A Comparative Study on Feto-Maternal Outcome of GDM Treated by Either Insulin or Metformin

Background: Gestational Diabetes Mellitus (GDM) is linked with amplified risk of variety of maternal and perinatal complications. There have been a number of studies comparing metformin with insulin in the management of GDM. Methods: A clinical trial (Quasi experimental) was conducted on fifty women with GDM at their 24 – 34 weeks of gestation with the aim to compare maternal and perinatal outcomes treated by either insulin or metformin. The study population were recruited from obstetrics and gynaecology outpatient department of Medical College for Women and Hospital, Uttara, Dhaka, from July 2012 to December 2012.The patients were divided into two groups (nonrandomized), 25 patients in each, and were subjected to either injection insulin or oral metformin medication. Results: The patients were grouped as insulin or metformin group. They were compared in terms of age, parity and developing maternal complications like preeclampsia (p=0.24), UTI (p=0.40), polyhydramnios (p=0.70). However, the incidence of preterm birth was higher among metformin group in comparison to insulin group (P=0.007).There was no significant difference between insulin and metformin group as regard to mode of delivery. The proportion of neonatal hypoglycemia in insulin group was higher than metformin group (P=0.46) but statistically not significant. Other neonatal outcomes such as macrosomia, birth asphyxia and hyperbillirubinaemia did not differ significantly between two groups. Conclusion: In women with GDM, treatment with metformin is associated with higher proportion of preterm birth than with insulin. Proportion of neonatal hypoglycemia is higher with insulin use. Bangladesh J Obstet Gynaecol, 2019; Vol. 34(1): 8-14

Abstract Vol.32(2)

Not Available Bangladesh J Obstet Gynaecol, 2017; Vol. 32(2) : 128-129

Maternal Weight Gain and its Relationship with Birth Weight of Baby at Term

Background: Perinatal health is influenced by maternal weight gain. Increase in obesity in population and excess weight during pregnancy may be different complications including large for gestational age fetus. As a result cesarean delivery has increased in prevalence. Maternal weight gain during the 2nd and 3rd trimesters is an important determinant of fetal growth Objective: To determine the relationship between maternal weight gain and birth weight of baby at term. Methodology : A cross sectional study was carried among 50 pregnant women at term in the Department of Obstetrics and Gynaecology, Shaheed Suhrawardy Medical College and Hospital and Anwer Khan Modern Medical College Hospital during the period of January 2013 to July 2013. Data were collected in pre-designed data collection sheet. Results: This study found maximum (36%) were age group 21-25 years followed by 28% were ≤20 years, 24% were between 26-30 years, 8% were between 31-35 years and only 4% were of 36-40 years. The average age was 25 years. Among these 50 pregnant women, 2 cases (4%) had BMI < 18.5, 15 cases (30%) had a BMI 18.5-24.9, 19 cases (38%) had a BMI 25-29.9 and 14 cases (28%) had a BMI ≥30. The mean birth weight was 2.77±0.33. kg. Mean weight gain was 10.72±3.72 Kg. Conclusion: This study showed that reasonable maternal weight gain significantly increased birth weight of the baby at term. Bangladesh J Obstet Gynaecol, 2017; Vol. 32(2) : 79-83

A Study on Management of Premature Rupture of Membranes (PROM)

Background: Premature rupture of membranes (PROM) is a common obstetric complication. Knowledge of etiopathogenesis, diagnosis, complications & management of PROM has increased due to extensive research in the recent past. Yet, there is no unanimous opinion regarding optimum management of PROM. The aim of the study was to observe the patients during labor and compare the latent period, duration of first stage of labor, modes of deliveries and the use of oxytocin and its outcome in PROM cases with controls. Materials and methods: In this study, the definition of PROM used is – rupture of fetal membranes before the onset of true labor pain. The minimum gestational age was taken to be 28 weeks. Diagnosis of PROM was mainly clinical. A cohort study was conducted in the Dept. of Obs & Gynae of KPL Medical College & Hospital, Kolkata on 100 cases of PROM and 100 cases of comparison group, over a period of one year. Results: It was observed that onset of labor was more rapid with increasing gestational age, use of oxytocin for induction & augmentation of labor & operative deliveries were higher in PROM cases. Conclusion: Individualized management of PROM cases depending on the gestational age and risk of complications is the best way to achieve a good feto-maternal outcome. Bangladesh J Obstet Gynaecol, 2017; Vol. 32(2) : 94-98

Society News Vol.32(2)

