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

  This is an Open Access Journal Open Access journal
ISSN (Print) 2320-1770 - ISSN (Online) 2320-1789
Published by Medip Academy Homepage  [12 journals]
  • Comparative study of tubal patency by sonosalpingogram
           hysterosalpingography and diagnostic laparoscopy

    • Authors: Spoorthy Reddy, M. Padma
      Pages: 3435 - 3441
      Abstract: Background: Sonosalpingography has been suggested as the first-line method to study tubal patency. This study is to bring into focus the value of pelvic sonogram in accessing tubal patency in order to overcome the radiation hazard associated with hysterosalpingogram reduce the cost of examination and encourage it at first-line office. Objective of this study was to compare the diagnostic efficacy of sonosalpingogram, hysterosalpingography and diagnostic laparoscopy for tubal patency as a cause for female infertility.Methods: It is a prospective study in 100 patients attending for evaluation of infertility for a period of 2 years were chosen for this study. All cases with primary and secondary infertility who have attended infertility clinic for tubal causes.Results: 68 cases were found to have bilateral patency as per SSG while 58 cases had bilateral patency as HSG. Similarly 24 cases had bilateral block as per SSG while 28 cases had bilateral block as per HSG. 8 cases had unilateral block as per SSG while 14 cases had unilateral block as per HSG.  This difference in observations may probably attribute to tubal spasm in HSG. Bilateral patency was observed in 68 cases as against 64 cases in laparoscopy.  Out of these 68 cases 9 cases were false positive as bilaterally patent.  However bilateral blocks were shown to be 24 in both methods. Out of 12 cases of unilateral block as per laparoscopy 8 cases were detected by SSG. There was false negative rate of 5%. There was false negative rate of 10% for tubal patency with HSG.Conclusions: For low risk subjects for tubal factors in infertility, sonosalpingogram can be employed as a screening test of choice and for high risk subjects HSG and laparoscopy can be used.
      PubDate: 2019-08-26
      DOI: 10.18203/2320-1770.ijrcog20193768
      Issue No: Vol. 8, No. 9 (2019)
  • Prospective study of primary amenorrhoea and its management in a rural
           tertiary centre

    • Authors: Pavanaganga A., Sai Prathyusha Ivalla, Nagarathnamma R., Sailakshmi M. P. A.
      Pages: 3442 - 3446
      Abstract: Background: Amenorrhoea (absence of menstruation) is a symptom of varied causes. It results from dysfunction of hypothalamic-pituitary ovarian axis, uterus and vagina. It is a major concern for pubertal girls and their family members. It has a major impact on the physical, mental, psychological and social life of the girl and her family. The objective of the present study was to evaluate the aetiology and management of primary amenorrhoea in young adolescent girls.Methods: It was a prospective study conducted for a period of 2 years from August 2016 to July 2018 at Rajarajeswari medical college and hospital. Patients presenting with history of amenorrhoea that is, absence of menses by the age of 13 years with no visible development of secondary sexual characteristics or by 15 years of age with the presence of normal secondary sexual characteristics were included in our study. Cases of secondary amenorrhoea were excluded. Detailed history, examination, investigations and management was documented and analysed.Results: A total of 25 patients of primary amenorrhea were studied during the study period. In our study outflow tract anomalies were the commonest cause of amenorrhoea accounting for 84%, of which imperforate hymen (32%) and Mayer Rokitansky Küster Hauser syndrome (MRKH) 36% were the two most common Mullerian anomaly causing primary amenorrhoea. Gonadal dysgenesis accounted for 12% of the cases. Amenorrhoea was the commonest complaint patients presented with accounting to 76%, followed by cyclical pain abdomen accounting for 16% of cases.Conclusions: Primary amenorrhoea is multifactorial and is of major concern among adolescent girls. Early diagnosis and intervention has an impact on the physical and psychological wellbeing of the girl.
      PubDate: 2019-08-26
      DOI: 10.18203/2320-1770.ijrcog20193694
      Issue No: Vol. 8, No. 9 (2019)
  • Evaluation of fetal fibronectin rapid bedside test as a predictor of
           preterm labour: a prospective study

    • Authors: Kusum Dogra, Meenakshi Tanwar
      Pages: 3447 - 3452
      Abstract: Background: Preterm birth defined as birth before 37 weeks of gestation is a significant public health issue. Identification of patients at risk of preterm labour while ruling out those who are not is a fundamental but challenging goal for clinicians. This study was done to evaluate bed side dipstick test for detecting fetal fibronectin in cervico-vaginal secretions as a predictor of preterm delivery in symptomatic and asymptomatic high risk group.Methods: This was a hospital based prospective, double blinded study. We enrolled 100 pregnant women presenting with or without symptoms of preterm delivery, between 20 and 35 weeks of gestation. A rapid bed side dipstick test was performed to detect FFN in cervico-vaginal secretions of all enrolled women (symptomatic and asymptomatic high risk women) and results were evaluated for prediction of preterm labour. Qualitative data were analyzed by using Chi-square and Fisher’s exact test and quantitative data were analyzed by using unpaired Student’s t test and Mann-Whitney test. P value < 0.05 was considered significant.Results: In symptomatic group sensitivity, specificity, PPV and NPV of FFN test in predicting delivery within 48 hours, 7days 14days and preterm delivery was 100%, 63.2%, 46.2%, 100%; 100%, 72.7%, 65.4%, 100%; 100%, 75%, 69.2%, 100%; 80%, 76%, 76.9%, 79.2% respectively. In asymptomatic high risk group, sensitivity, specificity, PPV and NPV of FFN test in predicting preterm delivery (<37weeks) was 0%, 87.5%, 0%, 77.8%.Conclusions: The high negative predictive value may be of value in avoiding unnecessary interventions with potentially hazardous medications and identifying symptomatic women who are not in true labour and also allaying anxiety of asymptomatic high risk women.
      PubDate: 2019-08-26
      DOI: 10.18203/2320-1770.ijrcog20193698
      Issue No: Vol. 8, No. 9 (2019)
  • Association of new-born birth weight with maternal parameters

    • Authors: Anshika Kashyap, Pushpinder Kaur, Puneet Srivastava, Veena Singh
      Pages: 3453 - 3458
      Abstract:  Background: Birth weight is the single largest determinant of the neonatal survival and wellbeing. Maternal anaemia is the commonest medical disorder in pregnancy and is associated with significant maternal morbidity and mortality. The effect of haemoglobin levels of the mother on the foetus however remains unclear. This study aims at evaluating the effect of maternal anaemia on neonatal birth weight. It also evaluates the effect of parity, gestational age and maternal age on the new-born birth weight.Methods: A retrospective study was carried out on patients who had delivered in Al Falah hospital, a newly setup medical college in rural Haryana. The population was studied for maternal age, gestational period, and parity and haemoglobin levels. These parameters were correlated with neonatal birth weight. The study was carried out on deliveries which occurred over a period of six months from November 2018 to April 2019.Results: The low birth weight new-borns were 10.5%. Maternal anaemia was present in 79.74 % of women in the study group. Amongst all parameters studied, only higher parity and greater period of gestation had a positive correlation with neonatal birth weight. Haemoglobin levels or maternal age didn’t show a significant impact on the neonatal birth weight. Anaemic mothers didn’t have a higher incidence of low birth weight babies.Conclusion: The most significant contributor to improved neonatal weight is the gestational age of the foetus. All efforts to ensure better neonatal outcome must primarily concentrate on prevention of preterm births. Maternal haemoglobin levels do not directly impact the neonatal birth weight. However, as anaemia is a risk factor for preterm delivery, anaemia indirectly impacts on the neonatal birth weight and outcome.
      PubDate: 2019-08-26
      DOI: 10.18203/2320-1770.ijrcog20193635
      Issue No: Vol. 8, No. 9 (2019)
  • Study on bacterial vaginosis in pregnant women and associated factors on
           maternal and fetal outcome

    • Authors: Chitti Sudha A., G. Kanthi Teja
      Pages: 3459 - 3465
      Abstract: Background: Bacterial vaginosis (BV) is a condition in which the normal, lactobacillus-predominant vaginal flora is replaced with anaerobic bacteria, gardnerella vaginalis and mycoplasma hominis1. It is one cause of vaginitis among pregnant and non-pregnant women and an extremely prevalent vaginal condition.Methods: The present study was conducted on all antenatal women attending OPD satisfying the inclusion criteria was taken during the study period 1st October 2012 to 30th June 2014 in GSL General Hospital, Rajahmundry was examined for bacterial vaginosis using Nugent score. All pertinent obstetric and neonatal data covering antenatal events during the course of pregnancy, delivery, puerperium and condition of each newborn at the time of birth was collected. BV was detected by both Gramstain (Nugent criteria) and gold standard clinical criteria (Amsel’s composite criteria).Results: In this study bacterial vaginosis is seen in 313 cases of educated women (62.6%) as most of them have got primary education and 187 (37.4%) cases are uneducated. In this study, symptomatic bacterial vaginosis is more common in multigravida (Bladder -23; Discharge -50) 73 (22%) when compared with primigravida 11 (6.5%) probably because of longer period of marital life. In this study antenatal risk factors like previous IUCD (4.2%) use, H/O STD’s (1.4%), husband having h/o of multiple sexual partners (1.8%) are 7.4%.No cases of smoking, alcohol, drug abuse, douching were reported.Conclusions: Both primigravida and multigravida asymptomatic cases are more when compared to symptomatic cases leading to the need for routine screening. Routine screening of antenatal women resulted in the decrease of adverse pregnancy outcome.
      PubDate: 2019-08-26
      DOI: 10.18203/2320-1770.ijrcog20193693
      Issue No: Vol. 8, No. 9 (2019)
  • An analysis of tubal ectopic pregnancy in a rural tertiary care hospital
           in India: a retrospective study

    • Authors: Chandana Galidevara, Swaramya C.
      Pages: 3466 - 3470
      Abstract: Background: The objective of this study was to analyse distribution of predisposing risk factors for ectopic pregnancy and to study the various modalities of management instituted along with surgical characteristics.Methods: This is a retrospective data analysis of tubal ectopic pregnancies (EP) managed in a tertiary rural referral centre over three years.Results: A total of 160 women were managed for tubal EP. Majority of the women belonged to the age group of 21-30 years (73%). Multigravidae constituted 71.3% of the women and overall, 90.6% women conceived spontaneously. History of ovulation induction was present in 3.7% of women, IUI in 1.2% and IVF in 4.4%. Risk factors encountered in the study include previous EP (9.4%), history of tubal sterilisation (6.9%), caesarean section (13.1%), PID (7.5%), miscarriage (25%), tubal recanalization (3.7%). Conservative management was instituted in 16.8%. Amongst the women managed surgically, 67.5% underwent laparotomy with the remaining being managed laparoscopically. Of the surgically managed patients 72.9% had ruptured EP. There was a predominance of right sided ectopic in our study (79%) and ampullary region of the fallopian tube was the most common site of tubal EP (81.2%). The most common procedure performed was total salpingectomy (56.4%). Supportive treatment with blood transfusion was required amongst 18.8% of the women who had EP. In the postoperative period, fever was noted in 13.5% of women and 2.5% needed intensive care unit admission for hemodynamic stabilisation. The incidence of wound discharge was 12% of women who underwent surgery.Conclusions: This study underpins the importance of early diagnosis, appropriate clinical managementwith timely intervention to improve outcomes associated with EP and to prevent severe morbidity and mortality.
      PubDate: 2019-08-26
      DOI: 10.18203/2320-1770.ijrcog20193636
      Issue No: Vol. 8, No. 9 (2019)
  • Maternal mortality and its causes in a tertiary care hospital

    • Authors: Goter Doke, Jyoti Kamda
      Pages: 3471 - 3474
      Abstract: Background: Maternal mortality is defined as the death of a woman while being pregnant or within 42 completed days of termination of pregnancy. The aim of this study was to study the maternal mortality and analyze the complications leading to maternal deaths.Methods: A retrospective study of hospital records and death summaries of all maternal deaths over the period of two year from April 2017 to March 2019 was conducted in the Department of Obstetrics and Gynecology, Tomo Riba Institute of Health and Medical Science, a tertiary level healthcare referral center in  Naharlagun, Arunachal Pradesh, India.Results: There was a total of 6 maternal deaths out of 6311 live births giving maternal mortality ratio (MMR) of 95.07 per 1,00,000 live births. The majority of deaths were reported in the age groups 30-40 years (66.66%). More deaths were reported in multiparous women (83.33%) as compared to primiparous women (16.66%). Most of them were unbooked cases (66.66%). Haemorrhage (33.33) and pregnancy induced hypertension (33.33%) were the major direct cause of maternal deaths.Conclusions: Haemorrhage and pregnancy induced hypertension were found to be major cause of maternal deaths. In our study, there was no maternal death from anemia and other medical disorder.
      PubDate: 2019-08-26
      DOI: 10.18203/2320-1770.ijrcog20193637
      Issue No: Vol. 8, No. 9 (2019)
  • A retrospective study to assess prevalence of gestational diabetes
           mellitus among those who delivered in Saveetha Medical College and

    • Authors: Sharmila Kumar Gopalan, Kohila Kalimuthu
      Pages: 3475 - 3479
      Abstract: Background: Gestational diabetes mellitus (GDM) defined as any degree of carbohydrate intolerance with onset or first recognition during pregnancy contributes to about 90% of diabetes complicating pregnancy. GDM imposes risks for both mother and fetus, some of which continues throughout the life of mother and child. The objective of the present study was to determine the prevalence of gestational diabetes mellitus and the associated risk factors among those who delivered in Saveetha medical college and hospital.Methods: A retrospective study was conducted by analysing the medical records of the patients who were admitted in the Department of Obstetrics and Gynaecology over a period of 1 year at Saveetha medical college and hospital, Chennai, Tamil Nadu, India. The diagnosis of GDM was made mainly by 75gm one step oral glucose tolerance test (OGTT). The guideline endorses 2-hours 75-gm OGTT, irrespective of last meal timings with a cut off value of ≥140 mg/dl. All data was analysed by simple descriptive statistics and percentage method.Results: In the present study, the total number of deliveries for 1 year from April 2018 - March 2019 were 511 and among those the total number of antenatal mothers with GDM who delivered were 46. Therefore the prevalence of GDM was calculated to be 9% or 90 per thousand deliveries. In the present study, 37 (65.1%) pregnant women of GDM group were seen in the age group of above 25 years, 27 (58.59%) were multiparous, 25(54.25%) pregnant females with GDM were found to have overweight and obese out of 46 cases.Conclusions: Our current study concludes the Prevalence of GDM in Saveetha Medical College Hospital is 9% between April 2018-March 2019. We have identified the following risk factors for developing GDM: multiparity≥2; previous history of diabetes mellitus; age ≥ 25; BMI ≥25; and family history of diabetes.
      PubDate: 2019-08-26
      DOI: 10.18203/2320-1770.ijrcog20193638
      Issue No: Vol. 8, No. 9 (2019)
  • Study of outcome of the treatment with intravenous iron sucrose in
           moderately anaemic pregnant women

