European Journal of Molecular & Clinical Medicine

Background: Preeclampsia isa state of insulin resistance. Insulin resistance features like
Hypertension, hyperinsulinemia, glucose intolerance, and lipid abnormalities are
associated with pregnancy-induced Hypertension.
Aimsandobjectivesofthestudy:
1. Tostudyinsulinresistanceinwomenwith pre-eclampsia.
2. TocompareandevaluatetheroleofmeasuringIR amongwomenwith
preeclampsiaandnormalpregnancy.
Methodology: AProspectiveandobservational one year study conducted in
GovernmentGeneralHospital.Kurnool. Atotalof 50Womenwith
preeclampsiaand50women withnormalpregnancy. Women were instructed for 12hrs
overnight fasting about 2ml of venous blood was collected in a
fluorideethylenediaminetetraacetic acid vial using proper aseptic precautions. Plasma
was separated by centrifugationand usedforestimationof
plasmaglucoseandplasmainsulinlevels. Values are presented as mean ± standard deviation
(SD) and the statistical analysis was done using SPSS 17.0software. Student’s unpaired ttest
was used for comparison of parameters between two groups. The p-value
oflessthan0.05was consideredas statistically significant.

Background:Hypertension is a prevalent and serious disorder that can cause or
exacerbate many health issues. Blood pressure is directly associated to cardiovascular
disease and mortality. Stroke, MI, angina, heart failure, renal failure, and
cardiovascular mortality are all linked to BP. As a result, hypertension is often referred
to as "the silent killer." The study's aim is to assess maternal morbidity and mortality
in pregnant women with pregnancy-induced hypertension. Birth weight, Apgar score,
NICU admission, prenatal morbidity and mortality.
Materials and Methods: During two years, pregnant women aged 21 to 40 weeks were
studied at Govt Medical College &Hospital Nalgonda (July 2019-July 2021). An 80-
patient study. The institutional ethics committee review board approved. Each patient
had a comprehensive history, clinical examination, and proforma. In all instances, the
length of hospital stay, patient recovery, perinatal outcome (birth weight, Apgar score,
NICU admission), and perinatal morbidity and mortality were examined.
Results: he present investigation found that unbooked cases had more severe
preclampsia and eclampsia. Preeclampsia patients who had not had routine prenatal
care were 40 percent unbooked. Unbooked cases have increased maternal and perinatal
mortality. In this study, 40% of NICU admissions were due to LBW/asphyxia. Overall,
50% of newborns were born underweight. PIH was a prominent cause of iatrogenic
premature birth.
Conclusion: 100% registration of pregnant women and good quality antenatal
treatment including weight, blood pressure, and urine analysis with adequate referral
mechanism to tertiary care centres.All family physicians and medical officers need to be
advised to follow a standard management protocol in a case of preeclampsia and
eclampsia with an awareness for prompt referral of women who require to be managed
by specialist. Every tertiary care centre must have specialised expertise. Though PIH is
not preventable, adequate ANC care can slow its progression and timely intervention
can significantly improve perinatal outcomes.

Background: To determine the clinical value of first trimester and second-trimester
uterine artery Doppler indices in the prediction of adverse pregnancy outcome
(preeclampsia, IUGR, unexplained stillbirths).
Materials &Methods:This was a prospective study in which uterine artery Doppler was
performed at 22-24 weeks of gestation 100 high-risk women attending antenatal OPD at
Dr psims & rf in the first trimester between 11 to 13 weeks6days POG for early
pregnancy scan and uterine artery Doppler, followed with second-trimester uterine
artery doppler at the time of anomaly scan 18 to 20weeks from June 2019 to June 2020.
Results: Among the high-risk women in the present study the risk factors are chronic
hypertension (40%), precious pregnancy (10%), overt DM (12%), previous history of
preeclampsia (15%),RPL(10%),SLE (7%), twins (3%), oligohydramnios (3%).
Abnormal uterine artery Doppler indices had the highest sensitivity (100.0%) for
predicting preeclampsia in the mother and the lowest sensitivity (51.4%) for predicting
preterm. For predicting pre-eclampsia, IUGR, neonatal mortality, preterm the
sensitivity of RI was 100%,85.7%,83.3%,51.4% respectively, and the specificity was
92.3%,100%,95.8%,100% respectively. Overall, 35 (35.0%) women had a preterm
delivery, 16 (36%) had a cesarean delivery, and 19 (61%) had a spontaneous vaginal
delivery. Among the preterms, 18(51.4%) died due to prematurity and its associated
complications. The positive predictive value of abnormal uterine artery Doppler was
highest for preeclampsia (36.84%) among all adverse pregnancy outcomes assessed.
Conclusion: Uterine artery Doppler ultrasonography at 22-24 weeks of gestation is a
significant predictor of at least one adverse pregnancy outcome, with the highest
prediction for preeclampsia.