Not Available Bangladesh J Obstet Gynaecol, 2017; Vol. 32(2) : 130-132

Relationship of Age and Different Histological Types of Ovarian Tumors

Background: Ovarian tumours are common problem in gynaecology and have varied age of appearance of different histopathological types. Objective: This study was undertaken to find out the relationship of age and different histological types of ovarian tumors Methods: A retrospective study was carried out in the Department of Obstetrics and Gynaecology and Department of Pathology, Sir Salimullah Medical College and Mitford Hospital, Dhaka, during May 2010 and December 2014. Five hundred forty seven (547) cases of ovarian tumours were studied in respect to their age and histopathological appearance. Results: The range of age of patients with ovarian tumour was 11 – 82 years. About 63% malignant and 73% benign ovarian tumours were found in the age group of 20 – 49 yrs. About 31% malignant ovarian tumours and 15% Benign tumours occurred in menopausal woman (≤50 yrs.). Overall, mean age of presentation of ovarian tumours was 34.29± 12.84 yrs. Mean age of patients with malignant ovarian tumour was 40.29± 14.28 (median 40 yrs; mode 45 yrs.). Mean age of benign ovarian tumour was 34.69 ± 13.08 (median 34 yrs; mode 40yrs) and mean age for borderline tumours 32.75 ± 11.70 mm (median 33 yrs., mode 20 yrs.). Mean age of non tumour ovarian masses / cysts was 31.14± 10.76 yrs (median 29.5; mode 25.4). The difference of mean age of occurance of malignant and benign ovarian tumours were statistically significant P<0.00>. Dysgerminoma (mean age 23.5± 4.43) and yolk sac tumour (mean age 18 .00 ± 5.00 yrs) occurred in younger patients. Serous cyst adenocarcinoma, endometriod carcinoma and poorly differentiated carcinoma occurred around 45 years of age. Mean age of presentation of most of the benign ovarian tumours was between 30 – 37 yrs.; except thecoma which occurred in extremes of age. Conclusion: Most of the patients with malignant and benign ovarian tumours have presented in reproductive age adult women (20 – 49 yrs.); and some specific varieties of tumour (e.g. thecoma) presented in the extremes of age. Bangladesh J Obstet Gynaecol, 2017; Vol. 32(2) : 99-105

Serum Uric Acid Level in Preeclamptic Women Determine the Severity of Preeclampsia

Background: Serum uric acid is a relatively insoluble metabolite of purine metalolism which is mainly secreted by the kidneys and the rate is dependant on renal blood flow . It increases in preeclampsia and studies show it may be marker of severe preeclampsia. Methods and materials: This cross sectional study was conducted in Dhaka Medical College Hospital in eclampsia ward of gynae & Obs department during the period from January 2010 to December 2011 with the objective to determine the serum uric acid level in preeclampsia, to compare the serum uric acid level between mild and sever preeclampsia and to find out any relationship of the serum uric acid level with hypertension in preeclampsia. The study group composed of 92 diagnosed case of preeclampsia patient. Out of the 92 cases, 42 had mild preeclampsia (group-A) and 50 had severe preeclampsia (group B). Result: The results of the study showed that the mean serum uric acid level was significantly higher in severe preeclampsia (6.91+1.02) compared to mild preeclampsia (4.99 + 0.80) and there is a positive and significant relationship of serum uric acid level with severity of hypertension in preeclampsia (p<.0001). Conclusion: There is significant association between serum uric acid level and severity of hypertension in Preeclampsia. Bangladesh J Obstet Gynaecol, 2017; Vol. 32(2) : 67-72

Risk Factors and Outcome of Preterm Labour in Tertiary Health Centre

Background: Currently preterm labour is one of the most challenging problems confronting the obstetricians and perinatologists. This unfortunate episode accounts for 50-75% of the perinatal mortality. Methods: A cross sectional study was conducted on 210 pregnant women with preterm labour admitted in Monno Medical College Hospital, Manikganj from June 2014 to December 2015, to study the causes and outcome of preterm birth in Tertiary health centre of Manikganj. Results: Occurence of preterm birth was 13.82%; 47.14% occured between 34-37 weeks of gestation; 33.80% occured 31-33 weeks of gestation and occurred in 28-30 weeks 19.04%. About 22% patients presenting with preterm labour had a past history of abortions and 14.3% had a history of preterm delivery. Premature rupture of membranes was found to be the most common risk factor related with preterm labour in the present pregnancy. Genitourinary tract infection was the next important risk factor of preterm labour; 24.8% (86) patients had either vaginal infection (19.5%) or urinary infection (21.4%) or both. Another important risk factor identified in this study was antepartum haemorrage which was cause in 11.4 % cases. Preterm babies commonly suffered from various complications like jaundice (32.1%), respiratory distress syndrome (22.6%), asphyxia (13.5%), sepsis, hypoglycemia and coagulopathy. Conclusion: Most of the preterm births occured between 34-37 weeks of gestation. Most common risk factors of preterm births are history of abortion and preterm delivery in previous pregnancy; PROM UTI vaginal infection, PIH and APH in correct pregnancy. Newborn jaundice, RDS and birth asphyxia are the common neonatal morbidity in preterm labour. Identifying risk factors to prevent the onset of preterm labour and advanced neonatal care unit can help decrease neonatal morbidity and mortality. Bangladesh J Obstet Gynaecol, 2017; Vol. 32(2) : 90-93

