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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]
  • Surgical intervention on uterine fibromyoma in a country with limited
           resources: case of the gynaecology-obstetrics department of the Communal
           Medical Centre of Ratoma Conakry - Guinea

    • Authors: Mamadou H. Diallo, Ibrahima S. Balde, Amadou D. Diallo, Ousmane Balde, Fatoumata B. Diallo, Mamadou S. Fofana, Alhassane Sow, Alpha B. Barry, Telly Sy, Namory Keita
      Pages: 2227 - 2233
      Abstract: Background: In developing countries, treatment of uterine fibromyoma is confronted with numerous problems, namely: financial inaccessibility to the proposed treatments, fear of surgery and the weakness of the technical platform. The objectives of the study were to calculate the frequency of uterine fibromyomas, describe the socio-demographic characteristics of patients, identify the main clinical data and to describe the modalities of surgical management.Methods: It was a mixed descriptive study, cumulative over a period of 5 years (60 months) with data collection in two phases: a 4-year retrospective study from January 1, 2015 to December 31, 2018 and a 1-year prospective study from January 1, 2019 to December 31, 2019.Results:
      Authors collected 135 cases of uterine fibromyomas operated on out of a total of 260 cases of gynaecological pathologies, i.e. a frequency of 51.92%. Nulliparous women were the most concerned (45.18%), and women who attended school (60%) and those who did not attend school (40%). Women at home and housewives accounted for 42.20% and 54.07% respectively. Clinically, the circumstances of discovery were dominated by menometrorrhagia and menorrhagia respectively 77.77% and 68.14%. The large uterus was the most frequent physical sign found in 96.29% of cases. Uterine fibromyomas were recorded in 86.6% of cases in women with genital activity. The operative indications were dominated by the large polymyomatous uterus (64.44%), followed by hemorrhagic fibroma (18.52%) The surgical treatment was conservative in 92.60%. The total hysterectomy was performed in 7.40. Lethality was 1.4%.Conclusions: The surgical management of fibroids contrasts conservative treatment (myomectomy) with radical treatment (hysterectomy) with multiple possible approaches (hysteroscopy, vaginal surgery, laparoscopy or laparotomy). In this context, only laparotomy was possible due to lack of equipment. Laparoscopy and hysteroscopy equipment are necessary for less invasive surgery.
      PubDate: 2020-05-27
      DOI: 10.18203/2320-1770.ijrcog20202028
      Issue No: Vol. 9, No. 6 (2020)
       
  • Knowledge, attitude and practice of contraception among nursing and
           para-medical staff in a tertiary care hospital of Mathura, Uttar Pradesh,
           India

    • Authors: Parul Garg
      Pages: 2234 - 2238
      Abstract: Background: The objective of this study was to study the knowledge, attitude and practice of contraception among nursing and para-medical staff in a tertiary care hospital and also to identify factors that are associated with non-usage of contraception.Methods: The study was conducted on 100 nursing and paramedical staff working at K. D. Medical College and associated hospital at Mathura from November 2019 to January 2020. After obtaining consent, randomly selected married nursing and paramedical staff were given a pre-designed, structured questionnaire on socio-demographic variables, knowledge, attitude and practice towards contraception.Results: In the present study, out of 100 participants, 89 had awareness of contraception. Majority of them knew about condoms, followed by Copper-T/multiload and OCPs. The knowledge about contraception was mainly obtained through social media and health professionals.Conclusions: Health care providers should be equipped with recent information on all the available family planning methods through intensive in-service trainings, seminars/conferences, etc. This will get them informed and all misconceptions will be erased and in turn each health care provider will be able to make informed choice from the various options of family planning methods and practice the best suitable method. 
      PubDate: 2020-05-27
      DOI: 10.18203/2320-1770.ijrcog20202044
      Issue No: Vol. 9, No. 6 (2020)
       
  • Comparison of outcome in medical versus expectant management in unruptured
           tubal pregnancy with β-hCG 1000-3000 IU/L

    • Authors: Sidra Arshad, Sonia Andeel, Samia Asghar, Sana Hafeez, Sana Asghar, Naheed Fatima
      Pages: 2239 - 2243
      Abstract: Background: Ectopic pregnancy (EP) is an important cause of maternal morbidity as well as mortality in the 1st trimester. This study was done to compare outcome in medical versus expectant management in patients with unruptured tubal pregnancy having β-hCG 1000-3000 IU/L.Methods: In this randomized controlled trial, 82 (41 in each group) women with tubal ectopic pregnancy (TEP) having β-hCG levels between 1000-3000 IU/L and 18 to 40 years of age were enrolled. Women having non-tubal pregnancy, ruptured ectopic pregnancy, heterotopic pregnancy, hypersensitivity to methotrexate were excluded. Included women were randomly assigned to either Group-A (expectant management) or Group-B (medical management). Outcome was measured after one week and considered successful if patient had β-hCG levels negligible i.e. <10 IU/L and complete resolution on ultrasonography (absence of adnexal mass, pelvic free fluid, gestational sac).Results: Overall mean age was 30.65±6.37 years. The mean gestational age in Group-A was 7.12±2.12 weeks and 7.63±2.41 weeks in Group-B. The mean β-hCG levels in Group-A was 1984.63±515.81 IU/L and 1937.33±519.68 IU/L in Group-B. Outcome was successful in 90.24% in Group-A and 63.41% in Group-B (p-value=0.004).Conclusions: Expectant management is associated with better outcome as compared to medical management in tubal ectopic pregnancy having β-hCG between 1000-3000 IU/L.
      PubDate: 2020-05-27
      DOI: 10.18203/2320-1770.ijrcog20202069
      Issue No: Vol. 9, No. 6 (2020)
       
  • Immediate post placental insertion of intrauterine contraceptive device at
           caesarean delivery: a prospective study

    • Authors: Sravani Mukka, Madhavi Y.
      Pages: 2244 - 2248
      Abstract: Background: In India almost 65% of the women have an unmet need for family planning in the first postpartum year. Increasing rates of institutional deliveries creates an opportunity for providing quality post-partum family planning services. Post-partum Intrauterine contraceptive device (PPIUCD), a form of long acting reversible contraception (LARC) is one of the most affective and safest method available. The present study aims at evaluating the safety, efficacy, rate of acceptance and rate of discontinuation of Intra caesarean inserted contraceptive device Copper T-380A.Methods: This was a prospective study conducted at ESIC Medical College, Sanathnagar in women delivered by caesarean section during the period between March 2018 to February 2019. Recruitment was done based on the WHO medical eligibility criteria (MEC) for PPIUCD and also their willingness to participate in the study. Follow-up visits were scheduled at 6 weeks, 3 months and 6 months.Results: Of the 265 women fulfilling the WHO MEC, 180 (67.92%) were willing to participate in the study. Total acceptance rate was 67.7%. Majority of them belonged to the age group 21-30 years (80%) and para 2 (53.88). 93.3% of the women were literates. 12 (6.66%) cases lost to follow up and the complications were studied in the rest 168 women. During follow up -38.69% had missing strings, 12.5% menstrual disturbances, 4.76% abdominal pain and spontaneous expulsion in 4.1%. No cases of perforation and pregnancy were reported. Total continuation rate was 84%.Conclusions: PPIUCD is a safe and convenient option of contraception with low expulsion rates and high continuation rates.
      PubDate: 2020-05-27
      DOI: 10.18203/2320-1770.ijrcog20202068
      Issue No: Vol. 9, No. 6 (2020)
       
  • Fertility outcomes following myomectomy in infertile patients at our
           centre: a retrospective analysis

    • Authors: Nidhi Goyal, K. Jayakrishnan
      Pages: 2249 - 2252
      Abstract: Background: Fibroids have been known to cause infertility due to multiple factors. However, the role of myomectomy in patients with intramural and subserosal fibroids has been a topic of debate. This study evaluates outcomes following myomectomy in patients seeking treatment for infertility at study centre.Methods: This was hospital based retrospective study which evaluated 92 infertile patients who took treatment for infertility.Results: A total 41.3% patients conceived within one year of myomectomy. Pregnancy rates were better in patients with intramural combined with submucous fibroids, age between 30 and 35 years, size of largest fibroid between 3 and 6 cm and when number of fibroids were between 3 and 6 and conception was maximum after ovulation induction.Conclusions: Pregnancy rates after myomectomy are better in young patients with large fibroids. Active management for infertility needs to be done after myomectomy.
      PubDate: 2020-05-27
      DOI: 10.18203/2320-1770.ijrcog20202083
      Issue No: Vol. 9, No. 6 (2020)
       
  • Hysteroscopy in one hundred cases of postmenopausal uterine bleeding, in
           the detection of uterine cancer and atypical endometrial hyperplasia

    • Authors: Pratibha Devabhaktuni, Padmaja Allani, Suneetha Komatlapalli, Rekha Rani Ksheerasagara
      Pages: 2253 - 2261
      Abstract: Background: Evaluation was done in 100 women presenting with postmenopausal bleeding, (PMB), to discuss the utility of hysteroscopy combined guided endometrial curettage in the diagnosis of uterine cancer and endometrial hyperplasia, and, treat benign lesions, like polyps, synechiae at the same sitting. At MGMH during the years, 2002 to 2006, there were 57 women, and at care, 40 women with PMB during 2011 to 2013, and three in a nursing home, Hyderabad, were investigated.Methods: Evaluation was done in 100 women presenting with PMB by hysteroscopy and curettage to diagnose the cause of PMB and benign lesions like polyps, synechiae were managed by operative hysteroscopy. Bettocchi 5 mm hysteroscope, monopolar instruments and glycine was used for excision of polyps.Results: In one hundred women with PMB, 19% had cancer. Endometrial adenocarcinoma in 14, endocervical carcinoma in 2, uterine carcinosarcoma in 3 cases. All 3 cases of uterine carcinosarcoma on hysteroscopy were large polyps measuring 5×5-6 cm size. Atypical hyperplasia endometrium in 7% and simple hyperplasia in 17%, was reported on histopathology, in cases with hyperplastic endometrium on hysteroscopy. Benign polyps in 41% were managed at the same sitting by operative hysteroscopy.Conclusions: Women with postmenopausal bleeding must have USG, trans vaginal sonography (TVS), endometrial thickness (ET) measurement, preferably endometrial echo complex (EEC). In women with PMB, the risk of uterine cancer would be 19%, i.e., 1 out of 5 women. Atypical hyperplasia in 7%. Hysteroscopy guided curettage, with histopathology, is the gold standard protocol in cases of PMB.
      PubDate: 2020-05-27
      DOI: 10.18203/2320-1770.ijrcog20202084
      Issue No: Vol. 9, No. 6 (2020)
       
  • The sunshine vitamin D: ubiquitous source, still so deficient in mother
           and baby duo

    • Authors: Shilpa S. K., Naima Fatima
      Pages: 2262 - 2268
      Abstract: Background: Vitamin D is a fat-soluble vitamin, a sunshine vitamin. Vitamin D deficiency is now recognized as a pandemic. Fetus depends on mother for its need of vitamin D, thus there is growing concern for its impact on neonates. This study was designed to determine the correlation between 25-hydroxyvitamin D (vitamin D3) levels in maternal blood and in cord blood.Methods: A total 50 term pregnant women attending antenatal clinic at SVS medical college, Telangana and their neonates were included in the study. At term after taking written consent, maternal and cord blood vitamin D3 were measured, and values were correlated. Antenatal and neonatal complications were noted, and correlated with vitamin D3 levels.Results: In this study 80% of pregnant women and 88% of neonates were vitamin D3 deficient. Mean maternal blood vitamin D3 was 17.62±10.01 and cord blood vitamin D3 was 12.84±7.68. Maternal blood vitamin D3 correlated positively with cord blood vitamin D3 (r=0.951, p<0.001). Antenatal and neonatal complications were observed, but statistically significant association with vitamin D3 deficiency could not be established.Conclusions: This study has demonstrated a very high prevalence of vitamin D deficiency in apparently healthy, young, pregnant women despite abundant sunlight leading to deficiency in their neonates. To establish strong association between vitamin D3 deficiency and various antenatal and neonatal complications further studies with large subject groups are required.
      PubDate: 2020-05-27
      DOI: 10.18203/2320-1770.ijrcog20202027
      Issue No: Vol. 9, No. 6 (2020)
       
  • Knowledge, attitude and practice of antenatal care among pregnant women
           attending antenatal clinic in a tertiary care hospital of Mathura, Uttar
           Pradesh, India

    • Authors: Parul Garg, Divya .
      Pages: 2269 - 2273
      Abstract: Background: The objective of this study was to assess the knowledge, attitude and practice of antenatal care among pregnant women attending antenatal clinic in a tertiary care hospital and also to identify factors that are associated with non-usage of antenatal care.Methods: The study was conducted on 150 pregnant women attending antenatal clinic in department of obstetrics and gynecology of K. D. Medical College and associated hospital of Mathura from September 2019 to December 2019. After obtaining consent, randomly selected pregnant women were given a pre-designed, structured questionnaire on socio-demographic variables, knowledge, attitude and practice towards antenatal care.Results: In the present study, out of 150 respondents, 62.7% had knowledge and awareness regarding antenatal care. There was inadequate knowledge about frequency of antenatal visits with 59.3% subjects wanting to deliver in the hospital.Conclusions: To improve effective utilization of ANC services, we need to bring behaviour changes, improve communication and quality of service delivery, along with effective monitoring and evaluation. Awareness should be developed in the community about the importance of registration for ANC, educating women about the detection of complications during pregnancy, importance of TT injection, IFA tablets and extra nutrition.
      PubDate: 2020-05-27
      DOI: 10.18203/2320-1770.ijrcog20202072
      Issue No: Vol. 9, No. 6 (2020)
       
  • A comparative study of the effect of induction of labour with vaginal
           misoprostol versus prostaglandin E2 gel on the incidence of pathological
           cardiotocography tracing

    • Authors: Archana Kumari, Nikita Chauhan, Anubha Vidyarthi
      Pages: 2274 - 2280
      Abstract: Background: The objective of the present study was to compare the two most commonly used agents for induction of labor-vaginal misoprostol and intracervical dinoprostone gel in terms of the incidence of cardiotocography (CTG) abnormalities and its correlation with fetal distress and fetomaternal outcome.Methods: This is prospective case-control study conducted in department of obstetrics and gynecology, RIMS, Ranchi over a period of 15 months. 112 women requiring induction were randomly assigned to two groups of 56 each, Group M received vaginal misoprostol and Group D received intracervical dinoprostone E2 gel. 56 women with spontaneous labor served as control group. Groups were compared in terms of the incidence of suspicious or pathological CTG tracings, fetal distress, induction to vaginal delivery time, vaginal delivery rates, dose requirements, rate of emergency cesarean.Results: Misoprostol was associated with shorter induction to delivery time (9.54 hours) than dinoprostone gel (13.54 hours), higher vaginal delivery rates (80.35% versus 62.5%), higher delivery rates (73.9%) with single dose itself unlike Group D, where 47.22% required more than one dose. Incidence of suspicious CTG was higher in group M (15.68%) versus 10.25% in Group D. Incidence of pathological CTG was also highest in Group M (7.8%) followed by Group D (2.56%) and Group C (7.8%). Dinoprostone gel lead to failed induction in 25% women, and hence higher caesarean rates.Conclusions: While misoprostol is a better agent for induction when compared with dinoprostone E2 gel in terms of induction-delivery time, higher vaginal delivery rates, less dose requirement, it is associated with greater incidence of non-reassuring/pathological CTG. There was justified improvement in perinatal outcome due to preparedness beforehand with use of CTG.
      PubDate: 2020-05-27
      DOI: 10.18203/2320-1770.ijrcog20202045
      Issue No: Vol. 9, No. 6 (2020)
       
  • Assessment of labor room communication skills among postgraduate students
           of obstetrics and gynecology

    • Authors: Amit Gupta, Bharti Gupta, Ashok Verma, Chanderdeep Sharma, Sita Thakur, Anjali Soni
      Pages: 2281 - 2287
      Abstract: Background: “Communication with patients” is an important skill needed for every physician in their clinical practice.  These soft skills are required in dealing with patients at every step which include history taking from the patients, explaining them the diagnosis, the prognosis of the disease with associated complications. Dealing with empathy, taking informed consent, explaining the operative procedure and the complications associated with surgery, the art of breaking bad news are the mandatory skills for a good clinician. Labouring women like other patients also require special attention and empathy. So, the residents working in labor room need commitment to develop these soft skills in order to improve the labor room experience of expectant mothers. Objective of this study was to analyse role of a formal training in labor room communication skills among post graduate students of the department of obstetrics and gynecology.Methods: Faculty and students’ sensitization was done after approval from institutional ‘ethics committee’ for conducting this study. Pre-workshop assessment of residents for communication skills attitude and effective communication was done through ‘communication skill attitude scale’ (CSAS) and ‘GAP-KALAMAZOO scale’. Workshop for communication skills on the framework of Calgary Cambridge patient interview model and online teaching of students through what’s app videos, role-play demonstrations was followed by reassessment of the residents through above used scales.Results: Results depicted both improvements in attitude and effective communication skills among residents. 100% of the students were convinced and opined that good communication skills necessary for perfect clinical practice.Conclusions: The skill to communicate with patients is a fine art and needs to be mastered to be a good clinician. A formal training in effective communication skills is absolutely necessary to bring professionalism in medical practice.
      PubDate: 2020-05-27
      DOI: 10.18203/2320-1770.ijrcog20202297
      Issue No: Vol. 9, No. 6 (2020)
       
  • Clinical outcome of post-abortion intrauterine contraceptive device
           insertion

