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Objective To evaluate prospectively mitral stenosis in pregnancy with emphasis on women with persisSetting King Edward VIII Hospital, a tertiary referral obstetric unit.Participants One hundred and twenty-eight consecutive women with mitral stenosis. DemographicsThe mean age was 27 years and 38 women (30%) were primigravidae. Seventy-eight (61%) women had their first cardiac evaluation in the third trimester. Fifty-four women (42%) of these women had mitral stenosis diagnosed for the first time in the index pregnancy. Twenty-nine (23%) had a previous mitral valvulotomy. Nineteen women (15%) developed hypertension during pregnancy, 10 of whom had pre-eclampsia. Sixty-three women (49%) had a mitral valve area of I 1.2 cm2 with 11 having critical mitral stenosis (mitral valve area I 0.8 cm2). Atrial fibrillation was present in 12 women. Most women (87%) required medical therapy to control the heart rate.Outcome in persistent symptomatic women Intervention was considered in 37 women (29%) who remained symptomatic, 11 (9%) of whom had a calcified mitral valve. The remaining 26 women were scheduled for balloon mitral valvulotomy during pregnancy, 20 of whom had balloon mitral valvulotomy with good effect (16 antepartum; 4 postpartum). In seven women, scheduled balloon mitral valvulotomy was not performed because of advanced preterm labour (n = 3, fetal distress (n = 1) and preterm labour with fetal distress (n = 1). These seven, together with the 11 with calcific mitral stenosis, were managed conservatively with good outcome.Maternal complications Fifty-one percent had maternal complications, the majority occurring at their initial admission to hospital. Pulmonary oedema was the most frequent. Multiple logistic regression analysis showed that the severity of stenosis assessed by measurement of the mitral valve area by echo-Doppler was the most powerful predictor of maternal pulmonary oedema. The other factors were late antenatal presentation, presence of symptoms prior to the index pregnancy and diagnosis of cardiac disease for the first time in the index pregnancy.Conclusion Despite serious disease, women with persistent symptoms treated either by balloon mitral valvulotomy where feasible, or conservatively with close noninvasive monitoring, had a satisfactory fetal and maternal outcome. tent symptoms.

Background: Fetal well-being has traditionally been evaluated on the basis of fetal activity fetal heart and presence of meconium in liquor amnii in vertex presentation. The significance of meconium claimed to vary between its entirely being physiological to a sign of fetal distress. Passage of meconium is considered physiological exhibiting sign of fetal maturity on one hand & a sign of fetal distress and response to hypoxic insult on the other hand. Methods: The present study is a case-control study of meconium stained amniotic fluid, its significance and early maternal and neonatal outcome and was carried out in the department of Obstetrics & Gynecology, Dhiraj General Hospital, Pipariya during April 2011 to March 2012. Results: The incidence of passage of meconium was relatively higher in patients with pregnancy induced hypertension (20%) and pregnancy beyond 40 weeks (14.66%). Amongst the cases 28.66% patients had an abnormal fetal heart pattern and 12% had a variable fetal heart pattern whereas in controls the values were 8% and 3.33% respectively. The total number of patients with meconium aspiration was 18% whereas those with meconium aspiration syndrome were 6%. Conclusions: Meconium passage still remains an enigma to the obstetrician. However, as shown in the study, thick meconium or thin are indicative of fetal distress. If modern management is based on the understanding of underlying pathophysiology of meconium passage than the harmful effect of meconium can certainly be lessened. [Int J Reprod Contracept Obstet Gynecol 2013; 2(2.000): 190-193

Purpose. To study prevalence of uncontrolled seizures in patients with juvenile myoclonic epilepsy [JME] and assess factors responsible for it. Methods. An ambispective study of all patients with JME attending our epilepsy clinic was done. We recruited all patients with JME evaluated between 1 January 2009 and 31 December 2013 and followed them up to 31 December 2015. Results. Amongst 876 patients with epilepsy, JME was present in 73 patients. Amongst them, 53 [72.6%] had uncontrolled seizures prior to neurology consultation. Factors responsible for uncontrolled seizures included pitfalls in diagnosis like absence of prior neurology consultation missed history of myoclonus in prior consults and pitfalls in interpretation of EEG. Pitfalls in management were incorrect antiepileptic drug use, underdosing of AED, noncompliance with lifestyle, noncompliance with medicines, associated psychogenic nonepileptiform events, patients deliberately missing medicines for secondary gain, and concomitant alternative medicine use. 45 (84.9%) patients had “pseudorefractoriness.” True refractoriness [seizures despite 2 correctly dosed rational drugs] was seen in 8 (15.1%) patients only. Conclusion. Three-fourth of our patients had uncontrolled seizures initially, predominantly due to pitfalls in its diagnosis and management. Improving patient awareness and primary physician training for JME management is the need of the hour.