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

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Intl. J. of Advances in Medicine     Open Access   (Followers: 2)
Intl. J. of Basic & Clinical Pharmacology     Open Access   (Followers: 2)
Intl. J. of Clinical Trials     Open Access   (Followers: 3)
Intl. J. of Community Medicine and Public Health     Open Access   (Followers: 7)
Intl. J. of Contemporary Pediatrics     Open Access   (Followers: 6)
Intl. J. of Otorhinolaryngology and Head and Neck Surgery     Open Access  
Intl. J. of Reproduction, Contraception, Obstetrics and Gynecology     Open Access   (Followers: 14)
Intl. J. of Research in Dermatology     Open Access   (Followers: 1)
Intl. J. of Research in Medical Sciences     Open Access   (Followers: 5)
Intl. J. of Research in Orthopaedics     Open Access  
Intl. J. of Scientific Reports     Open Access   (Followers: 4)
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International Journal of Reproduction, Contraception, Obstetrics and Gynecology
Number of Followers: 14  

  This is an Open Access Journal Open Access journal
ISSN (Print) 2320-1770 - ISSN (Online) 2320-1789
Published by Medip Academy Homepage  [12 journals]
  • Retrospective study on assessment of risk for gestational diabetes using
           fetal medicine foundation’s gestational diabetes risk assessment
           calculator in a tertiary care hospital in coastal Karnataka, India

    • Authors: Pradeep Ganiga, Vivek V. Subhash
      Pages: 1324 - 1327
      Abstract: Background: Gestational diabetes is defined as impaired glucose tolerance with onset or first recognition during pregnancy. Undiagnosed or inadequately treated gestational diabetes can lead to significant maternal and fetal complications. Even though there are guidelines for diagnosis of GDM (gestational diabetes mellitus) by the Government of India, there is poor penetration of the implementation throughout the nation.Methods: The study was conducted in A. J. Institute of Medical Sciences between April to June 2019. 56 patients were evaluated with the fetal medicine foundation GDM risk calculator to assess the risk for gestational diabetes in a retrospective approach.Results: Incidence of GDM in the study was 15.9%. At a cut-off of 1/80, the calculator predicted increased risk for 37 out of 56 patients. There was a sensitivity of 91.6% and specificity of 63.6% with a negative predictive value of 96.5% and positive predictive value of 29.5%. there was a false positive rate of 43.2%.Conclusions: The fetal medicine foundation GDM risk calculator will prove to be an invaluable tool to predict high risk patients who need closer monitoring of blood glucose into the third trimester.
      PubDate: 2020-03-25
      DOI: 10.18203/2320-1770.ijrcog20200857
      Issue No: Vol. 9, No. 4 (2020)
       
  • Analytical study of thyroid and prolactin hormone levels in infertile
           women with menstrual irregularities

    • Authors: S. R. Keerthanaa, P. B. Hiremath
      Pages: 1328 - 1334
      Abstract: Background: Infertility is the inability of a couple to achieve pregnancy over an average period of one year (in a woman under 35 years of age) or 6 months (in a woman above 35 years of age) despite adequate, regular (3-4 times per week), unprotected sexual intercourse. It is of two types, primary infertility and secondary infertility. It can be due to the woman, the man, or both men and woman. Though there are several factors plays role in the causing infertility, endocrine hormones play a crucial role in it. Among all the hormones, thyroid and prolactin hormone have profound effects on reproduction and pregnancy.Methods: A prospective analytical study was conducted among 200 female patients, of age group 20-40 years, attending the outpatient department of obstetrics and gynecology. Sent for analysis of thyroid profile and prolactin levels. The data of the patients who have been completely followed up after six months was entered in excel sheet and analyzed using SPSS (version 16).Results: In this study the mean age of the study participants were 31.33±4.12 years and 4 of them were below 25 years of age. There is high prevalence of hypothyroidism (23.5%) and hyperprolactinemia (31%) was noted among the infertile females.Conclusions: The assessment of thyroid function and prolactin levels is mandatory in the work up of all infertile women, especially those presenting with menstrual irregularities. Also, early initiation of treatment may help in restoring the fertility among the infertile woman.
      PubDate: 2020-03-25
      DOI: 10.18203/2320-1770.ijrcog20201025
      Issue No: Vol. 9, No. 4 (2020)
       
  • Accuracy of visual inspection with acetic acid for cervical pathology
           screening in low cost setup

    • Authors: Aditya Sisodia
      Pages: 1335 - 1338
      Abstract: Background: Cancer cervix, a preventable disease continues to be a cause of great concern to women’s health, being associated with agonizing morbidity and high mortality. Approximately 493,100 new cases and more than 273,000 deaths occur each year, among women worldwide.IN India the screening is largely based on pap smear, which is cumbersome procedure due to transportation of samples and follow up of patients are not usually feasible. Visual inspection with Acetic acid (VIA) is simple and easy to teach procedure. Follow-up of patients usually doesn’t require.Methods: This study includes a total of 1000 patients who attended OPD of gynecology. Each patient is subjected to VIA examination. Biopsy is taken from women with abnormal findings on VIA. The objectives of this study were to evaluate the sensitivity and specificity and positive predictive value of inspection of cervix with acetic acid in precancerous lesions of cervix.Results: When biopsy is taken as reference standard, VIA has sensitivity of 97.7%, specificity of 76.6%, PPV of 62.9% and NPV of 98.5%. The accuracy rate for VIA is 84.8%.Conclusions: VIA is highly sensitive for diagnosis and treatment of cervical pathology at the same sitting. It can be done cost effectively in low resource set up.
      PubDate: 2020-03-25
      DOI: 10.18203/2320-1770.ijrcog20200858
      Issue No: Vol. 9, No. 4 (2020)
       
  • A clinical observational study on second-trimester abortion

    • Authors: Geetha Lakshmi R., Bommireddy Pranavi, Neethu George, K. Saraswathi
      Pages: 1339 - 1345
      Abstract: Background: Second-trimester abortion is an important component of the comprehensive women’s health care. Data’s regarding second-trimester abortion is still under-reporting. Though the percentage of induced second-trimester abortion is low, its morbidity is higher than the first-trimester induced abortion. The abortion related mortality usually increases with the age of gestation.Methods: A retrospective observational study was conducted in the department of obstetrics and gynecology at Sree Balaji Medical College and Hospital, Chennai, over a period of one year. The data were collected from the medical case records and we have analyzed on the epidemiology, etiologies, complications and the methods of second- trimester abortion using statistical analysis.Results: In this study, there was no standard regimen of mifepristone and misoprostol were used for second-trimester abortion.  The dosages were varied based on the gestational age of pregnancy. As the gestational age progresses, the amount of misoprostol required for the induction of second trimester abortion decreases and the difference is statistically significant. There was no reported case of rupture uterus, but varied complications such as post-abortal hemorrhage, retained placenta, need for blood transfusion, uterine perforation and one maternal death were reported during the study period.Conclusions: In order to reduce the morbidity and mortality of second trimester abortion, more policies and monitored services have to be rendered by the health system. Data regarding the second trimester abortion have to be improved. 
      PubDate: 2020-03-25
      DOI: 10.18203/2320-1770.ijrcog20201008
      Issue No: Vol. 9, No. 4 (2020)
       
  • Retrospective study of histopathological pattern of endometrium in
           abnormal uterine bleeding

    • Authors: A. Shantha, Nazia Hussain
      Pages: 1346 - 1349
      Abstract: Background: Abnormal uterine bleeding (AUB) is a common gynaecological complaint associated with considerable morbidity. It significantly affects the patient’s family personal and social life. The aim of this study was to analyse the histopathological patterns of endometrium in patients presenting with AUB.Methods: This is a retrospective study conducted in the teaching hospital in the department of obstetrics and gynecology along with the pathology department. All patients with AUB were included in the study. This study of 138 samples both from hysterectomy specimens and endometrial biopsy were included.Results: The specimen obtained for examination of the endometrial samples 86 comprised from dilatation and curettage and rest 52 samples were obtained from hysterectomy specimens. Most common histopathological pattern was found to be proliferative endometrium, followed by disordered proliferative endometrium and atropic endometrium.Conclusions: Study of the histopathological pattern of the endometrial biopsies can be included in the initial evaluation of women with AUB when the cause of bleeding is not known along with ultrasound examination, then using it as the last modality for diagnostic and therapeutic purposes, irrespective of age group.
      PubDate: 2020-03-25
      DOI: 10.18203/2320-1770.ijrcog20201065
      Issue No: Vol. 9, No. 4 (2020)
       
  • Assessing the pros and cons of vaginal birth after caesarean relative to
           elective repeat caesarean section

    • Authors: Sangeeta G. Prasad, Preeti Malhotra
      Pages: 1350 - 1355
      Abstract: Background: Recent years have witnessed a rise in rate of primary caesarean section (CS). No. of women reporting with a previous CS scar is also increasing. Judicious trial of labor in such patients can prevent repeat caesarean section. Aim of this study was to assessing the safety and success rate of vaginal birth after caesarean (VBAC) in selected cases of patients who have undergone previous lower segment CS (LSCS) is the main aim of this study.Methods: In this prospective observational study carried out in a tertiary care teaching hospital over a period of 1 year. 375 pregnant women with a history of one previous LSCS for non-recurrent indications were enrolled. The statistical technique of t-test was administered for relative comparison with respect to maternal and neonatal complications across the two groups, i.e. repeat LSCS and vaginal delivery.Results: Out of 375 patients 187 patients (49.9%) underwent elective LSCS for recurrent indication and for non-recurrent indication associated with some complicating factor. Trial of labor in 188 (50.10%) was given out of which 59.3% had spontaneous vaginal delivery,7.20% had instrumental delivery and 33.50% landed into emergency CS. Commonest cause of Em. LSCS being Fetal distress. As regards maternal complications, no statistically significant difference was found between the Repeat LSCS and Vaginal delivery groups (t = 0.779, p > 0.05). On similar lines, there was no statistically significant difference across both groups as regards neonatal complications (t = 0.632, p > 0.05).Conclusions: Taking into account the increased trend of primary CS, trial of VBAC in selected cases is very important. It can be concluded that VBAC has chances of success in cases with previous one LSCS but it must be carefully investigated and monitored.
      PubDate: 2020-03-25
      DOI: 10.18203/2320-1770.ijrcog20201085
      Issue No: Vol. 9, No. 4 (2020)
       
  • Polycystic ovarian syndrome and insulin resistance: a South Indian study

    • Authors: V. Anuradha, Keshav Gangadharan, Rajiv Kumar Saxena, L. Krishna
      Pages: 1356 - 1360
      Abstract: Background: Polycystic ovary syndrome (PCOS) is a common endocrine disorder in women of reproductive age. Some studies have characterized different aspects of women presenting with PCOS. In this study we characterise the association of insulin resistance (IR) in patients with PCOS in the southern Indian state of Andhra Pradesh.Methods: A total of 50 women diagnosed to have PCOS according to Rotterdam criteria were studied. IR was estimated using Homeostatic model assessment - insulin resistance (HOMA-IR) and clinical characteristics were recorded.Results: The prevalence of IR among the study population was 36%. All PCOS patients with IR were overweight or obese, and had impaired glycaemic status, 75% of PCOS patients with IR also had features of hirsutism.Conclusions: Considering the prevalence of IR, obesity and impaired fasting glucose in women with PCOS, early institution of treatment by lifestyle changes or medication would lead to improvement in reproductive and metabolic abnormalities.
      PubDate: 2020-03-25
      DOI: 10.18203/2320-1770.ijrcog20201054
      Issue No: Vol. 9, No. 4 (2020)
       
  • Evaluation of induction of labour in a tertiary care hospital

    • Authors: Janupalli Kiran Poornima, Vijayalakshmi K., Anuradha C. R., Famida ., Sai Latha R.
      Pages: 1361 - 1365
      Abstract: Background: The objective is to evaluate the preferred methods for labor induction, including incidence of caesarean section, operative and normal vaginal delivery rate, need for oxytocin augmentation, and Apgar score at 1 and 5 min.Methods: This was a hospital-based study carried out in 110 inductions of labour during the study period. misoprostol 50 mcg was inserted in posterior fornix of vaginal in cases with PROM and intracervical 0.5 mg Dinoprostone for other causes in whom induction was decided. Maternal and neonatal outcomes were observed. collected data were analyzed using SPSS and MS excel.Results: Most preferred methods of induction of labour were observed to be Dinoprostone and Misoprostol, augmentation was done by oxytocin. normal delivery rate was 54% in Dinoprostone gel and 58.3% in misoprostol group. Caesarean and operative vaginal delivery rates were 42.8%, 3% in Dinoprostone gel group and 33.3%, 8.3% respectively in misoprostol group. Mean Apgar scores were observed to be similar in both methods of induction at 1st and 5th minutes.Conclusions: It was found that misoprostol had higher percentage of normal and operative vaginal delivery and need for oxytocin augmentation than Dinoprostone. Neonatal outcome as predicted by Apgar score were similar in both groups.
      PubDate: 2020-03-25
      DOI: 10.18203/2320-1770.ijrcog20201055
      Issue No: Vol. 9, No. 4 (2020)
       
  • Knowledge, attitude and practice of post-natal exercises among post-natal
           women from a tertiary care centre, South India

    • Authors: Raja Sundaramurthy, Sasikala Kathiresan, Sriandaal Venkateshvaran, Surya Kannan
      Pages: 1366 - 1371
      Abstract: Background: Stressful puerperal period and its complications can be prevented by adequate care, proper diet and exercises. Though studies have indicated post-natal exercises (PNE) is helpful in reducing the effect of perineal muscle weakness, many women are unaware of its full benefits. This study is planned to know the knowledge, attitude and practice of PNE in post-natal mothers.Methods: Descriptive cross-sectional study was conducted in department of obstetrics and gynecology for 3 months (November 2019 to January 2020). 160 post-natal women were enrolled with convenient sampling. Structured questionnaire was used to collect socio-demographic and obstetric details, source of information, knowledge, attitude and practice of PNE.Results: A total 58.8% of this study participants revealed health care professions were the commonest source of information. More than half of them had adequate knowledge but still many were not aware of full benefits of PNE as only 3-5% aware of other benefits like prevention of urinary incontinence. 98.8% of the women’s felt PNE is essential and 62.5% felt household work hinder them doing. 92.5% said they will emphasize the importance of PNE to others. No significant correlation found between socio-demographic characters and knowledge, attitude and practice of PNE.Conclusions: Though most of the study population had adequate knowledge and positive attitude, household activities were the commonest barrier in doing PNE. Educating and creating awareness among family members is essential to improve the adherence. Continuing influence by health care workers during antenatal and postnatal period will be the key for improving adherence.
      PubDate: 2020-03-25
      DOI: 10.18203/2320-1770.ijrcog20201026
      Issue No: Vol. 9, No. 4 (2020)
       
  • Comparative study of diclofenac suppository with tramadol suppository in
           addition to acetaminophen for post caesarian analgesia

    • Authors: Reetu Hooda, Prachi Pathak, Rahul Chavhan
      Pages: 1372 - 1376
      Abstract: Background: Pain after emergency and elective caesarean section may adversely affect patient’s recovery and breastfeeding initiation. The aim of present study was to compare the analgesic efficacy of diclofenac suppository-intravenous acetaminophen (APAP) combination, tramadol suppository-intravenous APAP combination and intravenous APAP alone for postoperative pain relief after caesarean section.Methods: We designed a randomized double-blind control study. Three hundred parturient scheduled for caesarean section were randomized to receive diclofenac rectal suppository (100 mg), tramadol rectal suppository (100 mg) or glycerin rectal suppository in Group A, B and C respectively (100 parturient in each group). All the women routinely received 1000 mg acetaminophen intravenously. Assessment of pain was done using a visual analogue scale (VAS) at 0, 1, 6, 12, 18 and 24 hours. injection Pentazocine 0.3 mg/kg IV was given as rescue analgesia when VAS score > 30.Results: The mean VAS score was significantly higher in Group C as compared to Group A and Group B (p value < 0.001). This suggests better efficacy of multimodal treatment as compared to monotherapy. Group A as compared to Group B showed better efficacy in term of VAS score at 12 and 18 hours (p = 0.05, p = 0.02 respectively).Conclusions: We found that when controlling for socio-demographic characteristics, combination of either diclofenac or tramadol suppository with acetaminophen has significantly better results when compared with monotherapy of acetaminophen alone in post-operative analgesia after caesarean section. However, the combination of diclofenac suppository has proved to be superior in comparison to tramadol suppository.
      PubDate: 2020-03-25
      DOI: 10.18203/2320-1770.ijrcog20201086
      Issue No: Vol. 9, No. 4 (2020)
       
  • Prevalence of premenstrual syndrome and dysmenorrhea among medical
           students and its impact on their college absenteeism

    • Authors: Arshia Syed, Smitha B. Rao
      Pages: 1377 - 1381
      Abstract: Background: Dysmenorrhea and premenstrual syndrome are two most common gynaecological problem leading to college absenteeism seen among female medical students. Aim of the study was to evaluate the factors associated and prevalence of dysmenorrhoea and PMS and its effects on the quality of life, particularly absenteeism from college in female medical students. The health care profession has an obligation to provide and to promote education on menstruation and related subjects.Methods: This is a prospective study, conducted on 100 MBBS students studying in a medical college at Mangalore. All participants were given a preformed questionnaire to complete. Dysmenorrhea was assessed based on WaLiDD scoring system. Diagnosis of PMS in the present study was made according to diagnosis criteria proposed by American College of obstetrician and gynecology. The severity of their condition was assessed based on their absenteeism from college/classes.Results: The average age of the participants was 21 year±1 year. The prevalence of dysmenorrhea was 45% and that of the pre-menstrual syndrome was 68%. Pre-menstrual syndrome (p = 0.05) is significantly associated with overweight, obesity and physical inactivity but not the same for dysmenorrhea. 73% and 60% of students consumed junk food suffered from PMS and dysmenorrhea respectively, 40% of students with dysmenorrhea reported limitation of daily activities and significantly associated with college absenteeism (p = 0.005). The most frequent somatic symptom of PMS in this study was breast tenderness (41%) and affective symptom was irritability (35%).Conclusions: Dysmenorrhea and PMS is highly prevalent among female medical students; it is related to college/class absenteeism. Unhealthy and sedentary lifestyle could be the attributing factors which has to be addressed by health education in order to improve the quality of life and academic performance by the medical students.
      PubDate: 2020-03-25
      DOI: 10.18203/2320-1770.ijrcog20201042
      Issue No: Vol. 9, No. 4 (2020)
       
