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Intl. J. of Advances in Medicine     Open Access   (Followers: 5)
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International Journal of Reproduction, Contraception, Obstetrics and Gynecology
Number of Followers: 16  

  This is an Open Access Journal Open Access journal
ISSN (Print) 2320-1770 - ISSN (Online) 2320-1789
Published by Medip Academy Homepage  [12 journals]
  • Association of serum ferritin with insulin resistance in women with
           polycystic ovarian syndrome

    • Authors: Taslima Begum, Shakeela Ishra, Begum Shaira Sharifa, Shamsun Nahar, Hosne Ara Begum, Sadia Sultana Khan
      Pages: 2924 - 2931
      Abstract: Background: Emerging scientific evidence has disclosed unsuspected influences between iron metabolism, insulin resistance and type 2 diabetes. Even mildly elevated body iron stores are associated with statistically significant increases in glucose homeostasis indices. But till now high serum ferritin associated with type 2 diabetes is not recognized as an entity in the current clinical guidelines for the management of type 2 diabetes.Methods: This was a Cross sectional study carried out from September 2016 to March, 2017 at PCO clinic of infertility outpatient department (OPD), department of obstetrics and gynecology, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh. The study population consisted of all the diagnosed PCOS patients. Purposive sampling Main outcome variable: serum ferritin level and insulin resistance index (Homeostatic model assessment of insulin resistance: HOMA-IR).Results: Most of the (90.9%) patients were aged 20-30 years having BMI >25 kg/m2, mostly overweight (52.53%) or obese (25.25%). Significant increase of serum ferritin level (72.89±34.97; p=0.001) was noted in PCOS patients with insulin resistance. Marked increase in serum ferritin (82.81±31.57, p<0.001), fasting serum insulin (16.39±7.1; p<0.001), HOMA-IR (3.51±1.55; p<0.001) and more cases with insulin resistance (78.3%; p<0.001) were found in women with high ferritin level (when ≥45.5 ng/ml). Statistically significant strong positive correlation between serum ferritin level and fasting insulin level (r=0.528; p<0.001) as well as HOMA-IR (r=0.492; p<0.001) were observed.Conclusions: These results demonstrated that elevated level of serum ferritin was associated with insulin resistance in PCOS women.
      PubDate: 2021-07-26
      DOI: 10.18203/2320-1770.ijrcog20212936
      Issue No: Vol. 10, No. 8 (2021)
       
  • Relationship between myometrial thickness and latency interval of
           pregnancy after preterm premature rupture of membranes

    • Authors: Wael S. Nossair
      Pages: 2932 - 2936
      Abstract: Background: Preterm premature rupture of membranes (PPROM) increases the risk of prematurity and leads to a number of other perinatal and neonatal complications. Prolonged latency interval increases probability of complications in mothers with PPROM. The aim of this study was to assess the relationship between the myometrial thickness and the length of latency interval after PPROM.Methods: This study included 62 pregnant women admitted due to spontaneous PPROM from 26 to 37 weeks gestational age. All selected cases were subjected to full medical history, full clinical examination, laboratory investigations, and ultrasound evaluation with measurement of myometrium thickness at lower uterine segment and uterine fundus, measurement of amniotic fluid index.Results: A total 32 (51.7%) of our patients had latency interval <1 week while the rest of patients had latency interval ≥1 week with mean latency interval value was 5.45±2.4 days. Sonographic evaluation of the myometrial thickness showed that the mean thickness at lower uterine segment was 6.6±1.26 mm and at fundus was 6.1±1.28 mm. we found that at cut off point ≥6.9 mm lower uterine segment myometrial thickness had 87.5% sensitivity and 93.3% specificity in prediction of latency interval≥1 week, while at cut off point≥6.4 mm uterine fundus myometrial thickness had 81.3% sensitivity and 63.3% specificity in prediction of latency interval more than 1 week.Conclusions: Sonographic evaluation of myometrial thickness appears to be helpful in prediction of latency interval in PPROM.
      PubDate: 2021-07-26
      DOI: 10.18203/2320-1770.ijrcog20212775
      Issue No: Vol. 10, No. 8 (2021)
       
  • Obstructed labour in a Nigerian tertiary health facility: a mixed-method
           study

    • Authors: Akaninyene Eseme Ubom, Omotade Adebimpe Ijarotimi, Ifeoluwa Emmanuel Ogunduyile, Ayobami Omilakin, Solomon Nyeche, Emeka Philip Igbodike, Ogunjide Olakunle Emmanuel, Ernest Okechukwu Orji, John Igemo Ikimalo, Adebanjo Babalola Adeyemi
      Pages: 2937 - 2943
      Abstract: Background: Obstructed labour remains a leading cause of maternal and perinatal mortality and morbidity in sub-Saharan Africa. This study aimed to determine the incidence, causes, complications and outcomes of obstructed labour at the Obafemi Awolowo University Teaching Hospitals Complex (OAUTHC), Ile-Ife, Osun state, Nigeria.Methods: A mixed methods approach was employed for this study. A 10-year retrospective review of all cases of obstructed labour managed at the OAUTHC, between January 1, 2008, and December 31, 2017, was done. Ten in-depth interviews were conducted for some selected patients. The quantitative data was analysed using SPSS version 24, while the qualitative data was analyzed with NVivo version 12.Results: The incidence of obstructed labour was 1.99%. Most of the patients were unbooked (217, 90.4%), primigravid (138, 57.5%), and either had no formal or only primary/secondary education (120, 50%). Cephalopelvic disproportion (CPD) was the commonest cause of obstructed labour (227, 94.6%). The most common maternal complication was wound infection (48, 20%). There were three maternal deaths, giving a case fatality rate of 1.25%. The most common foetal complication was birth asphyxia (85, 34.7%). The perinatal mortality rate was 18.8 %. From the qualitative arm of the study, reasons given by parturients who suffered obstructed labour, for avoiding hospitals for delivery, included religion, finance, fear of hospitals, faith/belief in mission homes/maternity houses, and proximity.Conclusions: Obstructed labour remains an important obstetric problem in our environment, contributing significantly to the burden of maternal and perinatal mortality and morbidity. 
      PubDate: 2021-07-26
      DOI: 10.18203/2320-1770.ijrcog20212937
      Issue No: Vol. 10, No. 8 (2021)
       
  • Efficacy of letrozole versus clomiphene citrate for infertile women with
           polycystic ovary syndrome

    • Authors: Sinan S. Ay, Özer Birge, Mehmet S. Bakır, Ayşe E. Yumru
      Pages: 2944 - 2949
      Abstract: Background: The aim was to compare ovulation induction protocols in anovulatory patients, who make up a significant percentage of infertility patients, and to determine the most appropriate treatment for patients in the clinic based on the findings.Methods: The effectiveness of clomiphene citrate (CC) and letrozole (aromatase inhibitor) in ovulation induction treatments were retrospectively compared in patients who applied for infertility in the last 5 years and were found to be anovulatory. 20 of these patients were being treated with clomiphene citrate, while the 18 were being treated with letrozole.Results: The study included a total of 38 anovulatory infertile patients. The mean age of the patients was found to be 29.3. When the endometrial thicknesses (ET) after the treatment were compared, the first group's mean EC was 6.1, while that of the second group was 9.05. The endometrial thicknesses measured after the treatments were found to be significantly different, which were consistent with other studies in the literature. Post-treatment ovulation responses were similar with 55% in both groups. In the evaluation of pregnancy outcomes, 20% of pregnancy was achieved in the first group and 33% in the second group.Conclusions: The use of letrozole, an aromatase inhibitor, may be suggested as an alternative to CC in the ovulation induction protocol in our clinical practice, particularly in obese patients.
      PubDate: 2021-07-26
      DOI: 10.18203/2320-1770.ijrcog20212938
      Issue No: Vol. 10, No. 8 (2021)
       
  • Determinants of contraceptive methods use after voluntary induced abortion
           at the Yaounde Central Hospital, Cameroon

    • Authors: Florent Y. Fouelifack, Cadette C. N. Mba, Anyimbi M. Ofeh, Pierre M. Tebeu
      Pages: 2950 - 2954
      Abstract: Background: Abortion is the termination of pregnancy with expulsion of the product of conception before the age of fetal viability- 28 weeks. In Africa, 96% of abortions are unsafe and there is an estimated 1 death for 150 abortions. Few data are available in Cameroon on the determinants of contraception after a voluntary termination of pregnancy. The objective of this study to investigate the determinants of the use of contraceptive methods after a voluntary termination of pregnancy.Methods: The study was descriptive cross-sectional lasting 09 months in the gynecology and obstetrics unit of the Yaounde Central Hospital. We included women admitted to this unit who have already had at least one abortion. All women who did not give their consent were excluded. The data were entered and analyzed using the Epi-info software version 7.2.2.6. The tools used to express our results were the Student's and Whitney's test, the Wald test and the Odd ratios (OR) with their 95% confidence interval. The significance level was 5%.Results: Out of 139 participants, 86 (61.87%) had already used a modern contraceptive method after voluntary termination of pregnancy. The mean age was 27.13±6.16 years with extremes of 16 and 42 years. Being single and having unwanted pregnancies independently increased contraceptive method use after abortions.Conclusions: An intensification of campaigns for behaviour change and men's involvement would further improve the use of contraceptive methods after abortion.
      PubDate: 2021-07-26
      DOI: 10.18203/2320-1770.ijrcog20212939
      Issue No: Vol. 10, No. 8 (2021)
       
