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Intl. J. of Advances in Medicine     Open Access   (Followers: 2)
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International Journal of Reproduction, Contraception, Obstetrics and Gynecology
Number of Followers: 14  

  This is an Open Access Journal Open Access journal
ISSN (Print) 2320-1770 - ISSN (Online) 2320-1789
Published by Medip Academy Homepage  [12 journals]
  • Targeted treatments for dysfunctional uterine bleeding based on
           endometrial thickness

    • Authors: Thi Thi Htwe, Hla Hla Yi, Saw Kler Ku
      Pages: 900 - 905
      Abstract: Background: Dysfunctional uterine bleeding is a common presentation to both general practitioner and gynaecologists which can have a significant effect on a woman’s quality of life. The aim of this study is to assess the effectiveness of treating dysfunctional uterine bleeding according to endometrial thickness.Methods: This study was a hospital based prospective study undertaken in gynecology outpatient clinic of Central Women’s Hospital, Mandalay, Myanmar for one-year period (2016). A total of 60 patients were recruited and divided into 3 groups based on endometrial thickness and offered targeted hormonal treatments. At the end of the one-month treatment, patients were asked to return for a follow-up visit and from their menstrual diaries, the number of bleeding days and bleeding scores were assessed and calculated.Results: Among sixty women with dysfunctional uterine bleeding, 55% of patients had endometrial thickness less than 6 mm, 25% had endometrial thickness 6-11 mm, with 20% of patients having endometrial thickness more than 11 mm. After one month of study period, treatment was found to be effective in 86.6% of the patients according to bleeding days and in 70% of the patients according to bleeding score.Conclusions: In women presenting with dysfunctional uterine bleeding, increased endometrial thickness was found to be associated with increased BMI. In the treatment of dysfunctional uterine bleeding, when the endometrial thickness of the patient was assessed and hormonal treatment was given according to the endometrial thickness, treatment was proven to be effective.
      PubDate: 2020-02-27
      DOI: 10.18203/2320-1770.ijrcog20200570
      Issue No: Vol. 9, No. 3 (2020)
  • Comparative study of sFlt-1/Plgf ratio with uterine artery doppler indices
           in prediction of preeclampsia at 22-24 weeks period of gestation

    • Authors: Taru Gupta, Pooja Sharma, Sarika Arora, Divya Baruhee
      Pages: 906 - 910
      Abstract: Background: Hypertensive disorders like pre-eclampsia along with hemorrhage and infection, contributes greatly to maternal morbidity and mortality. Various pro and antiangiogenic factors like sFlt-1 and Plgf have been linked to the etiopathogenesis of placental vascular disease and their combination with uterine artery doppler studies may improve the prediction accuracy. Present study was conducted to analyze sFlt-1/Plgf ratio and uterine artery doppler indices among high risk patients and to compare these in prediction of preeclampsia.Methods: A prospective observational study was conducted from September 2017 to February 2019 in which 100 patients giving consent and satisfying inclusion criteria were evaluated for various risk factors and were subjected to sFlt-1/Plgf ratio test and uterine artery doppler study at 22-24 weeks period of gestation. They were followed up and maternal outcome was analysed.Results: Among the cohort of 100 women with high risk factors, 35% of the study participants developed pre-eclampsia. Using sFlt-1/Plgf ratio 40% of them were screened positive for pre-eclampsia. This percentage of screened positive was 40%, 43%, and 53% using uterine artery RI, PI, and SD respectively. sFlt-1/Plgf was found to have a sensitivity of 91.4% and specificity of 87.7%. ROC curve analysis showed highest area under curve (AUC) for sFlt-1/Plgf (0.858).Conclusions: sFlt-1/Plgf ratio was found to be a better predictable biomarker than uterine artery Doppler indices in prediction of pre-eclampsia at 22-24 weeks period of gestation.
      PubDate: 2020-02-27
      DOI: 10.18203/2320-1770.ijrcog20200492
      Issue No: Vol. 9, No. 3 (2020)
  • Effect of premature rupture of membranes on the maternal and fetal
           prognosis during childbirth at the gynecology-obstetrics department of the
           Matam Communal Medical Center, Conakry, Guinea

    • Authors: Ibrahima Conté, Diallo Boubacar Alpha, Bah Oumou Hawa, Touré Souleymane, Baldé Ibrahima Sory, Sylla Ibrahima Kalil, Sylla Ibrahima, Sow Ibrahima Sory, Sy Telly, Keita Namory
      Pages: 911 - 917
      Abstract: Background: Premature rupture of membranes (RPM) is defined by rupture of the amnion and chorion before entering labor within 24 hours leading to vaginal discharge of amniotic fluid without uterine contractions. Objective of this study was to improving the management of premature Ruptures of the membranes received in the service.Methods: This was a descriptive and analytical prospective study lasting six months from January 1 to June 30 2016.Results: During the study period, we collected 108 cases of RPM out of 1543 deliveries, representing a hospital frequency of 7%. RPM had more frequently concerned pregnant women aged 25-29 (37.04%), housewife (37.03%), primiparous (45.37%) and referral (52.78%). 95.37% were single pregnancies with cephalic presentation (80%) received between 37-42 weeks (84.26%). Management mainly consisted of antibiotic prophylaxis (100%), fetal pulmonary maturation and childbirth. The vagina was the main mode of delivery (62.04%). The maternal prognosis was dominated by chorioamnionitis (12.96%). The fetal one was made up of respiratory distress (40.71%) and prematurity (12.39%).Conclusions: RPM is frequent at the Matam municipal medical center. It is essential for its prevention to ensure health education of the population in general and genital hygiene in particular, to make a coherent prenatal follow-up while putting a particular accent on the detection and the treatment of genital infections.
      PubDate: 2020-02-27
      DOI: 10.18203/2320-1770.ijrcog20200513
      Issue No: Vol. 9, No. 3 (2020)
  • Results of hysteroscopic management of endometrial pathology through laser
           diode in naval medical center: number of cases

    • Authors: Yanet Fermin Aldama, Cesar Rodriguez Villán, Sara E. Hernández Flores
      Pages: 918 - 921
      Abstract: Background: Hysteroscopy consists of an excellent technique for the diagnosis of uterine pathology, the diode laser for treatment has been included, which is energy in the form of a beam of light, monochromatic and coherent, equipped with a great capacity to cut tissues and vaporize them. Objective of this study was to know the result of the hysteroscopic treatment with diode laser, in patients of reproductive age with uterine pathology in the naval medical center of Mexico for a period of one year.Methods: A descriptive study was carried out in 8 patients, with abnormal uterine bleeding and uterine pathology, to know the result of the hysteroscopic treatment with diode laser, inclusion criteria were age of 18 to 40 years, uterine pathology, without previous treatments, exclusion criteria were pregnancy, medical treatment, does not accept the procedure, in a period of September 1, 2017 and September 1, 2018 at the Naval Medical Center of Mexico, the 45-watt 980 nm and 1470 wavelength diode laser console nm with 3fr extra flexible conical tip glass fibers.Results: The average age 29.9±8.5 years, without comorbidities; 60% had an initial diagnosis of endometrial thickening and abnormal uterine bleeding and 40% had a diagnosis of infertility, the most frequent pathology is an endometrial polyp, during the procedure none of the patients required analgesia or post-surgical sedation. The average bleeding was 24.44 ml.Conclusions: The hysteroscopic removal of uterine pathology with diode laser was performed without anesthesia, in an outpatient, feasible and safe way, the surgical time is reduced, with a follow-up of 12 months without recurrence.
      PubDate: 2020-02-27
      DOI: 10.18203/2320-1770.ijrcog20200555
      Issue No: Vol. 9, No. 3 (2020)
  • Evaluation of risk of malignancy index in adnexal masses at a tertiary
           hospital: a prospective study

    • Authors: Ritanjali Behera, Paramita Pradhan, Bharati Misra
      Pages: 922 - 927
      Abstract: Background: The discrimination between benign and malignant adnexal masses is important in deciding clinical management and optimal surgical planning. The aim of the study was to evaluate the effectiveness of risk of malignancy index (RMI) to identify cases with high potential of ovarian malignancy at a tertiary hospital.Methods: This prospective study was conducted over a period of two years from September 2017 to August 2019 at obstetrics and gynecology department of M. K. C. G. Medical College and Hospital, Berhampur. A total case of 130 patients with adnexal masses who underwent surgical treatment were included as histopathological report was taken as gold standard to calculate accuracy of RMI.Results: Of the total masses, 85 (65.4%) were benign and 45 (34.6%) were malignant. The mean age of patients was 41.03±14 years. The best cut off value for the RMI-3 was 225 with highest area under the ROC curve 87%, sensitivity of 75.55%, specificity of 98.82%, PPV of 97.14%, NPV of 88.42% and an accuracy of 90.76%.Conclusions: The present study demonstrated that RMI was a reliable method in detecting malignant ovarian tumors. The RMI is a simple and practically applicable tool in preoperative discrimination between benign and malignant adnexal masses in non-specialized gynecologic departments, particularly in developing countries.
      PubDate: 2020-02-27
      DOI: 10.18203/2320-1770.ijrcog20200491
      Issue No: Vol. 9, No. 3 (2020)
  • Placenta praevia: percreta and accreta, our experience

    • Authors: Preeti F. Lewis, Shreya Chinchoriya
      Pages: 928 - 931
      Abstract: Background: morbidly adherent placenta has an increasing incidence over decades. The purpose of this study is to identify risk factors and etiology of placenta previa- accreta and percreta.Methods: A cross sectional observational study of patients with morbidly adherent placenta previa including placenta accreta and placenta percreta were studied over a period of three years from June 2017 to June 2019 in a tertiary care centre, Mumbai.Results: Cases showed a higher incidence in patients with previous cesarean delivery (CS), grandmultiparity, abortions without the history of check curettage and anterior/central placentae.Conclusions: History of uterine surgeries and previous cesarean are some important risk factors for accreta in placenta previa patients.
      PubDate: 2020-02-27
      DOI: 10.18203/2320-1770.ijrcog20200512
      Issue No: Vol. 9, No. 3 (2020)
  • Comparative evaluation of intravaginal slow release Dinoprostone insert,
           transcervical foley’s catheter, intracervical Dinoprostone gel for
           induction of labor in patients with poor Bishop’s score: a randomized
           control study

    • Authors: Taru Gupta, Ritu Singh, Nupur Gupta, Sangeeta Gupta, Khushbu Singal
      Pages: 932 - 936
      Abstract: Background: Induction of labor is indicated when the continuation of pregnancy poses risk to the mother or fetus. A variety of mechanical and pharmacologic methods are available but the best method of labor induction still remains unknown, study aimed at comparing the efficacy and safety among the two agents: transcervical Foley’s balloon catheter (FBC) and intravaginal slow release Dinoprostone E2 insert (DVI) with dinoprostone gel as control.Methods: A total of 174 patients were randomized into three groups of 58 each (Group A: dinoprostone 10 mg slow release intravaginal insert, Group B: transcervical Foley’s 16 French catheters, and Group C as control: 0.5 mg intracervical Dinoprostone gel. The safety and efficacy was compared among the groups. A p value of < 0.05 was considered statistically significant.Results: The mean insertion to active labor time (in hours) was significantly lower in Group A as compared to Group B (5.88±3.06 versus 13.56±2.8, p < 0.0001). Meantime of insertion to delivery (in hours) was significantly lower in Group A as compared to Group B (10.91±5.24 versus 21.17±2.99, p < 0.0001). The requirement of oxytocin for induction and augmentation in Group A was significantly lower as compared to Group B. Majority of the patients had normal vaginal delivery (NVD) in all the three groups. Regarding safety profile we found that slow-release DVI had more incidence of uterine tachysystole, but none of the cases had any fetal heart rate abnormality. Maternal fever was more in the FBC group, however, neonatal outcomes were comparable in both groups.Conclusions: The study concludes that slow release DVI is better in terms of efficacy as compared to transcervical FBC for induction of labor as assessed by improvement in Bishop score, insertion to active labor time and insertion to delivery time and comparable in terms of safety profile.
      PubDate: 2020-02-27
      DOI: 10.18203/2320-1770.ijrcog20200493
      Issue No: Vol. 9, No. 3 (2020)
  • Role of intrauterine instillation of levobupivacaine as a local
           anaesthetic for outpatient gynaecological procedures: a randomized
           controlled study

    • Authors: Taru Gupta, Ankita Mansinghka, Anil Thakur
      Pages: 937 - 941
      Abstract: Background: Procedures such as intrauterine device (IUD) insertion and endometrial biopsy, are routinely performed in the outpatient setting for various indications. Satisfactory pain control for women undergoing outpatient gynecological procedures is critical for both patient comfort and procedure success. The perception of pain during gynecological procedures originates from manipulation of the cervix and/or uterus.Methods: This study evaluated the role of intrauterine instillation of 0.5% levobupivacaine as local anesthetic in terms of pain score during and post outpatient gynecological procedures (endometrial aspiration biopsy and IUD insertion), reduction in need for post procedural analgesia and allowance of early return to normal activity. The trial medication was intrauterine anesthesia, either 5 mL 0.5% levobupivacaine or 5 mL 0.9% saline (control group) on 100 patients. Primary outcome was self-reported pain scores on numerical pain scale at various points of procedure, point (0) was a grade for as no pain and the worst pain was graded as ten point (10) in this scale. During the procedure, degree of pain was specified by study subjects at 4 steps. These steps were 1) immediately after tenaculum application, 2) during the solution instillation and 3) IUD insertion or EB and 4) 15 minutes after the procedure and 24 hours later.Results: Pain scores of the intrauterine levobupivacaine groups were found to be significantly lower than the control group also there was reduced need for additional analgesia and also, they had early return to normal activity.Conclusions: Study sought to reduce pain during OPD procedures which might lead to better patient experience, reduce anxiety and produce an overall better outcome.
      PubDate: 2020-02-27
      DOI: 10.18203/2320-1770.ijrcog20200494
      Issue No: Vol. 9, No. 3 (2020)
  • Pregnancy outcome among gestational diabetes mellitus patients in a
           tertiary care centre

    • Authors: Jesu Thangam M., Jameela Ponmalar A. R., Vishnupriya S.
      Pages: 942 - 944
      Abstract: Background: Gestational diabetes mellitus poses numerous health problems for both mother and the fetus. Even though there are improved outcomes, complications of gestational diabetes still persists. Objectives of this study was to find out the maternal and perinatal outcomes in gestational diabetes mellitus.Methods: This study was done among pregnant women attending antenatal outpatient department at Sree Mookambika Institute of Medical Sciences, Kulasekharam. oral glucose tolerance test was done at between 24 to 28 weeks and the values more than their cutoff was labelled as gestational diabetes and their outcome was measured as complications during antenatal period, mode of delivery and perinatal outcome in view of neonatal intensive care unit admissions due to hyperbilirubinemia and respiratory distress syndrome.Results: Out of 500 antenatal mothers 65 were found to have gestational diabetes which is approximately 13%. Obstetric outcomes were 10% of them developed pregnancy induced hypertension, 12% of them ended in preterm labour and polyhydramnios in 2%. Delivery by caesarean section and vaginal route is almost similar. Maximum number of neonatal intensive care admissions are due to hyperbilirubinemia followed by respiratory distress.Conclusions: Screening for gestational diabetes and adequate glycemic control is necessary in preventing short term and long-term complications.
      PubDate: 2020-02-27
      DOI: 10.18203/2320-1770.ijrcog20200495
      Issue No: Vol. 9, No. 3 (2020)
  • Microbiological study of cervical flora in preterm labour

    • Authors: Meenakshi Ruhil, Priti A. Hatkar
      Pages: 945 - 951
      Abstract: Background: Preterm labour occurs due to various causative factors. Genital infections contribute significantly to the preterm labour. Ours is a prospective, observational study looking at the cervical microbiota involved in the preterm labour. The cervical flora contributing to the occurrence of preterm labour was studied. The results were analyzed based on the microbiological study of cervical swabs. The primary objectives of this study were to determine the association of cervical microbiota of pregnant women with spontaneous preterm delivery. To characterize the effect of cervical microbiota on birth gestation. The secondary objective of this study was to analyse the role of cervical microbiota and its relationship between social and behavioural factors.Methods: It is a prospective, observational study, which includes 193 patients, studied over a period of one and a half year. It was conducted at our tertiary care centre after the approval by ethics committee, and the results were analysed. As this is a purely observational study, management decisions of treating obstetrician were not interfered with. No additional cost, intervention or injury was caused to the study subject.Results: In our study, cervical swab culture shows growth in 2.07% which is statistically insignificant. Though, it was found that preterm labour is more common with leucocytosis, i.e. WBC > 11000 cmm, which is found to be statistically significant (p value = 0.023).Conclusions: In our study, we found that there was no significant association of cervical flora with preterm labour, though we found an association with leucocytosis.
      PubDate: 2020-02-27
      DOI: 10.18203/2320-1770.ijrcog20200496
      Issue No: Vol. 9, No. 3 (2020)
  • Problems associated with menstruation among medical students: a cross
           sectional study