    • Authors: Rupali Dewan, Priyanka Rani
      Pages: 2288 - 2292
      Abstract: Background: Clinical outcome of post abortion IUCD varies according to type of abortion, method of abortion and period of abortion. There is paucity of Indian literature regarding factor affecting clinical outcome of post-abortal intrauterine contraceptive device insertion. This study was conducted to evaluate clinical outcome of post abortion intrauterine contraceptive in terms of acceptability, safety and continuation rate.Methods: A prospective cohort study where 112 patients over period of 18 months (November 2017 to April 2019) were included in study done at VMMC and Safdarjung Hospital, New Delhi, India.Results: Total 112 patients recruited. Their age ranges from 26-30 years. Mean age of women were 28.11±4.51 years. Majority of women who underwent IUCD insertion were para2. Regardless of type of IUCD, the most common side effects associated with copper wearing IUCD were change in amount of menstrual flow. Two cases of PID after CuT380A insertion and one case of PID after cu375. No perforation occurred. Continuation rate were 86.79%. Satisfaction rate were 82.14%.Conclusions: There is higher rate of continuation and satisfaction among women who had undergone immediate post abortion OUCD insertion. Early insertion of IUCD after abortion is safe, effective and well tolerated by women. Clinical outcome of post abortion is not affected by type of copper containing IUCD i.e., Cu380A and Cu375.
      PubDate: 2020-05-27
      DOI: 10.18203/2320-1770.ijrcog20202298
      Issue No: Vol. 9, No. 6 (2020)
       
  • A prospective clinical study of foetomaternal outcome in relation to
           amniotic fluid index in pregnant females beyond 36 weeks of gestation at
           tertiary centre

    • Authors: Nimisha Gupta, Oby Nagar, Kritika Tulani, Shraddha Kiran Swami
      Pages: 2293 - 2298
      Abstract: Background: Amniotic fluid plays a vital role during foetal life. The main purpose of this study was to evaluate the foetomaternal outcome in relation to amniotic fluid index in pregnant females beyond 36 weeks of gestation.Methods: This prospective type of study was conducted for one-year duration from May 2018 to May 2019 in 350 pregnant females beyond 36 weeks of gestation with clinically significant abnormal liquor volume. Clinical diagnosis was later on confirmed with ultrasonography and patients were categorized in three categories as patients with Amniotic fluid index (AFI) 5 to 24, AFI <5 and AFI > or = 25. Complete labour record was made and fetomaternal outcome was assessed.Results: In this study, incidence of oligohydramnios was found to be more than polyhydramnios at term. No significant differences were found in relation to age, parity, religion, residence and booking status in all the study groups. Mostly patients 119 (52%) delivered by caesarean section in oligohydramnios group whereas vaginal delivery was commonly seen in patients with normal AFI (80%) and polyhydramnios (55%). Growth restriction 59 (26%) and malpresentation 18 (8%) were commonly seen with oligohydramnios. In the polyhydramnios group, 14 (35%) babies had malformations whereas only 6 (3%) babies had malformations in patients with oligohydramnios. Significant differences were found in the foetal outcome between the patients with oligohydramnios and polyhydramnios in comparison to patients with normal AFI.Conclusions: In pregnant females with abnormal liquor volume increases the chances of maternal morbidity and perinatal morbidity and mortality.
      PubDate: 2020-05-27
      DOI: 10.18203/2320-1770.ijrcog20202299
      Issue No: Vol. 9, No. 6 (2020)
       
  • Histomorphological analysis of placental changes of pre-eclampsia patients
           in a tertiary care hospital of Puducherry, India

    • Authors: Rupal Samal, Anandraj Vaithy K., S. Sowmya
      Pages: 2299 - 2304
      Abstract: Background: Placenta is a dynamic tissue synthesized physiologically to serve as a nutrient source for developing fetus it is exposed to several changes in reaction to many toxemic conditions associated with pregnancies. Studies had proved that placental changes observed on histomorphology is directly proportional to reaction to hemodynamic compensatory mechanisms, thereby aiding the obstetricians to manage the sequelae of complications. Objective of this study was to study the placental histomorphology in pregnancies associated with pre-eclampsia and to quantitate the observed placental changes.Methods: The study comprised on 101 placental specimens obtained from department of obstetrics and gynecology, Mahatma Gandhi Medical College and Research Institute, Pondicherry. Toxemia of pregnancies were divided into mild, severe preeclampsia and eclampsia based on blood pressure. The 101 cases were divided as 4 groups: Group 1 (control group); Group 2 (mild preeclampsia); Group 3 (severe preeclampsia); Group 4 (eclampsia).Results: Among the 101 cases, 38 placentas were from uncomplicated full-term deliveries which constitutes the control group. The rest 63 placenta were from toxemia of pregnancies which constitutes the study group.Conclusions: The incidence of toxemic pregnancies and pre-eclamptic cases are on higher margin than assumed. Histomorphology examination of placenta plays a vital role in assessing etiopathogenesis and mechanism of toxemic pregnancies. This aids the obstetrician to further manage subsequent sequelae and fix the complication to significant proportion.
      PubDate: 2020-05-27
      DOI: 10.18203/2320-1770.ijrcog20202300
      Issue No: Vol. 9, No. 6 (2020)
       
  • A comparative study of Pap smear and colposcopy guided biopsy in the
           evaluation of unhealthy cervix

    • Authors: Meenakshi Venkatesh, Ushadevi .
      Pages: 2305 - 2309
      Abstract: Background: Cancer of cervix ranks as the third common malignancy in females worldwide. In developing countries like India, carcinoma cervix is the second commonest malignancy affecting females. In India, every year 1,26,000 new cases are identified and 67,477 deaths occur due to cervical carcinoma. Cervical carcinoma affects women of age 15-44 years and disease peaks at 55-66 years. On average, Indian women have a 2.5% risk of developing carcinoma cervix. It was estimated worldwide that every 5th woman, who suffer from cervical cancer belongs to India.Methods: A comparative study which included 110 married women of age 20 to 65 years. Women who presented with white discharge, lower abdominal pain, post coital bleeding and post-menopausal bleeding were subjected to Pap smear and colposcopy guided biopsy.Results: A total 53.6% women had inflammatory smear, followed by 34.5% women with normal Pap smear, 0.1% women had bacterial vaginosis, 6.4% women had LSIL and 4.5% women had HSIL.
      Authors found that 63.6% women had chronic cervicitis. 15.4% had chronic endo papillary cervicitis, 13.6% had CIN 1, 5.4% women had CIN 2 and 1.8% women had squamous cell carcinoma. Association of Pap smear with histopathology is statistically significant (p value <0.001).Conclusions: Pap smear can be used as screening test for detecting premalignant lesions of cervix. Colposcopy guided cervix biopsy has got better specificity than Pap smear, so all symptomatic women should be subjected to colposcopy guided cervix biopsy to detect carcinoma at early stage.
      PubDate: 2020-05-27
      DOI: 10.18203/2320-1770.ijrcog20202301
      Issue No: Vol. 9, No. 6 (2020)
       
  • The relation between of insulin like growth factor II and endometrial
           carcinoma

    • Authors: Hossam Hassan El Sokkary, Doaa Ibrahim Hashad, Ahmed Nooman Sallam, Amal Zaki Azzam, Mohamed Ebied Abo Koura
      Pages: 2310 - 2313
      Abstract: Background: Endometrial cancer is the most common gynecologic malignancy in the United States and the fourth most common cancer in women. The need of a soft marker that can be used with CA-125 tumor marker for early detection of endometrial cancer and to predict late stages and advanced histopathological grades and to specify the cases who will be managed by complete surgical staging including para aortic and pelvic lymphadenectomy is of great importance. The aim of the study was to evaluate the role of insulin like growth factor 2 in endometrial carcinoma and to correlate it with different histopathological grades of the disease.Methods: This study was applied on sixty patients with abnormal uterine bleeding and were divided into two groups, Group A included 30 cases of endometrial carcinoma, while Group B included 30 cases complaining of abnormal vaginal bleeding due to other causes as a control group. Serum samples were taken from all patients and estimation of IGF-2 serum levels using ElISA technique was done. Comparison of IGF-2 serum level between both groups and correlation of its levels with different histopathological grades of endometrial cancer group were done.Results: As regard comparison between both groups and ILGF2 serum level, study results demonstrated that ILGF2 levels ranged between 600.0-1440.0 ng/ml and 40.0-560.0 ng/ml with the mean of 781.33 ng/ml±196.45 and 336.0 ng/ml±212.86 for cases Group A and control Group B respectively. There was a statistically significant difference between the two studied groups regarding ILGF2 serum level (p<0.001). As regards correlation between histopathological grades and ILGF-2 serum level in cases Group A, the study revealed a strong positive correlation.Conclusions: ILGF-2 can be used as a serum marker for endometroid adenocarcinoma of the body of the uterus and to predict its higher histopathological grades.
      PubDate: 2020-05-27
      DOI: 10.18203/2320-1770.ijrcog20202302
      Issue No: Vol. 9, No. 6 (2020)
       
  • Vitamin D deficiency and maternal complications

    • Authors: Anu B. Chandel, Rita Mittal, Anoop Sharma, Shivika Mittal
      Pages: 2314 - 2316
      Abstract: Background: Vitamin D deficiency is prevalent in India, a finding that is unexpected in a tropical country with abundant sunshine. Vitamin D deficiency is recognized as the most untreated nutritional deficiency currently in the world. Several studies reported the relationship between maternal vitamin D deficiency and adverse maternal and fetal outcomes including gestational diabetes, preeclampsia, preterm labour, low birth weight and increased rate of caesarean section.Methods: The study was conducted in the department of obstetrics and gynecology, Kamla Nehru Hospital, Shimla, Himachal Pradesh, India over a period of 12 months. Six hundred women were included in the study.Results: Forty-eight (8%) subjects developed preeclampsia-eclampsia syndrome, of which none had sufficient vitamin D levels, whereas 48 (100%) subjects had vitamin D deficiency.Conclusions: Maternal antenatal complications are more common in vitamin D deficient group.
      PubDate: 2020-05-27
      DOI: 10.18203/2320-1770.ijrcog20202303
      Issue No: Vol. 9, No. 6 (2020)
       
  • Effect of one-time dextran-polyacrylamide polymer matrixes treatment on
           female reproductive function

    • Authors: Valentyna A. Sribna, Oksana N. Kaleinikova, Yulia I. Kuziv, Alena A. Vinogradova Anyk, Igor N. Karvatskiy, Tetiana Y. Voznesenskaya, Taras V. Blashkiv, Natalia V. Kutsevol
      Pages: 2317 - 2322
      Abstract: Background: recently, it has been proved that copolymers with dextran cores and grafted polyacrylamide are effective in photodynamic and chemotherapy. However, further research is needed to define correct dosage and to assess the risks. Thus, animal studies are becoming more relevant to determine the effect of the treatment of such drug nano-systems on female reproductive function in particular.Methods: a technique for estimation of pre- and post-implantation death rates, in vitro meotic maturation of oocytes, double fluorescent vital assay and statistical analysis were used. The effects of a one-time treatment of different doses of dextran-polyacrylamide matrices and silver (Ag)-nanoparticles-dextran-polyacrylamide (AgNPs-D-PAA) on reproductive function, namely on 1) the number of oocytes isolated from one ovary and the meiotic maturation of such oocytes in vitro; 2) the indicators of cell viability of the cells of follicular environment of oocytes (FEO) and the cells of inguinal lymph nodes (ILN); 3) the pre- and post-implantation mortality rates and the number of live newborns (pups) were investigated in female mice.Results: no significant changes in the number of oocytes isolated from one ovary and meiotic maturation of such ovarian oocytes in vitro, the number of living cells of follicular environment of oocytes  and the number of such cells with morphological signs of apoptosis and necrosis, pre- and post-implantation mortality rates of embryos and the number of live newborns (pups) have been established under conditions of one-time treatment with dextran-polyacrylamide at doses of 0.39 mg/kg and 3.90 mg/kg and Ag-nanoparticles-dextran-polyacrylamide at doses of 0.20 mg/kg and 2.00 mg/kg.Conclusions: branched polymer systems (dextran-polyacrylamide (D-PAA) polymer matrices) are promising materials for use in next-generation medicine.
      PubDate: 2020-05-27
      DOI: 10.18203/2320-1770.ijrcog20202304
      Issue No: Vol. 9, No. 6 (2020)
       
  • Pattern and risk factors of non-fistulous urinary incontinence among
           gynaecological clinic attendees in a Nigeria tertiary health institution

    • Authors: Charles O. Njoku, Amarachukwu N. Njoku, Cajethan I. Emechebe, Andrew E. Okpe, Christopher I. Iklaki
      Pages: 2323 - 2327
      Abstract: Background: Urinary incontinence is the involuntary loss of urine. It is rarely disclosed by the patients and usually under-reported. Objective of this study was to determine the prevalence, pattern and risk factors of non-fistulous urinary incontinence among women attending gynaecological clinics in Calabar, Nigeria.Methods: This was a cross-sectional study of 658 women attending gynecological clinic from June 2018 to June 2019. English version of International consultation on incontinence questionnaire-urinary incontinence-short form (ICIQ-UI-SF) was used to obtain data. Statistical analysis was done using SPSS version 22.Results: The prevalence of urinary incontinence was 16.1%. Stress incontinence was the commonest of urinary incontinence (73.3%), other types were urge incontinence (17.2%) and mixed incontinence (9.5%). Independent risk factors for urinary incontinence were 40 years and above (AOR = 5.610; p<0.001), parity ≥3 (AOR = 4.454; p<0.001), lower educational level (primary) (AOR = 2.588; p<0.001), vaginal/instrumental deliveries (AOR = 4.358; p<0.001), carrying heavy load (AOR = 3.688; p<0.001) and farming (AOR = 3.510; p<0.001).Conclusions: Non-fistulous urinary incontinence is common among women in our environment. Stress urinary incontinence was the most common type. Advanced age, higher parity, vaginal and instrumental deliveries and farming were independent risk factors for urinary incontinence.
      PubDate: 2020-05-27
      DOI: 10.18203/2320-1770.ijrcog20202305
      Issue No: Vol. 9, No. 6 (2020)
       
  • Comparison of oral nifedipine and oral labetalol as a single drug therapy
           for control of blood pressure in preeclampsia

    • Authors: Alpesh R. Patel, Sneha R. Arora, Jalpa K. Bhatt
      Pages: 2328 - 2332
      Abstract: Background: Worldwide hypertension during pregnancy is a common cause of maternal and fetal morbidity and mortality. Effective control of blood pressure is one of the important steps in management of preeclampsia. Few drugs like nifedipine, labetalol, methyldopa, and hydralazine have acceptable high safety profile during pregnancy.Methods: In this study 120 antenatal women with non-severe preeclampsia were compared by giving either nifedipine or labetalol as a single drug therapy for control of blood pressure. Various parameters like control of blood pressure, side effects of drugs, gestational age at the time of delivery, mode of delivery, any complication and perinatal outcome were assessed.Results: In this study authors found that in both group, adequate control of blood pressure was achieved. This study shows slightly higher rate of pre term delivery and LSCS with labetalol and minimal side effects with nifedipine but difference in each group is insignificant.Conclusions: Labetalol and nifedipine both the drugs are equally effective in reducing blood pressure and any of it can safely be used as a first choice of drug for management of hypertension in preeclampsia and it can be decided as per clinician’s experience and familiarity with drug.
      PubDate: 2020-05-27
      DOI: 10.18203/2320-1770.ijrcog20202306
      Issue No: Vol. 9, No. 6 (2020)
       
  • Factors associated with induced second trimester abortion at a tertiary
           level hospital of Uttarakhand region: a 6-year retrospective study

    • Authors: Shweta Nimonkar, Priyanka Chaudhari, Vineeta Gupta, Namrata Saxena, Shivangi Agarwal
      Pages: 2333 - 2336
      Abstract: Background: Despite the liberalization of the abortion services since the early 1970s in India, access to safe abortion services remains limited for the vast majority of Indian women particularly from rural areas. Second trimester abortions have different indications and associated with increased maternal morbidity and mortality as compared to the first trimester abortions.Methods: This study was a retrospective study conducted from the January 2014 to December 2019 at obstetrics and genecology department of Shri Guru Ram Rai Institute of Medical and Health Sciences, Dehradun, Uttarakhand, India. All patients of 12 weeks to 20 weeks of confirmed gestational age were given medical method of second trimester abortion. Data was collected and analyzed regarding demographic features, gestational age, indications, and induction-abortion interval and post abortion contraceptive methods accepted by patient.Results: During this study period a total of 180 patients had second trimester abortion at study institute. Maximum number of patients 69 (38.3%) were of 25-30 years of age group and 161 (85%) patients were of Hindu religion. Major indication was failure of contraception (42.8%) and congenital anomalies in the fetus (45.6%). There was one case of failed medical abortion in which emergency hysterectomy was done for undiagnosed adherent placenta. All patients were compliant of using contraceptive methods after the abortion because of recent medical and mental stress and majority 82 (45.6%) of the patients preferred oral combined contraceptive pills.Conclusions: Apart from congenital anomalies rest all indications can be reduced if women in our country are empowered to control their fertility, get education to become more aware and provided with social security.
      PubDate: 2020-05-27
      DOI: 10.18203/2320-1770.ijrcog20202307
      Issue No: Vol. 9, No. 6 (2020)
       
  • Acute abdomen with adnexal masses in the reproductive age group: diagnosis
           and management

