Reduced Endothelial Progenitor Cells: A Possible Biomarker for Idiopathic Fetal Growth Restriction in Human Pregnancies.

BACKGROUND: Circulating endothelial progenitor cells (EPCs) may be necessary throughout pregnancy by ensuring proper placentation and embryonic growth. The lack of standardized EPC quantification techniques has prevented conclusive proof of an increase in EPC during pregnancy. OBJECTIVES: The purpose of this study was to determine whether EPC levels change for healthy and idiopathic fetal growth restriction (FGR) pregnancies. MATERIALS AND METHODS: The study population consisted of 48 healthy pregnant females with no previous history of IUGR (10 in the first trimester, 15 in the second, and 23 in the third), 48 women with pregnancy complicated by idiopathic FGR, and 15 non-pregnant women. By using flow cytometry, EPCs in maternal blood were recognized as CD45dim/CD34/KDR cells. ELISA was used to measure plasmatic cytokines. RESULTS: We ascertained a progressive rise in EPCs in healthy pregnancies that was apparent in the first but more pronounced in the third trimester. At comparable gestational ages, FGR-complicated pregnancies had impaired EPC growth. Placental growth factor and stromal-derived factor-1 levels in the blood were significantly lower in FGR than in healthy pregnancies, which may have contributed to the degradation of the EPCs. CONCLUSION: The count in EPCs might hold considerable promise toward developing a peculiar authentication marker for observing pregnancies, and could be the focus of cutting-edge tactics for the prognosis and treatment of FGR pregnancies.

Linking of oxidative stress and mitochondrial DNA damage to the pathophysiology of idiopathic intrauterine growth restriction.

Objective: A common and serious pregnancy issue known as intrauterine growth restriction (IUGR) occurs when the fetus is unable to reach its full growth potential. Mitochondria are crucial to the development of the fetus and the placenta. We aimed to elucidate the role of oxidative stress parameters and markers of DNA damage. The integrity of the mitochondrial DNA (mtDNA) was studied. Materials and Methods: Blood samples were collected from 48 females (cases and controls, respectively). Oxidative stress parameters were analyzed. DNA was extracted followed by high-performance liquid chromatography to study 8-OH-dG and mt DNA by real-time polymerase chain reaction. Western blot analysis was performed for nuclear-encoded mitochondrial proteins and DNA damage markers. Results: When pregnant women were compared to non-pregnant women in their first, second, and third trimesters, a highly significant progressive drop in circulating mtDNA was found. In addition, mtDNA was considerably higher in mothers carrying IUGR fetuses than in healthy pregnancies. Sirtuin-3 protein expression was considerably suppressed in the IUGR placenta (P = 0.027), whereas Nrf1 expression was not statistically different from the control group in the IUGR. Increased oxidative stress led to greater DNA damage in IUGR. The highest concentrations of 8-OH-dG were found in IUGR with levels significantly higher than those in the non-pregnant group. Conclusion: Our research sets the path for further investigation into mitochondrial anomalies in IUGR pregnancies and offers evidence for disturbed mitochondrial homeostasis. The mtDNA might offer a fresh perspective on the processes involved in physiological gestation. In addition, the presence of mtDNA may aid in the diagnosis of IUGR during pregnancy.

Centres of Excellence for Adolescent Health and Development: A Case Study from Uttar Pradesh, India.

Adolescents and young adult comprise a significant proportion of India's population. Although, this group of the population faces serious challenges to their health and well-being. To promote their health and well-being, Centre of Excellence (CoE) at King George's Medical University, Lucknow, India, serves as an advanced care facility for 10-24-year-old adolescents and young adult women. This paper reports the socio-demographic characteristics of, and health services availed to adolescents and young adults who are visiting the CoE in Lucknow, India. A total of 6038 beneficiaries received clinical services during June 2018-March 2022. Out of total clinical services, 38.37% counselling and 37.53% referral services were utilised. Menstruation (46.29%), sexual and reproductive (28.19%), nutrition (5.91%), and mental health (1.67%) related problems were highly reported. The age of beneficiaries is classified into three categories, i.e., 10-14, 15-19, and 20-24 years. Prevalence of overweight was highest among adolescents aged 20-24 years compared to other age groups. Other than nutrition, late-adolescent girls (15-19) faced more health problems than their counterparts. The percentage of beneficiaries decreased significantly during and post the COVID-19 period (<0.001). Therefore, age-specific programs are currently needed, and interventions need to be designed accordingly.