    • Authors: Kohila Kalimuthu, Vanusha Avudaithangam
      Pages: 3480 - 3484
      Abstract: Background: Moderate anaemia seen in about 15-20% of pregnant women. Iron sucrose complex which is used intravenously for the correction of Iron deficiency anaemia. The drug has been able to raise the haemoglobin to satisfactory level when used in moderately anaemic iron deficient pregnant women. The objective of this study was to study the improvement of Hb% after treatment with intravenous Iron sucrose complex in moderately anaemic pregnant women belonging to 24-32 weeks of gestational age.Methods: 50 antenatal patients between gestational age 24-32 weeks with hemoglobin between 8-9.5g/dl were selected and included in this study. They were subjected to blood hemoglobin estimation, hematocrit and peripheral smear study. In each infusion, the maximum total dose administered was 200 mg iron sucrose in 100 ml of normal saline, slow IV infused over 30 minutes. Monitoring was done throughout the infusion to observe for any side effects.Results: Mean hemoglobin among the 50 patients before starting the therapy was 8.172g/dl and the mean hemoglobin at the end of one month of completing the therapy was 11.066g/dl. The rise in mean hemoglobin i.e. the difference in the mean hemoglobin before and after treatment was 2.894g/dl. The p value is 0.0001 which is statistically significant. The mean hematocrit of the 50 patients studied before starting the treatment was 26.772% with a standard deviation of 1.914. The mean hematocrit after completing the therapy was 33.872% with a standard deviation of 1.321. The difference in the mean hematocrit was 7.100% with a p value of 0.0001 which is statistically significant.Conclusions: Intravenous iron sucrose complex is well tolerated and highly efficacious in improving hemoglobin, hematocrit in the treatment of iron deficiency anaemia in antenatal women.
      PubDate: 2019-08-26
      DOI: 10.18203/2320-1770.ijrcog20193695
      Issue No: Vol. 8, No. 9 (2019)
  • Efficacy of tranexamic acid in preventing postpartum haemorrhage in
           vaginal delivery

    • Authors: G. Anantha Lakshmi Satyavathi, Chandrika K.
      Pages: 3485 - 3491
      Abstract: Background: Postpartum blood loss is difficult to evaluate especially in developing countries like India where most of the women are anaemic with poor reserve and these conditions are further aggravated by increased demand during pregnancy and blood loss during third stage of labour. The present study was planned to compare the efficacy of prophylactic 10 IU intramuscular oxytocin and 10 IU intramuscular oxytocin +1g Tranexamic acid in reducing blood loss in the third stage of labour.Methods: The present study was carried out on full term pregnancies primigravida/ multiparas with singleton pregnancy being delivered vaginally at GSL Hospital, Rajahmundry between 2016-2017 were included. For this comparative study, 200 women in labor were included after obtaining informed consent. A detailed obstetric history, history of previous medical illnesses, history of the treatment received earlier, cardiovascular and respiratory system and other systems including thyroid and breast were noted.Results: The average total blood loss in IIIrd stage of labour with IM oxytocin was 210 ml and with IM oxytocin + Tranexamic acid was130 ml, which was statistically significant (p<0.001). Oxytocin + Tranexamic acid group had less blood loss when compared to oxytocin group alone. Side effects like, nausea vomiting, headache were slightly more with oxytocin + Tranexamic acid group when compared to oxytocin group alone.Conclusions: In the active management of IIIrd stage of labour 10 IU intramuscular Oxytocin + one gram of tranexamic acid IV is a better combination in reducing the blood loss at delivery when compared to 10 IU intramuscular oxytocin alone.
      PubDate: 2019-08-26
      DOI: 10.18203/2320-1770.ijrcog20193666
      Issue No: Vol. 8, No. 9 (2019)
  • Laparoscopic cervicopexy in uterine prolapse, a prospective study

    • Authors: Anu Aliyar, Saphina Palakkan, Abdul Vahab, Mumtaz P.
      Pages: 3492 - 3496
      Abstract: Background: Pelvic organ prolapse is a common condition and a major cause of gynecological surgery. The lifetime risk of having an operation for prolapse may be 11%. Uterine conserving surgeries using synthetic mesh, especially in younger age group can restore normal anatomy relieving their pelvic symptoms. To evaluate the safety, intra operative and postoperative complications and efficacy of the laparoscopic cervicopexy.Methods: This Prospective observational study was carried out on women aged below 45 years attending gynaecology outpatient department with uterine prolapse at MES Medical College, Perinthalmanna between January 1st and December 31st, 2015. 39 women underwent laparoscopic cervicopexy and follow up assessments was done among them at 2 weeks, 3 months and 6 months. Results: The mean operative time was 27.6 minutes and blood loss was 0.4 gm/dl. No intraoperative and postoperative complications occurred. Short duration of hospital stay with mean of 1.4 days. 7.7% patients and 5.5% had mersilene tape reaction at 3 months and 6 months. The POP Q score C was significantly away from hymen at 2 weeks,3 months and 6 months (+4.4 - -4.3). 7.7% and 2.6% had recurrence at 3 month and 6 months. 5.1% underwent vaginal hysterectomy to get relieved from symptom.Conclusion: Laparoscopic cervicopexy is an effective option for women with pelvic organ prolapse who desire uterine preservation.
      PubDate: 2019-08-26
      DOI: 10.18203/2320-1770.ijrcog20193633
      Issue No: Vol. 8, No. 9 (2019)
  • Hematological changes in pregnancy induced hypertension in their third
           trimester at Jhalawar Medical College, Jhalawar, India

    • Authors: Neelam Jhajharia, Madhureema Verma
      Pages: 3497 - 3501
      Abstract: Background: Pregnancy induced hypertension (PIH) is one of the most common and potential life-threatening complications of pregnancy. This study is aimed to investigate and correlate the hemoglobin, haematocrit, white blood cell count, lymphocytes and platelets in PIH patients in their third trimester.Method: Total 126 subjects were studied out of them 63 patients (case) and 63 healthy pregnant women (control) visiting the Obstetrics and Gynaecology department Jhalawar Medical College, Jhalawar were registered in the study and followed during their pregnancy. Two millilitre of blood sample was drawn aseptically using the 5ml syringe from the median ante cubital vein of all the cases and control participants into EDTA-anticoagulated tubes. Haematological parameter calculated by using Sysmex XN-9100™ Automated Haematology System.Results: The mean hemoglobin level of the case group (8.8206±2.53779) was significantly lower than that of the control group (9.7289±2.47033) (p<0.05). The mean platelet count of the case group (131.4937±62.05999) was significantly lower than that of the control group (324.9683±230.78764) (p<0.05). The mean lymphocytes level of case group (1.2510±0.56369) was significantly lower than that of the control group (1.9295±1.4150) (p<0.05). The mean WBC level of case group (36.3467±119.90635) was significantly high than control group (11.5260±4.83059) (p<0.05). The mean haematocrit level of case group (32.6851±7.29789) was significantly high than control group (30.0424±23.38116) (p<0.05).Conclusion: The mean hemoglobin, mean platelets and mean lymphocytes are lower in PIH patients. The mean WBC and haematocrit are higher in PIH patient. 
      PubDate: 2019-08-26
      DOI: 10.18203/2320-1770.ijrcog20193632
      Issue No: Vol. 8, No. 9 (2019)
  • Screening for gestational diabetes mellitus by two step method and the
           pregnancy outcome: a study in Indian women

    • Authors: Suguna Srinivasan, Vijayalakshmi Palanisamy
      Pages: 3502 - 3504
      Abstract: Background: In recent times, gestational diabetes is becoming more common Worldwide and complications are seen in fetal development, growth, labour and delivery due to maternal hyperglycemia. Gestational Diabetes Mellitus(GDM) is associated with adverse maternal and fetal outcomes. Among South Asian Population, Indian Women are at high risk of developing carbohydrate intolerance during pregnancy. Hence this study is undertaken to screen for gestational diabetes mellitus by two step method in Indian Women.Methods: This study was done in 153 nondiabetic pregnant women of gestational age 24-28 weeks, excluding diabetes mellitus diagnosed prior to pregnancy. Two step method was followed in the present study and GDM was diagnosed and the pregnancy outcomes were noted.Results: In our study the prevalence of GDM is 8.1% by two step method. Most of the women diagnosed with GDM were of age 26-30 yrs (41.66%). Among the women who were diagnosed as GDM, (58.33%) cases required Insulin along with diet control. In our study 33.33% had vaginal delivery, 8.33% had Emergency LSCS and 58.33% had Elective LSCS.Conclusion: Indian Women have high prevalence of GDM, hence universal screening is essential to diagnose GDM, which will improve the pregnancy outcome.
      PubDate: 2019-08-26
      DOI: 10.18203/2320-1770.ijrcog20193630
      Issue No: Vol. 8, No. 9 (2019)
  • A study of visual inspection of cervix under acetic acid and visual
           inspection of cervix under Lugol's iodine for screening of carcinoma

    • Authors: Sunita Kanash, S. D. Shirodkar, Swati Gawai
      Pages: 3505 - 3509
      Abstract: Background: Carcinoma cervix is the most common cancer among women in developing countries. The objectives of the study were to study the sensitivity and specificity of visual inspection of  the cervix with acetic acid (VIA) and Lugol's iodine (VILI) for cervical cancer screening. To study the correlation of demographic data like age, socioeconomic status, education residential area, parity, age at marriage in premalignant lesion of  the cervix.Methods: The present study was conducted in the department of Obstetrics and Gynecology  at a Tertiary Medical Care Center over a period of two years. Five hundred fifty women between 20-65 years of age who fulfilled the selection criteria were enrolled in our study. Positive tests for VIA was opaque aceto white lesion on applying 5% acetic acid or detection of definite yellow iodine non uptake areas with Lugol's iodine in the transformation zone or close to touching the squamocolumnar junction. Positive cases were scheduled for cervical biopsy. Ethical approval of the study protocol was obtained from the ethics committee of the institute.Results: On down staging 7.2% (40/550) of cases  had an unhealthy cervix and 0.36% (2/550) with a suspicious cervix. VIA positive in 4.55% (25/550), VILI positive in 2.73% (15/550). Biopsy was taken from positive with VIA and VILI. On histology 2.9% (16) were chronic cervicitis, CIN I had (1), 0.2%, CIN II (2) 0.4%, CIN III (4) 0.7% and squamous cell carcinoma (2) 0.4% VIA sensitivity 72.22%, specificity 97.74%. VILI sensitivity 100%, specificity 98.89%.Conclusions: VIA and VILI are simple, inexpensive, low resources technique. Both have high sensitivity and specificity.
      PubDate: 2019-08-26
      DOI: 10.18203/2320-1770.ijrcog20193665
      Issue No: Vol. 8, No. 9 (2019)
  • Study on maternal and foetal outcome of pregnancy with positive glucose
           tolerance test by diabetes in pregnancy study group diagnostic criteria

    • Authors: G. Anantha Lakshmi Satyavathi, Chitti Sudha A.
      Pages: 3510 - 3517
      Abstract: Background: Diabetes in Pregnancy Study group, India (DIPSI) diagnostic criteria is a single step method of screening and diagnosis of gestational Diabetes. Therefore, this prospective study was undertaken to ascertain the validity of DIPSI criteria to diagnose GDM based on pregnancy outcome in Indian population.Method: The present Hospital based prospective study was conducted at OBGY department, GSL Medical College and General Hospital, Rajahmundry during 2013 to 2015. Women who were attending OBGY OPD for Antenatal check-ups within 24-28 weeks of GA during the study period were included in the study. Each mother at 24-28 weeks of gestation irrespective of last meal timing, fasting / non fasting was given 75 gm glucose dissolved in a glass of 200 ml water to drink and after two hours venous blood was collected.Result: Out of 500 cases, 26 cases are diagnosed as having gestational diabetes by DIPSI criteria and 474 cases are Normal glucose tolerant. Maximum number 53.9% of cases diagnosed as GDM by DIPSI are of age >25 yrs (53.9%), primigravida (65.7%), BMI>25 (57.7%). In present study, family h/o diabetes is a risk factor for GDMConclusion: Our results suggest that a policy of universal screening for GDM should be adopted in all antenatal clinics and 75 gm OGTT has a high predictive value. This single step procedure is a simple economic and feasible method. It serves both for the purpose of screening and diagnosis at the same time. 
      PubDate: 2019-08-26
      DOI: 10.18203/2320-1770.ijrcog20193634
      Issue No: Vol. 8, No. 9 (2019)
  • Chronic kidney disease in pregnancy and fetomaternal outcome

    • Authors: Pooja Gupta, Indu Chawla, Anjum Ara, Renuka Malik
      Pages: 3518 - 3523
      Abstract: Background: Chronic kidney disease is a heterogeneous group of renal dysfunctions with complex and varied presentations in pregnancy. With a long asymptomatic course, timely diagnosis and management is crucial for fetomaternal wellbeing.Methods: A retrospective cohort study over a period of 3 years and 4 months included all obstetric in patients with known or newly diagnosed renal disorders. Maternal outcome was measured with regard to biochemical parameters presence /absence of proteinuria, hypertension, mode of pregnancy termination and complications. Fetal outcome was noted with respect to antenatal complications, weight, Apgar, NICU stay. Computation of results was done using percentages, mean and proportions.Results: Out of 13 women studied, 53.8% were pre-diagnosed cases of renal dysfunction and 46.2% were diagnosed during pregnancy. 38% had proteinuria at first visit and 50% remained so even after delivery. 60% had history of pregnancy induced hypertension in their previous pregnancies. Secondary hypertension and superimposed preeclampsia were seen in 30% and 38% cases respectively, with only one patient requiring magnesium sulphate prophylaxis in post-partum. Cardiac dysfunction was found to be coexisting in 15.3% cases with pre-existing renal leision. Intrauterine growth restriction was seen in 61.5% cases Average fetal weight was 2. 26kg with 30% having NICU stay. 30.6% had preterm delivery. Mode of delivery was caesarean section in 46% cases.Conclusions: Pregnancy with CKD is a high-risk pregnancy with adverse fetomaternal outcomes. For optimal pregnancy outcomes, an expert multidisciplinary team is required. With limited studies in south Asian population, there needs to be an upgradation in registry system.
      PubDate: 2019-08-26
      DOI: 10.18203/2320-1770.ijrcog20193769
      Issue No: Vol. 8, No. 9 (2019)
  • A clinical observational study in cases of eclampsia

    • Authors: Bipin Kanani, Nirav J. Garala
      Pages: 3524 - 3527
      Abstract: Background: Eclampsia is a life threatening condition and one of the leading causes of maternal deaths worldwide. It is also associated with complications like acute renal failure, DIC, postpartum hemorrhage, etc. and adverse fetal outcomes.  Hence we aimed to study fetomaternal outcomes in cases of Eclampsia.Methods: A total of 75 cases of eclampsia out of 13524 deliveries were evaluated, from 1st January 2016 to 30th June 2017 at RZ Hospital, a government tertiary referral centre. Maternal outcomes were studied for its complications, effectiveness of magnesium sulphate treatment, fetal outcome and mode of delivery.Results: Incidence rate of eclampsia was 0.55%, 62.66% of all cases were primigravida, 76% of cases were in age group of 21-26 years, 84% cases were from lower socio economic status, maternal mortality occurred in 2 of 75 cases. 66.67% of patients were of term pregnancy (37 to 42 weeks). 71%(53) patients delivered vaginally out of which 9 deliveries were spontaneous and 44 deliveries were induced vaginal delivery. 22 patients required caesarean section.Conclusions: Early detection and prevention of pregnancy induced hypertension and pre-eclampsia and other associated risk factors for eclampsia might help to reduce the incidence of eclampsia. Maternal adverse outcomes in this study were magnesium toxicity, acute renal failure (ARF), disseminated intravascular coagulation (DIC) and post partum hemorrhage (PPH) while 92% patients had no complications.
      PubDate: 2019-08-26
      DOI: 10.18203/2320-1770.ijrcog20193770
      Issue No: Vol. 8, No. 9 (2019)
  • Intracervical PGE2 gel application for cervical ripening and induction of
           labour: a clinical study