  • Menstrual cup: awareness among reproductive women

    • Authors: Shwetha Ballal K., Amritha Bhandary
      Pages: 1382 - 1387
      Abstract: Background: Menstrual cup is an alternative to sanitary pads, which has received attention in relatively small-scale studies in high income, and low- and middle-income countries, including among schoolgirls. Made of high-grade medical grade silicone (biodegradable) have the advantage of reuse, and can potentially last up to 10 years. Objective of this study was to assess and analyse the awareness regarding menstrual cup among the women of reproductive age group.Methods: Data collected from the selected eligible participants by an interviewer administered study proforma. It is a descriptive cross-sectional study over 1 month in women in reproductive age in A. J. Institute Mangalore, Karnataka, India.Results: A total 82% were aware about menstrual cup but only 2.6% have used it.Conclusions: One challenge of menstruation that is taken for granted in affluent countries is the simple question of how to manage or contain the menstrual flow and what happens to a girl or woman who is not able to do this successfully. Menstrual hygiene management is therefore an increasingly important (yet often unrecognized) issue that is heavily intertwined with girls’ education, empowerment, and social development.
      PubDate: 2020-03-25
      DOI: 10.18203/2320-1770.ijrcog20201066
      Issue No: Vol. 9, No. 4 (2020)
       
  • A single abnormal value of 100 g oral glucose tolerance test and pregnancy
           outcomes

    • Authors: Walairat Kemthong
      Pages: 1388 - 1391
      Abstract: Background: In the worldwide, diabetes mellitus is one of the most common medical complications in pregnancy, the prevalence is about 5% and seems to increase. Objective of this study was to evaluate the effect of a single abnormal value of 100 g OGTT on pregnancy outcomes.Methods: This retrospective cohort study was conducted from January 2014 to December 2018 to identified 600 singleton pregnancies who tested for gestational diabetes by 100g OGTT. They divided into 2 groups equally. Pregnancy outcomes of women who had a single abnormal value were compared with women who had a negative test. Pregnancies with prior cesarean delivery were excluded.Results: Between two groups, the baseline characteristic of the patients were comparable except maternal age [33 (26.37) versus 30 (24.36), p = 0.001] was statistically higher in the study group. Even though the most of adverse pregnancy outcome tend to be higher in study group, but not reach the significance, the rate of cesarean delivery (35.7% versus 25.7, RR 1.39, 95% CI 1.08-1.78), postpartum hemorrhage (38.6% versus 30%, RR 1.29, 95% CI 1.03-1.62) and NICU admission (5.6% versus 1.0%, RR 5.69, 95% CI 1.80-17.96) were higher in study group with significant difference. Caesarean delivery (38.8% versus 28.7%, p = 0.04) and NICU admission (9.5% versus 1.9%, p = 0.0003) were more common if the blood glucose greater than 10 mg/dl normal level.Conclusions: A single abnormal value of 100 g OGTT had significant impact on pregnancy outcome such as increase cesarean section, postpartum hemorrhage and NICU admission.
      PubDate: 2020-03-25
      DOI: 10.18203/2320-1770.ijrcog20201070
      Issue No: Vol. 9, No. 4 (2020)
       
  • Non-haemorrhagic causes of obstetrical intensive care unit admissions in
           tertiary care setting

    • Authors: Preet Kamal, Surinder Kaur, Harleen Kaur, Madhu Nagpal
      Pages: 1392 - 1397
      Abstract: Background: Management of critically ill obstetric patients involve intensive monitoring in intensive care unit. In present scenario there are significant number of obstetric patients with sepsis, tropical diseases and medical illness that require ICU care. The aim of this study was to evaluate in more detail the non-haemorrhagic causes of obstetric ICU admissions and to identify and adopt high risk strategies as prime learning objective.Methods: It is a prospective ongoing study conducted in 50 patients in SGRDUHS, Amritsar from December 2016 to October 2019, who were admitted in obstetric ICU, out of them 30 cases were attributed to non-haemorrhagic obstetric causes. All demographic parameters along with gestational age, diagnosis on admission, intervention done prior to shift to ICU and details of treatment given in ICU were evaluated. Patient outcome, review of mortality and area of improvement were also noted.Results: Majority of the patient (70.1%) were admitted in 3rd trimester. Obstetric sepsis (13.33%), infective diseases (16.66%), tropical conditions (16.66%), medical disorders (26.66%) and hypertensive disorders (26.66%) were the major causes of admission to obstetric ICU. There were 33.3% mortalities observed in present study and 40% were due to respiratory failure. In ICU mechanical ventilation was done in 63.3% cases and blood products were given in 33.3% of patients.Conclusions: A multidisciplinary approach is ideal to handle non-haemorrhagic situations especially related to medical disorders and tropical diseases. Review of the ICU admissions and periodic audit can improve management of morbidities as well as reduce maternal mortalities.
      PubDate: 2020-03-25
      DOI: 10.18203/2320-1770.ijrcog20201007
      Issue No: Vol. 9, No. 4 (2020)
       
  • Incidence of congenital uterine malformation in fertile female population
           undergoing laparoscopic tubal ligation at a tertiary care centre, Lucknow,
           Uttar Pradesh, India: a study of six years

    • Authors: Deepali Srivastava, Sandeepa Srivastava
      Pages: 1398 - 1401
      Abstract: Background: Congenital uterine anomalies are not only uncommon, many are asymptomatic. A uterine malformation is a type of female genital malformation resulting from an abnormal development of the mullerian ducts during embryogenesis. The prevalence of uterine malformation is estimated to be 6.7% in general population.Methods: This study has included 2423 women who attended family planning OPD in KGMU for purpose of laparoscopic tubal ligation along with general and systemic examination. During the laproscopic ligation procedure the observed uterine anomalies were noted and compared to the data available in the existing medical literature.Results: Out of 2423 females included in this study during 2011-2016, 104 (4.29%) females were diagnosed with uterine anomalies. The Commonest uterine anomaly was arcuate uterus which was seen in 77 patients. (3.1%). Uni-cornuate uterus was seen in 19 patients (0.8%) and bi-cornuate uterus was seen in 9 patients (0.3%). 3 out of these were uni-cornuate uterus with rudimentary horn.Conclusions: Though the congenital uterine malformations are frequent findings in infertile patients but few malformations like uni-cornuate uterus, arcuate uterus and bicornuate uterus are although rare but seen in fertile females, showing their lesser impact on pregnancy and its outcome.
      PubDate: 2020-03-25
      DOI: 10.18203/2320-1770.ijrcog20201006
      Issue No: Vol. 9, No. 4 (2020)
       
  • Serum magnesium at 18-20 weeks of gestation: can it be a predictor of
           gestational hypertension and fetomaternal outcome'

    • Authors: Sasikala Kathiresan, Agalya Angelina Sanjevrajah, Jeyashree Kathiresan
      Pages: 1402 - 1406
      Abstract: Background: Hypertensive disorders of pregnancy (HDP) is a major cause of maternal, fetal morbidity and mortality complicating 10% of all gestations. As effective treatments are very limited, prediction of HDP occurrence is most importance. Though many biomarkers have shown relationship with HDP, serum magnesium (Mg) has shown better predictor as involved in maintaining vascular contractility, tone. This study is intended to analyse incidence of GHT and fetomaternal outcome in pregnant women with normal and low serum magnesium level measured at mid trimester (18-20 weeks).Methods: A total of 105 consecutive singleton pregnant women in between 18-20 weeks of gestation attending OBG outpatient department were enrolled. After obtaining the informed consent, structured proforma was used to collect demographic, clinical details. Serum magnesium was measured by the colorimetric method and study participants were divided into two groups based on Mg cut off 1.5 mg/dl and followed up throughout pregnancy for fetomaternal outcome.Results: This study results revealed that 35.2% (37/105) pregnant women had serum Mg level < 1.5 mg/dl and mean value of Mg of all participant is 1.7 mg/dl, just above the lower limit. During follow-up of these two groups, statistically significant correlation between serum Mg levels (< 1.5 mg/dl) with GHT (8/12) occurrence and pre term birth was found. Other fetomaternal outcome not had significant correlation.Conclusions: As per the findings, serum Mg concentration measurement in between 18-20 weeks can be considered as a one of the predictors for subsequent occurrence of maternal outcome of GHT and fetal outcome of pre-term birth.
      PubDate: 2020-03-25
      DOI: 10.18203/2320-1770.ijrcog20201024
      Issue No: Vol. 9, No. 4 (2020)
       
  • Etiological factors and maternal outcome in pregnancies with
           malpresentation: an observational study

    • Authors: S. Shruthi, A. Anisha Apollo
      Pages: 1407 - 1411
      Abstract: Background: The most common presentation of the fetus is malpresentation. These include breech, face, brow, shoulder and compound presentations. Malpresentations of fetus complicate labor in about 5% of pregnancies. To find out the incidence of malpresentation, to analyze etiological factors of malpresentation, to evaluate the maternal outcome in cases with a malpresentation.Methods: This prospective observational study was done in, Chengalpattu Government medical college and hospital. Study period from October 2018 to September 2019. Pregnancies with malpresentation presenting to the department of obstetrics and gynecology at CMCH were included in the study.Results: A total of 680 malpresentation were admitted in this period were included in this study. The incidence of malpresentation during the study period was 7.72%. The incidence of the breech was 4.38%, transverse lie 1.11%, face 0.28%, brow 0.05% and compound presentation 0.13%. The common causes were prematurity, multiple gestations, grand multiparty, IUGR, oligohydramnios, anomalies of uterus, polyhydramnios, contracted pelvis, placenta previa, hydrocephalus, prematurity was reported as the commonest cause of breech presentation and multiparty for transverse lie, face and brow presentations. The most common complication was obstructed labor 6.9% followed by post-partum hemorrhage 3.65%. There was no maternal death due to malpresentation during the period of study.Conclusions: Early diagnosis and timely management can prevent the complications of labor associated with a malpresentation. Delivery should be planned at centers which have expertise in conducting vaginal delivery in malpresentation with good intrapartum monitoring and with facilities for cesarean section for the better feto-maternal outcome.
      PubDate: 2020-03-25
      DOI: 10.18203/2320-1770.ijrcog20200859
      Issue No: Vol. 9, No. 4 (2020)
       
  • Perception about pap smear screening test among females attending a
           tertiary care center

    • Authors: A. Shantha, Priya Somu
      Pages: 1412 - 1415
      Abstract: Background: Knowledge regarding the screening test (Pap smear) among women has been proven to be a significant predictor of first-time screening and in turn helps in early diagnosis and treatment of the disease. Hence this study was conducted to assess the knowledge and practice of pap smear screening test for cervical cancer among the women attending the outpatient department of obstetrics and gynecology.Methods: The cross-sectional study was conducted by the department of obstetrics and gynecology, at Sri Muthukumaran Medical College Hospital and Research Institute, among the women attending the outpatient department, during the month of August 2019. A total of 180 participants were included in the study. Data was entered in Microsoft excel and data analysis was done using statistical package for social sciences (SPSS) version 17.Results: Knowledge about carcinoma cervix and pap smear were present among 86.7% and 74.4% of participants, respectively. About the practice of pap smear, only 24.4% of the study participant have undergone the screening test and only two participants had taken the HPV vaccine.Conclusions: Most of the women had poor attitude and practice related to screening and vaccination for cervical cancer. But their attitude is favorable for screening. Hence promotion of free regular health check-up and vaccination for cervical cancer among general population might increase the awareness and decrease the disease burden.
      PubDate: 2020-03-25
      DOI: 10.18203/2320-1770.ijrcog20201064
      Issue No: Vol. 9, No. 4 (2020)
       
  • Co-relation of endometrial thickness by transvaginal sonogram with
           histopathology pattern in abnormal uterine bleeding: a study from South
           India

    • Authors: Chippy Tess Mathew, Uma Maheswari, Karthikeyan Shanmugam
      Pages: 1416 - 1421
      Abstract: Background: Under normal circumstances, a woman's uterus sheds a limited amount of blood during each menstrual period (around 80 ml). Bleeding that occurs erratically or excessive menstrual bleeding is called abnormal uterine bleeding (AUB). The causes of AUB are many and varied. Initial investigations include transvaginal ultrasound and histopathologic assessment of the endometrium. Objective of this study was to evaluation of endometrial thickness with trans-vaginal ultrasound and its correlation with histopathology by dilatation and curettage in abnormal uterine bleeding. To determine the efficacy of transvaginal ultrasound in evaluating the endometrial thickness. To correlate the endometrial thickness by transvaginal ultrasound with endometrial histopathology in women with AUB.Methods: It is a retrospective observational study. All reproductive and perimenopausal age group women who underwent dilatation and curettage for abnormal uterine bleeding during the period June 2014-June 2016 was taken and analyzed and correlated with their endometrial thickness measured with Transvaginal ultrasound.Results: Around 478 patients who underwent endometrial sampling over a period of two years were analyzed. Maximum number of patients were in the fourth decade and the overweight category 36.6%. Proliferative endometrium was the most common histopathologic picture (44.76%). Detection of precancerous lesions were-5.87% and endometrial cancer was 1.05%.Conclusions: An ET of 8 mm and above gave 100% sensitivity and negative predictive value for precancerous and cancerous lesions.
      PubDate: 2020-03-25
      DOI: 10.18203/2320-1770.ijrcog20201198
      Issue No: Vol. 9, No. 4 (2020)
       
  • Association of menopausal sexual dysfunction with demographic and
           obstetric factors in postmenopausal women in Hamadan, Iran

    • Authors: Narges Alavipour, Seyedeh Zahra Masoumi, Farideh Kazemi, Parisa Parsa
      Pages: 1422 - 1428
      Abstract: Background: Sexual dysfunction is a common menopausal problem that may be affected by demographic factors. The present study aimed to determine demographic and obstetric factors affecting sexual dysfunction in menopause.Methods: The present cross-sectional descriptive-analytical study was conducted on 315 postmenopausal women in Hamadan. The research instruments included demographic questionnaire, and female sexual function index (FSFI). Univariate and multivariate linear regressions were used to investigate the association of different factors and sexual function at a significance level of less than 0.05.Results: The participants' mean age was 54.15±4.24 years. Their mean sexual function score was 18.92±4.25 indicating poor sexual function. The multivariate analysis indicated that increasing the number of spouse marriage, sexual function score decreased by 2.45 (p=0.006). Furthermore, the sexual function score in those, who were not satisfied with their marriage, was 5.58 points lower than those who were satisfied with their marriage status (p <0.001).Conclusions: Given the relationship between number of spouse marriage and marital satisfaction with sexual function in postmenopausal women, it is necessary to design and implement training sessions for them. 
      PubDate: 2020-03-25
      DOI: 10.18203/2320-1770.ijrcog20201199
      Issue No: Vol. 9, No. 4 (2020)
       
  • Completeness of information in electronic compared with paper-based
           patients’ records in a maternity setting in Dakar, Senegal

    • Authors: Mame D. Ndiaye, Mamour Gueye, Simon B. Ndour, Ndama Niang, Ndeye G. Fall, Khalifa Fall, Abdoulaye Diakhate, Mouhamadou Wade, Aliou Diouf, Moussa Diallo, Magatte Mbaye
      Pages: 1429 - 1433
      Abstract: Background: Evaluate the consistency of information in paper-based records when registered in parallel with an electronic medical record.Methods: The study was performed at PMSHC in Dakar Senegal. From the end of year 2016, patients’ files were recorded on both paper-based and electronically. Additionally, previous records were electronically registered. To investigate the completeness of records before and after the electronic recording system has been implemented, information about some maternal and fetal/neonatal characteristics were assessed. When the variable was recorded, the system returned 1, unrecorded variables were coded as 0. We then calculated, for each variable, the unrecorded rate before 2017 and after that date. The study period extended from 2011 to June 2019, a nearly ten-year period. Data were extracted from E-perinatal to MS excel 2019 then SPSS 25 software. Frequencies of unrecorded variables were compared with chi-squared test at a level of significance of 5%.Results: A total of 48,270 unique patients’ records were identified during the eight-year period.  Among the study population, data for patients’ age, address and parity were available most of the time before and after 2017 (0.5% missing data versus 0.3% for age and 2.6% versus 1.3% for home address and from 0.3% to 0.0% for parity). However, phone number, maternal weight, maternal height, last menstrual period and blood group were found to be missing up to 96% before 2017. From 2017, these rates experienced a sudden decrease at a significant level: from 82.4% to 27.8% for phone number, from 96% to 56.3% for maternal weight and from 60.1% to 21.3% for blood group. Regarding newborns’ data, it was found that fetal height, head circumference and chest circumference were missing up to just under 25% before 2017. After that date, their completeness improved and flattened under 5%.Conclusions: Structured and computerized files reduce missing data. There is an urgent need the Ministry of health provides hospitals and health care providers with guidelines that describes the standardized information that should be gathered and shared in health and care records.
      PubDate: 2020-03-25
      DOI: 10.18203/2320-1770.ijrcog20201200
      Issue No: Vol. 9, No. 4 (2020)
       
  • Abdominal sacrohysteropexy versus vaginal hysterectomy for pelvic organ
           prolapse in young women