    • Authors: Anuradha D. Murki, Vasundhara Kamineni, Sowmya R. Velagapudi, Ashok K. Deshpande
      Pages: 2337 - 2341
      Abstract: Background: Women with adnexal masses can present with acute symptoms such as abdominal pain, nausea and vomiting. As there is insufficient evidence on the frequency, presentation and management of adnexal masses we conducted this study to evaluate the clinical profile, surgical findings and histopathology of adnexal masses in women presenting with acute abdomen and needing surgical intervention.Methods: In this prospective observational study, history, examination, investigations and ultrasound of abdomen and pelvis were evaluated in women presenting with acute abdomen with adnexal mass and needing surgical intervention. Diagnosis was confirmed from the operative findings and histopathology. Etiology and its correlation with clinical symptoms and signs and radiological diagnosis formed the primary objective of the study.Results: Of the 79 patients enrolled in the study, the mean age was 30.82±6.69 years. Younger women were likely to have ectopic pregnancy while older women (>35 years) other tubal pathologies. Pain abdomen (n=70) and nausea (n=53), bleeding per vagina(n=33), menstrual irregularities (n=18), fever (n=10) abdominal distension (n=10) and dysuria (4) were the common symptoms. Etiology of the adnexal mass was ectopic pregnancy (57%), ovarian mass (34%), tubal mass (7.5%), tube and ovary (2.5%) in 46, 25, 6 and 2 patients respectively. 61% (n=48) of the women underwent laparoscopic management. Women with ruptured ectopic pregnancy were more likely to have abdominal distension, pallor, hypotension, cervical motion tenderness and need for blood transfusions.Conclusions: In women from reproductive age group with adnexal mass and needing surgery, ectopic pregnancies and benign ovarian tumours were the common etiologies. Urine pregnancy test and ultrasound are useful tests to differentiate ectopic from ovarian and tubal pathology.
      PubDate: 2020-05-27
      DOI: 10.18203/2320-1770.ijrcog20202308
      Issue No: Vol. 9, No. 6 (2020)
       
  • A prospective clinical study of foetomaternal outcome in relation to
           oligohydramnios in pregnancies beyond 36 weeks of gestation

    • Authors: B. S. Meena, Nimisha Gupta, Oby Nagar, Swati Trivedi
      Pages: 2342 - 2345
      Abstract: Background: Amniotic fluid is contributed by both mother and foetus. It plays a vital role in foetal growth. The main purpose of this study was to evaluate the foetomaternal outcome in pregnant females with oligohydramnios beyond 36 weeks of gestation.Methods: This study was conducted on 230 pregnant females beyond 36 weeks of gestation with decreased liquor clinically and confirmed sonographically. It was conducted from May 2018 to May 2019. Females with leaking per vaginum, patients who did not give consent and with intrauterine foetal death were excluded. Complete labour record was made. Assessment of maternal outcome was done in terms of mode of delivery and foetal outcome was done in terms of birth weight, Apgar score at one and five-minute, respiratory distress, meconium aspiration, seizures in first 24 hours of life, congenital malformations, neonatal intensive care unit admission and death of baby.Results: A total of 230 pregnant females met the inclusion criteria who were having AFI <5. 121 (53%) females were primigravida and 119 (52%) underwent for caesarean section. Most common indication of LSCS was foetal distress. Apgar score at 1 minute was <7 in 97 (42%) babies and after 5 minutes, it was <7 in 93 (40%) babies. Other neonatal outcome results were IUGR in 59 (26%) babies, meconium aspiration syndrome in 52 (23%) babies, respiratory distress in 92 (40%) babies, congenital malformation in 6 (3%) babies, NICU admission of 93 (40%) babies and neonatal death of 11 (5%) babies.Conclusions: Oligohydramnios increases the chances of maternal morbidity and perinatal morbidity and mortality.
      PubDate: 2020-05-27
      DOI: 10.18203/2320-1770.ijrcog20202309
      Issue No: Vol. 9, No. 6 (2020)
       
  • Neuro-imaging in severe hypertensive disorders of pregnancy: a study from
           North Indian tertiary health care institution

    • Authors: Rohit Dogra, Rama Thakur, Vijay Thakur, Anita Pal, Shaina Chamotra, Ankit Chaudhary
      Pages: 2346 - 2351
      Abstract: Background: Hypertensive disorders of pregnancy comprising of pre-eclampsia and eclampsia are a major cause of adverse pregnancy outcomes. Neurological manifestations of pregnancy induced hypertension are the most common cause of maternal and foetal morbidity and mortality. Cranial neuro-imaging reveals focal regions of symmetric hemispheric oedema; with parietal and occipital regions getting most commonly affected.Methods: The study was conducted among 65 antenatal women diagnosed with pre-eclampsia and eclampsia at gestational age >20 weeks in the department of obstetrics and gynecology, Kamla Nehru State Hospital for Mother and Child IGMC Shimla. Clinical signs and symptoms, neuroimaging findings were recorded for study purpose.Results: About 17.6% of severe pre-eclampsia and 100% of eclampsia had findings observed on cranial MRI. Headache and visual complaints were most frequently recorded. PRES was the predominant neuroradiographic finding in present study and occipital lobe was commonly affected region. No significant difference was observed regarding blood pressure parameters between MRI positive and negative subjects.Conclusions: Neuroimaging in antenatal with severe hypertensive disorders might aid in better understanding of the poorly explained phenomenon. In addition, this would be helpful in better management of the disorders along with their much-dreaded complications. Patients with hypertensive disorders of pregnancy should be subjected routinely to cranial imaging for the better perinatal outcomes.
      PubDate: 2020-05-27
      DOI: 10.18203/2320-1770.ijrcog20202310
      Issue No: Vol. 9, No. 6 (2020)
       
  • Pregnancy outcome of external cephalic version in singleton pregnancy with
           breech presentation at term

    • Authors: Rajesh Kumar Mishra, Shakti Vardhan, Sanjay Singh, Swati Sagarika Panda
      Pages: 2352 - 2355
      Abstract: Background: Breech delivery is associated with poor perinatal outcomes irrespective of the route of delivery. External cephalic version can be a useful tool in management of breech presentation at term by converting it to a cephalic presentation. A study was conducted to evaluate maternal and neonatal outcome of external cephalic version in singleton pregnancies with breech presentation in third trimester.Methods: A prospective observational study was carried out at a tertiary care hospital over a period of 2 years. This study included a total of 65 uncomplicated cases of breech presentation who fulfilled the inclusion criteria. External cephalic version was carried out after 36 weeks of period of gestation in primigravida and after 37 weeks in multigravida women. These patients were followed up till delivery and data was collected and analysed regarding the mode of delivery, maternal and fetal outcome.Results: External cephalic version was successful in 41 patients with a success rate of 63%. Out of them, vaginal delivery could be achieved in 31 cases (75.6%) and LSCS was done for rest of the 10 cases. The success rate was higher in multigravida ladies compared to primigravida ladies. No major procedure related adverse event was noticed in our study.Conclusions: External cephalic version is a very safe and easy procedure which can reduce the rate of cesarean delivery in singleton pregnancies with breech presentation. The results of this study are in favor of wider practice of this procedure in selected cases.
      PubDate: 2020-05-27
      DOI: 10.18203/2320-1770.ijrcog20202311
      Issue No: Vol. 9, No. 6 (2020)
       
  • Eclampsia: a comparative study in a tertiary hospital setting in
           South-South Region of Nigeria

    • Authors: Eugene M. Ikeanyi, Isaac J. Abasi
      Pages: 2356 - 2363
      Abstract: Background: Eclampsia remains a leading cause of maternal and perinatal morbidity and mortality often in settings of poor health seeking behaviour and services. Objective of this study was to determine the incidence, investigate the risk factors, obstetric outcomes and suggest ways of improving the impact of eclampsia.Methods: An analytical observational study on consecutive cases of eclampsia managed in a tertiary hospital setting from 2014 to 2019. For each case of eclampsia recruited the next gestational hypertensive and normotensive cases managed in the period were recruited to serve as controls. Computer statistical software, Chi square for test of associations were used for analysis with statistical significance set at p<0.05.Results: Among 3625 deliveries within the study period were 57 cases of eclampsia; an incidence of 1.57%. Most (74.4%) were antepartum eclampsia. Majority of the eclamptic mothers were unbooked (81.4%), of lower social class (86.0%), poorly educated (81.4%) and nulliparous (58.1%). Eclamptic mothers were more likely to be youth ≤24 years (39.5%), teenagers (25.6%), and unmarried. Twenty-four (55.8%) had abdominal delivery, anaemia (23.3%) and were transfused. Three women died from eclampsia; a case fatality of 6.98%. Twenty-four (55.8%) neonates were preterm, low birth weight (48.8%), intrauterine growth restriction (25.6%), special care baby unit admission (32.6%) and perinatal mortality 13 (30.2%).Conclusions: Eclampsia is still an un-mitigating malady in this study settings with increased maternal and perinatal complications. Nulliparity, low social status, young age and lack of prenatal care appeared significant risk factors. Quality prenatal care, early detection and management of pre-eclampsia will mitigate eclampsia occurrence and severity. Women empowerment is proffered.
      PubDate: 2020-05-27
      DOI: 10.18203/2320-1770.ijrcog20202312
      Issue No: Vol. 9, No. 6 (2020)
       
  • Effect of antenatal retroviral therapy on feto-maternal outcome in human
           immunodeficiency virus seropositive patients

    • Authors: Swati Trivedi, Oby Nagar, Shashank Trivedi, Prasoon Rastogi
      Pages: 2364 - 2369
      Abstract: Background: To study the effect of HIV and duration of ART on term of delivery, newborn birth weight and adverse fetal outcomes.Methods: Prospective comparative study of 40 HIV seropositive pregnant females with varying duration of ART (tenofovir 300 mg + lamivudine 300 mg + efavirenz 600 mg) and HIV seronegative pregnant females attending ANC and delivering in department of obstetrics and gynecology at S. M. S. Medical College, Jaipur, Rajasthan, India.Results: Most HIV seropositive patients were in age group 25 to 30 years and more number were booked in comparison to unbooked. Adverse fetal outcomes were seen more in HIV seropositive patients and they were found to be statistically significant (p=0.029). No relationship could be derived of duration of ART on either the birth weight or term of delivery or adverse fetal outcomes.Conclusions: Maternal HIV infection was significantly found associated with adverse fetal outcome and this was not affected by the use of ART.
      PubDate: 2020-05-27
      DOI: 10.18203/2320-1770.ijrcog20202313
      Issue No: Vol. 9, No. 6 (2020)
       
  • Knowledge of pregnant women on the factors that influence anaemia in
           pregnancy in a rural farming district of the Western Region of Ghana

    • Authors: Kennedy D. Konlan, Roberta M. Amoah, Joel A. Saah, Juliana A. Abdulai, Iddrisu Mohammed, Kennedy Dodam Konlan, Abdul Razak Doat
      Pages: 2370 - 2376
      Abstract: Background: The presence of anaemia in pregnancy is one of the serious public health concerns across the globe especially in developing countries like Ghana. This study assessed pregnant women's knowledge on factors influencing aneamia in pregnancy in a low-income district of Ghana.Methods: A quantitative descriptive cross-sectional study. Data was collected using a pretested questionnaire. 112 pregnant women seeking antenatal care were recruited using systematic sampling technique in the Wassa East district of Ghana. Data were cleaned and entered into SPSS version 22 and analysed into descriptive statistics.Results: Majority of participants; 72.3% did not know the causes of anaemia in pregnancy. Pregnant women (27.7%) indicated nutritional deficiency as a common cause of anaemia; 18.7% of them could identify appropriately at least one sign of anaemia in pregnancy with 28% asserting that pregnancy-related anaemia can affect labour, despite 72% indicating that anaemia could cause maternal mortality. The reasons for irregular ANC attendance included; perceived non importance of ANC (18.8%), financial difficulties (17.9%), health facility inaccessibility (18.8%) and time constraints (44.5%). There was a strong association between knowledge level on the cause of anaemia in pregnancy and the educational level of pregnant women (p=0.005 chi square = 50.289).Conclusions: Lack of knowledge on the importance of antenatal care and financial constraints were among the reasons leading to a surge in anaemia amongst pregnant women in the district. Health providers should incorporate services which enable pregnant women to access valuable information on anaemia prevention in pregnancy.
      PubDate: 2020-05-27
      DOI: 10.18203/2320-1770.ijrcog20202314
      Issue No: Vol. 9, No. 6 (2020)
       
  • Study of endothelial function in pregnant women with gestational diabetes
           mellitus by flow mediated dilation of brachial artery

    • Authors: Nidhi Pandey, Poonam Goel, Anita Malhotra, Reeti Mehra, Navjot Kaur
      Pages: 2377 - 2382
      Abstract: Background: The objective of the study was to assess vascular function in normal pregnant women and women with gestational diabetes and to study its temporal relationship with gestational age at 24-28-week POG and at 36-38-week POG and changes in FMD in postpartum period.Methods: Assessment of vascular function was done at 24-28-week POG, 36-38-week POG and at 6-12-week postpartum by flow mediated dilation of brachial artery in 37 healthy pregnant women and 37 pregnant women with GDM.Results: In GDM group mean FMD at 24-28 weeks of POG, at 36-38 weeks POG was lower as compared to the control group (11.225±6.20,8.464±6.09 versus 14.49±5.21, 10.898±4.12) although the difference in mean FMD in two groups was not statistically significant. It was found that the decrease in FMD at 36-38-week POG as compared to 24-28 weeks POG was statistically significant in both the groups (p<0.001).Conclusions: This study revealed that when endothelial function as assessed by FMD was compared at different period of gestation, the mean decrease in FMD at 36-38-week POG as compared to 24-28-week POG and 6-week post-partum was statistically significant in patients with GDM and as well as the control group, however this trend of change was same in both the groups and was not statistically significant when compared between the two group (GDM versus control). A negative correlation of FMD was found with BMI, and HBA1c, that was stronger in GDM group.
      PubDate: 2020-05-27
      DOI: 10.18203/2320-1770.ijrcog20202315
      Issue No: Vol. 9, No. 6 (2020)
       
  • The use of emergency contraception among female senior high students in
           the Ho municipality of the Volta Region, Ghana

    • Authors: Kennedy D. Konlan, Roberta M. Amoah, Joel A. Saah, Abdul Razak Doat, Kennedy Dodam Konlan, Milipaak Japiong, Juliana A. Abdulai
      Pages: 2383 - 2392
      Abstract: Background: Emergency contraception (EC) is one option for preventing unplanned pregnancy when it is available and properly used. Unsafe abortions are responsible for nearly one third of maternal deaths in sub-Saharan Africa and about quarter of unsafe abortions are among teenagers.Methods: A quantitative descriptive cross-sectional study. Data was collected using a pretested questionnaire. 260 senior high students were selected using a systematic sampling method in the Volta Region, Ghana. Data were cleaned and entered into SPSS version 22 and analysed into descriptive statistics.Results: Respondents acquired awareness about EC from friends (36.9%), family members (5.6%) and the mass media (41.6%). The required time for EC to be taken were stated as immediately after sex (57.9%), 24 hours after sex (1.2%) and (30.6%) did not know. 28.4% of participants indicated they would not use EC in the future as their faith was against it, 18.0% believed EC is ineffective and 24.9% consider it dangerous to their health. Reasons for use of EC included condom slipped (35.7%), inability to be on daily pill (33.7%), forced unprotected sex (8.2%) and miscalculation of the safe menstrual period (22.4%). There was a significant relationship between age and history of use of EC (p=0.000, c2=8.128, n=260).Conclusions: Strengthening education in Senior High Schools on sexual and reproductive health, with special emphasis on emergency contraceptives as a pregnancy preventive procedure will remain imperative to reducing the canker of maternal mortality attributed to adolescent abortions while improving understanding of the appropriate use of EC.
      PubDate: 2020-05-27
      DOI: 10.18203/2320-1770.ijrcog20202316
      Issue No: Vol. 9, No. 6 (2020)
       
  • A prospective study of demographic profile, risk factors and pregnancy
           outcome in Hepatitis B and Hepatitis C virus positive pregnant women in a
           tertiary care centre

    • Authors: Arti Sharma, Shubhra Agarwal, Garima Bajpai, Anupriya Singh, Nikita Agarwal, Shweta Mishra
      Pages: 2393 - 2396
      Abstract: Background: Viral hepatitis is the most common liver disease in pregnancy and is also the most common cause of jaundice in pregnancy in tropical countries. Risk factors for transmission are intravenous drug abuse, surgical and dental procedures done without adequate sterilization of instruments, sexual route etc. Early diagnosis and management can prevent maternal and fetal complications. This study was done to evaluate the frequency, risk factors and pregnancy outcome in hepatitis B virus (HBV) and hepatitis C virus (HCV) positive antenatal women.Methods: This case control study was conducted in Teerthankar Mahaveer Medical College and Research Centre, Moradabad, Uttar Pradesh, India from January 2017 to June 2018 on total 2511 pregnant women. The serum samples were checked for presence of hepatitis B surface antigen (HBsAg) and presence of IgG antibodies to HCV. Analysis of sociodemographic profile, risk factors and pregnancy outcome were done in all HBV and HCV positive women.Results: Out of 2511 pregnant women, 292 were tested positive for hepatitis. Maximum number of women were in the age group of 21-30 years. Most of the seropositive women were multipara. Frequency of positivity was maximum for HCV (67.1%). The risk factors for transmission in study population were intravenous drug abuse, blood transfusion, history of surgery and tattooing.Conclusions: Hepatitis infection rate is increasing. Universal screening for HBV and HCV can be recommended in pregnant women in developing countries. Education and awareness of public and health care workers can reduce the risk of transmission. 
      PubDate: 2020-05-27
      DOI: 10.18203/2320-1770.ijrcog20202317
      Issue No: Vol. 9, No. 6 (2020)
       
  • Comparison of obstetric outcomes with use of two different standard doses
           of oxytocin for induction of labor

