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Intl. J. of Advances in Medicine     Open Access   (Followers: 2)
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Intl. J. of Contemporary Pediatrics     Open Access   (Followers: 5)
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Intl. J. of Scientific Reports     Open Access   (Followers: 3)
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International Journal of Reproduction, Contraception, Obstetrics and Gynecology
Number of Followers: 12  

  This is an Open Access Journal Open Access journal
ISSN (Print) 2320-1770 - ISSN (Online) 2320-1789
Published by Medip Academy Homepage  [12 journals]
  • Perspectives of health care professionals on artificial insemination of
           donor semen: appraising their knowledge and perceptions. A single
           institution study in Nigeria

    • Authors: Olajide O. Abiola, Akinlabi E. Ajao, Olumuyiwa A. Ogunlaja, Sunday O. Adeoye, Ayodeji A. Ojo
      Pages: 2959 - 2968
      Abstract: Background: Artificial inseminations of donor semen (AID) involve use of heterologous donated semen for conception in infertile couple when indicated or in a single woman desirous of pregnancy. Its practice often requires regulation to address possible ethical and legal issues which may arise. In formulating acceptable guidelines/policies, the perspectives of health professionals and the participants should be considered. Therefore, we sought to explore the knowledge and perception of semen donation for artificial insemination among health professionals.Methods: A cross sectional study conducted on consenting health workers in a single health institution using a structured questionnaire to assess their knowledge and perception on artificial insemination of donor semen (AID). Descriptive and analytical statistics were applied to the data collected with a statistically significant value of <0.05.Results: One hundred and twenty-one health professionals completed the questionnaires. The mean age of the respondents was 27.58±5.5years. Sixty of the respondents were males while 61 were females. Eighty-four of the respondents (69.4%) demonstrated good knowledge of AID while 37 (30.6%) had poor knowledge. Cadre of health professionals and marital status influenced the knowledge of respondents. Perceptions on AID varied among the respondents mostly influenced by psycho-social factors and possible legal disputes on third party reproductive process. None of the male respondents has ever donated semen and willingness to donate semen was low; with anonymity preferred by the willing donors.Conclusions: Substantial knowledge gap of AIDS existed among health professionals which were influenced by cadre and marital status. Psycho-social factors and possible legal disputes influenced their perceptions of AID.
      PubDate: 2019-07-26
      DOI: 10.18203/2320-1770.ijrcog20193504
      Issue No: Vol. 8, No. 8 (2019)
  • Ectopic pregnancy in a tertiary care centre of Jharkhand, India

    • Authors: Meetali Parashar, Meena Mehta
      Pages: 2969 - 2973
      Abstract: Background: Ectopic pregnancy is one in which the fertilized ovum is implanted and develops outside the endometrial cavity. It is an important cause of maternal morbidity and mortality in first trimester. The present study was conducted to study the risk factors, clinical presentation and management of ectopic pregnancy in RIMS, Ranchi, Jharkhand, India.Methods: This was a prospective study conducted in the department of obstetrics and gynaecology, RIMS, Ranchi, Jharkhand during May 2017 to September 2018. A total of 90 cases were included in the study.Results: 80% of the patients presented with amenorrhoea, 98% had abdominal pain and 69% had vaginal bleeding. Ultrasonography revealed hemoperitoneum in about 93% patients. 16 (18%) patients had history of infertility whereas 10 patients (11%) had taken treatment of infertility.6 (7%) patients had history of STD or PID.14 (16%) had undergone bilateral tubectomy.2 (2%) had history of IUCD insertion and 12 (13%) patients had undergone previously lscs. 54 patients (60%) had undergone D and C and 6 patients (7%) had a previous history of ectopic pregnancy. 68 (76%) underwent only salpingectomy.12 (13%) had salpingo-oophorectomy and 10 (11%) had salpingectomy with contralateral tubectomy.Conclusions:Diagnosis of ectopic pregnancy requires clinical suspicion and supportive investigations like UPT, ultrasonography, β HCG and laparoscopy. It is an important cause of admission to RIMS as maternal near miss cases.Background: Ectopic pregnancy is one in which the fertilized ovum is implanted and develops outside the endometrial cavity. It is an important cause of maternal morbidity and mortality in first trimester. The present study was conducted to study the risk factors, clinical presentation and management of ectopic pregnancy in RIMS, Ranchi, Jharkhand, India.Methods: This was a prospective study conducted in the department of obstetrics and gynaecology, RIMS, Ranchi, Jharkhand during May 2017 to September 2018. A total of 90 cases were included in the study.Results: 80% of the patients presented with amenorrhoea, 98% had abdominal pain and 69% had vaginal bleeding. Ultrasonography revealed hemoperitoneum in about 93% patients. 16 (18%) patients had history of infertility whereas 10 patients (11%) had taken treatment of infertility.6 (7%) patients had history of STD or PID.14 (16%) had undergone bilateral tubectomy.2 (2%) had history of IUCD insertion and 12 (13%) patients had undergone previously lscs. 54 patients (60%) had undergone D and C and 6 patients (7%) had a previous history of ectopic pregnancy. 68 (76%) underwent only salpingectomy.12 (13%) had salpingo-oophorectomy and 10 (11%) had salpingectomy with contralateral tubectomy.Conclusions: Diagnosis of ectopic pregnancy requires clinical suspicion and supportive investigations like UPT, ultrasonography, β HCG and laparoscopy. It is an important cause of admission to RIMS as maternal near miss cases.
      PubDate: 2019-07-26
      DOI: 10.18203/2320-1770.ijrcog20193505
      Issue No: Vol. 8, No. 8 (2019)
  • Comparing use and acceptability of menstrual cups and sanitary pads by
           schoolgirls in rural Western Kenya

    • Authors: Linda Mason, Elizabeth Nyothach, Anna Maria van Eijk, David Obor, Kelly T. Alexander, Isaac Ngere, Kayla Laserson, Penelope Phillips-Howard
      Pages: 2974 - 2982
      Abstract: Background: Girls in low and middle-income countries (LMIC) lack access to hygienic and affordable menstrual products. We explore Kenyan schoolgirls’ use and views of the cup compared to girls provided with disposable sanitary pads for a feasibility study.Methods: Schoolgirls aged 14-16 years, received a menstrual cup in 10 schools or 16 pads/month in another10 schools. All were trained by nurses on puberty, hand washing, and product use. They self-completed a net book survey at baseline and twice a term during a year follow-up. We examined their reported ease of insertion and removal, also comfort, soreness, and pain with product use. An aggregate ‘acceptability’ score was compiled for each product and girls’ socio-demographic and menstrual characteristics were compared.Results: 195 participants received cups and 255 pads. Mean age was 14.6 years, menarchial age was 13.6 years, with an average 3.8 days menses per month. Cup use was 39% in month 1, rising to 80% by month 12 (linear trend p<0.001). Pad use rose from 85% to 92% (linear trend p=0.15). Measures of cup acceptability demonstrated girls had initial problems using the cup but reported difficulties with insertion, removal and comfort reduced over time. Girls using pads reported fewer acceptability issues. At baseline, approximately a quarter of girls in the pad arm reported inserting pads intravaginally although this was significantly lower among girls with prior experience of pad use (aRR 0.62; 0.45-0.87).Conclusions: While a smaller proportion of girls provided with cups used them in the first months compared to girls given pads, reported use was similar by study-end, and early acceptability issues reduced over time. Girls in LMIC may successfully and comfortably use cups, but require instruction, support and some persistence.
      PubDate: 2019-07-26
      DOI: 10.18203/2320-1770.ijrcog20193506
      Issue No: Vol. 8, No. 8 (2019)
  • Maternal and fetal outcome of heart disease in pregnancy: an audit in a
           tertiary hospital in India

    • Authors: Lalita Kambhampati, Kimaya A. Mali, Meena N. Satia
      Pages: 2983 - 2990
      Abstract: Background: There has been a rising incidence of pregnancy complicated by heart disease in India. The importance of heart disease in pregnancy lies in its high morbidity and mortality in both maternal and fetal outcomes combined with lack of enough established guidelines in its management.Methods: A study was done in department of obstetrics and gynaecology, KEM hospital, Mumbai from January 2016 to April 2017 retro prospectively studying the different manifestations of heart disease in pregnancy and the maternal and fetal outcomes.Results: During the study period, there were 6500 deliveries in the study center and of them 135 presented with heart disease. Of the 135 cases observed, 100 cases came under the inclusion criteria and were included in the study. The incidence of heart disease in pregnancy in the current institute is 2%. In the 100 cases, 55% were seen to have Rheumatic heart disease, 32% with cyanotic and acyanotic congenital heart disease and 13% with other conditions such as peripartum cardiomyopathy and mitral valve prolapse. Maternal outcome shows 44 patients delivered vaginally, 21 by assisted vaginal delivery and 35 required caesarean section. Maternal adverse cardiac events comprised of heart failure seen in 11 cases, ICU admissions required in 14 patients and maternal mortality in one case. Neonatal outcome comprised of 31 preterm births, still births 2, low birth weight seen in 41 and 16 needing NICU admissions.Conclusions: Early diagnosis and prompt management with a multidisciplinary approach is fundamental in managing a case of heart disease in pregnancy.
      PubDate: 2019-07-26
      DOI: 10.18203/2320-1770.ijrcog20193507
      Issue No: Vol. 8, No. 8 (2019)
  • Comparison of efficiency between RMI1 and RMI2 in diagnosing ovarian

    • Authors: Rashmi R. Shalagar, Narayan Y. Kabadi
      Pages: 2991 - 2996
      Abstract: Background: This study was conducted in department of obstetrics and gynaecology, to know the efficiency of risk of malignancy index (RMI) to differentiate a malignant from a benign tumor and to compare the efficiency of risk of malignancy index 1 and 2 (RMI1 and RMI2). The study was conducted from June 2012 to August 2013 in women who got admitted with adnexal tumor.Methods: It was a prospective study. A proforma was designed for each patient which included, name, age, complaints, menopausal status, parity, past and family history and associated medical condition were asked. Indivisual parameters namely ultrasound score, CA125 and menopausal status and risk of malignancy index was calculated and compared with final histopathological diagnosis and sensitivity specificity and positive predictive value was calculated for each.Results: : The sensitivity of RMI1 is 87.95%, specificity is 75%, positive predictive value is 94.8%, negative predictive value is 54.54%, percentage of false negative is 12.04% and percentage of false positive is 25%. The sensitivity of RMI2 is 86.74%, specificity is 81.25%, positive predictive value is 96%, negative predictive value is 54.16%, percentage of false negative is 13.25% and percentage of false positive is 18.75%.Conclusions: The efficiency of RMI was definitely better than indivisual parameters and efficiency of RMI 1 and RMI2 are similar.
      PubDate: 2019-07-26
      DOI: 10.18203/2320-1770.ijrcog20193508
      Issue No: Vol. 8, No. 8 (2019)
  • Pelvic floor muscle training with and without biofeedback in treatment of
           overactive bladder

    • Authors: Preethi Badda, Achla Batra, Sheeba Marwah, Rupali Dewan
      Pages: 2997 - 3004
      Abstract: Background: Overactive bladder (OAB) is a commonly encountered problem in gynaecological practice. It has profound effect on quality of life (QOL), affecting simple daily activities as well. Prevalence rates of OAB in Asians are 53.1%. The first line management of OAB is behaviour modification and pelvic floor muscle training (PFMT). Objective of this study was to comparative assessment of biofeedback assisted PFMT (BAPFMT) versus PFMT alone in treatment of OAB using strength of pelvic floor muscle and QOL before and after treatment.Methods: A prospective comparative randomized controlled trial was conducted to compare the effect of PFMT versus BAPFMT on OAB symptoms over period of 12 weeks. Total of 100 patients fulfilling inclusion and exclusion criteria were selected. Randomization of patients was done into two groups of 50 patients each; half of them were subjected to PFMT and other half to BAPFMT. Appropriate statistical test were applied.Results: At the end of 12 weeks of intervention, there was a significant improvement in pelvic floor muscle strength and QOL in both groups (p<0.001). The improvement in pelvic floor muscle strength was more with BAPFMT; however there was no difference in improvement of QOL between the groups.Conclusions: Addition of biofeedback to PFMT may be a useful adjunct in OAB patients.
      PubDate: 2019-07-26
      DOI: 10.18203/2320-1770.ijrcog20193509
      Issue No: Vol. 8, No. 8 (2019)
  • Mirena: a novel alternative to hysterectomy

    • Authors: Parag M. Hangekar, Ganesh Mhaske, Gulabsingh Shekhawat
      Pages: 3005 - 3008
      Abstract: Background: To study the awareness and efficacy of Mirena (Levonorgestrel intrauterine system) in treatment of abnormal uterine bleeding.Methods: A prospective analytical study was conducted from January 2012 to June 2018 at Smt. Kashibai Navale medical college and general hospital, Pune, Maharashtra, India. Total 30 women between age of 35 to 45 yrs age were included in the study. Mirena was inserted post-menstrually in the operation room under sedation was done. The women were called for follow-up after 1 month, then 4 months, and then yearly (for maximum 2 years); and asked regarding the relief they have obtained from the antecedent menstrual complaints.Results: At end of study, Overall satisfaction rate among women was 76.67% and decrease menstrual blood flow observed in 20 (74.07%) cases. Most common side effect observed was irregular menses in 6 (22.22%) cases. Hysterectomy was required in 3 (11.11%) cases.Conclusions: Menorrhagia is a common gynaecologic problem often needing hysterectomy. The LNG-IUS reduces bleeding in women with menorrhagia due to benign causes. The patient acceptance and satisfaction is high. Main problem is irregular bleeding especially for the first 3 months after insertion. If the patients can be counseled before insertion, continuation rates for LNG-IUS are high. It has the potential to replace hysterectomy as treatment of choice in certain patients.
      PubDate: 2019-07-26
      DOI: 10.18203/2320-1770.ijrcog20193510
      Issue No: Vol. 8, No. 8 (2019)
  • Maternal mortality by direct obstetric causes in an urban referral
           hospital: case of Boulmiougou District Hospital in Ouagadougou, Burkina

    • Authors: Yobi Alexis Sawadogo, Hyacinthe Zamané, Sibraogo Kiemtoré, Sansan Rodrigue Sib, Dantola Paul Kain, Issa Ouédraogo, Adama Ouattara, Charlemagne Ouédraogo, Ali Ouédraogo
      Pages: 3009 - 3014
      Abstract: Background: Complications during pregnancy and childbirth are the leading causes of death and disability for women of childbearing age. Objective of this study was to study maternal mortality of direct obstetric origin at the Boulmiougou district hospital from 2010 to 2014.Methods: This was a retrospective cross-sectional descriptive and analytical study of maternal deaths by direct obstetric cause at the maternity ward of Boulmiougou District Hospital during the period from January 1st 2010 to December 31st, 2014, i.e. 5 years.Results: The maternal mortality rate by direct obstetric cause of 147.68 maternal deaths per 100,000 live births. The average age of the patients was 27.09 years old. The direct causes of maternal death were hemorrhage (47.06%), hypertensive disorders (20.59%), infections (14.71%) and unsafe abortion (11.76%). Contributing factors to maternal deaths were delay in evacuation (47.06%) and delay in care (38.23%).Conclusions: Maternal mortality remains high in the Boulmiougou District Hospital. To effectively combat maternal mortality, it is important to focus on the continuous training of staff and the strengthening of the technical platform.
      PubDate: 2019-07-26
      DOI: 10.18203/2320-1770.ijrcog20193511
      Issue No: Vol. 8, No. 8 (2019)
  • Clinicopathological analysis of ovarian tumors: a two year retrospective

    • Authors: Kanika Chandra, Neetu Arora
      Pages: 3015 - 3020
      Abstract: Background: Ovarian tumours are a heterogeneous neoplasm with a varied clinical, morphological and histological feature. Increasing mortality rate due to ovarian cancers has been reported in recent years. Ovarian tumours in post-menopausal females have high risk of malignancy and it has a very poor outcome. The aim and objective of this study was to determine clinical and histopathological spectrum and the frequency and age distribution of various ovarian tumors.Methods: It is a retrospective observational study of patients with ovarian tumors in the department of obstetrics and gynecology, SGRRI of Medical Health & Sciences and Hospital from January 2016 to December 2017 in a total number of 86 patients. All specimens were sent to pathology department and categorised according to WHO  hispathological classification.Results: Out of 86 cases examined, 64 cases were benign (74.4%), 3 cases were borderline (3.4%) and 19 cases were malignant (22.2%). Majority of the ovarian tumors (73.4%) were seen in the age group of 20 to 50 years. Most commonly encountered benign ovarian tumour was serous cystadenoma (58.1%). Surface epithelial tumors were the commonest tumors (64%) followed by germ cell tumors (29%).Conclusions: A variety of benign and malignant tumours of ovary were reported in this study. Early diagnosis and appropriate treatment of ovarian neoplasms favour the good prognosis. Most common benign tumour encountered in this study was serous cystadenoma.
      PubDate: 2019-07-26
      DOI: 10.18203/2320-1770.ijrcog20193163
      Issue No: Vol. 8, No. 8 (2019)
  • Kisspeptin: new biomarker of pregnancy

    • Authors: Priyanka Meena, Rati Mathur, Mohan L. Meena
      Pages: 3021 - 3024
      Abstract: Background: The recently identified hormone kisspeptin has been suggested to play an important regulatory role in placentation. The aim and objective of the study is the measurement of serum kisspeptin level in asymptomatic pregnant women and to find out the association of serum kisspeptin with gestational age in women with early pregnancy.Methods: This was a longitudinal study to the evaluation of 178 asymptomatic pregnant women with a gestation of 6 to 16 weeks attending routine antenatal booking visit recruited as study participants from the Antenatal Clinical of Obstetrics and Gynaecology Department, S.M.S. Medical College and Attached Hospitals, Jaipur, Rajasthan, India.Results: After initial clinical examination of every participant, a single blood sample was taken for the measurement of serum kisspeptin. Serum kisspeptin measurement test was performed by ELISA method and results were expressed as ng/ml. Pregnancy outcome was recorded prospectively. Mean serum kisspeptin level of study participants was 2.80±1.87ng/ml and median were 2.41 (Range 0.244-14.06ng/ml). Our result showed the relationship of serum kisspeptin with gestational age (GA) (p<0.000).Conclusions: serum kisspeptin level increases in pregnancy and showed positive relationship with gestational age significantly (p<0.000).
      PubDate: 2019-07-26
      DOI: 10.18203/2320-1770.ijrcog20193105
      Issue No: Vol. 8, No. 8 (2019)
  • Sonographic assessment of fetal head deflexion using occiput: spine angle
           measured during first stage of labour and its role in predicting the mode
           of delivery among nulliparous women

