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Publisher: Medip Academy   (Total: 12 journals)   [Sort by number of followers]

Showing 1 - 12 of 12 Journals sorted alphabetically
Intl. J. of Advances in Medicine     Open Access   (Followers: 2)
Intl. J. of Basic & Clinical Pharmacology     Open Access   (Followers: 3)
Intl. J. of Clinical Trials     Open Access   (Followers: 2)
Intl. J. of Community Medicine and Public Health     Open Access   (Followers: 5)
Intl. J. of Contemporary Pediatrics     Open Access   (Followers: 4)
Intl. J. of Otorhinolaryngology and Head and Neck Surgery     Open Access  
Intl. J. of Reproduction, Contraception, Obstetrics and Gynecology     Open Access   (Followers: 12)
Intl. J. of Research in Dermatology     Open Access   (Followers: 1)
Intl. J. of Research in Medical Sciences     Open Access   (Followers: 5)
Intl. J. of Research in Orthopaedics     Open Access  
Intl. J. of Scientific Reports     Open Access   (Followers: 2)
Intl. Surgery J.     Open Access   (Followers: 1)
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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]
  • Prevalence of cesarean section on demand in Assiut Governorate, Egypt

    • Authors: Mahmoud S. Zakherah, Tarek A. Farghaly, Elham S. Ahmed, Ahmed M. Abbas
      Pages: 1223 - 1226
      Abstract: Background: The current study aims to evaluate the prevalence of CS on demand in Women's health hospital, Assiut University and Abnob Central Hospital in Assiut Governorate, Egypt.Methods: A cross sectional study conducted in Assiut Women Health Hospital and Abnob central hospital from January 2017 to December 2017. The total number of cesarean section done was 180 cases and the number of CS on demand was 64 (35.6%). The demographic data were collected by one of the study investigators. Women were asked about the causes of requesting CS before surgery.Results: The study group was 64 women with age ranging from 18-40 years old, 40 primipara and 24 multipara. Of those 24 women, 21 of them previously delivered vaginally and only 3 women delivered by emergency CS. Twenty- six women had a history of previous abortion. Fear of pain was the main cause for CS on demand in the whole study participants (57.8%). In primipara, the main cause for requesting CS is fear of pain in 62.5% of participants followed by fear on the baby in 45 % of women. On the other hand, in multipara, the main cause for CS on demand was bad history of previous experience (60%) followed by fear of pain in 50% of cases. There was statistical significant difference between both groups in only two causes; fear of pelvic floor injuries (50% in multipara vs. 20% in primipara, p=0.02) and bad history of previous experience (60% in multipara vs. 0% in primipara, p=0.001). Other causes were not statistically different.Conclusions: The incidence of cesarean sections performed on request without medical indications is rising. The reasons for this are not only for perceived medical benefit, but also due to social, cultural, and psychological factors.
      PubDate: 2019-03-26
      DOI: 10.18203/2320-1770.ijrcog20191175
      Issue No: Vol. 8, No. 4 (2019)
       
  • Factors influencing the acceptance of HPV vaccine among civil servants in
           Delta State Secretariat

    • Authors: Uchechukwuka Nnemdi Okwe, Helen Chime, Ezekiel Uba Nwose
      Pages: 1227 - 1232
      Abstract: Background: The importance of cervical screening and HPV vaccination cannot be overemphasized. Yet, the level of uptake of HPV vaccination has never been evaluated among Secretariat personnel in Delta State of Nigeria. This part-of-four piece of study aimed to identify the barriers to the acceptance of HPV vaccination in Delta State, Nigeria.Methods: A cross-sectional, descriptive survey method was adopted using a structured questionnaire. 285 participants were included. The structured questionnaire included questions on acceptance of HPV vaccination and the factors influencing acceptability. Statistical analysis included percentage proportions of respondents. Absolute and relative frequencies of the factors were also determined. Chi-squared analysis was performed based on dichotomy of participants based on yes/no response to being vaccinated.Results: Less than 8% of respondents have completed the HPV vaccination program. Low income earners have accepted the vaccination more than the high income group (p <0.003). Nature of work implying time constraints was an absolute factor. Accessibility is one of four factors that were significantly associated (p <0.002).Conclusions: Given the observation on nature of work and associated implication of time constraints and also inaccessibility as potentially major factors; it suffices to suggest that acceptance of HPV vaccination may be improved by expounding the days and sites of vaccination programs to be closer to the offices and scheduled around lunch-break times.
      PubDate: 2019-03-26
      DOI: 10.18203/2320-1770.ijrcog20191176
      Issue No: Vol. 8, No. 4 (2019)
       
  • The women knowledge, attitude, and perceptions of pre-eclampsia and
           eclampsia in Madagascar

    • Authors: Randriamahavonjy Romuald, Tanjona A. Ratsiatosika, Rakotonirina A. Martial, Rainibarijaona A. Lantonirina, Rakotonirina Ando-Miora, Andrianampanalinarivo H. Rakotovao
      Pages: 1233 - 1239
      Abstract: Background: Preeclampsia is a complication of pregnancy responsible for high rates of morbidity and mortality, particularly in Africa and Madagascar. The objective of present study was to assess patients' knowledge, attitudes and beliefs about pre-eclampsia in Madagascar.Methods: This is an observational study on the knowledge, belief and attitudes of women seen at the Befelatanana Gynecology and Obstetrics Hospital and conducted by questionnaires from 1 December 2017 to 30 May 2018.Results: During the study period, 102 patients agreed to answer our questionnaire. Terminology exists in the local language to describe convulsions and hypertension, but there were no terms that are specific to pregnancy. More than half of our patients knew preeclampsia. In 41% of cases, patients attributed excessive salt intake as a cause of high blood pressure during pregnancy and in 20% secondary to stress. Headache was the best-known symptom of patients. Signs of danger such as epigastric pain, genital bleeding, visual disturbances, convulsions and decreased sensation of fetal movements are not well known to patients. One-third did not know it was lethal. Regarding fetal complications, the occurrence of fetal death in utero was the best known. The majority of patients were aware that blood pressure measurements and urine dipstick testing were mandatory during pregnancy follow-up. To prevent preeclampsia, 46.07% thought that reducing salt intake would reduce the occurrence of preeclampsia.Conclusions: Few patients are aware of preeclampsia, its danger signs and its complications, especially during prenatal consultation. This requires the improvement of knowledge of all health actor. Community health workers should receive basic and ongoing training to facilitate dialogue and information for pregnant and non-pregnant women in each society.
      PubDate: 2019-03-26
      DOI: 10.18203/2320-1770.ijrcog20191177
      Issue No: Vol. 8, No. 4 (2019)
       
  • Prevalence of anti-sperm antibodies, risk factors associated and their
           impact on spermatobioscopy in infertile men

    • Authors: Ignacio A. Cardeña, Andrea C. Andrade Rodríguez, Edgar O. Ruiz Treviño, Junior J. Araiza Navarro, Enrique R. Muñoz, Enrique R. Muñoz, Armando Roque Sánchez, Patricia A. González
      Pages: 1240 - 1245
      Abstract: Background: The first immunological correlation with male infertility was reported in 1954 by Wilson and Rumke with the identification of anti-sperm antibodies. The prevalence of anti-sperm antibodies in infertile men varies from 9%-36%, the main cause being the loss of the blood-testicular barrier and otherwise the association with chronic inflammation. It has been shown that immune infertility is found in 15% of patients with varicocele.Methods: A transversal comparative study was carried out with 360 infertile men who were tested for anti-sperm antibodies between January 2011 and July 2018. Two groups were integrated; Group 1, infertile men with positive anti-sperm antibodies >50%, group 2, infertile men with negative anti-sperm <50%. Seminogram parameters were evaluated according to the WHO 5th edition and associated risk factors with anti-sperm antibodies.Results: 360 infertile men were evaluated during the study, 42 were excluded because they did not meet the inclusion criteria, the prevalence of anti-sperm antibodies was 14.5%. Group 1; n=46 (14.5%) and group 2, n=272 (85.5%), the clinical characteristics and the hormonal profile were compared at study admission without significant difference. There was a significant decrease in progressive motility in group 1 (38.7±23.8) vs group 2 (50.1±18.9) p=0.03. Analyzing the risk factors, varicocele was found to be significant 23.7%, OR 2.14 (1.27-3.61) p=0.004 as well as retractable testicle 26.4%, OR 2.13 (1.23-3.70) p= 0.008.Conclusions: The affectation of motility was confirmed, which leads to the suspect varicocele and retractable testicle as risk factors.
      PubDate: 2019-03-26
      DOI: 10.18203/2320-1770.ijrcog20191178
      Issue No: Vol. 8, No. 4 (2019)
       
  • Prenatal care perception of Saudi females of childbearing age: an
           epidemiological study

    • Authors: Saleh F. Alqifari, Fahad A. Alharbi, Abdulrahman Algeffari
      Pages: 1246 - 1249
      Abstract: Background: The purpose of this study is to assess perception of Saudi women of childbearing age regarding prenatal care.Methods: Participants were invited to participate in a voluntary online survey. The brief survey consisted of 15 basic multiple choice questions administered in Arabic, and delivered as a secure link through private social media messaging services. The survey permitted only 1 attempt per user. In order to reach and capture non-respondents, 2 follow-up reminders 10 days apart were sent through the same channels of communication. The survey data was collected and analyzed using the survey software platform, Qualtrics by Qualtrics © LLC 2017.Results: Approximately 9% of participants reported previous pregnancy without use of prenatal care. Nearly 12% of respondents thought that prenatal care is only indicated for malnourished pregnant females, and 7% reported not knowing who prenatal care is specifically indicated for. Nearly 21% reported prenatal care should start after confirmation of pregnancy, 14% thought proper start is anytime within the first 3 months, 8% reported proper start should be after confirmation of healthy pregnancy and 8% reported not sure when to initiate prenatal care. Approximately 12% thought taking prenatal vitamins should be once weekly or some days of the week, while 5% do not advice women to take prenatal vitamins during pregnancy at all.Conclusions: The majority of Saudi women are well educated on prenatal care. However, women in early and late twenties are less aware of proper usage of prenatal care.
      PubDate: 2019-03-26
      DOI: 10.18203/2320-1770.ijrcog20191179
      Issue No: Vol. 8, No. 4 (2019)
       
  • A comparative study of ultrasonographic evaluation of vaginal bleeding in
           pregnancy with clinical examination

    • Authors: Sumathy K. K.
      Pages: 1250 - 1253
      Abstract: Background: Ultrasound helps in assessing the type of abortion. Life threatening emergency like ectopic pregnancy, when evaluated by ultrasound gives scope for conservative approach without affecting the fertility status. The objective of this study was to compare the utility of ultrasound with clinical examination findings in pregnant females having vaginal bleeding.Methods: A hospital-based prospective study was conducted among 100 pregnant patients who have the problem of bleeding. A complete general physical and pelvic examination was done, and patients were then subjected to ultrasound examination. Epi info 7 software was used for statistical analysis. Chi- square test was used as the test of significance and correlation in terms of sensitivity, specificity was seen. P<0.05 is considered statistically significant.Results: 72 cases were diagnosed by ultrasonography as viable pregnancies with sensitivity, specificity negative predictive value (NPV), and positive predictive value (PPV) of 82% and 28 cases were diagnosed as non-viable pregnancies by ultrasonography with sensitivity of 52%, specificity of 81%, and NPV of 72%. The clinical diagnosis had sensitivity of 82%, specificity of 52%, and PPV of 40% in diagnosing viable pregnancies. In diagnosing non-viable pregnancies, clinical diagnosis had a very poor statistical correlation with sensitivity of 52%, specificity of 81%, PPV of 64%, and NPV of 72%.Conclusions: Judicious utilization of ultrasonography and a close connection with the sonologist is necessary. However, it should be realised that ultrasound is complementary in the pelvic examination and cannot substitute obstetric history and clinical examination.
      PubDate: 2019-03-26
      DOI: 10.18203/2320-1770.ijrcog20191090
      Issue No: Vol. 8, No. 4 (2019)
       
  • Role of LNG-IUS in adenomyosis in reproductive age group women: a
           prospective interventional study

    • Authors: Eshna Gupta, Shashi Prateek, Poonam Mani, Lalita Yadav, Mamta Tyagi, Arushi Singh
      Pages: 1254 - 1259
      Abstract: Background: The objective of the present study was to observe the efficacy of LNG-IUS in the treatment of heavy menstrual bleeding and dysmenorrhoea associated with adenomyosis.Methods: LNG-IUS was inserted in forty women between 20-50 years of age presenting with heavy menstrual bleeding and dysmenorrhoea associated with adenomyosis diagnosed on transvaginal ultrasonography and followed up after 1 month, 3 months and 6 months of insertion. Subjective assessment of menstrual blood loss was done by pictorial blood loss assessment chart and dysmenorrhoea was assessed on the basis of universal pain assessment tool and side effects were noted at each visit.Results: Mean patients’ age was between 31-40 years (72.5%) and the follow up duration was 6 months. Significant improvements in dysmenorrhea, HMB and haemoglobin levels were observed. There was no significant change in the uterine volume. The most common side effect was prolonged vaginal spotting (n=26, 65%) and pain abdomen (n=13, 32.5%). LNG-IUS expulsion was observed in 1 patient (n=1, 2.5%). 3 patients underwent hysterectomy (n=3, 7.5%). The overall success rate of LNG-IUS was 82.5%.Conclusions: The LNG-IUS appears to be an effective method in alleviating dysmenorrhoea and heavy menstrual bleeding associated with adenomyosis during 6 months of study. It may be a valuable long-term alternative for the treatment of adenomyosis in young and perimenopausal women and it is a good strategy to reduce the number of hysterectomies in women with adenomyosis.
      PubDate: 2019-03-26
      DOI: 10.18203/2320-1770.ijrcog20190970
      Issue No: Vol. 8, No. 4 (2019)
       
  • Is hysterectomy a risk factor for urinary incontinence'

    • Authors: Maria C. Alexander, Vaibhav Londhe, Emily D. Ebenezer, Aruna N. Kekre, Visalakshi Jeyaseelan
      Pages: 1260 - 1265
      Abstract: Background: Hysterectomy is the most common gynecological surgery performed. There are few studies evaluating hysterectomy as a risk factor for urinary incontinence. If hysterectomy is found to be a risk factor for developing urinary incontinence, women undergoing hysterectomy can be well informed prior to the procedure regarding the same. The objective of the present study was to study the prevalence of urinary incontinence in post-menopausal women and its relationship to hysterectomy. To evaluate the association of metabolic syndrome, to urinary incontinence.Methods: This study was a prospective cohort study done in Christian Medical College and Hospital, Vellore, Tamil Nadu between December 2016- December 2017. Postmenopausal women both with natural and surgical menopause, were enrolled into the study after an informed consent. The UDI-6 questionnaire was used to assess urinary incontinence. The categorical variables were presented using frequencies and percentages. The comparison of categorical variables was done using Fisher's exact test. The odds ratio and confidence interval were calculated for the prevalence. P value < 0.05 was considered to be statistically significant.Results: A total of 600 women were enrolled into the study with 300 women having attained natural menopause and 300 women with a surgical menopause. The prevalence of urinary incontinence among these post-menopausal women was 46.24%. The prevalence of urinary incontinence amongst the women with natural menopause was 47.3% and amongst the women with surgical menopause was 45% (p = 0.566). Women with metabolic syndrome suffered from urinary incontinence more than their counterparts without metabolic syndrome (55.8% vs. 36%, p <0.0001).Conclusions: The prevalence of urinary incontinence in the natural menopause and surgical menopause groups was similar, thus proving that hysterectomy is not a risk factor for developing urinary incontinence. However, metabolic syndrome was found to be associated with urinary incontinence. 
      PubDate: 2019-03-26
      DOI: 10.18203/2320-1770.ijrcog20191061
      Issue No: Vol. 8, No. 4 (2019)
       
  • Awareness and practices of cervical cancer screening among women in
           Rajnandgaon district, central India: health education is the need of the
           hour

    • Authors: Meena Armo, Vimal Khunte, Siddhi Sainik, Rohini Kanniga G., Nandani Jatwar
      Pages: 1266 - 1270
      Abstract: Background: Cervical cancer is a leading cause of morbidity and mortality among rural women in India. Early screening has been shown to be the most effective measure to prevent the disease. However, lack of awareness, lack of infrastructure, social stigma and fear are barriers to cervical cancer screening. The study was undertaken to assess the knowledge and practice among rural women regarding cervical cancer and screening tests with the aim of helping health professionals to revise policies and practices.Methods: It was a cross-sectional questionnaire-based study, conducted from January 2018 to September 2018 in the Department of Obstetrics and Gynecology at Government Medical College Rajnandgaon. A tertiary care hospital located in the southwest Chhattisgarh. A total of 506 women aged 21-65 years were included and assessed. Qualitative data were presented as frequencies and percentages by using SPSS version 21.Results: Of the total 506 respondents, 15.41 % had heard of cervical cancer, while 8.1% about cervical cancer screening. Unfortunately, only 1.2% women were ever been screened by Pap test. Although importance of screening had been thoroughly explained to the respondents, despite the fact only 57.1% showed willingness to undergo cervical cancer screening in the future. However, 63.9%women having gynecological complains were significantly associated with better attitude towards future cervical cancer screening than women without having gynaecological complains.Conclusions: Awareness and practice of the screening for cervical cancer was very poor in the rural population as well as in health care providers. Hence intensive health education is the need of the hour to change the scenario.
      PubDate: 2019-03-26
      DOI: 10.18203/2320-1770.ijrcog20190971
      Issue No: Vol. 8, No. 4 (2019)
       
  • Impact of dietary and lifestyle choices on menstrual patterns in medical
           students

    • Authors: Sreelakshmi U., V. Tushara Bindu, Subhashini T., K. Saritha
      Pages: 1271 - 1276
      Abstract: Background: The aim of the study was to evaluate average age of menarche, the pattern and types of menstrual disorders and their relation with BMI, dietary habits, physical exercise and stress.Methods: A cross sectional prospective study was conducted on female medical students during the academic year 2018-2019 at Mallareddy medical college for women, Suraram, Hyderabad, India. The various life style factors including BMI, junk food consumption and physical exercise were factored. Prevalence of each different menstrual abnormality were identified and analyzed by Chi-squire test and p value <0.005 was considered as statistically significant.Results: Study included 255 medical students who had attained menarche without known medical problems. Mean age of menarche was 12.81years. The most frequent menstrual disorders were premenstrual syndrome 192 (75 %), dysmenorrhoea 146 (57 %), and irregular cycle 97(38%). Statistically significant association of Body mass index (BMI) related to premenstrual syndrome (PMS) and dysmenorrhoea was reported (both p<0.05). Similarly, statistically significant association of lack of physical activity had greater risk of premenstrual syndrome and dysmenorrhoea (both p<0.0001). Unhealthy dietary patterns had statistically significant higher risk for dysmenorrhoea (p<0.0001).Conclusions: In conclusion premenstrual symptoms, dysmenorrhoea and menstrual irregularities were more prevalent. Majority of symptoms were stress, pain abdomen, irritability, mood swings. Comprehensive education programs on lifestyle modifications like regular physical activities, promoting healthy eating habits should be emphasised to prevent menstrual abnormalities of young students as early as at school level.
      PubDate: 2019-03-26
      DOI: 10.18203/2320-1770.ijrcog20190980
      Issue No: Vol. 8, No. 4 (2019)
       
  • Comparison of efficacy and safety of injectable iron sucrose with oral
           ferrous ascorbate in the treatment of anaemia in pregnancy

