C S Madkar

Introduction: Proteinuria is a major component of preeclampsia. Urine protein measurement after 24-hour urine collection is the traditional standard method for the detection of proteinuria. It is time-consuming. As an alternative, spot sampling for a urine protein to creatinine ratio (PCR) ratio has been investigated. Aim & Objectives: To determine the accuracy of the spot protein- creatinine ratio in comparison with 24 hours urine collection for detection of proteinuria in pre- eclamptic patients. Materials and Methods: A hospital based prospective study was conducted with 120 patients to assess the quantification of proteinuria in preeclamptic patient and comparing the two methods i.e. 24-hr urine protein levels and random protein creatinine ratio conducted at tertiary care centre. Results: There was a good positive statistical correlation between 24-hour total urinary protein level and spot protein: creatinine ratio with a correlation coefficient (r) of 0.769.Conclusion: Random and spot urine protein creatinine ratio can predict with high accuracy the amount of 24- hour urine protein excretion. The urine PCR is reliable, relatively faster and accurate for proteinuria and can correlate well with 24-hour urinary protein excretion which is gold standard. Keywords: Preeclampsia,Proteinuria, 24-hour urine collection, Spot urine PCR (protein to creatinine ratio)

Episiotomy is most commonly performed surgery for assisting vaginal delivery in indicated cases. Mediolateral episiotomy is most commonly performed in view of its benefits over other types. Postoperative complications and morbidity of patients is most important which should be given thought. One of the factor that plays a major role is type of suture material used. In our study we are comparing traditionally used chromic catgut with the fast acting polyglactin 910. Materials and Methods: The new prospective study and randomized control study compares long term and short term results of suturing episiotomy with Chromic Catgut 1.0 and polyglactin 910 (2.0). The parameters taken into consideration were pain and analgesia, gaping, dyspareunia etc. Total sample size was 560 consisting of 280 pts in each group. Results: The present study showed that the results of fast acting polyglactin 910 was definitely better than chromic catgut. Also morbidity in relation to pain, wound healing and other complications was found to be lesser in group of polyglactin 910. Conclusion: The present trend of suturing episiotomy with polyglactin is definitely better in terms of results and reduced morbidity. Keywords: Episiotomy, Chromic catgut, Fast absorbing polyglactin 910, Morbidity.

Introduction: Hypertension disorders are major factors responsible for morbidity and mortality in pregnancy and preeclampsia is the leading cause. The etio-pathology of PE is not known even after significant research done on it. Only thing which we can do is try to reduce the incidence and severity by predicting its occurrence. In our study we are trying to know the effect of serum calcium and serum magnesium on pre-eclampsia. Materials and Methods: Total 256 pregnant patients attending D.Y. Patil hospital were included in our study. They were divided into two groups namely normotensive and hypertensive. The diagnosis of Pre-eclampsia was made by standard protocol, inclusion and exclusion criteria were applied for selection of case after permission from ethical committee of the institution and consent of the patients. In them we estimated serum calcium and serum magnesium levels and the correlation of these levels was studied with the pre-eclampsia related factors. Results: Both groups comparable in terms of age, gravida, parity, high risk factors, BMI. The data was analysed by application of statistical test of significance. Conclusion: Our study shows that low levels of calcium and magnesium are found in serum of pre-eclampsia patients as compared to normotensive cases of the study population. Also since calcium deficiency plays role in aetiology of pre-eclampsia antenatal administration of Ca supplements was done and its effect was studied to find out whether it is useful in reducing the severity of PE.  Keywords: Hypertensive disorder in pregnancy, Pre-eclampsia, S. calcium, S. magnesium.