    • Authors: Keerthi Somu, Sujatha B. S., Shripad Hebbar, Shyamala G., Muralidhar V. Pai
      Pages: 3025 - 3030
      Abstract: Background: The attitude of the fetal head during labour significantly influences the progress and outcome of delivery and is mainly diagnosed by vaginal examination during labour. The aim of the study was to quantify the extent of deflexion of the fetal head by measuring the fetal occiput spine angle (OSA) through transabdominal ultrasonography in the first stage of labour and to determine whether the fetal OSA can predict the mode of delivery.Methods: We conducted a prospective observational study on 145 nulliparous uncomplicated singleton pregnant women without occiput-posterior position of the fetus during active labour. The OSA was measured as the angle between the two tangential lines to the occipital bone and the vertebral body of the first cervical spine, during active labour and monitored until delivery. Intra- and interobserver reproducibility of the OSA measurement and the correlation between the OSA and mode of delivery were also evaluated.Results: For the study population, the mean value of the OSA measured in the active phase of the first stage was 124.2±11.5⁰. The OSA measurement showed excellent intraobserver agreement (r = 0.82; 95% confidence interval [95% CI] 0.70-0.80) and fair-to-good interobserver agreement (r = 0.62; 95% CI 0.51-0.71).  The mean OSA was significantly less for the group of patients who required conversion to cesarean section due to labour arrest (n=32) as compared to those who had vaginal delivery (n=113) (116.25±9.2⁰ versus 126.53±11.1⁰, P<0.01). An OSA of ≥121° was associated with vaginal delivery in 80.5% (91/113) of women, whereas 87.5% (28/32) of the women who delivered by cesarean section had an OSA <121⁰.Conclusions: Measurement of the OSA, by sonography is feasible, reproducible and an objective tool to assess the degree of fetal head deflexion during labour and to predict the mode of delivery.
      PubDate: 2019-07-26
      DOI: 10.18203/2320-1770.ijrcog20193147
      Issue No: Vol. 8, No. 8 (2019)
  • Study of heart disease in pregnancy and its effect on maternal outcome

    • Authors: Nitin Kumar Jain, Shabana Sultan
      Pages: 3031 - 3036
      Abstract: Background: Heart diseases in pregnant women and has higher incidence of maternal mortality and morbidity and is regarded as risk factor for unfavourable outcome of pregnancy both for the mother and the foetus. Heart disease in pregnancy was found to be second indirect cause contributing to maternal mortality in India.Methods: This study is a hospital based prospective analytical study carried out in the Department of Obstetrics and Gynaecology, Sultania Zanana Hospital, Gandhi Medical College, Bhopal over a period of 1 year from 1st March 2017 to 28th February 2018. Patients were evaluated clinically by both obstetrician and cardiologist and followed all through their hospital stay till discharge.Results: Total 51 cases of heart disease were found during the study period. Incidence of heart disease in our study during study period was found 0.25%. Most patients were unbooked 33(64.71%) and maximum number of patients belonged to NYHA functional class II 24 (47.06%), RHD cases were 4 times more common than CHD. 24 (47.06%) patients had undergone surgical intervention for heart disease. Congestive cardiac failure was most common complication seen. Three maternal deaths were seen. All cases belonged to NYHA functional class III. All 3 cases were unbooked presented first time in labor.Conclusions: We found that pregnancy outcome was good in booked cases with regular checkup by obstetrician and cardiologist, surgically corrected cases and those with NYHA functional class I and II. Hence, joint management by obstetrician, cardiologist, and anesthetist is required to ensure better maternal outcome.
      PubDate: 2019-07-26
      DOI: 10.18203/2320-1770.ijrcog20193107
      Issue No: Vol. 8, No. 8 (2019)
  • Maternal outcome of primigravida patient with term pregnancy with engaged
           versus unengaged foetal head at onset of labour

    • Authors: Aditi Goyal, Rekha Wadhwani
      Pages: 3037 - 3040
      Abstract: Background: The primigravida are a group at risk as their capacity of child bearing has never put to the test, “primigravida is a dark and untired horse". The potential for future child bearing is determined by outcome of first labour. Hence, if first pregnancy results in normal healthy child, patient is mentally better prepared for subsequent pregnancies. Foetal head is said to be engaged when its biparietal diameter, the greatest diameter in an occiput presentation, passes through the pelvic inlet. Unengagement of head in primigravida has long been considered a possible sign of cephalopelvic disproportion.Methods: The study had 220 primigravida of which 110 had unengaged head as study group and 110 engaged head as controls. Data collection was done and the course of labour in all the patients recorded on partograph and all the patients were studied in detail. Engagement of the head was defined on the basis of Second Pawlik’s grip and Crichton’s fifth’s formula.Results: Our study shows that higher age group had more number of cases with unengaged head. The patient with engaged head had higher number of vaginal delivery than study group with unengaged head. More number of LSCS i.e. about 39.1% in study group as compared to 21% of controls is statistically significant difference (p value 0.05).Conclusions: We can conclude that primigravida with unengaged foetal head at onset of labour may deliver vaginally with minimal maternal morbidity, if proper   monitoring and maintenance of partogram is done.
      PubDate: 2019-07-26
      DOI: 10.18203/2320-1770.ijrcog20193106
      Issue No: Vol. 8, No. 8 (2019)
  • The incidence detection of tuberculosis in patients with infertility and
           abnormal uterine bleed: a study in North Indian population

    • Authors: Simmanjit Kaur, Unmesh Santpur, Sunita Mor
      Pages: 3041 - 3046
      Abstract: Background: Tuberculosis (TB) remains a major global health problem, responsible for ill health among millions of people each year. TB ranks as the second leading cause of death from an infectious disease worldwide, after the human immunodeficiency virus (HIV). The latest estimates included in this report are that there were 9.0 million new TB cases in 2013 and 1.5 million TB deaths (1.1 million among HIV-negative people and 0.4 million among HIV-positive people). In India the incidence of genital tuberculosis is nearly about 18%. And in female genital tract it is estimated that 18% in India suffer from genital TB.Methods: The study was carried-out during November 2014 to March 2016 at Maharishi Markandeshwar deemed to be University, MMIMSR Mullana (Ambala).  A total of 100 females of reproductive age attending the Gynaecology Outpatient were finally recruited on the basis of inclusion and exclusion criteria.Results: In our study majority i.e. 39 (39.0%) patient were found in the group of 20-29 years of age followed by 38 (38.0%) patients in the group of 30-39 years of age. Only 23 (23.0%) were found in the group of 40-49 years of age. In our study majority i.e. 54 (54.0%) patients were from Haryana followed by 44 (44.0%) patients were from Uttar Pradesh and only 2 (2.0%) patients were from Punjab. Out of 100 patients majority i.e. 76 (76.0%) patients had negative TB with either of investigation and only 24 (24.0%) patients had positive TB with either of investigation.Conclusions: Female genital tuberculosis affects the females of reproductive age group. The disease manifests itself as pelvic inflammatory disease in its acute form with menstrual irregularities and later infertility, and is almost always secondary to a primary lesion elsewhere.
      PubDate: 2019-07-26
      DOI: 10.18203/2320-1770.ijrcog20193109
      Issue No: Vol. 8, No. 8 (2019)
  • A study on maternal near miss cases in Government Medical College
           Shivpuri, India

    • Authors: Uma Jain
      Pages: 3047 - 3055
      Abstract: Background: Obstetrics near miss is an important indicator that reflects the quality of obstetrics care in a health facility. It assesses and monitors the activities aimed for prevention of maternal mortality. The aim and objective of this study was to find out the incidence, the prevalence and causes of maternal near miss due to severe obstetric complications and to identify the gapes and contextualize corrective measures to be taken in our facility.Methods: This is a retrospective study done in department of Obstetrics and Gynecology in GMC associated with DHS Shivpuri MP. The study was done during a period from 1st January 2018 to 30 April 2019.Results: In this study the hospital maternal near miss incidence ratio was 14.34%. In our study we found the most common morbidity was (30.18%) hypertensive disorder of pregnancy. These 159 near miss diagnoses were comprised of (30.18 %) cases of Hypertensive disorder of pregnancy, (27.67%) cases of major obstetric hemorrhage, (6.91) Severe systemic infection or sepsis, (4.40%) Labour related disorders. In Medical disorders very Severe Anemia, (1.88%) was most common cause of near miss. The most common cause of death was post-partum hemorrhage 37.5% and most of the patients referred from periphery in very critical condition.  The median time taken to get clinical intervention among cases was 20-40 minutes after admission.Conclusions: Hemorrhage and hypertension disorders are the leading causes of MNM. Prompt diagnosis and adequate management of near miss cases can reduce mortality rates.
      PubDate: 2019-07-26
      DOI: 10.18203/2320-1770.ijrcog20193149
      Issue No: Vol. 8, No. 8 (2019)
  • Prevalence and pattern of anaemia and correlation with booking status in a
           new Medical College in Haryana, India

    • Authors: Anshika Kashyap, Tabassum Bano, Nadia Babar
      Pages: 3056 - 3060
      Abstract: Background: Anaemia is the commonest medical disorder in pregnancy. It is a leading cause of maternal morbidity and mortality.  This study analyses the   prevalence and pattern of anaemia and correlates it with booking status in a   new medical college in rural Haryana.Methods: This retrospective study was conducted to analyze prevalence, severity and morphology of anaemia in hospitalized pregnant patients at the time of labour in a new medical college in rural Haryana.  Antenatal booking status was correlated with haemoglobin levels and severity. The study was conducted over a period of six months from Nov ’18 to April’19.Results: 390 singleton labour patients at or near term with no other known medical complications were evaluated. Prevalence of anaemia in the centre serving as a referral with onsite blood bank facilities was as high as 79.7 %. 47.9%   of patients did not have even a single antenatal visit. 50.8% had microcytic hypochromic anaemia followed by 32.3% who had normal morphological picture; dimorphic was 14% and macrocytic 2.8%. The prevalence in booked patients was 78.91% compared to 80.1% in unbooked.Conclusions: Anaemia continues to be a major challenge to the obstetric services despite targeted efforts by the government and various organizations to provide free prophylaxis. Iron deficiency or nutritional anaemia is the commonest.  However, booking visits, counselling and free distribution of iron tablets doesn’t ensure that the patient is protected from anaemia. This raises concerns about compliance and hence effectiveness of oral iron therapy. An aggressive strategy for diagnosis, prophylaxis and treatment of anaemia as well as a method to ensure compliance must be developed.
      PubDate: 2019-07-26
      DOI: 10.18203/2320-1770.ijrcog20193150
      Issue No: Vol. 8, No. 8 (2019)
  • Correlation of placental thickness with gestational age in antenatal women

    • Authors: Priyanka Verma, Monika Gupta, Shraddha Verma
      Pages: 3061 - 3066
      Abstract: Background: Accurate estimation of gestational age and fetal wellbeing is mandatory to ensure safe pregnancy and healthy delivery. With recent development in USG, basic scan, Doppler imaging and interventional radiology helped greatly in accurate estimation of gestational age and delivering timely care. The objectives of this study was to determine the USG placental thickness at the level of insertion of cord in antenatal women from gestational age 11 to 40 weeks. To correlate placental thickness with gestational age. To calculate composite gestational age from USG parameters; CRL, BPD, HC, AC, FL. To compare the relationship of menstrual gestational age with placental thickness and composite gestational age separatelyMethods: It is a comparative study of 2 years duration. Total 322 patients were included. Gestational age was determined from LMP. Patient’s routine obstetric USG was done and composite gestational age was calculated from fetal parameters like BPD, HC, AC and FL (CRL in 11 to 14 weeks). At the same time placental thickness was determined at the level of insertion of umbilical cord. The plane of USG image was adjusted so that the thickness measured from cord insertion is perpendicular to the margin of uterine wall.Results: The following parameters were noted: correlation of period of gestation (weeks) with composite gestational age (weeks) correlation of period of gestation (weeks) with gestational age calculated by placental thickness (weeks).Conclusions: Placental thickness can give an estimation of gestational age. The linear correlation and statistical compatibility of placental thickness makes it an alternate parameter for gestational age. Knowledge of correct gestational age helps in delivering proper antenatal care, assessing fetal wellbeing, identifying pathology at the earliest and timely decision of termination and providing safe motherhood.
      PubDate: 2019-07-26
      DOI: 10.18203/2320-1770.ijrcog20193512
      Issue No: Vol. 8, No. 8 (2019)
  • Analytical study to evaluate the relation between vaginal birth and pelvic
           organ prolapse quantification stages

    • Authors: Prachi Kushwah, Sona Soni
      Pages: 3067 - 3072
      Abstract: Background: Pelvic organ Prolapse (POP) is the downward displacement of central pelvic organs that are normally located at the level of or adjacent to the vaginal vault. These conditions are common and affect a progressively larger percentage of women as age advances especially in the postmenopausal years.Methods: Data were collected as a retrospective study. Thorough history was taken and physical examination was done. Demographic details of each patient were recorded including age, residence type, education and socio- economic status. A detailed history of all the patients was obtained included parity, live birth and nutrition status.Results: Significant difference was observed between patients with premenopausal and postmenopausal and POPQ stages (p=0.001). In postmenopausal 41(59.42%) in stage III and 20(28.99%) in stage IV POPQ, chances of POP was higher compared to premenopausal women 33(70.21%) in stage III and 6(12.77%) in Stage IV. Most of the patients belong to birth order 4 or more than that [73 (62.9%)] followed by birth order 3 [26 (22.4%)] and 2 [16 (13.8%)] whereas 38 (32.7%) patients had birth order >4. In patients with birth order ≥4 and 3 had higher distribution of POPQ stage III and IV respectively.Conclusions: From Present study it can be concluded that vaginal child birth plays a major role in development of POP. POPQ stages were statistically significant with high birth order.
      PubDate: 2019-07-26
      DOI: 10.18203/2320-1770.ijrcog20193513
      Issue No: Vol. 8, No. 8 (2019)
  • Comparative study on levonorgestrel intrauterine system and oral
           progestogen in women with heavy menstrual bleeding in terms of efficacy,
           user satisfaction and quality of life using MMAS score

    • Authors: Krishna Dahiya, Supriya Mahipal, Archit Dahiya, Isha Nandal, Priyanka Narang
      Pages: 3073 - 3077
      Abstract: Background: To compare the efficacy, safety and user satisfaction of levonorgestrel intrauterine system (LNG-IUS) with oral progestogen in medical management of heavy menstrual bleeding (HMB).Methods: This prospective study was conducted on 80 women with HMB in age group of 35-55 years. Patients were divided into two groups of 40 each and followed for six months. In Group I, LNG-IUS was inserted in post menstrual period and in Group II, patients received oral norethisterone 5 mg twice a day during 5th-25th day of cycle for 6 months. Patients were evaluated about amount and duration of blood loss by pictorial blood assessment chart (PBAC) along with haemoglobin estimation on each follow up visit. MMAS (Menorrhagia Multi-Attribute Scale) score comparison between two groups was done to measure the improvement in quality of life. The results were analysed by using Chi-square test and Student t-test.Results: Percentage reduction in PBAC score after six cycles of treatment was 89.3% in LNG IUS group as compared to 68% in norethisterone group. LNG-IUS was found to be more efficient in correcting anemia, lowering duration of bleeding and improving MMAS score as compared to norethisterone.Conclusions: Present study showed that LNG IUS was superior to oral progestogen in decreasing quantity and duration of bleeding and improving overall quality of life over time. 
      PubDate: 2019-07-26
      DOI: 10.18203/2320-1770.ijrcog20193514
      Issue No: Vol. 8, No. 8 (2019)
  • The use of C-reactive protein in case of preterm labor with intact

    • Authors: Tanjona A. Ratsiatosika, Randriamahavonjy Romuald, Rajaonarivony Marie Valérie, Rainibarijaona A. Lantonirina, Rakotonirainy Tahiana, Rakotonirina Ando-Miora, Rasolonjatovo Jean de la Croix
      Pages: 3078 - 3084
      Abstract: Background: Preterm labor, defined as delivery between 22 and 37WA, is the leading cause of perinatal morbidity and mortality. Through this study, we wanted to know if the high CRP rate in preterm labor with intact membranes could be a risk factor for poor prognosis on pregnancy and the newborn.Methods: We conducted a prospective cohort study from November 1, 2018 to April 31, 2019 at Befelatanana University Hospital of Gynecology-Obstetrics on singleton pregnancies with preterm labor and intact membranes. The population is divided in two groups according to the rate of CRP and we have chosen as a pathological threshold a CRP ≥7 mg/l.Results: We included 71 cases of MAP over 1735 births, or 4.09%, of which 47% had a CRP≥7mg / l (group I) and 51% a CRP <7mg / l (group II). There was a significant difference in the persistence of uterine contraction after 48h of tocolysis in group I and II [p = 0.0013, RR 5.20 (1.63-16.55)] as well as within of delivery (7.68±5.33 versus 21.36±11.30 days, p <0.05). There was no difference in the occurrence of neonatal asphyxia and neonatal infection between the 2 groups. However, the risk of prematurity is high in the group with a high CRP level [RR 1.34 (1.06-1.70)] (p = 0.02).Conclusions: In the case of preterm labor with intact membrane, CRP is a determinant of delivery delay, failure of tocolysis, and occurrence of preterm delivery.
      PubDate: 2019-07-26
      DOI: 10.18203/2320-1770.ijrcog20193515
      Issue No: Vol. 8, No. 8 (2019)
  • Paracetamol versus meperidine for relief of labour pain in primiparous
           women: a randomized controlled trial