    • Authors: Sunitha H. B., Sunil Kumar G. S.
      Pages: 1277 - 1282
      Abstract: Background: Anemia due to Iron deficiency is the commonest malnutrition disorder seen throughout the world and in India. It is also responsible for increased incidence of premature births, low birth weight babies and high perinatal mortality. Hence, the present study undertaken to assess efficacy and safety of injectable iron sucrose with oral ferrous ascorbate.Methods: 100 pregnant women, between gestational age 14 and 28 weeks were divided randomly into two groups i.e. group A consists of oral iron, a total of 200 mg of elemental iron per day, two 100mg iron tablets per day and group B consists of iron sucrose at the rate of 200mg on alternate OPD day. Informed consent was taken from each patient.Results: The percentage rise in hemoglobin at fourth and eighth weeks of treatment was statistically significant when compared to the baseline. Statistically significant rise in hemoglobin, PCV and ferritin levels were found at fourth and eighth weeks in IV group when compared to oral group.Conclusions: This study concluded that intravenous iron sucrose is safe and highly efficacious for the treatment of anemia in pregnancy. It restores iron stores more promptly. Iron sucrose therapy is more effective in achieving the optimum results, an increase in hemoglobin concentration, PCV levels and an increase in ferritin levels also. Therefore, it is a suitable alternative to oral iron with minimal side effects in those patients who cannot tolerate oral iron therapy. 
      PubDate: 2019-03-26
      DOI: 10.18203/2320-1770.ijrcog20190973
      Issue No: Vol. 8, No. 4 (2019)
       
  • Placental location and development of preeclampsia: a longitudinal study

    • Authors: Ananya Priyadarshini, Purnima Upreti, Ruchira Nautiyal, Mamta Goyal
      Pages: 1283 - 1287
      Abstract: Background: Preeclampsia is one of the leading causes of morbidity and mortality worldwide. A number of pregnant women suffer from it after 20 weeks of their pregnancy. The study was designed to know the association between location of placenta and the development of preeclampsia in pregnant women. the purpose of the study is to determine the incidence of lateral location of placenta and to study the relation between placental location and development of preeclampsia.Methods: A prospective study conducted on pregnant women who attended the antenatal clinic of SRHU Hospital over period of 12 months. The study was hospital based longitudinal study with a sample size of 100 cases presenting over a period of 12 months in Obstetrics and Gynecology Department. Simple Random Sampling was used for random selection of antenatal case at 18 to 24 weeks gestation with singleton pregnancy, after taking written consent and agreeing for follow-up till delivery.Results: Out of the total 100 cases taken for the study, there were 68 cases of lateral placenta and 32 cases of central placenta. Most of the cases belonged to middle class living in urban areas. The development of preeclampsia is mainly due to mineral deficiency and high systolic BP.Conclusions: In present study, 48.5% patients with lateral placenta and 46.9% with central placenta developed pre-eclampsia.  There was a significant association that was found between laterality of placenta and development of PIH. The laterally located placenta is associated with increased risk of developing preeclampsia. Therefore, looking for placental laterality at the time of a mandatory antenatal ultrasound scanning (level II) may serve as a non-invasive test to predict pre-eclampsia.
      PubDate: 2019-03-26
      DOI: 10.18203/2320-1770.ijrcog20191005
      Issue No: Vol. 8, No. 4 (2019)
       
  • Analysis of caesarean section rate according to modified Robson’s
           classification at tertiary care centre in Uttarakhand, India

    • Authors: Kusum Dogra, Neetu Arora, Bhawna Sharma, Meenakshi Tanwar
      Pages: 1288 - 1293
      Abstract: Background: High caesarean section rate worldwide including India is matter of concern. The aim of this study is to analyse caesarean section rate at tertiary care centre according to Modified Robson’s classification.Methods: This retrospective study was conducted at Shri Guru Ram Rai Institute of Medical and Health Sciences (SGRRIMHS) and Shri Mahant Indiresh Hospital at Dehradun from April 2018 to September 2018. All women delivered during this period were classified according to modified Robson’s classification using their maternal characteristics and obstetric history. For each group, authors calculated the caesarean section rate within the group and its contribution to overall caesarean section rate.Results: Out of total 1302 women delivered, 395 underwent CS (30.3%).The major contribution to overall caesarean section rate was 33.4% by group 5 (Previous CS, singleton, cephalic, >37weeks) followed by 16.7% by group 1 (nullipara, singleton, cephalic, >37 weeks, spontaneous labour), 12.4% by group 3 ( multipara, singleton, cephalic, >37 weeks, spontaneous labour ).CS rates among various group ranges from 100% among women with abnormal lie (group 9) to 77.5% in nulliparous breech (group 6), 73.7% in previous CS (group 5) and least 11.2%  in multipara induced or pre labour CS (group 4).Conclusions: Modified Robson classification is simple, systematic, reproducible and can be effectively utilized in analyzing delivering women. Major contribution to overall caesarean section is made by previous CS.
      PubDate: 2019-03-26
      DOI: 10.18203/2320-1770.ijrcog20191091
      Issue No: Vol. 8, No. 4 (2019)
       
  • Obstetrics ICU admissions: learning objectives

    • Authors: Preetkamal ., Ripan Bala, Simranjeet Kaur, Madhu Nagpal
      Pages: 1294 - 1299
      Abstract: Background: The management of critical illness in pregnancy requires intensive monitoring of obstetric patients in the intensive care unit. Systematic way of surveillance will allow the measurement of outcomes of interest and associated risk factors. Intensive care unit is highly specified and sophisticated area of hospital which is specifically designed, staffed, furnished and equipped, dedicated to the management of critically sick patients, injuries or complications. The aim of this study was to know the frequency of ICU admission in obstetrical patients, to analyse the medical or surgical comorbidity related to obstetrical problems, to segregate the cause of morbidity and to identify the risk reducing strategies.Methods: This observational study was conducted in 40 ICU patients in present institute from 1st December 2016 to 28th February 2019. The present study was divided into two groups in group I, intervention was done first followed by ICU intervention and in group II, ICU stabilization was done first followed by obstetrical intervention. The parameters noted were age, parity, gestation age, diagnosis on admission, associated medical and surgical comorbidity, reason for ICU admission, any surgical procedure performed, details of treatment given in ICU like ventilator support, blood transfusion, dialysis or ionotropic support. Patients outcome, review of mortality and area of improvement were also noted.Results: There were 17.5% mortalities observed in present study. The most common ICU intervention was blood transfusion (81.19%) followed by mechanical ventilation (37.8%). Commonest cause of mortality was multiorgan dysfunction (28.5%) followed by hypertensive disorder of pregnancy (14.3%), peripartum cardiomyopathy (14.3%), acute fatty liver of pregnancy (14.3%), septic shock (14.3%) and acute febrile illness (14.3%). Most of the patients were unbooked (74.3%), 47.2% cases did not receive antenatal care.Conclusions: There is need for antenatal registration of all pregnant women and institutional deliveries should be the aim. There should be antenatal detection and management of medical and surgical comorbidities. There is need for training in emergency obstetrics so that complication can be recognized and managed at an optimum time.
      PubDate: 2019-03-26
      DOI: 10.18203/2320-1770.ijrcog20191019
      Issue No: Vol. 8, No. 4 (2019)
       
  • Sublingual Misoprostol for labour augmentation

    • Authors: Aruna Verma, Abhilasha Gupta, Monika Kashyap
      Pages: 1300 - 1303
      Abstract: Background: Labour dystocia is associated with a number of adverse maternal and neonatal outcomes. Augmentation of labour is a commonly used intervention in cases of labour dystocia. Misoprostol is an inexpensive and stable prostaglandin E1analogue. Present study was done to see the effectiveness of sublingual misoprostol for labour augmentation and foeto-maternal outcome.Methods: Total 100 labouring women of term gestation were taken and divided in two groups: group A (study group) and group B (control group). In study group 25mcg sublingual misoprostol given 4 hourly till adequate uterine contractions developed, i.e. >3 contractions in 10 minutes, each lasting for 40-45 seconds. A maximum of 200mcg of misoprostol or 8 doses were used and in group B no drug was given for augmentation of labour. Maternal and foetal outcome were observed in both groups.Results: Augmentation to delivery interval was very short in group A in comparison to group B. Maternal and foetal outcome were almost same in both groups.Conclusions: Sublingual misoprostol is a safe and effective drug for augmentation of labour leading to early delivery without any major side effects.
      PubDate: 2019-03-26
      DOI: 10.18203/2320-1770.ijrcog20191062
      Issue No: Vol. 8, No. 4 (2019)
       
  • Serum magnesium level in eclampsia at tertiary care center, Gujarat, India

    • Authors: Nidhi Patel, Nilesh Shah
      Pages: 1304 - 1307
      Abstract: Background: Magnesium may be physiologically important in blood pressure regulation whereas changes in magnesium levels could contribute to the patho-etiology of hypertension. The objective of the present study was to study the level and effect of magnesium in eclamptic pregnant women.Methods: This cross-sectional study was conducted among 50 clinically diagnosed women with eclampsia in their third trimester of pregnancy. Inclusion criteria for the study was; females with singleton pregnancy, all in the third trimester which were diagnosed to have PIH based on the development of hypertension for the first time, proteinuria with or without edema, with no history of previous urinary tract troubles and no evidence of UTI. The concentration of total serum magnesium was measured by atomic absorption spectroscopy.Results: Mean age, mean gestational age, mean total hospital stays, mean BMI, mean systolic BP and diastolic BP was 24.3 years with 5.1 SD, 36.4 week with 3.3 SD, 7.8 days with 2.4 SD, 28.9 wt/ht2 with 4.8 SD, 146.5 mmHg with 14.7 SD and 95.9 mmHg with 11.2 SD respectively. Mean magnesium level was 1.9 mmol/L with 2.2 SD.Conclusions: Hypomagnesemia is present in eclamptic pregnant women. In developing countries like India, sufficient dietary supplementation should be given above the recommended dietary allowances in pregnancy at least in susceptible pregnant women.
      PubDate: 2019-03-26
      DOI: 10.18203/2320-1770.ijrcog20191063
      Issue No: Vol. 8, No. 4 (2019)
       
  • Emergency peripartum hysterectomy at a tertiary care hospital: analysis of
           epidemiology, clinical profile, indications and outcome

    • Authors: Anitha E., Ramalakshmi S.
      Pages: 1308 - 1312
      Abstract: Background: Peripartum hysterectomy is a life-saving obstetric procedure that is performed at the time of a caesarean section or postpartum following either vaginal delivery or caesarean section. The purpose of the present study was to determine the incidence, risk factors ,indications ,maternal and neonatal morbidity, mortality and complications  of emergency peripartum  hysterectomy performed at a tertiary teaching hospital in South India and to compare the results with other reports in literature.Methods: During the period of study between January 2015-December 2016, there were 50 cases of emergency peripartum hysterectomy at Tirunelveli medical college hospital, Tirunelveli, Tamil Nadu, South India. Medical, pathology and operation theatre records were analyzed retrospectively. Details of maternal age, parity, booking status, underlying risk factors, past obstetric history, gestational age at delivery ,mode of delivery ,indications for emergency peripartum hysterectomy, type of operation, intraoperative and post-operative complications, blood components transfusion ,maternal and neonatal  outcomes were noted and analyzed.Results: During the 2-year study period there were 50 emergency peripartum hysterectomy out of 14,363 deliveries, a rate of 1 per 294 deliveries (3.4/1000 deliveries). 80% of hysterectomies were performed after caesarean delivery and 20%  after vaginal delivery. The two major indications were abnormal placentation (40%) and uterine atony (28%). There were 6 maternal deaths among patients who underwent emergency peripartum hysterectomy during the period of study.Conclusions: Improved antenatal care, correction of anaemia, identification of risk factors for peripartum hysterectomy, timely referral, expedite management, timely decision, availability and liberal use of blood components and appropriate management of post-operative complications by experienced clinical team are the main stay for saving maternal lives. With increasing rate of caesarean section there is rise in the incidence of abnormal placentation.
      PubDate: 2019-03-26
      DOI: 10.18203/2320-1770.ijrcog20191092
      Issue No: Vol. 8, No. 4 (2019)
       
  • Does advanced maternal age influence obstetric outcome: a study in a
           tertiary care centre

    • Authors: Jose C. V., Lissiamma George, Sunitha Sukumaran
      Pages: 1313 - 1316
      Abstract: Background: Advanced maternal age defined as age 35 years and older at estimated date of delivery has become increasingly common in last two to three decades. The International Federation of Gynaecology and Obstetrics in 1958 recommended that all women going through their first pregnancy over the age of 35 years should be considered high risk for pregnancy and included in this category 1.Methods: A one-year prospective observational study conducted in a tertiary care hospital after institutional ethical clearance. All 165 women above 35yrs who delivered during this period were taken as Cohort 1. Same number of women aged between 20 and 34 years were randomly selected as comparison group (Cohort 2). Both the groups were compared in terms of preexisting medical disorders, obstetrical morbidities, antenatal complications, intrapartum complications.Results: Older and younger women had similar antenatal booking, occupational and socioeconomic status. The main reason for pregnancy at advanced age group was late marriage. The risk of chronic hypertension, gestational diabetes mellitus, pre-existing medical disorders were higher in advanced maternal age.Conclusions: Increasing maternal age is associated with elevated risks for pregnancy complications. They are at high risk for gestational diabetes, cesarean section and to have low birth weight babies. Since these women are at higher risk of complications, they should be advised to adhere to frequent antenatal visits and close supervision.
      PubDate: 2019-03-26
      DOI: 10.18203/2320-1770.ijrcog20190976
      Issue No: Vol. 8, No. 4 (2019)
       
  • Maternal pregnancy associated plasma protein-A (PAPP-A) and uterine artery
           Doppler changes as predictors of pre-eclampsia: a prospective
           observational study from a teaching hospital in Mysore, Karnataka, India

    • Authors: Sharanya Satish, K. B. Suma, Madhu B., Sujatha M. S.
      Pages: 1317 - 1321
      Abstract: Background: Hypertensive disorder affects 10-12% of pregnancies. Identifying women, who are at risk is conducive to prompt gestational management. PAPP-A is a protein complex produced by the developing trophoblasts. Low levels of PAPP-A at 10–14 weeks is a marker of impaired placentation and a smaller placental mass. Doppler imaging permits non-invasive evaluation of the uteroplacental circulation and is invaluable in the management of high-risk pregnancies. The uterine artery Doppler screening identifies patients at risk for developing preeclampsia. To study the association of PAPP-A and the uterine artery Doppler changes as predictor of pre-eclampsia in pregnant women at 11-14 weeks of gestation.Methods: This was a prospective study of 150 pregnant women presenting at 11-14 weeks of gestation for a prenatal check-up. After considering the inclusion and exclusion criteria, serum samples for PAPP-A were assayed. Ultrasound Doppler was used to obtain uterine artery flow velocity waveforms and mean pulsatility index and resistance index of uterine arteries were calculated. Cases were followed up till term and observed for development of pre-eclampsia.Results: 48.6% had low serum PAPP-A levels, in which 77% developed PE. The Mean PI and RI is 2.34±1.16 and 0.58±0.1 respectively. 30% women with abnormal PI values and 24% of women with abnormal RI values developed PE.Conclusions: The combination of maternal history with low serum PAPP-A levels and abnormal uterine artery Doppler at 11-14 weeks can be used as predictor of pre-eclampsia.
      PubDate: 2019-03-26
      DOI: 10.18203/2320-1770.ijrcog20190977
      Issue No: Vol. 8, No. 4 (2019)
       
  • Maternal and perinatal outcome in placenta previa: an observational study
           at a tertiary care hospital in Mysore, Karnataka, India

    • Authors: Maunica Reddy Sorakayalapeta, Nandish S. Manoli
      Pages: 1322 - 1326
      Abstract: Background: 2-5% of the pregnancies are complicated by antepartum haemorrhage. About one third of them are due to placenta previa thus contributing to a significant amount of maternal and perinatal morbidity and mortality. In the present times with liberally increasing caesarean section rates, there is a changing trend in the incidence and complications of placenta previa. The objective of this study was to evaluate the obstetrical characteristics and maternal and perinatal outcome of cases of placenta previa.Methods: This was a prospective observational study conducted in the Department of Obstetrics and Gynaecology of JSS Medical College and Hospital, Mysore during the period January 2017 to June 2018.Results: Out of total 13,150 deliveries during this period, placenta previa was observed in 131 cases with an incidence of 1%. Majority belonged to the age group 25-29 years (48.8%). 66% of the cases presented with painless vaginal bleeding as their chief complaint. The major risk factor was previous caesarean delivery seen in 29.8% cases followed by history of abortion in 18.3%. 67% cases had major degree placenta previa. Remaining 33% cases had minor degree. One case was complicated by placenta accrete. Peripartum hysterectomy was performed in 3.1%. Preterm deliveries amounted to 29.8%. Maternal and perinatal mortality were 0.76% and 3.05% respectively. 10.7% cases had Postpartum haemorrhage and 3.8% required ICU admission. 25% neonates required NICU admissions and 10% had RDS.Conclusions: Placenta previa is a prime contributor to substantial maternal and perinatal morbidity and mortality. Early referral to tertiary care centres, anticipation of clinical complications and appropriate measures can avoid grave consequences. Such cases must always be managed at a higher centre with good NICU services and round the clock operation theatre and blood bank facility.
      PubDate: 2019-03-26
      DOI: 10.18203/2320-1770.ijrcog20190978
      Issue No: Vol. 8, No. 4 (2019)
       
  • A prospective study of maternal and fetal outcome in repeat LSCS mother

    • Authors: Pradeep Ganiga, Shanthala Rudrappa
      Pages: 1327 - 1330
      Abstract: Background: Cesarean section is one of the most commonly performed abdominal operations on women in most countries. The incidence of primary LSCS is increasing all over the world, Consequently, there is a rise in multiple repeat LSCS with associated complications. Previous LSCS is a common indication for repeat LSCS. Primarily, authors aim at studying the influence of repeat LSCS on maternal and fetal outcome in a tertiary centre.Methods: All mothers with one previous LSCS admitted for emergency/elective LSCS at term gestation with singleton pregnancy in A.J. Institute of Medical Sciences and Research centre, Mangalore were recruited in the study from July to December 2018. Detailed history with antenatal risk factors were noted. Intraoperative and postoperative events were noted. Neonatal outcome was also noted correlated.Results: Majority of patients (58%) were in age group of 20-24years. Most of them were between 38 to 39 weeks of gestation. Most common intraoperative complication was bladder adhesion (18% of cases). In postoperative period febrile morbidity (7%) was common followed by urinary tract infection (2%). Most of the neonates (80%) weighed 2.5 to 3kg at birth. The incidence of poor APGAR respiratory distress, NICU admission was not significantly increased. There were 5 morbidly adherent placenta, 1 scar rupture, 4 scar dehiscence, no maternal or perinatal death.Conclusions: Previous caesarean is the most common cause of repeat caesarean and is associated with maternal morbidity. Measures should be taken to reduce primary caesarean sections which indirectly reduces the incidence of repeat cesarean sections.
      PubDate: 2019-03-26
      DOI: 10.18203/2320-1770.ijrcog20190979
      Issue No: Vol. 8, No. 4 (2019)
       
  • Admission test cardiotocography in labour as a predictor of foetal outcome
           in high risk pregnancies

    • Authors: Anvesha Kumar, Purshottam Bantaklal Jaju
      Pages: 1331 - 1336
      Abstract: Background: Continuous fetal heart monitoring in all pregnant women in labour has gained prominence in obstetric practice in the recent years. The aim of this study was to emphasize on the role of admission cardiotocography (CTG) in labour as a predictor of foetal outcome in high risk pregnancies.Methods: This was a prospective observational study done on 340 high risk patients admitted in labour with a period of gestation of ≥37 weeks. An admission CTG which consists of a 20-minute recording of FHR and uterine contractions was taken and the foetal outcome was correlated with it. The non-parametric Chi-square test was used for statistical calculations and a p valve of <0.05 was considered to designate statistical significance.Results: The admission CTG was reactive in 69.4% of all patients, equivocal in 22.2% and pathological in 8.4% of the 340 recruited patients. A total of 37.5% of the patients were post-dated followed by 20.6% of pregnancy incuded hypertensive patients. The neonatal outcomes in terms of fetal distress, meconium stained liquor, NICU admission were considerably higher in pathological test. The specificity of the test was 53.3%, and the negative predictive was    86.49%.Conclusions: Admission CTG is a simple, useful screening test and serves as a non-invasive tool in forecasting the adverse foetal outcomes in high risk pregnancies.
      PubDate: 2019-03-26
      DOI: 10.18203/2320-1770.ijrcog20190981
      Issue No: Vol. 8, No. 4 (2019)
       
  • HIV and pregnancy: fact sheet of a tertiary care hospital in Ajmer,
           Rajasthan, India

