Objective Hypertensive disorder of pregnancy is a major cause of fetal and maternal morbidity and mortality. The current approach for pregnancy‐induced hypertension (PIH) screening is complex and expensive. The present prospective cohort study assesses the advantage of combining first‐ and second‐trimester uterine artery pulsatility index (UAPI) for predictive diagnosis of PIH. Methods A total of 151 prenatal cases in their first trimester were studied and followed up till delivery. The mean UAPI was calculated for the first and second trimesters during the nuchal translucency and anomaly scans. Receiver operating characteristic analysis was used to calculate the cut‐off of UAPI for first‐trimester, second‐trimester, and both trimesters combined. Results Twenty‐seven (17.9%) pregnant women developed PIH. Mean ± SD UAPI values for first and second trimesters were 1.92 ± 0.60 and 1.23 ± 0.36, respectively. The cut‐offs for abnormal UAPI were ≥2.51, ≥1.32, and ≥1.91 for first trimester, second trimester, and both trimesters combined, respectively. The sensitivity and specificity of UAPI in predictive diagnosis of PIH were 82% and 95% for first trimester, 93% and 85% for the second trimester, and 93% and 98% for both trimesters combined. Conclusion Combining UAPI of first and second trimesters improves the predictive diagnosis of PIH, which can be carried out during the nuchal translucency and anomaly scans without imparting extra cost to the patient.
Background: Ovarian cancer imposes a significant health burden worldwide. Although various tumor markers are available to diagnose ovarian cancer, low-resource countries like India require a humble marker or index. The Risk of Malignancy Index (RMI) has been found to be a simple yet promising tool that can be used for this purpose. In this study, we attempted to validate various RMIs with the help of menopausal status, ultrasonogram score, cancer antigen (CA) 125 value and compare all four RMIs, which would be useful to differentiate benign and malignant ovarian masses. This could be an essential tool, especially in lowresource settings.Method: This prospective study was conducted at Kalinga Institute of Medical Sciences in Odisha, India, from September 2020 to September 2022 involving 191 patients with ovarian mass with histopathology, which was deemed the "gold standard" diagnostic tool. The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of RMI 1, 2, 3, and 4 were calculated and compared.Results: Out of 191 patients, 32 (16%) had malignancy and 159 (83.2%) had benign pathology. It was apparent that RMI 4 was a better tool for the initial assessment of patients with ovarian masses with a sensitivity of 80.6%, specificity of 96.2%, PPV of 81%, NPV of 96% at a cutoff of 334, and an area under the curve value of 0.939. Conclusion: RMI 4 followed by RMI 3 were relatively better indices than RMI 1 and RMI 2 for identifying benign and malignant ovarian masses. RMI 4 was a valuable and applicable method in diagnosing pelvic masses with a high risk of malignancy.
Introduction: Placental calcification, identified before the 36th week of gestational age, is known as premature placental calcification (PPC). PPC could be a clue for the poor fetal outcome. However, its association with adverse perinatal outcomes is yet to be confirmed. Objective: The primary objective was to determine and compare the perinatal outcomes in pregnancies with and without documented premature placental calcification. Methodology: The present study was a prospective cohort study performed from October 2017 to September 2019. We consecutively enrolled 494 antenatal women who presented to our antenatal OPD after taking consent to participate in our study. Transabdominal sonographies were conducted between 28–36 weeks of gestation to document placental maturity. We compared maternal and fetal outcomes between those who were identified with grade III placental calcification (n = 140) and those without grade III placental calcification (n = 354). Results: The incidence of preeclampsia, at least one abnormal Doppler index, obstetrics cholestasis, placental abruption, and FGR (fetal growth restriction) pregnancies were significantly higher in the group premature placental calcification. We also found a significantly increased incidence of Low APGAR (Appearance, Pulse, Grimace, Activity, and Respiration) scores, NICU (Neonatal Intensive Care Unit) Admission, Abnormal CTG (cardiotocography), meconium-stained liquor, and low birth weight babies in those with grade III placental calcification. Conclusion: Clinicians should be aware of documenting placental grading while performing ultrasonography during 28 to 36 weeks. Ultrasonographically, the absence of PPC can define a subcategory of low-risk pregnant populations which probably need no referral to specialized centers and can be managed in these settings.
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