Journal of Obstetrics and Gynecology of India最新文献

Introduction: Preeclampsia (PE) is a multiorgan disease of pregnant women. The main pathophysiology of PE is a trophoblastic invasion into maternal circulation leading to alterations in circulatory levels of matrix metalloproteinases (MMPs), inflammatory markers, and endothelin 1(ET1) levels. Therefore, the present study has explored the role of MMP-9 and ET1 and their association in PE. The advantage of the study is to provide insight into the pathology of PE. These markers may help in the early diagnosis and prognosis of PE.

Objective: To investigate MMP-9 gene expression, ET1 level in PE cases and their correlation with blood pressure (BP), gestational age, weight, and height.

Methods: The study design was a case-control observational study, which included 70 subjects in each case (PE) and controls (normal pregnant women (NPW)). Whole blood (250 ul) was utilized for RNA extraction (Trizol method) and synthesized cDNA as per manufacturer protocol. MMP-9 gene expression was analyzed by real-time PCR. Serum was utilized for ET1 estimation by sandwich ELISA.

Results: The ET1 levels and MMP-9 gene expression were significantly increased in preeclamptic women as compared to controls. There was no significant correlation between MMP-9 gene expression and serum ET1 levels. However, a significant moderate association between systolic BP and diastolic BP with ET1 levels and MMP9 gene expression was seen in both PE and NPW.

Conclusion: A significantly increased circulatory concentration of ET1 and MMP-9 gene expression in PE might be used as an early diagnostic as well as a prognostic marker of PE.

Background: There are many established risk factors for postpartum depression (PPD). It is controversial whether the mode of delivery is associated with PPD. This prospective study assessed the prevalence of PPD among women who delivered normally versus cesarean section and the association between sociodemographic factors and clinical factors with PPD.

Materials and methods: This prospective cohort study was conducted in the Department of Obstetrics and Gynecology, JIPMER Hospital Puducherry, from July 2019 to June 2020. Women without high risk factors for PPD were included. The sample size was 121 in the normal delivery (ND) group and 121 in the cesarean section (CS) group. PPD screening was conducted within one week of delivery and again after six weeks of delivery using a validated Tamil or English version of the Edinburgh Postnatal Depression Scale (EPDS). A score of EPDS score ≥ 13 was considered positive for PPD. Univariate and multivariable analysis was done to find out the association.

Results: The overall prevalence of PPD was 27.27%. The prevalence of PPD was higher in the CS (34.71%) than in the ND group (19.83%). PPD was found 2.1 times (OR-2.1, CI 1.2-3.8) in the CS group within one week and 2.5 times (RR-2.5, CI 1.5-3.9) at six weeks of delivery, respectively. Among the social factors, a history of domestic abuse or violence was found to be significantly associated with PPD by both univariate and multivariable analysis.

Conclusion: PPD was twice higher among women in the CS than in the ND group. Domestic abuse or violence was very highly significantly associated with PPD.

Purpose of study: To study the predictive accuracy of maternal characteristics, mean arterial pressure, uterine artery doppler and maternal ophthalmic artery doppler in second trimester for subsequent development of pre-eclampsia.

Methods: A prospective cohort study of 440 women at 19-24 weeks' gestation. It included recording of maternal demographic characteristics and calculation of HDP Gestosis Score, measurement of MAP and ultrasound evaluation for fetal anatomy, Uterine artery doppler and maternal ophthalmic artery doppler. The mean Peak Systolic Velocity ratio was obtained by taking two sets of reading from both eyes. The statistical analysis was done using independent t-test for quantitative variables and chi-square test, Fisher's exact test for qualitative variables and Area Under Curve was obtained at 10% False Positive Rate.

Results: Among 440 pregnant women, 43(10.8%) developed Hypertensive Disorder of Pregnancy (8 early onset PE, 16 late onset PE and 19 GHTN) and 42 were lost to follow up, with an incidence rate of 10.8%. Combination of Gestosis Score + OAD PSV Ratio had highest AUC of 0.73. Whereas combination of Gestosis Score + MAP + UtAPI + OAD-PSV Ratio had highest sensitivity of 97.67%. The OAD PSV ratio improved detection rate of Gestosis Score (from 90 to 100%) for prediction of development of PE, especially Preterm PE at 10% FPR.