    • Authors: Shilpa Modi, Jayalaxmi Mahur, Shashank V. S.
      Pages: 3528 - 3534
      Abstract: Background: PGE2 gel (cerviprime) not only helps in cervical ripening but also sensitizes the uterine musculature to physiological PGE2 for generation and maintenance of uterine contractions. In the present study the efficacy of PGE2 intracerival gel for ripening and induction of labour has been reported.Methods: This is a randomized prospective study of 80 cases admitted to the labour room during period of 2 years i.e. March 2017 to March 2019 in Department of Obstetrics and Gynecology, KBNIMS, Gulbarga, Karnataka. All patients had clear indications for termination of pregnancy. The initial bishop score determined prior to induction by pelvic examination. Under aseptic precautions PGE2 endocervical gel was instilled. The results analyzed for successful ripening, induction delivery interval, results in primigravida and multigravida with single instillation or reinstallation if required, mode of delivery and maternal and perinatal complications.Results: The present study of 80 cases showed that a single application of intracervical PGE2 gel caused favorable changes in cervix by increasing Bishop score and shortened induction delivery interval with minimal side effects. Successful ripening with single application was achieved in 92.5% of cases (primi 42.5% and multi 50%). Only 6.25% of primi's and 1.25% of multi’s required reinstallation of PGE2 gel. Successful induction was achieved in 47.5% primi's and 50% multi’s i.e. 97.5% cases.Conclusions: The study concludes that single low dose intracervical PGE2 (cerviprime) gel proved to a safe, reliable and effective method for cervical ripening and induction of labour.
      PubDate: 2019-08-26
      DOI: 10.18203/2320-1770.ijrcog20193771
      Issue No: Vol. 8, No. 9 (2019)
  • Availability and utilization of emergency obstetric care public health
           facilities in Zaria, Northern Nigeria

    • Authors: Ya’u Samira L., Tukur Jamilu
      Pages: 3535 - 3542
      Abstract: Background: Maternal mortality rates continue to soar high in Northern Nigeria despite all sorts of interventions being put in place. This has necessitated the need to emphasize on Emergency Obstetric Care (EmOC) to tackle obstetric complications which are the largest direct causes of maternal mortality. The study was conducted to assess the availability of Emergency Obstetric Care facilities in Zaria Local Government Area (LGA) located in Northern Nigeria.Methods: This was a hospital based cross- sectional descriptive study carried out in Zaria LGA. Data was collected from seven public health facilities using a structured interviewer administered questionnaire.Results: The LGA met the WHO requirement for the population served while none of the designated BEOC met the UN criteria for such designation. Only 8% of births took place in the health facilities and 0.7% of deliveries were by caesarean section. The met need for EmOC in Zaria LGA was 25.1%. Human resources were lacking in number and skills. Some key drugs and equipment needed to carry out signal function were also absent.Conclusions: Public health facilities in Zaria did not meet the requirements of the United Nations (UN) process indicators. There is need to upgrade the health facilities with the necessary human resource, equipment and facilities to enable them perform their designated EmOC functions.
      PubDate: 2019-08-26
      DOI: 10.18203/2320-1770.ijrcog20193772
      Issue No: Vol. 8, No. 9 (2019)
  • The study of association between maternal serum magnesium levels and
           preterm labour in a tertiary care hospital

    • Authors: Shifali Anand, Jyoti Hak, Niveditaa Prashar, Nikita Gandotra, Rohini Jaggi
      Pages: 3543 - 3549
      Abstract: Background: Serum magnesium level in pregnancy is a valuable tool to find out preterm onset of labour. In the asymptomatic group, greater surveillance and administration of steroids, tocolytics and transfer to a higher centre wherever necessary has to be done with mothers with low serum magnesium level. The objective of the study is to find association between serum magnesium levels and women with preterm labour, and to compare these values with those patients who have a term delivery.Methods: The subjects included 100 pregnant women with preterm labour (cases) between 28 and 37 weeks gestation (Group A) and similar number of pregnant women with term labour (controls) between 37 and 40 weeks (Group B). Inclusion criteria for cases was singleton pregnancy, painful uterine contractions more than two in 30 minutes, intact fetal membranes, cervical dilatation (at least 1 cm) and effacement (80%). Serum magnesium levels were done in both the groups. Patients were followed until delivery. Routine antenatal investigations were done. Serum levels of magnesium were estimated by Erba’s semi auto-analyser.Results: 62% patients in Group A were from rural areas. More patients in Group A (70%) were from low socioeconomic class. More women in Group A were anaemic (44%). Mean value of hemoglobin in Group A was 9.93gm/dL. More patients in Group A had muscle cramps (89%). VLBW (<1500gm) neonates were more in Group A (21%). Also, LBW (1500-2499gm) neonates were more in Group A (60%). Mean neonatal birth weight in Group A (1907.3gm) was less. Neonatal morbidity and mortality was observed significantly more in Group A. Mean serum magnesium was less in Group A. Mean serum magnesium levels in primi and multigravida patients were less in Group A. Moreover, mean serum magnesium levels were less in urban and rural patients in Group A. Mean serum magnesium levels were less in normal and overweight patients in Group A. Also, mean serum magnesium levels were less in patients with cervical dilatation <3cm and >3cm in Group A.Conclusions: Low maternal serum magnesium level is associated with preterm labour. Patients with preterm labour have significantly low serum magnesium level when compared with labour at term.
      PubDate: 2019-08-26
      DOI: 10.18203/2320-1770.ijrcog20193773
      Issue No: Vol. 8, No. 9 (2019)
  • Neuro-imaging study in eclampsia

    • Authors: Sujata Swain, Paresh Kumar Jena
      Pages: 3550 - 3555
      Abstract: Background: Eclampsia is associated with increased risk of maternal death varying from 1.8 % in developed countries to 14 % in developing countries. Cerebral complications are the major cause of death in eclampsia patients. Eclampsia along with hypercoagulopathy of pregnancy is a high risk fact for patient in respect of development of cerebrovascular thrombosis/haemoorhage. Eclampsia patients have been found to have various CNS pathological conditions amenable to the medical treatment. The aim of the study is to know the neuropathophysiology behind an eclamptic seizure to reduce the morbidity associated with it.Methods: Prospective study design included 50 patients for the study. All patients were admitted in the eclampsia room with h/o convulsions. All patients were put on MgSO4 therapy and anti-hypertensive. Cranial CT scan examinations were performed for all patients within 24hours of last convulsion without intravenous contrast material injection. Time taken to recover from all the clinical symptoms like altered consciousness, defective vision, headache and seizure and the maternal outcome are compared.    Results: 62% of patients with eclampsia had detectable pathological changes in CT scan. Cerebral edema was the most common CT scan finding with parietal lobe was the most common site (90.32%) of pathological changes. Mortality rate was high among eclamptic patients with cerebral hemorrhage.Conclusions: CT scan was found to be effective in detecting cerebral pathology in more than half of the eclamptic patients. The most common pathological changes detected are cerebral edema and cerebral infarction. CT scan may not be required for the diagnosis of eclampsia, but it must be used in certain complicated patients to detect cerebral pathology at the earliest so that specific management could be provided to reduce the maternal mortality.
      PubDate: 2019-08-26
      DOI: 10.18203/2320-1770.ijrcog20193774
      Issue No: Vol. 8, No. 9 (2019)
  • Comparative evaluation of menstrual patterns and hormonal profiles in
           normal and abnormal perimenopause

    • Authors: Harshiba Kaur, Neerja Goel
      Pages: 3556 - 3563
      Abstract: Background: Currently there is only one marker to objectively establish perimenopause ie menstrual irregularities. Due to the wide variation in hormones like LH, FSH, estradiol, they become unreliable in predicting approaching menopause. This study was conducted to study and compare the patterns of LH, FSH and Estradiol in normal and abnormal perimenopause using the Stages of Reproductive Ageing Workshop (STRAW) criteria.Methods: A comparative evaluation was done after enrolling 200 patients out of which 100 women were in normal perimenopause (early-25 and late perimenopause-75, depending upon menstrual characteristics as defined by STRAW criteria) and 100 having AUB. Sociodemographic data, presence of menopausal symptoms were recorded. S. LH, S.FSH and S. estradiol we determined by adapted solid phase direct sandwich ELISA.Results: FSH was in menopausal ranges (>20IU/L) in early and late perimenopause. LH and FSH in women with AUB ranged from pre to post menopausal ranges. There was significant difference in LH and FSH between normal perimenopause and abnormal uterine bleeding. Estradiol levels showed a significant difference between late perimenopause and AUB p=0.015.Conclusions: This study shows that there is a progressive incremental trend in FSH and LH and decremental trend in Estradiol from early to late perimenopause due to decrease in ovarian follicular reserve, although the difference is not significant. Clinical symptoms present in 50% of late perimenopausal women showed that besides menstrual characteristics we can correlate these menopausal symptoms with raised FSH and low Estradiol. These women can be picked up and preventive therapy may be provided.
      PubDate: 2019-08-26
      DOI: 10.18203/2320-1770.ijrcog20193775
      Issue No: Vol. 8, No. 9 (2019)
  • Analysis of still births in a tertiary care system and changed scenario
           over six year period

    • Authors: Rita Mittal, Shivika Mittal, Anubala Chandel, Poonam Samyal
      Pages: 3564 - 3572
      Abstract:                        Background: In India, the maternal and infant mortality rates have been steadily decreasing in recent years, but there has been no corresponding decrease in the perinatal mortality. Hence, there is need to evaluate the factors leading to this unfortunate event. The objective of this study was to find out various factors (especially preventable) responsible for perinatal stillbirths.Methods: An analytical comparative study in a tertiary care hospital comparing fresh and macerated still births over a period of one year in 2011 and 2017 and responsible factors were analysed.Results: Amazingly, despite improvement in the antenatal services, more institutional deliveries, there is no change in the incidence of still birth rate. However, there was decrease in the rate of still births due to extreme prematurity and congenital malformations. There was no change in incidence of PIH/ Eclampsia, IUGR and placental causes but there was substantial increase in the incidence of GDM.Conclusions: Perinatal mortality can definitely be reduced by strengthening and improving quality of antenatal services, early identification of high risk pregnancies, timely referral and appropriate intervention.
      PubDate: 2019-08-26
      DOI: 10.18203/2320-1770.ijrcog20193776
      Issue No: Vol. 8, No. 9 (2019)
  • A clinical study of maternal outcome in post dated pregnancy in a tertiary
           care hospital

    • Authors: Nikhil Anand, Hardik Shah
      Pages: 3573 - 3577
      Abstract: Background: Pregnancy lasting beyond 40 weeks is a known complication of normal delivery. Studies have found incidence between 2-14%. Post-dated pregnancy carries specific hazards to both mother and fetus. While mothers are faced with problems like increased incidences of induced labour, instrumental delivery and LSCS with associated morbidities, fetuses are faced with morbidities ranging from IUGR to macrosomia. We here tried to study maternal outcome in post-dated pregnancy. The objective is to study maternal outcome in post-dated pregnancy and to compare maternal outcome in spontaneous versus induced labour in post-dated pregnancy.Methods: This study was done at a tertiary care hospital in obstetrics and gynecology department for duration of 18 months. After screening according to inclusion criteria, all patients who were admitted in labour wards were grouped in two groups according to clinical examination. First group consists of patients with spontaneous onset of labour and second group consists of patients with induction of labour. In each group same protocol for fetal monitoring were performed, and labor monitored according to standard partograph. Maternal outcomes in both groups were studied.Results: Maternal outcomes were nearly same in both groups; induced and spontaneous onset of labour, except rate of LSCS, Which was more in induced group though not statistically significant.Conclusions: Women with uncomplicated post dated pregnancies with good bishop score should be allowed spontaneous labour and those with poor bishop should be offered induction of labour, while women with any complicating factors LSCS should be considered.
      PubDate: 2019-08-26
      DOI: 10.18203/2320-1770.ijrcog20193777
      Issue No: Vol. 8, No. 9 (2019)
  • A study of cervical cytology in females above 21 years of age

    • Authors: Nidhi Singh, Hanslata Gehlot
      Pages: 3578 - 3583
      Abstract:  Background: Cancer cervix is the leading cause of mortality and morbidity in developing countries like India most probably due to lack of proper screening facilities or due to the lack of awareness amongst the women of developing countries. Worldwide, cervical cancer is the second most common and 5th deadliest cancer in women. This study was conducted in department of obstetrics and Gynaecology, Umaid hospital, Dr. S. N. Medical College, Jodhpur Rajasthan, India. The objective of this study was to study the various high risk factors involved in premalignant and malignant lesions of cervix. To study the incidence of different epithelial abnormalities of cervix in females above 21 years of age. To study premalignant and malignant lesions of the cervix in relation to the presenting complaintMethods: The study was conducted in 500 females above 21 years of age and who were not pregnant, who had been attending Umaid Hospital, Jodhpur for various gynaecological complaints, of different parity, residential status and socioeconomic class. Detailed history was taken and thorough examination was done. Pap smear was prepared and all smears were reported as per the Bethesda system.Results: Maximum numbers of patients were in the age group of 21-40 years (70.2%). Majority of patients were from rural area (52.4%) and from lower socioeconomic class (30.2%). Most of women were found to have duration of marriage between 10 to 30 years (63.4%). Most of the women in our study had age at marriage between 17 to 19 years (49.4%). Multiparity was seen in 84.2% of cases. The commonest presenting complaint was white discharge (46.8%). On Pap smear, maximum cases were of inflammatory smear (91.4%), 1.4% had ASCUS, 1.2% AGC, 1.4% LSIL, 1% HSIL and 0.4% had SCC.Conclusions: Cervical cytology is an important tool for early detection of premalignant and malignant lesions of cervix. Regular pap smear screening should be conducted in vulnerable age groups.
      PubDate: 2019-08-26
      DOI: 10.18203/2320-1770.ijrcog20193778
      Issue No: Vol. 8, No. 9 (2019)
  • Comparative evaluation of colposcopy, cytology and histopathology for
           diagnosis of cervical lesions

