Pre-eclamptic Toxaemia Research Articles

Is there a relationship between morphokinetic parameters and obstetrical complications? An analysis of singleton live births after single fresh embryo transfer

BackgroundWith the advancement in embryology and the introduction of time-lapse monitoring system, the embryologists' goal might be to find not only the embryo with the highest probability of live birth, but also the embryo with the highest probability to progress to a healthy full-term delivery. Thus, we aimed to investigate the association between morphokinetic time-lapse parameters and obstetrical and perinatal complications.MethodsA cohort study reviewing fertility and delivery files of all singletone births from IVF patients whose embryos were cultured in a time-lapse monitoring system and had a single fresh embryo transfer at our center between 2013–2019. We conducted multiple comparisons between complicated and uncomplicated pregnancies of each perinatal complication, including: gestational diabetes mellitus (GDM); small for gestational age (SGA); pre-eclamptic toxemia (PET); preterm labor < 37 weeks of gestation (PTL); and third stage of labor complications. A comparison between pregnancies with and without a composite outcome of placental complications including GDM, SGA, PET and PTL was also conducted. Baseline characteristics, treatment and morphokinetic parameters in complicated and uncomplicated gestations were compared. Logistic regression analysis was utilized to adjust results for potential confounders.ResultsOne hundred seventy-six single embryo transfers resulted in 176 live births. Morphokinetic time-lapse parameters were similar between the groups, except for a shorter time to full blastulation in the SGA group (tB-tPNf = 75.5 ± 1.3 h vs. 79.5 ± 4.8 in the non-SGA group, p < 0.001), and shorter third cell cycle duration in the PET group (CC3 = 12.4 ± 1.1 h vs. 13.6 ± 2.9 in the non-PET group, p = 0.02). On multivariate regression analysis, none of the morphokinetic parameters were found to be significantly correlated with any of the perinatal complications.ConclusionTime-lapse morphokinetic parameters of the embryo transferred are not associated with adverse obstetric and perinatal outcomes.

Usage of blood components in obstetric practice

Transfusion of blood and its components form an important component in obstetric care. Almost 5% of pregnant mothers require some sort of red cell and/or component transfusion as part of their obstetric management. Although red cell usage in large parts of developed countries are coming down, its usage in obstetric care is increasing. About 27% of maternal deaths in the world are due to hemorrhage. There are many causes where transfusion with different blood components is required in obstetric practice; to name a few are – accidental hemorrhage, placenta previa, hemoglobinopathies, pre-eclamptic toxemia, postpartum hemorrhage, amniotic fluid embolism, disseminated intravascular coagulation, malaria, etc. Certain complications and challenges of transfusion such as transfusion related acute lung injury, microangiopathy, Thrombotic thrombocytopenic purpura, isoimmunization, and transfusion-associated cardiac overload occur with increased frequency in pregnant mothers. Transfusion requirement around peripartum period is uncertain and sometimes could be massive. Hence, both obstetrician and transfusion experts should remain prepared for this eventuality. Transfusion of blood products even though has never been safer than it is today; yet, this procedure carries with it many immunological, infectious, and other complications, hence, should be used judiciously and very cautiously. Several procedures such as apheresis and intraoperative cell salvage are being increasingly used nowadays for various facets of management and obstetric care. Present review condenses on the knowledge of usage of blood and blood products in obstetric care.

Assessment of maternal and perinatal outcome in preterm labour associated with asymptomatic bacteriuria

Background: Asymptomatic bacteriuria is a bacterial infection of the urine without any of the typical symptoms that are associated with a urinary infection, and occurs in 2% to 15% of pregnancies. The present study was conducted to assess maternal and perinatal outcome in preterm labour associated with asymptomatic bacteriuria.Materials and Methods: 104 preterm labor patients were divided in two groups as follows- group I patients with age nineteen years and above, who are <37 weeks period of gestation ending up in preterm labor not associated with bacteriuria. Group II patients with age nineteen years and above, undergoing preterm labor associated with bacteriuria. Parameters such as parity, BMI, comorbidity, preeclamptic toxaemia, preterm premature rupture of membrane, intrauterine growth restriction and low birth weight (LBW) was recorded.Results: Parity was nulliparous in 15 and 17, multiparous in 32 and 28, grand multi in 5 and 7, BMI was obese in 34 and 26 and non- obese in 18 and 26 in group I and II respectively. Comorbidity was anaemia in 5 and 2, GDM in 7 and 2, hypertension in 3 and 1 and hypothyroidism in 8 and 2 in group I and II respectively. The difference was significant (p<0.05). Preeclamptic toxaemia was seen in 4 and 1, preterm premature rupture of membrane in 6, intrauterine growth restriction in 3 and 1 and low birth weight (LBW) in 8 and 2 in group I and group II, NICU admission was seen in 4 in group I and 1 in group II, perinatal deaths were recorded 5 in group I and 1 in group II respectively. The difference was significant (p<0.05).Conclusion: Pre-eclamptic toxaemia, preterm premature rupture of membrane, intrauterine growth restriction and low birth weight (LBW), NICU admission and perinatal deaths was higher in pre- term labour patients with bacteriuria as compared to those without it.

