Feto-maternal outcome; trial of labour a study at tertiary care hospital

Trial of labour is a clinical test to assess the adequacy of pelvis and ability of fetus and mother to withstand labour. If progressive changes in dilation and station do not occur, a cesarean delivery is performed. Feto-maternal outcome after trial of labour in women with gestational age b/w 37 to 42 weeks. Cross sectional study. Department of Obs/ Gyn unit-I Liaquat University Hospital Hyderabad. One year from 01-02-2009 to 31-01-2010. 100 pregnant women, with gestational age between 37-42 weeks, who underwent trial of labour at labour ward, Obs/Gyn Unit-1 Liaquat University Hospital, after fulfilling the inclusion criteria were included in the study. Detailed history and examination including abdominal and pelvic examination as well as Ultrasound for fetal well being was performed. Fetal monitoring was done by auscultation and CTG. Partogram was maintained to observe the progress of labour. Those who progressed with trial either delivered normally or with the help of instruments and those who did not progress were delivered by C-section. After delivery, mothers were watched for any postpartum complication and condition of neonates was assessed by APGAR score. Out of 100 women included in this study 58% delivered vaginally, 31% delivered by cesarean section and 11% had instrumental deliveries. Labour was induced in 34%, augmented in 34% and 32% had spontaneous labour. 77.0% babies had apgar score > 5[7.1 +/- 0.72], 16% < 5[3.68 +/- 2.18] and 6% were still birth. 81% mothers had no complication during or after delivery, whereas 19 developed complications and these were 12 Genital tract traumas, 5 postpartum haemorrhage, one uterine rupture and one retained placenta. There was no statistically significant difference [P=0.42] when mode of delivery was compared with the trial of labour. However augmentation of labour was associated with increased rate of maternal complications when maternal outcome was compared with the type of labour [P=0.03]. Trial of labour in carefully selected women with high probability to deliver their babies vaginally decreases the rate of LSCS, thereby reducing the maternal morbidity and mortality associated with it. However augmentation of labour is associated with increased rate of maternal complications as compared to spontaneous or induced labour

Frequency of anemia among patients of abruptio placentae

To determine the frequency of anemia and need for blood transfusion in patients of placental abruption. This prospective cross sectional study was conducted at Department of Obstetrics and Gynecology for a period of 15 months from September 2010 to December 2011. All pregnant ladies who presented with Abruptio Placentae were included by completing a proforma for each patient After confirming the diagnosis, the blood of these patients was sent to laboratory for hemoglobin level, blood group and other routine investigations. According to hemoglobin level and the amount of bleeding, the number of blood units required by each patient was analyzed on SPSS v 15. 100 patients suffering from placental abruption were studied. 83% ladies were anemic and 61 were moderate to severely anemic. 98% received blood transfusion and 91% received 1-4 units of blood. Majority of patients presenting with placental abruption were found to be anemic and required multiple blood transfusions. The association between anemia and placental abruption is well documented, however, it needs to be established whether anemia leads to abruption or anemia is the consequence of abruption

Placental abruption; frequency of its risk factors

To determine the frequency of risk factors associated with Placental Abruption. Prospective and Observational Case Study. Department of Obstetrics and Gynecology, Liaquat University of Medical and Health Sciences Hyderabad, for a period of 15 months from January 2006 to March 2007. All the antenatal patients/ pregnant ladies admitted to labour room /ward and delivered during the above mentioned period were scrutinized and those suffering from Abruptio Placentae were entered into this study by completing a proforma for each patient. The risk factors studied were; Age of Patient, Parity, past history of abruption, rural belonging, history of trauma, association with diabetes, hypertension, smoking and anemia. Results were analyzed on SPSS version 10. A total of 100 patients suffering from placental abruption were studied during 15 months period. The commonest age group was 30 years [47%]. Majority [54%] was multiparous, 66% belonged to rural population and among these, 2/3 were unbooked. Only one patient gave history of trauma. 5 patients had history of previous abruption. History of diabetes was present in only one patient, whereas 38% were hypertensive. Only 4 patients gave positive history of smoking. Anemia was the single most common factor present in 83% ladies. Age around 30 years, multiparity, hypertension, presence of anemia, rural belonging and previous abruption are the risk factors for placental abruption as per this study. No association of abruption has been found with trauma, diabetes or smoking in this study

