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Intl. J. of Advances in Medicine     Open Access   (Followers: 2)
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Intl. J. of Community Medicine and Public Health     Open Access   (Followers: 5)
Intl. J. of Contemporary Pediatrics     Open Access   (Followers: 5)
Intl. J. of Otorhinolaryngology and Head and Neck Surgery     Open Access  
Intl. J. of Reproduction, Contraception, Obstetrics and Gynecology     Open Access   (Followers: 13)
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International Journal of Reproduction, Contraception, Obstetrics and Gynecology
Number of Followers: 13  

  This is an Open Access Journal Open Access journal
ISSN (Print) 2320-1770 - ISSN (Online) 2320-1789
Published by Medip Academy Homepage  [12 journals]
  • Nutritional management of very low birth weight at a hospital center of

    • Authors: Zoly Nantenaina Ranosiarisoa, Mirana Zita Ramananirina, Rosa Lalao Tsifiregna, Lovaniaina Ravelomanana, Noëline Ravelomanana
      Pages: 4654 - 4659
      Abstract: Background: Very low birth weight (VLBW) new-borns represent vulnerable group. The lower the birth weight, the higher the mortality rate. The objective of this study was to describe the nutritional management of VLBW new-borns and to determine their hospital outcome.Methods: A retrospective cohort study was carried out during 24 months in a hospital center of Antananarivo. All newborns weighing less than 1500 g at birth and admitted to neonatal resuscitation service were included.Results: Of the 577 newborns admitted during this period, 48 were retained as very low birth weight. All had less than to 37 gestational age. New-borns less than or equal to 32 gestational age had a 4.02-fold risk of dying. VLBW with a birth weight less than 1,000 g were 2.12 times more likely to die than those between 1,000 and 1,499 g. The use of artificial milk was neither associated with the onset of digestive intolerance nor associated with VLBW early outcome.Conclusions: Hospital nutritional management of VLBW requires specific and delicate care. Breast milk is ideal for the newborn. But if it is not available immediately, the alternative that is not disadvantageous is artificial milk.
      PubDate: 2019-11-26
      DOI: 10.18203/2320-1770.ijrcog20195188
      Issue No: Vol. 8, No. 12 (2019)
  • Study of changes in levels of salivary estriol and progesterone in preterm
           labor in comparison to normal pregnancy

    • Authors: Richa Yadav, Urmila Singh
      Pages: 4660 - 4667
      Abstract: Background: This prospective research was designed to evaluate changes in levels of salivary Estriol and Progesterone in preterm labor in comparison to normal pregnancy. Spontaneous onset of labor at term is produced by definite increase in estriol and fall in progesterone. This rise in free estrogen should precede the onset of labor according with the known effect of estrogen and progesterone on myometrial activity. Concentration of steroid in saliva reflect unbound unconjugated and biologically active fraction.Methods: The present study was carried for duration of one year enrolling 115 antenatal women between 28 and < 37 weeks of gestation with or without labour pains attending the antenatal clinic in KGMU, Lucknow and those admitted in Queen Mary’s Hospital Lucknow. 5 ml of saliva was collected in cryovials from each patient to estimate estriol and progesterone. The estimation of saliva progesterone and estriol was done by immunoenzymatic colorimetric method of the supernatant of sample.Results: In our study mean value of saliva progesterone levels of pregnant women with preterm delivery (study group IIA) was lower than the control group (Group l) but the difference was not significant (3814.46±751.14 pg/ml versus 3945.16±577.11 pg/ml, p = 0.351). Mean value of estriol study group who delivered preterm (3512.85±586.16 pg/ml) was higher as compared to the mean value of control group (2691.72±681.08 pg/ml) and difference was significant (p value < 0.001).Conclusions: Thus, there is significant rise in level of saliva estriol, it can be used as a predictor for detecting symptomatic and asymptomatic women at risk for preterm birth.
      PubDate: 2019-11-26
      DOI: 10.18203/2320-1770.ijrcog20195223
      Issue No: Vol. 8, No. 12 (2019)
  • The effect of antenatal corticosteroids on maternal glycemic control, in a
           tertiary care centre in North Kerala

    • Authors: Beena B., Libu G. K., Akhila M. S., Jyothi Chandran
      Pages: 4668 - 4673
      Abstract: Background: Antenatal glucocorticoid therapy (ACT) can be life-saving in preterm babies and risk of PTL is increasing in. The prevalence of GDM also increasing. Virtually, all women will experience deterioration in their glycaemic control following ACT. The NICE guideline recommends additional insulin and the national Indian guidelines recommend a 20% increase. Objective of this study was to evaluate the changes in maternal serum glucose following corticosteroids in antenatal women.Methods: Prospective controlled trial of 206 patients, divided into 2 groups. Group 1:105 patients with no GDM and Group 2: 101 patients with GDM. Ethical committee approved. FBS and PPBS measured for following 5 days of D1. BMI and starting dose of insulin and dose of insulin hike were recorded. FBS >90 mg/dL and PPBS >120 mg/dL were taken as abnormal. Data were analyzed using SPSSV22.Results: There were a total of 206 of which 105 were in group 1(51%) and 101(49%) were in Group 2. FBS >90 mg/dL in over 65% of all women on D2 10 new cases on D3 and PPBS >120 mg/dL in over 66% of all women on D2 and 13 new cases on D3. Insulin was started in a total of 66 patients of 105 (62.9%) in Group 1 and 33 out of 40 (82.5%) in GDM on MNT. Of the 66 patients who started on insulin in Group 1, 17 (16.2%) patients had to continue insulin and out of 33. In MNT subgroup 10 (25%) had to continue. BMI was high in the patients, who was given and continued insulin.Conclusions: The findings support the concept of increasing the dose of insulin even before the hyperglycemia documented. In the Group 1 66 of 105 patients were started on insulin due to hyperglycemia and 17 had to continue insulin 25.7%), and 33 of 40 patients in GDM on MNT were started on insulin and 10 (30.33%) had to continue. We suggest testing all patients for hyperglycemia and to start  insulin especially in the those with high BMI (>25 as per the Asian Indian).
      PubDate: 2019-11-26
      DOI: 10.18203/2320-1770.ijrcog20195189
      Issue No: Vol. 8, No. 12 (2019)
  • Adenomyosis: correlating clinical suspicion with histopathological
           diagnosis in a retrospective study

    • Authors: Preet Kamal, Ripan Bala, Madhu Nagpal, Harleen Kaur
      Pages: 4674 - 4677
      Abstract: Background: Adenomyosis and leiomyoma are the common causes of abnormal uterine bleeding (AUB). In this study it is aimed to evaluate the correlation of clinical and histopathological examination (HPE) of these entities leading to abnormal uterine bleeding.Methods: This retrospective study was carried out on hysterectomy specimens of subjects who presented themselves in the department of obstetrics and gynaecology of Sri Guru Ram Das Institute of medical sciences and research, Amritsar with chief complaints of AUB not responding to conservative treatment.Results: A total of 100 women with clinical diagnosis of AUB in which hysterectomies were performed, leiomyoma was found in 42% cases, adenomyosis in 22% cases. The most frequent combination of diagnosis was leiomyoma and adenomyosis i.e. 26%. In 9% cases chronic cervicitis and ovarian cyst were detected. In one case endometrial malignancy was found.Conclusions: Though adenomyosis and leiomyoma are clinically diagnosed along with other pathological conditions of the reproductive organs but their confirmation is still to be relied upon HPE; a most important investigation.
      PubDate: 2019-11-26
      DOI: 10.18203/2320-1770.ijrcog20195206
      Issue No: Vol. 8, No. 12 (2019)
  • Region wise referrals to a tertiary care centre: a retrospective analysis

    • Authors: Sirisha Paidi, Aashritha Thonangi
      Pages: 4678 - 4683
      Abstract: Background: Emergency obstetric care in health care requires a linked referral system to be effective in reducing maternal morbidity and mortality. This review is aimed at summarizing the proportion of referrals from urban, rural and tribal areas of surrounding districts to tertiary care centre, King George Hospital, Visakhapatnam for a 6 month period; from May 2018 to October 2018.Methods: Retrospective study done at a tertiary care teaching hospital, including 3157 cases referred from the surrounding urban, rural and tribal areas.Results: Out of the 3157 referred cases, most of them (1658) were from rural areas, 1030 from urban and 469 from tribal areas. Referrals done in view of post caesarean pregnancies were more in urban and rural areas whereas more preeclampsia and anaemia cases were referred from tribal areas. Various indications of referral are documented. Majority of them were unbooked cases.Conclusions: Specific guidelines regarding whom to refer, how to refer and when to refer would be helpful in making timely referral. These would also help to decrease the burden on the tertiary care centers which deal with a huge caseloads in spite of limited infrastructure and manpower. Adequate attention and better care can be given to complicated cases if the total case load is reduced. Stringent documentation in referral slip and better co-ordination are required for a strong health care system.
      PubDate: 2019-11-26
      DOI: 10.18203/2320-1770.ijrcog20195201
      Issue No: Vol. 8, No. 12 (2019)
  • Pregnancy outcome in elderly primigravida

    • Authors: Kumudini Pradhan, Lina Baru, Ashish Dharua
      Pages: 4684 - 4689
      Abstract: Background: Incidence of elderly primigravida has increased now days, due to rising education level, effective means of birth control and high carrier goals. The women who conceived in advanced age more than 35 years for first time is defined as elderly primigravida. Indian standard is fixed at more than 30 years by Dutta 2013. These women are high risk for maternal and foetal complication and outcome. The study was done to assess pregnancy outcome in elderly primigravida.Methods: This is a prospective hospital-based study done from October 2016 to November 2018. Women of reproductive age group with first pregnancy admitted to department of obstetrics and gynaecology, Veer Surendra Sai Institute of Medical Science and Research, Burla were taken after exclusion criteria.Results: The incidence of elderly primigravida was 2.51%. But majority (84.76%) though married early, conceived late. Most of them are belongs to high socioeconomic group (62.86%). Anaemia was commonest complication (28.57%), fibroid in 5.71% cases. Pre-eclampsia (18.09%), eclampsia (3.81%), IUGR (12.38%) and twin pregnancies (5.72%) were seen more frequently than young primigravida. 55.24% were developed complications during labour like foetal distress (33.33%), PPH (3.81%) and retained placenta (2.86%). Gestational diabetes mellitus in (0.95%), caesarean section rate 29.52%, normal delivery 51.42%, and congenital anomaly 8.15%.Conclusions: Elderly primigravida are high-risk for several complications like spontaneous abortion, preterm labour, prolonged labour, foetal distress, high caesarean rate, PPH, congenital anomaly and increased incidence of perinatal mortality. Majority of this patients properly supervised are capable of safe and successful pregnancies ending in healthy mother and healthy baby.
      PubDate: 2019-11-26
      DOI: 10.18203/2320-1770.ijrcog20195172
      Issue No: Vol. 8, No. 12 (2019)
  • Relation between immediate postpartum APGAR score with umblical cord blood
           pH and fetal distress

    • Authors: Varuna Pathak, Deep Shikha Sahu
      Pages: 4690 - 4694
      Abstract: Background: The one-minute Apgar score, proven useful for rapid assessment of the neonate, is often poorly correlated with other indicators of intrauterine well-being. Fetal asphyxia is directly associated with neonatal acidosis. Umbilical cord pH is best indicator of fetal hypoxemia and hypoxemia leads to neonatal acidosis. In today scenario, fetal distress is the leading indication of emergency cesarean section.Methods: A observational cross-sectional study conducted of one year between march 2017 to February 2018; of full-term obstetric patients undergoing emergency cesarean section for fetal distress as an indication. All patients included are term gestation with low risk pregnancy excluding medical disorders and other complications of pregnancy. Immediately after delivery umbilical artertial cord blood from placental site collected and sent for pH determination and Apgar score calculated of newborn.Results: Emergency cesarean section was being done for fetal distress diagnosed based on guidelines for Intermittent auscultation; maximum patients had fetal bradycardia (240) followed by fetal tachycardia (12) and irregular rhythm (18). Relation between pH value and the fetal outcome babies who had low pH value. i.e. <7.1; had maximum referrals with poor Apgar score at 1 min (<3) and at 5 min (<3). Out of 270 babies 18 had Apgar score <3 at 1 min, out of which 10 continued to have Apgar score <3 at 5 mins. These babies were referred to department of pediatrics and were not alive beyond day 2-4.Conclusions: The values of mean Apgar score and cord blood pH decreases, which is inversely proportion to duration and severity of intrauterine/intra partum asphyxia. Umbilical arterial cord blood pH correlation was found to be significant with Apgar score in neonates delivered with indication as fetal distress.
      PubDate: 2019-11-26
      DOI: 10.18203/2320-1770.ijrcog20195185
      Issue No: Vol. 8, No. 12 (2019)
  • Emergency obstetric hysterectomy: a two-year observational study at
           tertiary care center in Berhampur, Odisha, India

    • Authors: Ritanjali Behera, Bibekananda Rath
      Pages: 4695 - 4699
      Abstract: Background: Emergency obstetric hysterectomy is an unequivocal marker of severe maternal morbidity and, in many respects, the treatment of last resort for rupture uterus, severe postpartum hemorrhage (PPH) and other such life-threatening conditions. In no other gynaecological or obstetrical surgery is the surgeon in as much a dilemma as when deciding to resort to an emergency hysterectomy. On one hand it is the last resort to save a mother’s life, and on the other hand, the mother’s reproductive capability is sacrificed. This study is conducted with an aim to determine the frequency, demographic characteristics, indications, and feto-maternal outcomes associated with emergency obstetric hysterectomy in a tertiary care centre.Methods: We conducted a prospective, observational, and analytical study over a period of two years, from September 2017 till September 2019. A total of 56 cases of emergency obstetric hysterectomy (EOH) were studied in the Department of Obstetrics and Gynecology, MKCG Medical College, Berhampur.Results: The incidence of EOH in our study was 12 following vaginal delivery and 44 following caesarean section. The overall incidence was 56 per 21,128 deliveries. Uterine rupture (37.5%) was the most common indication followed by atonic postpartum hemorrhage (25%) and placenta accrete spectrum (10.7%). The most frequent sequelae were febrile morbidity (25.7%) and disseminated intravascular coagulation (21.4%). Maternal mortality was 17.1% whereas perinatal mortality was 51.7%.Conclusions: A balanced approach to EOH can prove to be lifesaving at times when conservative surgical modalities fail and interventional radiology is not immediately available. Our study highlights the place of extirpative surgery in modern obstetrics in the face of rising rates of caesarean section and multiple pregnancies particularly in urban settings in developing countries.
      PubDate: 2019-11-26
      DOI: 10.18203/2320-1770.ijrcog20195202
      Issue No: Vol. 8, No. 12 (2019)
  • Prevalence of dual endocrinopathy: hypothyroidism and gestational diabetes
           mellitus in patients of preeclampsia

    • Authors: Natasha Gupta, Sudhaa Sharma, Sunita Jamwal
      Pages: 4700 - 4704
      Abstract: Background: Hypertension associated with proteinuria greater than 0.3g/L in a 24-hour urine collection or 1+ by qualitative urine examination, after 20 weeks of gestation is preeclampsia. The present study was conducted to evaluate prevalence of dual endocrinopathy (hypothyroidism and gestational diabetes mellitus) in patients of preeclampsia.Methods: The observational study was conducted within a period of one year from November 2015 to October 2016 in the Department of Obstetrics and Gynaecology SMGS Hospital, GMC, Jammu. A total of 400 patients of preeclampsia were included in the study and underwent serum TSH and oral glucose tolerance test.Results: In this study 32.5% of the preeclampsia patients (130 out of 400) had hypothyroidism, 15.25% patients (61 out of 400 preeclampsia) had gestational diabetes mellitus, 9.75 % patients of preeclampsia had dual endocrinopathy  (both hypothyroidism and gestational diabetes mellitus).Conclusions: The current study concluded that dual endocrinopathy (both hypothyroidism and gestational diabetes mellitus) has substantially higher prevalence (9.75%) in the patients of preeclampsia.
      PubDate: 2019-11-26
      DOI: 10.18203/2320-1770.ijrcog20195304
      Issue No: Vol. 8, No. 12 (2019)
  • Maternal factors affecting outcome of induction of labour