    • Authors: Anuja V. Bhalerao, Vaidehi Ajay Duddalwar
      Pages: 1434 - 1441
      Abstract: Background: Pelvic organ prolapse (POP) is the descent of the pelvic organs beyond their anatomical confines. The definitive treatment of symptomatic prolapse is surgery but its management in young is unique due to various considerations. Aim of this study was to evaluate anatomical and functional outcome after abdominal sacrohysteropexy and vaginal hysterectomy for pelvic organ prolapse in young women.Methods: A total 27 women less than 35 years of age with pelvic organ prolapse underwent either abdominal sacrohysteropexy or vaginal hysterectomy with repair. In all women, pre-op and post-op POP-Q was done for evaluation of anatomical defect and a validated questionnaire was given for subjective outcome.Results: Anatomical outcome was significant in both groups as per POP-Q grading but the symptomatic outcome was better for sacrohysteropexy with regard to surgical time, bleeding, ovarian conservation, urinary symptoms, sexual function.Conclusions: Sacrohysteropexy is a better option.
      PubDate: 2020-03-25
      DOI: 10.18203/2320-1770.ijrcog20201201
      Issue No: Vol. 9, No. 4 (2020)
       
  • The impact of sexual activity during the third trimester of pregnancy on
           labor outcome in nulliparous women

    • Authors: Janice H. Simo, Pascal Foumane, Ngo Um E. Meka, Julius S. Dohbit, Felix Essiben, Emile T. Mboudou
      Pages: 1442 - 1447
      Abstract: Background: In the environment, there’s not enough studies on the effects of sexual activity during pregnancy on labor outcome, especially for nulliparous women. The aim was to assess the effects of sexual activity during the third term of pregnancy on the outcome of labor in nulliparous women.Methods: A prospective cohort study on labor was carried out for 11 months at the labor ward of the Yaoundé gynaeco-obstetric and pediatric Hospital. In this study compared women were exposed to at least one unprotected sexual intercourse with vaginal ejaculation per week during the third trimester of pregnancy (exposed group), to those who had less than one unprotected sexual intercourse per week (non-exposed group).Results: Of the 1123 primiparous women who gave birth within the study period, 426 consented to enroll in the study. Amongst these women, 186 women in the exposed group compared to 240 women in the non-exposed group. Intercourse during pregnancy predisposed on arrival into the labor ward to a Bishop’s score ≥7 (RR = 1.94; CI = 1.63-2.3) and within the course of labor to a spontaneous per vaginal delivery (RR = 1.18; CI = 1.06-1.31) and an active phase duration <6 hours (RR = 1.52; CI = 1.36-1.7). Furthermore, sexual intercourse during pregnancy protected against labor induction (RR = 0.21; CI = 0.12-0.36), dystocia (RR = 0.36; CI =  0.27-0.49), cesarean section (RR = 0.29; CI = 0.15-0.55), episiotomy (RR = 0.56; CI = 0.36-0.87) and an Apgar  score <7 at the first minute of birth (RR = 0.31; CI = 0.14-0.7).Conclusions: Sexual activity during pregnancy improves the prognosis of labor in primiparous women. In the absence of contraindications, consented unprotected heterosexual vaginal intercourse should be promoted in nulliparous women.
      PubDate: 2020-03-25
      DOI: 10.18203/2320-1770.ijrcog20201202
      Issue No: Vol. 9, No. 4 (2020)
       
  • Prospective observational study to evaluate the efficacy of labetalol
           versus nifedipine in the management of preeclampsia

    • Authors: Sarulatha D., Menaga M.
      Pages: 1448 - 1450
      Abstract: Background: Hypertensive disorders of pregnancy are the common medical disorders in pregnancy. It has effects both on expectant mother and fetus. Pre-eclampsia is a pregnancy specific multisystem disorder of unknown etiology, and accounts for 12-18% of maternal mortality. There is general consensus that maternal risk is decreased by antihypertensive treatment that lowers very high blood pressure. Objective of this study was to study the efficacy of oral labetalol versus oral Nifedipine in the management of preeclampsia in the antepartum and intrapartum period.Methods: The present study was conducted in a tertiary care centre, Chennai from October 2013 to September 2014. It was a prospective observational study done in antenatal ward and labor ward. All antenatal women diagnosed to have pre-eclampsia, irrespective of gestation are included in this study.Results: Age distribution of PIH patients and the maximum number of patients were 20-25 years of age. maximum patients of severe preeclampsia were primigravida. Both systolic and diastolic BP in the two groups (oral labetalol and oral Nifedipine groups) were not statistically significant as the p value is >0.005.Conclusions: From this study, authors found that both oral labetalol and oral nifedipine are effective and well tolerated when used for rapid control of blood pressure in severe hypertension of pregnancy.
      PubDate: 2020-03-25
      DOI: 10.18203/2320-1770.ijrcog20201203
      Issue No: Vol. 9, No. 4 (2020)
       
  • Effect of epidural analgesia on the duration of labour and pains: a
           comparative study

    • Authors: Pallavi Chauhan, S. D. Shirodkar
      Pages: 1451 - 1456
      Abstract: Background: Epidural analgesia is regional anaesthesia that blocks pain in a particular region of the body. The use of Epidural Analgesia (EA) in labor is widespread in modern labor ward practice, and its benefits in terms of pain relief are well-recognized. Objective of this study was to study the effect of epidural analgesia on the duration of labour and pains.Methods: The present study was conducted on 60 women in the department of obstetrics and gynecology at Topiwala National Medical College, Mumbai during a period from October 2014 to January 2017. The women requesting EA were assigned as the study group (Group A - 30 cases) and women not receiving EA were included in the control group (Group B - 30 cases).Results: The duration of active phase of first and second stage of labour was found to be prolonged in patients who received EA as compared to control group. An increase in number of caesarean sections and requirement of oxytocin augmentation was found to be more in Group A as compared to Group B. There was no statistically significant difference in Apgar score of newborns at 1 min and 5 min in both the groups. The patients demanding epidural drug had better pain relief during labour. In Group A, 17% of patients and in Group B, 7% of patients had nausea and vomiting. Other side effects were minimal.Conclusions: Epidural analgesia is not a totally free of disadvantages, it is the most effective mode of pain relief available compared with other techniques. The addition of patient-controlled epidural analgesia and innovations using new technologies enhance patient satisfaction.
      PubDate: 2020-03-25
      DOI: 10.18203/2320-1770.ijrcog20201204
      Issue No: Vol. 9, No. 4 (2020)
       
  • Role of bundled intervention in reducing surgical site infection rate in
           gynecologic surgeries

    • Authors: Nisha Singh, Shweta Rai, Shuchi Agrawal, Gopa Banerjee, Renu Singh
      Pages: 1457 - 1462
      Abstract: Background: Surgical site infection (SSI) is most common nosocomial infection (15%) among surgical patient’s and contributes significantly to morbidity and mortality. CDC (2015) provides “bundled intervention for prevention of SSI. The present study was planned to evaluate the feasibility and usefulness of these bundled intervention in reducing SSI in our setup. Objectives of this study to study the effect of bundled interventions on SSI in gynaecologic surgery.Methods: A total 50 cases  undergoing gynecological surgery in elective OT included in pilot group and bundled intervention followed  these pilot group cases compared with 50 control group operated in same OT in which bundled intervention not followed outcome measures recorded were Incidence of SSI, type of SSI, need for antibiotic usage, need for secondary suturing, duration of hospital stay.Results: Out of 50 subjects in pilot group, five developed signs and symptoms of SSI giving an SSI rate of 10%. Out of those five, two had superficial SSI and three had deep SSI, none of the patient had organ space SSI.SSI rate in 50 cases operated in the same operating room during the same time period without use of bundled interventions (control group) was 12%.Conclusions: Bundled approach is easy and feasible in all setups. It adds only three extra minutes to the total duration of the surgery with risk reduction of SSI.
      PubDate: 2020-03-25
      DOI: 10.18203/2320-1770.ijrcog20201205
      Issue No: Vol. 9, No. 4 (2020)
       
  • Analysing trends in caesarean sections at a tertiary care teaching
           hospital in South India: findings from a clinical audit using Robson
           criteria

    • Authors: Aruna Kumari Yerra, Mohammed Ismail Khan
      Pages: 1463 - 1469
      Abstract: Background: Caesarean section (CS) is a potentially life-saving surgery when performed for indicated reasons. The rates of CS deliveries have sky rocketed in the last few years. A CS does not come without complications and risk and therefore its trends in all institutes should be audited for ensuring optimization of obstetric care standards.Methods: The study was conducted as a retrospective analysis of all the CS deliveries for 12 months and their categorization using the WHO recommended Robson ten group classification system; with an aim to evaluate and understand the indication for each CS performed in the institute. The Robson was further subclassified to closely understand the circumstances in which the CS was performed in each group.Results: In this study evaluated a total of 2831 deliveries out of which 1557 (55%) were CS births. Out of these CS births, 48.5% were indicated for emergency indications. Class 5, 1 and 10 were the main contributors to the CS rate with 50.6%, 19.3% and 10% contributions respectively. From a total of 799 patients with previous CS, only 12.1% could have a successful trial of scar. The most common indications documented for Group 1 was foetal distress, cephalo pelvic disproportion and prolonged labour, in decreasing order. Among the singleton pre-terms who had a CS, a majority (92.3%) were operated before the onset of labour.Conclusions: The audit helped to understand the trends of CS in the institute and helped in the realizing that all the CS in the institute has questionable indications. This led to implementation of clinical and administrative reforms to ensure a reduction in unnecessary CS being performed. 
      PubDate: 2020-03-25
      DOI: 10.18203/2320-1770.ijrcog20201206
      Issue No: Vol. 9, No. 4 (2020)
       
  • A prospective interventional study of intra-caesarean copper intrauterine
           contraceptive devices insertion in a teaching hospital in a rural medical
           college in Telangana, India

    • Authors: Gillella Vijayalakshmi, Kavitha Kothapally, Uma Bhashyakarla, Vasantha Kavati
      Pages: 1470 - 1476
      Abstract: Background: Providing quality contraceptive services to women is essential for achieving maternal and child health. Objective of this study was to evaluate the efficacy of intra-caesarean insertion of copper IUCDs as postpartum contraception. To study the side effects of intra caesarean copper device. To study the continuation rates of intra-caesarean copper IUCDs. To study the acceptability of intra-caesarean copper IUCD as immediate postpartum contraceptive.Methods: The prospective study was undertaken at Bhaskar medical college and general hospital, Yenkepally, Moinabad, Telangana, between January 2016 and March 2018 after ethical committee clearance. About 60 pregnant women were enrolled into the study after an informed written consent regarding the procedure, benefits and complications and the need for follow up for at least one year. Copper T 380A/multiload copper 375 was inserted into the uterine cavity after delivery of the placenta and membranes during caesarean section. Patients were followed up at 6 weeks, 6 months and one-year intervals for any complaints, visibility of threads and for ultrasound examination for position of copper IUCDs in the uterus. Data analysis was done using Microsoft excel 2016.Results: Nearly 48.33% continued intra-caesarean copper IUCDs for more than 1 year. 70% did not have any complaints. 86.67% came for more than one follow-up visit. 47% had copper IUD threads visible by one year. No case of perforation either during insertion or during continuation was noted. None conceived with copper IUCD in situ. Removal of copper IUCD was also easy and none required hysteroscopic removal.Conclusions: Intra-caesarean copper IUCD insertion is a safe and effective long acting reversible contraceptive method in the postpartum period.
      PubDate: 2020-03-25
      DOI: 10.18203/2320-1770.ijrcog20201207
      Issue No: Vol. 9, No. 4 (2020)
       
  • A study to correlate association between vitamin D with fibroid and its
           supplementation in the progression of the disease

    • Authors: Somila Xess, Jaiprakash Sahu
      Pages: 1477 - 1481
      Abstract: Background: Uterine fibroids, or leiomyomas are the most common benign tumors of the female reproductive tract, affecting up to 60% of Indian women with only 25% of women who are symptomatic. Symptoms do not always correlate with the size, number, or location of the fibroids. Recent studies suggest that hypovitaminosis D is associated with an increased risk of uterine fibroids.Methods: Total 110 women diagnosed with fibroid in USG were included in the study. Inclusion and exclusion criteria were applied and size of the fibroid noted. 60 women were included in the study group who took Vitamin D supplementation and 50 women in the control group who didn’t perform the study properly.Results: The growth pattern of fibroids with study group under supplementation with 25-OH-D3 seems to be stable, with no increases or decreases in size or number of identified lesions. Instead, women in control group, who did not perform appropriate vitamin D supplementation seem to have a slight but significant increase in size of the lesions.Conclusions: It was seen that hypovitaminosis D was associated with fibroid and thus supplementation with Vitamin D helped in the shrinkage of fibroid or slower the progression of the disease.
      PubDate: 2020-03-25
      DOI: 10.18203/2320-1770.ijrcog20201208
      Issue No: Vol. 9, No. 4 (2020)
       
  • Comparison of adnexal torsion in different phases of women’s life: a
           retrospective cohort study

    • Authors: Karthiga Prabhu J., Shanmugapriya C., Sunita Samal, Balaji Ramraj
      Pages: 1482 - 1486
      Abstract: Background: Ovarian torsion is one of the most common causes of emergency surgery in gynecology. Though it is more common in reproductive age group, it can occur in extremes of age group. So, we had analysed the clinical presentation, surgical characteristics, and causes of adnexal torsion among adolescent population, reproductive-age women, and postmenopausal women.Methods: Patients with adnexal torsion who were treated in department of obstetrics and gynecology, SRM Medical College Hospital and Research Centre from October 2016 to March 2019 were retrospectively analyzed.Results: Among the 53 cases of adnexal torsion during the study period, maximum (38, 71.6%) were in the reproductive age group. There were three patients with ovarian torsion during pregnancy. Acute pain abdomen was the significant presenting symptom in adolescent group compared to other two group (100% versus 80.6% versus 40%, p = 0.03). Adnexal pathology was in the ovary in 76% and isolated tubal pathology in 5%. Bilateral salpingo-oophorectomy with or without total abdominal hysterectomy was more commonly performed in postmenopausal patients (100%), as opposed to conservative surgery- detorsion and cystectomy in premenopausal women (56%). In Adolescent patients 62% had polycystic ovaries as intraoperative finding. Histopathology were benign except for a patient in postmenopausal age group who had granulosa cell tumour.Conclusions: An early identification of adnexal torsion is necessary in order to achieve conservative treatment in order to maximize the future reproductive potential in younger patients.
      PubDate: 2020-03-25
      DOI: 10.18203/2320-1770.ijrcog20201209
      Issue No: Vol. 9, No. 4 (2020)
       
  • Predicting pregnancy outcomes from homocysteine level: an evidence from a
           North Indian study

    • Authors: Shaina Chamotra, Kushla Pathania, S. K. Verma, Ankit Chaudhary
      Pages: 1487 - 1492
      Abstract: Background: Hypertensive disorders of pregnancy are a major cause of adverse pregnancy outcomes. Though the etiology of spectrum of vascular disorders of pregnancy is still not understood completely, yet abnormally elevated homocysteine level has been implicated in the causal pathway and pathogenesis. Hyperhomocysteinemia has been significantly associated with increased risk of poor maternal and foetal outcomes in terms of PIH, abruption, IUGR, recurrent pregnancy loss, intrauterine death and prematurity.Methods: The present prospective study was conducted among 180 pregnant women (57 exposed and 123 non exposed) in Kamla Nehru State Hospital for Mother and Child, IGMC Shimla, Himachal Pradesh with an objective of determining association of abnormally elevated homocysteine level in pregnancy and adverse pregnancy outcomes. Socio-demographic, clinical, biochemical including homocysteine level, laboratory, ultrasonographic parameters and foeto-maternal outcomes of pregnancy of all the participants were documented.Results: The mean homocysteine level of exposed group (23.26±10.77 µmol/L) was significantly higher than the unexposed group (8.99±2.47 µmol/L). Among hyperhomocysteinemic subjects, 10.5% had abruption, 15.8% had PRES and 8.7% PPH which was significantly higher than normal subjects. Similarly, patients with homocysteinemia had significantly higher proportion (21.3%) of poor Apgar score, more (41.9%) NICU admissions and higher frequency (4.7%) of meconium aspiration syndrome.Conclusions: The present study generates necessary evidence for associating abnormally elevated homocysteine levels with pregnancy related hypertensive ailments and adverse pregnancy outcomes. It further demands the need of robustly designed studies and trials to further explore the phenomenon. Moreover, it emphasizes on a simple and timely intervention like estimating the much-neglected homocysteine levels during pregnancy which can definitely contribute in predicting and preventing adverse perinatal outcomes.
      PubDate: 2020-03-25
      DOI: 10.18203/2320-1770.ijrcog20201212
      Issue No: Vol. 9, No. 4 (2020)
       
  • Vitamin D deficiency and its correlation with pregnancy outcome

    • Authors: Maya Menon, Sridevi T. A., Thuthi Mohan, Aruna B. Patil
      Pages: 1493 - 1497
      Abstract: Background: There is a growing concern about the high prevalence of vitamin D deficiency and its relationship with variety of diseases worldwide. The objective of this study was to determine the prevalence of vitamin D deficiency and its association with pregnancy outcome.Methods: This was a cross sectional study conducted among 150 antenatal women from October 2014 to April 2015. Data containing socio-demographic details, vitamin D level, serum calcium, pregnancy complications and growth situation of newborns were collected and analyzed.Results: A total 150 pregnant women participated in the study, 75.3% were vitamin D deficient, 22.1% vitamin D insufficient and 2.6% normal. There was no significant adverse maternal outcome. NICU admission was required in 28.3 and 15.2% in the vitamin D deficient and insufficient groups respectively.Conclusions: Women from different socioeconomic status, irrespective of parity and educational levels had vitamin D deficiency and insufficiency. This study fails to show a relation of vitamin D deficiency with other high-risk factors of pregnancy and does not show any adverse fetal outcome.
      PubDate: 2020-03-25
      DOI: 10.18203/2320-1770.ijrcog20201211
      Issue No: Vol. 9, No. 4 (2020)
       
