Biomedical subjects

G I Dhall

Publications and source records attributed to G I Dhall.

At least 19 recordsLinked to original sources

PubMed1997

Pattern of cervical dilatation in previous lower segment caesarean section patients.

The pattern of cervical dilatation during labour in 100 patients with previous lower segment caesarean section (LSCS) was determined in a prospective partographic study. Eighty-four subjects delivered successfully by vaginal route. The mean initial dilatation rate (IDR) and average dilatation rate (ADR) were 0.884 cm/hour and 1.255 cm/hour respectively. The mean IDR and ADR of the patients who delivered vaginally were 0.96 cm/hour and 1.41 cm/hour respectively, while of those who required repeat LSCS mean IDR was 0.44 cm/hour and mean ADR was 0.42 cm/hour. Hence ADR in cases who required repeat LSCS was significantly slower as compared to those who delivered vaginally (p < 0.01). Most (87.5%) of the cases who required repeat LSCS crossed the alert line as compared to 34.5% of patients who delivered vaginally. The mean admission delivery interval (ADI) was 9.45 +/- 4.29 hours in patients with no previous vaginal delivery and 8.02 +/- 4.83 hours in patients with previous vaginal delivery. The mean durations of 1st and 2nd stages of labour were 11.8 +/- 5.35 hours and 29.4 +/- 27.3 minutes respectively. It is concluded that partographic evaluation is an important aspect in management of labour of such patients.

Adult↗

PubMed1995

Return of fertility following discontinuation of Norplant-II subdermal implants. ICMR Task Force on Hormonal Contraception.

A total of 627 women who had discontinued the use of the Norplant-II implants for various reasons and were exposed to the risk of pregnancy were followed-up for two years for return of fertility. The cumulative conception rates in women who had discontinued due to planning pregnancy were 80.3 per 100 women at one year and 88.3 per 100 women at two years. The majority of women who did conceive (90 percent), had full-term normal live births; about 4 percent of women had spontaneous abortions, the remaining 6 percent decided on elective termination of pregnancy (ETP). The cumulative conception rates in women who discontinued due to bleeding irregularities and 'other reasons' were 64.5 and 55.8 per 100 women at one year and 77.9 and 75.1 per 100 women at two years, respectively. These rates were significantly lower as compared to those observed in women who discontinued due to planning pregnancy. A large proportion, about 40 percent, of women who conceived after discontinuation of the method due to bleeding irregularities and "other reasons," opted for ETP indicating that many women in these two groups did not desire another child and that such women need to be counselled for adopting another method of contraception. The spontaneous abortion rates observed in ex-users of Norplant-II implants (1.7 to 4.4% pregnancies) were comparable to the spontaneous abortion rates prior to Norplant-II implant use (3.6% pregnancies) indicating that ex-users of Norplant-II implants were not at a higher risk of spontaneous abortion.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

PubMed1995

The relationship of sonographic placental grading, biochemical pulmonary maturity and neonatal outcome in pregnancy-induced hypertension.

In a prospective study, the accuracy of placental grade in predicting pulmonary maturity was evaluated in 50 cases of pregnancy-induced hypertension (PIH) between 28 and 41 weeks of gestation. Pulmonary maturity was measured by lecithin/sphingomyelin (L/S) ratio and phosphatidylglycerol (PG) in amniotic fluid and by clinical development of respiratory distress syndrome (RDS) in the neonates. Fifty normotensive healthy primigravidae, who were matched for age and period of gestation, served as control. No difference (p > 0.05) in the placental grading was observed between normotensive and hypertensive pregnancies. The advancement of placental grade was found to be associated with an increase in L/S ratio and PG level in amniotic fluid. A mature placental grade (grade III) identified by real-time sonography corresponded to foetal lung maturity (L/S > or = 2.0, PG > or = 0.36 mg/dl) and absence of RDS in all cases. Hence, in PIH a grade III placenta appeared to be a reliable predictor of foetal lung maturity in the population examined.