  • Laparoscopic evaluation of pelvic organ in case of subfertility

    • Authors: Polly Ahmed, T. A. Chowdhury, Kaniz Mahmud
      Pages: 2955 - 2960
      Abstract: Background: Globally subfertility affects 10-15% of couple. All these people need proper evaluation and treatment. Now a days laparoscopy considered as a gold standard procedure for evaluation of pelvic organ. The aim of this study was to find out the different causes of female factor infertility with the help of laparoscopy.Methods: This retrospective study was conducted in infertility clinic of BIRDEM hospital, Dhaka, Bangladesh during the period of May, 2007 to October 2007. The study group comprised 100 cases of infertile patients.Results: In this study, among 100 patients 68% had primary and 32% had secondary infertility. In laparoscopy majority (55.0%) had normal ovary, 20.0% had cystic change with thick capsule in right ovary and 22% had in left ovary, 7.0% had endometriosis, 8.0% had adhesion, 10.0% had simple cyst in right ovary and 8% had in left ovary and rest could not be visualized. 79.4% right and 77.9% left fallopian tube patent in primary subfertility cases and 56.3% right and 59.4% left tube normal in secondary subfertility cases. Both fallopian tube patent in 62%, unilateral block 21% and bilateral block in 17% cases in this study peritoneum was normal in 78% cases, 8% cases there was endometriosis and 14% cases there was adhesion of fallopian tube with the ovary, adhesion of uterus with intestine and also with bladder.Conclusions: Laparoscopy is an important tool for diagnosing anatomical and pathological abnormalities of pelvic organ which has a major role in subfertility management. 
      PubDate: 2021-07-26
      DOI: 10.18203/2320-1770.ijrcog20212940
      Issue No: Vol. 10, No. 8 (2021)
       
  • Factors affecting time of spontaneous delivery of dichorionic diamniotic
           twin pregnancy

    • Authors: Nermeen Mohamed Hefila
      Pages: 2961 - 2968
      Abstract: Background: The incidence of twin pregnancy has markedly increased recently due to ART and advanced maternal age. The mother may also experience higher obstetrical morbidity and mortality rates. Aim of the work was to investigate factors affecting the time of spontaneous delivery in dichorionic diamniotic twin pregnancy to improve perinatal outcomes.Methods: The study was a cross-sectional study had been conducted at Elshatby university maternity hospital between October 2019 to May 2020 on 150 cases of dichorionc diamniotic twins pregnancy admitted for spontaneous delivery.History was taken from all women including general, abdominal and vaginal examination to assess pelvic capacity, first twin presentation, amniotic membrane state and cervical os measurements including cervical dilatation, effacement, station and orientation.Results: In our study ART twin pregnancies are higher than spontaneous pregnancy regarding the complications. In group A, we found that the uterine contractions are more frequent (6.5 times/30 min) and in B was (6.3 times/30 min) while in group C (2.8 times/30 min) (P<0.001). The cervical dilatation in group A on admission was statistically significant compared with the group B and C (p<0.001). PROMs (p=0.042) and incompetent internal os of cervix (IIOC, p<0.001) found to be the most important factor affecting the time of twin delivery specially before 36 weeks.Conclusions: The frequency and potency of uterine contractions, the cervical internal os dilatation and the state of amniotic membrane are the most important factors affecting the time of delivery in twin pregnancy.
      PubDate: 2021-07-26
      DOI: 10.18203/2320-1770.ijrcog20212941
      Issue No: Vol. 10, No. 8 (2021)
       
  • Effect of COVID-19 lockdown on reproductive activity in Rivers state

    • Authors: Barinua K. Gbaranor, Humphrey N. Agara, Onisojime M. Alasia, William A. Mube, Iboroma Dumoateli, Blessing Z. Ovili-Odili, Sofiri S. Peterside, Vivian I. Ile
      Pages: 2969 - 2974
      Abstract: Background: Reproductive activity is an important biological process that always take place between married and unmarried couples across the globe. The study was carried out to evaluate the effect of COVID-19 on reproductive activity during and post-lockdown in Rivers state. The aim of the study was to evaluate the effect of COVID-19 on reproductive activity during and post-lockdown in Rivers state.Methods: A well-structured questionnaire containing demographics and effect of COVID-19 on reproductive activity were administered to participants. Each participant had one questionnaire to fill appropriately and independently after instructions were given to them by the researchers.Results: The study revealed that 57.58% (57/99) of the participants were between the ages 16-20, 58.82% (60/102) were single and 99.03% (102/103) of the participants (women) have unprotected sexual intercourse during COVID-19 lockdown. 99.03% (102/103) the participants engaged in unprotected sex because the pharmacist’s stores were closed. The study also shows that 43.69% (103) have the urge for sex due to inactivity and 76.60% (102) of the participants got pregnant and 96.25% (77/80) of the pregnancy were not planned. 51.29% (41/80) of the participants aborted the pregnancy and 92.68% (38/41) 0f the women who got pregnant did not attend antenatal clinic.Conclusions: A total number of 103 respondents participated in the research. 76.6% of the population got pregnant during the lockdown for different reasons and most of the participants were singles and did not plan for the pregnancy. 
      PubDate: 2021-07-26
      DOI: 10.18203/2320-1770.ijrcog20212942
      Issue No: Vol. 10, No. 8 (2021)
       
  • Evaluation of yolk sac size and embryonic heart rate in first trimester
           and pregnancy outcome

    • Authors: Waleed M. Tawfik
      Pages: 2975 - 2980
      Abstract: Background: Accurate differentiation between normal pregnancy and pregnancy loss in early gestation remains a clinical challenge-previous studies have described the association between embryonic well-beings and the characteristics of gestational sac. The aim of the study was to evaluate the yolk sac size and embryonic heart rate as a prognostic factor for the first trimester pregnancy outcome.Methods: This was a prospective cohort observesional study. It included 52 pregnant women in their first trimester from 6 week till 12 weeks gestation. Transvaginal sonographic examination after explanation and agreement of each patient. All pregnancies were followed for their pregnancy outcome after completion of 12 weeks. The adverse outcome was spontaneous miscarriage occurring before or at 12 weeks of gestation. These patients allocated into four study groups: according to gestational age at presentation and pregnancy outcome. Group I included women who were examined during (6-7 weeks+6 days). Group II included women who were examined during (8-9 weeks+6 days). Group III included women who were examined during (10-12 weeks). Group IV included women who had their pregnancies resulted into first trimester spontaneous miscarriage.Results: The validity of YS diameter regarding the prognosis of first trimester pregnancy outcome shows that; YSD had 100% specificity and 97.8% sensitivity in prediction of miscarriage. Regarding embryonic heartbeat, there was a statistically significant difference between group IV and the other groups. There was embryonic bradycardia in the miscarriage group. EHR had a sensitivity of 97.5% and specificity of 100% in prediction of first trimester pregnancy outcome.Conclusions: Abnormal yolk sac diameter, in the form of small, enlarged, absent or irregular yolk sac, and embryonic bradycardia are associated with poor pregnancy outcome.
      PubDate: 2021-07-26
      DOI: 10.18203/2320-1770.ijrcog20212943
      Issue No: Vol. 10, No. 8 (2021)
       
  • Evaluation of reproductive profile in male albino rats following varied
           duration of administration with Revive capsule