    • Authors: Sandhya Choudhary, Swati .
      Pages: 1337 - 1340
      Abstract: Background: As HIV infection in women occurs primarily during reproductive years, hence incidence of HIV infection especially in sexually active women is more sensitive marker to track course of HIV epidemics. Pregnant women represent low risk population, so prevalence in pregnant women is proxy to HIV in general population.Methods: A prospective study was conducted in the Department of Obstetrics and Gynecology in JLN Medical College, Ajmer from April 2015 to August 2018. It included women attending antenatal clinic and emergency ward of labor room of our hospital.Results: Total 71 women were found positive for HIV out of 36,006 pregnant women who attended antenatal clinic, giving the prevalence of 0.197%. Out of these 71 cases, 1 case was positive for both HIV1 and HIV2. The prevalence of HIV positive women delivering in our hospital was 0.269%. 40.84% women belonged to age group 25-29.9 years and 39.43% to 19-24.9 years. Among 71 antenatal seropositive women, primigravida and second gravid accounted for equal fraction of the study population i.e. 33.80% each. 19.72% came from urban areas while 80.28% were from rural areas. 22.53% (16/71) had sero-discordant spouses. All seropositive women had singleton pregnancy and were housewives. 94.61% were registered for Anti-Retroviral Treatment (ART) and 5.39% went loss to follow up.Conclusions: The serodiscordance rate in our region is quite high (22.53%). Increased awareness in society leading to increase in number of pregnant women attending ICTC will help in reducing transmission of HIV by safer sex practices.
      PubDate: 2019-03-26
      DOI: 10.18203/2320-1770.ijrcog20191017
      Issue No: Vol. 8, No. 4 (2019)
       
  • Efficacy of vaginal Misoprostol versus transcervical Foley’s catheter
           and vaginal Misoprostol in induction of labor

    • Authors: Vijayalaxmi Davalagi, Lakshmikantha G., Neeta .
      Pages: 1341 - 1346
      Abstract: Background: The objective is to compare the efficacy of vaginal Misoprostol versus transcervical Foley’s catheter and vaginal Misoprostol.Methods: A prospective study analyzing the comparative efficacy of intravaginal instillation of Misoprostol in two groups (tablet Misoprostol 50mg alone and combination of intracervical Foley’s catheter and tablet Misoprostol 50mg) carried out in the labour room on 300 subjects (150 subjects in each group), from May 2013 to November 2015.Results: The common gestational age at the time of induction was 36-40 weeks and the most common indication was premature rupture of membrane. In both the groups, most of the cases delivered within 12 hours. present results show that statistically significant number of cases delivered vaginally within 12 hours with the group using Misoprostol plus Foley’s catheter as compared to the group using Misoprostol alone. Cesarean section rate was 12.67% in Misoprostol group and 10.67% in Misoprostol plus Foley’s catheter group. Incidence of failure of induction was similar in both the groups. The incidence of babies with Apgar score less than 8/10 at 5 minutes and incidence of early neonatal death were similar in both the groups.Conclusions: Addition of intracervical Foley’s catheter to vaginal Misoprostol for induction of labor in subjects with unfavorable cervices reduces the Induction-Delivery interval without added side effects or complications to the mother and fetus.
      PubDate: 2019-03-26
      DOI: 10.18203/2320-1770.ijrcog20190982
      Issue No: Vol. 8, No. 4 (2019)
       
  • Placental thickness and its correlation with estimated foetal weight: a
           cross-sectional study in a tertiary care centre in South India

    • Authors: Goldy S. J., Sheba Rosatte Victor, Bewin Oral J., Adaline Thangam, Usha Christopher, Adlin Rose
      Pages: 1347 - 1354
      Abstract: Background: The placenta is a multifaceted organ which modulates and modifies the maternal environment resulting in foetal development. It could be assumed that a healthy placenta culminates in a healthy foetus. Hence the morphometric analysis of a placenta during sonogram is inevitable. The aim of the study was to estimate the relationship between placental thickness and estimated foetal weight.Methods: The study was a cross-sectional study and included 450 antenatal women attending the department of Obstetrics and Gynaecology, Tirunelveli Medical College from May 2013 to May 2014. These women had regular cycles with a known Last menstrual period and a singleton foetus. After ethics committee approval, meticulous history including age, parity, demographic factors and past history were recorded. After obtaining consent, these women underwent placental thickness measurement between 14-40 weeks of pregnancy.Results: In the study mean placental thickness between the ranges of 11-49mm was 28.7mm and mean estimated foetal weight was 1.421kilogram. The correlation between the two was 0.943. Hence the positive correlation between the placental thickness and foetal weight is confirmed (p value <0.001).Conclusions: Determining the estimated foetal weight is an important reason for doing a sonogram, especially in third trimester. Placental thickness measured at the level of umbilical cord insertion can serve as an additional parameter in estimating foetal weight in addition to the foetal parameters, since there is a linear correlation between placental thickness and foetal weight.
      PubDate: 2019-03-26
      DOI: 10.18203/2320-1770.ijrcog20191018
      Issue No: Vol. 8, No. 4 (2019)
       
  • Abruptio placenta retrospective study: maternal and fetal outcome

    • Authors: Shanthadevi Sambath, Vanitha Rukmani V. H., Subalakshmi S.
      Pages: 1355 - 1358
      Abstract: Background: Placental abruption is the most common cause of antepartum haemorrhage. Incidence appears to be increasing due to increase in prevalence of risk factors like age, parity, anaemia, poor nutrition, Preeclampsia, PROM, previous MTP. Abruption may be partial or total. Pain and Vaginal bleeding hallmark of abruption.Methods: Retrospective observational study carried out during period of October 2017 to October 2018 at Govt Theni medical college- tertiary care institute. To investigate incidence, cause, maternal and perinatal outcome. Maternal Data includes incidence, age, parity, gestational age, risk factors, intra-operative events, amount of blood loss. Other causes of APH-Placenta praevia and extra-placental causes are excluded. Neonatal data includes Term/preterm, Birth weight, NICU admission, perinatal morbidity and mortality.Results: Total number of deliveries from October 2017 to September 2018 were 7010. Total number of abruptio placenta cases were 55. This study shows increased incidence of severe preeclampsia with abruption. Increasing age as predisposing factor. Mean age of abruption was 26-30 years mainly seen in term pregnancy. Mode of delivery varied. Major complication were PPH and shock managed with blood products.Conclusions: This study reveals increasing age, parity, severe preeclampsia are risk factors. Routine and regular antenatal checkup early detection and correction of Preeclampsia, anemia helps to deduce no of abruption and improving maternal and fetal outcome though maternal morbidity is reduced with modern management of abruption, Timely diagnosis and intervention is necessary. Team efforts by obstetricians, anesthetist and neonatologist is required for better maternal and fetal outcome.
      PubDate: 2019-03-26
      DOI: 10.18203/2320-1770.ijrcog20191180
      Issue No: Vol. 8, No. 4 (2019)
       
  • Chlorhexidine-alcohol versus Povidone-Iodine-alcohol for surgical site
           antisepsis in caesarean section

    • Authors: Vishnu Priya Kesani, Sruthi Talasila, Sheela S. R.
      Pages: 1359 - 1362
      Abstract: Background: Caesarean section is one of the most common procedures performed. Recent studies found that surgical-site infection (SSI) was the most common healthcare-associated infection.
      Authors hypothesized that optimization of preoperative skin antisepsis may decrease postoperative infections. The objective was to establish the efficacy of chlorhexidine-based antiseptic protocol versus povidone-iodine protocol in reducing SSI for patients undergoing caesarean deliveries.Methods: This is a randomized prospective study conducted from April 2017 to September 2017 at a tertiary care center in India. Women who underwent caesarean sections were allocated into either group. Enrolled patients were randomly assigned to have the surgical site painted with chlorhexidine-alcohol preparation or painted with a solution of 10% povidone-iodine and then with surgical spirit. The outcomes were any SSI occurring within a week or during the 30 day follow up period of the surgery including any of: superficial or deep surgical site infection, or endometritis, according to Centers for Disease Control and Prevention definitions.Results: A total of 560 subjects (273 in the chlorhexidine group and 287 in the iodine group) qualified for the study. The number of surgical-site infection was significantly lower in the chlorhexidine group than in the iodine group (6.95% vs. 14.28%; P=0.005). Chlorhexidine–alcohol was significantly more protective than iodine-alcohol against both superficial incisional infections (5.49% vs. 10.10%, P=0.03) and deep incisional infections (1.46% vs. 4.18%, P=0.04).Conclusions: This study highlighted that Chlorhexidine-alcohol provided superior skin antisepsis in comparison to povidone iodine-alcohol.
      PubDate: 2019-03-26
      DOI: 10.18203/2320-1770.ijrcog20191181
      Issue No: Vol. 8, No. 4 (2019)
       
  • A cross sectional study of depression during pregnancy and its risk
           factors among pregnant women attending a tertiary care hospital in
           Puducherry, India

    • Authors: Sabita P., Prakash M., Sharmila E.
      Pages: 1363 - 1368
      Abstract: Background: Depression during pregnancy is a recognized global health issue which can lead to wide range of maternal and neonatal complications to extremes like maternal suicide to infanticide. This study was done to estimate the magnitude of depression during pregnancy and its risk factors among pregnant women attending a tertiary care hospital in Puducherry.Methods: A descriptive cross sectional study was done among 220 pregnant women attending routine antenatal checkup in outpatient department of a tertiary care hospital in Puducherry, using a systematic random sampling technique. A semi structured questionnaire using Patient Health Questionnaire-9 was used to screen the mothers for antenatal depression.Results: 220 pregnant women were evaluated for antenatal depression. Mean age of the study participants was 25.02±3.13 years. Using PHQ-9 authors found that 19.5% pregnant women were having risk for antenatal depression, of which the mild, moderate and moderately severe levels of depression were 16.4%, 1.4% and 1.8% respectively. The risk of antenatal depression was statistically significant among the women age more than 30 years, husband’s educational status as higher secondary and below, residence in rural area, multigravida, having a male child, strained relationship, no support during pregnancy and pressure for a male child. Logistic regression analysis revealed age ≥30 years (aOR 3.03, 95% CI 1.04-8.82), and no support during pregnancy (aOR 3.30, 95% CI 1.10-9.90) were the significant factors.Conclusions: Since the risk for antepartum depression is huge in this region, there is a need for screening for antepartum depression as a routine antenatal checkup in the out patient department. Reinforcing the importance of appropriate for conception and support for the mother during pregnancy plays a vital role in reducing the magnitude of this depression.
      PubDate: 2019-03-26
      DOI: 10.18203/2320-1770.ijrcog20191182
      Issue No: Vol. 8, No. 4 (2019)
       
  • Diagnostic evaluation of causes of bleeding per vagina in pregnancy
           through ultrasonography

    • Authors: Sumathy K. K.
      Pages: 1369 - 1372
      Abstract: Background: Vaginal bleeding is a common obstetric situation ranging from an insignificant episode to life threatening emergency. Ultrasonography is playing an increasing role in the diagnostic process. The objective of present study was to evaluate the uses of ultrasound as new diagnostic aid for patients of bleeding PV in pregnancy.Methods: A hospital-based prospective study was conducted among 100 pregnant patients who have the problem of bleeding. A complete general physical and pelvic examination was done, and patients were then subjected to ultrasound examination. Epi info 7 software was used for statistical analysis. Chi- square test was used as the test of significance. P<0.05 is considered statistically significant.Results: Among these 100 cases, Incomplete abortion was the commonest cause of bleeding. This was observed in 15 cases (27%). There were 8 (20%) cases of complete abortion in the present study in the scan done on <20 weeks. Abruptio placenta was seen in 10 (25%) cases as the most common cause in the scan after 20 weeks.Conclusions: Ultrasound is a valuable tool in the differentiation of causes of first trimester vaginal bleeding. Ultrasound is helpful in the decision-making algorithm about the safe continuation of the pregnancy, timely intervention for abnormal pregnancy.
      PubDate: 2019-03-26
      DOI: 10.18203/2320-1770.ijrcog20191183
      Issue No: Vol. 8, No. 4 (2019)
       
  • Knowledge, attitude and practice of long acting reversible hormonal
           contraception (LARHC) among women in urban upper Egypt

    • Authors: Abo bakr A. Mitwaly, Ahmed M. Abbas, Amal Fathy Mohammed, Alaa M. Ismail, Ayman H. Shaamash, Alaa El Din A. Youssef
      Pages: 1373 - 1379
      Abstract: Background: The current study aims to assess the knowledge, attitude and practice of long acting reversible hormonal contraception (LARHC) among women in urban upper Egypt.Methods: A cross sectional study which included 902 married women, in the reproductive age, attending the outpatient clinics (Gynecology and family planning) of: 1-Assiut University Maternity Hospital, 2- Sohag University Hospital, and 3-Gehina General Hospital (MOH hospital) with current or previous use of any method of LARHC methods. A Questionnaire file was designed to assay knowledge attitude and practice of clients towards contraceptive methods. All data collected from clients reviewed separately to assess knowledge, attitude and practice of women towards contraceptive methods.Results: The most popular contraceptive method is COCs followed by IUD then DMPA. 99% of studied sample heard with good description about different types of LARHC. 54.9% of studied sample most popular/famous LARHC DMPA, most sources of information on LARHC were, Hospital, Relative/friends and health workers. 94.24% of the studied sample were in favor to use of LARHC, 94.2% of them agree to take a space between births, about 55.4% of them were health child and 61% comfortable lifestyle benefit from birth spacing, 33% of studied sample were maternal health, 68% of them were think/prefer to use implants, 64.5% of them didn’t pregnant while breastfeeding. 11% of sample women never used any contraception before and most reasons for not using contraception are fear of side effects, desire for more children, irregular sexual relationship, and husband opposition. Only 16.6 % of studied sample used LARHC before and most of them used DMPA, however 3 women who used DMPA get pregnant while using it.Conclusions: There is a good level of knowledge between upper Egypt women about LARHC methods.
      PubDate: 2019-03-26
      DOI: 10.18203/2320-1770.ijrcog20191184
      Issue No: Vol. 8, No. 4 (2019)
       
  • Factors influencing the acceptance of cervical cancer screening among
           civil servants in Delta State Secretariat

    • Authors: Uchechukwuka Nnemdi Okwe, Helen Chime, Ezekiel Uba Nwose
      Pages: 1380 - 1386
      Abstract: Background: Cervical cancer is one of the top two cancers affecting Nigerian women. This has created impetus to investigate the situation. This third of a four-part series seeks to evaluate perception, acceptance and psychosocial factors of cervical screening among women who are gainfully employed in the State’s civil service within Delta State Secretariat.Methods: Based on cross-sectional descriptive survey using a structured questionnaire and ‘N=285’ participants. Statistical analysis assessed percentage proportions of respondents; as well as absolute and relative frequencies of the factors associated with acceptance of screening. Chi-squared analysis was based on no/yes response to have done cervical screening.Results: About 10% of respondents have undergone cervical screening. 16% of the lowest income earners have done the screening, compared to 8% and 10% of the mid income and high income group, respectively. Nature of work implying time constraints was an absolute factor. Knowledge of what cervical cancer is; the causes; how to detect and prevent it are significantly associated (p <0.01), while accessibility, fear of adverse effect and attitude of healthcare workers were significant psychosocial factors (p 0.01).Conclusions: This report affirms nature of work and accessibility as two of four major factors influencing acceptance of cervical screening among working class women in Delta State secretariat. It is hereby suggested to expound sites of cervical service programs.
      PubDate: 2019-03-26
      DOI: 10.18203/2320-1770.ijrcog20191185
      Issue No: Vol. 8, No. 4 (2019)
       
  • Effect of perineal massage in the second stage of labour, on the incidence
           of episiotomy and perineal tears

    • Authors: Abinaya Raja, Pallavee P., Rupal Samal
      Pages: 1387 - 1392
      Abstract: Background: This study aimed to investigate whether perineal massage during second stage of labour could decrease perineal trauma in the form of episiotomy and perineal tears.Methods: One hundred and fifty term antenatal women in labour were randomly assigned to two groups, one of which received perineal massage and the other received routine care during the second stage. Frequency of episiotomies, perineal tears, intact perineums, degrees of perineal tears, duration of second stage of labour and perineal pain after 24 hours was compared.Results: Perineal massage was efficient in reducing incidence of episiotomy, duration of second stage of labour and perineal pain assessed 24 hours after delivery. The frequency of perineal tears and intact perineums did not differ significantly. Perineal massage was protective against severe form of third degree perineal tears.Conclusions:
      Authors suggest that perineal massage can be routinely practiced by health professionals to improve quality of life in women post vaginal delivery.
      PubDate: 2019-03-26
      DOI: 10.18203/2320-1770.ijrcog20191186
      Issue No: Vol. 8, No. 4 (2019)
       
  • Study of placental location and pregnancy outcome

    • Authors: Vidhu V. Nair, Sobha S. Nair, Radhamany K.
      Pages: 1393 - 1397
      Abstract: Background: Placental location can be estimated easily using ultrasonogram by 16 weeks. It can be classified based on its location into central and lateral. Central can be anterior or posterior. Lateral can be left lateral or right lateral. Placental location has been attributed to both normal and abnormal pregnancy and neonatal outcomes.Methods: This is a prospective cohort study conducted in the department of Obstetrics and Gynecology which comprised of 450 singleton gestations between 18 and 24 weeks. The primary objective is to determine the association between placental location and pregnancy outcome and secondary objective is to find out the association between placental location and neonatal outcome. The study population was divided into two groups – central and lateral. Results were analyzed using SPSS version 20, Chi square test and independent two sample t-test.Results: The frequency of central placenta was 377 (83.8%) and lateral placenta in 73 (16.2%). Central placentation had an abnormal outcome in 182(48.3%), lateral placentas with abnormal outcome were 44(60.3%). Abnormal maternal outcomes like hypertensive disorders (33.3%), Intra Uterine Growth Restriction (10.2%), Antepartum haemorrhage (25%), Preterm birth (16.3%) were more in lateral placentation. The number of central placentas having NICU admissions were 62(16.4%) and lateral placenta with NICU admissions were 19(26%).Conclusions: There is a significant association between lateral placentation and abnormal pregnancy and neonatal outcomes. Second trimester ultrasound can be used as non-invasive predictor of adverse pregnancy and neonatal outcomes. 
      PubDate: 2019-03-26
      DOI: 10.18203/2320-1770.ijrcog20191187
      Issue No: Vol. 8, No. 4 (2019)
       
  • Comparison of lipoprotein and apolipoprotein levels in cord blood

    • Authors: Ruqaya Aziz, Mehbooba Beigh, Qazi Najeeb, Ashaqullah Bhat, Irshad .
      Pages: 1398 - 1402
      Abstract: Background: Hyperlipidemia is the primary risk factor for coronary artery disease and subsequently leading to morbidity and mortality in adulthood. It is a well-known fact that coronary artery disease can initiate in the fetal stage itself. The present study was planned to analyse cord blood lipoproteins and apolipoproteins levels and its association with gender and birth weight.Methods: This cross-sectional study was conducted in the Department of Biochemistry, in collaboration with Department of Gynecology and Obstetrics at SKIMS Medical College and Hospital, Bemina, Srinagar. A total 200 pregnant women who delivered by normal vaginal delivery and caesarean section were included in the study. 10 ml of umbilical cord blood was collected in a plain vial from the placental end within five minutes of delivery and serum lipoprotein and Apo-lipoprotein levels were measured.Results: Out of 200 newborns102 were males and 98 were females. Statistically significant difference was seen in parameters Apo A1, Apo B, Atherogenic index (Apo B/Apo A1) and LDL between the genders rest of the parameters were statistically. Also 32 newborns (16.0%) had <2500, 152 (76.0%) new born had 2500-4000 and 16(8.0%) > 4000 grams birth weight. The mean lipoprotein and Apo-lipoprotein levels in these new born were compared between the groups. The mean serum levels of TC, TG, LDL and HDL were statistically significant (<0.05) between the three groups were as Apo A1, Apo B, Atherogenic index (Apo B/Apo A1) and VLDL was insignificant (>0.05) respectively.Conclusions: CVD being a leading cause of morbidity and mortality in the developing countries, early screening of the at risk babies i.e. low birth weight newborns using cord blood lipoproteins and apolipoproteins levels helps in primordial and primary prevention of diseases.
      PubDate: 2019-03-26
      DOI: 10.18203/2320-1770.ijrcog20191188
      Issue No: Vol. 8, No. 4 (2019)
       