    • Authors: Rashmi Saxena, Alpana Agrawal, Neelima Agarwal, Manisha Gupta, Divya Shubham, Priyanka Rathore
      Pages: 3584 - 3589
      Abstract: Background: Cervical cancer is the fourth most frequent cancer globally in women with an estimated 570,000 new cases and 311,000 deaths in 2018 representing 6.6% of all female cancers. To correlate the cytology, colposcopy and histopathology of cervical lesions in patients attending gynaecology OPD in a tertiary care centre, Ghaziabad.Methods: 208 women were enrolled from Gynaecology OPD of Santosh Medical College and Hospital, Ghaziabad, irrespective of their chief complaints. Women aged 19-80 years were included in the study group. Those with pregnancy and already diagnosed or treated with CIN, Cervical cancer or Cervical HPV infection were excluded from the study. PAP-smear was taken for all the patients followed by colposcopy without waiting for PAP-smear report. Cervical biopsy was taken from patients with abnormal colposcopic findings (90 patients).Results: Majority of women were in age group 30-39 years. 37.5% had unhealthy, 21.6% had hypertrophied cervix and only 9.1% had normal cervix. It was found that PAP -smear has a sensitivity of 33.33%, specificity of 92.59%, accuracy of 68.89%, positive predictive value of 75% and negative predictive value of 67.57%. Test parameters calculated for colposcopy revealed that it has sensitivity of 73.33%, specificity of 92%, PPV of 64.7%, NPV of 94.52% and accuracy of 88.89%.Conclusions: The results from the current study conclude that it is better to use cytology and colposcopy together as part of routine screening for cervical cancer rather than pap smear alone in order to detect maximum number of lesions.
      PubDate: 2019-08-26
      DOI: 10.18203/2320-1770.ijrcog20193779
      Issue No: Vol. 8, No. 9 (2019)
  • Compare the safety and efficacy of intravenous iron supplementation with
           iron sucrose to the oral supplementation with ferrous ascorbate in
           subjects with post-partum anemia

    • Authors: Ganesh Mhaske, Preeti Vadehra, Chandrakala Maran
      Pages: 3590 - 3594
      Abstract: Background: The post-partum period is challenging enough for most new mothers. Recovering from birth, learning to parent, and taking care of her child requires lot of energy. Having anemia in postpartum period can make this process much more difficult. According to WHO, in India incidence of anemia in postnatal mother is around 58% and according to ICMR prevalence of anemia in Tamil Nadu population 76% during pregnancy. The objective of this study was to compare the efficacy of intravenous iron supplementation with Iron sucrose to the oral supplementation with ferrous ascorbate in management of patient with post-partum anemia. To study the safety and side effects of these two preparations.Methods: This was a prospective study conducted on 100 post-partum anemic women in KG Hospital  in Coimbatore, October 2012 to November 2013 with hemoglobin less than 10g/dl but more than 6g/dl within 24-48 hours of delivery ,after satisfying inclusion and exclusion criteria were included in the study.Results: Mean hemoglobin of oral group was 8.49±0.75 and mean hemoglobin of IV group was 8.43±0.76; 24 hours after delivery. After treatment, that is after 4 weeks mean hemoglobin of oral group was 10.38±0.79 and mean hemoglobin of IV group was 11.20±0.71.on comparing both groups, the increase in hemoglobin in the IV groups was significant. Reticulocyte count and other parameters increased significantly after four wks of starting therapy in IV group compare to the oral group. No major side effects or anaphylactic reactions were noted during study period.Conclusions: Intravenous iron sucrose complex is safe, convenient and effective in postpartum anemic women as compared with the oral ferrous ascorbate. Intravenous iron sucrose have shorter treatment periods, increased likelihood of compliance, a lack of gastrointestinal side effects, and rapid replenishment of iron stores, making them superior to oral ferrous ascorbate. 
      PubDate: 2019-08-26
      DOI: 10.18203/2320-1770.ijrcog20193780
      Issue No: Vol. 8, No. 9 (2019)
  • Clinical and sonographic estimation of fetal weight and correlation with
           the birth weight: a research article

    • Authors: Alvencia Vaz, Aheibam Bidya Devi, Naorem Nabakishore Singh, Wahengbam Jatishwor Singh, Laiphrakpam Ranjit Singh, Dylan Momin
      Pages: 3595 - 3601
      Abstract: Background: Accurate estimation of fetal weight is of paramount importance in the management of labour and childbirth. In developing countries including India, estimation of fetal weight by clinical method is important as ultrasound is not available in all health care settings. In view of this, the present study was conducted to estimate the fetal weight assessed by clinical and ultrasound method and correlating with the birth weight.Methods: A cross-sectional study was conducted to estimate fetal weight clinically by using Johnson’s formula and sonographically based on Hadlock’s formula in the Department of Obstetrics and Gynecology in collaboration with Department of Radiodiagnosis, Regional Institute of Medical Sciences, Imphal from October 2016 to March 2018. The study consisted of 525 pregnant women between 37 to 40 weeks of gestation in whom delivery was anticipated within one week of fetal weight estimation by clinical and ultrasound method and correlating it with the baby’s birth weight measured immediately after delivery. Analysis was done using Chi-square and Student’s t-test and p-value of <0.05 was taken as significant.Results: Both methods showed positive correlation with birth weight but clinical method (r=0.925) had stronger correlation compared with ultrasound method (r=0.508).Conclusions: Fetal weight estimation using Johnson’s formula had stronger correlation with the birth weight than ultrasound method and hence, useful for developing countries and all health care workers may be sensitized about the method. 
      PubDate: 2019-08-26
      DOI: 10.18203/2320-1770.ijrcog20193781
      Issue No: Vol. 8, No. 9 (2019)
  • Comparison of RMI 3 and RMI 4 in pre-operative evaluation of ovarian

    • Authors: Badugu Rao Bahadur, Gangadhara Rao Koneru, Prabha Devi Kodey, Jyothi Melam
      Pages: 3602 - 3608
      Abstract: Background: To differentiate ovarian mass as benign or malignant could change clinical approach. Finding a screening and diagnostic method for ovarian cancer is challenging due to high mortality and insidious symptoms. Risk malignancy index (RMI) has the advantage of rapid and exact triage of patients with ovarian mass.Methods: Prospective study carried for 2 years at NRI Medical College and General Hospital, Chinakakani, Mangalagiri, Andhra Pradesh, India. 79 patients with ovarian mass were investigated and risk malignancy index (RMI-3 and RMI-4) calculated. Final confirmation was done based on histopathological report. Sensitivity, specificity, positive predictive value and negative predictive value were calculated for RMI 3 and RMI 4 taking histopathology as control and comparison was done.Results: (n=79); 50 (63.29%) cases were benign and 29 (36.70%) were malignant based on histopathology. RMI 4 is more sensitive (68.96%) than RMI 3 (62.06%), but RMI 3 is more specific (94%) than RMI 4 (92%).The positive predictive value of RMI-3 and RMI-4 were 85.71%  and 83.33% respectively. The negative predictive value for RMI-4 and RMI-3 were 83.63% and 81.03% respectively.Conclusions: With increasing age, chance of malignancy increases. RMI 4 was more sensitive than RMI-3, however less specific than RMI 3 in differentiating benign and malignant tumors. The positive predictive value is slightly more for RMI 3, than RMI 4. Negative predictive value is slightly more for RMI 4, than RMI 3. 
      PubDate: 2019-08-26
      DOI: 10.18203/2320-1770.ijrcog20193782
      Issue No: Vol. 8, No. 9 (2019)
  • Determinants of anemia among pregnant women: A hospital based cross
           sectional study

    • Authors: P. Kalpana, A. Kavitha
      Pages: 3609 - 3613
      Abstract: Background: The objective was to study the determinants of anemia among pregnant women. There is a negative effect on the health of the mother and as well as that of the child due to anemia in women with pregnancy. Death rate is more in women who are pregnant and having anemia. The objective of this study was to study the determinants of anemia among pregnant women.Methods: A hospital based cross sectional study was carried out among 40 pregnant women over a period of six months. Demographic data like age, residence, occupation etc was recorded. Obstetric data like gravida, parity, previous LSCS was also recorded. The data was presented as means and student’s t test was applied.Results: The mean age was 23.43±3.4 years. Majority were young between the ages of 19-22 years. Majority belonged to urban residents i.e. 57.5%. 20% of the subjects were found to be illiterate. Majority of the mothers were housewives i.e. 82.5%. Majority were multi-gravida i.e. 60%. Majority had no history of abortions in the past i.e. 75%. Out of total 19 repeat pregnancies, majority i.e. 84.2% had lower segment cesarean section. Majority reported that they had normal menstrual history. The mean hemoglobin level was found out to be 7.94 gm/dl. It was found that the mean hemoglobin level did not differ significantly across age, residence, education, occupation, gravidity, history of abortions, type of delivery but differed significantly by abnormal menstrual cycle.Conclusions: Mean hemoglobin level was more in women with normal menstrual history compared to those women with abnormal menstrual history and this difference was found out to be statistically significant. Hence abnormal menses should be promptly treated, hemoglobin assessed.
      PubDate: 2019-08-26
      DOI: 10.18203/2320-1770.ijrcog20193783
      Issue No: Vol. 8, No. 9 (2019)
  • A cross sectional study to determine polycystic ovarian disease among
           students of a tertiary care teaching hospital

    • Authors: Raja Sekhar Jalemu, Kasthuribai Sabbe, Grishma Jalemu
      Pages: 3614 - 3617
      Abstract: Background: India now has highest number of patients with type 2 diabetes mellitus globally and speedy rise of the incidence of obesity in children is the major reason for increasing insulin resistance, the metabolic syndrome, dyslipidemia and polycystic ovarian syndrome. But proportion for PCOD is unknown in community. Objective of this study was to estimate the prevalence of PCOD among students in Tertiary care teaching hospital.Methods: A cross sectional study was conducted among students of aged 16-24 years in a teaching hospital in Kerala. Sample sizes of 256 students were randomly selected from various batches of medical and paramedical courses. Occurrence of hyper androgenic features and menstrual irregularities were evaluated, and they were physically examined. The diagnosis of PCOS was made based on Rotterdam’s criteria. Epi-info 7 was used for analysis.Results: Seventy-five students (30%) met the criteria to be diagnosed as polycystic ovarian syndrome. Twenty students (10%) had a history of thyroid dysfunction. The other clinical features of hyperandrogenism were like acne (25%), oily skin (13.5%), and increased hair growth (7%), male pattern thinning of hair (9.75%).Conclusions: PCOD can be assumed of as a forerunner syndrome that, if screened for, can help in early identification of risk of highly morbid conditions, in adolescent girls.
      PubDate: 2019-08-26
      DOI: 10.18203/2320-1770.ijrcog20193784
      Issue No: Vol. 8, No. 9 (2019)
  • Diagnostic utility of semen analysis in infertile couples: a prospective

    • Authors: Roopali Jandial, Mehnaz Choudhary, Kuldeep Singh
      Pages: 3618 - 3621
      Abstract: Background: Infertility is defined as a failure to conceive after at least 12 months of unprotected intercourse. It is broadly established that 40% cases of infertility has male factor. Semen analyses is an imperative diagnostic tool in the valuation of the male partners of infertile couples.Methods: We carried out a prospective study wherein semen analyses of the male partners of infertile couples presented to Department of Pathology, Government Medical College and Associate Hospital, Jammu was done. A total of 300 cases were studied and comparison of each abnormality and combined defects were subjected to incidence distribution.Results: We analysed 300 samples in this study. Mean age of the men was 32.5 years. Duration of infertility in (200; 66.6%) was seen in men married for less than 5 years, (84; 28%) between 5-10 years of married life and there were (16; 5.3%) with more than 10 years of infertility period after marriage. Addiction to alcohol made the majority in our study (187; 62.3%), followed by tobacco chewing and addiction to both tobacco chewing and alcohol consumption (89; 29.6%) and (24; 8%), respectively, men were amongst those with abnormal seminograms.Conclusions: Male infertility is an alarming global health issue. Males contribute towards infertility in couples significantly and further study and assessment is required to accurately predict the importance of this.
      PubDate: 2019-08-26
      DOI: 10.18203/2320-1770.ijrcog20193785
      Issue No: Vol. 8, No. 9 (2019)
  • A cross-sectional study to evaluate sonographic foetal humerus length for
           estimation of gestational age in normal singleton pregnancies at a
           tertiary care centre

    • Authors: Premlata Mital, Richa Ainani, Nupur Hooja, Priya Sonkhya, Vishwas Pradodh, Kavita Chaudhary, Urmila Kharbas, Saloni Sethi, Jeetendra Singh, Ankita Chaudhary
      Pages: 3622 - 3628
      Abstract: Background: Accurate knowledge of gestational age of the foetus is essential for planning a timely and uneventful outcome. Biparietal diameter, head circumference, abdominal circumference and femur length reliably predict gestational age. The humerus length is not widely used as biometric parameter for determining the GA so the present study was done to estimate foetal gestational age by measuring humerus length between 18 to 36 weeks of normal singleton pregnancies and to compare humerus length with routine parameters.Methods: This was a hospital based descriptive cross-sectional study, 200 women with viable singleton pregnancy, with known LMP, between 18 weeks to 36 weeks of gestation were included. Various foetal measurements such as biparietal diameter, head circumference, abdominal circumference, femur length and humerus length were measured using electronic calipers on ultrasound. Data were statistically analyzed.Results: The mean humerus length at 18 weeks was 25.27±1.16 mm and at 36 weeks of gestation was 57.11±1.58 mm. Simple linear regression analysis shows a strongly significant linear relationship between humerus length and gestational age. Where, gestational age (weeks) Y= 0.5213 x humerus length (X) + 4.905; with high degree of correlation coefficient (R2 =0.9785 and P≤0.0001). When Compared with BPD, HC, AC and FL, humerus length also shows a linear correlation.Conclusions: The measurement of the humerus length can be an important additional parameter for estimating gestational age along with other parameters and can be used to predict the gestational age of fetuses in special circumstances.
      PubDate: 2019-08-26
      DOI: 10.18203/2320-1770.ijrcog20193786
      Issue No: Vol. 8, No. 9 (2019)
  • Assessing the new ICD-MM classification for assigning the cause of
           maternal mortality at a tertiary centre in Western India: a retrospective

    • Authors: Tosha M. Sheth, Palak P. Vaishnav, Nandita K. Maitra
      Pages: 3629 - 3634
      Abstract: Background: The World Health Organisation (WHO) in 2012 introduced the 10th revision of International Classification of Disease (ICD 10) to deaths in pregnancy, labour and puerperium (ICD-MM) for consistent collection, analysis and interpretation of information on maternal deaths. The proper use of this classification requires training to avoid heterogeneity and error in the classification of maternal deaths.Methods: We analysed the Maternal Death Review (MDR) forms of 295 deaths over a period of 5 years (January 2014 to December 2018 inclusive) occurring at a tertiary health centre in Western India. The ICD-MM classification was used to reassign the cause of death.Results: There were 295 deaths in women during pregnancy, childbirth and puerperium during the 5 year period. Of these there were 294 maternal deaths and one coincidental death. There were 173 deaths of the direct type (58.84%), 105 deaths of the indirect type (35.71%) and 16 deaths (5.44%) of the unspecified type. Obstetric haemorrhage was  the highest contributor to direct deaths (23.8%) and anaemia contributed to the maximum deaths from indirect causes (13.6%) followed by liver diseases in pregnancy (10.54%).Unanticipated complications of management accounted for 2% of the total deaths. There was considerable inaccuracy in assigning cause of death by consultants who were untrained in the use of the ICD-MM classification.Conclusions: ICD-MM classification promotes an accurate assignment of the cause of death. Training of healthcare providers performing maternal death reviews in the use of this classification is essential to identify accurate underlying cause of death and contributory conditions. 
      PubDate: 2019-08-26
      DOI: 10.18203/2320-1770.ijrcog20193787
      Issue No: Vol. 8, No. 9 (2019)
  • A study on laparoscopic sterilisation using 5mm laparoscope and direct
           trocar entry method

