Objective: To determine the clinical course of critically ill, SARS-CoV-2 positive pregnant women and to critically analyze the circumstances which led to their mortality.Methods: A retrospective review of case records examined to analyze the clinical condition with which critically ill SARS-CoV-2 positive pregnant patients were admitted, the inpatient management protocol followed and subsequent clinical course which led to their deaths.Results: There were a total number of 13 maternal deaths which were directly attributed to COVID-19 pneumonia during the study period.Many of these patients had reported with poor oxygen saturation at the time of admission.Oxygen therapy, plasma therapy, antiviral drugs and immunomodulators were administered as part of in -patient management protocol.Conclusion: There is an urgent need of dedicated COVID care facilities for pregnant women.Maternal mortality has always been a matter of concern during any pandemic.Specific needs of pregnant women during this pandemic require urgent attention.

Objectives:An alarming rate of adverse perinatal outcomes as well as maternal deaths has been reported worldwide during this pandemic. It would be prudent to start thinking on the lines of acute or chronic intrauterine fetal hypoxia due to placental microvascular pathology or villitis caused by severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) infection. Autopsy studies of deceased patients with severe COVID-19 have revealed the presence of diffuse pulmonary alveolar damage, thrombosis, and microvascular injuries. It is expected that similar pathological features such as microvascular injuries could be found in the placenta of infected pregnant women. Materials and Methods:Placentas of singleton pregnancies from 42 SARS-CoV-2 positive mothers delivered at term were submitted for histopathological examination. Those with multifetal gestation, hypertensive disorder, fetal growth restriction, structural or chromosomal anomalies in the fetus, thrombophilia, prolonged prelabor rupture of membranes, and placenta accreta spectrum were excluded from the study. Histopathological examination was done by two pathologists independently and only those results concurred by both were reported. Histopathological features and corresponding neonatal outcome were analyzed. Results:Reports of 42 placentas from patients with SARS-CoV-2, delivered at term (37-40 weeks) were analyzed in our study. Features of maternal vascular malperfusions (MVM) were present in 45% (n = 19) cases. Features of fetal vascular malperfusions (FVM) were present in 23.8% (n = 10) cases. There were 47.6% (n = 20) cases showing at least one feature of acute inflammatory pathology (AIP) and 42.8% (n = 18) showing features of chronic inflammatory pathology (CIP). Neonatal respiratory distress syndrome was found in 19% (n = 8) of the neonates. Correspondingly, nearly all placentas (n = 7) of these neonates showed features of MVM, FVM, AIP and CIP. There was no maternal or neonatal mortality in our study group. Conclusion:The main findings of our study include maternal as well as fetal vascular malperfusions and placental inflammatory pathology. These findings provide an outline for better understanding of etiological factors and pathogenesis of adverse perinatal outcomes in SARS-CoV-2 infection.

Prenatal screening for chromosomal abnormalities has two components i.e. prenatal screening (maternal serum screening and cell-free fetal DNA screening) and prenatal diagnosis (chorionic villus sampling, amniocentesis, and cordocentesis). Prenatal testing in the past decade is evolving towards non-invasive methods to determine the chromosome abnormality disorders in the fetus without incurring the risk of miscarriage. Conventional tools for prenatal screening included maternal age, maternal serum markers, ultrasound marker (nuchal thickness), and their combinations. With the increased risk of screening test patients were offered diagnostic tests (chorionic villus sampling, amniocentesis, and cordocentesis). After the availability of noninvasive prenatal tests for commercial use in 2011, a great marketing drive is there to establish it as a master tool for prenatal testing. However various society guidelines i.e. ACOG, RCOG, and ISUOG have clearly stated that cell-free fetal DNA based noninvasive prenatal tests is a screening test, not a diagnostic test. In the succeeding paragraph, we will review current trends in the field of cell-free fetal DNA noninvasive prenatal tests and the relevance of invasive testing in the context of noninvasive prenatal tests. Noninvasive prenatal tests does not entirely replace invasive prenatal testing procedures. Positive noninvasive prenatal tests findings must be confirmed by diagnostic tests based on an invasive sample source, mainly chorionic villus sampling or amniocentesis due to false positive and false negative reports of cell-free fetal DNA based tests. Continuing research and development efforts are focused on overriding noninvasive prenatal tests limitations. Recent studies show that procedure-associated risks in the case of prenatal invasive testing are very low as compared to previous studies. Prenatal invasive testing will remain as the backbone of prenatal diagnostic testing until the limitation of noninvasive prenatal tests is overcome.