Assessment of endocrine disrupting chemicals in breast milk: Association with dietary habits and duration of lactation.

The present study was aimed to assess infant safety associated with the presence of persistent organochlorine pesticides (OCPs) in breast milk, a possible route of transfer of endocrine-disrupting chemicals to newborns in North India. Colostrum and breast milk samples (n = 130) were collected at different stages of lactation. Pesticides analysis was performed using gas chromatography mass spectrometry (GC-MS). We observed that of all the samples analysed, OCPs concentration was higher in breast milk than in colostrum, suggesting pesticides contamination increases over lactation period. As far as OCPs are concerned, dieldrin [1196.64 ± 673.75 ng/g lipid weight (lw)], and ß-HCH [1107.78 ± 1301.72 ng/g lw], were the predominant OCPs, followed by aldrin [977.09 ± 707.69 ng/g lw], α-HCH [948.04 ± 476.65 ng/g lw] and 1,1'-(2,2-Dichloroethene-1,1-diyl)bis(4-chlorobenzene) (p,p'DDE) [790.11 ± 399.35 ng/g lw]. The association between OCPs levels and women dietary habits were also explored, and all the OCPs were grouped and compared to each other by consumption level of fish, meat, sea foods, eggs, and dairy products. We found that women consuming non vegetarian food, like fish and meat, were exposed 3.5 times more to OCPs than women consuming vegetarian food. In addition, we also observed that factors like mother's age was positively (<0.005 - <0.001) correlated while gestational age and infant birth weight were negatively (<0.005) associated with the levels of OCPs in colostrum and breast milk, respectively. Unfortunately, neither any standards nor guidelines are available for the use of pesticides, therefore, it is suggested that careless use of OCPs should be checked and suitable remedial measures be taken to decrease human contamination. Moreover, further studies are warranted to elucidate relationship between pesticide residues in breast milk and the maternal and child health.

Association of Maternal Serum Ischemia Modified Albumin (IMA) with Placental Histopathological Changes and Fetomaternal Outcome: A Prospective Case Control Study in Normotensive and Pre-eclamptic Women.

Introduction: Ischemia and oxidative stress leads to generation of hydroxyl free radicals and modification of 'N-terminus' of human serum albumin. This modified albumin molecule, known as Ischemia Modified Albumin (IMA), is elevated in early stages of ischemia. It has recently been approved by US Food and Drug Administration (US FDA) for its clinical use, as early marker of myocardial ischemia in cardiology. IMA is a novel marker of ischemia and is elevated in other clinical conditions associated with ischemia like pulmonary embolism, uncontrolled type II diabetes mellitus, acute decompensated heart failure, preeclampsia, recurrent pregnancy losses and IUGR. Role of IMA in birth asphyxia in perinatology is of current interest and needs further research. Methodology: A prospective case control study was conducted in a tertiary center in North India for one year. Total 80 pregnant women between 34 and 40 weeks were recruited and allocated in two groups. Case group comprised of 40 pre-eclamptic pregnant women and control group comprised of 40 normotensive pregnant women. Comparison and association of maternal serum IMA levels with fetomaternal outcome and number and types of placental histopathological changes was done in two groups. Results: In preeclampsia group mean serum IMA (115.23 ± 49.51) was significantly higher as compared to the normotensive group (79.21 ± 14.35). The optimum cut off value of IMA to detect a case was 94.5 IU/ml (sensitivity 65%, specificity 87.5%, PPV 83.9%, NPV 71.4% and diagnostic accuracy of 76.3). Pre-eclamptic women, had significantly higher incidence of PTVD, lower fetal birth weight and placental histopathological changes as compared to normotensive group. 83.8% of the women with raised IMA levels were pre-eclamptic. Raised IMA levels were significantly associated with higher incidence of PTVD, birth weight ≤ 2 kg and hypoxic histopathological lesions of chorangiosis, intervillous fibrin and hyalinization. Conclusion: Determination of maternal serum IMA levels early in pregnancy can predict preeclampsia and avoid future severe preeclampsia related complications. It might be useful to optimize both maternal and fetal/neonatal outcomes.