    • Authors: Onengiyeofori Ibama, Kinikanwo I. Green, Edna O. Nwachuku, Adline Erinma Ben-Chioma
      Pages: 2981 - 2986
      Abstract: Background: Revive capsule is a polyherbal formulation commonly used to treat erectile dysfunction or enhance libido in men. Some of the individual herbs used in the formulation of this drug have been known scientifically to affect various biochemical components of the human body; hence this study was aimed at evaluating the reproductive profile in male albino rats following varied duration of administration with Revive capsule.  Methods: A total of 42 male albino rats were used for the study, and were divided into six (6) groups of seven (7) rats each. They were allowed to acclimatize for two (2) weeks by maintaining 12-hour light and dark cycles daily, with access to standard feed and water ad libitum. Group A (negative control) rats were administered with distilled water once daily, while groups B, C, D, E and F were administered once daily with 72 mg/kg of Revive capsule for 1 week, 2 weeks, 3 weeks, 4 weeks and 6 weeks respectively. The rat dose administered was extrapolated from the human dose using the formula by Paget and Barnes. At the end of each treatment week, the rats were allowed to fast overnight, followed by their anaesthetization using chloroform, and blood sample collection via jugular vein puncture. Also, the testes were excised; the epididymis were also excised from the testes and used immediately for semen analysis, while the epididymis-free testes were examined histologically. Rat-specific test kits with ELISA method were used to analyze serum LH, FSH and testosterone.Results: The results showed a significant increase (p<0.05) in serum LH, FSH and testosterone levels, and a significant increase in sperm count and sperm quality parameters in the treatment groups compared to the negative control, with the maximum levels attained after 6 weeks of treatment (group F). Also, photomicrographs of histologically examined testes of the treatment groups appeared indifferent from those of the negative control.Conclusions: These findings may suggest that in using a rat model, treatment with Revive capsule at the appropriate dosage for 6 weeks is safe, and that, besides its acclaimed use in enhancing libido or treating erectile dysfunction, it may also be effective in promoting male fertility. 
      PubDate: 2021-07-26
      DOI: 10.18203/2320-1770.ijrcog20212944
      Issue No: Vol. 10, No. 8 (2021)
       
  • Evaluation of transvaginal ultrasound role in the prediction of
           adenomyosis: correlation with histopathology

    • Authors: Naglaa Ali M. Hussein, Mohammed H. El Rafaey
      Pages: 2987 - 2992
      Abstract: Background: Adenomyosis is a common gynecologic disorder that primarily affects women of reproductive age that has reported incidence of 5-70% in surgical and postmortem specimens. The aim of this study was to evaluate the accuracy of various transvaginal sonographic findings in adenomyosis by comparing them with histopathological results and to determine the most valuable sonographic feature in the diagnosis of adenomyosis.Methods: All transvaginal US findings were correlated with those from histologic examination. The frequency of presenting symptoms and signs of adenomyosis were evaluated. Transvaginal US depicted 10 of 12 pathologically proved cases of adenomyosis. Adenomyosis was correctly ruled out in 33 of 38 patients.Results: Transvaginal US had a sensitivity of 83%, a specificity of 86%, and a positive and negative predictive value of 66% and 94%, respectively. Of the 10 patients with true-positive findings at transvaginal US, the myometrium demonstrated heterogeneous with or without the presence of cysts in nine (75%) patients, linear striation in four (33.3%) patients and globular uterus in six (50%) patients. Three (25%) of 12 cases of adenomyosis had an enlarged uterus, adenomyosis was a significant association with high parity.Conclusions: Adenomyosis can be diagnosed with a considerable accuracy by transvaginal ultrasound. The most common sonographic criteria of adenomyosis are heterogeneous myometrial appearance while the most specific criteria are myometrial cysts, sub-endometrial echogenic linear striations and globular configuration of the uterus.
      PubDate: 2021-07-26
      DOI: 10.18203/2320-1770.ijrcog20212945
      Issue No: Vol. 10, No. 8 (2021)
       
  • Effect of abnormal yolk sac, gestational sac and embryonic heart rate in
           pregnancy outcome

    • Authors: Jyoti Jaiswal, Anand Kumar Jaiswal, Geetanjali Patel, Abha Daharwal
      Pages: 2993 - 2998
      Abstract: Background: The purpose of the study is to know the effect of abnormal yolk sac, abnormal gestational sac and abnormal embryonic heart rate on outcome of pregnancy in the tertiary care centre of Chhattisgarh.Methods: This prospective observational study included 50 pregnant females between 6-9 weeks gestation with singleton pregnancy attending antenatal clinic in a tertiary medical institution. Transvaginal sonography was carried out to quantify yolk sac characteristics. Abnormal yolk sac was defined according to Nyberg criteria.Results: Out of 50 cases, 25 cases had abnormal yolk sac, 23 cases had abnormal gestational sac and 22 cases had abnormal embryonic heart rate and heart rate was absent in 23 cases. Out of 50 cases, 32 got aborted and rest 18 cases had ongoing pregnancy beyond 20 weeks. Normal yolk sac diameter (YSD) (2-5 mm) showed 72.2% sensitivity, 62.5% specificity, 52% positive predictive value and 80% negative predictive value in predicting pregnancy outcome. Gestational sac diameter had 66.66% sensitivity, 53.12% specificity, 44.44% PPV and 73.91% NPV and for EHR had 22.22% sensitivity, 96.87% specificity, 80% PPV and 68.88% NPV.Conclusions: The embryos with abnormal YSD are highly associated with poor pregnancy outcome with good sensitivity and NPV. Present study indicates that the yolk sac measurement is reliable prognostic factor in predicting 1st trimester pregnancy outcome.
      PubDate: 2021-07-26
      DOI: 10.18203/2320-1770.ijrcog20212814
      Issue No: Vol. 10, No. 8 (2021)
       
  • Obstetric hysterectomy: a surgical emergency 3 years review in a tertiary
           care centre

    • Authors: Shanti Sah, Shipra Gupta
      Pages: 2999 - 3004
      Abstract: Background: Obstetric haemorrhage is a life threatening complication associated with increased maternal morbidity and mortality. Its incidence is 0.2-4 per 1000 deliveries in developed countries and much higher in developing countries. The main cause still remains rupture uterus, postpartum hemorrhage (PPH) and placenta accreta spectrum (PAS).Methods: A retrospective analysis of obstetric hysterectomies performed over a period of 3 years from July 2017 to June 2020 was done. Incidence, risk factors, indication, outcome and complications of obstetric hysterectomies were evaluated.Results: A total 72 cases of obstetric hysterectomy were performed over 3 years period. Out of 72 cases, 33%, 28% and 14% cases were of peripartum hysterectomy done due to rupture uterus, PAS and PPH respectively. There was an increase in the incidence of PAS compared to previous years. There was no observed difference among patients undergoing total or subtotal hysterectomies. No difference as regard to duration of surgery, pre-operative or post-operative hemoglobin, IV fluid and blood product transfusion was noted among elective and emergency procedures. Statistically significant blood loss was observed in emergency hysterectomy compared to elective hysterectomy with p value of 0.004. An average need of transfusions was double in case of peripartum hysterectomy done for PPH compared to rupture uterus or adherent placenta. Bladder injury, burst abdomen and resuturing were three important morbidities. Maternal mortality was 2.8% in our study population.Conclusions: Emergency obstetric hysterectomy still remains a live saving procedure in case of catastrophic intractable hemorrhage and rupture uterus. Proper antenatal supervision, identification of risk factors and timely referral can reduce the incidence of associated morbidity and mortality.
      PubDate: 2021-07-26
      DOI: 10.18203/2320-1770.ijrcog20212810
      Issue No: Vol. 10, No. 8 (2021)
       
  • Severe preeclampsia and eclampsia: adverse obstetric outcomes and
           prognostic factors

    • Authors: Suparna Grover, Ajay Chhabra
      Pages: 3005 - 3010
      Abstract: Background: Hypertensive disorders of pregnancy are globally a threat to maternal and fetal outcomes. Despite massive efforts worldwide, these disorders continue to be a major adverse influence on the health goals especially in developing countries. The aim of the study was to measure the impact of hypertensive disorders of pregnancy in its most severe form on maternal and fetal outcomes in our region along with the important prognostic factors. The objective of this study was to investigate the maternal and fetal outcome in cases of severe preeclampsia and to evaluate the risk factors and complications associated with adverse outcomes.Methods: Indoor records of pregnant females at more than 20 weeks gestation with preeclampsia with severe features (as defined by the ACOG practice bulletin 222) and eclampsia admitted over a period of one year in a unit of obstetrics at Government Medical College, Amritsar were studied and results were statistically analysed.Results: The incidence of hypertension in pregnancy was 11.85% while that of severe preeclampsia was 6.14%. 57.94% of these women were primigravida’s and 80.16% of the women with severe preeclampsia/eclampsia were in the age group 20-29 years. Severe preeclampsia and eclampsia contributed to 43.75% of maternal deaths (OR 8.8, p value=0.0001) and there was increased incidence of stillbirth (OR 10.03, p value<0.0001) and perinatal mortality (OR 12.97, p value<0.0001). The incidence of preterm birth in cases with severe preeclampsia/eclampsia was 57.14%. Severe anemia as a comorbidity along with respiratory distress and renal impairment were associated with increased probability of maternal death.Conclusions: In addition to ensuring the implementation of routine management principles of, the policy makers should focus on developing critical obstetric care and NICU infrastructure along with dedicated human resources at obstetric centres to manage these high-risk cases. Improvement in the quality of antenatal care can help in diagnosing such patients before the onset of severe features so as to optimize maternal and neonatal outcomes.
      PubDate: 2021-07-26
      DOI: 10.18203/2320-1770.ijrcog20212791
      Issue No: Vol. 10, No. 8 (2021)
       