    • Authors: Alka Gupta, Rucha Thakare, Madhva Prasad
      Pages: 2397 - 2402
      Abstract: Background: The interventions used in a suspected abnormal labor include amniotomy (artificial rupture of membranes), oxytocin infusion, forceps application and caesarean section. No study is available for individualised treatment with oxytocin. Considering the literature review, many unanswered questions remain regarding the use of oxytocin and definite improvements are possible. All this led us to choose this as the topic for study.Methods: This study was conducted over a duration of 18 months (January 2017 to June 2018) where ninety (90) laboring patients admitted in a tertiary care hospital were included. They were categorized into two groups, one group (30 patients) received the low dose and the other group (60 patients) received high dose oxytocin infusions. The labor outcomes including the maternal and fetal outcomes were observed.Results: The average age in the study population was 26 years and the average gestation was 38 weeks. The overall rate of cesarean section in this study was 16.67% (23.33% in the low dose group and 13.33% in the high dose group). Gravidity and parity have an association with the vaginal delivery.Conclusions: It is safe to use oxytocin infusion either in the low dose or the high dose for induction of labor as both the regimens are equally effective and comparable in terms of outcomes. The low dose oxytocin regimen can be safely recommended in a patient requiring oxytocin infusion for induction of labor and the treating doctor should consider starting with low dose oxytocin. 
      PubDate: 2020-05-27
      DOI: 10.18203/2320-1770.ijrcog20202318
      Issue No: Vol. 9, No. 6 (2020)
       
  • Evaluation of reasons for participation refusal among pregnant women in a
           perinatal outcome research

    • Authors: Vijayan Sharmila, Thirunavukkarasu Arun Babu
      Pages: 2403 - 2407
      Abstract: Background: The number of protocol-eligible patients, refusing to participate in a biomedical research is often not mentioned in the results of the studies. There are no studies that have looked at the data on willingness to participate in a research among pregnant women in India. The aim of this study is to report the number of pregnant women who refused to participate and to evaluate the reasons for not participating in a research that was concerned with swabbing of the genital tract for culture.Methods: A prospective research study was done among healthy pregnant women, that required collection of vaginal swabs for culture to study the vaginal flora. The women eligible to participate in the study were approached for their willingness to participate in the study. The details of women who refused to participate in the study and the various self-reported reasons for their refusal were documented and analysed.Results: A total 48.2% of the total protocol-eligible group refused to participate in the study and the refusal rate was alarmingly higher than expected. Some of the common responses for their refusal include reasons such as the study involved tests from their private parts, lack of interest to participate and the need to discuss with their partner or that their partner wound not allow them to participate in research.Conclusions: It is important for research studies to include data on the refusal to participate and also the reasons why people refuse to participate in research so as to formulate strategies to improve the acceptance rate for participation in research. 
      PubDate: 2020-05-27
      DOI: 10.18203/2320-1770.ijrcog20202319
      Issue No: Vol. 9, No. 6 (2020)
       
  • Prevalence of gestational diabetes mellitus using IADPSG and DIPSI
           criteria: a cross-sectional study

    • Authors: Trupti C. Ruge, Nisha Kanchana
      Pages: 2408 - 2414
      Abstract: Background: Considering the magnitude of adverse pregnancy outcomes related to gestational diabetes, the present study was undertaken to find out the prevalence of gestational diabetes mellitus using the international association of diabetes in pregnancy study groups criteria (IADPSG) and diabetes in pregnancy study group India (DIPSI) criteria to ascertain whether the present practice of diagnosing GDM by the guidelines recommended by DIPSI 21 based on WHO criterion of 2-h PG ≥140 mg/dL can still be followed in this study settings or adopt IADPSG recommendation.Methods: This study was done at Antenatal Clinic, department of obstetrics and gynecology, KLES Dr Prabhakar Kore Hospital, Belgaum from January 2013 to December 2013. A total of 225 pregnant women between 24 to 28 weeks gestations were studied. Diagnosis and the prevalence of GDM were assessed by applying both DIPSI and IADPSG criteria.Results: Most of the women (58.11%) were between 22 to 25 years and the mean age was 23.78±3.38 years. Based on the IADPSG criteria, the prevalence of GDM was 19.11% and by applying DIPSI criteria, prevalence of GDM was 16.89%. The difference in diagnostic capability between IADPSG and DIPSI was found to be 2.8% and the kappa statistics showed good strength of agreement between the two tests (p>0.302; Kappa=0.774).Conclusions: It was concluded that, the diagnosis GDM based on DIPSI is as effective as IADPSG criteria. Further, in resource poor countries like India, DIPSI procedure would be used with an advantage of being less costly and without compromising the clinical equipoise. 
      PubDate: 2020-05-27
      DOI: 10.18203/2320-1770.ijrcog20202320
      Issue No: Vol. 9, No. 6 (2020)
       
  • A prospective observational study of role of epidural in trial of labour
           after cesarean section in view of maternal and neonatal outcome in a
           tertiary care hospital

    • Authors: Jothi Sundaram, Divya Vinoth, Malathi Sriram
      Pages: 2415 - 2419
      Abstract: Background: In a well-equipped hospital, trial of vaginal delivery is done in selected cases of previous C-section (CS). Epidural analgesia administration has been proved to be good adjunct in trial of labor after caesarean (TOLAC).Methods: This study is a prospective observational study done in a tertiary care institution in Tamil Nadu from May 2019 to July 2019. 50 cases with previous history of one CS were selected. Single ton pregnancy, previous transverse lower segment cesarean section admitted cases with adequate pelvis with no other co-morbidities were selected. Epidural analgesia was administered once mother was in established labor. TOLAC was continued till satisfactory progress and emergency repeat caesarean was taken in case of Suspected scar dehiscence (SSD) or abnormal fetal heart rate tracings. Quantitative data was expressed in mean and standard deviation. For qualitative data percentage was used.Results: In 50 cases observed the mean age of the cases was 26±3.64 years. TOLAC was successful in 41 (82%) mothers out of 50. The mode of delivery in 41 TOLAC mothers was found to be forceps in 18 cases (36%) and ventouse delivery 18 cases (36%). Only 9 cases had needed emergency CS (18%). The major indication for CS in TOLAC was found to be fetal distress in 4 number of cases (8%). 43 babies delivered were healthy, 6 babies (12%) admitted in NICU.Conclusions: With the application of epidural analgesia on attempted vaginal delivery in previous cesarean, vaginal delivery was 82% cases.
      PubDate: 2020-05-27
      DOI: 10.18203/2320-1770.ijrcog20202321
      Issue No: Vol. 9, No. 6 (2020)
       
  • Dengue in pregnancy, maternal and fetal outcome: a case series managed at
           a Zonal Hospital

    • Authors: Tina Singh, S. M. Singh, M. M. Paprikar
      Pages: 2420 - 2423
      Abstract: Background: Dengue is a vector borne disease with various grades of severity. Pregnancy is a high-risk group and is prone for complications of dengue haemorrhagic fever. The aim of this study was to evaluate the clinical profile of pregnant patients with dengue and to assess the maternal and fetal outcomes of dengue in pregnancy.Methods: All pregnant patients reporting to the hospital with fever and serologically confirmed dengue infection were included in the study. Clinical and laboratory data of patients were collected. The cases were followed up till their delivery to monitor the effect of dengue. An account of the mode of delivery in these patients was made. The neonates were evaluated and followed up till 6 weeks of life.Results: A total 100% patients reported with fever and serologically confirmed dengue infection. 15% had severe thrombocytopenia requiring platelet transfusion. 31% required ICU care and 15% needed mechanical respiratory support due to severe complications of dengue. NICU admission rate was 30% but there was no major neonatal complication or vertical transmission noted. A high index of suspicion should be maintained by the clinician with an aim to identify infection early, start supportive treatment and evaluate for complications. In-patient care should be provided for feto-maternal monitoring.Conclusions: The progression of dengue infection in pregnancy was rapid leading to major complications. Close materno-fetal monitoring and timely obstetric care are essential to ensure a favorable pregnancy outcome
      PubDate: 2020-05-27
      DOI: 10.18203/2320-1770.ijrcog20202322
      Issue No: Vol. 9, No. 6 (2020)
       
  • Study of clinical characteristics of women with polycystic ovarian
           syndrome

    • Authors: Jeevanthy P. Upadhya, Supriya Rai, Shrikrishna V. Acharya
      Pages: 2424 - 2428
      Abstract: Background: Polycystic ovarian syndrome (PCOS) is one of the most common endocrinal disorders of the reproductive age group causing anovulation, infertility incidence being 8.7-17.8%. It is associated with obesity, insulin resistance, dyslipidaemia and metabolic syndrome. This study was aimed to study the different clinical characteristics of women diagnosed with PCOS, attending a tertiary care hospital outpatient department.Methods: This was a hospital-based cross-sectional observational study of 200 patients with PCOS meeting the revised Rotterdam criteria from January 2018-June 2019 excluding pregnant and women with other systemic disorders. A detailed history and examination done, data collected regarding menstrual complaints, features of hyperandrogenism, hirsutism, acne, oily skin and Acanthosis Nigricans (AN) was documented. All data were statistically analyzed and compared using the chi-square or fissures’ exact test. p-value <0.05 considered significant.Results: A total of 200 patients with PCOS were included in the study, of which 41% were obese, 18% lean. The mean age was 24.44±5.62 years. Menstrual complaints were present in 88% -oligomenorrhea (49%) being the most common. 59% had hirsutism,38% of severe grade. Acanthosis nigricans was present in 33% of the patients. Correlation between hirsutism and alopecia, waist to hip ratio (WHR); acanthosis and WHR were statistically significant.Conclusions: PCOS is an ill-defined symptom complex where ethnicity plays a vital role, hence creating a greater need to know the characteristics of the syndrome in different populations and ethnicity. All women presenting with oligomenorrhea or other menstrual complaint should be investigated for PCOS and treated accordingly. The syndrome usually occurs with multiple characters. Though obesity is common in PCOS, non-obese are also at risk. The prevalence of AN and Hirsutism in PCOS were comparable. This mandates a need to increase awareness regarding the syndrome in the general population.
      PubDate: 2020-05-27
      DOI: 10.18203/2320-1770.ijrcog20202323
      Issue No: Vol. 9, No. 6 (2020)
       
  • Prophylactic and emergency cesareans: a comparative study on 718
           observations at the maternity ward of Ignace Deen National hospital

    • Authors: Ibrahima S. Balde, Roland Adjoby, Mamadou Hady Diallo, Ousmane Balde
      Pages: 2429 - 2436
      Abstract: Background: The objective of the study is to compare the frequency, the socio-demographic characteristics, the indications, the fetal maternal prognosis and the Robson classification of prophylactic and emergency caesarean sections.Methods: This was a comparative study of prophylactic and emergency caesarean sections at the maternity of Ignace Deen national hospital. It was a 12 month (July 1, 2016 to June 30, 2017) descriptive and analytical study.Results: Prophylactic caesarean sections accounted for 12, 51% of caesarean sections and 3.96% of deliveries at the ward. Prophylactic caesarean sections involved pregnant women aged from 20 to 29, holder of higher education degrees (51.54%), married (92.76%) employed (56.83%) and whose prenatal visit was provided by the obstetrician (73.54%). While the emergency caesarean section concerned parturient aged between 20 and 34, mostly non-schooled (36.49%), transferred patients (80.22%) and nulliparous (58.5%). Surgical indications were mainly scarred uterus (32.32%) and maternal pathologies (18.11%) prophylaxis; bleeding in the last quarter (25.90%) acute fetal distress (20.33%) in emergency. Groups 6 and 5 of the Robson classification were the most represented with a 2.23% morbidity and a zero maternal lethality in prophylaxis versus groups 5 and 6 with a 10.03% morbidity and a 1.67% maternal lethality in emergency.Conclusions: Improving this prognosis would be achieved through an increase in the frequency of prophylactic caesarean sections.
      PubDate: 2020-05-27
      DOI: 10.18203/2320-1770.ijrcog20202324
      Issue No: Vol. 9, No. 6 (2020)
       
  • A comparative study of ferric carboxymaltose and iron sucrose as a
           parenteral iron treatment in iron deficiency anaemia during pregnancy

    • Authors: Alpesh R. Patel, Vipul S. Patel, Parth R. Patel
      Pages: 2437 - 2441
      Abstract: Background: Iron deficiency anemia during pregnancy is a serious global concern specially in developing country, which is preventable with effective measures. In women who cannot tolerate oral iron or have moderate to severe anemia, parenteral iron in the form of iron sucrose or ferric carboxymaltose can be very much useful. This study aimed to compare efficacy and safety of iron sucrose and ferric carboxymaltose in iron deficiency anemia during pregnancy.Methods: This prospective interventional comparative study was conducted during May 2016 to April 2018 at tertiary care hospital and total 100 antenatal women from 28 to 34 weeks of gestation having moderate to severe anemia were included in this study and all women were divided in to 2 groups randomly and were given either iron sucrose or ferric carboxymaltose according to iron requirement. Rise in haemoglobin and serum ferritin were noted and data analysed statistically.Results: The mean rise of haemoglobin with iron sucrose was 1.8 gm% and with ferric carboxymaltose was 2.6 gm%. The mean rise of serum ferritin with iron sucrose was 82.4 ng/ml and with ferric carboxymaltose was 100.9 ng/ml. Other than minimal local reaction one woman had developed severe anaphylactic reaction after receiving iron sucrose.Conclusions: Intravenous ferric carboxymaltose is better and safe molecule than iron sucrose and it has advantage of ability to administer large dose in single sitting which reduce overall cost of therapy.  Hence ferric carboxymaltose is a drug of choice as parenteral iron therapy in iron deficiency anemia during second trimester of pregnancy. 
      PubDate: 2020-05-27
      DOI: 10.18203/2320-1770.ijrcog20202325
      Issue No: Vol. 9, No. 6 (2020)
       
  • Asymptomatic bacteriuria in pregnancy: what is the validity of urine
           sediment microscopy as a screening tool in a low resource setting'

    • Authors: Rashmi Polnaya, Amritha Bhandary
      Pages: 2442 - 2445
      Abstract: Background: Asymptomatic bacteriuria in pregnancy should be screened and treated to reduce the risk of morbidity and mortality. Urine culture is the recommended test. In low resource setting with large patient load urine culture in all pregnant patients is not feasible. In this study authors have assessed the validity of urine microscopy in the screening of asymptomatic bacteriuria in pregnancy.Methods: Midstream clean catch urine specimen collected from 675 pregnant women was subjected to urine sediment microscopy and culture. It was considered screen positive if pus cells were >5/HPF. Asymptomatic bacteriuria was diagnosed if there were >/=100000 CFU of a single uropathogen per ml. Results obtained were statistically analysed for the prevalence of asymptomatic bacteriuria, sociodemographic and medical risk factors, causative organisms, antibiotic sensitivity and validity of urine sediment microscopy in detecting asymptomatic bacteriuria.Results: The incidence of asymptomatic bacteriuria in our study was 10.2%. The incidence was higher in the age group between 20-30 years, in gravida 3 and above, in upper lower and lower socioeconomic status, in women with hyperglycemia in pregnancy and anaemia. E. coli was the commonest bacterial isolate in culture positive cases. Bacterial isolates had poor sensitivity for Ampicillin, amoxicillin and nitrofurantoin and good sensitivity for cephalosporins and aminoglycosides. The sensitivity, specificity, positive and negative predictive values for urine microscopy was 43%, 85%, 25% and 93% respectively.Conclusions: This study shows poor sensitivity and positive predictive value and good specificity and negative predictive value.
      PubDate: 2020-05-27
      DOI: 10.18203/2320-1770.ijrcog20202326
      Issue No: Vol. 9, No. 6 (2020)
       
  • Evaluation of complication during third stage of labour at tertiary care
           center

    • Authors: Komal K. Rangholiya, Saumya P. Agrawal, Sapana R. Shah, Hetal Dodiya
      Pages: 2446 - 2451
      Abstract: Background: The objective of the present study was to determine the maternal outcome of complications of third stage of labour and to determine the risk factors and evaluate the management protocols for these complications.Methods: This is retrospective study of maternal outcome with complications of third stage of labour carried out at tertiary care centre from June 2016 to December 2019. Patients who developed any complications of third stage of labour after vaginal delivery or caesarean section were included.Results: Complications observed during third stage of labour were atonic PPH 0.82% (74 cases), traumatic PPH 0.55% (50 cases), retained placenta (including placenta accreta spectrum) 0.21% (19 cases), secondary PPH 0.03% (3 cases), uterine inversion 0.03% (3 cases) and amniotic fluid embolism 0.01% (1 case). Maximum cases were seen in 18-24 years of age group. Only 36% patients having atonic PPH responded to medical treatment, 46% patients having atonic PPH responded to conservative surgery, 18% of patients required radical surgery.Conclusions: Third stage complications are potentially life threatening. Associated conditions for third stage complication are high parity, anemia, hydramnios, multiple pregnancy, malpresentation, placenta previa, and adherent placenta. Early anticipation and early intervention with proper planning is required to reduce the maternal morbidity and mortality in third stage complication.
      PubDate: 2020-05-27
      DOI: 10.18203/2320-1770.ijrcog20202327
      Issue No: Vol. 9, No. 6 (2020)
       
  • Association of polycystic ovarian syndrome and metabolic syndrome in
           Tripura, India

    • Authors: Ipsita Batra, Jahar Lal Baidya, Mamata Pradhan
      Pages: 2452 - 2456
      Abstract: Background: A total 4-11% of women in India are affected by PCOS. Studies show that incidence and prevalence is increasing. It is a constellation of metabolic and endocrine abnormalities with significant cost to quality and quantity of life. Aim of this study was to find out the association of metabolic syndrome with PCOS. Objectives of this study were identified subjects suffering from PCOS and measure strength of association of metabolic syndrome.Methods: Case-control study conducted in the department of Obstetrics and Gynaecology Agartala Government Medical College, Agartala, Tripura from January 2017 to June 2018. Fifty cases were diagnosed by Rotterdam criteria and 50 cases age matched controls were recruited. Hundred subjects underwent evaluation for metabolic syndrome according to ESHRE/ASRM criteria. Statistical analysis was done using SPSS 17.0.Results: Mean age was 19.4±3.5 years. Oligomenorrhea found in 42 out of 50 cases. Hirsutism found in 54% of cases. There is a statistically significant difference in weight, BMI and waist circumference among PCOS cases and controls. Hypertriglyceridemia was found to be significantly higher among PCOS cases. Fasting glucose and 2-hour OGTT were found to be statistically significantly different. No association was found between metabolic syndrome and clinical hyperandrogenism, but metabolic syndrome was significantly associated with higher BMI. BMI, Hip circumference and oral glucose tolerance test were independent predictors of polycystic ovarian syndrome. Metabolic syndrome was present in 34% of cases. The odds ratio of having metabolic syndrome in a case of PCOS is 5.92.Conclusions: Association between PCOS and metabolic syndrome is statistically significant. The two entities are intrinsically linked to each other and early identification of one may lead to the diagnosis and management of the other.
      PubDate: 2020-05-27
      DOI: 10.18203/2320-1770.ijrcog20202328
      Issue No: Vol. 9, No. 6 (2020)
       
