Predicting adverse maternal and perinatal outcome after threatened miscarriage

Objectives: Threatened miscarriage is the most common complication of pregnancy, occurring in 20% - 25% of ongoing pregnancies. The purpose is to study maternal and perinatal outcome in women with threatened miscarriage. Methods: A prospective study was conducted over a period of 20 months in the Department of Obstetrics and Gynaecology, Pannadhay Mahila Chikitsalaya, a tertiary care center in Udaipur, India. It included a cohort of pregnant patients with a history of threatened miscarriage during the first twenty weeks of pregnancy. They were registered, followed up prospectively at antenatal clinics and delivered in the same hospital. For the purpose of comparison, another group of booked patients (controls) without a history of threatened miscarriage were recruited, similarly scanned and followed throughout pregnancy and labour. All women were matched for age, parity, social class, BMI and gestational age at booking. Discrete variables were taken as counts (or frequencies) and were evaluated by Chi-square test. Continuous variables with normal distribution were presented as mean ± standard deviation (SD) and were compared by unpaired Student’s t test. Data were fed into a Microsoft Excel worksheet and were analyzed by using the SPSS ver.17 (SPSS Inc., Chicago, IL, USA). p-value > 0.05 was considered statistically significant. Results: Out of 62 cases, 13 (21%) patients spontaneously aborted after diagnosis of threatened miscarriage. Women with threatened miscarriage had a significantly higher incidence of low lying placenta (p = 0.02) when compared with those without firsttrimester bleeding. They were more likely to experience PROM (p = 0.02), preterm delivery (p = 0.02) and to have babies with low Birthweight (p = 0.03). Conclusion: Pregnancies complicated by threatened miscarriage are at a higher risk for obstetric complications.

Evaluation of the Risk Factors for Pelvic Lymph Node Metastasis in Early Stage Cervical Cancer

Objective: This study evaluated the risk factors for pelvic lymph node metastasis in patients with early stage cervical cancer. Material and Methods: A cross sectional study was carried out in the Division of Gynaecologic Oncology at Bangabandhu Sheikh Mujib Medical University (BSMMU) between July 2014 and July 2015 to evaluate demographic factors and histopathological findings of women with cervical cancer stage IB-IIA who underwent primary radical hysterectomy and bilateral pelvic lymph node dissection. Results: Fifty women aged 30 years or above were included in the study. Lymph node metastases were identified in 20% of patients. By univariate analysis, preoperative anemia, a history of smoking, tumor size greater than 4 cm and lack of cervical inflammatory reaction by histopathology were significant variables associated with lymph node metastasis. Multivariate analysis showed that the lack of inflammatory reaction in the uterine cervix was the most important predictor for pelvic lymph node metastasis when adjusting for other variables. Moderate to severe inflammatory reaction in the uterine cervix was 18 times less likely to have pelvic lymph node metastasis than those who had mild inflammation. Conclusion: An association was found between the presence of pelvic lymph node metastasis in cervical cancer and certain variables: the lack of contraceptive use, smoking, preoperative anemia, bulky tumors, invasion of deep two-third of the uterine cervix, mild inflammatory reaction in the cervix, and keratinizing carcinoma. After adjusting for other factors, presence or absence of inflammatory reaction in the cervix was found to be the most important predictor for pelvic lymph node metastasis.