    • Authors: Mohammed sidhiq C., Mini C. H.
      Pages: 3635 - 3638
      Abstract: Background: Laparoscopic sterilization is a widely accepted method of permanent contraception. The techniques of abdominal entry are open direct trocar and veress method. The objectives of this study were to performance and practice of 5mm direct trocar entry techniques in Laparoscopic sterilization. To prepare a list of benefits and complications.Methods: Retrospective analysis of patients who underwent direct 5mm trocar entry for laparoscopic sterilization.  Period: 1st April 2017 to 30th November 2017. Patient came on the day of surgery with empty stomach. Intravenous pethedine 50mg and phenergan 12.5mg and antibiotics were given. Injection lignocaine intraumbilically and incision of 5mm was made. 5mm trocar and canula inserted directly. 5mm scope inserted.  After ensuring peritoneal cavity, pneumoperitonium created. Secondary 7mm port made under vision and ring applicator inserted and fallop ring applied on both tubes. Port closure done by N Butyl 2 cyano accrylate. Patient was observed for 6 hours and discharged with analgesics and antibiotics.Results: We operated 220 interval sterilizations and 31 posts MTP.  In 250 cases, the method was successful.  Only in one woman 5mm trocar was insufficient to make peritoneal entry since the patient was morbidly obese. Hence 10mm trocar was used.Conclusions: Laparoscopic tubal sterilization can be done with 5mm laparoscope and direct trocar entry method is safe and saves time.
      PubDate: 2019-08-26
      DOI: 10.18203/2320-1770.ijrcog20193788
      Issue No: Vol. 8, No. 9 (2019)
  • A comparative study of pregnancy outcomes among women with and without
           threatened miscarriage in the first trimester in Abakaliki Southeast

    • Authors: Johnbosco Ifunanya Nwafor, Victor Jude Uchenna Onuchukwu, Vitus Okwuchukwu Obi, Darlinghton-Peter Chibuzor Ugoji, Blessing Idzuinya Onwe, Chukwunenye Chukwu Ibo, Chuka Nobert Obi
      Pages: 3639 - 3643
      Abstract: Background:Threatened miscarriage is the commonest complication of pregnancy and has been aBackground: Threatened miscarriage is the commonest complication of pregnancy and has been associated with adverse pregnancy outcomes. Therefore, the aim of this study is to determine the association between threatened miscarriage and adverse maternal and perinatal outcomes.Methods: This was a retrospective case-control study undertaken at the Alex Ekwueme Federal University Teaching Hospital, Abakaliki. The study involved 228 women presenting with threatened miscarriage in the first trimester and 228 asymptomatic matched controls. The statistical analysis was done using Epi info version 7.1.5, March 2015 (CDC, Atlanta, Georgia, USA).Results: Women with threatened miscarriage were more likely to have preterm delivery (OR = 7.1, 95% CI = 3.51-14.32, P <0.0001), placenta praevia (OR = 2.4, 95% CI = 1.13 - 5.26, P = 0.03), placental abruption (OR = 3.6, 95% CI = 1.40 - 9.03, P = 0.01) and retained placenta (OR = 2.9, 95% CI = 1.18 - 6.97, P = 0.02). Similarly, women with first trimester threatened miscarriage were more likely to develop postpartum haemorrhage (OR = 2.4, 95%               CI = 1.17 - 5.06, P = 0.02). There was no significant differences in the stillbirth rate, Apgar scores at 5 minutes less than 7, admission into neonatal intensive care unit and early neonatal death. Threatened miscarriage was associated with intrauterine growth restriction (OR = 3.5, 95% CI = 1.77 - 6.88, P <0.0001) and low birth weight <                 (OR = 3.2, 95% CI = 1.33 - 7.69, P = 0.01).Conclusions: Women with threatened miscarriage in the first trimester are at increased risk of adverse pregnancy outcomes and the risk factors should be taken into consideration when deciding upon antenatal surveillance and management of their pregnancies.
      PubDate: 2019-08-26
      DOI: 10.18203/2320-1770.ijrcog20193789
      Issue No: Vol. 8, No. 9 (2019)
  • Addressing adenomyosis: Implications beyond we actually know

    • Authors: Ganesh Kumar, Purnima Pachori
      Pages: 3644 - 3648
      Abstract: Background: Hysterectomy is one of the commonest gynecological surgeries being performed in India for various pelvic pathologies like fibroid uterus, endometrial hyperplasia, dysfunctional uterine bleeding, etc. But pre-operative diagnosis of adenomyosis and making it an indication for hysterectomy is not as common as pathologists find it in histo-pathology of hysterectomized specimens. The aim of the study was to study the frequency of adenomyosis in comparison to leiomyoma as a uterine pathology in hysterectomized specimens and correlate them clinically.Methods: A retrospective comparative study was carried out on 1646 hysterectomy specimens, during January 2014 to December 2016, which showed either adenomyosis or leiomyoma or both. Clinical records of these cases were retrieved and histo-pathology was correlated to clinical presentations and pre-operative ultrasonography.Results: Of the 1646 specimens taken for comparision between adenomyosis and leiomyoma, 49% showed only adenomyosis, 37% only leiomyoma and 14% had dual pathology showing findings of both. The peri-menopausal age group (45-54 years) accounted for the maximum number of patients undergoing hysterectomy (37.12%). But adenomyosis was found maximum in 35 - 44 years age group (38.04%). The clinical presentations for these two pathologies were similar and maximum patients presented with abnormal uterine bleeding and pelvic pain. Ultrasonography was able to diagnose only 32% cases of adenomyosis pre-operatively whereas this figure was 87% for fibroids.Conclusions: Adenomyosis and leiomyoma both account for the most frequent findings in hysterectomy specimens. Fibroids are easily diagnosed pre-operatively, but adenomyosis needs to be diagnosed pre-operatively by high index of clinical suspicion and imaging techniques. Adenomyosis is not just a disease of middle age, it needs to be addressed for infertility, recurrent pregnancy loss (RPL), bad obstetric history, IVF failures and adherent placenta as well.
      PubDate: 2019-08-26
      DOI: 10.18203/2320-1770.ijrcog20193790
      Issue No: Vol. 8, No. 9 (2019)
  • Prevalence of abnormal cervical cytology and HPV DNA positivity among HIV
           positive women

    • Authors: Sunita Malik, Supriti Kumari, Harsha S. Gaikwad, Archana Mishra, Mausumi Bharadwaj
      Pages: 3649 - 3653
      Abstract: Background: The relationship among HIV, HPV, and development of CIN is complex and incompletely understood. Present study is undertaken to find out the prevalence and relationship of abnormal cervical cytology and HPV infection in HIV positive women.Methods: This was a cross-sectional, case control study conducted on 95 HIV seropositive and 95 seronegative women. Specimen was collected from the cervix for HPV DNA testing, subtyping and cytology.Results: HPV DNA positivity was higher in seropositive group (18.6% vs. 7.4%). Premalignant conditions were found only in seropositive group. At CD4 count <249 HPV DNA positivity was 53%, at 250-499 the percentage of HPV DNA positivity was 31% and at >500 HPV DNA positivity was 19%.Conclusions: Prevalence of abnormal cytology and HPV DNA positivity is higher amongst HIV positive women and there is an association between HPV DNA positivity with lower CD4 counts. 
      PubDate: 2019-08-26
      DOI: 10.18203/2320-1770.ijrcog20193791
      Issue No: Vol. 8, No. 9 (2019)
  • Health seeking behaviour of women with unwanted pregnancies: a tertiary
           care centre based study of eastern Uttar Pradesh, India

    • Authors: Sudhir Kumar Gupta, Harish Chandra Tiwari, Reena Srivastav
      Pages: 3654 - 3657
      Abstract: Background: Termination of an unwanted pregnancy is legal in India. Many women in this region are still not aware about safe abortion services and its consequences. Especially young, economically deprived and those without a supportive male partner are at higher risk of unsafe abortion. There is no clear and established evidence on this issue in our region. In the study, the aim was to explore the health seeking behaviour of women with unwanted pregnancies.Methods: Present cross-sectional study was conducted among 303 patients visiting to obstetrics and gynecology ward of BRD Medical College, Gorakhpur from April 2018 to September 2018. Their socio demographic profile, reasons for current termination of pregnancy and health seeking behaviour was explored.Results: Most common reason given for terminating the current pregnancy was completed family size 65.3%. Unmarried girls with pregnancy were 5.6 % who wanted termination of pregnancy. Majority (67.0%) took medication for termination of pregnancy from nearby medical store without an expert consultation 15.8% of women consulted to a local quack or local dai for termination of pregnancy. 12.9% of women tried a method as advised by family/friends for termination of pregnancy. About 4% of women 1st tried traditional and herbal medicines, drinking tea or juice for termination of pregnancy. Majority of women (84.5%) visited to medical college for management of complications of earlier tried method of termination of pregnancy.Conclusions: Completed family size was found most common reason for termination of pregnancy. Self medication without consultation of authorised doctor was found most common practice of abortion leading to complications. 
      PubDate: 2019-08-26
      DOI: 10.18203/2320-1770.ijrcog20193792
      Issue No: Vol. 8, No. 9 (2019)
  • Screening for gestational diabetes mellitus by two step method and the
           neonatal outcome

    • Authors: Suguna Srinivasan, Vijayalakshmi Palanisamy
      Pages: 3658 - 3660
      Abstract: Background: As Indian women has increased risk of developing GDM, screening for GDM is essential for early diagnosis and treatment and hence to reduce the adverse neonatal outcomes.Methods: The antenatal women are screened for GDM by administering 50g GCT and the screening test value of >130mg/dl measured at 1 hours were considered screening test positive and subjected to standard 2 hour 75gm OGTT and the neonatal outcome were observed in relation to neonatal birth weight, Apgar, and the occurrence of complications like hypoglycemia, hypocalcemia, hyperbilirubenemia.Results: The average neonatal birth weight in the study population was 3kg. The women with GDM who required diet alone had average neonatal birth weight of 2.9kgs and the GDM women who were on diet and insulin therapy had average neonatal birth weight of 3.4kg. There was increased incidence of hyperbilirubinemia 33.3% .There was only 1 preterm birth.Conclusions: There is association with neonatal Complications like hyperbilirubenemia and hypoglycemia with women who had screening positive for GDM.
      PubDate: 2019-08-26
      DOI: 10.18203/2320-1770.ijrcog20193631
      Issue No: Vol. 8, No. 9 (2019)
  • Prospective comparative study between colposcopy and histopathology for
           diagnosis of CIN and carcinoma cervix

    • Authors: Kishorkumar Hol, Shweta S. Mishra, Sameer Darawade, Hemant Damle
      Pages: 3661 - 3663
      Abstract: Background: Cervical cancer develops from precursor lesions and detection of these lesions is of utmost importance. The detection of precancerous lesions is made with help of screening tests most important include PAP smear and colposcopy. So we conducted this study to understand the role of colposcopy in down staging of Carcinoma cervix.Methods: We performed a prospective study between Jan 2018 to Dec 2018 on 180 subjects chosen from patients who sought consultation for various gynaecological complaints between age group of 18-60 years. A Pap smear followed by a colposcopy was performed and colposcopic directed biopsies were taken and subjected to histolopathological examination.Results: Colposcopy had a sensitivity of 83.3%, specificity of 78.5%, PPV of 68.9% for CIN 1. It had a sensitivity of 90.9%, specificity of 95.2%, PPV of 83.33% for CIN 2 and 3 when co related with gold standard histopathology which is much higher as compared to Pap smear.Conclusions: Colposcopy is an effective tool in down staging of Carcinoma cervix.
      PubDate: 2019-08-26
      DOI: 10.18203/2320-1770.ijrcog20193793
      Issue No: Vol. 8, No. 9 (2019)
  • Correlation of HbA1c levels in late pregnancy with maternal and perinatal
           outcome in patients with gestational diabetes mellitus

    • Authors: Navjot Kaur, Poonam Goel, Reeti Mehra, Jasbinder Kaur
      Pages: 3664 - 3670
      Abstract: Background: Estimation of HbA1c in gestational diabetes mellitus patients is not being recommended by any societies/guidelines as studies regarding the role of HbA1c for monitoring of euglycemic control and predicting the maternal and perinatal outcomes in GDM patients (unlike overt diabetes) are conflicting and sparse.Methods: This was a prospective study with an aim to evaluate the role of HbA1c estimation in late pregnancy (early and late third trimester) for prediction of pregnancy outcomes in GDM patients. 53 patients with GDM (diagnosed before third trimester) were recruited for the study. HbA1c levels were estimated in late pregnancy (at 28-32 weeks and again repeated at 37 - 39 weeks or at the time of delivery). Correlation of HbA1c levels in third trimester with maternal and perinatal outcome was studied in patients with gestational diabetes mellitus and cut off taken was 5.8%.Results: Of the total 53 patients 54.7% had HbA1c levels <5.8% and 45.3% had HbA1c ≥5.8% done at 28-32 weeks. Also when HbA1c levels done at 37-39 weeks POG/ at the time of delivery, 52.8% patients had <5.8% and 47.2% had HbA1c ≥5.8%. Approximately one-fourth of the patients had HbA1c ≥ 5.8% even with normal blood sugar levels (euglycemic) control. There was statistically significant increased incidence of polyhydramnios, LGA (large for gestational age babies) and increased mean birth weight in patients with HbA1c ≥ 5.8%, done in late pregnancy. However there was no statistically significant difference in the incidence of preterm labour, gestational hypertension or preeclampsia, urinary tract infections, vulvovaginal infections, caesarean deliveries and postpartum haemorrhage in patients with HbA1c ≥5.8% compared to patients with HbA1c <5.8%.Conclusions: The study revealed that in patients of GDM with HbA1c levels ≥5.8% done in third trimester was statistically significantly associated with increased incidence of polyhydramnios, large for gestational age babies and increased mean birth weight when compared to patients with HbA1c <5.8%.
      PubDate: 2019-08-26
      DOI: 10.18203/2320-1770.ijrcog20193794
      Issue No: Vol. 8, No. 9 (2019)
  • Study of adolescent clinic: holistic approach for women health with dual
           client methodology