  • A prospective study of fetomaternal outcome in cases of placenta previa

    • Authors: Gunvant K. Kadikar, Mayur R. Gandhi, Rakesh R. Kapadia
      Pages: 1403 - 1407
      Abstract: Background: The incidence of placenta previa ranges from 0.5-1% amongst hospital deliveries. Placenta previa is major cause of antepartum haemorrhage and is potentially devastating complication. Obstetric haemorrhage is most common cause for maternal and perinatal morbidity and mortality in India. This study aimed to determine frequency, type of placenta previa, risk factors and adverse fetomaternal outcomes of placenta previa.Methods: This was a prospective study carried out in Department of Obstetrics and Gynaecology, Government Medical College and Sir-T hospital, Bhavnagar from July 2007 to July 2009 to analyze fetomaternal outcome in cases of placenta previa. All patients of placenta previa with gestational age > 28 weeks up to full term were included in the study. All cases were confirmed by Ultrasound examination. All cases were carefully analyzed to find out the incidence, type of placenta previa, its clinical presentation and its outcome in relation to mode of delivery, birth weight, maternal and perinatal morbidity.Results: There was total 50 cases of placenta previa out of 5636 deliveries. The prevalence of placenta previa was 0.88% and was more commonly present among multiparous women (82%). Most common type was type IV placenta previa in 23 (46%) cases followed by type III in 11 (22%) cases. Out of 50 cases, 06 (12%) cases had atonic PPH and 02 (04%) cases underwent peripartum hysterectomy. Most common predisposing factors were age >35 years (04%), multiparity (50%), previous cesarean section (16%) and previous history of abortion (12%). All cases of perinatal mortality were between 28 to 30 weeks weighing between 1-1.5 kg. There was no maternal mortality in this study.Conclusions: Managing a case of placenta previa during pregnancy poses a great challenge to every obstetrician in present day obstetrics due to its increased risk of maternal and perinatal complications.
      PubDate: 2019-03-26
      DOI: 10.18203/2320-1770.ijrcog20191189
      Issue No: Vol. 8, No. 4 (2019)
       
  • Audit of caesarian deliveries in a tertiary care center, in rural
           Bangalore, India

    • Authors: Rajiv K. Saxena, Anju Balan
      Pages: 1408 - 1413
      Abstract: Background: The Robson’s Ten-Group Classification System allows critical analysis of caesarean deliveries according to characteristics of pregnancy. The objective was to analyze caesarean section rates in a rural tertiary care teaching hospital in Bangalore, using Robson’s ten groups classification.Methods: This study was done in MVJ Medical College and Research Hospital, a rural tertiary care teaching hospital. All patients who underwent caesarean delivery, between November 2017 and October 2018, were included in the study. Women were classified in 10 groups according to Robson’s classification. For each group, authors calculated its relative contribution to the overall caesarean rate.Results: The overall caesarean section rate was 46.7%. The main contributors to this high caesarean rate were primiparous women in spontaneous labour (group 1) and women with previous caesarean section (group 5).  52.1% of CS were conducted on women who were unbooked or booked at a peripheral health facility and referred to present institution due to complications in labor. Strategies to lower CS rates would include encouraging women with previous CS, to undergo trial of labor to reduce CS rates for group 5C. Sensitization of staff in peripheral medical facilities for early referral of high-risk pregnancies to a tertiary care center for better control of medical complications like hypertensive disorders of diabetes mellitus. Other strategies include offering external cephalic version to eligible women with breech presentation and consider offering vaginal breech delivery to suitable women in groups 6 and 7.Conclusions: The Robson’s classification is easy to use. It is time to implement obstetric audit to lower the overall CS rates.
      PubDate: 2019-03-26
      DOI: 10.18203/2320-1770.ijrcog20191190
      Issue No: Vol. 8, No. 4 (2019)
       
  • Maternal and perinatal morbidity and mortality in severe pre-eclampsia and
           eclampsia in a tertiary care hospital: a prospective study

    • Authors: Neeta Chaudhary, Natasha Tyagi, Smita Tyagi, Shivani Singhal
      Pages: 1414 - 1420
      Abstract: Background: Hypertensive disorders of pregnancy are a leading cause of maternal and perinatal morbidity and mortality worldwide. In India, they account for the third most important cause of maternal mortality. The objective of this study was to evaluate maternal and perinatal outcome and complications in cases with severe pre-eclampsia and eclampsia and measures to prevent them.Methods: A prospective study was carried out on 100 patients with severe pre-eclampsia and eclampsia in tertiary care referral hospital over a period of one year i.e. from November 2017 to October 2018. Only those cases with initial blood pressure reading of ≥160/110mmHg or presenting with eclampsia were in included in the study. Detailed history and examination was carried out. Investigations and management were carried out as per standardized department protocol and maternal and fetal outcomes were analyzed.Results: 48% of women were between 21-25 years age, 82% were from rural area, and 86% cases were unbooked, 68% cases were primigravida. Liver Function Tests were deranged in 18% of the patients and 19% had abnormal Renal Function Tests. Labetalol was the most commonly used antihypertensive. Lower segment cesarean section was the mode of delivery in 59% of the cases. Most common maternal complication was Eclampsia. There were 5 maternal deaths i.e. maternal death rate was 5%. 54.3% of live births needed NICU admission and out of these 50% were preterm deliveries.Conclusions: Accessible healthcare and health education and awareness regarding antenatal checkup for all women will lead to early detection of severe pre-eclampsia. Hence, early treatment and management of patient’s complications will certainly improve the maternal and perinatal outcome.
      PubDate: 2019-03-26
      DOI: 10.18203/2320-1770.ijrcog20191191
      Issue No: Vol. 8, No. 4 (2019)
       
  • Study of pattern of nosocomial infections among post-operative patients
           following obstetrical and gynaecological surgeries in a tertiary care
           institute of northern India

    • Authors: Latika ., Smiti Nanda, Pushpa Dahiya, Sushila Chaudhary
      Pages: 1421 - 1425
      Abstract: Background: Hospital acquired infections (HAIs) are the major causes of morbidity and mortality, functional disability and financial burden among the patients admitted in hospitals. The nosocomial infection has thrown a big challenge to the health sector in both the developing and developed countries; therefore, it is important to put in place surveillance system for monitoring its incidence rate and planning early interventions for its prevention. The aim and objective of the study was to study the socio demographic profile of the patients who underwent Obstetrical and Gynecological surgeries and to identify the risk factors and causative organisms associated with the post-operative nosocomial infection and pattern of antibiotics sensitivity.Methods: It was a record based retrospective study carried out in a tertiary care referral institute. The case files of all post-operative patients from January 2015 to July 2015 were retrieved from the Medical Record department and an extensive analysis was carried out.Results: It was found that majority of the patients (75%) with nosocomial infection were in the age group of 20-35 years and all were married. Most of them (72%) were from the rural background. It was observed that around 9% patients reported nosocomial infection after emergency laparotomy procedure as compared to 8% of patients after elective procedure.Conclusions: In this study it was found that surgical site infection (SSI) was most common nosocomial infection followed by Urinary tract infection. The majority of surgical site infections can be prevented by the preoperative, intraoperative and postoperative phases of care.
      PubDate: 2019-03-26
      DOI: 10.18203/2320-1770.ijrcog20191192
      Issue No: Vol. 8, No. 4 (2019)
       
  • Caesarean section audit in a tertiary hospital of North India using
           Robson’s classification

    • Authors: Ruchi Gupta
      Pages: 1426 - 1430
      Abstract: Background: In view of upsurging Caesarean section (CS) rate worldwide WHO conducted two multicountry surveys to diagnose the driving determinants. In two WHO surveys increased overall CS rate was observed from 26.4% to 31.2% worldwide except Japan. Both WHO 2014 and FIGO 2016 recommend Robson ten- group classification for monitoring caesarean rate over time because of its clarity, tenacity, resilience and pliability. Our Aim is to classify women delivered in our Hospital as per Robson ten –group classification and access the factor driving caesarean rate in each group.Methods: This is a retrospective study 1671 caesarean section conducted in tertiary hospital over 6 months (July- December) 2018. All the delivering women were classified according to Robson ten-group classification and data was analyzed using Microsoft excel and SPSS 23 software.Results: During the study period there were 5917 deliveries. Of these 1671 deliveries were CS accounting for CS rate of 28.24% . The major contributor to CS rate were women in group 5 followed by primigravida’s in group 1 and 2. Increasing  CS rate was observed in group 1 ,2, 3 and 5. Most common indication for caesarean section was fetal distress , failed induction , previous caesarean , breech and Antepartum hemorrhage.Conclusions: Increasing trend in CS rate is observed in group 1,2 ,3 and 5. In order to reduce CS rate among group 2 better patient selection is required for induction of labour based on Bishop score. In order to reduce CS rate in group 5 promotion of  VBAC deliveries should be encouraged. By classifying women according to Robson group 10 classification  helps in identification of women likely to deliver by caesarean  and to identify effective strategies to optimize the CS rate.
      PubDate: 2019-03-26
      DOI: 10.18203/2320-1770.ijrcog20191193
      Issue No: Vol. 8, No. 4 (2019)
       
  • Large adnexal mass: is laparoscopic surgery a safe option'

    • Authors: Prathap Talwar, Karishma Talwar, Pranidha Shree C. A.
      Pages: 1431 - 1435
      Abstract: Background: Laparoscopic surgery is regarded as the gold standard for management of adnexal tumours due to many advantages. Currently, the exact size of the adnexal tumour contraindicating laparoscopic management has not been clearly defined. Some studies suggest laparotomy for the treatment of adnexal tumours larger than 8 to 10 cm. Risk of malignancy increases with large cysts. Issues with operation of huge adnexal masses are limited surgical field, difficulty in inserting trocars and removing the specimen without rupture. This study aims to evaluate the feasibility and surgical outcomes of laparoscopic surgery for large adnexal masses.Methods: A prospective observational study was conducted in the Department of Obstetrics and Gynaecology, JSS Medical College, Mysuru.Results: 35 patients with large adnexal masses, which were thought to be benign, were subjected to laparoscopic surgery. Mean diameter of masses as per the pre-operative ultrasound measurements was 12.2cm (range: 10.1-20.4cm). The mean operative time was 51.15minutes, estimated blood loss was 85.4ml, duration of postoperative hospital stay was 2.8 days. Serous cystadenoma was the most common histopathological finding. However, one case of borderline tumour was found.Conclusions: The potential risk of malignancy is the most important limiting factor for laparoscopic management of large ovarian cysts. Therefore, it is necessary to establish risk profiles of patients with adnexal masses in order to benefit from minimally invasive surgery wherever possible. The current study supports laparoscopic management of large ovarian cysts as a technically feasible method if proper case selection is made.
      PubDate: 2019-03-26
      DOI: 10.18203/2320-1770.ijrcog20191194
      Issue No: Vol. 8, No. 4 (2019)
       
  • Assessment of the menopausal symptoms of women by using the menopausal
           rating scale

    • Authors: Shweta Pradhan, Anupama Dave
      Pages: 1436 - 1439
      Abstract: Background: Although menopause is a universal phenomenon, there is a considerable variation among women regarding the manifestation of menopausal signs and symptoms. Symptoms experienced with the menopausal transition and early post menopause are varied and span both physical and psychological domains. Therefore, a need is felt to evaluate menopausal symptoms on a pretested scale to provide a subjective and clinically reproducible picture of menopausal symptoms.Methods: A descriptive cross-sectional study was conducted in MYH ,Indore Obstetrics and Gynecology Department, from July 2016 to December 2016.A pretested,  semi structured, interview based, oral questionnaire was used to assess the menopausal symptoms and their severity in women of age group 35 to 65 years attending MYH, Indore OPD, using MRS scale and to evaluate these symptoms in perimenopausal as compared to postmenopausal women.Results: The results were evaluated for psychological (P), somatic (S), and urogenital (U) symptoms. A significantly higher percentage of perimenopausal women  showed a P score of ≥7; while a higher percentage of postmenopausal showed S score and U score ≥7 ;p ≤ (0.001).Working women seem to suffer more from psychological symptoms whereas nonworking women showed a greater incidence of somatic symptoms.Conclusions: The present study revealed that proportion of menopausal symptoms was significantly high and there was variation of severity of menopausal symptoms with any of the socio demographic variables, menopausal status or duration of menopause.
      PubDate: 2019-03-26
      DOI: 10.18203/2320-1770.ijrcog20191195
      Issue No: Vol. 8, No. 4 (2019)
       
  • Obstetrics critical care: a 2 years retrospective study in a medical
           college hospital of western India

    • Authors: Savita C. Pandit, Surendra D. Nikhate
      Pages: 1440 - 1444
      Abstract: Background: This study highlights the possibilities of new contribution to the management of high risk pregnancies and those pregnancies with unpredictable outcomes. The objective was to study the incidence and the clinical profile of antenatal and postpartum women requiring admission to the ICU, the interventions required in these women and final outcome.Methods: A retrospective cohort study of all obstetric critical care admissions during 2-year period from January 2016 to December 2017 was done at 1296 bedded tertiary care hospital. During the study total 349 obstetric patients were admitted to the ICU. The data were analysed by using percentage.Results: Primigravida (54.73%) were more as compared to multigravida (45.27%). Only 15.76% patients were in antepartum period while majority of patients (84.24%) were admitted during postpartum period. The main obstetric indications for ICU admission were pregnancy-induced hypertension (14.32%) followed by obstetric hemorrhage (9.16%) and community acquired pneumonia (7.44%). Other indications were valvular heart disease (5.44%), ANC with severe anemia (1.72%), monitoring (6.30%). In the present study maternal mortality among the women admitted to ICU was 18.05%. The leading cause of maternal death was obstetric hemorrhage (28.57%) followed by pregnancy induced hypertension (25.40%). An ICU intervention during the stay of the patients in terms of mechanical ventilation was used in 250 (71.63%) cases.Conclusions: A high quality multidisciplinary care is required in complicated pregnancies for safe motherhood. So, there is a need for dedicated ICU for obstetric patients.
      PubDate: 2019-03-26
      DOI: 10.18203/2320-1770.ijrcog20191196
      Issue No: Vol. 8, No. 4 (2019)
       
  • Study of serum lipid profile and magnesium in preeclampsia

    • Authors: Hymavathi K. Reddy, Vineela P., Bhargavi M. Chowdary
      Pages: 1445 - 1450
      Abstract: Background: A comparative study of serum lipid profile and magnesium levels in normal pregnancy versus preeclampsia (PE).Methods: A prospective study done for 2 years (October 2014 to October 2016) in the Department of Obstetrics and Gynecology, Narayana medical college and hospital, a tertiary care centre, Nellore, Andhra Pradesh, India. A sample size of 200 pregnant women, recruited and divided into group A and B. group A being women with PE and group B is normal pregnant women.A10ml of venous blood was collected in the fasting state and serum collected from clotted blood to measure lipid profile, magnesium, Apo lipoprotein A-I and Apo lipoprotein B 100.Serum Lipid profile  measured by enzymatic method using commercially available kit Human (GmbH Germany) using humastar 600 chemistry analyzer (Human GmbH Germany). Serum magnesium measured by dye binding method using commercially available kit Human (GmbH Germany) using Humastar 600 chemistry analyzer (Human GmbH Germany). Serum ApoA-I and ApoB were measured by immune-turbidometry using commercial kits from Spinreact Spain. Urine albumin done by dipstick method.Results: Serum total cholesterol (TC), Triglyceride (TG), low density lipoprotein (LDL), very low-density lipoprotein (VLDL), Apo lipoprotein B 100 (Apo B100) were high and serum Magnesium, high density lipoprotein (HDL) and Apo lipoprotein A1(Apo A1) were low in the study group (group A) compared to controls (group B).Conclusions: Abnormal lipid profile (low HDL and increased TG concentration) and serum hypomagnesaemia may be contributing etiologies of preeclampsia, having good predictive value as a screening procedure for PE in high risk pregnant population.
      PubDate: 2019-03-26
      DOI: 10.18203/2320-1770.ijrcog20191197
      Issue No: Vol. 8, No. 4 (2019)
       
  • Overcrowding and possible solutions for a busy gynecological emergency
           department: a hospital-based setting

    • Authors: Mahvish Qazi, Najmus Saqib, Sachin Gupta
      Pages: 1451 - 1456
      Abstract: Background: The objective of this study is to determine the trends of patients presenting in Obstetrics and Gynecology emergency department and to identify possible solutions.Methods: This retrospective hospital record-based study was conducted at Government Medical College Jammu, Jammu and Kashmir, India from the department of Gynecology and Obstetrics and comprised data of all patients presenting to the emergency department between 1st January 2018 to 31st December 2018.  Patients were assessed in terms of demographic features, presenting complaints, admission types (urgent, non-urgent), referral from other hospitals or coming from home. The total number of patients admitted and the number of patients sent home was also recorded.Results: A total of 1,46,366 patients were analyzed retrospectively. Out of which 63,004 (43.05%) were send home from the OPD while 83,362 (56.95%) presented to the emergency department. Of them, 49,383 (59.24%) were discharged straight away from the ED after emergency treatment and care while 339,79 (40.76%) were admitted. Out of 339,79 patients, 24,932 (73.37%) stayed in the emergency whereas 9047 (26.63%) admitted into different wards for elective procedures. Majority of the patients 26,098 (89.92%) came from home and 2927 patients (10.08%) were referred from other hospitals. Labour pains 7833 (31.42%) was the most common presentation. Trauma was the reason for admission in 112 (0.45%) patients out of 29025. 971 (3.89%) patients presented with gynecological problems. 4093 (14.10%) patients presented with non-urgent indications. Rest of all patients presented with indications which were categorized as urgent and were admitted. All data was analysed using SPSS version 20.Conclusions: To reduce the overcrowding in the emergency department and improve quality of obstetrics and gynecological services, Inpatients and Outpatient departments at primary and secondary care levels need to be strengthened. Patients with non-urgent problems should be provided adequate care at primary and secondary health care centers.
      PubDate: 2019-03-26
      DOI: 10.18203/2320-1770.ijrcog20191198
      Issue No: Vol. 8, No. 4 (2019)
       
  • Adnexal mass: a clinicopathological study at a tertiary care centre in
           Assam, India

    • Authors: Mukut Jyoti Das, Pranay Phukan
      Pages: 1457 - 1462
      Abstract: Background: An adnexal mass may be found in females of all ages with significantly variable prevalence, but more common among women of reproductive age. Adnexal masses pose a special dilemma to the attending gynaecologist because the diagnosis is often difficult and differential diagnosis is vast. Clinical examination is the first step in evaluation of patients with adnexal mass. Pelvic masses which are undetected or overlooked on physical examination can be identified by Ultrasonography. The aims and objectives of the study were to: to find out different types of adnexal pathology clinically, correlation of clinical finding with histopathology, correlation of ultrasonography finding with histopathology.Methods: The present study was carried in the Department of Obstetrics and Gynecology, Assam medical college and hospital, Dibrugarh from 1st July 2017 to 30th June 2018. This study was a hospital based observational study which included 145 patients of adnexal mass attending the GOPD who required admission and operative intervention. All cases underwent an abdominal ultrasound examination with color Doppler. Transvaginal sonography was done wherever feasible. Following surgery, specimens were sent for histopathological examination and the reports were correlated with pre-operative clinical and ultrasonography findings.Results: The most common site of origin of adnexal mass was ovary (92.41%) followed by fallopian tube (6.20%) and broad ligament (1.39%). Majority (79.31%) were non neoplastic or benign adnexal masses. All cases of adnexal malignancy were of ovarian origin. The sensitivity and specificity of clinical examination for diagnosis and discriminating benign and malignant ovarian neoplasms were 70% and 86.6% and that of ultrasonography was 86.67% and 96.65% respectively.Conclusions: Adnexal mass in reproductive age group were mostly non neoplastic and benign, whereas malignancy was mostly seen in peri and post-menopausal age group. Ultrasonography is a useful adjunct to clinical examination for diagnosis and proper management of patients with adnexal mass in low resource setup.
      PubDate: 2019-03-26
      DOI: 10.18203/2320-1770.ijrcog20191199
      Issue No: Vol. 8, No. 4 (2019)
       