    • Authors: Shravani Devarasetty, S. Habeebullah
      Pages: 4705 - 4710
      Abstract: Background: Induction of labour is a common procedure in modern obstetrics and accounts for 20% among all deliveries. This study aims to assess the factors associated with success/failure of induction of labour.Methods: This is a cohort study involving 220 women who underwent induction of labour in the department of obstetrics and gynaecology, MGMCRI from December 2016 to May 2018. After obtaining informed consent, patients were recruited into the study. Maternal parameters like age, parity, gestational age, BMI, Bishop score, indication of induction, method of induction, mode of delivery, maternal complications and neonatal parameters like Apgar score, birth weight and NICU admission were analyzed. Association of all parameters with mode of delivery was done by chi square test or Fisher exact test.Results: Out of 220 women who were induced, vaginal delivery rate was 56.4%. Vaginal delivery rate was high in young women of age 20-25 years (65.2%), multiparous women (65.1%), gestational age of > 40-42 weeks (64.7%), with normal BMI (67.7%), with Bishop score ≥ 5(94.6%), induced for PROM and postdates (68.6%) and induced with single agent (74%). Most common indication of caesarean section was fetal distress (43.7%) followed by meconium stained liquor (30.2%). There were no adverse perinatal outcomes.Conclusions: Women of age 20-25 years, normal BMI and induced with single agent showed statistically significant successful induction of labour.
      PubDate: 2019-11-26
      DOI: 10.18203/2320-1770.ijrcog20195305
      Issue No: Vol. 8, No. 12 (2019)
  • A comparative study of thyroid stimulating hormone among lean and obese
           women with polycystic ovarian syndrome

    • Authors: Sangeetha M. C., Suman Shivanagouda Patil, Nalini Arunkumar
      Pages: 4711 - 4715
      Abstract: Background: The polycystic ovarian syndrome (PCOS) is an abnormality of young women of reproductive age. Between 20-50% of women with PCOS are normal weight or thin, and the pathophysiology of the disorder in these women may be related to a hypothalamic-pituitary defect that results in increased release of LH. PCOS and Thyroid disorders share certain common characteristics, risk factors, and pathophysiological abnormalities. In this study we have compared the serum TSH levels in obese and non-obese PCOS women to detect if there is a significant difference in the occurrence of hypothyroidism based on the BMI.Methods: Non-pregnant women attending the gynecological OPD diagnosed with PCOS as per Rotterdam criteria were included. Serum TSH was done in all women diagnosed as PCOS and based on their BMI women were either included in obese or non-obese group using Asian cut-off for BMI and the values compared.Results: In the present study 152 women were included. Women with low BMI and normal BMI were grouped as lean PCOS or non-obese PCOS and the overweight and obese women together were grouped as obese PCOS. The total number in the lean group was 28 and 124 in the obese group. Raised serum TSH levels were observed in 23.02%(35) women out of which 17.14%(6) belonged to the non-obese group and the remaining 82.85%(29) to the obese group. Among the 152 women thyroid enlargement was seen in 1.3%(2). Both women had raised serum TSH levels and both belonged to the obese group.Conclusions: The results of our study seem to indicate that thyroid dysfunction in PCOS women developed irrespective of presence or absence of obesity.
      PubDate: 2019-11-26
      DOI: 10.18203/2320-1770.ijrcog20195306
      Issue No: Vol. 8, No. 12 (2019)
  • Awareness of polycystic ovarian syndrome among young women in Western

    • Authors: Esha G. Chainani
      Pages: 4716 - 4720
      Abstract: Background: Polycystic ovary syndrome (PCOS) is a complex condition characterized by elevated androgen levels, menstrual irregularities, and/or small cysts on one or both ovaries. It is a common issue affecting more than 7% of adult women, causing many problems including but not limited to infertility, irregular menses, hirsutism, acne and alopecia. The primary cause of PCOS is still unknown but awareness and lifestyle modification is known to be an efficient therapy route to relieve symptoms of this syndrome. Objective of the study was to assess the knowledge about PCOS in young women in Navi Mumbai, Maharashtra, India.Methods: A cross sectional study was performed on 500 women of age group 18-30 years coming to outpatient departments of D. Y. Patil Hospital, Navi Mumbai. Written informed consent was obtained and simple random technique was applied for selection of study participants. Pre-designed, pre-tested, semi-structured questionnaire was used for data collection. The data collected was analyzed through percentages and frequencies using Excel. Relevant statistical test was applied was applied and p value was calculated wherever required and considered statistically significant when <0.05.Results: Among 500 participants, only 38% of the women were aware of the term PCOS. 26% of the subjects were aware about the organ system involved in this disease. Most of the people know about this disorder through friends or relatives. 17% of the women knew about the various symptoms associated with PCOS.Conclusions: The alarming results of present study show that very small number of young women understand what this disease is and thus when to consult a physician. This could be why PCOS is an underrepresented and underdiagnosed disease. This widely prevalent disease among young women should be talked about more and more young women must be educated on this to help prevent the sequelae of this syndrome on fertility and insulin resistance.
      PubDate: 2019-11-26
      DOI: 10.18203/2320-1770.ijrcog20195307
      Issue No: Vol. 8, No. 12 (2019)
  • Maternal and fetal outcomes in pregnancy induced hypertensive patients and
           normotensive patients

    • Authors: Kapil Dev, Rajeev Sood, Anoop Sharma
      Pages: 4721 - 4726
      Abstract: Background: Hypertensive disorder of pregnancy complicates 5 to 8% of pregnancies and is a major cause of maternal and perinatal morbidity and mortality. Hypertensive disorders of pregnancy account for nearly 18% of all maternal deaths worldwide, with an estimated 62000-77000 deaths per year.Methods: This one-year prospective case control study total 200 pregnant women attending antenatal care and admitted in Eclampsia ward fulfilling the inclusion criteria were studied. Fetal and maternal outcomes data recorded and documented. Statistical analysis of data was done by student’s t-test and p-value.Results: In PIH 68% women had normal vaginal delivery (p=0.004) 10% women had instrumental delivery. In PIH group 22% women had emergency caesarian section and in normotensive group 10% women had emergency caesarian section. In PIH group 58% delivered at term and 42% had preterm delivery. In normotensive 95% delivered at term and 5% had preterm delivery (p <0.001). PIH group 29% women developed IUGR whereas in normotensive group all women had normal growth velocity (p <0.001). In PIH group 69% mothers had newborn with birth weight <2.5 kg and 31% women had newborn with birth weight >2.5 kg (p=0.0009). While In normotensive group only 9% women had newborn with birth weight <2.5 kg. In PIH group, 24% newborn babies needed NICU admission and in normotensive group only 5% newborn needed NICU admission (p=0.001). In PIH group 76% women had normal maternal outcome (p <0.001). 11% had associated abruption (p=0.0019). In the rest 13% patient develop PRES.Conclusions: We concluded that there is a significant rise of complication in mothers having PIH and also there is an increased risk of delivering low birth weight and preterm babies. The early use of antihypertensive drugs, optimum timing of delivery and strict fluid balance, anticonvulsants in cases of eclampsia will help to achieve successful outcome.
      PubDate: 2019-11-26
      DOI: 10.18203/2320-1770.ijrcog20195308
      Issue No: Vol. 8, No. 12 (2019)
  • Study of amniotic fluid index and its pregnancy outcome

    • Authors: Manisha M. Parmar, Sandeep M. Parmar
      Pages: 4727 - 4731
      Abstract: Background: Amniotic fluid is vital to the well-being of the fetus. Severe oligohydramnios and polyhydramnios are associated with increased maternal morbidity and perinatal morbidity and mortality.Methods: This was prospective observational study conducted at tertiary teaching institute from July 2012 to July 2013. Total 200 patients were included in the study. On the basis of amniotic fluid index (AFI), patients were categorized in 3 groups, Normal AFI (8-24 cm), oligohydramnios (AFI <5cm) and polyhydramnios (AFI > = 25 cm). Results were analysed in the form of incidence, mode of delivery and perinatal outcome which includes preterm, low birth weight, still births, NICU admissions and neonatal deaths in all the 3 groups.Results: Out of 200 patients, there was 150 cases of normal AFI, 39 cases of oligohydramnios and 11 cases of polyhydramnios. Incidence of oligohydramnios was 4.1% and polyhydramnios was 1.1%. PIH was the most common etiological factor found in oligohydramnios (30.7%) and in polyhydramnios congenital anomalies (36.3%) followed by idiopathic cause (27.2%) was most common. Incidence of caesarean section was 58.9% in oligohydarmnios and 17.3% in normal AFI group. Incidence of NICU admission was 25.6% in oligohydramnios and 50% in polyhydramnios group in comparison to 9.3% in normal AFI group.Conclusions: Amniotic fluid index is an important part of antepartum fetal surveillance. Abnormalities of AFI are associated with high perinatal morbidity and mortality and maternal morbidity.
      PubDate: 2019-11-26
      DOI: 10.18203/2320-1770.ijrcog20195309
      Issue No: Vol. 8, No. 12 (2019)
  • A clinical study of McIndoe vaginoplasty in vaginal agenesis

    • Authors: Samarina Kamal, Sarita Tirkey, Shashibala Singh, Shobha Chakraborty
      Pages: 4732 - 4735
      Abstract: Background: The aim of this study is to determine the effectiveness of McIndoe Vaginoplasty in the creation of a neovagina for patients with vaginal agenesis.Methods: this is a retrospective study of 50 cases of vaginal agenesis, who underwent McIndoe Vaginoplasty over a period of 8 years (2004-2012) by using skin graft in 25 cases and amnion as graft in the remaining.Results: McIndoe Vaginoplasty was performed successfully in all 50 patients and post-surgical result was acceptable to the patient psychologically, sexually and aesthetically.Conclusions: McIndoe Vaginoplasty is a safe and effective procedure for providing a satisfactory and functional vagina in patients with MRKH syndrome. 
      PubDate: 2019-11-26
      DOI: 10.18203/2320-1770.ijrcog20195310
      Issue No: Vol. 8, No. 12 (2019)
  • Clinico histopathological evaluation of abnormal uterine bleeding in women
           of reproductive and perimenopausal age group

    • Authors: Ela jha, Arun Kumar Jha, Annie Samuel
      Pages: 4736 - 4740
      Abstract: Background: Abnormal uterine bleeding constitutes a significant proportion of cases attending gynaecology outpatient department. It affects woman’s physical, emotional, social and maternal well-being, and hence it demands adequate management. It is a multifactorial entity; presented in various patterns, signs and symptoms. The PALM COEIN classification is the most recent method of categorizing AUB (abnormal uterine bleeding) based on structural and non-structural causes. The treatment of AUB depends on age, parity, symptom severity, investigation findings and cause. Various invasive and non-invasive investigations including USG, endometrial biopsy and hysteroscopy helps find different causes. Whatever be the etiology endometrium gets affected; hence AUB is likely managed through hormonal preparations, LNG-IUS, endometrium ablation/resection and ultimately hysterectomy as the last resort.Methods: A retrospective study comprising 216 patients in the age group of 30-50 years with complaints of AUB were recorded as per a structured proforma at department of obstetrics and gynaecology, MGM MCH over a period of one year (January 2018-19). The results of investigations, ultrasound scans, endometrial biopsy and histopathology of hysterectomised specimens were correlated. The endometrial biopsy and histopathology of the specimens was done at department of pathology, MGM MCH.Results: The most common age group showing AUB lies under 35-40 years (40.2%) and 40-45 years (33.7%). Menorrhagia was found to be the most common symptom (66.2%). As per PALM COEIN classification, the most common type in our study was of AUB-L (33.7%) and the associated histopathological pattern was of secretory type (50.4%).Conclusions: The features and patterns of AUB differ according to the age of patient, affecting mostly women in perimenopausal and late reproductive age group. There are various modalities for its diagnosis and management and PALM COEIN classification helps better understand the disease etiology.
      PubDate: 2019-11-26
      DOI: 10.18203/2320-1770.ijrcog20195311
      Issue No: Vol. 8, No. 12 (2019)
  • Risk factors for ectopic pregnancy; an institutional study in a tertiary
           care hospital

    • Authors: Ranjita Ghadei, Swayamsiddha Mohanty, Sushree Sovana Mishra, Debashis Giri
      Pages: 4741 - 4746
      Abstract: Background: Ectopic pregnancy is the leading cause of maternal death during the 1st trimester of pregnancy, accounting for approximately 10% of all pregnancy related deaths. A better understanding of ectopic pregnancy risk can help prevent its occurrence. The present study was designed to evaluate the ectopic pregnancy risk factors and their strength of association with ectopic pregnancy at a tertiary care hospital.Methods: It was a prospective study with 104 cases of ectopic pregnancy and 125 controls conducted in the Department of Obstetrics and Gynecology, SCB Medical College, Cuttack for a period of 1 year. Detailed history suggestive of risks factor for ectopic pregnancy, menstrual and obstetrics history was taken. General, systemic, abdominal and vaginal examination was done. Diagnosis of ectopic pregnancy was confirmed by clinical examination, urine pregnancy test, ultrasonography and culdocentesis and only confirmed cases were included in the study group. Healthy pregnant women were taken as control group.Results: The study revealed that the risk of ectopic pregnancy was associated with the traditional risk factors including previous EP [Adjusted odds ratio (AOR) = 9.98, 95% CI: 0.89-11.1%], previous infertility (AOR= 7.29, 95% CI:2.53-21.0) and previous history of sterilization (AOR=12.47,95% CI: 3.50 - 44.4) and previous history of abortion (AOR= 3.10, 95% CI: 1.53-6.30). Age comparison between cases and controls revealed that the ODDS of having ectopic pregnancy was 4 times in the age group 30 to 35 years as compared to uterine pregnancy and this difference was statistically significant (P value = 0.007).Conclusions: Risk factors such as previous ectopic pregnancy, induction of ovulation, intra uterine device usage, abortion as well as increased maternal age along with recent diagnostic tools aid in early detection of ectopic pregnancy in women resulting in proper and timely treatment.
      PubDate: 2019-11-26
      DOI: 10.18203/2320-1770.ijrcog20195312
      Issue No: Vol. 8, No. 12 (2019)
  • Comparison of placental grading at different periods of gestation in PIH
           patients and their outcome

    • Authors: Sneha S., Sreelatha S., Renuka Ramaiah
      Pages: 4747 - 4750
      Abstract: Background: The current study follows grannum grading of placenta. It is well known that there is accelerated placental maturation in PIH patients and the ultrasonic appearance of grade 3 placenta before 37 weeks may signify placental dysfunction and is associated with development of low birth weight babies, IUGR meconium stained liquor, low APGAR score. Hence this study was conducted to emphasize on placental grading at different periods of gestation to predict and prevent increased obstetric and fetal compromise and to compare the outcomes.Methods: Obstetric scans were performed in all PIH patients attending antenatal OPD and inpatients at ESIC and PGIMSR medical college, Bangalore to know the placental grading and biophysical profile. These women were followed till their delivery for obstetric and fetal outcomes.Results: Grade 3 placenta is seen in 17 patients in group 1(50%) and 39 patients (59%) in group 2. For statistical analysis grade 1 and 2 were combined and compared with  grade 3. P-value 0.198 which was not statistically significant. There was no statistically significant difference in age and gravidity between two groups. The medical disorders were more in group 2 i.e., between 37 - 40 weeks. The complications of PIH were also more in group 2. There were more number of LSCS (n=19 versus 14) in 34-36 weeks group which was not statistically significant. Fetal outcomes like IUGR and IUD were more in group 2 which was not statistically significant. The mean birth weight in group 1 was 2 kg as compared to 2.7 kg in group 2. All associated medical disorders were more in group 2.Conclusions: In hypertensive women there is accelerated placental maturation leading to maternal and fetal complications. Hence women with accelerated placental maturity in ultrasound should be closely monitored and appropriately managed. However, we recommend larger randomized studies are necessary.
      PubDate: 2019-11-26
      DOI: 10.18203/2320-1770.ijrcog20195313
      Issue No: Vol. 8, No. 12 (2019)
  • Contraceptive practices and awareness: a survey among nursing staff at a
           tertiary care hospital

    • Authors: Snigdha Kumari, Mansi Dhingra, Syed Nawaz Ahmed
      Pages: 4751 - 4756
      Abstract: Background: India is the second most populous country in the world next to China. Increasing the contraceptive awareness and practice and proper implementation of family planning services are the major tool for improving the health of the population along with stabilizing it. Knowledge and contraceptive practice in the Nursing personnel can positively or negatively influence the population coming in contact with them. Objective of this study was to investigate the knowledge and practice of contraceptive methods among the nursing staff at a tertiary care set up.Methods: Tertiary care set up, cross sectional study. This was a cross sectional study conducted over a period of three months. Fifty staff nurses under the age of 49 years were interviewed through a pre-designed questionnaire regarding knowledge and use of contraceptive methods.Results: Contraception was practiced in 88 percent of the staff nurses. Barrier method of contraception was the most commonly used form of contraception. Permanent method of contraception was opted in 14 percent of cases. Fifty-seven percent of the females were aware of emergency contraception. Twenty-eight percent of females had used emergency contraception in the past.Conclusions: A high percentage of nursing staff was practicing some form of contraception; however, the use of permanent methods and hormonal methods remains low. Only half of study population was aware of post coital methods of contraception with only 28 percent having used it in the past.
      PubDate: 2019-11-26
      DOI: 10.18203/2320-1770.ijrcog20195314
      Issue No: Vol. 8, No. 12 (2019)
  • Study of sociodemographic factors of women undergoing caesarean section in
           tertiary care centre of rural area of central India