Aspirin to Prevent Preeclampsia

Background: Pre-eclampsia is a major cause of mortality and morbidity during pregnancy and childbirth. There are recommendations on use of medications to prevent preeclampsia, including low dose aspirin. Objective: The objective of this review is to discuss role of aspirin in reducing the incidence and maternal mortality and morbidity due to preeclampsia including its dose and duration of use. Methods: Review of available literature in internet and from libraries. Results: Four large randomized trials have demonstrated a reduction in the incidence of preeclampsia in patients treated with low-dose aspirin prophylaxis compared with placebo/ no treatment (15 versus 19 percent, 18 versus 20 percent, 6.7 versus 7.6 percent, and 1.6 versus 4.3 percent); however, the results were statistically significant in only the last trial. When data from these and other trials were pooled, meta-analyses supported the significance of the trend observed in individual trials. When begun early in the second trimester, use of low-dose aspirin (75-150 mg) reduced the incidence of preeclampsia by at least 10 percent, with the greatest absolute benefit in women at moderate to high risk of developing the disease. Serious sequelae of early onset preeclampsia, such as preterm birth and fetal growth restriction, were also reduced. Conclusion: Low-dose aspirin reduces the frequency of preeclampsia, as well as related adverse pregnancy outcomes (preterm birth, growth restriction), by about 10 to 20 percent when given to women at moderate to high risk of the disease. It has an excellent maternal/ fetal safety profile in pregnancy. WHO recommends Low-dose acetylsalicylic acid (aspirin, 75 mg) for the prevention of preeclampsia in women at high risk of developing the condition; should be initiated before 20 weeks of pregnancy. It should be taken preferably from 13th week of pregnancy, daily, regularly and may be discontinued 5 to 10 days before delivery. Bangladesh J Obstet Gynaecol, 2017; Vol. 32(2) : 106-116

Evaluation of Nitric Oxide Concentrations in Preeclampsia and Normal Pregnancy

During pregnancy Nitric oxide is one of the most important relaxing factors for myometrium and also in the control of blood flow in uterus and placenta. Nitric oxide is generated by endothelial type II nitric oxide synthase (NOS) and acts as a vasodilator. Objective:To investigate the level of nitric oxide (NO) production in pregnancies complicated by preeclampsia and in normal pregnancy. Materials and Methods: A case control study was undertaken in Department of Gynaecology and Obstetrics of Bangabandhu Sheikh Mujib Medical University (BSMMU), from january to july 2014. The study population was pregnant women having preeclampsia and normal pregnancy who attended the OPD Department of Obstetrics and Gynecology in BSMMU between 29 to 40 weeks of gestation. As because of transient and volatile nature of nitric oxide, it was unsuitable to measure the nitric oxide level by conventional method. However, two stable break down product, nitrate (NO3 -) and nitrate (NO2 -) could be easily detected by sprectophototric means. Nitrate (NO2 -) was first converted to Nitrite (NO3 -) by reduction process using cadmium. Then concentration was measured by using Griess reagent in UV sprectophototric machine. This procedure was done in the Biochemistry Department, Dhaka University. Results: The mean nitrite level was found 18.37}3.64 mol/L in case group and 25.57}2.11mol/ L in control group, which was significantly (p<0.05) higher in control group. The mean serum creatinine level was found 1.19}0.28 mg/dl in case group and 0.65}0.1 mg/dl in control group. The mean serum creatinine level was significantly (p<0.05) higher in case groups. Nitrite level had no correlation with onset of hypertension (r=-0.006; p=0.966), onset of proteinuria (r=0.071; p=0.623), systolic blood pressure (r=0.012; p=0.933), diastolic blood pressure (r=-0.159; p=0.269) and urine protein (r=0.047, p=0.748). Conclusion: As pregnancy progressed there was a decrease in plasma nitric oxide levels in preeclampsia. Urine uric acid to creatinine ratio increased with the decrease in nitric oxide levels and can be used as a marker for preeclampsia. Bangladesh J Obstet Gynaecol, 2017; Vol. 32(2) : 60-66