Reddi Rani

Comparison of different criteria for diagnosis of gestational diabetes mellitus.

Introduction: The International Association of Diabetes in Pregnancy Study Group (IADPSG) criteria for gestational diabetes mellitus (GDM) has been adopted by most associations across the world including the American Diabetes Association and World Health Organization (WHO). We conducted a study comparing the IADPSG and previous WHO criteria and their effects on neonatal birth weight. Methods: The study was carried out in Obstetrics and Gynaecology Department of a tertiary care institute in South India in collaboration with Endocrinology Department. Thousand two hundred and thirty-one antenatal cases with at least one risk factor for GDM and gestational age of more than 24 weeks were included in the study. Both criteria were compared on the basis of 75 g oral glucose tolerance test results. Results: The prevalence of GDM using IADPSG and previous WHO criteria were 12.6% and 12.4%, respectively. The prevalence of GDM was 9.9% when both criteria had to be satisfied. Both GDM criteria groups did not differ in neonatal birth weight and macrosomia rate. However, there was a significant increase in lower segment cesarean section in IADPSG criteria group. Elevated fasting plasma glucose alone picked up only one GDM in the previous WHO criteria group. Conclusions: A single 2 h plasma glucose is both easy to perform and economical. A revised WHO criterion using a 2 h threshold of ≥140 mg % can be adopted as a one-step screening and diagnostic procedure for GDM in our country.

Comparison of the American Diabetes Association and World Health Organization criteria for gestational diabetes mellitus and the outcomes of pregnancy

Two to five percent of pregnancies are complicated by diabetes, of which 90% are classified as gestational diabetes mellitus.The aims and objectives of this study were to analyse the screening and diagnostic procedure for gestational diabetes mellitus (GDM) recommended by American Diabetes Association (ADA) in comparison with the World Health Organization (WHO) criteria and to study the outcome of GDM diagnosed by both the criteria. This prospective study was carried out in the Department of Obstetrics and Gynaecology, JIPMER between August 2006 and July 2008. Three-hundred-and-fifty antenatal cases of gestational age ≥24 weeks attending the outpatient department, with any one of the risk factors for GDM, were included in the study. A seventy-five gram oral glucose tolerance test (GTT) was performed on each subject. Results were interpreted using both ADA and WHO criteria. Antenatal complications of GDM, mode of delivery, intrapartum or postnatal maternal and neonatal complications in cases diagnosed with GDM by either criterion were noted. The data collected were analysed using the SPSS software program. The prevalence of GDM was 4% by ADA criteria versus 19.4% by WHO criteria. The diagnostic pick-up rate was approximately five times more with WHO than with ADA criteria. In total, 43% (ADA) and 29% (WHO) of GDM cases had antenatal complications. Seventy-four percent of mothers with macrosomic babies were identified by WHO criteria whereas only 26% of mothers with macrosomic babies were diagnosed by ADA criteria. ADA criteria identify more severe cases of GDM but mild cases diagnosed by WHO are missed. The GTT by WHO criteria was abnormal in a greater percentage of women with adverse outcomes especially macrosomia, than the GTT using ADA criteria.

Comparison of scarred and unscarred uterine ruptures.

Uterine rupture is a major obstetric hazard and more commonly involves a previous uterine scar [1]. Rupture of an unscarred uterus, either traumatic or spontaneous, is rare in countries where intrapartum care is adequate. We reviewed the case records of women who delivered at the Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Pondicherry, India, between January 1994 and December 2006, to compare the labor characteristics and complications, maternal and perinatal outcomes, and occurrence of complete uterine rupture in women with a scarred and unscarred uterus. With approximately 10,000–12,000 deliveries annually, our institute is an important referral center covering 200 km of the surrounding area. There were 113,976 deliveries over the study period and of these 201 involved a complete uterine rupture: 102 (50.74%) women had a scarred uterus and 99 (49.26%) had an unscarred uterus. Of the total deliveries over the study period, 9.81% of women had undergone a previous cesarean delivery and the risk of rupture in these women was 1.71%. The risk of rupture in women with an unscarred uterus was 0.16%. These rates are similar to those reported in studies from low income countries [2–4], but are very high compared with studies from high income countries [1]. Although we identified a similar number of cases of uterine rupture in the scarred and unscarred uterus groups, rupture is 10 times more common in women with a previous uterine scar. Only one case in the scarred uterus group was associated with a repaired uterine perforation scar, while the rest were associated with a previous cesarean delivery. No significant demographic differences were noted between the 2 groups. The risk factors for rupture in women with an unscarred uterus were: cephalopelvic disproportion (64 cases); malpresentation (20 cases); multiparity (12 cases); and instrumental delivery (3 cases). Several studies have reported that maternal and neonatal morbidity and mortality were higher in patients with rupture in an unscarred uterus [2–4]. In our study, the comparison was not statistically significant (Table 1). Bladder injury was more common in the scarred uterus group. As complete or partial extrusion of the fetus and/or placenta occurs in both situations, the impact on maternal and newborn morbidity is equally negative. Measures should be taken when possible to prevent and to optimize early recognition of uterine rupture to minimize its profound consequences. ⁎ Corresponding author. QR-NO-Type-V-12, Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry, India. Tel.: +91 413 2271272; fax: +91 413 2272067. E-mail addresses: drksahoo@gmail.com, cdl_drksahoo@sancharnet.in (L. Sahu).

Successful Outcome of Twin Gestation with Partial Mole and Co-Existing Live Fetus: A Case Report.

Sad fetus syndrome comprising of a live twin gestation with a hydatidiform mole is a rare entity. The condition is even rarer when the co-existing live fetus is associated with a partial mole than a complete mole. We report the case of a 24-year-old G2P1L1 at 28 weeks gestation who presented to our casualty in the second stage of labour. She had a previous ultrasound scan at 13 weeks which showed a live fetus with a focal area of multicystic placenta. She delivered an alive preterm male fetus weighing 1.32 kg vaginally. Following expulsion of normal placenta of the live fetus, partial mole was expelled. The fetus was admitted to neonatal ICU and discharged after two weeks. Soon after delivery, β-hCG (human chorionic gonadotropin) was 1,21,993 mIU/ml which decreased to 30mIU/ml within two weeks. The patient was discharged with advice of regular follow up of β-hCG reports.

Delayed presentation of intraperitoneal bladder rupture following domestic violence in pregnancy

Trauma during pregnancy can present a unique challenge because of care for the mother and the fetus. About 6–7% of all pregnant patients are exposed to some sort of trauma, especially during the third trimester, with 0.3–0.4% requiring hospitalization. Although mostly accidental, injuries are sometimes caused by intentional violence. There is no published report on bladder rupture following trauma in pregnancy. We report a case of bladder injury following abdominal trauma in a pregnant woman.