Background: Engagement of head is the most important event in labor which decides obstetric outcome. Floating head in primigravida at term is considered an important obstetric risk factor. Cephalopelvic disproportion, occipito-posterior position and deflexed head should be suspected in most cases of floating head. Present study was conducted to determine the outcome of labor in primigravida with floating head at term. The primary objectives of the study was to analyse the progress of labor, need of medical and surgical interventions and fetomaternal outcome. The secondary objective was to find out the rate of caesarean section for floating head in all situations whether elective or emergency in labor.Methods: This study was conducted in department of Obstetrics and Gynaecology SGRDIMS and R, Sri Amritsar on 100 primigravida subjects with floating head at term admitted through OPD admissions for induction of labor /spontaneous labor or referred from outside directly in early labor.Results: In present study the mean age was 24.95±3.01 years. The youngest case was 19 years old and eldest being 32 yrs old. The mean height was 151±3.41. At the time of admission 21% of cases had floating head, 55% cases were at -3 station, 17% of cases had -2 station, with only 7% of cases had -1 station.  56% of women delivered by caesarean section, 8% by forceps assisted vaginal delivery and 36% by normal vaginal delivery. The mean duration of labor was more in free floating and -3 stations in comparison to -2, or -1 stations. The need for augmentation was more in higher head stations.  Mean birth weight was 2.84±0.31, it was more in higher fetal stations in comparison to lower fetal stations. No significant maternal and fetal morbidity was seen. There was no significant difference in the Mean APGAR score of higher head stations in comparison to lower fetal stations.Conclusions: Primigravida with floating head at term and during labor should be managed cautiously. By proper monitoring and maintenance of partogram most of these cases deliver vaginally and without any maternal and fetal morbidity. The attitude of watchful expectancy and timely intervention will be used in all cases, especially in those appearing to be taking a protracted course.

Background: Preterm birth is one of the most important cause of perinatal morbidity and mortality. PROM is defined as spontaneous rupture of membranes before the onset of uterine contraction. Objective of present study was to evaluate the role of CRP as an early predictor of Chorioamnionitis in PPROM.Methods: A prospective study was done on 50 cases with PPROM and 50cases of control group without PPROM. All mothers and babies were observed from the time of admission to the time of discharge.Results: C-reactive protein appears to be the most sensitive acute phase protein; rising of less than 24 hours makes it suitable to serve as a marker for diagnosing an infective process in early stage. On comparing C-reactive protein levels with other laboratory tests and indicators of infection (e.g. total leucocyte count DLC, maternal fever, maternal tachycardia, fetal tachycardia) we found CRP level to be more sensitive (100%) but less specific (69.56%) in identifying clinical Chorioamnionitis. The positive predictive value was 22.22% and negative predictive value was 100%.Conclusions: In cases of PPROM, raised CRP is an early predictor of clinical Chorioamnionitis as well as histological Chorioamnionitis.

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INTRODUCTIONThyroid disorders constitute one of the most common endocrine disorders seen in pregnancy. Maternal thyroid function changes during pregnancy and inadequate adaptation to these changes results in thyroid dysfunction.These changes are a result of various factors like an increase in thyroglobulin due to elevated estrogen and human chorionic gonadotrophin, increased renal losses of iodine due to increase in glomerular filtration rate, modifications in peripheral metabolism of maternal thyroid hormone and modifications in iodine transfer to placenta. The production of thyroid hormone and iodine requirement increases by 50% during pregnancy.1 During pregnancy, the thyroid gland increases in size by 10% in iodine sufficient countries and to greater extent in iodine deficient countries 1 .Pregnancy is a stress test for thyroid gland, resulting in hypothyroidism in women with limited thyroidal reserve or iodine deficiency.Thyroid disorders during early pregnancy has been associated with adverse obstetric and fetal outcome. The main obstetric complications are abortion, pre-eclampsia, abruptio placenta, preterm labour and the fetal complications are prematurity, low birth weight, still birth and perinatal death. Children born to untreated mothers have profound effect on future intellectual development.2 Prenatal and postnatal adverse effects including attention deficit and hyperactivity syndrome have been reported in children born to hypothyroid mothers. 2,3 There is an increase in the incidence of NICU ABSTRACT Background: Thyroid disorders are among the common endocrine problems in pregnant women. Often overlooked in pregnancy due to nonspecific symptoms and hyper-metabolic state of pregnancy. Western literature shows prevalence of hypothyroidism in pregnancy as 2.5% and hypothyroidism as 0.1-0.4%. There is paucity of data on prevalence of thyroid disorders in India pregnant population. This study was carried out to know prevalence of thyroid disorders in pregnant women in Indian population. Methods: One hundred pregnant women attending antenatal clinic in first trimester were registered. Detailed history and examination was done. Apart from routine basic and obstetrical investigations, TSH, FT3 and FT4 level estimation was done.Results: Prevalence of thyroid dysfunction was high in this study in first trimester pregnant women, with subclinical hypothyroidism in 6%, overt hypothyroidism in 2%, subclinical hyperthyroidism 2 % and overt hyperthyroidism 0%. Conclusions: Prevalence of thyroid disorders, especially subclinical hypothyroidism (6%), overt hypothyroidism (2%) and subclinical hyperthyroidism (2%) was high. To prevent adverse effects on maternal and fetal outcome, we are emphasizing the importance of routine antenatal thyroid screening.