Amniotic Fluid↗

PubMed1995

Significance of nuchal cord.

Perinatal events of 180 babies with nuchal cord (umbilical cord entanglement around foetal neck) over one year have been studied. The incidence of nuchal cord was 5.74% of all hospital deliveries. More than one third (39%) of them had tight nuchal cord (TNC) and 61% had loose nuchal cord (LNC). Babies with TNC were more frequently met with foetal distress (51%), prolonged second stage (11%), non-toxaemic accidental haemorrhage (7%) and operative delivery (56%) when compared to babies with LNC and controls (without nuchal cord). Nearly one fourth (24%) of the babies with TNC were born as small for date, had birth asphyxia (61%) and 8.5% died during perinatal period. Perinatal outcome was adversely affected by TNC in comparison to LNC and controls.

Female↗

PubMed1994

Purification and characterization of a low molecular weight zinc binding protein from human placenta.

A low molecular weight, native zinc binding, cytosolic protein (LMZP) has been isolated, purified and characterized from human normal term placenta. Gel filtration of heat treated placental cytosol after sequential acetone precipitation (80% ppt) revealed a major zinc binding protein in the range of low molecular weight. This partially purified zinc binding fraction was further fractionated on DEAE-Sephadex A-25. The zinc was eluted in one of the three peak fractions. Further, the purity of zinc binding protein was confirmed on fast protein liquid chromatography (FPLC). The purified placental LMZP was homogenous on SDS-polyacrylamide gel electrophoresis with a single band. Ultraviolet (UV) spectrum of LMZP showed an absorption maximum at 257 nm which disappeared at pH 2. Molecular weight of LMZP as determined by gel chromatography, SDS-polyacrylamide gel electrophoresis and amino acid analysis was 6 kDa. It was calculated that 1 g atom of zinc was bound to 1 mole of the LMZP. Unlike in classical metallothionein, the amino acid composition of placental LMZP revealed the presence of aromatic amino acids, lower content of cysteine and higher content of histidine, glutamic acid and aspartic acid (10, 9 and 5 residues/mole, respectively).

Amino Acids↗

PubMed1994

Significance of serum iron levels as a biochemical marker in pregnancy-induced hypertension.

OBJECTIVE: To determine the changes in serum iron levels, if any, as a biochemical marker of pregnancy-induced hypertension (PIH). METHOD: Fifty-four primigravidas with PIH formed the study group and 20 normotensive primigravidas comprised the control group in a prospective study. Serum iron levels were estimated at diagnosis of PIH, at termination of pregnancy and in the postpartum period. Data was analyzed using Student's t-test, the chi 2-test and regression analysis. RESULTS: Subjects with PIH were found to have higher serum iron levels at diagnosis of PIH (recruitment value) and at termination of pregnancy than the controls (P < 0.001). Serum iron levels in the PIH subjects decreased markedly in the postpartum period simultaneously with the clinical recovery from PIH. Serum iron values of > or = 110 micrograms/dl was found to differentiate PIH from normotensive pregnancies with a sensitivity and specificity of 89% and 90%, respectively. CONCLUSIONS: Changes in serum iron levels correlated with the clinical course of PIH and appeared to be a uniform and specific biochemical marker of PIH although its correlation with the severity of PIH was found to be poor.

Adult↗

PubMed1994

A safer and more effective treatment regimen for eclampsia.

In a prospective controlled trial 91 consecutive women with eclampsia were randomly allocated either to a magnesium sulphate and nifedipine regime or to a lytic cocktail and nifedipine group. The type and severity of disease, details of labour and delivery, and the maternal and perinatal outcomes and complications related to the 2 treatment regimens were compared. Recurrence of fits, aspiration pneumonia and sudden hypotension were significantly reduced when patients were treated with the new magnesium sulphate and nifedipine regimen compared with the lytic cocktail plus nifedipine regimen. No patient treated with the new regimen died or had respiratory depression; in the other group there were 2 maternal deaths plus 1 case of severe hypoxic brain damage. No difference was observed in duration of labour or mode of delivery. Perinatal mortality was significantly lower in the magnesium sulphate plus nifedipine treated group. The synergistic action of magnesium sulphate and nifedipine in the dosage employed in this study may be used to reduce maternal and perinatal mortality and morbidity in women with eclampsia.