BACKGROUND: Gestational Diabetes mellitus (GDM) is defined as Glucose
Intolerance, the valuesof plasma glucose falling in the range of Diabetes which is
observed and detected for the first
timeduringsecondorthirdtrimesterofpregnancy.GDMisquite
oftenassociatedwithhighermaternalandneonatalmorbiditiesin theshort andlong-term
andpredisposesbothwomen andchildto laterdevelopment of type 2 Diabetes
OBJECTIVE OF THE STUDY: the objective of our study is
tocomparematernalandneonataloutcomesinGDMpatientswhoareonmetforminandinsulin.
MATERIALS &METHODS: the study on evaluation of metformin versus insulin
therapy in themanagement of gestational diabetes was conducted in dept. of OBG Adesh
Institute of
MedicalSciences,Ambalaafterobtaininginstitutionalethicalcommitteeclearanceforaperiod
ofoneyearfromJanuary 2021 to December 2021 in the age group of 26-35 years.
Maternal and neonatal outcomesrecorded include: maternal: incidence of pre-eclampsia,
PIH, neonatal outcomes include: macrosomia,birth weight, the incidence of small for
gestational age, prematurity, Apgar score at the age of 5 min,hypoglycaemia. We also
compared the mode of delivery (spontaneous, assisted or caesarean section)between the
two groups. RESULTS & CONCLUSIONS: It is quite evident from in our study
thattherewerenostatisticallysignificantdifferencesinboththegroupswithrespecttomaternalc
omplications, mode of delivery and neonatal complications. In our study, we found that
the oral antidiabetic medication metformin is equally effective as insulin in the treatment
of GDM patients andwithout higher risks for maternal or neonatal complications.
However, further randomized clinicalstudies with large number of patients and with
long-term follow-up of children is needed to
determinetheroleofMetforminasanalternativetreatmenttoinsulinin GDMpatients

BACKGROUND: Gestational Diabetes mellitus (GDM) is defined as Glucose
Intolerance, the valuesof plasma glucose falling in the range of Diabetes which is
observed and detected for the first
timeduringsecondorthirdtrimesterofpregnancy.GDMisquite
oftenassociatedwithhighermaternalandneonatalmorbiditiesin theshort andlong-term
andpredisposesbothwomen andchildto laterdevelopment of type 2 Diabetes
OBJECTIVE OF THE STUDY: the objective of our study is
tocomparematernalandneonataloutcomesinGDMpatientswhoareonmetforminandinsulin.
MATERIALS &METHODS: the study on evaluation of metformin versus insulin
therapy in themanagement of gestational diabetes was conducted in dept. of OBG Adesh
Institute of
MedicalSciences,Ambalaafterobtaininginstitutionalethicalcommitteeclearanceforaperiod
ofoneyearfromJanuary 2021 to December 2021 in the age group of 26-35 years.
Maternal and neonatal outcomesrecorded include: maternal: incidence of pre-eclampsia,
PIH, neonatal outcomes include: macrosomia,birth weight, the incidence of small for
gestational age, prematurity, Apgar score at the age of 5 min,hypoglycaemia. We also
compared the mode of delivery (spontaneous, assisted or caesarean section)between the
two groups. RESULTS & CONCLUSIONS: It is quite evident from in our study
thattherewerenostatisticallysignificantdifferencesinboththegroupswithrespecttomaternalc
omplications, mode of delivery and neonatal complications. In our study, we found that
the oral antidiabetic medication metformin is equally effective as insulin in the treatment
of GDM patients andwithout higher risks for maternal or neonatal complications.
However, further randomized clinicalstudies with large number of patients and with
long-term follow-up of children is needed to
determinetheroleofMetforminasanalternativetreatmenttoinsulinin GDMpatients