The Efficacy of the Spinal Anesthesia during Emergency Cesarean Section for Severe Preeclampsia and Eclampsia Patients

Background: In Bangladesh, severe preeclamptic toxemia and eclampsia are life-threatening conditions in pregnancy that are the leading cause of perinatal maternal and neonatal mortality and morbidity. Objective: in this study our main aim is to evaluate the efficacy of the Spinal Anesthesia during Emergency Cesarean Section for Severe Preeclampsia and Eclampsia Patients. Method: This cross sectional study was carried out at tertiary medical hospital from January 2021 to January 2022. Total 200 cases of severe PET (n=110) and eclampsia (n=100) patients were selected by subarachnoid block for emergency LUCS. Each patient was given magsulph as prophylactic or maintenance dose and judiciously preloaded by crystalloid fluid. Results: Most of the patients belong to 31-40 years age group, 52% and 95.8% cases were multigravida. In severe PET group, intraoperative hypotension was observed in 32% cases and postoperative period hypotension was observed in 8% cases. Whereas preeclampsia group, intraoperative hypotension was observed in 31% cases and postoperative period hypotension was observed in 9% cases. In addition,maternal morbidity where acute renal failure seen in 5%, syndrome 7%, DIC 7%, abruptio placentae 12%, pulmonary edema 4%, septicemia 13%, PPH 10% and postpartum eclampsia 15%.In severe PET group, 21% cases transferred to eclampsia ward, followed by 9% shifted to ICU, 1% case was expired. Whereas, in preeclampsia group 20% cases transferred to eclampsia ward, followed by 8% shifted to ICU, 2% case was expired. In eclamptic group 7% cases were transferred to NCU, whereas 8% had PET. Neonatal mortality was observed in 3% cases. p value was found 0.000 which is very highly significant. Conclusion: With close monitoring of perioperative events, spinal anesthesia may be used as a safe alternative technique to GA or epidural in severe preeclampsia and eclampsia, even in cases of altered consciousness or restlessness in the presence of an expert and skilled anesthesiologist, reducing perioperative maternal and neonatal morbidity and mortality

FREQUENCY OF IRON DEFICIENCY ANAEMIA IN PREGNANCY

Objective: independent of gestational age, to ascertain the prevalence of iron deficiency anaemia in pregnant women.Study design: a descriptive studyDuration and place of study: From January to Dec 2013, descriptive research was carried out at the MardanMedical Complex’s Gynae-B Unit in Mardan.Material and methods: In 2013, descriptive research was carried out at the Mardan Medical Complex’s Gynae-B Unit in Mardan. All Gynae B Unit pregnant patients, both indoor and outdoor, met the inclusion criteria.Of these expectant patients, 100 with a haemoglobin percentage of less than 10 gm/dl underwent further testing,including a detailed history assessment and questionnaire completion. All pertinent tests for iron deficiency anaemiawere performed, including serum ferritin, Hb electrophoresis, and a complete blood picture. The whole blood picturealso determines anaemias other than iron deficiency. The patient’s iron status is determined by serum ferritin, but thevarious forms of haemoglobin in the blood are identified by haemoglobin electrophoresis. Results: Out of 100 patients,73% had iron deficiency anaemia, 6% had thalassemia, and there were warning signs of hemolytic anaemia andblood loss anaemia from eclampsia, APH, and PET. In one instance, severe iron deficiency anaemia was discoveredto be caused by a malarial parasite.Conclusion: The most common type of anaemia during pregnancy is iron deficiency due to the increased demandfor iron stores from repeated pregnancies.Key Words: Haemoglobin, pre-eclamptic toxaemia, antepartum haemorrhage, total iron binding capacity

Telehealth: improving maternity services by modern technology

Hypertension is considered one of the most common medical disorders causing complexities in pregnancy. It could be a newly developed pregnancy-induced hypertension (PIH) or a pre-existing hypertension developing into superimposed...

