Background & objective: To see the relationship between preeclampsia and iron parameters (serum iron, serum ferritin and total iron binding capacity). Methods: The present case-control study was carried out in the Department of Obstetrics & Gynaecology, Dhaka Medical College Hospital (DMCH), Dhaka in collaboration with the Department of Biochemistry, BSMMU, Dhaka over a period of 1 year from July 2012 to June 2013 Pregnant women with preeclampsia admitted in the above-mentioned hospital were considered as case, while the pregnant women without preeclampsia were included as control. A total of 60 women-31 cases and 29 controls were purposively included in the study. The exposure variables were serum ferritin, serum iron and total iron binding capacity (TIBC), while the outcome variable was preeclampsia. The serum iron level > 100 μg/L was considered as hyperferritenemia. Result: Nearly two-thirds of the women were in their 2nd decades of life belonged to lower socioeconomic class. The body mass index was also fairly comparable between the groups with most women having normal BMI. No significant difference was observed between the groups with respect to obstetric variables as well. Level of haemoglobin and hematocrit were also identically distributed between groups. The result showed that a significantly higher proportion (35.5%) preeclamptic women had elevated serum ferritin (> 100 μg/L) as opposed to 10.3% of the control group (p = 0.021). The risk of developing raised serum ferritin in women with preeclampsia was estimated to be 4-fold (95% CI =1.2 – 19.4) higher than that in the normal pregnant women. Analyses also revealed that women with severe preeclampsia had a higher mean serum ferritin (207.3 ± 44.1 ng/ml) than the women with mild preeclampsia (41.7 ± 2.7) and an even higher level compared with the normal pregnant women (21.7 ± 1.4 μg/ml) (p = 0.001). Similar result was observed in serum iron with greater the severity, higher is the level of serum iron (p = 0.067). Conversely, the serum total iron binding capacity (TIBC) was decreased with severity of preeclampsia (p = 0.058). Conclusion: The study concluded that women with preeclamsia might be associated with higher serum ferritin, higher serum iron and lower serum TIBC although it is not known whether the rise in serum ferritin and serum iron precedes or contributes to the clinical manifestations of preeclampsia. Ibrahim Card Med J 2017; 7 (1&2): 64-69

Background & objective: Road traffic accident (RTA), now a days, has become a common event worldwide. As face is the most exposed part of the body, is most at risk of sustaining trauma in RTA. However, there is paucity of information regarding the relationship between head injuries and facial trauma. A number of reviews have looked at brain injuries in patients with facial fractures. But these reviews failed to differentiate between major and minor brain injuries. Moreover, most studies were retrospective and based upon large trauma registries, which tend to preselect patients with multiple trauma and capture only major brain injuries. The incidence of minor brain injuries and concussion in this population is thus overlooked. This study was aimed to find the proportion of major and minor brain injuries in patients with facial bone fracture. Materials & Methods: This cross-sectional study was carried out in patients with facial bone fractures who attended at outpatient clinic, hospital ward of the Department of Oral and Maxillofacial Surgery, Dhaka Dental College Hospital, Dhaka, Neurosurgery Department, Emergency Department of Intensive Care Unit of Dhaka Medical College Hospital, Dhaka over a period of 2 years from January 2012 to December 2013. Only the patients of first encounters were included in the study. Patients referred from other centers with facial bone fracture were excluded. A total of 150 such patients were enrolled in the study. To assess and communicate the extent of an unconscious patient’s injury rapidly Glasgow Coma Scale (GCS) was used. The outcome variable was brain injury (major and minor). Result: Majority (80%) of the patients was male with mean age of the patients being 25 years (range: from 4 – 80 years). The most common mechanism of injury in the present study was road-traffic accident (60%), followed by assault (20%), fall from height (12%), crash (6%) and blast trauma (2%). Nearly half (46%) of the patients had multiple facial bone fractures. Over 10% of the patients received Zygomatico-maxillary complex fracture. Mandible fracture and frontal bone fracture each accounted for 7.3%. Nasal bone fracture was 6.7%, isolated maxilla fracture was 5.3%, Le Fort I fracture was 4.7% and orbital floor fracture was 4.0%. The Glasgow coma score 12 or below 12 was found in 52% cases