  • Efficacy of betadine vaginal toileting before caesarean section in
           postoperative infections

    • Authors: Tarang Preet Kaur, Asmita M. Rathore, Latika Sahu
      Pages: 2457 - 2462
      Abstract: Background: The objective of the current study was to evaluate the efficacy of preoperative betadine vaginal toileting in reducing post caesarean infections (endometritis, febrile illness, wound sepsis).Methods: This prospective longitudinal study was conducted at Maulana Azad Medical College, New Delhi over 3 months among 200 women who underwent caesarean delivery. Inclusion criteria were defined as women undergoing caesarean section. Exclusion criteria included placenta previa, active genital herpes, cord prolapse, chorioamnionitis, allergy to iodine. After taking informed consent, subjects were divided into two groups by simple randomization method using computer generated random numbers- Group 1 (case) - subjects who underwent 5% povidone iodine sponge stick cleansing in all the fornices and walls of vagina for 30 seconds after foley’s catheter insertion and before abdominal scrubbing. Group 2 (control) - subjects who didn't receive betadine vaginal toileting before caesarean section Subjects were followed for 10 days postpartum (or till suture removal/ discharge from hospital, whichever was late). Demographic data, operative details and postoperative parameters were compared between the two groups.Results: Both groups were matched for baseline patients’ characteristics (age, BMI, gestational age, operative time). Women who received preoperative betadine vaginal toileting had markedly less incidence of endometritis (case-3%, control-10%, p<0.05), overall postoperative morbidity (case-13%, control-33%, p<0.001). Incidence of postoperative febrile illness (case-6%, control-12%, p>0.05) and wound sepsis (case-5%, control-12%, p>0.05) were found to be less but not significant between both groups.Conclusions: Preoperative vaginal cleansing helps in reducing postoperative morbidity by decreasing incidence of postoperative infection.
      PubDate: 2020-05-27
      DOI: 10.18203/2320-1770.ijrcog20202329
      Issue No: Vol. 9, No. 6 (2020)
       
  • Evaluation of clinical outcome of post placental insertion of Cu T 380 A
           in women undergoing caesarean delivery

    • Authors: Dineshwar Singh, Sita Thakur, Ajay Sood
      Pages: 2463 - 2469
      Abstract: Background: The objective of the study was to evaluate clinical outcome of insertion of post placental Cu T 380 A in women undergoing caesarean delivery.Methods: A prospective observational study was carried out in the department of obstetrics and gynecology, Dr RPGMC Kangra at Tanda (Rural Medical College) to evaluate the clinical outcome of post placental Cu T 380 A insertion in women undergoing caesarean section after taking approval of protocol review and institutional ethics committee of the institution. A total of 104 women delivering by caesarean section and wanting post-placental intra-caesarean Cu T 380 A insertion and who were meeting WHO standard medical criteria for PPIUCD insertion and were willing to comply with the study protocol was recruited for the study.Results: The present study showed that there were no major complications and only minor side effects were like pain, fever, discharge and irregular bleeding which were observed in only 5-15% of women during hospital stay and during follow up visit up to 6 months. String became visible in 72.12% of women at the 6 weeks follow up visit. The string visibility increased with time and at 6 months follow up stings became visible in 90.81% of the cases. Continuation rate was 100% at 6 weeks post-partum follow up. After that spontaneous expulsion occurred in 4 cases (3.84%) and another 4 women (3.84%) requested removal for various reasons leading to continuation rate of 92.3% at six months post-partum follow up. There was no case of pregnancy with Cu T in situ with no failure at the end of study at six months post-partum.Conclusions: Intra caesarean insertion of PPIUCD is practical, convenient, safe, effective and acceptable contraceptive method for spacing of the birth in this rural setting.
      PubDate: 2020-05-27
      DOI: 10.18203/2320-1770.ijrcog20202330
      Issue No: Vol. 9, No. 6 (2020)
       
  • A comparative study of intramuscular sulfate versus intravenous magnesium
           injection among eclampsia patients in Eastern, Uttar Pradesh, India

    • Authors: Uzma Kauser, Anjali Chaudhari
      Pages: 2470 - 2475
      Abstract: Background: Hypertensive in pregnancy is the second most common cause of maternal mortality in India. Among the hypertensive disorders that complicate pregnancy, pre-eclampsia and eclampsia stand out as major causes of maternal and perinatal mortality and morbidity. The majority of deaths due to pre-eclampsia and eclampsia are avoidable through the provision of timely and effective care to the women presenting with these complications. Objectives of this study were to find out the effectiveness of intravascular and intramuscular magnesium sulfate in management of eclampsia. To compare the side effects and complications of intravascular and intramuscular magnesium sulfate in management of eclampsia.Methods: A total 100 patients presenting with eclamptic fits reporting to the center that has been included in the study. The study has been conducted in the labor room of Nehru Chikitsalaya of B. R. D. Medical College, Gorakhpur, Uttar Pradesh for 12 months duration period. Statistical analysis of observations has been done by Chi-square test with p-value <0.05 has been considered in the study.Results: Majority of eclampsia patients belonged to 20-25 years age group (63%) followed by above 30 years of age (22%).  Nearly 16% patients in IM MgSO4 group and 12% patients in IV MgSO4 received recurrence of seizure after starting of treatment (p value >0.5). About 26% patients in IM MgSO4 group and 18% patients in IV MgSO4 group had mild side effects of MgSO4 but no patients in both the group had major side effects of MgSO4.Conclusions: The study concludes that intramuscular injection of MgSO4 is painful and the chances of abscess formation that's why compliance of intramuscular MgSO4 is not very good in compared to intravascular infusion of MgSO4. The chances of Mg toxicity are more MgSO4 regimen because of the dose required in IM MgSO4 regimen is more (44gm) that of IV MgSO4 (28 gm).
      PubDate: 2020-05-27
      DOI: 10.18203/2320-1770.ijrcog20202331
      Issue No: Vol. 9, No. 6 (2020)
       
  • An observational study of fetomaternal outcome in euthyroid women with
           anti-thyroid peroxidase antibodies at tertiary care hospital

    • Authors: Harendra K. Netra, Reena Pant, Krishna P. Banerjee
      Pages: 2476 - 2481
      Abstract: Background: Several changes are observed in maternal thyroid function during pregnancy and failure to adapt to these physiological changes results in thyroid dysfunction, especially if complicated by the presence of thyroid antibodies. The presence of TPO-Ab is associated with increased rate of pregnancy complications such as miscarriage, preterm delivery, placental abruption, pregnancy-induced hypertension, intrauterine death and low birth weight. Objective of this study was to study the effect of anti-TPO Ab positivity on pregnancy outcome and estimate the prevalence of anti-TPO Ab in euthyroid obstetric women.Methods: This observational study enrolled 500 euthyroid pregnant women, age 20-35 years, up to 20 weeks gestation. Venous blood samples collected and analyzed for the anti TPO Ab levels. On the basis of anti TPO Ab positivity they were divided into two groups, anti-TPO Ab positive and Ab negative group. These two groups were followed up till delivery or abortion and compared for maternal and fetal outcomes.Results: Prevalence of anti-TPO antibody positivity was 5.2% in euthyroid obstetric women. Most of anti-TPO Ab positive women were overweight. There were higher numbers of miscarriage (11.54%) in anti-TPO Ab positive euthyroid pregnancies than (2.53%) in antibody negative women. Incidence of low birth weight babies was 4-fold higher in anti-TPO Ab positive women. More than two-fold increase in incidence of placental abruption in anti-TPO Ab positive women. Parity, anaemia, gestational hypertension, preeclampsia, GDM, PROM, PPH, low Apgar scores, NICU admission, IUD and neonatal death were not significantly associated with anti-TPO Ab positivity.Conclusions: Anti TPO Ab positivity significantly associated with pre-pregnancy BMI, miscarriage rates and low birth weight of newborns. 
      PubDate: 2020-05-27
      DOI: 10.18203/2320-1770.ijrcog20202332
      Issue No: Vol. 9, No. 6 (2020)
       
  • A prospective study to know the efficacy of short-term use of injectable
           depot medroxy progesterone acetate for contraception in tertiary care
           hospital from North West Rajasthan, India

    • Authors: Swati Kochar, Arun Kumar, Ankur Nama, Neha Suthar
      Pages: 2482 - 2485
      Abstract: Background: Population explosion is a major issue especially in our country with the second largest population in world next only to china starting the use of contraception in postpartum period is an effective method of increasing the gap between two pregnancies and hence reducing the family size. Objective was to study the efficacy of DMPA injection in postpartum period for contraception.Methods: The study was a prospective study conducted on 100 patients during June 2018 to May 2019 in the department of obstetrics and gynaecology, S. P. Medical College Associate A. G. H., Bikaner, Rajasthan, India.Results: In present study mild irregular bleeding was present in 21, 35 and 38 cases at initial visit, at 3 months and at 6 months follow up respectively. Moderate irregular bleeding was present in 8 cases at initial visit, 27 cases at 3 months and 18 cases at 6 months follow up while 37 and 43 cases had severe irregular bleeding at 3 and 6 months follow up respectively. At baseline, 89 and 10 and 1 cases had their blood sugar <100, 100-120 and >120 respectively, at 3 months follow-up, 94, 6 and 0 cases had their blood sugar level <100, 100-120 and >120 respectively while at 6 months follow-up 97, 3 and 1 cases had their blood sugar level <100, 100-200 and >200 respectively.Conclusions: Injection DMPA use in postpartum period is safe, effective and reversible method with no deleterious metabolic effects and do not need special training to administer to it, so it is a good option of contraception for women who are lactating. 
      PubDate: 2020-05-27
      DOI: 10.18203/2320-1770.ijrcog20202333
      Issue No: Vol. 9, No. 6 (2020)
       
  • A study to assess proportion of the maternal near miss to maternal death
           in a tertiary care teaching hospital of North East India

    • Authors: Pradip Sarkar, Jahar Lal Baidya, Ashis Kumar Rakshit
      Pages: 2486 - 2491
      Abstract: Background: The objective of present study was to assess the proportion of maternal near miss and maternal death and the causes involved among patients attending obstetrics and gynaecology department of Agartala Govt. Medical College of North Eastern India.Methods: Potentially life-threatening conditions were diagnosed, and those cases which met WHO 2009 criteria for near miss were selected. Maternal mortality during the same period was also analyzed. Patient characteristics including age, parity, gestational age at admission, booked, mode of delivery, ICU admission, duration of ICU stay, total hospital stay and surgical intervention to save the life of mother were considered. Patients were categorized by final diagnosis with respect to hemorrhage, hypertension, sepsis, dystocia (direct causes) anemia, thrombocytopenia, and other medical disorders were considered as indirect causes contributing to maternal near miss and deaths.Results: The total number of live births during the study period (January 2017 to June, 2018) was 9378 and total maternal deaths were 37 with a maternal mortality ratio of 394.5/1 lakh live births. Total near miss cases were 96 with a maternal near miss ratio of 10.24/1000 live births. Maternal near miss to mortality ratio was 2.6. Of the 96 maternal near miss cases - importantly 20.8% were due to haemorrhage, 19.8% were due to hypertension, 13.5% were due to sepsis, and 11.5% were due to ruptured uterus. In maternal death group (n-37), most important causes were hypertensive (40.5%) followed by septicemia (21.6%), haemorrhage (10.8).Conclusions: Haemorrhage, hypertensive disorders and sepsis were the leading causes of near miss events as well as maternal deaths.
      PubDate: 2020-05-27
      DOI: 10.18203/2320-1770.ijrcog20202334
      Issue No: Vol. 9, No. 6 (2020)
       
  • Analysis of epidemiological factors for pelvic floor defects in Indian
           women

    • Authors: Maitreyee S. Parulekar, Shashank V. Parulekar
      Pages: 2492 - 2497
      Abstract: Background: Pelvic floor defects is one of the commonest conditions requiring gynecological reference. This study was aimed at evaluation of epidemiology which would help us in having a better understanding regarding the prevalence, risk factors, the natural course and associated complications of the disease in Indian women where the number of women presenting with pelvic floor defects is on a rise but there is a considerable lack of research in literature as compared to the western population.Methods: It was an observational, non-interventional, prospective type of study including 88 patients over a period of 3 years at the department of obstetrics and gynecology at a tertiary hospital in Mumbai, Maharashtra, India.Results: The mean age of the patients was 52.38±11.35 years, 54 (61.36%) of the patients were of postmenopausal age group. The mean duration for which the complaints were present were 48±6.73 months. Seventy-six patients (86.83%) presented with complaints of mass per vagina, 22 patients (25%) had history of prolonged labor and 9 patients (10.2%) had history of instrumental delivery. Eighty-six women (97.72%) had history of all vaginal deliveries and only 4 (4.54%) patients had history of a caesarean section. Forty-four patients (55.69%) of patients had grade 3 utero-vaginal descent, 74 patients (84.09%) presented with cystocele and 79 (89.77%) of the patients presented with rectocele.Conclusions: This paper provides an insight into the factors affecting the prevalence of this disease in Indian women and the unique differences from other populations.
      PubDate: 2020-05-27
      DOI: 10.18203/2320-1770.ijrcog20202335
      Issue No: Vol. 9, No. 6 (2020)
       
  • Prevalence and distribution of various human papillomavirus genotypes in
           women with high risk for cervical carcinoma

    • Authors: Sheenu Maheshwari, Ruchira Nautiyal, Aarti Kotwal, Smita Chandra
      Pages: 2498 - 2503
      Abstract: Background: In India, cervical cancer is second most common cancer in women and is the second most common cause of death due to cancers in women. Human papillomavirus (HPV), mainly genotype 16 and 18, are responsible for most of the precancerous lesions of cervix and for cervical cancer. Therefore, it is necessary to prevent the spread of HPV infection and its early treatment to decrease cervical cancer associated morbidity and mortality. Aims of this study was to find out the prevalence and distribution of various HPV genotypes in women high risk for cervical carcinoma. To find correlation between HPV DNA test and cytology report.Methods: An observational study was done on a total of 384 women who were at a high risk for cervical cancer.  Ectocervix and endocervix samples for conventional cytology along with cervical swab collection for HPV DNA isolation were obtained from women aged 21-65 years. Multiplex real time PCR used for HPV DNA isolation and genotyping and Bethseda classification 2014 was used for reporting cytology. Statistical analysis was done using SPSS version 22 and Microsoft excel 2010 software. Data assessment was done using independent t-test, Chi-square test or Fisher’s exact test.Results: Prevalence of HPV in women high risk for cervical cancer in our study was 14.58%. Most common high-risk genotypes were HPV 18 (7.03%) followed by HPV 16 (6.51%). All genotypes except genotype 31, were more frequently seen as a single infection rather than a multiple infection. In 323 subjects which were negative for Pap smear, 31 were positive for HPV DNA showing a statistically significant result with a p value of <0.0001.Conclusions: It was analysed that infection with HPV is very common (9.60%) even in women who had a negative Pap smear test showing a positive correlation between the two tests. HPV DNA testing can improve the detection rate of cervical intraepithelial lesions.
      PubDate: 2020-05-27
      DOI: 10.18203/2320-1770.ijrcog20202336
      Issue No: Vol. 9, No. 6 (2020)
       
  • Comparative study of mifepristone versus balloon catheter for cervical
           ripening and induction of labour in previous caesarean section

    • Authors: Krishna Dahiya, Nisha Yadav, Pushpa Dahiya, Isha Nandal
      Pages: 2504 - 2507
      Abstract: Background: The objective of this present study was to compare the efficacy of oral mifepristone and balloon catheter for cervical ripening and induction of labour in women with previous caesarean section.Methods: This prospective study was conducted on 130 pregnant women with previous 1 caesarean section and term singleton pregnancy admitted for induction of labour. Sixty-five patients were induced with oral mifepristone (Group 1) and in another 65 transcervical balloon catheter (Group 2) was inserted for induction of labour. Both groups were than compared with respect to change in bishop score, induction to active phase interval, induction to delivery interval, dose of oxytocin in milliunits, mode of delivery, maternal complication and fetal outcomes.Results: Change in bishop score after induction was more in mifepristone group than balloon catheter group (p=0.002). Favorable bishop score was more in Group 1 (83.07%) than Group 2 (66%), p=0.05. There was significant difference in mode of delivery between two groups, 61.53% in Group 1, and 32.3% in Group 2 delivered vaginally (p<0.001).Conclusions: Present study showed that mifepristone is an alternative to balloon catheter for induction of labour in women with previous one caesarean section with poor bishop score.
      PubDate: 2020-05-27
      DOI: 10.18203/2320-1770.ijrcog20202337
      Issue No: Vol. 9, No. 6 (2020)
       
