Rakhee R Sahu

Abstract

Hypertensive disorders complicates 5-10% of all pregnancies. WHO has found that 16% of maternal deaths worldwide are due to gestational hypertension. Aim: To determine the efficacy of uterine artery pulsatility index (UA-PI) and Pregnancy associated plasma protein A (PAPP-A)done in the first trimester as a predictor of gestational hypertension(GHT) and adverse fetal outcomes like fetal growth restriction, Small for gestational age babies, Preterm deliveries. Materials and Methods: This is a prospective observational cohort study of 287 antenatal women, whose 1st trimester UA-PI and PAPP-A MoM values were obtained. Results: Of the total 287 women, 68 (23.7%) developed GHT and 31 women developed adverse fetal outcomes. 28 women (9.8%) had an abnormal UA-PI (>/= 2.70) and 11 (3.8%) women had an abnormal PAPPA value ( hypertension. The sensitivity of UA-PI for prediction of GHT was 35.29%, specificity-98.17%, accuracy- 66.73% and p-value-0.0005 which is statistically significant. Of the 11 women who had abnormal PAPPA MoM value, 3 developed GHT. The sensitivity of PAPP-A for the prediction of GHT was 4.41%, specificity- 96.35% , and p-value was 0.925 which is statistically insignificant. Conclusion: The study shows that 1st trimester UA-PI levels can be considered as a good predictor of GHT, while PAPP-A- was not reliable predictor for GHT. Both UA- PI and PAPP-A value, were not found to be useful markers in the prediction of adverse fetal outcomes in my study. Keywords: Gestational hypertension, Uterine artery – Pulsatility index, serum. PAPP-A level.

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Abstract

Epidural analgesia is regional anaesthesia that blocks pain in a particular region of the body. The use of epidural analgesia (EA) in labor is widespread in modern labor ward practice, and its benefits in terms of pain relief are well-recognized. Aims: To study the effect of epidural analgesia on second stage of labor, maternal and neonatal outcomes and its efficacy in labor. Study Design: This is Prospective Cohort Study was carried at Dr. L. H. Hiranandani Hospital. All the women admitted in labour room for delivery were divided into 2 groups. Case Group: Included 84 women who opted for epidural analgesia. Control Group: Included 90 women who did not take epidural analgesia. Results: The 2nd stage of labor in epidural group was 54.61 (± 37.24) mins and 37.36 (± 26.79) mins in the non epidural analgesia group. By using unpaired t-test, it was found that the data was significant (p=0.032). The incidence of caesarean section in the epidural group was 16.66% and the in non-epidural group was 12.22%. It was observed that epidural analgesia did not increase the rate of instrumental delivery or caesarean section. The mean VAS Score before epidural analgesia was 6.2 (± 1.07) whereas it was 3.95 (± 1.46) after epidural analgesia. On applying Wilcoxon Matched Pair test, it was found that the pain was reduced significantly in the mothers after receiving the epidural analgesia. Conclusion: Epidural analgesia can be safely recommended as a method of labor analgesia. Epidural analgesia has no significant adverse effects on maternal and neonatal outcomes Keywords: Epidural analgesia, VAS – Visual analogue score, 2nd stage of labour, Caesarean sect. 

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Abstract

Leiomyoma is the most common benign tumor of uterus and rarely it may be seen in other parts female reproductive system like the round ligament, utero-sacral ligament, inguinal canal and vagina. There are only few cases reported in literature about vaginal origin fibroid1. These vaginal tumors arise most commonly from the anterior vaginal wall causing varied clinical presentations. We report a case of vaginal lateral wall fibroid of 8 cm size and extending into ischiorectal space. The vaginal mass was surgically excised and histopathology confirmed the diagnosis of leiomyoma. Keywords: Vaginal leiomyoma, Perineal mass.  

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