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Background: Approximately 5-10 % of pregnancies are complicated by pre- eclampsia and it is a prime cause for maternal and perinatal mortality and morbidity worldwide, particularly in developing countries. In pre-eclampsia insufficient invasion of maternal spiral arteries by the trophoblast early in gestation due to abnormal implantation or maternal vascular disease results in impaired placental perfusion. Aspirin is a potent anti-inflammatory drug, has been shown to inhibit the biosynthesis and release of prostaglandins, even in low dosage. Ingestion of low dose aspirin may result in a decrease in the incidence of pre-eclampsia and fetal growth restriction and the precise mechanism by which it prevents preeclampsia in some women is also uncertain.Methods: The present prospective observational study was carried out in females between 18-20 weeks of gestation with raised uterine artery PI attending antenatal clinic in obstetrics and gynaecology department in SVP Hospital Ahmedabad from May 2023 to December 2023 using Microsoft excel and SPSS version 23.Results: In this study all the females were with raised uterine artery PI in 18-20 weeks ultrasound among them 51.85% were normotensive in later pregnancy. 48.14% developed pre-eclampsia in later pregnancy. In our study the middle cerebral artery indices in doppler ultrasound showed increased diastolic flow (including brain sparing effect) among 37% of the patients. The umbilical artery doppler showed that 62.9% of subjects were having normal umbilical artery indices, 18.5% of the patients were having decreased diastolic flow, 11.1% of the patients were having reversal of diastolic flow and 7.4% of the patients were having absent end diastolic flowConclusions: Doppler study for fetal surveillance in pre-eclampsia is a very useful and non-invasive method and abnormal uterine artery velocimetry lead to the worse pregnancy outcomes in the present study. The knowledge of uterine and umbilical artery doppler is very helpful to improve pregnancy management and to identify and assess hypertensive disorder of the pregnancy at early gestational age compared to other antepartum test modalities.
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Background: Preterm birth is truly a global problem. Cervical length is one of the major determinants of preterm births. Diagnosis of cervical insufficiency can be made by history of previous mid trimester loss, on clinical evaluation or sonographically by measuring cervical length or seeing funnelling of OS. The mainstay treatment of cervical insufficiency is the cervical cerclage.Methods: Present study includes 55 cases of cervical length less than or equal to 2.5 cm on TVS examination between 18 to 22 weeks of gestation of singleton pregnancy was conducted at department of obstetrics and gynaecology at SMT NHL medical municipal hospital, Ahmedabad from July 2022 to December 2023 and shows comparison of rate of full term and preterm deliveries.Results: Out of 55 patients with cervical incompetence, 22 (40%) patients were diagnosed on examination. Out of 55 patients with cervical incompetence 33 (60%) patients had preterm births and only 19 (35%) patients delivered full term, 3 (5%) had abortions. Present study shows there were 35% full term deliveries, 60% preterm deliveries and 5% had abortion among patients having cervical length less than or equal to 2.5 cm.Conclusions: Internal OS status of every patient should always be examined by ultrasound between 18 to 22 weeks. Thus, cervical length is very useful in prognostication and prediction of preterm birth. There are highest chances of late preterm in cervical incompetent patients. Our study showed better outcome with OS tightening group compared to conservative group.
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Background: Thrombocytopenia is the second most haematological abnormality in pregnancy where the platelets count below 1,50,000/µl. Gestational thrombocytopenia is most common cause of thrombocytopenia, accounts for 70% of thrombocytopenia in pregnancy.Methods: It is retrospective study with 30 antenatal women at any gestational age having thrombocytopenia, platelet count less than 1,50,000/µl at SVP Hospital, Ahmedabad during duration of May 2023-November 2023. All the pregnant women who attend OPD and admitted in SVP Hospital, Ahmedabad were included in the study.Results: The present study found that gestational thrombocytopenia (53.34%) accounted for most common cause of thrombocytopenia, followed by hypertensive disorders (10.0%), HELLP syndrome (6.67%), dengue and malaria (6.67%), DIC (6.67%) and ITP (3.34%) in which 53.34% women has mild, 36.67% has moderate and 10% has severe thrombocytopenia. In this study vaginal delivery accounts for 33.34% and caesarean delivery accounts for 66.67%. In present study 50.0% patient of gestational thrombocytopenia didn’t required any treatment. About 6.67% patients required transfusion of PRC and 33.34% of neonates needed NICU admission. Neonatal mortality due to complications like prematurity, septicemia was seen in 10.0% of the cases.Conclusions: Outcome of pregnancy with moderate to severe thrombocytopenia depends mainly on the etiology of thrombocytopenia. Early interdisciplinary evaluation of thrombocytopenia during pregnancy can help in optimizing care as fetal outcomes and management depend on the etiology.