    • Authors: Sherif M. Habib, Mohamed H. Mostafa, Mohamed H. Salama, Hend G. Swilam
      Pages: 3085 - 3091
      Abstract: Background: Most parturient women request analgesia, of which, there are two types; opioids and non-opioids. Opioids include morphine and meperidine, while non-opioids, which are milder forms of painkillers, include acetaminophen (paracetamol) and non-steroid anti-inflammatory drugs. The major concerns associated with opioids are the risk of neonatal respiratory depression, the cost and availability.Methods: The aim of this study was to compare the efficacy and safety of paracetamol versus meperidine for intra-partum pain relief. A total of 92 primiparous singleton term pregnant women were randomly allocated to receive intravenous paracetamol (1000 mg), or intramuscular meperidine (50 mg), at the beginning of the active phase of labor. The primary outcome was the labor pain perception, assessed using the visual analogue scale (VAS), at baseline, 15, 30, 60 and 120 minutes after administration of the drug.Results: Women of both groups showed significant reduction of the VAS after administration of the medication. There were no differences between both groups regarding the mode of delivery and the durations of the first or second stages of labor. However, meperidine was associated with higher rates of dizziness and nausea/vomiting. The 1-min Apgar scores were significantly lower in meperidine group. However, there were no differences in the 5-min Apgar score, need for neonatal resuscitation or neonatal respiratory distress.Conclusions: intravenous paracetamol as analgesia during labor is effective with no fetal or maternal adverse effects. Its use should have more chance for intrapartum pain relief. Additionally, it can be used as adjuvant with other types of analgesics.
      PubDate: 2019-07-26
      DOI: 10.18203/2320-1770.ijrcog20193516
      Issue No: Vol. 8, No. 8 (2019)
  • An intronic polymorphism of the gene Plakophilin-3 is associated with IVF

    • Authors: Mohamad Sami Joha, Chadi Soukkarieh, Marwan Alhalabi
      Pages: 3092 - 3097
      Abstract: Background: Implantation failure is determined when transferred embryos fail to implant following in vitro fertilization (IVF). In recent years, many studies suggest that implantation failure could be related to several genetic factors. In the current study, authors aimed to investigate the association of PKP3 rs10902158 (G>A) polymorphisms with the risk of implantation failure after ICSI treatment.Methods: 97 women, who underwent ICSI treatment owing to male factor infertility, were prospectively recruited in this cross-sectional study. Genomic DNA was prepared from peripheral blood samples in order to analyze the polymorphism (rs10902158) at the PKP3 gene by PCR-RFLP. The Results were presented as a genotype (GG, GA, and AA), and their relationship to IVF outcome was analyzed.Results: The patients were divided into two groups according to clinical pregnancy: the pregnant group included 51 patients (53%) and the non-pregnant group included 46 patients (47%). The clinical pregnancy outcome was significantly different between genotypes, which was 0%, 45.8% and 58.8% in the patients having the genotype AA, GA and GG respectively (p-value = 0.03).Conclusions: The presence of the allele A of the PKP3 SNP rs10902158 is associated with a reduced clinical pregnancy outcome in the patients undergoing ICSI treatment and may be helpful predictor for implantation failure.
      PubDate: 2019-07-26
      DOI: 10.18203/2320-1770.ijrcog20193517
      Issue No: Vol. 8, No. 8 (2019)
  • Fetomaternal outcome in caesarean section at full dilatation

    • Authors: Kavita Gupta, Apurva Garg
      Pages: 3098 - 3101
      Abstract: Background: To study indications, intraoperative and postoperative complications and fetomaternal outcome in cesarean sections done at full dilatation.Methods: This is a prospective cross-sectional study which was conducted in the department of obstetrics and gynecology, RNT medical college, Udaipur from November 2018 to April 2019. 100 cases of caesarean sections at full dilatation which were performed during this period were analyzed for indications and maternal and fetal morbidity.Results: Among these 100 cesarean sections, majority of cases were in the age group of 21-30 years (46%), booked and  Primigravida(81%).Most common indications were cephalo-pelvic disproportion (27%) and fetal distress (21%). Most commonly baby was delivered either by vertex (44%) or by Patwardhan (31%). Intraoperative complications were higher in terms of hematuria in 41%, Atonic PPH in 35%, uterine incision extension in 28% of cases. In one case bladder injury was noticed. Increased incidence of post-operative febrile illness and wound infection were noted. 44% baby’s required nursery admission, most commonly due to birth asphyxia (16%) and RDS (11%).Conclusions: Cesarean section in the 2nd stage of labor is associated with significantly increased maternal morbidity, Neonatal morbidity and mortality. So proper monitoring during labor and involvement of skilled obstetrician in decision making and delivery is crucial to minimize fetomaternal complications.
      PubDate: 2019-07-26
      DOI: 10.18203/2320-1770.ijrcog20193518
      Issue No: Vol. 8, No. 8 (2019)
  • Hindi translated version of menopausal rating score questionnaire: a
           method to evaluate post menopausal symptoms in India

    • Authors: Renuka Malik, Chanderkala Pokaria, Swati Singh, Kaveri Khera
      Pages: 3102 - 3109
      Abstract: Background: There are large number of post menopausal patients in India deserving more care and attention than is given at present.MRS questionnaire in Hindi (MRS-H), a translated and validated version of original MRS Scale (MRS-E), self assessed by patients in their own native language. This tool can be used to assess and document current quality of life as well as improvement with treatment of severe post menopausal symptoms, in Indian population.Methods: 30 bilingual English and Hindi speaking postmenopausal patients were recruited for this study.MRS Questionnaire has 11 questions covering somatic, pschycological and genitourinary symptoms of menopause. The scoring system is simple. Hindi translation of MRS Questionare was done from English (MRS-E) to Hindi (MRS-H) by 4 independent translations using standard protocol. The MRS-H was tested for internal validity and also compared with MRS - E.Results: Quality of life is a subjective perception modified by the cultural habitat in which one lives. MRS-H showed high validity and good co-relation with MRS-E. The MRS-H possessed good convergent and discriminant validity. MRS-H showed anICC (Intraclass coefficient) was more than 0.5 and cronbach alpha more than0.5. There was found to be strong correlation between MRS-E and MRS-H questionnaire with all correlation value above 0.7.Conclusions: The authors recommend the use of the self assessed MRS-H in Hindi should be used to assess menopausal complaints and relief with treatment in India.
      PubDate: 2019-07-26
      DOI: 10.18203/2320-1770.ijrcog20193519
      Issue No: Vol. 8, No. 8 (2019)
  • An observational study of maternal and fetal outcome in pregnant women
           with Hepatitis E

    • Authors: Ranjana Mishra, Arun H. Nayak, Madhuri Mehendale
      Pages: 3110 - 3116
      Abstract: Background: Hepatitis E in pregnancy has been a subject of interest in the recent years as the available research work is very limited and conflicting especially in pregnant women as compared to infection in men and non- pregnant women in which the disease is usually self- limiting. The mechanism of liver injury in hepatitis E is not clear and no conclusive theories about the exact pathogenesis are available. This study was done to gain insight into the effects of hepatitis E virus on pregnancy in terms of maternal and fetal outcome.Methods: Total of 40 pregnant women with Hepatitis E Virus IgM antibodies was included in the study. Hepatitis cases due to other viral and non-infective causes were excluded. Maternal outcomes in terms of mode of delivery, complications like PPH, hepatic encephalopathy, fulminant hepatic failure, coagulopathy and maternal mortality was studied. Fetal outcomes in terms of intrauterine fetal deaths, stillbirth, live births, and neonatal deaths were studied.Results: This study showed high mortality rates (42.5%) in pregnant women with hepatitis E. The most common obstetric complication was IUFD (45%) followed by preterm labor (32.5%) and postpartum hemorrhage (22.5%). Hepatic encephalopathy (62.5%) was the commonest medical complication followed by coagulopathy (25%). A statistically significant association was found between the presence of medical complications and poor maternal outcome.Conclusions: Hepatitis E virus infection in pregnancy often has a fulminant course with poor maternal and fetal outcome. Its management therefore requires an early diagnosis, and a multidisciplinary approach.
      PubDate: 2019-07-26
      DOI: 10.18203/2320-1770.ijrcog20193520
      Issue No: Vol. 8, No. 8 (2019)
  • Can serum homocysteine predict hypertensive disorders of pregnancy':
           an evidence from a case control study in a North Indian tertiary health
           care institution

    • Authors: Kushla Pathania, S. K. Verma, Shaina Chamotra, Ankit Chaudhary
      Pages: 3117 - 3122
      Abstract: Background: Hypertensive disorders of pregnancy are a major cause of both maternal and foetal morbidity and mortality. Although pregnancy induced hypertension (PIH) is still regarded as a disease of theories and unknown etiology, elevated homocysteine level has been hypothesized as a key risk factor. Abnormally raised homocysteine has been significantly associated with increased risk of PIH, abruption, intrauterine growth restriction, recurrent pregnancy loss, intrauterine death and prematurity.Methods: The present case control study was conducted among 180 pregnant women (90 cases and 90 controls) in Kamla Nehru State Hospital for Mother and Child, IGMC Shimla, Himachal Pradesh with an objective of ascertaining the role of homocysteine in pregnancy related hypertensive disorders. Socio-demographic, clinical, biochemical including homocysteine level, laboratory and ultrasonographic parameters of all the participants were documented.Results: The mean homocysteine level of cases (18.30±10.81) was significantly higher than the controls (8.70±2.64).  About 62.2% cases had abnormally raised homocysteine level (>15 µmol/L), while only 1.1% controls had such level. The odds of a case having abnormally elevated homocysteine level were 146.6 (CI: 19.52-1101) times to that of controls. Eclamptics had the highest homocysteine level followed by preeclamptics and controls.Conclusions: The present study significantly associates the abnormally elevated homocysteine levels with pregnancy related hypertensive ailments and demands much needed robustly designed studies to further explore the phenomenon. A simple intervention like estimating the much neglected homocysteine levels prior to pregnancy can definitely aid in predicting and preventing perinatal outcomes.
      PubDate: 2019-07-26
      DOI: 10.18203/2320-1770.ijrcog20193521
      Issue No: Vol. 8, No. 8 (2019)
  • Compare the effect of amniotomy and oxytocin infusion in duration of

    • Authors: Katta Jyothi, Senadhipathi Shakunthala
      Pages: 3123 - 3128
      Abstract: Background: Labour is a unique experience in a women’s life, it is a physiological but painful event. It is a dynamic and continuous process which cumulates in the birth of a healthy baby followed by expulsion of the placenta and the membranes. The objective of this study was to determine the effectiveness of amniotomy and oxytocin in terms of duration of labour, mode of delivery and maternal and fetal outcome.Methods: A non-randomized comparative study of accelerating effect of  oxytocin and amniotomy has been studied, in the age group of 19-30 years, who are admitted in obstetric ward 200 primigravidae were studied out of which 100 belongs to control group and 100 study group.Results: In the study series 93 cases had labour lasting less than 4 hours when compared to only. The mean total duration of labour is reduced in study group with a difference of 204 minutes. Quantity and duration of blood loss is significantly less in study group when compared to control group. There was no significant difference in terms of mode of delivery, maternal and foetal outcome between the two groups.Conclusions: Oxytocin infusion combined with amniotomy is safe and effective in accelerating the first and second stage of labour in apparently normal cases. No statistically significant adverse effects were noted with oxytocin infusion and amniotomy.
      PubDate: 2019-07-26
      DOI: 10.18203/2320-1770.ijrcog20193522
      Issue No: Vol. 8, No. 8 (2019)
  • Maternal and neonatal outcome in pregnancy at 40 years and beyond in a
           tertiary care center: a retrospective case control study

    • Authors: Vrunda Appannagiri, Divya K., Beena Kingsbury, Swati Rathore, Jiji E. Mathews, Mahasampath Gowri
      Pages: 3129 - 3134
      Abstract: Background: Obstetric outcome in women with advanced maternal age (AMA) is not usually studied especially in India.Methods: This study was a case control study. The cases were pregnancy in 100 women at 40 years of age and beyond and there were two control arms of 100 each of ages 20-29 years and 30-39 years. The demography, maternal complications, delivery outcomes and neonatal outcomes were compared.Results: Women with AMA were mostly multipavrous and had higher Body Mass Index (BMI). Hypertensive disease in pregnancy was more common in AMA but the difference was statistically significant. Women with AMA were more likely to have gestational diabetes (p ≤ 0.011), more likely to have anemia (p = 0.038), more likely to have preterm birth (p = 0.001), other medical complications compare to the control group (p = 0.005). They were also more likely to have Lower Segment Caesarean Section (LSCS) (p ≤ 0.001) and have postpartum complications. The birth weight of the neonate was significantly decreased in the AMA group (p < 0.001). The neonates were also more likely to be admitted to Neonatal Intensive Care Unit (NICU) (p ≤ 0.006).Conclusions: Adverse maternal and neonatal outcomes were seen despite individualized and optimal obstetric care. Thus, these women need preconceptional counselling.
      PubDate: 2019-07-26
      DOI: 10.18203/2320-1770.ijrcog20193523
      Issue No: Vol. 8, No. 8 (2019)
  • Study of prevalence and determinants of polycystic ovarian syndrome among
           adolescent girls in rural area: a prospective study

    • Authors: Manisha M. Laddad, Nitin S. Kshirsagar, Gauri P. Shinde, Vaishnavi S. Shivade
      Pages: 3135 - 3139
      Abstract: Background: Polycystic ovarian syndrome (PCOS) is the most frequent endocrinological disorder affecting 5-10% of women in the reproductive age. This prevalence ranging from 2.2% to 26% in adult women from 18-45 year. In a recent study the prevalence of a confirmed diagnosis of PCOS in adolescents aged 10 to 19 years was 5-15%, which increased to 10-22%. When undiagnosed cases with documented symptoms qualifying for PCOS according to NIH (National institute of Health) criteria were included. PCOS is a complex endocrine disorder which is most common in women of reproductive age. PCOS may first present in adolescence, but the incidence of PCOS in adolescence is not known, as diagnostic criteria for PCOS in the adolescent age-group is still not defined, PCOS symptoms tend to overlap with normal pubertal changes making the diagnosis even more challenging. The objective is to study prevalence and symptomatology of polycystic ovary syndrome (PCOS) in adolescent girls.Methods: Prospective Cross sectional study between April 2018 and March 2019. 150 adolescent girls aged 10 to 19 years attending OPD with oligomenorrhea, irregular menstrual cycle, obesity and/or hirsutism were advised for biochemical, hormonal, and ultrasonographic evaluation for diagnosis of PCOS on the basis of Rotterdam's criteria at the Department of Obstetrics and Gynaecology, Krishna Institute of Medical Sciences, Deemed University, Karad, Maharashtra, India.Results: Prevalence of PCOS in the study was 17.33% in the study group.Conclusions: PCOS is increasingly encountered during adolescence, although the overall prevalence is low and evaluation of PCOS in adolescents is challenging. At this age, lifestyle modification is imperative to prevent long-term metabolic and reproductive complications.
      PubDate: 2019-07-26
      DOI: 10.18203/2320-1770.ijrcog20193524
      Issue No: Vol. 8, No. 8 (2019)
  • Maternal mortality statistics and risk factors at a tertiary hospital in
           Makurdi, Nigeria

    • Authors: Samuel K. Hemabh-Hilekaan, Eka P. O., Maanongun M. T., Unazi U. E.
      Pages: 3140 - 3146
      Abstract: Background: To determine the magnitude of maternal mortality and its major causes including the trend and social demographic factors associated with the problem in our environment.Methods: A retrospective institutional review of all the case notes of maternal mortality at the Benue State University Teaching Hospital, Makurdi over a six-year study period, from July, 2012 to June, 2018 were computed and analyzed.Results: A total of 2,442 deliveries took place within the period under review, out of which 2,325 were live births. Total maternal deaths were 26, giving a total maternal mortality ratio (MMR) of 1,118 deaths per 100, 000. The major causes of maternal mortality during this period were unsafe abortion and its complications, hypertensive diseases in pregnancy, puerperal sepsis and obstetric hemorrhage.Conclusions: Maternal mortality remains very high at our facility          y, although with a declining trend. This may be a reflection of the situation in the general population. Increased coverage of the National Health Insurance Scheme, blood availability and utilization of antenatal services will further reduce maternal mortality in Nigeria.
      PubDate: 2019-07-26
      DOI: 10.18203/2320-1770.ijrcog20193525
      Issue No: Vol. 8, No. 8 (2019)
  • Maternal and neonatal complications in macrosomic pregnancies

    • Authors: Rehab Husain Basher, Mohmed Soliman Hussien, Nuriya Baharie Nessr
      Pages: 3147 - 3151
      Abstract:  Background: Fetal macrosomia is a common problem in obstetrics which leads to morbidity and mortality to both mothers as well as to the new-born due to complications of fetal macrosomia like prolonged labour, operative delivery, postpartum haemorrhage, perineal trauma, shoulder dystocia, birth trauma, perinatal asphyxia and perinatal mortality. This prospective study was conducted on fetal macrosomia to help future identification of such pregnancies, anticipate complications and to plan proper management.Methods: Maternal, fetal and neonatal consequences of macrosomia with specific attention to etiology of macrosomia in 170 pregnant women having gestational age of 37 weeks or more and high risk of fetal macrosomia were studied. Clinical estimation of fetal body weight was done using Leopold’s maneuvers and patient then referred for ultrasonography.  Data was collected about mode of delivery, nature and severity of birth trauma.Results: It was found that maternal age (51.76%), multiparity (61.76%), maternal diabetes (20.59 %) was significantly associated with macrosomia. Total caesarean rate in macrosomia was 26.4%. We got only 8 cases of birth trauma out of 170 macrosomic births.Conclusions: Pregnancies complicated by fetal macrosomia can be best managed by giving a trial of labour for babies with fetal weight below 5000 gram. Post gestation, multiparity found to be main risk factor for macrosomia.
      PubDate: 2019-07-26
      DOI: 10.18203/2320-1770.ijrcog20193526
      Issue No: Vol. 8, No. 8 (2019)
  • Assessment of maternal and perinatal outcome in cases of prolonged
           pregnancy in a tertiary healthcare institute: a cross sectional
           observational study

