) followed by sex cord stromal tumor (3%) and germ cell tumour (1. 6%). Most of the cases 61% in the present studyhad presentation at advanced stages (stage III & IV) while as only 39% cases had presented at early stages (stage I & II).Majority of the patients having ovarian tumors underwent surgical staging with surgery in 88% cases. Chemotherapy was themost common adjuvant therapy in 38% patients who had malignant ovarian pathology and had advanced stage of diseases.while as 7 patients (1%) received radiotherapy for brain and bone mets.Conclusion: Majority of patients were from rural background with pelvic pain as most common presenting symptom Most ofour cases presented in late stages of disease. Greater awareness among our community is needed to reduce the morbidityand mortality associated with Ovarian Ca

Comparison of Hysterosalpingography and Laparoscopy in Diagnosis of Tubal Occlusion.

Background: Infertility is one of the most common conditions confronting Gynecologists and tubal factor is one of the most common causes of infertility. Hysterosalpingography and laparoscopy are used as methods for diagnosis of tubal patency in infertility. HSG is an OPD procedure and, for many years has been used as an invaluable procedure for diagnosis of tubal patency and intrauterine pathology in infertility. Laparoscopy is an invasive procedure and is used for evaluation of tuboperitoneal factors. Aims and objectives: To evaluate the diagnostic accuracy of hysterosalpingography in the diagnosis of tubal pathology in infertility in comparison to laparoscopy Methods: 60 patients of infertility were evaluated in the department of Gynecology and obstetrics, Government Lalla Ded Hospital ,Srinagar from April 2013 to August 2014. A prospective cross sectional study was performed. HSG was performed in the pre-ovulatory phase .Laparoscopy was performed under general anesthesia at least three months after HSG in the premenstrual phase. Diagnostic laparoscopy was considered as the reference standard in detecting tubal blockade and findings of hysterosalpingography were compared with laparoscopy. Results: All the patients in the study group were complaining of infertility. The total number of patients in this study was 60 in which 41 were in primary infertility group and 19 were in secondary infertility group. The age of patients was between 21 and 39 years. The average duration of primary infertility was 4.08 years and secondary infertility was 5.15 years. The sensitivity of HSG was 90.91% (95%CI: 76.43-96.86) and specificity was 77.78% (95%CI 59.24-89.39) with positive predictive value of 83.33% (95%CI 68.11-92.13) and negative predictive value of 87.50% (95%CI 69.0- 95.66),when tubal pathology was defined as any form of tubal occlusion detected at laparoscopy, either one sided or two sided. The further advantage of laparoscopy is the possibility of visualization of some other pelvic abnormalities which may be the cause of infertility. In our study, in patients with tubal block, adnexal adhesions were found in 15 (45%), endometriosis in 8(25%) and suspected intratubal block in 10(30%). Conclusion: HSG is the first step diagnostic test for assessment of fallopian tubes. Although laparoscopy is more invasive than HSG, laparoscopy with chromotubation is the gold standard for diagnosis of tubal block, and for identifying periadnexal adhesions and endometriosis and thus to guide appropriate therapy.