  • Granulocyte colony stimulating factor in COS-IUI cycles

    • Authors: Pradnya Devdas Shetty, Nikita Lad, Pallavi Vishwekar, Mamta Vijay Shivtare
      Pages: 1463 - 1466
      Abstract: Background: An unresolved assisted reproductive technique problem is the unresponsive, thin endometrium. Approximately 0.6%-0.8% of patients do not reach the minimum thickness. Using endometrial co culture, G-CSF>130pg/mL was associated with significantly improved pregnancy rate in ART cycles. This is a retrospective study that included all unexplained infertility cycles with controlled ovulation stimulation –IUI protocols. Aim was to note the effects of G-CSF on thin endometrium and pregnancy rate in G-CSF administered COS-IUI cycles.Methods: This study was done in the IVF department of Dr D Y Patil University, Navi Mumbai, India. Thin endometrium was defined as ET<7mm on transvaginal ultrasound. Clomiphene citrate was used for ovulation induction in strengths of 100mg or 50mg on day 2 of their cycle based on the antral follicle count. Trigger used was injection 10,000µg urinary hCG. On the same day when the trigger injection was given, 300 units G-CSF was instilled into the uterus. Post 36 hours IUI was done under aseptic precautions .After 16 days β-hCG levels were done to determine whether there is a pregnancy.Results: In present study,200 COS-IUI cycles were analysed.50 cycles showed a thin endometrium and in them G-CSF was used. The chemical pregnancy rates was 32%, the intrauterine pregnancy rate was 28%, ectopic pregnancy rate was 4%.Conclusions: Present study concluded that G-CSF increases ET significantly in COS-IUI cycles in the event of thin endometrium. In view of small cohort size further larger randomized controlled trials may be required  to substantiate the above conclusions.
      PubDate: 2019-03-26
      DOI: 10.18203/2320-1770.ijrcog20191200
      Issue No: Vol. 8, No. 4 (2019)
       
  • Prospective study of colposcopic screening of unhealthy cervix

    • Authors: Pushpa Kannoujiya, Arpita Shrivastava, Tariq Ahmed Mala
      Pages: 1467 - 1472
      Abstract: Background: The study was conducted to screen women who have abnormal vaginal discharge with Pap smear to do histopathological analysis of colposcopically directed biopsies.Methods: A prospective analytical study carried out in the department of obstetrics and gynaecology. The patients were randomly selected who fulfilled the selection criteria and was carried out to study the correlation of Pap smear and colposcopy in women with unhealthy cervix.   Results: Among all patients 13% were between 20-29 years, 38% were between 30- 39%, 31% belonging to 40-49 years group and 18% was between 50-59%.  Among 100 Women studied, 33% were illiterates, 55% had primary/high school education and 12% had Higher education Majority of the patients (68.7%) of CIN occurred in the age group of 30-49years, 41.7% with CIN were paragrvida 2, 43.8% with CIN were paragravida 3 and 18.6% were greater than paragravida 4 showing high incidence of CIN in multiparity.The incidence of CIN was found to be high among the lower income group 87.5%.The major presenting complains in the study patients were white discharge per vagina.Conclusions: Colposcopy was found to be useful in understanding the morphology of the cervical lesion, both of the neoplastic and nonneoplastic ones and was very helpful in planning their management. Cytology is an accepted method for screening for cervical cancer and the value of colposcopy has been recognized. Hence it may be better to utilize cervical cytology smear with colposcopy should be offered as a diagnostic method in all patients with unhealthy cervix.
      PubDate: 2019-03-26
      DOI: 10.18203/2320-1770.ijrcog20191201
      Issue No: Vol. 8, No. 4 (2019)
       
  • Study of knowledge, attitude and practices of contraception in
           breast-feeding mothers

    • Authors: Aiyleen Shiza Shawl, Vidya Thobbi
      Pages: 1473 - 1479
      Abstract: Background: In India, as in many other countries, postpartum family planning is usually initiated after 6 weeks postpartum. Early resumption of sexual activity coupled with early and unpredictable ovulation leads to many unwanted pregnancies in the first year postpartum. Increase in hospital deliveries provides an excellent opportunity to sensitize women and provide effective contraception. Hence the present study was done at our tertiary care centre to assess the knowledge, attitude, practice regarding contraception and to find out the relationship between knowledge and attitude regarding contraception among breast feeding mothers.Methods: A hospital based observational study. The patients admitted at our tertiary care centre in the Department of Obstetrics and Gynecology.Results: Majority of the participants (72%) were in the age group of 21-25 years. 21.2% of the study group was educated up to primary level while 33.2% and 18.4% of the participants studied till SSC and HSC respectively. Majority of participants were from middle class (50%) followed by lower class (36.4%) and upper class (13.6%). 69.6% participants resided in rural areas while 30.4% participants were from urban areas. It was observed that age, education and mode of delivery were the significant factors.Conclusions: As the government gives incentives to couples who opt for permanent sterilization, which is an effective drive, it should also give incentives to couples who follow temporary methods and delay pregnancies. Couples who adopt one child norm or 2 children norm should be encouraged by benefits either in the form of children’s education or health insurance.
      PubDate: 2019-03-26
      DOI: 10.18203/2320-1770.ijrcog20191202
      Issue No: Vol. 8, No. 4 (2019)
       
  • Consequences of antepartum hemorrhage and its maternal and perinatal
           outcome

    • Authors: Himang Jharaik, Bishan Dhiman, S. K. Verma, Aditi Sharma
      Pages: 1480 - 1486
      Abstract: Background: Antepartum haemorrhage, a life-threatening event, is defined as bleeding per vaginum occurring after the fetus has reached the period of viability, considered to be 20 weeks in developed countries and 28 weeks in countries with low resource settings. We evaluated the consequences of antepartum haemorrhage, their maternal and perinatal outcome so as to outline the proper management of patient in order to improve both maternal and perinatal morbidity and mortality.Methods: This one-year prospective study totaled 133 cases of APH fulfilling the inclusion criteria were studied. Data was recorded on the MS excel sheet for further analysis and processing.Results: Total 6693 deliveries were conducted out of which 133 presented as APH and incidence of APH was found out to be 1.98%. Placenta previa was most common. APH was commonly associated with multigravida and most cases were in age group of 26-30 years. Most of the PP and abruption cases were admitted at 34-37 weeks and 31-33 weeks respectively. High risk factors included previous LSCS and D and C, hypertension, multiple pregnancies and malpresentations. Most of the patients underwent preterm LSCS. Most fetal complications were due to prematurity. 58.6% patients were transfused blood. Overall perinatal mortality was 20.1% and maternal mortality was zero.Conclusions: Early diagnoses, timely referrals and transfusion facilities along with trained team of doctors with well-equipped ICU facility goes a long way in avoiding APH related maternak and fetal complications.
      PubDate: 2019-03-26
      DOI: 10.18203/2320-1770.ijrcog20191203
      Issue No: Vol. 8, No. 4 (2019)
       
  • A study on premenstrual syndrome symptoms and their association with sleep
           quality in nursing staff

    • Authors: Gauri Kore, Heena Merchant, Hiba Narvel, Ajita Nayak, Avinash De Sousa
      Pages: 1487 - 1490
      Abstract: Background: Symptoms in the premenstrual period can be debilitating and troublesome and impacts the general health of women. There is a dearth of studies examining the relationship between sleep quality and premenstrual symptoms in women, especially in Indian settings. The current study was conducted with the aim of looking at the frequency of premenstrual syndrome (PMS) in different age groups and the association of these symptoms with sleep quality in nursing staff.Methods: The cross-sectional study involved 450 female nursing staff between 25- 50 years of age from various tertiary care hospitals who were administered the Premenstrual Tension Syndrome Rating Scale (PMTS) and Pittsburgh Sleep Quality Index (PSQI). The data was then statistically analyzed.Results: The prevalence of premenstrual symptoms was found to be 85.6% amongst the participants (according to the ACOG criteria), while the proportion of females suffering from PMS (according to DSM IVTR criteria) was 36.5%. A correlation analysis between total scores of PMTS and PSQI showed a positive, linear and significant association.Conclusions: The intensity of PMS was associated with reduction in sleep quality in present study. Further studies on PMS and sleep related parameters need to carry out in larger samples to give impetus to our findings.
      PubDate: 2019-03-26
      DOI: 10.18203/2320-1770.ijrcog20191204
      Issue No: Vol. 8, No. 4 (2019)
       
  • An evaluation of abnormal pueperium

    • Authors: Aarti Jeenwal, Hemlata Jharbade, Nishita Singh
      Pages: 1491 - 1494
      Abstract: Background: Puerperium is strictly defined as the period of confinement during and just after birth. It is the period following childbirth during which body tissues specially the genital organ reverts back approximately to the pre-pregnant state both anatomically and physiologically. At some stages some of these well-orchestrated changes can go away resulting in complications which can endanger life.Methods: Retrospective c study was conducted in Department of Obstetrics and Gynecology of M.G.M. Medical College and M. Y. Hospitals, Indore. The cases were selected randomly from the patient who were admitted in M.Y. Hospital who had either a vaginal or caesarean delivery (both in our institution as well as outside institution) during the study period, irrespective of age, parity and registration status. Data was recorded in predesigned coded case report forms and statistical analysis was performed.Results:
      Authors found that puerperal pyrexia was the most common complication, accounting for 38.96% of total cases. The second most common complication was perineal pain affecting 28.15% of cases. The other complication was wound gaping/discharge (11.71%), mastitis and breast abscess (6.81%), secondary postpartum hemorrhage (5.33%), episiotomy gaping and infection (4%), perineal hematoma (0.59%), wound dehiscence (0.3%) and other rare causes accounted for 4.15% of the complication.Conclusions: Puerperal period is as important as antenatal period. Anaemia, suboptimal personal hygiene as well as improper sterilization can resulted in severe health hazards such as septicemia, disseminated intravascular coagulation as well as death. So, risk factor should be treated vigorously.
      PubDate: 2019-03-26
      DOI: 10.18203/2320-1770.ijrcog20191205
      Issue No: Vol. 8, No. 4 (2019)
       
  • Selective estrogen receptor modulator: efficacy in abnormal uterine
           bleeding in perimenopausal women

    • Authors: Ankita Mani, Kanchan Sharma, Arun Kumar, R. K. Talukdar
      Pages: 1495 - 1499
      Abstract: Background: Abnormal uterine bleeding affects 50% women of perimenopausal age group. The use of ormeloxifene (SERMS) in management of AUB is well known. The objective of the present study was aimed to see the effects of ormeloxifene on different types of endometrium.in the medical management of Abnormal Uterine Bleeding (AUB).Methods: It was Prospective, interventional study. A total of 90 women who attended Outpatient Gynaecology Department, Guwahati with complain of AUB in perimenopausal age group (37-48) were prescribed 60mg ormeloxifene twice weekly for 3 months followed by once weekly for next 3 months after preliminary D and C.Results: Ormeloxifene was found to be more effective in reducing PBAC score and ET in patients with proliferative and secretory endometrium The reduction in mean PBAC score with ormeloxifene (175.3 to 20.93)(p value 0.0001) and ET (9.6 to 2.9 mm) (p value 0.0001) in proliferative endometrium, (179.2 to 14.8 (p value 0.0001) ) and ET 11.1 to 1.9 mm (p value 0.0003)in secretory endometrium was observed after 6 months. However, it was found not to be effective in reducing PBAC score and ET in patients with atrophic endometrium. Change in PBAC SCORE from 176.4 to 150.8 (p value 0.08) and in ET from 2.8 to 2.1mm( p value 0.3) was observed. No major side effects were reported.Conclusions: Ormeloxifene is effective in AUB with proliferative and secretory endometrium.
      PubDate: 2019-03-26
      DOI: 10.18203/2320-1770.ijrcog20191206
      Issue No: Vol. 8, No. 4 (2019)
       
  • Partogram and its relevance in modern obstetrics

    • Authors: Anjali Choudhary, Meenakshi Tanwar
      Pages: 1500 - 1504
      Abstract: Background: Normal labor and childbirth is fraught with complexities. In the modern times the child birth has proven to be more challenging than ever. Partogram has proven to be a simple and useful tool in monitoring normal labor. The objective of this endeavor was to site our experiences in using partogram for ‘plotting’ labors, to assess its utility, limitations and cite controversies.Methods:
      Authors analyzed progress of labor plotted on partograms in parturient women to see whether their labor patterns conform to the standard partogram, and can logical conclusions be drawn from their use to decide partogram’s utility and applicability.Results: The use of partogram was not universal and its charting inadequate due to lack of motivation on part of labor room residents, busy labor rooms. When plotted meticulously they showed a wide variation, and many women did not conform to the rates of dilatation of the graph. The use of partogram did not alter the rate of cesarean section for non-progressive labors with use and non-use of partogram.Conclusions: Philpott’s partogram is a very visual and useful tool to monitor labours and detect labour abnormalities timely. Although it has served as a labour management tool across the labour rooms its use is not universal. There is a plethora of conflicting opinions regarding its utility in modern obstetrics today, ranging from a complete faith in the tool to finding it obsolete and in need of a revision to calling it a medicalization of a natural process.
      PubDate: 2019-03-26
      DOI: 10.18203/2320-1770.ijrcog20191207
      Issue No: Vol. 8, No. 4 (2019)
       
  • Lactate dehydrogenase levels in preeclampsia and its correlation with
           maternal and perinatal outcome

    • Authors: Nirmala Bhandari, Anjali Gupta, Simmi Kharb, Meenakshi Chauhan
      Pages: 1505 - 1510
      Abstract: Background: Hypertensive disorder of pregnancy occurs in approximately 6-8% of all pregnancies. The most serious consequences for the mother and the baby are the result of preeclampsia and eclampsia. Lactate Dehydrogenase (LDH) is an intracellular enzyme. Recently LDH has been suggested as potential marker to predict severity of pre-eclampsia. The objective of the present study was to compare the serum lactate dehydrogenase levels in women with preeclampsia and normal pregnant women and to correlate lactate dehydrogenase levels with maternal and perinatal outcome in preeclampsia.Methods: An observational prospective study was conducted on 200 antenatal women attending the labour room emergency. Women with singleton pregnancy and cephalic presentation, from 28 weeks onwards were enrolled in the study. Out of 200, 100 were normal pregnant women and 100 were preeclamptic women. Serum LDH levels were measured in all women and maternal and perinatal outcome was assessed in terms of LDH levels.Results: Higher levels of LDH was observed in pregnant women with preeclampsia (627.38±230.04 IU/l) as compared to normal pregnant women (224.43±116.61 IU/l). The maternal complications were found to be maximum in women with LDH > 800 IU/l.  Abruption was the most common complication. The perinatal mortality and neonatal deaths were found to have significant correlation with high LDH levels.Conclusions: Maternal and perinatal complications were associated with higher LDH levels in preeclampsia patients. Serum LDH levels can be offered to all patients of preeclampsia and can be used to predict the prognosis of preeclampsia.
      PubDate: 2019-03-26
      DOI: 10.18203/2320-1770.ijrcog20191208
      Issue No: Vol. 8, No. 4 (2019)
       
  • Spectrum of dengue morbidity in pregnancy and its impact on maternal and
           perinatal outcome

    • Authors: Anuradha G., Sandya M. R., Shirley George
      Pages: 1511 - 1516
      Abstract: Background: Dengue is a vector borne viral infection with seasonal outbreaks every year. The spectrum varies from just a febrile morbidity to the severe form of dengue shock syndrome (DSS). The objective of the present study was to study the influence of dengue fever on pregnancy and to analyze the maternal and perinatal outcome.Methods: Thirty-six pregnant women beyond 28weeks of gestation who tested positive for dengue infection were retrospectively analyzed during a 5year study period (Jan 2014-Dec 2018). The study was conducted in the Department of OBGYN St John’s Medical College Hospital, Bangalore. Thirty-three of these patients delivered at St John’s and there were three postpartum referral cases. The necessary data was obtained by patient record review. The data was analyzed using SPSS and the results were expressed as Mean±SD and percentages.Results: Out of 36 women analyzed the mean age was found to be 23.93±4.5 years. Majority were primigravidae (58.3%). The most common clinical manifestation was fever seen in 47.2%. Twenty five percent of patients had platelet count of <20,000 on admission. Overall 66% of the patients required transfusion. Nearly fifty three percent of the patients had vaginal delivery. There were 4 maternal mortalities (11.1%) and 2 perinatal mortalities (5.5%) both were still births in the present study.Conclusions: Dengue infection in pregnancy was associated with increased maternal and perinatal morbidity as well as mortality. The severity of the infection has direct impact on the outcome. Hence early diagnosis and prompt management in a tertiary care centre, with multidisciplinary approach improves the outcome and minimizes the complications.
      PubDate: 2019-03-26
      DOI: 10.18203/2320-1770.ijrcog20191209
      Issue No: Vol. 8, No. 4 (2019)
       
  • Incidence and risk factors of intra uterine fetal death: a retrospective
           study at a tertiary care centre in Kashmir, India

    • Authors: Shabnam Ara, Shazia Nisar, Umrazia Bashir
      Pages: 1517 - 1519
      Abstract: Background: Intrauterine fetal death (IUFD) is the tragic event contributing to high perinatal mortality in developing countries. So many risk factors have been seen associated with IUFD that can be prevented with better antenatal care and timely detection at the earliest so that the prevalence can be decreased. This study was done to identify the risk factors associated with IUFD.Methods: This is a retrospective study from done from March 2017 to March 2018 at skims maternity hospital. IUFD was defined as fetal death beyond 20 weeks of gestation. Records were analyzed and data was compiled.Results: In our study there were total of 2500 deliveries out of which 70 were IUFD. Incidence was 28 per 1000 live births. It was found more common in the age group of 20-29 year (65.71%)  %). Preeclampsia was the risk factor in 17.14% of cases , followed by abruption in 11.42% followed by placenta previa in 7.14% of cases. However, 20% of the cases had unidentified risk factor.Conclusions: Present study was an effort to compile common risk factors associated with IUFD at tertiary centre of Kashmir.
      PubDate: 2019-03-26
      DOI: 10.18203/2320-1770.ijrcog20191210
      Issue No: Vol. 8, No. 4 (2019)
       
  • Post void residue in women with pelvic organ prolapse: a prospective
           observational study

    • Authors: Nanthini Saravanan, Aruna N. Kekre, Mahasampath Gowri S.
      Pages: 1520 - 1524
      Abstract: Background: The objective of the present study was to observe the post void residual volume (PVRV) in women with pelvic organ prolapse (POP) pre and postoperatively and to correlate stage of prolapse with lower urinary tract symptoms and quality of life in women with pelvic organ prolapse.Methods: This is a prospective observational cohort study of 100 women with symptomatic pelvic organ prolapse of stage II or greater. Patients were admitted for Vaginal hysterectomy with pelvic floor repair for pelvic organ prolapse in Gynaecology Department at Christian Medical College Hospital, Vellore, India over one year were recruited. This study was approved by the institutional review board and ethical committee of the hospital. Pre- and post-operative PVR were measured. The statistical analysis was done by using SPSS version 21 and P value < 0.05 was considered as statistically significant.Results: In this study 100 patients were recruited and 11% of women had pre-operative high post void residual volume of more than 100 ml. Stages of POP did not correlate with severity of LUTS and QOL. Pre-operative elevated PVR resolved post operatively in 91%, the P value <0.000 which was highly significant.Conclusions: 11% of women had preoperative high PVR. Stages of POP did not correlate with severity of lower urinary tract symptoms (LUTS) and quality of life(QOL). Pre-operative elevated PVR resolved post operatively in 91%, the P value < 0.000 which was highly significant. Majority of the patient with severe pelvic organ prolapse had elevated pre-op PVR which resolved post- operatively after surgical correction.
      PubDate: 2019-03-26
      DOI: 10.18203/2320-1770.ijrcog20191211
      Issue No: Vol. 8, No. 4 (2019)
       
  • Comparison of Ketamine and Pentazocine with Fentanyl and Propofol
           combination for anaesthesia during laparoscopic tubal ligation