Conclusion: Maternal Ophthalmic artery doppler study significantly improved prediction of development of PE at 19-24 weeks' gestation, both independently as well as in combination with HDP-Gestosis Score, MAP and uterine artery doppler.

Background: The aim of this study was to evaluate hyperemesis gravidarum in pregnant women and its psychological impact.

Methods: This retrospective study included 109 pregnant females suffering from hyperemesis gravidarum admitted during 2019-2020 at Maternity Ain shams university hospital.

Results: Disease severity and laboratory investigations such as Na and K levels (P = 0.007 and < 0.001, respectively) and serum creatinine level (P < 0.001) were significantly positively correlated. Depressive symptoms included guilt feeling for leaving family (49.5% patients), suicidal thoughts (9.2%), crying (56.9%) and lost concentration (33.9%).

Conclusions: Medical staff should be aware of psychological impact of the disease and refer to specialists if needed.

Background: Sheehan's Syndrome (SS) is an important cause of hypopituitarism especially in developing countries though it remains underdiagnosed to a great extent. Torrential bleeding after delivery followed by lactation failure and amenorrhoea gives a clue to the diagnosis which is usually made after several years of delivery.

Materials and methods: It was a retrospective observational study conducted by reviewing the case records of 38 cases of SS. The age, anthropometric measurements, signs and symptoms, biochemical parameters, hormone levels and imaging reports were examined and analyzed.

Results: The mean age at presentation was 36.5 years because there was a delay of 8.4 years from last delivery before diagnosis could be made. Ninety percent patients presented with lactation failure. Anaemia, hypotension, hypogonadism, hypothyroidism, and altered lipid profile were the most common findings. The mean systolic blood pressure (BP) was 80.95 mm and diastolic BP was 51.6 mm of Hg at the time of presentation. Hyponatremia was the most common electrolyte abnormality noted and low HDL was the commonest lipid abnormality.

Conclusion: A large percentage of patients presented with amenorrhea, lactation failure, and decreased or absent axillary/pubic hair. Shock, anemia, and hyponatremia were also common symptoms among the patients studied. The diagnosis of SS rests upon a thorough history taking of the postpartum events in cases presenting with hypopituitarism irrespective of the age at presentation. Proper antenatal care with exclusive institutional deliveries can reduce the prevalence of SS in developing countries.

Background: This objective of this study was to diagnose Obstructive Sleep Apnoea (OSA) in pregnant women using Questionnaire-based methods and to determine any association of Sleep-Disordered Breathing (SDB) with Hypertensive Disorder of Pregnancy (HDP). Additionally, the study aimed to identify factors associated with OSA.

Methods: This case-control study was conducted in department of Obstetrics in tertiary care hospital in Delhi. We Identified SDB using Berlin Questionnaire and Modified Stop-Bang Questionnaire in 100 pregnant women with Hypertension and 100 normotensive controls. We compared the groups using appropriate statistical analysis.

Results: The mean age of women with HDP (25.46 ± 4.38) was found to be slightly higher than controls (24.13 ± 3.89) (p value-0.02). Sleep apnoea as depicted by the presence of either high-risk STOP Bang or Berlin score was seen more often in hypertensive women in 45% as compared to controls in 8% (p value < 0.001). Higher pre-pregnancy weight (58.58 ± 9.77 vs. 53.0 ± 6.59), higher BMI (24.03 ± 5.89 vs. 20.68 ± 1.49), higher mean neck circumference (14.97 vs. 14.27 inches) weight gain more than 11 kg during pregnancy (55.6% vs. 38.2%) were the high-risk factors more commonly associated with SDB as seen in women with OSA in hypertensive women. On logistic regression analysis, the presence of OSA was singularly responsible for development of Hypertension (Odds Ratio-13.014, 95% CI 5.237-32.337) (p value < 0.001).

Conclusion: Gestational hypertension appears to be strongly associated with the presence of obstructive sleep apnoea. The recognition and treatment of OSA during pregnancy may lead to improved outcomes.