  • Moderate to severe maternal anaemia in pregnancy and its impact on
           perinatal outcome in tertiary care hospital

    • Authors: Ashram Khatana, Suniti Verma, Ram Narain Sehra, Kanti Yadav
      Pages: 1498 - 1502
      Abstract: Background: Anaemia is the commonest medical disorder in pregnancy and has a varied prevalence, etiology and degree of severity in different populations. The purpose of this study was to evaluate the prevalence of maternal anaemia in pregnancy and its impact on perinatal outcome.Methods: This was a prospective observational study conducted in department of obstetrics and gynecology JLN Hospital Ajmer, Rajasthan, India from October 2015 to December 2016. Total 325 pregnant women were included in the study who fulfilled the inclusion criteria and found to have moderate to severe anaemia.Results: Prevalence of anaemia in pregnancy was 80% in present study. Perinatal mortality was 13.3% in moderate anaemia and in severe anaemia 42%. In present study maximum 56% of cases were in the age group of 20-25 years, and maximum number of cases were primigravida (33.84%). Out of 225 cases of moderate anaemia only 50 cases (22.22%) had antenatal check-up once or twice. Out of 225 cases of moderate anaemia, 66.66% cases were rural and 33.33% cases were of urban group. Fetal outcome in present study was in form of 49.23% premature birth with 33.12% perinatal mortality.Conclusions: Maternal anaemia in pregnancy is associated with illiteracy, low socioeconomic status, multiparity, inadequate antenatal care and rural geographic area.  Severe anaemia was associated with high perinatal mortality.
      PubDate: 2020-03-25
      DOI: 10.18203/2320-1770.ijrcog20201210
      Issue No: Vol. 9, No. 4 (2020)
       
  • Obstructed labour at Usmanu Danfodiyo university teaching hospital Sokoto:
           a five-year review

    • Authors: Ahmed Yakubu, Tukur Dabo Sagir, Abubakar A. Panti, Garba Jamila A., Isah Usman Mani, Anas Rabiu Funtua, Aliyu Muhammed Chappa, Mbakwe Markus
      Pages: 1503 - 1506
      Abstract: Background: Obstructed labour is an obstetric emergency and one of the major causes of maternal and perinatal morbidity and mortality in the developing countries, Nigeria inclusive. The aim of this study was to determine the prevalence, causes and feto-maternal outcome of cases of obstructed labour managed at Usmanu Danfodiyo University Teaching Hospital Sokoto from 1st January, 2014 to 31st December, 2018.Methods: This was a retrospective review of all cases of obstructed labour managed at Usmanu Danfodiyo University Teaching Hospital Sokoto over 5 years. List of cases managed during the study period was obtained and case notes were retrieved. Relevant information such as age, booking status, parity, educational status, address, causes, mode of delivery and both maternal and foetal outcomes were obtained from the case notes. Data analysis was done using statistical package for social sciences version 22 (SPSS Inc, Chicago, IL, USA).Results: A total two hundred and seventy-six cases of obstructed labour were managed out of the 15,452 total deliveries during the study period. This gives an obstructed labour prevalence of 1.79%. The major cause of obstructed labour identified in this study was Cephalopelvic disproportion (74.6%) and majority of the patients were delivered by emergency lower segment caesarean section (70.6%). Up to 32.3% of the patients had no maternal complications and also 42.3% of them had live birth with no fetal complication. However, 20.2% of these patients had ruptured uterus and 37.9% of them had still birth, while 19.8% had live birth complicated by birth asphyxia.Conclusions: This study has found that obstructed labour resulted in adverse maternal and perinatal outcome. Hence, there is need to prevent obstructed labour in order to avert this consequence.
      PubDate: 2020-03-25
      DOI: 10.18203/2320-1770.ijrcog20201213
      Issue No: Vol. 9, No. 4 (2020)
       
  • The use of NAAT- PCR to determine asymptomatic chlamydia and gonorrhoea
           infections in infertile patients undergoing hysterosalpingogram at the
           federal medical centre, Yenagoa, South-South Nigeria

    • Authors: Chibuzor P. Oriji, Kelvin E. Kiridi, Dennis O. Allagoa, James E. Omietimi, Idowu B. Orisabinone, Olakunle I. Makinde, Chidiebere Njoku
      Pages: 1507 - 1514
      Abstract: Background: The roles of Chlamydia trachomatis and Neisseria gonorrhoeae in the aetiology of infertility due to tubal occlusion have been established by various studies. These organisms may lead to pelvic infection by ascending into the upper genital tract through any instrumentation like hysterosalpingography. The objectives were to determine the prevalence of asymptomatic chlamydial and gonorrhoeal infections of the genital tract among women being investigated for infertility referred for hysterosalpingography; the relationship of these infections with tubal pathologies; and if routine endo-cervical screening and prophylactic antibiotics be recommended for these patients.Methods: This was a descriptive cross-sectional study. The study population consisted of consecutive 220 infertile women that met the inclusion criteria for this study. Consent was obtained. Endo-cervical swab was taken for NAAT-PCR for Chlamydia trachomatis and Neisseria gonorrhoeae. Hysterosalpingography was carried out. Data was analyzed using SPSS (version 22).Results: Amongst the 220 women, 9 (4.1%) had asymptomatic chlamydia infection. None had gonorrhoea infection and 211 (95.9%) had none of these two organisms. Forty-eight (21.9%) of the 220 women had bilateral tubal blockage and 9 (18.8%) out of these 48 women had asymptomatic infection with Chlamydia trachomatis.Conclusions: There is a statistically significant association between tubal blockage and chlamydia infection (p = 0.00) [RR 4.31 (3.37-5.50)]. There was no evidence to recommend routine screening/antibiotics considering the low prevalence of microbes and the absence of post-HSG pelvic infection. Results from a multicenter randomized controlled trial will be more representative.
      PubDate: 2020-03-25
      DOI: 10.18203/2320-1770.ijrcog20201214
      Issue No: Vol. 9, No. 4 (2020)
       
  • Will women’s choice of position in first stage of labor affect labor
           process'

    • Authors: Shubha Rao, Shylabhirami Sridharan, Akhila Vasudeva, Roopa P. S.
      Pages: 1515 - 1519
      Abstract: Background: Controlling the process of childbirth has disabled the parturient to embrace the most spontaneous position of delivery but constricting her to assume a recumbent position. Objective of this study was to study if alternating comfortable maternal positioning i.e., recumbent and alternative position have any influence in the process of labor, type of delivery, neonatal well-being.Methods: Study conducted an observation study on term pregnant women. Study inclusion criteria included all term pregnant women. Exclusion criteria included multiple pregnancies, preterm patient, severe pre-eclampsia, and eclampsia, preterm premature rupture of membranes, sever intrauterine growth restricted fetus. The measured date were maternal general characteristics, duration of labor process, type of delivery and neonatal outcome. Patients were divided into two groups. Group A - if they spent more than 50% in a recumbent position and Group B - any other alternating position.Results: A total 250 women were equally included in this study. The demographic characteristics were matched in both groups and found no significant difference. In the process of labor, Group B had a difference of 1 hours as compared to Group A and the rate of cervical dilation was also faster in Group B. Both of these variables were found to be statistically significant. However, there were no significant difference in the terms of type of delivery and neonatal outcome.Conclusions: The ancient practice of recumbent position during labor is to be discarded as alternating maternal position during the process of labor may a positive influence on the total duration labor. However even though it may or may not have an influence on the other outcome such as route of delivery and neonatal outcome, it is best to encourage women to move and deliver in the most comfortable position.
      PubDate: 2020-03-25
      DOI: 10.18203/2320-1770.ijrcog20201215
      Issue No: Vol. 9, No. 4 (2020)
       
  • A sonographic assessment of previous caesarean section scar: is a reliable
           safeguard for trial of labour'

    • Authors: Vandana Dhama, Sonam Gupta, Rachna Chaudhary, Shakun Singh
      Pages: 1520 - 1527
      Abstract: Background: Over the time the caesarean delivery rate has significantly increase worldwide from 18.2% in 2002 to 30.3% in 2012. In parous women, previous caesarean section has been found to be the most common indication for caesarean delivery in as high as 67% cases. Unsecure prediction of the integrity of the scarred LUS during labor appears to be one of the reasons for high repeat caesarean rates. The purpose of this study was to assess the usefulness of sonographic measurement of the lower uterine segment scar before labour for deciding whether it is a reliable safeguard for trial of labour or not in a woman having previous one caesarean delivery.Methods: This study was a prospective observational study, carried out on 108 pregnant women having previous one CS, gestational age >37, singleton pregnancy, cephalic presentation. Trans-abdominal USG was done to measure scar thickness. Trial of labour was given to each patient irrespective of scar thickness. Pregnancy outcome were noted in terms of successful VBAC or emergency LSCS and compared with scar thickness. Correlation between sonographic and intra-operative finding of scar were noted.Results: Result shows strong correlation between scar thickness and successful trial of labour. Scar thickness increases chances of successful vaginal deliveries.Conclusions: Sonographic assessment of previous scar has a practical application to predict the thickness and thinness of previous scar and can be taken as a reliable safeguard for trial of labour after previous cesarean but cut off value above which vaginal delivery could be considered safe is yet to be identified.
      PubDate: 2020-03-25
      DOI: 10.18203/2320-1770.ijrcog20201216
      Issue No: Vol. 9, No. 4 (2020)
       
  • Study of maternal mortality in a tertiary care hospital in a tribal KBK
           area of Odisha, India

    • Authors: Sasmita Behuria, Jyoti Narayan Puhan, Subhra Ghosh, Bhabani Sankar Nayak
      Pages: 1528 - 1531
      Abstract: Background: Pregnancy, although being considered a physiological state, carries risk of serious maternal morbidity and at times death. This is due to various complications that may occur during pregnancy, labor, or thereafter. The major causes of maternal mortality are mostly preventable through regular antenatal check-up, proper diagnosis, and management of labor complications. Therefore, the factors at different levels affecting the use of these services need to be clearly understood. The aim is to study the incidence of MMR, assess the epidemiological aspects, causes of maternal mortality and avoidable factors that can prevent maternal deaths.Methods: A retrospective hospital-based study was conducted in obstetrics and gynecology department, SLN MCH, a tertiary care referral hospital in a tribal area of southern Odisha over a period of 2 years from April 2017 to March 2019.Results: A total of 108 deaths were analyzed over 2 years period and MMR was calculated to be 1124/1 lakh live births. Most of the maternal deaths occurred in the age group of 20-24 years (35.1%), majority of maternal deaths were observed in multipara (46.3%), 70.3% deaths occurred within 24 hours of admission. Hypertensive disorders in pregnancy (37%) were the leading direct cause followed by hemorrhage (14.8%) and sepsis (11.1%). Among the indirect causes jaundice (7.4%) and anaemia (3.7%) were the leading cause.Conclusions: MMR in our study was very high as compared to national average of 167/1,00,000 live births, being a tertiary care hospital as most of the patients were referred from peripheral centers. Most maternal deaths are preventable by intensive health education, basic obstetric care for all, strengthening referral and communication system and emphasizing on overall safe motherhood.
      PubDate: 2020-03-25
      DOI: 10.18203/2320-1770.ijrcog20201217
      Issue No: Vol. 9, No. 4 (2020)
       
  • A prospective randomized comparative study of the efficacy of sustained
           release vaginal insert versus intracervical gel in primigravidae at term
           pregnancy

    • Authors: Thejaswi R. Thupakula, Bela Makhija, Arpana Haritwal
      Pages: 1532 - 1539
      Abstract: vBackground: Induction of labour is the intentional initiation of labour before spontaneous onset for the purpose of delivery of fetoplacental unit. Failure of induction is responsible for increased incidence of caesarean delivery. This study performed to assess and compare the clinical effects of sustained release vaginal insert versus intracervical gel in primiparous women with term pregnancy in terms of improvement of Bishop’s score, Induction delivery interval, incidence of hyperstimulation, maternal and neonatal outcomes.Methods: A total 100 consecutive term pregnant women who underwent labor induction for fetal or maternal indications were divided randomly into two groups. Group A - sustained release Vaginal insert and Group B - Intracervical gel. Informed consent was taken from each patient.Results: Statistically significant increase in final Bishop’s score (p=0.008) and hyperstimulation (p=0.04) was seen in Vaginal insert group as compared to Intracervical gel group, while there were no statistically significant differences in maternal outcomes, neonatal outcomes and need for oxytocin augmentation in both groups.Conclusions: In this study we found that insert did not improve the induction delivery interval or rate of successful induction, nor did it have any advantage in terms of neonatal outcome although it did improve the Bishops score – Its advantage was in terms of single application, few prevaginal examinations, longer duration of action and immediate retrieval in case of hyperstimulation. Its main drawback remained the maintenance of cold chain without which its efficacy decreases. Another significant observation was the dropout rate of insert (16%).
      PubDate: 2020-03-25
      DOI: 10.18203/2320-1770.ijrcog20201218
      Issue No: Vol. 9, No. 4 (2020)
       
  • Study of cases of post-partum hemorrhage after spontaneous vaginal
           delivery in labour room of obstetrics and gynecology department of
           tertiary care center, Ranchi, Jharkhand, India

    • Authors: Bratati Moitra, Bulllu Priya Oraon
      Pages: 1540 - 1544
      Abstract: Background: Postpartum haemorrhage is one of the common causes of maternal death worldwide. Whenever the amount of blood loss from or into genital tract is 500 ml or more after delivery of baby or any amount of bleeding that makes patients haemodynamically unstable is post-partum haemorrhage.Methods: In this study amount of blood loss after spontaneous vaginal delivery was measured in 100 cases by calibrated blood drape. Patients having high risk criteria for PPH were excluded.Results: In this study 55% patients were from 20-30 years age group. 82% cases were nontribal. 94% belonged to lower middle class. 67% patients were primigravida. 89% patients had atonic PPH and 11% had traumatic PPH. 85% patients had mild PPH. 60% of atonic PPH was managed by oxytocin only. 10% required oxytocin + Methergin, 6% required oxytocin + Methergin + Misoprostol. 6% required Oxytocin + Methergin + Misoprostol + Carboprost. In this study surgical intervention was required in 18% cases. Blood transfusion was required in 74% cases. 75% cases were from non-tribal ethnicity.Conclusions: PPH is a life-threatening condition. If it can be diagnosed early and managed properly then many maternal lives can be saved. In this study there was no maternal death.
      PubDate: 2020-03-25
      DOI: 10.18203/2320-1770.ijrcog20201219
      Issue No: Vol. 9, No. 4 (2020)
       
  • Clinicopathological study of anemia during pregnancy

    • Authors: Sarojamma C., R. Atchutha Subiksha
      Pages: 1545 - 1548
      Abstract: Background: In developing countries the prevalence of anemia among pregnant women averages 60% resulting in varying levels of adverse pregnancy outcomes. Iron, Vitamin B12 and folic acid deficiencies, malaria, intestinal parasitic infections and hemoglobinopathies are the principal causes of anemia in pregnancy. Above nutritional requirements increase during pregnancy and if it is not maintained, may result in adverse maternal and fetal outcomes. The aim of this study was to study the prevalence of anemia in pregnant mothers, study the clinical patterns of anemia in pregnancy and to study the histopathological patterns of anemia during pregnancy.Methods: This is a prospective study done on 60 pregnant women whose hemoglobin level is less than 10.9 gm/dL. Blood samples were taken, and peripheral blood smears were examined along with their complete clinical and obstetric history.Results: Out of 60 cases of anemia, 40% were found to have dimorphic anemia, 30% with microscopic hypochromic anemia, 20% of patients have normocytic hypochromic anemia, 1.7% had sickle-cell anemia and 8.3% of patients were thalassemia cases. The risk factors for anemia in this study is noted to be low social economic status, occurrence of complications during previous pregnancy and multiparty. In this study anemia was more commonly found in the multigravida women and in the third trimester of pregnancy.Conclusions: With improved social economic conditions, early detection, good antenatal care, awareness regarding available treatment, a healthy diet, routine antenatal counselling and adequate iron supplementation, anemia in pregnancy can be avoided.
      PubDate: 2020-03-25
      DOI: 10.18203/2320-1770.ijrcog20201220
      Issue No: Vol. 9, No. 4 (2020)
       
  • The efficiency and efficacy of tranexamic acid in prevention of blood loss
           during or after caesarean delivery: a comparative study

    • Authors: Supriya Raina, V. Suguna, Padmaja Prabraju
      Pages: 1549 - 1553
      Abstract: Background: The practice of caesarean section is increasing day by day. Delivery by caesarean section can cause more complications than normal vaginal delivery and one of the most common complications is primary or secondary postpartum hemorrhage. The aim of present study was to study the efficacy and safety of tranexamic acid in reducing blood loss during and after caesarean section.Methods: This study was conducted at Deccan College of Medical Sciences, Hyderabad. It was a prospective randomized double blind placebo controlled study. This study includes 60 pregnant women divided in to two groups. Just before the induction of anesthesia 1 gm of tranexamic acid in 20 ml of normal saline was given over 10 minutes in test group and 20 ml of normal saline was infused in control group.Results: The demographic characters of patients in two groups were comparable. There was no statistically significant difference in the heart rates, respiratory rates and blood pressures in the two groups. There was statistically significant difference in the quantity of the blood loss from during the operation and 2 hours postpartum (p=0.003). Total mean blood loss in control group was 718.80±233.1 ml and in study group was 554.28±207.8 ml. The drop in hemoglobin after caesarean section in study group was not significant where as in control group was significant. There was no significant difference in the prothrombin time and partial thromboplastin time in the groups, pre and post operatively. In this study the use of tranexamic acid reduced the dose of other uterotonics like syntocin in study group.Conclusions: Tranexamic acid significantly reduced the amount of blood loss during the caesarean section and also reduced the use of other uterotonics. Thus, tranexamic acid can be used safely and effectively in subjects undergoing caesarean section.
      PubDate: 2020-03-25
      DOI: 10.18203/2320-1770.ijrcog20201221
      Issue No: Vol. 9, No. 4 (2020)
       
