Anjali Tempe

Glyburide as treatment option for gestational diabetes mellitus

The aim of this study was to assess the efficacy of glyburide in the treatment of gestational diabetes mellitus and to compare the maternal and fetal outcome between two groups treated either with insulin or glyburide.

Conventional and color Doppler sonography in preoperative assessment of ovarian tumors.

Objective: To study the vascular patterns of ovarian tumors by color Doppler imaging (CDI) and compare the findings of conventional sonographic studies and CDI with histopathologic findings for the same tumors. Methods: Fifty nonpregnant women scheduled for elective surgery for ovarian tumors were examined by sonographic scanning and CDI by the same physician. Sonographic morphology scores [SMSs] were used, and the pulsatility index (PI) and resistance index (RI) were calculated after locating vessels in and around the tumors by CDI. Results: It was possible to obtain CDI results in 26 of the 50 women. The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were 100%, 71.43%, 73.33%, and 100%, respectively, for SMS. With CDI, the sensitivity, specificity, PPV, and NPV were 100%, 85.72%, 95%, and 100% for PI and 100%, 71.43%, 90.48%, and 100% for RI. RI sensitivity and specificity were identical to those of SMS, i.e., 100% and 71.43%, respectively, but PI specificity was better (85.72%). Conclusion: In this study, CDI was definitely better than SMS when color flow could be obtained through the tumors. The overall efficiency in diagnosing the nature of tumors is very high if SMS and CDI are both used in patients having ovarian tumors.

Ruptured ectopic pregnancy associated with tubal schistosomiasis

Endemic in major parts of Africa and Middle East, Schistosoma haematobium is a common cause of recurrent urogenital infections and obstetric complications such as spontaneous abortions, ectopic pregnancies, and low birth weight babies. The involvement of fallopian tubes is not rare in endemic areas and may predispose to ectopic pregnancy and infertility. Indian subcontinent is a very lowrisk region for schistosoma infection. Tubal schistosomiasis is not exceptional in endemic zones, but is rarely found in India. The species most often isolated is S. haematobium. Contamination occurs via vascular anastomoses between the bladder and the genital organs. We report a case of tubal schistosomiasis presenting as ruptured ectopic pregnancy discovered on a surgical specimen after salpingectomy.

Psychiatric Disorders during Pregnancy and Postpartum

Pregnancy is the most beautiful and memorable time in a woman’s life. Apart from medical and obstetrical challenges it involves a of lot emotional, psychological and social aspects too. Although women having medical and obstetrical disorders commonly seek treatment, psychological problems are often not addressed. A female may continue to live in a state of emotional turmoil and may attribute these changes to the hormonal changes in the body due to pregnancy. Psychiatric disorders which remain untreated can disrupt the social life and can have undesirable effects on fetal and neonatal development, so it becomes important to identify women at risk for developing psychiatric disorders during pregnancy and postpartum and initiate timely management. Although the American College of Obstetrics and Gynaecology recommended strongly considering screening pregnant women for depression in 2006, it is not done as a routine. Recently we came across two interesting cases of ante partum and post-partum mental disorders. Which led us to write a review article on Psychiatric disorders in pregnancy? Let’s review the two cases in brief.

Pregnancy with multiple sclerosis: The obstetricians' approach

Multiple sclerosis (MS), an inflammatory, demyelinating disease of central nervous system, is the most common cause of neurological disability in young females. MS occurs in India but is comparatively very less as compared to the West. Due to its rarity, obstetricians do not encounter pregnancies with MS in India often. We report a case of a 21-year-old, primigravida who presented to us at 9 weeks of pregnancy. She was a diagnosed case of MS for 4 years. Later in pregnancy, she had walking and gait difficulty. No change in drug dosage was required, and patient had a static course of disease during pregnancy. The patient had an emergency cesarean section. Pregnancy in women with MS is not considered high risk anymore; however, there are some challenges such as managing disability and modifying ongoing therapy. Multi-disciplinary approach is the mainstay of management. Due to severe disability of routine activities such as walking, nursing herself and the baby, pregnancy with MS poses big management challenge. Social issues should be taken care of prior to conception in Indian perspective.

Should Abnormal Vaginal Flora in 2 nd Trimester of Pregnancy be Treated to Prevent Preterm Labor

Screening and treatment of abnormal vaginal flora during pregnancy to prevent preterm labor is a matter of debate for practicing obstetrician and physician in a country where maternal health and its outcome is a big concern. The recent evidence suggests that infection may be implicated in a substantial proportion of cases of preterm delivery. Neonatal morbidity and mortality are primarily influenced by gestational age and less so by birth weight. Microbial flora normally present in the human vagina play a key role in preventing pathological organisms including those responsible for sexually transmitted diseases, yeast infections, bacterial vaginosis (BV), and urinary tract infection. The outcome gathered from various recent studies have been remarkably consistent and managed to support the hypothesis that antibiotic treatment before 20 weeks of gestation reduces the risk of preterm birth. It is concluded that screening for abnormal vaginal flora cannot be generalized, but it may be safely carried out in pregnant women who have a previous history of preterm labor. Antibiotics with lactobacillus treatment can eradicate abnormal vaginal flora in pregnancy, however, screening and treating all pregnant women with asymptomatic BV to prevent preterm birth and its consequences is not substantiated by evidence.