Background: Preeclampsia is associated with adverse pregnancy outcome and is a major cause of the fetomaternal morbidity and mortality. This study aimed at finding the role of lipid profile and uterine artery Doppler as a reliable predictor of risk of preeclampsia in early second trimester. Methods: This study is conducted in the obstetrics and gynecology department of a tertiary care teaching hospital, Amritsar. Lipid profile and Uterine artery doppler is estimated in 100 antenatal women from 14-20 weeks of period of gestation who met the inclusion criteria and are followed up till delivery or till preeclampsia sets in. Results: Out of 100 subjects 74 remained normotensive (Group A) and 26 developed preeclampsia (Group B). The mean serum level of total cholesterol (TC), triglycerides (TG), low density lipoprotein cholesterol (LDL) and very low-density lipoprotein cholesterol (VLDL) was significantly higher in Group B as compared to group A women. The Preeclamptic women showed significant fall in high density lipoprotein cholesterol (HDL) level as compared to normal pregnant women. The mean S/D ratio, PI and RI values of uterine artery Doppler were higher for group B and were statistically significant. Conclusions: The combined predictive value of lipid profile and uterine artery Doppler for estimating risk of preeclampsia was more reliable than of any of the test individually.

Background: The objectives of the current study were to compare the efficacy and safety of 25μg and 50μg of intravaginal misoprostol for induction of labor at term and to study the maternal and fetal outcome.Methods: A Prospective Study was done on 50 cases with 25μg misoprostol and 50 cases of 50μg of misoprostol intravaginal, repeated every 6 hourly till adequate uterine contractions or maximum 5 doses. Total dose of induction, induction delivery interval, mode of delivery, maternal and fetal outcome were recorded.Results: Mean induction delivery interval was 13.8±5.9 and 14.0±5.7 hours (P=0.9) with the 25μg and 50μg misoprostol respectively. The 25μg misoprostol group had a lower delivery rate with a single dose compared with the 50μg group (38% and 42% respectively). However, 25μg group had more deliveries than 50μg group with increasing number of misoprostol doses (36% vs. 38%, and 20% vs. 16% for 2 doses and 3 doses respectively). The need for oxytocin augmentation among participants was higher in the 25μg group (20%) than in 50 μg group (16%).This was however not statistically significant (P=0.603). At lesser initial bishop score, with 50µg misoprostol less doses are needed as compared to 25 µg and hence induction delivery interval decreases. The rates of caesarean section and operative vaginal delivery were similar in both groups. There was no significant difference in maternal side effects and neonatal outcomes among the women in the two groups.Conclusions: The 25 µg of intravaginal misoprostol administered six‑hourly appears to be as effective but safer than 50 µg for induction of labor. The use of 50 µg misoprostol may be recommended when there is a need to expedite vaginal delivery especially in cases of lesser initial bishop score.

Though cerebrovascular accident in hypertensive disorders of pregnancy is a rare entity, it causes high morbidity and mortality because of unpredictable onset and late diagnosis. Incidence of intracranial hemorrhage (ICH) accompanying nonfatal eclampsia is unknown, but the lesion is found in 10-60% of all mortalities that occur due to eclampsia. We report an unusual case of a 25-year-old primigravida who developed sudden eclampsia and intracranial hemorrhage leading to a mass effect on the right ventricle and a midline shift. She was managed by a multidisciplinary approach involving an emergency lower section cesarean section by an obstetrician, a craniotomy by a neurosurgeon, and intensive care by an anesthesiologist.

BackgroundMany HIV databases and applications focus on a limited domain of HIV knowledge. Since even a “simple” organism like HIV represents a very complex system with many interacting elements, the fractured structure of existing databases and applications likely limits our ability to investigate and understand HIV. To facilitate research, therefore, we have built HIVToolbox, which integrates much of the knowledge about HIV proteins and presents the data in an interactive web application. HIVToolbox allows quick and convenient hypotheses generation, experiment interpretation, and potential new drug structure creation.MethodsHIVToolbox was built as a standard three-tier J2EE web application, consisting of 1) an underlying relational MySQL database, 2) a set of standard Java data access objects that pull data from the database, and 3) a set of dynamic web pages the user interacts with. HIV-1 data from external sources such as the Protein Data Bank, NCBI, Los Alamos, etc. was collected, curated, and stored in the HIVToolbox database. Additional data, such as homology and position statistics matrices, was generated from existing data. Since version 1, drug binding site and drug resistant mutation data has also been added.ResultsHIVToolbox was used to create several new hypotheses about HIV-1 integrase, including predicting the location of a CK2 phosphorylation site, which was later confirmed by experiment. A new version of HIVToolbox support display of the 3D locations of drug resistant mutations on surface plots of HIV proteins and the drug binding sites for structures of complexes of HIV proteins with drugs.ConclusionHIVToolbox is an open-access web application that allows virologists and structural biologists to access detailed information about HIV-1 proteins, such as sequence, structure, functional sites and relationships, homology, drug binding sites, and drug resistant mutations, and to immediately see the relationships between any or all of them. Weblink: [http://hivtoolbox.bio-toolkit.com]