Morphology and Morphometric Study of Human Placenta in Rural Southern India.

Aims: To study the morphology and do the morphometric analysis of placenta and to correlate with the foetal parameters, in order to help in the assessment of the state of well being of foetus. To study the histomorphological features of placenta in various conditions complicating the pregnancy. Study Design: Descriptive type of study. Place and Duration of Study: Department of Pathology and Department of Obstetrics and Gynaecology, Sri Manakula Vinayagar Medical College, Puducherry, between July 2013 and August 2013. Methodology: We included 51 fresh placentae. Gross examination including weight, shape, thickness, feto-placental ratio, placental co-efficient was calculated. Later, histo- morphological study was done. Results: Out of the 51 placentae, 48 were circular in shape and 3 were oval in shape. In the present study the mean (± SD) diameter of the placenta was 14.65 cm and thickness of the placenta was 1.42 cm. The thickness of placenta was reduced (<1.5cm) in all cases of Pregnancy induced hypertension (PIH), Isoimmunisation, twin pregnancy, prematurity and anemia. Placental weight was reduced in all cases of PIH, low birth weight baby, prematurity and Increased placental weight was seen in the gestational diabetes. Fetoplacental ratio was 5.39:1(both sexes considered together) and placental coefficient was 0.19. In PIH, the average foeto-placental ratio was 5.20:1and the average placental coefficient was 0.19. Gestational diabetes showed a foeto-placental ratio of 5.30:1, the placental coefficient being 0.18 with a considerable increase in the birth weight and in the placental weight. Anaemia showed a significant reduction in the placental weight, with a foeto-placental ratio of 5:1 and an increase in the number of ill-defined cotyledons. In prematurity, average foeto-placental ratio was 4.43:1, while Rh isoimmunisation did not show any decrease in the foeto- placental ratio. Conclusion: As anticipated, in case of PIH complicating pregnancies, the morphometric values of the placenta like the diameter, number of cotyledons and the average placental and foetal birth weights were found to be lower than that of the normal, uncomplicated pregnancies. At the same time, all these parameters were increased in cases of diabetes. So morphometric investigation of the placenta will be tremendously useful in the early assessment of placental insufficiency and also the state of foetal well being.

Macular ischaemia as a marker for nephropathy in diabetic retinopathy.

PURPOSE: To determine whether diabetic macular ischaemia is associated with ischaemic heart disease (IHD), hyperlipidaemia, hypertension (HTN) and nephropathy. METHODS: Prospective case-control study from January to December 2001, involving 102 type 2 diabetic patients (aged 40-80 years), 59 with unilateral / bilateral macular ischaemia and 43 concurrent controls. Diabetic retinopathy was graded and macular ischaemia assessed by fundus examination, central fundus photography and fluorescein angiography. Systemic examination and laboratory investigations were done to evaluate systemic diseases. The associations were analysed by Chi-square test and Student's t-test. The significance of the variables as independent risk factors was tested by logistic regression analysis. RESULTS: Macular ischaemia was not associated with IHD (P=1.00); HTN (P=1.00) and hyperlipidaemia (P=0.30). Nephropathy was significantly associated with macular ischaemia (P=0.025; odds ratio [OR]: 2.62; 95% confidence interval [CI]: 1.16-5.9). The association remained significant after controlling for age, gender, duration of diabetes, severity of retinopathy, HTN, IHD and hyperlipidaemia. Further, the association with nephropathy was not affected by the presence of macular isachaemia in one or both the eyes (P=0.39). CONCLUSION: Macular ischaemia may serve as a marker for nephropathy in type 2 diabetes mellitus irrespective of the severity of retinopathy.

Ocular manifestations of congenital rubella syndrome in a developing country.

PURPOSE: To describe the ocular manifestations of congenital rubella syndrome (CRS), a common cause of congenital cataracts in developing countries. METHODS: Retrospective analysis of case records of 46 sero-positive infants under 12 months of age who presented at Aravind Eye Hospital, Madurai between July 1993 and February 2001. The ocular and systemic examination details were recorded. RESULTS: Both eyes were affected in 41 (89%) patients. Cataract was present in 81 (93.1%) eyes; most of them were nuclear cataract (79, 97.5%). Other common ocular presentations included microphthalmos in 74 (85.1%) eyes, iris abnormalities in 51 (58.6%) eyes, and pigmentary retinopathy in 33 (37.9%) eyes. Cataract, microphthalmos and iris hypoplasia was a common combination present in 49 (56.3%) eyes. Systemic manifestations included cardiac anomalies in 23 (50%) and neurological anomalies in 16 (34%) children. Multi-system involvement was present in 32 (70%) children. Low birth weight (below 2 kg) was seen in 30% infants. CONCLUSION: CRS may present with a wide spectrum of ocular and systemic findings and requires a high index of suspicion for diagnosis. Any sick infant with unilateral or bilateral congenital cataract should be investigated thoroughly for CRS.

Sodium bicarbonate--an alternative to hyaluronidase in ocular anaesthesia for cataract surgery.

PURPOSE: To evaluate and compare the safety, efficacy and cost-effectiveness of 7.5% sodium bicarbonate buffered lidocaine (pH 7.2) with hyaluronidase mixed lidocaine (pH 4.6) for local anaesthesia in cataract surgery. METHODS: This prospective study comprised two parts. Part I: We evaluated the ocular and systematic anaesthetic safety and efficacy of 7.5% sodium bicarbonate buffered lidocaine on 112 consecutive patients undergoing cataract extraction with intraocular lens (IOL) implantation. At 12-week postoperative follow up final visual acuity and detailed fundus examination was done. Part II: It was conducted as a double blind, randomized comparative clinical trial involving 120 patients undergoing cataract surgery under retrobulbar anaesthesia. Patients were randomly assigned to one of the two groups: 60 eyes received 2 ml of 2% lidocaine with 1:200,000 epinephrine and 1 ml of 7.5% sodium bicarbonate, (0.299 mmol/ml); the remaining 60 eyes received 2 ml of 2% lidocaine with 1:200,000 epinephrine and 450 units of hyaluronidase (15 U/ml). In the event of incomplete akinesia, retrobulbar blocks were supplemented at 10 minutes. Onset and duration of anaesthesia and akinesia were assessed and compared in both groups. RESULTS: The pH-adjusted lidocaine group did not show any demonstrable variation in blood pressure (BP) or other systemic reaction. No anaesthesia-related adverse ocular effects were observed either during or after surgery. Thirty-one eyes (51.6%) achieved complete anaesthesia and akinesia within 5 minutes compared to 13 eyes (21.6%) in the hyaluronidase group. However, the overall mean onset time of anaesthesia and akinesia, repeat block rate and the duration of the anaesthesia were comparable in both the groups--p: 0.14). Twelve weeks postoperatively 88.39% of patients showed a best corrected visual acuity of 6/18 or better (73.21%-6/12 or better). CONCLUSION: In this study, sodium bicarbonate buffered 2% lidocaine was found to be a safe and effective local anaesthetic, with reduced time of onset, and improved quality of both anaesthesia and akinesia. Sodium bicarbonate (7.5%) may be used as an alternative to hyaluronidase in ocular anaesthesia. It is readily available and is cost effective.