Comparison of high sensitivity C-reactive protein level between obese and non-obese pregnant women

To find out whether obesity is associated with low grade systemic inflammation as measured by serum c-reactive proteins [CRP] levels. Cooperative Observational Study. This was conducted in the department of Physiology BMSI, JPMC with the collaboration of gynecology and obstetric department of JPMC Karachi from October 2008 to May 2009. This study includes thirty obese pregnant women and thirty normal weight pregnant women as a control group of similar age, sex, height and gestational age. Subjects were randomly selected from gynae OPD of JPMC Karachi. The mean values of C - reactive protein concentration was higher in obese pregnant women as compared with control group [4.3 +/- 0.16 mg/L vs 9.0 +/- 12 mg/L]. It showed statistically significant positive correlation with body mass index [BMI]. Higher BMI was associated with higher C-Reactive proteins concentration. These findings suggest a state of low-grade systemic inflammation in obese pregnant women

High prevalence of mild hyperhomocysteinemia and folate, B12 and B6 deficiencies in an urban population in Karachi, Pakistan

To find out the prevalence of hyperhomocysteinemia, and deficiencies of folate, vitamin B6 and vitamin B12 in an urban population in Karachi, Pakistan. In a pre and post experimental study, eight hundred and seventy-two apparently healthy adults [aged 18-60 years; 355 males and 517 females] were recruited from a low-income urban locality in East of Karachi from February 2006 to March 2007. Fasting venous blood was obtained. Serum was analyzed for folate and vitamin B12. Plasma was analyzed for pyridoxal phosphate [PLP, coenzymic form of B6] and total homocysteine. A group of vitamin-deficient individuals [n=194] was given 3-week supplementation with folic acid [5mg/day], methycobalamin [0.5mg/day] and pyridoxine hydrochloride [vitamin B6, 50 mg/day]. After supplementation, serum/plasma levels of folate, vitamin B12, PLP and homocysteine were again determined. Prevalence of hyperhomocysteinemia [>15micromol/l] was 32%. Similarly percent values of folate deficiency [<3.5ng/ml], vitamin B6 deficiency [PLP<20 nmol/l] and vitamin B12 deficiency [<200pg/ml] in the study population were 27.5%, 33.7% and 9.74%, respectively. Hyperhomocysteinemia was associated with male sex, folate deficiency, vitamin B12 deficiency [OR [95%CI], 8.3[5.7-12.1]; 2.5[1.76-3.58]; 2.6[1.5-4.5], respectively]. A 3-week supplementation with folic acid, methycobalamin and pyridoxine hydrochloride in vitamin-deficient subjects decreased plasma homocysteine levels by 37%. High prevalence estimates of folate, vitamin B12, and vitamin B6 deficiencies appear to be the major determinants of hyperhomocysteinemia in a low income general population in Karachi

Role of glycemic control and blood pressure in the development of microalbuminuria in NIDDM patients

To assess the relationship of elevated urinary albumin excretion to glycated hemoglobin and increased blood pressure in non-insulin-dependent diabetic patients. Analysis of glycated hemoglobin, blood pressure, serum and urinary creatinine, body mass index in groups I, II and III, i.e., 21-120, 1 21-170 and 171-200 micro g/min, respectively, based on rate of albumin excretion in 24 hours urine samples of patients with NIDDM. Department of Biochemistry, Basic Medical Sciences Institute and Diabetic Clinic of Jinnah Postgraduate Medical Centre, Karachi. A total of one hundred patients having NIDDM diagnosed at least two years previously and 25 apparently healthy subjects as control with similar socioeconomic status were selected. Serum glycated hemoglobin, urinary albumin, albumin creatinine ratio and creatinine clearance were significantly increased in all groups when compared to controls, whereas systolic blood pressure of group-Ill was highly significant. The results of this study prove the effect of poor glycemic control and increased blood pressure on development of microalbuminuria in NIDDM patients