Thrombocytopenia in pregnancy; prevalence, causes and fetomaternal outcome

Background: Thrombocytopenia is seen in up to 12% of pregnancies. Most cases are due to benign gestational thrombocytopenia and have no adverse effects. It can, however, be due to underlying serious causes and can lead to adverse maternal and perinatal consequences. Objective: To discover the prevalence and causes of thrombocytopenia and the impact of its severity on feto-maternal outcome. Materials and Methods: This is a retrospective comparative study. Thrombocytopenia was defined as platelet count less than 150×109/L detected any time after 24 weeks gestation and averaged during prenatal visits. All thrombocytopenic pregnant patients who completed 24 weeks of gestation were included. Cases were then divided into mild (group 1, platelet count between 70 and 150×109/L) and moderate to severe (group 2, platelet count less than 70×109/L) thrombocytopenia. Results: The prevalence of thrombocytopenia in pregnant women was 7.20%. Benign gestational thrombocytopenia (BGT) accounted for 78.53%, with idiopathic (immune) thrombocytopenic purpura (ITP) accounting for 1.93%, pre-eclamptic toxaemia (PET)/HELLP syndrome accounting for 7.41%, drugs 7.23%, systemic lupus erythematosus (SLE) with or without antiphospholipid antibodies (APA) 0.84%, and various maternal diseases 4.04%. Compared with mild thrombocytopenic pregnant women (group 1), moderate to severe thrombocytopenic women (group 2) were at a significantly greater risk of caesarean section, antepartum hemorrhage (APH), postpartum hemorrhage (PPH), wound haematoma, intrauterine fetal death (IUFD), preterm delivery, and intrauterine growth restriction (IUGR). Conclusion: Thrombocytopenia is prevalent in this obstetric population with various obstetric and nonobstetric causes. The consequences of thrombocytopenia in pregnancy are mostly benign, but moderate to severe thrombocytopenia was associated with adverse obstetric and perinatal outcomes. This was due to the nature and severity of the underling maternal diseases and their medication. The authors recommend studying prospectively each of these thrombocytopenia-induced diseases in pregnancy.

Vitamin D Status and Pregnancy Complications: Serum 1,25-di-hydroxyl-Vitamin D and its Ratio to 25-hydroxy-Vitamin D are Superior Biomarkers than 25-hydroxy-Vitamin D.

Vitamin D (VitD) deficiency during pregnancy has been associated with adverse neonatal outcomes and increased risk of late pregnancy complications. We planned to correlate serum VitD biomarkers; 25-hydroxyvitamin D (25-OH-VitD) and 1,25-dihydroxyvitamin D (1,25-diOH-VitD) levels; and their ratio with the frequency of feto-maternal pregnancy complications. A prospective cross-sectional case-control study was conducted at Aljouf Maternity and Children Hospital, Sakaka, Saudi Arabia, during the period of September 1, 2017 to September 30, 2019. 322 pregnant women were stratified into 2 groups: controls (110 cases) and complicated group (212 cases). The later comprised severe preeclamptic toxemia associated with intrauterine growth restriction (58 cases), gestational diabetes mellitus (GDM; 82 cases), abortion (26 cases), undisturbed ectopic pregnancy (16 cases), premature rupture of membranes (PROM; 14 cases), and, inevitable preterm labour (16 cases). After clinical assessment, peripheral blood samples were collected. Serum biomarkers were measured using specific immunoassays. The direct 1,25-diOH-VitD/25-OH-VitD ratio was calculated. Serum 25-OH-VitD indicated widely spreading VitD deficiency among participants with significantly higher levels in controls vs. GDM subgroup only. 1,25-diOH-VitD levels and the ratio were markedly reduced in the six complicated subgroups vs. controls, with non-significant differences amongst the complicated subgroups. ROC analysis showed very high sensitivity and specificity, to differentiate patients from controls, only for 1,25-diOH-VitD (AUC = 0.965; 0.947 - 0.983, p <0.001) followed by the ratio but not 25-OH-VitD. In conclusions, 25-OH-VitD did not show significant changes except for GDM. 1,25-diOH-VitD levels and the ratio showed strong associations with pregnancy complications. Serum 1,25-di-OH-VitD and its ratio to 25-OH-VitD are more reliable and physiologically relevant biomarkers for VitD status in pregnancy.

