Infertility is a rising problem worldwide, hampering the psychological and social wellbeing of thousands of couples. There is a huge financial involvement for its diagnosis and treatment as well. The main goal of reproductive pelvic surgery is to restore pelvic anatomy ensuring a patent and functional pathway for the sperm to reach the ovulated oocyte and a safe implantation into the endometrial cavity. The striking progress in assisted reproductive technology (ART) have upgraded the fertility outcome in despondent cases recently. This review article aims to highlight some surgical procedures commonly performed for better fertility outcome. It involves studying the available material in the textbooks, printed and online journals. The surgically treatable causes of infertility include Endometriosis, Polycystic Ovarian Syndrome, Tubo-peritoneal disease, Mullerian Anomalies and Uterine Myoma. In addition, Endometrial Polyps and Asherman’s Syndrome may also be treated surgically. A thorough evaluation and work up is mandatory to individualize the treatment plan for each patient. A wide spectrum of promising surgeries is available for the treatment of infertility. The surgical approaches have to be individualized depending upon the disease aspect. This is the sound way to measure the effectiveness of reproductive surgeries to restore the natural conception. CBMJ 2021 January: vol. 10 no. 01 P: 59-65
Gestational diabetes mellitus is a common medical condition during pregnancy that has detrimental effects on maternal health and fetal well-being. Many serum markers are known to be associated with gestational diabetes, a subclinical inflammatory state that liberates inflammatory mediators, acute phase proteins like CRP into the maternal circulation. This phenomenon has invited many researchers to study inflammatory mediators and acute phase proteins as markers of gestational diabetes mellitus.This case-control study was conducted in the Department of Obstetrics and Gynecology of Bangabandhu Sheikh Mujib Medical Univer- sity, Dhaka, between July 2016 and June 2017. The objective of the study was to evaluate the association of serum CRP level with gestational diabetes mellitus. A total of 140 pregnant women who attended the out-patients antenatal clinic at their 2nd and 3rd trimester (13-40 weeks) of pregnancy were enlisted for the study. The case group consisted of 70 pregnant women who were diagnosed with GDM. Similar number of healthy pregnant women were recruited as control. GDM was diagnosed using standard 75 g OGTT. Blood sample was taken from study subjects to estimate the serum CRP level. CRP level up to 5mg/L was taken as normal. Data analysis was done by utilizing SPSS version 16. The mean BMI of the case group women was significantly higher than the mean BMI of the control (p=0.001). The mean CRP level in case was 13.87±10.19 and the mean for CRP for control group was 4.59±2.41. There was an association of raised level of CRP with GDM. Pregnant mothers with raised level of CRP (& gt; 5 mg/L) were 6.1 times more likely to have GDM than mothers with normal level of CRP. The study concluded that a significant association was found between the raised level of CRP and gestational diabetes mellitus. BSMMU J 2022; 15(2): 96-101
Background: In the recent years, the prevalence of chronic kidney disease (CKD) has increased in the community. CKD has been associated with several cardiac diseases. The aim of the study was to assess the cardiac status of the CKD patients. Methods: This cross-sectional study was done in Rangpur Medical College Hospital, Rangpur from June 2013 to November 2013. A total of 50 CKD patients were selected by convenient type of sampling. An informed written consent was taken before enrolling the patients into the study. All the data were recorded in a pre-structured questionnaire. Analysis of the data was done by SPSS V.22. A P value of <0.05 was considered as significant. Results: A total of 50 cases were studied; age ranging from 23 years to 75 years and the mean age ± SD was 45.8 ± 11.56. We study showed that 30% of patients had cardiac dysfunction, among them 18% had systolic dysfunction and 12% had diastolic dysfunction. In the study, among the diastolic dysfunction 10% had slow relaxation pattern and 02% had restrictive pattern of diastolic dysfunction. In our study, we have seen that 36% patients had left ventricular hypertrophy. ECG findings showed that 36% of patients had LVH, 6% showed anterolateral ischaemia, 6% showed inferior ischaemia, 4% showed sinus bradycardia, 2% sinus tachycardia, 2% anterior ischaemia and 2% septal ischaemia. In our study chest X-ray P/A view showed 30% had cardiomegaly, 4% had pulmonary oedema, 4% had pleural effusion and 62% had normal findings. When we staged the CKD with the GFR, it was shown that 90% patients had GFR <15, 6% had GFR in between 30—59 and 4% had in between 15-29ml/min. Systolic dysfunction was more (8%) in patients having GFR < 15, whereas it was only 1% in patients having GFR in between 30—59. Conclusion: This study an suggested association between chronic kidney disease (CKD) and cardiac dysfunction, both systolic and diastolic. It demonstrated a high prevalence left ventricular hypertrophy (LVH) as well. Early detection and treatment of causes of CKD should be pursued aggressively at the earliest possible time to prevent cardiovascular complications and thus reduce morbidity. Bangladesh Crit Care J September 2022; 10(2): 99-103
Coronavirus disease (COVID-19) has emerged as a global threat. The disease largely attacks adults with higher mortality among the aged and compromised people. Although previous coronavirus havocs caused significant number of maternal and neonatal demise, most pregnant cases with COVID-19 infection are either asymptomatic or with mild symptoms only. This pandemic brought significant disruption of essential antenatal and intranatal care worldwide. The health resources became diverted to focus on general population needs rather than the specified needs of pregnant women. Limited information is known about the effect of COVID-19 disease on pregnancy. Recent evidence indicates that pregnant women are not vulnerable group for severe COVID-19 illness. However, immunological and physiological alterations during pregnancy expose women more vulnerable to SARS-CoV- 2 infection in comparison to general population.Covid-19 pandemic has created a global crisis causing great challenges for pregnant women and their obstetricians. Although the due course of pregnancy is not strained by the disease itself but complications can happen in absence of proper care and caution. Both the pregnant mother and care-giver should be vigilant and the obstetric management should be implemented following evidence based standard protocol. Bangladesh J Obstet Gynaecol, 2021; Vol. 36(1): 49-56
Coronary artery disease in pregnancy is a catastrophic situation that may endanger the lives of both the mother and the fetus. Cardiac diseases may account for up to 15% of maternal mortality. Pregnancy may increase the risk of acute myocardial infarction up to 4-fold. Various hemodynamic derangements may occur during pregnancy including expansion of plasma and blood volume, compression of inferior vena cava and fall in both systemic and pulmonary vascular resistances. If pregnant women present with acute coronary artery disease, medical management should be attempted first and if any intervention or surgery is needed, efforts must be made to lower the risk. A multidisciplinary approach is essential involving obstetrician, cardiologist, cardiac surgeons, anesthesiologist and neonatologists or pediatrician. Pregnancy is considered to be a relative contraindication to thrombolytic therapy due to some complications. Revascularization may be considered in acute coronary syndrome in pregnant women like other nonpregnant patients. Primary per cutaneous coronary intervention or coronary artery bypass graft have been performed successfully during pregnancy and may be considered as therapeutic option in pregnancy in selective cases. Percutaneous coronary intervention (PCI) is considered to be relatively safe for maternal and fetal survival during pregnancy. Main worry in PCI is radiation exposure and need to dual antiplatelet therapy. Bare metal stent is preferred during pregnancy because of shorter duration of anticoagulation therapy. Early second trimester is the optimum surgical period to coronary artery bypass surgery (CABG) in pregnant women. Coronary artery bypass surgery can be safely done after 28 weeks of gestational age and immediately after cesarean section. Early detection, a multidisciplinary approach and timely interventions must be considered in coronary artery disease in pregnancy for better obstetric outcome. Cardiovasc j 2021; 14(1): 61-69
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