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
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
“It is remarkable that a newborn baby does not smile for 6 weeks, butsmiles frequently in utero.” - Prof. Campbell
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)
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
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
“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
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
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
Antenatal Corticosteroids
The Unknown:
• Advantage of Second Dose?
• Role of Intra amniotic Injection?
-Newnham et al: Current Opinion in ObG Jan 2003
Durga alias Kanupriyawas 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”