  • An analytical study of abnormal uterine bleeding in women of child bearing
           age group

    • Authors: Jayneel V. Shah, Munjal J. Pandya, Prakash B. Prajapati, Dharmik B. Senta, Meet K. Patel
      Pages: 3011 - 3018
      Abstract: Background: AUB (abnormal uterine bleeding) is defined as any variation from the normal menstrual cycle including alteration in its frequency, regularity of menses, duration of flow and amount of blood loss. In India, the reported prevalence of AUB is 17.9%. It can occur any time between menarche to menopause. A good clinician tries to recognize and identify the causative factors responsible for the disease, reverse the abnormality and induce or restore the cyclic predictable menses which should have normal volume and duration.Methods: 200 cases of AUB fitting the selection criteria were taken from OPD and gynecology ward between September 2020 to June 2021.Results: AUB was more common in the age group 41-45 years, that is, perimenopausal age group, more in multiparous women and women with previous surgeries on uterus and adnexa. Heavy menstrual bleeding was the most common complaint. Endometrial hyperplasia was the most common finding on ultrasound examination. Medical therapy was beneficial in some patients, rest had to undergo surgical intervention later.Conclusions: Transvaginal sonography is very accurate in assessing the endometrium as well as uterus and adnexa and diagnosing their abnormalities. Medical therapy is the first line of management in most cases. Dilatation and curettage should be used along with hysteroscopy for better results. LNG-IUS gives very good result in suitable cases. Hysterectomy is the final measure if everything else fails. Vaginal hysterectomy is preferred wherever possible.
      PubDate: 2021-07-26
      DOI: 10.18203/2320-1770.ijrcog20212946
      Issue No: Vol. 10, No. 8 (2021)
       
  • Maternal mortality-a three-year retrospective study in a rural medical
           college of India

    • Authors: Jayasree Hansda, Debobroto Roy, Krishnapada Das, Manojit Sarkar, Rumpa Das, Arpita Pramanik
      Pages: 3019 - 3022
      Abstract: Background: Maternal mortality is a tragic event as family revolves around a mother. The deadly obstetrical triad of hemorrhage, preeclampsia and infection has accounted for a third of all deaths. This study was conducted to assess maternal mortality ratio, demographic profile and causes of maternal death.Methods: This retrospective longitudinal study was conducted in the department of obstetrics and gynecology for a period of three years from 1st January 2018-31st December, 2020. Total no of death during this period was 134.Records of deaths and demographic profiles were retrieved from the medical record library of aforesaid hospital.Results: There were 134 maternal deaths amongst 56815 live births with MMR 235.85. The majority of deaths were in 20-29 year of age group and most of the deaths seen in multigravida. The 91.79% death was observed within the 24 hours and after 72 hours. Eclampsia, preeclampsia and hemorrhage were leading cause of maternal death seen in the study.Conclusions: Maternal mortality is higher than national MMR. Majority of maternal death were preventable by proper antenatal care, early detection of high-risk pregnancies and their timely referral to tertiary care centre.
      PubDate: 2021-07-26
      DOI: 10.18203/2320-1770.ijrcog20212947
      Issue No: Vol. 10, No. 8 (2021)
       
  • Relationship of lunar phases and sex of the foetus: a retrospective study

    • Authors: Aman Deep Raj, Roshni Abichandani, Harish Sethi
      Pages: 3023 - 3028
      Abstract: Background: The relation of lunar phases at the time of conception to the sex of the child at birth has been touted as a method of sex selection by various birth calendars with controversial results. It is made to believe that indeed there is a relation of lunar phase at the time of conception/intercourse which results in birth of a particular gender. The purpose of this study was to examine the influence of the lunar phase on the possible relationship between lunar position at EDD/LMP and the gender of the child.Methods: One thousand and five deliveries were retrospectively analysed from 1 January 2016 to 31 December 2018 at the department of obstetrics and gynaecology of military hospital, Gwalior (latitude and longitude coordinates: 26.218287, 78.182831). Females having regular menstrual periods history around conception and in general their periods have been normal and regular were included in the study. Females having irregular menstrual periods history or having oligomenorrhoea/polymenorrhoea, ART/IVF conceptions were excluded from the study. Exact lunar phases were determined at the time of EDD and not with their LMP since that would automatically corelate well with LMP because of regularity of their periods. The actual date of birth was not considered while corelating with moon phase because of obvious reason of unexpected timing of labour.Results: The analysis revealed no significant correlation of gender of the child to lunar phases at EDD. This would indirectly corelate well with the LMP since the inclusion criterion had females having normal and regular menstrual periods.Conclusions: There is no predictable influence of the lunar phase on the gender of the baby. As expected, and in agreement with some recent studies this pervasive myth is not evidence based.
      PubDate: 2021-07-26
      DOI: 10.18203/2320-1770.ijrcog20212948
      Issue No: Vol. 10, No. 8 (2021)
       
  • Occupational COVID-19 exposure among health care workers in obstetric unit
           in a Central Government Hospital in India: initial experience

    • Authors: Neha Pruthi Tondon, Renuka Malik, Kanika Kumari, Anjali Singh
      Pages: 3029 - 3034
      Abstract: Background: Health care workers (HCW) are the frontline warriors who are at a high risk of acquiring the COVID-19. HCW in obstetrical department are at high-risk due to their close proximity with the patient for examination, giving treatment and in delivery. The objectives of this study were to evaluate the positivity rate of COVID-19 in the initial 3 months of pandemic in health care personnel working in obstetric unit in a tertiary care hospital.Methods: Prospective cohort study was conducted in department of obstetrics and gynecology at tertiary care hospital in Delhi from 10 April to 10 June 2020. Predesigned questionnaire was used to record data of HCWs exposed to COVID-19 patients.Results: In a period of 3 months (April-June 2020), 152 health care workers were exposed to 30 COVID-19 patients.  Out of this, 10 HCW were found to be positive on testing, showing a positivity rate of 6.58%. Positivity ratio was 6:3:1 among nurses, auxiliary workers and doctors respectively. Labor room was area of high infection as 80% of HCW were infected in the labor room .80% HCW acquired infection during patient care in hospital and 20% were infected in contact with asymptomatic COVID-19 positive HCW.Conclusions: Positivity rate in obstetric department is comparable to that of general population. Appropriate infection prevention measures like use of PPE, handwashing and maintain safe distance from the patient is the key to prevention of infection. Gloves and N95 masks have been shown to provide superior protection as compared to triple layer masks. Nursing staff and auxiliary workers should be reinforced the importance of use of PPE, hand hygiene and physical distancing.
      PubDate: 2021-07-26
      DOI: 10.18203/2320-1770.ijrcog20212949
      Issue No: Vol. 10, No. 8 (2021)
       
  • Pregnancy outcomes after spontaneous conception with previous spontaneous
           abortion preceding present pregnancy

    • Authors: Shree Kant Dadheech, Meenakshi K. Bharadwaj, Brig Aruna Menon
      Pages: 3035 - 3039
      Abstract: Background: The objective of the present study was to study pregnancy outcomes in patients with Spontaneous conception with history of previous spontaneous abortion preceding present pregnancy.Methods: A prospective study included patients with spontaneous conception with history of previous spontaneous abortion preceding present pregnancy admitted in the department of obstetrics and gynecology, command hospital, Pune between October 2018 and April 2020. The patients were booked (minimum 3 visits in antenatal outdoor clinic) or admitted for the first time as an emergency. The detailed history about previous abortions was taken and routine as well as investigations for possible etiologies of previous abortions were done. Cases with history of mid-trimester abortion were investigated for cervical incompetence. All the patients were observed for complications during present pregnancy like threatened abortion, preeclampsia, preterm labour, intrauterine death and final outcome.Results: A total of 110 patients with history of previous spontaneous abortion were admitted, all patients were booked. Majority (51.8 %) of patients belong to the age group 25-30 years. All patients were with history of previous one abortion followed by pregnancy with spontaneous conception. The final outcomes were term live birth (86.4%), abortion (8.2%), preterm delivery (5.4%), and no still birth. Caesarian section was done in 32.7% patients for various indications.Conclusions: Previous history of spontaneous abortion is associated with adverse pregnancy outcome. There is increased risk of abortion, preterm delivery, need for caesarean sections and fetal loss in cases of previous spontaneous abortions. These complications and fetal loss can be reduced by booking the patients and giving due antenatal care.
      PubDate: 2021-07-26
      DOI: 10.18203/2320-1770.ijrcog20212950
      Issue No: Vol. 10, No. 8 (2021)
       
  • Pregnancy outcome in pre-gestational and gestational diabetic women: a
           prospective observational study