    • Authors: A. Shantha, Roselin V., Srisanthanakrishnan V.
      Pages: 952 - 955
      Abstract: Background: Medical students are at high risk for developing menstrual irregularities due to their lifestyle, food pattern and exercise habits. Also, majority of the menstrual disorders are preventable by changing better lifestyle, early diagnosis and treatment. Hence this study was conducted with the objective of addressing the menstrual disorders and associated problems among the medical students.Methods: The cross-sectional study was conducted by the department of obstetrics and gynaecology, at Sri Muthukumaran Medical College Hospital and Research Institute, among the first, second- and third-year female students who are doing their MBBS course in the same institute, during the month of December 2019. A total of hundred students were included in the study. Data was collected using a proforma and analysis was done using Statistical Package for Social Sciences (SPSS) version 17.Results: Menstrual cycle periodicity was irregular among 17% of participants. Dysmenorrhoea, mid cycle pain, heavy menstrual bleeding was noted among 27%, 19% and 11% respectively. Also 10% of students reported sickness absenteeism due to menstrual disorders.Conclusions: Adolescent students should be educated on the importance of physical and mental health in terms of healthy food habits and regular physical exercise to overcome the menstrual disorders and to enjoy healthy reproductive period.
      PubDate: 2020-02-27
      DOI: 10.18203/2320-1770.ijrcog20200514
      Issue No: Vol. 9, No. 3 (2020)
  • A study to determine the prevalence of urinary incontinence in antenatal
           women at a tertiary care centre in central India

    • Authors: Deepa Joshi, Sheetal Achale, Nilesh Dalal, Alka Patel
      Pages: 956 - 959
      Abstract: Background: Urinary incontinence is a common condition in pregnancy and postpartum. There are more than a thousand articles on urinary incontinence (UI) in pregnancy but very limited literature from Indian subcontinent is available. Incidence and prevalence figures of UI in association with pregnancy vary substantially. Not many reviews have focused solely on incidence and prevalence of UI in association with pregnancy. Prevalence of UI in pregnancy ranges from 32% to 64%.Methods: A cross sectional observational study was conducted in the department of obstetrics and gynecology, MGM Medical College and M.Y. Hospital, Indore over the period of 6 months on 1000 pregnant women who were following antenatal care (ANC) clinic. Pregnant women, who were severely sick, diagnosed with kidney or urinary infection and vaginal infections women were excluded from the study. The data were collected using a structured questionnaire. After the purpose of the study was explained, written consent was obtained from each voluntary participant. This study was approved by institutional ethical committee. The data was recorded in predesign coded case report form and statistical analysis was performed using the STATA 12.1.Results: In the present study the prevalence of urinary incontinence reported is 16.4% of women during pregnancy.Conclusions: In this study the prevalence of UI during current pregnancy was found to be lower compared to previous studies conducted. The previous history of surgery, constipation, obesity and respiratory problems were found to be significantly associated with UI during pregnancy.
      PubDate: 2020-02-27
      DOI: 10.18203/2320-1770.ijrcog20200518
      Issue No: Vol. 9, No. 3 (2020)
  • Change in awareness levels of cervical cancer among rural women after
           intervention by health education: a community-based study

    • Authors: G. Kalpana, Keshav Gangadharan, Pradeep S., Devivaraprasad M.
      Pages: 960 - 964
      Abstract: Background: Cervical cancer is the fourth most common cancer among women worldwide. The prevention and control of cervical cancer depends on awareness about the disease, screening procedures, and preventive measures. Objectives of this study was to assess the awareness levels on various aspects of cervical cancer among women aged 25-65 years, and to assess the impact of health education intervention among them.Methods: This community-based interventional study was conducted for a period of 15 months among 250 women aged 25-65 years by cluster sampling method in a rural population. Data on all aspects of awareness about cervical cancer, i.e., risk factors, signs and symptoms, diagnosis and treatment and prevention were collected using a pre-tested semi-structured proforma. This was followed by a post-test 2 months after health education.Results: Overall awareness for cervical cancer was found to be very poor among the study subjects in the pre-test. Awareness on risk factors, signs and symptoms, diagnosis and treatment, and prevention of cervical cancer was found to be 6%, 3.6%, 1.2%, and 1.6% respectively. A significant increase in the knowledge level was found after health education.Conclusions: As the awareness levels regarding the cervical cancer was poor among the study population, health education programme and campaigns, along with periodic screening is need of the hour to effectively prevent cervical cancer.
      PubDate: 2020-02-27
      DOI: 10.18203/2320-1770.ijrcog20200561
      Issue No: Vol. 9, No. 3 (2020)
  • Maternal and neonatal outcomes in vacuum assisted births in the government
           tertiary care hospital in Mandya: a retrospective record-based study

    • Authors: Shwetha M., Shilpa M. N.
      Pages: 965 - 969
      Abstract: Background: Vacuum extraction and forceps are the two options when an instrument is needed to facilitate a vaginal birth. Vacuum extraction has recently gained popularity because of new designs of vacuum cups with reduced risk of injury to the neonate. Vacuum extraction is one of the evidence-based interventions that can prevent complications by shortening the second stage of labour. The present study has been carried out to evaluate the maternal and neonatal morbidity, mortality and failure associated with vacuum assisted vaginal deliveries, at a Government tertiary care hospital in Mandya, Karnataka, India.Methods: The study was a record-based study including a total of 207 women who underwent vaginal assisted delivery in the form of vacuum assisted deliveries in a period of 6 months from January 2019 to June 2019 at the Government tertiary care hospital in Mandya, Karnataka, India. Records of women who had vacuum assisted deliveries and records of their newborn children were accessed.Results: In our study 41.5% of the subjects were in the age group of 21-25 years. Nearly 3/4th (74.4%) of the subjects were primigravida. More than half (54.1%) of the study subjects had to be put under vacuum assisted techniques for delivery because of the prolonged second stage of labour, failure rate was 0.4%. Out of 207 vacuum assisted deliveries maternal complication rate was 8.21%, 17.3% neonates had NICU admission and 14.97% had perinatal complications.Conclusions: Vacuum assisted vaginal delivery is comparatively a better choice in preventing the complications caused due to prolonged second stage of labour thus reducing the cesareans rate. It is a safe alternative to cesareans delivery in rightly chosen case. Vacuum assisted delivery by a skilled person and a proper technique is associated with lesser maternal and neonatal morbidity.
      PubDate: 2020-02-27
      DOI: 10.18203/2320-1770.ijrcog20200569
      Issue No: Vol. 9, No. 3 (2020)
  • Outcome of Dengue infection in pregnancy at a tertiary care hospital in

    • Authors: Naimah Raza, Nitin P. Dhungat
      Pages: 970 - 974
      Abstract: Background: Dengue is one of the most important mosquito-borne diseases in India. This study was done to study the course of dengue infection in pregnant women, its effects, foeto-maternal outcome, and associated complications.Methods: Clinical, laboratory findings, and maternal/foetal outcome were collected from patients with confirmed dengue infections in pregnancy treated at a tertiary care hospital in India, during a 6-month period.Results: A total 12 seropositive cases of dengue infection in pregnancy were diagnosed during the study period. Thrombocytopenia coupled with rising haematocrit were seen in all cases. Prophylactic platelet transfusion was not necessary in any of the cases without bleeding manifestation. Three patients developed severe dengue with some complication requiring extra measures, including a case of dengue encephalitis which responded to supportive treatment. One case of intra-uterine foetal demise and multi-organ failure leading to maternal death was seen. Perinatal outcomes of the other cases were satisfactory.Conclusions: Dengue in pregnancy requires early diagnosis and treatment. A high index of clinical suspicion is essential in any pregnant woman with fever, especially in endemic areas. Further studies are necessary as evidence-based data in the management of dengue in pregnancy is inadequate.
      PubDate: 2020-02-27
      DOI: 10.18203/2320-1770.ijrcog20200576
      Issue No: Vol. 9, No. 3 (2020)
  • Are we operating unnecessarily': caesarean audit in a single unit of a
           private tertiary care hospital in North India

    • Authors: Nidhi Singh, Manjusha .
      Pages: 975 - 980
      Abstract: Background: Caesarean section emerged as a lifesaving surgery in situations where vaginal delivery could put the mother and fetus at risk. Over the years global rise in caesarean delivery rate has been alarming and may be attributed to changes in medical practice and societal expectations, especially in urban areas and developing countries. Rising caesarean rate is worrisome as it increases maternal morbidity, exposes the mother to future obstetric risks, besides increasing financial burden on the health care system. Caesarean audits could be an effective tool to analyse, understand and propose solutions to reduce caesarean rates. Hence, this retrospective study was conducted to audit caesarean sections done over a period of 5 years (2011 to 2015) in a single unit of a tertiary care private hospital in North India.Methods: The case records of all caesarean deliveries from January 2011 to December 2015 were analysed retrospectively for demographic profile, clinical parameters and recorded indication of caesarean section on the basis of Robson’s classification.Results: The caesarean section rate in the study was 61.8%. According to Robson’s 10 system classification, Group 2, 5 and 10 were the largest contributors. The commonest indication was previous LSCS (18.7%) followed closely by fetal distress (15.4%) and prolonged labor/failed induction (13.3%). Maternal request contributed 10.6% of the Caesarean deliveries.Conclusions: The caesarean section rate in our study is way higher than the national average. We need to re-duce caesareans in primigravidae and consider VBAC where appropriate. Use of Electronic fetal monitoring during labor needs to be optimized. Appropriate use of oxytocics, proper monitoring and using robust criterion to infer non progress of labor are important. Appropriate counselling and assured pain management during labor may help reduce caesareans on maternal request.
      PubDate: 2020-02-27
      DOI: 10.18203/2320-1770.ijrcog20200577
      Issue No: Vol. 9, No. 3 (2020)
  • Success of uterine artery embolization in the management of postabortal
           arteriovenous malformations

    • Authors: Sunil Kumar Juneja, Pooja Tandon, Gagandeep Kaur
      Pages: 981 - 983
      Abstract: Background: Uterine artery arteriovenous malformations are an abnormal and non-functional connection between the uterine arteries and veins. It may be congenital or acquired. AVM can cause heavy menstrual bleeding and may have an impact on infertility. Uterine artery embolization is an alternate method to hysterectomy preserving the menstrual and reproductive function. Objectives of this study was to diagnose Arterio-venous malformations after abortions in patients with heavy menstrual bleeding and treating these patients with UAE.Methods: The retrospective study of patients with postabortal arteriovenous malformations managed at Dayanand Medical College and Hospital, during January 2012 to December 2018 was done. Inclusion criteria for this study post abortal heavy menstrual bleeding patients in reproductive age group diagnosed to be having AV malformations on CT angiography. Exclusion criteria for this study were H/O AUB prior to abortion, patients with fibroids, PID, endometriosis, adenomyosis, genital tract malignancies. Patients who do not have AV malformations on CT angiography.Results: This is a retrospective seven years study between January 2012 to December 2018 during which we received 23 patients who developed arterio-venous fistula following an abortion. The patients had heavy menstrual bleeding. All the patients had taken some hormonal treatment before reporting to us. All these patients underwent CT angiography. After that they all were subjected to UAE. All these patients were followed up to 6 months where they showed improvement in the symptoms.Conclusions: Acquired AVM is rare disorder following an abortion or a caesarean section. Heavy menstrual bleeding is a common symptom often requiring hysterectomy but with the advent of uterine artery embolization by blocking the uterine artery we can conserve the uterus where a lady can have normal menstrual and reproductive functions.
      PubDate: 2020-02-27
      DOI: 10.18203/2320-1770.ijrcog20200860
      Issue No: Vol. 9, No. 3 (2020)
  • Attainment of menstrual hygiene by girls in boarding secondary schools in
           a state in Sub-Saharan Africa

    • Authors: Emmanuel C. Inyang Etoh, Uwemedimbuk S. Ekanem, Aniefiok J. Umoiyoho
      Pages: 984 - 990
      Abstract: Background: Menarche is the most dramatic manifestation of puberty in girls; unlike the biometric developmental changes that occur at puberty, menarche requires the personal adjustment and response of an affected girl in order to attain good menstrual hygiene. This study was designed to evaluate how boarding secondary school girls manage their menstruation in school, away from the guidance of their parents.Methods: A cross sectional survey was performed in four public boarding secondary schools in the study area with the aid of structured questionnaires to evaluate how such girls manage their menstruation while in school.Results: The study population was 975 girls whose survey revealed the mean age at menarche of 12.5±1.4 years.  Seven hundred and two (72.0%) respondents had received sexuality education before onset of menarche. Respondents who attained good menstrual hygiene were 775(79.5%). Such respondents were those who had received sexuality education (p<0.001) and those who had access to synthetic sanitary pad (p=0.005). Duration of the menstrual period and the volume of menstrual blood loss did not affect (p=0.219) the ability of respondents to attain good menstrual hygiene. Respondents who received sexuality education had about 605 chances of attaining good menstrual hygiene than those who did not receive such education.Conclusions: A vast majority of the respondents had received sexuality education before onset of menarche and a larger proportion attained good menstrual hygiene. Major factors that positively influenced the girls’ capacity to attained good menstrual hygiene were prior sexuality education and access to synthetic sanitary pad.
      PubDate: 2020-02-27
      DOI: 10.18203/2320-1770.ijrcog20200861
      Issue No: Vol. 9, No. 3 (2020)
  • Feto-maternal outcome in human immunodeficiency virus seropositive mothers
           in co-relation with CD4 count

    • Authors: Swati Trivedi, Oby Nagar, Prasoon Rastogi, Manish Bhardwaj
      Pages: 991 - 996
      Abstract: Background: To study the effect of human immunodeficiency virus (HIV) infection on pregnancy outcomes and new born as mother to child transmission of HIV is a major route on new infections in children and compare it with HIV uninfected pregnancies.Methods: Prospective comparative study conducted on 40 HIV seropositive and 40 HIV seronegative pregnant women attending ANC and delivering in the department of obstetrics and gynecology, S. M. S. Medical College, Jaipur, Rajasthan, India.Results: CD4 count had no effect on birth weight of baby or term of delivery. HIV seropositive pregnancies were more prone to IUD, still birth and preterm birth (p=0.029). Mother to child transmission was 2.7%.Conclusions: HIV infection increases the risk of adverse foetal outcome in terms of intrauterine demise, still birth and preterm labour.
      PubDate: 2020-02-27
      DOI: 10.18203/2320-1770.ijrcog20200862
      Issue No: Vol. 9, No. 3 (2020)
  • A study to assess predictive value of yolk sac diameter by transvaginal
           sonography with the pregnancy outcome

    • Authors: Saniya Sheik, Anjana B.
      Pages: 997 - 1002
      Abstract: Background: Ultrasonography is one of the most important and useful diagnostic tools in the field of modern medicine. Being non-invasive, safe and without hazards of radiation, it has gained wide acceptability, as an integral part of basic investigative procedures. A yolk sac can be detected easily by transvaginal sonography when the mean gestational sac diameter is 5 to 6 mm. Generally, the yolk sac should be observed when a gestational sac measures greater than 8. The yolk sac is situated between the amnion and the chorion.Methods: The present Prospective study was conducted in the department of obstetrics and gynecology, K. L. E. S. Dr. Prabhakar Kore charitable Hospital and Medical Research Centre, Belagavi during the period of January 2015 to February 2016. Records of pregnant women registering between 6 to 10-week 6 days’ period of gestation in OPD at KLES Dr. Prabhakar Kore Charitable Hospital and Medical Research Centre, Belagavi and who were fulfilling eligible selection criteria were studied prospectively.Results: A total of 254 study participants were included in the study and analysed. In this study, 49 cases were from age group of 20 years or less than 20 years i.e. around 19.29% of total study population. Majority of the cases were with normal yolk sac diameter (YSD) i.e. around 201 cases which accounts for 79.13% of total study population and total number of cases with abnormal yolk sac diameter (YSD) were 53 which accounts for 20.87% of total study population.Conclusions: Measurement of the secondary yolk sac diameter between 6th to 10th weeks 6 days of gestation can be used as a valuable tool in predicting outcome of the pregnancy.
      PubDate: 2020-02-27
      DOI: 10.18203/2320-1770.ijrcog20200863
      Issue No: Vol. 9, No. 3 (2020)
  • Routine versus selective use of episiotomy in primigravida: a prospective
           non-randomized case-control study

    • Authors: Dipti A. Modi, Palak P. Vaishnav
      Pages: 1003 - 1006
      Abstract: Background: Episiotomy is a surgically planned incision on the perineum and the posterior vaginal wall during second stage of labour. It is an inflicted second-degree perineal tear. Objective of this study was to determine the possible benefits and risks of the use of selective episiotomy versus routine episiotomy during delivery in primigravida.Methods: This is a prospective non-randomized case-control study designed to analyze and compare the maternal outcomes following routine versus selective use of episiotomy in primigravida. In control group, 122 patients were recruited and mediolateral episiotomy was given in all patients; while in study group, 61 patients were recruited, in whom episiotomy was given selectively.Results: In study group 61 patients were recruited, out of which episiotomy can be avoided in 23 (37.7%) of cases. There was no 3rd or 4th degree perineal tear found in any group. Perineal pain score on 3rd day postpartum was less in study group, as compared to control group on bed rest, sitting, walking and defecation.Conclusions: Selective use of episiotomy can improve maternal outcome by reducing perineal lacerations and those having intact perineum can have the best outcome when episiotomy is given selectively.
      PubDate: 2020-02-27
      DOI: 10.18203/2320-1770.ijrcog20200864
      Issue No: Vol. 9, No. 3 (2020)
  • Incidence of thrombophilia in patients with recurrent pregnancy loss