  • Acute kidney injury and its outcome in obstetrics

    • Authors: Dipal C. Shah, Babulal S. Patel, Akshay C. Shah, Shashwat K. Jani, Saumya P. Agrawal, Vismay B. Patel, Adwait B. Patel
      Pages: 2508 - 2511
      Abstract: Background: Acute kidney injury occurring during pregnancy, labour, delivery, and/or postpartum period. Proper management of AKI (acute kidney injury) is challenging because (i) both maternal and fetal health must be considered and (ii) the cardiovascular and renal adaptations of pregnancy add to the complexity for management.Methods: The objective of this study was to study association and contributing factors in AKI, a retrospective study of 20 cases of AKI complicating pregnancies carried out in department of obstetrics and gynecology, SVPIMSR over a period of 12 months and results were studied and analysed. Etiological factors, associated liver pathology, coagulation abnormality, thrombocytopenia, sepsis, recovery status and fetomaternal outcome were studied and tabulated. AKI was analysed in terms of maximal stage of renal injury attained as per risk, injury, failure, loss of function, and end-stage renal disease (RIFLE) criteria.Results: The incidence of ARF (acute renal failure) in pregnancy was about 0.3%. Hypertensive disorders were the major causative factor. Amongst the 20 cases, 8 cases were referred from outside and two of them died. Total 5 of 20 cases required hemodialysis and two of them had partial recovery.Conclusions: AKI complicating pregnancies are not uncommon. If recognized and treated promptly, recovery is assured in majority of cases. Early identification and prompt management of pre-eclampsia and sepsis can prevent majority of cases. Ultrasonography revelation of placenta previa or abruption helps in early management eventually decreases the chances of bleeding which is one of the causes of AKI (pre-renal cause).
      PubDate: 2020-05-27
      DOI: 10.18203/2320-1770.ijrcog20202338
      Issue No: Vol. 9, No. 6 (2020)
       
  • Lomiphene citrate versus letrozole as first line ovulation induction drug
           in infertile anovulatory polycystic ovarian syndrome women: a prospective
           randomized controlled trial

    • Authors: Monica Soni, Jeevika Gupta, Arti Meena
      Pages: 2512 - 2515
      Abstract: Background: The present study was design to compare letrozole (5 mg) and clomiphene citrate (100 mg) as first line ovulation induction drug in infertile anovulatory polycystic ovarian syndrome (PCOS) women.Methods: This prospective randomized clinical trial included 60 cases of PCOS with anovulatory infertility. The first group comprised of 30 patients who received 5 mg letrozole daily and the second group received 100 mg clomiphene citrate daily for 5 days starting on day 2-5 of menses. Both the groups were followed by ultrasound for follicle monitoring, ovulation and endometrial thickness. When dominant follicle reaches a diameter of more than or equal to 18mm and endometrial thickness ≥7.5 mm, human chorionic gonadotrophin (hCG) 5,000 IU was given intramuscularly and timed intercourse was advised. Main outcome measures were occurrence of ovulation, endometrial thickness and pregnancy rates.Results: The mean age, body mass index, and number of cases of primary and secondary infertility in both the groups showed no statistically significant difference. Multi-follicular development during induction was statistically significantly greater in the clomiphene group (1.27±1.11 versus 2.03±1.65; p=0.041). Ovulation occurred in 24 subjects (80%) in letrozole group and 18 subjects (60%) in the clomiphene group, with a statistically significant difference between the two groups (p=0.024). Pregnancy occurred in 16 subjects (53.33%) in letrozole group and 7 subjects (23.33%) in clomiphene group, which shows statistically significant difference between the two groups (p=0.048).Conclusions: Though number of developing follicles was found statistically significant with clomiphene citrate but ovulation rate and pregnancy rate were higher with letrozole group. Therefore, letrozole is a safe and better alternative for ovulation induction in patients of anovulatory PCOS, and it may be considered as a first line treatment for ovulation induction in these patients. 
      PubDate: 2020-05-27
      DOI: 10.18203/2320-1770.ijrcog20202339
      Issue No: Vol. 9, No. 6 (2020)
       
  • Retrospective study of multiple factors imparting effect on pregnancy
           outcomes in an in-vitro-fertilization centre

    • Authors: Preksha T. Singh, Shreyans D. Singhvi, Utkarsh Kachhia, Trishala Punjabi, Shital Punjabi, Rajesh Punjabi
      Pages: 2516 - 2519
      Abstract: Background: Assisted reproductive technology (ART) cycles include in vitro fertilization of the sperm and ovum and transferring the embryo formed into the uterus of the patients. In ART cycles, there is still a shroud of doubt regarding the pregnancy outcomes of embryo transfer on day 3 versus the embryo transfers on day 5 as well the better pregnancy outcome with fresh versus frozen embryo transfer and the number of embryos transferred. This study is aimed to evaluate these factors and study the way to optimize methods to obtain highest pregnancy outcomes.Methods: A retrospective study was performed of 87 patients who had undergone embryo transfers during the duration of the study from an IVF centre in Ahmedabad. Multiple factors were studied and the clinical outcome was tabulated. The pregnancy outcomes were compared using the values of beta- hcg (human chorionic gonadotropin). The data was compiled and analyzed using Google spreadsheets. To find the statistical difference between different factors- the statistical method of Fischer’s exact test and p-value was used.Results: No statistical difference between day 3 and day 5 embryo transfer as well as between frozen and fresh embryo transfer were both. All of them were found equally efficacious, although 3 and 5 number of embryo transfers were found efficacious.Conclusions: In conclusion authors recommend a day 5 embryo transfer with 3 or 5 embryos which are best-quality frozen or fresh embryos to achieve maximum pregnancy outcomes.
      PubDate: 2020-05-27
      DOI: 10.18203/2320-1770.ijrcog20202340
      Issue No: Vol. 9, No. 6 (2020)
       
  • A comparative study of vaginal misoprostol versus oral misoprostol for
           induction of labour

    • Authors: Raj M. Mehta, Babulal S. Patel, Akshay C. Shah, Shashwat K. Jani, Vismay B. Patel, Adwait B. Patel, Jui Rakesh Shah
      Pages: 2520 - 2524
      Abstract: Background: Induction of labour defined as artificial initiation of uterine contractions before the onset of spontaneous labour, after the period of viability, by any methods. The successful outcome depends on the Bishop Score, maternal age and parity.
      Authors compared the most preferred two routes; vaginal and oral for induction and outcome, adverse events and side effects were noted.Methods: This was a prospective comparative study carried out at SVPIMSR, Ahmedabad, from January 2019 to June 2019, Gujarat, 100 patients who required induction were randomly divided in two groups- Group A received 25µg oral misoprostol, Group B - received 25µg vaginal misoprostol repeated 4 hourly up to maximum five doses in both groups. The induction to delivery interval, mode of delivery, maternal and neonatal outcome and complications were observed.Results: The mean induction to delivery interval was less in vaginal group than oral (18.7 hours in vaginal versus 22.4 hours in oral). Vaginal delivery and caesarean section rates were comparable in both groups. 60% patients in Group A required more than two doses as compared to 36% in Group B. No major complications or adverse events were observed.Conclusions: Both oral misoprostol in a dose of 25μg and vaginal misoprostol 25μg every four hours, to a maximum of five doses, have safety and efficacy for induction. With The vaginal route, delivery occurs in less time and few doses required as compared to oral.
      PubDate: 2020-05-27
      DOI: 10.18203/2320-1770.ijrcog20202341
      Issue No: Vol. 9, No. 6 (2020)
       
  • Study of effects of oligohydramnios on perinatal outcome

    • Authors: Aashka M. Mashkaria, Babulal S. Patel, Akshay C. Shah, Shashwat K. Jani, Vismay B. Patel, Adwait B. Patel, Aastha M. Mashkaria
      Pages: 2525 - 2529
      Abstract: Background: Oligohydramnios has got a noteworthy influence on perinatal outcome. Hence, early detection and its timely management will aid in curtailing of perinatal morbidity and mortality and leading to decreased operative interventions. Therefore, the present study is conducted to look for the effects of oligohydramnios.Methods: This comparative study was a prospective observational study conducted at study institution. The women were divided into study and control groups based on AFI (amniotic fluid index), 100 cases were selected in each group.Results: Out of the 200 women, included in the present study, 35% of the patients in the study group had non-reactive non-stress test (NST) while in the control group 7% had it. Caesarean section was performed in 58% of cases in the study group as compared to 30% in the control group. Amongst these, Fetal distress was the most common indication for LSCS (lower segment caesarean section). There were no perinatal deaths in this study.Conclusions: Based on this study it has been observed that, amniotic fluid index of ≤5 cm was commonly associated with increased LSCS rates, intrauterine growth restriction, non-reactive NST, and abnormal Doppler velocimetry studies. Therefore, every case of oligohydramnios requires to be assessed meticulously. Prompt detection; timely management and treating the underlying condition improve outcome.
      PubDate: 2020-05-27
      DOI: 10.18203/2320-1770.ijrcog20202342
      Issue No: Vol. 9, No. 6 (2020)
       
  • Study of obstetric and perinatal outcome of twin pregnancy

    • Authors: Chandni V. Mehta, Babulal S. Patel, Akshay C. Shah, Shashwat K. Jani, Dipal C. Shah, Vismay B. Patel, Adwait B. Patel
      Pages: 2530 - 2535
      Abstract: Background: Multifetal pregnancy constitutes a significant portion of high-risk pregnancies. This is due to the increasing obstetric and perinatal morbidity and mortality rates associated with it. Maternal and perinatal outcome of twin pregnancies has been evaluated in this study.Methods: Total 30 patients with twin pregnancy and having gestational age more than 28 weeks were included in this observational study.Results: Incidence of twins in the study was found to be 2%. Twin pregnancies were more common in multiparous women aged between 20 and 30 years. Most common foetal presentation was vertex- vertex presentation. Most common maternal complication was preterm labour seen in 67% women, followed by anaemia seen in 50% women. Most of the women were delivered by caesarean section (63.3%). Most common perinatal complication was birth hypoxia (41.6%). Other perinatal complications were jaundice, septicemia, intrauterine growth restriction. 71% of the neonates had birth weight less than 2.5 kg. Perinatal mortality was found to be 11.6%.Conclusions: Twin pregnancies are high risk pregnancies associated with higher obstetric and perinatal morbidity. Perinatal morbidity was more common for the second coming twin. Regular antenatal visits, planned delivery and better NICU facilities can help combat these complications. A team of skilled obstetricians and pediatricians along with a multidisciplinary approach is essential for the effective management of twin pregnancies.
      PubDate: 2020-05-27
      DOI: 10.18203/2320-1770.ijrcog20202343
      Issue No: Vol. 9, No. 6 (2020)
       
  • Prospective study of complications of first trimester medical termination
           of pregnancy at tertiary care center

    • Authors: Radha Rastogi, Bharat Tailor
      Pages: 2536 - 2541
      Abstract: Background: MTP (is common procedure done by obstetrician under certain circumstances as per MTP rules and guideline, but it has certain complication and data about complication are not fully available. The aims of this study are to analyse various complication and causes of this complication following MTP presenting at our hospital.Methods: This study was conducted in 100 patients coming to Pannadhay Rajkiya Mahila Chikitsalaya, RNT Medical college, Udaipur attending OPD (including emergency OPD) and IPD during August and September 2019 after MTP. This Study also included maternal mortality among all women participated in the study.Results: A total of 100 cases included in study attended OPD (including emergency OPD) and IPD during study period. All cases were eligible for inclusion in the study. Medical method of abortion (MMA) was the most common method of termination of pregnancy adopted by patient. Prolonged bleeding, anaemia and Incomplete abortion was the common complication related to MTP and manual vacuum aspiration was done in majority of cases to manage incomplete abortion in our hospital setting.Conclusions: The high rate of MTP related morbidity is due to induced abortion continue to be done at inappropriate places using inappropriate methods by person not eligible to do so.
      PubDate: 2020-05-27
      DOI: 10.18203/2320-1770.ijrcog20202344
      Issue No: Vol. 9, No. 6 (2020)
       
  • Randomised controlled trial: comparing effects of metformin versus
           myoinositol versus metformin and myoinositol on ovarian functions and
           metabolic factors in polycystic ovarian syndrome

    • Authors: Shikha Singh Thakur, Shaheen Anjum, S. S. Siddiqui
      Pages: 2542 - 2549
      Abstract: Background: Polycystic ovarian syndrome (PCOS) characterized by anovulation and features of hyperandrogenism (clinical or biochemical) and insulin resistance. Metformin and myoinositol being insulin sensitizers improve clinical and biochemical parameters. This study was done to compare the effects of these drugs on clinical features and biochemical profile.Methods: A randomized, comparative, clinical study was conducted on 72 patients. The patients were randomized with the help of computer-generated random numbers and were allocated to either of the three treatment groups A, B and C. Patients in group A received metformin 500 mg TDS, group B received myoinositol 1000 mg BD, group C received combination of metformin 500 mg and myoinositol 550 mg BD for 24 weeks. At first visit patients detailed history and baseline investigations were recorded. Follow up was done 24 weeks after start of therapy to assess the improvement in clinical and biochemical profile.Results: There was significant improvement in menstrual irregularities, cutaneous manifestations, pregnancy rate, LH/FSH ratio, insulin sensitivity and HOMA-IR after 24 weeks of treatment in all three groups (p value <0.05), although there was greater improvement in cases treated with combination of metformin and myoinositol than metformin and myoinositol alone.Conclusions: The combination of metformin and myoinositol has resulted in more significant reduction in insulin resistance and improvement in metabolic and hormonal profile along with regularization of menstrual cycles and spontaneous conception than metformin and myoinositol alone.
      PubDate: 2020-05-27
      DOI: 10.18203/2320-1770.ijrcog20202345
      Issue No: Vol. 9, No. 6 (2020)
       
  • Clinical study of tubectomy and it’s complications

    • Authors: Fasiha T. Abdul Aziz, Kruthi R.
      Pages: 2550 - 2555
      Abstract: Background: Tubectomy is most accepted method of contraception in India. Female sterilization may be performed in several ways such as abdominal tubal ligation, laparoscopic and hysteroscopic methods. Although considered as minor and safe procedure, complications leading to even death have been reported. So, this study was taken up to study complications of different types of tubal ligation. Objective of this study was to study complications of different types of tubal ligation.Methods: This is a prospective analytical study over the period of 18 months. This study includes all cases that have reported or referred as female sterilization complication.Results: At study institute both laparoscopic tubal ligation (TL) and abdominal tubal ligation are done. During the period of 18 months, 50 cases of tubectomy complications were noted at our institute, out of 40 cases (80%) were of abdominal method and rest 10 (20%) were of laparoscopic method. In 33 cases (66%) sterilization was performed at primary health centre. 3 cases of death reported in this study.Conclusions: At study institute both laparoscopic tubal ligation (TL) and abdominal tubal ligation are done. During the period of 18 months, 50 cases of tubectomy complications were noted at our institute, out of 40 cases (80%) were of abdominal method and rest 10 (20%) were of laparoscopic method. In 33 cases (66%) sterilization was performed at primary health centre. 3 cases of death reported in this study.
      PubDate: 2020-05-27
      DOI: 10.18203/2320-1770.ijrcog20202346
      Issue No: Vol. 9, No. 6 (2020)
       
  • Geriatric gynecology: need and spectrum

    • Authors: Mridula Singh, Sudha Chourasia
      Pages: 2556 - 2559
      Abstract: Background: Geriatric gynaecology deals with gynaecological pathologies essential in post-menopausal women aged 65 years and above. The spectrum of geriatric gynaecological disorders in India differs from those in developed countries as there are no effective screening program for early detection of cancer and the burden of ignorance and taboos. In this study we aim to find the spectrum of gynaecological disorders in geriatric women and establish the need of dedicated geriatric unit.Methods: A cross-sectional comparative study was conducted on menopausal women of age 45 years or above who attended gynecology OPD for general counselling about menopause or treatment of menopausal problems over the period of 6 months duration. All these menopausal women attending OPD during this interval were evaluated on the basis of pretested questionnaire.Results: Out of 234 post-menopausal women who entered the study, 29% women belong to geriatric group. Post-menopausal bleeding due to both malignant and benign causes and pelvic organ prolapse are the major problems in geriatric women whereas somatic complaints like flushing, night sweats are more common in younger menopausal women.Conclusions: Where the medical science has successfully increased the life expectancy, focused approach to geriatric gynecology around us is our responsibility, where female still hesitate to come out. The need for dedicated geriatric gynecology unit in India on urgent basis is emphasized by this study wherein cancers can be screened in early stage and severe lifestyle hampering conditions like pelvic organ prolapse can be treated timely.
      PubDate: 2020-05-27
      DOI: 10.18203/2320-1770.ijrcog20202347
      Issue No: Vol. 9, No. 6 (2020)
       
  • Study to compare the effectiveness of intravaginal misoprostol alone with
           combined use of intravaginal misoprostol and intracervical foley’s
           catheter for termination of mid trimester pregnancy

    • Authors: Puneeta Mahajan, Neeraj Sharma, Parwati Sharma
      Pages: 2560 - 2565
      Abstract: Background: The main concern of obstetrician is to provide the most effective and safest regimen for mid trimester termination of pregnancy which combines the shortest expulsion interval with least side effects. The combination of intravaginal misoprostol and intracervical Foley catheter for second trimester pregnancy termination has been described in previous studies with conflicting results. Hence gap exists in literature and not adequate evidence available so this study is undertaken.Methods: A prospective and interventional randomized comparative study was conducted in the department of obstetrics and gynecology, tertiary care centre, New Delhi. A total 60 pregnant female of 14 to 20 weeks of gestation who were admitted for termination of pregnancy due to any indication included in the study. Patients were divided into two groups (30 patients in each group). Group A (misoprostol and foleys combination group) and Group B (misoprostol group). Quantitative variables were compared with unpaired t-test/Mann-whitney test (when the data sets were not normally distributed) between the two groups and qualitative variables were compared by using chi-square test/Fisher’s exact test.Results: The mean induction to abortion interval was 18.31±1.95 hours in the female where misoprostol and foleys combination was used and 21.90±2.62 hours in the women where misoprostol alone used group.
      Authors found a significant reduction in induction to expulsion time in misoprostol and foleys combination group as compared to misoprostol alone group for mid-trimester termination of pregnancy. Total required dose of misoprostol use for termination of pregnancy was significantly less (p 0.008) in the women where both misoprostol and foleys was used than misoprostol alone.Conclusions: With the use of intracervical Foley’s catheter, the duration from induction to expulsion of abortus gets shortened and required dose of misoprostol is also reduced without any significant increase of side effects.
      PubDate: 2020-05-27
      DOI: 10.18203/2320-1770.ijrcog20202348
      Issue No: Vol. 9, No. 6 (2020)
       