OBJECTIVE: The ongoing COVID-19 pandemic is causing widespread concern, fear, stress, anxiety, and depression throughout the population worldwide. Pregnant women, being a vulnerable group, are grossly affected by these changing environmental scenarios. The spread of Corona Virus infection itself and the subsequent nation-wide lockdown in India, just like many other countries, has caused a serious impact on antenatal patients. The objective of this study was to bring out the specific concerns of pregnant women during the ongoing COVID-19 pandemic and also to assess the prevalence of Depression and Anxiety Disorder owing to the pandemic. STUDY DESIGN: This cross-sectional survey among antenatal patients was conducted in the outpatient department of a tertiary care obstetric center which is also a designated COVID hospital. Prevalidated questionnaires, Personal Health Questionnaire-9 & Generalized Anxiety Disorder questionnaire-7 were used for data collection. A semi-structured questionnaire was used to evaluate pregnancy-specific concerns of the patients with respect to the COVID-19 pandemic. RESULTS: The overall prevalence of moderate to severe depression in the survey was found to be 13.2% (n=66). The prevalence of moderate to severe anxiety disorder was found to be 9.8% (n=49). CONCLUSION: This study has brought out the need for urgent attention to the psychological impact of COVID-19 on pregnant women. Pregnant women being a vulnerable group, especially during this pandemic, need special attention to their psychological wellbeing as well.

ReseaRch aRticle is 5%.The incidence of the disease, however, is now on the decline worldwide, from 1.3-1.7% in the 1980s to 0.17% in the 1990s.The incidence of Rh incompatibility in Rh-negative women carrying an Rh-positive fetus is about 10% of all Rh-negative pregnancies.Sensitization, however, occurs only in about 5% of these cases, giving an incidence of 6-7/1000 of all the pregnancies and one in 15 Rh-negative pregnancies.Today, Rh IG prophylaxis has markedly decreased the prevalence to 0.14-0.2%. 3,4Failure of Rh immunoprophylaxis is a cumulative cascade of inadequate use of Rh immunoprophylaxis after potential sensitizing events and administration of an inadequate dose.Validation of MCA-PSV for detection of fetal anemia and the need for fetal blood 1-

Introduction Fetal hydrops is a serious condition which has high morbidity and mortality. Incidences of immune hydrops have decreased by manifold after introduction of anti-D immunoglobulin. Intra-uterine fetal blood transfusion revolutionized the treatment of these affected fetuses after diagnosis of immune fetal hydrops. In this study we aim to evaluate the clinical characteristics of immune hydropic fetuses and perinatal outcome after institution of intra-uterine transfusions. Materials and methods A retrospective study was carried out in pregnant women with immune fetal hydrops from October 2004 to December 2019 in our tertiary care hospital. After diagnosis of fetal hydrops, all the fetuses received intra-uterine transfusions. All the newborns were followed up till 3 months postdelivery. All the fetuses were divided in two groups: hydrops diagnosed below 32 weeks (Group A) and in second group hydrops diagnosed after 32 weeks gestation (Group B). Results Total 63 patients were diagnosed to have hydrops during the study period. Group A had 48 fetuses and Group B had 15 fetuses. Average gestational age of diagnosis of hydrops in group A was 24.2 weeks and in group B it was 32.5 weeks. All the fetuses received intra-vascular intra-uterine transfusion. Pericardial effusion was found to be significantly associated with group A. Successful perinatal outcome was seen in 92% fetuses. 87% fetuses had complete resolution of hydrops before delivery. All the fetuses received phototherapy and intra-venous immunoglobulin after delivery, and 5 fetuses underwent exchange transfusion. Conclusion Favourable perinatal outcome was achieved in hydropic fetuses with intra-uterine blood transfusions. Complete resolution of hydrops before delivery increases the chances of perinatal survival.

