Case reportA 39 year old woman came to the antenatal clinic for booking at the 12 th week of her ®fth pregnancy. She complained of pruritis, particularly over her hands and feet. The pruritis preceded her pregnancy by ®ve months. There was no change in urine or stool colour and her appetite was good. Physical examination showed no abnormality. She had no rash, took no medication, and there was no family history of liver disease. She drank less than 15 units of alcohol per week before her pregnancy and had then become abstinent.She had four previous pregnancies, the ®rst pregnancy being complicated by pre-eclampsia at term, the second and third ending in miscarriages in the ®rst trimester, and the fourth being an uneventful full term pregnancy. Five years previously she had attended her general practitioner with tiredness, nausea, headache, reduced appetite and her stool looking`different'. Liver function tests revealed an elevated gamma-glutamyl transferase level at 112 iu/L. Ultrasound examination of her liver was normal. Liver function tests repeated one week later showed no change. As her symptoms had improved by the second consultation, no follow up was thought necessary. Her past medical history included infection with hepatitis A virus, and depression after her second miscarriage.

a Case reportA 39 year old woman came to the antenatal clinic for booking at the 12 th week of her ®fth pregnancy. She complained of pruritis, particularly over her hands and feet. The pruritis preceded her pregnancy by ®ve months. There was no change in urine or stool colour and her appetite was good. Physical examination showed no abnormality. She had no rash, took no medication, and there was no family history of liver disease. She drank less than 15 units of alcohol per week before her pregnancy and had then become abstinent.She had four previous pregnancies, the ®rst pregnancy being complicated by pre-eclampsia at term, the second and third ending in miscarriages in the ®rst trimester, and the fourth being an uneventful full term pregnancy. Five years previously she had attended her general practitioner with tiredness, nausea, headache, reduced appetite and her stool looking`different'. Liver function tests revealed an elevated gamma-glutamyl transferase level at 112 iu/L. Ultrasound examination of her liver was normal. Liver function tests repeated one week later showed no change. As her symptoms had improved by the second consultation, no follow up was thought necessary. Her past medical history included infection with hepatitis A virus, and depression after her second miscarriage.

Background: Pregnancy induced hypertension (PIH) is a significant cause of morbidity among pregnant females and also affects the foetal outcome. Numerous risk factors have been identified. This study was conducted to estimate the prevalence of PIH and the factors associated with PIH. Methods: This was a cross-sectional hospital-based study. Pregnant women admitted for delivery in the gynaecology and obstetrics department of SKIMS Soura formed the study participants. Patients with chronic hypertension were excluded. A minimum sample size of 295 was calculated but finally a sample of 402 was achieved. The data was collected over a 3-month period from July to September 2021 using convenient sampling. Data was entered in Microsoft excel and analysed using IBM SPSS version 23. Results: A total of 402 pregnant women were included. Majority (61%) of the participants were up to 30 years of age, majority (97.8%) were up to para 3 and 89% were literate. The prevalence of PIH was 6.5%. Hypertension was more frequent among the women with age more than 30 years (p=0.041) and women with higher pre-pregnancy BMI (p=0.010). Maternal education, occupation and parity were not associated with hypertension in pregnancy. Conclusions: In our study older women and women with higher body mass index (BMI) were more at risk of having PIH in pregnancy. Therefore, we would recommend earlier age at marriage and lifestyle modification for maintaining normal BMI.

Background: Pre-eclampsia is a multi-system disorder of unknown etiology involving almost every organ of body including kidney, liver, brain, heart, stomach and adrenals. In liver periportal hemorrhagic necrosis, ischemic lesions and fibrin deposition occurs due to thrombosis of arterioles. Objective: To compare the liver function tests in normal pregnancy and preeclampsia Methodology: This study was conducted in the Department of Obstetrics and Gynaecology, SKIMS, Soura, Kashmir for 18 months. Participants were divided into two groups: Cases: Comprised of 200 patients with toxemia of pregnancy, Controls: comprised of 500 normal, healthy normotensive pregnant women. This group was studied to get the normal values of liver enzymes and served as controls. A complete blood count, microscopic examination of urine, liver function test, kidney function test , 24 hour urinary protein estimation was done on all participants. Results: Among the cases, 49(24.5%) patients while 76 (15.2%) controls had deranged serum bilirubin. Ninety-nine(49.5%) cases had deranged ALT while 16(3.2%) controls had so. Among the cases, 103(51.5%) had deranged AST level while it was deranged in 64(12.8%) controls. ALP and serum total protein followed similar pattern (more deranged in cases than controls). Conclusion: Liver function test impairment occurs in preeclampsia which is characterized by rise in mean level of serum transaminase levels and serum bilirubin level and fall in serum total protein and albumin level.

Background: Motherhood is often a positive and fulfilling experience but for many women it is associated with suffering, ill health, and even death. Improving maternal health is one of the thirteen targets for the sustainable development goal 3 (SDG-3) on health adopted by the international community in 2015. Objective of the study was to find out the attitude of pregnant women towards institutional delivery in Khaag block of district Budgam.Methods: A cross-sectional, community-based study was conducted, in February 2018 to March 2018, to assess attitude of pregnant women towards place of delivery in a tribal area of Khaag area of district Budgam. For this study, 99 pregnant women were approached. Informed consent was obtained from the participants and the registered pregnant women were interviewed by a pre-designed questionnaire.  Results: Mean age at the time of contact was 28 years with a standard deviation of 3.87 years. The maximum years of schooling were 10 years. It was found that the last delivery was conducted at hospital for about 76% of women but for the present pregnancy 88% of the women had decided to have it conducted at the hospital. Thus, the attitude of women towards institutional deliveries has changed positively (p=0.001).Conclusions: Percentage of institutional deliveries is still less in rural area of Khaag is Kashmir. For decreasing the maternal and infant mortality rates further, much is still to be done. Awareness needs to be generated among common masses for promoting institutional deliveries. Educating women folk will make them confident in decision making.