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Haemolysis (H), elevated liver enzymes (EL) and low platelet count (LP) i.e., HELLP syndrome is a vaguely understood condition of pregnancy which can present with rapid onset. It is commonly associated with pre - eclampsia. HELLP is also known to manifest itself without the clinical features of pre - eclampsia. The present study aims to assess the maternal and foetal complications associated with HELLP syndrome. METHODSThis retrospective study included all the pregnant women who developed HELLP / partial HELLP with gestational age of ≥ 28 weeks. The variables analyzed were obstetric history, menstrual history, antenatal complications, laboratory investigations (haemolysis, ALT / AST, LDH, CBC), mode of delivery, postnatal complications, maternal outcomes and perinatal outcomes. RESULTS72 patients were included in the present study. The mean age of pregnant women with HELLP syndrome was 23.6 ± 4.15 years. The average age of gestation was 33.17 ± 4.02 weeks. 58 % patients were primigravida. As per Mississippi triple-class system 82 % patients had partial HELLP, 18 % had complete HELLP. 4 %, 4 % & 10 % patients had HELLP class I, II & III respectively. Among the total cases, 74 % patients had antepartum onset, 10 % had intrapartum & 17 % postpartum onset of HELLP syndrome respectively. 65 % patients delivered vaginally & rest 35 % underwent caesarean section. High risk factors such as pre - eclampsia (65 %), eclampsia (3 %) & previous history of HELLP (8 %) were noted in study cases. Abruptio placentae (18 %), postpartum haemorrhage (17 %), pulmonary oedema (14 %), renal failure (14 %) & DIC (7 %) were the maternal complications noted. Maternal mortality was 7 %. The major perinatal morbidities noted were prematurity (67 %) & FGR (42 %). Intrauterine death was noted in 19 % babies. Neonatal intensive care (NICU) was required for 58 % babies, of which 42 % had respiratory distress. Neonatal death was noted in 17 %. CONCLUSIONSHELLP syndrome is a life threatening condition of pregnancy which has serious maternal and perinatal morbidities. Prompt referral, timely and appropriate interventions can save lives. Availability of Intensive Care Units (ICU) facilities, dialysis units and blood and its components along with Neonatal Intensive Care Unit (NICU) facilities can remarkably reduce the maternal and neonatal complications.
RESUMO
Background: Overweight and increased Body MassIndex (BMI) have been among the major changes ingirls and is one of the likely factors affecting themenarche age. Aim and Objectives: To determinecorrelation of age at menarche with BMI in adolescentgirls of urban and rural schools of Vijayapura, NorthKarnataka. Material and Methods:Aprospective crosssectional study was conducted by Department ofObstetrics and Gynaecology, Shri. B. M. Patil MedicalCollege Hospital and Research Centre, BLDE (Deemedst thto be University), between 1 July 2019 to 29 February2020.Girls below the age of 19 years who had attainedmenarche were included. Height and weight weremeasured, and BMI was calculated. Statistical analysiswas carried out in SPSS software, version 23.0 andMicrosoft 2010. Correlation between age at menarcheand BMI was assessed in adolescent girls of urban andrural schools of Vijayapura. Results: The mean age atmenarche among adolescent girls of urban and ruralschools was about 13.6 ± 1.2 years. Among allparticipants, 60.2% were from urban area and 39.8%were from rural area. The mean age of the menarchewas 13.8 ± 1.2 in rural population and 13.5 ± 1.3 inurban population (p value <0.001). Among all studyparticipants, 48.3% had normal BMI; however, 29.8%,15.4%, 5.8% and 0.7% were underweight, severeunderweight, overweight, and obese respectively.Majority of girls had normal BMI in both urban (49.2%)and rural settings (47.0%). Conclusion: A statisticallysignificant association (p< 0.05) was noticed betweenonset of menarche and area of residence. There was aninverse correlation between BMI and age at menarche,although this was not statistically significant.
RESUMO
Background: Mortality related to pregnancy and childbirth causes half a million women around the world to die annually. About 35% of these deaths are from postpartum hemorrhage (PPH). Prevention of PPH has been advised by the WHO by the use of Oxytocin 10 IU IM or IV and Misoprostol 600 µg in low resource settings in vaginal delivery. However there have been only a few reports on the use of Misoprostol during cesarean section. The best route and dose of Misoprostol is still being debated.Methods: One hundred women with term singleton pregnancy undergoing elective or emergency cesarean section under spinal anesthesia were randomly allocated to receive either Misoprostol 600µg sublingually or intravenous oxytocin 10 IU soon after delivery of the baby. Estimated blood loss and comparative change in preoperative hemoglobin to post operative hemoglobin levels and side effects were evaluated.Results: Blood loss was found to be more in Misoprostol than Oxytocin. Eight patients of the Misoprostol group required additional oxytocics. Oxytocin group did not receive any additional drugs. No surgical intervention was made in either of the groups. The most common side effect with Misoprostol was shivering (46%) and in Oxytocin group fever (4%).Conclusions: Sublingual Misoprostol of 600µg works to prevent postpartum bleeding. In our study Oxytocin was more effective than Misoprostol in preventing PPH during cesarean section. Late onset of action of Misoprostol in comparison to Oxytocin may render suturing of the uterus difficult due to pooling of blood. In settings in which use of Oxytocin is not feasible, Misoprostol might be a suitable alternative for post-partum hemorrhage.