Swapan Das

Rabies in a pregnant woman and delivery of a live fetus

presented late in labor compared with 16% in the control group. In the present study, the prevalence of domestic violence in pregnancy was 50% and husbands were the most common perpetrators. The violence was unrelated to sociodemographic parameters. Domestic violence was a marker for adverse maternal and neonatal outcomes with statistical significance. The prevalence of domestic violence in the present study was higher than the prevalence of 28% reported by Ameh and Abdul [3] in Nigeria, indicating a rising trend in domestic violence. The finding that husbands were the most common perpetrators paralleled a study conducted in Abuja, Nigeria [4]. The present study, like that of Ezechi et al. [5], reported no association between domestic violence and sociodemographic characteristics, which further emphasizes its pervasive effect across all sociodemographic groups. The adverse maternal outcomes reported in the present study were similar to reports by other researchers [6], with higher rates of instrumental vaginal and cesarean deliveries needed to expedite delivery because of fetal distress due to premature rupture of membranes and preterm labor. The adverse neonatal outcomes were consistent with previous reports of adverse neonatal outcome as a complication of domestic violence in pregnancy [6]. The pathway of the direct effect of physical trauma from domestic violence encountered during pregnancy and leading to adverse obstetric outcome [6] was not applicable in the present study, while the indirect pathway of late onset of prenatal care, late presentation in labor, and physical and emotional deprivation appear to be more relevant [6]. In conclusion, domestic violence is prevalent in this environment, appears to be increasing, and is a marker for adverse pregnancy outcomes. Routine screening for domestic violence during prenatal booking is recommended to identify vulnerable women, interrupt the cycle of abuse, and prevent adverse pregnancy outcomes.

Comparison of Lipid Profiles in Normal Pregnancy and in Pre- Eclampsia: A Case Control Study

Objective: The objective of the study was to compare the changes in lipid profile in normal pregnancy and in preeclampsia. Study Design: A case control study. Method: In this case control study total 180 study subjects were evaluated, 90 normotensive pregnant woman as control group and 90 pre-eclamptic subjects as study group. Fasting venous blood samples were collected and serum levels of triglycerides (TG), Total cholesterol (TC), low density lipoprotein- cholesterol (LDL-C), and Very low density lipoprotein – Cholesterol (VLDL-C), High density lipoprotein cholesterol (HDL-C) were measured. Result: Results showed that in pre-eclamptic group serum triglyceride (212.75 ± 50.29 mg/dl) was increased significantly (p < 0.02) as compared to normotensive pregnant woman (185.60± 40.67 mg/dl). Other parameters TC, LDL-C, VLDL-C and HDL-C were not changed significantly. Conclusion: The findings of the present study are consistent with previous studies, suggesting increased level of serum triglyceride as an important factor in the pathological process of pre-eclampsia.

Study of Hematological Parameters in Pregnancy

Objective: To determine the effect of pregnancy on haematological parameters and compare the haematological parameters at different stages of pregnancy. Methods: The study involved 30 healthy pregnant women as the study group and 10 non-pregnant women as control. The age range of these women was 19-37 years. 2.5 ml of venous blood was collected from each pregnant and non-pregnant women and put into EDTA vial. Complete blood count was estimated using automated haematological analyzer. Results: The result showed that study group exhibited statistically significant lower values of haemoglobin, PCV, monocyte and lymphocyte while WBC, eosinophil and ESR were significantly elevated. There was no significant difference in all haematological parameters among the three trimesters. Conclusion: Normal healthy pregnancy may have effect on haemotalogical parameters. So it is essential to monitor these parameters during pregnancy. We also find that trimester of pregnancy have no effect on haematological indices.