Background: Obesity is one such pre-existing maternal morbidity that puts a pregnancy at risk. Maternal obesity is a frequent high-risk factor with substantial prenatal, intranasally, and postnatal problems. This study aimed to analyze maternal and fetal outcome in obese pregnant women (BMI more than 30) at our tertiary care teaching hospital.
Material and Methods: This study was prospective & observational study, conducted in pregnant women, gestational age > 28 weeks, with BMI > 30, delivering at our labour room. Maternal and neonatal outcomes were analysed.
Results: Among 453 pregnant women with BMI > 30kg/m², majority were from 19—25 years age group (45.1 %), 48.03% were primigravida, 82.33% had > 37 weeks of gestation. In the study group 78.43% were moderately obese, 15.69% were severely obese and only 5.88% were morbidly obese. Most common pre pregnancy medical disorder in obese women were preeclampsia (21.57 %), previous LSCS (20.59 %), severe anaemia (19.54 %), gestational diabetes mellitus (12.75 %), gestational hypertension (9.80 %) & multiple pregnancy (1.96 %). Common intrapartum events were Preterm labor (16.67 %), PPH (6.78 %), Abruptio placenta (4.90 %), Mal presentation Breech (4.90%) & Eclampsia(1.96%).63.71%of obese pregnant women delivered by normal vaginal delivery, 31.37% of obese pregnant women underwent cesaerian section & 4.90% of obese women were requiring instrumental delivery. Common indication for NICU admission were infant of diabetic mother (22.55 %), preterm (14.71 %), meconium aspiration (5.88 %), macrosomia (3.92 %), asphyxia (1.96 %) & transient tachypnia of new born (1.96%). No maternal or neonatal mortality observed in present study.
Conclusion: In obese pregnant women with BMI >30kg/m², higher incidence of gestational hypertension, preeclampsia, gestational diabetes mellitus, anaemia, malpresentation, cephalopelvic disproportions and hypothyroidism isnoted,

Background: To find correlation of clinical, hematological and biochemical parameters
in women with severe preeclampsia and maternal outcome and to study the maternal
and perinatal outcome in severe preeclampsia and.
Materials and Methods: The study was done in the Department of Obstetrics and
Gynaecology, Raichur Institute of Medical Sciences, Raichur. 140 patients with blood
pressure ≥ 160/110 mm of hg with proteinuria or Blood pressure ≥ 140/90 mm of hg
with proteinuria of ≥ 2+ were involved in the study. Statistical analysis was done by
applying chi-square.