    • Authors: Ganesh Bharaswadkar
      Pages: 1007 - 1010
      Abstract: Background: Approximately 1-3% of women of reproductive age suffer from recurrent pregnancy loss. Objective of this study was to evaluate the association between recurrent pregnancy loss and thrombophilia.Methods: This is a descriptive study, involving retrospective analysis of patients with recurrent pregnancy losses. Patients with recurrent pregnancy loss in whom associated morbidity factors were excluded underwent screening for both acquired and inherited thrombophilia.Results: A total of 20 patients were screened for acquired and inherited thrombophilia with recurrent pregnancy loss. Thrombophilia was diagnosed in 70% cases. Out of which, anticardiolipin antibodies was found positive in 57% of patients, protein C 7% and protein S deficiency was observed in 35% cases.Conclusions: Thrombophilias are associated with recurrent pregnancy loss. Patients in whom other associated morbid factors are excluded, should be offered screening for thrombophilia. Multidisciplinary management involving hematologist is vital for management.
      PubDate: 2020-02-27
      DOI: 10.18203/2320-1770.ijrcog20200865
      Issue No: Vol. 9, No. 3 (2020)
  • Computed tomography features of benign adnexal mass lesions

    • Authors: Ezzat Khalda, Ashok Kumar Mandal, Hafizur Rahman
      Pages: 1011 - 1016
      Abstract: Background: Adnexal masses originating from gynaecologic and nongynecologic sources may be benign or malignant. The objective of this study was to describe multi-detector computed tomography features of benign adnexal masses for diagnostic accuracy and disease understanding.Methods: Study retrospectively evaluates the multidetector computed tomography features of benign adnexal mass lesions, which were referred for MDCT examination with a primary diagnosis of adnexal masses on clinical or USG. Patients who underwent MDCT and subsequently underwent surgery and proved to benign adnexal mass lesion on histopathological examination were included in this study.Results: Forty five percent benign adnexal mass were in the age group of 36-50 years followed by 32.7% in the age group of 21-35 years. Common presenting symptoms of benign adnexal masses were pain abdomen or pelvic pain (65.5%) followed by mass abdomen (42%) while in one fourth of the patients it was asymptomatic and detected as incidental finding. Pathologic diagnosis of most common benign adnexal mass detected were serous cyst adenoma (54.5%), followed by mature cystic teratoma (18.2%), mucinous cyst adenoma (14.5%) and par ovarian cyst (9.1%). Benign ovarian mass had a characteristic CT appearance of cystic lesion (83.6%), unilocular (65.5%) with regular/well defined and thin wall (83.6%) with occasional septations (21.8%) and papillary projections (14.5%). Ascitis (5.5%) was an uncommon finding of a benign adnexal mass lesion. Computed tomography was most accurate to characterize mature cystic teratoma with a typical cystic lesion having fat deposition and calcifications.  Serous cyst adenoma had a CT appearance of thin walled cyst mass with no septations or solid component. Mucinous cyst adenoma ovary had a characteristic multilocular cystic lesion with different fluid attenuation and thin septations.  Endometrioma had a variable CT appearance with uni or multilocular cystic lesion and hyperdense lesion with focal calcifications.Conclusions: Multi detector computed tomography may provide accurate and valuable diagnostic information about benign nature of an adnexal mass lesion.
      PubDate: 2020-02-27
      DOI: 10.18203/2320-1770.ijrcog20200866
      Issue No: Vol. 9, No. 3 (2020)
  • Correlation of lateral placental location with development of preeclampsia

    • Authors: Anjali Gupta, Priyanka Bansal, Jyotsna Sen, Savita Rani Singhal
      Pages: 1017 - 1022
      Abstract: Background: Preeclampsia is a complex clinical syndrome which involves multiple organ systems and remains the principle cause of maternal and perinatal morbidity and mortality. Preeclampsia is a disease of trophoblastic tissue. Placental abnormality is one of the initial events in patients who are destined to develop pregnancy induced hypertension subsequently. Objective of this study was to evaluate the association of laterally located placenta on ultrasound with development of preeclampsia.Methods: This prospective observational study was conducted on 200 antenatal women with singleton pregnancy at 18-24 weeks of gestation who attended antenatal clinic of obstetrics and gynaecology, PGIMS Rohtak from October 2017 to October 2018. Detailed antenatal transabdominal ultrasound along with placental location was done between 18-24 weeks of gestation in women who fitted into inclusion criteria. All the antenatal women belonged to 18-24 weeks of gestation were included in the study except those women with chronic hypertension, diabetes mellitus, renal disease, severe anaemia, thyrotoxicosis, low lying placenta, previous history of preeclampsia or eclampsia.Results: Out of 200 antenatal women, 84 had lateral placenta while 116 had central placenta. Out of these 84 women who had lateral placenta, 55 women (65.5%) developed preeclampsia and out of 116 (58%) women who had central placenta, 28 women (24.1%) developed preeclampsia.Conclusions: From the above study, we concluded that women with laterally located placenta by ultrasound at 18-24 weeks of gestation have greater risk of developing preeclampsia.
      PubDate: 2020-02-27
      DOI: 10.18203/2320-1770.ijrcog20200867
      Issue No: Vol. 9, No. 3 (2020)
  • Oxytocin versus Misoprostol used as an induction of labour in term in
           early rupture of Amniotic membranes

    • Authors: Jaydeep J. Bhatu, Ankita B. Chaudhari, Nilesh R. Chauhan
      Pages: 1023 - 1028
      Abstract: Background: Pre labor Rupture of membranes is a common obstetrical problem, significant event as it transforms an ordinary pregnancy into a high risk one. Majority of cases of PROM - of about 60% occur after 37 completed weeks Induction of labour is artificial. Misoprostol is receiving attention as a cervical modifier and labour induction agent. This study compares the safety and efficacy of Misoprostol with Oxytocin in labour induction in term pre labour rupture of membranes. Objective of this study was to compare the safety and efficacy of Misoprostol with that of Oxytocin in labour induction in PROM. The effects were compared between primipara and multipara in a selected sample.Methods: General condition is assessed by pulse rate, blood pressure, height, weight with particular attention to pedal odema, anemia. Cardiovascular and respiratory systems were examined, rule out cephalo pelvic disproportion and for Bishop’s scoring. USG for foetal maturity, Liquor status and for foetal well-being. Admission CTG.Results: There is no significant difference was observed between two groups either in vaginal delivery or in incidence of LSCS. Mean induction delivery interval in misoprostol group for nullipara is 8.5 hours. For multipara it is 6.6 hours. And in oxytocin group for nullipara is 10:4 hours. In multipara it is 6.5 for primipara it was significantly reduced in misoprostol group compared to syntocinon group.Conclusions: Misoprostol is an effective, cheap, safe, stable at room temperature and easy to use if it is used in appropriate dosage for induction of labour in pre-labour rupture of membranes at term.
      PubDate: 2020-02-27
      DOI: 10.18203/2320-1770.ijrcog20200868
      Issue No: Vol. 9, No. 3 (2020)
  • Gastrointestinal symptoms in pregnancy among antenatal clinic attendees in
           Abubakar Tafawa Balewa University Teaching Hospital Bauchi, Northeast

    • Authors: Muhammad Baffah Aminu, Mohammed Alkali, Bala M. Audu, Toyin Abdulrazak
      Pages: 1029 - 1033
      Abstract: Background: Pregnant women are at increasing risk of GI symptoms such as nausea, vomiting and heartburns, most of these symptoms are as a result of the hormonal and physical changes associated with pregnancy. This study aimed to determine prevalence of gastrointestinal symptoms (GI) among pregnant women attending booking clinic at a Northeastern Nigerian Teaching Hospital.Methods: The study was a cross-sectional, questionnaire-based survey of four hundred and fifty-two pregnant women booking for antenatal care. Their sociodemographic variables as well as the presence or absence of gastrointestinal symptoms in index pregnancy were obtained at by the use of researcher-administered questionnaire. Data were analyzed and presented as frequencies and percentages. A 5% significance level (p <0.05) to test associations.Results: Two fifty-five women had heart burns (56.4%) while 235 (52.0%) had nausea in pregnancy, these were observed to be the most prevalent GI symptoms among the women. Diarrhea and hemorrhoids were the uncommon GI symptoms in the study population constituting 406 (89.5%), and 360 (79.6%) respectively. Easy fullness was noted in 39.8% of the women while vomiting was in 41.8% and constipation in 29% of the respondents. A significant association was observed (p value <0.05) between parity and development of anorexia and hemorrhoids in pregnancy (p values of 0.049 and 0.051 respectively) but not for the other symptoms.Conclusions: GI symptoms are common in pregnancy, the most prevalent symptoms are that of heart burns and nausea, while diarrhea is relatively uncommon.
      PubDate: 2020-02-27
      DOI: 10.18203/2320-1770.ijrcog20200869
      Issue No: Vol. 9, No. 3 (2020)
  • Evaluation of factor VIII value in normal women and whom encountered
           recurrent pregnancy loss: is there any significant difference'

    • Authors: Douaa Al Rez, Hasan Naser Eldine, Marwan Alhalabi
      Pages: 1034 - 1038
      Abstract: Background: Recurrent pregnancy loss (RPL) is a serious problem on the women, it defined as two or more consecutive pregnancy losses before the fetus has reached birth. The aim of this study is to evaluate the association between the elevation in the factor VIII and RPL. Because women who have thrombophilia have increased risk of fetal loss in most studies.Methods: A total 72 women were recruited in this case control study. They divided into two groups: the RPL group included 41 women with a history of recurrent pregnancy loss and the control group included 31 healthy women, who had at least one successful pregnancy and none of them had a history of fetal loss or complicated pregnancy.Results: A majority of the patients of this study didn't have a high level of factor VIII, 9 of 41 (22%) patients of RPL group in comparison with 21 of 32 (65,6%) of control group, that suffer from the increase rate of FVIII, this means that factor VIII doesn't effect on RPL.Conclusions: The present study showed that the serum elevation in the factor VIII is not significantly associated with RPL.
      PubDate: 2020-02-27
      DOI: 10.18203/2320-1770.ijrcog20200870
      Issue No: Vol. 9, No. 3 (2020)
  • Menstrual hygiene practice between rural and urban high school adolescent
           girls in Bangladesh

    • Authors: Rajea Sultana, Ela Rani Shom, Fahima Khatun
      Pages: 1039 - 1044
      Abstract: Background: Menstruation is a natural, normal biological process experienced by all adolescent girls and women. Urinary tract infection, reproductive tract infection and complication during pregnancy are the impact of poor menstrual hygiene practices. The aim of this study is to compare the menstrual hygiene practice between rural and urban high school adolescent girls in Bangladesh.Methods: A descriptive comparative study design was used. Cluster sampling technique was used to select 120 study participants. The data were collected through self-reported questionnaire by structured questionnaires. In descriptive statistics; frequency, percentage, mean, standard deviation and in inferential statistics; chi-square-test, t-test was used to compare the menstrual hygiene practice between rural and urban. Data was analyzed using SPSS version 23.Results: There was significant difference between rural and urban girls regarding mean age at menarche (5.50, p = 0.000). There was a statistically significant difference between rural and urban girls using of sanitary pad (30.54, p = 0.000) and reusable cloth (38.92, p = 0.000).Conclusions: This study found that menstrual hygiene practice (MHP) was more among the urban high school adolescent girls than in the rural high school adolescent girls. The result provides baseline information regarding menstrual hygiene practice (MHP) among rural participants that’s why need more emphasize on health promotion and counseling program regarding menstrual hygiene practice (MHP) among rural and primary level health sectors in Bangladesh.
      PubDate: 2020-02-27
      DOI: 10.18203/2320-1770.ijrcog20200871
      Issue No: Vol. 9, No. 3 (2020)
  • Utility of paperless partogram in labor management

    • Authors: Nazli Tarannum, Nishat Akhtar
      Pages: 1045 - 1049
      Abstract: Background: Partograph use in labor has revolutionized the obstetric care. WHO recommends universal use of WHO modified partograph, which in clinical setup is less often used. Debdas (2006) proposed the paperless partogram which is designed for use by clinician/nurses/midwives as it is very simple and low skill method. The present study is proposed to evaluate the effectiveness of paperless partogram as a bedside tool and its comparison with WHO modified partograph.Methods: It was a prospective analytical study done in department of obstetrics and gynecology, JNMCH, AMU, Aligarh from September 2017 to July 2019 and included 400 pregnant women at term, divided into 2 groups of 100 each Group A (paperless partogram) and Group B (WHO modified partograph) and their labor events were followed.Results: Out of 200 women that were included in each group, maximum women were multigravida, 58.5% in group A and 61.5% women in Group B. Mean age in Group A was 24.68±3.8years and Group B was 24.93±3.75 years. The mean duration of labor in Group A was 3.57±2.20 hours and Group B was 3.40±2.03 hours. There were 87.5% of women who delivered before alert ETD, likewise in Group B; women who delivered before alert line are 88.5%. These differences were statically not significant. Perinatal outcome was also similar in both groups.Conclusions: In our study, the paperless study was found to be as efficient as WHO modified partograph for management of labor. The mean delivery time was 3.57 hours similar to WHO partograph of difference between alert and action line. Thus, for resource poor setting like India with overburdened population paperless partogram can be used as an alternative to WHO modified partograph which is complex and time consuming.
      PubDate: 2020-02-27
      DOI: 10.18203/2320-1770.ijrcog20200872
      Issue No: Vol. 9, No. 3 (2020)
  • Maternal body mass index: how much it affects mother and baby

    • Authors: Chaitanya A. Shembekar, Shantanu C. Shembekar, Manisha C. Shembekar, Parul Sharma Saoji, Jayshree J. Upadhye
      Pages: 1050 - 1054
      Abstract: Background: Overweight, obesity, and morbid obesity in the mother are associated with adverse obstetrics well as neonatal outcome. Aim of this study was to assess the prevalence of overweight and obesity, and the impact of body mass index (BMI) on maternal and neonatal outcome.Methods: This is a retrospective study from January 2018 to September 2018 on 180 women with singleton term pregnancies. Maternal and neonatal outcomes at delivery were noted.Results: In present study, 3 (1.66%) pregnant women were underweight, 57 (31.66%) pregnant women had normal BMI, 71 (39.44%) pregnant women were overweight while 49 (27.22%) pregnant women were obese. Gestational weight gain was less than 8 kgs in 40 (22.22%) pregnant women, weight gain was 8-15.9 kgs in 132 (73.33%) pregnant women while weight gain was more than 16 kgs in 8 (4.44%) pregnant women. Out of 3 underweight women, 1 delivered by cesarean section and 2 had normal delivery, out of 57 women with normal BMI, 21 delivered by cesarean section and 36 had normal delivery, out of 71 overweight women, 47 delivered by cesarean section and 34 had normal delivery while out of 49 obese women, 38 delivered by cesarean section and 11 had normal delivery. PET and GDM was seen in 9 (7.5%) women each while macrosomia were seen in 5 (4.16%) women.Conclusions: Increased association was seen with maternal obesity and adverse outcome of pregnancy like PIH, GDM, cesarean section.
      PubDate: 2020-02-27
      DOI: 10.18203/2320-1770.ijrcog20200873
      Issue No: Vol. 9, No. 3 (2020)
  • Assessment of knowledge regarding anaemia and its preventive measures
           among lactating mothers of North Gujarat region, India

    • Authors: Pankajkumar B. Nimbalkar, Maulik D. Joshi, Nilesh Thakor, Avirat A. Bhatt
      Pages: 1055 - 1059
      Abstract: Background: Anaemia in pregnancy and lactation period has detrimental effects on maternal and child health. Objective of this study was to assess knowledge of lactating mothers regarding anaemia and its preventive measures before and after educational intervention.Methods: The interventional study conducted in purposively selected lactating mothers attending the outpatient department of obstetrics and gynecology. Hospital ethical committee permission was obtained. After taking informed consent 100 lactating mothers were selected by systemic random sampling methods. Knowledge of lactating mothers regarding anaemia and its preventive measures was assessed by pre-designed, pre-tested and semi structured questionnaire. Health education for 30 minutes was given to selected lactating mothers. Knowledge of pregnant women for the same was assessed after health education. Thus, collected data was analyzed using Epi info 7.Results: Awareness among lactating mothers regarding causes, signs and symptoms of anemia and dietary sources of iron was 41%, 26% and 5% respectively which was significantly increased to 73%, 56% and 42% respectively after health education. Awareness among lactating mothers regarding factors which inhibit and increase iron absorption was 31% and 22% respectively which was significantly increased to 80% and 65% respectively after health education. Out of 100 lactating mothers only 24% were aware regarding treatment of anemia.Conclusions: Lack of awareness among lactating mothers regarding anemia and its preventive measure should be addressed by health education during hospital visits.
      PubDate: 2020-02-27
      DOI: 10.18203/2320-1770.ijrcog20200874
      Issue No: Vol. 9, No. 3 (2020)
  • An analytical cross sectional study on hypothyroidism in pregnancy, its
           maternal and fetal outcome

