IntrOductIOnInfertility clinics have been facing the challenge to determine the degree of ovarian reserve so that treatment can be implemented effectively and wisely. There are several methods of evaluating ovarian reserve (size of ovarian follicle pool and remaining time left to conceive) such as elevated serum Follicle Stimulating Hormone (FSH), low ovarian volume, an Antral Follicle Count (AFC) AntiMullerian Hormone (AMH) of <5 per ovary, low inhibin B levels and serum AMH levels [1]. AMH, a member of the transforming growth factor β family is a novel marker for predicting ovarian response. It has an inhibitory effect on the primordial follicular recruitment in the ovary and on the responsiveness of the growing follicles to the FSH; thus it is important in patients with polycystic ovary syndrome [2,3]. AMH serum levels are not controlled by gonadotropins [4,5]. During infancy AMH levels increase, whereas during adolescence, a plateau until the age of 25 year is observed. From the age of 25 year onward, the serum AMH levels correlate inversely with age, implying that AMH is applicable as a marker of ovarian reserve only in women of 25-year-old and older. Thus the total number of ovarian follicles is determined early in life, and the depletion of this pool leads to reproductive senescence [6,7]. The serum AMH levels are not controlled by hypothalamic-pituitary-gonadal axis which makes it a useful marker in diagnosing conditions such as Polycystic Ovarian Syndrome (PCOS) and premature ovarian failure [8]. Furthermore serum AMH could also indicate the presence of underlying PCOS in those cases in whom TVS is not possible because of either non acceptance or some psycho-social issue [9].We conducted this study for assessing the effect of serum AMH levels on infertility treatment outcome and compared our findings with some of the studies previously done from India and other countries. MAterIAls And MethOdsThis cross-sectional study was conducted in Department of Obstetrics and Gynaecology, King George's Medical University (KGMU), Lucknow, for one year (May 2012-April 2013). Inclusion criteriaAll female patients (n=150) who visited infertility clinics of a.Obstetrics and Gynaecology Department were considered as cases. Twenty uniparous or multiparous females in reproductive b.age group with no complaints of infertility were considered as controls. exclusion criteriaAll the females c.who did not give consent for participation in study.Those patients who were lost for follow-up (n=10). d.Serum levels of AMH were measured in all the participants on 2 nd day of menstrual cycle using ultra sensitive enzyme linked immunosorbent assay AMH Gen II ELISA Kit (Beckman Coulter). These cases were followed up for the period of one year. The occurrence of conception was confirmed either by ultrasonography or by urine pregnancy card test. We extracted the patient's sociodemographic data, clinical history (e.g., hirsutism, oligomenorrhea, and amenorrhea), anthropometric measurements and other relevant data from information given by p...
Background: The presence of polymorphic methylenetetrahydrofolate reductase (MTHFR) in mothers poses a risk for numerous detrimental outcomes in neonates. The present study investigated the association of maternal MTHFR A1298C and C677T single nucleotide polymorphisms (SNPs) with the clinical outcomes in their neonates.Materials and methods: The cross-sectional study included 60 mothers and their neonates. Blood samples from mothers were analyzed for MTHFR A1298C and C677T SNP genotyping by real-time polymerase chain reaction. Clinical details of mothers and neonates were documented. Study groups were stratified based on wild, heterozygous, and mutant genotypes for the respective polymorphisms observed in mothers. Multinomial regression was applied for the association, followed by gene model formulation to estimate the impact of the genetic variants on the outcomes.Results: The frequency percentages of mutant CC1298 and TT677 genotypes were 25% and 8.06%, respectively, and the mutant allele frequencies (MAF) were 42.5% and 22.5%. Percentages of adverse outcomes such as intrauterine growth restriction, sepsis, anomalies, and mortality were higher in neonates born to mothers with homozygous mutant genotypes. Maternal C677T MTHFR SNPs revealed a significant association with neonatal anomalies (p = 0.001). The multiplicative risk model depicted OR (95% CI) for CT vs. CC+TT as 3.0 (95% CI: 0.66-13.7), and for TT vs. CT+CC was 15 (95% CI: 2.01-112.12). The C677T SNP in mothers predicted a dominant model for neonatal death (OR (95% CI): 5.84 (0.57-60.03), p = 0.15), whereas the A1298C reported recessive model for 1298CC mothers (OR (95% CI): 11 (1.05-115.5), p = 0.02). Both the genotypes assumed a recessive model for adverse neonatal outcomes: OR (95%CI) for CC vs. AA+AC was 3.2 (0.79-12.9, p = 0.1), and for TT vs. CC+CT was 5.48 (0.57-175.7, p = 0.2). The risk for sepsis in neonates was nearly six times higher in those born from mothers with homozygous CC1298 and TT677 than in the wild and heterozygous variants.Conclusion: Mothers with C677T and A1298C SNPs are highly susceptible to adverse outcomes in their neonates. Hence, screening the SNPs during the antenatal period can purposefully serve as a better predictive marker, following which proper clinical management could be planned.
Objective: To present an unusual case of meconium peritonitis diagnosed during prenatal period and its postnatal outcome. Conclusion:MP needs to be considered if the fetus has isolated ascites with internal echoes and progresses to hydrops, as it is one of the treatable causes of hydrops fetalis. Perinatal morbidity and mortality rate is about 80%. In-utero diagnosis and timely intervention are associated with favourable perinatal outcome. Neonatal septicemia is the most common cause of postoperative morbidity and mortality with an added risk of prematurity as was in our case.
Introduction: Small for Gestational Age (SGA) is a compelling obstetric adversity with multiple consequences. Early diagnosis, although a challenge, can help blunt the adverse effects. One of the markers is Pregnancy Associated Plasma Protein-A (PAPP-A) which can be an early predictor of SGA. Aim: To find the association of low levels of pregnancy associated plasma protein-A with small for gestational age. Materials and methods: This prospective observational study was conducted in the Department of Obstetrics and Gynaecology at All India Institute of Medical Sciences, Raipur, Chhattisgarh, India, between June 2018 and September 2019. The demographic profile, PAPP-A Multiples of Median (MoM) levels, complications in pregnancy and birth outcome data of a total of 203 women were noted. For analysis of descriptive and categorical data, IBM Statistical Package for the Social Sciences (SPSS) statistical software version 23.0 was used. Shapiro-Wilk and KolmogorovSmirnov tests were performed to assess normality of distribution. Qualitative data were analysed by Chi-square test and categorical data, by Mann-Whitney’s U test. Results: The prevalence of SGA was 18.2%, out of which PAPP-A MoM levels were ≤0.49 in 59.4%. The association between PAPP-A levels and SGA was statistically significant (p-value=0.03) with unadjusted odds ratio of 8.27 (95%CI, 3.78-18.08). Simple logistic regression showed an inverse relationship of PAPP-A with SGA. At the cut-off of ≤0.49 considered in the study, sensitivity was 86.7%, specificity was 54.1%, positive predictive value was 29.5% and negative predictive value was 94.8%. Positive likelihood ratio was 1.88 and negative likelihood ratio was 0.24 and the diagnostic accuracy was found to be 59.9%. Conclusion: An inverse relationship between levels of PAPP-A MoM (≤0.49) and SGA was found in the study. Low levels of PAPP-A MoM can be a useful early predictor of SGA.
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