Aim: To evaluate the fundus changes in patients withGestational
hypertension,preeclampsia oreclampsia.
Methods: All the patients who fulfilled the diagnostic criteria of Gestational
hypertension, preeclampsia or eclampsia(>20 weeks of pregnancy, high arterial blood
pressure of more than or equal to 140/90 , proteinuria more than or equal to
300mg/day or protein creatinine ratio more than or equal 30 mg/mmol or evidence of
maternal organ dysfunction or uteroplacental dysfunction , convulsions or coma) were
included in this study. After taking history for any eyesymptoms, anterior segment was
examined with torch light on the bed itself. Both pupils were dilated with 1%
tropicamide eye drops and fundus examination was done by ophthalmologist with direct
ophthalmoscope in a semi dark room in the ward. Hypertensive retinopathy changes
seen in right or left or both eyes, was taken as positive findings in that patient.
Results: A total of 100 patients were examined. The mean age of patients was 31.2±6.2
years (range 20-50 years). The gestation period ranged between 25 and 41 weeks. 45
(45%) were primigravidas , 33 (33%) were multigravidas and 22(22%) were
grandmultiparas. 41(41%) had mild preeclampsia, 56(56%) had severe preeclampsia
and 3(3%) had eclampsia. Retinal changes (hypertensive retinopathy) were noted in
58(58%) patients . There was statistically significant positive association between the
presence of retinal changes and blood pressure (P =0.001), proteinuria (P=0.021) and
severity of hypertensive disorders( P=0.027). However, age(P = 0.44), race ( P=0.89) and
gravida (P =0.37 were not associated with occurrence of retinopathy in our study.
Conclusion: Fundus examination in gestational hypertension , preeclampsia and
eclampsia is important in monitoring and managing cases as it correlates with severity
as it indirectly implies severity of changes in placental micro-circulation that can help to
predict the foetal outcome and ocular morbidity.

Background: Preeclampsia (PE) is a multisystem disorder that complicates 5%–
10% of pregnancies and constitutes a major source of morbidity and mortality
worldwide. Primigravidae are high risk group for development of PE and are
almost four times as likely to develop the disease with its adversematernal and fetal
outcome. Our study aimed to evaluate the platelet indices and serum uric acid and
their significance in prediction of preeclampsia and assessment of its severity.
Patients and methods: this study was included 108 primigravida at gestatational age
(24-28) weeks at the first visit and divided into: group (1): including 54 pregnant
women with pregnancy induced hypertension (PIH) of varying severity; group (2):
including 54 normotensive pregnant women. Full history taking, complete clinical
examination and laboratory investigations including platelet indices (platelet count
(PC), mean platelet volume (MPV), platelet distribution width (PDW) and serum
uric acid was estimated. Results: Age was distributed as 27.07±3.44 and 27.0±3.45
respectively between Preeclampsia group and Control group without significant
difference and GA at start of the study was 26.01±1.49 and 26.11±1.40 respectively
with no significant difference. SBP and DBP were significantly higher among
Preeclampsia group. There was no significant difference between cases or control.
PLT was significantly higher among control at all times but MPV and PDW were
significantly higher among cases at al times. Low APGAR1, preterm, CS delivery
type and PPH were significantly associated with preeclampsia group. Conclusion:
The estimation of platelet indices and serum uric acid can be considered as an
early, economical and rapid procedure for assessment of Preeclampsia in pregnant
women. Thus platelet indices can have a significant impact on maternal and
perinatal outcome.

Introduction:Hypertensive disorders complicating pregnancy is the one of the most common medical problem of pregnancy. Worldwide, hypertensive disorders in pregnancy causes complication in about 10 -16% of pregnancies. High blood pressure in pregnant women is related with incidence of large placental infarct and decreased placental growth resulting in intra uterine fetal growth restriction and intrauterine death. Hypertension in pregnancy is diagnosed when blood pressure is 140/90 mm of hg or greater with proteinuria and edema after 20 week of gestation. Plasma   lipid and lipoprotein (a) undergo both qualitative and quantitative changes during pregnancy. During the course of normal pregnancy, plasma triglycerides and cholesterol concentration rises by 200-400% and 25-50% respectively. An abnormal lipid profile is known to be strongly associated with atherosclerotic changes and has direct effect on endothelial dysfunction. In preeclampsia women, thromboxane rise more than in normotensive pregnant women. Increased lipid synthesis causes increase in PGI2:TXA2 ratio and plays a role in pathogenesis of pregnancy induced hypertension (PIH), hence the hyperlipidemia may be an important marker of toxemia of pregnancy.
Aim and Objectives:To asses and compare the serum levels of lipid and lipoprotein (a) in pregnant women with PIH and normotensive pregnant women.
Materials  and Methods: A  study  conducted  on  total of 100 pregnant patients  (50  cases  and  50  controls)  selected  according  to  inclusion  and  exclusion  criteria.  3ml  of venous  blood  was  drawn  to  estimate  total lipid profileand Serum Lipoprotein (a)  levels  in  each  subject.The data was analyzed results were expressed as Mean and standard deviation of various parameters in different group. P value < 0.05 is considered as significant. ROC curve analysis was done to assess maximum sensitivity, specificity and diagnostic efficiency
Results:In our study the mean ±SD values of total cholesterol, triglycerides, LDL,VLDL, Serum  Lipoprotein (a) are statistically significant higher in PIH  cases whereas HDL levels are low in cases when compared to controls.
Conclusion:A high lipid profile levels is observed to be associate with preeclampsia thus, serum lipid concentration and serum Lipoprotein (a) levels may provide a useful marker for screening patients at risk for developing PIH.