Cervical gestational trophoblastic neoplasia: A rare form of gestational trophoblastic disease.

Gestational trophoblastic neoplasia (GTN) is a rare disease and is characterized by an abnormal proliferation of trophoblastic cells of placenta. Since majority of them are chemotherapy sensitive, they are one of the highly curable cancers. However, due to its varied presentation, clinicians still face many challenges in its diagnosis and management. We present a case of 26-year-old woman, P0 + 3 (previous 3 abortions) who presented to us with a history of vaginal bleeding postuterine evacuation after 2 months of incomplete abortion. After clinical, radiological assessment and high human chorionic gonadotropin (hCG) titers, the patient was diagnosed as a case of cervical GTN. Risk assessment by the WHO prognostic scoring system was done and "Low Risk" was assigned to her. She was given total nine cycles of single agent chemotherapy including two consolidation cycles after normalization of hCG titers which patient tolerated well and remained asymptomatic.

Assessment of genotoxicity and oxidative stress in pregnant women contaminated to organochlorine pesticides and its correlation with pregnancy outcome.

The present study was aimed to assess the correlation between transplacental transfer of xenobiotics and resulting biochemical alterations (including genotoxicity and oxidative stress) in non-occupational pregnant women of North India along with the effect on pregnancy outcomes. Maternal and cord blood samples were collected from 221 healthy mother-infant couples and divided according to their gestational age and birth weight. Genotoxic effects in mother and cord blood were examined using comet assay. The quantitative determination of Organo-chlorine pesticides in blood serum of study population was carried out using gas chromatography-mass spectrometry (GC-MS). Notably higher Organo-chlorine pesticides levels were observed in maternal blood of preterm than term subjects for almost all of the compounds detected, with the maximum concentration found for aldrin (3.26 mg/l) in maternal blood and dieldrin (2.69 mg/l) in cord blood. The results showed a significant increment in olive tail moment, tail full length, catalase, super-oxide dismutase, and malondialdehyde levels whereas lower glutathione reductase and peroxidase were found in preterm babies when compared with term group and it varied in the order: maternal blood > cord blood. A clear trend was observed for preterm babies with their lower birth weight and cesarean mode of delivery. Therefore, reduction in birth weight in newborns may be the consequence of increased oxidative damage and genotoxicity brought about by pesticides and these markers could be employed for early detection of pesticides related ailments and toxicities. To the best of our knowledge, this was a pioneering study and it may help to increase our knowledge with regard to xenobiotic exposure in biological system and the need for stringent guidelines for agricultural use of pesticides.

Association Between PON1 (L55M and Q192R) Genetic Polymorphism and Recurrent Pregnancy Loss in North Indian Women Exposed to Pesticides.

