Deaths during pregnancy, childbirth and puerperium: Exploring causes, context and evidence from Eastern India.

AIM: The study was aimed to identify the specific reasons and circumstances of maternal deaths in West Bengal. METHODS: The present study is a retrospective study of 317 maternal deaths, conducted between November 2013 and October 2015 at two major referral hospitals of eastern India, West Bengal. The frequencies, proportions, measures of central tendency and dispersion were used to describe the data. The data were analyzed using the statistical software spss version 20.0. ArcGIS 10.1 was also employed to show the distributional pattern of maternal deaths. RESULTS: The overall maternal mortality ratio was estimated as 561 per 100 000 live births. Eclampsia or hypertensive disorders of pregnancy contributed to one-third (33.1%, n = 105/317) of maternal deaths. The maternal deaths were more common (41%) among women belonging to the age group of 20-24 years and primiparous (36.9%) group. The average distance for traveling to reach the final hospital was 47.37 km. Approximately, three-fourths (72.2%) of maternal deaths were in the post-partum period. Half of the women (50.5%) sought medical care after 12 hrs of developing complications. The majority of the cases (80.1%) were referred and about 45% of patients had a cesarean section. CONCLUSION: The result suggests there was a shift in causes of maternal deaths from hemorrhage to eclampsia. Establishment of separate eclampsia units at lower-level health facilities may be a more plausible pathway to prevent eclampsia-related maternal deaths in West Bengal.

Vitamin D deficiency, insulin resistance and anti-mullerian hormone: a tale of trio in expression of polycystic ovary syndrome.

OBJECTIVE: To study the association between altered vitamin D profiles and different indices and clinical features of polycystic ovary syndrome (PCOS), including anti-mullerian hormone (AMH) levels, phenotypes [A {hyperandrogenism (HA)+ ovulatory dysfunction (OD)+ polycystic ovarian morphology (PCOM)}], B (HA+OD), C (HA+PCOM), and D (OD+PCOM)], insulin resistance (IR), oligomenorrhea, hyperandrogenism, obesity indices, and stress biomarkers in the ethnic population of West Bengal. DESIGN: Case-control observational study. SETTING: Outpatient department of gynaecology and obstetrics, Medical College, Kolkata-700073, and environing Kolkata, West Bengal, India. PARTICIPANTS: (Patients and Control): Sample size: case group (PCOS, n=160), age: 16-38 years, and their gender, age, and ethnicity-matched healthy control (n=160). INTERVENTIONS: In this observational study, a structured questionnaire for menstrual status and to determine the scores of cutaneous manifestations, a bioelectrical impedance analyser for measurement of anthropometric indices, relevant biochemical assessments (vitamin D, AMH, insulin, glucose and other associated hormonal profiles), statistical software for the social sciences, and Microsoft Office Excel were used to evaluate and analyze different indices (significant at P<0.01 and P<0.05). MAIN OUTCOME MEASURES: Study of the association of vitamin D deficiency with differential manifestations of PCOS such as phenotypes of the syndrome, altered AMH levels, and risk of insulin resistance. An attempt has been made to determine the cut-off value of AMH of the PCOS patients belonging to the ethnic population of West Bengal using receiver operating characteristic (ROC). RESULTS: Vitamin D deficiency was found to be directly correlated (P=0.000) with AMH in PCOS phenotype A (67%), oligomenorrhea, and PCOM, along with a substantial (P<0.01) agonistic relationship with insulin resistance in the PCOS population under study. In the PCOS phenotype B, the AMH level was highest, with a cut-off value of 5.27 ng/ml (asymptotic sig.=0.000, 95% CI: 8.37-9.95, derived by receiver operating characteristic-ROC analysis, with area under the ROC curve-AUC=0.949, sensitivity=0.882, and specificity=0.880). Oligomenorrhic PCOS women possess significantly (P=0.000) higher values of AMH (8.70±3.66>3.09±1.86) than the regular menstrual rhythm within the same group. PCOS patients had significantly (P<0.01 and 0.05) less skeletal muscle mass and greater subcutaneous fat content than the control group. CONCLUSIONS: 25-hydroxy-vitamin D might be intermeshed with the underlying pathophysiology and severity of PCOS, and associated metabolic disorders like IR. The AMH level is finely tuned by most of the plausible effectors of PCOS and contends to be a promising biomarker for the diagnosis and prognosis of PCOS.

