BACKGROUNDAge of menarche is showing a declining trend in all parts of the world. The reasons for this decline is proposed to be related to improvement in nutritional status, environmental factors, heredity, and body mass index. Weight at birth of the child has also been considered to influence the onset of menarche.The aim of the study is to identify whether birth weight influenced the age of menarche in girls.
BACKGROUND Preterm premature rupture of membranes (PPROM) occurs in less than 3% of deliveries and contributes to one third of preterm deliveries and is a major contributor for obstetric morbidity and adverse perinatal outcome. PPROM is multifactorial in aetiology with several risk factors postulated including maternal infections. The obstetric outcome is also dependent on these risk factors. MATERIALS AND METHODS Settings and Design-This was a prospective analytical study conducted in Department of OB/GYN, Government Medical College, Thrissur over a period of two years. 160 cases of singleton pregnancies presenting as PPROM between gestational age of 24 to 36 weeks were analysed for their sociodemographic factors and followed up for their obstetric outcome including latent period, mode of delivery, obstetric complications and perinatal outcome. RESULTS On analysing the complications, it was found that 11.25% of patients developed chorioamnionitis as a consequence of PPROM compared to an incidence of 3.1% (166 out of 5205) patients out of the total deliveries (chi square 30.4, p value 0.0000). 7.5% had antepartum haemorrhage in which two third (67%) were detected to have placenta praevia on ultrasound while one third (33%) were diagnosed with abruptio placenta compared to 3.86% of APH in the total population (201 out of 5205) (Chi square 5.38, p value 0.02). Cord prolapse occurred in 1 patient (0.6%) with PPROM, in which baby was stillborn (chi square 1.94, p value 0.16) when compared to 2 cases of cord prolapse in the total number of patients delivered (.04%). 13.1% of patients in this study developed postpartum haemorrhage with 4.1% requiring blood transfusion compared to 5.15% of PPH in the total population (268 out of 5205) (chi square 19.3, p value 0.00001). CONCLUSION PPROM is a significant contributor of poor obstetric outcome. Many of the contributing factors of PPROM if detected sufficiently early and appropriately treated may not only decrease the onset of PPROM, but also have the potential to reduce the complications.
A B S T R A C T BACKGROUNDHELLP syndrome characterized by haemolysis, elevated liver enzymes and low platelet count is an acronym coined by Dr Louis Weinstein in 1982 1 . It occurs in about 0.5-0.9% of all pregnancies and in 10-20% cases with severe preeclampsia. HELLP syndrome is associated with substantial risk for the mother and foetus. There is always a controversy regarding the definition, diagnosis, cause and management of this enigmatic disease.
METHODSThis was a retrospective study conducted in the Department of O&G, Government Medical College, Thrissur, Kerala. Women with more than 24 weeks of gestational age diagnosed as HELLP Syndrome by abnormal laboratory parameters, during the study period were analyzed for their demographic variables, clinical presentation and obstetric and perinatal outcome.
RESULTSOf the 55 patients in the study, 24 % had some complications. Postpartum haemorrhage was the most common complication followed by DIC. Caesarean hysterectomy was done in one case following severe atonic PPH. There was one case of maternal death, who developed DIC and acute renal failure. 89.1 % of the babies were complicated by intrauterine growth restriction and 78.2% were preterm.
CONCLUSIONSHELLP syndrome is an alarming diagnosis which has high maternal and perinatal morbidity and mortality. Outcome of HELLP syndrome depends on its severity, timely intervention, availability of blood and blood products and tertiary care hospital facilities. In spite of recent advances in our health care system, more efforts and further skilled care are required for satisfactory decline in adverse maternal and foetal outcome.
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