  • Effects of antenatal corticosteroids administration on fetoplacental
           circulation in preterm pregnancies with intrauterine growth restriction
           and its correlation with perinatal outcome

    • Authors: Neelima Choudhary, Ashima Kesri, Shilpi Nain, Vikas Chaudhary, S. S. Trivedi
      Pages: 2566 - 2575
      Abstract: Background: Antenatal corticosteroid administration in preterm pregnancies is recommended to promote fetal lung maturation. Studies have reported temporary reduction in fetal heart rate, breathing and movements following maternal corticosteroid administration.
      Authors studied effect of maternal corticosteroid administration on fetoplacental circulation in preterm pregnancies with IUGR and its correlation with perinatal outcome.Methods: Observational study included 77 preterm singleton pregnant women with IUGR. Color doppler day 0 (before betamethasone) of umbilical artery of 77 cases done. All received two doses of 12 mg of betamethasone intramuscularly 24 hours apart. Umbilical artery doppler on day 2 (24 to 48 hours of 1st dose of betamethasone) and day 4 (72 to 96 hours of 1st dose of betamethasone) done. Pulsatility index (PI) of umbilical artery on doppler and Neonatal details of all women noted.Results: On day 2 doppler, 56 (73%) women (Group A) showed decrease in umbilical artery PI while 21 (27%) women (Group B) did not show decrease in umbilical artery PI. Mean umbilical artery PI of 77 cases on day 0 and day 2 were 1.73±0.73 and 1.54±0.76 respectively (p<0.001). Mean Umbilical artery PI values of undelivered 60 cases on day 0, day 2 and day 4 were 1.55±0.61, 1.33±0.55 and 1.47±0.63 respectively (p<0.001). Group B neonates had poorer Apgar scores, higher neonatal complication, longer hospital stay, lesser umbilical pH at birth and higher perinatal mortality rate than Group A neonates.Conclusions: Significant reduction in mean umbilical artery PI observed on day 2 following betamethasone administration (p<0.001), which was maintained till 4th day after 1st dose of betamethasone (p<0.05). Women who showed improvement in umbilical artery pulsatility index following betamethasone administration had a better perinatal outcome as compared to women who did not.
      PubDate: 2020-05-27
      DOI: 10.18203/2320-1770.ijrcog20202349
      Issue No: Vol. 9, No. 6 (2020)
       
  • Epidemio-clinical study of the first iterative cesarean in the
           gynecology-obstetric service at the teaching hospital of Cocody

    • Authors: Cassou R. Adjoby, Soh V. Koffi, Ibrahima S. Balde, Denis Effoh, Eleonore Gbary Lagaud, Aya V. Angoi, Nawa M. Mamy, Ngolo A. Soro, Zingbe Soumahoro
      Pages: 2576 - 2580
      Abstract: Background: The iterative caesarean section, is a caesarean section that is performed on a uterus already healed, therefore for fear of maternal and perinatal risks, is recognized as one of the main causes of the inflation of caesarean section in the world. One in three caesarean sections is performed because of a scar uterus. Objective of this study was to analyse the epidemiological and clinical factors of iterative caesarean sections in the gynecology-obstetrics department at the Teaching Hospital of Cocody (Abidjan).Methods: This was a retrospective and descriptive study conducted from June 1st, 2018 to May 31st, 2019, including 349 iterative caesarean section cases.Results: The first iterative C-section accounted for 16.1% of the C-section indications during the study period. The average age of the patients was 30 years. Nearly half of the patients practiced in the informal sector 47.9%, were uneducated in 38.1% of cases and lived with a partner in 73.1% of cases. The majority of patients in this series 75.1% performed at least 4 ANCs. Patients were followed by prenatal visits in 61% of cases by midwives and in 8.6% of cases had an inter-reproductive space of less than 18 months. This study patients were evacuated in 46.4% of cases. Acute fetal distress was the first indication of first iterative caesarean section with 20.3% of cases. Emergency caesarean sections accounted for 84.4% of the cases in this series.
      Authors found maternal death 0.3% and 6.7% perinatal mortality.Conclusions: The iterative caesarean section is a caesarean section likely to cause difficulties and complications per- operative. Although in constant improvement the prognosis of the mother-child couple still remains a problem in this context, prenatal monitoring should be the prerogative of obstetrician gynecologists.
      PubDate: 2020-05-27
      DOI: 10.18203/2320-1770.ijrcog20202350
      Issue No: Vol. 9, No. 6 (2020)
       
  • A comparative study of transcervical foley’s catheter with intracervical
           PGE2 gel for pre-induction cervical ripening

    • Authors: Anupma ., U. Karya, Harsha S. Gaikwad, Anamika ., Shalini .
      Pages: 2581 - 2586
      Abstract: Background: To compare the efficacy of transcervical foley’s catheter with intracervical PGE2 gel for pre -induction cervical ripening.Methods: It was a prospective interventional study conducted between April 2012 to April 2013 in the department of obstetrics and gynecology at L. L. R. M. medical college and S. V. B. P. hospital Meerut. A total of 80 pregnant women of ≥28 weeks of gestation with bishop score less than or equal to 4 and with various indications for induction of labour were randomly allocated to receive intracervical PGE2 gel (Group A) or transcervical foley’s catheter (Group B). Bishop score was repeated after 6 hours by the same person and the results were compared.Results: The groups were comparable with respect to maternal age, gestational age, indications of induction of labour and initial bishop’s score. The intragroup results were calculated by Wilcoxon signed rank test and intergroup results were calculated by Mann Whitney U-test. The change in bishop score in PGE2 group was 3 and in foley’s group was 3.25 after 6 hours of induction (interquartile range of median) which is significant. The mean change in bishops score was 2.65 in PGE2 group and 3.1 in foley’s group after 6 hours of induction and was significant, however the bishop’s score was comparable in both the groups and statistically insignificant.Conclusions: Both foley’s catheter and PGE2 gel are equally effective in pre-induction cervical ripening of cervix.
      PubDate: 2020-05-27
      DOI: 10.18203/2320-1770.ijrcog20202351
      Issue No: Vol. 9, No. 6 (2020)
       
  • Recurrent ectopic pregnancies with secondary infertility: a case report

    • Authors: Shivangi Jain, Indu Verma
      Pages: 2587 - 2590
      Abstract: Infertility is defined as 1 year of unprotected sexual intercourse without pregnancy. It is further classified as primary and secondary. Secondary infertility is one in which prior pregnancy not necessarily live birth has occurred. Pelvic infections as a cause for infertility are seen in 12% cases while genital tuberculosis contribute 10-15%. Various studies have well established a relationship between subclinical infection and infertility with the two most potential pathogens being: Chlamydia trachomatis and mycoplasma species.
      Authors are presenting two cases one of a 30yr female, P0+5, with class 2 obesity with previous three ectopic pregnancies with LSO done 1 year back i/v/o left ruptured ectopic now presenting with secondary infertility for 1 year and another case of a 21 years female, P0+2, with previous two ectopic with LSO done 2 years back now presenting with infertility. These cases emphasize that infections are important causes for recurrent ectopic pregnancies and infertility.
      PubDate: 2020-05-27
      DOI: 10.18203/2320-1770.ijrcog20202352
      Issue No: Vol. 9, No. 6 (2020)
       
  • Successful reduction of acute puerperal uterine inversion with use of
           Bakri postpartum balloon

    • Authors: Divya Saha, Dipika Singh, Sarika Verma
      Pages: 2591 - 2594
      Abstract: Acute puerperal inversion is rare but potentially fatal obstetric emergency and prompt recognition will enable immediate repositioning of uterus before it becomes edematous and incarcerated. Manual repositioning along with use of uterine balloon tamponade is simple and effective way for repositioning of inverted uterus as well as prevention of recurrence.
      PubDate: 2020-05-27
      DOI: 10.18203/2320-1770.ijrcog20202353
      Issue No: Vol. 9, No. 6 (2020)
       
  • Endosalpingiosis with concurrent endometriosis of ovary masquerading as
           ovarian malignancy

    • Authors: Amita Shah, Rinchen Zangmo, Kalpana Jain
      Pages: 2595 - 2597
      Abstract: Endosalpingiosis is a rare gynecological disorder of müllerian origin, characterized by the presence of tubal epithelium outside the fallopian tube, which involves structures of the female genital tract, peritoneum, and sub-peritoneal tissues. Endosalpingiosis can be associated with endometriosis or endocervicosis, although it often appears alone.
      Authors report a case of endosalpingiosis with concurrent endometriosis in a 42-year-old P2L1 patient. The patient presented to us with complaints of heaviness in lower abdomen, a feeling a lump in the lower abdomen and low-grade fever for 15 days. On per abdominal examination, a large solid cystic mass up to 20 weeks size was felt, which was more on the left side. Cervix was normal on speculum examination, the same mass was felt on per vaginal examination, separate from the uterus, the right fornix appeared free. Patient was asked to get a set of investigations done and to review as early as possible. An exploratory laparotomy with peritoneal wash cytology, total abdominal hysterectomy, bilateral salpingo-ophorectomy with supracolic and infracolic omentectomy and bilateral pelvic lymph nodes dissection was done on 18/07/18. Per operatively, there was a large cystic mass occupying the abdominal cavity adhered to the bowel and to posterior wall of the uterus, adhesiolysis followed by staging laparotomy was done.Patient’s postoperative course was uneventful and she was discharged on the 5th day of surgery in stable condition. The final histopathology report was suggestive of endosalpingiosis with concurrent endometriosis.
      PubDate: 2020-05-27
      DOI: 10.18203/2320-1770.ijrcog20202354
      Issue No: Vol. 9, No. 6 (2020)
       
  • Uterine smooth muscle tumor of uncertain malignant potential: a case
           diagnosis, management and follow-up in the department of
           gynecology-obstetrics II of the Hassan II teaching hospital of Fes in
           Morocco

    • Authors: Alpha Boubacar Conte, Jihad Jamor, Fatima Zohra Fdili Alaoui, Sofia Jayi, Hikmat Chaara, Moulay Abdelilah Melhouf
      Pages: 2598 - 2601
      Abstract: Rarely diagnosed in authors department, uterine smooth muscle tumor of uncertain malignant potential (STUMP) is one of the histologic types of uterine sarcoma. Among women undergoing hysterectomy or myomectomy for a presumed diagnosis of leiomyoma, 0.01% receive a diagnosis of STUMP.
      Authors report a case occurring to a patient aged of 55 which was diagnosed, managed successfully and followed-up in authors department.
      PubDate: 2020-05-27
      DOI: 10.18203/2320-1770.ijrcog20202355
      Issue No: Vol. 9, No. 6 (2020)
       
  • Anaesthetic management of a young primigravida with 8 months amenorrhea,
           rheumatic heart disease, hypothyroidism and met-hemoglobinimea schedule
           for cesarean section

    • Authors: Misha Katyal
      Pages: 2602 - 2604
      Abstract: A young patient, primigravida with rheumatic heart disease, hypothyroidism and met-hemoglobinemia had central and peripheral cyanosis was scheduled for caesarean section under general anesthesia in two days. Author managed met-hemoglobinemia with ascorbic acid keeping methylene blue as standby. Haemoglobin saturation was 89% at room air and 92% with supplemental oxygen. Initial met-haemoglobin levels were 31.54% (normal values <1%). After optimizing thyroid and RHD status (moderate MR and mild MS), she was given tablet ascorbic acid 2 gram thrice a day with methylene blue as standby. Conventional balanced general anesthesia technique was used and she was followed up in postoperative period with ICU care. A healthy live female baby was extracted and mother had stable vital parameters. Postoperative treatment with ascorbic acid was continued. Repeated methaemoglobin levels showed a drop from preoperative value of 31.54% to 11.39% by 3rd postoperative day and 8.05% at the end of 1st week. At the time of discharge, she did not have any cyanosis. Ascorbic acid is a good alternative drug with limited experience in met-hemoglobinemia. Author present a case of a met-hemoglobinemia treated with ascorbic acid successfully to emphasize the use of ascorbic acid as an alternative method without any adverse effects.
      PubDate: 2020-05-27
      DOI: 10.18203/2320-1770.ijrcog20202356
      Issue No: Vol. 9, No. 6 (2020)
       
  • Aggressive angiomyxoma of the vulva - a rare entity: case report and
           review of literature

    • Authors: Amrita Gaurav, Poonam Gill, Kavita Khoiwal, Sandipan Chowdhuri, Dhriti Kapoor, Jaya Chaturvedi
      Pages: 2605 - 2609
      Abstract: Aggressive angiomyxoma (AA) is an extremely rare locally invasive mesenchymal tumor with a high risk of recurrence. Till date, only about 350 cases reported worldwide. Because of the rarity it should be considered as differential diagnosis whenever patient present with vulvovaginal growth. The diagnosis is clinched on histopathology. These are hormone-dependent and have estrogen and progesterone receptors. Hence sometimes GnRH agonists are used for ovarian estrogen secretion suppression but long-term use is not advocated due to side effects. A 45-year-old P4 L4 perimenopausal female presented to the GOPD with a 4×4×3 cms pedunculated painless globular mass on right labia majora. On palpation, the globular mass was firm, non-tender and with a smooth surface. Mass was excised and on gross histopathology, cut sections showed white myxoid areas. On microscopy epidermal lined tissue with stellate and spindle-shaped mesenchymal cells was found, embedded in a loose myxoid stroma with few collagen fibers. The cells were small and bland and lacked nuclear atypia. Small to medium-sized blood vessels were present with the thickened wall. Entrapped nerves and adipocytes were also present. No necrosis or mitosis was identified. All these features were suggestive of an aggressive angiomyxoma. Immunohistochemistry markers ER, PR, CD34, desmin, SMA were all positive. Imaging was done to rule out metastatic lesions and wide local excision was done around the stump with laparoscopic bilateral oophorectomy. Aggressive angiomyxoma is a rare disease. In women with asymptomatic growth in the vulvovaginal region, perineum or pelvis, aggressive angiomyxoma should be considered as a differential diagnosis. Ideal treatment is a wide local excision to prevent local recurrences, which are common and a hypoestrogenic milieu is created by either GnRH Agonists or by bilateral oophorectomy due to their hormone-sensitive nature.
      PubDate: 2020-05-27
      DOI: 10.18203/2320-1770.ijrcog20202357
      Issue No: Vol. 9, No. 6 (2020)
       
  • A rare case of lower segment scar pregnancy

    • Authors: Jaydeep Bhatu, Nikhil A. Anand, Ankita B. Chaudhari
      Pages: 2610 - 2611
      Abstract: Caesarean scar ectopic is one of the rarest of all ectopic pregnancies. The incidence of caesarean scar ectopic has increased due to increase in number of caesarean deliveries. A 31-year-old woman (G4P3003) presented from an outside facility to Sola Civil Hospital with vaginal bleeding and discharge with no abdominal pain or any discomfort. The gestational sac was located in an anterior position toward the anterior lower uterine segment at the level of prior caesarean scar with little visible myometrium noted anterior to the gestational sac in the lower uterine segment and Tissue was sent for histopathological examination and diagnosis of caesarean scar ectopic pregnancy was confirmed. Reports found that It is life threatening condition, causes excessive hemorrhage and risk of uterine rupture. The diagnosis of this type of ectopic pregnancy is very difficult and false negative diagnosis can lead to major complications.
      PubDate: 2020-05-27
      DOI: 10.18203/2320-1770.ijrcog20202358
      Issue No: Vol. 9, No. 6 (2020)
       
  • Primary pelvic hydatid cyst: a rare case report

    • Authors: Artika Gupta, Neeta Natu
      Pages: 2612 - 2615
      Abstract:  Primary pelvic hydatid cyst disease is a zoonotic parasitic disease most frequently caused by Echinococcus granulosus or Echinococcus multilocularis. Primary pelvic hydatid cyst is a rare entity. A 39-year-old, para 3 living 3 presented to casualty with acute pain abdomen and a suprapubic mass. Patient gave history of acute lower abdominal pain since 4 days associated with vomiting. On examination, a palpable mass around 18 weeks size, firm to hard in consistency with ill-defined margins and restricted mobility and suprapubic tenderness. Lower limit could not be reached, extending from right iliac fossa to midline. Per vaginum findings suggestive of mass deviated to right side with fullness in right fornix. No cervical motion tenderness. The pre-operative tumor marker levels were as follows: CA125=12.44 U/mL (normal=0-35), CEA=0.09 ng/mL (normal=0-2.5). CA19.9=16.79 U/mL (normal=1.2-30). Erythrocyte sedimentation rate (ESR) was found to be 82 mm in the first hour. Transabdominal ultrasound suggestive of adnexal mass' ovarian with moderate ascites. Urinary bladder seen separately. Contrast enhanced computed topography (CECT) suggestive of complicated right para-ovarian /ovarian cystic mass like cystadenoma. Exploratory laparotomy was done and specimen (uterus, cervix, omental biopsy and peritoneal washings) was sent for Histopathological report. Histopathological examination of the haematoxylin and eosin-stained section revealed ruptured brood capsule releasing daughter cyst. Post-operative period was uneventful. Patient received full course of anti-helminthic treatment.
      PubDate: 2020-05-27
      DOI: 10.18203/2320-1770.ijrcog20202359
      Issue No: Vol. 9, No. 6 (2020)
       
  • Sex cord stromal tumor of ovary masquerading as polycystic ovarian
           syndrome

