High Fetal Wastage Research Articles

AN OBSERVATIONAL STUDY OF ASSOCIATION OF SUBCLINICAL HYPOTHYROIDSIM AND ABNORMAL UTERINE BLEEDING

Introduction Abnormal uterine bleeding is a common gynecological presentation, accounting for atleast 20% of all new outpatient visits. It has been recognized that thyroid dysfunction may have profound effects on the female reproductive system. Both hypothyroidism and hyperthyroidism are associated with a variety of changes, including delayed onset of puberty anovulatory cycles, and abnormally high fetal wastage. Hence,this study was conducted to know the thyroid status of the patient with abnormal uterine bleeding. Aim & Objective: 1. To estimate the Prevalence & association of subclinical hypothyroidism among women presenting with abnormal uterine bleeding.Methods: A descriptive cross-sectional study was conducted in 250 patients with abnormal uterine bleeding in a tertiary care hospital. Data was collected using a questionnaire which includes patients prole ,the pattern of abnormal uterine bleeding, and thyroid prole. Settings and Design: This study was done in a MGM medical college indore & myh hospital in Madhya Pradesh. Results: Out of 250 patients presenting with AUB, 163 (71.6%) were euthyroid, 20 (3.6%) were overt hypothyroid, and 10 (0.5%) was hyperthyroidism and 57 ( 24.2%) were subclinical hypothyroidsim. the mean levels of the thyroid-stimulating hormone were 4.28 ± 2.76 mIU/L. The mean triiodothyronine and thyroxine were 132.6 ± 34.90 and 9.81 ± 3.60, respectively The most common symptom abnormal uterine bleeding was menorrhagia 74 (29.8%), followed by polymenorrhoea 53 (21.4%), hypomenorrhoea 32 (12.9%) , intermenstrual bleeding 31(12.5%), acyclicalbleeding 6 (2.8%) and oligomenorrhea 3 (1.2%). The maximum number of patients was between 41-50 years with the mean age of 41years. Conclusion: There is signicant association between subclinical hypothyroidism and abnormal uterine bleeding The prevalence of subclinical hypothyroidism in the study group was 24.2% It is suggested that women with early onset menorrhagia and oligomenorrhea with or without symptoms & signs attributable to thyroid dysfunction should be offered thyroid function testing to detect subclinical stage Early detection by selective screening and specic pharmacotherapy for subclinical thyroid disease early in the course of the disease will prove to be a superior alternative to surgical treatments like hysterectomy

Thyroid Dysfunction in Patients with Abnormal Uterine Bleeding in a Tertiary Care Hospital: A Descriptive Cross-sectional Study.

Abnormal uterine bleeding is a common gynecological presentation, accounting for at least 20% of all new outpatient visits. It has been recognized that thyroid dysfunction may have profound effects on the female reproductive system. Both hypothyroidism and hyperthyroidism are associated with a variety of changes, including delayed onset of puberty, anovulatory cycles, and abnormally high fetal wastage. Hence, this study was conducted to know the thyroid status of the patient with abnormal uterine bleeding. A descriptive cross-sectional study was conducted in all the patients with abnormal uterine bleeding in a tertiary care hospital from 2 August 2019 to 2 February 2020. Ethical clearance was received from the institutional review committee of KIST Medical College. Convenient sampling was done. Data was collected using a questionnaire which includes patients profile, the pattern of abnormal uterine bleeding, and thyroid profile. Statistical analysis was done using Statistical Package for the Social Sciences version 23. Out of 79 patients, it was found that 67 (84.8%) were euthyroid, 11 (13.9%) were hypothyroid,and 1 (1.2%) was hyperthyroidism. The most common type of abnormal uterine bleeding wasmenorrhagia 34 (43%), followed by polymenorrhoea 23 (29%), oligomenorrhoea 13 (16.5%), menometrorrhagia 6 (7.6%), metrorrhagia 2 (2.5%), and hypomenorrhea 1 (1.3%). The maximum number of patients was between 20-25 years with the mean age of 31 years. Among hypothyroid, 7(8.8%) had subclinical hypothyroidism and 4 (5%) had frank hypothyroidism. Most females with abnormal uterine bleeding were euthyroid. Menorrhagia was the most common pattern of abnormal uterine bleeding.

The Fetal Outcome and Fetal Wastage Pattern among Different Types of Obstetric Fistula at the National Obstetric Fistula Centre, Abakaliki, Nigeria

BACKGROUND: Obstetric Fistula is a major public health problem in developing world. It is associated with a high fetal wastage rate. The objective of this study was to evaluate different types of obstetric fistula and their fetal wastage rate. METHOD: A retrospective population study was done at the National Obstetric Fistula Centre, Abakaliki between 1st January-31st December, 2016. The calculated minimum sample size was 3, however, the total number of 203 patients were studied. The case notes of all the women who had obstetric fistula repairs over the period were analyzed. RESULTS: The mean age from this study was 38 ± 12.1 years. The fetal wastage rate from this study was 82.76% while the live birth was 17.24%. Seventy percent of the stillbirth were delivered via SVD, while 11% of stillbirth were delivered through EmCS. Twelve different types of fistula were identified in this study using anatomical classifications. Large extensive fistula, urethral loss and multiple fistula had the highest fetal wastage of 100% respectively. This was followed by mid-vaginal fistula (95.7%), Juxtaurethral fistula 94.4%, Juxtacervical fistula 88.5%, Intracervical fistula 85.71%, Ureteric fistula 85.71%, Vesicouterine 84.21%, Vault fistula 62.5%. Rectovaginal fistula had the least fetal wastage of 15.79% and the highest live birth of 84.2%. CONCLUSION: The findings showed a high fetal wastage rate amongst women with obstetric fistula. There was high fetal wastage across different types of obstetric fistula. Rectovaginal fistula had the best outcome in terms of live births.

