European Journal of Molecular & Clinical Medicine

To assess the correlation of maternal serum glycosylated fibronectin level in preeclamptic pregnant women with severity of pre-eclampsia.
Methods: An 18-month prospective study was conducted at the Rajarajeshwari Medical College and Hospital (RRMCH), Bengaluru, in the department of obstetrics and gynaecology (Jan 2021 – May 2022). Twenty-five preeclamptic pregnant women ≥20 weeks gestation made up the anticipated sample size. The Lumella^TM PE test gadget was used to perform the maternal serum GlyFN test using the GlyFN POC device (from DiabetOmics, Inc.).
Results: There was statistically significant difference in severe pre-eclampsia between <=350 and >350 serum fibronectin values (P value <0.05). There were 93.75% (15 out of 16) severe pre-eclampsia cases in >350 serum fibronectin group where it was only 6.25% in <=350 group.
Conclusion: GlyFn POC test is a promising biochemical marker for severity of preeclampsia, and may be a useful adjunctive tool for rapid and accurate triage and intervention.

Pregnancy-induced hypertension constitutes a significant cause of morbidity and mortality in developing nations and complicates about 6-8% of pregnancies. Severe preeclampsia poses a serious dilemma for the anaesthesiologist, especially in emergencies, with respect to difficulty in endotracheal intubation and exaggerated haemodynamic responses due to anaesthetic procedures.
Objective: This study aimed to observe intra-operative haemodynamic, anaesthesia parameters, maternal and foetal complications and indications of the need for postoperative critical care. Methods: This study included 145 patients with severe pre-eclampsia who underwent emergency caesarean section. Out of 145 patients, 103 patients were administered spinal anaesthesia (SA), and 42 patients received general anaesthesia (GA) based on the consent of the patient, fasting status of the patient, maternal and foetal distress and active respiratory tract infection (RTI). Patients were categorised into two groups: those who received SA as Group S and those who received GA as Group G.
Results: The Mean intra-operative SBP in group S and group G was 129.8±14.23 mmHg and 136.5±17.25 mmHg respectively, with statistically significant differences (p-value of 0.017). Mean intra-operative DBP group S and group G were 79.1±12.64mmHg and 85.4±15.38mmHg, respectively, with statistically significant differences (p-value of 0.012). The most common maternal complication among group S was headache (6.8%), and among the group G was pulmonary oedema (8.3%) (p<0.001). 74.8% of patients in group S and 31% in group G were complications-free (p<0.001). Out of 103 patients in group S, nine (8.7%) were admitted to ICU and 19 (45.2%) out of 42 patients in group G. The difference was statistically significant (p-value< 0.001).
Conclusion: Spinal anaesthesia is a safer alternative to general anaesthesia in severe preeclampsia, with less postoperative morbidity and mortality for mothers and babies. These findings agreed with many previous studies worldwide.

Cardiac dysfunction is a predominant complication of hypertensive disease complicating pregnancy especially affecting left ventricular systolic and diastolic function example Ejection fraction, Fractional shortening, E/A ratio, Isovolumetric relaxation time, Deceleration time. These changes usually return to normalcy after delivery by six weeks postpartum in Normotensive patients.
Aim: To study the cardiac function in preeclamptic pregnant women by transthoracic echo in comparison with normal pregnant women in 32-38 weeks of gestation.
Methodology: This is a prospective observational study conducted in government institute of obstetrics and gynaecology hospital Egmore, chennai and government ISO Kasthurba Gandhi hospital chennai in 125 pregnant women and 125 preeclamptic women. The study subjects underwent echo at 32 38 weeks by using parameters such as ejection fraction l, factional shortening isovolumetric relaxation and deceleration time. This study also evaluated bmi, age, gestational age blood pressure and time of delivery. All preeclamptic patients were followed up to 6 weeks postpartum with echocardiography
Results: The average values of the following parameters were high in preeclamptic women as compared to normotensive controls.
BMI in preeclampsia women 28.71 +/- 4.89 and in Normotensive 27.9 +/- 2.9 (with p value 0.13). Fractional shortening was 28.5 +/- 2 in preeclamptic women and in Normotensive 33.26 +/- 1.62 with P value <0.01.
Isovolumetric relaxation time was in 126.02 +/- 58.6 in preeclamptic women and in Normotensive 99.76 +/- 4.66 with P value <0.001.
Deceleration time was in 230.06 +/- 17.23 in preeclamptic women and in Normotensive 203.34 +/- 6.74 with P value<0.001.
All echo values were highly significant.
Conclusion: Echocardiograph was rarely performed on all preeclamptic pregnant patients in developing countries like India. By performing echo on preeclamptic patients we will be able to detect left ventricular dysfunction early, start treatment, prevent complications and reduce morbidity and mortality. This study shows that echocardiography is extreme valuable and should compulsorily be made a part of all antenatal investigations..