OBJECTIVES: Suppressed immune system and physiological changes in pregnancy put pregnant women vulnerable to various viral diseases. Various studies have reported adverse pregnancy outcomes in SARS-CoV-2 infection. This study aimed to evaluate the maternal and fetal outcomes in SARS-CoV-2 affected pregnancies at our set up. STUDY DESIGN: It was a prospective cohort study conducted at a tertiary care Army Hospital, India. The first 50 cases of SARS CoV-2 positive pregnant women and 144 suspected cases that were found SARS-CoV-2 negative, received and managed at separate set up, during a period extending from 01 April 2020 to 15 Sep 2020 were included in our study. Their obstetric and neonatal outcomes along with the demographic and other clinical data were compared. RESULTS: Total RT-PCR positivity rate of SARS-CoV-2 infection in pregnant women was 2.7%. 96% of our patients were asymptomatic for SARS-CoV-2 infection. Premature rupture of membrane, preterm delivery, and NICU admission was similar in both groups. There were increased incidences (70%) of cesarean section in SARS-CoV-2 positive pregnant women. CONCLUSION: The study reported comparable maternal and fetal outcomes in SARS-CoV 2 positive pregnant women when compared with SARS-CoV-2 negative pregnant women.

OBJECTIVES: Suppressed immune system and physiological changes in pregnancy put pregnant women vulnerable to various viral diseases. Various studies have reported adverse pregnancy outcomes in SARS-CoV-2 infection. This study aimed to evaluate the maternal and fetal outcomes in SARS-CoV-2 affected pregnancies at our set up. STUDY DESIGN: It was a prospective cohort study conducted at a tertiary care Army Hospital, India. The first 50 cases of SARS CoV-2 positive pregnant women and 144 suspected cases that were found SARS-CoV-2 negative, received and managed at separate set up, during a period extending from 01 April 2020 to 15 Sep 2020 were included in our study. Their obstetric and neonatal outcomes along with the demographic and other clinical data were compared. RESULTS: Total RT-PCR positivity rate of SARS-CoV-2 infection in pregnant women was 2.7%. 96% of our patients were asymptomatic for SARS-CoV-2 infection. Premature rupture of membrane, preterm delivery, and Neonatal intensive care unit admission was similar in both groups. There were increased incidences (70%) of cesarean section in SARS-CoV-2 positive pregnant women. CONCLUSION: The study reported comparable maternal and fetal outcomes in SARS-CoV 2 positive pregnant women when compared with SARS-CoV-2 negative pregnant women.

Introduction: After the ACOG guideline in 2007 recommending that all women, regardless of age, should be offered aneuploidy screening before 20 weeks of gestation. This protocol in the name of the fetal aneuploidy screening program was slowly introduced in various Indian hospitals. This observational study was performed to analyze population-based trends of prenatal testing (serum screening and invasive testing) for aneuploidy over 3 years (2017–2019). Materials and methods: A retrospective single-center study was carried over a period of 3 years (January 2017 to December 2019). This hospital was a tertiary care hospital with fetal medicine unit that had approximately 3,000 annual births. Analysis of data of all pregnant women undergoing prenatal testing before 20 weeks of gestation was collected in the following subheads: (1) aneuploidy screening data, (2) invasive testing data [amniocenteses and chorionic villus samplings (CVSs)], and (3) tertiary care hospital birth statistics from January 2017 to December 2019. Results: Over a period of 3 years, aneuploidy screening was accepted by the target population and at present > 85% target population undergo aneuploidy serum screening. Annual numbers of invasive prenatal tests climbed steadily from 2017 to 2019. The proportion of invasive testing performed for abnormal serum screening (ASS) increased steadily from 51% in 2017 to 72% ( p < 0.05) in 2019. While the indications abnormal ultrasound finding (AUS) showed a steady decline over the same timeline but an indication of previous baby affected with aneuploidy (PBAA) remained in the same range. By 2019, the most common indications for invasive tests were positive ASS (72%) and AUS abnormality (15%). The diagnostic yield of all invasive tests for a major chromosome abnormality over a 3-year study period was 4.7%. The rate of CVS to amniocentesis rose to 17.5% in 2019 from 4.6% in 2017. Fewer complications of invasive tests were observed as compared to previous studies. Conclusion: The study demonstrates a rise in aneuploidy serum screening and its acceptance in the pregnant population. Abnormal serum screening is the main indication of prenatal invasive testing. This study also adds to the safety profile of invasive testing.