    • Authors: Vishma H. Shetty
      Pages: 3671 - 3674
      Abstract: Background: The study is done to understand the gynaecological problems in adolescent girls. Do counseling, imparting knowledge for the girl and her mother, hence creating a holistic approach towards the women health in the family by dual client approach.Methods: 400 adolescent girls attending the clinic were studied (prospective observational study). Hb%, S.TSH was done for all the girls. Ultrasonography abdomen and pelvis was done on patient basis. Treatment was given. Mothers were counseled regarding their gynecological issues and screening tests (pap smear, self breast examination) was done after taking consent.Results: 70% girls had menstrual disturbances, 20% had complains of vaginal discharge. 44% had anemia (4% had severe anemia). Subclinical hypothyroidism was detected in 8% of cases. Ultrasonography was done in 52% of cases in which 81 patients had features suggestive of polycystic ovaries. 85.5% of the adolescent girls were accompanied by their mothers. 12% girls took HPV vaccination and 52% mothers underwent pap smear.Conclusions: Teenage problems need to be dealt very sensitively. Counseling is an integral component of treatment strategies. At present, adolescent gynaecology remains an area to which increased awareness and greater attention should be given to promote the health of teenagers and incult healthy lifestyle practices. In the same set up even the mothers of girls can be given counseling and address their gynaecological issues as majority of times mothers are the accompanying person creating the dual client approach in one setting. Hence adolescent clinic should aim for holistic, dual client approach for improvement of overall women health in the family.
      PubDate: 2019-08-26
      DOI: 10.18203/2320-1770.ijrcog20193795
      Issue No: Vol. 8, No. 9 (2019)
  • Robson ten groups classification system for caesarean section audit: are
           our operation theatre registers RTGC enabled'

    • Authors: Fasiha T. Abdul Aziz, Sushma R. Bhoosreddy
      Pages: 3675 - 3678
      Abstract: Background: Rising caesarean section rate is a global problem. Robson ten groups classification (RTGC) system of audit has been recommended as the first step towards planning strategies to reduce caesarean section rate. Getting data for this audit is often difficult. If operation theatre (OT) registers are maintained properly this would become easy. The study proposes to know if enough information is available in the operation theatre registers to get caesarean section data for ten groups of Robson classification system. To suggest changes in OT register format for future convenience.Methods: We studied data from 100 consecutive caesarean section entries in OT registers from two medical college institutions to know if the information recorded is adequate to classify these 100 caesarean sections into ten groups given by Robson. Last 100 caesarean section entries into the OT register during the period 1st April 2018 till 31st March 2019 were studied.Results: Presentation of the foetus was the only factor which could be clearly known for all 100 cases. Labour onset whether spontaneous or induced was the least recorded observation in traditional operation theatre registers. The next information which was commonly not recorded was the labour status (woman in labour or not in labour) at the time of caesarean section.Conclusions: For Robson’s classification of caesarean sections to become useful tool to guide strategies in reducing caesarean sections we need to modify format of our OT registers. Traditional OT registers do not provide enough information to categorize caesarean section cases into Robson ten groups. Missing information makes caesarean section audit imperfect or impossible. We suggest a format for it to be incorporated into the operation theatre registers of centres providing maternity services.
      PubDate: 2019-08-26
      DOI: 10.18203/2320-1770.ijrcog20193796
      Issue No: Vol. 8, No. 9 (2019)
  • Decision to delivery interval in emergency LSCS and its impact on fetal

    • Authors: Vidhu V. Nair, Sobha S. Nair, Prasanna Venugopalan
      Pages: 3679 - 3683
      Abstract: Background: Emergency LSCS can be categorized based on RCOG guidelines into category I and II which indicates maternal or fetal compromise. Here an urgent delivery and the DDI (decision to delivery interval) within 30 and 45 minutes respectively is needed.Methods: This is a retrospective cross-sectional analysis conducted on a sample of 630 patients who underwent caesarean section over a year, from June 2016 to June 2017. The DDI were further classified into ≤30 and >30 minutes for category I, ≤45 and >45 minutes for category II LSCS. The primary objective is to determine whether DDI in Category I and II emergency LSCS has an impact on fetal outcome and secondary objective is to ensure that DDI is within the standard criterion as per RCOG protocol.Results: Out of 630 samples of caesareans, it was found that 173 falls in Category I and 189 falls in Category II. Out of 87 (50.29%) patients delivered within 30 minutes in Category I, 29 babies required NICU admission. DDI was more than 30 minutes in 86 (49.71%) cases in Category I out of which 38 babies got admitted in NICU with low APGAR scores. Out of 176 (93.12%) patients who delivered within 45 minutes in Category II, 56 babies required NICU admission. DDI was more than 45 minutes in 13 (6.88%) cases in Category II and all these babies got admitted in NICU.Conclusions: Decision -delivery interval has a significant impact on fetal outcome.
      PubDate: 2019-08-26
      DOI: 10.18203/2320-1770.ijrcog20193797
      Issue No: Vol. 8, No. 9 (2019)
  • A study of comparison of efficacy and side effects of intravenous
           paracetamol and intravenous diclofenac as a postoperative analgesic

    • Authors: Sharda A. Agrawal, Surendra D. Nikhate, Manasi M. Thakur, Himadri Bal
      Pages: 3684 - 3688
      Abstract: BBackground: A postoperative patient suffers from pain the best relief of which is a clinician’s duty. Till date very few studies have been conducted for comparison of paracetamol and diclofenac as analgesics. As a result a comparative study between Paracetamol and Diclofenac was carried out. The aim of the study was to compare the efficacy and side effects of intravenous Paracetamol and intravenous Diclofenac in patients undergoing major abdominal open surgeries in obstetrics and gynaecology. The study was conducted to assess the postoperative visual analogue pain scores (VAS) and total analgesic requirement in the first 24 hours and also to study the total requirement of additional analgesics despite administration of either Paracetamol or Diclofenac in postoperative period.Methods: 100 patients satisfying the inclusion/exclusion criteria were recruited for the study. They were divided into two groups of 50 each. Group A was given IV Paracetamol 6 hourly for 48 hours starting 2 hours after surgery. Group B was given IV Diclofenac 8 hourly for 48 hours starting 2 hours after surgery. Patients were assessed for pain relief by visual analogue scale (VAS) of zero to ten after 6 hours, 12 hours, 24 hours and 48 hours of surgery by asking the patient to point the position on the 100 mm scale.Results: The results revealed that when we compared the VAS scores between the 2 Groups at different time intervals, it showed that at 24 hours and 48 hours VAS score in the Diclofenac Group was significantly less than the Paracetamol Group. The main side effects were nausea and vomiting in both the groups. There was more nausea and vomiting in Diclofenac group compared to Paracetamol group.Conclusions: It was concluded that at 24 hour and 48 hour pain reduction was more in the Diclofenac group as compared to Paracetamol group, but the side effects were more in the Diclofenac group compared to Paracetamol group.
      PubDate: 2019-08-26
      DOI: 10.18203/2320-1770.ijrcog20193798
      Issue No: Vol. 8, No. 9 (2019)
  • A comparative study of intra-cervical foley’s catheter and PGE2 gel for
           induction of labour at term

    • Authors: Anjali R. Kanada, Mahima Jain
      Pages: 3689 - 3693
      Abstract: Background: In cervical ripening, before induction of labour, is needed to increase the success of labour induction, to reduce complications and to diminish the rate of caesarean section and duration of labour. Pharmacological preparations are in widespread use for cervical ripening but are not free from side-effects and complications. Mechanical methods, i.e. the use of Foley’s catheter balloon, though effective have not gained much popularity because of the fear of infection. Therefore, the study has been conducted to prove the efficacy and safety of extra amniotic Foley catheter balloon and to compare it with intra-cervical prostaglandin E2 (PGE2) gel. The objective of the study was to the success of induction of labor depends on the cervical status at the time of induction. For effective cervical ripening both Foley's catheter and PGE2 gel are used. The aim of this study was to compare the efficacy of intra cervical Foley's catheter and intra cervical PGE2 gel in cervical ripening for the successful induction of labor.Methods: A randomized, comparative study was conducted in the department of obstetrics and gynaecology, Civil hospital, B.J. Medical College Ahmedabad, during a period of 8 month from September 2018 to April 2019. 100 patients at term with a Bishop's score ≤5 with various indications for induction were randomly allocated to group F (intra-cervical Foley’s catheter) and group P (PGE2 gel) with 50 women included in each group.Results: The groups were comparable with respect to maternal age, gestation age, indication of induction and initial Bishop's score. Both the groups showed significant change in the Bishop's score, 5.10±1.55 and 5.14±1.60 for Foley's catheter and PGE2 gel, respectively, p <0.001. However there was no significant difference between the two groups. There was no significant difference in the side effects and caesarean section rate in both groups. The induction to delivery interval was 16.01±5.50 hours in group F and 16.85 ± 3.81 hours in group P (p=0.073). Apgar scores, birth weights and NICU admissions showed no significant difference between the two groups.Conclusions: The study shows that both Foley's catheter and PGE2 gel are equally effective in pre induction cervical ripening.
      PubDate: 2019-08-26
      DOI: 10.18203/2320-1770.ijrcog20193799
      Issue No: Vol. 8, No. 9 (2019)
  • A study on clinico social impact of teenage pregnancy in a tertiary care

    • Authors: Anuradha Konduru, Anil Kumar Bathula, R. Nageswara Rao, N. Prabhavathi
      Pages: 3694 - 3698
      Abstract: Background: In India, teenage pregnancy is an important public-health problem, although the national policy of the Government of India advocates the minimum legal age of marriage for girls to be 18 years. Data of the National Family Health Survey (NFHS)-3 revealed that 16% of women, aged 15-19 years, have already started childbearing. Teenage pregnancies represent a high-risk group in reproductive terms because of the double burden of reproduction and growth. Complications of pregnancy and childbirth are the leading cause of mortality among girls aged 15-19 years in developing countries. Aim and objective of the study was to study the prevalence of teenage pregnancies and to study the clinic social impact of teenage pregnancies.Methods: The observational cross-sectional study was conducted in Government General Hospital, Guntur in the department of Obstetrics and Gynaecology over three Months from August to October 2018. All pregnant women coming to either OPD or directly to the labour room were included in the study group. History was taken and examination was done.Results: Among the 709 deliveries in the institute, 138 are teenage pregnancies contributing to 19.4%. Prevalence of anaemia in teenage mothers is as high as 63.7%, pregnancy induced hypertension contributing to 26.8% and abortions 9.4%. The neonatal outcome is poor in teenage mothers, low birth weight 20.2% contributing to the main morbidity.Conclusions: Teenage pregnancy is associated with an increased incidence of preeclampsia, eclampsia, preterm delivery, increased incidence of instrumental deliveries and lower segment caesarean sections due to cephalopelvic disproportion, neonatal complications, increased neonatal morbidity and mortality mainly due to low birth weight was noted in babies delivered to teenage mothers. 
      PubDate: 2019-08-26
      DOI: 10.18203/2320-1770.ijrcog20193800
      Issue No: Vol. 8, No. 9 (2019)
  • Effect of high blood pressure on thyroid and lipid profile of pregnant

    • Authors: Gurpreet Kaur Gill, Mandeep Kaur, Partapbir Singh, Juhi Kataria
      Pages: 3699 - 3704
      Abstract: Background: Hypertension is common medical problem encountered during pregnancy, complicating up to 10% pregnancies. Hypertension is defined as the systolic blood pressure ≤140 mmHg and a diastolic blood pressure ≥90 mmHg on two separate measurements at least 4-6 hours apart. During pregnancy thyroid demand changes with increased iodine uptake and synthesis of thyroid hormone. Serum from pre-eclamptic women had both a higher ratio of free fatty acid to albumin and increase up take of free fatty acids, which are further esterified to triglyceride. The aim of the present study was to evaluate thyroid hormone, lipid profile and urine albumin in hypertensive pregnant women and its comparison with normotensive pregnant womenMethods: Total 90 samples were collected from Beri Maternity Hospital and Civil Hospital, Amritsar. Blood samples were analysed for biochemical parameters viz. lipid profile and thyroid profile. Urine samples were also analysed for presence of albumin.Results: From the study it has been revealed that thyroid stimulating hormone (TSH) levels increased in hypertensive pregnant women mean (4.26±1.1µ/ml). The total cholesterol (234.56±14.2mg/dl), triglyceride (138±16.96mg/dl), HDL (50.7±7.4mg/dl), LDL (156.2±17.11mg/dl) and VLDL (27.7±3mg/dl) was found altered in hypertensive pregnancy as compared to normotensive pregnancy. The albumin excretion was seen in 13.3% hypertensive pregnancies.Conclusions: TSH were elevated in hypertensive pregnant women due to the effects of estrogen. Among all the parameters of lipid profile, total cholesterol, TG, LDL and VLDL has been increased significantly in hypertensive pregnant women as compared to normotensive pregnant women due endothelial dysfunction. 
      PubDate: 2019-08-26
      DOI: 10.18203/2320-1770.ijrcog20193801
      Issue No: Vol. 8, No. 9 (2019)
  • The predictive value of sFlt-1/PIGF ratio in high risk patients for the
           development of preeclampsia

    • Authors: Isha Sunil, Mitali Sharma
      Pages: 3705 - 3709
      Abstract: Background: Hypertensive disorders of pregnancy constitute a major cause of maternal morbidity and mortality. Pre-eclampsia/eclampsia ranks second only to haemorrhage as a specific, direct cause of maternal mortality. A number of markers have been under study for the early detection of this disease. The study aims to evaluate the predictive value of sFlt-1/PlGF ratio for preeclampsia.Methods: This study was conducted in the Department of Gynaecology and Obstetrics of ASCOMS hospital, Jammu for a period of 6 months from Jan 2019 to June 2019. 50 antenatal patients attending the outpatient department with risk factors for developing preeclampsia were enrolled in the study. Their sFlT-1/PIGF ratio was determined at gestational age of 20 weeks to 37 weeks and its predictive value was evaluated.Results: In the present study, 8 patients developed preeclampsia subsequently. The mean sFlt-1/PIGF ratio values were significantly higher in the patients who developed preeclampsia (73.5) than who did not develop the disease (26.07). The positive predictive value at 1 week was 41.66% and negative predictive value was 100%. At 4 weeks, positive predictive value was 66.66% and negative predictive value was 100%.Conclusions: The present study suggests sFlt-1/PIGF ratio values are useful marker was a predictor of preeclampsia and values >38 were associated with preeclampsia. It is more useful in ruling out preeclampsia than ruling in the disease.
      PubDate: 2019-08-26
      DOI: 10.18203/2320-1770.ijrcog20193802
      Issue No: Vol. 8, No. 9 (2019)
  • Assessment of quality of care provided at a tertiary hospital of Sikkim by
           patient's degree of responsiveness

    • Authors: Hafizur Rahman, Ezzat Khalda
      Pages: 3710 - 3714
      Abstract: Background: Quality of care is concerned with the interface between provider and patients, between health services and community. The aim of the current study was to evaluate the quality of provided health care and patient experiences at a tertiary hospital based on the concept of responsiveness.Methods: This was a cross-sectional survey among reproductive women of Central Referral Hospital over a period of 5 months from August 2016 to December 2016. A pre-designed, pretested, self-administered response questionnaire on rate of service utilization using the WHO health system responsiveness modulewas used.Results: A total of 450 women were approached and requested to participate during the study period of which 374 women completed the survey. According to the evaluation of in-patient care (Table 2), "able to change doctor if wanted" showed the lowest degree of responsiveness (52.7%). A significant proportion of patients experienced discrimination for different reasons: 9.6% reported feeling they had been treated worse than others because of lack of money, while a similar proportion reported they had been discriminated for the language they speak or because they were having insurance from a company.Conclusions: Health care access in terms of prolong waiting  time in the reception and before being attended by doctor, difficulty to change doctor when wanted and discriminatory experiences were identified as priority areas for actions to improve responsiveness and patient satisfaction.
      PubDate: 2019-08-26
      DOI: 10.18203/2320-1770.ijrcog20193803
      Issue No: Vol. 8, No. 9 (2019)
  • The incidence, pattern and management of sexual assault in a tertiary
           hospital in North-western Nigeria