    • Authors: Shuchi M. Jain, Ketki Thool, Poonam V. Shivkumar, Manish A. Jain
      Pages: 4757 - 4761
      Abstract: Background: Many studies have attempted to examine and evaluate the changes in population characteristics that may have contributed to the observed increase in CS rate. The aim of this study was to determine the caesarean section rate and demographic characteristics of women undergoing caesarean section in our rural tertiary health centre of central India.Methods: This prospective study was conducted in department of obstetrics and gynecology. The study instrument comprised a pre-structured data collection proforma which had various sections; social demographic characteristics, obstetric history and gestation details.Results: The overall caesarean section rate (CSR) was 36.88%. Maximum women (39.62%) who underwent Caesarean section were of age group 25-29 years. 58.05% from rural while 41.95% from urban area. CS was more in women of lower middle (22.80%) and upper lower (20.80%) class. Majority of women who had caesarean section were educated till higher school (31.87%) or were graduate (22.61%), 5.85% were illiterate. Majority of women (56.40%) were housewives. CSR was 70.83% in referred and 28.31% in booked. 52.86% women were nulliparous. Caesarean section was maximum (83%) in term, 16.92% preterm women and 0.08% post term women. 38.69% were referred from other health facilities. Maximum referrals 43.21% were from the district hospital.Conclusions: It was noted that the preference for caesarean section is more in women of 25-29 years, lower middle and upper middle class, rural women, educated upto high school and housewives at our centre. This hospital also serves as referral centre from surrounding health facilities increasing the caesarean section rate of the institute.
      PubDate: 2019-11-26
      DOI: 10.18203/2320-1770.ijrcog20195315
      Issue No: Vol. 8, No. 12 (2019)
  • Study of fetomaternal outcome in twin pregnancy

    • Authors: Bijal D. Rami, Somika Kaul
      Pages: 4762 - 4765
      Abstract: Background: Twin pregnancy being one of the causes of high-risk pregnancy is associated with both maternal and fetal complications. This study aims at analysing the fetal and maternal outcome in such cases. All cases were studied according to their parity, maternal age, fetal presentation, mode of delivery and gestational age.Methods: This prospective study was conducted at one of the tertiary care teaching institutes over a period of one year from January 2018 to December 2018. Out of a total number of 7295 deliveries, 130 were twin pregnancy. It included all women admitted in labour room with clinical or ultrasound diagnosis of twin pregnancy after 20 weeks of gestation.Results: In the present study incidence of twin pregnancy was 1.78%. We observed the highest incidence of twins in the age group of 20-29 years. The least incidence was below the age of 20 years. Incidence of twin pregnancy in our study in primipara was 47.7% and in multipara was 52.3%. Most of the patients (43%) delivered at 32-36 weeks of gestation. Maternal complications were noticed as anemia in 29.2% patients, pregnancy induced hypertension in 55.4% patients, post-partum hemorrhage in 4.6% patients, polyhydramnios in 3.1% patients, premature rupture of membranes in 8.5% patients, gestational diabetes in 0.8% patients and urinary tract infection in 2.3% patients. Majority of the patients delivered vaginally (60.8%), others by lower segment cesarean section (LSCS). In this study 95.8% babies were low birth weight. There were 34 neonatal deaths (13%).Conclusions: Twin pregnancy is a high-risk pregnancy associated with significantly increased maternal morbidity, neonatal morbidity and mortality. Such pregnancies require good antenatal care, early detection of maternal and fetal complications and timely referral to a centre well equipped for management of such cases. 
      PubDate: 2019-11-26
      DOI: 10.18203/2320-1770.ijrcog20195316
      Issue No: Vol. 8, No. 12 (2019)
  • A prospective study on the role of Hysterolaparoscopy in the evaluation of

    • Authors: Pandeeswari B., Shalini Mahana Valecha
      Pages: 4766 - 4774
      Abstract: Background: Infertility affects about 10-15% of couples of reproductive age groups. The current evidence indicates a 9% prevalence of infertility with 56% of couples seeking medical care. Hysterolaparoscopy provides a comprehensive investigative procedure in which various factors causing female infertility can be assessed at one sitting.Methods: A total 100 infertile women between 20-40 years of age including primary and secondary infertility were evaluated. Patients would be investigated thoroughly for infertility and in preparation for anaesthesia. Tests include follicular study, Ultrasound pelvis. Hysterolaparoscopy was performed in the pre ovulatory period between days 6-10 of the cycle for infertility evaluation.Results: In the present study out of 100 cases for infertility evaluated, primary infertility were 57(57%) and secondary infertility were 43(43%). In our study out of 100 patients, Hysterolaparoscopy showed tuberculosis in 24 (24%) patients, remaining were endometriosis, polycystic ovarian syndrome, congestion, intra-pelvic adhesions, hydro-salpinx.Conclusions: It is concluded that while treating the causes of female infertility combined simultaneous diagnostic laparoscopy and hysteroscopy should be performed in all infertile patients as” seeing is believing” and if any pathologies found to be operable the gynaecologist can perform operative hystero-laparoscopy at that time, hence anticipating the pathologies after pre-operative work up is very important.
      PubDate: 2019-11-26
      DOI: 10.18203/2320-1770.ijrcog20195317
      Issue No: Vol. 8, No. 12 (2019)
  • Knowledge attitude and practice of contraception in Barabanki district of
           Uttar Pradesh: how far are we from meeting the unmet needs of

    • Authors: Neha Thakur, Nahid Zia Khan, Narendra Rai
      Pages: 4775 - 4779
      Abstract: Background: Barabanki one of the most populous districts of Uttar Pradesh with population growth rate being much higher than the national population growth rate. The objective of this study was to gain the knowledge about awareness and contraceptive practices in married women residing in Barabanki. To identify socio-demographic factors associated with unmet needs for contraceptionand also to ascertain the participation of husband in family planning.Methods: A cross sectional study was conducted in outpatient department of Obstetrics Gynecology and Department of Pediatrics in Medical college hospital in Barabanki. 144 females were enrolled in the study during the study period of one year. They were interviewed on the basis of a pre-structured proforma. Data obtained was then analyzed.Results: A total 144 women in the age group 18-45 years participated in the study of which 53% had knowledge of contraception. More than two thirds were not using any form of contraception. The most common method of contraception was barrier method followed by Depot medroxy progesterone acetate. Copper T was least used mode of contraception. The most common source of knowledge regarding contraception was from electronic media followed by friends and family. The most common reason behind the absence of contraception was lack of knowledge of contraception and husband disapproval.Conclusions: Poor knowledge of contraception led to decreased usage of contraceptive measures. Husband participation is virtually absent in family planning leading to high fertility. In order to make our family planning programs successful we must incorporate media for wider coverage to increase awareness and husbands for better implementation.
      PubDate: 2019-11-26
      DOI: 10.18203/2320-1770.ijrcog20195318
      Issue No: Vol. 8, No. 12 (2019)
  • A clinical study on peripartum cardiomyopathy at tertiary care hospital

    • Authors: Seeta S. Garag, Vinay Raju D.
      Pages: 4780 - 4782
      Abstract: Background: Cardiac diseases complicate 1-4% of pregnancies in women without pre-existing cardiac abnormalities. Cardiac disease in the pregnant woman can present a challenge to the obstetrician, cardiologist and neonatologist. Peripartum cardiomyopathy (PPCM) is an idiopathic disorder defined as heart failure occurring in women during the last month of pregnancy and up to 5 months postpartum. Aim is to study the burden of the disease, maternal outcome in PPCM.Methods: The present study was conducted among the antenatal women admitted in the department of Obstetrics and Gynecology at KIMS, Hubli with a previously diagnosed cardiac disease or diagnosed after admission during index pregnancy from December 2016 to May 2018. The mothers were followed up till discharge. Maternal outcome was noted as discharged or died.Results: A total of 11 cases of PPCM noted in our study out of which one case was developed before delivery, and 10 cases developed postnatally. Out of ten cases which were developed postnatally, 5 patients died giving around 50% of mortality rate.Conclusions: PPCM affects previously normal healthy women in the last month of pregnancy and up to 5 months after delivery. Careful assessment of risk factors contributing PPCM could help in their prevention. And these patients should be stratified in developing PPCM in future pregnancies through proper tools available.
      PubDate: 2019-11-26
      DOI: 10.18203/2320-1770.ijrcog20195319
      Issue No: Vol. 8, No. 12 (2019)
  • Categorization of patients with abnormal uterine bleeding according to
           PALM-COEIN FIGO classification

    • Authors: Arihant Tater, Prakash Jain, Kamal Nayan Sharma
      Pages: 4783 - 4785
      Abstract: Background: Abnormal uterine bleeding is a common problem of the women in the reproductive age group and leads to the frequent visits of women in hospitals to health care providers. In an effort to create a universally accepted system of nomenclature to describe uterine bleeding abnormalities in reproductive-aged women, an alternative classification system polyp, adenomyosis, leiomyoma, malignancy and hyperplasia, coagulopathy, ovulatory dysfunction, endometrial, iatrogenic, and not yet classified, known by the acronym PALM-COEIN developed.Methods: It is a retrospective study on 200 patients of abnormal uterine bleeding to categorize them on the basis of PALM-COEIN classification. Patient grouped under these categories after detailed history, examination, investigations and histopathological reports.Results: Ovulatory dysfunction was the most common cause of AUB in patients presenting to the gynecology outpatient department (n=60, 30%). It was followed by leiomyoma (n=48, 24%) and endometrial causes (n=38, 19%) and were the top three etiologies for AUB respectively. Adenomyosis (n=26, 13%), not classified (n=12, 6%), iatrogenic (n=8, 4%), polyp (n=4, 2%) and malignancy and coagulopathy each (n=2, 1%) contributing least to the PALM-COEIN classification as an etiology for AUB.Conclusions: PALM-COEIN classification is a universally accepted and consistent method of knowing exact etiology following investigations, so the proper treatment can be done for AUB.
      PubDate: 2019-11-26
      DOI: 10.18203/2320-1770.ijrcog20195320
      Issue No: Vol. 8, No. 12 (2019)
  • Review of 113 cases of autoimmune disorders in pregnancy

    • Authors: Maheswari S., Poornima C., Seetha Panicker
      Pages: 4786 - 4792
      Abstract: Background: Autoimmune disorders are chronic multisystem disorders affecting women of their reproductive age. Pregnancy among these women is complicated by the disease itself. Flaring up of disease, uteroplacental insufficiency due to vasculitis and drugs used for treatment are main reason for unfavourable pregnancy outcomes. The objective of this study was to analyze the pregnancy complications and outcome among 113 cases of autoimmune disorders.Methods: This study is a retrospective analysis of case records of pregnant women with autoimmune disorders. This study was conducted at PSG IMSR and Hospital, Coimbatore, and Tamil Nadu from July 2012 to June 2018. The case sheets were retrieved from medical record department and the details such as type of disease, maternal age, parity, status of disease at conception, treatment taken during pregnancy, maternal complications and fetal complications were collected and analyzed.Results: During 6-year period there were 113 pregnant women with autoimmune disorders, and they were studied of their previous and present pregnancy outcome. The disease incidence was 7.01% per 1000 deliveries. 40.7% were less than 25 years age group and 71.6% were multigravidae. We had forty-one patients (36%) who were positive for APLA syndrome which were the maximum number of patients with auto immune disorder in pregnancy and 37 patients (32.7) with SLE. We had significant numbers of maternal and fetal complications for common disorders. Most of the rare auto immune disorders were diagnosed before pregnancy and these pregnancies were managed by multi-disciplinary approach, and continued on immunomodulators throughout pregnancy, hence maternal and fetal complications were less for them.Conclusions: Adequate pre-conceptional counseling, vigilant monitoring during pregnancy and post-partum will avoid pregnancy related complications and have favorable outcomes.
      PubDate: 2019-11-26
      DOI: 10.18203/2320-1770.ijrcog20195321
      Issue No: Vol. 8, No. 12 (2019)
  • Knowledge and awareness of emergency contraception methods in rural and
           urban areas of Haryana, India

    • Authors: Sukhbir Pal Kaur, Susmita Sharma, Gagan Lata
      Pages: 4793 - 4797
      Abstract: Background: Emergency contraception (EC) is usage of contraceptive method after an unprotected sexual intercourse. It provides a window of opportunity for females for prevention of an unplanned pregnancy. In India, emergency contraceptive usage continues to be very poor. Thus, this study was planned to analyse the knowledge, awareness, and practices of married women in Haryana towards EC methods.Methods: This observational study was undertaken in a single centre on a section of rural and urban population in Haryana. A total of 500 women of reproductive age group were included in the study. A series of questions were asked in a face to face interview from a pre-structured questionnaire in a non-formal yet confidential environment. The data were collected, analysed, and compared with data available in literature.Results: In our study, more than 50% women had never heard of EC. Of those who were aware, majority (95.83%) knew about EC pills. IUD as EC was known to a very few women (2.08%). Television was the most common source of information followed by family and friends. The most common source of procurement of EC pills was from chemist shops (83.3%). Very few women (4.1%), knew the correct time for taking the EC pills.Conclusions: Our study affirms a poor knowledge about use of emergency contraception among women in Haryana. Imparting knowledge through television, social media and incorporating and highlighting EC use in sex education programs can greatly help to increase the awareness and knowledge of correct EC use.
      PubDate: 2019-11-26
      DOI: 10.18203/2320-1770.ijrcog20195322
      Issue No: Vol. 8, No. 12 (2019)
  • A prospective observational study of fetomaternal outcome in second stage
           caesarean section

    • Authors: Isha ., Prabha Lal, Vikram Dutta, Aayushi Kaushal
      Pages: 4798 - 4802
      Abstract: Background: Incidence of caesarean section is rapidly rising over last two decades and one fourth is contributed by caesarean section in second stage. The objective of this study was to study of fetomaternal outcome in second stage caesarean section.Methods: Prospective observational study was done in 80 women undergoing second stage caesarean section from December 2015 to March 2017 at Lady Hardinge Medical Collage Delhi. These women observed from labour to caesarean section in second stage of labour till post-operative period for any complication. Intraoperative and postoperative complications were observed in these women.Results: Caesarean section rate was 22% in which 3.9% were done in second stage of labour. Most common gestational age being 39-40 weeks (47%). Most common indication being deep transverse arrest (41.25%). Intraoperative complication as bladder injury (5%), extension of uterine incision (23%), PPH (33%) and need for blood transfusion (31%) and post-operative complication as wound sepsis in 58% and 20% requiring resuturing, post-operative fever, prolong hospital stay, prolonged catheterization etc. neonatal complications as severe birth asphyxia (2.5%), respiratory distress (55%), need for mechanical ventilation.Conclusions: Thus, caesarean section done in second stage of labour is associated with increased maternal and neonatal morbidity.
      PubDate: 2019-11-26
      DOI: 10.18203/2320-1770.ijrcog20195323
      Issue No: Vol. 8, No. 12 (2019)
  • Study of spectrum of cardiac disease complicating pregnancy and the
           maternal and foetal outcome

    • Authors: Sudha R., Anjali R.
      Pages: 4803 - 4807
      Abstract: Background: Heart diseases are the most important non obstetrical causes of maternal deaths during pregnancy, accounting for almost 10% of maternal deaths. They complicate 1-3% of all pregnancies.Methods: The study was conducted at Cheluvamba Hospital from January 2015 till July 2016. All pregnant women with cardiac disease were included in the study. Pregnant women with cardiac disease were followed up during antenatal period, evaluated and maternal and foetal outcome was studied.Results: Total number of deliveries in the one and half year study period was 18,803 cases and the total number of women with cardiac disease was 90. Most of the subjects belonged to NYHA grade I and II (95.5%), whereas NYHA grade III and IV constituted only 4.4% of cases. Rheumatic heart disease was the principal cardiac lesion (62.22%) among the pregnancies, while congenital heart disease (33.33%) was the second most common cause. 16.7% had cardiac complications and there were 2(2.22%) maternal mortality. 91.86% were live births with 5.88% IUDs and 2.35% neonatal deaths. 15.29% of the babies were Preterm, 8.14% were IUGR babies and 2.35% had congenital anomalies. It was noted NYHA grade III/IV cases had more preterm babies compared to NYHA grade I/II. NICU admissions were also more with NYHA grade III/IV.Conclusions: The results suggest the need for pre-pregnancy counselling, early diagnosis, correction of cardiac lesions where indicated, close surveillance during pregnancy and a team approach comprising of obstetricians, cardiologists, neonatologists and nursing personnel for a successful pregnancy outcome.
      PubDate: 2019-11-26
      DOI: 10.18203/2320-1770.ijrcog20195324
      Issue No: Vol. 8, No. 12 (2019)
  • The effect of caffeine ingestion in prevention of post-operative ileus
           after caesarean section: a randomized controlled trial

