Role of creatine phosphokinase as a diagnostic marker in tubal ectopic pregnancy.

Background and Aim: Ectopic pregnancy (EP) is still one of the leading preventable causes of maternal morbidity and mortality in the first trimester. Amidst the use of sensitive assays for ß-HCG and high-definition ultrasonography for the identification of EP, the search for a more reliable and sensitive marker remains a challenge till date. Our aim was to determine the validity of creatine phosphokinase (CPK) and its isoenzyme (CPK-MB) in the prediction of tubal EP. Materials and Methods: A prospective and comparative diagnostic accuracy study was conducted among 105 pregnant women in the first trimester who met the eligibility criteria in the Department of Obstetrics and Gynecology, North Eastern Indira Gandhi Regional Institute of Health and Medical Sciences (NEIGRIHMS). The study included 35 patients each with tubal EP (EP), abortive intrauterine pregnancy (AP), and normal intrauterine pregnancy (NP). CPK, CPK-MB, and ß-HCG were measured among all the participants, and the participants were followed up longitudinally. Results: A total of 105 pregnant women were included. The mean CPK and CPK-MB levels were significantly higher among the women with EP when compared to NP (P < 0.05) and AP (P < 0.05) women; however, there was no significant difference between the NP and AP groups (P > 0.05). Moreover, the receiver operating characteristic (ROC) curve showed that both CPK and CPK-MB were good predictors of EP, with CPK (area under the curve [AUC] = 0.764) being a better predictor than CPK-MB (AUC: 0.650) in the diagnosis of EP. Conclusion: Early diagnosis of EP allows appropriate and timely management, which would not only reduce mortality and morbidity associated with the condition but also enable preservation of fertility and improve future pregnancy outcome. Hence, the need of the hour is a reliable biochemical diagnostic marker for EP, such as CPK.

Comparison of the efficacy of intravenous labetalol versus oral nifedipine in patients with severe pregnancy-induced hypertension beyond 30 weeks of gestation.

Hypertensive disorders of pregnancy affect 5% to 10% of all pregnancies globally. The aim of treatment is to bring down blood pressure (BP) quickly and smoothly, which is safe for the mother and baby. The aim of our study was to study the efficacy and safety of intravenous labetalol and oral nifedipine in severe pregnancy-induced hypertension. Materials and Methods: It is a retrospective observational study, intravenous labetalol 20 mg was given initially in escalating doses of 40 mg, 80 mg, 80 mg, and 80 mg every 15 mins up to a maximum dose of 5 or until the goal BP ≤150/100 mmHg was reached. Some women with severe pregnancy-induced hypertension were given oral nifedipine to control their BP according to the choice of the attending consultant. Nifedipine 10 mg tablet was given initially in repeated doses of 10 mg every 15 mins up to a maximum of five doses or until the goal of BP ≤150/100 mmHg was reached. Results: In our study, we found that there was a strong statistical significance in stabilizing the BP with oral nifedipine than with intravenous labetalol drug used. The majority of the patients in the oral nifedipine group got to normal BP quicker when compared to intravenous labetalol group patients. Conclusion: From this study, both drugs were found to be safe and effective in the reduction in BP. The use of nifedipine may be recommended in low-resource settings since it has an oral regimen and dosage is simple when compared to incremental intravenous dosing of labetalol.

Guillain-Barré syndrome complicating pregnancy and correlation with maternal and fetal outcome in North Eastern India: A retrospective study.

BACKGROUND: Guillain-Barré syndrome (GBS) is rare in pregnancy with an estimated incidence between 1.2 and 1.9 cases per 100,000 people annually, and it is generally accepted that it carries a high maternal risk. Most reports of GBS with pregnancy are case reports only. AIM: Purpose of this retrospective study was to find the correlation between pregnancy and GBS. SETTINGS AND DESIGN: Records of patients admitted in neurology division were analyzed in a tertiary care teaching hospital in the northeastern Indian pregnant female population with GBS between 15-49 years during the period of 2009-2013. MATERIALS AND METHODS: We analyzed the records of 47 patients with pregnancy and GBS, evaluated and treated in our institute from August 2009 to December 2013. This is retrospective observational study done in North Eastern Indira Gandhi Regional Institute of Health and Medical Sciences (NEIGRIHMS), India. RESULT: Predominant form of GBS was acute inflammatory demyelinating polyneuropathy (AIDP). The weakness started from the lower limbs in majority of patients. Ten percent of women had bifacial weakness. Most of patients had good maternal and fetal outcome. Two patients received intravenous immunoglobulin (IVIG). Only two patient required ventilator supports and one patient had intrauterine death (IUD) and died due to respiratory failure. CONCLUSION: Our results indicate that risk of GBS increases in third trimester and first 2 weeks after delivery. Demyelinating variety of GBS was common in our population. GBS natural course during pregnancy is mild and showed quick recovery. Maternal and perinatal outcome was good.

Role of Combination OF Mifepristone and Misoprostol Verses Misoprostol alone in Induction of Labour in Late Intrauterin Fetal Death: A Prospective Study.

OBJECTIVE: To compare efficacy, safety and tolerance of combination of mifepristone and misoprostol versus misoprostol-only in induction of late intrauterine fetal death (IUFD). MATERIALS AND METHODS: This prospective study included a consecutive series of 52 women gravid up to fourth with IUFD after 28 weeks of gestation between January 2008 and June 2011. Women were divided into two groups. First group of women received a single oral dose of 200mg mifepristone, and after 24 hours, 100ug of intravaginal misoprostol was administered, followed by intravaginal 100µg misoprostol at four hourly intervals if required. Second group of women received 100 µg misoprostol at four hourly interval per vaginally (maximum 600µg in 24 hours). Oxytocin was given for augmentation if needed. RESULTS: The induction-to-delivery time was shorter with the combination regimen (p < 0.001) group. The total dose of misoprostol needed was lower in the group pre-treated with mifepristone (p < 0.001). Oxytocin was required only in misoprostol group. The two groups did not differ as regards complications experienced during labor and delivery significantly. CONCLUSION: Both regimens, misoprostol-only and the combination of mifepristone and misoprostol are safe in induction of labor after intrauterine fetal death (IUFD). Pre-treatment with mifepristone is more effective in terms of reducing of induction delivery interval, requirement of lesser dose of misoprostol and no need of augmentation with oxytocin.

A case of unilateral dysmenorrhea.

Unilateral dysmenorrhea in an adolescent may be associated with uterine malformation. Relevant investigations in suspected cases and timely intervention can prevent future complications in such cases. Here, we present a case of unicornuate uterus with rudimentary horn in an adolescent complaining of unilateral dysmenorrhea.

Hyperprolactinemia with normal serum prolactin: Its clinical significance.

Amenorrhea and infertility with an added feature of galactorrhea makes a provisional diagnosis of hyperprolactinemia. But again, normal serum prolactin with all clinical features of hyperprolactinemia might question the diagnosis and further management. The answer lies in the heterogeneity of the peptide hormone - the immunoactive and the bioactive forms. This has been further illustrated with the help of a case which had been treated with cabergoline.

Case report of a primary ovarian pregnancy in a primigravida.

Primary ovarian pregnancy occurs quite rarely and that too usually in young highly fertile multiparous women using intra uterine device. We present a case where a young primigravida presented with abdominal pain and was diagnosed as ectopic pregnancy and was confirmed intra-operatively and histopathologically as primary ovarian pregnancy, managed with partial ovariectomy.