    • Authors: Constance E. Shehu, Ojogbane I. Ekele, Abubakar A. Panti, Ibrahim Ango, Bissallah A. Ekele, Mohammed Umar
      Pages: 3715 - 3721
      Abstract: Background: Sexual assault is any sexual act performed by one person on another without the person’s consent or on a victim who is incapable of giving consent. It is a violation of basic human rights, a gender-based issue and a violent crime against both the individual and the society. The objectives of the study were to determine the incidence, pattern and management of sexual assault in Usmanu Danfodiyo University Teaching Hospital, Sokoto, Nigeria.Methods: This was a 10 - year retrospective study. Case records of sexual assault from 1st January, 2007 to 31st December, 2016 were retrieved and relevant data extracted and analyzed using the SPSS for windows version 20.0Results: The incidence of sexual assault was 0.8%. Majority, 88 (85.4%) occurred in children and adolescents. Peno-vaginal penetration was the most common form of assault 65 (63.1%) and the assailants were known to the victims in 74 (71.9%) of the cases. Involvement of psychiatrists/psychologists in the management of the victims was poor as psychiatrists were involved in only 13 (12.6%) of the cases. Most of the victims were lost to follow up.Conclusions: Sexual assaults occurred mostly in children and adolescents in this study. Increased public awareness and preventive interventions are required especially among the at-risk age groups to enhance their safety. Training of relevant persons in the institution to offer counselling to the victims is recommended as referral for psychiatrists’ consultation was poor. It is important to institute a good tracking system to follow up the victims as most are lost to follow up.                                                                
      PubDate: 2019-08-26
      DOI: 10.18203/2320-1770.ijrcog20193804
      Issue No: Vol. 8, No. 9 (2019)
  • Assessment of the customized birth weight formula in a low risk Indian

    • Authors: Dipti Das, K. Aparna Sharma, Vatsla Dadhwal, Dipika Deka, Perumal Vanamail
      Pages: 3722 - 3725
      Abstract: Background: Birth weight is probably the single most important factor that affects neonatal mortality, infant and childhood morbidity in both developed and developing countries. Objective of the study was to formulate a model for prediction of fetal weight at term based on individualized fetal growth parameters.Methods: 131 participant low risk gravidas were enrolled into the study. The participants underwent an ultrasound 7 days prior to delivery. All fetal variables of growth of a random 100 participants were incorporated in an equation derived using multiple regressions to predict birth weight at term. The new equation was then prospectively applied to another 31 pregnant women for validation. The diagnostic performance of the new regression formula was then compared to the Hadlock formula.Results: The customised birth weight formula predicted a higher accuracy with MPE±SD of 0.790±9. compared to the Hadlock formula with MPE±SD - 4.42±8.73. The new formula also explained a greater variance in birth weight of 56% compared to the Hadlock formula of 49%.Conclusions: The new model based on individualized fetal growth parameters recognizes the capacity to modulate an accurate final birth weight, thus emphasizing the need for customized population specific birth weight formulas.
      PubDate: 2019-08-26
      DOI: 10.18203/2320-1770.ijrcog20193805
      Issue No: Vol. 8, No. 9 (2019)
  • Clinical and hormonal profile of patients diagnosed with polycystic
           ovarian syndrome at tertiary care hospital in Tamil Nadu

    • Authors: Sathiya S., Renuka S., Famida A. M., Jennifer Britto J., Vijayalakshmi K., Sailatha R.
      Pages: 3726 - 3731
      Abstract: Background: In recent years due to the changing sedentary life style, irregular periods and infertility has become a major concern. There are many causes for infertility out of which ovulatory disorders contribute to a great extend. The main objective of the study was to assess the clinical and hormonal profile of patients diagnosed with polycystic ovarian disease at tertiary care hospital in Tamil Nadu.Methods: This study was a cross sectional study and was carried out at the Department of Obstetrics and Gynaecology at a tertiary care hospital of Tamil Nadu. The study was done for a period of 6 months. For confirming polycystic ovaries, patients were interviewed thoroughly about their menstrual and fertility history. Blood investigations like LH, FSH were done on D2/D3 of menstrual cycle. 125 patients with PCOS were included in this study. The data was analysed with SPSS-IBM (V.22.0) software.Results: The patients having polycystic ovaries were higher in women of 21-30 years of age. BMI was more than 25. Infertility was found that 57%, hirsutism 45%,  oligomenorrhoea 21% and amenorrhea 20%. On day 2, mean serum LH was 5.9±3.6 and serum FSH was 3.9±2.3. This study showed that the proportion of menstrual complaints is reported more in higher age group. Likewise lower income group presented with menstrual complaints. This was found to be statistically significant (P value <0.05).Conclusions: The study showed that patients diagnosed to have PCOS overweight. PCO in obese women had more severe ovulatory dysfunction. Infertility was the most common complaint.
      PubDate: 2019-08-26
      DOI: 10.18203/2320-1770.ijrcog20193806
      Issue No: Vol. 8, No. 9 (2019)
  • Correlation of serum magnesium levels in eclampsia with pritchard and
           single dose magnesium sulphate regimen

    • Authors: Shreya M. S., Nayana D. H.
      Pages: 3732 - 3737
      Abstract: Background: Magnesium sulphate is anticonvulsant of choice for eclampsia. Single dose magnesium sulphate therapy was tried for the management of Eclampsia and Imminent Eclampsia considering the low body mass index of Indian population.Methods: A prospective interventional study comprising of total 80 patients having either eclampsia or imminent eclampsia, to whom the Pritchard or a single dose MgSO4 was given alternatively in a tertiary hospital   from October 2014 to October 2017. Serum magnesium levels, maternal and perinatal outcome and recurrence of convulsions were evaluated using Student- t test and chi square test.Results: Mean Serum Magnesium levels in eclampsia and imminent eclampsia group at 0 min, 30 min, 4 hours in Pritchard regimen were 1.96mg/dl, 5.85mg/dl, 4.68mg/dl while in single dose regimen it was 1.78mg/dl, 462mg/dl, 3.63mg/dl respectively. Those who received Pritchard regimen showed higher level of Serum magnesium levels at 30 minutes and 4 hours than those receiving single dose. By applying T-test it was found that there is a significant difference in serum magnesium levels range in both group but no statistical difference in the control of convulsions in both groups.Conclusions: With increased and almost widespread use of magnesium sulfate in obstetrics there has been concerns regarding its safety. In the study, although P-values are not significant because of small sample size, there is considerable difference in serum magnesium levels 30 min and 4 hours, recurrence of convulsions and maternal morbidity between Pritchard regimen and single dose regimen. The goal which was achieved with Pritchard regimen previously, now can be achieved with single dose regimen in Indian women. Single dose magnesium sulphate is safe and effective in controlling convulsions with improved maternal and perinatal outcome.
      PubDate: 2019-08-26
      DOI: 10.18203/2320-1770.ijrcog20193807
      Issue No: Vol. 8, No. 9 (2019)
  • Knowledge about obstetric danger signs among pregnant women attending
           antenatal clinic in a tertiary care hospital of Delhi: a cross sectional

    • Authors: Ashok Kumar, Geeta Yadav, Vijay Zutshi, Suman Bodat
      Pages: 3738 - 3743
      Abstract: Background: According to UNICEF, globally 800 million women die due to preventable causes related to pregnancy and childbirth; 20% of which occur in India. It is therefore imperative to understand the level of knowledge about danger signs among pregnant women to augment timely redressal of preventive obstetric causes of mortality.Methods: A hospital based, cross sectional study was conducted at the ANC Clinic in Safdarjung Hospital, New Delhi from 2nd July to 27th July 2018. Convenient sampling was used to identify and interview 354 pregnant women, using a semi structured questionnaire. Data was entered and analysed with SPSSv21. Results were presented as frequencies and proportions. Chi square was used to test for association between qualitative variables, and p-value less than 0.05 was considered significant.Results: 48.3%, 35.6%, and 40.1% of pregnant women had knowledge about danger signs during pregnancy, labour and postpartum respectively. Majority of the women had knowledge about abdominal pain (58.4%) and severe fatigue (80.7%) as danger signs of pregnancy, while bleeding (82.5%) was the most common response as danger sign of labour. More than half had knowledge about heavy bleeding (59.9%) as danger sign of postpartum. The women lacked awareness about Convulsions (92.9%) as danger signs of pregnancy and labour, as well as smelly vaginal discharge (79.6%) in postpartum.Conclusions: Knowledge of obstetric danger signs among pregnant women is still lower. It needs further awareness as it can help in early diagnosis and referral of patients thus reducing maternal mortality and morbidity.
      PubDate: 2019-08-26
      DOI: 10.18203/2320-1770.ijrcog20193808
      Issue No: Vol. 8, No. 9 (2019)
  • Evaluating iron deficiency anaemia in the third trimester of pregnancy
           with haematological parameters and serum ferritin concentration

    • Authors: Niranjani Selva Muthukumaran, Radha B. P. Thangappah, Amrin Azad, Kesari Sravaniy
      Pages: 3744 - 3749
      Abstract: Background: Iron deficiency is the commonest cause of anaemia and at least half of anaemia cases will have causes other than iron deficiency. The objective of this study was to determine the prevalence of iron deficiency anaemia among antenatal mothers based on haematological parameters and serum ferritin levels.Methods: This was a hospital based cross sectional study, conducted at Meenakshi Medical College and Research Institute, Kancheepuram from January 2017 to June 2018. Two hundred antenatal mothers who were diagnosed with anaemia in the third trimester of pregnancy were evaluated by haematological parameters and serum ferritin assay.Results: 38% of women had mild anaemia, 50% had moderate anaemia and 12% had severe anaemia. On peripheral smear, 60% had microcytic hypochromic anaemia indicating iron deficiency, and 12% had megaloblastic anaemia. In 41% of cases, the mean corpuscular volume was <82fL indicative of iron deficiency. Among the 120 women diagnosed with iron deficiency anaemia on smear, the mean ferritin level was 16.62±73.42 (less than 30µg/l). There was a statistically significant low levels of serum ferritin levels in those diagnosed with iron deficiency anaemia (P < 0.05). The serum ferritin level was >160µg/lit in 19% of cases.Conclusions: Based on the haematological parameters and serum ferritin estimation, in 60% of cases, anaemia was due to iron deficiency. Before initiating treatment, it is important to differentiate various types of anaemia, so that appropriate treatment can be given.
      PubDate: 2019-08-26
      DOI: 10.18203/2320-1770.ijrcog20193809
      Issue No: Vol. 8, No. 9 (2019)
  • Maternal foetal attachment and perceived stress during pregnancy

    • Authors: Akankshi Srivastava, Pallavi Bhatnagar
      Pages: 3750 - 3756
      Abstract: Background: In recent years, the construct of maternal foetal attachment (MFA) has gained a lot of attention. The significance of the bond between the mother and her child she is carrying has led researchers to study how the expecting woman’s feelings towards the unborn child, have long lasting effects on the child. Although several psychological factors, such as maternal anxiety, attitude towards the baby and access to foetal imaging procedures, have been established to significantly influence a mother’s attachment to her foetus, there seems to be a paucity of empirical work on the relationship between maternal stress during pregnancy and maternal foetal attachment. The present research is a step in this direction and purports to explore this relationship.Methods: The study explored the relationship between MFA and stress using the maternal foetal attachment scale by Cranley and the stress scale of the ADSS by Bhatnagar et al. The sample consisted of 53 pregnant women with a mean age of 26.4.Results: The results suggest a significant negative relationship between stress and MFA, r=-0.55 (p<0.01). Stress also showed a negative correlation with the subscales of MFAS, with highly stressed women reporting lower levels of self-giving behavior, fewer thoughts of role taking and lesser interactive behavior with the foetus.Conclusions: High stress during pregnancy could impede the formation of a strong bond between the expecting woman and her foetus. Thus the best practices during pregnancy should aim to reduce stress and encourage maternal foetal interaction.
      PubDate: 2019-08-26
      DOI: 10.18203/2320-1770.ijrcog20193810
      Issue No: Vol. 8, No. 9 (2019)
  • Prevalence and determinants of postnatal depression in a tertiary care
           teaching institute in Kerala, India

    • Authors: Heera Shenoy T., Remash K., Sheela Shenoy T.
      Pages: 3757 - 3764
      Abstract: Background: Pregnancy and childbirth produce a variety of physiological, psychological and social consequences. Attitudes toward pregnancy and childbirth vary from culture to culture. Prevalence estimates range from 13 to 19% in resource-rich settings and 11 to 42% in resource- limited settings PND has a significant impact on the mother, the family, her partner and mother-infant interaction. This research aims to aid the early diagnosis of postnatal depression and the socio-demographic, obstetric, family dynamics, neonatal characteristics and psychiatric determinants of depression using EPDS among postnatal women in a tertiary hospital in Kerala state, India.Methods: 119 women between 2 to 6 weeks of postpartum period were subjected to a pre-tested pre-structured standard questionnaire. Diagnosis of depression was made using the Edinburgh postnatal depression scale. Possible depression is values >13 or more are invariably associated with depression.Results: Young age at marriage (p-value 0.022), love marriage (p-value 0.040) and low social support inadequate relationship with the in-laws was significantly associated with PND (p-0.003). Low birth weight was a significant determinant of PND (p-value-0.018). Gender of the new-born, fear and preference towards any particular gender and order of female child in multiparous woman had no association in determining postnatal depression. Childcare stress (p-value-0.011), psychiatry history in family and personal history of depression and mothers with low self-esteem (p-value-0.001) had odds of developing postnatal depression in the study.Conclusions: Early screening of the women and counselling of women and their family will reduce the maternal morbidity and adverse child outcomes.
      PubDate: 2019-08-26
      DOI: 10.18203/2320-1770.ijrcog20193811
      Issue No: Vol. 8, No. 9 (2019)
  • Expression and cellular distribution of insulin-like growth factor 1
           receptor during window of implantation in infertile women with intramural

    • Authors: Annu Makker, Madhu Mati Goel, Dipti Nigam, Amita Pandey
      Pages: 3765 - 3769
      Abstract: Background: The “window of implantation” (WOI) is a transient but well defined period during which the hostile endometrial lining is transformed to a surface receptive to accept the embryo. Recently, data are beginning to accumulate suggesting negative influence of non-cavity distorting intramural uterine fibroids (NCD-IMF) on endometrial receptivity that may have implications for implantation failure. However, molecular mechanisms underlying infertility associated with NCD-IMF remain unclear. The aim of present study was to examine the expression and cellular distribution of insulin-like growth factor 1 receptor (IGF1R) during WOI in infertile women with NCD-IMF and fertile controls. While, reports are available that support role of IGF1R in mediating adhesive interaction with the implanting blastocyst, the effect of NCD-IMF on IGF1R expression during the WOI is not defined.Methods: Quantitative real-time polymerase chain reaction and immunohistochemistry were used to evaluate messenger RNA (mRNA) and protein expression of IGF1R in midsecretory endometrial biopsies obtained from infertile women with NCD-IMF (n=20) and healthy fertile controls (n=10).Results: As compared to fertile controls, significantly higher IGF1R: i) mRNA levels (1.59 fold up regulation; p=0.044) and ii) immunoscore in the luminal epithelium (8.94±3.13 versus 6.31±1.49; p=0.009) were observed in infertile women with NCD-IMF.Conclusions: Over expression of IGF1R in infertile women with NCD-IMF, during the window of receptivity, may result in altered ability of uterine epithelial cells for blastocyst adhesion and subsequent implantation, which might lead to poor reproductive outcome in these women.
      PubDate: 2019-08-26
      DOI: 10.18203/2320-1770.ijrcog20193812
      Issue No: Vol. 8, No. 9 (2019)
  • Study of medical disorders in pregnancy among in patients at a tertiary
           care hospital in Haryana, India