    • Authors: Mamta Mahajan, Amit Gupta, Anju Vij, Aanchal Gupta Sharma
      Pages: 3040 - 3048
      Abstract: Background: India is considered the world capital of diabetes, proper care and management of the same is the demand of society. The present study is carried out to identify the disease burden of GDM/ overt DM among antenatal cases. The main objective was to study the maternal and fetal outcome of diabetes complicating pregnancy.Methods: The present study was conducted at Dr. Rajendra Prasad Government Medical College at Tanda, District KangraHP from October 2015 to September 2016. All antenatal cases were screened for diabetes by OGTT 75 gm, 2-hour blood glucose level as per DIPSI guidelines and labelled as GDM/ overt DM. Those who fulfilled selection criteria were enrolled in the study. A total of 6452 cases who attended antenatal clinic during the study duration and were screened were selected for the study. 116 cases were found to have GDM / overt DM. Seventy-nine had GDM with OGTT>140 mg/dl (DIPSI guidelines) and 37 had overt DM with 2 hours PP >200 mg/dl (WHO criteria). Total 100 cases comprised of study group were followed till delivery to study maternal and fetal outcome.Results: The prevalence of diabetes in pregnancy was found to be low 1.79%. GDM was found to be more prevalent than overt diabetes in pregnant women (66% versus 34%). Among the antenatal maternal complications observed missed abortion (11.8% versus 1.55; p=0.026), polyhydraminos (26.4% versus 10.6%; p=0.04) and preterm labour (17.6% versus 4.5%; p=0.003) were significantly more common in overt diabetics than GDM cases. IUFD (8.8% versus 0; p=0.014) was also significantly more common in overt diabetics than GDM case. RDS was found significantly higher in neonates of overt diabetics as compared to GDM mothers (14.7 % versus 1.5%; p=0.009).Conclusions: Early detection and good glycemia control by MNT and insulin, regular antenatal check-ups, patient counselling and compliance, intrapartum fetal monitoring and early neonatal care are keys to improved outcome. 
      PubDate: 2021-07-26
      DOI: 10.18203/2320-1770.ijrcog20212951
      Issue No: Vol. 10, No. 8 (2021)
       
  • The effect of clonidine with bupivacaine on perioperative hemodynamics and
           post-operative analgesia in cesarean section cases

    • Authors: Priti Kumar, Sangeeta Arya, Sushil Kr. Singh, Sunil Kumar
      Pages: 3049 - 3052
      Abstract: Background: Cesarean section is the commonest procedure in Obstetric practice and postoperative pain can be a major factor for wound healing as well as mother and baby bonding. Spinal anesthesia is considered to be safest and easiest modality for cesarean section cases. Bupivacaine is the commonest drug given in spinal anesthesia, but many additive drugs have been introduced to cover post-operative analgesia. Clonidine is an alpha 2 agonist which can be used as an adjunct to heavy bupivacaine to extend analgesic effects.Methods: A randomized double-blind study was performed in 100 women undergoing elective cesarean section under spinal anaesthesia. After proper informed written consent patient undergoing cesarean section were divided by computerized method into group A (Given 10.0 mg 0.5% hyperbaric Bupivacaine) and Group B (Given 9.0 mg 0.5% hyperbaric bupivacaine and 30 μg clonidine).Results: Intraoperative hypotension is the most worrisome factor but it is transient and can be managed by ephedrine effectively. Intraoperative nausea and vomiting are slightly higher with clonidine as occurrence of hypotension is more. VAS scoring in post-operative period was better and need of first analgesic dose was much delayed in women been given clonidine with bupivacaine.Conclusions: Clonidine can be considered as adjunct in spinal anesthesia to extend post-op analgesic cover. 
      PubDate: 2021-07-26
      DOI: 10.18203/2320-1770.ijrcog20212952
      Issue No: Vol. 10, No. 8 (2021)
       
  • Prevalence of surgical site infection post caesarean with increased
           patient load during COVID-19 pandemic in tertiary care centre

    • Authors: Prashansa Santosh Raut, Reena Wani, Theertha Shetty, Roshni Khade, Anjali Mulchandani
      Pages: 3053 - 3057
      Abstract: Background: Increased referrals and workload during the pandemic lead to overcrowding in hospitals and increase in LSCS rates. Surgical site infection is one of the most common complication post LSCS causing physical and mental duress to the patients. The objective of the study was to analyse the effect of COVID-19 on SSI, the incidence, commonly associated factors and bacteriology of SSI. The design was prospective study design.Methods: 577 patients undergoing LSCS were studied from Day 1 till 30 days post LSCS from 1st August 2020 to 31st October 2020.Results: Out of 577, 28 (4.85%) patients developed SSI. 60% of SSI in our study were unbooked, 50% had haemoglobin less than 9.9 g/dl. Most common risk factor for developing of SSI included pre-eclampsia (32.14%) followed by previous LSCS (28.57%). Common organism isolate was MRSA (25%) and 75% required surgical management.Conclusions: Regular ANC visits can help in managing comorbidities at an earlier stage leading to reduction in SSI. Strict aseptic precautions should be followed to reduce SSI in cases with PROM and second stage arrest. SSI rate is not influenced by COVID-19 status but hospital facilities and overcrowding definitely have an effect.
      PubDate: 2021-07-26
      DOI: 10.18203/2320-1770.ijrcog20212953
      Issue No: Vol. 10, No. 8 (2021)
       
  • Analysis of outcome of pregnant women affected with COVID-19 in a tertiary
           care hospital

    • Authors: Prasannalakshmi S., S. S. Gayathri, K. M. Swathisree
      Pages: 3058 - 3061
      Abstract: Background: Corona virus is a single stranded RNA virus with a diameter of 80 to 120 nm. It causes respiratory illness ranging from mild nasal stuffiness to severe respiratory infection which may lead to death. The aim of the study was to evaluate the effect of COVID-19 on maternal and perinatal outcome.Methods: This retrospective study was conducted in the department of obstetrics and gynaecology, Government Sivagangai Medical College from June 2020 to November 2020. Totally 406 mothers were included in this study and the maternal and perinatal outcome analysed.Results: Majority of the patients were less than 30 years (85.95%) and only 14.03% were more than 30 years. Out of 406 patients 208 (51.23%) were multigravida. Out of 406 patients 148 patients had medical disorders like gestational hypertension, hypothyroidism, gestational diabetes mellitus, heart disease, anemia and bronchial asthma. Anemia being the most common followed by gestational hypertension. Among 406 patients, 100 (24.64%) patients were asymptomatic, 89 patients (21.92%) had fever, 50 patients (12.31%) had cough, 22 patients (5.4%) had difficulty in breathing, 62 patients (15.2%) had nasal congestion, 28 patients (6.8%) had headache, 55 patients (13.54%) had anosmia.72 (17.7%) patients had minimal ground glass opacity, 21 patients (5.17%) had ground glass opacity with consolidation, 15 patients (3.69%) had pneumonia with pleural effusion. Remedisivir IV was administered as per protocol to symptomatic patients and patients with CT findings. None of the mothers needed ventilator support or high flow oxygen (>12 l) and there was no maternal death. Among 207 babies (1 twin) delivered, about 91 babies weighed more than 3 kg, 77 babies weighed 2.6 to 3 kg, 31 babies weighed 2.1 to 2.5 kg, 8 babies weighed less than 2 kg. 38 babies had low birth weight. Five babies were found to be COVID-19 positive at birth and all five of them weighed more than 3 kg.Conclusions: Appropriate timely management is the key for safe motherhood and healthy offspring during this pandemic.
      PubDate: 2021-07-26
      DOI: 10.18203/2320-1770.ijrcog20212954
      Issue No: Vol. 10, No. 8 (2021)
       
  • A case control study on behavioural risk factors of anaemia among pregnant
           women delivered at a tertiary care hospital in Haryana

