K. Buckshee

Maternal and perinatal outcome in thyrotoxicosis complicating pregnancy

In this report we describe 32 pregnancies complicated by hyperthyroidism cared for over a 7-year period at AIIMS, New Delhi. In 6 cases hyperthyroidism was diagnosed during pregnancy; others were diagnosed before conception and were on antithyroid therapy during pregnancy. For control of thyrotoxicosis thiourea derivatives, carbimazole (CMZ) and propylthiouracil (PTU), were both used. The dosage of antithyroid drugs could be decreased or stopped in the third trimester in only 28% cases, while 50% cases did not require any change in the dosage during gestation and 21% required an increase in dosage with advancing gestation to control thyrotoxicosis. Maternal and fetal complications included preterm labour (25%), PIH (22%), thyroid crisis (9%) and intrauterine growth retardation (13%). Thyroid status of neonates was found abnormal in 9% cases, including 1 case (3%) of neonatal thyrotoxicosis with goitre and 2 (6%) cases of neonatal hypothyroidism. One maternal death occurred due to thyroid storm. No case of stillbirth or perinatal death occurred in the present study. In our experience of 32 cases maternal and fetal complications are reported with increased frequency, requiring close surveillance of thyroid status to maintain euthyroidism and intensive fetal monitoring during pregnancy to achieve good maternal and perinatal outcome.

Micronized flavonoid therapy in internal hemorrhoids of pregnancy

Objective: To assess the safety, efficacy and acceptability of a micronized flavonoid formulation in the treatment of internal hemorrhoids of pregnancy. Method: In an open study on hospital outpatients, we studied therapy with micronized diosmin 90% and hesperidin 10% for a median of 8 weeks before delivery and 4 weeks after delivery, in 50 women with acute hemorrhoids. The outcome measures were symptoms and signs of hemorrhoids; adverse effects; and acceptability of treatment. Result: On intention to treat analysis, 66% (95% confidence interval, range 79.1–52.9) had relief from acute symptoms by the 4th day; 53.6% (95% confidence interval, range 70–37.1, P < 0.001) fewer patients had relapse in the antenatal period. Treatment was well accepted, and did not affect pregnancy, fetal development, birth weight, infant growth and feeding. Conclusion: In the short term, micronized diosmin 90% and hesperidin 10% is safe, acceptable, and effective in the treatment of hemorrhoids of pregnancy.

Medical management of placenta accreta

Placenta accreta is a rare condition associated with considerable maternal morbidity and mortality. Though hysterectomy is definite and recommended treatment, conservative management may be considered in patients desiring future pregnancy and in whom bleeding is not excessive. We report a case successfully managed using methotrexate. A 2%year-old para 1 was referred to us on the second post-par-turn day with adherent placenta. On admission she had mild pallor, was afebrile, the uterus was well retracted up to umbilicus and bleeding per vaginum was minimal. Ultrasound showed that the whole of the placenta was adherent to the uterine wall. Serum was positive for beta human chorionic gonadotropin (BHCG). A high vaginal swab was taken for culture. As the patient was not bleeding and wanted to conserve her uterus, she was started on

Aetiology and outcome of acute viral hepatitis in pregnancy

Abstract The aetiologic types of sporadic acute viral hepatitis in 169 pregnant women were compared with those of 70 non‐pregnant women and 287 adult men. The majority of pregnant women (87.6%) came with acute hepatitis in the last trimester of pregnancy. Non‐A, non‐B (NANB) hepatitis accounted for 81.6% of hepatitis during pregnancy in comparison with 48.6% in non‐pregnant women and 57.1% in adult men. Hepatitis A was extremely uncommon during pregnancy. Hepatitis B infection accounted for 17% of all cases in pregnant women compared with 45% in controls. Acute viral hepatitis in pregnancy had a poor outcome as assessed by maternal and/or fetal mortality (28.5%). The outcome was equally bad in hepatitis NANB and hepatitis B. Pregnant women generally had significantly lower immunoglobulin levels in comparison with non‐pregnant women. In acute NANB hepatitis during pregnancy, serum IgG and IgM levels were lower and higher, respectively, compared with those in non‐pregnant women and pregnant women with acute hepatitis B. It is suggested that an immune suppression during pregnancy might be responsible for increased susceptibility to acute NANB viral hepatitis, which, by itself, seems to induce only a transient acute phase IgM response.

Fetal foot length ― a new parameter for assessment of gestational age

Ultrasonographic measurement of fetal foot length, a new parameter, was correlated with the gestation age. One hundred and five ultrasonographic measurement of fetal foot length was performed between 13 and 42 weeks gestation. Comparison of linear regression of foot length versus gestational age demonstrated a strong correlation with an r2 value of 0.84 (P < 0.001). Ninety‐five percent confidence intervals at each week compared favorably with both biparietal diameter and femur length data. Mean foot lengths at each week of gestation compared favorably with data based on pathological specimens described in 1920 (Streeter GL: Weight, sitting height, head size, foot length and menstrual age of the human embryo. Contrib Embryol Carnegie Inst. 11: 143, 1920). Measurement of fetal foot length is of particular use when other parameters do not accurately predict gestational age, e.g. hydrocephalus, anencephaly, short limb dysplasia. It can also be used in conjunction with biparietal diameter and femur length in the management of patients with premature labor in order to accurately predict gestational age. Hence the present study demonstrates that the ultrasonographic measurement of foot length is a reliable indicator of gestational age.