    • Authors: Sushila Chaudhary, Savita Rani Singhal, Meenakshi B. Chauhan, Anjali Gupta, Monika Dalal
      Pages: 3770 - 3773
      Abstract: Background: Pregnancy is a physiological condition in which various changes occur in pregnant women just to accommodate growing fetus. Pregnancy is a stress test for woman and may unmask certain underlying chronic diseases like, DM, hypertension which were silent or asymptomatic prior to pregnancy. This study was done to know the incidence, type and demographic profile of medical disorders in pregnancy among in patient at a tertiary care hospital.Methods: It was a retrospective study conducted on 578 patients of medical disorders in pregnancy admitted in a tertiary care hospital from January 2017 to December 2017. Data collected from record room and analysis done.Results: Total antenatal admissions were 4721. Incidence of medical disorders was 12.24%. Majority of women were in age group 20-30 years (65.5%). Low-parity (P0, P1). Hypertensive disorders in pregnancy was commonest reported disorder (42.3%), followed by hematological disorder (38.7%), liver disorder 5%, endocrine disorder 4.8%, epilepsy 3.8% and HIV 2.6% in present study.Conclusions: Hypertensive disorders were commonest medical disorder followed by hematological, liver, endocrine and epilepsy. All medical disorders in pregnancy to be managed by team approach.
      PubDate: 2019-08-26
      DOI: 10.18203/2320-1770.ijrcog20193813
      Issue No: Vol. 8, No. 9 (2019)
  • Fresh versus frozen embryo transfer: a retrospective cohort study

    • Authors: Raksha K. Shetty, Purnima K. Nadkarni, Pooja P. Singh, Prabhakar Singh, Aditi A. Nadkarni, Vaibhav K. Nadkarni
      Pages: 3774 - 3781
      Abstract: Background: Elective frozen embryo transfer (FET), has recently increased significantly with improvements in cryopreservation techniques. Observational studies and randomized controlled trials suggested that the endometrium in stimulated cycles is not optimally prepared for implantation; risk of ovarian hyperstimulation syndrome reduced and pregnancy rates increased following FET and perinatal outcomes are less affected after FET. However, the evidence is not unequivocal and recent randomised control trials challenge the use of elective FET for the general IVF population. Pregnancy rates were analysed in a cohort of patients undergoing embryo transfers.Methods: This was a retrospective cohort study of patients who underwent embryo transfers from April 2018 to March 2019 at study centre in Surat.175 cycles of embryo transfers (119 fresh and 56 frozen) were included in the study. Outcomes measured were positive pregnancy, clinical pregnancy and ongoing clinical pregnancy rates achieved in the IVF-ET cycles.Results: There were no statistically significant differences between positive pregnancy rate (54.6% versus 60.7%, Odds ratio (OR) 0.78; 95% Confidence Interval (CI) 0.41-1.49), clinical pregnancy rate (48.73% versus 57.14%, OR 0.52; 95% CI 0.1- 2.64) and ongoing clinical pregnancy rate  (45.38% versus 51.78% OR 1.4; 95% CI 0.29 - 6.67) in fresh ET and FET cycles, respectively, p < 0.05 was considered statistically significant for all measures.Conclusions: Despite the observed higher rates of positive biochemical, clinical and ongoing clinical pregnancy per transfer in the FET cohort, these did not reach statistical significance. Thus, both transfer strategies are reasonable options, although there is a trend favouring the freeze-all strategy.
      PubDate: 2019-08-26
      DOI: 10.18203/2320-1770.ijrcog20193814
      Issue No: Vol. 8, No. 9 (2019)
  • Relationship of umbilical coiling index and cord twist direction with
           adverse perinatal outcomes

    • Authors: Pratibha S. Sarkate, Sujitkumar Hiwale
      Pages: 3782 - 3788
      Abstract: Background: The main objectives of this study were to examine - (1) relationship of pregnancy-related factors (maternal age, gestational diabetes mellitus, pregnancy-induced hypertension, oligohydramnios, small for gestational age (GA), and fetal gender) and postnatally measured umbilical coiling index (UCI); (2) association of UCI and cord twist directions with the following adverse perinatal outcomes, meconium staining of amniotic fluid, non-reassuring FHR on CTG, low Apgar score (<7) at one and five minutes, low birth weight, and NICU admission.Methods: The inclusion criteria were singleton live-birth pregnancy with GA > 34 weeks. The cases were categorized in hypocoiled (UCI <10th percentile), hypercoiled (UCI >90th percentile) and normocoiled groups. To study relationship of pregnancy-related factors and UCI, multivariate logistic regression was used; whereas bivariate analysis was used to study impact of UCI on various adverse perinatal outcomes. UCI was measured by a single observer.Results: In total, 100 subjects were enrolled. The mean UCI was 0.268 (SD = 0.13; 10th percentile = 0.139; 90th percentile = 0.410) coils/cm. Pregnancy-related factors had non-significant relationship with UCI. For adverse perinatal outcomes, only the non-reassuring/abnormal FHR patterns were significantly associated with hypercoiled groups (OR = 4.5; CI =1.15 - 17.58). Both cord directions had almost equal distribution without any significant difference in outcomes; however, anticlockwise twisted cords were found to have significantly high UCI.Conclusions: No significant relationship was observed with pregnancy-related factors and UCI. However, it was observed that hypercoiled cords had significant association with non-reassuring/abnormal FHR patterns on CTG.
      PubDate: 2019-08-26
      DOI: 10.18203/2320-1770.ijrcog20193815
      Issue No: Vol. 8, No. 9 (2019)
  • Cardiovascular disease in pregnancy

    • Authors: Rupa Vyas, Priya Gupta, Sapana Shah, Komal Rangoliya
      Pages: 3789 - 3793
      Abstract: Background: Maternal cardiac disease is a major cause of non-obstetric maternal morbidity and mortality. The care of pregnant women with cardiac disease requires a multidisciplinary approach, involving obstetricians, cardiologists and anesthesiologist.Methods: A prospective analytical study of maternal heart disease and its fetomaternal outcome is carried out in the department of obstetrics and gynecology at tertiary hospital and teaching institute. The study was carried out on 50 cases belonging to age group 18-50 years with various cardiac diseases during their pregnancy and peripartum period.Results: In this study, 78% of the cases were registered with our hospital. The present study shows about 32% of the women having cardiac disease were in the age group of 20-25 years. 34% belonged to NYHA class II and had a relatively uneventful peripartum period. Among all forms of heart disease, RHD was common constituting 26% of cases. Most common condition associated with cardiac disease in pregnancy was preeclampsia (36%) in our study, with anemia being other one (10%). The common complications were congestive cardiac failure (12%) and pulmonary edema (8%). Combination of diuretics and beta blockers was used most commonly (22%). 56% of women delivered with caesarean section. 42 patients delivered after age of viability with 29 (69%) term deliveries and 13 (30%) preterm deliveries with 8 requiring NICU care.Conclusions: Valvular heart disease of rheumatic origin is the most common cardiac disease associated with pregnancy.The availability of adequate systems of early diagnosis of cardiac lesion, reference to tertiary care center & close monitoring of patient and delivery with multidisciplinary approach include specialized cardiologic care, high risk obstetric support and neonatology expertise that can minimize the serious consequences and helps to improve fetomaternal outcome. Pre-conceptional counseling and surgical correction of certain conditions improves maternal as well as fetal outcome. Awareness needs to be created about heart diseases during pregnancy and the importance of regular antenatal check-ups.
      PubDate: 2019-08-26
      DOI: 10.18203/2320-1770.ijrcog20193821
      Issue No: Vol. 8, No. 9 (2019)
  • Postpartum spontaneous bladder rupture

    • Authors: Vijay Zutshi, Sana Tiwari, Renu Arora
      Pages: 3794 - 3797
      Abstract: Spontaneous bladder rupture after normal vaginal delivery is a rare complication. Patients may present with abdominal distention, fever, haematuria, oliguria and deranged KFT (kidney function test). We are reporting two cases of primigravida with postpartum bladder rupture, one case was diagnosed at laparotomy and the other preoperatively. A patient who presents with retention of urine, haematuria ascites and deranged KFT after uneventful normal vaginal delivery, spontaneous bladder rupture should be suspected. Early diagnosis and management can decrease the morbidity.  
      PubDate: 2019-08-26
      DOI: 10.18203/2320-1770.ijrcog20193816
      Issue No: Vol. 8, No. 9 (2019)
  • Management of pseudohypoparathyroidism in pregnancy: a rare entity

    • Authors: Mrinalini Sinha, Anjum Ara, Indu C. Chug, Saunri Hansadah, Avani Goyal
      Pages: 3798 - 3800
      Abstract: Pseudohypoparathyroidism is a very rare genetic disorder and during pregnancy poses multiple challenges related to its monitoring and management.
      Authors present the case of a  30year old primigravida who was a diagnosed case of pseudohypoparathyroidism since 22 yrs of age, presented to our obs/gynae OPD at 5+5 wks of POG. She was managed by serial monitoring of serum calcium, phosphate and vitamin D throughout  pregnancy with careful dose modification of calcium from 1gm to 3.5gm daily and vitamin D from  0.5mcg  to 1.5mcg daily. During her course of pregnancy, she developed gestational hypothyroidism, gestational diabetes mellitus, intrahepatic cholestasis of pregnancy and gestational hypertension which were controlled and managed successfully. She had an elective caesarean section at 37+6 wks POG for transverse lie. Both maternal and perinatal outcome were good. Patient was discharged with advice to continue with her monitoring of serum calcium, phosphate, vitamin D along with supplementation of calcium and vitamin D life long.
      PubDate: 2019-08-26
      DOI: 10.18203/2320-1770.ijrcog20193817
      Issue No: Vol. 8, No. 9 (2019)
  • A case of foetal macrosomia

    • Authors: Pushpashree Acharya, Sanjay Singh
      Pages: 3801 - 3804
      Abstract: Fetal macrosomia is an upcoming challenge in the field of obstetrics due to its rising incidence. The incidence varies according to ethnicity, genetic differences and anthropometric discrepancies between populations. Obesity, previous history of macrosomia, multiparity, diabetes and post-dated pregnancy are few risk factors associated with macrosomia. Management of macrosomia is a big challenge as no precise guidelines have been set. Macrosomia is associated with multiple maternal and foetal complications like operative delivery, post partum haemorrhage, perineal trauma, shoulder dystocia, brachial plexus injury, skeletal injury, birth asphyxia etc. We report a case of foetal macrosomia, weighing 5.5kg which was delivered by LSCS to a woman having BMI - 26.6kg/m² with 39 weeks of pregnancy with history of previous LSCS. There was no maternal or foetal complication. There was no history of diabetes in present pregnancy and inter conception period. Because of rarity of this condition we report this case of foetal macrosomia with a short review of literature.
      PubDate: 2019-08-26
      DOI: 10.18203/2320-1770.ijrcog20193818
      Issue No: Vol. 8, No. 9 (2019)
  • A case of an uncorrected double outlet right ventricle with ventricular
           septal defect in pregnancy

    • Authors: Kedar M. Tilak, Uma N. Wankhede
      Pages: 3805 - 3807
      Abstract: Congenital Heart Diseases (CHD) lead to various changes in the normal mechanisms of hemodynamics. Pregnancy in women with CHDs is rare. Double Outlet Right Ventricle (DORV) is a rare disorder, in which both the aorta and the pulmonary artery arise from the right ventricle. We present a case of a thirty-year-old pregnant woman who presented to us with 22 weeks of amenorrhea. She had DORV with VSD, which was undiagnosed till she came to our hospital. Double Outlet Right Ventricle (DORV) is a rare congenital heart disease. Pregnancy in a patient with DORV needs early diagnosis and a stepwise multidisciplinary approach for successful outcomes.
      PubDate: 2019-08-26
      DOI: 10.18203/2320-1770.ijrcog20193819
      Issue No: Vol. 8, No. 9 (2019)
  • Successful management of a triplet heterotropic caesarean scar pregnancy
           in spontaneous conception

    • Authors: Nilofar Imamhusen Yelurkar, Dharam Jatin Shah, Meena Naresh Satia, Vijaya Rajesh Badhwar
      Pages: 3808 - 3811
      Abstract: A cesarean scar ectopic pregnancy -CSEP is a fairly uncommon presentation wherein the conceptus is implanted at the exact scar site of the previous cesarean section deep in the myometrium. Given the relatively rare incidence of CSEP establishing a diagnosis of CSEP can be challenging current standards of therapy have been derived from data obtained from a limited number of patient’s management options for CSEP range from medical line of treatment to surgical interventions such as sonography guided injections to laparoscopic excision or laparotomy or combination of these modalities. Herein we report a rare case of triplet pregnancy with one gestation sac implanted at the site of lower segment scar diagnosed on transvaginal ultrasonography along with MRI who was managed successfully with systemic methotrexate.
      PubDate: 2019-08-26
      DOI: 10.18203/2320-1770.ijrcog20193820
      Issue No: Vol. 8, No. 9 (2019)
  • Emergency peripartum hysterectomy: a 7-year review at tertiary hospital

    • Authors: Manjula S. K., Suvarchala Katakam, Shobha G.
      Pages: 3812 - 3816
      Abstract: Emergency peripartum hysterectomy (EPH) is a major obstetric procedure, usually performed as a life-saving measure in cases of intractable obstetric hemorrhage. The aim of this study was to determine the incidence, indications and the risk factors and complications of emergency peripartum hysterectomy (EPH). The medical records of 13 patients who had undergone EPH, between January 2012 and December 2018, were reviewed retrospectively. All necessary data was obtained by record review. The mean age of pregnant women was 30 year. There were 13 EPHs out of 15768 deliveries, a rate of 0.82 per 1,000 deliveries. Out of 13 women who underwent EPHs, 8 hysterectomies were performed after cesarean delivery and 5 after vaginal delivery. The most common indication for hysterectomy was abnormal placentation (7/13), followed by atony (4/13), rupture of scared uterus (1/13) and rupture of unscared uterus (1/13). There were two cases of intra-operative bladder injury, we had 1/13 maternal death because of EPH. There were no cases of neonatal mortality. In our series, abnormal placentation was the most common of indication for EPH. The risk factors for EPH were previous CS for abnormal placentation and placental abruption for uterine atony and peripartum hemorrhage. Limiting the number of CS deliveries would bring a significant impact on decreasing the risk of EPH.
      PubDate: 2019-08-26
      DOI: 10.18203/2320-1770.ijrcog20193692
      Issue No: Vol. 8, No. 9 (2019)
School of Mathematical and Computer Sciences
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