    • Authors: Sunny Ohlan, S. K. Jha, Parul Singhal
      Pages: 3062 - 3065
      Abstract: Background: Anaemia in pregnancy (AIP) is one of the most common preventable causes of maternal morbidity and poor prenatal outcome. World Health Organization (WHO) has accepted up to 11 gm/dl as the normal hemoglobin (Hb) level in pregnancy. In Haryana state, the prevalence of anaemia among pregnant women is 50.2% in urban areas and 58.1% in rural areas. Pregnant women are predominantly susceptible to nutritional deficiencies because of the increased metabolic demands imposed by pregnancy and its related factors. The aim and objective of the study was to determine the behavioural factors associated with anaemia among pregnant women delivering at a tertiary care hospital in Haryana.Methods: This hospital-based case control study was carried out in BPS Government Medical College for Women, Khanpur Kalan, Sonipat (Haryana). Study was conducted for one year. One hundred sixty-eight pregnant women were enrolled for study. Inclusion criteria for cases and controls was age of 18 years and above and residents of Sonepat district. Analysis was performed by using R statistical software.Results: The majority 57 (67.9%) of cases and 49 (58.3%) of controls were in age group of 18-24 years. Among different behavioral risk factors studied, not using bed nets, not wearing shoes consistently, eating pica and no use of the other drugs during pregnancy were significantly associated with anemia during pregnancy. However, on Multivariable Logistic regression analysis, the major behavioral risk factors for anemia were not using bed net during pregnancy (AOR: 1.83, 95% CI: 0.68-5.01), and not wearing shoes consistently during pregnancy (AOR: 2.77, 95% CI: 0.83-10.01). The odds of getting anaemia in pregnant mothers who reported pica during their pregnancy was AOR = 2.85 (CI: 0.90 – 10.01) than odds of mothers who did not report pica during their pregnancy.Conclusions: Consistent use of bed net, wearing shoes and not consuming pica prevent anaemia during pregnancy. 
      PubDate: 2021-07-26
      DOI: 10.18203/2320-1770.ijrcog20212955
      Issue No: Vol. 10, No. 8 (2021)
       
  • Evaluation of efficacy and safety of cryotherapy in benign and
           premalignant cervical lesion

    • Authors: Krishankumar D. Patel, Ronak D. Karnavat, Dimple G. Viramgama, Roma K. Dalal
      Pages: 3066 - 3071
      Abstract:  Background: Cervical cancer ranks 3rd leading cause of cancer in the world. Cervical erosion is mostly asymptomatic in women but when symptoms like postcoital bleeding and vaginal discharge occur in the presence of cervical erosion, it becomes important to identify whether the erosion is a benign lesion or CIN or cancer by means of PAP smear and Biopsy. Treatment for benign and precancerous lesion can be provided by ablative or excisional methods. Cryotherapy was reliably used to treat cervical lesions.Methods: Women among 18 to 60 years of age attending outpatient department who had history of chronic discharge per vaginum, postcoital bleeding, dyspareunia, chronic pelvic pain. Patients were divided in two by PAP smear in erosion with inflammatory changes and presence of low grade squamous intraepithelial lesion. Cryotherapy was performed using double-freeze single session procedure. Each patient was followed up at 2, 6 and at 12 weeks. Complications and patients’ satisfaction were recorded and compared to calculate cure rate of symptoms, healing of lesion.Results: The healing efficacy of cryotherapy at 6th and 12th week was 87.8% and 91.1% respectively. Cryotherapy had high satisfaction rate. The cure rate was not affected by location of lesion and size of lesion in both inflammation and LSIL.Conclusions: Cryotherapy is an effective method for treatment of cervical erosion and effectively eliminates symptoms. Patients were highly satisfied. Cryotherapy is cheap, easy, and safe treatment. It is suitable for both hospital and office-based practice.
      PubDate: 2021-07-26
      DOI: 10.18203/2320-1770.ijrcog20212956
      Issue No: Vol. 10, No. 8 (2021)
       
  • A cross sectional study to evaluate indications and outcomes of caesarean
           section in a district hospital of West Bengal

    • Authors: Pratima Maurya, Sandeep Saini, Bhawna Saini, Mohit Kumar, Ajit Kumar Adhya, Ranjit Kumar Mondal
      Pages: 3072 - 3078
      Abstract: Background: There is drastic rise in caesarean section (CS) rate worldwide in last decade as compared to optimal CS rate (10-15%) recommendation by WHO. This study was conducted to assess incidence and feto-maternal outcome in CS delivery.Methods: A cross-sectional study was conducted in pregnant women admitted over one year from September 2017- August 2018 in West Bengal. Demographic details and indication of CS were recorded along with documentation of feto-maternal outcomes. Statistical analysis was performed with help of Epi Info (TM) 7.2.2.2. Z-test and corrected Chi square (χ2) test. p<0.05 was considered to be statistically significant.Results: Out of total 10831 deliveries, 2914 (27%) women underwent CS. Demographic analysis shows maximum number of patients to be between 20-25years (51.7%), rural (58%), primigravida (51.3%), term pregnancy (87.7%). Non-progression of labour or NPL (45%) was most common indication of CS followed by previous CS (26.2%) and fetal distress (17.9%). Post CS wound infection was seen in 33 (1.1%) women. Two maternal deaths were recorded. Still born was documented in 0.8% while 6.8% fetus were referred to paediatric ICU.Conclusions: Rise in CS rates was mainly reported in 20-25 years age group, rural patients, in term pregnancy of primigravida patients. Most common indication for CS was NPL followed by previous CS and fetal distress. Mostly patients showed no complication in postpartum period. Only few patients had wound infection, hysterectomy and post-partum haemorrhage. More than 99% fetus survived without any complications. 
      PubDate: 2021-07-26
      DOI: 10.18203/2320-1770.ijrcog20212957
      Issue No: Vol. 10, No. 8 (2021)
       
  • Retrospective analysis of maternal mortality: a paradigm shift from 2010
           to 2020

    • Authors: Sujani Kempaiah, Urvashi ., Mamatha ., Jessica Celina Fernandes, Gayatri Devi Sivasambu, Shaziya Azmathulla, Shruthi Shivashankar
      Pages: 3079 - 3085
      Abstract: Background: Maternal mortality is attributed usually to complications that generally occur during or around labour and these are mostly preventable through proper understanding, diagnosis and management of labour complications. The quality of health services women receive during pregnancy, intranatal and postnatal periods are crucial for the survival and well-being of the mother and her newborn baby. The objective was to analyse the changing trends in maternal mortality occurring over a decade, to assess factors associated with maternal mortality and propose effective interventions in preventing such mortality.Methods: It was a retrospective study to analyse maternal mortality between January 2010 and January 2020 in Ramaiah medical college hospital. Data was collected the institutional medical and delivery records and patient details regarding obstetric history, pre-existing comorbidities, cause of death, interventions done was noted and review of maternal mortality was done.Results: The maternal mortality in the present study was 432.73/1 lakh live births. There were 57 maternal deaths in the study period. Most deaths occurred in the 20-25 age group. 42.10% of deaths occurred ninety six hours after admission. Sepsis (42.1%), hypertensive disorders (12.30%) and haemorrhage (10.5%) are the most common direct causes of maternal death. Post-operative and post abortal sepsis, ARDS, cardiogenic shock, pulmonary embolism and AFLP are the other direct causes. Hypertensive disorders (9.64%) and haemorrhage (19.5) is the two leading indirect causes of maternal deaths.Conclusions: Maternal health services should move beyond the focus on emergency obstetric care, to a broader approach that encompasses preventive and early interventions and integration with existing services. Most of the maternal deaths can be prevented if the high risk antenatal women are identified earlier and referred to the tertiary centre earlier for diagnosis and management. 
      PubDate: 2021-07-26
      DOI: 10.18203/2320-1770.ijrcog20212958
      Issue No: Vol. 10, No. 8 (2021)
       
  • Role of emergency bilateral internal iliac ligation in postpartum
           hemorrhage

    • Authors: Sunder Pal Singh, Shipra Misra, Naresh Sharma
      Pages: 3086 - 3089
      Abstract: ABSTRACTBackground: The aim of the study was to determine the effectiveness of emergency bilateral internal iliac ligation in intractable postpartum hemorrhage.Methods: A retrospective study was done on 33 women who have undergone emergency bilateral internal iliac ligation in obstetrics haemorrhage.Results: In all of 33 women under this study bilateral internal iliac ligation was performed in emergency. (11) of the cases were of atonic PPH, placenta previa (8), uterine rapture (7), extension of C-section scar (3), vaginal and cervical laceration (3) and uterine perforation (1). hysterectomy was not performed in any of the cases. internal iliac artery was injured in one case during the procedure and was managed successfully but two patients died during and after the BIIL.Conclusions: BIIL is an effective, less time consuming and life-saving procedure in intractable obstetrics hemorrhage if early decision is taken and performed by practiced surgeons.
      PubDate: 2021-07-26
      DOI: 10.18203/2320-1770.ijrcog20212959
      Issue No: Vol. 10, No. 8 (2021)
       
  • A retrospective study on causes of unsafe abortions in referred patients,
           at a tertiary care centre in western Uttar Pradesh