Objective: Osteoporosis is a skeletal disorder characterized by diminished bone strength that increases the risk of fracture at instances of trivial trauma. Asians have a lower bone mass than the west. The present study was designed to add data from India on women above the age of 40 years with respect to low bone mineral density (BMD) and its associated high risk factors. Materials and Methods: After a written informed consent, a detailed history was taken. Basal metabolic index was recorded, and biochemical and endocrine tests were done, followed by dual X ray absorptiometry scan. Results: Average age of the study population was 46.54 years and BMI 26.58. The prevalence of osteopenia in the study was 36%, and that of osteoporosis, 4%; the overall prevalence of low BMD being 40%. Proportion of women with low BMD increased with advancing age and menopausal status. On endocrine evaluation, 53.44% cases with insufficient vitamin D, 62.5% with hyperparathyroidism, 100% with hypothyroidism, 75% with hyperthyroidism suffered from low BMD. Among chronic diseases, 75% women with diabetes, 33.3% with hypertension, 25% with deranged liver function and 50% with rheumatoid arthritis were found to have low BMD. 46.75% women with sun exposure less than one hour daily had poor bone mineralization. The proportion of women with normal BMD decreased from 84.09% to 43.33% with decrease in daily physical work. On logistic regression analysis, insufficient serum vitamin D concentrations, less physical work and inadequate sun exposure were found to be significantly associated with low BMD. Conclusion: Low BMD is not a disorder confined to postmenopausal women alone. It is widely prevalent in women above 40 years of age. Screening women above 40 in the absence of any high risk factors has the potential of nipping this silent killer in the bud.

BACKGROUND:Fibroids are the most common benign tumours of uterus. Heavy menstrual bleeding is the commonest concern for which medical attention is sought. Hysterectomies for leiomyoma constitute a third of all hysterectomies. Thus, healthcare cost to society due to uterine leiomyomas is of considerable importance.METHODS:A prospective study was conducted at tertiary care hospital of armed forces. 120 women in pre-menopausal age group with complaints of menorrhagia, Pictorial Bleeding Assessment Chart (PBAC) scoring ≥100 and at least one fibroid ≥2.5 cm in size were recruited in the study. Patients in Group 1 were given Tab Tranexemic acid (500 mg) and Tab Mefenemic acid (500 mg) three times a day during menstrual bleeding for a period of 6 months. Patients in Group 2 were given Tab Mifepristone 50 mg twice a week. They were followed up at 1, 3 and 6 months of starting the medicine. Results were statistically analysed using Microsoft Excel sheet and paired t-test.RESULTS:The average age was 40 years in the Group 2 and 45 years in Group 1. A size reduction of 36.99% in intramural and 39.39% in submucosal fibroids after six months of treatment with Mifepristone resulted in marked clinical improvement. 10% patients had side effects. In 30% of patients symptoms reappeared during the follow up period.CONCLUSION:Mifepristone when given in bi-weekly doses was found to be safe, efficacious, and cost effective as compared to treatment with tranexemic acid and mefenemic acid for management of fibroid uterus.

Separation of pubic symphysis during delivery is a rare complication resulting in considerable and prolonged morbidity for parturient women. The usual presentation is that of something giving way in the region of the symphysis pubis sometimes with an audible crack at the time of delivery. Unbearable pain on moving from side-to-side and on performing any weight-bearing activity (such as walking or climbing stairs) precludes ambulation in the immediate postpartum period. This could be accompanied by disruption of the sacroiliac joint, hemorrhage, or urine incontinence in severe cases. Radiography, ultrasound, and magnetic resonance imaging are the diagnostic modalities that aid confirmation of diagnosis. The magnitude of separation does not correlate well with the severity of symptoms. Treatment modalities range from conservative management (including analgesics, pelvic binders, transcutaneous nerve stimulation) and chiropractic management to orthopedic interventions such as external fixation or open reduction and internal fixation. Since postpartum pain is frequently dismissed as attributable to labor and childbirth, the diagnosis of pubic symphysis diastasis is often delayed and sometimes missed altogether. Since there is no consensus in the scientific literature on the definition, etiopathogenesis, and management of this rare complication, we attempted to review the literature on the subject and present a series of two cases.