    • Authors: Jitendra Pundlik Ghumare, Ganesh Mahadeo Bargaje
      Pages: 3152 - 3155
      Abstract: Background: Prolonged pregnancy has always been regarded as a high‑risk condition because perinatal morbidity and mortality is known to rise. The interest in postdatism (just beyond expected date of delivery) has been recent and the management is controversial, more so with the advent of sonography providing information about placental aging and amount of amniotic fluid.  The aim of the present retrospective study was to analyze the outcome of pregnancies which crossed the expected date of delivery.Methods: The present study was a cross sectional observational study, conducted between April 2018 to September 2018, among 90 cases presented with post dated pregnancy under the department of obstetrics and gynecology, in a tertiary medical teaching institute in Maharashtra.Results: Maximum number of cases, i.e., 22.22% indications were meconium stained liquor with fetal distress, in 18.51% cases indications were failure of induction, in 22.22% indications were nonreactive NST, in 17.61% cases indications were CPD.Conclusions: It was concluded that prolonged pregnancy was associated with significant risk of perinatal complications such as fetal distress, meconium aspiration syndrome and IUGR.
      PubDate: 2019-07-26
      DOI: 10.18203/2320-1770.ijrcog20193527
      Issue No: Vol. 8, No. 8 (2019)
  • Role of diagnostic hystero-laparoscopy in the evaluation of female

    • Authors: Deepa Shanmugham, Nambala Divya Sahitya, Sindhu Natarajan, Deepak Kannan Saravanany
      Pages: 3156 - 3160
      Abstract: Background: Infertility affects about 10-15% of reproductive age couples. The main causes of infertility include male factor, ovulatory disorders, tubal factor and endometriosis. This study was conducted to determine the role of Diagnostic hystero-laparoscopy (DHL) in the evaluation of female infertility.Methods: This study was a prospective study done in a tertiary care centre over a period of 1 year on all infertile couples. The exclusion criteria: male factor infertility, hypothyroidism, hyperprolactinemia, acute pelvic inflammatory disease. Diagnostic hysterolaparoscopy was performed in all study patients in pre ovulatory phase, under general anaesthesia. The findings were then documented and analysed.Results: A total number of 90 patients were recruited for the study. The mean age of the patients was 28±3 years. The mean BMI of the study patients was 25±4 kg/m2. The mean duration of infertility was 5.4 years. On laparoscopy, 28 patients had polycystic ovaries (31.1%), 4 patients had pelvic adhesions (4.4%), 2 patients had endometriosis (2.2%) and tubal block was identified in 10 patients (11.11%). 10 patients had abnormal findings on hysteroscopy.Conclusions: Hystero laparoscopy is an effective diagnostic tool in the evaluation of infertility and has to be included in basic diagnostic workup.
      PubDate: 2019-07-26
      DOI: 10.18203/2320-1770.ijrcog20193528
      Issue No: Vol. 8, No. 8 (2019)
  • Retrospective analysis of indications of primary caesarean sections done
           at a tertiary care hospital

    • Authors: Kamna Datta, P. Singh, Namita Chopra
      Pages: 3161 - 3167
      Abstract: Background: Caesarean section rates have globally risen above the levels that can be considered medically necessary. The aim of the study is to analyze the rate and indications of caesarean sections for primigravidae in the period 2016 to 2018 at a tertiary care hospital in Delhi.Methods: It is a retrospective observational study conducted in the Department of Obstetrics and Gynaecology at PGIMER and Dr RML Hospital, New Delhi. A total of 552 caesarean deliveries in primigravidae were studied.Results: The total deliveries during the study period were 3346 and the total caesarean section rate observed was 30.66%. The caesarean section rate among primigravidae was 29.1%. The rate of caesarean section in primigravidae rose from 22.7% in 2016 to 39.3% in 2018 with 17% increase. Majority of them belonged to the age group 20-30 years (79.34%) and 2.53% were elderly primigravidae. Out of the total number of primigravidae caesarean deliveries, 67.2% were performed in emergency and 32.7% were performed electively. Among the emergency caesarean sections performed, 64% of patients had induced labor and 22% had spontaneous labor. The most common indication of caesarean section was fetal distress (19.77%) followed by arrest of labor (17.87%) and malpresentations (8.9%). The short-term caesarean morbidity rate was 25.4% including one mortality. Wound infection was the most common complication.Conclusions: Various reasons like changing maternal risk profile increased IVF pregnancies, scientific advances, personal choice and medico legal considerations have been cited for increased caesarean rate. Following evidence-based labor protocols, judicious use of cardiotocography, proper patient selection for labor induction and patient education will contribute in reduction of caesarean sections and related complications.
      PubDate: 2019-07-26
      DOI: 10.18203/2320-1770.ijrcog20193529
      Issue No: Vol. 8, No. 8 (2019)
  • Does cervical favourability and mode of delivery affect the maternal and
           perinatal outcome in eclampsia': a cohort study

    • Authors: Momina Zulfeen, Radha Tatapudi, Ravella Sowjanya
      Pages: 3168 - 3173
      Abstract: Background: To study the association between cervical favorability at admission and maternal, perinatal outcome. To study the association between mode of delivery and maternal, perinatal outcome in eclampsia.Methods: This was a retrospective cohort study carried out in a tertiary hospital. All women (92) admitted with antepartum eclampsia from April 2015 to April 2016, with >32 weeks gestation, reassuring foetal heart and no other complications were included in the study. They were divided into two cohorts delivery, maternal and perinatal outcomes were compared between the two groups.Results: Group with favourable cervix achieved higher vaginal deliveries. Perinatal mortality and morbidity were significantly higher in patients with unfavourable cervix (mortality 39.6% and 20.5% respectively, p: 0.046: morbidity 25.6% and 7.8% respectively, p: 0.033), more so in vaginal delivery (RR 2.355). However there was no significant difference in maternal morbidity. Higher induction-to-delivery interval was the major contributory factor.Conclusions: Perinatal outcome was worse in patients with unfavourable cervix at induction. This can be attributed to increased induction to delivery time and vaginal route of delivery. Prolonged induction should be avoided in eclampsia.
      PubDate: 2019-07-26
      DOI: 10.18203/2320-1770.ijrcog20193530
      Issue No: Vol. 8, No. 8 (2019)
  • Cervical traction: a simple step ahead in the prevention of postpartum

    • Authors: Harshita Naidu, Sujatha B. S., Muralidhar V. Pai
      Pages: 3174 - 3178
      Abstract: Background: Postpartum hemorrhage is the most common preventable cause of maternal mortality in developing countries. The present study aimed to examine the impact of cervical traction technique in reducing the amount of postpartum blood loss and rate of PPH.Methods: This was a case-control, pilot study conducted in a tertiary hospital between June 2017 to June 2018. A total of 200 singletons, low-risk pregnant females, undergoing normal vaginal delivery, were enrolled in this study. Subjects showing a high risk for PPH were excluded. Patients were randomized as case group (n=100) and control group (n=100). The case group received sustained traction for 90 seconds to anterior and posterior lip of the cervix with active management of the third stage of labor, whereas the control group received routine active management of the third stage of labor. All subjects were followed up for 6 hours post-delivery. The amount of blood loss, hematocrit and hemoglobin post-delivery were compared between both groups.Results: The mean blood loss (ml), decrease in hemoglobin (g/L) and decrease in hematocrit post-delivery in cases were significantly low compared to controls (207±37.6 versus 340±49, P<0.01), (0.78±0.2 versus 1.4±0.3, P=0.03) and (1.7±0.2 versus 3.5±0.2, P<0.01). PPH occurred in 7 of 200 (3.5%) patients. The difference in the number of PPH was not significant (5/100; 5% versus 2/100; 2% P=0.2). There were no complications reported due to cervical traction.Conclusions: Cervical traction is a simple and safe maneuver to reduce the amount of postpartum blood loss. Larger RCT is recommended to investigate the reduction in PPH rate.
      PubDate: 2019-07-26
      DOI: 10.18203/2320-1770.ijrcog20193148
      Issue No: Vol. 8, No. 8 (2019)
  • Analytical study on indications of primary cesarean section in tertiary
           care hospital

    • Authors: Arpitha S. Ballu, Asha M. B.
      Pages: 3179 - 3182
      Abstract: Background: Cesarean delivery is a commonest obstetric surgical procedure performed. WHO stated that regional cesarean section rate should not exceed 10 to 15%. However in many countries cesarean delivery has increased steadily over years. Hence present study is conducted to analyze various indications of primary cesarean section in a tertiary hospital, with an aim to reduce cesarean section rate.Methods: This is a retrospective study conducted in Cheluvamba hospital, Mysore Medical College Research Institute, Mysore, which is a tertiary care centre. For a period of 6months from 1st June 2018 to 31st November 2018Inclusion criteria: All primary cesarean section done at Cheluvamba hospital during study period were included.Exclusion criteria: Previous cesarean section, patients with previous history of laparotomy done for any obstetric or gynecological cause were excluded.Results: During the study period there was 3799 number of cesarean section. Amongst these 983 cases were primary cesarean section done for varying indications. Hence the rate of cesarean section in our hospital is 25.87%. There were 40.3% cases of fetal distress, failed induction (13.6%), breech (10%), CPD (8%), IUGR with poor BPP (1.8%) Ante partum haemorrhage (3%), DTA (3.5%).Conclusions: From our study, we would conclude that rising trend in cesarean section is an alarming issue. Measures need to be taken to reduce cesarean delivery like Regular use of partograph, Judicious use of amniotomy, oxytocin with inducing agents, Expertization of skills to conduct instrumental vaginal delivery, which is a lost art in modern obstetrics.
      PubDate: 2019-07-26
      DOI: 10.18203/2320-1770.ijrcog20193531
      Issue No: Vol. 8, No. 8 (2019)
  • A study evaluating knowledge of and attitude towards hepatitis B among
           pregnant women at a teaching hospital in Nellore, India.

    • Authors: Swetha Munivenkatappa, Srinivas M. Govindaraj
      Pages: 3183 - 3188
      Abstract: Background: Hepatitis B infection is a common and preventable infection in India. Mother to child transmission is the most common method of infection in our country. Awareness regarding hepatitis B among pregnant women is important to take preventive measures like screening during pregnancy, vaccination of child. Studies evaluating knowledge, attitude and practice (KAP) towards hepatitis B among the pregnant women in our country are sparse.Methods: A cross sectional survey was conducted to evaluate KAP towards hepatitis B among pregnant women was conducted after handing over an information hand-out. Data was collected using a standard questionnaire with three sections: i) Demographic data ii) Knowledge questions iii) Attitude and Practice questions.   Results: 42% of the 350 participants were aware about hepatitis B infection. The mean knowledge score was 6.33 (±2.86). Only 33.3% were aware that hepatitis B is transmitted by unprotected sex and 8.2% were knowledgeable of mother to child transmission. The mean attitude/practice score was 2.97 (±1.69). Only 30% would insist on safe equipment and blood/blood products. 84% would hesitate to have casual contact with hepatitis B infected persons. Most feared the stigma associated with hepatitis b infection than its health consequences. 70% would vaccinate their child to prevent hepatitis B infection. Women with greater knowledge about hepatitis B had better attitude/practice towards its prevention.Conclusions: Knowledge about HBV among pregnant women was poor and needs to be improved to prevent mother to child transmission. Educational programs need to be tailored for the target population for better uptake.
      PubDate: 2019-07-26
      DOI: 10.18203/2320-1770.ijrcog20193532
      Issue No: Vol. 8, No. 8 (2019)
  • Current status of cesarean section myomectomy-prospective ongoing study

    • Authors: Ripan Bala, Preet Kamal, Madhu Nagpal, Sheena Singh
      Pages: 3189 - 3193
      Abstract: Background: The aim of the study was to assess the feasibility, safety and efficacy of performing myomectomy during cesarean section.Methods: It was prospective study conducted in Sri Guru Ram Das University of Health and sciences which is a tertiary care referral centre. Myomectomy was conducted in 34 pregnant women during elective or emergency cesarean section. Analysis was done with reference to age, parity, character of myomas, intraoperative and post-operative morbidity, duration of surgery and duration of stay in hospital.Results: In this study 34-58 fibroid of various size (2-14 cm) were removed in 34 patients during cesarean section. Majority of fibroids were located in body of uterus (65.5%) and in anterior wall (55.2%) and all them were sub serosal. No significant difference was found in mean preoperative hemoglobin (11.8±0.7) and postoperative hemoglobin (10.9±0.8). No patient had postpartum hemorrhage requiring cesarean hysterectomy. Only two patient needed blood transfusion postoperatively. Mean time taken for surgery was 58.4±8.94 minute and average duration of hospital stay was 6.7±1.6.Conclusions: With the advent of better anesthesia, easy availability of blood and blood component, cesarean myomectomy is safe surgical procedure when performed by experienced obstetrician in carefully selected patients.
      PubDate: 2019-07-26
      DOI: 10.18203/2320-1770.ijrcog20193533
      Issue No: Vol. 8, No. 8 (2019)
  • Maternal periodontitis and its influence on duration of gestation and
           fetal birth weight

    • Authors: Swetha Munivenkatappa, Srinivas M. Govindaraj
      Pages: 3194 - 3200
      Abstract: Background: There has been a lot of interest in knowing the effects of oral health on adverse pregnancy outcomes like preterm births and low birth weight. Studies have yielded contradicting results and there are lot of confounding issues that blur the picture.  Aim of the study is to determine the prevalence of periodontitis is pregnant population and determine the effect of periodontitis on preterm births and low birth weight.Methods: This was a cross sectional study of singleton pregnant women attending ante-natal checkups with oral interview and clinical examination. Oral examination was done at the beginning of third trimester of pregnancy. They were followed up to delivery to note the duration of gestation, birth weight of babies.Results: The prevalence of periodontitis was 22% with 90.9% having mild and 9.1% having moderate periodontitis. Maternal education (high school and above) was associated with lower prevalence of periodontitis (p=0.042). There was no difference in the birth weights between the group with and without periodontitis (2.9±0.41kgs vs 2.74±0.36kgs, p=0.11). The incidence of low birth weights was also similar (p=0.22). The average gestational age was slightly less in the group with periodontitis (38 weeks 3 days vs 37 weeks 5 days) but the rates of preterm births were similar between the two groups (p=0.61).Conclusions: Mild/moderate periodontitis does not appear to have a significant effect on pre-term births and low birth weight. Maternal education and awareness seem to mitigate development of periodontitis and adverse pregnancy outcomes.
      PubDate: 2019-07-26
      DOI: 10.18203/2320-1770.ijrcog20193534
      Issue No: Vol. 8, No. 8 (2019)
  • Prevalence of pregnancy induced thyroid disorders, diabetes and

    • Authors: Gowthami Mummalaneni, Tamaraba Narasingarao, Krishna Kumari Myneni
      Pages: 3201 - 3206
      Abstract: Background: Pregnancy induced thyroid disorders, gestational diabetes mellitus (GDM) and gestational hypertension are common problems in women with gestational period. Published literate shows wide range of prevalence in pregnancy induced disorders in other states of India, and as of now the exact prevalence in our study population is not studied. Hence, there present study was aimed to know the prevalence of pregnancy induced disorders in pregnant women in South Indian population.Methods: A total of 120 subjects were followed-up at the time of recruitment to entire gestational period. Standard guidelines were followed for the assessment of thyroid hormone levels, glucose tolerance test (OGTT) and blood pressure values at different intervals and positions. Apart from detailed clinical history has been taken and routine basic and obstetrical investigations were done.Results: Prevalence of thyroid dysfunction (15.0%), gestational diabetes mellitus (11.7%) and gestational hypertension (9.2%) was reported in the present study population. Subclinical hypothyroidism was highest prevalence amount thyroid disorders. Gestational diabetes subjects have mean blood glucose levels of 230.68±17.48 mg/dL with OGTT test. Gestational hypertensive patients had SBP of 152.4±10.8 and DBP of 96.6±6.4; pre-hypertensive subjects had SBP of 134.2±5.48 and DBP of 6.8±4.6 respectively.Conclusions: Our study findings were slightly higher than normal prevalence’s which are reported earlier by various authors. We suggested that early screening, diagnosis and treatment are warranted for the prevention of maternal and fetal complications in Indian population. 
      PubDate: 2019-07-26
      DOI: 10.18203/2320-1770.ijrcog20193535
      Issue No: Vol. 8, No. 8 (2019)
  • Elective versus emergency caesarean section: differences in maternal

    • Authors: Anshu Sharma, Rajiv Acharya, Yashika Pehal, Bhawna Sharma
      Pages: 3207 - 3212
      Abstract: Background: Caesarean section is a life-saving surgical procedure when certain complications arise during pregnancy or labour. The use of CS worldwide has increased worldwide unprecedented levels although the gap between higher- and lower-resource settings remains. The present study evaluates the difference in maternal outcome in elective versus emergency caesarean sections in our institute.Methods: The study included first 65 cases of emergency caesarean section (group A) and during the study period, first 65 elective caesarean section (group B) if they fulfilled the inclusion criteria. Various intra operative and postoperative events were recorded which included intra operative complications, postpartum haemorrhage and transfusion indices.Results: The most common indication of caesarean section in group A was fetal distress (27.7%). In group B most caesarean sections were classified under 5 followed by class 6, the most common indication being previous caesarean section (27.6%). It was observed that pre-operative mean haemoglobin in group A was 10.6 g/dl and in group B was 11.2g/dl. A drop of 1.36 g/dl in group A and 1.10 g/dl in group B was observed in the post-op period. Cross match / transfusion ratio 1.5 in group A and  2 in group B, transfusion probability ratio was 60 % in group A and  66.7%  in group B and transfusion index was 1 in group A and  group B. There was significantly higher contraception acceptance in group B compared to group A.Conclusions: Elective caesarean section has more favourable maternal outcome as compared to emergency caesarean section as the former is done under controlled and planned circumstances.  However, there should be stringent audit to scrutinise indication of caesarean section, outcome of caesarean and blood transfusion practices.
      PubDate: 2019-07-26
      DOI: 10.18203/2320-1770.ijrcog20193536
      Issue No: Vol. 8, No. 8 (2019)
  • A study of prevalence, severity, stages, conception rate and associated
           problems in patients with endometriosis