Twin versus singleton pregnancy in women ≥ 45 years of age: comparison of maternal and neonatal outcomes

Objectives: The aim of the study is to compare the effect of very advanced maternal age (≥45 years) on maternal and neonatal outcomes of twin and singleton pregnancies. Materials and methods: This retrospective cohort study included women ≥ 45 years of age who gave birth to twins. Each was randomly matched to two women ≥ 45 years of age who gave birth to singletons within 7 days of the study subject. Data on maternal age, gravidity, parity, background medical information, body mass index at conception, number of fetuses, mode of conception (either spontaneous or assisted reproductive technology [ART]), mode of delivery, and gestational age at delivery were extracted from a real-time computerized database. Results: The data of 75 twin pregnancies of women aged ≥ 45 years were compared with those of 150 singleton pregnancies matched for maternal age. There were significantly more cases of hypertensive complications among the twin pregnancies compared to the singleton pregnancies (41.33 versus 14.00%, respectively, OR = 3.33, 95% CI = 2.26–8.30, p = .000) and more cases of preeclamptic toxemia (29.33 versus 12.00%, respectively, OR = 3.04, 95% CI = 1.51–6.13, p = .001). The duration of twin pregnancies was much shorter compared to singleton pregnancies, with a higher incidence of deliveries prior to 37 weeks’ gestation (56.00 versus 8.00%, respectively, OR = 14.64, 95% CI = 6.94–30.85, p = .000), and deliveries prior to 34 weeks’ gestation (22.67 versus 2.00%, respectively, OR = 14.36, 95% CI = 4.06–50.86, p = .000). More infants of twin pregnancies had a low birth weight (68.00 versus 10.00%, respectively, OR = 19.13, 95% CI = 10.14–36.06, p = .000), and many had a very low birth weight (10.67 versus 0.67%, respectively, OR = 17.79, 95% CI = 2.33–135.97, p = .000). The infants of twin pregnancies also included more cases of intubation (10.00 versus 0.00%, respectively, p = .000), more cases of hypoglycemia (12.67 versus 5.33%, respectively, OR = 2.57, 95% CI = 1.09–6.08, p = .026), and were admitted much more often to the neonatal intensive care unit (36.00 versus 8.00%, respectively, OR = 6.47, p = .00, CI = 3.29–12.74). Conclusions: Women ≥ 45 years of age with twin pregnancies and their neonates sustain more severe adverse outcome compared to matched pairs of singleton pregnancies. It is recommended that a single embryo transfer should be offered in preference to multiple embryos when those women are undergoing ART.

Risk Factors of Persistent Pulmonary Hypertension of Newborn (PPHN) in Different Gestation

Persistent Pulmonary Hypertension of Newborn (PPHN) is a critical neonatal problem resulting from failed circulatory adaptation at birth, associated with substantial perinatal morbidity as well as mortality. Despite significant advancement in management of PPHN across the globe, it still remains a challenge especially in developing countries like Bangladesh. So the study was conducted over five years in United Hospital Limited to determine the risk factors of PPHN in relation to gestational age. All PPHN cases diagnosed by echocardiogram were included in the study and divided into term (≥ 37 wks) and preterm group (<37 wks). Among 157 of PPHN cases, 66% were male, 59% were preterm, mean gestational age and birth weight were 35.6 ± 2.54 wks and 2598.22 ± 760.353 gm respectively. Maternal asthma (p 0.01) and pre-eclamptic toxemia (p 0.010) were significant risk factors for persistent pulmonary hypertension of newborn. PPHN was found high in neonates with Respiratory Distress Syndrome (p 0.000) and Meconium Aspiration Syndrome (p 0.000). Most (96%) of the babies were discharged to home.