Abstract Objective: To quantify cell free fetal DNA (cffDNA) with fetal specific epigenetic marker, hypermethylated RASSF1A, in maternal plasma of normal pregnant women from 20 weeks of gestation and to assess its relationship with maternal age, height, pre-pregnancy weight and body mass index (BMI). Methods: Hundred normal pregnant women within the gestational age of 21–40 weeks were randomly selected and grouped into five (n = 20). Group 1: 21–24, Group 2: 25–28, Group 3: 29–32, Group 4: 33–36 and Group 5: 37–40 weeks. Maternal plasma DNA was extracted, digested with methylation-sensitive restriction enzyme, BstUI and the fetal specific DNA (cffDNA) was quantified by Real-time polymerase chain reaction (qRT-PCR). Results: The mean hypermethylated RASSF1A concentrations in different gestational groups were Group 1: 30.1 ± 14.9, Group 2: 52.6 ± 22.18, Group 3: 93.2 ± 19.08, Group 4: 172.8 ± 26.81 and Group 5: 337.8 ± 52.9 copies/ml. Pearson’s correlation analysis showed highly significant positive correlation between cffDNA and gestational age (r = 0.899, p < 0.001). BMI was also found to be positively related to cffDNA (r = 0.217, p < 0.05). However, it did not show any correlation with maternal age, height and pre-pregnancy weight. Conclusions: The gestational age-dependent increase of hypermethylated RASSF1A; the fetal specific epigenetic marker in maternal plasma was demonstrated, in an Indian study group of normal pregnant women. Findings would form the basis of future studies involving pregnancy complications that would aid in the early diagnosis of placental pathologies with hypermethylated RASSF1A.

Objectives: Cell free fetal DNA (cffDNA) and its hypermethylated RASSF1A gene signify a recent advancement in non-invasive prenatal diagnosis of feto-placental anomalies like pre-eclampsia. The study uses hypermethylated RASSF1A gene to quantify cffDNA and to assess its relationship with placental and urine proteins in pre-eclampsia cases.Design and methods: DNA was isolated from plasma samples of clinically diagnosed cases of pre-eclampsia (n = 103) and normal pregnancy (n = 616) from 21 weeks of gestation. Through methylation sensitive enzyme (BstUI) digestion; followed by real time-polymerase chain reaction (RT-PCR), quantification of hypermethylated RASSF1A was done. Immunoassays determined: placental protein-13 (pp-13) and pregnancy associated plasma protein A (PAPP-A) and pyrogallol red molybdate assay for 24 h urine protein.Results: Highly significant differences between control and pre-eclampsia cases for hypermethylated RASSF1A concentrations were found; Group I: 33 +/- 7.35 vs 74.46 +/- 16.71, Group II: 53.75 +/- 16.65 vs 244.22 +/- 35.68, Group III: 93.25 +/- 19.08 vs 412.31 +/- 80.18, Group IV: 144.30 +/- 18.13 vs 1056.89 +/- 153.78, Group V: 307.55 +/- 40.76 vs 2763.76 +/- 259.76 copies/ml. Multivariate Pearsons correlation analysis of hypermethylated RASSF1A with pp-13, PAPP-A and urine proteins showed positive and very highly significant (P < 0.001) associations.Conclusions: Diagnostic potential of fetal specific, hypermethylated RASSF1A was evaluated. Its positive relationship with placental and urine proteins submit the case for considering it as a reliable marker for pre-eclampsia. (C) 2016 International Society for the Study of Hypertension in Pregnancy. Published by Elsevier B.V. All rights reserved.