and loss of consciousness and perievent amenesia were observed in 54% and 56% cases respectively. The major and minor brain injuries were found in 52% and 32% cases respectively together comprising an occurrence of 84% in facial bone fractures. Male patients, receiving trauma through RTA and multiple facial bones fractures were significantly associated with brain injury (p = 0.019, p < 0.001, p = 0.001 respectively). However, mandible and nasal bone fractures were less prone to be associated with brain injury in (p = 0.001 and p < 0.001 respectively). Conclusion: The study concluded that majority of the patients with facial bone fractures have had concomitant brain injuries. Male patients, receiving trauma through RTA and multiple fractures of the facial bones are more prone to be associated with brain injury than females, receiving injury through mechanisms other than RTA and isolated facial bone fractures. Ibrahim Card Med J 2016; 6 (1&2): 33-40

Background & objective: Management of pregnancy with intrauterine fetal death (IUFD) is always puzzling to the obstetricians and mental agony to the patients. Intravenous oxytocin infusion was previously practiced for termination of pregnancy with IUFD. But recently misoprostol is claimed to be better than oxytocin in terms of its efficacy and safety. This prospective study was carried out to find which of these two drugs is suitable for termination of pregnancy with IUFD. Methods: Based on predefined criteria,a total of 100 singleton pregnant women with gestational age more than 22 weeks, ultrasonographically confirmed as having dead fetus in utero were included in the study and were randomly assigned to vaginal Misoprostol and Oxytocin infusion groups. The outcome was evaluated in terms of time required for induction of labor, induction to delivery time and complications encountered by each group. Result: The overall time required for induction to delivery was significantly shorter in Misoprostol group than that in Oxytocin group irrespective of their Bishop’s score (p < 0.001). Even in patients in whom the cervix was unripe (Bishop's score < 6), the mean time required from induction to delivery was much shorter in Misoprostol group (p < 0.001), but in patients in whom the cervix was ripen, the mean time from induction to delivery in Misoprostol group was shorter, but the difference did not turn to significant (p = 0.079). Both nulliparous and multiparous women experienced significantly shorter durations of labor in the Misoprostol group than those in the Oxytocin group (p < 0.001 and p = 0.001 respectively). Complications like hyperstimulation, retained placenta and postpartum hemorrhage all were somewhat higher in Misoprostol group than those in Oxytocin group, but the differences were not statistically significant (p = 0.357, p = 0.500 and p = 0.500 respectively). Conclusion: The use of vaginal misoprostol is more effective than intravenous infusion of oxytocin in induction of labor in patients with IUFD. The time required from induction to delivery is appreciably shorter when Misoprostol is used compared to that needed when oxytocin is used. Ibrahim Card Med J 2019; 9 (1&2): 74-79

Background & objective: To find the association between serum vitamin B12 and food behavior of the pregnant women and its influence on perinatal outcome. Methods: This cross-sectional study was conducted in the Department of Obstetrics & Gynaecology, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka between June 2012 to July 2013. A total of 102 uncomplicated pregnant women attending at the Obstetrics & Gynaecology Department of BSMMU, Dhaka were the study population. Plasma vitamin B12 was measured by Abbott Axsym System using a Enzyme Immuno Assay Technique with the blood collected in a plain test tube. A serum vitamin B12 level of < 200 pg/mL was considered as low serum vitamin B12 level. The outcome variables were birth weight, small-for-date, neural tube defects and other congenital malformations. Result: The selected pregnant women were housewife (74.5%) from low socioeconomic strata. They were generally urban resident (90.2%) with mean age being 26.4 years. In terms of education 17.6% were primary level, 30.4% SSC level, 31.4% HSC level and 20.6% graduate and higher level educated. Majority (90.2%) was urban resident with average monthly family income being Taka 29460. One-third (33.3%) was overweight and 6.9% obese. Two-thirds (66.7%) were at 37-39 weeks of gestation and nullipara. More than 60% received ANC (antenatal care) aregularly. Over one-third (35.3%) had low serum vitamin B12 (< 200 pg/mL). The food behaviour of the women was found to be associated with vitamin B12 deficiency. The pregnant women with low serum vitamin B12 (< 200 pg/ml) had significantly lower