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INTRODUCTIONHypertensive disorders are frequently encountered complications in pregnancies and are associated with increased risk of both adverse maternal and fetal outcome. Overall 10-15% of maternal death are directly associated with preeclampsia and eclampsia. Preeclampsia is a disorder of widespread vascular endothelial dysfunction and vasospasm that occur after 20 weeks of gestation and can present as late as 4-6 week postpartum.2 The etiology of preeclampsia is unknown but thought to be related to hypoxia in the placenta due to abnormal placentation. Mild preeclampsia occurs in approximately 15% of pregnancies and severe in 1-2%. 3It complicates 10% of pregnancies in developing countries and responsible for about 76000 maternal deaths every year. 4,5 Minimum criteria for preeclampsia include blood pressure >140/90 mm Hg after 20 weeks gestation, proteinuria >300 mg/24 hours or >1+ dipstick. The measurement of protein excretion in a 24-hour urine collection is used as gold standard for the diagnosis and follow-up of pathological urinary excretion. However, the standard practice of collecting a 24-hour urine for a protein is cumbersome, time consuming and inconvenient ABSTRACT Background: The measurement of albumin: creatinine ratio (ACR) in a spot urine sample avoids the influence of variation in urinary solute concentration and provides a more convenient and rapid method to assess protein excretion. The aim of this study was to evaluate urinary spot ACR as a new marker for proteinuria and to study its correlation and accuracy in comparison with 24-hour urinary protein. Methods:The prospective one-year study was conducted on 100 pregnant women, 18-40 years, >20 weeks gestation with a diagnosis of preeclampsia. A spot midstream urine sample was taken for detection of albuminuria by dipstick method. Another spot sample was taken for detection and calculation of spot ACR. The 24-hour urine collection was taken immediately afterward to evaluate 24-hour urinary protein excretion. Results: A positive linear relation exists between ACR and 24-hour urinary protein excretion The ROC revealed cutoff of 20.4 with 88.5% sensitivity, 75% specificity, 98.8% positive predictive value and 21.4% negative predictive value. Spot urinary ACR >20.4 correctly identified women having 24-hour urinary protein excretion in excess of 0.3 gm/DL. Conclusions: A strong correlation exists between single spot urinary ACR with 24-hour urinary protein excretion in women with preeclampsia.

Background: Anaemia is a global public health problem. To optimize iron delivery in pregnancy, new intravenous complexes like Ferric carboxymaltose (FCM) have been developed in the few years. This study aims to compare the efficacy and safety of FCM vs the iron sucrose during pregnancy.Methods: This study was conducted in the Department of Obstetrics and Gynaecology, Shri Maharaja Gulab Singh (S.M.G.S.) Hospital, Government Medical College Jammu, Jammu and Kashmir over a period of 1 year. 100 pregnant females with haemoglobin (Hb) in the range 7-9.9 g/dl between 28 to 36-week gestation, were selected randomly out of which 50 were administered FCM (Group A) and 50 were administered Iron Sucrose (Group B). Hb and serum ferritin were assessed 2 weeks and 4 weeks after treatment and side effects of each drug was studied.Results: The rise in mean Hb level at 2 weeks and 4 weeks in FCM group was significantly higher as compared to Iron Sucrose group (1.09 versus 0.52 g/dl and 1.80 versus 1.09 g/dl, respectively). Similarly, the rise in mean serum ferritin level at 2 weeks and 4 weeks was more in FCM as compared to Iron Sucrose group (144.25 vs 95.84 mcg/L and 121.31 vs 84.46 mcg/L, respectively). The adverse reactions were observed in 30% of patients in FCM group and 48% patients in iron sucrose group.Conclusions: Ferric carboxymaltose was found to be more safe and efficacious as compared to iron sucrose.

BACKGROUNDThe present study was conducted with an aim to study the sex differences in various congenital anomalies, overall and by subtype.

Background: Placenta accreta spectrum is a pathologic condition of placentation in which the villous tissue adheres or invades the uterine wall. Present study was aimed to study cases of abnormal placentation in the form of placenta accreta spectrum and the maternal and perinatal outcomes associated with it in our hospital. Material and Methods: Present study was single-center, prospective, observational study, pregnant female, gestational age>32weeks, with morbidly adherent placenta diagnosed antenatally by USG/ DOPPLER/ MRI or per operatively (on table). Maternal & Perinatal, outcomes & parameters were studied. Results: Among 58 patients' majority were (43.1%) of the age group of 30 to 34 years, were third gravida (41.4%), 33 (56.9%) delivered before 37 weeks of gestation. 56 (96.6%) patients had at least one LSCS in past pregnancies, 22 (37.9%) had prior curettage, 20 (34.5%) had prior LSCS and curettage, 49 (84.5%) had associated placenta previa. 31 out of 58 patients (53.3%) were diagnosed with morbidly adherent placenta antenatally on ultrasound doppler or MRI and 27 patients (46.6%) were intraoperatively (on table) diagnosed. 33 (56.9%) were diagnosed with placenta percreta, 16 (27.6%) had placenta increta and 9 (15.2%) were diagnosed with placenta accreta. 48 (82.8%) patients had hysterectomy as the rst line of treatment. 47 patients (81%) were shifted to ICU, 23 patients (39.7%) had bladder injuries due to placenta percreta invading the bladder, 30 patients (51.7%) had haemorrhagic shock, sepsis was seen in 3 (5.2%) patients, 2 patients (3.4%) landed in DIC and there were 3 (5.2%) mortalities. 33 (56.8%) neonates had APGAR score at 5 mins of < 7, 58.6% were born preterm, 55.1% required NICU admissions, and 13.7% died in neonatal period. Conclusion: Morbidly adherent placenta is one of the most devastating complications in pregnancy, associated with signicant and increased maternal and perinatal mortality and morbidity.