Pre-eclampsia is a hypertensive disorder in pregnancy, which accounts for 10-15% of the maternal and perinatal mortality worldwide. Abnormal placental development and tissue hypoxia are its main etiologic factors. The present diagnostic methods of blood pressure monitoring and renal function evaluation are insufficient in the early detection of pre-eclampsia. Since molecular events portent well ahead of the disease onset, biomarker research for the early diagnosis of pre-eclampsia has recently generated ambitious clinical targets. However, no clinically validated biomarker has so far been reported for the prediction of pre-eclampsia. Therefore, this review takes stock of the current understanding of pre-eclampsia from a molecular biology perspective and critically evaluates the following diagnostic potentials claimed for the biomarkers: placental proteins, angiogenic markers, and cell-free fetal DNA (cffDNA) in maternal circulation. Though the emerging evidences in favor of the fetal-specific epigenetic marker, hypermethylated RASSF1A of cffDNA, are highlighted, it pitches for a broader strategy of 'combination biomarker approach' for the reliable forecasting and triaging of pre-eclampsia.

BACKGROUND:Prevention of parent to child transmission (PPTCT) program was initiated in Armed Forces to reduce the vertical transmission of HIV by instituting single dose Nevirapine (sdNVP) in untreated HIV positive mothers in labour. The aim of this study was to evaluate the role of sdNVP to decrease viral load of HIV infected mother during labour and its efficacy in prevention of mother to child transmission of HIV.METHODS:Thirty antenatal women tested positive for HIV at our PPTCT centre and delivered between Jan 2006 and May 2008 were evaluated. During labour these women were given sdNVP. Newborns were given syrup Nevirapine. The babies were tested for HIV infection at 48 h and six weeks after delivery.RESULTS:Thirty HIV positive women delivered at our centre and four newborns were found positive for HIV infection at 48 h. After six weeks interval three neonates were detected for HIV infection as one infant at six weeks was found to be negative for HIV infection.CONCLUSION:The protection rate of Nevirapine in untreated HIV positive women is not ideal. It is recommended that all HIV positive women should be offered Highly Active Antiretroviral therapy as primary mode for PPTCT.

Background: Pre-eclampsia is one of the leading causes of high rates of maternal and perinatal mortality and morbidity. Pathophysiology of pre-eclampsia is still obscure. Currently, there are no screening tests for pre-eclampsia that are reliable, valid, and economical. Parameters of oxidative stress could be early markers of endothelial dysfunction that predates clinical pre-eclampsia. Aim: This study was to study ceruloplasmin in nulliparous women as marker of oxidative stress and lipid profile to evaluate their value in prediction of pre-eclampsia. Materials and Methods: Prospective observational study. 306 nulliparous women had their serum lipid profile and ceruloplasmin levels measured at 14-16 weeks period of gestation as sample 1 and at 18-20 weeks as sample 2. All cases were followed up till the end of pregnancy for development of pre-eclampsia. Results: There was no statistically significant difference between the normals and pre-eclampsia cases at 14-16 week for all the oxidative stress parameters (P > 0.05), but at 18-20 week, there was statistically significant difference between the normals and pre-eclampsia cases in cholesterol and ceruloplasmin parameters (P < 0.05). Conclusion: Cholesterol and ceruloplasmin levels in second trimester (18-20 weeks) can predict the development of pre-eclampsia.

Human follicular fluid (HFF) has been proven to contain biologically active molecules and proteins that may affect follicle growth and oocyte fertilization. Based on this concept, HFF proteomic characterization is having a significant impact in the delineation of a biomarkers' profile for oocyte quality estimation and, maybe, for in vitro fertilization (IVF) success improvement.Follicular fluid is characterized by a vast protein complexity and a broad dynamic range of protein abundances that hinder its analysis. In this study we determined a proper solubilization and resolution method of HFF in 2-DE, minimizing sample manipulation, protein loss, and experimental artifacts. According to our methodology some low-abundance proteins were detected and identified by MS. Identified proteins were then functionally cross-linked by a pathway analysis. The generated path highlighted the occurrence in HFF of a tight functional-network in which effectors and inhibitors control and balance a space- and time-dependent induction/inhibition of inflammation, coagulation, and ECM degradation/remodeling. Such fine modulation of enzymatic activities exerts a fundamental role in follicle development and in oocyte competence acquiring. Alpha-1-antitrypsin resulted in the core protein of the delineated net and we interestingly detected its differential incidence in FF and serum from two small cohorts of patients who underwent IVF.Human ovarian follicular fluid (HFF) is the in vivo microenvironment for oocyte during folliculogenesis. It contains biologically active molecules that may affect oocyte quality, fertilization, and embryo development. HFF is also one of the most abundant “waste product” in assisted reproduction. This makes HFF a readily accessible source of biomolecules for competence evaluation of collected oocytes. The methodological improvement we obtained in proteomics characterization of HFF lead to a wide overview on the functional correlation existing between several fluid components and on how their aberrant occurrence/activity may affect oocyte quality and ovulation.This article is part of a Special Issue entitled: From Genome to Proteome: Open Innovations.