weekly consumption of fishes and eggs which are the rich source of vitamin B12. The weekly fish, eggs and amount of milk consumed by the pregnant women with low serum vitamin B12 were much lower than those consumed by the pregnant women with normal serum vitamin B12. The pregnant women with low serum vitamin B12 were more likely to carry a higher risk of adverse perinatal outcome. The incidences of low-birth weight and small-for-dates were staggeringly higher in women with low serum vitamin B12 (33.3% and 27.8% respectively) compared to those in women with normal serum vitamin B12. Conclusion: The study concluded that pregnant women with low serum vitamin B12 are accustomed to taking low fish and eggs in their daily diet compared to those who have normal serum vitamin B12. The incidence of low birth weight and small-for-date babies are more prevalent in the pregnant women with subclinical deficiency of vitamin B12. Ibrahim Card Med J 2017; 7 (1&2): 84-91

Objective: The present quasi-experimental (comparative clinical trial) study was conducted to compare the outcome of active versus conservative management in patients with prelabour rupture of membrane (PROM) at term with an unfavourable cervix. Materials & Methods: The study was carried out at Gynae & Obstetrics Department, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka over a period of 12 months from July 2009 to June 2010. Women admitted in the Obstetrics & Gynaecology Ward of BSMMU with pre-mature rupture of membrane (PROM) at term with unfavourable cervix was the study population. A total of 86 women with rupture of membranes at > 37 weeks of gestation with a single foetus in a cephalic presentation, Bishop's score below 6, absence of active labour, no history of previous uterine surgery, no contraindication to vaginal delivery, a normal cardiotocogram and an adequate pelvis on clinical pelvimetry were included in the study and divided into two groups – study group (who received 25 μg of misoprostol every 6 hours in the posterior fornix of the vagina to a maximum of 4 doses) and control (who received conservative treatment for 24 hours). Result: The result shows that the study and control groups were almost identical in terms of age (p = 0.058), parity (p = 0.812), H/O past abortion (p = 0.366). Majority (94.3%) of the patients in case group and 64.4% in control group took 24 or < 24 hours to deliver their babies. The mean interval between PROM and uterine contraction and that between ROM and delivery were significantly less in the study group than those in the control group (p < 0.001 and p < 0.001 respectively). About 63% of study group experienced significant uterine contractions after 1st dose, 23.3% after 2nd dose, 9.3% after 3rd dose and 4.7% after 4th dose of misoprostol, while none of the patients in control group experienced significant contraction during the same period (p < 0.001). Twenty two (50.6%) of controls needed oxytocin for induction as opposed to none in the study group. The need for oxytocin during labour in study group were significantly less (37.2%) than that in control (80.5%) (p= 0.024). The incidence of failed induction was even less in study group (11.6%) than that in control (44.2 %) (p = 0.001). Two (4.7%) patients in the study group developed uterine hyperstimulation, 2.3% uterine tachysystole and another 2.3% nausea/vomiting while none of patients in control group developed the same complications. One (2.3%) of the patients in study group experienced chorioamnionitis and 9.3% exhibited group-B streptococci in high vaginal swab culture. In contrast, 18.6% of the controls developed chorioamnionitis and 14% showed the presence of group-B streptococci in high vaginal swab. In terms of mode of delivery, normal vaginal delivery (NVD) occurred in 88.4% study group as compared to 53.5% of control group (p<0.001). There was no significant difference between the groups in terms of foetal distress (p= 0.747) and neonatal sepsis (p = 0.121). Over half of the patients in the both groups had a history of less than 4 vaginal examinations during labour. There was no significant differences between the groups with respect to Apgar score at 1 minute of birth, neonatal sepsis and foetal distress (p=0.063, p=0.121 and p=0.747 respectively). Conclusion: The study concluded that management of premature rupture of membrane with unfavourable cervix using vaginal misoprostol increases the rate of normal delivery thereby reducing the risk of caesarean section, while conservative management of premature rupture of membrane usually fails to augment normal delivery. So it is safer to give induction to women presenting with premature rupture of membrane with unfavourable cervix using vaginal misoprostol. Ibrahim Card Med J 2015; 5 (1&2): 35-39