    • Authors: Vinodhini S., Vilvapriya S., Veeraragavan K.
      Pages: 1060 - 1068
      Abstract: Background: Hypothyroidism is associated with maternal and fetal complications. This study aims to evaluate the prevalence, maternal and fetal outcome in hypothyroidism. Objective of this study was to determine whether thyroid function test can be recommended as a universal or selective screening in pregnancy.Methods: An analytical cross-sectional study with internal comparison carried out at Govt. Kilpauk Medical College & Hospital from September 2017 to July 2018 for antenatal mothers in third trimester. Serum TSH and freeT3, T4 in case of abnormal TSH were measured, grouped into subclinical and overt hypothyroidism and were treated with Levothyroxine. Six-week follow-up with TSH, pregnancy complications were observed.Results: 932 pregnant mothers were followed up. Prevalence of hypothyroidism was 10.5% (n = 98). Among the hypothyroid 62.24% (n = 61) had subclinical and 37.76% (n = 37) had overt hypothyroidism. The prevalence of anaemia was 35% in overt and 15% in subclinical hypothyroid group (p = 0.019). Preeclampsia is reported in 49% of overt and 16% of subclinical hypothyroid group (p = <0.001), statistically significant. Eclampsia was noted in 1 (1.64%) overt hypothyroid patient. Abruptio placenta was observed in 1 subclinical and 4 overt hypothyroid patients (5.1%). The incidence of preterm labour in this study subjects was 38% in overt and 20% in subclinical hypothyroid group (p = 0.048). The incidence of LBW fetus was 41% in overt hypothyroid and 21% in subclinical hypothyroid group (p = 0.041). The incidence of complication in this study was 41% in subclinical and 78% in overt hypothyroid group (p = <0.001).Conclusions: Early screening, adequate treatment and follow up will bring down maternal and fetal complications in hypothyroidism.
      PubDate: 2020-02-27
      DOI: 10.18203/2320-1770.ijrcog20200875
      Issue No: Vol. 9, No. 3 (2020)
  • Effectiveness of ursodeoxycholic acid therapy in intrahepatic cholestatsis
           of pregnancy

    • Authors: Devdatt I. Pitale, Sujata N. Jadhav
      Pages: 1069 - 1072
      Abstract: Background: Intrahepatic cholestasis of pregnancy (ICP) is a pregnancy specific disorder and commonly presents with maternal pruritus, abnormal liver function tests and adverse maternal -foetal outcomes. ICP lacks protocol-based therapy as etiology is multifactorial and is based on symptomatic treatment. The overall incidence of ICP is variable from 0.1 to 15.6% worldwide. The aim of this study is to assess the effectiveness of UDCA in ICP with regards to reduction in pruritus, normalizing LFTs and maternal-foetal outcomes.Methods: This multicentric prospective study was performed from June 2017 to December 2019 in pregnant women with ICP attending the Antenatal clinic at INHS Patanjali, MH Dehradun, INHS Asvini, INHS Sandhani. In this study, 50 women with ICP. who satisfied the inclusion and exclusion criteria were started on UDCA therapy. The effectiveness of therapy was evaluated on the basis of normalization of LFT levels, reduction in pruritus, safe confinement, maternal-foetal outcomes and adverse effects if anyResults: The pregnant women with ICP on UDCA therapy showed marked improvement in pruritus, near normal LFT levels. After the UDCA therapy the frequency and intensity of pruritus was reduced in 50 (100%) of women. Safe confinement was achieved, with normal delivery in 45 (90%) women with no any major adverse effects and adverse maternal-foetal outcomes.Conclusions: This study shows the effectiveness of URCA therapy in reducing the ICP associated pruritus, normalizing LFTs and safe confinement without any major adverse effects. UDCA therapy is an effective and safe option in ICP.
      PubDate: 2020-02-27
      DOI: 10.18203/2320-1770.ijrcog20200876
      Issue No: Vol. 9, No. 3 (2020)
  • Role of obstetric colour doppler studies in predicting perinatal outcome
           in pregnancy induced hypertension

    • Authors: Ritu Mishra, Aditya P. Misra
      Pages: 1073 - 1078
      Abstract: Background: Pregnancy induced hypertension (PIH) is associated with adverse perinatal outcome. Multi vessel colour Doppler studies are useful in these cases for timely intervention. The aim of present study was to know the significance of umbilical, middle cerebral and uterine artery Doppler in PIH and to analyse their role in predicting perinatal outcome.Methods: This is a study of 150 pregnant women with pregnancy induced hypertension (PIH). These patients were evaluated with colour Doppler and were followed subsequently for any adverse perinatal outcome.Results: Out of 150 cases 70% of cases were found in 20-30 years age group. 98 cases had abnormal uterine artery Doppler indices accounting for 65.3%, while 52 cases had a normal Doppler index accounting for 34.3%. Out of 150 cases, 94 (64.6%) cases had abnormal middle cerebral artery. In our study 53 cases had abnormal umbilical artery Doppler indices accounting for 35.4%, while 97 cases had a normal Doppler index accounting for 64.6%. Out of 150 cases in our study 27 cases had Reversal of a wave in ductus venosus waveform that is in 18%. In this study total 5 cases (35.7%) of perinatal mortality were seen.Conclusions: The knowledge of various doppler parameters may help to improve pregnancy outcome and identification of PIH at earliest gestation age as compared to other antepartum test modalities.
      PubDate: 2020-02-27
      DOI: 10.18203/2320-1770.ijrcog20200877
      Issue No: Vol. 9, No. 3 (2020)
  • Effect of autologous platelet rich plasma on thin endometrium in frozen
           thawed embryo transfer

    • Authors: Adaboina Anitha, Burri Sandhya Rani
      Pages: 1079 - 1082
      Abstract: Background: Endometrium is one of the main factors in implantation and pregnancy. Some of the assisted reproductive technology treatment (ART) cycles get cancelled due to inadequate endometrial growth. This study was conducted to evaluate the effectiveness of PRP (platelet rich plasma) in the treatment of thin endometrium and its outcome on pregnancy and live birth rates.Methods: This study was a prospective cohort which was conducted from January 2018 to December 2018 at Laxmi Narasimha Hospital, Warangal, Telangana State. 30 patients with history of inadequate endometrial growth in frozen thawed embryo transfer cycles were recruited into the study. Intrauterine infusion of PRP was performed. Endometrial thickness was assessed.Results: 30 women were recruited in the study data of the 24 women were collected. Live birth was seen in 5 patients in the week range of 37±to 37±5 and average EMT in mm was 7.8, abortion was seen in 3 patients in the week range of 6 to 8±2 and average EMT in mm was 7.4 , chemical pregnancy was seen in 2 patients in the week range of 6 and average EMT in mm was 7.2 and number of women who were not pregnant were 14 and average EMT in mm was 7.0. Live birth was observed in 21% of the patients, abortion was observed in 13%, chemical pregnancy was seen in 9% and women who were not pregnant were 58%.Conclusions: Ability of autologous PRP to restore the endometrial receptivity of damaged endometrium has some aspects other than increasing the EMT.
      PubDate: 2020-02-27
      DOI: 10.18203/2320-1770.ijrcog20200878
      Issue No: Vol. 9, No. 3 (2020)
  • Study of mullerian anomalies over 5 years in a tertiary care centre

    • Authors: Ramalingappa C. Antaratani, Sanjana Kumar, Vinay Raju
      Pages: 1083 - 1088
      Abstract: Background: Mullerian anomalies-developmental anomalies of the mullerian system might involve the uterus, cervix, fallopian tubes and vagina of which anomalies of the uterus are the most common. They are often regarded as a treatable form of infertility and have a prevalence of 0.5% in the general population. Though most of them remain asymptomatic, they contribute a good proportion of recurrent pregnancy losses, obstetric complications and infertility. Their timely diagnosis, management and evaluation of associated anomalies proves to be necessary.Methods: A prospective observational study was undertaken at KIMS, Hubli from 2014 to 2018. The study involved those women who were admitted in the department of obstetrics and gynecology at KIMS, Hubli for various reasons and were detected to have a mullerian anomaly. Their mode of presentation, method of detection, associated anomalies were analysed and statistical conclusions drawn from the same.Results: During the study period of 5 years, a total of 85 cases of mullerian anomalies were detected amounting to an incidence of 0.15%. 35% of them were asymptomatic, infertility (24%) being the next common mode of presentation. Septate/sub-septate uterus was found to have the poorest obstetric outcome. Mullerian anomalies were seen in combination in 14% of the cases and had an association with other anomalies like renal anomalies in 10% of the cases. Surgical correction was done for most of the cases of vaginal septum and septate/sub-septate uterus.Conclusions: Mullerian anomalies are often regarded as an uncommon but treatable form of infertility. Their timely detection, treatment and watchful obstetric management is in need.
      PubDate: 2020-02-27
      DOI: 10.18203/2320-1770.ijrcog20200879
      Issue No: Vol. 9, No. 3 (2020)
  • Extraperitoneal cesarean section: a retrospective analysis

    • Authors: Partha Pratim Sharma, Sneha Gond, M. D. Kamaluddin Ansari, Narra Madhuri, Surendra N. Bera
      Pages: 1089 - 1091
      Abstract: Background: Morbidity of caesarean section still persist in terms of pain, infection and adhesion. This study will focus on different morbidities associated with ECS.Methods: A retrospective analysis of 29 ECS were included from June to September 2018, done at Midnapore Medical college, West Bengal, India.Results: Contracted pelvis (12/29, 41.37%) and cephalopelvic disproportion (10/29,34.48%) were common indications for ECS. Mean gestational age was 39.65±1.31 weeks and birth weight were 3.01±0.40 kg. Time taken for ECS was 33.06±10.85 minutes. Extension of uterine incision and mild distension of abdomen occurred in 3.44% each. Post-operative period was uneventful and all discharged after 72 hours of operation.Conclusions: ECS can be performed safely by experienced hands with less feto-maternal morbidity and early discharge of mother and baby.
      PubDate: 2020-02-27
      DOI: 10.18203/2320-1770.ijrcog20200880
      Issue No: Vol. 9, No. 3 (2020)
  • Screening for non-communicable diseases

    • Authors: D. M. Christe, S. Vijaya, K. Tharangini
      Pages: 1092 - 1096
      Abstract: Background: This study was conducted to enumerate the results of screening for non-communicable diseases in the NCD clinic over a period of one year in a tertiary health centre.Methods: The results from screening tests conducted in the NCD clinic, for detecting hypertension, diabetes mellitus, breast cancer and cervical cancer, in Government tertiary care Hospital for Women, Chennai, were recorded. The flowchart and screening methods followed were those recommended by the NHM - NPCDCS. Data thus obtained was analyzed using standard statistical methods.Results: Of 42,519 women screened for common non communicable diseases - hypertension, diabetes mellitus, breast cancer and cervical cancer, nearly 5.55% women (n = 2359) had positive results, for any one of the diseases screened. Of 11,708 women screened for diabetes mellitus and 13,971 screened for hypertension, positive results were found in 856 women and 1,216 women respectively. Around 7,568 women were screened for cervical cancer and 175 women tested positive. A large number of 9,272 women were screened for breast cancer and 112 women had positive results. As per the guidelines, women who tested positive for screening tests were referred to the concerned departments in RGGGH.Conclusions: Nearly 42,519 women were screened for common non-communicable diseases (NCDs) - hypertension, diabetes mellitus, breast cancer and cervical cancer, and 5.55% women had positive test results for any one of the diseases screened. The screening revealed, 8.7% of women had raised blood pressure, 7.31% had raised blood sugar levels, 1.21% women had positive screening test results for breast cancer, and 2.31% women for cervical cancer.
      PubDate: 2020-02-27
      DOI: 10.18203/2320-1770.ijrcog20200881
      Issue No: Vol. 9, No. 3 (2020)
  • Polycystic ovarian syndrome among adolescent and young women: a hospital
           based observational study in a tertiary care teaching Hospital

    • Authors: Arpita Jain, Swati Garg, Urvashi Sharma
      Pages: 1097 - 1105
      Abstract: Background: Polycystic ovarian syndrome (PCOS) is one of the most common endocrine disorder among women of fertile age. The incidence of PCOS as claimed by various observer ranges from 2.2% to as high as 26%. India is considered as an emerging epidemic area for PCOS and limited studies are done. Hence aim of this study is to find the prevalence of PCOS and determine the associated determining factors in adolescent girls.Methods: All the girls aged 15-24 years were approached and after undergoing detailed history, examination and investigations were further diagnosed as PCOS. The study subjects were then classified into two group: the PCOS and non-PCOS group and compared to determine significant differences as per the Rotterdam criteria.Results: The prevalence of PCOS was 7.5%, 18.68% and 11.18% as per NIH, Rotterdam and AES criteria respectively. BMI more than 30, waist circumference > 80 cm, hyperandrogenic manifestations, menstrual irregularity (oligomenorrhea) and family history of PCOS and DM showed statistically significant association with PCOS. Serum LH, LH/FSH ratio, S. Testosterones, serum insulin and HOMA-IR had significant association with PCOS. No significant association of Fasting blood sugar levels and deranged lipid profile was found with PCOS.Conclusions: PCOS is an emerging disorder during adolescents and hence awareness creation, early screening in order to inculcate early life style modifications and prevent metabolic and reproductive complications of this disease.
      PubDate: 2020-02-27
      DOI: 10.18203/2320-1770.ijrcog20200882
      Issue No: Vol. 9, No. 3 (2020)
  • Pregnancy outcomes in non-gynecological and non-hematological cancers: a
           retrospective cohort

    • Authors: Minakshi Kumari, Hilda Yenuberi, Swati Rathore, Deepak Abraham, V. T. K. Titus, Jiji Elizabeth Mathews, Ashish Singh
      Pages: 1106 - 1109
      Abstract: Background: Of all the cancers in women, about 10% manifest in the reproductive age group. These can be broadly classified as gynaecological cancers and non-gynaecological cancers; Among the non-gynaecological cancers besides haematological cancer, breast, thyroid, colon, bone and CNS are seen rarely. Clinical acumen in diagnosis and management of these rare cancers that appear during pregnancy or before pregnancy are difficult due to insufficient guidelines and rarity of the conditions.Methods: A retrospective analysis of rare cancers during a period of 10 years in this hospital was performed. Data concerning the gestational age at delivery, birth weight, mode of delivery and complications and the management of the cancers during the pregnancy were collected.Results: Among the 41 women with these rare non-gynecological, non-hematological cancers, 13 pregnancies were in women with prior history of cancers and 28 pregnancies were with current history of cancer. Majority of these cases with prior history were thyroid cancers who had uneventful pregnancies and delivered normally. Among pregnancies with current history of cancer, breast, CNS, GIT, and head and neck were the cancers with 5-6 cancers in each category. About 50% of these cancers were delivered early between 31-35 weeks to facilitate optimal treatment. Cancers with guarded prognosis diagnosed before 20 weeks had a termination of pregnancy.Conclusions: Cancers during pregnancies are rare and their care must be individualized.
      PubDate: 2020-02-27
      DOI: 10.18203/2320-1770.ijrcog20200883
      Issue No: Vol. 9, No. 3 (2020)
  • Antenatal service utilization among women in South India: a community
           based cross sectional study

    • Authors: Chethana K., Manjula Anil, Maria Nelliyanil
      Pages: 1110 - 1114
      Abstract: Background: Antenatal period is important for identifying pregnancy related threats and antenatal care (ANC) is one of the most effective health interventions during this period. It provides a unique opportunity for screening and diagnosis, health promotion and disease prevention. This study assessed the antenatal service utilization pattern and its determinants among women.Methods: A community based cross sectional study was conducted in the field practice area of a teaching hospital in Mangalore. Study included 142 women who had delivered in the last one year in the study area, selected using snowball sampling method. A pretested semi-structured validated questionnaire was used to collect the data. Predictors of full ANC were identified using univariate analysis and explanatory variables were entered into multivariate regression model to obtain the adjusted odds ratios to find the association between full ANC coverage and its determinants.Results: Among the participants, 99.3% registered their pregnancy and 78.9% had early registration. Majority, 91.5% had minimum antenatal visits, 83.1% consumed iron and folic acid supplements for more than three months and tetanus toxoid (TT) coverage was 98.6%. Full ANC coverage was found to be 81% and unadjusted analysis showed higher odds of full ANC coverage among housewives, primiparous, women in joint family and among literates. However, multi variable analysis revealed literacy as the major determinant of full ANC.Conclusions: In the present study, majority of the women had adequate antenatal care utilization. Full antenatal coverage was found to be statistically significant among literate women.
      PubDate: 2020-02-27
      DOI: 10.18203/2320-1770.ijrcog20200884
      Issue No: Vol. 9, No. 3 (2020)
  • A study of thrombocytopenia in pregnancy