    • Authors: Amr A. Nadim, Reda M. Ghanem, Madonna G. Benyamine, Fady N. Abdallah, Ahmed M. Abbas
      Pages: 4808 - 4814
      Abstract: Background: Caesarian section (CS) has become more prevalent than the vaginal delivery in Egypt. Many complications could occur after an abdominal surgery. One of the commonest but yet serious complications is the postoperative ileus that can possibly be prevented by caffeine ingestion. The aim of the study is to assess the value of caffeine ingestion in promoting intestinal motility and prevention of postoperative ileus after CS.Methods: This is a randomized controlled trial that was conducted on 560 cases who were recruited from emergency unit and inpatient wards in Ain Shams University maternity hospital. The patients were divided into two groups where the intervention group received caffeinated coffee while the other group received decaffeinated coffee.Results: There was statistically significant difference between the two groups regarding the bowel function after CS (p <0.05). The intervention group had improved intestinal functions after the CS. Patients from the intervention group had audible intestinal sound sooner than the control group. In addition, they passed flatus and were able to tolerate food in less time.Conclusions: Consuming caffeinated coffee after CS contributes significantly to faster restoration of intestinal function. Coffee is a popular drink and can be used to decrease the incidence of postoperative ileus-related complications.
      PubDate: 2019-11-26
      DOI: 10.18203/2320-1770.ijrcog20195325
      Issue No: Vol. 8, No. 12 (2019)
  • Ferric carboxymaltose: choice of treatment in postpartum anaemia in
           multispeciality zonal hospital of armed forces medical services

    • Authors: Dhananjay S. Borse, Binay Mitra, Debkalyan Maji
      Pages: 4815 - 4817
      Abstract: Background: World Health Organization has defined postpartum anemia (PPA) as hemoglobin (Hb) of < 10 gm% during the postpartum period. The objective of the present study was to compare the safety and efficacy of ferric carboxymaltose (FCM) in the treatment of post-partum anaemia (PPA).Methods: A total of 214 patients were identified in a zonal hospital of Armed Forces Medical Services, between Jan 2019 and August 2019 who found to have PPA. Patients having hemoglobin (Hb) <10 g/dl were assigned to receive Intravenous FCM, as per the calculated dose. Changes in hemoglobin (Hb) and serum ferritin levels at 2 and 6 weeks after treatment were recorded and analyzed. Adverse effects to FCM administration were also recorded.Results: Significant rises in Hb and serum ferritin levels were observed. The mean increase in Hb after 2 weeks was 3.1±0.50 g/dl and 4.0±70 g/dl at 6 weeks. The mean increase in serum ferritin levels after 2 weeks was 210.40±38.50 and 270.25±14.60 ng/ml after 6 weeks. Adverse drug reactions were significantly less (p<0.001).Conclusions: Ferric carboxymaltose increases Hb level and restores iron stores faster without any severe adverse drug reactions. Patient tolerance was good after FCM injection.
      PubDate: 2019-11-26
      DOI: 10.18203/2320-1770.ijrcog20195326
      Issue No: Vol. 8, No. 12 (2019)
  • Modified mattress sutures vs running sutures in uterine closure: which is

    • Authors: Swar S. Shah, Jayneel V. Shah, Shivani A. Valia, Uday J. Patel
      Pages: 4818 - 4823
      Abstract: Background: Conventional closure of uterus has been known to bear risk of scar dehiscence and scar rupture in subsequent pregnancies and thus, a study was conducted to compare the outcome of uterine closure with modified mattress manner and running manner and to establish a better method of uterine closure during caesarean section. Objective was to compare the conventional single layer running sutures and single layer modified mattress sutures for closure of uterus in caesarean section and find out which method is superior.Methods: This prospective interventional study was carried out in Dhiraj Hospital, a tertiary care hospital in Vadodara. 60 pregnant women in the study criteria were equally divided randomly into 2 groups. Uterine closure was done in single layered sutures, one by running sutures and other group by modified mattress sutures.Results: Uterine scar thickness on 8th day and 6 months post-operatively was significantly more in single layered suturing by modified mattress suture compared to running suture (p <0.05).Conclusions: Uterine closure by single layered modified mattress suture is better in comparison to conventional single layer running suture.
      PubDate: 2019-11-26
      DOI: 10.18203/2320-1770.ijrcog20195327
      Issue No: Vol. 8, No. 12 (2019)
  • Intravenous oxytocin bolus and infusion versus infusion alone on the blood
           loss during caesarean section

    • Authors: Priyanka Mathe, Suniti Kale, Aruna Batra, Achla Batra, Shipra Aggrawal, Abhishek Nagarajappa
      Pages: 4824 - 4828
      Abstract: Background: PPH is one of the leading causes of maternal mortality in the world. In India >30% maternal mortality is because of PPH.Methods: 250 females posted for LSCS were randomised into 2 groups. Group A: 5U oxytocin bolus + 40U oxytocin infusion @125 ml/hour in 500 ml saline. Group B: 5 ml Saline bolus + 40 U oxytocin infusionPrimary outcome was to measure blood loss (objective and subjective). Secondary outcomes were time for uterine hardening, additional uterotonic agents, hemodynamic changes, side effects and need for blood transfusion within 24 hours of LSCS.Results: Blood loss was significantly less in Group A in objective as well as subjective assessment (p<0.001). Requirement for additional oxytocin bolus was significantly higher in Group B as compared Group A (p=0.025). Postoperative hematocrit of Group A was higher than that of Group B (p<0.001). Transfusion requirement was significantly higher (p=0.04) in Group B (9.6% versus 3.2%). There was no significant difference in hemodynamics between the groups in the intraoperative period (p>0.05). However, during the postoperative period increase in heart rate was noted in Group B (p<0.05). Vomiting was the only major side effect observed, which was higher in Group A (5.6% versus 3.2%).Conclusions: Combination of 5U oxytocin bolus followed by an infusion of 40 U oxytocin given over 4 hours routinely in ASA grade I and ASA grade II parturient significantly decreases the operative blood loss during LSCS without causing any hemodynamic variability. This regimen provides better uterine contractility, lesser need for additional utero-tonic agents and lesser requirement of blood transfusion.
      PubDate: 2019-11-26
      DOI: 10.18203/2320-1770.ijrcog20195328
      Issue No: Vol. 8, No. 12 (2019)
  • Transvaginal sonography versus saline infusion sonohysterography, which
           has better diagnosing accuracy in detecting cause of abnormal uterine
           bleeding in perimenopausal women'

    • Authors: Saika ., Tania Singh
      Pages: 4829 - 4833
      Abstract: Background: Saline infusion sonohysterography (SIS) is a simple, safe, reliable, effective and well-tolerated method without complications that complements transvaginal sonography (TVS) in the pre-operative examination of uterine pathology. SIS has been found to be superior to TVS in most studies that have compared their effectiveness in detecting intracavitary lesions and has also been found to decrease the number of diagnostic hysteroscopies to as much as 50%. Patients in whom no intracavitary abnormality is detected by SIS require no further evaluation and are best treated with medical therapy.Methods: The observational study was conducted in the postgraduate department of gynaecology and obstetrics, Lalla Ded Hospital, Government Medical College Srinagar. All consecutive patients with perimenopausal abnormal uterine bleeding attending gynaecology OPD were enrolled in the study after taking informed written consent.Results: SIS has better accuracy than TVS in diagnosing the cause of AUB in perimenopausal women. TVS had sensitivity, specificity and PLR of 60 and 93.8, 9.8, respectively for fibroids while polyps had 27.3, 98.8 and 17.5, respectively, AUP had 81.8, 79.2, 3.9 respectively. SIS had sensitivity, specificity, PLR and NLR values of 80.0, 96.9, 40.7 and 0.21, respectively for diagnosing fibroids, while 63.6, 98.4, 26 and 0.37 respectively for polyp, and 90.9, 94.3, 16.1 respectively for AUP.Conclusions: Accuracy of SIS as a test for detecting pathology in AUB in perimenopausal patients is moderately good and suitable for developing countries.
      PubDate: 2019-11-26
      DOI: 10.18203/2320-1770.ijrcog20195329
      Issue No: Vol. 8, No. 12 (2019)
  • A clinical study of trends of ectopic pregnancy and its management in a
           tertiary care hospital

    • Authors: Chandana M. Puttaraju, Nagothi Nagendra Prasad, M. P. A. Sailakshmi
      Pages: 4834 - 4841
      Abstract: Background: Ectopic gestation is a gynaecological emergency which culminates in pregnancy loss and causes significant maternal morbidity, mortality besides jeopardizing future conception. The study discusses the incidence, risk factors, symptomatology and management of ectopic pregnancy in a tertiary care teaching hospital.Methods: This was a prospective study of 45 cases of ectopic pregnancies at a tertiary care teaching hospital from January 2012 to December 2013. Information was collected in a structured proforma, tabulated and descriptive analysis was carried out.Results: The incidence of ectopic pregnancy was 1.17%. Majority of the patients (80%) belonged to 20-30 yrs age group. Second gravidas predominated (42.2%). Fallopian tube was the most common site (95.5%). Rudimentary horn ectopic accounted for 4.65%. Previous abdominopelvic surgery (31.1%), IUCD usage (22.2%), PID (20%), abortions (20%), tubectomy (15.5%) were the principal risk factors. 42% of the patients had no risk factor. The triad of amenorrhea, bleeding per vaginum and abdominal pain was seen in 51.1% of cases. Ultrasound, UPT, β-hCG estimation were the diagnostic tools. Ruptured ectopic pregnancy accounted for 64.4%. Nearly 95.5% of patients underwent surgery; salpingectomy (76%). Methotrexate was successful in 4.44%. There was no maternal mortality.Conclusions: Mostly diagnosis, prompt surgical or medical management is cornerstone of treatment. Primary prevention such as improved access to family planning services, sex education, treatment of STI, PID, surgical asepsis  and haemostasis, implementing legislation for dispensing MTP drugs ameliorate risk factors and hence reduce ectopic pregnancy.
      PubDate: 2019-11-26
      DOI: 10.18203/2320-1770.ijrcog20195330
      Issue No: Vol. 8, No. 12 (2019)
  • Placenta previa: risk factors, feto-maternal outcome and complications

    • Authors: Pushpa A. Yadava, Riya R. Patel, Anushka S. Mehta
      Pages: 4842 - 4846
      Abstract: Background: Placenta previa is defined as placenta that is implanted somewhere in the lower uterine segment either over or very near the internal cervical os. Placenta previa and coexistent accrete syndromes contribute substantively to maternal and perinatal morbidity and mortality.Methods: All This is a retrospective study of 88 cases of placenta previa, which were admitted under department of obstetrics and gynecology in our institute during July 2017 to June 2019. 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. Outcome measures prevalence of placenta previa, maternal and neonatal outcomes, and case fatality rate.Results: The total number of deliveries performed during the study period was 16330, of them, 88 cases were placenta previa. Thus, the prevalence of PP was 0.53%. Multiparity was one of the etiological factors in 84.09%, whereas previous LSCS was 47.73%, previous H/O D and E was 14.73%, previous H/O placenta previa was 7.95%. Obstetric hysterectomy was done in 7 (7.95%) patients out of 88 patients. 92.04% of patients delivered with cesarean section and 7.95% patients delivered with normal vaginal delivery. 22 (26.50%) babies out of 83 live born were admitted in NICU.Conclusions: Advancing maternal age, multiparity, prior cesarean section, and prior abortions are independent risk factors for placenta previa. Placenta previa remains a risk factor for adverse maternal and perinatal outcome. The detection of placenta previa should encourage a careful evaluation with timely delivery to reduce the associated maternal and perinatal complications. Measures to reduce the primary caesarean section rate should be adopted.
      PubDate: 2019-11-26
      DOI: 10.18203/2320-1770.ijrcog20195331
      Issue No: Vol. 8, No. 12 (2019)
  • A prospective study of endometriosis and its outcome at tertiary care

    • Authors: Shilpa Ninama, Bijal D. Rami
      Pages: 4847 - 4851
      Abstract: Background: This study was conducted to detect various presenting clinical features, type and severity of pelvic endometriosis according to revised American fertility society classification. Objective of this study was to assess outcome of endometriosis after medical and surgical treatment in form of pregnancy, reduction of symptoms like dysmenorrhoea, dyspareunia and others.Methods: This prospective study conducted at one of tertiary care teaching institutes for period of 3 years from January 2011 to December 2013. A total number of 100 patients of pelvic endometriosis were examined and divided according to Revised American Fertility Society Classification on bases of severity, type and clinical features and laparoscopic findings. After 1 year of follow up, outcome assessed after completion of medical and surgical treatment in form of pregnancy, reduction of dysmenorrhoea and dyspareunia and other symptoms.Results: This study showed most affected patients (46%) belongs to 26-30 years of age group, dysmenorrhoea was the most common presenting symptoms in 76% patients. Most common site affected (52%) was ovaries. Laparoscopy was done in 86% patients. Most patients (44%) were benefited with fulguration of endometriotic nodules. 62% of patients were given oral contraceptive pills or progesterone pills after definitive surgery as freely available in Governmental setup and fewer side effects as compared to Danazol and GnRH analogues. 40 patients became pregnant after medical and surgical treatment, where 60 patients had reduced dysmenorrhoea and 20 patients had reduced dyspareunia.Conclusions: Laparoscopy is gold standard diagnostic as well as therapeutic tool in pelvic endometriosis as it can rule out other causes of infertility without interfering normal anatomy.
      PubDate: 2019-11-26
      DOI: 10.18203/2320-1770.ijrcog20195332
      Issue No: Vol. 8, No. 12 (2019)
  • A study on patterns of needle - stick injuries among gynaecologic and
           general surgeons in open surgery

    • Authors: Abhinav Chadha, Ashok Verma, Sapna .
      Pages: 4852 - 4857
      Abstract: Background: An estimated 3,84,000 percutaneous injuries are reported by HCW in hospitals in the United States each year, placing them at risk of exposure to HIV, HBV, or HCV. Suture needles have been identified as the most frequent cause of injury. They are involved in as many as 44% of such injuries. This study is designed to note the NSI in major gynaecological procedures and surgical procedures using conventional method (CM) versus (VS) use of HK.Methods: Study was conducted over a period of 12 months from January 2017 to December 2017. 60 patients were included in this study and were divided into 2 groups A and B with 30 patients in each group. Group A was major surgery performed by conventional method; Group B was major surgery performed by using harmonic knife. NSI in two groups were studied and analyzed.Results: Most of the operated patients were between 41-50 years age group. 16.6% procedures were emergency and 83.3% were elective. NSI in conventional surgery was 63.3% in the surgeon and 33.3% with harmonic knife. There were 13.3% NSI in first assistant in conventional surgery and 23.3% in harmonic scalpel group. No such injuries were reported by second assistant in either group. Injuries were more in non-dominant hand in either groups in the surgeon and first assistant.Conclusions: It is concluded that NSI are common in surgeons and first assistant. Such injuries are more in non-dominant hand and in procedures where there is little exposure like vaginal hysterectomy. Use of innovative technologies like harmonic scalpel may be useful.
      PubDate: 2019-11-26
      DOI: 10.18203/2320-1770.ijrcog20195333
      Issue No: Vol. 8, No. 12 (2019)
  • Status of seroprevalence of Hepatitis B in pregnant females: a
           hospital-based study

    • Authors: Rojaleen Das, Shilpee Kumar
      Pages: 4858 - 4861
      Abstract: Background: India has more than 37 million of HBV carriers and contributes a large proportion of the global burden. The perinatal route is the major route of the transmission. This study was conducted to estimate the seroprevalence rate of Hepatits B infection in female of reproductive age group. Since sexual route and perinatal transmission of HBV are major targets to prevent the transmission of the infection, the study focused on pregnant females attending antenatal care (ANC) clinic of the hospital.Methods: This was a retrospective observational study. The cohort enrolled for the study was pregnant females who attended the antenatal care clinic of a tertiary care hospital situated in Delhi. The blood sample was collected as a part of routine screening for HBV infection and the samples were tested for HBsAg by qualitative indirect ELISA. The study period was March to Sept 2019.Results: 7163 pregnant females were enrolled in the study and 113 were sero-positive for HBsAg. The seroprevalence of HBsAg was 1.6% (113/ 7163). The highest prevalence was found in the age group of 31-35 year (2.7%).Conclusions: As observed in the present study, the sero-prevalence rate of HBV infection in pregnant females is 1.6%, this rate amounts to nearly 4 million HBV infected women in the reproductive age and yearly putting 4 lakhs babies at risk of acquiring HBV infections by vertical transmission. The successful implementation of the National Viral Hepatitis Control Program is the need of the hour to protect every child from acquiring HBV infection.
      PubDate: 2019-11-26
      DOI: 10.18203/2320-1770.ijrcog20195334
      Issue No: Vol. 8, No. 12 (2019)
  • Forceps deliveries and fetomaternal outcome in modern obstetrics