    • Authors: Swapna Y., Asma Mohammed Yousuf Ali
      Pages: 3213 - 3218
      Abstract: Background: Endometriosis should be suspected in women with sub-infertility, dysmenorrhea, dyspareunia or chronic pelvic pain. However, these symptoms can also be associated with other diseases. Endometriosis may be asymptomatic even in some women with more advanced disease. The objective of this study was to prevalence, severity, stages, conception rate and associated problems in patients with endometriosisMethods: Present study was retrospective and prospective study from January 2007 to September 2012 which included 200 infertile patients who underwent laparoscopy and were diagnosed with endometriosis in the Department of Obstetrics and Gynecology at Owaisi Hospital and Research Centre, Hyderabad, Telangana, India.Results: Majority of the patients belonged to the age group of 18-25 years i.e. 45.5%. The most common symptom with which the women presented to the hospital was abnormal uterine bleeding seen in 26% of the cases. Out of total cases, 64% had primary infertility and remaining i.e. 36% had secondary infertility. Ovarian endometrioma was seen in 22% of the cases. Majority of the patients had dysmenorrheal in 62% of the cases. Majority were found out to be present in the stage one or minimal endometriosis i.e. they constituted 78 women which amounted at 39% of the total cases. As the severity of the endometriosis increased, the symptomatic relief rate after laparoscopy decreased. As the severity of the endometriosis increased, the conception rate following laparoscopic laser fulguration decreased.  As the severity of the endometriosis increased, the requirement for ART increased.Conclusions: Laparoscopy is considered to be better than laparotomy since there is less morbidity and less adhesions and tissue trauma.
      PubDate: 2019-07-26
      DOI: 10.18203/2320-1770.ijrcog20193537
      Issue No: Vol. 8, No. 8 (2019)
  • Postpartum intrauterine contraceptive device: evaluation of acceptance and

    • Authors: Sindhu S. Gaur, Suman Mendiratta
      Pages: 3219 - 3222
      Abstract: Background: Postpartum intrauterine contraceptive device is inserted within 10 minutes to 48 hours of expulsion of placenta. The objective of the study was to determine acceptability, safety and complications of PPIUCD in tertiary care center.Methods: This is a retrospective study conducted at Zenana Hospital, SMS Medical College, Jaipur over a period of 1 year from April 2018 to March 2019. Women were followed after 6 weeks and their complaints and various parameters were analyzed.Results: 5653 women were inserted PPIUCD during 1 year period. Acceptance rate was 29.26% and higher in multipara (54.30%) and between 18 to 25 years of age (50.29%). The main complaints at follow-up were pain and bleeding which were dealt mainly by reassurance. Main cause of removal was bleeding, pain and family pressure.Conclusions: The acceptance was high in this study group. PPIUCD is safe, effective and acceptable with negligible side effects. PPIUCD has abundant scope in India where accessibility for contraception is lower during interval period and women do not come for follow-up after delivery.
      PubDate: 2019-07-26
      DOI: 10.18203/2320-1770.ijrcog20193538
      Issue No: Vol. 8, No. 8 (2019)
  • A longitudinal study of near-miss and maternal mortality at a tertiary
           centre in rural Uttarakhand: addressing the fourth delay

    • Authors: Mishu Mangla, Ruchira Nautiyal, Deepmala .
      Pages: 3223 - 3228
      Abstract: Background: India is a signatory of the sustainable development goals and is committed to reduce the maternal mortality ratio to less than 70 per lakh live births. Review of maternal deaths and near miss cases is a very important step towards achieving this aim.Methods: A prospective observational study was carried out in a tertiary care centre in rural Uttarakhand for a period of one and half year using WHO criteria for maternal near-miss, in an attempt to assess the quality of obstetric care in the region and to identify the possible delays leading to this.Results: Haemorrhage was the most common cause leading to severe maternal outcome, followed by early pregnancy complications and hypertensive disorders of pregnancy. The mortality index was 15% and maternal near miss to mortality ratio was 7:1. We could identify some type of delay in at least 70% of near miss and mortality cases. Although delay in seeking healthcare was the most common, lack of community participation was identified as an important fourth delay.Conclusions: For substantive reduction of maternal mortality in this region of Uttarakhand, the main action needed is strengthening of primary health care, educating the patients regarding warning signs of pregnancy and strengthening the social status of women in society, increasing community support in women health care. 
      PubDate: 2019-07-26
      DOI: 10.18203/2320-1770.ijrcog20193539
      Issue No: Vol. 8, No. 8 (2019)
  • Review on oral methotrexate in medical management of ectopic pregnancy: a
           2 years experience in hospital Shah Alam

    • Authors: Wan Nurul Ezyani Wan Jabarudin, Normala Mohammad Som, Afidatul Mardhiah Mohammad Daud, Nor Dalila Shamsuddin, Nazian Hanna Yaacob, Hamidah Omar
      Pages: 3229 - 3233
      Abstract: Background: The objective of this study is to determine the success rate of oral methotrexate in Hospital Shah Alam for the past 2 years.Methods: This is a cross-sectional study using secondary data obtained from medical record office in Hospital Shah Alam on patients with ectopic pregnancy. A total of 35 patients who fulfilled the criteria for medical management were selected. They were prescribed with oral methotrexate with the dose of 60 mg given in 3 divided doses every 2 hours using the standard tablet of 2.5mg. Follow up was done at day 4, day 7 and till HCG level achieve less than 20 iu/litre.Results: 29 patients were successfully treated with oral methotrexate 60 mg (82.8%). Another 6 patients had to undergo laparoscopic surgery with confirmed leaking, ruptured tubal pregnancy. 4 patients needed second dose of Methotrexate due to rising HCG level and all of them were successfully treated after the second dose. The side effects of oral methotrexate were tolerated well by all patients. There are numbers of predictors for success which are the level of HCG <4000 iu/litre, size of mass <4cm, no abdominal pain during early presentation and decrease of HCG level in between day 4 to day 7 after oral methotrexate.Conclusions: The success rate of oral methotrexate for stable ectopic pregnancy is good making it a suitable option for clinical settings which has no specialised equipment to handle cytotoxic drugs.
      PubDate: 2019-07-26
      DOI: 10.18203/2320-1770.ijrcog20193540
      Issue No: Vol. 8, No. 8 (2019)
  • Epidemiology of maternal mortality in Befelatanana maternity during

    • Authors: Tanjona A. Ratsiatosika, Romuald Randriamahavonjy, Tahiana Rakotonirainy, Marie Valérie Rajaonarivony, A. Lantonirina Rainibarijaona, Thierry Randrianambinina, Ando-Miora Rakotonirina, Jean de la Croix Rasolonjatovo, Rakotovao Andianampanalinarivo Hery
      Pages: 3234 - 3239
      Abstract: Background: Maternal mortality remains a permanent obsession for the pregnant woman and her entourage, and is still one of the topical issues faced by a developing country, such as Madagascar. Our study aims to determine the epidemiological and etiological profile.Methods: We conducted a descriptive retrospective study over a 2-year period from January 1st, 2016 to December 31st, 2017 at the Befelatanana Gynecology-Obstetrics Hospital on maternal deaths.Results: We had 76 maternal deaths out of 5430 births, or 1.39%. The average age was 31.18±8.38 years with extremes of 14 and 49 years. The average parity was 2.67±1.85. The majority of pregnancies were poorly followed with a mean ANC of 2.18±1.85. The referred patients predominated at 68.42%. Women living in the urban area had a 57.89% majority. Among the etiology, hypertensive complications predominated at 42.11% followed by hemorrhagic (38.16%) and infectious (19.14%) complications. The patients who underwent surgery predominated at 78.94% and 59.21% were transfused.Conclusions: Maternal mortality remains a major concern at the Befelatanana Obstetrics Gynecology Hospital. During our study, hypertensive complications were found to be the most common causes requiring adequate management. For this, an awareness of pregnant women for the standardization of ANC, as well as regular training of health actor are necessary.
      PubDate: 2019-07-26
      DOI: 10.18203/2320-1770.ijrcog20193541
      Issue No: Vol. 8, No. 8 (2019)
  • Obstetric outcome in pregnancies with borderline versus normal amniotic
           fluid index

    • Authors: Tony Augestine, Saphina Palakkan, Umadevi N.
      Pages: 3240 - 3244
      Abstract: Background: Amniotic fluid is an indicator of placental function on the fetal development. It is regulated by several systems, including transmembraneous pathway, fetal production (fetal urine and lung fluid) and uptake (fetal swallowing), and the balance of fluid movement via osmotic gradients. The amniotic fluid index is the most commonly used method of measuring amniotic fluid. An AFI between 5 to 8 cms is borderline oligohydraminos. To compare the fetal and maternal outcome in pregnancies with borderline amniotic fluid index (5 to 8 cms) and normal AFI.Methods: This prospective cohort study was carried out on 94 pregnant patients attending the antenatal clinic of MES Medical College, Perinthalmanna between January 1st and December 31st 2016. Women with a singleton pregnancy in the third trimester were enrolled into the study. Of these 47 cases were in the normal AFI group and 47 cases in the borderline group. Adequate information was obtained from the patient’s medical record and the groups were compared on maternal and fetal complications.Results: The study results showed that more cases with borderline AFI had their non stress test to be nonreactive (59.6% versus 23.4%) and was associated with more fetal heart rate abnormalities (51% versus 17%). The number of meconium stained amniotic fluid (48.9% versus 19.1%) and caesarean deliveries (51.1% versus 21.2%) were also more among the borderline group.Conclusions: Findings indicated that there are more adverse fetal and maternal outcome among the borderline AFI group.
      PubDate: 2019-07-26
      DOI: 10.18203/2320-1770.ijrcog20193542
      Issue No: Vol. 8, No. 8 (2019)
  • Focussed antenatal care a possible opportunity towards safe motherhood

    • Authors: Sunkad M. A., Rajeshwari Kadakol, Darshit Shetty, Javali S. B., Satish Dhamankar
      Pages: 3245 - 3249
      Abstract: Background: The Primary Health Care Setting gives a challenging opportunity for the clinicians to deal with pregnancy into favorable outcomes solely based on the clinical skills in view of innumerable socio-cultural-economic barriers. The Pregnant women make satisfactory progress-  to  full term, deliver  with  minimal morbidity, no loss of life and healthy baby-How to ensure' This is the objectives of our study. Suppose Obstetricians spare time, use checklist, Prioritize and provide care will it make any difference in saving mothers' Objectives: Describe in detail the process of Focused Antenatal Care as practiced in Primary Health Care setting and Minimize mortality and morbidity due to pregnancy by 25 percent from 169. (Maternal Mortality Rate (MMR 169).Methods: This is a community based descriptive, prospective, cohort study about a group of pregnant women till their delivery, using multiple cluster random sampling of 251 high risk pregnant women and subsequent follow up over 3 months with focused care. Compilation of data and analysis using SPSS Version 20.Results: Total Study participants 251 represented all the sections of target population with regard to socio-economic and cultural background. The participants attended FANC giving a response rate of 100%. These participants had one or more risk factor. All but 10 participants attended 4 or more FANC clinic visits 241 (96%). In these participants the commonest manageable morbid conditions are underweight (20%), anaemia (14%) preeclampsia (8%), eclampsia (2%) and gestational diabetes. In our finding 87% mothers completed full term pregnancy, 11.5% preterm (>28 but < 37 weeks) while 1.5% Post term. There were 241 live births, 87% Baby weight > 2.5Kg, 13% Baby weight < 2.5 Kg. with an average of 2.9Kg.Conclusions: We are able to describe the Focused ANC and able to help improve the quality of life and to minimize morbidity and mortality in pregnant women.
      PubDate: 2019-07-26
      DOI: 10.18203/2320-1770.ijrcog20193543
      Issue No: Vol. 8, No. 8 (2019)
  • The significance of expression of Her2neu in squamous cell carcinoma of
           uterine cervix

    • Authors: Shakti Kumar Yadav, Alekh Verma, Sompal Singh, Namrata Sarin
      Pages: 3250 - 3254
      Abstract: Background: Cervical cancer is one of the leading causes of cancer related deaths among females. It arises from precursor lesions i.e. squamous intraepithelial lesions which are closely associated with infection by HPV. The ERBB2 protooncogene encodes for a cellular transmembrane protein (erb-b2) which has tyrosine kinase activity and has been implicated in the regulation of cellular growth and proliferation in various cancers. Application of monoclonal antibodies against Her2neu has shown higher response and improved survival. The aim of the study was to evaluate the expression of Her2neu in squamous cell carcinoma of cervix in relation to tumor characteristics and to compare the expression with normal control subjects.Methods: It was a cross-sectional analytical study. Paraffin embedded tissue blocks from 30 cases of squamous cell carcinoma were obtained from the archives. Twenty age matched cases of normal cervix removed for lesions other than that related to cervix (like leiomyoma) were taken as control. Tumour characteristics were noted from the records. Her2neu immunostaining was done. Her2neu expression was scored as positive or negative according to the American Society of Clinical Oncology and the College of American Pathologists (ASCO/CAP) scoring system for Her2neu. The Chi-square test was used to compare and find association between the variables. Student t-test was used to compare the variable between cases and controls.Results: Her2neu was positive in 20% and negative in 80% cases of the study group. Her2neu positivity is not associated with size, histological grade and FIGO stage of the tumor. We found that all Her2neu positive cases showed no lymph node metastasis. This association between Her2neu positivity and lymph node status was statistically significant.Conclusions: Her2neu immunoexpression is variable across various categories of squamous cell carcinoma. Her2neu positivity might be negatively associated with lymph node metastasis. However, a more comprehensive study encompassing various factors related to Her2neu overexpression is required to validate these results.
      PubDate: 2019-07-26
      DOI: 10.18203/2320-1770.ijrcog20193544
      Issue No: Vol. 8, No. 8 (2019)
  • Evaluation of Podocalyxin level in pre-eclampsia with severe
           features' patients: a cross-sectional study

    • Authors: Ahmed F. Amin, Hisham Abou-Taleb, Mustafa Gamal, Marwa M. Thabet, Nashwa Azoz, Ahmed M. Abbas
      Pages: 3255 - 3258
      Abstract: Background: This study aims to evaluate the level of podocalyxin (PCX) in preeclampsia with severe features patients and correlate it with the results of laboratory tests.Methods: The current study was a cross-sectional study conducted in Assiut Women Health Hospital between April and October 2018.  The study included 60 patients divided into two groups; Group (A): 30 patients diagnosed to have preeclampsia with severe features and Group (B): 30 patients as normal control group. Complete laboratory investigations with measurements of the PCX level was performed for all study participants.Results: No statistically significant difference between the study group and control group according to blood urea (p= 0.339) and serum creatinine (p= 0.801).There was statistically significant difference between the study group and control group according to PCX level (p= 0.001); the mean PCX was 3340.0 ± 2394.6 in the study group versus 1083.5±1400.2 in the control group. Univariate analysis revealed podocalyxin was not correlated with clinical data or laboratory investigations.Conclusions: Podocalyxin levels were significantly elevated in preeclampsia.
      PubDate: 2019-07-26
      DOI: 10.18203/2320-1770.ijrcog20193545
      Issue No: Vol. 8, No. 8 (2019)
  • Satisfaction of patients received in emergencies in the department of
           obstetrics and gynecology at the Yalgado Ouedraogo teaching hospital:
           comparative study before and after the introduction of free care

    • Authors: Hyacinthe Zamané, Sibraogo Kiemtoré, Paul Dantola Kain, Lydie Zounogo Ouédraogo, Blandine Bonané Thiéba
      Pages: 3259 - 3263
      Abstract: Background: The quality of care perceived by the users of health care services is an important indicator of the quality of care. The aim of this study was to assess the satisfaction of patients received in obstetric and gynecological emergencies department of Yalgado Ouedraogo Teaching Hospital before and after the introduction of free care.Methods: This was a cross-sectional investigation. Data collection was carried out from February to July 2016, covering the last three months before the start of free care and the first three months of implementation of this free policy in Burkina Faso.Results: A total of 620 patients formed the sample. The reception (p=0.0001), the waiting period (p=0.0001), respect for treatment schedules (p=0.0001), respect for intimacy (p=0.0001), communication between providers and patients (p=0.007), the comfort of the delivery room (p=0.003) and the comfort of the ward room (p=0.002) were more favorably appreciated by patients before the free treatment than during that period. Overall patient satisfaction was better before the effectiveness of free care (p=0.003).Conclusions: The realization of free care process was followed by a lower patient’s satisfaction reflecting an alteration in the quality of health care services. A situational analysis of this free health care process is necessary in order to make corrective measures. Also adequate preventive measures should be adopted before any implementation to a larger scale of this free policy.
      PubDate: 2019-07-26
      DOI: 10.18203/2320-1770.ijrcog20193546
      Issue No: Vol. 8, No. 8 (2019)
  • Analysis of comorbidities among pregnant woman attending rural Medical
           College Hospital

    • Authors: Raja Sekhar Jalemu, Kasthuribai Sabbe, Grishma Jalemu
      Pages: 3264 - 3267
      Abstract: Background: In pregnancy Anaemia and Depression is an important factor associated with an increased risk of maternal, fetal and neonatal mortality, poor pregnancy outcomes, and impaired cognitive development. To assess prevalence and factors associated with anemia and Depression among pregnant women attending antenatal clinic.Methods: A Facility based cross-sectional study was conducted on 284 pregnant women to at Rural Medical college hospital from June to August 2018. Data on sociodemographic and clinical characteristics of the study participants were collected using a Pretested structured questionnaire by interview and review of medical records. Binary Logistic regression analysis had been used to check for association between dependent and independent variables in all cases. P-value less than 0.05 was considered statistically significant.Results: The prevalence of anemia was found to be11.6% (95 %CI; 7.8%-14.8%) and Depression was 8.6% Pregnant women in the second and third trimester [AOR (95% CI), 8.31 (1.24-55.45), and P=0.029] were more likely to be anemic when compared to pregnant women in their first trimester. Pregnant women who did not receive iron/folic acid supplementation [AOR (95%CI),4.03(1.49 10.92), and P=0.01] were more likely to be anemic when compared to pregnant to women who did take supplementations.Conclusions: In this study the prevalence of anemia and Depression in pregnancy was low compared to the findings of others. Gestational age (trimester) and iron/folic acid supplementation were statistically associated with anemia. 
      PubDate: 2019-07-26
      DOI: 10.18203/2320-1770.ijrcog20193547
      Issue No: Vol. 8, No. 8 (2019)
  • The comparison of the efficacy of intra-peritoneal instillation along with
           local infiltration with bupivacaine versus placebo for post-operative
           analgesia after laparoscopic tubal ligation