    • Authors: Kalpna Kulshrestha, Barkha Gupta, Kalpana Verma, Mandvi Tarun
      Pages: 3090 - 3094
      Abstract: Background: Unsafe abortions occur when pregnancy is terminated by unqualified person or in an environment that do not conform to minimal medical standards or both. The aim of this study was to analyse the causes in referred patients of unsafe abortions, methods used and complications with which patients were admitted.Methods: A retrospective observational study conducted in the department of Obstetrics and Gynaecology, SIMS Hapur Uttar Pradesh, India from 1stJune 2019 to 29thFebruary 2020. Data was collected from previous hospital records. Total 150 women aged between 18-40 years, admitted with complications of unsafe abortions and who had taken advice for termination outside our institute, were included. The demographic profile, detailed history, first contact person for abortion advice, abortion service provider, method of termination and prior ultrasound were noted. Exclusion criteria was period of gestation more than 20 weeks and spontaneous abortions.Results: The study showed 92% contacted unqualified person, out of which 22.5%were uncertified doctors, 30.4% ANM’s, 16.7% Nurses, 12.3% consulted quacks and 10.9% Chemists. Among the abortion service providers 23.6% were uncertified doctors, 45.7% Chemists, 15% Nurses, 5.7% Quacks, 3.6% ANM’s and 6.4% had taken self-medication. Prior ultrasound was done in 28% cases. Method of termination was medical in 78.7% and surgical in 21.3% cases. Period of gestation was <8 weeks in 69.3%, 8-12 weeks in 27.3%, 12-16 weeks in 2%. 37.3% had parity 2 and 55.3% were Hindus.Conclusions: Despite availability of safe abortion services, unsafe abortion practices are still prevalent. Approved MTP centres, skilled and certified abortion providers must be easily accessible to women even in rural areas to safeguard their health.
      PubDate: 2021-07-26
      DOI: 10.18203/2320-1770.ijrcog20212960
      Issue No: Vol. 10, No. 8 (2021)
       
  • Maternal and neonatal outcome of twin pregnancies with single fetal demise

    • Authors: Gunjan Rai, Sudhir Mansingh, Bikram Bhardwaj
      Pages: 3095 - 3100
      Abstract:  Background: In current study we managed twin pregnancies having single fetal demise with a successful outcome. Generally monochorionic and monoamniotic pregnancies are having high probability of complications, so we have to be more watchful in these pregnancies. Termination of pregnancy is not the only option as we can manage and prolong pregnancies with a good outcome by strict monitoring of patients. Aim of our study was to look for fetomaternal outcome in twin pregnancies with single fetal demise.Methods: This is a retrospective study done between July 2017 to June 2020 at Command hospital, Panchkula, Haryana. Total 3249 deliveries have been conducted during above said period. Out of which 47 deliveries were having twin pregnancy. We had six twin pregnancies who reported with one fetal demise. These cases were managed with regular monitoring of coagulation profile and strict fetal surveillance for surviving twin. The cases were studied for antenatal, postnatal and any neonatal complication.Results: No antenatal, postnatal maternal or any neonatal complication observed in this study. During study period we delivered total 3249 patients, out of which 47 were twin pregnancy. Out of these 47 (1.44%) twins’ pregnancies 33 (70.31%) were DADC and 14 (29.69%) DAMC. We studied six twin pregnancies who had single fetal demise. Conclusions: Even with single fetal demise pregnancies can be continued till term with strict monitoring for maternal and fetal complications. Termination is not the only answer in twin pregnancies with single fetal demise. Although our study was small, it indicates that in case of twin pregnancy with single fetal death and under good surveillance, the live fetus can be salvaged. 
      PubDate: 2021-07-26
      DOI: 10.18203/2320-1770.ijrcog20212961
      Issue No: Vol. 10, No. 8 (2021)
       
  • Role of lipid profile in early second trimester for prediction of
           pre-eclampsia

    • Authors: Surbhi ., Bangali Majhi
      Pages: 3101 - 3105
      Abstract: Background: The aim of the study was to determine association of abnormal lipid profile in early second trimester (14 to 20 weeks) with development of pre-eclampsia.Methods: A prospective observational study included 260 women between 14-20 weeks of pregnancy attending a tertiary care Hospital in New Delhi. Serum lipid profile analysis was performed at the time of enrolment and cohort was followed up for occurrence of pre-eclampsia till 48 hours after delivery. Outcomes measured were difference in mean lipid levels in study (abnormal lipid profile) and control group (normal lipid profile) and accuracy of abnormal lipid profile to predict pre-eclampsia.Results: The incidence of pre-eclampsia in our study was 11.13%. The mean serum total cholesterol was significantly higher in pre-eclampsia group (199.74 mg/dl vs 171.7 mg/dl; p<0.05). The difference in mean triglyceride, HDL, VLDL and LDL levels between two groups was not significant. Total cholesterol has 44.83% sensitivity, 84.85% specificity, 27.08% PPV, 92.45% NPV with diagnostic accuracy of 80.38% in predicting pre-eclampsia (with 0.65% AUC with 95% confidence interval). While VLDL has maximum sensitivity of 68.97% while HDL has maximum specificity of 86.15% in predicting pre-eclampsia.Conclusions: Abnormal total cholesterol levels have diagnostic accuracy of 80.38% to predict pre-eclampsia and abnormal lipid profile in early second trimester is a simple, non-invasive and economical test for prediction of pre-eclampsia. 
      PubDate: 2021-07-26
      DOI: 10.18203/2320-1770.ijrcog20212962
      Issue No: Vol. 10, No. 8 (2021)
       
  • Comparison of conventional Papanicolaou smear and liquid‑based cytology:
           a study of cervical cancer screening at a tertiary care center in
           Bengaluru

    • Authors: Chaitra Krishna, Savitha Chandraiah, Chandana Krishna
      Pages: 3106 - 3111
      Abstract: Background: Cervical cancer is the fourth commonest cancer affecting women worldwide and the second most common cancer in women aged 15-44 years. The Papanicolaou (Pap) smear has been the cornerstone of screening for cervical neoplasm for the last 50 years. Liquid-based cytology (LBC) was introduced in mid-1990s as an alternative technique to process cervical samples has many benefits over Pap. A new second generation technique, Liquiprep was introduced after a decade has the advantage of a much lower cost. However, the information available on second generation liquid based cytology is limited. The objective was to look for the efficacy of LBC and to compare it to that of conventional cytology.Methods: This hospital based comparative study was undertaken 100 women who attended gynaecology OPD during 2017 at a tertiary care hospital in Bengaluru. Two cervical smears were simultaneously prepared from each subject, one for Pap smear and another for LBC followed by colposcopy and biopsy.Results: Among the study subjects, 89% of Pap smear analysis and 100% of smears in LBC showed satisfactory smear. Cytological abnormality was detected in 11% and 21% in pap and LBC, respectively. The present study showed higher sensitivity and specificity of 100% and 75% by LBC when compared to Pap smear (55% and 100% respectively).Conclusions: The present study showed that liquid based cytology is better in detecting cervical lesions when compared to conventional smear. 
      PubDate: 2021-07-26
      DOI: 10.18203/2320-1770.ijrcog20212963
      Issue No: Vol. 10, No. 8 (2021)
       
  • Comparative study of ormeloxifene and low dose oral contraceptive pill for
           the treatment of dysfunctional uterine bleeding in peri-menopausal age
           group

    • Authors: Maitri Shah, Chirayu Parmar, Riddhi Gor
      Pages: 3112 - 3118
      Abstract: Background: Dysfunctional uterine bleeding (DUB) is the most common menstrual disorder of women in any age group and is a diagnosis of exclusion. Medical management of menorrhagia is a difficult task as there are wide variations in the available drugs and a lot of different regimes are available. Present study evaluates efficacy and safety of ormeloxifene a selective estrogen receptor modulator (SERMs) as compared to combined oral contraceptive pills in treatment of dysfunctional uterine bleeding in perimenopausal women.Methods: Total 60 patients meeting with our inclusion and exclusion criteria were enrolled in the study over a time period of 6 months and were further divided randomly into two groups. One group was given Ormeloxifene and the other group was treated with combined oral contraceptive pills (COCP) over a period of six months. The outcome variables noted were pictorial blood loss assessment chart (PBAC) score, Hb level and combined endometrial thickness (CET). Quantitative variables were compared using independent t test/Mann-Whitney test between the two groups and paired t Test/Wilcoxon test was used for comparison between pre and post within the group.Results: Both ormeloxifene and COCP significantly reduce blood loss in these patients evidenced by decrease of PBAC score, rise in hemoglobin levels and decrease in CET levels. However, ormeloxifene was found to be superior to COCP in reducing the menstrual blood loss. Ormeloxifene was also tolerated better compared to COCP with fewer side effects experienced by patients.
      PubDate: 2021-07-26
      DOI: 10.18203/2320-1770.ijrcog20212964
      Issue No: Vol. 10, No. 8 (2021)
       
  • Laparoscopic management of adnexal masses in admitted patients at tertiary
           care centre, Bhilai, Chhattisgarh, India