    • Authors: Komal Modi, Jaydeep Chaudhari, Disha Vaja
      Pages: 1115 - 1118
      Abstract: Background: Thrombocytopenia is defined as low platelet count and if it is present during pregnancy can jeopardize the maternal and fetal outcome. Thrombocytopenia occurs in 6-15% of pregnancies. Causes of thrombocytopenia include gestational, idiopathic thrombocytopenia, preeclampsia, HELLP, DIC, malignancy and marrow failure. Aim of this study was to find out the common causes of thrombocytopenia in this hospital and management being used.Methods: Data was collected form those women who came to the antenatal clinic (booked) and labour room (unbooked) in the department of obstetrics and gynecology, GMERS Medical College and Hospital, Sola, Ahmedabad. Data of a total of 75 pregnant women were collected during the period of July 2018 to June 2019.Results: There were 66.67% cases of gestational thrombocytopenia, 13.33% related to preeclampsia, 8% in Eclamptic patients, 2.67% in HELLP and DIC, 6.67 in ITP, and lastly 2.67% in dengue cases. There were number of associated complication whether directly related (PPH) or part of the disorder. PPH was observed in 22.67% which is maximum among all complications. Other complications were part of major associated illness i.e. liver failure (6.67%), renal failure (5.3%), DIC (5.3%) and HELLP (8%).Conclusions: Mode of delivery was not influenced by platelet count, but for obstetric indications. Management of patients was as per the diagnosis. Single donor plasma is preferable to random donor plasma. PPH was the commonest complication and we should be wary of that.
      PubDate: 2020-02-27
      DOI: 10.18203/2320-1770.ijrcog20200885
      Issue No: Vol. 9, No. 3 (2020)
  • The predictive role of color doppler sonography in evaluating hypoxia and
           acidosis in intrauterine growth restriction fetuses: correlation with
           arterial blood gas analysis

    • Authors: Triptpal Kaur, Reema Kumar Bhatt
      Pages: 1119 - 1123
      Abstract: Background: Doppler is an ultrasound technique allowing non-invasive measurement of artery blood flow velocities. Objective of this study was to evaluate the role of umbilical artery (UA) and middle cerebral artery (MCA) Doppler study in predicting fetal hypoxia and acidosis in IUGR fetus and a population subjected to hematologic fluctuations.Methods: In this study 100 subjects with IUGR fetuses was evaluated for comparison of Doppler sonography analysis of fetal middle cerebral arteries and umbilical arteries and cord blood samples (pCO2, pO2) that was collected at the time of delivery.Results: Among the 100 subjects (between 28-32 gestational week) of IUGR showed a high risk of hypoxia and acidosis type condition. The observations were recorded in terms of MCA/UA ratio, the abnormal MCA/UA ratio was observed in significant (p<0.05) number of patients growth restricted fetuses (n=96), as compared to normal. There is a direct correlation found in the pH and pCO2 values. The results of arterial blood gases with respect to pH were found to be less than 7.3±1.6 in 96 subjects with abnormal MCA/UA ratio as compared to normal, that relates to the increase in the relative pCO2 (61.66%) [Acid increase] and decrease in pO2 arterial gases (Hpoxia increase).Conclusions: The study provides an insight that shows IUGR fetuses have a relatively higher risk of hypoxia (less oxygen) and acidosis (low pH and high pCO2), showed the most important determinants variations.
      PubDate: 2020-02-27
      DOI: 10.18203/2320-1770.ijrcog20200886
      Issue No: Vol. 9, No. 3 (2020)
  • Connective tissue disorders in pregnancy: maternal and fetal perspective

    • Authors: Nehul Jha, Hemangi K. Chaudhari
      Pages: 1124 - 1131
      Abstract: Background: The objective of this study was to study maternal and fetal outcome in connective tissue disorders in pregnancy.Methods: This was a retrospective type of observational study done in department of obstetrics and gynecology and department of rheumatology at a King Edward Memorial hospital over a period of 1.5 years. 48 women were included in this study after informed consent. All these women presented with collagen disorders to ANC outpatient department or to rheumatology outpatient department or in emergency. All postpartum patients having connective tissue disorders not recruited during ANC were also included in this study after taking their written, informed and valid consent.Results: Connective tissue disorders are associated with multiple voluntary and involuntary abortions as well as intrauterine fetal deaths. Even in those women having live births, many undergo cesarean sections due to various indications like fetal distress, poor biophysical profile, non-reassuring non stress test etc. Neonates born to mothers with connective tissue disorders are growth restricted and many of them need intensive care admission. Also, these women were found to have multiple associated medical comorbidities in pregnancy.Conclusions: The data collected and the results arrived upon should help contribute significant literature regarding collagen disorders in pregnancy and help in better fetal and maternal management during pregnancy.
      PubDate: 2020-02-27
      DOI: 10.18203/2320-1770.ijrcog20200887
      Issue No: Vol. 9, No. 3 (2020)
  • Impact of gum chewing on recovery of bowel activity after caesarean

    • Authors: Manisha ., Nirmala Duhan
      Pages: 1132 - 1137
      Abstract: Background: Childbirth is a memorable part in every woman’s life. Each labour experience is unique and calls for a celebration. Objective of this study was to evaluate the effect of gum chewing on recovery of bowel motility after caesarean section.Methods: This prospective randomized controlled trial was conducted on 220 women who had undergone cesarean section and were further sub-divided into two groups of 110 women each Group I (Study group, n=110) in whom chewing gum was advised postoperatively and Group II (Control group, n=110)  who were managed as per standard departmental postoperative feeding protocol.Results: Mean age in Group A women was 24.86±3.89 years and 25.28±3.34 years in Group B. There was no statistically significant difference between the study and control group regarding their age, parity, occupation, LSCS/previous abdominal surgery, type of cesarean section, indications of cesarean section, skin incision, intraperitoneal adhesions. The mean time of bowel sound appearance in Group A was 3.27±0.95 and it was 8.22±2.0 hours in Group B. The mean time of passage of flatus was found to be 9.77±3.21 hours in Group A and 7.15±3.07 hours in Group B. In Group A, the mean time of passage of stools was 18.79±4.23 hours and it was 39.12±6.56 hours in Group B. Mean duration of hospital stay was significantly lesser (3.23±0.60 days) in gum chewing group than in the non-gum chewing group (4.18±1.28 days).  Seventy-six (69.09%) women of Group A needed only one chewing gum before appearance of bowel sound / flatus / feces. Only three women required three chewing gums. Out of 31 cases, who required two chewing gums, five were of previous 1 LSCS and 12 were previous 2 LSCS, thus suggesting delayed return of gut motility in women with > 1 previous LSCS.Conclusions: It was evident that gum chewing, a form of sham feeding is considered as an effective and inexpensive method which hastens the return of gut motility after caesarean section.
      PubDate: 2020-02-27
      DOI: 10.18203/2320-1770.ijrcog20200888
      Issue No: Vol. 9, No. 3 (2020)
  • Comparison of empirical use of low dose aspirin and enoxaprin in the
           treatment of unexplained recurrent pregnancy loss

    • Authors: Sunil Kumar Juneja, Pooja Tandon, Gagandeep Kaur, Bakul Kapoor, Guneet Singh Sidhu
      Pages: 1138 - 1142
      Abstract: Background: Recurrent pregnancy losses have commonly been defined as three or more consecutive spontaneous pregnancy losses. About 1-2% of women suffer from recurrent miscarriages. The cause is multifactorial such as uterine anomalies, endocrine disorders, immunological causes, infections, chromosomal anomalies and maternal autoimmune diseases. In 50-60% of cases recurrent pregnancy losses, the cause remains unclear. Objective of this study was to compare the maternal and fetal outcome in patients with unexplained recurrent pregnancy loss treated with LMWH (Enoxaparin) vs Aspirin during pregnancy.Methods: Women with 3 or more pregnancy losses, aged between 18-40 years, booked for antenatal care and delivery in our hospital between January 2012 and December 2016 were followed till 6 months after delivery.Results: A total number of 146 women were assessed for eligibility. We had 62 women in Group A (aspirin group) and 84 women in Group E (enoxaparin group). Enoxaparin was given to all those ladies who had taken aspirin in previous pregnancies with no live outcome. Good neonatal outcome was observed with Enoxaparin.Conclusions: Live birth rates did not show significant difference between the two study groups. But empirical use of enoxaparin in patients with no live birth who have taken low dose aspirin in previous pregnancy had shown improved results, so enoxaparin should be used empirically as a first line agent in such cases.
      PubDate: 2020-02-27
      DOI: 10.18203/2320-1770.ijrcog20200889
      Issue No: Vol. 9, No. 3 (2020)
  • Placental cord drainage during third stage of labour: a randomized control
           trial at a tertiary care centre

    • Authors: Megha Chaudhary, Maitri Shah, Nitin Makwana
      Pages: 1143 - 1147
      Abstract: Background: Labour is a physiological process, but it is often associated with morbidity and mortality, with the most common cause being blood loss. Primary postpartum hemorrhage is commonly defined as a blood loss of 500 ml or more within 24 hours after normal vaginal birth. A prolonged third stage of labour (more than 20 min) is associated with postpartum hemorrhage. The present study was undertaken with the objective of assessing efficacy of placental cord drainage (PCD) during active management of third stage of labour.Methods: This is a randomized control trial in which full term primi gravida who were expected to have normal vaginal delivery, admitted in labour room of a tertiary care centre were evaluated for inclusion in the study. Total 126 participants were enrolled after having normal vaginal delivery. In study group (n = 63), placental cord drainage was used for management of third stage of labour while in control group (n = 63), third stage was managed without PCD.Results: The mean difference in duration of third stage of labour in study and control group was 1.79 minute and the mean difference in blood loss during third stage of labour in both groups was 57.86 ml which was statistically significant.Conclusions: The results of this study show small positive effects from cord drainage in reducing the length of the third stage of labour and in reducing the amount of blood loss when compared with those without cord drainage. The observed changes may be of clinical significance in reducing third stage related complications.
      PubDate: 2020-02-27
      DOI: 10.18203/2320-1770.ijrcog20200890
      Issue No: Vol. 9, No. 3 (2020)
  • Clinical presentation of tubal ectopic pregnancy

    • Authors: Kavitha Garikapati, M. Parvathi Devi, N. Alekya Goud
      Pages: 1148 - 1152
      Abstract: Background: When the fertilized ovum gets implanted at site other than normal position of uterine cavity, it is known as ectopic pregnancy. Incidence of ectopic pregnancy is 1-2% of all reported pregnancies. It is an unmitigated disaster of human production and the most important cause of morbidity and mortality in first trimester with major cause of reduced child bearing potential. It is notorious in its clinical presentation, challenging the attending physician.Methods: women with risk factors, signs and symptoms and with confirmed diagnosis. Women discharged against medical advice. Study population is 50. Retrospective analysis for 3 years (2016-2019). Objectives of this study were to study the incidence, risk factors, clinical presentation, diagnosis and changing trends of modern management. Results analysed after entering the information in the excel sheets using descriptive analysisResults: Out of 4940 deliveries, 50 were tubal ectopic pregnancies 1.012%. Women aged 20-25 years were 52%. In our study, multiparous were 68%. Common symptoms were abdominal pain 80.2%, amenorrhea 72%, urine gravindex test positive 92.8%. Etiology was PID 20%, previous ectopic pregnancy 4%, IUCD 4%, LSCS with tubectomy 16%, most common site is ampulla 82%. About 78% were ruptured. Tubal abortions 4%, salpingectomy done in 82%. Laparotomy in 2.43% in hemodynamically unstable. Medical management 8%. Salpingostomy in 4% and expectant management 2%. Morbidity in the form of blood transfusion 23.48%, DIC with ICU admission 2%. No mortality.Conclusions: A high index of clinical suspicion with underlying risk factors may get us early diagnosis for timely intervention.
      PubDate: 2020-02-27
      DOI: 10.18203/2320-1770.ijrcog20200891
      Issue No: Vol. 9, No. 3 (2020)
  • A study to evaluate the efficacy of combined prostaglandins and vaginal
           estradiol compared to prostaglandin alone in labor induction

    • Authors: Anjana B., Saniya Sheikh
      Pages: 1153 - 1158
      Abstract: Background: Induction of labor (IOL) is a process where labor is initiated artificially before its spontaneous onset for the delivery of feto placental unit by mechanical or pharmacologic methods.Methods: The present Hospital based prospective randomized comparative study was conducted in the department of obstetrics and gynecology, KLES Dr. Prabhakar Kore Charitable Hospital, Belagavi during the period of January 2015 to December 2015.The selected women were randomized into two groups by simple randomization using an opaque sealed envelope, into either without vaginal estradiol Group A: Group PGE2 - Prostaglandin E2 gel intracervical alone group or Group B: PGE2 + E (Estradiol) - combined Prostaglandin E2 gel intracervical and 50 µg of estradiol tablet intravaginal group.Results: In the present study 65% of the women in group PGE2 required three doses of prostaglandins compared to 23.33% in group PGE2 and estradiol for the cervix to become favorable. In this study there is significantly longer mean interval time noted for induction to cervical ripening (12.88±4.91 versus 8.92±5.07; p <0.001), induction to active labor (16.97±4.93 versus 11.02±4.72; p <0.001) and induction to delivery time (21.97±3.83 versus 13.14±4.98; p <0.001) in group PGE2 compared to combined PGE2 and estradiol group.Conclusions: Thus, vaginal estradiol along with prostaglandins has the potential in cervical ripening and induce labor and in an efficacious way. There is beneficial fetal outcome when combined vaginal estradiol along with intracervical prostaglandin E2 was used.
      PubDate: 2020-02-27
      DOI: 10.18203/2320-1770.ijrcog20200892
      Issue No: Vol. 9, No. 3 (2020)
  • Advanced maternal age and obstetric outcome

    • Authors: Ritu ., Mini .
      Pages: 1159 - 1163
      Abstract: Background: The objective of this study was to compare the adverse obstetric and perinatal outcome of pregnancies in women with advanced maternal age > 35 years with that of younger women in age group 20-34 years.Methods: A retrospective comparative study was carried out in department of obstetrics and gynecology at Adesh Medical College over the period of one year from June 2017 to June 2018. The obstetric and perinatal outcome of 100 women with advanced maternal age (study group) was compared with those of 100 younger women aged 20-34 years (control group).Results: Among antenatal complications, women of advanced maternal age had increased incidence of hypertensive disorder of pregnancy (26.6% versus 4.4%; p = 0.00009) and breech presentation (8.8% versus 1.1%; p = 0.04).  The rate of caesarean delivery was significantly higher in advanced maternal age (28.8% versus 17.7%; p = 0.05). In perinatal outcome, older women had significantly higher incidence of perinatal death (7.7% versus 0%; p = 0.01).Conclusions: Thus, from this study, it can be concluded that advanced age women had higher incidence of hypertensive disorder of pregnancies and mal presentation, were more likely to deliver by caesarean section and had increased incidence of perinatal death.
      PubDate: 2020-02-27
      DOI: 10.18203/2320-1770.ijrcog20200893
      Issue No: Vol. 9, No. 3 (2020)
  • Common menstrual disorders in adolescent girls attending a tertiary care

    • Authors: Hibina K. P., Nishi Roshini K., Andrews M. A.
      Pages: 1164 - 1168
      Abstract: Background: Menstrual disorders are an important cause of concern among adolescent girls. Most problems are physiological but few have underlying pathology which has adverse effect on the future reproductive health Aim of the study was to know the prevalence and to evaluate the underlying cause of the menstrual problems in adolescent girls seeking medical care.Methods: This is a cross sectional study conducted in in 215 adolescent girls aged 13-19 years who sought medical care over a period of 12 months for menstrual complaints from the department of obstetrics and gynecology, Govt. Medical College, Thrissur, a tertiary care center in middle of Kerala, South India. Data was analyzed by SPSS software and p value <0.05 was taken statistically significant.Results: Dysmenorrhea was the most common problem (57.5%), followed by scanty menstruation (35.35%) and 25.2% of girls suffered from premenstrual symptoms. Hypothyroidism was seen in 2.4% of girls 40% were anemic. Statistically significant association was found between hypothyroidism and features of hyperandrogenemia with cycle irregularity. Ultrasonographic evidence of polycystic ovarian morphology was identified among 61.9% girls with irregular cycles.Conclusions: Even though majority of menstrual issues are self-limiting proper evaluation and follow up for medical disorders like hypothyroidism and anemia are important and appropriate intervention is crucial for future reproductive and general health of adolescents presenting with Menstrual disorders.
      PubDate: 2020-02-27
      DOI: 10.18203/2320-1770.ijrcog20200894
      Issue No: Vol. 9, No. 3 (2020)
  • Study on knowledge, attitude and practice of ante-natal care among
           pregnant women attending antenatal tertiary care institution