One of the most difficult and dangerous pregnancy problems is acute kidney injury (AKI). We discuss our observations regarding the clinical characteristics and results of 60 patients who had AKI due to pregnancy who were seen throughout the research period. Examining the prevalence, characteristics, and effects of acute kidney injury (AKI) during pregnancy in the Indian population was the aim of this study. Materials and Method: in the study the patients were women who were pregnant with AKI.Patients were examined using demographic data, a detailed history, a clinical examination, and laboratory tests. The main result was a change in maternal renal function, including progression to chronic kidney disease and restoration to normal renal function (CKD). The delivery method, pregnancy-related issues and maternal mortality were all regarded as secondary outcomes. Results: The present study included 60 patients in total, with an average age of 26 years. 41.2% of the individuals were primigravida, and 49.9% had severe anaemia. AKI was primarily brought on by pre-eclampsia and postpartum haemorrhage. During the three-month follow-up period, it was noted that the renal outcome had significantly improved, with 30 patients achieving full renal recovery and remaining patients developing CKD with mild to no recovery. Serum glutamic oxaloacetic transaminase and glutamic pyruvic transaminase levels were increased in all individuals but later recovered to normal. Conclusion: According to our study, women with AKI due to pregnancy frequently experience multi-organ problems and need mechanical ventilation and renal replacement therapy. As a result, managing AKI caused by pregnancy offers a challenge that necessitates an accurate assessment of the contributing factors to enable effective therapy

Pre-eclampsia is a disease of unknown etiology characterized by development of hypertension to the extent of 140/90 mm of Hg or more with proteinuria after the 20th week in a previously normotensive and non-proteinuric patient. Incidence of Pre-eclampsia varies from 8-10% in India, being 10% in the primigravidae and 5% in multigravidae. Objective: The present study, conducted in the department of Biochemistry of a tertiary care teaching hospital, proposes the value of serum copper levels as marker in etiopathogenesis and in assessment of the severity of pre-eclampsia. Methods: The serum copper levels were measured in sixty newly diagnosed pre-eclampsia patients admitted in the wards of Department of Obstetrics and Gynecology of the tertiary care teaching hospital and sixty age and sex matched normal healthy relatives of patients attending the Out Patient Departments. Result: The outcome of the study indicated that the levels of serum copper were increased statistically significantly in the pre-eclampsia cases group when equated to the normal pregnant control group. Moreover when levels of serum copper were correlated with the systolic and the diastolic blood pressure in pre-eclampsia patients, significant positive correlation was detected. Conclusion: Hence the result obtained concludes that serum copper level may be considered as an influence having a role in the etiopathogenesis of the disease and may also be used as severity indicator in patients with pre-eclampsia.