  • Clinical presentation, diagnosis and management of bacterial vaginosis: a
           hospital based cross-sectional study

    • Authors: Manju Agarwal, Rakhee Soni, Adhunika Singh
      Pages: 1554 - 1558
      Abstract: Background: Bacterial vaginosis is most common cause of vaginal discharge. Clinical presentation varies from person to person. The management of bacterial vaginosis is largely syndromic and empirical, it is usually based on naked eye examination of vaginal discharge and that is unsatisfactory because the diagnostic accuracy is lost without microscopic examination. The modern management of bacterial vaginosis demands a specific diagnosis which is a combination of naked eye examination plus laboratory workup.Methods: The study was carried out on 183 females with complaint of vaginal discharge in the outpatient department of obstetrics and gynecology. Specimens were collected in outpatient department of Jhalawar Medical College in associated Zanana Hospital. The laboratory work was conducted in the department of microbiology in Jhalawar Medical College, Jhalawar, Rajasthan, India.Results: The prevalence of microbial positivity in our study was 79.9%. Bacterial vaginosis was the most common diagnosis seen in 86 (47.0%) cases. Maximum patients presented with complaint of copious amount of foul-smelling yellow discharge.Conclusions: The study concludes that it is important to know the various presentations, confirm the diagnosis by proper microbiological tests, and provide appropriate treatment to patients to prevent resistance and recurrence of bacterial vaginosis.
      PubDate: 2020-03-25
      DOI: 10.18203/2320-1770.ijrcog20201222
      Issue No: Vol. 9, No. 4 (2020)
       
  • Pregnancy outcome in patient who had first trimester bleeding in previous
           pregnancy: a prospective study

    • Authors: Faswila M., Ramya N. R.
      Pages: 1559 - 1562
      Abstract: Background: Patient who had history of spontaneous abortion in her previous pregnancy is associated with adverse outcome in her present pregnancy.Methods: A total 63 pregnant women attending OPD and admitted in department of obstetrics and gynecology, Yenepoya Medical College, from April 2017 to September 2017, considered and outcome were studied.Results: Out of 63 patient’s majority (57.1%) of patients belong to the age group 21-29 year. Anemia was found to be very severe in 4.3%, severe in 10% and moderate in 30% patients. Maximum patients (45.7%) were with history of previous one abortion followed by previous two abortions (38.6%). The final outcomes were term livebirth 47 (74.3%), abortion 9 (14.3%), preterm delivery 5 (8.6%), and stillbirth 2 (2.8%) caesarean section (23.3%) for various indications. 19.23% had term PROM, 9.09% had PPROM, 5.76% had term IUGR, 3.84% term IUD, preterm IUD accounts for 9.09% and still birth accounted for about 1.92% which was term, pre-eclampsia accounted for 4.76%, malpresentation for 7.93%, total 3 cases of antepartum hemorrhage out of which  placenta previa accounts for about 3.1% and abruption for 1.58%, manual removal of placenta 4.7% and low birth weight 7.6%.Conclusions: Previous history of spontaneous abortion is associated with adverse pregnancy outcome. There is increased risk of abortion, preterm delivery, need for caesarean sections and fetal loss which can be reduced by booking and giving antenatal care.
      PubDate: 2020-03-25
      DOI: 10.18203/2320-1770.ijrcog20201223
      Issue No: Vol. 9, No. 4 (2020)
       
  • Interventions to reduce caesarean section rates at government medical
           college and hospital Aurangabad, India

    • Authors: Shrinivas Gadappa, Honey Gemavat, Sonali Deshpande, Ankita Shah
      Pages: 1563 - 1569
      Abstract: Background: Caesarean sections are effective in saving maternal and infant lives, but only when they are performed for medically indicated reasons, The Objective of this study was to reduce caesarean Section rate at GMCH, Aurangabad and to improve overall birthing experience with respectful maternity care.Methods: The caesarean sections done at GMCH Aurangabad were audited using Robson`s Ten Group classification system to identify the major contributors to the overall CS rate. The following clinical and non-clinical interventions were applied dynamically to control the caesarean section rates. Clinical Interventions were changes in protocols regarding induction of labour, Intermittent auscultation as opposed to continuous electronic foetal monitoring in low risk cases, use of a partogram, encouragement of different birthing positions, promoting TOLAC to reduce the secondary CS rate. Nonclinical interventions include encouragement of DOULA (birth companion), ante-natal counselling of the expectant mothers, training of healthcare staff for respectful maternity care and use of evidence based clinical practice guidelines with mandatory second opinion for every non recurrent indication of CS. Auditing of caesarean section using Robson classification.Results: In this study there has been steady decline in LSCS rates from 33% to 26.9%. On analysis with Robson classification, group 5 (previous LSCS) made largest contribution of 36.9% followed by Group 1, 2, 10 each contributed 18.01%,13.2% and 11.2% respectively. Group 6 to 10 account for 23%. Various birthing positions lowered use of oxytocics from 33 % to 19% as well lowered episiotomy rates with greater success in vaginal delivery.Conclusions: Modification of induction protocols have reduced the primary LSCS rates and successful VBAC using FLAMM score was helpful in reducing the repeat caesarean Sections. Various birthing positions, DOULA gave greater success in vaginal delivery. LSCS rates in mothers with breech, multiple or oblique/transverse lies were largely unmodifiable. Limiting the CS rate in low-risk pregnancies by individualizing every labour and not to set a time limit as long as mother and baby are closely monitored.
      PubDate: 2020-03-25
      DOI: 10.18203/2320-1770.ijrcog20201224
      Issue No: Vol. 9, No. 4 (2020)
       
  • A study of maternal and fetal outcomes in critically ill obstetric
           patients

    • Authors: Fasiha Tasneem, Vinutha M. Sharma
      Pages: 1570 - 1575
      Abstract: Background: Pregnancy related morbidity is becoming a nightmare in Indian women. Some of these women end up in mortality and a few of them narrowly escape death. Critical care should be and is an authenticated part of obstetric practice. This study is an effort initiated to understand the risk of maternal morbidity, to investigate the contributing factors, foetal outcome, to study the adverse event, cause of maternal death and remedial measures.Methods: All the obstetric cases admitted in Intensive care unit in a government institute in Maharashtra during January 2018 to June 2019 were analyzed prospectively. The indications for transfer into intensive care, risk factors, co morbidities if any were studied. Maternal and fetal morbidity and mortality were included in the study.Results: During the study period, there were 10, 208 deliveries. There were 12 maternal deaths and 98 critically ill patients became morbid. Anemia is found to be a major pre-existing contributing factor (25.5%) and an important risk factor making pregnancy become critical. DIC is found to be a major reason for ICU admission (39.1%), 72.7% needed mechanical ventilator and 60.1% needed ionotropic support.Conclusions: Anemia is a major problem still existing in our country. Gestational hypertension is another leading cause of critical illness in pregnancy. Identification of patients who are going downhill, timely referral to higher centers and appropriate management can improve both the maternal and the fetal outcomes.
      PubDate: 2020-03-25
      DOI: 10.18203/2320-1770.ijrcog20201225
      Issue No: Vol. 9, No. 4 (2020)
       
  • A study of the efficacy and safety of the balloon tamponade in the
           management of atonic post-partum hemorrhage

    • Authors: Aruna Kumar, Khushboo Kachchhap, Shubha Shrivastava
      Pages: 1576 - 1579
      Abstract: Background: The most common cause of post-partum hemorrhage (PPH) is uterine atony. Treatment for atony follows a well-defined stepwise approach, including drugs and mechanical interventions followed by surgery as a last resort. Early use of intrauterine balloon tamponade is a way of limiting ongoing uterine blood loss while initiating other measures and can be readily implemented by providers with minimal training.Methods: This prospective interventional study was conducted in 112 consecutive patients attended department of obstetrics and gynecology, Gandhi Medical College and Associated Sultania Zanana Hospital, Bhopal, Madhya Pradesh, India, in one year of study period.Results: In this study most of the patients had gestational age >37 weeks [83 (74.1%)]. Most of the patients in the study had vaginal delivery [64 (57.1%)]. In 84 (75%) patients Bakri balloon was used followed by Burke balloon in 17 (15.2%) patients, condom catheter in 7 (6.2%) patients and CG balloon in 4 (3.6%) patients. Different types of balloons were used according to availability of balloon at the time of management. Most of the patients [71 (63.3%)] had trans-vaginal route of balloon placement and 41 (36.7%) patients underwent trans-abdominal balloon placement. Most of the patients 69 (61.65%), responded to tamponing within 20 minutes of balloon placement while 9 patients had negative tamponade and continued to bleed. Bakri balloon tamponade was most commonly used in 84 (75.0%) patients. CG balloon and condom catheter were used only in 4 (3.6%) and 7 (6.3%) patients respectively. Tamponading was effective and successful in 103 (92%) patients.Conclusions: PPH is still a leading but preventable cause of maternal morbidity and mortality. In the majority of cases, relatively simple methods are used to avert a disaster, although these are not always employed. Uterine tamponade using intrauterine balloons appears to be an effective tool in the management of PPH.
      PubDate: 2020-03-25
      DOI: 10.18203/2320-1770.ijrcog20201226
      Issue No: Vol. 9, No. 4 (2020)
       
  • Study of intrapartum fetal distress with the help of cardiotocography and
           its correlation with umbilical cord blood sampling

    • Authors: S. Neeraja, Sugathi Parimala, Naima Fathima
      Pages: 1580 - 1584
      Abstract: Background: Even in low risk mothers, fetal acidosis occurs as in high risk groups. Aim of fetal monitoring is to detect early response to intrauterine hypoxia and prevent irreversible neurological damage and death. Objective of this study was to correlate the intrapartum fetal distress with the help of cardiotocography CTG with umbilical cord blood sampling.Methods: A total 100 consecutive patients attending the labor ward were studied. Immediately at birth, before the baby’s first breath and before delivery of the placenta, the umbilical cord blood was collected as per the standard guidelines laid down in the standard textbooks. Fetal acidosis was assessed by umbilical cord arterial blood pH. Fetal acidosis was considered when umbilical artery pH <7.2. Cardiotocography features were used to clinically diagnose fetal distress.Results: Most of the mothers were multigravida. They belonged to the age group of 20-25 years. Only 18% had abnormal CTG. Out of 50 mothers with normal vaginal delivery, all had normal CTG. Out of 43 mothers who were delivered by LSCS, no one had normal CTG, 25 had indeterminate CTG and 18 had abnormal CTG. As CTG became abnormal, proportion of mothers with the thick meconium increased. NICU admission proportion increased as CTG changed from normal to the abnormal. There was a significant association between the abnormal CTG and the umbilical cord blood pH being acidic.Conclusions: CTG is a simple test, easy to perform and can alert obstetrician for necessary interventions in case of an abnormal CTG. It can detect fetal distress in labor thus helping to reduce neonatal morbidity by early intervention in cases of abnormal tracing.
      PubDate: 2020-03-25
      DOI: 10.18203/2320-1770.ijrcog20201227
      Issue No: Vol. 9, No. 4 (2020)
       
  • Role of hysterolaparoscopy in the diagnosis and management of infertility

    • Authors: Saumya P. Agrawal, Nupoor Kedia, Shashwat K. Jani, Siddharth P. Agrawal
      Pages: 1585 - 1589
      Abstract: Background: Infertility is defined by WHO and ICMART as a disease of the reproductive system by the failure to achieve a clinical pregnancy after 12 months or more regular unprotected sexual intercourse. Objective of this study were to assess the role of hysteroscopy and laparoscopy in the evaluation of female infertility. To assess the therapeutic role of these endoscopic modalities in cases of infertility.Methods: A prospective study of 112 women coming with the complain of infertility to a tertiary care centre hospital in Ahmedabad over a period of 30 months from January 2017 to June 2019.Results: Of the 112 cases, 69.7% had primary infertility and 30.3% had secondary infertility. Septum was the most common hysteroscopic finding (7.1%) followed by polyps (5.4%) and synechiae (3.6%). Adhesions was the most common laparoscopic finding (23.2%) followed by tubal blocks (19.7%) and fibroid (17.9%). Polycystic ovaries were seen in 12.5% patients followed by endometriosis in 10.7% women. Myomectomy was most common therapeutic procedure (17.9%) followed by adhesiolysis in 14.3% women and PCO drilling in 8.9% women.Conclusions: Hysterolaparoscopy is useful as a diagnostic and therapeutic measure for women having infertility.
      PubDate: 2020-03-25
      DOI: 10.18203/2320-1770.ijrcog20201228
      Issue No: Vol. 9, No. 4 (2020)
       
  • Effect of low dose aspirin on maternal outcome in women at risk for
           developing pregnancy induced hypertension

    • Authors: Madhusmita Pradhan, Kishore S. V., Jyotiranjan Champatiray
      Pages: 1590 - 1595
      Abstract: Background: Pre-eclampsia is not totally a preventable disease. It is found more related to chains of social ills such as poor maternal nutrition, limited or no antenatal care and poor reproductive education. However, some specific “high-risk” factors leading to pregnancy induced hypertension (PIH) may be identified in individuals which include and not limited to young and elderly primigravida, multiple pregnancy, diabetes, Rh incompatibility, new paternity, pre-existing vascular or renal disease, family history of hypertension, pre-eclampsia and eclampsia, obesity, thrombophilia. Low dose aspirin given in 2nd trimester in these high-risk women is anticipated to prevent the development of PIH.Methods: This prospective randomized controlled trial was conducted in the department of obstetrics and gynecology, SCB MC and Hospital, Cuttack during November 2018 to October 2019. Pregnant women between the gestational age of 13th to 28th weeks were screened for risk factors and included in this study. Low dose aspirin of 60 mg daily till delivery was given to pregnant women who consented to be a part of study randomly with the other group having placebo.Results: Protienuric hypertension was high in control group who did not receive aspirin. Low dose aspirin significantly reduces PIH in high-risk group (3.48% in case versus 23.52% in control). Low dose aspirin was not associated with significant increase in placental bleeding. Low dose aspirin was generally safe for the fetus and new born infant with no evidence of an increased likelihood of bleeding.Conclusions: Low dose aspirin has a definite role in the prevention of PIH in high risk pregnancy. Low dose aspirin reduces the incidence of PIH. Low dose aspirin can be considered a safe drug without any deleterious side effect for mother and the fetus. Benefits of prevention of PIH, justifies its administration in women at high risk.
      PubDate: 2020-03-25
      DOI: 10.18203/2320-1770.ijrcog20201229
      Issue No: Vol. 9, No. 4 (2020)
       
  • Prevalence of anemia among school going adolescent girls in rural area of
           Pune, Maharashtra, India

    • Authors: Suman Bodat, Rakesh Bodat, Prasanth Vinjamuri V. V. G., Anita Raj Rathore
      Pages: 1596 - 1602
      Abstract: Background: Anemia is like the tip of an iceberg, as majority of anemic subjects are asymptomatic. Low iron diet for longer period perpetuates an inter-generational cycle of anemia, anemic women giving birth to anemic children. This situation is more acute in rural area due to their dietary habits, illiterate parents, socio-economic status, misconception about food, religions belief, menstruation and physical activity.Methods: This descriptive cross-sectional study was conducted in rural field practice area of Rural Heath Training Centre (RHTC) under department of community medicine, Bharati Vidyapeeth Medical college Pune, Maharashtra, India. There are 11 villages under RHTC Lavale: Out of them one village viz. Pirangut village was randomly selected. (by using random sampling method). This study was conducted in 2013. Total 740 senior secondary school girls studying in class 6th to 12th (10-19 age group) were included. Hb level was measured by Sahli′s hemoglobinometer. Chi square was used to test for association between qualitative variables, and p-value less than 0.05 was considered significant.Results: The Hb level of girls reveal that majority 648 (87.6%) of them were anemic. It was found that 305 (47.06%) and 340 (52.48%) were suffering from mild and moderate anemia while 3 (0.46%) had severe anemia. The significant association was found with BMI for age.Conclusions: Active measures to decrease the prevalence of anemia through educating these girls and their mothers, school diet supplementation, providing low cost diet.
      PubDate: 2020-03-25
      DOI: 10.18203/2320-1770.ijrcog20201230
      Issue No: Vol. 9, No. 4 (2020)
       
  • Clinicohaematological study of anaemia in antenatal patients

    • Authors: Veena Gupta, Karishma Sharma, Amrita Chaurasia
      Pages: 1603 - 1609
      Abstract: Background: According to WHO, approximately 75% of pregnant women in developing countries and 18% in developed countries are anaemic. In India prevalence of anaemia is reported to be 33%-89% and is one of the important causes of maternal morbidity and mortality. The present study was done with the objective to study the socio-demographic factors related to anemia and the distribution of different types of anaemia in antenatal patients.Methods: A prospective analytical study was done on 205 pregnant females who presented with anemia (Hb <11 gm/dl) in 1st, 2nd and early 3rd trimester (up to 30 weeks of gestation) in the department of obstetrics and gynecology of Swaroop Rani Nehru Hospital, Prayagraj from September 2017 to September 2018.Results: The rural background with lower socio-economic status comprised majority of the anemic patients (65.9%) with the major cause being iron deficiency anemia (68.8%). The patients mainly presented with anemia at late second or early third trimester (82.4%). Clinical signs like pallor, oedema and symptoms like palpitations and dyspnoea were more associated with severe anemia than mild and moderate anemia.Conclusions: Anemia prevention and prompt detection is the need of the hour with effective management. In India, major cause of anaemia are nutritional deficiencies which can be treated by proper diet and medications. The advises of routine iron supplementation during pregnancy, regardless of whether the mother is anemic or not, is strongly recommended by this study. 
      PubDate: 2020-03-25
      DOI: 10.18203/2320-1770.ijrcog20201231
      Issue No: Vol. 9, No. 4 (2020)
       
