Maternal vitamin D deficiency has been proposed as a risk factor for preeclampsia, but no significant studies have been conducted to evaluate its relationship with eclampsia. Our goal in this study was to assess the prevalence and potential risk of vitamin D deficiency for both preeclampsia and eclampsia in Bangladesh. Using a case-control design, we measured serum 25(OH)D levels in pregnant women receiving care at the Dhaka Medical College Hospital with preeclampsia (n=33), eclampsia (n=79), and normal pregnancy (controls, n=76). Odds of developing preeclampsia and eclampsia with vitamin D deficiency were calculated using logistic regression analysis. The prevalence of vitamin D insufficiency was very high with more than 3 quarters (78%) of all subjects having a serum 25(OH)D level<30 ng/ml. The mean serum 25(OH)D level was 24.86 ng/ml in controls, 23.96 ng/ml in pre-eclamptic women, and 21.56 ng/ml in eclampsia patients. Comparing to those who had a serum 25(OH)D level of ≥30 ng/ml, the odds ratio (95% CI) of developing preeclampsia and eclampsia in mothers with vitamin D insufficiency were 3.9 (95% CI=1.18-12.87) and 5.14 (95% CI=1.98-13.37), respectively (adjusting for age, BMI and duration of pregnancy). The odds of developing preeclampsia and eclampsia may increase by up to 5-fold in women with vitamin D insufficiency. Since preeclampsia and eclampsia can lead to serious complications for both mother and the offspring, vitamin D may be supplemented during pregnancy in high risk populations to decrease these adverse consequences.

Background Misfolded proteins in the urine of women with preeclampsia bind to Congo Red dye (urine congophilia). We evaluated a beta prototype of a point-of-care test for the identification of urine congophilia in preeclamptic women. Methods Prospective diagnostic case-control study conducted in 409 pregnant women ( n = 204 preeclampsia; n = 205 uncomplicated pregnancies) presenting for delivery in two tertiary level hospitals located in Bangladesh and Mexico. The GV-005, a beta prototype of a point-of-care test for detecting congophilia, was performed on fresh and refrigerated urine samples. The primary outcome was the prevalence of urine congophilia in each of the two groups. Secondary outcome was the likelihood of the GV-005 (index test) to confirm and rule-out preeclampsia based on an adjudicated diagnosis (reference standard). Findings The GV-005 was positive in 85% of clinical cases (83/98) and negative in 81% of clinical controls (79/98) in the Bangladesh cohort. In the Mexico cohort, the GV-005 test was positive in 48% of clinical cases (51/106) and negative in 77% of clinical controls (82/107). Adjudication confirmed preeclampsia in 92% of Bangladesh clinical cases (90/98) and 61% of Mexico clinical cases (65/106). The odds ratio of a urine congophilia in adjudicated cases versus controls in the Bangladesh cohort was 34 . 5 (14 . 7 – 81 . 1) ( p <0 . 001) compared to 4 . 2 (2 . 1 – 8 . 4; p <0 . 001) in the Mexico cohort. Interpretation The GV-005, a beta prototype of a point-of-care test for detection of urine congophilia, is a promising tool for rapid identification of preeclampsia. Funding Saving Lives at Birth.

Introduction:Cesarean section (CS) is the most common obstetric operation carried out in daily obstetric practice and the incidence has shown a dramatic increase over the last few decades globally. 1 With the improvement of operative technologies, anaesthia coverage and blood transfusion facilities, safety of cesarean section has increased considerably. Still it is a major operation and is associated with certain risks and complications.Complications rate associated with cesarean section is known to be several fold than that of vaginal deliveries. 2,3 This may be due in part to the pathology underlying the indication for the operation or the quality of surgery.In some cases, the complications mandates a repeat laparotomy -(Relaparotomy) requiring the patient to return to the operating theater. Most of the time, relaparotomy is performed when the conditions of Original Articles

It is sometimes difficult to select the most effective, easy to use, safest, widely accepted and less expensive method for induction of labour and thereby spontaneous vaginal delivery. Prostaglandin E1 analogue ie misoprostol as a successful method both in oral and vaginal form has been used for induction of labour. The present study was conducted with an aim to compare the efficacy and safety of oral and vaginal administration of misoprostol tablets for cervical ripening and induction of labour in pregnant women using similar dosing regimen in two groups of pregnant women. A prospective randomized trial was done on one hundred pregnant women for the purpose. They were between 37 and 42 weeks of gestation with singleton pregnancy, cephalic presentation and unfavourable cervix (modified Bishops score of 4 or less) in the department of Obstetrics and Gynaecology of Dhaka Medical college Hospital during the period between February 2003 and March 2004. The mode of delivery did not vary significantly between the two groups. Mean induction delivery interval, mean doses of misoprostol, number of women delivered within 24 hours, oxytocin requirement and mean time to delivery were nearly similar in the two groups. Only nulliparous women in oral group took longer time to deliver than vaginal group though it was not statistically significant. The mode of delivery also did not differ significantly. The proportion of emergency caesarean section was high in vaginal group than oral group. Neonatal outcome was satisfactory and the results were comparable. (J Bangladesh Coll Phys Surg 2006; 24: 44-49)