Introduction: Vaginal agenesis may present as a single defect in development or associated with other anomalies. It is usually associated with Mayer-Rokitansky-Kuster-Hauser (MRKH) and Androgen Insensitivity Syndromes (AIS). The incidence is about 1 in 4000-5000 live female births. This is a case series of six cases of vaginoplasties performed by three varied surgical techniques over a period of two years, with a follow up. Cases: A comparison of three techniques of vaginoplasties was done. Six total cases were included-three cases using modified McIndoe’s technique with amnion graft, two using split thickness skin graft and one by Laparoscopic Peritoneal Pull through technique. Patients were followed up meticulously over the course of two years and results were recorded. The comparison scoring was done based on relative ease of the operative procedure, pain experienced, vaginal depth on follow up, uptake of graft and sexual satisfaction in the married females. Result: Despite new techniques of vaginoplasty advancing over the years such as laparoscopic approaches and use of different materials as grafts, vaginoplasty with amnion graft is stillpreferredfor the treatment of vaginal agenesis.The technique is simple and safe and provides a satisfactory and functional vagina in majority of the patients. Keywords: Vaginoplasty, Mayer-Rokitansky-Kuster-Hauser, McIndoe’s technique, Neo-vagina.

Introduction: A variety of neurological disorders may be encountered during pregnancy and puerperium. These disorders may be unrelated to the pregnant state (e.g., tuberculous meningitis) or peculiar to or more prevalent during pregnancy which are still a cause of significant maternal morbidity and mortality in rural India (e.g., eclampsia and cortical venous thrombosis). Aim: To study the clinical profile of patients presenting with primary and secondary neurological disorders during pregnancy and puerperium and their outcome.  Materials and Methods: This study was carried out at the Mamata Medical College between january 2009 and december 2013. All antenatal patients, postabortal or postpartum period requiring neurological consultation were included in this study. Women with eclampsia were excluded.  Results: There were 75 women included in this study, with 45 cases of primary and 30 of secondary neurological disorders. The former included epilepsy,21 CNS infections,12 cerebrovascular disorders,9 intra cranial tumour,1 post traumatic paresis1 and encephalomyelitis.1 The latter included hepatic encephalopathy,28 enteric encephalopathy1 and polyneuropathy.1 In patients of epilepsy, the seizures had an equal distribution in all the trimesters and post-partum period, they were mainly of generalized type (77.27%) and were controlled in the majority (90.9%). No fetal congenital malformations were seen. Tubercular meningitis,8 pyogenic meningitis3 and viral encephalitis1 were the CNS infections encountered and pregnancy outcome was good in most cases. All cases of CVT presented in the postpartum period with fever and neurological signs following delivery. Among them 2 patients recovered completely, one patient had residual deficits, another had persistent seizures. We had one maternal death. HE affected patients mainly during the latter half of pregnancy or the post-partum period and was associated with 64.3% mortality. Conclusion: The incidence of neurological disorders in pregnancy and puerperium was very high especially in our hospital since it is a tertiary care referral centre. Epilepsy and hepatic encephalopathy were the commonest primary and secondary neurological disorders respectively found in our study. Keywords: Cerebrovascular disorders, CNS infections, Pregnancy, Seizures.

Introduction: PIH complicates 6-10% of all pregnancies. It contributes mainly to maternal and fetal complications. Patients with PIH are at a greater risk of abruptio placenta, cerebrovascular events, organ failure and DIC. Fetuses are at a greater risk of IUGR, preterm birth, small for gestational age and IUD. Materials and Methods: 250 patients with PIH were studied. Pregnant women with 90mm hg or more with or without proteinuria diagnosed after 20 weeks were included. A predesigned semi-structured questionnaire was prepared based on review of literature on PIH and its maternal & fetal outcomes. Observation & Results: In this study, 6% cases were 18 years of age, 37% were 18-24 years, 44% were 25-28 years, 10% were 29-35 years and 3% more than 35 years. In the present study, 44% had edema and 56% had no edema. 42% had proteinuria out of which 66.7% had 1+, 23.3% had 2+ and 9.5% had 3+. 58% had no proteinuria. Normal vaginal delivery was seen in 56% cases, 10% had instrumental delivery among these 6% had forceps assisted and 20% had vacuum delivery. In this study, 8.8% required neonatal resuscitation, 91.2% did not require neonatal resuscitation. 10% of the neonates had NICU admission and 90% did not require any NICU admission. Conclusion: Preterm birth and IUGR are the most commonly encountered perinatal outcomes in PIH. Low birth weight is the most common neonatal outcome. Proper ANC with early diagnosis of PIH could significantly reduce its perinatal, natal, and maternal outcomes in patients. Keywords: PIH, IUGR, Preterm labour, HELLP syndrome.