Introduction: This study was done to assess and compare the efficacy and safety of mifepristone and misoprostol combination versus misoprostol alone for second trimester termination of pregnancy in relation to induction abortion interval, average amount of misoprostol required in each group, success rate and side effects.

Materials and methods: This randomised control study was conducted on 100 women admitted in the Department of Obstetrics & Gynaecology, S.C.B. Medical College & Hospital, Cuttack, for second trimester termination of pregnancy, divided into two groups, Group A and Group B of 50 patients each. Group A patients received 200 mg of oral mifepristone followed by 400 mcg of vaginal misoprostol after 48 h, and then 400 mcg of vaginal misoprostol every 3 hourly until complete expulsion or up to a maximum of 6 doses. Group B patients received 400 mcg of vaginal misoprostol every 3 hourly until complete expulsion or up to maximum 6 doses.

Results: Complete abortion was seen in 92% and 72% cases in Group A and Group B, respectively. Mean induction abortion interval was 11.59 ± 2.71 h in Group A and 15.57 ± 2.27 h in Group B (p value < 0.001). The average dose of misoprostol required was less in combination regimen, i.e. 1128 ± 384 mcg compared to 1680 ± 302 mcg in misoprostol alone group (p value < 0.001). Side effects like nausea, vomiting and diarrhoea were less in combination regimen than misoprostol alone group.

Conclusion: Mifepristone and misoprostol combination is more effective and safer alternative than misoprostol alone in second trimester termination of pregnancy.

Background: Polycystic ovary syndrome (PCOS) is an endocrinopathic disorder commonly affecting women in the reproductive age group, predisposing them to risk of metabolic syndrome. Currently, body mass index (BMI) is used as a marker to assess obesity. However, it is the central obesity which is a prevalent characteristic of PCOS which goes undetected in many women who exhibit an apparently lean PCOS. Recently, indices, such as body fat percentage (BFP), visceral adiposity index (VAI) and lipid accumulation product (LAP), have been deemed more effective, as they present formulas, anthropometric indices and biochemical measures. The aim of this study was to compare the other central fat accumulation indices-VAI, LAP and BFP with BMI in women with PCOS.

Methods: The descriptive type of cross-sectional study was conducted in a tertiary care hospital which included 110 women, aged 18-40 year fulfilling the Rotterdam criteria for diagnosis of polycystic ovary syndrome. Height, weight and lipid profile were measured, and BMI, LAP and VAI were calculated. Body fat percentage was measured by the body fat analyser using the bioelectrical impedance method. All indices were then compared.

Results: BMI showed a significant positive correlation with BFP (r = 0.68). VAI and LAP showed significant correlation with each other (p < 0.05). LAP and VAI were found to weakly correlate with BFP. However, lean PCOS also had higher values of visceral adiposity indices and hence did not show strong correlation.

Conclusion: Central fat accumulation indices should be integral in assessing body fat distribution. BFP, VAI and LAP assess fat distribution and function both and, hence, present complete information at low cost.

Introduction: The placental examination provides important information about the effect of maternal abnormalities on the placenta or the cause of preterm delivery, fetal growth restriction, or fetal neurodevelopmental damage. Placental anatomical and pathologic lesions are usually associated with pregnancy complications and neonatal impaired outcome.

Patients and methods: We included in our study 100 patients with gestational age of 37-40 weeks. These cases have been then subdivided into the following study groups: Group A: 50 placentas from pathological pregnancies; and, Group B: a control group of 50 physiological or normal pregnancies due to the absence of maternal, fetal, and early neonatal pathologies.

Results: In group of complicated pregnancies (Group A), most common complication was severe pre-eclampsia (20%) followed by Gestational hypertension (18%) and Anaemia (16%). Abnormal placental findings were seen in 42% in Group A and in 24% patients in group B. C. Over all neonatal complications were significant significantly high in group A compared to Group B (60% and 36%). LBW (40% and 22%), Need for NICU admission (52% and 32%) and APGAR Score < 7, (8% and 2%) were significantly high in group A compared to Group B. One neonate was expired in Group A and in Group B, no mortality seen.

Conclusions: Present study shows that identification of placental histology can be associated with pregnancy outcomes and complications. Understanding Placental histology could help in association with biological markers or more sophisticated instruments for early diagnosis.