Nithya, S (2013) A cross-sectional study of prevalence of diabetes, thyroid dysfunction and hyperprolactinemia in women with recurrent pregnancy loss. Masters thesis, Kilpauk Medical College, Chennai.
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Abstract
INTRODUCTION: Spontaneous abortion or miscarriage is defined as the involuntary termination of pregnancy before 20 weeks of gestation or below fetal weight of 500g. Traditionally, Recurrent pregnancy loss was defined as three or more consecutive spontaneous miscarriages. In 1930s and 1940s, Malpas and Eastman suggested that the proportion to pregnancy losses in next pregnancy after three consecutive losses was as high as 73 - 84%. Incidence 1 in 300 pregnancies. Years later, clinical studies demonstrated that the risk of miscarriage is actually lower than predicted. In the recent era, investigation and treatment is considered in couples with two consecutive spontaneous miscarriages, documented by ultrasound or histopathological examination (Leon Speroff et al). Evaluation is indicated when any of the following are present 1. Embryonic heart activity observed before any earlier pregnancyoss. 2. Normal karyotype of the products of conception obtained from an earlier loss. 3. Female partner over 35 years of age, Women with previous history of infertility. AIM OF THE STUDY: 1. To evaluate the prevalence of diabetes both preconceptionally and antenatally in a women with previous history of recurrent miscarriage. 2. To evaluate the association of thyroid dysfunction in a women with history of recurrent miscarriage. 3. To evaluate the prevalence of hyperprolactinemia in recurrent miscarriage. MATERIALS AND METHODS: This study was conducted among 100 patients who attended the Genetic clinic, The Department of Obstetrics and Gynaecology in Government Kilpauk Medical College Hospital, Chennai. Ethical committee clearance obtained on Febraury 2011. Study period: February 2011 to September 2012. This study was done after obtaining ethical committee clearance conducted in Kilpauk Medical College Hospital. Sample size: 100. About 100 patients are selected, after a complete evaluation of history, clinical examination and all basic investigations, they are subjected to the study. Inclusion Criteria: Women with previous history of two or more abortions that occurred in the first trimester among the reproductive age group were included Exclusion Criteria: 1. Second trimester abortions. 2. Women who conceived after Assisted Reproductive Technologies. 3. Previous ectopic pregnancies. 4. Previous molar pregnancies. 5. Known diabetic patients. 6. Known patients with thyroid disorders. 7. Women taking Anti – psychotics. METHODOLOGY: After selection of 100 women based on the inclusion criteria, the patient was explained about the study and after obtaining the consent, they are subjected to the study. Detailed history was taken to evaluate the presence of risk factors. A thorough general and systemic examination was done. All basic clinical investigations were performed. Blood samples are collected and assayed for the following tests: 1. Thyroid stimulating hormone. 2. Serum prolactin. 3. Glucose Tolerance test. Reports are evaluated and the prevalence of each disorder is correlated with the casuation of Recurrent pregnancy loss. Patients were advised to come in their fasting states. They were advised not to eat, drink, or exercise strenuously for atleast 8 hours and be in rest during the test. SUMMARY: About 100 patients with previous history of 2 or more miscarriage who reported to Kilpauk Medical College and who fulfilled the inclusion and exclusion criteria were included in the study In recurrent miscarriage group of my study, There was 19% incidence of hypothyroidism, of which 57.9% are distributed among women with previous 4 losses. Diabetes has been reported in 5% of population in this group, of which 80% were in the age group more than 30. Menstrual disturbances were observed in 63.2% of hypothyroid patients, 80% of diabetic patients and in all patients who had hyperprolactinemia. In women with previous history of infertility, 42.1% had hypothyroidism and 20% had Diabetes. In women with family history of thyroid, 31.6% had hypothyroidism and 66.7% had hyperprolactinemia. In my study, there is no statistical significance between Diabetes and hyperprolactinemia with the occurrence of abortion. Age and Body mass Index has a significant association with recurrent miscarriage. CONCLUSION: Recurrent miscarriage is a distressing situation both to the patient and the investigator until and unless the cause is established. The evaluation of endocrinological causes has been simple, easy and cost effective for the general population. 1. Women with endocrinological dysfunction, majority of them will have some form of menstrual abnormality which could be evaluated by a proper history. 2. Hypothyroidism has a significant association with recurrent miscarriage group, hence early routine screening, diagnosis, treatment of subclinical and overt forms has a better obstetrical outcome reducing the mental agony of the patient. 3. Women with positive family history of thyroid abnormality along with hypothyroidism are those candidates who need thyroid antibody evaluation. Routine screening for all cases is not necessary. 4. Though, Diabetes mellitus as such do not cause abortion, women with poor glycemic control and those with elevated fasting blood glucose level are still considered as risk factors. This group of women also has an associated insulin resistance which influences their future outcome. 5. Thyroid function test is done before confirming the diagnosis of hyper prolactinemia, and initiation of thyroxine substitution would correct subtle abnormalities in prolactin levels.
| Item Type: | Thesis (Masters) |
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| Uncontrolled Keywords: | prevalence of diabetes ; thyroid dysfunction ; hyperprolactinemia ; women ; recurrent pregnancy loss ; cross-sectional study |
| Subjects: | MEDICAL > Obstetrics and Gynaecology |
| Depositing User: | Punitha K |
| Date Deposited: | 17 Jun 2018 08:13 |
| Last Modified: | 17 Jun 2018 09:22 |
| URI: | http://repository-tnmgrmu.ac.in/id/eprint/8527 |
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