    • Authors: Aniket S. Kakade, Naval Dudam, Tushar M. Panchanadikar
      Pages: 3268 - 3270
      Abstract: Background: Intra-peritoneal instillation of local anesthetics has been shown to minimize post-operative pain after laparoscopic surgeries. The present study was undertaken with the following aim to compare the efficacy of intra-peritoneal instillation and local infiltration with bupivacaine versus placebo for post-operative analgesia after laparoscopic tubal ligation. To correlate the advantages and side effects of the drugs during the procedure. To establish a protocol for the use of bupivacaine instillation and infiltration for post-operative analgesia after laparoscopic tubal ligation.Methods: A prospective study was carried out in a tertiary care hospital attached to a teaching medical institute. Institutional ethics committee approval was obtained for this randomized control study (double blind) including 50 women who will be divided in two groups. Group A will be administered intra-peritoneal bupivacaine along with local infiltration. Group B will be administered normal saline. Post-operative pain will be monitored by a blind observer and rescue analgesia will be administered at visual analogue score of 3.Results: Both the groups were comparable with respect to age and BMI. The mean duration of analgesia in Group A with bupivacaine was 315.60±79.9 min (Median 300 min).  The mean duration of analgesia in Group B with normal saline was 138.20±46.97 min (Median 150 min, p value <0.001).Conclusions: The study depicts a significant pain relief after use of bupivacaine. Bupivacaine instillation in the peritoneal cavity along with local infiltration of the drug gives prolongs pain relief as compared to normal saline.
      PubDate: 2019-07-26
      DOI: 10.18203/2320-1770.ijrcog20193548
      Issue No: Vol. 8, No. 8 (2019)
  • Hysteroscopic salpingosonography: a novel technique for infertile patients

    • Authors: Garima Kapoor, Bindu Bajaj, Usha Rani, Geeta Pardeshi
      Pages: 3271 - 3275
      Abstract: Background: Infertility is akin to curse in our country. Patients of infertility run from pillar to post to get relief. Government Hospitals in India lie at the tail end of window-shopping of infertility centres by the patients having exhausted all their resources. Patients report without any detailed records, lost reports, coming after long hiatus of having stopped treatment in desperation, making one wonder how to proceed. At the other end are patients who have undergone laparotomy for various reasons like intestinal obstruction, tubercular abdomen, adnexal masses and their tubal status is not very clear on HSG. So, repeat laparoscopy in the former group and performing ab initio in the latter, involves putting the patients to the risk of general anesthesia, injury to internal organs due to anticipated adhesions. Although Hassan’s technique of open trocar entry is well accepted the first port entry, whatever be the mode, is an entry open to risks.Methods: In a selected group of infertile women, a baseline TVS was done on 2/3 day of menses and on the 7/8 day of menstrual cycle hysteroscopy was done which was immediately followed by another transvaginal ultrasound. The descriptive statistics is presented in the form of percentages and appropriate graphs.Results: Among the 54 patients who underwent this procedure, 65% had normal uterine cavity. 18% were referred for IVF. 9.2% conceived post procedure.Conclusions: Successive use of transvaginal ultrasound after hysteroscopy i.e Hysteroscopic sonosalpingography is a useful procedure in a select group of infertile patients.  
      PubDate: 2019-07-26
      DOI: 10.18203/2320-1770.ijrcog20193549
      Issue No: Vol. 8, No. 8 (2019)
  • Congenital heart diseases and pregnancy, Universitary Hospital Center of
           Gynecology Obstetrical of Befelatanana, Madagascar

    • Authors: Tanjonirina Razafindrainibe, Sidonie Rakotonomenjanahary, Mamitiana Andrianirina, Nasolotsiry E. Ravel
      Pages: 3276 - 3279
      Abstract: Background: Congenital heart diseases are malformations formed during the first weeks of life. Thanks to advances in medicine, they could be cared properly and pregnancies on heart diseases could be continued and completed. These malformations are sources of morbidity even high maternal fetal mortality. Whence our motivation to carry out this study and improve its care.Methods: This is a retrospective observational study reporting clinical cases of congenital heart disease pregnancies, only seen at the UHC-GOB over a seven years period (01 February 2007 - 28 February 2014).Results: We have identified 10 cases of congenital heart diseases out of 56 320 deliveries, that is, an incidence of 0.12 per 1000 deliveries. Isolated arterial canal persistence is predominant. The average age is 26±1. Four cases of congenital heart diseases diagnosed and repaired during childhood, have been noted as well as 02 cases of fortuitous discovery during pregnancy. No joint obstetric and cardiac follow up was performed for our patients. Delivery by high way is recommended in 70% of cases which 57% under peridural anesthesia. Half of the patients had peri-gestational cardiac decompensation such as dyspnea, pre-eclampsia and vacuo-shock progressively decreasing in post-partum. On the fetal side, we recorded 01 intra-uterine delayed growths, 03 premature births and 02 deaths.Conclusions: Pregnancy prognosis on congenital heart disease is based on the type of malformation, close follow up and a multidisciplinary care (Gyneco-obstetrician, Cardiologist, Reanimator, Pediatrician and Geneticist.
      PubDate: 2019-07-26
      DOI: 10.18203/2320-1770.ijrcog20193550
      Issue No: Vol. 8, No. 8 (2019)
  • Emergency obstetric hysterectomy: experience at a tertiary care centre in
           Central India

    • Authors: Jayashree Mulik, Tanvi Vibhute
      Pages: 3280 - 3284
      Abstract: Background: Obstetric hysterectomy is an important procedure in modern obstetrics and its proper indications, risks and complications need to be studied for judicious usage and improvement in outcome.Methods: A retrospective, record-based study was carried out over one and a half years at a tertiary care government hospital. All the patients who underwent emergency obstetric hysterectomy at the study centre during study period were studied. Labour room register, operation room register for emergency and elective cases, case records, referral slips and mortality register data were reviewed for the same and outcomes analysed.Results: Total 33 patients underwent emergency obstetric hysterectomy, with the incidence observed at 0.21%. The most common indications were atonic post-partum hemorrhage (42.4%), uterine rupture (33.3%) and morbidly adherent placenta (18.1%). Prior cesarean section (36.4%) and placenta previa (15.1%) were the commonest predisposing factors associated with PPH and uterine rupture. Subtotal hysterectomy (66.7%) was observed to be the preferred type of surgery. Out of total 7 maternal deaths that occurred, 4 (57%) were because of disseminated intravascular coagulation.Conclusions: There is increasing trend in the rate of obstetric hysterectomy along with rise in rate of previous LSCS, emphasizing the importance of the mode of delivery. Measures to reduce the rate of primary cesarean section are advisable.
      PubDate: 2019-07-26
      DOI: 10.18203/2320-1770.ijrcog20193551
      Issue No: Vol. 8, No. 8 (2019)
  • Fetal evaluation of post partum intrauterine contraceptive device versus
           interval intrauterine contraceptive device insertion

    • Authors: Hiral P. Godhani, Dhaval K. Patel
      Pages: 3285 - 3290
      Abstract: Background: Family planning is important not only for population stabilization, but it has been increasingly recognized as central tool to improve maternal and neonatal health. Aim of current study was to compare interval and post partum intrauterine contraceptive device (IUCD) insertion in terms of effectiveness and safety.Methods: This was a prospective observational cohort study, done in the department of Obstetrics and Gynecology, GMERS Medical College, Sola, Ahmedabad, from August 2015 to April 2017 was taken for evaluation. 80 women in each group who were inserted IUCD after delivery and in the interval period were studied. Outcome was measured by expulsion rate, continuation rate, and incidence of dysfunctional uterine bleeding (DUB), Pelvic inflammatory disease (PID), failure rate and effect on puerperium.Results: Expulsion rate in PPIUCD group was 8.75% while in interval IUCD group it was 1.25%. Continuation rate following Postpartum intrauterine contraceptive device (PPIUCD) and interval IUCD insertion was 86.25% and 95% respectively. Incidence of bleeding per vaginum (menorrhagia) was 7.5% in PPIUCD group while 8.75% in interval IUCD group. There was one case 1.25% of PID in interval IUCD group while no case in PPIUCD was noted. Failure rate was nil in both the group. There was no effect on puerperium following PPIUCD insertion group during present study.Conclusions: PPIUCD is an effective and safe spacing method of contraception as compared to interval IUCD insertion. There is no statistically significant change in incidence of expulsion rate, continuation rate and other complications in both the group.
      PubDate: 2019-07-26
      DOI: 10.18203/2320-1770.ijrcog20193552
      Issue No: Vol. 8, No. 8 (2019)
  • Comparative study of laparoscopic ovarian drilling and medical treatment
           in polycystic ovarian disease

    • Authors: Hema Verma, Prachi Srivastava
      Pages: 3291 - 3294
      Abstract: Background: To evaluate the result after medical treatment and laparoscopic ovarian drilling in PCOS patients and to compare the results of these two methods.Methods: In this prospective study 50 women with polycystic ovarian disease, were divided into two group,25 women received medical treatment and 25 women received surgical (laparoscopic ovarian drilling) treatment. Effect of treatment on ovulation, menstruation, fertility and androgen level was determined 3 month after therapy.Results: There was significant increase in ovulation and fertility, decrease in androgen levels and decrease in LH/FSH in individual groups when compared with pretreatment levels but difference between groups A and B was not statistically significant for these parameters.Conclusions: Medical treatment and laparoscopic ovarian drilling are equally effective in treating the women of polycystic ovarian disease. Result of both the treatment are similar in this study. However medical treatment should be the first line therapy, it has significant benefit for use in OPD, low cost, no hospital stays and convenience to the patient.
      PubDate: 2019-07-26
      DOI: 10.18203/2320-1770.ijrcog20193553
      Issue No: Vol. 8, No. 8 (2019)
  • Congenital anomalies in a tertiary care hospital in North East region,

    • Authors: R. K. Praneshwari, N. Nabakishore Singh, Akoijam Tamphasana Devi, Jyoti Priya, L. Ranjit Singh
      Pages: 3295 - 3299
      Abstract: Background: Congenital anomalies are important cause of morbidity and mortality in newborns and are defined as structural and functional abnormalities including metabolic disorders present at birth. These defects are of prenatal origin resulting from defective embryogenesis or intrinsic abnormalities in the process of development and are associated with various risk factors.Methods: Our study is a cross sectional study done at Regional Institute of Medical Sciences, Imphal over period of 3 years from January 2015 to December 2017. Aim of study was to find out incidence of congenital anomalies and proportions of different types of congenital anomalies. Outcome was studied in relation to maternal age, religion, parity, and gestational age, sex of the baby, outcome and sex of the baby.Results: Total numbers of congenital anomalies were 257 babies out of 29879 births giving the incidence of 0.86%. Most common congenital anomalies in this study are musculoskeletal followed by craniospinal, genitourinary, cardiovascular and gastrointestinal. It was more common in preterm babies and parity 1-3, more common in 21-30 years of maternal age. Consanguinity was seen in 7 out of 257 patients.Conclusions: Congenital malformations are a major cause of still births and infant mortality. Targeted scan should be done at 18-20 week to find out anomalies and reduce the prevalence. There should be widespread education in the community regarding the common congenital malformations, their outcomes and possible available mode of treatment
      PubDate: 2019-07-26
      DOI: 10.18203/2320-1770.ijrcog20193554
      Issue No: Vol. 8, No. 8 (2019)
  • Gestational diabetes mellitus, Vitamin D status and fetomaternal outcome

    • Authors: Rekha T., Shazia Parveen, Nasreen Noor, Seema Hakim, Shagufta Moin
      Pages: 3300 - 3303
      Abstract: Background: Diabetes is the most common medical complication of pregnancy. Vitamin D deficiency which was initially considered only to influence bone metabolism, is now known to exert a wide spectrum of extra-skeletal effects. Vitamin D deficiency is closely associated with gestational diabetes mellitus, it also leads to adverse maternal and child outcome. Objective of this study was to compare the vitamin D levels in healthy pregnant women and women with gestational diabetes mellitus and to observe the feto-maternal outcome.Methods: This prospective study was carried out on 160 pregnant women between the age group 20-40 years attending the Obstetrics and Gynaecology department of JNMC, AMU, Aligarh from October 2016 to October 2018. Women were divided into group A- normal pregnant women and group B- women with GDM. Estimation of vitamin D was done in both the groups.Results: Mean vitamin D levels were lower in women with GDM as compared to normal pregnant women.Conclusions: Women with vitamin D deficiency have an increased risk of developing GDM and adverse feto maternal outcome as compared to those who had normal level of vitamin.
      PubDate: 2019-07-26
      DOI: 10.18203/2320-1770.ijrcog20193555
      Issue No: Vol. 8, No. 8 (2019)
  • Postpartum Implanon/Nexplanon continuation rates and associated factors
           among women who ever used Implanon/Nexplanon in a tertiary hospital in
           Accra, Ghana

    • Authors: Kareem Mumuni, Kwaku Asah-Opoku, Vincent Ganu, Ali Samba
      Pages: 3304 - 3310
      Abstract: Background: Postpartum Implanon use serves as an important conduit to bridge the wide gap of unmet need for contraception. The study sought to determine the continuation rates of postpartum Implanon/Nexplanon use and factors associated with it.Methods: A retrospective review of electronic data of 391 women who had received postpartum Implanon/Nexplanon insertions from January 2012 to December 2015 was conducted at a family planning hospital in Accra, Ghana. Continuation rates and factors associated with discontinuation at 6 months, one year and two years post-partum were determined. Data were analysed using IBM Statistical Package for Social Science (SPSS) version 20.Results: A total of 391 postpartum Implanon/Nexplanon insertions were done during study period. Their mean age was 28.51±5.29 years and median parity was 2.0. Continuation rates of postpartum Implanon/Nexplanon at 6 months, 1 year and 2 years post uptake were 94.9%, 92.8% and 86.4% respectively. Women with tertiary level education were 64% less likely to continue Implanon/Nexplanon use at one-year post uptake (OR=0.36, CI=0.16-0.85). Women with education up to Senior High School were 62% less likely to continue postpartum Implanon/Nexplanon use at 2 years after uptake (OR=0.38, CI=0.18-0.81). Women between ages 20 and 29 years were 53% less likely to continue postpartum Implanon/Nexplanon use at 2 years (OR=0.47, CI=0.26-0.86). Reasons for discontinuation of postpartum Implanon/Nexplanon use were wishes to get pregnant and side effects of the method.Conclusions: Post -partum Implanon/Nexplanon continuation rates are high and remain as a viable choice for reduction of unplanned pregnancies post- delivery.
      PubDate: 2019-07-26
      DOI: 10.18203/2320-1770.ijrcog20193556
      Issue No: Vol. 8, No. 8 (2019)
  • Obstetric and perinatal outcomes in pregnancies occurring as a result of
           Fresh and Thawed frozen embryo transfer

    • Authors: Nishita Shah, K. Jayakrishnan
      Pages: 3311 - 3317
      Abstract: Background: In vitro fertilization is a known independent risk factor for adverse perinatal outcomes. To explore obstetric and perinatal outcomes in pregnancies occurring as a result of fresh and thawed frozen embryo transfer.Methods: Retrospective observational study with 208 patients. A period of 2 years from October 2015 to October 2017. Tertiary care Fertility, Laparoscopy and research centre. All pregnancies conceived by IVF (n= 208) between the study period were included. The patients were grouped by fresh (n= 108) versus frozen (n= 100) embryo transfer. Patients conceived with donor embryo transfer were excluded. Primary outcomes were missed abortions, ectopic pregnancy, live births. Incidence singleton pregnancies and multiple gestations, preterm delivery, birth weight, an obstetric complication includes gestational hypertension, preeclampsia, gestational DM, placenta previa.Results: A total 208 patient analyzed who conceived with IVF treatments, among them 108 patients were in Fresh ET group and 100 were in Frozen ET group. The incidence of Ectopic Pregnancy was more in fresh ET as compared to Frozen ET (14.8%, 02% respectively, p value <0.05) whereas that of missed abortions were more in Frozen ET (22% versus 11.1%, p value 0.03). There were no significant differences in obstetric and perinatal outcomes in both groups.Conclusions: In this study of IVF pregnancies, adverse obstetric and neonatal outcomes did not differ between fresh and frozen embryo transfers. Literature tells that there may be an increased risk of preeclampsia and large for gestational age babies in pregnancies conceiving after frozen embryo transfer. So freeze all policy should be applied to only indicated cases and not to all because both the groups having similar outcomes.
      PubDate: 2019-07-26
      DOI: 10.18203/2320-1770.ijrcog20193557
      Issue No: Vol. 8, No. 8 (2019)
  • Ovarian teratomas: clinicopathological study at tertiary care center

