Indu Gupta

Comparison of extraamniotic Foley catheter and intracervical prostaglandin E2 gel for preinduction cervical ripening

Background.  The success of induced labor depends on the degree of ripening of cervix. Pharmacological preparations are in widespread use for cervical ripening but are not free from side‐effects and complications. Mechanical methods, i.e. the use of Foley catheter balloon, though effective have not gained much popularity because of the fear of infection. Therefore, this study has been conducted to prove the efficacy and safety of extraamniotic Foley catheter balloon and to compare it with intracervical prostaglandin E2 (PGE2) gel.

Immunogenicity and safety of two schedules of Hepatitis B vaccination during pregnancy

Aim:  To test the immunogenicity and safety of Hepatitis B (HB) vaccination during pregnancy and passive transfer of antibodies to the newborn.

Association of angiotensin‐converting enzyme gene polymorphism with pregnancy‐induced hypertension

Background.  To investigate the potential association of angiotensin‐converting enzyme (ACE) gene polymorphism and serum ACE activity with pregnancy‐induced hypertension (PIH).

Tocolytic therapy in conservative management of symptomatic placenta previa

Objectives: To study the effect of ritodrine therapy on maternal and perinatal outcome in cases of symptomatic placenta previa being managed conservatively. Methods: A prospective, randomized controlled clinical trial was made of a total of 60 women whose pregnancies ranged from 28 through 34 menstrual weeks who were randomly allocated to the two study groups using Tippets random number table. Of these women, 30 were included in the study group where tocolysis with ritodrine was given whereas the other 30 in the control group did not receive tocolysis. Prolongation of pregnancy and birth weight of the newborn were evaluated. The unpaired t‐test and chi‐square test were used for statistical analysis. Results: Use of tocolysis in symptomatic placenta previa was associated with significant prolongation of pregnancy (25.33 vs. 14.47 days, P<0.05) and difference in birth weight (2270 g vs. 1950 g, P<0.05). There was no observed statistical difference between the two groups with regard to number of episodes of hemorrhage after admission, total amount of blood loss during stay in hospital, number of blood transfusions and maternal complications due to tocolysis in the study group. Conclusions: The present prospective study suggests that ritodrine hydrochloride in patients with symptomatic placenta previa tends to prolong the pregnancy and result in an increase in birth weight of the babies without causing any adverse effect on the mother and fetus.

Serial serum ferritin estimation in pregnant women at risk of preterm labor

Background. To estimate serial serum ferritin (SF) concentrations after 20 weeks of pregnancy in women at risk of having a preterm labor and to correlate them with the outcome of pregnancy.

Serum ferritin level as a marker of preterm labor

Objective: To compare the serum ferritin levels in women with preterm labor (PTL) or preterm premature rupture of membranes with those in normal gravid women. Method: The study group consisted of 50 consecutive subjects with preterm labor and 49 subjects with preterm premature rupture of membranes (PROM). The control group consisted of 50 subjects matched with the study group for hemoglobin (Hb) and gestation who did not have PTL or preterm PROM. Serum ferritin levels were assayed in both the groups. Results: Mean serum ferritin levels in patients with preterm labor and preterm premature rupture of membranes were 23.24±12.13 ng/ml and 29.44±28.41 ng/ml, respectively. The mean serum ferritin in control subjects was 8.69±3.7 ng/ml. The difference was evaluated by Students t‐test and was found to be statistically significant. Conclusion: The serum ferritin level is significantly raised in pregnant women with preterm labor and preterm PROM.

Evaluation of Serum Creatine Kinase as a Diagnostic Marker for Tubal Pregnancy

Forty women comprising of 20 each in study and control groups had their serum creatine kinase (CK) estimated. The study subjects were proven cases of ectopic pregnancy and the controls were either medical termination of pregnancy seekers or antenatal cases matched for gestational age and with a confirmed intrauterine pregnancy. Total serum creatine kinase levels were found to be significantly higher in the study group i.e. 34.15 ± 1.17 IU/L compared to the controls 18.72 ± 1.25 (p < 0.001). Creatine kinase is estimated routinely in cardiac patients even on an emergency basis. Our findings indicate that when in doubt the test could be used as a marker for the diagnosis of ectopic pregnancy.

Serial plasma fibronectin levels in pre-eclamptic and normotensive women.

Objective: Endothelial cell damage has been put forward as an underlying factor for development of pre‐eclampsia. This study was carried out to see if fibronectin, which is a marker of endothelial damage, could be used as a marker of pre‐eclampsia. Methods: A longitudinal study was conducted on 100 normotensive primigravidae registered before 20 weeks of gestation. These subjects were followed until delivery and three blood samples were collected, first at registration, i.e. before 20 weeks, second around 28 weeks and third at 36 weeks or later till delivery. Fibronectin levels were assayed by ELISA and women observed for any signs of pre‐eclampsia. Results: Fourteen subjects developed pre‐eclampsia. Fibronectin levels were observed to rise as pregnancy advanced but the rise was significantly higher in subjects who developed pre‐eclampsia. The fibronectin levels were also significantly higher in these 14 subjects even in the first sample, i.e. before 20 weeks of gestation when compared with normotensive subjects (P<0.01). Conclusions: Fibronectin levels could be used as an early valuable biomarker for the development of pre‐eclampsia.

Nitric oxide metabolite levels in preterm labor

Aim:  To investigate the role of nitric oxide metabolites as markers of infection in subjects with preterm labor or preterm premature rupture of membranes (PTPROM). PTPROM means that there was spontaneous rupture of fetal membrane before the onset of labor and gestational age was <37 weeks. This occurs because of imbalance between matrix metalloproteinase and tissue inhibitor of matrix metalloproteinase. The cause of this imbalance that leads to degradation of collagen causing PTPROM is infection. The bactericidal, fungicidal, viricidal and tumoricidal activities of macrophages are determined in part by elaboration of nitric oxide, hence nitric oxide levels have been found to be increased in infections

Estimation of cord blood erythropoietin in pre-eclampsia and eclampsia.

Objective: The estimation of cord blood erythropoietin in subjects with pre‐eclampsia and eclampsia. Method: Erythropoietin was measured, using ELISA, in the cord blood of infants born to 83 mothers with pre‐eclampsia, and 7 with eclampsia. Another 90 subjects with no evidence of pre‐eclampsia or eclampsia were taken as control subjects. Maternal parity, gestational age, blood pressures, 24‐h urine protein and Apgar scores of the infants delivered were also noted. Result: Cord blood erythropoietin levels were statistically significantly higher (P<0.001) in infants born to mothers with pre‐eclampsia and eclampsia. There was a significant positive correlation (P<0.01) between cord blood erythropoietin levels and maternal blood pressure (systolic and diastolic) and albuminuria. A negative correlation (P<0.01) was observed with the birth weights of infants. Conclusion: Pre‐eclampsia and eclampsia are associated with higher levels of cord blood erythropoietin.