Background & objective: To see the relationship between preeclampsia and iron parameters (serum iron, serum ferritin and total iron binding capacity). Methods: The present case-control study was carried out in the Department of Obstetrics & Gynaecology, Dhaka Medical College Hospital (DMCH), Dhaka in collaboration with the Department of Biochemistry, BSMMU, Dhaka over a period of 1 year from July 2012 to June 2013 Pregnant women with preeclampsia admitted in the above-mentioned hospital were considered as case, while the pregnant women without preeclampsia were included as control. A total of 60 women-31 cases and 29 controls were purposively included in the study. The exposure variables were serum ferritin, serum iron and total iron binding capacity (TIBC), while the outcome variable was preeclampsia. The serum iron level > 100 μg/L was considered as hyperferritenemia. Result: Nearly two-thirds of the women were in their 2nd decades of life belonged to lower socioeconomic class. The body mass index was also fairly comparable between the groups with most women having normal BMI. No significant difference was observed between the groups with respect to obstetric variables as well. Level of haemoglobin and hematocrit were also identically distributed between groups. The result showed that a significantly higher proportion (35.5%) preeclamptic women had elevated serum ferritin (> 100 μg/L) as opposed to 10.3% of the control group (p = 0.021). The risk of developing raised serum ferritin in women with preeclampsia was estimated to be 4-fold (95% CI =1.2 – 19.4) higher than that in the normal pregnant women. Analyses also revealed that women with severe preeclampsia had a higher mean serum ferritin (207.3 ± 44.1 ng/ml) than the women with mild preeclampsia (41.7 ± 2.7) and an even higher level compared with the normal pregnant women (21.7 ± 1.4 μg/ml) (p = 0.001). Similar result was observed in serum iron with greater the severity, higher is the level of serum iron (p = 0.067). Conversely, the serum total iron binding capacity (TIBC) was decreased with severity of preeclampsia (p = 0.058). Conclusion: The study concluded that women with preeclamsia might be associated with higher serum ferritin, higher serum iron and lower serum TIBC although it is not known whether the rise in serum ferritin and serum iron precedes or contributes to the clinical manifestations of preeclampsia. Ibrahim Card Med J 2017; 7 (1&2): 64-69
Background & objective:Thyroid disorders are among the common endocrine problems during pregnancy with well-known adverse effects on both mother and fetus. Many of these adverse effects could be prevented or ameliorated by early detection and appropriate treatment of conditions, provided routine antenatal thyroid screening is done. Considering this view, the present study was aimed to find the prevalence of thyroid disorders and their spectrum in pregnancy in order to justify the necessity of routine antenatal thyroid screening. Methods: This cross-sectional study was conducted in the Department of Obstetrics & Gynaecology, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka over a period 1 year from July 2012 to June 2013 on pregnant women to screen for the thyroid disorders in pregnancy. Based on predefined eligibility criteria, a total of 246 pregnant women up to 36 weeks of gestation were consecutively included in the study. A short history with brief physical examination was done followed by collection of blood samples. Thyroid function was assessed by measuring serum levels of thyroid stimulating hormone (TSH). Serum free thyroxin (FT4) level was estimated in 71 cases, where TSH value was deranged. Trimester specific reference range of serum TSH was used to define hypothyroid, euthyroid and hyperthyroid cases. The suspected risk factors were then compared between abnormal and euthyroid groups to find their association with thyroid disorders. Result: The results of the study showed that the overall prevalence of abnormal thyroid function status was 30.9% (hypothyroidism 29.7% and hyperthyroidism 1.2%) based on normal range of serum TSH in different trimesters of pregnancy. Pregnant women with thyroid disorders were generally older than their euthyroid counterparts (p = 0.039). Hypothyroid state was fairly common with advancing gestation (21.3%, 30.3% and 34% in the 1st, 2nd, and 3rd, trimesters respectively). Pregnant women with personal or family history of thyroid disease in the past exhibited a higher prevalence of abnormal thyroid function than those who did not have such history (p = 0.041 and p = 0.044 respectively). Past menstrual irregularity, past history of subfertility or abortion were significantly associated with thyroid disorders (p = 0.042, p = 0.004 and p < 0.001 respectively). Presence of goitre (21.1%) in current pregnancy also showed significant association with thyroid dysfunction (p = 0.001). The risk of developing abnormal thyroid function was observed to be 3.6(95% CI = 1.9 – 6.4) times higher in those who had at least one risk factor than those who did not have any risk factors (p < 0.001). However, a sizable portion (27.6%) of pregnant women without any risk factors developed abnormal thyroid function. Conclusion: The study concluded that one in every three women may have thyroid disorder during pregnancy, primarily hypothyroidism. Adopting risk factor-based screening for thyroid disorders in pregnancy, there is every chance that a substantial number of cases with thyroid dysfunction may be missed. Therefore, routine antenatal thyroid screening is recommended. Ibrahim Card Med J 2020; 10 (1&2): 74-83