Serous retinal detachment is an unsual cause of vision loss in preeclampsia. We report 21 year old patient with blilateral retinal detachment that resolved spontaneously following conservative management

Placenta is an important organ which is necessary for the intrauterine growth of foetus.complications .due to Pregnancy like hypertension(PIH) affects the placenta and is the major factor to cause maternal & foetal death.
Objectives:1. To study the morphological and histological features of placenta in normal and hypertensive patients . 2.To Compare the two groups and study the correlation of their changes with the foetal outcome.
Material & Methods: 100 specimens of placentas of patients from normal as well as hypertensive group were collected from the labour room & operation theatre of Dept. of Obstetric & Gynaecology of Dr. Panjabrao Deshmukh Medical College and hospital, Amravati, Maharashtra .At first the gross features ( morphological features) of placentas were observed.. To study the histology , sections from each placenta of size 5mm were taken. This was fixed in in 10% formal saline and further histological processing of the tissue was carried out.
Observations & Results: The gross morphological features like weight, size, surface area, number of cotyledons were reduced and areas of infarction, retroplacental clot, calcification were increase in hypertensive placenta than normal placenta. (p<0.005) Similarly, the histological features like increased syncytial knots, intravillous and intervillous fibrin deposition, cytotrophoblastic proliferation, hyalinised villi, atherosis were observed in hypertensive placentas. These all changes were correlated with the foetal mortality and morbidity. And we observed that there was increase in foetal mortality and morbidity in hypertensive patients with the above histological changes in their placentas.

Objective: Selection of an effective method of delivery for mother and child in pregnant women with gestational diabetes. The retrospective group included 67 women who passed through the regional perinatal center, city maternity complex and family clinics No. 5, No. 6 of the city of Bukhara in the periods from 2016 to 2018. The main (prospect) group consisted of 68 women whose pregnancy proceeded against the background of overt or gestational diabetes mellitus (GDM). The control group consisted of 36 women whose pregnancy proceeded physiologically. As a result of the study, the course of pregnancy and childbirth according to the history of childbirth and own observations revealed that in all (60%) pregnant women with GDM, pregnancy and childbirth proceeded with any complications, like in the mother and the fetus. Thus, pregnancy proceeded against the background of corrected diabetes with the use of the optimal insulin regimen and rational diet therapy, the absence of signs of diabetic fetopathy, then in this category of pregnant women, the delivery through the birth canal is considered the best option.

