BACKGROUND Obstetric cholestasis is a disorder of liver function commonly occurring in the third trimester of pregnancy. Clinical characters of this disorder include unexplained maternal pruritus, most common site being palms and soles, altered liver functions (elevated serum transaminases) and increased fasting serum bile acids (>10 micro mol/L) in previously healthy pregnant women. The incidence is variable geographically from 0.1% to 15.6% all over the world. The aetiology of this condition is not fully understood. Its pathogenesis is related to increased sex hormone synthesis, environmental factors and genetic predisposition. Obstetric cholestasis can lead to increased foetal morbidity and mortality with regards to preterm delivery, neonatal respiratory distress syndrome, foetal distress and sudden intrauterine foetal death. Treatment of the disease focus on relieving symptoms and signs. The aim of the study is to evaluate the pregnancy and foetal outcome of pregnant women with obstetric cholestasis. MATERIALS AND METHODS A cross-sectional study was conducted in M.K.C.G. Medical College and Hospital, Berhampur from February 2015 to May 2017. Inclusion Criteria-All patients having pruritus during course of pregnancy with biochemical evidence of raised liver function tests attending antenatal clinic or labour room. Exclusion Criteria-1) Pregnant women without pruritus; 2) Pregnant women having other liver diseases. RESULTS The incidence of obstetric cholestasis was 0.6%. Majority of cases were primigravida (72.9%). Positive family history was present in 11.4% of cases. Majority of cases (77.1%) had normal vaginal delivery. 22.9% of cases had caesarean section. Primary postpartum haemorrhage occurred in only 2.9% of cases. CONCLUSION Obstetric cholestasis can be managed by improving the circulating bile acid level, targeting the cause of pruritus and optimising the time of delivery as a result of which we can reduce adverse pregnancy outcomes.
Ovarian implantation of pregnancy is a rare entity. It represents 0.5%-1% of all ectopic pregnancy. The incidence ranges from 1 in 40,000 to 70,000 deliveries. The word ectopic comes from the Greek word "ektopos" which means out of place. Ectopic is a potentially life threatening adverse pregnancy outcome that requires prompt evaluation and treatment. Past studies have found that it affects an estimated 1-2% of all pregnancy. It results significant maternal morbidity, fetal loss, repeat ectopic, impairment of subsequent fertility.
BACKGROUND Abnormal cervix includes chronic cervicitis, erosion, eversion, leukoplakia, polyps. Loss of life from cancer of cervix can be reduced by early detection of precancerous conditions and their sequelae, and their treatment will go a long way in preventing overt carcinoma of cervix. Here comes the value of colposcopy, a valuable aid in clinical evaluation of precancerous lesions of the cervix. The objective of the present study was to evaluate the role of colposcopy in cases of abnormal cervix and compare it with cytologic examination. MATERIALS & METHODS A prospective study conducted from September 2015 to September 2016 in the Department of O & G, MKCG Medical College, Berhampur. A total number of 307 cases with abnormal Pap smear, cervicovaginal discharge or bleeding or with obvious abnormal looking cervix were examined after taking formal consent. Patients with concurrent illness, concomitant therapy, pregnancy or overt cases of carcinoma of cervix were excluded from the study. Colposcopic examination was done using 3% acetic acid. Colposcopic directed biopsy was taken and tissue was sent for histopathology. RESULTS Majority of patients had abnormal cervix in the age group of 31 to 40 years with multiparity. Sensitivity and specificity of Pap smear were 82.92% and 95.81% respectively and those of colposcopy were 97.56% and 96.74% respectively. Combination of both methods showed sensitivity & specificity of 82.92% and 99.06% respectively. CONCLUSION Colposcopy cannot replace cytology. However, when both methods are used in combination there is improved diagnostic accuracy.
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