Prenatal diagnosis (PND) is one of the most cost effective preventive methods, but it is available only in the large cities of India. Therefore, we initiated a program that offers PND and allows us to determine the prevalence of various mutations. Pregnant females (n = 111,426) were screened for hemoglobinopathies using complete blood count (CBC) and high performance liquid chromatography (HPLC). If the female had a hemoglobinopathy, her husband was then tested. If hemoglobinopathies were seen in both partners, a genetic mutation study was performed on the couple. Fetal samples were obtained by either chorionic villus sampling (CVS) in 70.6% or amniocentesis in 29.4%. The study included 282 couples. IVS-I-5 (G > C) was the most common mutation in all castes except in the Sindhis and Lohanas, where the 619 bp deletion was the most common. Prenatal testing was informative in 97.9% of the couples. A significant number of couples (41.0%) underwent PND during their first pregnancy. Seven patients with β-thalassemia (β-thal) trait had normal Hb A2 levels. The Hb A2 and Hb F values varied significantly (p < 0.0001 and 0.0082, respectively) among mutations associated with β-thal. The IVS-I-5, 619 bp deletion, codons 41/42 (-CTTT), codons 8/9 (+G) and IVS-I-1 (G > T or G > A), were present in 81.0% of the couples tested. β-Thalassemia mutation frequency varied among the different castes, underlining the need for evolving a testing strategy that considers the caste system. Targeting antenatal clinics could also prove to be a most cost effective way of preventing hemoglobinopathies.
Background: Over 500,000 women die each year due to complications of pregnancy and childbirth, a number that has remained relatively unchanged since 1990, when the first global estimates of the burden of maternal mortality were developed (WHO 2005). Objective of present study was to find out risk factors, management, related complications and associated maternal morbidity and mortality with rupture uterus.Methods: A retrospective analytical study was performed at Department of Obstetrics and Gynecology, PDU Medical College, Rajkot, Gujarat, India over a period of 3 years during 2014-2016. Evaluation of maternal age, parity, SE status, booking status, obstetric risk factors, duration of hospital stay, causes of rupture uterus, Management, intra-op and post-operative complications, maternal morbidity and mortality was done.Results: Total 29 cases of rupture uterus were found during study period. Most of them belong to age group of 21-30 (77.17%), Primipara (41.3%), Lower socioeconomic status (86.2%) and unbooked (65.52%) cases. Most common cause of rupture uterus was prolonged obstructed labor (51.72%) while scarred uterus (41.73%), transverse lie (3.44%) and injudicious use of oxytocin (3.44%) were others. In 16 cases obstetric Hysterectomy (55.17%) was performed while in 13 cases repair (44.82%) was done. We have found 2 cases of maternal death (6.89%) while study period with rupture uterus.Conclusions: Present retrospective analytical study has concluded that rupture uterus is a life threatening complication. Proper antenatal and intrapartum care, identification of high risk factors, promotion of skilled attendance at birth and institutional delivery are key factors in reduction and early diagnosis.
Background: Maternal mortality is one of the important public health challenges faced by India today. Being a country with highest number of maternal deaths worldwide, i.e. 63, 000 per year and having a Maternal Mortality Ratio of 230/1,00,000 live births, it is a matter of grave concern and high priority. Objective: To study the MMR and common causes leading to death, so that improving maternal health and reducing maternal mortality rate significantly. Methods:We have done Retrospective Observational study in Department of Obstetrics & Gynecology, P.D.U. Medical College, Rajkot between 1st August 2012 to 31 st July 2014. Results: There were 30 Maternal Deaths during Study Period of 2 years in the Institute. Maternal Mortality Ratio of the Study Centre was 219 per lakhs live births. Out of 30 maternal deaths 21-30 yrs age group having 77% of maternal death while 67% belongs to lower socio-economical class. Out of 30, 15 (50%) died within 24 hrs of delivery. Hemorrhage was the most common cause in 15(50%) cases while others were Eclampsia (13%), septicemia (11%), ARDS (13%), others (13%). Conclusions: Maternal Mortality Ratio of the Study Centre was 219 per lakhs live births. Hemorrhage was the most common cause. Early registration, regular antenatal care, early referral are key things in reduction of maternal deaths. Facility based maternal death review (FBMDR) should be done at every institute level to find out the deficit and thus helping in reduction of maternal deaths.
Background: Induced abortion is one of the safest procedures for unwanted pregnancies in medical practice. Vacuum aspiration is the preferred method for uterine evacuation before 12 weeks of pregnancy. Objectives: To study the efficacy of manual vacuum aspiration (MVA) in o8 wk versus 8-12 wk of pregnancy. Materials and Methods: A randomized comparative prospective study was performed at the Department of Obstetrics and Gynaecology, P D U Medical College, Rajkot, over a period of January 2012 to June 2013. Totally, 100 subjects were enrolled in the study, which were further divided into two groups (o8 wk and 8-12 wk of pregnancy, 50 in each). MVA was performed in both the groups, and comparison was done in view to evaluate completeness of procedure, requirement of add-on procedure, and complications. Results: Of 50 subjects in each group, perforation was found in two cases in group A and one case in group B. Requirement of oxytocics noted in only one case in group B, whereas incomplete abortion noted in two cases in group A and three in group B. All complications were found statistically insignificant (P = 1) between both the groups. Conclusion: This study focused on the efficacy of MVA in higher weeks of gestations, which was equal in both the groups. Thus, MVA is a safe and an acceptable procedure up to 12 wk of pregnancy.
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