Is ICSI superior to conventional IVF in severe male factor: a 3 year prospective observational study

To study whether IVF (in-vitro fertilisation) yields better outcome in severe male factor infertility over Intracytoplasmic sperm injection (ICSI) in terms of live-birth ,obstetric outcome and congenital anomalies. This prospective observational study included 253 women whose male partner had TMC (Total motile count) <1million and underwent conventional IVF or ICSI from January 2014 to December 2016. All subjects were between 25-37 years. Records of prenatal care of mother and neonates were reviewed. Developmental wellbeing of children born after IVF/ICSI were followed for three years. The 253 male partners who had semen analysis on day of oocyte retrieval with <1million motile sperm and morphology>4% after wash, were included and divided into Group A (GrA) (n=121) in which conventional insemination was done and Group B (GrB)(n=132) where ejaculated ICSI was done. Antagonist protocol was performed. Total fertilization failure were 6/121(4.9%) in GrA and 3/132(2.2%) in GrB. Rest 244 patients with 295 cycles were analysed. Other female factors-PCOS, endometriosis, tubal factors and uterine defects were excluded. Both groups were comparable in terms of age of both partners, BMI, dose of gonadotropins, estradiol on day of oocyte retrieval, endometrial thickness and number of oocytes retrieved. Conventional IVF group (496/840, 59.01%) had significantly lower fertilization rate than ejaculated ICSI (591/910, 64.94% p=0.0119). although number of day 3 embryos were comparable in both groups (GrA 407/496, 82.05% vs GrB 467/591,79.01%). Pregnancy rate per embryo transfer in GrA was 42.2% and GrB was 47.61% (p=ns). Pregnancy per oocyte retrieval was also comparable-38.58% in conventional IVF and 42.85% in ICSI. Live birth rate per oocyte retrieval was also similar in both groups (GrA 30.6% vs GrB 26.4%). Missed abortion, though higher in ICSI group was not significantly different than conventional IVF (GrA 26.53% vs GrB 29.1%). Antenatally two patients in ICSI group had pre-eclamptic toxaemia (PET) while none had the condition in IVF group. One baby in ICSI group was terminated due to chromosomal defect and two babies born after ICSI had birth defects (one hypospadius and the other imperforate anus). In IVF group one baby had posterior urethral valve. Incidence of PET and congenital anomalies could be chance findings in this study. In our study conventional IVF is as good as ejaculated ICSI in terms of reproductive outcome, where male partner had <1million motile sperm in post wash sample. IVF could be the first choice over ICSI in severe male factor infertility especially in developing countries which will decrease the cost of ART.

Indications of Emergency Caesarean Section at a Tertiary Care Hospital in Dhaka City

Background: Caesarean Section is now a common surgical practice during child birth.Objective: The purpose of the present study was to see the indication of emergency caesarean section.Methodology: This descriptive type of cross sectional study was conducted in the Department of Gynaecology &amp; Obstetrics at Dhaka Medical College Hospital during the period from July 2006 to December 2006 for a period of 6 months. The pregnant women who were selected for emergency caesarean section during the mentioned period of study were included as study population. The details of the indication of the caesarean section were recorded.Result: A total number of 100 cases were recruited in this study. Among the all indications of emergency caesarean section history of previous caesarean section was the most common which was found in 25(25.0%) cases. Foetal distress was the second common indication of emergency caesarean section which was 18(18.0%) cases. Obstructed labour was also reported in 11(11.0%) cases. Antepartum haemorrhage (8.0%) was another indication of emergency caesarean section. Considering the hypertensive disorder preeclamptic toxaemia (7.0%), eclampsia (5.0%) and pregnancy induced hypertension (1.0%) were the reported as the indications of emergency caesarean section. Some other indications of emergency caesarean section were recorded which were mal-presentation (7.0%), prolonged labour (6.0%), cephalopelvic disproportion (4.0%) and failed trial labour (4.0%).Conclusion: In conclusion history of previous caesarean section is the most common indication for emergency caesarean section obstructed labour, antepartum haemorrhage as well as foetal distress, malpresentation and cephalopelvic disproportion.Journal of Science Foundation 2017;15(2):36-40

Body Mass Index Impact and Predictability on Preeclamptic Toxemia

Background: PET is a systemic disorder of vascular endothelial dysfunction and vasospasm that occurs after 20 weeks’ gestational age and can present as late as 4-6 weeks postpartum. It is clinically defined by hypertension and proteinuria, with or without pathologic edema. Maternal obesity is a prominent hazardous risk factor for the pathological development of PET. Aim: To determine the correlation between the raised body mass index and the risk of PET.