    • Authors: Ovais Nazir, Asif Hussain Bhat, Hamid Yatoo, Sanjeevni Gupta, Rajesh Misra
      Pages: 1525 - 1530
      Abstract: Background: Laparoscopic tubal ligation have advantages of minimally invasive surgical technique, without risk of major haemorrhage, early postoperative ambulation and alimentation, making it suitable for ambulatory surgery. The choice of aneasthesia for laparoscopic ligation hence should consider the anaesthetic agents with a rapid onset of action and fast recovery time, with minimal problems for intraoperative control of haemodynamic, airway and pain relief as well as take consideration of the safety, quality, efficacy, and utilization of resources available to the given situation.Methods: A total of 100 patients aged from 18 to 45 years who were scheduled to undergo laparoscopic tubal ligation  were divided into Group I-  Ketamine plus pentazocine group (n=50), Group II- Propofol plus fentanyl group (n=50) and studied  for the intraoperative parameters (hemodynamic and respiratory profile), recovery time, postoperative side effects and discharge time.Results: Intraoperatively MAP and HR were consistently higher in group I as compared to group II. Incidence of apnea and need for bag and mask ventilation was significantly more in Group II than in Group I as was the incidence of Bradycardia. Postoperative nausea and vomiting, psychomimetic effects were significantly more in Group I than in Group II. The time to reach modified PADSS ≥9 (discharge time) was significantly longer in group I (140.3±12.82 min than in group II 102.2±9.2 min), P<0.01.Conclusions: Combination of ketamine and pentazocine gives good anaesthetic conditions during procedure with less incidence of airway and haemodynamic complications intraoperatively but more incidence of postoperative side effects like nausea, vomiting, psycomimetic effects, and time to meet discharge criteria, compared to propofol plus fentanyl.
      PubDate: 2019-03-26
      DOI: 10.18203/2320-1770.ijrcog20191212
      Issue No: Vol. 8, No. 4 (2019)
       
  • Epidemiological determinants and clinical profile of eclampsia: a case
           control study

    • Authors: Ritam De, Amit Dutta
      Pages: 1531 - 1537
      Abstract: Background: The incidence of eclampsia has reduced considerably in the developing countries due to good antenatal care and increased awareness within the population. To determine the magnitude of the problem, to assess trends and to identify risk factors and risk groups, it is worthwhile to periodically review this problem.Methods: A study using one control for each case of eclampsia was conducted among women who were admitted at Burdwan Medical College and Hospital between July 2014 and June 2015. Cases were women with a confirmed diagnosis of eclampsia. Eclampsia cases were identified by daily monitoring of all new admissions to Eclampsia ward of Burdwan Medical College and hospital. After strict exclusion criteria, a total of 500 eclampsia cases were studied along with same number of controls for identifying the epidemiological determinants.Results: Maternal age at extremes (<20 and >30 years) was identified as a risk factor of eclampsia. Nulliparity has been identified as a risk factor for eclampsia in present study. About 74.6% mothers were nulliparous. Most of the patients 66.6% were admitted during the antenatal period i.e. presented with antenatal eclampsia. 62.2% of them were at between 34-37weeks of gestational age during admission.Conclusions:
      Authors observed increased eclampsia risk among women with a prior history of pregnancies complicated by hypertensive disorders. Positive personal histories of hypertensive disorders of pregnancy and family history of hypertensive disorders are well known risk factors of eclampsia. Our findings point to public health and clinical measures that may be taken to potentially attenuate the incidence of eclampsia and mitigate associated maternal-fetal complications resulting from the disorder.
      PubDate: 2019-03-26
      DOI: 10.18203/2320-1770.ijrcog20191213
      Issue No: Vol. 8, No. 4 (2019)
       
  • Perinatal outcome in cases of severe oligohydramnios

    • Authors: Nilesh Dalal, Anjali Malhotra
      Pages: 1538 - 1541
      Abstract: Background: Oligohydramnios is defined as when on ultrasonography the single largest pocket in horizontal and vertical diameter is less than 2cm or amniotic fluid index is less than 5cm. Normal amniotic fluid index is 5-25cm. The overall incidence is 0.5 to more than 5%. However, the incidence increases in post dated pregnancies as many as 11%. It is increasing these days because of changes in lifestyle and also reduced maternal fluid intake.Methods: A prospective randomized study was done in Dept of Obstetrics and Gynaecology, MGMMC and MYH, Indore during the period of 6 months from 1st July 2017 to 31st December 2017. It included 200 cases from all the antenatal patients attending Antenatal OPD in routine and emergency and who are admitted in MYH beyond 28 weeks of pregnancy.Results: Majority of cases i.e. 64% were handover, babies with 26% were IUDs (intra uterine devices) and Rest 10% requiring neonatal care in nursery. The color Doppler changes showed normal flow in 54% in cases with 26% showing early fetal hypoxia and 14% showing uteroplacental insufficiency. Rest of the 6% cases were IUD. Incidence of IUGR was 50% in babies most commonly being constitutionally small. About 8% cases were found to be associated with abruption and 24% cases were found to be associated with pregnancy induced hypertension. Most common mode of delivery was vaginal delivery in 68% cases. However, 32% cases underwent LSCS.Conclusions: There has been reported cases of sudden IUD in severe oligohydramnios presenting with loss of fetal movements.
      PubDate: 2019-03-26
      DOI: 10.18203/2320-1770.ijrcog20191214
      Issue No: Vol. 8, No. 4 (2019)
       
  • Epidemiological study on body mass index distribution and health awareness
           among women at an urban tertiary care centre of north India

    • Authors: Kamna Datta, Pooja Gupta, Pushpa Singh
      Pages: 1542 - 1547
      Abstract: Background: Obesity has become a new worldwide health problem and is gradually moving towards an epidemic. overweight and obesity implies an abnormal excessive fat accumulation that poses health risk. According to National Family Health Survey-4, prevalence of obesity has doubled in country over the last decade. Asian Indians stand at higher risk for development of obesity related non-communicable diseases at lower body mass index levels.Methods: It was an observational interpretive study carried on 1000 randomly selected women over 3 months in a tertiary center of urban northern India. BMI was obtained by dividing weight in kilograms and height in meters squares. Patients were enquired about any menstrual complains, known comorbidities, awareness of obesity in terms of its cause and effects, about weight reduction and benefits of exercise and its practice and details noted in a preformed performa. No prior intervention or health education was given to avoid bias.Results: Out of 1000 women, mean BMI was found to be 31.85±8.85kg/m2. BMI classification (Asian standards) stated that 8.1% were overweight and 78% of patients were pre obese and obese (maximum in age of 21-40 years). Menstrual complaints were present among 39% of overweight and obese groups. Among comorbidities, hypothyroidism was found to be maximum being 9.5% in the obese group, followed by hypertension and diabetes mellitus. Only 26.3% of obese women were aware of the factors causing obesity. Knowledge of exercise benefits was grossly limited, with only one fourth of the pre obese and obese population being aware of it.Conclusions: Rising obesity in Indian women needs measures for prevention. Though there is knowledge of the cure among Indian females but there is limited ability to implement the same. Health education of women regarding obesity related comorbidities along with the benefits of weight loss with exercises should be promoted strongly.
      PubDate: 2019-03-26
      DOI: 10.18203/2320-1770.ijrcog20191215
      Issue No: Vol. 8, No. 4 (2019)
       
  • Rising trends of caesarean section: a retrospective study

    • Authors: Namrata Sethi, Sushma P. Sharma
      Pages: 1548 - 1552
      Abstract: Background: The indications of Caesarean Section (CS) have been changing over time, along with a visible, much talked about rise in the rate. Without a doubt, C-sections can effectively prevent maternal and perinatal mortality when done for a medical indication. However, little is researched about the extent of maternal indications and the fetal outcomes of C-sections.Methods: Data of January to March 2012 and January to March 2017 was obtained by detailed study of the patient files from the Medical Records Department of the hospital. A predesigned proforma was used to record the relevant information. Data was analysed using standard statistical methods.Results: Cephalo pelvic disproportion (CPD) and fetal distress (FD) remained the major causes of CS in both the groups, being 50.4% in group2012 and 60.5% in group2017. Trends of CS due to maternal demand and tubal ligations are emerging. Though the rise in CS was not significant in the 5 year period having gone up from 45.41% to 48.81%, there was significant increase in deliveries without complications, having jumped up from 74.8% to 88.3%.Conclusions: As per the study, there was non-significant rise in the incidence of C-sections in the time period of study. Major contributory factors observed were CPD and FD, in which it is imperative to perform C-sections.
      PubDate: 2019-03-26
      DOI: 10.18203/2320-1770.ijrcog20191216
      Issue No: Vol. 8, No. 4 (2019)
       
  • Aetiology of jaundice in pregnancy: observational study in a tertiary care
           hospital

    • Authors: S. Vinayachandran, Anaswara K.
      Pages: 1553 - 1557
      Abstract: Background: Jaundice in pregnancy has potentially serious consequences to both mother and foetus. This study aims to find out the aetiology of jaundice and its severity in pregnancy.Methods: This is an observational prospective study over a period of one and a half years conducted in the Department of Obstetrics and Gynaecology, Government Medical College, Kozhikode. Antenatal patients who presented with jaundice was included in this study.Results: Out of 24060 deliveries in the study period of one and a half years there were 52 cases of jaundice complicating pregnancy. Incidence of jaundice complicating pregnancy was found to be 0.22%. Largest number of women belonged to the age group 21-25 years of age. Most of the cases occurred in the third trimester. 55.8% of the cases were multigravidas Most common cause of jaundice in pregnancy was found to be HELLP syndrome (34.6%) followed by Hepatitis A (32.7%) 67.3% of the cases had only mild elevation of bilirubin levels (2-5.9mg/dl). 65.4% had an SGOT value of less than 200U/litre and 67.3 % had an SGPT value of less than 200U/litre.Conclusions: The decrease in the number of cases of viral hepatitis may be due to the increased awareness about the transmission of disease and improvement in sanitary conditions.
      PubDate: 2019-03-26
      DOI: 10.18203/2320-1770.ijrcog20191217
      Issue No: Vol. 8, No. 4 (2019)
       
  • Diagnostic value of risk malignancy index (RMI) for detection of
           malignancies in clinically diagnosed ovarian masses and to evaluate the
           validity of individual constituent parameter of risk malignancy index

    • Authors: Jenitha B., Subbiah M.
      Pages: 1558 - 1562
      Abstract: Background: Pre-operative knowledge regarding the nature of ovarian mass is necessary in order to plan surgery. Risk malignancy index (RMI) is a simple scoring system based on three factors serum CA 125, USG score and menopausal status. The RMI was interpreted as 1) score >250=high risk, 2) 25-250=intermediate risk, 3) score <25=low risk. The objective of the study was to evaluate risk malignancy index (RMI) in pre-operatively clinically diagnosed ovarian mass and to compare the validity of individual parameter in RMI i.e. menopausal status, serum CA 125 and USG score to differentiate the nature of clinically diagnosed ovarian masses as benign or malignant.Methods: This was an observational study conducted in the Department of obstetrics and gynaecology, Trichy SRM Medical College and Research Centre, Trichy from January 2017 to January 2018 with a sample size of 77 cases with clinical diagnosis of ovarian mass admitted for surgery. The validity of RMI and validity of individual parameters were calculated and compared.Results: A total of 77 patients with ovarian tumors were enrolled in this study. According to the histological examination of the surgical specimens of the 77 women, 27.3% (n=21) had malignant tumors and 67.7% (n=56) had benign disease. Most common benign tumour was serous cystadenoma and the most common malignant tumour was mucinous cystadenocarcinoma. Among 77 patients, 42.85% (n=33) were postmenopausal, 44.15% (n=34) had USG score of 4, 27.27% (n=21) had serum CA125 level >cut-off values and 27.27% (n=21) had RMI >250. In cases where RMI>250, 18 out of 21 were malignant. In cases where USG score was 4, 19 out of 34 were malignant. Of the cases where serum CA125 level was > cut-off values 16 out of 21 were found to be malignant. RMI showed better sensitivity of 85.71%, specificity of 94.64%, PPV of 85.71%, NPV of 94.64% and diagnostic accuracy of 92.20%.Conclusions: RMI is highly valuable and reliable in differentiating benign and malignant ovarian lesions and facilitates selection of cases for conservative management and oncology referral.
      PubDate: 2019-03-26
      DOI: 10.18203/2320-1770.ijrcog20191218
      Issue No: Vol. 8, No. 4 (2019)
       
  • Assessment of maternal and fetal outcome in trial of labor after cesarean

    • Authors: Sunita Kumari Beer, Jaya Chaudhary, Kalpana Tiwari, Sonam Choudhary
      Pages: 1563 - 1567
      Abstract: Background: Nowadays, cesarean sections are increasing consistently. Repeat cesarean sections are performed for a large percentage and associated with a higher rate of surgical complications and Long-term morbidities. The trial of labor after cesarean offers an alternative choice. This study carried out to assess the maternal and fetal outcome and to evaluate various parameters as a predictor of success of TOLAC.Methods: This prospective observational study conducted on 150 pregnant women with one previous LSCS who delivered at Mahatma Gandhi hospital, from January 2017 to July 2018. Patient having a singleton pregnancy, cephalic presentation, adequate pelvis size with spontaneous onset of labor were included. Cases were monitored carefully during the labor. Emergency LSCS was done if any indication appeared.Results: 78% of cases delivered safely by the vaginal birth and 22% of cases had an emergency repeat cesarean section (EmRCS). Favorable Bishop Score, active stage of labor and prior vaginal delivery were associated with higher success rate. One (0.66%) case of uterine scar rupture and 2 (1.33%) cases of scar dehiscence noted. No maternal mortality observed. Perinatal mortality occurred in 2 cases (1.33%).Conclusions: Present study shows that appropriate clinical settings and the properly selected group of patients can make the TOLAC safe and effective.
      PubDate: 2019-03-26
      DOI: 10.18203/2320-1770.ijrcog20191219
      Issue No: Vol. 8, No. 4 (2019)
       
  • Hysteroscopy versus transvaginal ultrasonography: finding the better
           modality for evaluation of postmenopausal bleeding

    • Authors: Mishika Bhoj, Shakti Kumar Yadav
      Pages: 1568 - 1574
      Abstract: Background: The most common cause of postmenopausal bleeding is benign pathology, but likelihood of malignancy must be promptly excluded. As excision of localized lesion has higher disease-free survival rate and lower morbidity as opposed to treatment for regional-stage disease. Commonly employed blind dilatation and curettage followed by histopathology is the current standard. A screening method with high sensitivity and specificity can help to prevent the invasive procedure and can also improve the accuracy of the biopsy. The objective of the present study was to study and compare the diagnostic accuracy of hysteroscopy and transvaginal ultrasonography in diagnosis of postmenopausal bleeding.Methods: 80 female patients with complaints of postmenopausal bleeding were enrolled and followed up for a period of 10 months. Each patient underwent transvaginal ultrasonography and hysteroscopy followed by endometrial biopsy. Result were analyzed to find sensitivity, specificity, accuracy, PPV and NPV taking histopathological diagnosis as gold standard.Results:
      Authors found that in 40 patients (50%), the cause of post-menopausal bleeding was caused atrophic endometrium followed by endometrial hyperplasia seen in 14 patients (17.5%). Hysteroscopy had higher overall sensitivity, specificity, NPV and accuracy as compared to transvaginal ultrasonography. Hysteroscopy was found to be highly accurate in diagnosing endometrial carcinoma (100%) and endometrial polyps (100%). However, both methods showed similar accuracy (97.5%) in diagnosis of proliferative endometrium and hyperplasia.Conclusions: Hysteroscopy is comparable to histopathology and superior to transvaginal sonography in the diagnosis of intrauterine causes for postmenopausal bleeding, it also offers the possibility of visualizing macroscopic or focal intra-uterine abnormalities.
      PubDate: 2019-03-26
      DOI: 10.18203/2320-1770.ijrcog20191220
      Issue No: Vol. 8, No. 4 (2019)
       
  • A study to evaluate serum 25-hydroxy vitamin D3 and calcium levels in
           maternal and cord blood and their effect on pregnancy outcome

    • Authors: Radha B. P. Thangappah, Ursula Sampson, Amrin Azad, Rathna Arumugam, Smriti Anand, Ponnalagan Karunakaran
      Pages: 1575 - 1582
      Abstract: Background: To determine the prevalence of vitamin D deficiency among pregnant mothers and their neonates and to study the effect of vitamin D deficiency on maternal and perinatal outcome.Methods: This prospective cohort study conducted in a teaching hospital included 223 pregnant mothers and their offspring born in 2017. Detailed history was taken to ascertain the causes of vitamin D deficiency.   vitamin D3 and calcium levels were estimated in maternal and cord blood samples. To study the association between the vitamin D status and the various maternal and neonatal parameters.Results: 91.9 % of women were house wives involved in indoor activities. Pre-eclampsia and GDM were seen in 4.5% of cases each. 5.41% were obese and 84%  were of medium complexion,  and 8% were  dark. 93.7% were non- vegetarians,  and fish, egg and milk consumption was adequate in 61.3% , 64% and 71% respectively. Only 5.40% of women had adequate exposure to sunlight.  The mean birth weight was 3.08± 0.36 Kg. and 14 babies were admitted to NICU for neonatal asphyxia.77.40% had deficient levels of vitamin D  <20 ng/ml. Only four pregnant mothers (1.8%) had sufficient levels vitamin D. There was no statistically significant association between vitamin D deficiency and various maternal and neonatal parameters.Conclusions: This study has shown that the prevalence of vitamin D deficiency among south Indian pregnant mothers and their newborn is very high and the ways to improve the vitamin D status among pregnant mothers should be looked at.
      PubDate: 2019-03-26
      DOI: 10.18203/2320-1770.ijrcog20191221
      Issue No: Vol. 8, No. 4 (2019)
       
  • Management of stillbirths: an observational analysis at a rural tertiary
           care centre in Kerala, India

    • Authors: Ajini K. K., Reena R. P., Radha K. R.
      Pages: 1583 - 1587
      Abstract: Background: Stillbirth is a distressing event, both for the expecting mother and the obstetrician. Several maternal, social and circumstantial factors influence its occurrence. These women with intrauterine fetal death need to be treated in a considerate manner. Our aim was to analyse different methods   of induction, management of labour and their outcomes in women with antepartum fetal demise.Methods: All women admitted to a tertiary care centre with intrauterine fetal death after 22 weeks during the study period of 24 months were recruited. Maternal sociodemographic characteristics and relevant investigations were studied. Induction of labour was achieved with mechanical and pharmacological methods.  Stillborn babies, placentae and umbilical cord were examined after delivery.Results: There were 175 women with IUFD   admitted during the study period. The stillbirth rate was 38.6 per1000 live births.148 women (84.57%) required induction of labour while16 women had spontaneous onset of labour. Among the 44 women with previous Cesarean section, 11 underwent elective Cesarean section. 19 women (57.6%) out of 33 cases of trial of labour after Cesarean had a successful vaginal delivery. There were 2 cases of rupture uterus and 10 women required ICU admissions. Intrauterine growth restriction was the leading cause of stillbirth (41.8%) followed by hypertensive disorders (27.7%).Conclusions: Present study has shown that vaginal birth can be achieved in most women with mechanical and pharmacological methods of induction within a reasonable period of time.
      PubDate: 2019-03-26
      DOI: 10.18203/2320-1770.ijrcog20191222
      Issue No: Vol. 8, No. 4 (2019)
       
  • Study on safety of non-descent vaginal hysterectomy for enlarged uterine
           size for benign uterine pathologies