Ruptured uterus: the unabating obstetric catastrophe in South eastern Nigeria

Ruptured uterus is an obstetric catastrophe and results in significant maternal and perinatal morbidity and mortality in Nigeria. To review the incidence and management of ruptured uterus over the 8-year period (2000-2004 and 2007-2009) and analysis of records of cases of ruptured uterus during the period under review in a descriptive study. The incidence of uterine rupture is 1 in 81 deliveries with a contribution of 13.8% to maternal mortality in Ebonyi State University Teaching Hospital, Nigeria. There was high fetal wastage as 99 (97.1%) of the babies died. The highest incidence of ruptured uterus was found in the para 2-4 group. Teenagers constituted 4 (3.96%) of the cases. Majority of the rupture, 69 (65.4%) occurred anteriorly. Fifty-seven (56.4%) had only repair of the rupture done. The greatest complication was septicemia, which occurred in 32 (31.7%) of the patients. The incidence of uterine rupture is very high in our center. It is one of the highest causes of maternal and perinatal morbidity and mortality. There should be a multi-pronged effort aimed at improving the utilization of medical services by the populace and the health institutions offering efficient obstetric emergency care.

An investigation of transmission ratio distortion in the central region of the human MHC

Transmission ratio distortion (TRD) describes a significant departure from expected Mendelian inheritance ratios that is fundamental to both the biology of reproduction and statistical genetics. The relatively high fetal wastage in humans, with consequent selection of alleles in utero, makes it likely that TRD is prevalent in the human genome. The central region of the human major histocompatibility complex (MHC) is a strong TRD candidate, as it houses a number of immune and regulatory genes that may be important in pregnancy outcome. We used a nonhaplotype-based method to select 13 tagging SNPs from three central MHC candidate regions, and analysed their transmission in 380 newborns and their parents (1138 individuals). A TRD of 54:46 was noted in favour of the common allele of a promoter SNP in the CLIC1 gene (P = 0.025), with a similar distortion using haplotypes across the same gene region (P = 0.016). We also found evidence that markers in the CLIC1 gene region may have been subject to recent selection (P < 0.001). The study illustrates the potential benefits of screening for TRD and highlights the difficulties encountered therein.

Snakebite during pregnancy

Little is known about snakebites during pregnancy and only a few cases have been reported in the literature. The fact that venomous snakebites during pregnancy result in high fetal wastage and may cause maternal mortality makes this an important, albeit, uncommonly encountered entity in emergency medicine. In this paper, we report on the successful treatment of three cases of snakebite in pregnancy.

Changing trends in the obstetric indications for cervical cerclage

Cervical incompetence causes repeated mid-trimester miscarriage and preterm delivery with high fetal wastage. Since the introduction of cervical cerclage in 1951, it has undergone many changes with regard to the techniques, indications and postoperative care. The objective of this study is to review the changing trends in the current indications of cervical cerclage and subsequent perinatal outcome at the maternity hospital from January 1992 to December 1999. All the files of women who had had cervical cerclage were evaluated in terms of characteristics of the women, indications and obstetric outcome after cervical cerclage. Of 65 539 who delivered in the hospital, 1021 women had had cervical cerclage, giving an incidence of 1.21%. There was a significant increase in the incidence of cervical cerclage, from 1.13% in 1992 to 1.40% in 1999 (P < 0.01). More women with multiple pregnancy in 1996 - 99 had cerclage than in 1992 - 94 period [22.7 vs. 8.5% (P < 0.01)]. It is clear that more cervical sutures are being performed in multiple pregnancies arising from assisted reproductive technology as well as after ultrasonographic evidence of cervical dilatation. A multicentre randomised clinical trial is therefore advocated to evaluate its effectiveness in these cases.

Management of snake and spider bite in pregnancy.

The fact that venomous snakebites during pregnancy result in a high fetal wastage and that both venomous snake and spider bites may cause maternal mortality, makes this an important, albeit uncommonly encountered, entity in obstetrics. Perhaps the most difficult aspect of dealing with this clinical situation is that care must be rendered simultaneously to two patients with a complex interrelationship. The object is to optimize maternal care and increase the chances of successful pregnancy. Adherence to the tenet that what is best for the mother is best for the fetus will probably produce the most satisfactory outcome.

749 TURNER'S SYNDROME: THE PATHOGENESIS OF THE PHENOTYPE

Two girls with Turner's phenotype and 45 X karyotypes in perpheral blood have good sexual development including menses. Buccal smears showed Barr bodies in 1/200 and 0/200 cells. Paraovarian fibroblasts from one girl gave 45 X on 40 spreads. Ovarian biopsies on both showed fibrous gonads with sparse follicles (est. total 8000/2 ovaries). Limited studies of estrogens and gonadotropins were normal. Traditional interpretation invokes mosaicism. A better interpretation is that these girls represent an expected extreme of a spectrum; that, because both X's are active in oogenesis before meiosis (Migeon and Jelalian, Nature 269:242, 1977), the XO complement causes an increased rate of atresia of follicles from the high fetal number, but does not prevent maturation. Somatic features of Turner's syndrome - almost uniform short stature and highly variable combinations of other features-can be explained by random inactivation during embryogenesis of the only X (Gartler and Sparkes, Lancet II:411, 1963) with ensuing cell death. This has never been seen because such cells are nonviable. This hypothesis would explain the high fetal wastage yet good viability of individuals who survive embryogenesis. The predicted reduction of cell number in early embryogenesis explains the uniform short stature in survivors. If such inactivation occurs, inactivation of the second X in normal cells must be prevented by interaction between the heterochromatic X(s) and the euchromatic X.