Serum Cystatin C Level for Evaluation of Renal Functions in Women with Severe Preeclamptic Toxemia

Abstract Background: Preeclampsia is a complex and serious multisystem disorder of pregnancy with a worldwide incidence of 5-7% and contributes significantly to maternal and perinatal morbidity and mortality. Altered renal function is an essential component of the pathophysiological process in PE, so close monitoring of renal function is important to ensure a timely delivery before serious renal damage occurs. Aim of the Work: To evaluate diagnostic value of cystatin C serum levels as an alternative marker of renal function in women with severe preeclamptic toxemia versus matching cases of normal pregnancy and compare it with the traditional markers of renal function, Creatinine, urea and serum uric acid. Patients and Methods: A case-control study includes 80 Primigravidae with singleton pregnancy and gestation ≥28 weeks and were divided into two groups, Group 1: (40 patients) with severe preeclampsia and Group 2: (40 patients) as a control group (normotensive and nonproteinuric). Markers of kidney function were investigated in two groups of pregnant women and comparison between both groups as regards to cystatin C serum levels, creatinine, blood urea and serum uric acid was done. Results: The difference in the mean serum uric acid level (5.10±0.96 versus 4.70±0.63mg/dl) was significantly higher in preeclampsia (p=0.027), the specificity was 100% and sensitivity of the test was 87.5%, the difference in the mean serum concentration of creatinine (0.94±0.16 versus 0.86± 0.12mg/dl) was significantly higher in preeclampsia (p=0.028), the specificity of the test was 100% and the sensitivity was 82.5%. Serum cystatin C level has a mean (1.26±0.21 versus 0.75±0.05mg/l) which was significantly higher in preeclampsia (p=0.001) with a specificity 100% and sensitivity 96%. Conclusion: It is concluded that among serum creatinine, blood urea, serum uric acid & serum cystatin C, Serum cystatin C is the earliest & a better marker of renal dysfunction in preeclampsia.

Diabetes insipidus in pregnancy

Key content There are various types of diabetes insipidus that occur due to different pathology that occurs outside of, during, and as a result of pregnancy. All pregnant women presenting with polyuria and polydipsia should be investigated with blood tests including urea and electrolytes, calcium levels and thyroid function tests. Plasma and urine osmolality can also be helpful in making the diagnosis. Additional symptoms that are suggestive of diabetes insipidus secondary to other underlying pathology (e.g. a pituitary tumour) are likely to require radiological imaging. Women diagnosed with diabetes insipidus should have regular consultant review in clinic with monitoring of serum electrolytes. They should also receive an antenatal anaesthetic review. A multidisciplinary approach should be adopted during labour and they should be managed on delivery suite with senior obstetric and anaesthetic input. Pre‐eclamptic toxaemia (PET) and haemolysis, elevated liver enzymes and low platelets (HELLP) can exacerbate diabetes insipidus as hepatic dysfunction leads to a reduction in vasopressinase metabolism. Furthermore, it has been suggested that pituitary hypoperfusion due to this syndrome could also be a cause of gestational diabetes insipidus. These women present a therapeutic challenge as they are in a volume‐depleted state as a consequence of DI, however they require judicious fluid management because of their PET. Early detection and effective management will reduce morbidity and mortality in both the mother and fetus. Untreated or undiagnosed, it has the potential to have serious consequences for the expectant mother and fetus. Learning objectives To understand the different subtypes of diabetes insipidus, their pathophysiologies and their effects during the ante‐, peri‐ and postnatal periods. To appreciate that diabetes insipidus can herald the onset of underlying hepatic dysfunction with associated serious maternal and fetal consequences arising from both the biochemical abnormalities associated with diabetes insipidus and the secondary problems of impaired liver function. To appraise the current theories of the link between PET and diabetes insipidus.

BJOG Editor-in-Chief number 8: James Young 1943-1963.