    • Authors: Neelam Manda, Oby Nagar, Lata Rajoria, C. P. Dadhich
      Pages: 1588 - 1593
      Abstract: Background: Vaginal hysterectomy is less commonly performed for benign pathologies if the uterine size exceeds 12 weeks in the belief that complications could be higher in this group. The aim of this prospective study was to compare surgical outcomes and safety of vaginal hysterectomy in women with non-prolapsed uteri of >12 weeks size to those with uteri of<12 weeks removed vaginally for similar indications.Methods: In this prospective cohort study, 92 patients were included who underwent NDVH for benign uterine conditions between May 2016 to December 2018. The index group comprised 32 women who underwent vaginal hysterectomy for non-prolapse uterus with uterine enlargement (>12 weeks), while the control group consisted of 60 women with uteri <12 weeks. Demographic data, duration of surgery, blood loss, intraoperative and postoperative complications were compared.Results: Women in the two groups had statistically similar mean age, Body Mass Index and parity (44 vs 42.77 years, 20.8 vs 21.56 kg m3 and 3.26 vs 3.83, respectively; p > 0.05). The mean operative time was significantly longer in the index group (62.47min; vs 48.17 min; p <0.0001). Women with enlarged uteri had greater mean estimated blood loss (123.2 ml vs 75.9 ml; p < 0.0001) but the mean length of hospital stay was similar (5.531 days vs 5.177 days; p > 0.05). Intra- and post-operative complications such as blood transfusion and pelvic sepsis, post-operative febrile illness and systemic infections were comparable in both groups.Conclusions: Vaginal hysterectomy in larger non-prolapsed uteri takes longer to perform and is associated with more blood loss compared to uteri <12 weeks but is not associated with a significant increase in complication rates.
      PubDate: 2019-03-26
      DOI: 10.18203/2320-1770.ijrcog20191223
      Issue No: Vol. 8, No. 4 (2019)
       
  • Comparison of maternal and perinatal outcome in pregnancy with altered
           thyroid profile and euthyroid patients: a prospective, observational and
           case control study in a tertiary care centre

    • Authors: Vandna Singh, Neeta Natu, Artika Sudhir Gupta
      Pages: 1594 - 1600
      Abstract: Background: Thyroid disease is one of the commonest endocrine disorder affecting women of reproductive age, and when untreated during pregnancy is associated with an increased risk of complications. The objective of this review was to increase awareness and to provide a review on adverse effect of thyroid dysfunction on maternal and perinatal outcome.Methods: This prospective, observational hospital-based case-control study carried on women coming for antenatal check-up in a Tertiary Care Hospital in INDORE from May 2018-December 2018. 50 known booked antenatal (case) patient with established thyroid disorder, more than 32 week of gestation, and 50-matched euthyroid patients (control) were taken.Results: Women suffering from overt and subclinical hypothyroidism and hyperthyroidism are nulliparous in 72% cases as compared to 32% in euthyroid patient. Increased maternal age was associated with higher incidence of thyroid dysfunction. Normal vaginal delivery by spontaneous labour seen in 56% of euthyroid, while it is reduced with thyroid dysfunction. 38% of altered thyroid profile patient undergo induction of labour and 24% cases undergo caesarean section as compared to control (17%). Adverse fetal outcome like intrauterine growth retardation, preterm birth and ICU admission seen increased with thyroid dysfunction  as compared to euthyroid patients.Conclusions: Thyroid dysfunction in pregnancy, although has a low incidence, but is associated with adverse maternal and fetal implications. Thus, thyroid screening should be done in antenatal period to improve fetomaternal outcome.
      PubDate: 2019-03-26
      DOI: 10.18203/2320-1770.ijrcog20191224
      Issue No: Vol. 8, No. 4 (2019)
       
  • Evaluation of severe acute maternal morbidity and mortality at a tertiary
           referral center of Uttarakhand, India

    • Authors: Lipi Verma, Ruchira Nautiyal, Pradeep Aggarwal
      Pages: 1601 - 1605
      Abstract: Background: Maternal mortality is an area of concern for the Governments across the globe. India is signatory to millennium declaration and is committed to achieving the target of millennium development goals by reducing MMR to 100. Known obstacles to reducing the MMR in developing countries, include lack of material and human resources, as well as difficulties in accessing services due to financial, geographical, and cultural limitations.Methods: It was a descriptive cross-sectional study conducted at a tertiary care centre in Uttarakhand for a period of one year. WHO’s near-miss approach was implemented for evaluation of severe maternal outcomes and to assess the quality of maternal health care.Results: During the period of this study there were 2243 total antenatal admissions, 1675 deliveries, 1591 live births and 59 near miss cases. Prevalence of SAMM in the present study is 3.52%. Out of every 9-10 women who survived a life-threatening condition 1 died. Mortality Index is 10.17%. Maternal mortality ratio is 377.12 per 1 lakh live births. A total of 43 patients with potentially life-threatening conditions were admitted in ICU out of which 26 were near miss cases. The leading cause of near miss in this tertiary health facility is obstetric haemorrhage (45.8%).Conclusions: Prompt identification of complications and timed intervention remains the key determinant in making mothers survive a life-threatening complication.
      PubDate: 2019-03-26
      DOI: 10.18203/2320-1770.ijrcog20191225
      Issue No: Vol. 8, No. 4 (2019)
       
  • Obstetric outcome in elderly gravida

    • Authors: Supriya S. Gaikwad, Kamlesh R. Chaudhari, Karuna Batheja
      Pages: 1606 - 1609
      Abstract: Background: Maternal age is an important determinant of the outcome of pregnancy. Advanced maternal age generally signify age after 35 years at the time of delivery. It is associated with decreased fertility and increased risk. Elderly gravida is associated with many complications during pregnancy, labour and also for the baby. In recent times women has changed their lifestyles such as pursuit of higher education and entry into work forces and career advancement outside the home.Methods: This was a retrospective study done in 57 elderly pregnant women more than 33 years age, over a period of 18 months, conducted in a multi-specialty hospital.Results: 57 elderly pregnant women were selected for the study. 47% were in age group of 33-35 years and 42% were in age group of 36-40 years. 61.40% patients were housewives and 38.59% were employed. 50.8% of patients had history of previous abortions and 35% were conceived after treatment for sterility. 64.9% of patients conceived spontaneously and 35% by assisted reproductive technology. Majority of patients (33.3%) required Invitro-fertilization. Multiple pregnancy was high- 21.05%. Hypertension was observed in 26.3% of patients, Antepartum haemorrhage in 4.34%,  Preterm delivery  49.1%, Induction of labour in 10.52%, Normal vaginal delivery only in14%. Majority of patients (80.7%) were delivered by caesarean section.Conclusions: Elderly pregnant patients have higher risks of specific pregnancy complications which contribute to a higher frequency of maternal morbidity and greater health care costs. The risks are due to Hypertension, diabetes, multiple pregnancy, preterm labour, antepartum haemorrhage, PROM, malpresentation, prolonged labour, increased caesarean section rate and postpartum haemorrhage.
      PubDate: 2019-03-26
      DOI: 10.18203/2320-1770.ijrcog20191226
      Issue No: Vol. 8, No. 4 (2019)
       
  • The role of tourniquet in myomectomy: an observational study

    • Authors: Urmi Sanyal, Shilpa Ghosh, Hiremath P. B., Reshma Hiremath
      Pages: 1610 - 1615
      Abstract: Background: Leimymoma is one of the commonest benign tumours encountered in women during the reproductive age. One quarter of these women may be symptomatic. When surgical management is indicated, myomectomy may be considered as the procedure of choice. Myomectomy can be complicated by severe intraoperative haemorrhage. One of the methods to reduce blood loss during myomectomy is the mechanical application of tourniquet.Methods: A prospective observational single arm study was done with 24 women who underwent open myomectomy to determine the utility of tourniquet in reducing blood loss during the procedure.  Women of reproductive age group, having symptomatic fibroid, not responding to medical therapy, not completed their family and with total uterine size not exceeding 20 weeks were included in the study while those with pregnancy, concomitant adenomyosis, cervical or broad ligament fibroid, bleeding diathesis were excluded. The 7-French pediatric feeding tube was used as tourniquet. Our primary end point was intra-operative blood loss. Secondary outcome measures included operative morbidity and blood transfusion rates.Results: It was seen that application of the tourniquet considerably reduced the amount of blood loss and made resection of the myoma much easier. 83.3% patients had a blood loss less than 200ml and the rest between 200ml and 400ml. For majority of the patients (75%) the postoperative change of PCV was between 1 and 2%.Conclusions: The infant feeding tube form of tourniquet is cheap, safe, readily available, effectively reduces blood loss during myomectomy while not adding to the complications due to the operation.
      PubDate: 2019-03-26
      DOI: 10.18203/2320-1770.ijrcog20191227
      Issue No: Vol. 8, No. 4 (2019)
       
  • Unengaged head at term in primigravida: does it affect the chance of
           having a normal delivery'

    • Authors: Sadiq Unnisa, Poornima M. S.
      Pages: 1616 - 1619
      Abstract: Background: In Obstetrics it is traditional concept that fetal head engagement occurs by 38 weeks in primigravida. Unengaged head in primigravida has been considered a possible sign of cephalo pelvic disproportion. It is associated with higher risk of cervical dystocia, which has led to increased rate of caesarean section with its financial implication and future restriction of family size. Labour is prolonged, the duration of both latent and active phase increases, due to improper fitting high fetal head.Methods: The prospective descriptive study was conducted at the Yenepoya Medical College hospital OBG Department.  Study population included were 75 primi gravidas with unengaged head at term. Details of labour were noted down.  Augmentation was done with oxytocin and dose of oxytocin was titrated . CTG was used to monitor fetal heart.  Emergency LSCS was performed in patients with fetal distress or non-progress of labour.  In case of vagina delivery, duration of 1st and 2nd stage, APGAR score at 1 and 5 minutes, and birth weights were recorded.Results: Of the 75 primigravida 66.66% were in the age group of 21-25yrs.  Majority of the women were of 39-40 weeks (42.66%) of gestation. Common causes of unengaged head was deflexed head in 15 (20%) CPD in 11 (14.66%), loops of cord around neck in 8 (10.66%), polyhydramnios in 2(2.66%), placenta previa type-I and II  : anterior in 5 (6.66%) 8 patients were with occipito posterior position.  No cause could be identified in 27 cases (36%). Vaginal delivery occurred in 68% and LSCS in 32%.Conclusions: Unengaged head in primi gravida with spontaneous onset of labour is not an indication for LSCS. The attitude of watchful expectancy and timely intervention especially in those cases in which no significant etiological factor is found, the chances of vaginal birth increase there by reducing maternal land foetal morbidity.
      PubDate: 2019-03-26
      DOI: 10.18203/2320-1770.ijrcog20191228
      Issue No: Vol. 8, No. 4 (2019)
       
  • Chemo-resistant gestational trophoblastic neoplasia: a review of cases at
           a tertiary cancer centre

    • Authors: Sharayu R. Mirji, Shilpa M. Patel, Ruchi S. Arora, Ava D. Desai, Meeta H. Mankad, Sangeetha K., Harsha P. Panchal
      Pages: 1620 - 1625
      Abstract: Background: Gestational trophoblastic neoplasia (GTN) was earlier a dreaded malignancy with high mortality rates. GTN is now considered to be one of the most curable solid tumours in women with cure rates greater than 90% even in the presence of metastases. Despite the high chemo sensitivity, treatment failure or drug resistance has been described in both groups.Methods: In this study, available records of GTN cases over 6 years were reviewed with emphasis on those who were resistant to the first line of chemotherapy. Of these, 37(34.58%) were resistant to the first line of chemotherapy. These cases were studied with respect to age, parity, antecedent pregnancy, interval from antecedent pregnancy, pretreatment β hCG, risk score and presence of metastases. The data was analyzed in order to find any risk factors associated with chemo-resistance.Results: Total number of cases of GTN was 107. Out of these 107 cases, 63 (58.88%) were low risk and 44 (41.12%) were high risk according to FIGO scoring system. Complete response was achieved with first line chemotherapy in 70 (65.42%) patients. The remaining 37 (34.57%) were resistant to first line chemotherapy. In the low risk group, 30 (47.62%) cases, and in the high-risk group, 7(15.91%) were resistant to first line of chemotherapy.Conclusions: Despite the high chemo sensitivity of GTN, resistance to first line chemotherapy may be encountered in up to 40% of cases.  It is important to identify the patients who are at risk to develop resistance, early identification of resistance and change of chemotherapy so as to minimize the exposure of these patients to ineffective chemotherapy.
      PubDate: 2019-03-26
      DOI: 10.18203/2320-1770.ijrcog20191229
      Issue No: Vol. 8, No. 4 (2019)
       
  • Hydralazine versus Labetalol for acute control of blood pressure in
           patients with severe pre-eclampsia: a randomized controlled trial

    • Authors: Nayanika Gaur, Priyanka Kathuria
      Pages: 1626 - 1629
      Abstract: Background:
      Authors sought to compare the effectively of intravenous hydralazine and intravenous labetalol in controlling acute rise in blood pressure in patients with severe preeclampsia.Methods: In this double-blind randomized controlled trial, all pregnant women with sustained increase in blood pressure (BP) of 160 mmHg systolic or 110 mmHg diastolic or higher were randomized to receive intravenous (IV) hydralazine 5 mg (max. 4 doses) or IV labetalol in escalating doses of 20mg, 40mg, 80mg, 80mg to achieve target blood pressure of 150 mmHg systolic and 100 mmHg diastolic or lower. The primary objective of the study was to assess the time taken to control blood pressure. Secondary agendas were the number of repeat doses required and other side effect profile.Results: In the study duration of September 2015 to September 2017, authors enrolled 60 participants for our trial. The median time taken to achieve the target blood pressure was 22.4 minutes in both the groups. Close to half of the participants did not require repeat doses (46.66% with labetalol and 50% with hydralazine). No serious maternal or foetal side effects were noted during the study. Statistical tests were performed using SPSS for Windows version 22.Conclusions: As operated in the study, the efficacy of hydralazine and labetalol to control the acute rise in blood pressure is similar.
      PubDate: 2019-03-26
      DOI: 10.18203/2320-1770.ijrcog20191230
      Issue No: Vol. 8, No. 4 (2019)
       
  • Waist hip ratio: an anatomical predictive marker of risk of PCOS

    • Authors: Sumitra Yadav, Ritu Tarware
      Pages: 1630 - 1632
      Abstract: Background: Polycystic ovarian syndrome (PCOS) is one of the most common endocrine disorders seen in infertility clinic of Gynae OPD. It is basically is disease of metabolic disorder and requires ultrasound and hormonal assay for its diagnosis.Methods: The study was carried out in the GOPD of MGM medical College and M.Y. Hospital Indore (M.P.) India. It included 200 women in the age group 18-40 years diagnosed as PCOS and who were compared with 200 women of same age group without PCOS. The height, weight BMI and waist hip ratio were measured and analyzed statistically.Results: The present study shows that women with PCOS had higher incidence of acne hirsutism and irregular menses (p<0.0001), women with PCOS had higher mean ovarian volume measurement (11±1.4cc) compared to female controls who had lower volume of ovary with a range of (7.94±2.34cc. (p<0.0001) as calculated by USG by sonologist.Conclusions: The presence of central obesity, (waist hip ratio >0.87) is an indication for presence of PCOS. Thus, these patients may undergo further hormone evaluation and this simple measurement can help to screen out PCOS from general population. This prevents financial burden on low resource settings.
      PubDate: 2019-03-26
      DOI: 10.18203/2320-1770.ijrcog20191231
      Issue No: Vol. 8, No. 4 (2019)
       
  • Accidental haemorrhage in third trimester: maternal and fetal outcome

    • Authors: Niranjan N. Chavan, Vibhusha Rohidas, Hanumant Waikule
      Pages: 1633 - 1636
      Abstract: Background: Abruptio placenta or accidental haemorrhage is one of the obstetrical emergencies and is truly accidental with few warning signs. Present study is planned to study the maternal and fetal outcome in patients of abruption placenta in a tertiary care referral hospital in a rural set up which is helpful to plan management strategies and to decrease mortality and morbidity.Methods: A prospective observational study was conducted at Department of Obstetrics and Gynaecology at tertiary care centre during September 2015 to August 2019. A total of 270 cases of abruptio placenta coming to the labor ward and delivered were included in the study. The information collected regarding maternal and fetal parameters were recorded in a master chart in Microsoft Excel 2010 and analyzed using the statistical package for the social sciences software (SPSS) version 20.0.Results: In the present study there were a total of 29887 deliveries with 270 cases of abruptio placenta, incidence being 0.9%. Bleeding per vagina is the most common presentation (85.6%) followed by pain abdomen (70.7%). Common risk factors for accidental hemorrhage were: Pre-eclampsia (39.6%) and anaemia (32.2%). Rate of cesarean section was 40.7% (n-110) while rate of forceps delivery was 4.8% (n-13). Associated maternal complications include: post-partum hemorrhage (18.9%), DIC (10%), acute renal failure (4.1%) and puerperal sepsis (1.9%) while maternal mortality rate was 1.9%. Low birth weight (<2.5kg) was observed in 74.8% cases while still birth and neonatal mortality rate was 35.2% and 12.6% respectively.Conclusions: Abruptio placenta or accidental hemorrhage is major risk factor for maternal and perinatal morbidity and mortality, thus efforts should be taken to reduce risk factor for abruptio placenta. Strengthening of antenatal care, anticipation and evaluation of associated high-risk factor and prompt management of complication can improve maternal and perinatal outcome in these cases. Abruptio placenta should be managed in centers where there is advanced maternal and neonatal health care facilities are available.
      PubDate: 2019-03-26
      DOI: 10.18203/2320-1770.ijrcog20191232
      Issue No: Vol. 8, No. 4 (2019)
       
  • Association of hyperlipidaemia in preterm delivery

    • Authors: Ruthvika Kundoor, Burri Sandhya Rani
      Pages: 1637 - 1640
      Abstract: Background: Premature infant is the most important outcome of preterm delivery and is also the cause for infant mortality after congenital abnormality. Around the world, there are 3.6 million per year neonatal deaths, of which in developing countries, 99% deaths are observed. This study was conducted to evaluate the elevated triglycerides and cholesterol relationship on preterm labor risk.Methods: 350 healthy pregnant women were included in the study group in the age group of 18-36 years, their gestational age was confirmed either by last menstrual period or by ultrasound. This study was conducted in Department of Obstetrics  and Gynaecology at Osmania University, Hyderabad, Telangana India.Results: The good outcomes were observed in mothers with normal cholesterol values and preterm deliveries were observed in 32.14% of mothers with abnormal cholesterol values. 0.3% of mothers with normal triglyceride values and 75% of mothers with abnormal values had preterm delivery. P value difference was statistically significant (P<0.05).Conclusions: By measuring serum total cholesterol and triglycerides, along with serum screening of α-fetoprotein and inhibin A, it can be used to predict the preterm labour.
      PubDate: 2019-03-26
      DOI: 10.18203/2320-1770.ijrcog20191233
      Issue No: Vol. 8, No. 4 (2019)
       
  • Association of first trimester serum level of placental growth factor
           (PlGF) and cervical length with onset of preterm labour

    • Authors: Ipsita Sahoo, Madhusudan Dey, Jayamol A.
      Pages: 1641 - 1645
      Abstract: Background: Preterm labour (PTL) or premature labour is defined as one where labour starts before the 37th completed week.  The incidence of preterm birth is around 5-10% and it is the leading cause of perinatal morbidity and mortality. Diagnosis and treatment of PTL is challenging. However, owing to the availability of effective strategies for prevention of preterm birth, risk identification and early prediction is even more essential. This may provide opportunity for intervention and better obstetric care. Various biochemical markers were studied for prediction of preterm labour, but the sensitivity and specificity were found to be low. This study focuses on determining whether serum level of PlGF and ultrasound measure of cervical length at 10 – 14 weeks period of gestation can be used for early prediction of preterm labour.Methods: 296 antenatal women participated in this prospective observational study carried out from Dec 2015 to Sep 2017 at a tertiary care hospital. Serum level of PlGF was determined at 10-14 weeks. In the same sitting, cervical length was measured by transvaginal sonography. All these patients were followed up in antenatal OPD for monitoring the onset of preterm labour.Results: Incidence of preterm labour was 6.76 %. Maternal characteristics and obstetric factors were comparable in cases and controls. Serum PlGF level and cervical length values were lower in preterm labour group than term deliveries. But this result was not statistically significant.Conclusions: Lower levels of PlGF and cervical length were seen in preterm labour group, although it was not found to be statistically significant.
      PubDate: 2019-03-26
      DOI: 10.18203/2320-1770.ijrcog20191234
      Issue No: Vol. 8, No. 4 (2019)
       
  • Indication and complication of caesarean section at tertiary care
           hospital: a retrospective study