Background: Preeclampsia is related to the inability to adapt to the physiological changes of pregnancy that result in decreased maternal organ perfusion. This complex clinical syndrome in preeclampsia can affect all organ systems such as the hemodynamic system, kidney, retina, and blood chemistry, which is manifested by increased blood pressure and protein urine.
Purpose: This study aimed to determine the correlation of the factors causing preeclampsia with blood pressure and protein urine.
Methods: This correlational study using the 127 respondents, sampling purposive sampling techniques, the independent variable factor in preeclampsia (age, genetics, history of diabetes mellitus, history of hypertension), and the independent variable blood pressure and protein urine. The measuring instrument used is a sheet checklist and analyzed by Spearman rank.
Results: The results showed the risk of preeclampsia in the age factor of 40.9% occurred in the 28-35-year-old respondents; 100% of patients had no history/genetic preeclampsia, 100% of respondents did not have a history of diabetes mellitus, and 88.9% did not have a history of hypertension. Systole blood pressure increased moderately and high by 26.0% and 22.0%, while diastolic blood pressure increased moderately and high by 26.0% and 11.0%. Respondents had positive proteinuria of 52%. The results of the analysis are not found a significant correlation between the factors of age, genetics, history of diabetes, and history of hypertension with blood pressure and preeclampsia protein urine on respondents.
Conclusion: History of hypertension associated with blood pressure and proteinuria in preeclampsia. History of hypertension is related to the condition of the blood vessels that manifest hypertension and decreased renal function (protein urine). Therefore, it is recommended in women with a history of hypertension to control blood pressure and perform routine prenatal care during pregnancy to prevent further complications.

Background: Preeclampsia is related to the inability to adapt to the physiological changes of pregnancy that result in decreased maternal organ perfusion. This complex clinical syndrome in preeclampsia can affect all organ systems such as the hemodynamic system, kidney, retina, and blood chemistry, which is manifested by increased blood pressure and protein urine.
Purpose: This study aimed to determine the correlation of the factors causing preeclampsia with blood pressure and protein urine.
Methods: This correlational study using the 127 respondents, sampling purposive sampling techniques, the independent variable factor in preeclampsia (age, genetics, history of diabetes mellitus, history of hypertension), and the independent variable blood pressure and protein urine. The measuring instrument used is a sheet checklist and analyzed by Spearman rank.
Results: The results showed the risk of preeclampsia in the age factor of 40.9% occurred in the 28-35-year-old respondents; 100% of patients had no history/genetic preeclampsia, 100% of respondents did not have a history of diabetes mellitus, and 88.9% did not have a history of hypertension.Systole blood pressure increased moderately and high by 26.0% and 22.0%, while diastolic blood pressure increased moderately and high by 26.0% and 11.0%. Respondents had positive proteinuria of 52%. The results of the analysis are not found a significant correlation between the factors of age, genetics, history of diabetes, and history of hypertension with blood pressure and preeclampsia protein urine on respondents.
Conclusion: History of hypertension associated with blood pressure and proteinuria in preeclampsia. History of hypertension is related to the condition of the blood vessels that manifest hypertension and decreased renal function (protein urine). Therefore, it is recommended in women with a history of hypertension to control blood pressure and perform routine prenatal care during pregnancy to prevent further complications.

Abstract. The aim of this study was to examine the impact of obesity in pregnant women in
the development of preeclampsia. All women were divided into 2 groups: the study group
included women with obesity (n=120) and the control group of pregnant women with
physiological course of pregnancy without obesity (n=60).

The results showed that there were differences in gestational age (p = 0.000), APGAR score (p = 0.000), birth weight (p = 0.001), birth length (p = 0.000) in severe preeclampsia, severe preeclampsia with complications, and maternal. pregnant normally. The results of this analysis indicate that infant outcomes are worse in mothers with preeclampsia.

This study was undertaken to determine the effectiveness of two anti-hypertensive drugs: oral Nifedipine and oral Labetalol in cases of extreme preeclampsia in terms of their side effect profile, BP regulation, time taken to lower BP, and number of doses required. The objective of the study was to calculate the time required to reduce the blood pressure to the target level of 90 / 100 mmHg diastolic and less than 160mmHg systolic.In the labetalol group the mean SBP before treatment was 158mm of Hg which was reduced to 140 mm of Hg. The decline rate in the labetalol group was 11.77%. This study proved that labetalol reduces the BP more effectively than nifedipine and also has minimal side effects with less frequent dosing schedule as compared to nifedipine thus indicating that labetalol is better than nifedipine in lowering the BP in cases of preeclampsia.