James Young was born in Edinburgh on 24 April 1883 and graduated MB ChB with first class honours from Edinburgh University in 1905. In 1910 he was awarded the gold medal for his MD thesis Reproduction of the Human Female, later published as a book. He self-funded cancer research, suggesting that a form of ‘pleomorphic bacterium’ isolated from 34 human cancers might be carcinogenic; it would be more than 50 years before the herpes virus was suggested as the cause of cervical cancer. However, he found more acceptance of his research into the causes of eclampsia, considered to be ‘a poison or toxin’ released by infarctions in the placenta (hence the term ‘pre-eclamptic toxaemia’). His comprehensive review of the topic was published in the Journal of the Royal Society of Medicine in 1914, following which his studies were interrupted by involvement in military campaigns in Gallipoli, Egypt, Palestine and France, about which he wrote a book, With the 52nd division in three continents. He reached the rank of lieutenant colonel, was twice mentioned in dispatches and in 1919 was awarded the Distinguished Service Order. He developed his clinical practice in the Edinburgh Royal Infirmary and the Simpson Memorial Maternity Hospital. His 1929 paper in the British Medical Journal highlighted the recurrence of pre-eclampsia in successive pregnancies; he concluded that ‘in view of the large risk of recurrence the need for antenatal supervision from an early stage in the event of the subsequent pregnancy should be clearly explained to the patient’. More controversially, he opined that ‘toxaemia in two or more pregnancies is an indication for the prevention of any further pregnancy’. In 1934 he was elected to a professorship in the University of London at the newly created British Postgraduate Medical School at Hammersmith (later to become the Institute of Obstetrics and Gynaecology), subsequently concentrating on training, teaching and writing. In 1937 he was appointed assistant editor of our Journal, becoming joint Editor in 1943 and Editor-in-Chief from 1946 until 1963 – a record for editorial longevity. His Textbook of Gynaecology ran to 11 editions. His administrative responsibilities included being Governor of the Imperial Cancer Research Fund and Chairman of the Scientific Advisory Committee of the National Birthday Trust. He was elected honorary Fellow of the American Association of Obstetricians and Gynecologists and a corresponding Fellow of the German Gynaecological Society. He piloted the Journal through its acquisition by the Royal College of Obstetricians and Gynaecologists in 1950 (following which, for the first time, the editor was paid a salary), was widely read and wrote in a literary style that contrasts with the minimalist orthodoxy of modern scientific writing. He regarded fundamental experimental investigations as ‘gold compared with the trash of case records…while an intensive study of ten cases may be rewarding, the study of 1000 cases of the same condition is in its nature likely to be perfunctory and sterile’. A strict but kindly man, he enjoyed sharing music with his wife, daughter, stepdaughter and two stepsons. He died in the year that he demitted office as Editor. None declared. Completed disclosure of interests form available to view online as supporting information. Image is available online as supporting information to the article.

Etiological Factors&amp; Clinical Courses of Birth Asphyxia in Rural and Urban Population of Kishanganj District.

Problem statement : perinatal asphyxia, neonatal or birth asphyxia is a medical condition from deprivation of oxygen to a newborn infant long enough during the process to cause physical usually to the brain. And it is almost all neonatal deaths occur in our rural and urban area. Where the majority is delivered at homes with negligible antenatal care and poor prenatal services.Methods: In this collaborative study conducted prospective, descriptive study. As a case of 150 newborn babies and as a control 1190 newborn babies are fulfilled the selection criteria for prenatal and birth asphyxia .Results: Incidence of birth asphyxia in relation to ante partum and intrapartum factors. And shows that mother with complication like eclampsia, APH, PROM, cord accidents, failed progress of labor, obstructive labor &amp; prolong 2nd stage of labor, etc were more likely to deliver asphyxiated baby, and analysis of maternal risk factors for birth asphyxia. Many pathological, biochemical &amp; metabolic changes occurs as a result of birth asphyxia. And the data were analyzed by slandered statistical test, namely, Z test, Chi square test, and uniovariate and ultivariate logistic regression analysis of risk factor.Conclusion: In our study it was observed that, Pregnancy related complication in rural &amp; urban population of Kishanganj district was mostly Eclampsia, pre-eclamptic toxaemia, Oligohydramnios, PROM(M24hr) etc. To prevent birth asphyxia trained personal and neonatal resuscitation equipment should be mandatory in all maternity home/hospital because prevention is the best and be only option to reduce the Pre natal &amp; birth asphyxia.Bangladesh Journal of Medical Science Vol.16(4) 2017 p.554-556

A prospective comparative study of cesarean section in multiparous and primiparous women