OBJECTIVE: The aim of the present study was to examine the relation between the PON1 polymorphisms and recurrent pregnancy loss (RPL). METHODS: In a cross-sectional study, blood samples were collected from 100 females. DNA was extracted and PON1 genotypes were determined by polymerase chain reaction (PCR) amplification. RESULTS: Regarding PON1 L55M, the mutated allele (M) frequency was found in 70.5% in RPL and in 53.5% in controls; the M allele was significantly associated with an increased risk of RPL (adjusted odds ratio [ORadj] = 2.07; 95% confidence interval [CI]; p < 0.001). However, regarding PON1 Q192R, the R mutated allele frequency was found in 28.5% in RPL and in 33% in controls. The R allele did not show any risk for RPL (ORadj 0.81; 95%CI; p = 0.329). CONCLUSION: The present study suggests that there is an effect of genetic polymorphism on RPL and provides additional evidence that combines with the growing information about the ways in which certain PON1 genotypes can affect the development of the fetus in the uterus.

OBJETIVO: O objetivo deste estudo foi examinar a relação entre os polimorfismos PON1 e perda recorrente de gravidez PRG. MéTODOS: Em um estudo transversal, foram coletadas amostras de sangue de 100 mulheres. O DNA foi extraído e os genótipos PON1 foram determinados por amplificação por PCR. RESULTADOS: Com relação ao PON1 L55M, a frequência do alelo mutado (M) foi encontrada em 70,5% no PRG e em 53,5% nos controles; o alelo M foi significativamente associado a um risco aumentado de PRG (odds radio ajustado [ORadj] =2,07; intervalo de confiança [IC] 95%; p < 0,001). No entanto, em relação ao PON1 Q192R, a frequência do alelo mutado R foi encontrada em 28,5% no PRG e em 33% nos controles. O alelo R não mostrou qualquer risco para PRG (ORadj 0,81; IC 95; p = 0,329). CONCLUSãO: O presente estudo sugere que há um efeito do polimorfismo genético sobre PRG e fornece evidências adicionais que se combinam com as informações crescentes sobre as maneiras pelas quais certos genótipos PON1 podem afetar o desenvolvimento do feto no útero.

Association Between PON1 (L55M and Q192R) Genetic Polymorphism and Recurrent Pregnancy Loss in North Indian Women Exposed to Pesticides / Associação entre o polimorfismo genético PON1 (L55M e Q192R) e a perda recorrente de gravidez emmulheres do norte da Índia expostas a pesticidas

Abstract Objective The aim of the present study was to examine the relation between the PON1 polymorphisms and recurrent pregnancy loss (RPL). Methods In a cross-sectional study, blood samples were collected from 100 females. DNA was extracted and PON1 genotypes were determined by polymerase chain reaction (PCR) amplification. Results Regarding PON1 L55M, the mutated allele (M) frequency was found in 70.5% in RPL and in 53.5% in controls; theMallele was significantly associated with an increased risk of RPL (adjusted odds ratio [ORadj]=2.07; 95% confidence interval [CI]; p<0.001). However, regarding PON1 Q192R, the R mutated allele frequency was found in 28.5% in RPL and in 33% in controls. The R allele did not show any risk for RPL (ORadj 0.81; 95%CI; p=0.329). Conclusion The present study suggests that there is an effect of genetic polymorphism on RPL and provides additional evidence that combines with the growing information about the ways in which certain PON1 genotypes can affect the development of the fetus in the uterus.

Resumo Objetivo O objetivo deste estudo foi examinar a relação entre os polimorfismos PON1 e perda recorrente de gravidez PRG. Métodos Em um estudo transversal, foramcoletadas amostras de sangue de 100 mulheres. O DNA foi extraído e os genótipos PON1 foram determinados por amplificação por PCR. Resultados Com relação ao PON1 L55M, a frequência do alelo mutado (M) foi encontrada em 70,5% no PRG e em 53,5% nos controles; o alelo M foi significativamente associado a um risco aumentado de PRG (odds radio ajustado [ORadj] =2,07; intervalo de confiança [IC] 95%; p<0,001). No entanto, em relação ao PON1 Q192R, a frequência do alelo mutado R foi encontrada em 28,5% no PRG e em 33% nos controles. O alelo R não mostrou qualquer risco para PRG (ORadj 0,81; IC 95; p=0,329). Conclusão O presente estudo sugere que há um efeito do polimorfismo genético sobre PRG e fornece evidências adicionais que se combinam com as informações crescentes sobre asmaneiras pelas quais certos genótipos PON1 podemafetar o desenvolvimento do feto no útero.