    • Authors: Vuppu Sitalakshmi, Pothu Bavyasri, Rajyalakshmi Talapala, Manjula Kopperla
      Pages: 1169 - 1180
      Abstract: Background: The primary aim of antenatal care is to achieve a healthy mother and baby. Antenatal care helps to identify the complications and to remove anxiety and dread associated with delivery. Current study designed to assess knowledge, attitude and ante natal care practice among pregnant women attending to antenatal tertiary care hospital.Methods: A cross-sectional study was conducted on 500 pregnant women attending antenatal care centre at department of obstetrics and genecology, Narayana Medical College and Hospital, Nellore during June 2017 to June 2019 under Narayana Mathru Seva Pathakam. Face to face interview was conducted to assess their knowledge, attitude and practice using a structured questionnaire.Results: A total 86% belongs to 20-29 years age group and 71.4% belongs to multiverdia. 20.6% women responded that they had completed 3 antenatal visits, 26.6% are those who thought that at least more than 5 ANC checkup should be done during pregnancy. 96.1% pregnant responded that registration for antennal care and visits is essential. 87.2% responds to take iron and folate during pregnancy and 11% responds does not taken the same. 92% pregnant responded that tetanus toxoid (TT) should be given during pregnancy but 3.2% told don’t know. When they asked about resting period, 24.2% responded 5-6 hours, 35.4% responded 7-8 hours, 35.6% responded > 8 hours per day to rest they are taking. 55.8% pregnant responded that they had taken decision to give birth the baby in the hospital. 71.2% pregnant females reported that they knew about the danger signs during pregnancy. The reasons for not attending antenatal check-up were financial reasons, illiterate (15.4%), transport and unaware about ANC.Conclusions: Information, education and communication activities should be increased on ANC through community campaign and mass media to motivate women to utilize maternal care services.
      PubDate: 2020-02-27
      DOI: 10.18203/2320-1770.ijrcog20200895
      Issue No: Vol. 9, No. 3 (2020)
  • Frequency and management of gestational diabetes mellitus according to the
           new diabetes in pregnancy study group of India guidelines among Sikkimese
           women attending tertiary teaching hospital of East Sikkim

    • Authors: Kirti Singh, Hafizur Rahman
      Pages: 1181 - 1185
      Abstract: Background: The screening of GDM is important as various pregnancy related complications are associated to it. With early screening and diagnosis, the complications associated with GDM can be reduced. Studies have shown various ethnic groups are at increasing risk of developing GDM with prevalence differing in different ethnicity. No data is available about frequency of GDM in different ethnic women of Sikkim. This study was performed to determine the frequency of GDM and its variation according to different demographic profiles of Sikkimese women.Methods: Pregnant women between 16-34 weeks of gestation, attending antenatal OPD were included for this study. All the patients were subjected to DIPSI recommended 75 gm oral glucose tolerance test. Diagnosis of impaired glucose tolerance was made when plasma glucose of ≥120-140 mg/dl and diagnosis of GDM was made when the plasma glucose of >140 mg/dl as per DIPSI guidelines.Results: A total of 202 consenting pregnant women during 16-34 weeks of pregnancy were evaluated with DIPSI recommended 75 g oral glucose tolerance test. Overall frequency of GDM was 11.9% among the Sikkimese women while 10.9% had impaired results in OGTT.Conclusions: Frequency of GDM was high (12%) in pregnant women attending tertiary hospital of Sikkim. This implies Sikkimese women should be universally screened for GDM. There was also high occurrence of GDM among Lepcha and Bhutia women which need further study to find out the contributing factors in these women.
      PubDate: 2020-02-27
      DOI: 10.18203/2320-1770.ijrcog20200896
      Issue No: Vol. 9, No. 3 (2020)
  • Compare the efficacy, safety and compliance of oral estradiol and vaginal
           estriol for urogenital problems in post-menopausal women

    • Authors: Shipra Kumari, Monika Singh
      Pages: 1186 - 1190
      Abstract: Background: Menopause is recognised to have occurred after 12 months of amenorrhoea for which there are no obvious pathological and physiological causes, it is retrospective diagnosis. Objective of this study was to compare the efficacy, safety and compliance of oral estradiol and vaginal estriol for urogenital problems in post-menopausal         women.Methods: A total of 100 postmenopausal women having urogenital symptoms were selected for the prospective study. The selected patients were randomly allocated in 2 groups. Group A received 2 mg of estradiol OD for 4 weeks and then evaluated after 4 weeks. Group B received 0.5 mg of vaginal estriol cream continuously for 4 weeks at night and then evaluated after 4 weeks. Patients were followed after 1,3 and 6 months. Inclusion criteria were postmenopausal women, vaginal symptoms, urogenital symptoms. exclusion criteria were all patients having estrogen dependent neoplasia and comorbidities.Results: For urinary complaints, symptomatic relief was assessed by AUA Score in which after 6 months; in Group A the difference in mean from baseline was 19.64±1.63 and in Group B it was 21±2.52 and was statistically insignificant from each other. For genital complaints, symptomatic relief was graded as 1, 2, 3, 4 in which grade 4 means complete relief. After 6 months of therapy 88.2% got complete relief in Group A and   91.1% in Group B. In vaginal cytological smears; in both groups, parabasal cells were reduced and superficial cells were increased after 6 months of therapy and both groups were statistically insignificant from each other. After 6 months of therapy, increase in mean value of KPI from the baseline is 24.54±10.1 in Group A and 28.6±10.11 in Group B and both groups were statistically insignificant. Endometrial thickness remained unchanged in both the groups after 6 months of therapy.Conclusions: Both drugs were equally effective in alleviating the urogenital symptoms with no significant side effects.
      PubDate: 2020-02-27
      DOI: 10.18203/2320-1770.ijrcog20200897
      Issue No: Vol. 9, No. 3 (2020)
  • A study of feto-maternal outcome in bleeding per vaginum in first
           trimester of pregnancy

    • Authors: Jaydeep J. Bhatu, Darshil S. Prajapati
      Pages: 1191 - 1195
      Abstract: Background: Bleeding per vaginum in the first trimester is a common obstetric entity. Four major causes of pathological bleeding in 1st trimester are miscarriage, ectopic pregnancy, implantation bleeding of pregnancy and cervical pathology. The purpose of this study was to investigate and understand the effect of first trimester vaginal bleeding on maternal and perinatal outcomes in the local population to which our hospital serves. Objective of this study was to estimate the degree of association between first-trimester bleeding and miscarriage, pregnancy outcomes in women with threatened abortion, various maternal complications and outcome of labor in pregnancy complicated by first-trimester bleeding and adverse fetal outcomes affected with first trimester bleeding.Methods: This prospective observational study was carried out on 110 women attending hospital with history of first trimester vaginal bleeding at a tertiary health center - sola civil hospital Ahmedabad for a period of twelve months.Results: Majority (69%) of first trimester bleeding occurs in age group of 21-30 years and majority of patients were primigravida constituting 53% out of 110 patients, 48 patients presented with abortions, out of which 26 had threatened abortion and 22 had other abortions. Primi para with previous history of bleeding per vaginum had more chances to go in full term in present pregnancy.Conclusions: Patients presenting with heavy bleeding per vaginum ended up in pregnancy loss and thus a poor outcome. In the presence of sub-chorionic hematoma, the prognosis of pregnancy is greatly affected as the risk of pre-term, IUGR and especially miscarriages increase significantly.
      PubDate: 2020-02-27
      DOI: 10.18203/2320-1770.ijrcog20200898
      Issue No: Vol. 9, No. 3 (2020)
  • Patient satisfaction and experience with various modes of Xylocaine
           administration for cervical dilatation and endometrial curettage: a
           randomized interventional study

    • Authors: Swati Kanchan, Shripad Hebbar
      Pages: 1196 - 1200
      Abstract: Background: Patient satisfaction after a surgical procedure is an important outcome of hospital care. Many of the gynaecological menstrual problems such as abnormal uterine bleeding, postmenopausal bleeding requires endometrial evaluation which is done traditionally by dilatation and curettage. But this procedure is painful and requires appropriate pain management protocol. The aim is to evaluate the post-operative patient satisfaction following dilatation and curettage procedure.Methods: This study was conducted in a tertiary care hospital belonging to a medical college. A total of 236 patients were recruited for the study who subsequently underwent dilatation and curettage with different mode of Xylocaine anesthesia for pain relief. Of them 16 patients were excluded due to valid reasons and the remaining 220 were interviewed face to face following the procedure. The level of anxiety was assessed using Beck’s Anxiety inventory and also perception of satisfaction was documented along with complication related to the anesthesia.Results: The overall level of satisfaction was higher in the group receiving both paracervical block and intrauterine instillation of lidocaine during the procedure of dilatation and curettage. A further analysis showed that increase in level of satisfaction was due to improvement in pain scores due to combined mode of paracervical and endometrial anesthesia.Conclusions: A multimodal pain management protocol which involves pre-procedural sedation, combined cervical and endometrial anesthesia improves overall outcome with respect to reduction in anxiety scores and postoperative satisfaction levels.
      PubDate: 2020-02-27
      DOI: 10.18203/2320-1770.ijrcog20200899
      Issue No: Vol. 9, No. 3 (2020)
  • A study comparing non-gestational diabetes mellitus and gestational
           diabetes mellitus in antenatal patients in a tertiary care center

    • Authors: Preeti Sharma, Neeta Chaudhary, Suchitra Singh
      Pages: 1201 - 1204
      Abstract: Background: Gestational diabetes mellitus is defined as any glucose intolerance with the onset or first recognition during pregnancy. Objectives of this study were to diagnose cases of GDM by screening with DIPSI criteria at less than 28 weeks. And observation and comparison of maternal and perinatal outcome in women diagnosed of GDM in less than 20 weeks and at 24-28 weeks.Methods: This was the prospective analytical study conducted in the department of obstetrics and gynecology for one year in Muzaffarnagar medical college and Hospital. After history taking, clinical and obstetrics examination 1503 antenatal patients of less than 28 weeks were enrolled underwent screening with DIPSI criteria. Out of which 80 patients with abnormal OGTT of gestational age less than 20 weeks and 69 patients with abnormal OGTT of gestational age 24 -28 weeks.Results: In early diagnosed GDM group alive and healthy babies were slightly lower as compared with late diagnosed GDM group.Conclusions: The diagnosis of GDM gives us an opportunity in identifying individuals who will be benefitted by early therapeutic intervention with diet, exercise, and normalizing the weight to delay or prevent the onset of the disease.
      PubDate: 2020-02-27
      DOI: 10.18203/2320-1770.ijrcog20200900
      Issue No: Vol. 9, No. 3 (2020)
  • A randomized controlled trial to study the efficacy of intravaginal
           hormonal ring for control of heavy menstrual bleeding as compared to
           combined oral contraceptive pills

    • Authors: Tarnima Saha, Meenakshi K. Bharadwaj, Shakti Vardhan
      Pages: 1205 - 1212
      Abstract: Background: Heavy menstrual bleeding (HMB) is one of the commonest presenting complaints in reproductive age group. Although combined oral contraceptives (COCs) are commonly used in such patients, combined hormones by intravaginal route has been found acceptable and effective. Aim of the study is to compare the efficacy and side effects of combined intravaginal hormonal ring (IHR) with COCs in control of HMB in these patients.Methods: Hundred women with HMB fulfilling inclusion criteria were randomized into two equal groups and treated with either IHR or COCs for three cycles. Each cycle consisted of three weeks of IHR/COC use followed by 1-week ring-free/non-hormonal pills period. Outcome measures were change in PBAC score (pictorial blood loss assessment chart), hemoglobin rise, side effects and overall patient satisfaction.Results: The percentage reduction in PBAC score, the duration of menses and increase in hemoglobin levels were statistically significant at the end of study in each group. The PBAC score reduction was 87.37% vs 61.52%, menses duration was 4.24±0.74 versus 5.16±1.67, and hemoglobin increase was 3.16 (95% CI:0.142-1.412) and 1.24 (95% CI:1.048-1.640) in the IHR versus COC group. However, the intergroup reduction of mean PBAC score was not statistically significant. Significantly more ring users were satisfied and elected to continue with treatment.Conclusions: Both the IHR and COCs are effective treatments for HMB in reproductive age group. IHR may be an attractive option for HMB due to better compliance and lesser systemic side-effects.
      PubDate: 2020-02-27
      DOI: 10.18203/2320-1770.ijrcog20200901
      Issue No: Vol. 9, No. 3 (2020)
  • Factors associated with increased blood loss during delivery

    • Authors: Paridhi Jain, Nisha Thakur, Ashu Jain, Sunita Agarwal, Sangeeta Kamra, Shyla Jacob
      Pages: 1213 - 1217
      Abstract: Background: The present study was done to assess the blood loss during delivery even after active management of third stage of labor with oxytocin and the maternal outcomes of PPH.Methods: We studied 100 pregnant women were either in spontaneous labor or admitted for induction of labor, underwent vaginal delivery or caesarean section in our institute. Active management of third stage of labor in all 100 cases included 10 IU intramuscular oxytocin or 10 to 20 IU intravenous in 500 ml of Ringer’s Lactate. Blood loss in all cases was noted.Results: Of the included cases, 27 had to be given extra-uterotonics for atonic uterus, of which 12 parturient still had PPH. Atonic uterus was the cause of PPH in 11 of the 12 cases, while one case was of atonic uterus plus trauma. Half of all PPH cases responded to medical management alone, five cases had to undergo tamponade/stepwise devascularization and one case had to undergo obstetric hysterectomy. Blood loss was significantly higher in women aged more than 35 years, primigravida, not in labor, oligohydramnios or post-datism, elective LSCS, scarred uterus in and had more than 1 high risk factor. Among various high-risk conditions, significantly higher blood loss was observed in patients with chronic hypertension, gestational hypertension, pre-gestational diabetes mellitus, multipara with prior PPH, placenta previa, preeclampsia and sickle cell trait.Conclusions: Fifteen women avoided PPH by using a reliable method of blood loss measurement and initiating interventions early. Organized PPH management protocol morbidity and mortality of the mother and neonate can be prevented.
      PubDate: 2020-02-27
      DOI: 10.18203/2320-1770.ijrcog20200902
      Issue No: Vol. 9, No. 3 (2020)
  • A comparative study to evaluate endometrial aspiration using Karman’s
           cannula versus dilatation and curettage in cases of abnormal uterine

    • Authors: Neetu Sangwan Tomar, Seerat Sandhu, Supriya Mahipal, Abhimanyu Chaudhary
      Pages: 1218 - 1221
      Abstract: Background: Abnormal uterine bleeding (AUB) is defined as any variation from the normal menstrual cycle such as changes in regularity, frequency, duration of flow or amount of flow. Objective of this study was to compare the adequacy and diagnostic accuracy of endometrial aspiration using Karman’s cannula versus dilatation and curettage in women with abnormal uterine bleeding.Methods: This prospective study was conducted on 250 women with AUB in age group of more than 40 years. In all patients, endometrial aspiration was done with manual vacuum aspiration (MVA) syringe attached to 4 mm Karman's cannula without anesthesia. The sample was collected in a bottle containing formalin and was labelled as sample A. After that, intracervical local anesthesia (1% Xylocaine) was given and cervix was dilated and scrapping of endometrial lining with sharp curette was done. The sample was also collected in a bottle containing formalin and was labelled as sample B. Both the samples A and B were sent for histopathology. The histopathology report of aspiration was compared with that of dilatation and curettage sample.Results: Endometrial aspiration biopsy had sensitivity of 92.3%, specificity of 100%, positive predictive value of 100% and negative predictive value of 99.56% for diagnosis of endometrial pathology while considering D and C gold standard. The sample adequacy of endometrial aspiration was 98.8% as compared to dilatation and curettage (98%).Conclusions: Present study showed that endometrial aspiration biopsy is an alternate to traditional dilatation and curettage in diagnosing endometrial pathologies in women with abnormal uterine bleeding.
      PubDate: 2020-02-27
      DOI: 10.18203/2320-1770.ijrcog20200903
      Issue No: Vol. 9, No. 3 (2020)
  • The neonatal outcomes of Dexamethasone administration before scheduled
           cesarean delivery at term: a randomized clinical trial

