A Prospective Study of Placental Growth Factor Assay as a Novel Biomarker in Predicting Early-Onset Preeclampsia in High-Risk Patients.

INTRODUCTION: Preeclampsia is a leading cause of maternal and perinatal mortality and morbidity, but signs and symptoms are non-specific and may vary. The root cause is imbalance of circulating angiogenic factors of placental (syncytiotrophoblast) origin, with consequent low levels of placental growth factor (PlGF) which may aid in diagnosis and prediction of disease. AIMS AND OBJECTIVES: To study the incidence of women at risk of developing early-onset preeclampsia by plasma placental growth factor biomarker assay in high-risk patients, to assess the maternal outcome in patients with PlGF values below cutoff for presenting gestational age, to calculate sensitivity, specificity, positive predictive value and negative predictive value of PlGF assay in predicting preeclampsia and to conclude whether PlGF biomarker assay can be an effective screening test in high-risk patients for prediction of early-onset preeclampsia. MATERIALS AND METHODS: The study was carried out in the Department of Obstetrics and Gynecology at a tertiary care center. It is a prospective study, and study period extended from April 2012 to October 2013. One hundred pregnant women with 20- to 34-week gestational age with possible high risk of developing preeclampsia attending the antenatal clinics and high-risk OPDs were screened in the present study after explaining the nature of the study. PLGF concentration was quantitated using plasma and processed in Triage kit device (fluorescence immunoassay device). PLGF concentration was categorized against a specific range for specific gestation, and values below the range or <12 pg/ml were considered screened positives. The cases were followed up till delivery. RESULTS: Twenty-two cases were screened positive, of which 20 developed preeclampsia with a strong positive prediction value of more than 90 %. CONCLUSION: PLGF is a strong predictor and a useful assay for early-onset preeclampsia.

Homocysteine as Predictive Marker for Pregnancy-Induced Hypertension-A Comparative Study of Homocysteine Levels in Normal Versus Patients of PIH and Its Complications.

OBJECTIVE: To find the correlation between serum homocysteine levels, relevant laboratory investigations and complications associated with PIH. METHODS: This was a prospective study conducted over 2 years. Two hundred and fourteen cases were studied. They were divided into mild preeclampsia (64), severe preeclampsia (50), eclampsia (32) and control groups (68). Parameters evaluated for statistical analysis were blood pressure, platelet counts, SGOT, SGPT and serum homocysteine levels. RESULTS: A definite statistical correlation was found between the homocysteine levels and severity of hypertension (8 mmol/l, p = .759). A higher level of homocysteine was also associated with many maternal complications like abruption, retinopathy, MODS, maternal mortality and eclampsia. Sixty-nine out of 87 patients with elevated homocysteine levels were complicated with some or the other condition, making a high percentage of 79.31 %. Patients with normal level of homocysteine delivered healthy babies (88.1 %). There were 6 maternal mortalities and 20 stillbirths in the hyperhomocysteinemia group. CONCLUSION: Homocysteine levels have a direct statistical correlation with the severity of hypertension and complication with preeclampsia and eclampsia. It can be considered as a reliable predictive marker for PIH and its wide syndrome.

LDH (Lactate Dehydrogenase): A Biochemical Marker for the Prediction of Adverse Outcomes in Pre-eclampsia and Eclampsia.

OBJECTIVE: The aim of the study was to find out the role of Serum lactate dehydrogenase in prediction of adverse outcomes of PE & E i.e., severity of disease and occurrence of complications. MATERIALS AND METHODS: This study was conducted in the Department of Obstetrics and Gynaecology, MGM Medical College, Indore. A total of 200 women were studied; they were divided into control (n = 100), severe pre-eclampsia (n = 32), eclampsia (n = 68). Demographic and hematological parameters were studied including LDH levels. RESULTS: The incidence of severe pre-eclampsia-1.2 % & Eclampsia 2.7 %, PE & E patients were significantly younger, with low gravidity and parity. They had significantly increased systolic and diastolic pressure, liver enzymes, uric acid, urine albumin, and LDH levels. Serum urea and creatinine were normal in majority of cases. The symptoms and complications of PE along with perinatal mortality were increased significantly in patients with LDH >800 IU/l compared with those who had lower levels. Complications like Retinopathy, ARF, Abruptio, DIC, CVA, MODS, Shock were also associated with high level of serum LDH >800 IU/L. Low birth weight of babies was also associated with high level of serum LDH levels in PE & E patients. The incidence of poor perinatal outcome was higher in PE & E patients with high serum LDH level (>600 IU/L). CONCLUSION: LDH is the earliest marker seen in blood during hypoxia and oxidative stress. It is a useful biochemical marker that reflects the severity of and the occurrence of complications of PE & E; these are preventable if identified at an earlier stage and adequately managed at a higher center. Test is easily available, so screening of all cases of PE & E with LDH levels must be made mandatory.