    • Authors: Sarda Devi Okram, Kalpana Betha, Jothsna Bodhanapati, Koorapati Tejasri
      Pages: 4862 - 4865
      Abstract: Background: In modern obstetrics practice has witnessed an increase in the caesarean section rates everywhere. The incidence of instrumental deliveries varies between 10-12% in UK. The incidence of instrumental deliveries varies between 2.7-5% in India. There is an urgent need to reintroduce instrumental need in the modern obstetrics. Instrumental delivery is one of the basic functions of emergency care according to WHO. This study was done to know the prevalence, indications and fetal outcomes of forceps deliveries.Methods: A retrospective study was conducted at a tertiary teaching hospital, India from January 2014 to December 2018. All cephalic singleton pregnant mothers who underwent forceps delivery after 28 weeks were included. All the forceps delivery done in twins and breech vaginal delivery were excluded. Demographic data, Indication of forceps delivery, maternal complications of forceps delivery like episiotomy extension, cervical tear, vaginal wall tear, PPH and neonatal outcome like low birth weight, NICU admissions, stillbirth, APGAR score at 1 and 5 minutes were recorded. Equal number of mothers of reproductive age group 20-45 ages who underwent normal non breech vaginal deliveries were randomly selected as control.Results: The prevalence of forceps delivery was 5.25%. The most common indication was fetal distress (55%). Most of the mothers were primigravidas in age group 20-30 years (p<0.001). Regarding the neonatal outcome, 72% of the babies were having weight >2.5 kgs.  APGAR <7 at 1 and 5 min was not significant.Conclusions: As fetal distress is the most common indication, every obstetrician should learn the skill of forceps delivery and it should not be a dying art.
      PubDate: 2019-11-26
      DOI: 10.18203/2320-1770.ijrcog20195335
      Issue No: Vol. 8, No. 12 (2019)
  • A comparative study between ferrous carboxy maltose and iron sucrose in
           the management of post-partum anaemia in tertiary care hospital

    • Authors: Seeta Sunil Garag, Sanjana Kumar
      Pages: 4866 - 4870
      Abstract: Background: Anaemia is a global public health problem contributing tremendously to maternal morbidity and mortality. It is the most common indirect cause of maternal mortality. Variety of injectable iron preparations are now available which can be effective tools for combating post-partum anaemia. This study aims to compare FCM (Ferrous carboxy maltose) and iron sucrose in the treatment of iron deficiency anaemia in post-partum women at KIMS, Hubli, Karnataka, India.Methods: This study was conducted at KIMS, Hubli in the year 2018-19 wherein 100 post-partum women with hb levels ranging from 5-10g% were selected for the study and randomly allocated into 2 groups- FCM group and iron sucrose group. They were administered 1g of FCM and 1g of iron sucrose respectively after clinical evaluation and baseline measurement of hb. They were followed up after 2 weeks for repeat hb% and review of signs and symptoms. FCM and iron sucrose were compared in terms of their efficacy.Results: The mean increase in hb% was found to be 3.2 g% in the FCM group and 2 g% in the iron sucrose group. FCM was also found to be more efficacious in providing relief of common signs and symptoms like easy fatigability and pallor compared to iron sucrose.Conclusions: Ferrous carboxy maltose was found to be more efficacious compared to iron sucrose.
      PubDate: 2019-11-26
      DOI: 10.18203/2320-1770.ijrcog20195336
      Issue No: Vol. 8, No. 12 (2019)
  • Prediction of efficacy of gonadotropin releasing hormone agonist trigger
           for final oocyte maturation through post-trigger 12-hour luteinizing
           hormone, follicle stimulating hormone and progesterone levels in COS: a
           prospective study

    • Authors: Sonal Agarwal, Deepika Krishna, Gautham Pranesh, Kamini A. Rao
      Pages: 4871 - 4877
      Abstract: Background: Circulating levels of luteinizing hormone (LH), follicle stimulating hormone (FSH) and progesterone (P4) in serum after administration of gonadotropin releasing hormone agonist (GnRHa) trigger for final oocyte maturation are found to be predictive of oocyte maturity. This prospective study was conducted at a tertiary care centre to evaluate relationship between serum LH, FSH and P4 levels at 12-h post-trigger and oocyte maturity rate and to predict which hormone has maximum sensitivity and specificity for appropriate oocyte maturation.Methods: Women at risk of ovarian hyper-stimulation syndrome who underwent either autologous or donor IVF cycle treated with flexible GnRH antagonist protocol were taken as participants of the study. GnRHa as trigger for final oocyte maturation was given. After 12 hours of agonist trigger, blood sample was drawn to assess LH, FSH and P4 levels in serum. Continuous variables were expressed as mean±SD. Independent sample t test was used for continuous variables which were normally distributed and Mann-Whitney U test for data not normally distributed. Main outcome measures were number of oocytes retrieved, oocyte maturity rate, fertilization rate, cleavage rate and grade of embryos.Results: There was a statistically significant reduction in number of retrieved oocytes, maturity rate, fertilization rate and grade 1 embryos with a concentration of serum LH and P4 less than the cut off value (p < 0.05).Conclusions: Serum LH and P4 level less than the cut off value at 12-hour post-trigger with GnRHa is associated with a dramatically less oocyte maturity rate and fertilization rate.
      PubDate: 2019-11-26
      DOI: 10.18203/2320-1770.ijrcog20195337
      Issue No: Vol. 8, No. 12 (2019)
  • A study of correlation of antenatal uterine scar thickness by
           transabdominal ultrasound with intraoperative lower uterine segment scar
           grading in elective repeat cesarean delivery

    • Authors: Haripriya Vedantham, Nandini Joshi Nee Jahagirdar, Ramadevi N., Vasundhara Kamineni, Sarada Saranu
      Pages: 4878 - 4884
      Abstract: Background: Caesarean section (CS) is the most common obstetric surgery performed world-wide. The objective of this study was to correlate the antenatal sonographic lower uterine segment (LUS) scar thickness in women with previous one cesarean section with intra operative LUS scar grading.Methods: A Prospective observational study was conducted from December 2014 to November 2015. In a tertiary care center. 200 pregnant women from ANC clinic with previous one LSCS were recruited. Transabdominal USG done between 36-38 weeks. LUS thickness was measured from bladder wall-myometrium interphase and myometrium-chorioamniotic membrane inter phase. Intraoperative grading of LUS scar was done. Based on grading of scar participants were assigned into scar dehiscence group (grade III and IV LUS scar) and non-dehiscence group (Grade I and II LUS scar).Results: Mean LUS thickness was 3.41±0.623 mm (range: 2-7 mm). Mean LUS thickness in the scar dehiscence group and non-dehiscence group was 2.98±0.55 mm and 3.48±0.60 mm (P value < 0.05) respectively. A cut off value of 3.5 mm was derived from ROC with sensitivity, specificity, positive and negative predictive value of 92.6%, 54.3%, 24.0%, 97.8%, respectively. The present study reported 27 (13.5%) cases of scar dehiscence.Conclusions: Ultra-sonographic evaluation of LUS thickness correlated significantly with intraoperative LUS appearance. USG evaluation of LUS can be used as a screening test to predict the LUS scar integrity. Risk of dehiscence is increased in women with thin LUS i.e. sonographic LUS thickness of < 3.5 mm and needs to be further evaluated. Women with previous one LSCS with thick LUS i.e. sonographic LUS thickness of > 3.5 mm, can be counselled regarding TOLAC if not contraindicated.
      PubDate: 2019-11-26
      DOI: 10.18203/2320-1770.ijrcog20195338
      Issue No: Vol. 8, No. 12 (2019)
  • Value of p53 and estrogen receptors immunohistochemical staining in
           endometrial carcinoma

    • Authors: Dejan Opric, Amer Suskic, Sanela Halilovic Suskic, Gorana Nikolic, Isidora Filipovic
      Pages: 4885 - 4890
      Abstract: Background: Since there are many articles dealing with estimating prognostic and diagnostic value of ER and p53, using different, usually complex ICH interpretation methods, we wanted to evaluate significance of p53 and ER ICH positivity in endometrial carcinoma, using easily applicable criteria that would help pathologists and clinicians to be sure in ICH findings noted in the report.Methods: This paper deals with data of the patients treated for endometrial carcinoma in Public Hospitals in Travnik, gynecological department in the period from 1st January 2013 to 1st January 2019. The study included 97 women with endometrial carcinoma, with ages ranging from 42 to 90 years (mean of 64 years). Sample consisted of 72 cases (74.2%) of endometrioid and 25 cases (25.8%) of non-endometrioid carcinoma.Results: p53 expression was observed in 13.8% carcinomas of the endometrioid type and in 68% carcinomas of non-endometrioid type, while estrogen receptors were more frequently observed in tumors of the endometrioid type (61%) in contrast to non-endometrioid type (28%). Among 72 cases, those with grade I expressed estrogen receptors (26 out of 34 cases - 72%) more frequently than those with grades II and III. Frequency of p53 positivity was significantly higher at higher grades (grade I - 5.8%, grade II - 11.5%, grade III - 71.4%). Stage I carcinomas showed p53 staining less frequently (22.2%) that carcinomas diagnosed at later stages (31.5%).Conclusions: Using 80% nuclei stained as threshold for p53 positivity, we concluded that p53 is marker of high-grade endometrial carcinomas: high grade endometrioid and non-endometrioid carcinomas. Using 1% of cells as threshold for ER positivity, we confirmed that ER are common in endometrioid type carcinoma, in contrast to non-endometrioid type. Although observed, higher frequency of ER in tumors with lower grade and stage was not statistically confirmed in our study population.
      PubDate: 2019-11-26
      DOI: 10.18203/2320-1770.ijrcog20195339
      Issue No: Vol. 8, No. 12 (2019)
  • Maternal and foetal outcome in women with neurological disorders

    • Authors: Daphne Rose Thomas, Beenakumari R., Priya V.
      Pages: 4891 - 4896
      Abstract: Background: Wide spectrums of neurological disorders are observed in pregnancy and puerparium. These disorders can alter the course of pregnancy and pregnancy can worsen them.Methods: This was a cross sectional observational study which included 154 patients in pregnancy and postpartum up to 6 weeks with neurological disorders admitted in department of obstetrics and gynecology, Government Medical College, Kottayam over a period of one year from December 2017. All patients underwent detailed general and systemic examination and were assessed by neurologist. After delivery maternal and foetal outcome and morbidity and mortality were observed.Results: Out of total 5202 deliveries, 154 patients presented in pregnancy and puerparium with neurological disorders amounting to 2.96 %. The age of patients ranged from 18-44. The commonest neurological disorder was epilepsy (60.4%). Other disorders were eclampsia (7.8%), cerebrovascular disorders (9.1%), brain tumors (4.5%), cranial nerve palsy (3.2%) and different types of other neurological disorders (14.9%). The most common presentation was generalized tonic clonic seizures (82.8%). 76.6% of patients had normal vaginal delivery and 13% underwent caesarean section. There were 5 cases of intrauterine death (3.2%), 5 cases of foetal anomalies (3.2%) and 3 cases of neonatal deaths (1.9%). One case of maternal mortality was there due to intra-cerebral hemorhhage.Conclusions: Epilepsy was the commonest disorder with good maternal and foetal outcome. Vascular disorders and eclampsia were associated with higher maternal and foetal morbidity and mortality.
      PubDate: 2019-11-26
      DOI: 10.18203/2320-1770.ijrcog20195340
      Issue No: Vol. 8, No. 12 (2019)
  • First trimester serum vitamin D, hs-CRP and second trimester uterine
           artery diastolic notching in predicting gestational hypertension and

    • Authors: Renu Arora, Sueba Salmani, Rekha Bharti, B. C. Kabi, Anjali Dabral
      Pages: 4897 - 4902
      Abstract: Background: Gestational hypertension and preeclampsia is one of the leading causes of maternal and fetal morbidity and mortality. The objective of this study was to study prediction of gestational hypertension/preeclampsia by using first trimester serum vitamin D and hs-CRP and second trimester uterine artery diastolic notching.Methods: It was an observational study conducted in the departments of obstetrics and gynaecology, clinical biochemistry and radiology, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India. All pregnant women with 11 to 14 weeks gestational age attending antenatal clinic between October 2012 and June 2013 were enrolled in the study. A detailed history including history of the duration of sun exposure was taken and a general physical examination including obstetrical examination was done at every visit. Serum sample were taken for hs-CRP and vitamin-D levels at 11-14 weeks. Uterine artery colour doppler study was done between 22-24 weeks for uterine artery diastolic notching. The main outcome measures were development of gestational hypertension/ preeclampsia/ eclampsia.Results: The mean vitamin D levels were significantly lower and mean hs-CRP levels were significantly higher in the hypertensive group as compared to the normotensive group, p=0.001 and p=0.004, respectively. Significant number women who developed hypertension had unilateral (46.2%) or bilateral (20.4%) uterine artery diastolic notching, p=0.005 and p=0.000, respectively. Crude’s odds ratio of uterine artery diastolic notching for prediction of hypertension in pregnancy was high, 9.894, 95% CI, 3.273-29.907 as compared to vitamin D (<13.5 ng/ml) and hs-CRP (>9.15 mg/L), 2.859, 95% CI, 1.418-5.763 and 7.16, 95% CI, 3.33-15.397.Conclusions: Uterine artery diastolic notching in the early second trimester is found to be the best predictor of PE followed by first trimester hs-CRP and vitamin D.
      PubDate: 2019-11-26
      DOI: 10.18203/2320-1770.ijrcog20195341
      Issue No: Vol. 8, No. 12 (2019)
  • A prospective randomized study to compare dexmedetomidine and
           dexamethasone as an adjunct to bupivacaine in transversus abdominis plane
           block for post-operative analgesia in caesarean delivery

    • Authors: Jitender Thakur, Bharti Gupta, Amit Gupta, Ravinder Kumar Verma, Anita Verma, Payal Shah
      Pages: 4903 - 4908
      Abstract: Background: Caesarean section is most frequently performed surgery worldwide. Patients experience moderate to severe pain in the first 48 hours post-operatively. Aim of this study was to evaluate the efficacy of dexmedetomidine and dexamethasone as an adjunct to bupivacaine in ultrasound guided TAP block for postoperative analgesia in patients of caesarean section.Methods: A total 120 ASA I and II patients undergoing elective and emergency caesarean section under subarachnoid block were randomly divided into three groups B, BDM, BDX to receive bupivacaine alone or dexmedetomidine or dexamethasone as an adjunct to bupivacaine in ultrasound guided TAP block. Postoperatively, the patients were evaluated for pain level at rest and on movement with a 10 cm visual analog scale (VAS) pain score (0 = no pain and 10 = worst pain), time to demand of first analgesic request, number of analgesic requirements, nausea or vomiting, sedation and patient satisfaction at 0 hours and at 2, 4, 6, 12, 18, and 24 hours.Results: VAS score was significantly higher in group B in comparison to BDM and BDX, and higher in BDX in comparison to group BDM. Mean duration of analgesia was significantly higher in group BDM in comparison to group B and BDX. Total number of rescue analgesic demands were significantly lower in group BDM in comparison to group B and BDX. Sedation score and satisfaction score was higher in group BDM as compared to group B and BDX.Conclusions: Addition of dexmedetomidine and dexamethasone as an adjunct to bupivacaine reduces postoperative pain, prolongs analgesia, decreases demand for additional analgesics and provides better maternal satisfaction as compared to plain bupivacaine group in TAP block in patients undergoing caesarean section under subarachnoid block. Among dexmedetomidine and dexamethasone, dexmedetomidine had prolonged analgesia as compared to dexamethasone group.
      PubDate: 2019-11-26
      DOI: 10.18203/2320-1770.ijrcog20195342
      Issue No: Vol. 8, No. 12 (2019)
  • Ormeloxifene versus combined oral contraceptive pills to control blood
           loss in cases of dysfunctional uterine bleeding

    • Authors: Ankita Gupta, Rishika Raj
      Pages: 4909 - 4914
      Abstract: Background: Dysfunctional uterine bleeding is one of the most often encountered gynecologic problems causing anemia, reduced quality of life and unnecessary hysterectomies. A prospective study was conducted on women with DUB to study the effect of ormeloxifene versus combined oral contraceptive pills in controlling blood loss in them.Methods: 100 Women with DUB were enrolled randomly in three groups. After baseline assessment each patient in group A was treated with iron tablets, containing 100 mg elemental iron and folic acid 1.5 mg, for three months and were termed as control group. Group B patients were treated with ormeloxifene in dose of 60 mg twice a week for twelve weeks. Group C patients were treated with combined oral contraceptive pills for twenty- one days starting from third day of their LMP. The treatment was continued for three consecutive cycles. The efficacy of the studied drugs was analyzed by comparing the baseline and post treatment PBAC score, haemoglobin level and endometrial thickness, using appropriate statistical tests.Results: Ormeloxifene was more effective than only iron or combined oral contraceptive therapy in controlling menstrual blood loss (79.11% versus 58.57%). There was a reduction in endometrial thickness in group receiving ormeloxifene as well as in the group receiving combined oral contraceptive pills (p=0.486), however this was statistically not significant.Conclusions: Ormeloxifene was significantly better than combined OCP in reduction of menstrual blood flow in cases of DUB. It has better compliance and marked improvement in subjective symptoms as compared to OCP.
      PubDate: 2019-11-26
      DOI: 10.18203/2320-1770.ijrcog20195343
      Issue No: Vol. 8, No. 12 (2019)
  • Role of color doppler ultrasonography in high risk pregnancies: a
           retrospective study