    • Authors: Bilal Ur Rehman, Hiba Gul
      Pages: 1646 - 1649
      Abstract: Background: The incidence of cesarean section is steadily rising. Cesarean delivery has played a major role in lowering both maternal and perinatal morbidity and mortality rates.  There are various factors involved in the rise of rate of cesarean section like rising incidence of primary cesarean delivery, identification of high-risk pregnancy, wider use of repeat cesarean section, rising rates of induction of labor and failure of induction, no reassuring fetal status etc.Methods: A retrospective cross-sectional study was conducted. Data was collected from patient records of the hospital during 1st January 2018 to 30th June 2018. All patients (N= 602) who had delivered their baby by caesarean section were included in the study. Data were analyzed by help of SPSS version 21 after proper compilation.Results: Among all women who underwent cesarean section, majority were age group between 21 and 30 years (67.1%). Repeat cesarean section (48.5%), followed by fetal distress (18.9%), oligohydramnias (6.6%) and cephalopelvic disproportion (6.5%) were most common among all major indication of cesarean section. Intrapartum complication (2.0%) includes postpartum hemorrhage (1.2%), CS hysterectomy (0.5%), bladder injury (0.3%) and postpartum complication (2.3%) including UTI (0.8), wound infection (0.5%), sepsis (0.5%), lactation failure (0.5%) were major maternal complication of cesarean section.Conclusions: Reduction of number of primary cesarean section, successful VBAC, individualization of the indication and careful evaluation, following standardized guidelines can help to keep rate of cesarean section to the possible minimum level.
      PubDate: 2019-03-26
      DOI: 10.18203/2320-1770.ijrcog20191235
      Issue No: Vol. 8, No. 4 (2019)
       
  • Study of cases of double mishap in a tertiary care teaching hospital

    • Authors: Fasiha Tasneem, Vijayalakshmi Shanbhag
      Pages: 1650 - 1654
      Abstract: Background: “Make every mother and child count”- the slogan for World health day 2005 reflects the reality and need of the society even today. In India, many women die due to pregnancy-related complications and those who survive suffer from severe maternal morbidity.
      Authors have been impressed that the same obstetric conditions that kill mothers are also responsible for most of the stillbirths and many of the neonatal deaths as well. This is the study to identify the risk factors that has an effect on the health of both mother and baby, to evaluate the complications leading to maternal and perinatal morbidity or mortality so that timely interventions to prevent maternal and perinatal morbidity and mortality can be made.Methods: All the cases getting admitted in Dr SCGMC Nanded are analysed for maternal and foetal outcome over the study period of 18 months. The cases with both maternal and perinatal morbidity or mortality are included in the study. The associating factors and comorbidities if associated with the cases of double mishap are studied.Results: During the study period of 18mths, there were 21905 deliveries conducted in the study hospital and 742 reffered cases of outside hospital deliveries, it was found that there were 204 cases of double mishap. Out of 204 cases of double mishap, 71.56% had preeclampsia, 29.41% were anaemic, 6.86% had febrile illness, 4.41% were of placenta praevia, 33.33% had abruptio placenta.Conclusions:
      Authors can conclude by stating that through better antenatal care, early detection and proper management of risk factors like pre-eclampsia, anaemia and active management of third stage of labour with careful feto maternal monitoring the absolute goal of Obstetrics of having a healthy mother and healthy baby at the end of delivery can be achieved.
      PubDate: 2019-03-26
      DOI: 10.18203/2320-1770.ijrcog20191236
      Issue No: Vol. 8, No. 4 (2019)
       
  • Effects of interpregnancy interval and outcome of preceding pregnancy on
           present pregnancy outcome

    • Authors: Sona Soni, Bharti Singh, Veena Agarwal
      Pages: 1655 - 1661
      Abstract: Background: The objective of the present study was to estimate the effects of interpregnancy interval and outcome of preceding pregnancy on present pregnancy outcome.Methods: This study was undertaken as observational study. 1000 women were included in this study then interpregnancy interval categorized in 4 groups. Outcome of preceding pregnancy were included in term of induce abortion, miscarriage, still birth and live birth.Results: For each group the highest rate of IA occur for woman whose previous pregnancy ended with an IA. For pregnancy after an IA the rate of subsequent IA is 16.6%, 11.6%, 5% for IPI of <6 month, 6-14 months and 27-50 months respectively. Overall lowest rate of IA found for IPI of 27-50 months following live birth i.e. 1.25% and for group III 2% only. Rate of miscarriage was higher for IPI of <26 months began with a miscarriage 15.6% and 13.6% for following live birth.Conclusions: Outcome of present pregnancy not only depend upon interpregnancy interval but also depend upon outcome of preceding pregnancy. So, outcome of previous pregnancy will also determine outcome of present pregnancy. 
      PubDate: 2019-03-26
      DOI: 10.18203/2320-1770.ijrcog20191237
      Issue No: Vol. 8, No. 4 (2019)
       
  • Intrauterine Misoprostol versus intravenous Oxytocin infusion during
           cesarean delivery to reduce intraoperative and postoperative blood loss: a
           randomised clinical trial

    • Authors: Ahmed A. Abdelaleem, Nasser A. Abdelaleem, Ahmed M. Abbas
      Pages: 1662 - 1667
      Abstract: Background: The objective of the present study was to compare the efficacy of intrauterine misoprostol with intravenous oxytocin infusion in reducing blood loss during and after cesarean section (CS).Methods: An open, randomized, clinical trial, registered (ClinicalTrials.gov ID: NCT03148574) conducted between July 1, 2017 and April 1, 2018. The study included 240 pregnant females that were recruited at term (37-40 weeks) gestation scheduled for either elective or emergency CS. Eligible participants were randomly allocated into two equal groups: Group A: patients who receive intravenous infusion of 10 I.U diluted to 500ml of normal saline for 30 minute after delivery. Group B: patients received 400μg misoprostol intrauterine just after cord clamping and delivery of the placenta. Primary outcome measure was assessment of amount of intraoperative and postoperative blood loss.Results: The intraoperative and 2h postoperative blood loss in the misoprostol group was higher than oxytocin group (p<0.001). Hemoglobin level decreased significantly among both groups, manifested by the highly significant p value in comparison of pre and postoperative Hb level in the two groups (p<0.001). However, the blood loss in the misoprostol group was higher than oxytocin group (p=0.004). There was a statistical significant differences between both groups as regards the need for additional uterotonic drug (66% in misoprostol group vs 5% in oxytocin group, P<0.001). Shivering and pyrexia were more in common in the misoprostol group while vomiting, headache and giddiness were significantly higher among oxytocin group.Conclusions: Administration of misoprostol 400mcg through intrauterine route appears to be less effective than intravenous oxytocin infusion in reducing blood loss during and after CS.
      PubDate: 2019-03-26
      DOI: 10.18203/2320-1770.ijrcog20191238
      Issue No: Vol. 8, No. 4 (2019)
       
  • When is the ideal time to remove cerclage in cases requiring cesarean
           hysterectomy for placenta accreta spectrum'

    • Authors: Futa Ito, Shinya Matsuzaki, Masayuki Endo, Tadashi Kimura
      Pages: 1668 - 1671
      Abstract: Placenta accreta spectrum (PAS) presents one of the highest risks to pregnancy and often requires a cesarean hysterectomy for management, but the challenges associated with this surgery often cause severe obstetric haemorrhaging and high rates of maternal morbidity. Shirodkar cerclage is usually performed in cases with cervical insufficiency, a short cervix with previous preterm birth, etc., to decrease the preterm birth rate. It is recommended that Shirodkar cerclage is removed when the patient approaches term, but the ideal timing of removal for patient for whom cesarean hysterectomy is planned is not clear. Here, authors present a case of PAS in whom Shirodkar cerclage that was difficult to remove at the timing of cesarean hysterectomy. After cesarean hysterectomy, the patient had a vaginal abscess and required antibiotic therapy for approximately two weeks. In the light of our case, authors discuss the timing of removal of cerclage in the cases of PAS.
      PubDate: 2019-03-26
      DOI: 10.18203/2320-1770.ijrcog20190972
      Issue No: Vol. 8, No. 4 (2019)
       
  • Case report of a posterior vaginal wall Mullerian cyst

    • Authors: Spyridoula P. Kasioni, Panagiotis N. Thesalokinefs, Ioannis V. Gialelis
      Pages: 1672 - 1674
      Abstract: Mullerian cysts are common types of vaginal cysts, which are small and mainly asymptomatic. Sometimes they present as large symptomatic cystic lesions arising issues of differential diagnosis. They are congenital cysts found anywhere along the length of development of Mullerian duct, occurring typically during the conventional gynaecological examination.
      Authors report of a premenopausal woman presenting with a small asymptomatic, palpable cystic lesion in the posterior vaginal wall, found during the gynaecological re-examination one month after an open surgery for an ovarian endometrioma excision. The whole lesion was 0.4cm and surgically excised under general anesthesia. Postoperative period was completely uncomplicated. Pathology affirmed a benign Mullerian cyst. Although the majority of vaginal cysts may be asymptomatic, a complete excision is required especially in cases of suspected malignancy or other pathology. Clinical examination and imaging are not enough for determining the pathology and a histopathology confirmation is always necessary.
      PubDate: 2019-03-26
      DOI: 10.18203/2320-1770.ijrcog20191239
      Issue No: Vol. 8, No. 4 (2019)
       
  • Retained plastic instrument after 5 years of illegal abortion: a case
           report and literature review

    • Authors: Randriamahavonjy Romuald, Tanjona A. Ratsiatosika, Rasolofomanana Sonia, Ravelojaona Andriniaina, Rakotonirina Mahefa, Rainibarijaona A. Lantonirina, Rakotonirina Ando-Miora, Andrianampanalinarivo H. Rakotovao
      Pages: 1675 - 1678
      Abstract: The retained of a foreign body during a surgical procedure is defined by the forgetting of a material, left by inattention in the body of the patient during this act. It is a rare event but is responsible for high morbidity and mortality.
      Authors report a retained foreign body incidentally discovered during a caesarean section. The patient had performed an illegal abortion by endo-uterine instrument which was complicated by uterine perforation five years previously. She was pregnant at 37 weeks and presented to the emergency department for bleeding and diagnosed as placenta previa. The antecedent of abortion had not been informed because it is an illegal act in Madagascar. The plastic instrument was in the broad ligament in contact with the ureter and the uterine artery. Caesarean section, the removal of the catheter and postoperative recovery was uneventful. Foreign body retention remains a malpractice and the diagnosis must be made in the face of chronic pain in patients who have undergone surgery.
      PubDate: 2019-03-26
      DOI: 10.18203/2320-1770.ijrcog20191240
      Issue No: Vol. 8, No. 4 (2019)
       
  • Role of fetal craniotomy in modern day obstetrics: case series

    • Authors: Somila Xess, Shipra Shrivastava
      Pages: 1679 - 1682
      Abstract: Although obstructed labor in vanished from the western world where the destructive operations are obsolete and not needed, in developing countries like India obstructed labor with dead fetus and severe infection is a sad reality, and destructive operations are an essential part of obstetric practice and cannot be wished away. In many situations they should be a preferred option to cesarean delivery which needs much better facilities and greater morbidity. Here authors present a case series of three patients who reported with obstructed labour and IUFD. Fetal craniotomy was done and thus maternal morbidity reduced. Craniotomy offers less postpartum morbidity, lesser expertise and resources and therefore better in cases presenting with obstructed labour and dead baby in developing countries.
      PubDate: 2019-03-26
      DOI: 10.18203/2320-1770.ijrcog20191241
      Issue No: Vol. 8, No. 4 (2019)
       
  • Potter’s syndrome: a case report

    • Authors: Latika ., Smiti Nanda, Savita Singhal, Amandeep Chahal
      Pages: 1683 - 1685
      Abstract: Potter’s syndrome is a rare congenital disorder characterized by characteristic atypical appearance of a newborn due to the oligohydroamnios experienced during the intrauterine life. Its incidence varies from 1 in 2000 to 1 in 5000. 40 years old G7P4L1 A2 at 37 weeks of period of gestation was admitted at a tertiary care institute with labour pains. Her previous obstetric history included three full term vaginal deliveries, two of the babies expired in postnatal period of 2 months and 7 days age respectively. One was alive and healthy. In fourth pregnancy she underwent emergency LSCS, but baby expired 5 months after birth. She had history of 2 abortions which were spontaneous and not followed by curettage. She also gave history of intake of some drugs at 6th week of gestation prescribed by a local Baba to have a male child. Her ultrasonography revealed fetus with bilateral renal agenesis. On per abdomen examination, clinically liquor was very much reduced, Fetal heart sounds were not heard. She delivered vaginally a still born fetus with ambiguous genitalia, anal atresia and malformed limbs. The fetus had typical facial appearance of “potter facies”. Potter’s Syndrome or Sequence is a rare fatal disorder. Apart from typical Potter’s facies, pulmonary hypoplasia, skeletal deformities are associated with this condition, severity depends on the degree and duration of oligohydramnios. Therefore, it is very important to pick up this condition during antenatal ultrasound at earlier gestation so that timely decision regarding further workup and pregnancy termination can be undertaken. This case report emphasizes upon the importance of regular antenatal check ups and examination in each and every patient as it picks up the suspicious cases which can lead to further workup, definite diagnosis of the condition and timely decision regarding management.
      PubDate: 2019-03-26
      DOI: 10.18203/2320-1770.ijrcog20191242
      Issue No: Vol. 8, No. 4 (2019)
       
  • HELLP syndrome, a difficult diagnosis: a case report

    • Authors: Shweta Pradhan, Somen Bhattacharjee
      Pages: 1686 - 1688
      Abstract: HELLP is an acronym that refers to a syndrome characterized by Haemolysis with a microangiopathic blood smear, Elevated Liver enzymes, and a Low Platelet count.  Recent studies suggested that some women will develop HELLP without the manifestations of classical symptoms.
      Authors present the case of a 22-year-old normotensive primigravida who went into severe thrombocytopenia and haemolysis leading to DIC, finally the diagnosis of normotensive HELLP syndrome was made. Present case report attempts to illustrate the diagnostic dilemma that a clinician faces in diagnosing an atypical presentation of HELLP syndrome. Management of jaundice during pregnancy especially in third trimester remains a dilemma for the obstetrician because of its varied aetiology, unpredictable prognosis and guarded perinatal outcome.
      Authors therefore recommend a rational stepwise approach toward the diagnosis of HELLP syndrome and its atypical presentation.
      PubDate: 2019-03-26
      DOI: 10.18203/2320-1770.ijrcog20191243
      Issue No: Vol. 8, No. 4 (2019)
       
  • Extramedullary hematopoiesis in ovary: a rare presentation of CML

    • Authors: Akriti Agarwal, Asha Niranjan Gokhale
      Pages: 1689 - 1691
      Abstract: Extramedullary hematopoiesis (EMH) is a rare phenomenon, and represents infiltration and proliferation of myeloid, erythroid, and megakaryocytic cells in non-bone marrow sites. Extramedullary hematopoiesis (EMH) is normal during fetal life, but after birth, the presence of EMH is considered to be abnormal.  EMH has been associated with CML (chronic myeloid leukaemia). Lymph node is the most common site of involvement, other sites being the abdomen (liver, spleen) and thorax (bone, mediastinum) but very rarely in the gynecological tract. Here authors report a case of a 20-year young female, a known case of CML who presented with abdominal pain with hemoperitonium, with negative urine pregnancy test. Initially hemorrhagic corpus luteal cyst was thought to be the cause of hemoperitonium and patient was taken for surgery wherein histopathology confirmed the diagnosis of extra medullary hematopoiesis of ovary. Women with CML when presents with hemoperitoneum, extramedullary hematopoiesis should be a differential diagnosis apart from rupture ectopic and other causes of spontaneous hemoperitoneum.  Patient was started on imatinib after diagnosis and is doing well.
      PubDate: 2019-03-26
      DOI: 10.18203/2320-1770.ijrcog20191244
      Issue No: Vol. 8, No. 4 (2019)
       
  • Multidrug resistant tuberculous meningitis in pregnancy: a rare case
           report

    • Authors: U. Nagashree, Charumathi ., U. Meenakshisundaram
      Pages: 1692 - 1695
      Abstract: The prevalence of tuberculosis, especially extrapulmonary tuberculosis is increasing worldwide. TB meningitis is one of severe manifestations of extra pulmonary TB. Prognosis of cases of multidrug resistance tuberculosis meningitis is worse and even more challenging in pregnant women. It’s mostly associated with increased frequency of maternal disability, hospitalisation during pregnancy, foetal growth retardation, prematurity, low-birth weight and increased perinatal mortality. As information on outcome of pregnancy among women with extra pulmonary TB is limited; various medical and surgical options for timely management has been discussed.
      Authors bring out a case report of a primigravida at 26 weeks gestation with severe multidrug resistant TB meningitis who was successfully managed at our hospital with a healthy infant. 
      PubDate: 2019-03-26
      DOI: 10.18203/2320-1770.ijrcog20191245
      Issue No: Vol. 8, No. 4 (2019)
       
  • Term pregnancy with large anterior wall intramural fibroid: an
           intra-operative challenge

    • Authors: Seema Mehrotra, Urmila Singh, Vandana Solanki, Nidhi Shanker
      Pages: 1696 - 1699
      Abstract: Leiomyomas are the most common benign smooth muscle tumors of the uterus. The incidence during pregnancy ranges between 1.6 to 10%. The management of fibroids encountered during caesarean section poses a therapeutic dilemma. We present a case of giant anterior wall lower segment leiomyoma complicating term pregnancy which posed a great surgical challenge. Myomectomy was performed before delivering the baby by lower segment caesarean section by locating the tumor free area using preoperative ultrasound. The tumor mass weighed 3kg. This case highlights the preoperative use of ultrasound in emergency caesarean section to avoid classical caesarean section and to prevent fetal mortality and morbidity by avoiding time consuming caesarean myomectomy before the delivery of the baby.
      PubDate: 2019-03-26
      DOI: 10.18203/2320-1770.ijrcog20191246
      Issue No: Vol. 8, No. 4 (2019)
       
  • Vascular endothelial growth factor correlation with clinicopathological
           parameters in ovarian cancer

    • Authors: Mahy Egiz, Alaa Masoud, Hamed Ellakwa, Mohamed Adel Elsayed
      Pages: 1700 - 1705
      Abstract: Epithelial ovarian cancer (EOC) is one of the most lethal gynaecologic malignancies with an increasing incidence worldwide; there is an increasing need for the identification of novel prognostic biomarkers in EOC patients. Given the key role of angiogenesis and growth factors in the biology of tumorigenesis, vascular endothelial growth factor (VEGF) is considered a milestone in the process of ovarian cancer progression and invasiveness.
      Authors aimed in the present study to evaluate the relevance of serum level of VEGF with clinicopathological parameters in patients with EOC. VEGF is reported to be correlated with variable parameters in EOC patients including International Federation of Gynecology and Obstetrics (FIGO) classification, lymph nodal involvement and ascites formation. In the following review, authors discussed these correlations and distinguished the possible future role of VEGF as a promising prognostic biomarker for EOC patients.
      PubDate: 2019-03-26
      DOI: 10.18203/2320-1770.ijrcog20191247
      Issue No: Vol. 8, No. 4 (2019)
       
  • Ruptured ovarian cyst hemorrhage: the swing between conservative and
           surgical management

    • Authors: Maryam Al-Shukri
      Pages: 1706 - 1707
      Abstract: Ruptured ovarian cyst hemorrhage is one of the causes of acute abdomen in women of reproductive age group that can be life threatening.1 There have been persistent interest in the discussion of managing ruptured ovarian cyst with or without ovulation.1–4 The dilemma of surgical versus conservative/non-surgical management always exist in such cases. It is more of a conundrum when the patient has abnormal coagulation due to either hematological disorders or as a result of anticoagulants.1,5 Commonly, indications for surgical interventions are variable and includes: if the source of the bleeding is not confirmed,  if patient is hemodynamically unstable, or if there are evidence of ongoing bleeding not settling despite conservative measures in a reasonable time.1
      PubDate: 2019-03-26
      DOI: 10.18203/2320-1770.ijrcog20191248
      Issue No: Vol. 8, No. 4 (2019)
       
 
 
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