To compare the indications for caesarean section in multipara and primipara, to compare the maternal morbidity and mortality, to study the incidence of perinatal mortality and to correlate the birth weight with multiparty.100 patients were selected at random for a thorough clinical study. The study was conducted for a period of 1 year i.e 2015-2016, in KMC Hospital Mangalore, Karnataka. The sample comprised of 50 cases of multiparous women undergoing caesarean section for the first time (30 cases grand multiparas and 20 cases of multiparas) 50 primigravida’s were included in the series for comparative study, the women admitted into the obstetric ward. Out of 208 deliveries the incidence of caesarean section is 48.4%. Most common age group is 26-30Yrs age group is multiparous women 16(32%) cases and in primiparous are of age 20-25 yrs are 14(28%) cases . 11 case (22%) of multis had elective caesarean section compared to 28 cases (56%) of primis. 39 cases (78%) of multies had emergency caesarean section as compared to 22 cases (44%) of primis. Most of caesarean section in multiparous were performed for maternal indication. incidence of elective and emergency LSCS in multie and primies was found to be very highly significant (p=0.0005). Antepartum haemorrhage was principle indication for all caesarean section in 23 cases (grand multi-6cases, muliti-5 and primiparous 12 cases) (23%). Cephalopelvic disproportion is more common in primiparous women. Hypertension and anaemia were common in multiparous women. Preeclamptic toxaemia and anemia in primiparous women are common. 4 cases of cesarean section were done for foetal indications in multiparous women. There were 3 cases of foetal morbidity, 1 due to Respiratory Tract Infection, 1 had jaundice and 1 had umbilical sepsis. There was only one neonatal death due to accidental haemorrhage. Wound infection and urinary tract infection was common in multiparaous women. Sub involution of uterus was seen more in primigravidas. It can be concluded that women who had previous uneventful labours, may have different complications during subsequent pregnancy and due importance should be given to each pregnant mother.

The causes of early neonatal death in Sulaimani Intensive Care Unite at Maternity Teaching Hospital between Jan 2016 - Feb 2017

Early neonatal death refers to all deaths of liveborn infants occurring on or before the first seven days of life. There is a shortage of research on the specific causes of early neonatal death. This study has been conducted in order to assess causes of early neonatal death in Sulaimani's Neonatal Intensive Care Unit at Maternity Teaching Hospital. Information was obtained retrospectively from the patients’ medical records, including (Mother and neonate socio-demographic, Maternal, Fetal and labor causes of death). Generally, this study found that in 2016 out of total 18.573 recorded delivery, 168 early neonatal deaths were analyzed from January 2016 to February 2017. However, this number was declined in comparison to the data of 2015, which estimated around 244 early deaths out of 21.142 total births. The mean age of mothers was ranged (28.22 ±7.69), 73.2% of neonate mothers were multi gravid with 67.3% of them delivered through normal vaginal, The majority of early neonate death was happening in the mean expected date delivery of (28.64 ± 2.90) weeks, with mostly weighing 700- 1.10 gm. Regarding the maternal causes, more than a quarter of the mother had Preeclamptic toxemia followed by (25% antepartum hemorrhage, 22.6% diabetes, respectively), In terms of the fetal causes, more than three-quarter of neonate were dead because of prematurity and the majority 85.2% were deceased because of the respiratory distress syndrome. Almost no labor causes. The study also found that there is a significant association between gravidity, mode of delivery and maternal cause in p value &lt; 0.05. However, that relationship was not found to fetal cause. Moreover, there is also no significant relationship between fetal cause and (Age of mother, Expected date delivery and fetal weight) in p-value &gt; 0.05 accept the gender of the neonate. In conclusion, some factors affecting early neonatal death have been identified in this study special care is essential for these children in order to reduce their mortality rates.

A study of labour outcome in breech delivery

Aim: Breech is the most common form of malpresentation. It is defined as when foetus occupies a longitudinal lie with the pelvic extremity at the pelvic brim and head at the fundus of the uterus. The present study was conducted on 100 cases of breech presentation to find out the labour outcome in breech deliveries and various factors affecting it. Materials and Methods: The present study was conducted in the Department of Obstetrics and Gynaecology, Umaid Hospital, attached to Dr. S.N. Medical College, Jodhpur. A total of 100 cases of breech presentation including single as well as plural pregnancies in which one or more foetuses were presenting as breech were taken. Both booked and unbooked cases in primigravidae and multigravidae were studied. The cases were selected at random among those who got admitted in labour room. Results: In the present series, incidence of breech deliveries came to be 4.1094%. Incidence of breech presentation was maximum (45%) in the age group of 21–25 years. In this study, out of 100 cases, 62 were multigravidae and 38 were primigravidae, and 43 cases (43%) were associated with factors which endanger of life of the foetus, among which twin pregnancy and pre-eclamptic toxaemia were the most commonly associated factors. In the present series, among 100 cases studied, 14 were breech babies and congenital malformation, of which hydrocephalus was the most common malformation found. Conclusion: The study concludes that prematurity is associated with high incidence of breech presentation. The most common variety of breech presentation is flexed breech, which is found more in multigravidae. Caesarean section is the mode of delivery of choice as it carries minimal foetal loss. Extended variety of breech is safest for the baby and carries minimal foetal loss.