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MATERNAL SERUM LIPIDS IN

PREECLAMPSIA

THESIS SUBMITTED TO
NATIONAL BOARD OF EXAMINATIONS NEW DELHI
FOR THE AWARD OF

DIPLOMATE OF NATIONAL BOARD


IN
OBSTETRICS AND GYNAECOLOGY
(2016-2018)

DR. SUMAN DATH.S

DEPARTMENT OF OBSTETRICS AND GYNAECOLOGY


HINDU RAO HOSPITAL,
DELHI 110007

DECLARATION BY CANDIDATE

This is to declare that work embodied in this thesis titled MATERNAL SERUM
LIPIDS IN PREECLAMPSIA is the bonafide work of Dr. Suman Dath S
conducted in Department of Obstetrics and Gynaecology, Hindu Rao Hospital,
Delhi under supervision and guidance of Dr. Suman Lata Mendiratta, Dr.
Jasmine Chawla Sharma and Dr. Rajiv Kumar Ranjan

Dr. Suman Dath. S


DNB STUDENT DEPARTMENT
OF OBSTETRICS &
GYNAECOLOGY, NDMC
MEDICAL COLLEGE AND
HINDU RAO HOSPITAL, DELHI
CERTIFICATE

This is to certify that Dr. Suman Dath.S has carried out the work in the thesis entitled
Maternal Serum Lipids in Preeclampsia under the guidance and supervision of her guide
and co-guide in the Department of Obstetrics & Gynaecology, Hindu Rao Hospital, Delhi.
This thesis fulfills the requirements stipulated by National Board of Examinations, New
Delhi and has not been submitted earlier in the candidature of any degree.

All the work related to this study was conducted by the candidate. Her approach to the
subject has been sincere and scientific.

This thesis is recommended for the Degree of Diplomate of National Board (Obstetrics
and Gynaecology).

GUIDE:
DR. SUMAN LATA MENDIRATTA
SR. CONSULTANT
DEPTT. OF OBSTETRICS & GYNAECOLOGY
HINDU RAO HOSPITAL, DELHI

CO-GUIDE: CO-GUIDE:
DR. JASMINE CHAWLA SHARMA DR. RAJIV KUMAR RANJAN
CMO CMO &HOD
DEPTT. OF OBSTETRICS & GYNAECOLOGY DEPTT.OF BIOCHEMISTRY
HINDU RAO HOSPITAL, DELHI HINDU RAO HOSPITAL, DELHI
CERTIFICATE

This is to certify that Dr. Suman Dath.S has carried out the work in the thesis entitled
Maternal Serum Lipids in Preeclampsia under the guidance and supervision of her guide
and co-guide in Department of Obstetrics & Gynaecology, Hindu Rao Hospital, Delhi.

It is further certified that the candidate has also fulfilled the condition of residency as under
rules. She has fulfilled all the condition necessary for submission of this thesis.

The data incorporated in this study is genuine and original. Her approach to the subject and
work has been satisfactory.

Dr. SUMAN LATA MENDIRATTA


SR. CONSULTANT
DEPTT. OF OBSTETRICS & GYNAECOLOGY
HINDU RAO HOSPITAL, DELHI
CERTIFICATE

This is to certify that Dr. Suman Dath.S has carried out the work in the thesis entitled
Maternal Serum Lipids in Preeclampsia under the guidance and supervision of her guide
and co-guide in Department of Obstetrics & Gynaecology, Hindu Rao Hospital, Delhi.

It is further certified that the candidate has also fulfilled the condition of residency as under
rules. She has fulfilled all the condition necessary for submission of this thesis.

The data incorporated in this study is genuine and original. Her approach to the subject and
work has been satisfactory.

Dr. Ajit Kumar Goyal


Medical Superintendent
Hindu Rao Hospital
Delhi
CERTIFICATE

This is to certify that Dr. Suman Dath.S has carried out the work in the thesis
entitled Maternal Serum Lipids in Preeclampsia under the guidance and
supervision of her guide and co-guide in Department of Obstetrics &
Gynaecology, Hindu Rao Hospital, Delhi.

It is further certified that the candidate has also fulfilled the condition of
residency as under rules. She has fulfilled all the condition necessary for
submission of this thesis.

The data incorporated in this study is genuine and original. Her approach to the
subject and work has been satisfactory.

Dr. MAMTA GUPTA


Head of the Department
Department of Obstetrics &Gynaecology
Hindu Rao Hospital
Delhi
ACKNOWLEDGEMENT

I take this opportunity to express my heartfelt thanks to those whose hands have helped me to
mould this piece of humble work.

First thanks to Almighty God, who grant me the strength and courage to complete my thesis.

I am indebted to Dr. Suman Lata Mendiratta for her keen interest, constant guidance and
supervision throughout the period of this study. I express my sincere gratitude, and thanks
which is too little to say, but this one comes deep from my heart for appreciation of the
instructions, advice, support, concerns, guidance and encouragement which always came on
time throughout the stage of the thesis.

I express my sincere gratitude to my co-guide, Dr. Jasmine Chawla Sharma and Dr. R K
Ranjan for their advice and guidance

I express my sincere thanks to all my seniors, juniors and colleagues for their constant
inspiration and guidance.

I express my sincere thanks to Dr. Som Pal Singh and Dr. Meenakshi from Pathodology
department for their inputs.

I shall fail in my duty if I do not acknowledge the immense help, cooperation of hospital
staff.

A very grateful appreciation, thanks and depth of love for my husband, Mr. Shiv Kumar and
my son Mrinank, who offered their help, endless support, understanding and encouragement.

A very special vote of thank to my brothers, Dr. Sunil Dath.S and Mr. Shravan Dath.S for
their valuable help and support.