    • Authors: Shereen B. Elbohoty, Ayman S. Dawood, Ahmed M. Abbas, Adel E. Elgergawy
      Pages: 1222 - 1227
      Abstract: Background: Caesarean delivery (CD) rates in developing countries are rising beyond the recommended rates of World health organization. Objective of this study was to evaluate whether Dexamethasone injections reduce neonatal incubation admissions when given before scheduled caesarean delivery (CD) at term or not.Methods: A double blinded, two armed, randomized clinical trial was conducted at Tanta University hospitals in the period from October 2017 to March 2019. Four hundred pregnant women admitted for scheduled CD with gestational age ≥37 weeks were included. Patients were randomized into study group and control group. The study group was given 3 dexamethasone doses, 8 mg each while control group was given saline injections simultaneously as a placebo drug. The primary outcome was the neonatal incubatory admissions.Results: Demographic data in both groups were comparable. Transient tachypnea of newborn (TTN) was 15.47% in study group versus 20.33% in control group with p=0.227. The respiratory distress (RDS) in study group was 6.63% versus 9.89% in control group with p=0.260. The incubation admissions were nasal oxygen 12.71% versus 15.38%, continuous positive airway pressure ventilation (CPAP) 5.52% versus 8.24% and mechanical ventilation was 3.87% versus 6.59% in the study and control groups respectively.Conclusions: Although Dexamethasone administration before scheduled CD at term reduced both respiratory morbidity and incubation admissions, the differences between study and control groups were not significant.
      PubDate: 2020-02-27
      DOI: 10.18203/2320-1770.ijrcog20200904
      Issue No: Vol. 9, No. 3 (2020)
  • Transvaginal ultrasound compared with serum β-hCG level for diagnosis of
           ectopic pregnancy in symptomatic patients

    • Authors: Somayeh Zeynizadeh Jeddi, Noushin Mobaraki, Akbar Pirzadeh
      Pages: 1228 - 1233
      Abstract: Background: Ultrasonography (US) is the most important imaging modality in detecting both intrauterine and ectopic pregnancies. The aim of this study was to comparison transvaginal ultrasound with serum β-hCG level for diagnosis of ectopic pregnancy (Ep) in referred women to Ardabil city hospital.Methods: In this cross-sectional study, a total of 207 women with diagnosis of Ep were enrolled during 2018. All women underwent transvaginal US in the first 24 hours and US done by an expert radiologist. Serum levels of β-hCG at first 24 hours and the time gap between US examination and last menstrual period (LMP) were compared between women with positive and negative US findings. Data collected by a checklist and analyzed by statistical method in SPSS version 21.Results: The primary US were positive in 174 women (84.1%) and negative in 33 women (15.9%). The mean of time gap between US and LMP in women with diagnosed EP was significantly higher than other women (median, 42 days versus 45 days, p=0.042). Also, the mean of serum level of β-hCG had significant difference between two groups. In logistic regression analysis results showed that the time gap between US and LMP hadn’t significant impact on EP diagnosis. The best discriminative zone was set at a serum β-hCG level of 105.65 mIU/ml with a sensitivity and specificity of 82% and 27%, respectively and the under-ROC area was 58%.Conclusions: According to our findings, the median serum level of β-hCG in women with undiagnosed Ep were significantly lower than women with correct diagnosis of Ep but the mean and median of time gap between US and LMP in women with diagnosed EP was more than women without Ep. Also, the proposed discriminative zone for serum level of β-hCG in our study is different from the previous studies.
      PubDate: 2020-02-27
      DOI: 10.18203/2320-1770.ijrcog20200905
      Issue No: Vol. 9, No. 3 (2020)
  • Labour analgesia and obstetric outcome in heart disease complicating
           pregnancy in tertiary care center

    • Authors: Subha Sivagami Sengodan, Dhivya Sharona
      Pages: 1234 - 1237
      Abstract: Background: One of the most severe pain experienced by a woman is during child birth. It is imperative to understand the pain transmission for providing labour analgesia. Hemodynamic status in labour fluctuates greatly during uterine contraction and true labour pains. Therefore, pregnant women with cardiovascular disease need epidural anaesthesia during labour depending upon the type of cardiovascular disease. Objective of this study was to assess the impact of labour analgesia and the obstetric outcome and cardiac events during labour.Methods: This is an observational study conducted in 46 pregnant women with cardiovascular disease during the period of January 2019 to December 2019 (12 months).Results: A total of 46 antenatal mother with cardiovascular disease was admitted in the department of obstetrics and gynecology over a period of one year out of which 25 patients who had epidural analgesia during labour and 21 patients who had no epidural analgesia during labour. Cardiovascular events significantly reduced in epidural group (25 patients) and there was no increase in cesarean section in epidural group.Conclusions: The data showed there was significant decrease in cardiovascular events related to arrhythmia hence decreased maternal morbidity and mortality. There was no associated increase in cesarean section rate but slight increase in instrumental vaginal delivery.
      PubDate: 2020-02-27
      DOI: 10.18203/2320-1770.ijrcog20200906
      Issue No: Vol. 9, No. 3 (2020)
  • Ovatrine, a compound from plant extracts, used for female infertility
           treatment and increase the number of ovarian follicles

    • Authors: Mahmoud Elnahas Hussein
      Pages: 1238 - 1244
      Abstract: Background: Recently natural products extracted from medical plants are very important in the field of alternative medicine. Glycosides, flavonoids and polyphenols are components of natural molecules have several health benefits such as anti-inflammatory, anti-oxidants, and have many ameliorative roles against male and female reproductive system intractable disorders. Objective of this study was to the compound of the plant extracts blend which is rich with glycosides, flavonoids and polyphenols was named as Ovatrine. The safety as well as the efficacy of some medical plants extracts on the fertility of the female mice was investigated using Ovatrine.Methods: Firstly, the safety of Ovatrine was evaluated using some mice and the levels of the follicle stimulating hormone in the serum of the treated animals with Ovatrine was evaluated using biochemical tests. Also, the effects of the Ovatrine on the histological parameters of the treated ovary and uterus were evaluated using histological analysis.Results: The animals treated with Ovatrine were healthy and did not show any signs of mortality, toxicities and there were no blood contents changes. Additionally, follicle stimulating hormone level in the serum increased after administration with Ovatrine twice a day for 30 days as compared with the non-treated animals. Furthermore, the histological structures of the ovary and uterus improved in the mice treated with Ovatrine compared with that in the non-treated mice.Conclusions: In general glycosides, flavonoids and polyphenols, which were found in the Ovatrine in a higher concentration, have important health benefits such as antioxidant, anti-inflammatory and improve the fertility in the female mice. In the future this study will be very important for drug development which composed mainly from safe natural products and used for infertility and intractable diseases treatment.
      PubDate: 2020-02-27
      DOI: 10.18203/2320-1770.ijrcog20200907
      Issue No: Vol. 9, No. 3 (2020)
  • Comparison of safety and efficacy of Ormeloxifene and Norethisterone
           acetate in the treatment of heavy menstrual bleeding

    • Authors: Sunil Kumar Juneja, Pooja Tandon, Gagandeep Kaur
      Pages: 1245 - 1249
      Abstract: Background: Menorrhagia (menstrual blood loss more than 80% per cycle) affects 10-33% of women at some stage of their lives. Medical management is the first line of therapy for menorrhagia (heavy menstrual bleeding: HMB). Progestins have been found to be very effective in the management of heavy menstrual bleeding especially during acute episodes, norethisterone acetate being widely used for the same. Ormeloxifene is a new drug with promising results in managing HMB. The study was undertaken to compare the efficacy, safety and acceptability of Ormeloxifene /Norethisterone acetate in the medical management of heavy menstrual bleeding.Methods: This was a retrospective study conducted from January 2016 till December 2018 in which 98 women of reproductive age group presented with abnormal uterine bleeding without any organic, systematic and iatrogenic causes. The patients were divided into 2 groups. Those wanting contraception along with control of HMB were assigned to Group O and given Ormeloxifene and others were given norethisterone (Group N). The primary outcomes measured were menstrual blood loss assessed subjectively by patients and ultrasonography for endometrial thickness. The secondary outcomes measured were acceptability and side effects of Ormeloxifene and norethisterone.Results: There is a significant reduction in menstrual blood loss as evidenced by the history of patients recorded on follow up and there was a significant reduction in the endometrial thickness as evidenced on follow up scan at the end of 3-4 months. no major side effects were observed with both the drugs.Conclusions: Ormeloxifene in comparison to norethisterone acetate with its effectiveness, significant results, convenient dosages schedule and no major side effects is an effective and safe alternative medical management of HMB.
      PubDate: 2020-02-27
      DOI: 10.18203/2320-1770.ijrcog20200908
      Issue No: Vol. 9, No. 3 (2020)
  • Prevalence of sub clinical hypothyroidism and pregnancy outcome: a
           prospective comparative study

    • Authors: Bilal Ur Rehman, Hiba Gull
      Pages: 1250 - 1254
      Abstract: Background: In pregnancy, subclinical hypothyroidism is more common than overt hypothyroidism, ranging from 15% to 28% in Iodine sufficient region. Evidence suggests that subclinical hypothyroidism is associated with adverse pregnancy outcome. The aim of this study was to find the prevalence of subclinical hypothyroidism in pregnant women and adverse pregnancy outcome.Methods: This hospital based prospective comparative study was conducted over a period of 6 months from 1st July 2018 to 31st December 2018 in department of obstetrics and gynecology SKIMS Soura Kashmir. All the subjects who fulfilled the inclusion criteria and who consented to participate were screened for subclinical hypothyroidism.Results: A total of 175 pregnant women participated in the study and subclinical hypothyroidism was diagnosed in 25 pregnant women (14.2%). Most of our patients were in age group 21 to 30 years (69.1%). Pregnant women with subclinical hypothyroidism had significant risk of preeclampsia (35%) and higher cesarean section rate (29.6%). Neonate of women with subclinical hypothyroidism had higher incidence poor Apgar score, NICU admission.Conclusions: The prevalence of subclinical hypothyroidism is high in pregnant women and the gravity of the complications like pre-eclampsia, neonate with low Apgar score, increased NICU admission, overweight the cost of screening. In this view, we propose screening of all pregnant women in the first trimester for diagnosis.
      PubDate: 2020-02-27
      DOI: 10.18203/2320-1770.ijrcog20200909
      Issue No: Vol. 9, No. 3 (2020)
  • Study of intrauterine fetal death cases in a tertiary care center

    • Authors: Lalita Meena, Ritu Gupta
      Pages: 1255 - 1258
      Abstract: Background: The death of a fetus is a tragic event not only for the parents but also a great cause of stress for the caregiver. It is thus vital to identify specific probable causes of fetal death to determine the risk of recurrence, prevention or corrective action.Methods: This retrospective observational study was carried out in department of obstetrics and gynaecology, Jhalawar Medical College, Jhalawar, from July 2019 to October 2019. Intrauterine fetal death was confirmed either with ultrasound or on clinical examination. The details of complaints, obstetrics history, examination findings, mode of delivery, fetal outcomes and investigation reports were recorded.Results: A total of 114 intrauterine fetal deaths were reported amongst 2982 deliveries conducted during the study period. The incidence rate of IUFD was 38.22/1000 live births. 85.96% deliveries were unbooked. 59.64% belonged to rural population. 59.64% fetal deaths occurred in women between 20 to 25 years of age. 45.61% women were primigravida. 41.2% IUFD occurred between 26 to 31 weeks of gestation. Among the identifiable cause’s hypertensive disorders (23.68) and placental causes (19.29%) were most common.Conclusions: Unexplained causes, PIH and abruptio placentae were major causes of IUFD. Majority of fetal wastage can be prevented with universal and improved antenatal care.
      PubDate: 2020-02-27
      DOI: 10.18203/2320-1770.ijrcog20200910
      Issue No: Vol. 9, No. 3 (2020)
  • Study of early perinatal outcome in lower segment caesarean section in
           severe foetal distress at tertiary care centre

    • Authors: Chandrakant A. Jadhav, Tirankar V. R., Gavandi P. S.
      Pages: 1259 - 1267
      Abstract: Background: For asphyxia, the fetus reacts with a series of responses. First there is redistribution of blood flow to vital centres to limit the deleterious effects of oxygen limitation in the brain, heart and adrenal glands. A further compensatory response is that overall fetal oxygen consumption declines to values as low as 50% of the control.Methods: This was a prospective study. Early perinatal outcome of newborns delivered through Caesarean section due to clinical foetal distress in labour was compared with a group of newborns similarly delivered via Caesarean section without a diagnosis of clinical foetal distress. Data collected and analysed using appropriate standard statistical methods i.e. Chi-square (X2) test and ‘Z’ - test.Results: Most common indication for NICU admission in study group was MAS (Meconium Aspiration Syndrome 14%) followed by MAS with perinatal asphyxia (5.33%), MAS with Hypoxic ischaemic encephalopathy (HIE) - stage III (3.33%) paerintal asphyxia (2.66%), severe PNA with HIE - III (0.66%) and TTN (0.66%) meconium gastritis (0.66%) respectively.Conclusions: Clinical foetal distress (study group) was found to be significantly associated with low 1 min and 5 min. Apgar score. There was no significant difference in immediate NICU admission whether D-D (i.e. detection fetal detection to delivery interval) time interval <30 minutes or >30 minutes. But rate of mortality was high when D-D (i.e. detection fetal detection to delivery interval) was >30 minutes.
      PubDate: 2020-02-27
      DOI: 10.18203/2320-1770.ijrcog20200911
      Issue No: Vol. 9, No. 3 (2020)
  • A rare case of perineal endometriosis with anal sphincter involvement

    • Authors: Bhadana Priyanka, Abha Kiran, Veena Ganju Malla
      Pages: 1268 - 1270
      Abstract: Perineal endometriosis is a rare entity which can be explained by direct implantation of endometriotic cells over the fresh episiotomy wound and subsequent development of scar endometriosis. Perineal scar endometriosis incidence is reported to be 0.3% to 1%. 28 years old, P1L1, presented with pain and swelling near episiotomy site which is associated with menstruation. Examination during menstruation revealed swelling was tender, erythematous and slightly increased in size. Clinical diagnosis of scar endometriosis was made after clinical examination. Mass excised and sent for histopathological examination. Although diagnosis essentially remains clinical, preoperative evaluation with perineal ultrasound and MRI was performed. Wide local excision remains treatment of choice and follow up for recurrence is recommended. Histopathological examination is obligatory to exclude rare possibility of malignant changes.
      PubDate: 2020-02-27
      DOI: 10.18203/2320-1770.ijrcog20200912
      Issue No: Vol. 9, No. 3 (2020)
  • Ruptured rudimentary horn pregnancy: a case report

    • Authors: Gopika Venugopal, Soumya Patil, Nandish S. Manoli, Pratap T., Hemapriya ., Madhuri N.
      Pages: 1271 - 1273
      Abstract: Uterine anomalies are congenital malformations arising due to embryological mal-development of mullerian ducts. The European society of Human Reproduction and Embryology (ESHRE) classifies these anomalies into 6 classes. Hemi-uterus is one such class of formation defect of mullerian duct with unilateral uterine development; the contralateral part could be either incompletely formed or absent. In a rare form of ectopic pregnancy, implantation can occur in the cavity of a rudimentary horn of the hemi-uterus.
      Authors report a case of 22-year G2P1L1 with 12 weeks gestation who presented with acute abdomen. Ultrasound showed hemoperitoneum with suspicion of ectopic pregnancy. Laparotomy confirmed the diagnosis of ruptured right rudimentary horn with fetus and placenta in the peritoneal cavity. Immediate laparotomy and excision of the horn with transfusion of blood and blood products saved the patient in the nick of time.
      PubDate: 2020-02-27
      DOI: 10.18203/2320-1770.ijrcog20200913
      Issue No: Vol. 9, No. 3 (2020)
  • A rare case report on complete cervical agenesis with vaginal atresia and
           suspended didelphys uterus with hematometra and left haematosalpinx

    • Authors: Divya Dwivedi, Madhu Jain, Shuchi Jain, Shivi Jain
      Pages: 1274 - 1277
      Abstract: Congenital uterine malformations are deviations from normal anatomy resulting due to defective fusion of Mullerian ducts or the paramesonephric ducts in the developing embryo. These anomalies may be isolated or in combination with urological abnormalities. The mean prevalence of female congenital malformations in general population is up to ⁓ 7%. Patients with these anomalies usually present during pubertal age due to absence of onset of menses, cyclical abdominal pain, or in reproductive age group as infertility or recurrent pregnancy loss depending upon the degree of malformation. Cervical agenesis is a rare Mullerian anomaly with an incidence of 1 in 80,000 females. It represents 3% of all uterine anomalies. It is rarely associated with a functioning uterus (4.8%). Cervical agenesis is often associated with vaginal atresia (less than 50%). It is important to classify these anomalies for easy diagnosis and plan appropriate preoperative treatment.
      PubDate: 2020-02-27
      DOI: 10.18203/2320-1770.ijrcog20200914
      Issue No: Vol. 9, No. 3 (2020)
  • Successful conservative surgical management of ovarian mucinous
           cystadenoma with silent torsion in pregnancy: a case report