Adult↗

PubMed1993

Single dose tinidazole prophylaxis in vaginal hysterectomy.

OBJECTIVE: To determine the efficacy and side effects of a single dose of tinidazole for infection following vaginal hysterectomy. METHOD: A randomized double-blind placebo-controlled trial using 2 g tinidazole 12 h before vaginal hysterectomy in 50 patients was conducted. No other antibiotic was used until the development of infection. RESULT: There was a significant reduction (P < 0.01) of post-operative vaginal cuff cellulitis (54-16%). A similar reduction (P < 0.05) in febrile morbidity was also observed. The duration of postoperative hospital stay (P < 0.001) and use of additional antibiotics (P < 0.01) were also reduced. No adverse effect of tinidazole was noted. CONCLUSION: A single dose of tinidazole appears to be a safe and effective alternative prevention against infection in vaginal hysterectomy.

Adult↗

PubMed1993

Tinidazole prophylaxis in elective abdominal hysterectomy.

OBJECTIVE: To determine whether a single dose (2 g) of tinidazole before abdominal hysterectomy could reduce the incidence of postoperative infection. METHOD: A randomized double-blind placebo-controlled study was undertaken with a single oral dose (2 g) of tinidazole, 12 h before surgery, in 100 patients undergoing abdominal hysterectomy for various benign diseases. Other antibiotic use was withheld until there was no postoperative infection. RESULT: A significant reduction (P < 0.05) of infectious morbidity (28% vs. 8%) as well as a decrease in additional antibiotic use (P < 0.01) and duration of hospital stay (P < 0.001) was observed. Febrile morbidity was also reduced from 36% to 14% (P < 0.05). Tinidazole was tolerated well by all the patients. CONCLUSION: Tinidazole prophylaxis (2 g oral dose) is considered to be a simple, safe and effective way to reduce postoperative infection in abdominal hysterectomy.

Adult↗

PubMed1993

Pregnancy in association with mitral valve prolapse.

Mitral valve prolapse (MVP) is considered to be the most common valvular heart lesion in adult females of reproductive age. Our report reviews the obstetrical performance and outcome of 34 pregnancies in 15 women with MVP. In 12 (80%) patients cardiac lesion was suspected due to enigmatic dyspnoea and palpitation during antenatal period. Four mothers required propranolol for cardiac arrhythmias. However, all of them tolerated pregnancy and labour well. Four pregnancies (11.8%) ended in spontaneous abortion and 1 mother had intrauterine fetal death due to severe pregnancy-induced hypertension. There were 25 (73.5%) term and 3 (8.8%) preterm neonates without congenital abnormality. One preterm neonate had tracheo-oesophageal fistula and died 6 hours after corrective surgery. The mean birth weight of 2.8 kg was appropriate for mean gestation of 38.5 weeks when compared to the Institute's reference neonatal weight curve. Infective endocarditis prophylaxis was recommended in cases having mitral regurgitation and complicated delivery. Awareness of this common cardiac lesion, thorough cardiovascular examination during pregnancy, early detection and treatment of cardiac arrhythmias if any, are the essential steps to prevent rare but dreaded maternal complications.

Adult↗

PubMed1993

Nonobstetric lower genital tract trauma.

In a 4-year-period there were 31 admissions to Nehru Hospital, because of nonobstetric injuries of the female genital tract. This constituted 0.8% of all gynaecological admissions over this period. The injuries were caused by voluntary coitus, automobile accidents and various types of astride injuries. Seven of the 18 patients with noncoital injuries presented with vulval haematomas and all were managed by evacuation under general anaesthesia. Two of the 13 patients with coital injury were admitted with haemorrhagic shock and required initial resuscitation with blood transfusion. The vaginal vault, especially the right and posterior fornices were the frequent sites of coital injury for parous women; on the other hand lower vaginal and introital injuries were caused by first acts of coitus. Except for trivial superficial lacerations with minimal bleeding, primary definitive surgical repair other than vaginal packing was favoured for better healing and to reduce morbidity.