Association of serum calcium and uric acid level with hypertensive disorders of pregnancy (pre eclampsia and eclampsia) and there correlation with disease severity

Background: Hypertensive disorders are the most common medical complications during pregnancy and are associated with high maternal and fetal mortality and morbidity.One way to reduce the impact of arterial hypertension on maternal mortality is to establish the correct diagnosis of preeclampsia, and to proceed with an early intervention when it is diagnosed. The clinical signs are considered to be a late manifestation of a disease. The utility of two biochemical markers like hyperuricemia and hypocalcemia for the diagnostic purposes and for the prognosis remains largely to be explored. Objectives: (1) To determine the role of calcium & uric acid in the pathogenesis of preeclampsia. (2) To determine the serum level of calcium and uric acid & its correlation with the severity with preeclampsia. Study Design: Hospital based cross sectional case control study. Methods: The study was conducted in the Ante Natal Ward in Obstetrics &Gynaecology Department, BankuraSammilani Medical College, Bankura, WB, which serves a rural population where majority of the patients belong to the tribal groups. Mild pre eclamptic patient defined as blood pressure of at least 140/90 mm of Hg. at least on two occasions at least 6 hrs apart accompanied by proteinuria of at least 300 mg per 24 hrs or at least 1+ on dipstick testing. 64 Severe preeclamptic patient defined as having one or more criteria of the following-  BP ≥160/110 mm of Hg at least on two occasions at least 6 hrs apart  Proteinuria of ≥5gm/24hrs or at least 3+ on dipstick testing  Oliguria<500ml/24hrs or Cerebral or visual disturbances or Pulmonary edema or any other features of end organ damage. Statistical Analysis: Students t test, Chi square test and statistical software Medcalc 11.3.0, Q1 Macros 2012. Results: There were no statistical significant difference in age, BMI, or birth weight of the baby between normal pregnant women and women with PIH but preeclamptic patients present early in gestational age and that was statistically significant. The serum calcium level in eclampsia and severe pre-eclampsia were significantly less than normal pregnant woman but there was no significant difference in serum calcium between normal pregnant woman and mild pre-eclamptic woman. The serum uric acid level in eclamptic woman and severe pre- eclamptic woman were significantly more than that of normal pregnant woman but there was no significant difference in serum uric acid between noral pregnant woman and mild pre-eclamptic woman. Conclusion: So the study indicates that hyperuricemia and Hypocalcaemia is significantly associated with Preeclampsia and their level varies with the severity of the disease process. Routine estimation of serum uric acid and calcium level may be useful as diagnostic marker in high risk pregnancies.

A Comparative Study of Vaginal Delivery Versus Caesarean Section In Primigravida with Eclampsia After 34 Weeks of Pregnancy.

Objective : To compare the results of vaginal delivery & caesarean section in the management of antepartum eclampsia in primigravidae with more than 34 weeks by gestation, with reference to perinatal morbidity and mortality and maternal morbidity & mortality. Materials & Methods: This institution based, descriptive study was conducted in the department of obstetrics & Gynaecology, Bankura Sammilani Medicare College & Hospital, Bankura during the period extending from February 2014 to January 2015. A total 100 eclamptic women who fulfilled the inclusion criteria & had no factors mentioned in exclusion criteria were included in the study. Patients were divided into two groups for comparative analysis. The first group consisted of patients in whom conservative obstetric management and delivery per vaginum was carried out and was called the V.D. Group. The second group consisted of patients in whom lower segment caesarean section was carried out due to eclampsia and varied associated indications was called C.D. Group. Conclusion: Maternal & perinatal morbidity & mortality were low in patient undergoing caesarean delivery than in vaginal delivery group. Both maternal and perinatal outcome can be improved by taking an early decision for caesarean section when the cervix is unfavourable on admission or delivery is not anticipated within 6 hours.

Feto Maternal Outcome in Second versus First Stage Caesarean Delivery in a Tertiary Rural Medical College

Objective: We performed a hospital based cohort study to compare neonatal and maternal outcomes of the primary caesarean section performed in first stage versus second stage of labour. Methods: At least 100 cases underwent caesarean delivery in the second stage of labour were taken. For each case two consecutive cases underwent caesarean delivery during the first stage of labour were taken as control for the study. Primary maternal outcomes of interest were uterine atonia, transfusion requirements, urinary system injury and requirement for uterine artery/ hypogastric artery ligation. Results: Urinary injury, transfusion requirement, uterine atonia and requirement for uterine artery or hypogastric artery ligation were significantly more frequent in women who underwent caesarean section in the second stage of labour compare to women undergoing caesarean delivery in the first stage of labour. Conclusion: Caesarean section in the second stage of labour is associated with increased maternal and neonatal morbidities. Special attention is required to the patients undergoing caesarean section in the second stage of labour.