Background & objective: Among the gynaecological cases admitted in tertiary care hospitals, abortion occupies the highest position. But detailed studies about the pattern of abortion admitted in the hospitals are limited. The present study was intended to find the proportion of abortion cases to total admitted cases and describe the types, clinical presentation and consequences of abortions. Methods: This study was carried out among a cross-section of abortion patients admitted in the Department of Obstetrics and Gynaecology, Dhaka Medical College Hospital. A total of 100 women admitted with a history of abortion between January and June, 2003 were consecutively included in the study. On admission, blood sample was sent for blood grouping & cross-matching and estimation of haemoglobin. Additional investigations like routine blood test, TC, DC, urine for R/E were done in septic abortion cases. High vaginal swab was collected from all cases but only in 5 patients, it was possible to carry out culture and sensitivity test. All cases were admitted and followed up to discharge for studying their consequences. Result: Majority (61%) of the patients was admitted in their third decade of life. The included cases were predominantly poor (68%), Muslim (97%) and urban residents (78%). Over half (54%) of the patients were illiterate. Sixty percent patients were multipara, 21% primipara and 19% nullipara. Two patients were unmarried. One-quarter had previous history of 1-4 abortions. Of the 100 cases of abortions, over three-quarters (77%) were of spontaneous abortions and 23% were of induced abortions. Two-thirds (66%) of the cases presented with incomplete abortions, which among others, included incomplete MR (13%). Septic abortion was 12%; of which 10% were induced and 2% spontaneous abortions, complicated to septic abortions. Missed abortion was 10%, inevitable 10% and threatened 6%. Out of 100 cases, 86% required operative intervention which included dilatation, evacuation and curettage (95.2%), subtotal hysterectomy, repair of perforation, hysterotomy and colpotomy. Two threatened abortions cases continued their pregnancy. One threatened abortion, five missed abortion, one septic abortion and six inevitable abortion cases spontaneously expelled their product of conceptus. Seventy-nine patients received whole blood transfusion to compensate for haemorrhage. Over 80% were discharged from the hospital within 5 days. Complications (except anaemia) of abortion were found in 49% cases. One case of septic abortion with endotoxic shock and severe anemia died of the disease. Conclusion: Complications of abortion are preventable if the patients are made aware about the grave consequences of abortion and appropriate health services are extended at field levels. Ibrahim Card Med J 2020; 10 (1&2): 66-73
Background & objective: Management of pregnancy with intrauterine fetal death (IUFD) is always puzzling to the obstetricians and mental agony to the patients. Intravenous oxytocin infusion was previously practiced for termination of pregnancy with IUFD. But recently misoprostol is claimed to be better than oxytocin in terms of its efficacy and safety. This prospective study was carried out to find which of these two drugs is suitable for termination of pregnancy with IUFD. Methods: Based on predefined criteria,a total of 100 singleton pregnant women with gestational age more than 22 weeks, ultrasonographically confirmed as having dead fetus in utero were included in the study and were randomly assigned to vaginal Misoprostol and Oxytocin infusion groups. The outcome was evaluated in terms of time required for induction of labor, induction to delivery time and complications encountered by each group. Result: The overall time required for induction to delivery was significantly shorter in Misoprostol group than that in Oxytocin group irrespective of their Bishop’s score (p < 0.001). Even in patients in whom the cervix was unripe (Bishop's score < 6), the mean time required from induction to delivery was much shorter in Misoprostol group (p < 0.001), but in patients in whom the cervix was ripen, the mean time from induction to delivery in Misoprostol group was shorter, but the difference did not turn to significant (p = 0.079). Both nulliparous and multiparous women experienced significantly shorter durations of labor in the Misoprostol group than those in the Oxytocin group (p < 0.001 and p = 0.001 respectively). Complications like hyperstimulation, retained placenta and postpartum hemorrhage all were somewhat higher in Misoprostol group than those in Oxytocin group, but the differences were not statistically significant (p = 0.357, p = 0.500 and p = 0.500 respectively). Conclusion: The use of vaginal misoprostol is more effective than intravenous infusion of oxytocin in induction of labor in patients with IUFD. The time required from induction to delivery is appreciably shorter when Misoprostol is used compared to that needed when oxytocin is used. Ibrahim Card Med J 2019; 9 (1&2): 74-79
Background: Fibroid or uterine leiomyoma is the most common benign tumor of the uterus in the reproductive age group and found in one out of every four women. They are symptomatic in 50% of women, with the peak incidence occurring among women in their 30s or 40s. Fibroid can cause a variety of symptoms which include menstrual disturbances commonly menorrhagia and dysmenorrhea. It is a common indication of hysterectomy in Indians. An effective medical treatment option may reduce hysterectomy-associated morbidity and mortality. This study is undertaken to evaluate the efficacy and safety of medical management of myoma and contribution in the reduction of myoma size comparing the two drugs ulipristal and mifepristone. Aims and Objectives: The study was conducted to compare reduction of menorrhagia (By pictorial blood loss assessment chart score), reduction of fibroid size (using transvaginal ultrasonography), and improvement of hemoglobin (Hb) level. We are also evaluating safety or side effects using these drugs. Materials and Methods: The study includes 210 patients who are divided into two groups. Group A includes 105 patients who are treated with tablet Ulipristal Acetate 5 mg daily for 3 months and Group B includes 105 patients who are treated with tablet mifepristone 25 mg daily for 3 months. Results: Ulipristal and mifepristone both are effective in reduction of menorrhagia and improvement of Hb levels, but Ulipristal is more effective in reduction of size of uterine myoma than mifepristone after 3 months of treatment. Conclusion: Multicentric study over a larger population is required to reach a valid conclusion.
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