Platelet indices as a predictive marker in neonatal sepsis and respiratory distress in preterm prelabor rupture of membranes.

Preterm Prelabor rupture of membranes (PPROM) accompanies 2-3% of all pregnancies and 1/3rd of all preterm deliveries leading to intraamniotic infection, postpartum infections, sepsis along with perinatal morbidity and mortality worldwide. Early diagnosis and treatment can prevent the complications of PPROM and improve mother and child health. The platelet indices (platelet count, Mean platelet volume, Plateletcrit and Immature platelet fraction) could be a useful predictive parameters in PPROM, as platelets are acute phase reactants and there parameters may vary with inflammation and increased platelet consumption/production. In the present study, Mean Platelet volume (MPV) levels showed significant increase in cases as compared to controls (10.47 ± 1.92 fl Vs 8.84 ± 1.30 fl; P < 0.004). Plateletcrit (PCT) levels were also significantly increased in cases with respect to controls (0.22 ± 0.10% Vs 0.18 ± 0.05%; P = 0.004). Immature platelet fraction (IPF) is significantly increased in cases than in control subjects (8.73 ± 6.67% Vs 4.43 ± 1.75%; P < 0.001). Also, Mean Platelet volume (MPV) levels were found to be significantly higher in subjects whose neonate had developed sepsis(11.39 ± 1.69 fl Vs 8.91 ± 1.31 fl; P < 0.001) and respiratory distress (10.62 ± 2.09 fl Vs 9.26 ± 1.56 fl; P = 0.003). Similarly, PCT was significantly higher in groups with positive neonatal sepsis (0.32 ± 0.74% Vs 0.19 ± 0.65%; P = 0.010) and with respiratory distress (0.24 ± 0.78% Vs 0.18 ± 0.59%; P < 0.001). Levels of IPF were also increased in positive neonatal sepsis group (10.11 ± 6.27% Vs 5.06 ± 4.07%; P < 0.001) and respiratory distress group (9.11 ± 6.38% Vs 5.54 ± 4.43%; P = 0.009). The findings suggest that maternal platelet parameters (MPV, PCT and IPF) can be utilized as evidence of early predictors of development of neonatal sepsis and respiratory distress and may be considered as a predictive markers for adverse neonatal outcome.

Beta-HCG Concentration in Vaginal Fluid: Used as a Diagnostic Biochemical Marker for Preterm Premature Rupture of Membrane in Suspected Cases and Its Correlation with Onset of Labour.

OBJECTIVES: To evaluate ß-hCG concentration in vaginal fluid as a biochemical marker for PPROM in suspected cases and its correlation with onset of labour. MATERIALS AND METHODS: This is a prospective case-control study carried out in tertiary care centre in 1 year. Total 150 pregnant women of gestational age 28-36 week + 6 days were included and were divided into two groups: control (Group 1) (n = 50) normal antenatal patients. Group 2 cases with history of leaking per vaginum subdivided into two groups-Group 2A-(n = 50) with no detectable leakage of amniotic fluid present on per speculum examination and Group 2B-(n = 50) with minimal leaking per vaginum present upon per speculum examination (frank leaking were excluded). ß-hCG level was measured by chemiluminescent microparticle assay, and all women were followed till onset of labour. RESULTS: Mean ß-hCG level in vaginal fluid was measured as 6.10 ± 8.52 mIU/mL, 57.10 ± 30.86 mIU/mL and 111.35 ± 36.01 mIU/mL in Group 1, Group 2A and Group 2B, respectively. By taking 21.5 mIU/ml as cut-off, receiver operating characteristic curve shows sensitivity 100%, specificity 92.0%, positive predictive value 92.6%, negative predictive value 100% and diagnostic accuracy 96%. Regarding the correlation of ß-hCG level with onset of labour if the ß-hCG level is < 21.5 mIU/ml, 100% pregnancy continued beyond 4 weeks and 56% women delivered within 4 weeks when ß-hCG level is > 75 mIU/ml. CONCLUSION: ß-hCG in vaginal fluid is a reliable biochemical marker for diagnosing suspected cases of PPROM and is well correlated with onset of labour.