    • Authors: Sunil Vitthalrao Jagtap, Nitin S. Kshirsagar, Shubham S. Jagtap, Saswati Boral, Nitesh Nasre
      Pages: 3318 - 3322
      Abstract: Background: Teratomas are belonging to a group of germ cell tumors. It is also referred to as dermoid cyst. Teratomas are most common germ cell tumor of the ovary. Teratomas are composed of various histological types. In this article we are presenting various morphological patterns, its clinical manifestation and its clinical significance.Methods: This is prospective study for a period of 3 years from March 2016 to February 2019 at tertiary care hospital. It consists of total evaluation of 82 cases of ovarian lesions which were surgically excised for clinically or radiologically suspected of ovarian neoplasm.Results: A total of 82 cases of ovarian specimen were included out of which 18 cases were of ovarian teratoma. In these 17 cases were benign teratomas, 1 case of immature teratoma. All the cases of mature teratoma were predominantly of cystic type with focal solid areas. Right sided ovary was involved in44.5% cases while left sided in 55.5% cases. The tumor size ranges from 2.5 cm to 20.8 cms. The age range in this study was from 20 to 60 year. The common age observed for ovarian teratoma was in group of 31-40 years, having 6 cases. The clinically most of cases were asymptomatic or presented with unexplained abdominal pain or palpable mass. USG finding in most of cases were diffuse or partial echogenic mass lesion with cystic nature and echogenic bands.Conclusions: In our study showed mature cystic teratoma is the most common type of ovarian teratomas. The immature and monodermal types are rare. The histopathological examination plays important role in final diagnosis   and patient management.
      PubDate: 2019-07-26
      DOI: 10.18203/2320-1770.ijrcog20193558
      Issue No: Vol. 8, No. 8 (2019)
  • Abruptio placenta and its maternal and fetal outcome

    • Authors: Ritu Mishra, Aditya Prakash Misra
      Pages: 3323 - 3326
      Abstract: Background: Abruptio placenta is one of the common cause of antepartum haemorrhage and is defined as premature separation of normally implanted placenta. It is more common in second half of pregnancy. Abruptio placenta is serious complication of pregnancy and causes high maternal and neonatal morbidity and mortality.Methods: This retrospective study of abruptio and its maternal and perinatal outcome was carried out between July 2016 and October 2017 at Rama Medical College Hospital and research centre.Results: Incidence of Abruptio placenta is 1.6%. It is most common in the women of age group 30-35 years. 75% of cases were associated with severe pre-eclampsia. Live births were 75% while stillbirths were 25%. PPH occurred in 30% of cases. DIC accounts for 25% of the complication.Conclusions: Abruptio placenta is life threatening complication of pregnancy and it is associated with poor maternal and fetal outcome if not managed appropriately. Hence early diagnosis and prompt resuscitative measures would prevent both perinatal and maternal mortality and morbidity.
      PubDate: 2019-07-26
      DOI: 10.18203/2320-1770.ijrcog20193559
      Issue No: Vol. 8, No. 8 (2019)
  • Evaluation of patients with polycystic ovarian syndrome at a tertiary care

    • Authors: Swapna Y., V. Srilakshmi
      Pages: 3327 - 3331
      Abstract: Background: It has been estimated that prevalence of PCOS ranges from 5-10% in reproductive females. Thus, it becomes most common endocrinopathy in this age group. Lack of ovulation and androgen over activity are key features of PCOS. The objective of this study was to patients with polycystic ovarian syndrome at a tertiary care center.Methods: Present study was following up study with 200 cases of PCOS. Rotterdam criteria were used for the diagnosis of the PCOS. This criterion includes three things. First is woman having in last year <6 periods of menstruation. Second is testosterone value >0.6 ng/ml and third is each ovary having >12 follicles with increased size and volume. Those cases with hypothyroidism, adrenal tumors, congenital adrenal hyperplasia etc were excluded from the present study. Those on steroid therapy were also excluded. Detailed history and clinical examination were carried out for included cases as well as required investigations.Results: Overall incidence of infertility was found as 27.9%. Out of these 200 cases, 44 (22%) had PCOS. Majority cases belonged to 20-24 years of age. Hirsutism was most common findings in clinical hyperandrogenism. Risk of insulin resistance syndrome was 4.79 times higher in obesity compared to not obese. Age, BMI, duration of infertility, ovarian volume, and menstrual pattern had effect on ovulation rate following laparoscopic ovarian drilling. Increasing duration of infertility and BMI had lower ovulation rate. Ovulation rate was highest when treated with clomiphene citrate alone than the combination therapy.Conclusions: Women with obesity have more chances of having PCOS as seen from the present study.
      PubDate: 2019-07-26
      DOI: 10.18203/2320-1770.ijrcog20193560
      Issue No: Vol. 8, No. 8 (2019)
  • Role of IV administered Iron sucrose with recombinant erythropoietin in
           the treatment of moderate and severe iron deficiency anemia in the third
           trimester of pregnancy

    • Authors: Namrita Sandhu, Sanjay Singh
      Pages: 3332 - 3338
      Abstract: Background: Iron deficiency Anemia in pregnancy is one of the most common and intractable nutritional problems in the world today. The objective of this study was to investigate the therapeutic efficacy and safety of rHuEPO combined with IV iron sucrose, in the treatment of pregnant women in third trimester with moderate and severe iron deficiency anemia and whether addition of erythropoietin will increase the rate of rise of Hb without compromising on the safety of the therapy.Methods: 60 pregnant women in the third trimester, diagnosed as cases of moderate and severe iron deficiency anemia were enrolled in this study with 30 subjects in each of the 2 groups. Recombinant Erythropoietin 2000 IU s/c and Inj Iron sucrose 100 mg slow intravenously in 100 ml 0.9% NS over 1 hr on alternate days was administered to the case group and the control group was administered only iron sucrose slow IV in the same dose on alternate days till target Hb (11gm%) was reached. Efficacy measures were reticulocyte count, increase in Hb/week, time to target Hb level and need for continued therapy after 4 weeks.Results: In the case group, the increases in Hb were greater after 1 week of treatment and this was found to be significant (P < .01), the median duration of therapy was shorter in the case group (22 versus 34 days), with more patients reaching the target hemoglobin level by 4 weeks as opposed to 7 weeks in the control group. Average rise in Hb/week was much more in the case group. The groups did not differ with respect to maternal and fetal safety parameters.Conclusions: Iron sucrose plus rhEPO is an effective treatment for iron deficiency anemia in pregnancy probably because of a synergistic action, with rhEPO stimulating erythropoiesis and iron sucrose delivering iron for hemoglobin synthesis. 
      PubDate: 2019-07-26
      DOI: 10.18203/2320-1770.ijrcog20193561
      Issue No: Vol. 8, No. 8 (2019)
  • Dysmenorrhea among students in Yaounde, Cameroon: associated factors and
           socio-cultural aspects

    • Authors: Jeanne Hortence Fouedjio, Florent Ymele Fouelifack, Jovanny Tsuala Fouogue, Lionel Etame, Loic Dongmo Fouelifa, Robinson Enow Mbu
      Pages: 3339 - 3343
      Abstract: Background: Dysmenorrhea is very common disorder. It affects the quality of life and is the main cause of school absenteeism’s among teenagers. The goal of this study was to determine socio-cultural aspects of dysmenorrhea among students in Yaounde and factors associated with it.Methods:
      Authors carried out a cross sectional analytic study in 2 secondary schools and a higher institute in Yaounde, from December 1, 2017 to June 30, 2018 (7 months).
      Authors included all students aged at least 15, in form 5 and above. In the higher institute, sampling was consecutive, while it was stratified into 2 clusters in the secondary schools.  Odds ratios were determined to assess association between variables and P-value ˂0.05 was considered significant.Results: Of the 1059 participants, 800 had dysmenorrhea (prevalence: 75.5%). Mean age was 18.88±3.62 years (range: 15-45 years). Family history of dysmenorrhea (OR: 4.20 (95% CI: 3.02-5.83)) and stress ((OR: 2.16 (95% CI: 1.55 - 3.02)) were significantly associated with dysmenorrhea. A duration of menses ≤3 days was protective ((OR: 0.31 (95% CI: 0.12-0.82)). Dysmenorrhea remains a taboo for 23.6% of participants.Conclusions: Family history of dysmenorrhea and stress are risk factors for dysmenorrhea which remains a taboo for almost a fourth of affected women.
      Authors recommend educating women about dysmenorrhea and control psycho-social stress.
      PubDate: 2019-07-26
      DOI: 10.18203/2320-1770.ijrcog20193562
      Issue No: Vol. 8, No. 8 (2019)
  • One step procedure for screening and diagnosis of gestational diabetes
           mellitus by diabetes in pregnancy study group of India

    • Authors: Dwarakanath L., Hema K. R., Hemashree P.
      Pages: 3344 - 3349
      Abstract: Background: In the Indian context, screening for Diabetes is essential in all pregnant women, as the Indian women have an eleven-fold increased risk of developing glucose intolerance during pregnancy. For this, we need a simple procedure which is economical and feasible. Hence this study was undertaken as a screening as it is acceptable, economical and feasible to perform. Aim of this study was to assess the feasibility of one step procedure for screening and diagnosis of Gestational Diabetes Mellitus by Diabetes in Pregnancy Study Group of India (DIPSI).aim of the study was to study the occurrence of Gestational Diabetes mellitus, Tumkur, to assess the sensitivity and specificity of glucose challenge test, to assess the need for universal screening and to study the maternal and perinatal outcomes in patient with Gestational Diabetes Mellitus.Method: Type of study was prospective study. this study included 200 pregnant women attending the antenatal OPD in Sri Siddhartha Medical College, Tumkur. Data collection was in a predesigned proforma. Pregnant women with 24-28 weeks of gestation were given 75 grams of oral glucose load, irrespective of their meal and venous blood sample drawn after 2 hours. If blood glucose value was ≥140mg/dl, the screening was considered as DIPSI positive. These patients underwent OGTT.Results: Incidence of GDM was found to be 3.5% in the patients studied. 40% of cases did not have risk factors, hencethere is a need for universal screening. DIPSI was positive in 10 cases, of which 7 were OGTT positive. Patients were managed with diet and insulin. The maternal and perinatal outcome of pregnancy was good.Conclusion: For universal screening, DIPSI performed irrespective of last meal timing with 75g glucose load is a patient friendly approach. This method recommended by WHO serves both as a one-step screening and diagnostic procedure & is easy to perform besides being economical.
      PubDate: 2019-07-26
      DOI: 10.18203/2320-1770.ijrcog20193563
      Issue No: Vol. 8, No. 8 (2019)
  • Gestational hyperglycemia on diet and medication: impact on placental
           pathology and pregnancy outcomes

    • Authors: Lalitha Natarajan, G. UmaMaheswari
      Pages: 3350 - 3356
      Abstract: Background: To evaluate the placental morphology and perinatal outcome in patients with gestational hyperglycemia on diet and medication.Methods: Placental examinations performed at the Department of Pathology between August 2016 to August 2018 were retrospectively reviewed. Of the received 140 placentas, 35 of gestational diabetes (GDM) and pre gestational diabetes were identified and segregated into hyperglycemia on diet and on medication. The clinical details, placental findings and perinatal outcome of patients in both the groups (gestational hyperglycemia on diet and medication) were collected and analyzed.Results: Among the 35 cases, there were 24 cases of mild gestational hyperglycemia controlled with diet and 11 cases of hyperglycemia on medication (oral hypoglycemic drugs ± insulin).Most of the placentae in both the groups weighed less than tenth centile. The cord abnormalities such as hyper coiling, velamentous /marginal insertion and furcate cord were observed more in women with GDM on diet. There was no significant gross placental lesion in those on medication. Placental histological features most consistently associated with both the groups include, disturbances of villous maturation (DVM), Derangements in uteroplacental / foetoplacental circulation and villous capillary lesions. Small for gestational age and intrauterine foetal death were found in both the groups, but more commonly in patients with hyperglycemia on medication.Conclusions: Villous maturation defects, uteroplacental / foetoplacental malperfusion are the essential placental changes which can result in adverse perinatal outcomes in women with hyperglycemia irrespective of the diabetic control.
      PubDate: 2019-07-26
      DOI: 10.18203/2320-1770.ijrcog20193564
      Issue No: Vol. 8, No. 8 (2019)
  • Maternal serum βhCG level and uterine artery doppler studies as
           predictors of pregnancy induced hypertension and intra uterine growth
           restriction: a prospective study

    • Authors: Vishal S. Sheth, Kanaklata D. Nakum, Mehul D. Patel, Mayank R. Lunagariya
      Pages: 3357 - 3361
      Abstract: Background: PIH, a pregnancy-specific disorder, is one of the major causes of maternal and perinatal morbidity and mortality worldwide.PIH and fetal growth restriction are important causes of perinatal and maternal morbidity and mortility.Methods: Hundred Indian pregnant women in their second trimester (13-20 weeks) and in their late second trimester (24-28 weeks) investigated for their serum β-hCG level and uterine artery Doppler studies respectively, attending OPD/IPD in Sir T. hospital, Bhavnagar from June 2014 to June 2015.Results: There is no clinical significance between parity and occurrence of PIH (p=0.2) and FGR (p=0.7). Out of 77 patients with their β hCG level ≤2 MoM, 2 patients (2.59%) developed PIH and FGR. And from 12 patients with their β hCG level ≥2 MoM 10 patients (80%) developed PIH and FGR which is highly significant (p<0.001). The study establishes the validity of beta HCG as a predictor of PIH and FGR with the sensitivity of 83.3%, specificity of 97.5%.Conclusions: This study can be concluded by there is a strong association between high maternal serum ß-hCG level, abnormal uterine Doppler studies with predicting adverse outcome of pregnancy like PIH and FGR. There is also a good association between high maternal serum ß-hCG level and rising severity of the disease.
      PubDate: 2019-07-26
      DOI: 10.18203/2320-1770.ijrcog20193565
      Issue No: Vol. 8, No. 8 (2019)
  • Unsafe abortion: the silent scourge

    • Authors: Sharadha Mallaiyan
      Pages: 3362 - 3367
      Abstract: Background: Unsafe abortions continue to cause maternal morbidity and mortality in developing countries. The practice of unsafe abortions by quacks needs to be checked. Our study aims to emphasize upon the unmet needs of medical termination pregnancies (MTP) services in rural India and to recognize the complications due to it and the efficient management of such cases at tertiary care center.Methods: A two years retrospective study of septic abortions from December 2009 to November 2011.Results: Among 1080 abortions reported, 44 were septic-4.07%. More commonly in the age group of >20years (81.9%). 77.3% of them were multiparous and 22.7% were nulligravidae, with an increased incidence of unmarried nulliparous pregnancies. Greater numbers occurred during 1st trimester (77.2% versus 22.7%), with 54.5%-grade I, 29.5%-grade II, 15.9% grade III in severity. Majority of cases were due to evacuation by quacks (72.7%). Among the 44 cases, emergency laparotomy was done for 5 cases of grade III severity. The mortality rates due to septic abortion were 6.25% (3) among the total of 48 maternal deaths.Conclusions: Septic abortion is totally preventable. Majority of uneducated rural women are not aware of MTP services. The reproductive and child health (RCH) services should effectively reach the underprivileged population like slum dwellers and migrants.
      PubDate: 2019-07-26
      DOI: 10.18203/2320-1770.ijrcog20193566
      Issue No: Vol. 8, No. 8 (2019)
  • Comparison of efficacy of buccal versus vaginal misoprostol in first
           trimester induced abortion

    • Authors: Nida Khan, Anita M. Kant, Pooja C. Thukral, Mohammad Saquib
      Pages: 3368 - 3373
      Abstract: Background: To compare the effectiveness, side effects, and patient satisfaction of buccal versus vaginal misoprostol administration in first trimester abortions.Methods: Women opting for first trimester abortion received oral Mifepristone followed 48 hours latermisoprostol. Group A received Misoprostol via buccal route whereas group B received Misoprostol vaginally. A comparative analysis using SPSS was done.Results: Giving 800µg Misoprostol by either buccal or vaginal route after oral Mifepristone have comparable efficacy in terms of complete abortion rate (96% in buccal group versus 98% in vaginal group; p value = 0.495), failure rate being statistically similar (4% versus 2%). Drug abortion interval was comparable in the two groups. (11.16 hour in buccal group and 12.32 hours in vaginal group). Few side effects like nausea and vomiting, shivering, diarrohea was significantly higher with vaginal Misoprostol while abdominal cramps, altered taste were found more with the buccal group.Conclusions: Buccal Misoprostol is comfortable and easier to administer when compared to other routes and it has potential to be developed as a self-administered regimen. Buccal Misoprostol is as efficacious as vaginal Misoprostol with significantly lesser side effects up to 7 weeks of period of gestation.
      PubDate: 2019-07-26
      DOI: 10.18203/2320-1770.ijrcog20193567
      Issue No: Vol. 8, No. 8 (2019)
  • Clitorial inclusion cyst in an adult: a rare presentation

    • Authors: Tanweerul Huda, Tarun Sutrave, Bharati Pandya
      Pages: 3374 - 3376
      Abstract: Dermoid cysts are benign lesions that grow slowly and can occur anywhere in the body. Clitoris is an extremely rare site for dermoids cysts. We present a case of inclusion cyst of clitoris in a middle aged woman, who had it for 10 years before presenting for relief from her symptoms. Local examination revealed a 3 cm X 4 cm size cystic mass at the clitoris giving it an appearance of clitoromegaly. She underwent an excision of the cyst at our hospital with the histopathology report suggesting the lesion to be a dermoid cyst. Postoperative recovery was uneventful with no evidence of recurrence on follow up.
      PubDate: 2019-07-26
      DOI: 10.18203/2320-1770.ijrcog20193108
      Issue No: Vol. 8, No. 8 (2019)
  • Broad ligament term pregnancy in an unscarred uterus: misdiagnosis and the

    • Authors: Shalini Singh, Madhubala Chauhan
      Pages: 3377 - 3381
      Abstract: A broad ligament pregnancy is a rare condition, but full term broad ligamnet pregnancy especially in an unscarred uterus is extremely rare. It is often misdiagnosed and usually finally diagnosed during surgery. Here is case of full term broad ligament pregnancy, which remained undiagnosed throughout her pregnancy, unfortunately had IUFD. Patient was referred to our hospital in view of failure of induction with increased BP records. No ultrasound was available on admission. On clinical assessment it appeared as transverse lie with IUFD. So cesarean was decided as a mode of delivery. Emergency ultrasound could just confirm IUFD with pelvic mass' Fibroid (actually deviated uterus). On laparotomy the broad ligament pseudosac had occupied entire abdomen. After delivery of baby, anatomy was found completely distorted. Highly vascular omental adhesions on fundus with difficulty in placental removal. Placenta could be traced reaching abdomen posteriorly. The first clinical impression was suspicion of placenta percreta. Uterus appeared non salvageable and hysterectomy was decided. Placenta was found lying in abdomen, adhered to bowel, omentum and fundus of uterus. The final diagnosis of broad ligament pregnancy could be made after the cut section of the uterus and anatomic evaluation. Patient required blood transfusions preoperatively .She remained stable and discharged on postoperative day nine. This case holds importance because may be outcome was different if it was a booked and investigated pregnancy. May be baby and uterus were salvageable with better outcome.
      PubDate: 2019-07-26
      DOI: 10.18203/2320-1770.ijrcog20193568
      Issue No: Vol. 8, No. 8 (2019)
  • Abdominal pregnancy misdiagnosed as an intrauterine pregnancy: a cause of
           failed induction of labour for fetal death