BACKGROUND:High prevalence of diabetes and genetic predisposition to metabolic syndrome among Indians places Indian women at risk to develop gestational diabetes mellitus (GDM) and its complications. Literature defines multiple criteria for GDM. This prospective study compares available diagnostic criteria for GDM in Indian women and their correlation with perinatal morbidity. METHOD:Nine hundred and forty-eight consecutive voluntary nondiabetic pregnant women were recruited for the study. Seven hundred and twenty-three of these (mean age 23.45 years; 75.7% < 25 years) who reported for the follow-up were screened for GDM at 24-28 weeks gestation by American College of Obstetrics and Gynaecology (ACOG) guidelines and World Health Organization (WHO) criteria. Glycated haemoglobin (HbA1c) and fasting and two-hours postglucose plasma insulin levels were also analysed. Pregnancy outcome was known for 291 of these. Concordance of risk factors and perinatal complications was analysed with respect to GDM. RESULTS:Prevalence of GDM at 24-28 weeks gestation was found to be 4.8% by WHO criteria, 6.36% by Carpenter and Coustan's criteria, and 3.5% by O'Sullivan's criteria. Prevalence was marginally higher in women of higher age, having past history of abortion or family history of diabetes mellitus (DM) (P > 0.05). None of these women had HbA1c > 6%. Relative risk of abnormal delivery (pregnancy outcome) was 1.93, 1.39, and 1.17 in women with GDM by O'Sullivan's, WHO, and Carpenter's criteria, respectively (P > 0.05). Abnormal deliveries were marginally higher in women with high postglucose load insulin levels. Mean weight of the newborns was essentially the same in GDM and nonGDM women by any of the criteria. One-hour and two-hours postglucose values were more sensitive in diagnosing GDM by O'Sullivan's criteria while fasting plasma glucose value had the poorest specificity with 2.5% of nonGDM women having values above the cut-off. Modifications of these criteria did not im-prove their predictive value for abnormal delivery over that of O'Sullivan's criteria. CONCLUSION:Prevalence of GDM and abnormal delivery in women < 35 years of age is low. Therefore, global screening for GDM may not be very useful in women < 25 years of age unless family history of DM or past history of abortion is present. Existing evidence is inadequate to justify the switchover from O'Sullivan's criteria for diagnosis of GDM.

Acute abdomen in pregnancy is due to consequence of pregnancy itself or is totally unrelated to pregnancy. During pregnancy, a woman is at an increased risk of acute abdomen due to various physiological changes. The article discusses the various conditions which can present as acute abdomen in women during pregnancy and in non-pregnant state. The clinician often has a difficult task in diagnosing and managing acute abdomen in pregnancy. Clinical evaluation is further confounded by various anatomical and physiological changes occurring in pregnancy. The growing gravid uterus too causes difficulty in detailed examination. The general reluctance to use conventional X-rays because of pregnancy should be set aside when faced with a seriously ill mother. A reluctance to operate during pregnancy adds unnecessary delay, which increases morbidity for both the mother and the fetus. Adnexal accidents should always be kept in mind in a woman with acute abdomen even if she is not pregnant. Such mistakes should be avoided as prompt diagnosis and appropriate therapy are crucial. A general approach to acute abdominal conditions in pregnancy is to manage these problems considering the risk to mother regardless of the pregnancy.