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Acute fatty liver of pregnancy is an uncommon, potentially fatal disorder. Between 1998 and 2000, two patients with acute fatty liver of pregnancy presented at the Christian Medical College Hospital, Vellore. Both patients were in the thirty-sixth week of pregnancy. jaundice and encephalopathy were the predominant symptoms. Both the mothers died after they delivered a stillborn Infant each. The maternal deaths were due to multiorgan failure and/or postpartum haemorrhage and sepsis. The route of delivery was vaginal in both the patients. Extrahepatic and metabolic complications in both cases Included renal failure, sepsis, hypoglycaemia, disseminated intravascular coagulation and gastrointestinal bleeding. Liver biopsy done in both patients was consistent with the diagnosis of acute fatty liver of pregnancy. To the best of our knowledge, this is the first report from India on acute fatty liver of pregnancy.

Background: Syphilis is a preventable cause of foetal loss and congenital disease. Although the VDRL test is an integral part of routine antenatal care in India, little is known about the disease burden in pregnancy in India. Therefore, we carried out a study to determine the prevalence of VDRL positivity and syphilis among pregnant women in Vellore and to audit the management and outcome of VDRL-positive pregnancies., Methods: A retrospective review of case records., Results: Only 0.98% of pregnant women were positive by the VDRL test. However, foetal loss occurred in 16 (32%) of the 50 seropositive women; 15 of these did not receive antenatal care. Seventeen of the 34 seropositive multiparous women had had previous foetal losses. Only 16 women had received penicillin., Conclusion: Although the seroprevalence of syphilis in pregnancy is low, it is an unrecognized cause of foetal loss in Vellore. An audit of the testing and management of VDRL positivity in pregnancy provides valuable information on the quality of antenatal care in an area.

Background: Beta-thalassaemia is the most common genetic disorder among Indians and a number of mutations causing this disease have been reported. Since effective treatment of thalassaemia major is complicated and very expensive, prenatal diagnosis has become an important option for those at risk of having an affected foetus. We report the use of a rapid hybridization method called 'reverse dot blot' for detection of specific mutations of the beta-globin gene., Methods: DNA was obtained from a 12-week-old foetus by chorionic villus sampling and was amplified using specific primers by the polymerase chain reaction and analysed by the reverse dot blot test. Results were available within 36 hours after sampling., Result: The father and mother were found to be heterozygous for codon 15 (G-A) mutation of the beta-globin gene. The foetus was normal., Conclusion: Reverse dot blot is a rapid and reliable technique for mutation detection in the beta-globin gene and can be useful for antenatal diagnosis.

Background: Colposcopy is usually done when the Papanicolaou smear is abnormal so that the necessity for cone biopsy is reduced. However, there is often a strong clinical suspicion of cervical neoplasia even though the smear is normal and this problem of the false negative Papanicolaou smear has not, we feel, been adequately addressed. We, therefore, examined the usefulness of colposcopy in detecting cervical neoplasia in women in whom the Papanicolaou smear was normal., Methods: A cross-sectional design was used which included 80 patients in whom cervical neoplasia was suspected and who had undergone colposcopy in one gynaecology unit at the Christian Medical College Hospital, Vellore. The Papanicolaou smear result of these patients was then related to their diagnosis on colposcopy., Results: The Papanicolaou smears were normal in 56 patients and abnormal in 24. In the normal Papanicolaou smear group there were 18 women with grade I cervical intra-epithelial neoplasia and 3 with grade II lesions. In the abnormal smear group there were 8 women with grade I cervical intra-epithelial neoplasia, 9 with grade II cervical intra-epithelial neoplasia and 1 had microinvasive carcinoma. Patients with abnormal Papanicolaou smears had a relative risk of 7.8 (95% CI 2.4 to 25.8) of having a lesion more advanced than grade I cervical intra-epithelial neoplasia compared with those in whom cervical neoplasia was only suspected clinically., Conclusion: When the clinician suspects cervical neoplasia but the Papanicolaou smear is negative, colposcopy reveals at least grade II cervical intra-epithelial neoplasia in 5% of patients. Such patients, therefore, need to be followed up closely or else have a colposcopy and directed biopsy.

Background: The oral glucose tolerance test for detecting women with gestational diabetes is too complicated and prolonged for routine use. Similar and less time consuming screening tests have been proposed including random plasma glucose estimation and the glucose challenge test (blood glucose estimation one hour after a 50 g glucose load). However, in practice, correct timing of the blood sample, which is of critical importance in the interpretation of the results of these tests, is difficult to ensure. This study was designed to evaluate these two screening tests in identifying women with abnormal glucose tolerance in pregnancy., Methods: One hundred and eleven consecutive pregnant women at risk for gestational diabetes and 121 consecutive pregnant women with no risk factors had random plasma glucose estimation followed by the 50 g glucose challenge test at 26 to 30 weeks of gestation. A 100 g 3 hour oral glucose tolerance test was done within two weeks of the screening tests. The sensitivity and specificity of screening tests in predicting abnormal glucose tolerance were calculated., Results: Seven (6.3%) women in the high risk group and four (3.3%) in the low risk group had gestational diabetes, while 11 (9.9%) and 8 (6.6%) had impaired glucose tolerance. Random plasma glucose level of 90 mg/dl or greater had a sensitivity of 63% and specificity of 66% in predicting abnormal glucose tolerance, while a threshold level of 115 mg/dl for the glucose challenge test yielded a sensitivity of 63% and a specificity of 55%., Conclusions: Neither random plasma glucose estimation nor the glucose challenge test is a useful screening procedure for abnormal glucose tolerance in pregnancy.