    • Authors: Gayak Kavitha, Nirupama Palakodeti, Silpahasa Samalla
      Pages: 4915 - 4918
      Abstract: Background: Numerous adverse perinatal outcomes are associated with high-risk. The usage of doppler ultrasound bids a non-invasive way to study the fetal and maternal circulation and guide the clinical management. Objective of this study was to investigate the role of color doppler ultrasonography in effective management of high-risk pregnancies.Methods: A retrospective record-based study was carried out Department of obstetrics and gynecology. Record of antenatal women who belonged to the age group of 20-30 years with singleton pregnancy of gestational age of 26 weeks to term and presence of one of the high-risk factors were included in the study. The risk factors which were considered are pregnancy-induced hypertension (PIH), diabetes, anemia, oligohydramnios. Doppler study of umbilical artery was done. Epi-info 7 was used for analysis.Results: A total of 140 cases were studied in which high-risk pregnancy was most common in the age group of 20-25 years. The most common high-risk factor in pregnancy was PIH which accounted for 50% of cases. Out of 140 cases high-risk pregnancies, 40% of cases resulted in intrauterine growth restriction (IUGR). 43% of cases, umbilical artery findings were abnormal.Conclusions: Color doppler can be used as most effective for fetal surveillance in high-risk pregnancy cases. Most importantly it helps in guiding early intervention and improving fetal outcome.
      PubDate: 2019-11-26
      DOI: 10.18203/2320-1770.ijrcog20195344
      Issue No: Vol. 8, No. 12 (2019)
  • A prospective study to compare levonogestrol intrauterine system and
           trans-cervical resection of endometrium for treatment of abnormal uterine

    • Authors: Kishorkumar V. Hol, Shraddha S. Shastri, Shilpa S. Magar, Sameer P. Darawade
      Pages: 4919 - 4925
      Abstract: Background: This article is a study comparing the two most accepted forms of treatment for abnormal uterine bleeding - levonorgestrol intrauterine treatment and transcervical resection of endometrium, with regards to its acceptability, efficacy, adverse effects and user satisfaction. Aim of this study was to compare the acceptability, efficacy, adverse effects and user satisfaction of LNG-IUS and TCRE for treatment for AUB.Methods: A prospective observational study conducted in SKNMC and GH. Forty-nine women with abnormal uterine bleeding after hysteroscopic evaluation were included in this study; where 17 opted for LNG-IUS; 32 opted for TCRE with bipolar electrode. 15 patients in LNG-IUS group and 28 pts in TCRE group completed follow up. Menstrual pattern, pictorial blood loss assessment chart score, adverse effects, acceptability, satisfaction and reason for discontinuation were recorded at 6 weeks, 6 months and 12 months after the procedure. Prior to LNG-IUS insertion or endometrial ablation, endometrial and cervical pathology were excluded by D and C and cervical smear, respectively. TVUS was used to exclude possible causes of menorrhagia, including myomas and endometrial polyp as well as adnexal pathology. LNG-IUS insertion was performed as an office procedure one day after cessation of menstrual bleeding with a negative urine pregnancy test.Results: Menstrual blood loss reductions in TCRE and LNG-IUS groups were by 85.7% and 87.6% respectively after a year. Amenorrhoea was more common in TCRE group while spotting and systemic effects were more common in LNG-IUS group. Satisfaction and acceptance rates are higher in TCRE group.Conclusions: The TCRE and LNG-IUS are equally effective in reducing bleeding in AUB patients. Acceptance and satisfaction are better with TCRE, as a modality of treatment for AUB.
      PubDate: 2019-11-26
      DOI: 10.18203/2320-1770.ijrcog20195345
      Issue No: Vol. 8, No. 12 (2019)
  • Study of the sexual and reproductive health of young women with visual

    • Authors: Prajakta Ganesh Joshi, Ganesh Arun Joshi
      Pages: 4926 - 4929
      Abstract: Background: Census figures in 2011 have depicted that half of the visually impaired in India are women and a third of these females are in reproductive age group. This study was undertaken to identify the gynaecological health problems of the visually impaired young women and impart them necessary health education.Methods: All young visually impaired women attending composite regional centre for persons with disabilities, Bhopal during one day were offered consultation by gynecologist. Their needs and clinical findings were recorded.Results: There were 15 young women in the age range of 19 to 27 years participating in the study. This was their first ever visit to gynecologist. More than half of them reported that menstrual hygiene was taught to them by their mother, a third by peers, and one participant each reported that sister, aunt, and teacher helped them learn it. The cramping pain and warmth of discharge per vaginum helped them identify the onset of menses. Primary dysmenorrhea was the commonest complaint for which they relied on rest and over the counter available medicine.Conclusions: This study highlights the need of the inclusion of the visually impaired girls in adolescent reproductive and sexual health education with appropriate teaching learning material. Access to a gynecologist for the visually impaired shall be ensured through camps on regular basis and referral on individual need basis.
      PubDate: 2019-11-26
      DOI: 10.18203/2320-1770.ijrcog20195346
      Issue No: Vol. 8, No. 12 (2019)
  • A prospective study on the role of umbilical artery doppler velocimetry in
           the perinatal outcome of growth restricted fetuses

    • Authors: Sumathi R., Mercy R. Rodrigo
      Pages: 4930 - 4938
      Abstract: Background: To compare pregnancy outcomes in growth-restricted fetuses retaining normal umbilical artery doppler flow and the outcomes of pregnancies with end-diastolic velocity diminished or severely reduced/absent.Methods: In a prospective observational study, one hundred pregnant women with growth-restricted fetuses were followed with doppler velocimetry of the umbilical artery between weeks 28 and 41 of pregnancy. Outcomes were compared for the normal doppler group (55%) (Group 1), the low-end diastolic flow group (32%) (Group 2), and the group with severely reduced or absent end-diastolic velocity waveforms (13%) (Group 3).Results: Fetuses with abnormal umbilical flow velocimetry had higher incidence of oligohydramnios (82.2%). The average birth weight and gestational age at delivery were lower in the abnormal doppler group. Significantly more women with severe reduction/AEDV, 31/45 (68.8%), underwent caesarean section, with 20 of them (44.4 %) for fetal distress, compared with 17/55 (30.9%) women in the normal doppler group, with 9 of them (16.4%) for fetal distress. Also, fetuses with abnormal umbilical artery velocimetry had early delivery at less than 36 weeks of gestation (38.2% versus 65.85%), increased NICU admission (32.7% versus 80%), need for PPV (5.5% versus 40%), low Apgar score (9.1 % versus 50.2%) than those with normal doppler. All the three stillbirths in the study population were in the abnormal doppler group.Conclusions: Umbilical artery doppler velocimetry helps in differentiating fetus with pathological growth restriction at risk for perinatal complications from small and healthy fetuses.
      PubDate: 2019-11-26
      DOI: 10.18203/2320-1770.ijrcog20195347
      Issue No: Vol. 8, No. 12 (2019)
  • Estimation and comparison of serum lipid profile of women with pregnancy
           induced hypertension and normal pregnancy

    • Authors: Kapil Dev, Rajeev Sood, Aanya Sharma
      Pages: 4939 - 4945
      Abstract: Background: Hypertensive disorders during pregnancy are the most common medical complication seen during pregnancy, affecting around 5-10% of all pregnancies. Raised blood pressure in pregnancy is the major cause of fetomaternal morbidity and mortality. The most important feature in preeclampsia is hypertension which is supposed to be due to vasospastic phenomenon in kidney, uterus, placenta and brain. Altered lipid synthesis leading to decrease in PGI2:TXA2 ratio is also supposed to be an important way of pathogenesis in pregnancy induced hypertension.Methods: This one-year prospective case control study total 200 pregnant women attending antenatal care and admitted in eclampsia ward fulfiling the inclusion criteria were studied. Serum lipid profile was estimated by semiautomatic analyzers. Statistical analysis of data was done by student’s t-test and p-value.Results: Mean total cholesterol in pregnancy induced hypertension was 278.5±52.52 mg/dl and normal pregnancy was 245.47±20.075 mg/dl. Mean triglycerides in pregnancy induced hypertension was 249.88±92.575 mg/dl and normal pregnancy was 206.89±46.345 mg/dl. Mean HDL in pregnancy induced hypertension was 43.69±4.135 mg/dl and normal pregnancy was 49.9±6.501 mg/dl. Mean LDL in pregnancy induced hypertension was 174.43±39.083 mg/ dl and normal pregnancy was 151.22±19.92 mg/dl. Mean VLDL in pregnancy induced hypertension was 46.885±15.143 mg/dl and in normal pregnancy was 40.964±9.061 mg/dl, total cholesterol, low density lipoprotein, very low density lipoprotein, triglycerides were increased in pregnancy induced hypertension when compared to normal pregnancy, which is statistically significant.Conclusions: We concluded that the Patient who developed pre-eclampsia have abnormal lipid profile. This abnormal lipid profile is responsible for endothelial dysfunction. This endothelial dysfunction may play a key role the pathophysiology of pre-eclampsia. Early detection of these parameters may help patient by preventing complications and is going to aid in better management of pre-eclampsia.
      PubDate: 2019-11-26
      DOI: 10.18203/2320-1770.ijrcog20195348
      Issue No: Vol. 8, No. 12 (2019)
  • Measurement of serum C-reactive protein levels in early second trimester
           as a predictor of preterm delivery

    • Authors: Sujatha Senthil, S. Dhamayanthi
      Pages: 4946 - 4950
      Abstract: Background: Preterm labour is the leading cause of perinatal morbidity and mortality. Infection plays a major role in preterm labour. Elevation of CRP, an inflammatory biomarker has been associated with spontaneous preterm birth. This study was aimed at evaluating the relation of C-reactive protein in early second trimester with preterm labour and neonatal morbidity.Methods: It is a prospective cohort study, 200 pregnant women of singleton pregnancy between the gestational age of 14 to 20 weeks were enrolled. After detailed history taking, maternal serum CRP levels were estimated by ELISA method. These women were divided into two groups according to CRP levels. Incidence of preterm delivery and incidence of neonatal morbidity was compared in both groups to ascertain if measured maternal CRP levels has any association with preterm labour and neonatal morbidity.Results: In this study 42 patients (21%) had preterm delivery. Of these 30 patients had CRP > 1.5mg/dl; 12 had CRP < 1.5 mg/dl. In CRP increased group, 30 patients (57.7%) delivered preterm, 22 patients (42.3%) had term. It was found that increased levels of maternal serum CRP in early pregnancy were associated with increased incidence of preterm delivery. According to this study if the CRP value 1.5 the sensitivity will be 71.4% and specificity will be 86% to predict the preterm. Of the total 42 preterm babies, 1 from Group A (8.3%) and 12 from Group B (40%) developed sepsis. So increased CRP has association with neonatal sepsis.Conclusions: Elevated maternal serum CRP concentration in early second trimester was associated with increased incidence of preterm delivery and showed a positive correlation with neonatal sepsis.
      PubDate: 2019-11-26
      DOI: 10.18203/2320-1770.ijrcog20195349
      Issue No: Vol. 8, No. 12 (2019)
  • Efficacy of combination of oral mifepristone and vaginal misoprostol in
           termination of pregnancy up to 63 days of gestation

    • Authors: Shivani Gupta
      Pages: 4951 - 4954
      Abstract: Background: Unsafe and illegal abortions are one of the major problems in women health in India. Despite legal approval for medical termination of pregnancy in 1971, unsafe abortion still remains the third leading cause of maternal deaths in the country, contributes eight percent of such deaths annually. The objective of this study was to study efficacy of Mifepristone 200 mg orally followed 36-48 hours later by Misoprostol 800 microgms per vaginally in women undergoing medical termination of early pregnancy (up to 63 days of gestational age).Methods: The present study included 60 pregnant women requesting termination of pregnancy in the first trimester. Women who fulfilled the inclusion criteria were included in the study. Women without medical or surgical contraindications to Mifepristone and Misoprostol were included. Patients with previous caesarean sections were also included.Results: In our study 60 women were included, majority were in age group 20-29 years of age and majority of cases were primipara or multipara. The success rate in terms of complete abortion was 97%, 2% needed surgical evacuation and 1% lost to follow up. Side effects were nausea, vomiting, diarrhoea, abdominal cramps, pyrexia etc. The method proved to be safe, effective, cheap, non-invasive and has minimal or no complications.Conclusions: Medical termination of pregnancy with oral mifepristone and vaginal misoprostol is an effective method for first trimester abortion. The prerequisite for the method is patient counselling, patient participation and willingness for regular follow up and to report any complication. Hence this method comes out to be a safe alternative to surgical method which is invasive and costly.
      PubDate: 2019-11-26
      DOI: 10.18203/2320-1770.ijrcog20195350
      Issue No: Vol. 8, No. 12 (2019)
  • Role of hysterolaparoscopy in the evaluation of female infertility in a
           tertiary care centre

    • Authors: Bharti Choudhary Parihar, S. Gowri
      Pages: 4955 - 4959
      Abstract: Background: Infertility is one of the most important and underappreciated reproductive health problems in developing countries. Inability to conceive bears a social stigma which causes societal repercussion and personal suffering. The advent of hysterolaparoscopy have redefined the evaluation and treatment of infertile women. Study aimed to assess the role of hysterolaparoscopy in the evaluation of female infertility.Methods: This prospective observational study was done in the department of obstetrics and gynaecology, Gandhi Medical College, Sultania Zanana Hospital, Bhopal, during the period between 1st December 2016 to 30th November 2017. 104 infertile patients either with primary or secondary infertility were included after thorough evaluation.Results: Out of 104 infertile patients, 82(78.8%) women had primary infertility and rest 22(21.1%) women had secondary infertility. In primary infertility group, most common laparoscopic finding was PCOD in 24(29%) women and in secondary infertility group, tubal blockage was seen in 9(40%) women. The most common pathology seen in hysteroscopy was submucous fibroid in 6(7.3%) women with primary infertility, whereas in secondary infertility group, synechiae was found in 2(9%) patients and septum was seen in 1(4.5%) patient. Out of 104 patients, 33 (31.7%) patients underwent various interventions. The most common intervention was ovarian drilling for PCOS in 21(63.3%) patients followed by hysteroscopic cannulation in 5(15.5%) patients.Conclusions: Hysterolaparoscopy is a very useful tool that can detect various structural abnormalities in multiple sites like uterus, tubes, ovaries and peritoneal cavity in the same sitting. When done by experienced hands and proper selection of patients, hysterolaparoscopy can be considered as a definitive investigative procedure for evaluation of female infertility.
      PubDate: 2019-11-26
      DOI: 10.18203/2320-1770.ijrcog20195351
      Issue No: Vol. 8, No. 12 (2019)
  • Sublingual versus vaginal use of Misoprostol for induction of labor

    • Authors: Mamta Bansal, Indu Sharma, Jyoti Lagoo, Harish Jadhav
      Pages: 4960 - 4965
      Abstract: Background: Induction of labor is one of the great challenges for obstetric care provider. Misoprostol is used for induction of labor by various routes with the advantages in being cheap and stable at room temperature and widely available even in resource-poor settings.Methods: A randomized controlled study was conducted in the obstetrics and gynecology department of Govt. Medical College and associated Maharani Hospital, Bastar, Chhattisgarh, India over a period of 1.75 years from September 2014 to May 2016. Study has comprised of 200 pregnant women admitted in the department for induction of labor fulfilling the inclusion and exclusion criteria. Data was collected and analyzed by SPSS 16.0. z-test and chi-square test to compare the safety and efficacy of both the routes of misoprostol use for IOL.Results: There were insignificant differences in number of doses required for induction with satisfactory maternal and neonatal outcome but shorter (12 hours) induction delivery interval with sublingual Misoprostol induction. Most of the cases of both the groups were delivered by vaginal route (86% and 62%) within 12 hours of induction(58% and 42%) yet significant (p value < 0.001) number of cases had undergone caesarean in group of vaginal misoprostol administration (29%) with major indications of meconium stained liquor (3% and 12%) and non assuring fetal heart rate (1% and 10%).Conclusions: Although both the routes of induction by Misoprostol are well tolerated by the women with satisfactory neonatal outcome, sublingual Misoprostol has an added advantage of quicker delivery, less caesarean and ease of administration indicates better safety and effectiveness.
      PubDate: 2019-11-26
      DOI: 10.18203/2320-1770.ijrcog20195352
      Issue No: Vol. 8, No. 12 (2019)
  • Knowledge about menstrual cup and its usage among medical students

