Research and Publication Paper
Department of Obstetrics and Gynecology
Dr. B L Rad
1. Maternal Adiposity Deliver Adverse Perinatal Consequences
Aim and Objective: To compare perinatal outcome of maternal adiposity to normal BMI Women. Material And Method: This is hospital based prospective study .results-a fatty women deliver more Macrosomic baby, need more NICU admission, more birth trauma, more hospital stay, more congenital anomaly baby, low apgar at 5 minite.
Keywords: BMI, NICU, maternal adiposity.
A maternal adiposity or fatty women problem increasing worldwide. Confidential EnquiryIn to Maternal and Child Health (CEMACH) 2004 report that in India every fifth pregnant women is fatty . Economic, technologic, and life style changes have created an abundance of cheap, high- calorie food coupled with decreased required physical activity. We are eating more and moving less. There is evidence for metabolic dysregulation among fatty women that has been linked with a number of possible environmental factors, including contaminants from modern industry. Maternal adiposity is a significant public health concern and is likely to remain so for the foreseeable future. Maternal health can have a significant impact onthe in utero environment and, thus, on fetal development and the health of the child later in life .
According to the in utero fetal programming hypothesis (Barker hypothesis), size at birth is related to the risk of developing disease later in life.2 Although the Barker hypothesis originally focused on low birth weight, there is evidence that high birth weight may have its own set of complications later in life.
A link between maternal adiposity problem in the first trimester and obesity in children has been demonstrated. Birth weight has also been shown to be directly correlated with body mass index (BMI) later in life3.Maternal adiposity is associated with abnormal fetal growth. Women who are heavier are less likely to have a pregnancy complicated by a small-for-gestational age infant or intrauterine growth restriction, but this protective effect appears to dissipate once the maternal BMI reaches the level of obesity (> 30 kg/m2). The major concern in obese pregnant women is fetal macrosomia (defined as an estimated fetal weight of greater than or equal to 4500 g), which appears to be increased 2- to 3-fold in obese .
Maternal obesity is associated also with an increased risk of neural tube defect (NTD) in the offspring, even after controlling for ethnicity, maternal age, education, and socioeconomic status. Parturients  To being larger, infants born of pregnancies complicated by GDM also have significantly larger skin folds at all areas of measurement (triceps, subscapular, flank, thigh, abdomen) and, as such, are at increased risk of shoulder dystocia and resultant birth injury leads to high NICU admission and hospital stay. In neonates, maternal obesity is associated with increased risk of stillbirths, prematurity [6-8] and associatedrespiratory distress in near term neonates.so timely physian adivice of prepregancy weight control through diet and exercise we can reduce this above morbidties. On a positive note, a recent survey of 900 obstetrician-gynecologists by The American College of Obstetricians and Gynecologists showed that 80% routinely counsel their pregnant patients about weight control, although only 35% believe that such prenatal counseling will significantly affect the incidence of obesity.
AIMS AND OBJECTIVES : To evaluate maternal adiposity and their effect on perinatal outcome To timely consider intervention on maternal adiposity and prevent perinatal morbidity
2. A STUDY OF EFFECT OF HIGH BODY MASS INDEX ON WOMEN IN TERM OF INTERTILITY AND EARLY PREGNANCY LOSS
Dr. Mool Chand (Khichar Assistant Professor Obstetrics And Gynecology,sp Medical College Bikaner)
Dr. Bajarang Lal Rad (Senior Specialist Doctor In Obstetrics And Gynecology SK Hospital Sikar) Corresponding Author
Aim and objective- a comparative study of effect of high mass index on women fertility and early pregnancy outcome.
Material and method-hospital based comparative longitudinal study
Results- A high BMI women more prone to early pregnancy losses and infertility.
High body mass index is emerging problem in modern world
due to unhealthy lifestyle changes and stressfull environment
conditions. Got a healthy baby for mother is a miracle in this
world .so modification in our lifestyle and healthy food intake
we can change our body mass index in normal side and
pregnancy outcome. Her simply high body mass index means
obese women. According to WHO, a global pandemic of
obesity is unfolding. Obesity is a growing global health
problem resulting in new challenges for all healthcare
professionals, especially those working with pregnant
women and neonates. Worldwide, in 2014 an estimated 1.9
billion adults are overweight and 600 million adults are
obese. At the current rate of increase , by 2015 , it is
expected that there will be 2.3 billion overweight and more
than 700 million obese adults worldwide.National Family
Health Survey system 2005-6 states that the percentage of
married women aged between 15-49, who are overweight or
obese increased from 11% in NFHS-2 (2003-04) to 15% in
MATERIAL AND METHOD
This hospital based comparative longitudinal study with follow-up was conducted in Department of Obstetrics and Gynaecology, SMS Medical College, Jaipur during the year 2013 to Dec 2014. Study comprising of 150 pregnant women as 2 study group (BMI >30 kg/m ) and 150 pregnant women as 2 control group (BMI 18.5 -24.9 kg/m ). INCLUSION CRITERIAAll nullipara pregnant women. EXCLUSION CRITERIAMedical disorder like chronic hypertension, anemia, pre pregnant diabetes ,Scarred uterus Placenta previa and vasa previa,Cardiovascular disease Multipara Multiple pregnancy.