    • Authors: Nkencho Osegi, Olakunle I. Makinde, Peter O. Eghaghe, Zakaa Zawua, Bright N. Ohaka
      Pages: 3382 - 3386
      Abstract: Abdominal pregnancy is a rare form of ectopic pregnancy usually associated with fetal death among other complications, although very rare cases of live births have been reported. There is also a high risk of maternal mortality. A high index of suspicion is required to make a preoperative diagnosis as diagnosis from history, examination and ultrasound is often missed. Misdiagnoses as an intrauterine pregnancy usually occur. This misdiagnosis makes management of patients with an abdominal pregnancy a challenge and may affect treatment outcome. We managed a 35 year old pregnant multipara who was referred to us on account of repeated failed attempts at induction of labour for intrauterine fetal death. Three obstetric ultrasound scans done during the course of patient’s management reported an intrauterine dead fetus. We also failed to achieve uterine evacuation. We resorted to carry out a hysterotomy and following laparotomy, we found an abdominal pregnancy. This finding was unexpected by us, however, we delivered the dead fetus and was able to successfully manage the placenta. Discovering an abdominal pregnancy at surgery carried out for a supposed intrauterine pregnancy is usual for many cases of abdominal pregnancy. Clinicians should be aware of the clinical signs and symptoms that raise a suspicion of abdominal pregnancy as prompt preoperative diagnosis of abdominal pregnancy helps to plan and offer early and appropriate intervention. This reduces the incidence of maternal mortality usually due to massive intra-abdominal haemorrhage arising from delayed diagnosis and poor placenta management.  
      PubDate: 2019-07-26
      DOI: 10.18203/2320-1770.ijrcog20193569
      Issue No: Vol. 8, No. 8 (2019)
  • Primary malignant melanoma of the uterine cervix treated with radical
           surgery and adjuvant chemo-radiation using temozolomide and cisplatin: a
           case report

    • Authors: Goter Doke, Shyam Tsering, Hage Nobin, Dacto Gara
      Pages: 3387 - 3390
      Abstract: Primary malignant melanoma of the uterine cervix is a rare neoplasm and the overall prognosis of patients with this disease is very poor. Herein, authors report a case of 45-year-old woman who presented with vaginal bleeding for one months and examination showed an exophytic, 6 cm polypoid blackish-pigmented tumor on the cervix involving vaginal fornix. She underwent abdominal radical hysterectomy with bilateral salpingo-oophorectomy and pelvic lymphadenectomy and further received adjuvant concurrent chemo-radiation with cisplatin (CDDP) and temozolamide but died 7 months after surgery.
      PubDate: 2019-07-26
      DOI: 10.18203/2320-1770.ijrcog20193570
      Issue No: Vol. 8, No. 8 (2019)
  • Laparoscopic management of ruptured non communicating rudimentary horn in
           second trimester of pregnancy

    • Authors: Akriti Jha, Richa Gupta, Lavesh Gupta, Deepesh Gupta
      Pages: 3391 - 3394
      Abstract: Rudimentary horn is a developmental anomaly of the uterus. Pregnancy in rudimentary horn is rare occurrence with incidence of less than 1 in 150,000. Prerupture diagnosis of rudimentary horn pregnancy with USG is technically difficult, with sensitivity of 30%. It is often not diagnosed unless it terminates by rupture in the second trimester leading to catastrophic haemorrhage and hence high incidence of maternal mortality. Management of such cases is a challenge till today due to diagnostic dilemma. Expertise in ultrasonography and early resort to surgical management is life saving in such cases. Here we present a case of ruptured non-communicating rudimentary horn pregnancy at 15 weeks presenting in our emergency department as a case of pain abdomen. Laparoscopic resection of the rudimentary horn was performed for the patient.
      PubDate: 2019-07-26
      DOI: 10.18203/2320-1770.ijrcog20193571
      Issue No: Vol. 8, No. 8 (2019)
  • A rare case of gartner duct cyst presenting as a genital prolapse: a case

    • Authors: Tanu Bhati, Sunil Takiar, Kalpana Verma, Kalpna Kulshrestha
      Pages: 3395 - 3397
      Abstract: Mullerian cysts are usually small, ranging from 0.1 to 2 cm in diameter. Rarely, they may be enlarged and mistaken for other structures such as uterovaginal prolapse/cystocele/rectocele or urethral diverticulum. Posterior vaginal wall cyst is a very rare case. We present a case of patient presenting with mass coming out from vagina, which, after clinical evaluation and USG, was diagnosed as a Gartner’s cyst. Gartner’s duct cyst is a derivative of Wolffian duct (mesonephric duct) in females. Assessment of the lesion via history taking and pelvic examination is important to confirm both the lesion’s size and location, but appropriate clinical evaluation supported with investigations clinched the diagnosis easily.
      PubDate: 2019-07-26
      DOI: 10.18203/2320-1770.ijrcog20193572
      Issue No: Vol. 8, No. 8 (2019)
  • Rare case of ruptured uterus in previously normal delivered patient due to
           hydatid cystic disease in pregnant uterus

    • Authors: Ganesh Mahadeo Bargaje, Jitendra Pundlik Ghumare
      Pages: 3398 - 3401
      Abstract: Hydatid cystic disease is parasitic disease caused by Echinococcus granulosus. Dogs and carnivors like fox are definitive hosts harbouring warms in intestine. Eggs passed in stools eaten by intermediate hosts and larvae encyst in liver, lungs and other organs. Humans are accidental hosts. Incidence of hydatid cystic disease in genital organs is low around 0.5%. Hydatid cyst most often found in liver - 60%, lungs - 30% accounting approximately 90% of the disease. Incidence of hydatid disease in pregnancy is very rare ranging from 1/20000 to 1/30000. 22 years old G2P1L1 with 39weeks gestation age (GA) with intrauterine fetal death (IUFD) with query ruptured uterus, extra uterine pregnancy, transverse lie with severe anaemia referred from Jalgaon civil hospital for further management.
      PubDate: 2019-07-26
      DOI: 10.18203/2320-1770.ijrcog20193573
      Issue No: Vol. 8, No. 8 (2019)
  • A case report on IgA nephropathy in pregnancy

    • Authors: Nupur Anand, A. V. Gokhale, Shonali Agarwal
      Pages: 3402 - 3405
      Abstract: IgA Nephropathy is a primary glomerular disease leading cause of primary glomerulonephritis and one of the important  leading cause of secondary hypertension. Pregnancy causes complex pathological changes in patients with IgA nephropathy affecting the renal function leading to secondary hypertension which in turn affects the prognosis of these patients. The association between chronic kidney disease and increased risk of adverse maternal and fetal outcomes which includes pre-eclampsia, accelerated decline in renal function, intrauterine growth retardation, preterm delivery and fetal death, is well recognised. Management of patients with IgA Nephropathy in pregnancy is challenging and thus authors are discussing here a case with successful outcome. Our patient was a known case of IgA Nephropathy and landed up with complications during pregnancy which was manged successfully. 
      PubDate: 2019-07-26
      DOI: 10.18203/2320-1770.ijrcog20193574
      Issue No: Vol. 8, No. 8 (2019)
  • Site of pregnancy obstetrician’s dilemma

    • Authors: Rudrika Chandra, Sanjay Singh
      Pages: 3406 - 3408
      Abstract: A 28-yr-old P2L2 lady, with history of two previous caesarean deliveries and tubal ligation, presented at 6weeks of amenorrhea with pain lower abdomen. The operative notes from her previous caesarean section stated that she had a unicornuate uterus without a rudimentary horn (ASRM Class II D Mullerian anomaly)5 and only right fallopian tube was visualised, which was ligated by Parkland’s method.On workup, she had a positive urine pregnancy test and ultrasound showed a left adnexal mass without any evidence of intraperitoneal collection, possibly an unruptured left ovarian ectopic pregnancy secondary to failed tubal ligation. Further investigation by MRI revealed an entirely new finding. The suspicious left adnexal mass was the left horn of bicornuate uterus which had an intrauterine gestational sac. Hence, her revised diagnosis was G3P2L2, post LSCS, bicornuate uterus (ASRM class IV B) with 6 weeks of intrauterine left horn pregnancy following failed tubal ligation.She underwent a medical followed by surgical evacuation of intrauterine pregnancy as patient was unwilling to continue the pregnancy.This case highlights the importance of a comprehensive evaluation, whenever a lady is diagnosed with a Mullerian anomaly, in order to correctly classify the patient and identify associated anomalies of urogenital tract which would avoid such erroneous diagnosis of site of pregnancy as illustrated in our case.
      PubDate: 2019-07-26
      DOI: 10.18203/2320-1770.ijrcog20193575
      Issue No: Vol. 8, No. 8 (2019)
  • Postpartum atypical haemolytic uremic syndrome: a rare clinical entity

    • Authors: Aanchal Sablok, Taru Gupta, Sangeeta Gupta, R. K. Duggal, Amrita Tiwari
      Pages: 3409 - 3413
      Abstract: P-aHUS has incidence of 1 in 25000 pregnancies. It’s characterized by microangiopathic haemolytic anemia, thrombocytopenia and renal failure. Mrs X, 26 year old lady, G2 P1L1 with 39 weeks POG came to emergency of a tertiary care hospital. She underwent LSCS in view of previous caesarean section not willing for trial of labour. Antenatal, intrapartum and immediate post operative period were uneventful. However, she became anuric 36 hours post operatively. Laboratory investigations suggested hemolysis. Complement system evaluation showed decreased complement levels. Diagnosis of p-aHUS was made by taking multidisciplinary approach and renal biopsy. Patient received 4 sessions of plasmapheresis and symptomatic treatment. Gradually her urine output increased and she was discharged with the baby on post operative day 19. Diagnosis of p-aHUS is tricky owing to similar clinical features with many other pregnancy associated conditions. Timely management and diagnosis are imperative to save the mother’s life.
      PubDate: 2019-07-26
      DOI: 10.18203/2320-1770.ijrcog20193576
      Issue No: Vol. 8, No. 8 (2019)
  • Large cervical fibroid: a rare case report

    • Authors: Sunanda N.
      Pages: 3414 - 3416
      Abstract: Although leiomyomas are the most common pelvic tumors presenting in the reproductive age group, cervical fibroids are rare accounting for 2% of all uterine fibroids. We report a case of 40 year old lady presenting with a firm, non-tender mass of 22-24 weeks size pregnant uterus with restricted mobility. Laparotomy showed a large mass arising from the anterior lip of cervix, with a small uterus pushed posteriorly. Enucleation followed by total abdominal hysterectomy was done. Large cervical fibroids are rare, presenting with surgical difficulties. Careful dissection by expert hands is needed in the management of such cases. 
      PubDate: 2019-07-26
      DOI: 10.18203/2320-1770.ijrcog20193577
      Issue No: Vol. 8, No. 8 (2019)
  • Repeated broad ligament hematomas managed by uterine artery embolization:
           time to execute

    • Authors: Subrat Panda, Nalini Sharma, Pranjal Phukan
      Pages: 3417 - 3421
      Abstract: Selective arterial embolization (SAE) of the uterine arteries is an alternative to surgery when medical management fails in cases of intractable posrtpartum haemorrhage. It is highly efficacious with low complication rate. Here we report a case of repeated broad ligament haematoma managed by selective uterine artery embolization. Present case 28year old P4L4 was referred from a district hospital as post LSCS case with broad ligament haematoma. Patients general condition was very poor at the time of admission. She underwent laparotomy twice and finally uterine artery embolization for repeated broad ligament haematoma and responded. Massive obstetric haemorrhage remains a significant cause of maternal morbidity and mortality. The threshold for uterine artery embolization (UAE) in women with obstetric haemorrhage should be low, as it is coupled with a high clinical effectiveness rate, low complication rate and preservation of fertility. However, it requires an infrastructure, multidisciplinary approach, as well as speedy and effective interaction between various specialties.
      PubDate: 2019-07-26
      DOI: 10.18203/2320-1770.ijrcog20193578
      Issue No: Vol. 8, No. 8 (2019)
  • A rare case of dicephalous dibrachius dipus conjoined twins:case report

    • Authors: Medha Davile, Mrunal Gaikwad
      Pages: 3422 - 3424
      Abstract: Conjoined twin is a rare complication seen in 1% of monochorionic monoamniotic twins and associated with severe morbidity and mortality. We are reporting a case of 30 years old second gravida referred to our tertiary care center at 35 weeks of gestation with ultra-sonographic diagnosis of dicephalus conjoined twin and further confirmed after caesarean delivery.
      PubDate: 2019-07-26
      DOI: 10.18203/2320-1770.ijrcog20193579
      Issue No: Vol. 8, No. 8 (2019)
  • A rare case of craniopagus parasiticus delivered vaginally at a district

    • Authors: Komal Kuldeepsingh Chhabra
      Pages: 3425 - 3427
      Abstract: Craniopagus Parasiticus is a very rare type of parasitic twinning. It has an incidence of only 4-6/10,00,000 births. Most of the babies with Craniopagus Parasiticus are still born with only few cases which survived after postpartum surgical separation. In Craniopagus Parasiticus the head of one of the twins is parasitic and protrudes from the head of the normal twin with an undeveloped or underdeveloped body. The skulls of the twins are fused but the body of one of the twins is not developed. The developed twin is known as the auto site while the undeveloped twin is the parasite. Age of the mother or certain nutritional factors have been implicated in the etiology of this type of twinning. This is a rare case report of a female baby with a parasitic craniopagus delivered vaginally at this district hospital. The patient was a fourth gravida 28 year old. There was antenatal polyhydramnios. The patient delivered preterm a still born female baby with a parasitic co-twin. In this case the heads of the twins were fused in temporal and parietal areas while the body of the parasitic twin was completely undeveloped. It was a morphologically female baby with rudimentary labia. The causes of Craniopagus Parasiticus are still not known. Scientists and researchers are continuing work to determine these and also to improve the prognosis and chances of post-surgical survival of these twins. Till present day however there have been only limited number of studies on Craniopagus Parasiticus owing to the rarity of the cases.
      PubDate: 2019-07-26
      DOI: 10.18203/2320-1770.ijrcog20193580
      Issue No: Vol. 8, No. 8 (2019)
  • Case report of a successful term pregnancy following renal transplantation

    • Authors: Prabhadevi Kodey, Badugu Rao Bahadur, V. Srilatha, G. Srinivasa Rao, Sowjanya P.
      Pages: 3428 - 3430
      Abstract: Pregnancy with renal disease is associated with high risk for both mother and fetus with adverse outcomes. Criteria for considering pregnancy in renal transplanted patients include good post-transplant health for 2 years, stable allograft function with a serum creatinine <1.5 mg/dl, absence of rejection, control of blood pressure, absence of proteinuria.
      Authors report a case of 26-year-old, primigravida had renal transplantation done in NRI Medical College and treated with immunosuppressive therapy with tablets Tacrolimus 1mg twice daily, Azathioprine 50mg twice daily, Prednisolone 10mg once daily and continued till delivery. Developed gestational hypertension treated with tablet Amlodipine 5mg once daily. Elective caesarean section done for contracted pelvis. Post-natal period was uneventful and discharged on immunosuppressive therapy and contraceptive advice. Post-renal transplantation pregnancy should have multidisciplinary approach for. With close medical and obstetric follow up, successful outcome for both mother and infant is possible.
      PubDate: 2019-07-26
      DOI: 10.18203/2320-1770.ijrcog20193581
      Issue No: Vol. 8, No. 8 (2019)
  • Retrospective review of maternal deaths and maternal near misses due to
           major obstetric haemorrhage at a tertiary care centre in India

    • Authors: Swati Agrawal, Anuradha Singh, Ratna Biswas, Abha Singh
      Pages: 3431 - 3434
      Abstract: Background: Maternal near miss (MNM) is now widely accepted as a better indicator of maternal health than maternal death and reflects the quality of obstetric care in a particular institution.Methods: This is a retrospective study conducted at Lady Hardinge Medical College and Smt. Sucheta Kriplani  Hospital over a period of 12 months (April 2016-March 2017), of  all cases of maternal death and near miss maternal deaths due to major obstetric haemorrhage(MOH).Results: During the period reviewed, there were 13,083 deliveries, 12,958 live births and 37 maternal deaths. There were 30 cases of near miss maternal deaths and 2 maternal mortalities due to MOH. The mortality index was 6.25%. Severe maternal outcome ratio (SMOR) was  2.46.Among the near miss cases (n=30), morbidly adherent placenta was the cause in 26.6% of cases(n=8), postpartum hemorrhage in 23% of cases(n=7); rupture uterus in 13% cases(n=4); massive abruption in 13% of cases(n=4) and placenta praevia with antepartum haemorrhage in 3% of cases(n=1). Early obstetric haemorrhage due to ruptured ectopic pregnancy and incomplete abortion resulted in MNM in 16% (n=5) and 3.3% (n=1) cases respectively.It was observed that in 40% (n=12) of MNM cases (8 cases of morbidly adherent placenta plus 4 cases of rupture uterus), previous cesarean section was the single most important causative factor  for the morbidity of the patient.Conclusions: Reduction in cesarean section rates is imperative to reduce morbidity and mortality associated with MOH. 
      PubDate: 2019-07-26
      DOI: 10.18203/2320-1770.ijrcog20193582
      Issue No: Vol. 8, No. 8 (2019)
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