No abstract

Idiopathic intracranial hypertension is a rare condition that usually affects overweight women. It is a diagnosis of exclusion in a pregnant woman presenting with headache. It is important to understand the medical and surgical treatment options in pregnancy. The mode of delivery is usually decided by obstetric factors. The risk of visual impairment is the same in pregnant and non-pregnant women with idiopathic intracranial hypertension. Learning objectivesTo identify how idiopathic intracranial hypertension presents in pregnancy.To know how to monitor and manage women with this condition during pregnancy. To understand the intrapartum, postpartum and long-term implications of this condition. Ethical issuesWhat is the extent of investigation before reaching the diagnosis of idiopathic intracranial hypertension? Do we need a high index of suspicion in all pregnant women presenting with headache? What is the preferred mode of delivery in idiopathic intracranial hypertension -do they all need a caesarean section?

The vast majority of patients are asymptomatic. The necessity of seeing all these patients in secondary care for follow-up needs to be questioned. With effective primary care follow-up, there may be a place to follow up patients with 3a tears in the community during the routine 6-week postnatal check and refer the symptomatic patients to the hospital for further review.

Objective(s):The aim of the study was to determine the prevalence of asymptomatic bacteriuria in pregnant women attending the antenatal OPD and to treat them. Also to identify the organisms causing asymptomatic bacteriuria and the risk factors in pregnant women.Materials and Methods: The present observational study was conducted in the Department of Obstetrics, NRI Medical College, Chinakakani, Mangalagiri from Aug-2012 to Aug-2014. Material for the study consisted of 100 urine samples obtained from asymptomatic 100 pregnant women in their first antenatal visit. The study group consisted of cases from in and around Mangalagiri, attending antenatal OPD, NRI Medical College, Chinakakani. Each patient was first asked whether she had any symptom of urinary tract infection such as dysuria, urgency, haematuria, loin pain and fever. After ascertaining that she was asymptomatic, preliminary data on maternal age, gravidity, parity and period of gestation were collected on a predesigned proforma. Detailed history about previous antenatal check-up, hypertension were also taken. A clean-catch midstream urine sample was collected and MacConkey agar, Blood agar plates were used for culture .Bacterial counts were done to determine the number of microorganisms per millilitre.Antimicrobial susceptibility testing was done for the isolates by the Kirby-Bauer method (disc diffusion).Results: The prevalence of asymptomatic bacteriuria in the study group was 15%.Escherichia coli, Klebsiella pneumoniae, Pseudomonas aeruginosa, Staphylococcus saprophyticus, Staphylococcus aureus were the isolates in the study group. Isolates showed maximum susceptibility to gentamycin followed by cefotaxime, nitrofurantoin and cotrimoxazole. They showed high degree of resistance to cephalexin and ceftriaxone. All the asymptomatic pregnant women with significant bacteriuria were treated and asked to come back after 7-10 days for repeat culture and susceptibility testing, which was done as a part of follow-up.Conclusion: Increasing gestational period showed increase in the incidence of asymptomatic bacteriuria and also increased incidence was seen in the pregnants with anaemia. Routine antenatal screening for asymptomatic bacteriuria should be implemented and treatment of those showing bacteriuria must be practiced to prevent adverse perinatal outcome. Untreated asymptomatic bacteriuria progresses to pyelonephritis (13-27%). Therefore, routine screening for bacteriuria is recommended during pregnancy.Bangladesh J Obstet Gynaecol, 2015; Vol. 30(1) : 30-36

Examination of the placenta is important and must be correlated with the clinical conditions. Placental histology can yield valuable information in cases of adverse perinatal outcome. Information obtained from the placenta is vital to formulate an appropriate plan of care in subsequent pregnancy. Learning objectivesTo understand the correlation between placental histology and pregnancy outcome.To identify the clinical conditions that will benefit from placental histology. To understand the process of storing the placenta for different examination techniques. Ethical issuesShould the placenta be sent for histology in all cases of growth restriction and stillbirth? Is it cost effective to undertake universal placental histology?