Pesticide Risk and Recurrent Pregnancy Loss in Females of Subhumid Region of India.

OBJECTIVE: The objective of this study is to determine the level of pesticides and their role in cases of recurrent pregnancy loss (RPL). MATERIALS AND METHODS: This was designed as a case-control study. Gas chromatography was used to characterize the pesticide level in 70 cases and 70 controls. Case refers to women with RPL, whereas controls refer to women with full-term delivery. RESULTS: A higher level of pesticide, namely beta-hexachlorocyclohexane, malathion, chlorpyrifos, and fenvalerate was found in the case group as compared to control group (P < 0.05). CONCLUSIONS: The present study suggests that high exposure of pesticide (organochlorine and organophosphates) may increase the risk of RPL in females of the subhumid region of India.

Case Control Study to Compare Serum Vascular Endothelial Growth Factor (VEGF) Level in Women with Recurrent Pregnancy Loss (RPL) Compared to Women with Term Pregnancy.

INTRODUCTION: Recurrent pregnancy loss (RPL) is defined as three or more spontaneous pregnancy losses before the 20th week of gestation or fetal weight of < 500 gm from the last menstrual period. Vascular endothelial growth factor (VEGF) is essential for implantation, development of embryo and placental angiogenesis. Women with low VEGF level are believed to be at higher risk of RPL. OBJECTIVE: To measure the level of VEGF in women with RPL and compare it with women with 1 or more successful pregnancies. METHODS: This is a Case control study carried out in King George Medical University, Lucknow from August 2015 to 2016. Participants sample size was 60 women. Thirty women with 3 or more spontaneous abortions were included as cases, and 30 women with at least 1 successful term pregnancy were controls. Serum VEGF level was analyzed using ELISA kit. Main outcome measured: 1. Serum VEGF level in the two groups. 2. Serum VEGF level in different underlying etiologies in women with RPL. RESULTS: Mean VEGF level was 105.3 pg/mL in RPL cases, while it was 156.8 pg/mL in fertile controls. (p = 0.01). VEGF level was 86.2 pg/mL in patients with anatomical defects, 109 pg/mL in APLA syndrome, 85.1 pg/mL in hypothyroidism and 122.2 pg/mL in unexplained RPL. CONCLUSION: The mean serum VEGF level was significantly lower in women with recurrent pregnancy loss compared with women with successful term pregnancy, implicating its role in maintaining pregnancy.

Association of 2-Methoxyestradiol (2ME) Plasma Levels with Clinical Severity Indices and Biomarkers of Preeclampsia.