    • Authors: Manorama Eti, Shreya M. S., Sailakshmi M. P. A.
      Pages: 4966 - 4970
      Abstract: Background: Menstrual cups have been available for decades, but their use in India is limited because of lack of awareness and popularity of sanitary pads. Since they are reusable, they reduce solid waste and are environment friendly. The need of the hour is education, awareness, and availability of the eco-friendly practices when it comes to managing menstrual waste effectively. Once that is taken care of, it will be easy for anyone to make a green switch.Methods: A total 400 medical undergraduate students (females) were given a questionnaire. The objective of the study was to assess knowledge about the menstrual cup among students.Results: Among 400 medical students, 28(7%) of them dint know what a menstrual cup was! 262(70.4%) students were for usage of menstrual cup in virgins. There was no clear picture among students regarding material used in cup manufacture, its emptying time and sterilisation technique. Among 372 students, none of them used a menstrual cup.Conclusions: All the students in the study used sanitary pads, owing to its popularity and promotion. There was lack of awareness about the cup. So, we conclude that menstrual cup needs promotion in India. To boost the adoption rate of menstrual cups, youth should be targeted, who are more open to the idea of environment-friendly products. The Government must conduct awareness programs in the rural areas and work constantly spreading the message across all socio-economic sectors so that we can make the dream of a “pad free country”, a reality soon.
      PubDate: 2019-11-26
      DOI: 10.18203/2320-1770.ijrcog20195353
      Issue No: Vol. 8, No. 12 (2019)
  • A study on peripartum hysterectomy in a tertiary referral government

    • Authors: Chaithra M., Tejeswini K. K., Savitha C.
      Pages: 4971 - 4974
      Abstract: Background: Emergency peripartum hysterectomy (EPH) is a major surgical venture invariably performed in the setting of life-threatening haemorrhage during or immediately after abdominal and vaginal deliveries. Aim of the study was to study the frequency and indications for peripartum hysterectomy and to assess the maternal outcome of peripartum hysterectomy.Methods: Cross sectional study was done in the department of obstetrics and gynaecology, Vanivilas hospital, Bangalore from September 2018 to august 2019. This study consists of 24 cases of emergency peripartum hysterectomy within 24 hours of delivery, operated at Vanivilas hospital.Results: The frequency of peripartum hysterectomy was 1.102/1000 deliveries and following caesarean section and vaginal deliveries are 3.544/1000 deliveries and 0.248/1000 deliveries respectively. Among 24 cases who had peripartum hysterectomy, 16 cases were delivered by caesarean section and 4 cases delivered by vaginal route while another 4 cases delivered by laparotomy for rupture uterus. 22 cases (91.67%) survived with major number of cases having morbidities and there were 2 (8.33%) maternal death.Conclusions: The most common mode of delivery before peripartum hysterectomy was Caesarean section. The most common indication was atonic postpartum haemorrhage. Better protocols for induction and augmentation of labour will decrease the necessity of peripartum hysterectomies.
      PubDate: 2019-11-26
      DOI: 10.18203/2320-1770.ijrcog20195354
      Issue No: Vol. 8, No. 12 (2019)
  • The role of trans obturator tape as a surgical procedure for female stress
           urinary incontinence and its impact on quality of life in Jammu region

    • Authors: Sapna Puri, Manisha Kohli
      Pages: 4975 - 4979
      Abstract: Background: Stress incontinence is one of the most common but debilitating health issue among women. It has a detrimental effect on overall health and quality of life of women. Trans obturator tape (TOT) has emerged as a promising treatment modality. The aim of present study was to assess the usefulness of TOT in terms of change in quality of life of stress incontinence patients.Methods: The study was performed at Department of Obstetrics and Gynecology, Acharya Shri Chandler of Medical Sciences (ASCOMS), Jammu. A total of 50 symptomatic women were enrolled in the study and underwent TOT procedure using outside-in technique. The quality of life of women was assessed at enrolment and 12 months after the procedure using King’s Health Questionnaire (KHQ). Change in QOL was assessed using paired ‘t’-test.Results: After 12 months follow-up, a total of 27 (54%) patients were entirely symptom free. As compared to pre-treatment QOL assessment on KHQ for general health/incontinence impact, quality of life and symptom scores a % decline of 73.2%, 79.8% and 78.4% was observed. For all the three parts, the change in scores was significant statistically. No other complications and side effects were reported.Conclusions: TOT is a useful procedure which provided symptomatic relief as well as QOL enhancement.
      PubDate: 2019-11-26
      DOI: 10.18203/2320-1770.ijrcog20195355
      Issue No: Vol. 8, No. 12 (2019)
  • Prevalence and associated risk factors of abnormal pap smear in pregnant

    • Authors: Neha Mohindroo, Anoop Sharma, Santosh Minhas, Kushla Pathania
      Pages: 4980 - 4984
      Abstract: Background: The Papanicolaou test is a method of cervical screening used to detect pre-cancerous and cancerous processes. The incidence of cervical cancer in India is alarmingly high and is the leading cause of cancer in women in India accounting for 147 deaths per lakh women. Cervical cytological abnormalities are found in up to 5% of all pregnancies. In Indian settings, published data on abnormal Pap smear in pregnancy is lacking. The present study was designed to know the prevalence of abnormal Pap smear in pregnant women and its associated risk factors.Methods: This prospective study included 450 pregnant and 450 non-pregnant women who fulfilled the inclusion criteria. After a detailed history, clinical examination and investigations, Pap smear was collected as per conventional method and reported using 2014 Bethesda system.Results: 53.6% pregnant and 44.6% non-pregnant subjects had abnormal Pap smear. Out of the abnormal smears in pregnant women, 31.18% had inflammatory cytology, 15.37% had bacterial vaginosis, 4.01% had Trichomonal and 3.34% Monilial pathology. No epithelial cell abnormality was seen. Rural residence, lower class, age at first intercourse less than 21 years and having more than one sexual partner were important risk factors observed in our study and were statistically significant.Conclusions: Bacterial vaginosis, the most common infection detected on Pap smear is strongly associated with previos preterm labour and delivery. This opportunity for screening of cervical cancer and counselling should not be missed in the antenatal period.
      PubDate: 2019-11-26
      DOI: 10.18203/2320-1770.ijrcog20195356
      Issue No: Vol. 8, No. 12 (2019)
  • Clinical and surgical outcomes of 3 cycles versus 6 cycles of neoadjuvant
           chemotherapy in advanced ovarian carcinoma

    • Authors: Monika Thakur, Archana Kumari, S. C. Saha
      Pages: 4985 - 4989
      Abstract: Background: Epithelial cancers are the most common ovarian malignancy accounting for 90% of all type of ovarian cancer. Objective of this study was to evaluate the surgical morbidity and to study clinical outcomes of 3 cycles versus 6 cycles of neoadjuvant chemotherapy.Methods: A total 30 women with diagnosis of advanced epithelial ovarian cancer were randomly divided equally to receive either 3 cycles (Group 1) or 6 cycles (Group 2) of neoadjuvant chemotherapy. End points noted were duration of surgery, extent of surgery, perioperative complications and length of stay.Results: Both groups had comparable demographic profile. Surgery was more difficult in early IDS group with lesser percentage of patients achieving minimum intended surgery in early IDS (61.53% versus 80. 47%) peri-operative complications were seen more commonly in early IDS group compared to late IDS group (26.66% versus 69.2%). However mean duration of surgery was similar in both groups. Mean duration of stay in hospital was 5.4 days in late IDS group and 7.6 days in early IDS group. The mean follow-up period in late IDS was 7 months and in early IDS was 5 months. Survival in both groups when patients were followed up till the end of study period (12 months) was similar (p=0.186).Conclusions:
      Authors conclude that late IDS may be used as a treatment option in the high-risk group of patients. Though there was no significant difference at 6 months follow up, higher percent of women were disease free in late IDS.
      PubDate: 2019-11-26
      DOI: 10.18203/2320-1770.ijrcog20195357
      Issue No: Vol. 8, No. 12 (2019)
  • A study on eclampsia and its maternal and perinatal outcome

    • Authors: Devika J. Kamat, Guruprasad Pednecar
      Pages: 4990 - 4994
      Abstract: Background: Eclampsia is one of the major causes of maternal and perinatal mortality in India. Here authors present a prospective study which was conducted in a tertiary health centre to study the cases of eclampsia, the mode of presentation and the maternal and perinatal outcomes.Methods: A total 95 women were diagnosed as eclampsia during the period of 2 years. Various parameters and their effects on maternal and perinatal morbidity and mortality were studied. Maternal outcomes were assessed based on parameters like antenatal care received, mode of delivery, complications associated with eclampsia. Perinatal outcomes were noted depending upon the period of gestation, NICU admission, stillbirths and neonatal deaths.Results:
      Authors found the incidence of eclampsia to be 0.9%. 52.7% women had irregular antenatal follow up at any nearby health centre. A total 76.8% women had antepartum eclampsia. 56.8% delivered by caesarean section while 7.4% required operative vaginal delivery. 61.1% women delivered within 10 hours of onset of convulsion.
      Authors had 02 deaths in the study group, one due to ARDS with DIC and the other attributed to pulmonary oedema. There were 51.6% preterm deliveries. 21 neonates required NICU admission with 5 neonatal deaths and 11 stillbirths.Conclusions: Due to inadequate antenatal care, most of the cases of pre-eclampsia go unnoticed increasing the referrals to tertiary care centre for intensive care. Thus, it is necessary to emphasise on timely interventions and availability of blood bank, ICU and NICU facilities at the closest referral centre for better maternal and perinatal outcome.
      PubDate: 2019-11-26
      DOI: 10.18203/2320-1770.ijrcog20195358
      Issue No: Vol. 8, No. 12 (2019)
  • Cerebroumbilical doppler ratio in pregnancy induced hypertension and its
           prediction for adverse perinatal outcome

    • Authors: Meena Bhati Salvi
      Pages: 4995 - 5001
      Abstract: Background: To compare the changes in pulsatility index (PI) values of fetal middle cerebral artery (MCA), umbilical artery (UA) and ratio of PI of MCA and UA (cerebroumbilical ratio, C/U ratio) in normal pregnancies with pregnancy induced hypertension (PIH) and to evaluate their usefulness for predicting adverse perinatal outcome.Methods: This was a prospective comparative study carried out over a period of 1 year on total 140 patients between 30-40 weeks of gestation. Study group comprised of 70 patients with PIH. The control group comprised of 70 patients with normal BP. Both the groups were followed by doppler ultrasound and the UA PI, the MCA PI and the C/U ratio were measured. The results of the last doppler ultrasound before delivery were considered in the correlation with various adverse perinatal outcome. Sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy of MCA PI and UA PI and C/U ratio were calculated and compared for predicting adverse perinatal outcome.Results: Abnormal C/U ratio was more common in PIH group (42.85%) than control group (5.71%). In the study group, 83.33% patients of abnormal C/U ratio showed adverse perinatal outcome. C/U ratio had highest sensitivity (75.75%), negative predictive value (80%) and diagnostic accuracy (81.42%) compared to MCA PI and UA PI for predicting adverse perinatal outcome in PIH women.Conclusions: Incidence of adverse perinatal outcome was more common with abnormal C/U ratio. C/U ratio is better predictor for adverse perinatal outcome in PIH women than individual MCA PI and UA PI.
      PubDate: 2019-11-26
      DOI: 10.18203/2320-1770.ijrcog20195359
      Issue No: Vol. 8, No. 12 (2019)
  • A comparative study of early postoperative feeding versus conventional
           feeding for patients undergoing caesarean section

    • Authors: Neeraja S., Naritha Reddy, Naima Fathima
      Pages: 5002 - 5007
      Abstract: Background: Early alimentation after caesarean delivery probably has limited clinical significance in terms of improved energy and protein intake. Decreasing the post-operative ileus is possible with early feeding. Objective of this study was to study efficacy of early postoperative feeding versus conventional feeding for patients undergoing caesarean section.Methods: Present study was hospital based comparative study carried out among 200 women who fulfilled the selection criteria. The cases were divided into 2 groups of 100 each by suitable random sampling technique. Group A included 100 cases who were given early feeding within 6 hours of caesarean delivery. Group B included 100 control who were given the feeding after 24 hours of caesarean delivery.Results: The mean duration of postoperative hospital stay in Group A and Group B was 4.59±0.65 and 4.81±0.81 days respectively (p <0.05). The mean time to return of bowel sounds in Group A and Group B was 2.79±1.36 and 3.55±1.49 hours respectively (p <0.01). 2(2%) cases in group A had postoperative ileus symptoms, whereas 3 (3%) cases in Group B had the same. Statistically significant difference (p <0.05) was seen in terms of vomiting 1% versus 17%, nausea 5% versus 16%, abdominal distention 2% versus 7%, diarrhea 4% versus 90% in the early feeding versus conventional feeding groups.Conclusions: It can be concluded from present study that fast return to the normal diet is possible with early feeding among women undergoing cesarean section compared to the conventional feeding among women undergoing cesarean section.
      PubDate: 2019-11-26
      DOI: 10.18203/2320-1770.ijrcog20195360
      Issue No: Vol. 8, No. 12 (2019)
  • Total laparoscopic hysterectomy: a retrospective study of 5 years

    • Authors: Suma S. Moni, Suchith Hoblidar, Rathnamala M. Desai, Sunil Kumar K. S.
      Pages: 5008 - 5013
      Abstract: Background: Hysterectomy is one of the most common gynecological surgeries performed around the world. This study was done to review the data of all patients who underwent TLH. With this study a uniform method of performing TLH by a single surgeon was assessed.Methods: A 5 years retrospective study was performed at Sri Dharmasthala Manjunatheshwara College of Medical Sciences and Hospital Dharwad, Karnataka India. Demographic data, pre-operative findings, indication for surgery, intra-operative and post-operative complications, duration of surgery were recorded and analyzed.Results: A total of 118 women were included in the study. Mean age of the patients wasMost common indication for the surgery was leiomyoma. Mean operating time was 162.18 minutes. Mean weight of the post-operative specimen was 208.45 grams. Intra-operative urinary bladder injury was seen in 1 patient. Conversion to laparotomy was needed in 2 patients.Conclusions: With improving experience TLH can be performed safely without complications. As number of surgeries done increases duration of TLH reduces. TLH can be effectively used to avoid laparotomy.
      PubDate: 2019-11-26
      DOI: 10.18203/2320-1770.ijrcog20195361
      Issue No: Vol. 8, No. 12 (2019)
  • Spot protein/creatinine ratio as a marker for fetomaternal outcome in
           hypertensive disorder of pregnancy

    • Authors: Ashima Taneja, Gagandeep Kaur, Manpreet Kaur, Muskan Chaudhary, Kulvir Kaur
      Pages: 5014 - 5021
      Abstract: Background: Gestational hypertension is defined as systolic BP level of > 140 mmHg or a diastolic BP of > 90 mmHg that occur after 20 weeks of gestation. Pre-eclampsia is the hypertensive disorder of pregnancy, associated with adverse fetomaternal complications. It is assosciated with proteinuria. 24 hours urine collection is cumbersome, time consuming and potentially misleading if collected inaccurately. The spot P/C ratio has been considered equivalent to 24-hour urinary protein for predicting proteinuria. Aim of study was to compare spot P/C ratio to 24 hours urinary protein in patients of pre-eclampsia and to determine the fetomaternal outcome in the patients admitted in Dayanand Medical College and Hospital, Ludhiana.Methods: A prospective simple random study. It included 100 hypertensive pregnant women being evaluated for pre-elampsia, regardless of the alerting signs or symptoms. The main measures were the urinalysis of patients which included urinary spot P/C and 24 hours urinary protein excretion and the fetomaternal outcome in these patients. The data was statistically analyzed.Results: A good positive correlation existed between the P/C ratio and 24 hours protein excretion, with a correlation coefficient (r) of 0.912. The sensitivity and specificity of 24 hours urinary protein versus spot P/C ratio ranged between 86.29%-99.51% and 8.35%-99.95% respectively. The positive and negative likelihood ratio of 24 hours urinary protein versus spot P/C ratio was 48 (ranged between 6.89-334) and 0.04 (ranged between 0.01-0.16) respectively. The positive and negative predictive value of 24 hours urinary protein versus spot P/C ratio was 97.96% and 96.08% respectively. Our data showed that urine spot P/C ratio above 3.9/mg strongly predicts significant proteinuria of more than 4 gram/day.Conclusions: Spot urinary P/C ratio with suspected preeclampsia can be used as a rapid alternative test to 24 hours urinary protein.
      PubDate: 2019-11-26
      DOI: 10.18203/2320-1770.ijrcog20195362
      Issue No: Vol. 8, No. 12 (2019)
  • Changes in blood and urine parameters among pregnant women during third

