The purpose of this study was to assess the predictive values of central obesity and hyperandrogenemia in development of insulin resistance and dyslipidemia in the polycystic ovarian syndrome (PCOS) patients in our region. Differences of fasting blood glucose level, insulin resistance index HOMA-IR, lipid parameters, waist hip ratio (WHR), body mass index, LH/FSH ratio and testosterone levels between 45 PCOS cases and 35 age matched controls were obtained. Strength of association between different parameters in the case group was assayed by Pearson's correlation analysis. Dependence of insulin resistance and WHR on different predictors was assessed by multiple linear regression assay. Total cholesterol, LDL cholesterol, LH, FSH, LH/FSH ratio, WHR and insulin resistance were significantly higher in the case group (p \ 0.05). Serum testosterone showed strong correlation with insulin resistance and LH/FSH ratio (r = 0.432 and 0.747, p = 0.01 and 0.001 respectively) in the PCOS patients while WHR and serum testosterone level stood out to be most significant predictors for the insulin resistance (b = 0.361 and 0.498; p = 0.048 and 0.049 respectively). Hyperandrogenemia and central obesity were the major factors predicting development of insulin resistance and its related metabolic and cardiovascular complications in our PCOS patients. We suggest early monitoring for androgen level and WHR in these patients for predicting an ensuing insulin resistance and modulating the treatment procedure accordingly to minimise future cardiovascular risks.

Background & objectives:Insulin resistance (IR) is a major confounding factor in polycystic ovarian syndrome (PCOS) irrespective of obesity. Its exact mechanism remains elusive till now. C/T polymorphism in the -34 promoter region of the CYP17 gene is inconsistently attributed to elucidate the mechanism of IR and its link to hyperandrogenemia in obese PCOS patients. In the present study we aimed to evaluate any association of this polymorphism with IR in non-obese women with PCOS.Methods:Polymorphism study was performed by restriction fragment length polymorphism (RFLP) analysis of the Msp A1 digest of the PCR product of the target gene in 75 PCOS cases against 73 age and BMI matched control women. Serum testosterone, BMI and HOMA-IR (homeostatic model of assessment-insulin resistance) were analyzed by standard techniques. A realistic cut-off value for the HOMA-IR was obtained through receiver operating characteristic (ROC) curve for exploring any possible link between IR and T/C polymorphism in the case group.Results:Significant increases in serum testosterone and HOMA-IR values were observed among the case group (P<0.001) without any significant elevation in BMI and FBG compared to controls. Cut-off value for IR in the PCOS patients was 1.40 against a maximum sensitivity of 0.83 and a minimum false positivity of 0.13. The analysis revealed an inconclusive link between the C/T polymorphic distribution and insulin resistant case subjects.Interpretation & conclusions:The results showed that CYP17A1 gene was not conclusively linked to either IR or its associated increased androgen secretion in non-obese women with PCOS. We propose that an increased sensitivity of insulin on the ovarian cells may be the predominant reason for the clinical effects and symptoms of androgen excess observed in non-obese PCOS patients in our region.

Objectives: To assess the effect of supplementation of high dose of calcium(2gm) in prevention of preeclampsia.Materials & Methods: A randomized controlled clinical trial on 272 healthy nulliparous woman were randomly allocated into two groups by means of a computer generation randomization list. From 20 weeks of gestation until delivery who received 2gm of oral elemental calcium per day (n=127 )were assigned to high dose calcium group or the study group and 145 women were assigned to low dose calcium or control group , receiving 500 mg of calcium per day. Ten women (3.67%) were lost to follow up after randomization (4 in the study group and 6 in the control group) . Thus a total of 123 woman in the study group and 139 in the control group were included in the final analysis. Data was collected by standard questionnaire, clinical examination and investigations and statistical analysis was performed by student’s t-test, chi square tests. P<0.05 was statistically significant.Results: Preeclampsia developed in Study Group were 5.7% and Control Group 13.7% and the difference was statistically significant (Chi-squares - 4.65, df =1, p = 0.031). There were 2.43% (3 of 123 women) preterm delivery in the study group and 7.91% (11 of 39 women) in the control group. So, there was a significantly lower risk of preterm delivery in the study group ( p = 0.049). Intrauterine growth retardation (IUGR) was found in 3.25% and 9.35% of women in the study and the control groups respectively. The incidence is higher in the control group when compared to the study group (p = 0.045).Conclusion: Calcium intake is beneficial for both pregnant women and her unborn child. Daily supplementation with 2 grams of calcium during pregnancy significantly reduced the risk of preeclampsia, preterm labor and IUGR. So, high dose calcium should be supplemented to all women during pregnancy in developing countries where preeclampsia and preeclampsia related morbidities and mortality are quite high.Bangladesh J Obstet Gynaecol, 2013; Vol. 28(2) : 66-70

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Objective: To analyze the causes of maternal death in eclamptic mothers. Materials and method:The study was conducted over a period of one year 1.1.2012-31.12.2012