Renu Arora

The Impact of Sleep-Disordered Breathing on Severity of Pregnancy-Induced Hypertension and Feto-Maternal Outcomes

BackgroundThere is a close association between sleep-disordered breathing (SDB) and preeclampsia. Both conditions have poor pregnancy outcomes.MethodsForty women with new-onset hypertension of pregnancy and 60 age-matched normotensive pregnant women were subjected to polysomnography. The maternal and fetal outcomes of all the subjects were noted.ResultsSDB occurs more frequently (p = 0.018; OR 13.1) and with more severity (p 0.001; OR 1.8) in women with hypertensive disorders of pregnancy even after controlling for pre-pregnancy body mass index (BMI). Furthermore, the BMI significantly correlated with both the Apnea–Hypopnea Index (AHI; r = 0.745; p < 0.001) and the blood pressure (r = 0.617; p < 0.001) highlighting the contribution of obesity in the causation of hypertension and SDB. We also found a significant correlation between AHI and blood pressure even after adjustment for BMI pointing toward an independent role of SDB in the development of hypertension (r = 0.612; p = 0.01). Maternal and fetal complications significantly correlated with different parameters of SDB–AHI, Arousal Index and minimum oxygen saturation, in the cases and with the fetal complications in the controls as well.ConclusionSDB occurs more frequently and with more severity in women with pregnancy-induced hypertension and is associated with more severe preeclampsia and adverse feto-maternal outcomes.

Data showing levels of interleukin-1β and nitric oxide in the plasma of uropathogenic E. coli infected UTI patients

Urinary tract infections (UTI) are a major cause of morbidity, affecting at least four million women worldwide, 65–75% of these infections are caused by Uropathogenic Escherichia coli (UPEC) (Foxman, 2010) [1]. Repertoire of virulence factors carried by UPEC provides the ability to precede urinary tract and additionally they provoke pro-inflammatory responses (Cirl et al., 2008; Verma et al., 2016) [2], [3]. In context to UPEC infected UTI patients, the levels of pro-inflammatory cytokine IL-1β and enzymatic antioxidant nitric oxide (NO) have not been reported worldwide till date, including India. In this data article, we report for the first time the levels of IL-1β and nitric oxide in the plasma of UPEC infected UTI patients. Data includes a profile of pro-inflammatory cytokine IL-1β and NO in the plasma of the confirmed UPEC infected UTI patients (N = 30) versus healthy controls (N = 40) from the present pilot study. The levels of IL-1β in plasma were significantly higher (p < 0.0001) in patients (252.3 ± 6.49 pg/ml) as compared to healthy controls (127.6 ± 3.98 pg/ml), whereas plasma levels of NO were significantly lower (p < 0.0001) in UPEC infected UTI patients (60.29 ± 1.1 μM) as compared to healthy controls (106.3 ± 8.75 μM).

Prelabour rupture of membranes at term prospective study of expectant management versus induction of labour

Background: Premature rupture of membranes (PROM) complicates 5-10 % of pregnancies. Approximately 60-70 % of term PROM cases are followed by the onset of labor within 24 hours. Diagnosis and proper management is very important. In spite of many studies available in the literature, the clinical management is surprisingly controversial. Methods: Study conducted was prospective randomised controlled trial. Total 150 women were selected fulfilling the inclusion criteria, randomly allotted to the 3 groups. In group A, patients were observed for 24 hours. If labor didn’t supervene in 24 hours since admission, induction of labor was done depending on the bishop’s score. In the group B, labour was induced by vaginal misoprostol 25 micrograms given 4 hourly for 4 doses and in group C, labor was induced by instillation of 0.5mg PGE2 gel in the posterior fornix. The women were observed for onset and progress of labour. Failure of induction was considered if patient was not in established labour within 24 hours of instillation of first dose of cerviprime/misoprostol. Labour was monitored and managed as per hospital protocol. The analysis verified the following variables: duration of latent phase and active phase of labour, mode of delivery (spontaneous/vaccum/forceps/LSCS), third stage complications (PPH/fever/retained placenta), neonatal outcome. Results: Thirty percent women had onset of spontaneous labor during expectant management in group A. The durations of latent phase and active phase of labour were lower in group B and C than group A (9 and 10.4 versus 15 hours; p<0.001) and (4 and 6 versus10 hours; p<0.001), respectively. Immediate induction in group B and C resulted in significantly lower rate of caesarean section (17% and 19% versus 28.5%, P= 0.049) and operative vaginal delivery (5% and 3% versus 13%, P=0.007). Only a few maternal-neonatal infections occurred and no significant difference was noted (2.7% and 3% versus 3.5%, P= 0.71). Conclusions: Immediate induction with prostaglandin shortens the delivery interval and lowers the caesarean section rate as compared to expectant management; however the neonatal outcome is similar in the three groups.