INTRODUCTIONVarious physiological adaptation of pregnancy related, immunological, metabolic, endocrine and vascular changes occurs during pregnancy which make the pregnant women susceptible to changes of skin and appendages.1 These changes can be categorised in three categories. First include various benign skin conditions due to physiological and hormonal changes like striae gravidarum, melasma, nail and vascular changes. Pre-existing skin conditions which flare-up during pregnancy included in second category. Third category have several pregnancy specific dermatoses.2 Pregnancyspecific dermatoses is a heterogeneous group of pruritic skin diseases unique to pregnancy. Ambrus-Rudolph proposed the latest classification of pregnancy-specific dermatoses in 2006 and includes pemphigoid gestationis (PG), polymorphic eruption of pregnancy (PEP), intrahepatic cholestasis of pregnancy (ICP), and atopic eruption of pregnancy (AEP).3 Most of these skin ABSTRACT Background: Various physiological adaptation of pregnancy related, immunological, metabolic, endocrine and vascular changes occurs during pregnancy which make the pregnant women susceptible to changes of skin and appendages to study the various cutaneous changes of pregnancy. Methods: This study was an observational cross-sectional study conducted in Obstetrics and Gynaecology Department at Umaid Hospital and Skin Department at MDM Hospital, Jodhpur. Total number of 200 pregnant females were included in this study after informed consent and ethical committee clearance in duration of 6 months. Detailed medical and obstetric history of patients were obtained, and physical and dermatological examination were performed. Relevant systemic examination and appropriate investigations were done to confirm diagnosis if required.Results: Most of patients show cutaneous changes, among them physiological changes were most common 196 (98%). The most common physiological change was hyperpigmentation, which was seen in 189 (94.49%) cases followed by striae distensae (76.5%), glandular changes (11.5%) and vascular (9%). Tinea cruris was noted in 04 cases (2%) while scabies was present in 10 females (5%). 15 (7.5%) cases of contact dermatitis were noticed, and psoriasis was found in 3 (1.5%) pregnant females. Herpes genitalis was seen in 1 case (0.5%). The most common Specific dermatoses was pruritic urticarial papules and plaques of pregnancy 10, (5%) followed by pruritic folliculitis 4 (2%), eczema 4 (2%) and intrahepatic cholestsis of pregnancy 2 (1%). Conclusions: Pregnant women are prone to various cutaneous manifestation during pregnancy. A detailed history and awareness of clinical presentation is helpful for confirmation of diagnosis and most appropriate laboratory evaluation is helpful to diminish the maternal and foetal morbidity.
Background: Dengue is a vector borne viral disease. Female Anopheles mosquito is the vector for the disease. Recently, there is an increase in the incidence of dengue fever in adult population in South Asian countries. With increasing rate of adult dengue fever victims, the number of infected pregnant women has also been increased. Dengue, during pregnancy may be associated with various complications, including abortions, preterm delivery, maternal mortality, low birth weight, neonatal admissions and fetal anomalies. Timely intervention can improve the maternal as well as fetal outcome. This study was aimed to assess the clinical profile, maternal and fetal outcome of dengue fever during pregnancy.Methods: The study was carried out on 25 pregnant females diagnosed and serologically confirmed to have dengue fever and were admitted in Umaid hospital, associated to Dr. S. N. Medical College Jodhpur, Rajasthan, India. Patients were included irrespective of the period of gestation of contracting the disease. Serological testing for dengue virus specific antigen and antibody was done for the diagnosis of dengue fever. The World Health Organization (WHO) classification and case definitions 2009 were used to categorize the dengue patients. A predesigned proforma was used to collect data related to maternal and fetal consequences both during pregnancy and at birth, as well as the effect on the newborn. Informed and written consent was taken from all those who participated in the study.Results: Thrombocytopenia (platelet count <1.5lakh/mm3) was found in 22 (88%) patients out of which 6 (24%) of them had platelet count below 20,000 cells/mm3 and 3(12%) patients required platelet transfusion. Other complications observed were spontaneous abortions (4%); preterm birth (16%), oligohydramnios (8%) and antepartum hemorrhage (4%). One patient was admitted to Intensive Care Unit. Fetal distress and meconium stained amniotic fluid was observed in 16% and 12% patients respectively. Adverse fetal outcome was observed in form of low birth weight, prematurity. 8% of the babies required NICU admission and 4% were Intra Uterine Fetal Death (IUFD).Conclusions: Maternal infection with the dengue virus during antenatal period represents a real risk of premature birth. Early onset or late onset in pregnancy appeared to have a bad prognosis. A high index of clinical suspicion is essential in any pregnant woman with fever during the epidemic. The treatment of dengue in pregnancy is mainly conservative as in non-pregnant adults. In case of high risk cases early referral to well-equipped health centres where technical, transfusion and intensive care facilities are available may prove lifesaving.
