Comparison Between Fetal Abdominal Subcutaneous Tissue Thickness and Abdominal Circumference to Predict Large for Gestational Age Neonate in Gestational Diabetes.

Objective: Increased subcutaneous fat deposition in abdomen in large for gestational age (LGA) fetuses of mothers with gestational diabetes mellitus can be measured by fetal abdominal subcutaneous tissue thickness (FASTT) using ultrasound. The current study aimed to evaluate the correlation between FASTT and birth weight and compare FASTT and abdominal circumference (AC) for prediction of LGA babies in gestational diabetes. Materials and methods: 150 term GDM women were enrolled into the study. FASTT was measured weekly. Birth weight was measured immediately after delivery and categorized into SGA, AGA and LGA according to International growth charts. The last FASTT and AC values were recorded for analysis. Correlation statistics was used to determine the relation between FASTT with birth weight and ROC curves were used to compare FASTT and AC for prediction of LGA fetuses. Results: There was weak positive correlation between FASTT and birth weight with Pearson's co-efficient (r) of 0.375. The cut-off value for FASTT to predict LGA fetuses obtained by ROC curve was ≥8.05 mm with sensitivity and specificity of 68.8% and 68.7%. The mean values of FASTT for small for gestational age (SGA), appropriate for gestational age (AGA) and LGA fetuses were significantly different. AUC for FASTT was 0.692 and for AC was 0.755. Conclusion: FASTT had a positive but weak correlation with birth weight. The utility of FASTT as a screening tool may not be impressive. FASTT can discriminate between SGA, AGA and LGA fetuses. AC is a better predictor than FASTT for LGA neonates.

A randomised comparative study of sublingual and vaginal misoprostol for cervical priming before minor gynaecological procedures.

This study aimed to compare the effect of misoprostol using vaginal or sublingual routes on the non-pregnant uterine cervix prior to minor gynaecological procedures. One hundred and forty women were randomised 1:1 into two groups: A and B. Group A received misoprostol 400 mcg vaginally and pyridoxine 40 mg sublingually and Group B received misoprostol 400 mcg sublingually and pyridoxine 40 mg vaginally 4 h prior to procedure. The outcomes studied were maximum size of Hegar's dilator that could be inserted into the cervix without any resistance, ease of dilatation, need and time required for further dilatation, side effects and complications. Baseline cervical dilatation was significantly more in Group A than Group B. Need for further dilatation and time required for further dilatation were also significantly less in Group A than Group B. Thus, we conclude that vaginal misoprostol is more effective than sublingual misoprostol in cervical priming before minor gynaecological procedures. Clinical Trial Registration Number: www.ctri.nic.in; CTRI/2018/07/015080 IMPACT STATEMENTWhat is already known on this subject? Cervical priming has been shown to result in shorter operative time, easier mechanical dilatation, reduced incidence of complications and blood loss when used prior to surgical abortion and has been recommended as a standard practice in various national and international guidelines for safe abortion practices. Misoprostol has many advantages over other ripening agents like osmotic dilators, other prostaglandins and mifepristone. Misoprostol can be given through oral, sublingual, vaginal, buccal and rectal routes. Use of misoprostol has been found to improve cervical dilatation, reduce need of further dilatation and ease of dilatation without many complications when compared to placebo for cervical priming of non-pregnant cervix. Studies comparing vaginal and sublingual routes have shown no significant difference for cervical ripening in pregnant women.What the results of this study add? We found that vaginal misoprostol for cervical priming was more effective than sublingual misoprostol in reaching a higher baseline cervical dilatation, with reduced need and time required for further dilatation before minor gynaecological procedures, although the ease of dilatation was similar in both groups. This effect of vaginal misoprostol was more marked in premenopausal women.What the implications are of these findings for clinical practice and/or further research? The results of our study are at variance with other studies done on use of misoprostol via the vaginal or sublingual routes, and hence it is imperative that large multi-center studies be performed to bring about consensus on the topic.

Chronic myeloid leukaemia in pregnancy: call for guidelines.

Although the incidence of chronic myeloid leukaemia (CML) in pregnancy is low, it is progressively rising. The management strategies for CML patients during pregnancy include tyrosine kinase inhibitors, interferon alpha, leukapheresis and hydroxyurea, each of which has their own deleterious effects on the mother and foetus. There are virtually no accepted guidelines on the therapeutic options for these patients. We report two cases of CML which were reported to us during pregnancy, on imatinib, with different ultimate pregnancy outcomes. We do believe that it is high time professional bodies frame guidelines for the management of these patients.

A Clinicopathological Evaluation of Postmenopausal Bleeding and Its Correlation with Risk Factors for Developing Endometrial Hyperplasia and Cancer: A Hospital-Based Prospective Study.

OBJECTIVE: The aim of this study is to investigate the clinical data from history and endometrial pathology by endometrial sampling in patients with postmenopausal bleeding and to identify risk factors associated with future development of endometrial cancer (EC). METHODS: We prospectively studied 76 postmenopausal women with vaginal bleeding and endometrial thickness (ET) >5 mm undergoing endometrial biopsy or dilatation and curettage. Patient characteristics and endometrial assessment of women with or without EC and hyperplasia were compared. Univariate and multivariate logistic regression identified factors associated with risks of endometrial neoplasia. RESULTS: In this study, the mean age at the time of presentation was 57.17 ± 7.11 years, mean menopausal age was 49.18 ± 3.69 years, and mean thickness of endometrial was 11.13 ± 6.37 mm. The histopathological analysis showed atrophic endometrium (30.3%), proliferative endometrium (27.6%), EC (15.8%), endometrium hyperplasia (11.8%), disordered proliferative endometrium (9.2%), and endometrial polyp (5.3%). Women of EC and hyperplasia group were more likely to be multiparous, diabetic, hypertensive, obese or overweight, has a history of recurrent bleeding episodes or thick endometrium. Using multivariate logistic regression, we found ET (adjusted odds ratio [AOR] = 17.76, confidence interval [CI] 1.91-165.02, P < 0.011, criterion ≥11 mm), recurrent episode of bleeding (AOR = 13.21, CI 1.10-158.91, P < 0.042), diabetes (AOR = 8.03, CI 1.15-55.78, P < 0.035) the best predictors of EC. CONCLUSION: As clinical characteristics are possible predictors of EC, these should also be taken into account in risk estimations and in the formulation of management plans. This not only has benefit in the process of disease detection but also may result in improved the efficiency of care.

Foetal fibular hemimelia with focal femoral deficiency following prenatal misoprostol use: A case report.

Misoprostol is a well known abortifacient. It can cause teratogenicity like Mobius sequence and terminal transverse limb defects. We report a rare case of proximal focal femoral deficiency with fibular hemimelia in a woman who had attempted abortion with self-administered misoprostol and later continued the pregnancy. Though the absolute risk of congenital malformations with its use is low ∼1%, this should be clearly communicated to the women requesting abortion to help them make fully informed reproductive health decisions.

Peripheral arterial disease in a female using high-dose combined oral contraceptive pills.

The association between oral contraceptive (OC) pills and vascular diseases is well-known, although, the present generation of pills is considered to be relatively safer in this regard. Hormonal treatment for severe abnormal uterine bleeding is usually considered after ruling out malignancy, when such bleeding is resistant to all other forms of treatment. We report a case of severe peripheral arterial disease in a female, who had been on high-dose OC pills for an extended period of time for severe uterine bleeding.