Urmila Singh

Calcitonin gene- and parathyroid hormone-related peptides in normotensive and preeclamptic pregnancies: a nested case–control study

PurposeTo identify whether CGRP and PTHrP serve as screening biomarkers for early detection of preeclampsia or even before the development of preeclampsia in early pregnancy.MethodsIt was a nested case–control study. The subjects were divided into normotensive (controls) and preeclamptic (cases) groups. Serum samples of 132 cases and 132 controls were collected during pregnancy at three different gestational periods and one sample post delivery, from within the cohort of pregnant women reporting to antenatal clinic. Circulating levels of CGRP and PTHrP were analyzed by enzyme-linked immunosorbent assay.ResultsMaternal serum concentrations of CGRP and PTHrP increased with the advancement of gestation age in both normotensive and preeclamptic pregnancies but the significantly less increased levels were observed in preeclamptic pregnancies as compared with normotensive pregnancies. In postpartum period level of CGRP significantly falls in both groups although level of PTHrP continues to increase even after delivery. Maternal serum CGRP and PTHrP concentrations were positively correlated with the infant’s birth weights.ConclusionMaternal circulating CGRP and PTHrP concentrations were significantly lower in women with preeclampsia, which may contribute to the development of preeclampsia.

Cutaneous metastasis from cervical carcinoma: An ominous prognostic sign

congenital adrenal hyperplasia. These tumours may produce oestradiol, leading to menorrhagia or postmenopausal bleeding. Cushing’s syndrome due to elevated serum prorenin has also been reported (Hayes et al. 1987). Magnetic resonance imaging is immensely useful in the characterisation of adnexal masses. Steroid cell tumours typically show an intermediate signal intensity solid mass with homogenous intense enhancement. Less commonly, they can be patchy with cystic and solid areas (Jung et al. 2005). If no tumour is identified, despite imaging studies, percutaneous sampling of the ovarian and adrenal vessels may be successful in identifying small steroid secreting tumours (De Freitas et al. 1991). Radiolabelled steroid scans using aldosterol, iodocholesterol and Se75 can identify ovarian steroid secreting tumours (De Freitas et al. 1991). The clinical behaviour of these tumours is uncertain. Treatment in older women consists of total abdominal hysterectomy and bilateral salpingo-oophorectomy with proper surgical staging. In younger women with stage 1 disease who wish to preserve their fertility, unilateral oophorectomy should be done (Reedy et al. 1999). The most accurate predictor of malignant behaviour is the presence of two or more mitotic figures per high power field. Malignant tumours also display grade 2–3 nuclear atypia, haemorrhage, necrosis and a diameter of 47 cm (Hayes and Scully 1987). In a large study, the Gynecologic Oncology Group assessed the efficacy of Bleomycin, etoposide and platinum and found this regimen to be immensely effective in women with primary and recurrent disease (Homesely et al. 1998). Gonadotropin-releasing hormone agonists have been used in the past as primary treatment to achieve complete resolution of ovarian androgen secreting tumour (Bames and Ehrmann 1997). Post-treatment follow-up using serum testosterone levels is recommended in view of the unpredictable behaviour of these tumours. Steroid cell tumours NOS are among the rarest of the ovarian tumours. They can be difficult to diagnose as the ovary may appear completely normal. Magnetic resonance imaging is valuable in arriving at a diagnosis.

A prospective double blind trial investigating impact of vaginal pH on efficacy of prostaglandin gel for cervical ripening and course of labour

This prospective, double blind investigation was carried out to see the effect of vaginal pH on the efficacy of prostaglandin gel (PGE2) for cervical ripening and course of labour. A total of 45 pregnant women with indications for induction of labour were allocated to two groups: a low vaginal pH (≤5.5, n = 20) and high vaginal pH (>5.5, n = 25) group. All women received prostaglandin E2 gel (0.5 mg in 2.5 ml) intravaginally with repeated dosing if needed, 6 h apart, maximum of three doses. Bishops score change over 18 h differed significantly between the two groups (p = 0.037). There was no significant difference between the groups with respect to time to onset of labour (9.65±6.29 vs 6.76±3.94, p = 0.066), time to active labour (15.38±9.49 vs 14.30±5.85, p = 0.664), time to complete cervical dilation (18.27±13.85 vs 18.34±6.45; p = 0.984), and time to overall delivery (21.52±9.66 vs 19.39±6.45, p = 0.381).

A prospective double blind study using oral versus vaginal misoprostol for labour induction

This prospective double blind study was undertaken to compare the safety and efficacy of oral vs vaginal misoprostol in equivalent doses (50 μg) for induction of labour. A total of 128 term pregnancies with indication for induction of labour were allocated to two groups to receive 50 μg misoprostol orally or vaginally, every 4 h until adequate contractions were achieved or a maximum of 200 μg dose. Induction to delivery interval was significantly shorter in the vaginal group compared with the oral group (14.6 h vs 22.5 h; p < 0.001). There was no significant difference between the groups with respect to mode of delivery, neonatal outcome and maternal side-effects. However, the incidence of abnormal contractility pattern was more common in the vaginal group (10/68, 14.6%) as compared with the oral group (4/60, 6.6%) (p = 0.146).

Molar pregnancy in postmenopausal women: a rare phenomenon

Benign gestational trophoblastic disease generally occurs in women of the reproductive age group and is extremely rare in postmenopausal women. We describe a case of complete hydatidform mole in a 60-year-old postmenopausal woman who was referred with diagnosis of suspected malignancy/myoma resulting in delay in management. This case highlights the fact that gestational trophoblastic disease can occur in menopausal woman and this should be included in the differential diagnosis of perimenopausal and postmenopausal haemorrhage to prevent delay in diagnosis and treatment.