Objectives: The aim of the study was to evaluate the performance of the postgraduate students in Objective Structured Practical Examination (OSPE) in the speciality of Obstetrics and Gynaecology. This new trend of assessment was implemented first time in Bangladesh as a part of clinical assessment in the Fellowship examination. Materials and Methods: Three Mock OSPE were arranged for the postgraduate students before appearing in the final Fellowship examination by the faculty of Obstetrics and Gynaecology along with Bangladesh College of Physicians and Surgeons (BCPS) in the month of September and November 2005. A total of 109 students participated. In OSPE, students rotate through different stations where they are asked to perform certain tasks. In each circuit three different categories of stations were arranged, procedural stations for demonstrating certain skills, interactive stations with simulated patients for patient education, counselling and history taking and question stations where specimens, instruments, data and scenarios were placed for evaluation of interpretation, decision making and problem solving skills. For the procedural and interactive stations a preformed standardized checklist was placed with an observer for evaluation. For the question stations answer keys were prepared for checking. Pass mark was set at 52% (13 grade) as decided by the Examination Committee of BCPS. Results: Fifty six (51.38%) students scored 52% or above and declared as having passed. Performance in the procedural station was very poor in the first Mock (40.20% success rate) but the results got better in the subsequent Mock (52% in Mock II and 72% in Mock III). Performance in the interactive stations was not at all satisfactory, 75% could not achieve the desired credit revealing the fact that the students were very poor in communication skills. Performance in the question stations was variable depending upon the objective and task enrolled. Conclusions: OSPE is objective, structured, reliable and valid way to assess all the component of clinical competency and is an option to improve quality of clinical assessment, teaching and learning. (J Bangladesh Coll Phys Surg 2007; 25 : 3-8)

Background:

Polycystic ovary syndrome (PCOS) is a common endocrine disorder affecting between 4% and 8% of reproductive aged women. Although the symptoms and signs of PCOS are very heterogeneous, the syndrome usually presents with any combination of the following, menstrual irregularities (usually oligomenorrhea or amenorrhea), signs of hyperandrogenism (hirsutism, acne, alopecia) a characteristic appearance of the ovaries on ultrasound examination and an endocrine disturbance often involving high serum concentrations of LH and androgens. There is a well established association between PCOS, insulin resistance and hyperinsulinemia. Insulin resistance is a pivotal defect in PCOS probably counts as one of the most important advances in the battle to control the disorder. This metabolic abnormality leads to a compensatory increase in circulating insulin and this elevated insulin level directly stimulates the ovary to produce excess androgens. It also decreases hepatic sex hormone binding globulin (SHBG), so increasing biologically available free testosterone concentration in the circulation. This metabolic derangement leads to oligomenorrhea and anovulation. Different insulin sensitizers are used to revert the hyperinsulinemic condition. Metformin is top of them, which proved to enhance ovulation in insulin resistant PCOS when used with different ovulation inducing agents. Metformin reduces insulin resistance of peripheral tissue and allows muscle and adipose cells to take in glucose at normal insulin levels. It inhibits hepatic glucose production, decreases intestinal absorption and promotes glucose uptake, utilization by peripheral tissues at the postreceptor level. In this way it reduces insulin level and subsequently androgen level. It is easily available, safe and no teratogenic or adverse fetal outcome were reported by any researcher. It can be used safely in clomiphene resistant PCOS patients.

Background: Antepartum hemorrhage complicates 2-5% of pregnancies, whichapproximately one-third are due to placenta previa. Placenta previa is acondition derived to an abnormal implantation of the embryos in thelower uterine segment. In placenta previa hemorrhage is more likely to occur during third trimester,as a consequence of the development of the lower uterine segment and of the dilation of the cervix due to the uterine contractions; alsovaginal examination may lead to an antepartum hemorrhage. Risk factors for the development of placenta previa include prior cesarean delivery, pregnancy termination, intrauterine surgery, smoking, multifetal gestation, increasing parity, maternal age and the rising rates of Cesarean section. Placenta previa is associated with adverse consequences for both mother and children, such as Intra-Uterine Growth Restriction (IUGR), preterm birth, antenatal and intra-partum hemorrhage, maternal blood transfusion and emergency hysterectomy. Placenta previa has been diagnosed increasingly in recent decades, due to mostly to the widespread use of ultrasound (US). Apart from ultrasound a valid imaging modality to study and investigate placenta in antepartum period seems to be magnetic resonance (MR).Careful monitoring of high risk pregnancies is of utmost importance. Avoidance of unnecessary caesarean sections and early week’s pregnancy terminations can minimize the placenta previa. In diagnosed cases, preoperative planning, preoperative decisions and good postoperative management can safe a mother and child.J Shaheed Suhrawardy Med Coll, June 2017, Vol.9(1); 26-30