Maternal physiology undergoes a number of transient and persistent changes throughout pregnancy. Nearly all maternal tissues change in some way during pregnancy.The prevalence of IHCP varies significantly across all ethnic groups. In the world, 0.2–2% of pregnant women experience it. Increased risks of post-partum haemorrhage, LSCS, severe pruritus with dyslipidemia, altered coagulation profile, and premature prelabour rupture of membrane are some of the complications associated to IHCP, so this study was conducted with an aim to assess the incidence of intra hepatic cholestasis among pregnant women and to assess the feto-maternal outcome pregnancy complicated by intra hepatic cholestasis.
Methods: After receiving approval from the research and ethical committee of the institute, this hospital-based prospective study was carried out among pregnant women with a diagnosis of intra hepatic cholestasis who were recruited over a period of 2 years in the department of Obstetrics and Gynaecology. A complete hemogram, liver function tests (total and conjugated serum bilirubin), aspartate aminotransferase (AST), alanine aminotransferase (ALT), alkaline phosphatase (AP), serum bile acids, urine routine, and microscopy test were performed on all patients. Ursodeoxycholic acid (UDCA) 10-15 mg/kg/day, with a maximum dose of 300 mg 8 hours a day, was indicated for oral administration to all confirmed patients of IHCP.
Results: The incidence of Intra Hepatic cholestasis among pregnant women was 3.88%.The mean age of pregnant women was 27.11±5.82 years. Around two third of pregnant women (69.0%) were diagnosed with Intra Hepatic cholestasis between 33-36 weeks of gestational age.Three fourth of the pregnant women with Intra Hepatic cholestasis had deranged total bilirubin (76.8%), Aspartate Aminotransferase (79.8%), and Alanine Aminotransferase (73.2%).The Pre-eclampsia and Postpartum haemorrhage were observed as complications among 22.0% and 14.3% of pregnant women with Intra Hepatic cholestasis respectively. The Apgar score at 1 minute and at 5 minutes was <7 in 12.5% and 8.3% of neonates born to pregnant women with Intra Hepatic cholestasis respectively.
Conclusion: Hepatic dysfunction in pregnancy is typically caused by intrahepatic cholestasis. In terms of higher incidence of lower segment caesarean sections and discomfort from pruritus, maternal morbidity has increased

Hypertension is one of the common problems associated with pregnancy that may be followed by eclampsia, acute renal failure, maternal death, premature delivery, intra-uterine growth restriction and other. This study was conducted to determine the results of pregnancies associated with hypertension in patients visiting in the Delivery Ward of Govt. Thanjavur medical college hospital (Tertiary care Centre) Thanjavur. Methods: A descriptive study was conducted on all the patients admitted to the aforementioned department and who possessed the inclusion criteria for hypertensive pregnancy. Results: Among the 7004 delivery cases examined, 1315 cases had hypertension (18.8%). Among these, 983 (74.7%) had gestational hypertension; 209 (15.9%) had preeclampsia- eclampsia; 38 (2.9%) had preeclampsia superimposed on chronic hypertension; 83 (6.3%) cases had chronic hypertension; and 3 (0.2%) had associated comorbid conditions like Liver & Renal disorders. Ninety-six point three percent (96.3%) had a systolic blood pressure (BP) of 140 - 190 mmHg, and 3.7% had a systolic BP greater than 190 mmHg. Whereas 61.1% of diastolic blood pressure 90 - 110 mmHg and 38.9% of the mothers had diastolic BP greater than 110 mmHg. The HELLP (Hemolysis, Elevated Liver enzymes & Low Platelet count) syndrome was present in 3.4% of cases; 22.1% experienced premature delivery; 2.5% had IUFD (intra uterine fetal death); 28.1% had IUGR (intrauterine growth retardation); and 21% had LBW babies. Conclusions: Based on our results, hypertensive mothers who are younger and have lower weight babies at birth experience more perinatal complications. The unpleasant effects of hypertension in pregnancy warrant the need for training, routine prenatal care, the early detection and treatment of hypertension at younger ages of pregnancy, and follow-up after delivery.

Introduction: Preeclampsia is a multisystem disorder and is a major contributor of maternal and perinatal morbidity and mortality. Identifying women, who are at risk is important to prompt gestational management. Uterine artery waveform and biomarkers like pregnancy-associated plasma protein-A (PAPP-A) may reflect the pathophysiology of preeclampsia.
Aim: We aim to find out whether abnormal uterine artery pulsatility index (PI) and low serum PAPP-A in the first trimester can be used to predict preeclampsia.
Material And Methods: Antenatal women at 11-13⁺⁶ weeks of gestation visiting Sri Guru Ram Das Universty Of Health And science, Amritsar were enrolled after informed consent. Uterine artery Doppler was done with the early anomaly scan at 11-13⁺⁶ weeks. Serum levels of PAPP-A were analyzed. The women were followed up at intervals up to delivery. Incidence of preeclampsia was noted.
RESULTS: The incidence of preeclampsia was 26%. The mean uterine artery PI among those who developed preeclampsia was 2.03, which was significantly higher than the unaffected group (p=0.001). The first-trimester uterine artery PI as a screening tool showed a sensitivity of 84.67% and specificity of 75.68 % .The mean PAPP-A MoM of the affected group was 0.91 which was lower than the unaffected group (p=0.028). The first trimester PAPP-A as a screening tool showed a sensitivity of 15.38%, specificity of 91.89%.
Conclusion: Both the tests were concluded to be good predictors of preeclampsia. Identification of high-risk factors, screening, and surveillance are  important for timely  prediction of  preeclampsia and initiation of preventive therapy.