I am thankful for endless cooperation and support of my parent

I would also like to pay my gratitude and tender my apology to all those who have helped me
in some or the other way, but remain undocumented.

Last but not the least, what I owe to my patients is supreme and cannot be explained merely
in words.

Dr. SUMAN DATH.S


CONTENTS

Chapter Name Page No.

1. INTRODUCTION 1-17
2. AIMS AND OBJECTIVES 18-19
3. MATERIAL AND METHODS 20-24
4. REVIEW OF LITERATURE 25-37
5. RESULTS AND OBSERVATION 38-49
6. DISCUSSION 50-59
7. SUMMARY 60-63
8. CONCLUSION 64-65
9. BIBLIOGRAPHY 66-77

ANNEXURES 78-85

List of Abbreviations
Study proforma
Consent form in English
Consent form in Hindi
Copy of approval of ethical committee
Copy of approval of scientific committee
Master Charts
Introduction
Aims and
objectives
Material And
Methods
Review of
literature
Results And
Observation
Discussion
Summary
Conclusion
Bibliography
Annexures
LIST OF ABBREVIATIONS

HDL High Density Lipoprotein


LDL Low density Lipoprotein
VLDL Very Low Density Lipoprotein
TG Triglycerides
TC Total cholesterol
BP Blood Pressure Systolic
Diastolic
HB Haemoglobin
PCV Packed Cell volume
AST Aspartate Aminotransferase
ALT Alanine Aminotransferase
Total Bilurubin
Direct Bilurubin
BU Blood Urea
SC S.Creatinine
S Uric Acid
PT Prothrombin Time
INR International Normalized Ratio
BMI Body Mass Index
Platelet Count
Fw Fetal Weight
NICU Neonatal Intensive Care Unit
Urinary Protein

PROFORMA

Group A / Group B UHID


Name w/o
DOA Telephone no.
Address

Presenting complaint

Headache Visual symptoms Pedal edema Vulval edema


Abd. wall edema BPV Leaking Dyspnoea
Epigastric pain Decreased FM Labor pains Others

POG POGat diagnosis of Pre-eclampsia


M/H

LMP EDD Cycles

O/H
.
.

..

..
Past /History

Epilepsy DM TB Asthma Thyroid


PET Eclampsia

F/H

DM HT

General Physical Examination

GC Ht Wt PR BP Pallor
Edema Icterus LN Thyroid Reflexes BMI

CVS RS
Abdominal Examination

Fundal Ht Presentation FHS


Contractions Liquor IUGR
Scar Scar Tenderness
L/E
P/V

Dilatation Effacement Cervix


Membrane Station Pelvis

Investigations

Hb gr/dl TLC Platelet count PCV


S.Bilurubin T/D mg/dl AST u/l ALT u/l s.LDHu/l
PT/INR S.Creatininemg/dl Blood Urea mg/dl
U.Protein(dipstick)/ Urine P/C

Serum lipid profile mg/dl


Patient Values
Cholesterol, total (mg/dl)
Triglycerides (mg/dl)
HDL Cholesterol (mg/dl)
LDL Cholesterol (mg/dl)
VLDL Cholesterol (mg/dl)

Fundus USG
Doppler
Severe symptoms of preeclampsia and complications

Features Antepartum Intrapartum Postpartum


Headache
Visual symptoms
Epigastric pain
Pulmonary edema
Renal changes(creat)
Thrombocytopenia
Serum transaminase
Hemolysis(LDH)
HELLP
Eclamptic fits
CHF
CVA
Haemorrhage
IUGR
IUD
Stillbirth
Foetal distress
Liver changes(T.bil)
Coagulation(PT/INR
)
DIC
Mortality& Cause

Mode of Delivery

Vaginal
Spontaneous
Induced
Instrumental

Caesarean section Indication


Delivery Outcome: BABY

POG at delivery
Birth weight Sex M/F APGAR ( 0,1,5 MIN)
Congenital Anomaly
Outcome Mother side NICU
Indication
Treatment
Discharged/expired

Delivery Outcome: MOTHER

Eclampsia PPH Vulvalhaematoma Failed


Induction
Intrapartum
Intra operative Others
events
Eclampsia PPH Need of BT Failure of
lactation
Postpartum
Puerperal Wound Subinvolution Others
sepsis infection

Treatment given

Labetalol Methyldopa
Nifedipine Magnesium Sulphate
Any other
H I N D U R AO H O S P I TA L

INFORMED CONSENT

I, W/O
______________________________________Age__________R/O_________________
_________________________________________give my free and voluntary consent to be
included in the clinical study "MATERNAL SERUM LIPIDS IN PREECLAMPSIA". I
have been explained to my full satisfaction the nature and purpose of the study by one of the
treating doctor, Dr. Suman Dath. S.During the course of the study, I also give my voluntary
consent to undergo any blood investigation and any other relevant investigation required for
the study. I have been explained that I have right to prevent use of my biological sample at
any time during conduct of research. I shall abide by the prescribed medication regime and
other instructions. I will present myself at the designated time and place in the hospital during
study follow-up. I will give my co-operation to the concerned treating doctor and the hospital
staff. I give my consent for publications of the results of the study. I will not seek any reward
or compensation for the study.I have explained that I can withdraw from the study at any time
of my own will without any adverse effect on my treatment and that my clinical records will
be kept confidential.

In case of any query I can contact:

Dr. Suman Dath. S(Dept. of Obst& Gyn. Hindu Rao Hospital)(9555705398)

Dr. Jasmine Chawla Sharma(Dept. of Obst&Gyn, Hindu Rao Hospital)(9310009321)

Signature/Thumb Impression of patient:

Date:
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