In vitro sperm phagocytosis by human peritoneal macrophages in endometriosis-associated infertility

PROBLEM: The mechanism of infertility in women with endometriosis remains obscure. In this context the role of peritoneal macrophages sperm phagocytic ability in infertile women with and without endometriosis was investigated.

Pre-rupture diagnosis and management of rudimentary horn pregnancy in the first trimester

A case of pregnancy in the rudimentary horn of a unicornuate uterus, suspected on routine pelvic examination and confirmed by sonography as early as at 8 weeks of gestation is presented. Ultrasonographic findings of the case and surgical management of ipsilateral adnexa at the time of excision of rudimentary horn are discussed.

Uterine balloon therapy to treat menorrhagia

Objective: To study the clinical efficacy, safety and acceptability of the thermal balloon endometrial ablation (TBEA) in patients with dysfunctional uterine bleeding. Methods: Thirteen patients with DUB who did not respond to medical treatment and dilatation and curettage consented to a trial of TBEA with EASYTM model of balloon catheter by Gynecare. All procedures were done under intravenous (IV) sedation and paracervical block. Patients were mostly discharged within 48 h. Follow‐up of 2–19 months is reported. Transvaginal ultrasound and hysteroscopy were performed in six patients after 6 months of TBEA. Results: Twelve patients (92.3%) reported a significant reduction in bleeding. Two patients (15.4%) experienced amenorrhea. Only two patients (15.4%) underwent subsequent hysterectomy, one for persistent menorrhagia and the other for severe pelvic pain. In successful patients of TBEA, transvaginal ultrasonography revealed marked reduction in endometrial thickness and no endometrium was visible in one patient who had developed amenorrhea. In successful cases follow‐up hysteroscopy revealed scarring in more than two‐thirds of the endometrium. Conclusions: Thermal balloon endometrial ablation is a safe, simple, effective, easy and minimally invasive procedure which can be done under IV sedation and paracervical block in an office setting. It has several advantages over hysterectomy, including preservation of the uterus, avoidance of surgical incision and potential to perform on an outpatient basis. It is a good alternative to hysteroscopic endometrial ablation with a comparable success rate with minimal risk and no limiting factors except the cost of the balloons. However, large scale randomized controlled studies are needed with TBEA and other endometrial ablation procedures.

Impact of roles of women on health in India.

Indias population has more than doubled since 1961. Although India has been a leader in developing health and population policies, there have been major implementation problems due to poverty, gender discrimination, and illiteracy. Yet, three‐quarters of the food produced annually in India is because of women. In 1991, only 39.3% of Indian women were literate. The literacy level of women can affect reproductive behavior, use of contraceptives, health and upbringing of children, proper hygienic practises, access to jobs and the overall status of women in the society. Early marriage and childbirth was a major determinant of womens health and was also responsible for the prevailing socioeconomic underdevelopment in India. The overall maternal mortality for India is 572.3 per 100 000 births, ranging from 14.9% in Bihar to 1.3% in Kerala. Anemia is an indirect factor in 64.4% of the maternal deaths. Trained birth attendants currently assist in about 60–80% of all births in women at the time of delivery. Socioeconomic factors are responsible for maternal deaths to a large extent — money in 18.3%, transport in 13.7%. When the mother dies it doubles the chances of death of her surviving sons and quadruples that of her daughters. Among the avoidable factors in maternal deaths, lack of antenatal care is the most important. Women, if educated and aware, can improve the health of their children by simple measures like good hygiene, exercise and dietary habits. Because of poverty, many of the young children, especially girls living on streets are easy prey for criminal prostitution rings, drug trafficking and consequences of HIV infection, and severe emotional and mental disturbances. Women are responsible for 70–80% of all the healthcare provided in India. Female healthcare providers can play an important role in educating society to recognize their health and nutrition needs. Women professionals and empowerment of women at all levels are required for improvement of the health and nutrition structure in India.

Pelvic examination, transvaginal ultrasound and transvaginal color Doppler sonography as predictors of ovarian cancer

Objective: To assess and compare the efficacy of pelvic examination, transvaginal ultrasound and transvaginal color Doppler imaging in differentiating benign and malignant ovarian tumors. Methods: 34 patients with ovarian tumors scheduled for laparotomy underwent pelvic examination and a diagnosis of benign or malignant tumor was made. Transvaginal ultrasound was carried out to study the ovarian morphology followed by color Doppler imaging. A score of ≥9 on Sassone scoring system or a pulsatility index <1 was taken as suspicious for malignancy. Results: Of all the three indicators (pelvic examination, transvaginal sonography and Doppler) transvaginal sonography had the highest sensitivity (100%) and Doppler had maximum specificity (96.29%) for predicting malignancy. However, statistical analysis did not show any difference in the predicting ability of these three modalities. Conclusion: Pelvic examination, transvaginal sonography and Doppler all had similar ability to predict malignancy in an adnexal mass.