  • Uterovaginal prolapse: the sociodemographic profile and reproductive
           health service uptake in a low resource setting, Calabar, Nigeria

    • Authors: Njoku Charles Obinna, Njoku A. N., Efiok E. E., Eyong E. M.
      Pages: 1610 - 1613
      Abstract: Background: Uterovaginal prolapse is a common gynaecological condition in low resource countries because of high prevalence of grand multiparity, low skilled attendant at delivery and low contraceptive usage. Objective of this study was to determine the prevalence, sociodemographic profiles, utilization of reproductive health services and delay in seeking medical care of patient with uterovaginal prolapse in Calabar, Nigeria.Methods: This was a retrospective study of women who presented with uterovaginal prolapse at University of Calabar Teaching Hospital, Calabar, Nigeria between 1st May 2009 and 1st June 2019. Patients case records were retrieved and analyzed. Statistical analysis was done using SPSS version 22.Results: The prevalence of genital prolapse was 0.3%. The mean age and parity were 60.19±8.71 years and 6.31±2.80, respectively. The mean duration of symptoms before presentation was 3.19±2.16 years. Genital prolapse was commonest among age group 60-79 years (52.8%), parity 5-9 (66.7%), post-menopausal (97.2%), primary education (55.6%) and farmers (47.2%). Grade 3 uterovaginal prolapse was the commonest grade (58.3%). Most patients (86.1%) had symptoms of genital prolapse for less than 5 years before seeking medical treatment. The majority of patients had no antenatal care during their pregnancies (80.6%), no skilled attendant at deliveries (86.1%) and no contraceptive use during their reproductive years (77.8%). Participants with lower parity (1-4) (p=0.03), higher educational level (p˂0.001) and teachers/civil servants (p=0.043) presented earlier (less than 1 year) to the hospital.Conclusions: There is poor utilization of reproductive health services among women who develop uterovaginal prolapse in study environment. Women with higher social status sought for help earlier. Increasing awareness of this condition and providing antenatal care, skilled birth attendants and contraceptive services will reduce the burden of this condition. 
      PubDate: 2020-03-25
      DOI: 10.18203/2320-1770.ijrcog20201232
      Issue No: Vol. 9, No. 4 (2020)
       
  • Comparison of diagnostic accuracy of bactec culture, gene-xpert and
           histopathology in the diagnosis of genital tuberculosis in women with
           infertility

    • Authors: Rachna Chaudhary, Vandana Dhama, Manisha Singh, Shakun Singh
      Pages: 1614 - 1621
      Abstract: Background: Female genital tuberculosis (FGTB) is often a silent disease sparing no age group but majority of patients are in the reproductive age. In infertility patient’s incidence of FGTB varies from 3-16% in India but the actual incidence of genital tuberculosis may be under reported due to asymptomatic presentation and paucity of investigations.Methods: Prospective case control study was conducted from June 2018 to May 2019 in LLRM Medical College Meerut. A total 100 Endometrial samples were collected during diagnostic laparoscopy from all suspected case of genital TB, presented with either primary or secondary infertility and samples sent for histopathology, Gene-xpert and Bactec culture.Results: Out of 100 samples Bactec culture was positive in 2 samples, Gene-xpert positive in 3 samples. On histopathology out of 100 cases, non-specific endometritis was found in 1 case, tubercular-endometritis in 1 case, proliferative enometrium (anovulatory) in 40 cases and secretory endometrium found in 58 cases.Conclusions: Female genital TB poses a diagnostic dilemma because of its varied presentation and lack of sensitive and specific method of diagnosis. Culture though remains the gold standard of diagnosis of female genital TB, gene-xpert, histopathology, Bactec culture or laparoscopy can be used for starting treatment. Endometrial biopsy on histopathology shows not only Tubercular endometritis but also gives hormone response on endometrium, local factors of endometrium concerning non-specific and specific infections and anovulatory cycles.
      PubDate: 2020-03-25
      DOI: 10.18203/2320-1770.ijrcog20201233
      Issue No: Vol. 9, No. 4 (2020)
       
  • Study of thrombocytopenia in pregnancy: clinical presentation and outcome
           at tertiary care rural institute

    • Authors: Jigyasa Singh, Kalpana Kumari, Vandana Verma
      Pages: 1622 - 1626
      Abstract: Background: Platelet count below 1.5 lakh/cumm is called as thrombocytopenia. After anaemia it is the second most common haematological disorder in pregnancy. It affects nearly 6 to 15%; on an average 10% of all pregnancies. Gestational thrombocytopenia is a clinically benign thrombocytopenic disorder usually occurring in late pregnancy. It resolves spontaneously after delivery.Methods: It is a hospital based prospective observational study over a period of 1 year. All pregnant women who attended OPD at the department of obstetrics and gynecology, UPUMS, Saifai for antenatal checkup were included for the study and blood sample was withdrawn.Results: Out of 263 cases enrolled for study, 90 women were found to have thrombocytopenia, and 173 had normal platelet count. Thus, incidence of thrombocytopenia was 34%. Gestational thrombocytopenia accounted for majority of cases of thrombocytopenia in pregnancy (50%) followed by hypertensive disorders (22.4%). It was further followed by ITP (11.11%) and dengue (5.5%).Conclusions: Gestational thrombocytopenia is the most common cause of thrombocytopenia during pregnancy (50%), but other underlying causes must be considered as well. A thorough history and physical examination will rule out most causes.
      PubDate: 2020-03-25
      DOI: 10.18203/2320-1770.ijrcog20201234
      Issue No: Vol. 9, No. 4 (2020)
       
  • Study of cutaneous manifestations of polycystic ovarian syndrome

    • Authors: Sukhleen Kaur, Sunil K. Gupta, Sunil K. Juneja, Sukhjot Kaur, Monika Rani
      Pages: 1627 - 1631
      Abstract: Background: Polycystic ovarian syndrome (PCOS) is one of the most frequently encountered endocrine disorders that occurs in as many as 4 to 10% of women of reproductive age group. It presents with a series of skin changes including acne, hirsutism, seborrhea, androgenetic alopecia (AGA) and acanthosis nigricans. Aim of the study was to determine the prevalence and frequency of different cutaneous manifestations in PCOS patients and to correlate them with the degree of hormonal abnormalities.Methods: A total 100 patients with features of PCOS who presented to department of dermatology, gynecology (January 2018-December 2019) with cutaneous manifestations were recorded and diagnosis of PCOS was made using Rotterdam’s criteria. Pregnant women and diagnosed cases of any other endocrine disorder were excluded. Hirsutism was assessed using Ferriman-Gallwey score and AGA according to Ludwig’s classification. Serum hormonal profile including FSH, LH, prolactin, testosterone (free), DHEAS, TSH, FBS, fasting insulin were done. Insulin resistance was determined by calculating HOMA-IR score.Results: Among cutaneous manifestations of PCOS, hirsutism (85%) was the most common finding followed by acne (73%), seborrhea (50%), AGA (36%), acanthosis nigricans (29%) and acrochordons (9%). The most common hormonal abnormality was insulin resistance in 53% patients, followed by raised free testosterone in 19% and serum prolactin in 18% patients. A statistically significant association was present between AGA and insulin resistance, hirsutism and raised prolactin levels, seborrhea and raised body mass index (p < 0.05).Conclusions: Dermatological manifestations of PCOS play a significant role in making the diagnosis and constitute a substantial portion of the symptoms experienced by women with this syndrome.
      PubDate: 2020-03-25
      DOI: 10.18203/2320-1770.ijrcog20201235
      Issue No: Vol. 9, No. 4 (2020)
       
  • A prospective clinical trial to evaluate the role of very low dose
           mifepristone 10 mg in medical management of uterine leiomyoma in tertiary
           care hospital from North West India

    • Authors: Swati Kochar, Neha Suthar, Shweta Chaudhary, Shahnaj Chandad
      Pages: 1632 - 1635
      Abstract: Background: Uterine leiomyomas are the most common benign tumours of the uterus and also the most common benign solid tumor in female. It arises from the uterine smooth muscles (myometrium) but contain varying amount of fibrous connective tissue. Aim of study was to evaluate the efficacy of very low dose Mifepristone (10 mg) on leiomyoma volume and its related symptoms.Methods: This was a prospective clinical study. 30 women met with the inclusion criteria and giving informed consent for the study.Results: Mean myoma volume was 60.32±51.89 at initial visit and 36.13±48.54 at 3 months follow up visit with 40.1% reduction which was statistically significant difference (p < 0.001). Mean PBAC score in Group I was 155.53±21.70 at initial visit and 0.97±2.97 at 3 months follow up visit with 99.3% reduction which was statistically significant (p < 0.001).Conclusions: Mifepristone 10 mg is efficacious in term of control of bleeding, alleviation of pain related symptoms with few side effects. So low dose mifepristone can be used as a suitable option for women with symptomatic fibroids in perimenopausal periods or patients not willing or fit for surgery.
      PubDate: 2020-03-25
      DOI: 10.18203/2320-1770.ijrcog20201236
      Issue No: Vol. 9, No. 4 (2020)
       
  • Perception and acceptability of bilateral tubal ligation among women
           attending antenatal clinic at Usmanu Danfodiyo university teaching
           hospital Sokoto

    • Authors: Ahmed Yakubu, Tukur Dabo Sagir, Abubakar Panti, Garba Jamila A., Isah Usman Mani, Anas Rabiu Funtua, Aliyu Muhammed Chappa, Mbakwe Markus
      Pages: 1636 - 1639
      Abstract: Background: Contraception can be defined as all temporary or permanent measures designed to prevent pregnancy. Bilateral tubal ligation is a surgical and permanent form of contraception offered to women who completed their family size or for limitation of family size due to medical condition. The practices of bilateral tubal ligation is limited in Sub-Saharan African countries, Nigeria inclusive because of great desire for a large family size, cultural and religious factors, misunderstanding and fear of the procedure. The aim of the study was to determine the perception and acceptability of bilateral tubal ligation as a form of contraception among women attending Antenatal clinic at Usmanu Danfodiyo University Teaching Hospital Sokoto.Methods: This was a cross sectional study conducted among women attending antenatal clinic between 1st of May to 31st of July, 2018. The information was obtained using a structured questionnaire to obtain the respondent’s socio-demographic characteristics, questions on perception and acceptability of bilateral tubal ligation. Data analysis was done with statistical package for social sciences version 22 (SPSS Inc, Chicago, IL, USA).Results: The study revealed that 73% of the respondents were aware of bilateral tubal ligation, but only 44% of them have good perception towards it. Majority of the respondents (63.8%) reject BTL for contraception. Most of their reasons were cultural believe (33.3%), regret (31.6%), religious believe (26.6%) and fear of surgery (8.5%).Conclusions: There was poor perception and low acceptability toward bilateral tubal ligation among the study population, mostly due to cultural and religious believes, as well as fear of regret, despite awareness of BTL among majority of the respondents.
      PubDate: 2020-03-25
      DOI: 10.18203/2320-1770.ijrcog20201237
      Issue No: Vol. 9, No. 4 (2020)
       
  • Incidence of retinal changes in pregnant women due to pregnancy induced
           hypertension and its correlation with clinical profile

    • Authors: Himanshy Rai, Zakia Rahman
      Pages: 1640 - 1645
      Abstract: Background: Pregnancy induced hypertension (PIH) is associated with many other pathological complications. Pathological changes of this disease appear to be related to vascular endothelial dysfunction and its consequences. One such complication or effect of PIH is retinal changes.Methods: This observational study was conducted of 110 cases over a period of 12 months from March 2018 to February 2019 in department of obstetrics of gynecology in Kamla Raja Hospital, G. R. Medical College, Gwalior, Madhya Pradesh. All the patients who fulfilled the diagnostic criteria of PIH admitted in the obstetric ward.Results: Retinopathic changes were noted in 36.36% out of which grade I, grade II, grade III and grade IV have 11.82%, 8.18%, 10.19% and 5.45% cases respectively. In + proteinuria 10.9% of cases have positive findings, in ++ proteinuria 18.18% cases have positive findings, in +++ 7.27% cases have retinopathy but severity increases with a grade of proteinuria. 40% cases retinopathic changes of mild preeclampsia have positive finding, 36.36% in severe preeclampsia and 23.64% in cases of eclampsia. As overall severity of PIH increases retinopathies in patients increases.Conclusions: Visual symptoms are few in patients with PIH and often absent unless the macula is involved. Sudden onset of headache, which is resistant to routine therapy in these patients, may be the warning symptom before the onset of first convulsion. By repeated fundus examinations at regular intervals one can assess the severity of the disease and also response to treatment instituted.
      PubDate: 2020-03-25
      DOI: 10.18203/2320-1770.ijrcog20201238
      Issue No: Vol. 9, No. 4 (2020)
       
  • Shortened versus standard post-partum maintenance therapy of magnesium
           sulphate in severe pre-eclampsia: a randomised control trial

    • Authors: Idowu B. Orisabinone, Uche Onwudiegwu, Adebanjo B. Adeyemi, Chibuzor P. Oriji, Olakunle I. Makinde
      Pages: 1646 - 1653
      Abstract: Background: Pre-eclampsia is a pregnancy-associated multi-organ disorder caused by altered trophoblastic invasion and endothelial cell dysfunction. It is associated with significant maternal and perinatal morbidity and mortality, especially in developing countries. Magnesium sulphate (MgSO4) is effective in the management of severe pre-eclampsia/eclampsia. Objective of this study was to compare the effectiveness of a shortened course of MgSO4 to the Pritchard regimen in patients with severe pre-eclampsiaMethods: This study was carried out at the obstetrics and gynecology department of the Obafemi Awolowo University Teaching Hospital, Ile-Ife. It was a randomised control study of 116 patients, 58 in each group. Group A received the standard Pritchard regimen: a loading dose of MgSO4 4g slow IV bolus plus 10 g IM (5 g in each buttock), followed by maintenance dose of 5g MgSO4 IM 4-hourly into alternate buttocks until 24 hours after delivery. Group B received same loading dose, but the maintenance dose was limited to three doses of 5g MgSO4 IM four hours apart after delivery. In both regimens, 2g MgSO4 was given IV for breakthrough fit. Data were analyzed using SPSS version 20.Results: This study revealed that twelve-hour postpartum MgSO4 was as effective as the Pritchard regime with no statistically difference in occurrence of seizures (X2 = 0.341, df = 1, p = 0.514). The average total dose of magnesium sulphate used was lower in the study Group B.Conclusions: Twelve-hour postpartum MgSO4 is as effective as the standard 24-hour Pritchard regime.
      PubDate: 2020-03-25
      DOI: 10.18203/2320-1770.ijrcog20201239
      Issue No: Vol. 9, No. 4 (2020)
       
  • Comparative study: normotensive and preeclampsia mother presenting with
           imminent symptoms of eclampsia in third trimester of pregnancy

    • Authors: Raji C., Suba S.
      Pages: 1654 - 1663
      Abstract: Background: This prospective study compares the maternal and fetal outcome in normotensive and preeclampsia mother presenting with imminent symptoms of eclampsia in third trimester. This prospective study was conducted in the department of obstetrics and gynaecology, Government Theni Medical College, Tamil Nadu, India in 2019.Methods: A total 100 antenatal mothers were selected for the study. Group A - 50 known case of preeclampsia presented with imminent symptoms. Group B-50 previously normotensive patients present with imminent symptoms of eclampsia. Maternal and fetal outcome were analysed.Results: Incidence of eclampsia - 0.1%, HELLP syndrome - 0.04%, pulmonary edema - 0.06%, PRES - 0.07%, abruptio placenta - 0.14% and maternal death in Group A was 2% and in Group B was 8%. Maternal complications are more in normotensive women (46%) presented with imminent symptoms than in preeclampsia women (26%) with imminent symptoms. Incidence of IUGR in Group A was 46%, whereas in Group B 12%. Incidence of preterm babies in Group A was 18%, whereas in Group B was 42%. Perinatal death incidence was 2.2% in imminent eclampsia.Conclusions: Because known preeclampsia patients were aware of imminent symptoms and presented early to hospital. Early identification and treatment of this dreadful outcome at the imminent state itself can reduce the complications. In current status on preventive aspect of eclampsia, atypical presentation should also be considered for which new screening and diagnostic tools has to be developed.
      PubDate: 2020-03-25
      DOI: 10.18203/2320-1770.ijrcog20201240
      Issue No: Vol. 9, No. 4 (2020)
       
  • A prospective observational study to determine the utility of placental
           laterality for prediction of preeclampsia in pregnancy

    • Authors: Anshul Rana, Rama Thakur, Rohini Rao
      Pages: 1664 - 1671
      Abstract: Background: Preeclampsia is a multisystem disorder of unknown aetiology and recently its link with placental laterality has been explored. The objective of this study was to find the association of placental laterality with maternal and fetal outcomes in pregnancy. Study also determined the predictive ability of placenta laterality for the development of hypertension in pregnancy.Methods: A prospective observational cohort study was conducted on 200 pregnant women. Routine investigations and doppler analysis were done. Placenta position was categorized into central and lateral. Maternal and fetal outcomes were recorded. The data was entered in MS excel spreadsheet and analysis was done using statistical package for social sciences (SPSS) version 21.0. A p value of < 0.05 was considered statistically significant.Results: Study found no significant association of placental laterality with hypertension in pregnancy. Various fetal complications, birth weight, Apgar scores and NICU admission were comparable among women with central or lateral placenta (p > 0.05). Even the maternal outcomes like mode of delivery, onset of labor, indication of labor induction and caesarean deliveries were comparable among women with central or lateral placenta (p > 0.05). On applying univariate logistic regression analysis, previous history of hypertension in pregnancy was a significant risk factor for development of preeclampsia with odds ratio of 168.43 (p < 0.05).Conclusions: It can be concluded that the maternal and fetal outcomes are independent of the placenta laterality. The doppler characteristics and placenta laterality did not show any increased risk for hypertension in pregnancy. However future studies are recommended with large sample size including more women with diagnosed hypertension in the pregnancy so that a better association can be derived with placenta laterality and doppler characteristics.
      PubDate: 2020-03-25
      DOI: 10.18203/2320-1770.ijrcog20201241
      Issue No: Vol. 9, No. 4 (2020)
       