Isosorbide Mononitrate a Nitric Oxide Donor: A Study of Its Efficacy and Safety as an Agent for Cervical Ripening.

OBJECTIVE: To study the efficacy and safety profile of isosorbide mononitrate (IMN) as an agent for cervical ripening. METHODOLOGY: This study was conducted in the Department of Obstetrics and Gynecology, M Y Hospital & M G M Medical College Indore from September 2011 to February 2013. Pregnant women attending the antenatal clinics were screened for possible participation in the study after explaining the nature of the study. This study was conducted on 150 patients. An initial dose of 40 mg IMN was applied in the posterior vaginal fornix, and the same dose was repeated after 6 h. Cervical ripening was assessed by the change in Bishop Score 12 h after the initial application. RESULTS: In a study of 150 cases, mean maternal age was 22.2 ± 2.6 years (range 19-35 years) and mean gestational age was 40.5 ± 1.07 (range 40-42 weeks). 52 women were primigravidas, while 98 were multigravidas. The mean Bishop Score-before drug administration was 1.94 ± 1.3 (range 0-5), and mean fetal heart rate was 137 ± 6.2 bpm. The mean of Bishop scores before IMN administration was 1.94 ± 1.3, while mean of Bishop score after drug administration was 6.7 ± 2.2; mean difference was equal to 4.76. P value was equal to 0.0001. By conventional criteria, this difference is considered to be statistically significant. The mode of delivery 96 (64 %) delivered vaginally, while 54 (36 %) were delivered by Cesarean section. Mean Apgar score at 1 min was 8.2 ± 0.9 SD (range 7-10), while mean Apgar score at 5 min was 9.4 ± 0.6 (range 8-10). The only side effect noted was headache, and 30 cases (20 %) complained of headache. CONCLUSION: IMN seems to be effective, safe, inexpensive, and well-tolerated agent for cervical ripening. It is cost effective and safe with minimal side effects.

Importance of Universal screening for thyroid disorders in first trimester of pregnancy.

OBJECTIVE: To determine the importance of screening for Thyriod disorders in the first trimester of pregnancy. MATERIALS AND METHODS: The Study was conducted on 305 patients which were were randomly selected and screened on OPD basis by TSH levels (cut off level 0.10-2.50 mIU/ml). RESULTS: In the 305 women screened mean age was 24.46 years, mean gestational age was 9.09 weeks, 89.83% were euthyroid, 9.8%were hypothyroid, 0.32% were hyperthyroid. Incidence of hypothyroidism in high risk population was 20.58% and in normal population was 6.7%. There was significant association of thyroid disorders with high risk factors (P < 0.001). In hypothyroid women 46% had adverse perinatal outcomes and 53.33% had normal outcomes. This shows statistically significant association abnormal TSH values with adverse pregnancy outcomes (P < 0.001). In abnormal perinatal outcomes 6.2% women had Caesarean section out of them 73.68% were euthyroid, 26.31% were hypothyroid 1.9% had preterm labour, out of them 50% were euthyroid, 50% were hypothyroid. Out of 2.2% spontaneous abortions 28.5% were in euthyroid group while 71.4% were in hypothyroid group. There was 1 term stillbirth in hypothyroid group. This study showed significant association between abnormal thyroid stimulating hormone (TSH) values and adverse perinatal outcomes (P < 0.001). CONCLUSION: There is significant correlation between risk factors and hypothyroidism. So high risk screening is mandatory in early pregnancy. But if we screen only high risk population we would miss 4.6% cases which could have been diagnosed and treated earlier. Therefore it is important to screen all pregnant women in the first trimester, it should be made mandatory.

Poor dental hygiene in pregnancy leading to submandibular cellulitis and intrauterine fetal demise: case report and literature review.

Ludwig's angina is an infectious process involving submandibular, sublingual, and submental spaces that can rapidly progress to hemodynamic instability and airway obstruction. A 38-year-old unbooked multipara of low socioeconomic status with a poor oral and dental hygiene presented with bilateral submandibular cellulitis and intrauterine fetal demise. She delivered vaginally, and subsequently drainage was done for cellulitis. The report highlights the importance of dental hygiene during pregnancy, lest life-threatening complications like Ludwig's angina occur, complicating the course of pregnancy.