INTRODUCTION: Preeclampsia is an important cause of maternal and perinatal morbidity and mortality. The pathophysiology of preeclampsia has been extensively studied. 2ME seems to maintain placental homeostasis necessary for appropriate cytotrophoblast invasion of the maternal deciduas. We plan this study to compare its value in the plasma of normotensive and preeclamptic women and studying its correlation with the severity indices of preeclampsia. AIM AND OBJECTIVES: The aim of this study was to estimate plasma levels of 2ME in preeclamptic and normotensive pregnant women and correlate it with the severity in terms of clinical indices, laboratory investigations, and fetomaternal outcome. MATERIALS AND METHODS: This study was a case-control study conducted in KGMU, Lucknow, August 2015-2016. Sample size was 90 pregnant women including 30 normotensive, 30 non-severe preeclampsia, and 30 severe preeclampsia patients. Plasma 2ME levels were analyzed using ELISA kit and the outcome was compared in terms of systolic and diastolic blood pressure, proteinuria, liver and renal function tests, serum LDH, uric acid, plasma 2ME levels, and fetomaternal outcome. RESULTS: There was a significant (p = 0.0001) difference in 2ME plasma levels among the groups (normotensive, non severe and severe preeclampsia patients). 2ME plasma levels significantly negatively correlated with SBP (r = - 0.62, p = 0.0001) and DBP (r = - 0.63, p = 0.0001). With one-unit increase in SBP, 2ME will decrease by 2445.14 units, and in one-unit increase in DBP, 2ME will decrease by 1807.28 units. The sensitivity and specificity of 2ME for preeclampsia were found to be high. CONCLUSION: It was seen that there was a statistically significant difference between plasma 2ME levels among the three groups. The ROC curve obtained showed that sensitivity was predicted to be 98.3%, specificity 76.7%, positive predictive value of 89.4%, negative predictive value of 95.8% and accuracy of 91.1%.

Leptin as a Predictive Marker in Unexplained Infertility in North Indian Population.

INTRODUCTION: According to WHO, the primary infertility in India is about 3.9% (age-standardized to 25-49 year) and 16.8% (age-standardized to 15-49 year), using the "age but no birth" definition. Several factors which affect fertility include low sperm production in men, poor egg quality and blocked fallopian tubes in women and also hormonal imbalances. Leptin plays a critical role in women's reproduction and neuroendocrine health. It is used for treating exercise-induced bone loss, eating disorders and infertility. AIM: To evaluate the serum leptin levels in Indians and to ascertain the relationship between serum leptin levels, Unexplained Infertility (UI) and related variables [height, weight, Waist Hip Ratio (WHR), Body Mass Index (BMI)] between obese infertile, non-obese infertile and healthy subjects. MATERIALS AND METHODS: The present case-control study was conducted at the Department of Obstetrics and Gynaecology, King George's Medical University (KGMU), Lucknow, India and funded by Department of Science and Technology, New Delhi, India. The study included 229 female participants in the age group of 18-40 years (120 cases and 109 controls) who were randomly selected. The blood samples were collected from the Infertility Clinic, Queen Mary's Hospital, KGMU, Lucknow, India. All the participants underwent complete physical examination. Initially, the participants were categorized into fertile and infertile groups, they were further divided on the basis of BMI, normal (BMI- 18.5-24.5) and overweight or obese (BMI≥25). Leptin level was measured by Active Human Leptin ELISA kit and BMI of all subjects was calculated in kg/m2 (weight in kg and height in m). RESULTS: A highly positive linear correlation (R=0.754, p<0.001) was found between BMI and serum leptin in unexplained infertile women, which indicates a strong relationship between BMI and serum leptin. The variation in serum leptin is explained by the independent variable, BMI. There was a partial positive linear correlation between BMI and serum leptin in the control group. Statistically there was no significant correlation (R=0.109, p=0.258) between BMI and serum leptin in the control group. CONCLUSION: The present study clearly demonstrates that level of leptin is higher in unexplained infertile than in the fertile group, and also shows that a strong relationship exists between BMI and serum leptin in the obese group. Serum leptin level was significantly higher in obese than non-obese subjects. Thus, leptin is an important factor for normal reproductive function. Obesity, the main cause of infertility may be controlled by regulating the leptin concentration.

Does microalbuminuria at mid-pregnancy predict development of subsequent pre-eclampsia?

