Comparing difference in mean total protein, albumin and globulin based on severity of rhesus isoimmunization: a prospective study

Background: Maternal RBC alloimmunization results from exposure and response to a foreign RBC antigen. Transplacental fetal to maternal hemorrhage is the most common cause of alloimmunization. Rh incompatibility can lead to either fetuses with hydropic features or non-hydropic. The precise mechanism leading to the development of hydrops is uncertain. Biochemical markers have the potential to be used to assess the severity of problem. But of the mechanisms proposed none have been able to totally explain the phenomenon or predict the prognosis. Objective of this study wads to compare the difference in mean total protein, albumin and globulin bases on severity of isoimmunization and comparing it with normal controls.Methods: A Total of 40 pregnant patients were enrolled which included 10 hydropic fetuses of Rh isoimmunised mothers, 10 non hydropic fetuses of Rh isoimmunized mothers. Control group included 18 Rh positive women without any fetal complication and 2 fetuses in women undergoing cordocentesis. Blood sampling was done at time of intrauterine transfusion and sent for estimation of total proteins, albumin, globulin in fetal blood. Pregnancies were followed up till delivery and fetal outcome noted.Results: Mean total protein, albumin and globulin between hydropic, non hydropic group and control group (3.25, 2.17 and 1.18 g/dl) in hydropic, (4.14, 2.70 and 1.44 g/dl) in non hydropic and (4.42, 2.95 and 1.47 g/dl) in control group respectively. Mean total protein, albumin and globulin between mild hydropic (3.43, 2.30 and 2.10 g/dl) and severe hydropic group (2.59, 1.6 and 1.3 g/dl) respectively.Conclusions: There was significantly lower levels of serum total proteins, albumin and globulin in hydropic fetuses as compared to non hydropic fetuses. Thus, hypoproteinemia can be considered a strong marker for development of hydrops in Rh isoimmunized fetuses.

Assessment of the customized birth weight formula in a low risk Indian population

Background: Birth weight is probably the single most important factor that affects neonatal mortality, infant and childhood morbidity in both developed and developing countries. Objective of the study was to formulate a model for prediction of fetal weight at term based on individualized fetal growth parameters.Methods: 131 participant low risk gravidas were enrolled into the study. The participants underwent an ultrasound 7 days prior to delivery. All fetal variables of growth of a random 100 participants were incorporated in an equation derived using multiple regressions to predict birth weight at term. The new equation was then prospectively applied to another 31 pregnant women for validation. The diagnostic performance of the new regression formula was then compared to the Hadlock formula.Results: The customised birth weight formula predicted a higher accuracy with MPE±SD of 0.790±9. compared to the Hadlock formula with MPE±SD - 4.42±8.73. The new formula also explained a greater variance in birth weight of 56% compared to the Hadlock formula of 49%.Conclusions: The new model based on individualized fetal growth parameters recognizes the capacity to modulate an accurate final birth weight, thus emphasizing the need for customized population specific birth weight formulas.

Congenital Absence of the Cervix - Its Place in the Present Classification of Female Genital Tract Malformations

Aims and Objective: To outline and group cases of cervical agenesis / dysgenesis according to the associated uterine and vaginal abnormalities, as per the proposed ESHRE/ESGE CONUTA classification. Methods: The study was conducted in a tertiary care hospital and involved a total of 93 young girls diagnosed as having an absent cervix. Patients with utero-vaginal anomalies alone, with a patent cervix - such as uterine septae, uterus didelphys, bicornuate uterus; or transverse vaginal septae, imperforate hymen and complete or partial vaginal atresia, were excluded. All cases were subjected to specific clinical and local examination. Detailed 2 D Ultrasound was done to study the uterus. Identification of the cervix, its presence or absence, length of the cervical canal, hemato-cervix or hematocolpos was done by trans-abdominal route. All the cases were operated by the same team of surgeons, with the first author as the chief surgeon, to confirm and make a final diagnosis. They were then tabulated as per the CONUTA classification. Result: There was absence of the cervix (aplasia / dysplasia) in 93 cases as per the clinical examination, ultrasound, MRI and operative findings. There was complete or partial vaginal atresia (aplasia) in 69 (74.19%) cases and a normal vagina in 22(23.65%) cases. There were 33 cases (35.4%) with a normal uterus, with no cases of T-shaped uterus. There were 29/33 cases (87.89%) without vagina. There was one case with septate uterus and complete cervical and vaginal aplasia. Cases with two Bicornuate uteri with a common aplastic/dysgenetic cervix was seen in 4 cases. In 3 cases the cervix was partially patent in the upper side and obstruction was present only in the lower 4-5mm, causing ‘hemato-cervix’. There were 14 cases (15.1%) with unilaterally formed uterine horn, with the non-communicating rudimentary horn. There were 13 cases (13.9%) of cervical aplasia of the unilateral formed uterine horn. In 11 out of 93 cases (11.8%) of cervical aplasia, uterine aplasia / dysplasia and rudimentary horns with cavity were present. Conclusion: Our findings underscore the fact the patients with congenital absence of the cervix present a diagnostic challenge and that this entity should be thoroughly evaluated. The new ESHRE/ESGE classification system has the potential to overcome the limitations of the previous classification systems as it provides an effective and comprehensive categorization of almost all the currently known anomalies of the female genital tract.