Table – 1: Distribution of Cases According to Age
Mean age was 23.29 ± 3.58 years in obese group compared to
22.47 ± 2.79 years in control group that is statistically
significant. 25.33% patients in obese group were ≥26 yrs
compared with 14% in control group. Difference was
statistically significant (P-value < .05). This could be due to the
age related weight gain in these patients.
3. A STUDY OF ENDOMETRIAL THICKNESS IN TRANS VAGINAL SONOGRAPHY IN RELATION WITH HISTOPATHOLOGY REPORT IN DILATION & CURRATAGE IN AUB WOMEN
Dr. Bajarang Lal Rar
Senior Specialist In Obstetrics And Gynae At Sk Hospital Sikar Corresponding Author
A study of of endometrial thickness on TVS in relation with histopathology report on dilation and curettage.
AIM AND OBJECTIVE-To set a cut off limit of endometrial thickness on TVS for differtiating between normal and abnormal endometrium.
MATERIAL AND METHOD- hospital based comparative study.
RESULTS-TVS is non invasive ,simple first line procedure in AUB women. Mean endometrial thickness in normal endometrial group was 8.00±2.44 mm and in abnormal endometrial group was 15.16±33 mm. The difference was found highly significant (p value<.001).
Abnormal uterine bleeding (AUB) is a common problem
which account for more than one fifth of all visits to outpatient
1,2 door and more than one fourth of all hysterectomies
.Abnorma l uterine bleeding is excessive, prolonged ,
unexpected or acyclic bleeding regardless of cause or
diagnosis, not only affects the quality of life such as intimate
relationships, day to day living but can have serious adverse
consequences like anemia or malignancy. Abnormal peri
menopausal bleeding should always be taken seriously and
properly investigated, no matter how minimal or persistent
.Perimenopause” include the period immediate prior to
menopause (when the endocrinological , biological and
clinical feature of approaching menopause commences )and
first year after menopouse. Evaluation of abnormal uterine
bleeding in perimenopause women is challenging because
waxing and waning function of ovary produces change in the
ministration pattern .Durin last decade various methods to
perimenopausal bleeding evaluation are transvaginal
sonography (TVS),endometrial biopsy, dilatation&curettage
and hysteroscopy.Diagnostic procedures obtaining material
for histopathlogy assessment (e.g.D&C, ,hysteroscopy,and
endometrial biopsy )can be more accurate but are also more
invasive and need anesthesia.TVS is simple method of
visualization of clear endomerium. TVS can be safely used as
an initial investigation in the management of AUB as it a non
invasive method for detection of endometrial pathology with
3.4 no need of anesthesia. No need of full urinary bladder as
compared to trans abdominal USG .TVS is prefferd in obese
patients , patients with extensive anterior abdominal wall
scarring and retroverted uterus . Thus, currently available
4 modalitie s are far from being perfect . Ability of TVS for
screening the lesions within the endometrial cavity is limited.
The finding of a thickened central endometrial complex seen
on TVS is often non-specific and may be caused by an
endometrial polyp,submucosal fibroids, endometrial
hyperplasia, carcinoma, or cystic atrophy. Focal lesions are
underdiagnosed at TVS because of limitations of the double-
5 layer thickness evaluation Disadvantages of TVS –Limited
transducer movements inside the vagina,Absence of sound
enhancement as seen withthe filled urinary bladder in
transabdominal sonography Unable to distinguish between
6 benign proliferation ,hyperplasia, polyp and malignancy .
AIM AND OBJECTIVE-
1. Set a relation endometrial assessment by TVS with
histopathology report obtained by D&C. 2. Deciding a cut off limit of endometrium thickness to reduce unnecessary diagnostic invasive curettage and hysteroscopy procedure.
MATERIAL AND METHOD
The present study was conducted in department obstetrics & gynecology, zenana hospital attached to s.m.s,medical college,jaipur .Study period was 2012-13 Case collection :- OPD and indoor cases taken.A total of fourty cases were taken.
Any patient above the age of fourty yrs with history of abnormal uterine bleeding.