Santosh K Kulkarni

Prevalence of pre- and postpartum depression in Jamaican women

BackgroundMaternal depression during pregnancy has been studied less than depression in postpartum period. The aims of this study were to find out the prevalence of prepartum and postpartum depression and the risk factors associated in a cohort of Afro-Jamaican pregnant women in Jamaica.MethodsThe Zung self-rating depression scale instrument was administered to 73 healthy pregnant women at 28 weeks gestation and at 6 weeks postpartum for quantitative measurement of depression. Blood samples were collected at 8, 28, 35 weeks gestation and at day 1 and 6 weeks postpartum to study the thyroid status.ResultsStudy demonstrated depression prevalence rates of 56% and 34% during prepartum and postpartum period, respectively. 94% women suffering depression in both periods were single. There were significant variations in both FT3 and TT4 concentrations which increased from week 8 to week 28 prepartum (p < 0.05) and then declined at the 35th week (p < 0.05 compared with week 28) and 1 day post delivery study (p < 0.05 compared with week 35). The mean values for TSH increased significantly from week 8 through week 35. The mean values at 1 day postpartum and 6 week postpartum were not significantly different from the 35 week values. For FT3, TT4 and TSH there were no significant between group differences in concentrations. The major determinants of postpartum depression were moderate and severe prepartum depression and change in TT4 hormone concentrations.ConclusionHigh prevalence of depression was found during pre- and postpartum periods. Single mothers, prepartum depression and changes in TT4 were factors found to be significantly associated with postpartum depression.

Correlation between transvaginal ultrasound measured endometrial thickness and histopathological findings in Afro-Caribbean Jamaican women with postmenopausal bleeding.

Postmenopausal bleeding is traditionally investigated with invasive procedures. Recent studies in white populations have suggested that these procedures can be avoided, as ultrasonographic endometrial thickness of < 5 mm is not associated with malignancy. We performed a prospective study in 75 Jamaican Afro-Caribbean women with postmenopausal bleeding to determine whether an endometrial thickness of < 5 mm excluded endometrial cancer. We also examined the aetiology of postmenopausal bleeding and looked for possible risk factors. Double-layer transvaginal ultrasonographic measurement of the endometrial thickness was followed by hysteroscopy, suction curettage and histopathological confirmation. Correlation between imaging and pathology was not reliable. Half the patients with endometrial cancer had an endometrial thickness of between 3 mm and 4 mm. Seventy per cent of the women with endometrial thickness of greater than 5 mm had benign pathology. Additionally, the following characteristics were found to be more strongly associated with women with endometrial cancer: age over 65 years and 5 or more years since menopause. However parity < 2 appeared not to have a significant effect.

A randomised controlled trial of outpatient versus inpatient cervical cerclage

Fifty patients with cervical incompetence were randomised to have cervical cerclage either as inpatients, spending 3 days in hospital post-procedure on supervised bed rest or as outpatients spending the time at home on bed rest. Both groups had a clinical diagnosis of cervical incompetence and both had either McDonald or Shirodkar cerclage with mersilene tape. Both groups were given salbutamol tablets for tocolysis, postoperatively. There were no significant difference in the demographic variables between the groups such as previous cerclage, gestational age at insertion, parity and gestational age at delivery. There were also no significant differences in early complications such as bleeding. Most late complications were also not different, including the spontaneous abortion rate, premature rupture of membranes, cervical dystocia and preterm delivery. However, more patients in the outpatient group had premature contractions (26·1% vs. 4·3% P =0·0479). More patients in the inpatient group had a delivery of a live neonate, 86·9% vs. 78·3%, but the difference was not statistically significant. In conclusion, out patient cerclage appears to be a valid option, the higher rate of premature contraction in this group is not a cause for concern in view of the similar mean gestational age at delivery.

The burden of gestational diabetes mellitus in Jamaican women with a family history of autosomal dominant type 2 diabetes

OBJECTIVES To determine if Jamaican women of African descent with a family history of early onset autosomal dominant type 2 diabetes have greater odds of developing gestational diabetes mellitus (GDM) than those without a family history of the disease. METHODS A comparative study was conducted of two groups of pregnant Jamaican women: the first with a family history of early onset autosomal dominant type 2 diabetes; the second with no history of the disease. Incidence, odds for developing GDM, and metabolic profiles in first and second trimesters were assessed using SPSS 11.5 (SPSS Inc., Chicago, Illinois, United States). RESULTS The incidence of GDM was 12.0% in women with a family history of early onset autosomal dominant type 2 diabetes and 1.5% in women without a family history of the disease (P<0.05). Women with a family history were nine times more likely to develop GDM than those without a family history of diabetes (95% confidence interval: 5.00-16.38, P<0.0001). CONCLUSION Family history of early onset autosomal dominant type 2 diabetes appears to increase susceptibility to GDM in Jamaican women. Pregnant women of any age with family history of early onset autosomal type 2 diabetes should be screened for GDM.

An Unusual Malignancy Arising in a Benign Cystic Teratoma of the Ovary

but relies on early diagnosis and the presence of a gestation sac. Unfortunately many ectopic pregnancies do not appear to develop a sac or do not present before it is too late to consider such conservative treatment. The key to a wider application of such treatment is a high index of suspicion, particularly in patients with a past history of pelvic infection, past or current use of an intrauterine device or a history of infertility. Other high risk groups are patients taking the minipill and those undergoing IVF and ET. It is important that such patients who have abnormal bleeding or pain in early pregnancy be assessed initially by the use of quantitative betaHCG assays and ultrasound examination, preferably using a vaginal probe. A clear role for intraamniotic methotrexate has yet to be determined. However this case demonstrates that this method can be effective in more advanced causes of unruptured ectopic pregnancy with preservation of tuba1 function. An added advantage is that such patients may be treated as day cases.

Maternal mortality in patients admitted to an intensive care unit in Jamaica

A retrospective review was conducted of severe acute maternal morbidity (SAMM) admissions to the intensive care unit (ICU) at the University Hospital of the West Indies (UHWI) Jamaica between January 2001 and December 2006. UHWI has 550 beds and is one of three tertiary care referral centers on the island; it has two 8-bed ICUs. A total of 57 women with SAMM were admitted to the ICU over the study period representing 2.8% of ICU admissions and 0.4% of total maternal admissions to the hospital. The mean age of the women was 30 years (range 26-36 years) and the mean duration of stay in the ICU was 6 days (range 1-35 days). The most common diagnoses were hypertensive disorders of pregnancy sickle cell disease and hemorrhagic disorders (Table 1). The cause of the admission in 32 (56.1%) patients was a direct obstetric cause while for 25 (43.8%) patients the cause was non-obstetric. Only 2 patients with viable pregnancies had inadequate prenatal care. Twenty-five women were admitted after cesarean delivery 11 after vaginal delivery 6 following laparotomy and 6 after induced abortion.