Changing Trends in Caesarean Section: Rate & Indications

Objective: The objective of this study is to compare the changes in rate and indication of Caesarean section during 2005 and 2012 after a gap of 7 years. Study Design: Comparative Study. Material and Methods: In this comparative study, 2 years data i.e. of 2005 and 2012 was collected from Hospital record. 2 years data were compared fort Caesarean section rate and trends of indication of Caesarean section. Results: The results showed that in year 2005 the rate of Caesarean section was 13.94% and in year 2012 it increased to 25.68%. In both years the main indication of Caesarean section was previous Caesarean section followed by dystocia and foetal distress. Conclusion: It is suggested to have obstetric audit by inter departmental meetings to assess the intrinsic role of Caesarean section in influencing the standard management guidelines.

Early Re-laparotomy after Gynaecological and Obsterical Surgery - a twelve months - Retrospective Study.

Objective(s): To study the incidence of early re-laparotomy, its indications and mortality rates in a rural tertiary teaching institution. Method(s): A retrospective descriptive study of early re- laparotomy after primary gynaecological and obstetrical surgery over a period of 12 months from 1 st August 2012 to 31 st July 2013 was done. Result(s): Total incidence of re –laparotomy was 0.169%. Most common complications requiring relaparotomy were intraperitoneal haemorrhage(36.36%) and PPH(36.36%) followed by rectus sheath haematoma(18.18%) and Burst abdomen(9.09%).Women who underwent primary surgeries for gynaecological and obstetrical condition required re-laparotomy in 0.16% & 0.17% cases respectively and mortality was 0% and 20% cases respectively. Conclusion: Indication of primary surgery,whether gynaecological or obstetrical, patient’s pre-operative general condition,surgeon’s experiences and care by the intensivist may influence the outcome of relaparotomy. Re-laparotomy should be considered as a procedure in case of near miss fatality of mother. To make it safe every effort must be adopted.

Evaluation of Thyroid Hormone Changes in Non-Pregnant, Normotensive Pregnant and Pregnancy with Preeclampsia

Objective: Normal Thyroid hormone level is essential in maintaining the normal fetal development. The objective of the study was to evaluate the thyroid hormone levels among healthy non-pregnant women with normotensive pregnant women and women with preeclampsia. Materials and methods: In these prospective study 90 women in the age group of 19 - 36 are divided into 3 groups consisting of 30 healthy non-pregnant women, 30 healthy normotensive pregnant women and 30 pregnant women with preeclampsia and evaluated for thyroid profile. Results: Serum TT4 and TT3 levels in normotensive pregnant women and preeclamptic women were significantly higher compared to the levels in non-pregnant women. In comparison to the normotensive pregnant women, women with preeclampsia had a non significantly higher TT4 level and significantly lower TT3. In preeclamptic women serum FT4 was marginally raised than in normotensive pregnant subjects but was significantly raised than in nonpregnant subjects. The FT3 level was significantly lower in preeclamptic women than in normotensive pregnant women compared to nonpregnant subjects. TSH levels were significantly higher in both preeclamptic and normotensive pregnant women. Conclusion: The main finding of our study indicates that there is a state of hypothyroidism in normal pregnancy and in preeclampsia and so raised serum TSH occurs. Detection of any changes in thyroid profile in preeclampsia may of health in preventing the development of preeclampsia.

Evaluation of Liver Function Test in Normal Pregnancy and Pre- eclampsia: A Case Control

Background and Objective: Preeclampsia is a multi system disorders that can affect every maternal organ predominantly the cardio-vascular system, kidneys, brain and liver. The present study was conducted to compare the liver function tests in preeclampsia with normotensive pregnancy. Methodology: The present case control study was carried out at the department of obstetrics and gynaecology of Bankura Sammilani Medical College, Bankura to find the serum bilirubin and serum levels of liver enzymes ALT, AST and ALP in 100 pregnant women (50 preeclampsia and 50 normotensive pregnant women). Results: The mean BMI of cases was 28.02 ± 3.67kg/m 2 and that of control was 24.48±3.09 kg/m 2 . The mean value of serum bilirubin in cases was