Massive rectus sheath haematoma mimicking abruptio placenta

expensive and exposes patient to ionising radiation (Moreno et al. 1997). Conservative management of RSH with rest, analgesics and discontinuation of anticoagulant therapy, blood and blood products transfusion as and when necessary, is feasible in the majority of the patients. Caesarean section could have been avoided if the correct diagnosis had been promptly made. Although conservative management is desirable, it is vital for all obstetricians to have a low threshold for surgical intervention in a haemodynamically unstable patient or if haematoma is complicated by anticoagulant therapy. This case also highlights the importance of being familiar with the clinical presentation of RSH in pregnancy. The sonographer should be prepared to make a firm diagnosis as this goes a long way in reducing unnecessary surgical intervention and decrease maternal and perinatal morbidity and mortality associated with RSH in pregnancy.

Association of IL-10 Gene Polymorphism (−819C > T, −592C > A and −1082G > A) with Preterm Birth

ObjectiveTo analyze the association of IL-10 gene and its polymorphisms with preterm birth (PTB).MethodsFive hundred and fifty nine women with term birth and 559 with preterm birth were recruited from Lucknow, India. Genetic association analysis was conducted between cases and controls. Subjects recruited as cases were women (aged between 18–40 y) with singleton delivery before 37 wk of gestation and controls were with delivery after or on 37 wk. The genotyping was performed for rs1800871, rs1800872 and rs1800896 for assessing the allelic distribution, haplotypic association and linkage disequilibrium analysis. IL-10mRNA levels were evaluated by real time quantitative polymerase chain reaction (PCR) method.ResultsThe risk of PTB was found significant in women carrying IL-10 (−1082) GA genotype [OR=1.72(1.7–2.5), p=0.006]. The haplotypic analysis of studied polymorphisms for rs1800871, rs1800872 and rs1800896 depicted the association of ATA (p=0.02) and ATC (p=0.01) haplotypes with PTB. The IL-10 mRNA levels were significantly lower in cases (p=0.05).ConclusionsIL-10 marks a protective impact in the inflammatory pathway of PTB.

Energy and protein intake during pregnancy in relation to preterm birth: A Case Control Study

ObjectiveTo find the association of maternal energy and protein intake with preterm birth.DesignCase-control studySettingTwo hospitals at Lucknow in Northern India.ParticipantsCases ({ptn}=350) were defined as mothers (age 18–40 y) of singleton live preterm (<37 wks) neonates. Controls (n=350) were mothers who delivered a singleton neonate, consecutive to enrolled case, after completing 37 weeks of gestation.ResultsThere was a statistically significant lower mean (SD) energy intake [cases 1624 (249) Kcal vs. controls 1911 (341) Kcal; P<0.001] and protein intake [cases 32.1 (6.1) vs. controls 37.2 (7.0); P<0.001] among women who delivered preterm neonates. Maternal energy and protein intake had significant positive correlation with neonatal weight, length, foot length, head circumference and chest circumference.ConclusionLower energy and protein intake during pregnancy is possibly associated with preterm birth.

A prospective double blind study comparing the effects of oxytocin and human chorionic gonadotrophin as trigger for ovulation

This study was undertaken to compare the effect of oxytocin and human chorionic gonadotrophin (hCG) on ovulation and conception. A total of 100 women with anovulatory infertility were allocated into two equal groups to take clomiphene citrate plus hCG or clomiphene citrate plus oxytocin. The size and number of follicles by transvaginal sonography determined the administration of hCG or oxytocin. The serum progesterone concentration was measured to provide evidence for ovulation. The ovulation and pregnancy rate of the two groups were compared. There was no significant difference between the groups with respect to mean number of follicles, mean follicular size and rate of ovulation in three cycles. The rate of pregnancy was higher in the oxytocin group compared with the hCG group (12% vs 4%) but it failed to reach statistical difference (p = 0.140). Mild pain was the only side-effect observed in the two groups. Oxytocin was found to be a viable alternative to hCG for triggering ovulation in infertile patients.

An analytical study on peripheral blood smears in anemia and correlation with cell counter generated red cell parameters

Context: Manual examination of peripheral blood smear in diagnosis of anemia has taken a backseat with the advent of automated counters. Though a lot of studies have been done to assess the efficacy and significance of red blood cell parameters in different hematological conditions fewer efforts have been made to standardize the visual examination of peripheral blood smears for diagnosing anemias. Aims: Standardization and grading of abnormal red cell morphology in peripheral blood smear and counter based red cell indices in cases of anemia of various etiologies. Settings and Design: Cross-sectional study of one year duration conducted in the Hematology laboratory, in a tertiary care hospital in North India. Materials and Methods: In 60 anemic patients, automated counts and peripheral blood smear were prepared and evaluated by three observers, according to a red cell morphology grading guide. Statistical Analysis Used: ANOVA, Tukey post hoc test were used. Results: Objective grading of peripheral blood smears in cases of anemia have a good inter observer correlation and hence have reduced subjective variation. Manual parameters like microcytosis, macrocytosis and hypochromia expressed as a percentage, have shown significant correlation, with their corresponding automated parameters, and the regression model so generated may provide a novel way for quality control of automated counters, if calculated for different models. Conclusions: Even in the age of molecular analysis, the blood smear remains an important diagnostic tool and sophisticated modern investigations of hematologic disorders should be interpreted in the light of peripheral blood features as well as the clinical context.