INTRODUCTIONHypertension in pregnancy constitutes the most common medical complication occurring in 12-22% of all pregnancies of which pre-eclampsia remains the leading cause that complicates 10% of all pregnancies.1,2 It is defined as new onset of elevated blood pressure and proteinuria (BP>/=140/90 and >/= 0.3gm protein in 24 hours urine specimen) after 20 weeks of gestation in a previously normotensive woman. 3,4 It is considered severe if blood pressure and proteinuria are increased substantially (BP>/=160/110 and >5 gm protein in 24 hours urine specimen) or symptoms of end organ damage like thrombocytopenia, altered liver function, oliguria, cerebral or visual disturbances, pulmonary edema and fetal growth restriction are present. 3,4 Eclampsia is defined as the new onset of generalized tonic clonic seizure in a woman with severe preeclampsia. Seizures most commonly occur in the postnatal period in 44% cases, antenatally in 38% and in the intrapartum period in 18%. 5 It was found that 3-5% of first pregnancies and 1% of subsequent pregnancies are complicated by preeclampsia.1 WHO estimated that approximately 60,000 women die each year from pre-eclampsia world-wide. Pre-eclampsia and eclampsia account for 24% of all ABSTRACTBackground: Pre-eclampsia accounts for the majority of referrals in a tertiary care centre as it stands one of the major causes of maternal and perinatal morbidity and mortality. The objective of this study was to study the maternal and fetal outcome in patients with severe pre-eclampsia and eclampsia in a tertiary centre over a period of one year. Methods: Total 150 women with severe eclampsia and eclampsia after 20 weeks of gestation were included. Women with medical complications like anemia, preexisting hypertension, epilepsy, diabetes, vascular or renal disease, multiple gestation, polyhydramnios were excluded. Patients were managed as per existing protocol after proper history, examination and investigations. Anti-hypertensive of choice was alphamethyl-dopa, labetalol and oral nefidipene. Magnesium sulphate was used as anti convulsant. Results: Out of 150 cases of severe pre-eclampsia and eclampsia, majority (69%) were between 20-30 years of age and 47% were primigravida. We had 75 patients with convulsions on admission and 75 with severe pre-eclampsia of whom 11 had convulsions. Headache was most common complaint. Common mode of delivery was caesarean section in 72 (48%) women, majority in view of failed induction or non-progress. Maternal complications were noted in 59% attributed to renal dysfunction, postpartum hemorrhage, DIC, placental abruption, HELLP, pulmonary edema, pulmonary embolism and renal failure. 4 maternal deaths were recorded. Conclusions: Maternal and perinatal complications are more in patients with eclampsia. The incidence of eclampsia can be reduced by better antenatal care, early recognition and prompt treatment of severe pre-eclampsia.

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Background: This is an observational analytical study carried out in department of obstetrics and Gynecology, in a tertiary care center to determine the factors influencing fetal and maternal outcome, prognosis and complications in preterm premature rupture of membrane cases.Methods: The present study is a prospective observational study of perinatal and maternal outcome in 100 cases of preterm premature rupture of membranes in between 2837 weeks gestation with singleton pregnancy, from 1st March 2013 to 28th February 2014. Patients with medical complications like anemia, preexisting hypertension, diabetes, vascular or renal disease, multiple gestations, uterine or fetal anomalies etc. are excluded from the study. Detailed history, physical examinations were carried out and appropriate management instituted as per individual patients need.Results: In this study maternal morbidity was 16%. Perinatal morbidity was 33% and most common causes were hyperbilirubinemia (23%), RDS (21%).  Perinatal mortality was seen in 15% and mainly due to RDS (53%). Twenty-five (25%) neonates were delivered by cesarean. The main indications for cesarean being malpresentation (36%) followed by fetal distress (24%).Conclusions: PPROM is one of the important causes of preterm birth that can result in high perinatal morbidity and mortality along with maternal morbidity. Looking after a premature infant puts immense burden on the family, economy and health care resources of the country. An understanding of gestational age dependent neonatal morbidity and mortality is important in determining the potential benefits of conservative management of preterm PROM at any gestation.

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Purpose To confirm GLS diagnostic sensitivity as parameter for the evaluation of LV systolic function in women with breast cancer who underwent chemotherapy including anthracyclines and to identify a pattern of decreased 2D speckle tracking regional longitudinal strain through the analysis of polar maps obtained with AFI technology. Methods We enrolled 60 female patients (age with 56.5±12 years) with breast cancer before the beginning of chemotherapy. The study protocol included clinical examination, ECG with QTc calculation, lab test (BNP and troponin I) and echocardiography with TDI and speckle tracking analysis (STI), that were performed before the beginning of the chemotherapy (basal) and after 3, 6 and 12 months. Echocardiography evaluation included the following parameters: LV end-diastolic and end-systolic volumes, LV ejection fraction (EF), average TDI S' at the mitral annulus, Global Longitudinal Strain (GLS), regional longitudinal strain, E/A ratio, E/E' ratio and sPAP. For each patient we analyzed the bull's eye maps before the beginning of the therapy (basal value) and when GLS showed the lowest values during the FU (FU value), to identify the pattern of regional longitudinal strain alterations. We compared basal and FU strain values for each of the 17 LV segments and the difference between them (delta) was calculated according to the formula [(FU LS –basal LS, (%)]. Results During the FU, systolic blood pressure, systolic pulse pressure and BNP values increased from the basal assessment to the 3 and 6 months FU. Similarly, a progressive worsening of GLS values has been observed (basal −20.4±2.6%, 3 months FU −18.2±2.5%, 6 months FU −17.7±2.9, 12 months FU −17.6±3, p value <0.001). Through the analysis of polar maps, we observed that regional strain values worsened significantly in all the LV segments but the most evident impairment was reported in the apical cap (−22.8±3.9 vs −17.1±3.8; p<0.001, Δ=−5,78%) and in the apical segment of the anterior interventricular septum (−23.4±4.5 vs −17±6.3; p<0.001, Δ=−6,2%), as reported in Figure. Conclusion GLS is able to identify LV systolic dysfunction that EF is not able to detect. However, since that it describes the global function of LV, GLS could result as normal (18–20%) when strain impairment of some LV segments is counterbalanced by the compensatory strain increase of other segments, determining an misdiagnosis of myocardial damage. Regional strain and particularly the Δ-strain, seem to suggest that anthracyclines induce a damage more evident in the apical cap and in the apical segment of the interventricular septum and this pattern could be typical in these patients. Thus, polar maps analysis could be provide additional information about cardiac damage in this population.