Background: A recent increase in the prevalence of overweight and obese women of reproductive age in India has been noted. Obesity during pregnancy is associated with an increased risk of gestational diabetes mellitus (GDM), pre‐eclampsia, miscarriage, venous thromboembolism, infection, and hemorrhage in the mother. The present study was aimed to explore various maternal and fetal outcomes, influenced by maternal obesity. Material and Methods: Present study was hospital based, prospective, observational study conducted in pregnant women, gestational age more than 32 weeks, singleton pregnancy, with BMI more than 30, delivered at our institute, willing to participate in present study. Results: During study period 107 pregnant women were considered for present study. Majority of women were from 26-30 years age (40.19 %), were primigravida (44.86 %), delivered at 37-40 weeks of gestation (40.19 %), 85.05 % had BMI 30-34.9 kg/m2 (moderately obese). In present study vaginal delivery was most common mode of delivery (52.34 %) followed by LSCS (40.19 %) & instrumental delivery (7.48%). Most common birth weight group was 2.5-3.99 kg (40.19 %), followed by 1.5-2.49 kg (34.58 %) group. Neonatal outcome noted was still birth (1.87 %), neonatal death (6.54 %) & rest of neonates were discharged with mother. 63.55 % babies required NICU admission. During postpartum period, complications such as wound infection (19.63 %), fever (14.02 %), wound dehiscence (6.54 %) & DVT (0.93 %) were noted. No maternal mortality was noted in present study. Conclusion: Maternal obesity is associated with development of gestational diabetes mellites, preeclampsia, need for labour induction, increased caesarean delivery as well as NICU admissions and increased incidence of postpartum infections.

Background: The triad of pregnancy induced hypertension (PIH), infections, and hemorrhages constitutes a significant proportion in the maternal mortality and morbidity. About 5 to 10 percent of pregnancies are complicated by the PIH. It is being observed that the sensitivity of this screening test is increased in detecting adverse perinatal outcome, if the doppler ultrasound is performed at gestational period of 23 to 26 weeks instead of 19 to 22 weeks. So, present study was conducted with an aim to evaluate the association of the deranged uterine artery velocity indices on doppler ultrasound with maternal and fetal outcomes among pregnant women with PIH.
Methods: The present prospective study was conducted among 132 singleton pregnant women (patient age: 19 to 33 years and gestational age: 25-39 weeks) with PIH in the department of Obstetrics and Gynecology in tertiary care teaching hospital of North India for 12 months (January 2021 to December 2021) after obtaining the ethical approval from the institutional ethical committee.The ultrasound examination was performed using a GENERAL ELECTRIC LOGIQ P5 ultrasound scanner machine.Chi square test was used to find association between uterine artery indices and fetal outcome and a p value of <0.05 was considered as statistically significant.
Results: The mean age of pregnant women was 24.8±3.7 years.In our study 40.8% of subjects were nulliparous, 43.9% of subjects were having parity of 1, 12.2% of subjects were having parity of 2.In our study, the doppler ultrasound was conducted among pregnant women with PIH for various indices. The uterine artery doppler ultrasound showed that 35.7% of subjects were having normal uterine artery indices, whereas 36.7% and 27.6% of subjects were having bilateral abnormal uterine artery indices and unilateral abnormal uterine dopplerrespectively.The chi-square analysis showed statistically significant association between perinatal mortality and abnormal uterine artery indices (p<0.05).
Conclusion: Doppler study for fetal surveillance in pregnancy-induced hypertension is a very useful device and abnormal uterine artery velocimetry also seems to have worse pregnancy outcomes in the present study.