Accidents↗

PubMed1993

Prescription drug use in lactating mothers: an experience at a referral hospital and in a community in India.

The aim of the study was to investigate the extent of prescription drugs administered for common disorders during the post partum period. This is a prospective survey of disorders and drug use in 1) immediate postpartum mothers (n = 200) admitted to the maternity wards, 2) in post-natal hospital follow-up clinic (n = 200) and in 3) the rural home based community (n = 100). A pretested questionnaire was filled in by medical officers after interviewing the mothers. The mean age of the mothers was 25 years and a literacy rate of 50% above the 10th grade. Over 80% of the women were multigravida in the entire sample; 45% underwent Caesarean Section in a hospital; 97.6% had a normal delivery in the community. In the hospital settings 4.1% infants had jaundice and 1% had congenital anomalies. In the community setting, diarrhoea and pneumonia was seen in 2.6% of the infants. Apart from the use of nutritional supplements, such as iron, calcium, multivitamins etc., most commonly prescribed drugs were analgesics (in 70% of patients in the hospital settings, 56% of the patients in the postnatal clinic and 37.6% patients in the community), and antibiotics (90% of the patients in the hospital settings, 86% of the patients in the postnatal clinic and 13% of the community based patients). Antihypertensives agents (2.5% of the patients), digoxin (1.5% of the patients), bronchodilators (1% of the patients) and sedatives (3.5% of the patients) were prescribed to admitted patients.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

PubMed1991

Short-term and long-term effects of Norplant-2 on plasma lipoproteins and glucose tolerance.

Twenty-five women using the levonorgestrel-containing contraceptive implant, Norplant-2, were studied longitudinally, to see the effects on lipid profile, glucose tolerance and hepatic transaminases with short-term (12 weeks) and long-term (18 to 24 months) use of Norplant-2 [corrected]. Total lipids, cholesterol, phospholipids, triglycerides and their subfractions were evaluated. There was a significant increase in LDL-cholesterol after 12 weeks of use (p less than 0.05), which did not persist at 18-24 months follow-up. The HDL-cholesterol, HDL/LDL-cholesterol ratio, phospholipids, other lipid fractions, hepatic transaminases and glucose tolerance did not alter significantly following short-term or long-term use of Norplant-2.

Adult↗

PubMed1991

Idiopathic pulmonary fibrosis (IPF) necessitating therapeutic midtrimester abortion: a case report.

A 35-year old multiparous lady was admitted at 19 weeks of pregnancy with rapid onset of dyspnoea which progressed to grade III in 2 months. She was diagnosed as a case of idiopathic pulmonary fibrosis (IPF). She had a vital capacity of 1.25 l, 46.5% of predicted and PaO2 of 60 mmHg at rest, dropping to 35 mmHg on mild exercise testing. She did not respond to prednisolone 40 mg daily given orally for one month. In view of lack of improvement, therapeutic abortion was carried out at 24 weeks by abdominal hysterotomy combined with tubal ligation. Subsequent to termination of pregnancy, her clinical status and pulmonary function improved markedly and she had only grade I dyspnoea 30 months later without corticosteroids. Effect of pregnancy on interstitial lung disorders especially IPF is not yet clear because of extreme rarity of their association. Therapeutic abortion should be seriously considered in patients who cannot increase their oxygen consumption 3 times normal without uncorrectable hypoxaemia.

Abortion, Therapeutic↗

PubMed1991

Cervico-oculo-acousticus syndrome with pregnancy.