Cord and peripheral blood erythrocyte analysis by scanning electron microscopy and flow cytometry.

INTRODUCTION: Human umbilical cord blood is rich in hematopoietic cells. We aimed to focus on the morphological, biochemical, membrane protein profile and surface protein expression differences of erythrocytes, isolated from cord and adult peripheral blood using techniques such as high-resolution scanning electron microscopy (SEM), gel electrophoresis (SDS-PAGE) and flow cytometry. METHODS: Adult peripheral blood was collected from consenting adults, and umbilical cord blood was procured from consenting mothers, post-delivery at Medical College, Kolkata. We emphasized on cord and adult peripheral blood erythrocytes' morphological variations using SEM images and protein expression by flow cytometric analysis. Some conventional biochemical analyses such as osmotic fragility of the cell membrane, haemoglobin co-oxidation study and lipid peroxidation assay were done for supporting evidence along with membrane protein content using gel electrophoresis. RESULTS: Our SEM images indicated clear morphological variations in cord erythrocyte with a higher degree of cellular deformities and difference in membrane texture. Flow cytometric analysis of cord erythrocyte showed a significant difference in CD235a expression than adults. We observed an overexpression of GLUT1 and decreased expression of Band 3 in cord erythrocyte membrane. Our results also showed cord erythrocytes have low osmotic fragility, a slower rate of co-oxidation of cord haemoglobin and a lesser lipid peroxidation level than that of adults. CONCLUSION: Cord blood erythrocytes have deeper indentations leading to higher flexibility, more oxygen-carrying capacity and less osmotic fragility in comparison with adult erythrocytes. The expression of CD235a and Band 4.5 (GLUT 1) was significantly higher in cord erythrocytes than peripheral adult erythrocytes.

Analyzing the etiology behind mortality associated with antepartum, intrapartum, and post-partum cases in a tertiary care teaching hospital of West Bengal

OBJECTIVE: The study was undertaken to understand the causes and circumstances of maternal deaths in West Bengal. MATERIAL AND METHODS: One hundred ten maternal deaths were reported during the period December 2010 through June 2012 in the Maternity Ward of Medical College and Hospitals, West Bengal. These deaths were reviewed using a facility-based Maternal Death Review protocol. The number and percentages were calculated and binary logistic regression analysis was performed. RESULTS: The majority of the deaths occurred in the 20-24 years' age group, those with Hindu religion, in the first and second gravida, and the postpartum period. One third of mothers had cesarean sections. The majority (78.2%) of deaths were among referred cases. Eclampsia was the leading cause of maternal death (29.1%). Approximately half of the deceased women sought care after 10 hours of developing complications. More than one-third of maternal deaths were registered with type 1 delays. CONCLUSION: Our study demonstrates that maternal deaths occurred among young women, referred cases, with cesarean sections and type 1 delays. We recommend that imparting basic skills and improving awareness to the community about the danger signs of pregnancy could be an effective measure to detect maternal complications at an earlier stage.

Did you choose the right suture material for skin closure in elective caesarean section?

Surgical incision should heal with first intension with minimum deformity. Pain perception during postoperative period (short term) and appreciation of scar (long term) are two key components assessed by patients after a caesarean section. The present study compares these parameters using absorbable and non-absorbable material for skin closure using subcuticular stitch. The study shows a significant difference in pain perception on 1st postoperative week along with shorter duration of hospital stay and patients appreciation of scar quality on long term are significantly better in absorbable suture group.