  • A study of caesarean section at full cervical dilatation

    • Authors: Bijal D. Rami, Somika Kaul, Asha Sailor, Shahna Jindani
      Pages: 1672 - 1675
      Abstract: Background: Caesarean sections performed in the second stage of labour are difficult and have many implications on both mother and baby. This study was conducted to analyse fetal and maternal outcome in case of caesarean section at full cervical dilatation.Methods: This prospective study was conducted at one of tertiary care teaching institute for period of 1st August 2019 to 31st January 2020. It includes all women delivered by caesarean section at full cervical dilatation at study institute during study period. Cases were looked for parity, maternal age, gestational age, baby birth weight, indication of cesarean section and associated factors.Results: Out of total 3657 deliveries 1690 were delivered by caesarean section, out of which 65 (3.8%) caesarean sections were conducted at full cervical dilation. The most common indication of caesarean section was deep transverse arrest in 66.15% of cases. The maximum number of cases (69.23%) were seen between the age group of 20 to 25 years. Majority of second stage cesarean section (70.77%) were performed in primi gravida. 80% of caesarean sections at full cervical dilatation were performed after 37 weeks of gestation. 15.38% of patients had anemia, 20% had hypertension, 4.61% had history of previous caesarean section. Baby weight at time of birth was 2.5 to 3.5 kg in 67.70% of cases. 15.38% of patients required blood transfusion.Conclusions: A skilled obstetrician is required to take timely and proper decision in such cases and also to conduct cesarean section at second stage of labour.
      PubDate: 2020-03-25
      DOI: 10.18203/2320-1770.ijrcog20201242
      Issue No: Vol. 9, No. 4 (2020)
       
  • A study on maternal and perinatal outcome in pregnancy with
           oligohydramnios: study from a tertiary care hospital, Karnataka, India

    • Authors: Shilpa Nabapure, Rashmi P. S., Prema Prabhudeva
      Pages: 1676 - 1680
      Abstract: Background: Oligohydramnios is described as a condition with decreased amniotic fluid volume relative to gestational age. It is a severe and common complication of pregnancy which is associated with increased maternal morbidity and adverse perinatal outcomes. This study was conducted to find out the significance of oligohydramnios in determining the maternal and perinatal outcome in pregnant women with oligohydramnios.Methods: The present study is a hospital-based study conducted in the department of obstetrics and gynecology, of SSIMS and RC Davanagere, during the period between August 2018 to April 2019. Detailed clinical history was taken, AFI was measured using Phelan’s four quadrant ultrasound technique. All the information was entered in the proforma and analyzed.Results: The mean age group of the study participants was 26.36±4.46 years. Majority (51.9%) of them were primigravida. Gestational age, birth weight and abnormal Doppler study were found to have an association with the perinatal outcome. Perinatal mortality in the present study was 4%.Conclusions: Oligohydramnios is a frequent occurrence in obstetrics and this condition requires intensive surveillance and proper antenatal care.
      PubDate: 2020-03-25
      DOI: 10.18203/2320-1770.ijrcog20201243
      Issue No: Vol. 9, No. 4 (2020)
       
  • Effect of gestational weight gain on pregnancy outcome of Indian mothers

    • Authors: Keyur Patel, Megha Chaudhary, Maitri Shah
      Pages: 1681 - 1685
      Abstract: Background: Gestational weight gain (GWG) and pre-pregnancy body mass index (BMI) play important roles in determining the pregnancy outcome. The weight gain recommendations by the IOM are based on Western WHO BMI cut-offs, making it difficult to generalize their findings to Asian Indians. We aimed to compare GWG among healthy pregnant women across different BMI with the IOM guidelines-2009. We also aimed to evaluate associated feto-maternal outcomes with GWG among the pregnant women enrolled in the study.Methods: A retrospective cohort study conducted at department of obstetrics and gynecology, from April 2019 to November 2019. Postnatal mothers whose weight was registered at first trimester of pregnancy and at term and delivered in SSG hospital were included. According to IOM Women were divided into: Group 1 less than recommended weight gain and Group 2 recommended weight gain.Results: Significant difference was seen in the baby weight between the two groups (p value <0.05). 92.75% of babies had low birth weight in Group 1 as compared to 42.21% in Group 2. On performing univariate logistic regression, significant association was seen between GWG and low birth weight (p <0.05), no association was seen between GWG and caesarean (p value >0.05), and no association was seen between GWG and preterm deliveries (p >0.05).Conclusions: Majority of patients in the both groups had term delivery. Women gaining less than recommended weight gain during pregnancy had new born with significantly lower birth weight. There was no association of mode of deliveries and GWG.
      PubDate: 2020-03-25
      DOI: 10.18203/2320-1770.ijrcog20201244
      Issue No: Vol. 9, No. 4 (2020)
       
  • Study of anemia in hypothyroid pregnant patients

    • Authors: Nidhi Singh, Poonam Mani, Lalita Yadav, Neha Naresh
      Pages: 1686 - 1690
      Abstract: Background: Hypothyroidism and anemia in pregnancy causes significantly high maternal and fetal morbidity and mortality. Aim of this study was to determine the prevalence of anemia, grade and type of anemia in hypothyroid pregnant patients.Methods: This prospective study was conducted at department of obstetrics and gynecology, CSSH, Meerut, Uttar Pradesh over a period of 2 years from August 2017 to August 2019. Patients who attended the OPD during the study period were included in the study according the inclusion criteria and were studied for the clinical profile, obstetric history and detailed examination. Investigations were done including hemoglobin, blood grouping, urine routine, HbsAg, Anti-HCV, HIV, RBS and serum TSH. The women with raised serum TSH, indicating hypothyroidism, test for free T3, free T4 and anti-TPO was done, and the hypothyroid females with anemia were further investigated with GBP for the type of anemia, data evaluated with adequate statistical analysis.Results: A total 223 patients, enrolled in the study, prevalence of anemia in hypothyroid patients was 69.95%. Most patients with overt hypothyroidism had mild anemia 26 (68.4%), while in sub-clinical hypothyroid patients’ group most of the patients had moderate anemia. In the overt hypothyroid and subclinical hypothyroid group dimorphic anemia was the most prevalent form of anemia with 52.6% and 74.6% respectively.Conclusions: Prevalence of anemia in hypothyroid pregnant patients is 69.95%. Dimorphic anemia is most prevalent; hence it is important to study anemia in antenatal patients with hypothyroidism and appropriate strategies should be used to prevent and treat anemia.
      PubDate: 2020-03-25
      DOI: 10.18203/2320-1770.ijrcog20201245
      Issue No: Vol. 9, No. 4 (2020)
       
  • A study of posterior reversible encephalopathy syndrome in patients with
           eclampsia

    • Authors: Seeta Garag, Mubashira Janvekar
      Pages: 1691 - 1694
      Abstract: Background: The association of posterior reversible encephalopathy syndrome with eclampsia has recently received a lot of attention recently. Advances in Imaging has led to better understanding of the pathophysiology of eclampsia. Present study was undertaken to study the clinical characteristics of patients with eclampsia with PRES.Methods: This is a prospective observational study of 50 cases of Eclampsia with PRES in a period of 1 year. Patients admitted with Eclampsia were subjected to neuroimaging with CT or MRI and those with diagnosis of Posterior Reversible Encephalopathy Syndrome were included in the study and clinical profile analyzed.Results: Total of 50 patients were studied in the period of 1 year. The average age of patients was 21.8 years, majority of them residing in rural areas (74%) and 72% were referred cases.Conclusions: PRES is now identified as core component of Eclampsia. More studies are required to compare the outcome of Eclampsia associated with PRES and without PRES.
      PubDate: 2020-03-25
      DOI: 10.18203/2320-1770.ijrcog20201246
      Issue No: Vol. 9, No. 4 (2020)
       
  • Pregnancy outcome after first trimester vaginal bleeding

    • Authors: Azhar Un Nisa Quraishi, Rabia Khurshid, Syed Aadil Andrabi, Kamran Ahmad Quraishi
      Pages: 1695 - 1699
      Abstract: Background: First trimester vaginal bleeding is one of the most common complications in pregnancy threatening its proper development and successful outcome.Methods: A case-control study was conducted from October 2016 to April 2018 in the department of obstetrics and gynecology SKIMS.200 cases with vaginal bleeding in first trimester were taken for study. Out of the cases, number of patients who had abortion, ectopic, molar pregnancy or continued their pregnancy beyond 20 weeks was noted. Those who continued their pregnancy were compared with 130 controls for complications developing later in pregnancy.Results: There was significantly higher incidence of PIH (15.4% of cases, 6.9% of controls, p value = 0.005) and abruption (7.7% and 1.5% among cases and controls respectively with p-value of 0.034) among cases than controls. Mean gestational age at delivery in cases was 35.6±3.63 weeks while in controls it was 38.5±1.94 weeks (p value <0.001). Mean birth-weight of the neonates in cases was 2.16±0.78 kgs while in controls was 3.05±0.53 kgs (p value <0.001). IUGR occurred in 9.2% of cases and 3.1% of controls (p value 0.039). There was significantly higher neonatal ICU admission rate in cases than controls (p value 0.019).Conclusions: Patients with first trimester vaginal bleeding are at increased risk for spontaneous loss and adverse pregnancy outcome.
      PubDate: 2020-03-25
      DOI: 10.18203/2320-1770.ijrcog20201247
      Issue No: Vol. 9, No. 4 (2020)
       
  • Comparison of fertility rates of combination of enclomiphene citrate and
           melatonin with fertility rates of plain enclomiphene citrate in cases of
           dysovulatory infertility

    • Authors: Monika Singh, Shipra Kumari
      Pages: 1700 - 1704
      Abstract: Background: Clomiphene citrate, a non-steroidal triphenylethylene compound, is the first line medicine used for ovulation in anovulatory women Worldwide. Objective of this study was to study fertility rates of combination of enclomiphene citrate and melatonin and compare it with fertility rates of plain enclomiphene citrate in cases of dysovulatory infertility.Methods: A total of 107 cases participated in the study out of which 7 women were excluded from the study. So, the results of 100 women were analyzed. Out of 100 women 50 were of Group A i.e., clomiphene supplemented with melatonin group and 50 were in Group B which was clomiphene only group with no supplementation. Cases were followed for three cycles and pregnancy rates in both groups were evaluated.Results: Study demonstrated the potential benefit of melatonin supplementation in naturally conceived cycles where ovulation induction was given by enclomiphene citrate. The ovulation rates were comparable in both study versus control group (68% versus 66%) while there was increase in pregnancy rate in melatonin group (36% versus 24%). However, difference between pregnancy rates in both the groups failed to reach statistically significant levels (p value 0.4065).Conclusions: The adjuvant role of melatonin with enclomiphene citrate in cases of dysovulatory infertility in improving pregnancy rates, which is due to strong anti-oxidant effect of melatonin which in turn reduces oxidative stress thus resulting in good quality oocyte production.
      PubDate: 2020-03-25
      DOI: 10.18203/2320-1770.ijrcog20201248
      Issue No: Vol. 9, No. 4 (2020)
       
  • Maternal and perinatal outcomes in multiple versus singleton pregnancies
           in Dakar, Senegal: a cross sectional study over 10 years

    • Authors: Mame D. Ndiaye, Mamour Gueye, Ndèye Aissatou Diop, Simon B. Ndour, Ndama Niang, Ndèye G. Fall, Abdoulaye Diakhate, Moussa Diallo, Magatte Mbaye
      Pages: 1705 - 1709
      Abstract: Background: The birth of twins is a singular event in most societies, and even more when it comes to multiple births. The objective of this study was to investigate maternal and perinatal outcomes in multiple versus singleton pregnancies.Methods: Cross-sectional study carried out at Philippe Maguilen Senghor health center in Dakar, Senegal from January 1, 2011 to June 30, 2019. Data were extracted from this E-perinatal electronic database and then analyzed in statistical package for social science software (SPSS 24, Mac version).Results: A total 42,870 mothers delivered 44,149 newborns including 1250 twins (2.8%) and 29 triplets. The mean maternal age was 27 years. Mothers with multiple pregnancies had 3 times the odds of poor maternal outcome compared to mothers with single pregnancies (OR 2.42, 95% CI; 1.98-2.94, p <0.001, for high blood pressure; OR, 2.66; 95% CI, 2.11-3.32, p= <0.001, for severe pre-eclampsia; and OR, 3.04; 95% CI, 1.64-5.66, p <0.001, for postpartum hemorrhage). Likewise, women with multiple gestations had significantly higher rates of preterm birth (OR 5.62; 95% CI: 4.91-6.41, p <0.001), breech presentations (OR = 11.02; CI = 9.68-12.53, p <0.001) and neonatal deaths (OR = 2.94; CI = 9.6852-12.5328 p= 0.004) as compared to women with singleton gestations. Furthermore, women with multifetal gestations had increased risk for caesarean section (OR 2.14; 95% CI: 1.91-2.41, p <0.001) compared with their singleton counterparts. The risks for episiotomy and perineal injuries were higher for women with singleton gestations as compared to multiple gestation mothers.Conclusions: This study results are in line with previous findings and contradict others. Particular attention should always be paid to multiple pregnancies’ management. However, the pattern of certain complications traditionally correlated with multiple pregnancies is to be confirmed.
      PubDate: 2020-03-25
      DOI: 10.18203/2320-1770.ijrcog20201249
      Issue No: Vol. 9, No. 4 (2020)
       
  • Hysteroscopic treatment of cervical pregnancy: case report

    • Authors: Aarón Jiménez Valdez, Sara Elia Hernadez Flores, Jorge Arturo Barbabosa Vilchis, Claudia Meixueiro Calderon
      Pages: 1710 - 1712
      Abstract: Of ectopic pregnancies, cervical implantation pregnancy is an exceptional entity, corresponding to less than 1% of ectopic pregnancies. With an incidence calculated at 1: 2500 to 1: 12,000 pregnancies. The risk factors for cervical pregnancy are the same as for other ectopic pregnancies. This entity, a difference from tubaric pregnancy where bleeding is within the peritoneal cavity, the main risk is incoercible vaginal bleeding, which usually ends in a hysterectomy, which limits the reproductive future of patients. There are currently no established criteria for candidates for medical versus surgical treatment. This case reports a case of cervical ectopic pregnancy, treated with Methotrexate, and culminating with hysteroscopy resection.
      PubDate: 2020-03-25
      DOI: 10.18203/2320-1770.ijrcog20200995
      Issue No: Vol. 9, No. 4 (2020)
       
  • Partial hydatidiform mole evolving into metastatic trophoblastic tumor:
           case report

    • Authors: I. Elmouri, S. Tanouti, H. Taheri, H. Saadi, A. Mimouni
      Pages: 1713 - 1716
      Abstract: Partial hydatidiform mole can evolve into a metastatic trophoblastic tumor. A 36-year-old, multiparous woman, pregnant with a 22-week embryonic hydatidiform mole, having spontaneously expelled. Histopathological examination showed a non-invasive partial mole. During biological monitoring, a trophoblastic tumor was diagnosed with pulmonary metastasis on CT-scan and myometrial invasion by MRI.
      Authors opted for a monochemotherapy with a good evolution. The potential risk of malignant transformation of the partial hydatidiform mole requires an adequate therapeutic strategy with strict monitoring.
      PubDate: 2020-03-25
      DOI: 10.18203/2320-1770.ijrcog20201250
      Issue No: Vol. 9, No. 4 (2020)
       
  • Anesthetic management for emergency caesarean section and craniotomy
           together: an overview of the challenge

    • Authors: Nidhi Pathak, Misha Katyal
      Pages: 1717 - 1720
      Abstract: Traumatic brain injury in a pregnant woman is a challenge for anaesthesiologist, surgeon as well as paediatrician as it involves care and management of two lives together. We hereby discuss anaesthetic management of a 23 year old pregnant woman with extra axial bleed and brain contusion and skull fracture. Since the fetus was viable without signs of fetal distress, decision of doing caesarean section followed by craniotomy was taken and our patient was discharged a week later and the baby was handed over to attendant the next day.
      PubDate: 2020-03-25
      DOI: 10.18203/2320-1770.ijrcog20201251
      Issue No: Vol. 9, No. 4 (2020)
       
  • Surgical management of a case of recurrent carcinoma cervix: a case report

    • Authors: B. Kalpana, S. G. Balamurugan, Soumya Ranjan Panda
      Pages: 1721 - 1723
      Abstract: Worldwide cervical cancer is the fourth most common cancers among females. Pelvic recurrence, distant metastases, or a combination of both can occur in patients of carcinoma cervix. A 42-year-old P2L2 with a history of carcinoma cervix stage 3-b came to our OPD for routine follow up. Two year back she was managed with chemoradiation for her primary carcinoma which had parametrium extension. There was a 1 × 1 cm lesion on the anterior vaginal wall which was diagnosed to be cervical recurrence. Patient underwent total abdominal hysterectomy with bilateral salpingo-oophorectomy with pelvic lymphadenectomy. Patient is disease free till now. Treatment decisions should be individualised based on the performance status of the patient, the site of recurrence and/or metastases, the extent of metastatic disease, and prior treatment.
      PubDate: 2020-03-25
      DOI: 10.18203/2320-1770.ijrcog20201252
      Issue No: Vol. 9, No. 4 (2020)
       
  • Tubercular pyometra in a young unmarried female - dilemma and pitfalls in
           diagnosis: a rare case report with review of literature