    • Authors: Manisha Jhirwal, Shashank Shekhar, Charu Sharma, Apoorva Tak
      Pages: 2616 - 2618
      Abstract: Virilization is a portentous sign that suggests the possibility of an ovarian or adrenal neoplasm. Diagnosis may be delayed in some patients due to nonspecific symptoms and overlapping symptoms with that of polycystic ovarian syndrome (PCOS). However, it must be remembered that PCOS usually causes mild to moderate elevation of serum testosterone with hirsutism whereas serum testosterone levels are many times elevated in cases of androgen secreting tumors and virilization is a norm. So high testosterone level with new onset virilization rule out PCOS.
      Authors are reporting two cases of Sertoli Leydig cell tumor despite their similar histopathology and equivalent levels of serum testosterone had a varied clinical spectrum of virilization.
      PubDate: 2020-05-27
      DOI: 10.18203/2320-1770.ijrcog20202360
      Issue No: Vol. 9, No. 6 (2020)
       
  • 46XX pure gonadal dysgenesis with dysgerminoma along with leydig cells: a
           unique presentation

    • Authors: Apoorva Tak, Pratibha Singh, Garima Yadav, Meenakshi Rao
      Pages: 2619 - 2621
      Abstract:
      Authors report a unique case of 46XX gonadal dysgenesis, with dysgerminoma in one ovary and other streak ovary with hilar nests of leydig cells. It is exceptionally rare to find dysgerminoma in a dysgenetic gonad with no Y chromosome and so is the presence of leydig cells in the contralateral streak ovary in a patient with 46XX pure gonadal dysgenesis.
      PubDate: 2020-05-27
      DOI: 10.18203/2320-1770.ijrcog20202361
      Issue No: Vol. 9, No. 6 (2020)
       
  • Caesarean myomectomy in a case of bad obstetric history and multiple
           fibroids: a case report

    • Authors: Kirty Nahar, Nikita Nahar
      Pages: 2622 - 2627
      Abstract: Uterine myomas are being observed in pregnancy more frequently now than in the past, because many women are delaying child bearing till their late thirties, which is the time for the greatest risk of the myoma growth. Traditionally, obstetricians are trained to avoid myomectomies during caesarean sections as severe haemorrhages can occur, which may often necessitate hysterectomies. Pedunculated fibroids which can be easily removed are an exception. A 38-year-old, elderly female, G3 A2, 37 weeks pregnancy with bad obstetric history and multiple fibroids was admitted in Apollo Hospitals, Ahmedabad. She underwent high risk caesarean section followed by myomectomy. Four large and one small fibroid were removed. One posterior wall intramural fibroid 6×5 cm was lower down, hence not removed. Histopathological examination showed leiomyomata with degenerative changes, infarct and calcification. She didn’t have any intraoperative haemorrhage or any postpartum complications. On follow up after 6 weeks, patient was healthy, had no complaints. Caesarean scar was healthy. Ultrasound scan showed normal uterus with one posterior wall intramural fibroid 3×3 cm. With the advent of better anaesthesia, easy availability of blood and blood components, caesarean myomectomy is a safe surgical procedure when performed by experienced obstetrician in carefully selected patients. Intraoperative assessment of fibroids is important in decision making for caesarean myomectomy.
      PubDate: 2020-05-27
      DOI: 10.18203/2320-1770.ijrcog20202362
      Issue No: Vol. 9, No. 6 (2020)
       
  • Is it correct to trust each ultrasonography report blindly' a case
           report on misdiagnosis, diagnosis and management of acardiac twin
           pregnancy

    • Authors: Pooja Chandak, Shobha Toshniwal
      Pages: 2628 - 2631
      Abstract: Multifetal gestation is often a high-risk pregnancy and especially the monochorionic twin pregnancy significantly contributes to fetal morbidity and mortality. Acardiac twinning, earlier known as chorioangiopagus parasiticus, is the most extreme manifestation of this condition. An acardiac twin is a rare complication of multifetal pregnancy, in the literature reported at an incidence of 1% of monochorionic twin pregnancies, i.e. 1 of 35,000 pregnancies. Often results from abnormal placental vascular anastomoses. This leads to twin reversal arterial perfusion with complex pathophysiology. Here authors present a case of acardiac twin pregnancy presented at 26 weeks with the ultrasonography report suggested'' Placental teratoma of size 11×11×13 cm with polyhydramnios as there was no reason to suspect something else as the picture described in the USG report with the polyhydramnios was fitting with the diagnosis of placental teratoma but as the scan was done at taluka place and the images provided were not clear authors decided to confirm the diagnosis from fetal medicine specialist as MTP was not the option for the patient as she was 28 weeks who confirmed that as a case of acardiac twin pregnancy and the case was managed accordingly.
      PubDate: 2020-05-27
      DOI: 10.18203/2320-1770.ijrcog20202363
      Issue No: Vol. 9, No. 6 (2020)
       
  • Unruptured ovarian ectopic gestation: a rare clinical scenario

    • Authors: Navdeep K. Ghuman, Priya S. Mathew, Aasma Nalwa
      Pages: 2632 - 2634
      Abstract: Ovarian pregnancy is a rare event, with the incidence ranging from 1 in 2000 to 1 in 60 000 deliveries and accounts for 3% of all ectopic pregnancies. The first case of ovarian pregnancy was published by Saint Monnisey.
      Authors report a case of a 23-year-old patient with severe lower abdominal pain following five weeks of amenorrhea diagnosed as tubal ectopic pregnancy on ultrasonography. The patient was taken up for emergency laparoscopy and unexpected finding of ovarian pregnancy was established. Early diagnosis and prompt treatment go a long way to prevent serious outcomes and to ensure favourable future reproductive potential.
      PubDate: 2020-05-27
      DOI: 10.18203/2320-1770.ijrcog20202364
      Issue No: Vol. 9, No. 6 (2020)
       
  • An unusual case of postoperative ascites after cesarean section

    • Authors: Namrita Sandhu, Sanjay Singh
      Pages: 2635 - 2637
      Abstract: Post-operative ascites following caesarean section is rarely reported in pregnancy. Ascites has multiple etiologies including malignancies, liver cirrhosis, intraperitoneal infections and trauma.
      Authors report a case of post-operative ascites following caesarean section performed at around 37 weeks of gestation. The patient was normotensive. The diagnosis and treatment of ascites as well as the pregnancy outcome is presented. Literature review of ascites in pregnancy is discussed as well. This case was that of an idiopathic ascites with no definitive cause. An allergic or inflammatory peritoneal reaction may be the most likely cause for this complication.
      PubDate: 2020-05-27
      DOI: 10.18203/2320-1770.ijrcog20202365
      Issue No: Vol. 9, No. 6 (2020)
       
  • Paediatric ovarian torsion: a case report and review of literature

    • Authors: Umang ., Harleen Kaur Cheema, Sidharth Khullar, Madhu Nagpal
      Pages: 2638 - 2641
      Abstract: Ovarian torsion is a surgical emergency, can result in ovarian loss, intra-abdominal infection and even death. Paediatric ovarian torsion is a rare condition, requires high clinical suspicion and prompt diagnosis. Diagnosis is a challenge since signs and symptoms are similar to those of other causes of acute abdominal pain such as appendicitis, gastroenteritis, urinary tract infection, renal colic or other conditions of acute abdominal and pelvic pain. Here, authors describe a case of a 4-year-old girl with a presentation of acute abdominal pain, treated empirically elsewhere. After investigations, a provisional diagnosis of ovarian torsion was made and patient was taken up for surgery. Intraoperatively, ovary was found to be necrosed. Detorsion was tried but ovary was unsalvageable. Right sided salpingectomy with oophorectomy was performed. Conservative surgery by laparoscopic detorsion can be tried in cases of ischemia but if necrosis has already set in, then salpingo-oophorectomy has to be performed.
      PubDate: 2020-05-27
      DOI: 10.18203/2320-1770.ijrcog20202366
      Issue No: Vol. 9, No. 6 (2020)
       
  • A rare case report of large bilateral vulval elephantiasis

    • Authors: Manmeet Kaur, Renuka Malik, Kamna Datta, Kaveri Khera
      Pages: 2642 - 2645
      Abstract: Elephantiasis, the result of chronic lymphedema, is characterized by gross enlargement of the limbs or genitalia. It occurs because of obstructive diseases of the lymphatic system. Genital elephantiasis is a common result of filariasis. Other causes are lymphogranuloma venereum. granuloma inguinale, carcinomas, lymph node dissection, irradiation and tuberculosis. Filarial elephantiasis of the female genitalia is extremely uncommon, about 1-2% of the total cases of filarial elephantiasis. Mrs. X, 25 years old female, P1L1, resident of a village in Bihar presented to gynaecology OPD of ABVIMS and Dr. RML Hospital on 06th January 2020 with complaint of huge progressively increasing vulval swelling since 3 years. Patient had come from Bihar for treatment. She had been showing in her native place for 2 years but now the lump had made her walking difficult. She did not give history of any drug given for treatment for filariasis. She gave history of being treated for pulmonary Koch 10 years back. On examination, there was a non- ulcerative, polypoidal growth of around 20×14×11 cm arising from bilateral labia majora and minora obstructing the vulval cleft. There was no associated lymphadenopathy or limb oedema. All the investigations were within normal limits. Microfilaria antigen testing done at night was negative. Patient was given diethylcarbamazine and excision of the lump was done on 14th February 2020. Histopathological report showed dilated lymphatics with non-caseating granulomas, consistent with filariasis. In endemic countries like India, filariasis is the commonest cause of elephantiasis; however genital filariasis in woman is very rare. Other cause could be tuberculosis which is still rarer. Early diagnosis and treatment of filariasis can eradicate this neglected tropical disease which causes disfigurement and severe morbidity as its sequelae.
      PubDate: 2020-05-27
      DOI: 10.18203/2320-1770.ijrcog20202367
      Issue No: Vol. 9, No. 6 (2020)
       
  • Management of caesarean scar ectopic pregnancy: a case report

    • Authors: Smritee Virmani, Pushpa Kaul
      Pages: 2646 - 2648
      Abstract: Caesarean scar ectopic involves an abnormal implantation of the embryo within the myometrium of previous caesarean scar. It is a rare and serious entity involving maternal complication like abnormal placentation, hemorrhage or death due to uterine rupture.
      Authors present a case report of 32 years old female diagnosed as a case of caesarean scar ectopic pregnancy on TVS and MRI and managed conservatively by USG guided D and C.
      PubDate: 2020-05-27
      DOI: 10.18203/2320-1770.ijrcog20202368
      Issue No: Vol. 9, No. 6 (2020)
       
  • A rare case of extragonadal immature teratoma mimicking as subserosal
           pedunculated myoma

    • Authors: Aditi Rai, Ramesh Bettaiah, Minal Kumbhalwar, Isha Rani, Hema Garlapati
      Pages: 2649 - 2652
      Abstract: Immature teratomas are usually derived from a malignant transformation of mature teratoma. The pure immature teratoma accounts for less than 1% of all ovarian cancers. It is the second most common germ cell malignancy and accounts for 10-20% of all ovarian malignancies seen in women younger than 20 years of age. Extragonadal origin are extremely rare and the most common extragonadal site of these teratomas is the omentum. We hereby describe a case report of a 29-year-old lady who presented with abdominal pain and her imaging with an ultrasound revealed a mass with features suggestive of a subserosal fibroid. She underwent a laproscopic myomectomy. A histopathologic diagnosis of Immature teratoma was made following her primary surgery. She subsequently underwent a staging laparotomy which was followed by chemotherapy. Immature teratomas predominantly occur in young patients, and preservation of fertility is an important factor in its management. Treatment should be initiated as soon as possible after surgery, preferably within 7-10 days, in those patients who require chemotherapy.
      PubDate: 2020-05-27
      DOI: 10.18203/2320-1770.ijrcog20202369
      Issue No: Vol. 9, No. 6 (2020)
       
  • Management and therapeutic implications of combined protein C and S
           deficiency in pregnancy: a case report

    • Authors: Neha Agrawal, Navdeep Ghuman, Pratibha Singh, Priyanka Kathuria
      Pages: 2653 - 2655
      Abstract: The pregnancy is an immunocompromised state. Thus, autoimmune diseases may affect pregnancy and get worsen during pregnancy. Here authors discuss a rare autoimmune thrombophilia disorder, protein C and S deficiency which may cause recurrent pregnancy losses by affecting haemostatic mechanisms in the body. This patient with recurrent pregnancy loss when evaluated extensively was found to have combined inherited protein C and S deficiency. It was successfully managed with thromboprophylaxis therapy, which resulted in the delivery of healthy baby. Long term anticoagulant prophylaxis should be considered weighing the risk of bleeding to thrombotic recurrence in such cases. In conclusion, combined protein C and S deficiency and that too presenting as recurrent pregnancy loss is very rare. Thrombophilia screening should be considered in cases of recurrent pregnancy losses. Adequate and appropriate thromboprophylaxis is an important part of the management of pregnant women with inherited thrombophilia.
      PubDate: 2020-05-27
      DOI: 10.18203/2320-1770.ijrcog20202370
      Issue No: Vol. 9, No. 6 (2020)
       
  • Leiomyoma in the space of Retzius: a rare location

    • Authors: Shweta ., Shaheen Anjum, Zehra Mohsin, Afzal Anees
      Pages: 2656 - 2658
      Abstract: Extrauterine locations of leiomyomas are extremely rare clinical conditions as in the case of space of Retzius. Space of Retzius is a small anatomical compartment located posterior to the pubic symphysis and anterior to the urinary bladder. Here authors report a very unique case of 22-year-old woman presented to the study hospital with complaints of inability to conceive and difficulty in urination. Clinical examination and imaging of pelvis suggest leiomyoma of uterus located between lower part of anterior uterine wall and bladder. An attempt to remove the tumour laparoscopically was taken but later it was converted into open laparotomy due to unusual location of leiomyoma. Histopathology revealed the tumour to be a leiomyoma.
      PubDate: 2020-05-27
      DOI: 10.18203/2320-1770.ijrcog20202371
      Issue No: Vol. 9, No. 6 (2020)
       
  • Multiple sclerosis in pregnancy: meeting the challenges

    • Authors: Bhupendra Chaudhary, Rashmi Basvantsing Rajput, Ansh Chaudhary
      Pages: 2659 - 2662
      Abstract: Multiple sclerosis being a chronic, autoimmune inflammatory disease of central nervous system with its common and uncommon semiology has a predilection for women of child bearing age. The stressful period of pregnancy is further complicated with presence of multiple sclerosis. Overall multiple sclerosis has stabilising effect on pregnancy especially in its second and third trimester but adversely affects the post-partum period with increasing relapse rate. This is related with intense immune response triggered by marked changes in levels of circulating hormones. A better understanding of anti-natal, natal and post-partum effect of multiple sclerosis helps us to decide for institution or continuation of disease modifying drugs which are generally associated with favourable outcome.
      PubDate: 2020-05-27
      DOI: 10.18203/2320-1770.ijrcog20202067
      Issue No: Vol. 9, No. 6 (2020)
       
  • Evaluation of unhealthy cervix by Pap smear and colposcopy guided biopsy

    • Authors: Meenakshi Venkatesh, Ushadevi .
      Pages: 2663 - 2665
      Abstract: Cancer of cervix ranks as the third common malignancy in females worldwide. In developing countries like India, carcinoma cervix is the second commonest malignancy affecting females. India accounts for 18% of the global burden of carcinoma cervix. To address the above problem a literature review was done using search engines like PubMed, Google scholar etc to evaluate the unhealthy cervix by comparison of Pap smear and colposcopy guided biopsy.
      PubDate: 2020-05-27
      DOI: 10.18203/2320-1770.ijrcog20202372
      Issue No: Vol. 9, No. 6 (2020)
       
  • Models of maternity care: a continuity of midwifery care

    • Authors: Suman Choudhary, Prasuna Jelly, Prakash Mahala
      Pages: 2666 - 2670
      Abstract: Pregnancy and birth are significant life events for women and their families and midwife supports a woman throughout pregnancy, birth and the postnatal period. So, the demand for services that are family friendly, women focused, safe and accessible is increasing. Evidence has shown that midwifery care is associated with lower cost, higher satisfaction rates among women, and less intervention. Because pregnancy and childbirth involve every part of feelings, physical and practical needs, hopes, religious and spiritual beliefs can all affect pregnancy and birth. So, model of maternity care addresses all these aspects to help give birth safely, naturally and confidently. The aim of this review is how midwives working in different model care constructed their midwifery role in order to maintain a positive work-life balance. Evidence from high income countries found such models to be a cost-efficient way to improve health outcomes, reducing medical interventions and increasing satisfaction with care.
      PubDate: 2020-05-27
      DOI: 10.18203/2320-1770.ijrcog20202373
      Issue No: Vol. 9, No. 6 (2020)
       
  • Depot medroxyprogesterone: the way forward

    • Authors: Sumita Mehta, Ekta Kale, Fatima Rashid
      Pages: 2671 - 2672
      Abstract: India has a high rate of unintended pregnancies and abortions contribute to 8% of maternal mortality. The addition of injection depot medroxyprogesterone (DMPA) to the basket of contraceptives has allowed women to use a long-term contraceptive which does not require any user action to maintain efficacy and whose effect is easily reversible. Injectable progestins are now estimated to be used by 6% women globally.1
      PubDate: 2020-05-27
      DOI: 10.18203/2320-1770.ijrcog20202374
      Issue No: Vol. 9, No. 6 (2020)
       
  • Prevalence and associated risk factors of abnormal Pap smear in pregnant
           women

    • Authors: Meenakshi Venkatesh, Ushadevi .
      First page: 2673
      Abstract: Mohindroo N et al, conducted a prospective study  about the prevalence and risk factors associated with abnormal pap smear in pregnant women.1 This study is in need of the hour because carcinoma cervix is on increasing trend due to multiple sexual partners, HPV infection, and use of OCP in young women lead in increase in adenocarcinoma of cervix.2 Indian women face a 2.5% cumulative lifetime risk and 1.4% cumulative death risk from cervical cancer.1
      PubDate: 2020-05-27
      DOI: 10.18203/2320-1770.ijrcog20202375
      Issue No: Vol. 9, No. 6 (2020)
       
 
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