    • Authors: Ahmed L. Osman, Abdelgadir Eltom, Marwan Ismail, Khalid Ahmed, Alaa Khalil, Eman Mohamed, Kiran Gopinath
      Pages: 5022 - 5026
      Abstract: Background: During pregnancy, the pregnant lady undergoes significant anatomical and physiological changes in order to nurture and accommodate the developing fetus. These changes begin after conception and affect every organ system in the body.Methods: The study was carried out in the United Arab Emirates - Ajman (Thumbay Hospital) during the period of (March - Jun) in the year of 2018 to estimate HbA1c% levels, hematological blood parameters and urine culture in healthy pregnant women during 3rd trimester. The study was conducted on (108) healthy pregnant women during3rd trimester. Urine culture was performed to detect the growth of bacteria after the culture, gram stain was done to differentiate the bacteria followed by biochemical test to detect the type of bacteria.Results: A total 26 (79%) of patients had normal HbA1c% result while 7(21%) had elevated HbA1c% result. The results of HbA1c% in last trimester mean±SD (range) HbA1c% (n=33) were 5.5±0.52% (111.5±14.8 mg/dL). Also, our results showed strong positive correlation between HbA1% with estimated Average blood glucose (r=0.78, P value=0.00), and weak positive correlation between HbA1 with age (years) (r=0.2, P value=0.02). Bacterial culture showed that two positive results of stenotrophomonas maltophilia was isolated, three cases of Staphylococcus aureus was isolated and three cases of staphylococcus saprophyticus. Hematological profile showed a clinically significant (≤ 0.05) in Hb mean 11.47, P value 0.001, HCT mean, 33.9 P value 0.001 and MCV mean 73.7 value 0.001. No clinically significant (≥ 0.05) in RBCs mean 3.93, P value 0.010, MCH mean 27.3 P value 0.061 and MCHC mean 30.9 P value 0.134.Conclusions: Our study conclude that estimation of HbA1c%, hematological blood parameters and urine culture level in last trimester will be helpful in diagnosis, monitoring and predicting fetal distress.
      PubDate: 2019-11-26
      DOI: 10.18203/2320-1770.ijrcog20195363
      Issue No: Vol. 8, No. 12 (2019)
  • Study of prevalence of heart disease in antenatal mothers along with fetal
           and maternal outcome from a tertiary care hospital, Salem, Tamil Nadu,

    • Authors: Subha Sivagami Sengodan, Shobhika Selvaraj
      Pages: 5027 - 5031
      Abstract: Background: Incidence of pregnancy in women with heart disease is increasing due to the increasing number of women with congenital heart disease. Although most cardiac conditions are well tolerated during pregnancy, there are some conditions that have adverse fetal and maternal outcome. Objective of this study is to study the prevalence of heart disease in antenatal mothers and fetal outcome with obstetric management.Methods: This is a prospective observational study carried out in the Department of Obstetrics and Gynaecology at Government Mohan Kumaramangalam Medical College and Hospital during January 2018 to March 2019 for a period of fifteen months.
      Authors included 149 antenatal mothers with heart disease and analysed the data using percentage analysis through excel software.Results: Incidence of heart disease in pregnancy was observed to be 1.2%. Rheumatic heart disease being 73.8%, congenital being 22.8% and complete heart block was 3.4%. Among rheumatic heart disease mitral stenosis was the most common lesion. Atrial septal defect was the most common congenital heart disease. The mean gestational age of delivery was 37 to 38 weeks. 58% delivered by vaginal route. Most common neonatal complication was prematurity. Pregnancy and neonatal outcome were favorable.Conclusions: Heart disease complicating pregnancy has increased due to late marriage, obesity, hypertension and diabetes. Early referral, regular follow-up and multi-disciplinary approach with tertiary care back-up will bring a favorable maternal and neonatal outcome in patients with heart disease.
      PubDate: 2019-11-26
      DOI: 10.18203/2320-1770.ijrcog20195364
      Issue No: Vol. 8, No. 12 (2019)
  • Anterior abdominal wall endometrioma: a diagnostic dilemma

    • Authors: Nilofar Imamhusen Yelurkar, Meena Naresh Satia, Ananya Rajendra Deekshit, Vijaya Rajesh Badhwar
      Pages: 5032 - 5035
      Abstract: The presence of functioning endometrium outside the uterine cavity is often encountered in gynaecological practice but an extremely rare entity is its extra pelvic variant is seen sometimes around the umbilicus, anterior rectus sheath vesical region, also rarely seen around the kidney’s nasal mucosa, lungs and the pleura. The incidence of this condition is as low as 0.03% to 0.15%. Endometrioma of the anterior rectus sheath is well documented in literature but because of its rarity may pose a diagnostic dilemma. Reporting herewith a case of anterior rectus sheath endometrioma where medical line of treatment failed and surgical excision was required.
      PubDate: 2019-11-26
      DOI: 10.18203/2320-1770.ijrcog20195365
      Issue No: Vol. 8, No. 12 (2019)
  • Fetal thoraco-abdominal lymphangioma: a case report

    • Authors: Kariman Ghazal, Mariam Rajab, Abir Malas
      Pages: 5036 - 5038
      Abstract: Lymphangiomas are rare congenital malformations of the lymphatic system.
      Authors present a case with giant, septated, axillary thoraco-abdominal lymphangioma. Diagnosis was made at 19 weeks’ gestation by antenatal ultrasonography. The case underwent prenatal expectation treatment.
      PubDate: 2019-11-26
      DOI: 10.18203/2320-1770.ijrcog20195366
      Issue No: Vol. 8, No. 12 (2019)
  • Successful management of a near miss case of eclampsia with intracranial
           haemorrhage requiring craniotomy

    • Authors: Aditi P. Kaundinya, Meena N. Satia, V. R. Badhwar
      Pages: 5039 - 5042
      Abstract: Large population-based studies on stroke report that intracerebral haemorrhage is rare in young women however it is a grave and disturbing complication of pregnancy. Preeclampsia is usually clinically silent, but may cause symptoms of neurological dysfunction such as headache, visual disturbances and impairment of consciousness. Eclampsia is in the occurrence of seizures in the context of preeclampsia and is often, but not always, preceded by the above neurological symptoms. Most published data support the view that preeclampsia and eclampsia are important causative factors for pregnancy related ICH. Sparse data is available with respect to the management of such cases. Identification of near miss cases is an important step in reducing mortality. Herein we report a near miss case of eclampsia with intracranial haemorrhage requiring craniotomy.
      PubDate: 2019-11-26
      DOI: 10.18203/2320-1770.ijrcog20195367
      Issue No: Vol. 8, No. 12 (2019)
  • Primary ovarian ectopic pregnancy: early diagnosis is the key

    • Authors: Priyanka H. Vora, Rana A. Choudhary, Kedar N. Ganla
      Pages: 5043 - 5045
      Abstract: Ectopic pregnancy means implantation of the embryo outside the uterine cavity. It may occur in the fallopian tubes, ovaries or the cervix. Primary ovarian ectopic is a very rare condition. In such cases preservation of ovary is extremely important, particularly in patients with infertility. We report a case of primary ovarian ectopic which was managed conservatively in a patient of primary infertility. Preservation of ovary is extremely important, particularly in patients with infertility.
      PubDate: 2019-11-26
      DOI: 10.18203/2320-1770.ijrcog20195368
      Issue No: Vol. 8, No. 12 (2019)
  • Pregnancy with chronic myeloid leukemia: case report and literature review

    • Authors: Tanzeem Sabina Chowdhury, Israt Jereen, T. A. Chowdhury
      Pages: 5046 - 5049
      Abstract: Chronic myeloid leukemia (CML) is a rare condition during reproductive age. Still, women may present with pre-existing or newly diagnosed CML during pregnancy. The management of chronic myeloid leukemia during pregnancy requires balancing the well-being of the mother with that of fetus. Tyrosine Kinase inhibitors are considered the most effective drug against CML but they are still not considered safe during pregnancy and breast feeding. So, there is a need for management of CML with alternate drugs during pregnancy. Here we report a case of a 26-year-old lady who was diagnosed with chronic myelogenous leukemia (CML) at 20 weeks of gestation and had an atypical chromosome translocation t (9:22). She was managed jointly by obstetrician and haemato-oncologist for the remainder of her pregnancy and eventually she delivered a healthy baby at term.
      PubDate: 2019-11-26
      DOI: 10.18203/2320-1770.ijrcog20195369
      Issue No: Vol. 8, No. 12 (2019)
  • Placenta accreta not previa: a rare case report of placenta accreta in an
           unscarred uterus

    • Authors: Renuka Malik, Swati Singh, Jaya Chawla, Meenakshi Bhardwaj
      Pages: 5050 - 5053
      Abstract: Placenta accreta spectrum disorders are usually associated with direct surgical scar such as caesarean delivery, surgical termination of pregnancy, Dilatation and curettage, Myomectomy, Endometrial resection and Asherman’s syndrome. It can also be associated with non-surgical scar and uterine anomalies. Rarely it can be encountered in unscarred uterus. Mrs X, 35-year female, unbooked patient, G7P2L2A4 with nine months of amenorrhoea reported in emergency of RML Hospital on 30/07/2019 with history of labour pains since 2 days. Patient gave history of four dilatation and curettage for incomplete abortion. On examination patient was found to be severely anaemic (Hb -6 gm). 2 Packed RBC were transfused preoperatively. There was no progress in labour beyond 6 cm for 4 hours. Patient was thus taken for LSCS for NPOL, with blood on flow. Intraoperatively, after delivery of the baby placenta which was fundo-posterior did not separate. In view of parity and morbidly adherent placenta (clinical grade III), subtotal hysterectomy was done. Patient was transfused 4 PRBC, 4 FFP and 2 platelets. Uterus with placenta in situ was sent for histopathology. Patient was in ICU for 2 days and recovered well. Post-operative period was uneventful. Placenta accreta is defined as abnormal trophoblast invasion of whole or a part of placenta into myometrium of uterine wall. Caesarean delivery is associated with increased risk of placenta accrete and the risk increases with each caesarean section, from 0.3% in woman with one previous caesarean delivery to 6.47% for woman with five or more caesarean deliveries. Placenta accreta spectrum disorders occur in 3% of woman diagnosed with placenta previa and no prior caesarean. In the developing world, the obstetrician should be prepared to encounter un diagnosed placenta accrete even in absence of previous LSCS. Curretage following MTP is also a risk factor, so vigourous currettage should be avoided to prevent endometrial damage.
      PubDate: 2019-11-26
      DOI: 10.18203/2320-1770.ijrcog20195370
      Issue No: Vol. 8, No. 12 (2019)
  • Misdiagnosis of interstitial pregnancy followed by circlage operation and
           failed induced midtrimester abortion: a case report

    • Authors: Nalini Sharma, Anusmita Saha
      Pages: 5054 - 5056
      Abstract: Interstitial pregnancy is rare form of ectopic pregnancy that can expand up to 18 weeks leads to massive haemoperitoneum hence early diagnosis is imperative to decrease mortality and morbidity. Present case diagnosed as interstitial pregnancy at laparotomy when she had taken for hysterotomy after two failed courses of medical abortion. Clinicians should bear in mind the limitations of various investigations and should have a higher degree of suspicion for interstitial pregnancy Any deviation from normal response to administration of medical abortificient, such as failure to abort, should instigate the diagnosis of ectopic (interstitial) pregnancy by expert radiologist.
      PubDate: 2019-11-26
      DOI: 10.18203/2320-1770.ijrcog20195371
      Issue No: Vol. 8, No. 12 (2019)
  • Successful live birth after heterotopic ruptured cornual pregnancy with
           twin intrauterine gestation in an in vitro fertilization conception

    • Authors: Venus Bansal, Muskaan Chhabra, Rahul Chopra, Pooja Prajapati
      Pages: 5057 - 5061
      Abstract: Heterotopic pregnancies, especially in the cornual region which were a rarity till recent times, have become a more common occurrence due to increasing practice of assisted reproduction. Optimal management of such cases is imperative to manage the risk of hypotension and shock in case of rupture and to judiciously preserve the intrauterine pregnancy. Here we are reporting a case of IVF conception of twin intrauterine pregnancy with a cornual heterotopic pregnancy. Patient presented to the emergency department with features of acute abdomen, haemoperitoneum and shock. Ultrasound findings were suggestive of rupture of cornual heterotopic pregnancy, 1500 ml haemoperitoneum with live twin intrauterine gestation. Patient was resuscitated with iv fluids blood transfusion. Immediate laparotomy was done and cornual site repaired and covered with an omental patch while preserving the intrauterine gestations. Thereafter, pregnancy was carefully monitored with a high index of suspicion for rupture of site of cornual repair with advancing gestational age. Patient was readmitted at 24 weeks with pain abdomen and cornual site was found to be 4mm in thickness. She was managed conservatively till 27 weeks when she had preterm rupture of membranes and emergency LSCS was done. She delivered healthy twin male babies, 780 gmb and 795 gm respectively. This case demonstrates that cornual heterotopic pregnancy is a diagnosis which may be easily missed and can present as a life-threatening complication if it ruptures and significant intraperitoneal bleeding occurs. However, it is possible to successfully manage these cases with timely intervention, proper uterine reconstruction and monitoring of intrauterine gestation.
      PubDate: 2019-11-26
      DOI: 10.18203/2320-1770.ijrcog20195372
      Issue No: Vol. 8, No. 12 (2019)
  • A near miss case of placenta percreta in a patient with post myomectomy

    • Authors: Vinita Singh, Rajshree Sahu, Esha Das, Pavan B. C.
      Pages: 5062 - 5064
      Abstract: The term placenta accreta or placenta accrete syndrome is used to describe a spectrum of an abnormal placental implantation and firm adherence which are classified according to the depth of invasion into the uterus. A 28-year-old elderly primigravida presented AIIMS OPD to for the 1st time at 13+2 weeks of gestation with brownish discharge per vaginum. Ultrasonography done showed 12 weeks single intrauterine pregnancy with subchorionic haemorrhage of 3.7×2.52 cm with placenta being fundoanterior. She underwent myomectomy 2 years back and during her antenatal care in 3rd trimester growth scan at 30+2 weeks of gestation placenta was fundoanterior with loss of retroplacental hypoechoic in the upper margin of placenta at the myomectomy scar site with small extra uterine collection seen measuring 7.6×2.3 cm and hence possibility of placenta accreta was suggestive by the above findings confirmed by MRI. Emergency cesarean section done at 36+6 weeks of gestation for leaking per vaginum. Manual removal of placenta was tried but it failed and soon atonic PPH developed. Seeing no response with uterotonics internal iliac artery ligation was also attempted but failed. Immediate decision for hysterectomy was taken as a life-saving method. On adhesiolysis in the fundal region placental tissue perforating uterine serosa was visible on the surface of uterus, hence diagnosis of placenta percreta was confirmed which was further confirmed on histopathological report. Currently hysterectomy or local resection is preferred over conservative management with methotrexate.
      PubDate: 2019-11-26
      DOI: 10.18203/2320-1770.ijrcog20195373
      Issue No: Vol. 8, No. 12 (2019)
  • Mucinous cystadenoma of ovary: are mammoths really extinct'

    • Authors: Namrita C. Sheregar, Reena J. Wani
      Pages: 5065 - 5067
      Abstract: The most common ovarian tumours are epithelial tumours. 80% of all tumours are benign, 10% borderline and 10% are malignant. Mucinous tumours represent 8-10% of the epithelial tumours; they may reach enormous size filling the entire abdominal cavity. We report here a case of a huge benign mucinous cystadenoma in a 57-year-old female. Ultrasound and MRI scan showed a large left ovarian cyst. CA-125 was 132 IU/ml. She underwent total abdominal hysterectomy and bilateral salpingo-opherectomy with appendicectomy and infracolic omentectomy. Her post-operative course was unremarkable.
      PubDate: 2019-11-26
      DOI: 10.18203/2320-1770.ijrcog20195374
      Issue No: Vol. 8, No. 12 (2019)
  • Human spaceflight: to infertility and beyond

    • Authors: Walter D. Cardona Maya, Stefan S. du Plessis
      Pages: 5068 - 5069
      Abstract: Garrett-Bakelman FE et al, demonstrated a spectrum of molecular and physiological changes attributed to spaceflight in their recently published “NASA Twins Study”.1 During his 340 days in space onboard the International Space Station (ISS), one of a pair of monozygotic twins was not only challenged by noise, isolation, hypoxia, and alterations in the circadian rhythm, but more importantly the exposure to ionizing radiation (IR) and microgravity. Terrestrials are subjected constantly to surface gravity and most if not all physiological processes have adapted accordingly. It is therefore easy to envisage that weightlessness can have consequences for space travellers.2
      PubDate: 2019-11-26
      DOI: 10.18203/2320-1770.ijrcog20195375
      Issue No: Vol. 8, No. 12 (2019)
School of Mathematical and Computer Sciences
Heriot-Watt University
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