Experience of a low-dose magnesium sulfate regimen for the management of eclampsia over a decade.

OBJECTIVE: To assess the safety and efficacy of a low-dose magnesium sulfate regimen for the management of eclampsia in Indian women. METHODS: A loading dose consisting of 3g of magnesium sulfate intravenously plus 5g intramuscularly (2.5g in each buttock) was followed by 2.5g intramuscularly every 4hours, for 24hours beyond the last seizure. In a first phase, which spanned 2001 and 2002, the regimen was evaluated prospectively with 554 women with eclampsia, and the results were compared with results from the Collaborative Eclampsia Trial. Regarding the second phase, which spanned the 9 following years, mortality was analyzed retrospectively for 2929 women treated by the same regimen at the same hospital. RESULTS: The mean±SD maternal weight and height were 41.7±5.3kg and 151±7cm, respectively. The low-dose regimen was associated with a lower seizure recurrence (6.1% vs 9.7%; P=0.02) and a slightly lower maternal mortality (2.7% vs 3.2%; P=0.6) compared with the Collaborative Eclampsia Trial. The overall case fatality rate for the second phase was 3.3%. CONCLUSION: The low-dose regimen was safe and effective for the management of eclampsia in a region where most women are of light weight.

Role of Hayman technique and its modification in recurrent puerperal uterine inversion.

Acute puerperal uterine inversion is a rare and fatal complication after delivery. The first priority is its rapid management and prevention of postpartum hemorrhage. On rare occasions, there may be recurrence of inversion after reduction. We applied Hayman technique to two cases of recurrent uterine inversion.

Nonobstetric lower genital tract injuries in rural India.

OBJECTIVE: To study the impact of nonobstetric genital tract injury (NOGTI) in rural India. METHODS: A prospective observational study of 52 consecutive women admitted with NOGTIs caused by voluntary coitus or accidental injury. Details of the causes of trauma, clinical presentations, and management were recorded. RESULTS: A total of 17 women (32.7%) presented with coital trauma, while 35 women (67.3%) sustained noncoital injuries: bicycle/automobile accidents (10); fall from height (7); cattle horn injury (7); straddle-type trauma (6); leech bites (3); and vaginal foreign bodies (2). Most women had multiple injuries; 15 women developed vulvar hematomas and 3 had anorectal lacerations. Management included immediate resuscitation along with primary repair of injuries, evacuation of vulvar hematomas, and removal of vaginal foreign bodies. Fifteen women (28.8%) required blood transfusions; none of the women died. CONCLUSIONS: Severe hemorrhage caused by NOGTIs is potentially fatal in rural settings if treatment is delayed. Prompt resuscitation, early referral, and appropriate surgical intervention can avert both morbidity and mortality.

Lipid peroxidation and vitamin E status in gestational diabetes mellitus.

AIM: To investigate any correlation between plasma levels of lipid peroxides, antioxidant nutrient (alpha-tocopherol) and oxidized high-density lipoprotein (HDL) in patients with gestational diabetes and those with a normal pregnancy and the incidence of pre-eclampsia. METHODS: Sixty pregnant women attending an antenatal clinic were recruited for the study and were divided into two groups. Thirty women with gestational diabetes mellitus were recruited in the study group. The glucose-tolerance-test criteria, using 100 g of glucose taken orally, as laid down by the American College of Obstetricians and Gynecologists (1994) for diagnosis of gestational diabetes mellitus was used. Thirty gestation-matched pregnant women with normal glucose tolerance test results were recruited as controls. A 10 mL venous blood sample was collected from each subject at the time of recruitment and thereafter at 4 week intervals until the time of delivery. Samples were analyzed for malondialdehyde thiobarbituric acid reactive, oxidized HDL-cholesterol and alpha-tocopherol. The incidence of pre-eclampsia and its correlation with antioxidant and lipid peroxide levels were compared in both the groups. RESULTS: Ten subjects out of 30 in the study group and three subjects out of 30 in the control group developed pre-eclampsia. The incidence of preterm labor in both the groups was same (16.66%). The mean lipid peroxide level was lower in the study group at recruitment and later the levels kept falling, whereas levels of alpha-tocopherol and oxidized-HDL were higher in the study group and kept on rising at follow up. CONCLUSION: Gestational diabetes is not associated with increased levels of lipid peroxides and decreased levels of alpha-tocopherol.