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Background: Abnormal uterine bleeding is one of the most common problems of the women of reproductive age group leading to increased number of hospital visits. International federation of gynecology and obstetrics (FIGO) has suggested a new etiological classification system polyp, adenomyosis, leiomyoma, malignancy and hyperplasia, coagulopathy, ovulatory dysfunction, endometrial, iatrogenic, and not yet classified, known by the acronym PALM-COEIN to standardize the terminology, investigations, diagnosis and management of abnormal uterine bleeding (AUB) in non-pregnant women of reproductive age group.Methods: This is a retrospective study on 150 patients of abnormal uterine bleeding to categorize them on the basis of PALM-COEIN classification. Patients were grouped under these categories after detailed history, examination, investigations and histopathological reports.Results: Ovulatory dysfunction was the most common cause of AUB in patients presenting to the gynecology outpatient department (n=42, 28%). It was followed by leiomyoma (n=37, 24.67%) and endometrial causes (n=23, 15.33%). They constitute the top 3 causes of AUB. Adenomyosis (n=22, 14.67%), not known (n=10, 6.67%), iatrogenic (n=5, 3.33%), polyp (n=6, 4%), coagulopathy (n=1, 0.67%) and malignancy (n=4, 2.66%) contributing least to the PALM-COEIN classification as an etiology for AUB.Conclusions: The PALM COEIN classification system is useful in understanding various etiological causes of AUB, facilitates accurate diagnosis and hence helps in optimizing the treatment.
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Background: Polycystic ovarian syndrome (PCOS) is relatively common endocrine disorder in reproductive aged women, which leads to reproductive, metabolic and endocrine abnormality. About 70 to 80% patients with PCOS have complained of infertility due to anovulation. Due to advanced diagnostic facility by endoscopic evaluation in infertility, incidence of PCOS has increased now a days.Methods: This is study of 100 cases of infertility with polycystic ovarian syndrome and its pregnancy outcome. In this study, from May 2019 to April 2020, 100 cases of infertility with PCOS were studied at tertiary care hospital. Hormonal assay, ultrasound and laparoscopy were used as diagnostic technique. Clomiphene citrate, letrozole, metformin, and laparoscopic ovarian drilling were used as treatment modalities.Results: The maximum number of patients in the study group are seen in the age group of 21-25 years. Menstrual irregularities are the most common presenting symptom affecting 70% females. Primary infertility is most commonly associated with PCOS. In PCOS, there is increased LH:FSH ratio. On USG examination, there are enlarged ovaries in 82% cases.Conclusions: PCOS is an emerging disease of new generation with high prevalence in infertile women. After proper diagnosis, management with lifestyle modification, pharmacotherapy with clomiphene citrate, letrozole and metformin are used as per necessities. Operative laparoscopy with ovarian drilling is the main treatment which results in good conception rate.
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Background: Placenta previa is defined as placenta implanted partially or completely in the lower uterine segment. It contributes upto 30% of the cases the antepartum hemorrhage. This catastrophic complication not only poses a risk to the fetus but also endangers the mother’s life. The objective of the study was to determine the incidence and risk factors, obstetric management, maternal mortality and morbidity and perinatal outcome in women presenting with placenta previa.Methods: It is the prospective study of 50 cases carried out to study the maternal and perinatal outcome in cases of placenta previa in tertiary care hospital. This study included antenatal patient diagnosed as placenta previa by ultrasound >28 weeks to full term pregnancy. This data was compiled and analyzed for maternal and neonatal outcome.Results: In the present study, the incidence of placenta previa is 0.8% among which 42% of cases having age group of 25-29 years and 72% cases are multigravida. In this study 60% cases have major degree of placenta previa and 66% cases have previous history of caesarean section. Out of total cases 96% cases delivered by caesarean section and 4% had Normal delivery. NICU admission in the study is 28 babies i.e. 56%. There is no maternal mortality seen in the present study.Conclusions: Risk factors that increase the cases of placenta previa are multiparity, previous caesarean section, previous abortion. Placenta previa is major risk factor for adverse maternal and perinatal outcome. Good antenatal care, availability of emergency obstetrics services with senior obstetricians, blood bank facility, ICU care and NICU services can improve maternal and neonatal outcome in high risk cases.