    • Authors: Arpita De, Reva Tripathi
      Pages: 1278 - 1281
      Abstract: To report the successful conservative surgical management of Ovarian mucinous cystadenoma with silent torsion in a 24 years old pregnant woman in a tertiary care center in Delhi. An antenatal woman came for a routine visit to the OPD of the hospital at 13 weeks gestation. She had a vague, mild pain in lower abdomen since the last four weeks. A cystic mass was discovered during an abdominal examination. Further on sonography, a multisepatated cystic mass was seen, likely to be mucinous cystadenoma. Routine tumor markers came out to be negative. A laparotomy was planned at 15 weeks. On laparotomy a 20 × 15 cm multiloculated cyst with one and half turns of torsion was found. Detorsion, cystectomy of the intact cyst followed by ovarian reconstruction was done after due consent. On histopathological examination the cyst was found to be Benign mucinous cystadenoma. The pregnancy continued without any adverse effects. The woman delivered vaginally at 38 weeks without any feto-maternal complications. She was able to conceive again spontaneously at 18 months post-delivery. After 16 weeks of gestation in the second pregnancy she went to her home town and no further follow-up was possible. This case emphasizes the importance of a thorough examination in all pregnant woman to rule out any adnexal mass separate from the gravid uterus. Big ovarian masses in pregnancy, if not diagnosed can cause growth retardation, preterm deliveries, acute abdomen due to infection, rupture or torsion. Sonography, MRI and tumor markers can facilitate diagnosis before surgery. Torsion and rupture of mucinous cystadenoma need prompt surgery. Wherever possible conservative surgery (detorsion and cystectomy) should be done especially in young women.
      PubDate: 2020-02-27
      DOI: 10.18203/2320-1770.ijrcog20200915
      Issue No: Vol. 9, No. 3 (2020)
  • Twin-Twin transfusion syndrome: a case report

    • Authors: Romi Bansal, Jasleen Kaur, Priyanka .
      Pages: 1282 - 1284
      Abstract: Twin to twin transfusion syndrome is a rare but serious complication of monochorionic twin pregnancy. It is characterized by the development of abnormal placental vascular communication from one foetus (donor) to the other foetus (recipient). If left untreated it led to high rates of perinatal morbidity and mortality due to its poorly understood etiology and difficulty in diagnosing and treatment.
      Authors report a case of twin to twin transfusion syndrome in 24 years old primigravida with gestational age of 18 weeks 5 days diagnosed on ultrasound.
      PubDate: 2020-02-27
      DOI: 10.18203/2320-1770.ijrcog20200916
      Issue No: Vol. 9, No. 3 (2020)
  • Chronic non puerperal uterine inversion due to submucosal fibroid: a rare
           case report

    • Authors: Shirish Dulewad, Chitikala Haritha
      Pages: 1285 - 1287
      Abstract: Chronic uterine inversion is a very rare and often difficult to distinguish between uterovaginal prolapse, submucous fibroid and cervical fibroid. Its diagnosis is based on high index of suspicion. A 50-year-old Para-3Live-3 tubectomised postmenopausal women with k/c/o psychiatric illness, resident R/0 Jambhrun, Mudhkhed came to our hospital with a complaint of irreducible mass protruding per vaginum since 2-3 months duration Subsequently vaginal hysterectomy has been done. The certainty of diagnosis of inverted uterus reached intraoperatively. Gross examination of cut uterus showed fundally located sub-mucous fibroid and specimen sent for histo-pathological report. Non puerperal chronic inversion of uterus is rare condition occurring in approximately 17% of all uterine inversions and most uterine inversions are acute and puerperal. Its incidence is 1/30,000 deliveries and is considered a serious complication of child birth. Most common factor causing inversion -> prolapse and extrusion of fibroids1 especially submucous myoma of fundus (80-85%). Its diagnosis should be considered at any age in post-menopausal period. Superinfection of the infected part should be suspected and treated with appropriate broad-spectrum antibiotics before the surgery.
      PubDate: 2020-02-27
      DOI: 10.18203/2320-1770.ijrcog20200917
      Issue No: Vol. 9, No. 3 (2020)
  • A rare case of abdominal pregnancy: diagnostic and therapeutic challenges

    • Authors: Nishita A. Mehta, Michelle N. Fonseca
      Pages: 1288 - 1291
      Abstract: Abdominal pregnancy refers to a pregnancy that has implanted in the abdominal cavity, the estimated incidence being 1 per 30,000 births. A 36-year-old primigravida with term pregnancy with fetal demise was referred to us. Examination was suggestive of single foetus of 30 weeks’ gestation with longitudinal lie and cephalic presentation with absent foetal heart sounds. The cervical os was closed, uneffaced. Ultrasound done at 18 weeks’ gestation had reported pregnancy in a bicornuate uterus. Present ultrasound revealed intrauterine foetal demise of 28.4 weeks. Cervical ripening, done using prostaglandins, mechanical dilation with Foley’s catheter and oxytocin, had failed, and thus patient was taken up for surgery. Findings revealed an abdominal pregnancy with a macerated fetus of 1070 grams (severely growth restricted). Placenta was found to be implanted on multiple areas of both small and large intestine and posterior peritoneum. Placenta was left in situ. Postoperative recovery was uneventful. She was given higher antibiotics, 4 doses of tablet mifepristone 200 mg and monitored regularly with ultrasound/ MRI and bHCG which showed slow placental resorption. Conclusion- Abdominal pregnancies, associated with a high maternal and perinatal morbidity and mortality, are diagnosed preoperatively only in 45% of cases. Thus, a high index of suspicion and improvement in diagnosis is the need of the hour. Successful management includes prompt intraoperative recognition and management of the placenta (we advocate leaving the placenta in situ), multidisciplinary approach with involvement of surgeons and interventional radiologists, access to blood products, meticulous postoperative care and close observation during the subsequent delayed reabsorption.
      PubDate: 2020-02-27
      DOI: 10.18203/2320-1770.ijrcog20200918
      Issue No: Vol. 9, No. 3 (2020)
  • Innovative use of tourniquet in the management of an advanced abdominal
           pregnancy to achieve an unusually normal postoperative outcome: a case

    • Authors: Emmanuel C. Inyang Etoh, Iniobong E. Ettete, Christian A. Adeneye, Imaobong O. Inwang, Augustine V. Umoh
      Pages: 1292 - 1295
      Abstract: Mrs. UVG was an un-booked G3P1+1 petty trader, who presented with an obstetric ultrasound scan report, with an incidental diagnosis of abdominal pregnancy at 32 weeks of gestation with the placenta attached to the fundus of the uterus. Her admission packed cell volume was 24%. She had pre-operative preparation and 2 units of compatible blood were transfused to correct the anemia. Four additional units of compatible blood were made available before she was scheduled for an exploratory laparotomy at 33 weeks of gestation. A grossly normal male infant weighing 2.2 kg was delivered from the peritoneal cavity with Apgar scores of 2 at 1 minute and the same at 5 minutes. The placenta which was attached to the fundus of the uterus was removed manually completely after a tourniquet had been applied distal to the point of separation. Intra-operative blood loss was 1000 ml. The infant died 1 hour after delivery due to respiratory failure. Autopsy report revealed massive intracerebral hemorrhage and pulmonary hypoplasia. The post-operative period was uneventful and the decline in serum assay of β-human chorionic gonadotrophin postpartum was normal. She was discharged home on the 8th post-operative day and seen at the postnatal clinic twice at weekly intervals with normal serum assay of β-human chorionic gonadotrophin. Her 6 weeks postnatal visit was also uneventful.
      PubDate: 2020-02-27
      DOI: 10.18203/2320-1770.ijrcog20200919
      Issue No: Vol. 9, No. 3 (2020)
  • Dilemma in diagnosing ovarian ectopic pregnancy

    • Authors: Harsha Rajpal, Harvinder Kaur, Urvashi Miglani
      Pages: 1296 - 1299
      Abstract: To study different presentation of ovarian ectopic pregnancy and its management. All the 4 patients of ovarian ectopic pregnancy presented in our hospital in the month of April 2019 were analysed. We reported 4 cases with a pre-operative provisional diagnosis of ruptured ectopic pregnancy and intra-operative diagnosis of' ovarian ectopic pregnancy, however histopathological examination confirmed the diagnosis of ovarian ectopic pregnancy in only 2 of the cases while the other 2 were ruptured corpus luteal cyst. Wedge resection was performed in all 4 patients. Ovarian ectopic pregnancy is rare and can be missed radiologically and intra-operatively. Establishing early diagnosis is a challenge to the clinician, it commonly mimics tubal ectopic or ruptured corpus luteal cyst. Provisional diagnosis can be made intra-operatively when a hemorrhage mass is seen near the ovary with a normal fallopian tube but can be confirmed by histopathological examination. The chief goal of the treatment remains life-saving intervention by early diagnosis to reduce maternal mortality and morbidity.
      PubDate: 2020-02-27
      DOI: 10.18203/2320-1770.ijrcog20200920
      Issue No: Vol. 9, No. 3 (2020)
  • Varicella meningitis in pregnancy: a clinical conundrum

    • Authors: Baljeet K. Gholkar, Lynda Verghese
      Pages: 1300 - 1302
      Authors present this experience of managing a case of Varicella meningitis in pregnancy in a patient presenting with headache in the third trimester. There was no history of dermatomal pain or rash. After intracranial hemorrhage and thrombosis were ruled out by imaging, a decision to perform a lumbar puncture was taken. The diagnosis was made following a PCR analysis on the cerebro-spinal fluid. Retrospective testing revealed immunity to varicella at booking, thus confirming reactivation of the infection. Treatment was done using intravenous acyclovir with complete recovery. It also created a clinical dilemma for the best possible monitoring plan for the fetus to rule out affection. A fetal medicine scan revealed no structural defects in the fetus. The subsequent pregnancy period was uneventful. A well grown normal baby was born at term. This case highlights the significance of considering a lumbar puncture in cases of intractable headache and also highlights the dilemma for fetal monitoring in such rare presentations.
      PubDate: 2020-02-27
      DOI: 10.18203/2320-1770.ijrcog20200921
      Issue No: Vol. 9, No. 3 (2020)
  • Endometrial cancer with implantation metastasis to vagina: a case report

    • Authors: Muhammad Eimaduddin Sapiee, Wan Rosmidah Wan Abas, Roziana Ramli, Muhd Afif Mohd Yusof, Ahmad Fazlin Nasaruddin
      Pages: 1303 - 1305
      Authors present a case of vaginal implantation metastasis following a diagnosis of endometrial cancer. A 58-year-old lady presented with postmenopausal bleeding and was later diagnosed to have endometrial cancer. She underwent an extra-fascial hysterectomy and bilateral salpingo-oophrorectomy with pelvic lymphadenectomy for Stage 3A endometrioid adenocarcinoma of the endometrium. The lymph nodes and cervix were free from the disease and no lymphovascular invasion was seen on the pathological specimen. She defaulted adjuvant radiotherapy and was lost to follow up. Six months later she had a tumour recurrence at the vaginal introitus just below the urethral orifice and awal from the vaginal vault with similar histopathological findings as previous cancer. This case highlights the rare occurrence of implantation metastasis of endometrial cancer.
      PubDate: 2020-02-27
      DOI: 10.18203/2320-1770.ijrcog20200922
      Issue No: Vol. 9, No. 3 (2020)
  • OHVIRA syndrome with Orofacial clefts: a rare association

    • Authors: Sambedna ., Amit Kumar, Mukta Agarwal, Nimisha Agrawal, Sudwita Sinha
      Pages: 1306 - 1309
      Abstract: Obstucted hemivagina with ipsilateral renal anomaly (OHVIRA) syndrome or Herlyn-Werner-Wunderlich syndrome (HWW) is a rare congenital anomaly consist of uterus didelphys, obstructed hemivagina, and ipsilateral renal agenesis. We are reporting an adolescent girl with orofacial defect who presented with lower abdominal pain. She attained menarche 3 months earlier and had a regular menstrual cycle with cyclical abdominal pain. On abdominal examination a firm, mobile tender mass extending from left iliac fossa up to umbilicus (24 weeks size) was found.  Lower border of mass could not be approached. Further evaluation with ultrasound showed enlarged uterus with collection with internal echoes and non-visualization of the left kidney. CECT showed absent left kidney and didelphys uterus with large left hematocolpometra with left complex adenexal cyst. Patient was posted for hematocolpos drainage and vaginoplasty. An unusual presentation of regular menstruation and nonspecific abdominal pain delays the diagnosis, which can lead to severe complications such as endometriosis and infertility.
      PubDate: 2020-02-27
      DOI: 10.18203/2320-1770.ijrcog20200923
      Issue No: Vol. 9, No. 3 (2020)
  • A case report on ACUM: a rare mullerian anomaly

    • Authors: Khushboo Malhotra, Bindu Bajaj
      Pages: 1310 - 1314
      Abstract: Accessory and cavitated uterine mass (ACUM) is a rare, newly recognized mullerian anomaly. It is an accessory cavity lined by functional endometrium within an otherwise normal uterine cavity, in contrast to the other mullerian anomalies in which the uterus is malformed. It is often misdiagnosed as myoma, adenomyosis or adenomyoma. The entity needs expertise to diagnose as it is a rare but treatable cause of severe dysmenorrhea and chronic pelvic pain in young females with a wide range of differential diagnosis. A 30 years old female with history of one abortion 2 years back, came to infertility OPD with complaints of lower abdominal pain with severe dysmenorrhea, dyspareunia and inability to conceive since 2 years. Her menstrual cycle was regular with normal flow. USG pelvis showed subserosal fibroid of 4×3 cm in fundus region of uterus. On HSG, bilateral fallopian tubes were patent. MRI-pelvis revealed normal uterus with thick walled cavitatory lesion of size 4.1×3.6 cm with thick T2W hypointense wall similar to myometrium in continuation with right fundal wall of uterus containing blood products suggestive of ACUM. Both ovaries were normal, no obvious adnexal lesion/collection/free fluid noted in peritoneal cavity. Laparoscopy followed by laparotomy with excision of ACUM was performed. The MRI findings of an accessory cavitated uterine mass located below the attachment of round ligament with haemorrhagic contents, normal shaped uterus with normal bilateral tubes and ovaries should suggest the diagnosis of ACUM pre-operatively.
      PubDate: 2020-02-27
      DOI: 10.18203/2320-1770.ijrcog20200924
      Issue No: Vol. 9, No. 3 (2020)
  • A rare case of caesarean scar ectopic pregnancy: a case report

    • Authors: Hiremath P. B., Vinothini Anandabaskar, Nivedhana Arthi, Rohini E., Indu N. R.
      Pages: 1315 - 1317
      Abstract: Scar ectopic pregnancy is a condition where the gestational sac implants into the previous caesarean scar site. Although it is a rare entity, its incidence is increasing due to rising rates of caesarean deliveries. Here authors report a case of caesarean scar ectopic pregnancy managed by laparotomy with caesarean scar ectopic excision following failed medical management. The patient recovered without any intraoperative or postoperative complications. An early diagnosis and management are vital in preventing maternal morbidity and mortality.
      PubDate: 2020-02-27
      DOI: 10.18203/2320-1770.ijrcog20200925
      Issue No: Vol. 9, No. 3 (2020)
  • Absence of Wharton’s jelly: an association with feto-maternal

    • Authors: Swati Trivedi, Lata Ratanoo, Shivani Purohit, Prasoon Rastogi
      Pages: 1318 - 1320
      Abstract: Umbilical cord contains two arteries and one vein connecting fetus to the placenta and is responsible for blood flow between the two. It is surrounded by Wharton’s jelly which is a gelatinous substance and functions as adventitia layer of umbilical vessels, thereby providing insulation and protection to the umbilical cord. Umbilical cord abnormalities are associated with poor perinatal outcomes. Very few cases of absent Wharton’s jelly are reported in literature. Ours might be the 8th one in which we did a lower segment caesarean section for meconium stained liquor but the baby died after 12 hours.
      PubDate: 2020-02-27
      DOI: 10.18203/2320-1770.ijrcog20200926
      Issue No: Vol. 9, No. 3 (2020)
  • A freaky motorbike accident causing vulvar hematoma: a case report at the
           Bafoussam Regional Hospital, West-Cameroon

    • Authors: Jovanny Tsuala Fouogue, Gerard Tama Fetse, Bruno Kenfack, Jeanne Hortence Fouedjio, Florent Ymele Foueifack, Jean Dupont Ngowa Kemfang
      Pages: 1321 - 1323
      Abstract: Non-obstetric vulvar hematomas are rare and have never been reported in West Cameroon. No guidelines are available to inform the management of cases.
      Authors herein report the successful management of a post-traumatic vulvar hematoma in a 17 years old gravida 1 para 1001 patient. She was referred to our emergency department ten hours after a fall in a squatting position during a road traffic accident. Prior to the referral she had been managed conservatively by analgesics and a compressive dressing of the vulva in a community clinic. Clinical assessment on admission revealed a good general condition, normal vital signs and a tense and painful hematoma of the right labia. Surgery was done under general anesthesia to drain the hematoma, ligate the bleeding vessels and repair the vulva. Post-operative course was uneventful and the patient was discharge six days later. This case reminds practitioners in remote health facilities that early referral of this rare pathology contributes to its successful surgical management in our semi-urban region.
      PubDate: 2020-02-27
      DOI: 10.18203/2320-1770.ijrcog20200927
      Issue No: Vol. 9, No. 3 (2020)
School of Mathematical and Computer Sciences
Heriot-Watt University
Edinburgh, EH14 4AS, UK
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