AIM: The aim of this study was to evaluate microalbuminuria at mid-pregnancy, using the albumin-to-creatinine ratio (ACR), as a predictor of pre-eclampsia. MATERIAL AND METHODS: This prospective observational study was carried out on 144 normotensive women, aged<35 years, body mass index<25kg/m², and live singleton pregnancy between 24 and 28 weeks. In all, the ACR was measured in spot random urine samples. Normoalbuminuria was an ACR of <30 mg/g, whereas microalbuminuria was an ACR of 30-299 mg/g creatinine. All were followed till delivery. Primary outcome was the development of pre-eclampsia. The secondary outcome measures were preterm births and neonatal birthweight. Statistical analysis was done with Fisher's exact and t-tests. RESULTS: Of all, 77.1% (111/144) had normoalbuminuria and 22.9% (33/144) had microalbuminuria. Of 33 microalbuminuric women, the mean blood pressure was significantly higher in those who subsequently developed pre-eclampsia (P<0.001). The mean ACR (mg/g) in this cohort was 60.6±29.4. The mean ACR (mg/g) in women who subsequently developed pre-eclampsia was significantly higher than in women who remained normotensive (P=0.003). Of 33 microalbuminuric women, 12 (36.4%) developed pre-eclampsia, and eight (24.2%) had preterm births. The mean birthweight (kg±standard deviation) was significantly lower in the microalbuminuria group (2.45±0.6) as compared to the normoalbuminuria group (2.8±0.37), P<0.001. CONCLUSION: Microalbuminuria in mid-pregnancy may be a significant predictor of development of subsequent pre-eclampsia, preterm birth and low-birthweight babies.

The decision-to-delivery interval in emergency Caesarean sections and its correlation with perinatal outcome: evidence from 204 deliveries in a developing country.

The international standard decision-to-delivery interval (DDI) for emergency Caesarean sections (CSs) is ≤ 30 minutes but there is little evidence to support this recommendation. The aim of this study was to evaluate DDI for emergency CS and its relationship to perinatal outcome. We undertook a prospective observational study of consecutive cases of emergency CS. Perinatal outcomes were recorded as: Apgar score; neonates requiring admission; and perinatal deaths. The relation between DDI and perinatal outcome was analysed using chi-square and one way analysis of variance (ANOVA). Of 204 pregnancies observed, 19% of deliveries were achieved in ≤ 30 minutes. The mean DDI was 42.5 ± 19.4 minutes. There was no difference between the perinatal outcome for babies with DDI of ≤ 30 versus 31-60 minutes. There was a significantly higher risk of poor perinatal outcome for babies with DDI > 60 minutes. The perinatal outcome between DDI of ≤ 30 and 31-60 minutes was statistically not different. However, the ≤ 30 minutes DDI should remain the gold standard.

Once a week (200 mg) elemental iron: an effective option for prophylaxis in non-anaemic pregnant women.

To evaluate effectiveness of 200 mg elemental iron once per week for prophylaxis in non-anaemic pregnant women, a prospective longitudinal study with observational design was carried out at a tertiary care teaching hospital. Fifty pregnant women received daily (group 1) and 50 pregnant women received weekly (group II) oral therapy (100 mg elemental iron, 1.5 mg folic acid and 15 microg of vitamin B12). Haemoglobin, PCV estimation were carried out during follow-up periods at 4, 8 and 14 weeks. Iron profile (serum iron, TIBC, serum ferritin) estimation was done before and after 14 weeks of iron supplementation. Haemoglobin, PCV and serum iron increased significantly in both the groups (p < 0.001) but on intergroup comparison it was significantly higher in group I than group II (p < 0.001). Serum ferritin improved in both the groups but improvement was not significant in weekly supplemented group. Compliance was better and side-effects were less in group II as compared to group I (11.36% versus 39.9%) The supplementation of pregnant women once per week with 200 mg of elemental iron is an effective option for prophylaxis in mild anaemic or non-anaemic pregnant women.

Fraser syndrome: recurrence in a family.

Fraser syndrome is a rare, autosomal recessive condition with classical features of cryptophthalmos, syndactyly, ambiguous genitalia, genitourinary mal-formations and mental retardation. We report a family with affected child where the pregnant woman was referred at 24 weeks of gestation for termination of pregnancy. The aborted fetus showed typical findings suggestive of Fraser syndrome.