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ObG Watch

ObG Watch. October 2003. VBAC – Is the risk acceptable?. Overall Risk of Rupture Uterus: 4.5/1000 Induction with PG: 24.5/1000 Induction without PG: 5.2/1000 PNM & Low Apgar: 11 times higher No method to measure probability of success

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ObG Watch

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  1. ObG Watch October 2003

  2. VBAC – Is the risk acceptable? • Overall Risk of Rupture Uterus: 4.5/1000 • Induction with PG: 24.5/1000 • Induction without PG: 5.2/1000 • PNM & Low Apgar: 11 times higher • No method to measure probability of success - Lydon & Rochelle: Data on >20000 women in Washington state – N Eng J Med

  3. "What is safe for my baby?" -Patient with Prev CS "My unequivocal answer is Elective Repeat CS!" -MF Greene New Eng J Med

  4. Are all roads leading to CS?-Guest Editorial:ObGynSurv Vol56 No10 • ACOG Guidelines are so stiff that many Hospitals & Practitioners have stopped offering VBAC in US • Patients with prev CS present late in labour in the hope of VBAC • Risk of Rupture Uterus at home has climbed

  5. "Single-layer closure of Uterine Incision increases risk of Rupture 6 times" (3.1% Vs 0.5%) Meta analysis Am J ObG

  6. Say cheese! “It is remarkable that a newborn baby does not smile for 6 weeks, but smiles frequently in utero.” - Prof. Campbell

  7. The scourge of Diabetes • 177 Million suffer from Diabetes in the World (WHO) • 20% are Indian • Asia’s count will hit 170 million by 2025 • India & China will account for 100 million - IDI (International Diabetes Institute)

  8. Why Asians? • Genetically prone to Insulin Resistance Syndrome • “Thrifty Genes” enabled survival during famine by storing fat in the abdomen • Changing Life style & Food habits

  9. Pregnancy& Diabetes • 5% of all Pregnant women are Diabetic • First Trimester Screening picks up Early onset GDM & Unrecognized Type II DM (30%) • Early onset GDM carries higher risk of Hypertension, Increased need for Insulin, Neonatal Hypoglycemia & Perinatal Death • Mx same as Pregestational Type II Diabetes

  10. HIV update “Nevirapine is superior to Zidovudine in preventing Vertical Transmission to Babies born to HIV+ Mothers and Breast-fed by them” -HIVNET Trial Uganda - Reported in Lancet

  11. Dose of Mifepristone

  12. Antenatal Corticosteroids The Good: • Improves Resp Function – Reduces RDS • Beneficial in even PPROM • Protects from Ventricular Haemorrhage • Halves the risk of Ventriculomegaly & Cerebral Palsy • Less need for Volume expansion & Vasopressor • Improves survival & Increases IQ

  13. Antenatal Corticosteroids The Bad • Reduction of Brain Weight • Inhibits Myelination • Suppresses Cortisol Secretion • Adverse development of Blood-Brain Barrier • Rise in Fetal BP • Predisposes to Diabetes later

  14. Antenatal Corticosteroids The Unknown: • Advantage of Second Dose? • Role of Intra amniotic Injection? -Newnham et al: Current Opinion in ObG Jan 2003

  15. India's First Test-tube Baby Durga alias Kanupriya was in Bangalore on October 3 for the 28th Anniversary of the World’s First IVF-ET She said, “I often feel like Edison’s Bulb”

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