Background and objectives: Predicting preeclampsia (PE) at 11-14 weeks of gestation is a new concept. Studies integrating multiple factors at 11-14 weeks of pregnancy have been conducted, but an algorithm with a good predictive value has yet to be created. This study aimed to design a methodology combining MAP, Uterine artery Doppler, and PAPPA at 11-14 weeks of pregnancy to predict PE in India. Basically objective is to determine whether higher Mean Arterial Pressure (MAP), increased Uterine Artery Pulsatility Index (UAPI), and low Pregnancy Associated Plasma Protein A (PAPP - A) between weeks 11-14 of pregnancy are linked to the growth of hypertensive diseases in pregnancy.
Method: This is a prospective cohort study. Data were obtained from 200 registered patients attending antenatal OPD in hospitals between 11 and 14 weeks of gestation. MAP, blood pressure, uterine artery Doppler, and serum sample for PAPPA were measured. IBM SPSS Version 22 for Windows was used to analyse the data.
Result: There were a total of 200 women enrolled in the study, and 24 of those women (37.1%) suffered difficulties. At 11-14 weeks of pregnancy, the uterine artery doppler pulsatality index (PI) was found to be an effective screening tool (sensitivity 29%, specificity 90%) for the prediction of pregnancy.
Conclusion: This study revealed that the uterine artery Doppler Pulsatality index is an effective screening approach for women at high risk of developing preeclampsia and related complications during the 11th to 14th week of pregnancy.
 

Background: According to the Indonesian Demographic and Health Survey (IDHS) in 2012 found that the main cause of maternal mortality in Jakarta is Hypertension (39%). Hypertension in pregnancy is caused by many factors, one of which is a low calcium diet. In the third semester of labor the need for calcium increases as the fetus begins to form and refine its bones, therefore the calcium level in the mother will reduce. This study was conducted to assess the association between a low calcium diet with hypertension in pregnant women. Method: This study used a cross-sectional design involving 161 pregnant women in the third trimester in Jakarta. Daily calcium data from the third-trimester mothers are taken by using the Food Frequency Questionnaire and interview, henceforth the blood pressure data is measured using a tensimeter. Data analysis using SPSS V.2.0 and the significance level used is 0.05. Result: Analysing using the Chi-square test, there was a significant relationship between a low calcium diet with hypertension in the pregnant woman. (P=0.000). Conclusion: This study shows a correlation between a low calcium diet with hypertension in pregnant women.

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: 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: 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.

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: 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: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: Pre-eclampsia is one of the leading causes of maternal and fetal morbidity and mortality. Lactate dehydrogenase (LDH) is an intracellular enzyme which converts pyruvic acid to lactic acid during glycolysis Present study was aimed to study the correlation of maternal and perinatal outcomes with serum LDH levels in women with hypertensive disorders of pregnancy.
Material and Methods: Present study was prospective, observational study, conducted in antenatal women with singleton pregnancy and gestational age 28 weeks onward with hypertensive disorders of pregnancy (mild/ severe pre-eclampsia), serum LDH levels were estimated.
Results: In present study, 50 pregnant women were studied. Majority women were from 20-25 years age group (60 %), nulliparous (70 %), unbooked (68 %). Hypertensive disorders of pregnancy were mild pre-eclampsia (56 %) & severe pre-eclampsia (44 %). In present study, Mean LDH value in mild preeclampsia group was 564.3 ± 184.3 IU/l & in severe preeclampsia group was 766.3 ± 264.3 IU/l, difference was statistically significant. Majority women underwent LSCS (64 %). Maternal complications such as eclampsia, abruption, HELLP were more in > 800 IU/L LDH value patients. Perinatal outcome was poor in pregnant women with > 800 IU/L LDH value, 8 (16 %) neonates required NICU admission, while 7 (14 %) were low birth weight. Perinatal mortality was noted in 2 cases (1 from 600-800 IU/L LDH group & 1 from >800 IU/L LDH group).
Conclusion: With raised LDH values, decision regarding management and prevention of complications should be taken, so as to reduce the maternal & neonatal, morbidity & mortality.

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

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.

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.

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).

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.

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.

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.