Background: Intrauterine fetal death (IUFD) is a cataclysmic event for the parents and a lamentable event for the caregiver. Intrauterine fetal death is an important indicator of maternal and perinatal health of a given population. This study was undertaken to study the maternal and fetal factors associated with intrauterine fetal death. In this traumatic time, it is important to ensure that the emotional needs of the family are met. The objective of the study was to evaluate and understand the prevalence, socio-epidemiological and etiological factors of IUFD.Methods: This was a prospective analytical study carried out at Umaid Hospital associated to Dr. S. N. Medical College, Jodhpur, Rajasthan from August 2015 to Jan 2016 for a duration of 6 months. Informed consent was taken from all the participants. A predesigned proforma was used to collect relevant information from all those who gave consent to participate in the study. The details of complaints at admission, obstetrical history, menstrual history, examination findings, per vaginal examination findings, mode and method of delivery, and fetal outcome and investigation reports were recorded.Results: A total of 435 intrauterine fetal deaths were reported amongst 11615 deliveries conducted during the study period in our hospital. The incidence of IUFD was 37/1000 live births. 327 (75.17%) deliveries were unbooked and unsupervised and had no antenatal check-up. 306(70.74%) patients were from rural areas and 243 (50.11%) were preterm and 430(98.85%) were singleton delivery. Amongst the identifiable causes, hypertensive disorders (22.75%) and very severe anaemia (13.10%) were the most common ones followed by placental causes (9.97%). Congenital malformations were responsible for 11.03% cases of IUFD and in rest 10.57% cases no obvious cause could be identified. Induction was done in 195 patients, 174 patients had spontaneous onset of labour and caesarean section was done in 66 patients.Conclusions: The incidence of intrauterine fetal deaths in our population is higher than that reported from the developed countries. The present study is an effort to compile a profile of maternal, fetal and placental causes culminating in IUFD at our centre. This emphasizes the importance of proper antenatal care and identification of risk factors and its treatment. Institutional deliveries should be promoted to prevent IUFD. Decrease in the incidence of IUFD would significantly reduce the perinatal mortality. Majority of fetal wastage can be prevented with universal and improved antenatal care.
Background: Cancer cervix is the leading cause of mortality and morbidity in developing countries like India most probably due to lack of proper screening facilities or due to the lack of awareness amongst the women of developing countries. Worldwide, cervical cancer is the second most common and 5th deadliest cancer in women. This study was conducted in department of obstetrics and Gynaecology, Umaid hospital, Dr. S. N. Medical College, Jodhpur Rajasthan, India. The objective of this study was to study the various high risk factors involved in premalignant and malignant lesions of cervix. To study the incidence of different epithelial abnormalities of cervix in females above 21 years of age. To study premalignant and malignant lesions of the cervix in relation to the presenting complaintMethods: The study was conducted in 500 females above 21 years of age and who were not pregnant, who had been attending Umaid Hospital, Jodhpur for various gynaecological complaints, of different parity, residential status and socioeconomic class. Detailed history was taken and thorough examination was done. Pap smear was prepared and all smears were reported as per the Bethesda system.Results: Maximum numbers of patients were in the age group of 21-40 years (70.2%). Majority of patients were from rural area (52.4%) and from lower socioeconomic class (30.2%). Most of women were found to have duration of marriage between 10 to 30 years (63.4%). Most of the women in our study had age at marriage between 17 to 19 years (49.4%). Multiparity was seen in 84.2% of cases. The commonest presenting complaint was white discharge (46.8%). On Pap smear, maximum cases were of inflammatory smear (91.4%), 1.4% had ASCUS, 1.2% AGC, 1.4% LSIL, 1% HSIL and 0.4% had SCC.Conclusions: Cervical cytology is an important tool for early detection of premalignant and malignant lesions of cervix. Regular pap smear screening should be conducted in vulnerable age groups.
Background: Heart disease complicates 1% of all pregnancies. Objective of the study is to evaluate the maternal and fetal outcome in patients with cardiac disease in pregnancy.Methods: An observational study was carried out in 25 pregnant women with known or newly diagnosed heart disease at tertiary care hospital.Results: The average age of women was 21-25 (36%), in which primigravida 52% and 48% were multigravida. 56% patients were unbooked and 44% booked. Rheumatic heart disease was the commonest aetiology and was found in 56% of patients. While 16% patients had RHD with PAH. Three (12%) patient had prosthetic valve replacement. 8% patient had Congenital heart disease while 8% had peripartum cardiomyopathy. 60% delivered vaginally and 40% of them had delivered by LSCS for various obstetrical indications. In our study none of the patient required therapeutic termination of pregnancy. Majority of patients 92% in our study group had no obstetric maternal complications. Two (8%) maternal mortality occurred in our study. Low birth weight babies were 24%, preterm labour in 4% patient. 8% babies were growth restricted. Regarding fetal outcome 25 were live birth babies. None of the patient had congenitally malformed baby and there was no perinatal loss in this study.Conclusions: Early diagnosis of heart disease, regular antenatal checkups, institutional delivery and collaboration between cardiologist and obstetrician should result in a fall in maternal deaths from conditions already diagnosed before pregnancy.
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