Cervico-oculo-acousticus syndrome is a very rare entity with only 21 cases described in the world literature. A study of a case of this syndrome with pregnancy is presented. This primigravida, in addition to the classical triad of the syndrome, had other dysmorphic features such as short stature (141 cm), and marked thoracic kyphosis with restricted ventilatory capacity. Her physical activity during pregnancy was guided according to her respiratory status. In spite of marked thoracic kyphosis the cephalo-pelvic relationship was found to be adequate for a vaginal delivery. A healthy male baby weighing 3.8 kg was delivered by an outlet forceps at term. Puerperium was uneventful. The child was clinically normal at the age of 2 years.

Abnormalities, Multiple↗

PubMed1990

Microdose intravaginal levonorgestrel contraception: a multicentre clinical trial. I. Contraceptive efficacy and side effects. World Health Organization. Task Force on Long-Acting Systemic Agents for Fertility Regulation.

A multicentre clinical trial, including 19 centres in 13 countries, assessed the contraceptive efficacy and clinical acceptability of a Silastic 382 vaginal ring releasing 20 micrograms of levonorgestrel for at least 90 days. A total of 1005 women entered the study and 8176.74 woman-months of experience was gathered. The rate of intrauterine pregnancy at one year of use was 3.6 per 100 women (95% confidence interval 2.2-5.0), and of ectopic pregnancy, 0.2% (one case). The principal reasons for discontinuation were menstrual disturbances (17.2% at one year), vaginal symptoms (6.0%) and repeated expulsion of the ring (7.1%). The pregnancy rate with this 20 micrograms levonorgestrel-releasing vaginal ring compares favourably with that of a low estrogen combination oral contraceptive tested by WHO and is less than half that of a progestogen-only oral contraceptive in a WHO randomized study. It is concluded that the WHO intravaginal ring releasing an average of 20 micrograms of levonorgestrel per 24 hours is an effective method of contraception for at least one year of use.

Administration, Intravaginal↗

PubMed1990

Microdose intravaginal levonorgestrel contraception: a multicentre clinical trial. II. Expulsions and removals. World Health Organization. Task Force on Long-Acting Systemic Agents for Fertility Regulation.

This paper investigates the relationship between expulsions and removals, and demographic characteristics of 1005 women from 19 centres using a vaginal ring releasing 20 micrograms levonorgestrel per 24 hours. Emphasis is placed on discontinuations of method use due to expulsions, on the number and rate of expulsions, and the time at which the first expulsion occurred. The overall life-table discontinuation rate due to expulsion was 7.1% at one year. Life-table discontinuation rates increased with parity and were highest in Asian and lowest in European women. In respect to the number of expulsions experienced by women (expulsions did not necessarily lead to discontinuation), the women of high parity and those from Asia and Europe have the highest rates. The life-table first expulsion rate is 29% at one year. Such rates are highest in Chinese and Asian women. Following a first expulsion, the second expulsion rate is 45% by the end of the subsequent six months. The majority of first expulsions occur at defaecation (134 or 57% of 234 women), urination (12%) and during menstruation (17%). Rings were removed by 121 (12%) women on 201 occasions and for a variety of reasons. The main medical reasons were vaginal discharge and irritation, bleeding pain and dyspareunia. Others removed the ring during defaecation, intercourse or because the ring came out of place. Women also removed rings for curiosity, to show their husbands and to clean.

Administration, Intravaginal↗

PubMed1990

Microdose intravaginal levonorgestrel contraception: a multicentre clinical trial. III. The relationship between pregnancy rate and body weight. World Health Organization. Task Force on Long-Acting Systemic Agents for Fertility Regulation.

This paper investigates the relationship between pregnancy rates and body weight of 1005 women using a vaginal ring releasing 20 micrograms levonorgestrel per 24 hours. While the overall pregnancy rate at one year was 3.7%, it was found that women have an increasing risk of pregnancy with increasing body weight. For example, a woman of 40 kg has an estimated pregnancy rate of 1.7% in contrast to 9.8% for a woman of 80 kg weight.

Administration, Intravaginal↗