Madhva Prasad

Novel FSH receptor mutation in a case of spontaneous ovarian hyperstimulation syndrome with successful pregnancy outcome

The objective is to study the FSH receptor (FSHR) for mutations in a case of spontaneous ovarian hyperstimulation syndrome (sOHSS). This is a single case study and it examined patient who presented with spontaneous critical OHSS in early pregnancy and had successful good obstetric outcome. Intervention of this study was analysis of blood for genetic analysis of FSHR postdelivery. The main outcome measure noted was FSHR mutation. The study resulted in a novel, here though unreported, heterozygous mutation in FSHR gene at nucleotide position 1346 (AC 1346 T to AAT) in exon 10 yielding a threonine to asparagine (Thr 449 Asn) substitution in the transmembrane domain helix 3 of the FSHR. To conclude FSHR gene analysis can add to our understanding of sOHSS.

The “Saturday Effect” in Obstetrics: A Comparison Between Referral Patterns on Saturday and Other Days of the Week

Through this communication, we wish to highlight that a disproportionate number of obstetric patients are referred from the firstor second-level facilities to tertiary centres on weekends, especially Saturdays [1]. Day-of-the-week linked referral patterns are recognised in Western literature, not necessarily only in obstetrics [2]. However, documentation in contemporary Indian literature is not extensive. Our research question aimed to find if ‘‘taking a break during weekends’’ by doctors leads to increased inter-institutional referrals. We conducted a prospective observational study at our tertiary-care hospital over 1 year to ascertain if differential referral patterns exist. All obstetric cases referred on Saturdays were compared to those referred on all other days, including Sundays; data regarding reasons for referral, consistency between indication for referral and actual diagnosis after admission; and maternal and perinatal mortality patterns were analysed. Of the total 8271 confinements, referrals constituted 38.12%; however on Saturdays, 46.49% cases were referred as compared to only 25.36% on other days, which was statistically significant. There was also statistically significant difference between reasons for referral on Saturdays versus other days, with referral for non-medical reasons predominating on Saturdays (non-availability of doctors and NICU). Noteworthy is that almost half the cases managed on Saturdays were referred. (Table 1). In our country, most doctors in public sector work on Saturdays, at least in the morning. To look for differences in referrals based on time of day, 24-h time period from 7 am was divided into 3-h intervals and the time of arrival of referred cases was noted. Majority of patients were referred between 4 pm on Saturdays and 1 am on Sundays, as compared to a more uniform distribution among all time periods on other days; this was statistically significant (p value = 0.0347). Major inconsistencies were observed between reason for referral and actual diagnosis, mainly need for NICU and PIH. 25 and 19.5% of cases referred on other days of the week for presumed need for NICU or a diagnosis of PIH, respectively, did not need NICU nor had PIH; this number increased to 35 and 30% on Saturdays, respectively, for NICU and PIH. This highlights unnecessary transfers on Saturdays. LSCS rate was similar, 32.2 and 28% on Saturdays and other days. Perinatal and maternal mortality rates were comparable other days. The commonest causes Anahita R. Chauhan is a Professor and HOU in Department of Obstetrics and Gynecology at Seth GS Medical College and KEM Hospital, Mumbai. Sumit Chamariya is a Registrar in Department of Obstetrics and Gynecology at Seth GS Medical College and KEM Hospital, Mumbai. Madhva Prasad is a Assistant Professor in Department of Obstetrics and Gynecology at Seth GS Medical College and KEM Hospital, Mumbai.

Comment on Two Recent Invited Mini-reviews

Respected Editor, I have been reading avidly the articles in your esteemed journal. Of particular interest was the article by Prof Hafizur Rahman in the September–October 2017 edition titled ‘‘Influence of Research on Health Policy and Clinical Practice’’. This article makes good reading and enlightens us all about the ‘‘bigger picture’’ of health care. It reemphasizes the need for the practising obstetrician-gynaecologist to engage in good-quality research and that true evidence-based medicine lays the foundation to good governmental policies and principles of professional organisations [1]. This article is commendable because it gives a ‘‘lens’’ with which many other articles can be viewed. I viewed the article titled ‘‘Down Syndrome Screening in India: Are We There Yet?’’ in the subsequent November–December 2017 edition by Dr Manikandan with this ‘‘lens’’ [2]. The title of the latter article could be rephrased as ‘‘How much has Down syndrome prevention research influenced Health policy and clinical practice?’’. There appear to be no easily available recent data from the FOGSI Birth Defects Registry of India [3]. Standardized data on the prevalence of the problem all over the country are also lacking, as clearly mentioned by Manikandan [2]. At present, the government of India does not seem to have any policy on Down syndrome or at least has not mentioned this in its website [4]. The latter article is a case in point of the large gap in knowledge–action, mentioned by Hafizur Rahman, the context being ‘‘Down syndrome prevention’’. Providing a transparent record of the birth defects registry and request to the government to frame a policy on Down syndrome prevention can be a start. Nevertheless, the movement from ‘‘research’’ to ‘‘clinical practice’’, and eventually ‘‘health care policy’’, not only in Down syndrome prevention but also in all spheres starts with us—the practising obstetrician-gynaecologists.

Clinical outcomes among pregnant patients with cardiac disease only and those with co-existing pregnancy-associated hypertension

Cardiac disease continues to have an overwhelmingly high proportion of contribution to the burden of maternal mortalities. The spectrum of cardiac diseases including rheumatic valvular, congenital heart disease, cardiomyopathies and ischemic heart disease can affect pregnant women. Patients with heart disease per se have poor obstetric outcomes. Ng et al studied a large cohort of pregnancies and in their study, the diagnosis of heart failure was around 126 cases in 100000 pregnancies. A wide variety of effects of heart disease was observed such as higher rates of preterm birth, cesarean delivery, neonatal death rates, lower birth weights and lower Apgar scores. Overall, a seven-fold increase in risk of death was observed. In the Eastern Meditteranean region, rheumatic heart disease contributed to one third of all the total deaths reported, and there appeared to be an ABSTRACT

Pregnancy in breast cancer survivor with anthracycline induced cardiomyopathy

With earlier diagnosis and improved treatment modalities and management of breast cancer patients, survival is improving. An increasing number of survivors are in the reproductive age group; however a neglected medical area is contraceptive advice, failure of which can result in unwanted pregnancy and further medical complications. An undiagnosed pregnancy in a breast cancer survivor with known anthracycline- induced cardiomyopathy is presented here.