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”