    • Authors: Rasika Aggarwal, Renuka Malik, Swati Singh
      Pages: 1724 - 1727
      Abstract: This rare case is the first case being reported as tubercular pyometra in a young unmarried woman. Diagnosis of genital tuberculosis which is a form of EPTB (extra pulmonary TB) can be baffling, compelling a high index of suspicion owing to paucibacillary load in the biological specimens. A negative smear for acid-fast bacilli, lack of granuloma on histopathology and failure to culture mycobacterium tuberculosis do not exclude the diagnosis of EPTB. A 25-year-old unmarried, government employee from Bihar presented to our OPD with secondary amenorrhea for two months carrying with her an USG, CT and MRI done in Bihar suggesting enlarged uterus with fluid collection. CT-also reported few enlarged lymph nodes. Her preoperative investigations revealed an elevated ESR and x-ray chest was normal. Dilatation was done under ultrasonic guidance in OT and 150 cc of thick caseous material was drained A gentle curettage was done on lateral wall near cornea and both the caseous material and endometrial tissue was sent for gram staining, TB-PCR (polymerase chain reaction), NAAT (nucleic acid amplification techniques) and culture. In the post-operative period gram staining for AFB, NAAT, TB-PCR all came negative and it was difficult to convince patient to take ATT. However, on day 10, HPE report came as granuloma suggestive of TB and patient was put on ATT. Culture too was reported negative later.  Paucibacillary female genital TB (FGTB) is difficult to diagnose because of varied presentation and limitations of diagnostic tests A raised ESR is presumptive but non-specific. Other tests are x-ray chest, HSG, endometrial tissue for TB PCR nucleic acid amplification techniques (NAAT, HPE and culture (conventional or Bactec). Patients with EPTB are, however, more likely to have negative sputum smear results and many EPTB cases do not have direct lung involvement.  Currently, there are no standard guidelines or algorithm for the diagnosis of FGTB. Female genital TB has varying presentation and diagnosis is difficult because of the paucibacillary nature.
      PubDate: 2020-03-25
      DOI: 10.18203/2320-1770.ijrcog20201253
      Issue No: Vol. 9, No. 4 (2020)
       
  • Ovarian cystadenofibromas: a three cases report

    • Authors: Hafsa Taheri, Mohammed Reda Kholti, Asma Hmila, Hanane Saadi, Ahmed Mimouni
      Pages: 1728 - 1731
      Abstract: Ovarian cystadenofibromas is a benign ovarian tumor that typically affects women in their fifth decade. Its risk factors remain unknown. This case study report 3 cases of ovarian cystadenofibromas treated in our department. The patients are aged 21, 28 and 50 years-old. The clinical pictures were polymorphic but the pelvic ultrasound of the case patients showed cystic ovarian masses suspected of malignancy. Two patients underwent laparoscopic ovarian cystectomy, and the third one, aged 50, underwent laparoscopic adnexectomy. The anatomopathological study showed benign ovarian cystadenofibromas. The operating follow ups were simple. It represents a relatively rare tumor whose macroscopic aspect evokes ovarian cancer wrongly leading to an aggressive surgical attitude.
      PubDate: 2020-03-25
      DOI: 10.18203/2320-1770.ijrcog20201254
      Issue No: Vol. 9, No. 4 (2020)
       
  • Case report on necrotizing fasciitis following episiotomy

    • Authors: Bhabani Pegu, Jayalakshmi D., Avantika Gupta
      Pages: 1732 - 1734
      Abstract: Necrotising fasciitis (NF) is an extremely rare but near fatal bacterial soft tissue infection, complicating the operative wounds. Here is a case report of Necrotising fasciitis in episiotomy wound in low socioeconomic, poorly nourished and anaemic women. A 39 years old, second gravida, delivered normally with medio-lateral episiotomy under local anaesthesia. On postnatal day four, patient developed high grade fever and on examination episiotomy was found to be unhealthy and gaped. She was started on broad spectrum antibiotics empirically but the cellulitis rapidly progressed to vulva, then to the bilateral thighs and extended till knees. Bilateral lower limb Doppler ultrasonography was done to rule out deep vein thrombosis which showed no abnormality. USG abdomen revealed huge pus collection in the lower abdomen. Under anaesthesia, surgical exploration was done, pus was drained followed by wound debridement and pus sent for culture and sensitivity. Pus and blood culture showed growth of Klebsiella pneumoniae, so started on appropriate antibiotics. Patient started recovering, when the wound was healthy, secondary suturing of episiotomy wound done. She was discharged on post-natal day 27 after full recovery. Early diagnosis and aggressive timely management are the corner stone to avoid morbidity and mortality of NF.
      PubDate: 2020-03-25
      DOI: 10.18203/2320-1770.ijrcog20201255
      Issue No: Vol. 9, No. 4 (2020)
       
  • Hamman’s syndrome: a case report of spontaneous pneumomediastinum
           after vaginal delivery

    • Authors: Marco Gentile, Mariaconcetta Zinna, Antonio Costanza, Andrea Remo, Giuseppe Sala, Pietro Catapano
      Pages: 1735 - 1737
      Abstract: Spontaneous pneumediastinum (Hamman’s syndrome) is a rare pathology defined as the presence of free air in the mediastinum with subcutaneous emphysema without trauma or medical problem. It is also a rare complication of labour and delivery and it usually occurs in the second stage of labour. A twenty-six-year-old primigravida presented to our hospital at 39 weeks and 6 days in spontaneous labour. Two hours following the delivery the patient developed neck tightness and chest tenderness with palpation. Chest X-ray and CT scan revealed pneumomediastinum extending into the soft tissue of the neck. A conservative management was performed. Spontaneous pneumomediastinum is a rare condition with a reported incidence of less than 1:44000 and in the setting of pregnancy or labor 1:100000. Regarding pregnancy, the valsalva maneuvers produced in the second stage of labor has been implicated in the development of spontaneous pneumomediastinum. Chest X-ray (posteroanterior and lateral view) is the most important test to confirm the diagnosis. The Hamman’s syndrome has usually a benign course and the management in often conservative. A timely diagnosis of Hamman’s syndrome is necessary for patient safety and correct management, but most cases have a self-limiting course.
      PubDate: 2020-03-25
      DOI: 10.18203/2320-1770.ijrcog20201256
      Issue No: Vol. 9, No. 4 (2020)
       
  • Labial hypertrophy as a cause for vulvae pruritis

    • Authors: Arshiya Firdaus, Rachna Chaudhary
      Pages: 1738 - 1740
      Abstract: Labia minora hypertrophy is a relatively uncommon surgical condition being popularised in the realm of vulvovaginal plastic surgeries. Apart from the unaesthetic appearance of the hypertrophied minora, these cases are also associated with itching, hygiene problem, pain while sitting down, sports activities, difficulty in wearing tight clothing, bleeding and discomfort while or after sexual intercourse, social embarrassment, insecurity and psychological diminution of confidence and self‐esteem. In a country like India, due to sociocultural reasons, patients hesitate to consult a doctor for such deformities. Most of the patients suffer in silence for years. Although common in the west, very few surgeons in the country perform this simple and rewarding surgery. Here, presenting a case of married women of reproductive age group presented to the study side with complains of severe vulvar itching, the cause of itching was labia minora hypertrophy.
      PubDate: 2020-03-25
      DOI: 10.18203/2320-1770.ijrcog20201257
      Issue No: Vol. 9, No. 4 (2020)
       
  • Primary ovarian ectopic pregnancy: an unusual case study

    • Authors: Shikha Sharma, Shelley Moudgil, Varun Kapoor, Anu Devi
      Pages: 1741 - 1742
      Abstract: Ovarian pregnancy is rare variant of ectopic pregnancy. An accurate preoperative diagnosis is very challenging various advances in diagnostic modalities like Transvaginal ultrasonography has evolved in identifying an ovarian pregnancy. It results in significant maternal morbidity, fetal loss, repeat ectopic, impairment of subsequent fertility. The case report a 34-year female who presented with pain and severe anemia and explored keeping in view ruptured tubal ectopic but intraoperatively diagnosed as primary ovarian pregnancy and managed conservatively by ovarian wedge resection.
      PubDate: 2020-03-25
      DOI: 10.18203/2320-1770.ijrcog20201258
      Issue No: Vol. 9, No. 4 (2020)
       
  • Uterine torsion of 90 degrees: case report

    • Authors: S. Tanouti, M. Chakri, H. Taheri, H. Saadi, A. Mimouni
      Pages: 1743 - 1745
      Abstract: Uterine torsion is defined as a rotation of uterus more than 45 degrees along its long axis. However, a pathologic rotation of the uterus beyond 45 degrees-torsion of the entire uterus-is rarely seen in obstetrical practice, authors report a case of torsion of the uterus by 90 degrees. The patient, a 30-year-old gravida 3 para 2 at 37 weeks’ gestation with a singleton pregnancy, her prior obstetrical history included two uncomplicated term vaginal deliveries, and the current pregnancy had been uncomplicated until the date of presentation was admitted to the obstetrical unit  with  labour at 37 weeks 5 days ,on obstetric examination the patient was in labour with transversal presentation of the fetus so an emergency caesarean section (CS) was carried out for. At the time of CS, the diagnosis of uterine torsion of 90 degrees was made. After the delivery of the baby, uterus returned to anatomical position and the torsion corrected spontaneously. The patient recovered and was discharged home with her baby on the third postoperative day. Uterine torsion is an infrequently reported and potentially dangerous complication of pregnancy that occurs mainly in the third trimester.
      PubDate: 2020-03-25
      DOI: 10.18203/2320-1770.ijrcog20201259
      Issue No: Vol. 9, No. 4 (2020)
       
  • A rare case presentation of large mucinous ovarian cystadenocarcinoma in a
           young female

    • Authors: Akansha Singh, Ankita Dadhwal, Ashok Verma, Swati Agarwal
      Pages: 1746 - 1749
      Abstract: Here authors report a case of large ovarian mucinous cystadenocarcinoma in a young female complicating young pregnancy. Ovarian mucinous adenocarcinoma is a rare ovarian tumour that arises from the surface epithelium of the ovary. A 25-year young female, 9 days post-partum presented to the hospital with complain of abdominal distension. USG finding suggesting large solid cystic mass 36 × 14 cm arising from pelvis extending up to epigastrium. MRI pelvis evident of heterogenous hyperintense solid cystic mass lesion giving bunch of grapes appearance with size 24.5 × 25 × 11.5 cms seen in intra peritoneal space extending cranially up to epigastrium and caudally into pelvis giving anterior displacement of uterus.  And posterior displacement of bowel loops. A large part of lesion is cystic with solid component with multiple internal echoes.
      PubDate: 2020-03-25
      DOI: 10.18203/2320-1770.ijrcog20201260
      Issue No: Vol. 9, No. 4 (2020)
       
  • Spontaneous uterine rupture of an unscarred uterus in primigravida: case
           report

    • Authors: Minakshi D. Bansode
      Pages: 1750 - 1752
      Abstract: A spontaneous rupture of the unscarred uterus in a primigravid patient is extremely rare and is associated with high perinatal and maternal morbidity and mortality. Study report a case of spontaneous rupture of an unscarred uterus at 36 weeks of gestation in a 22-years primigravid woman. Ultrasonography showed posterior low-lying placenta praevia with lower margin touching internal OS. Operative findings during emergent caesarean section revealed e/o 2 L of hemoperitoneum, uterus was bicornuate and pregnancy was in the right horn. There was fundal rupture of right horn measuring approximately 6-7 cm anteroposterior. Incision was taken on the lower part of right horn and placenta was seen on anterior wall. Baby delivered as breech after incising placenta. Postoperative recovery was uneventful. In, conclusion, bicornuate uterus may be an independent risk factor for uterine rupture, which can occur in primigravid patients and at any gestation.
      PubDate: 2020-03-25
      DOI: 10.18203/2320-1770.ijrcog20201261
      Issue No: Vol. 9, No. 4 (2020)
       
  • A rare case report of recurrent ectopic pregnancy

    • Authors: Prema Prabhudev, Sapna I. S., Soujanya M. Mudegoud
      Pages: 1753 - 1756
      Abstract: This case presenting a 30-year-old lady, a case of G4A1E2 who presented with history of 1 month of amenorrhoea, followed by bleeding per vaginum 1 week back for 3 days. Presented to hospital with spotting PV and pain abdomen for 2 days. UPT done at home was positive. USG revealed right ovarian complex haemorrhagic cyst and left adnexal ectopic pregnancy near left ovarian fimbriae. Conservative management by Methotrexate and Folinic acid regimen was tried but as there were no signs of resolution on serial ultrasonography reports and serial human chorionic gonadotropin (hCG) levels did not fall as expected, hence decision of laparoscopy/laparotomy was made and salpingectomy was done. Later patient was followed up with serial hCG levels.
      PubDate: 2020-03-25
      DOI: 10.18203/2320-1770.ijrcog20201262
      Issue No: Vol. 9, No. 4 (2020)
       
  • Unusual presentation of scrub typhus in pregnancy with postpartum dilated
           cardiomyopathy: a case report

    • Authors: Ashita Agarwal, Madhu Shweta Sharma
      Pages: 1757 - 1760
      Abstract: Though scrub typhus is one of the uncommon causes of fever in peripartum period it must be kept in differential diagnosis of any febrile illness particularly when the signs and symptoms points towards rickettsial etiology. Weil-Felix test can be used for diagnosis. Uncommon complications such as cardiomyopathy must be suspected in cases who present with undue dyspnea and signs of congestive heart failure. Patients with cardiomyopathy needs appropriate management in intensive care units. ECG and 2D echocardiography (2D echo) needs to be done in these patients which may show arrhythmias and ventricular hypokinesia and decreased ejection fraction respectively. A 21 years aged first gravida female at 34 weeks of gestational age was admitted with complaints of high-grade fever since 4-5 days with no previous antenatal visits. A diagnosis of rickettsial fever was suspected on the basis of presenting complaints and clinical examination. Weil-Felix test turned out to be positive with OX19 titre of 1:160. She underwent LSCS in view of fetal distress and delivered a healthy male child. In immediate postpartum period she developed respiratory distress. Her 2D echo showed features suggestive of dilated cardiomyopathy. She was managed in medical intensive care unit and was eventually discharged. Though uncommon rickettsial diseases should be kept in the differential diagnosis of any febrile illness particularly when presenting with characteristic rash. Serious complications such as cardiomyopathy must be diagnosed early and treated appropriately in these patients to prevent mortality.
      PubDate: 2020-03-25
      DOI: 10.18203/2320-1770.ijrcog20201263
      Issue No: Vol. 9, No. 4 (2020)
       
  • Rudimentary horn pregnancy: a rare entity

    • Authors: Sujamol Jacob, Lalithambica Karunakaran, Neena Devasia
      Pages: 1761 - 1765
      Abstract: Unicornuate uterus is the type 2 variety of mullerian duct anomaly resulting in unilateral agenesis or hypoplasia. The hypoplastic (Rudimentary) horn can be functioning or non-functioning and communicating or noncommunicating with the main uterine cavity. Pregnancy in the rudimentary horn is an extremely rare entity. It is often missed at ultrasound in the early trimester, presenting later with massive hemoperitoneum and shock from rupture of the horn.  A “high index of suspicion” is essential to derive at the correct diagnosis. Hence reporting this rare case for emphasizing the importance in early diagnosis and prompt management.
      PubDate: 2020-03-25
      DOI: 10.18203/2320-1770.ijrcog20201264
      Issue No: Vol. 9, No. 4 (2020)
       
  • Degenerated fibroid: a diagnostic dilemma

    • Authors: Nayanika Gaur, Manish Jha
      Pages: 1766 - 1768
      Abstract: Leiomyoma is one of the most commonly encountered benign gynaecological neoplasms. With a wide range of symptoms, sometimes even asymptomatic, these tumors are easy to diagnose and treat, unless there are degenerative changes, which makes them difficult to diagnose and differentiating them from other serious conditions including malignancy, thereby, complicating their management also. Here, the case present to you a case of 48-year-old women with symptoms and clinical examination suggesting fibroid uterus but imaging studies inconclusive to differentiate fibroid uterus with ovarian malignancy, thus, creating a diagnostic dilemma. Ultimately, patient underwent exploratory laparotomy, keeping possibility of ovarian malignancy. Histopathological examination of the specimen of total abdominal hysterectomy with bilateral salpingo-oopherectomy concluded extensive cystic degeneration of leiomyoma and no evidence of malignancy.
      PubDate: 2020-03-25
      DOI: 10.18203/2320-1770.ijrcog20201265
      Issue No: Vol. 9, No. 4 (2020)
       
  • Surgical management of caesarean scar pregnancy: a case report

    • Authors: Savita Singh Gautam, Manmeet Kaur
      Pages: 1769 - 1771
      Abstract: Caesarean scar ectopic is one of the rarest of all ectopic pregnancies. The incidence of caesarean scar pregnancy (CSP), which was extremely rare till recent times, has been rising steadily. Case have more of such cases being published in medical literature now. It is defined as when a blastocyst implants on a previous caesarean scar. The incidence of caesarean scar ectopic has increased due to increase in number of caesarean deliveries. Early diagnosis of this can be done by using ultrasound. It is very important because a delay can lead to increased maternal morbidity and mortality. Early diagnosis leads to prompt management and improves the outcome by allowing preservation of future fertility. Magnetic resonance imaging (MRI) has important role when sonography is equivocal or inconclusive before therapy or intervention. Case are reporting a rare case of G2P1l1 with previous one caesarean delivery, diagnosed as caesarean scar ectopic pregnancy with the help of sonography. Patient underwent laparotomy and on histopathological examination caesarean scar pregnancy was confirmed. Due to the rarity of this condition, there are no specific guidelines available for its management.
      PubDate: 2020-03-25
      DOI: 10.18203/2320-1770.ijrcog20201266
      Issue No: Vol. 9, No. 4 (2020)
       
 
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