    • Authors: Meena Naik, Pooja Singh, Rekha Ratnani
      Pages: 3119 - 3122
      Abstract: Background: Laparoscopy is most widely accepted procedure in gynaecological cases both for diagnostic and operative purposes. It is associated with early recovery, shorter hospital stay and significant patient satisfaction. This study has been conducted to evaluate the effectiveness and safety of laparoscopy in the management of adnexal masses. Our Primary aim was to find out indications, intraoperative findings and different interventions to deal with adnexal mass. The objective of the study was to determine laparoscopic management of adnexal mass in all women attending Obstetrics and Gynaecology department, Shanakaracharya Institute of Medical Science, Bhilai, Chhattisgarh.Methods: This is a retrospective record-based observational study conducted over a period of one year from March 2020 to March 2021 after getting approval from the institutional ethical committee. Patients diagnosed with adnexal mass were evaluated and data was collected and analyzed.Results: Of the 130 cases of adnexal mass admitted in the hospital during the period under review, 43 cases (33%) were diagnosed as ovarian cyst among which simple cystic ovarian cyst was found to be most common etiology followed by ectopic pregnancy (41 cases). Majority of cases were managed laparoscopically with a good success rate, better outcome and short hospital stay. Conversion rate to laparotomy was 3.8% mainly seen in cases with complex ovarian mass or dense adhesions.Conclusions: Diagnosis of adnexal mass is important and it may affect females of any age group. Laparoscopy is a better approach to deal with adnexal masses (except malignancy) as it has better paronamic vision with less complications, less post-operative pain, shorter hospital stay. Careful patient selection should also be taken into account. Current study is an overview in favor of laparoscopic management of adnexal mass.
      PubDate: 2021-07-26
      DOI: 10.18203/2320-1770.ijrcog20212965
      Issue No: Vol. 10, No. 8 (2021)
       
  • Awareness of cervical cancer and its screening methods in Indian women

    • Authors: Khushboo Singh, Alka Goel, Manisha Attri
      Pages: 3123 - 3127
      Abstract: Background: In spite of effective screening methods, cervical cancer continues to be a major public health problem in India. Therefore, the present study was carried out to assess the knowledge of cervical cancer and its screening among women, it also focuses on the reasons for not undergoing regular screening and the effect of counseling for the same.Method: 400 women were randomly enrolled from the women attending/visiting/working at a tertiary hospital. They were asked questions related to cervical cancer. All answers were obtained verbally and recorded in the questionnaire by the same investigator.Results: Out of 400 women, only 103 were aware of cervical cancer as well as its screening, and only 10 of them were undergoing regular screening. Among those who were aware of cervical cancer, majority (95.14%) were health care workers and most of them got this knowledge form their textbooks. After counseling, all except 6 women were willing for regular screening. The reason for refusal for the same was either they believed they were not at risk or they found pelvic examination uncomfortable.Conclusions: The study found that women had poor knowledge about cervical cancer and its screening. Awareness was higher among the women who had received higher education or were healthcare workers. However, cervical cancer screening rate was low even in these women. Government and health care professionals need to actively promote awareness of the risk factors of cervical cancer and encourage women to undergo regular Pap smear as a cervical cancer screening method.
      PubDate: 2021-07-26
      DOI: 10.18203/2320-1770.ijrcog20212966
      Issue No: Vol. 10, No. 8 (2021)
       
  • A study of effectiveness of injection Depot medroxyprogesterone in
           postpartum women

    • Authors: Priya G. Dhameliya, Parul T. Shah, Shlok V. Patel, Dhanvi J. Deliwala, Kinjal Kotahri
      Pages: 3128 - 3131
      Abstract: Background: Depot medroxyprogesterone (DMPA) injection 150 mg intramuscular was used in postpartum women for contraception in this study, once every 3 months. The aim of the study acceptance and compliance of DMPA, observe side effects related to usage of DMPA and establish its effectiveness as a postpartum contraception method.Methods: This is a prospective study carried out at Obstetrics and Gynaecology department over a period of 9 months and follow up was done. Only patients of full term normal delivery and Lower segment caesarean section (LSCS) were included. They were counselled properly and after their willingness for enrolment they were included in study after taken consent.Results: Out of 50 cases selected maximum patients, 48% were in the age group of 26 to 30, 38% were from lower socioeconomic class. Amenorrhoea and irregular spotting were found in 68% and 42%respectively. There was no case of failure of this contraceptive method in this study.Conclusions: DMPA is an effective and safe method of contraception in lactating period. Proper counselling will increase acceptance of DMPA. Awareness in patients regarding its benefits as compared to other contraceptive methods. 
      PubDate: 2021-07-26
      DOI: 10.18203/2320-1770.ijrcog20212967
      Issue No: Vol. 10, No. 8 (2021)
       
  • Current practice of induction of labour and maternal outcome in ≥37 week
           of gestation: an observational study

    • Authors: Jil Manishkumar Sheth, Anjani Shrivastava, Kedar Trivedi
      Pages: 3132 - 3136
      Abstract: Background: As we know induction is done when benefit to mother and fetus overweigh benefits of continuing the pregnancy. According to NICE guidelines, induction of labor leads to 15% of instrumental deliveries and 22% of total LSCS. In new civil hospital, Surat (according to 2017) failure of induction of labor was 2nd most common indication of LSCS. The objective of this study were to analyse labor induction with respect to indication for induction of labor and its maternal outcome so that we optimize our protocol of labor and reduce our LSCS rates for the same, can reduce feto-maternal morbidities also.Methods: This was prospective observational descriptive study carried out over duration of 6 month. 200 consecutive cases of consenting women requiring induction of labour and fulfilling inclusion criteria were selected. Induction was done with prostaglandin analogous. Data were collected includes age, parity, gestational age, bishop score, indication of induction, and maternal outcome. And data was analyzed by using EMI software.Results: Timely induction of labor can reduce maternal morbidity and ensure the delivery of a healthy baby. Among 200 consenting women 58.5% were multigravida and 41.5% were primigravida. Most common indication of induction among study participants is prolong rupture of membrane which is 35.5%. Among them 71.4% had vaginal delivery having poor bishop score. Most common indication for LSCS were fetal distress (34.8%).Conclusions: We concluded that elective induction of labor was associated with lower rates of LSCS and improved maternal and neonatal outcome.
      PubDate: 2021-07-26
      DOI: 10.18203/2320-1770.ijrcog20212968
      Issue No: Vol. 10, No. 8 (2021)
       
  • Correlation of amniotic fluid index with fetomaternal outcome

    • Authors: Vidyasagara M., Chandrashekhar T., Sunil S. Raikar
      Pages: 3137 - 3141
      Abstract: Background: Amniotic fluid acts like a protective cover around the baby. Advances in ultrasound have increased early detection of abnormal amniotic fluid volumes. Any variation in the amniotic fluid volume warrants antenatal foetal surveillance.Methods: 300 pregnant women between 37 to 40 weeks of gestation were included in the study. A detailed history, examination and ultrasound was done. Pregnant women were divided into 3 groups’ i.e. normal liquor, oligohydramios and polyhydramnios. All the women were closely monitored during labour and puerperium. Follow-up was done till 7 days post-delivery. Maternal and neonatal data were collected.Results: 300 pregnant women were included in the study, out of which 221 had normal amniotic fluid index (AFI), 64 had oligohydramnios and 15 had polyhydramnios. All baseline characteristics were comparable between the groups except body mass index (BMI). Incidence of meconium stained liquor was significantly higher in oligohydramnios compared to normal AFI and polyhydramnios groups (34.4% versus 10.5% versus 13.3%; p=0.0001). Caesarean section rates were significantly higher in polyhydramnios and oligohydramnios compared to normal AFI group (73.3% versus 70.3% versus 19.9%; p=0.0001). Higher cases of low birth weight were recorded in oligohydramnios group compared to normal AFI and polyhydramnios group group (32.8% versus 18.6% versus 13.3%; p=0.011). Neonatal intensive care unit (NICU) admissions were higher in oligohydramnios (35.9%) and polyhydramnios (33.3%) compared to normal AFI group (35.9% versus 33.3% versus 12.7%; p=0.0001).Conclusions: Abnormal liquor volumes are associated with increased caesarean section rates, NICU admissions and neonatal mortality. Careful assessment of pregnant women is imperative for proper counselling and management.
      PubDate: 2021-07-26
      DOI: 10.18203/2320-1770.ijrcog20212969
      Issue No: Vol. 10, No. 8 (2021)
       
  • Conception rate with or without hCG trigger in clomiphene induced cycles

    • Authors: Aruna Verma, Abhilasha Gupta, Monika Kashyap, Juveriya Meraj
      Pages: 3142 - 3147
      Abstract: Background: Clomiphene citrate (CC) is still the most common drug for ovulation induction. Most physicians use hCG trigger routinely for follicle rupture. Ideally hCG is recommended only where there is no spontaneous LH surge. Hence this study was conducted to see the role of hCG for follicle rupture in CC induced cycle. Aims and objectives of the study were to compare the ovulation rate in CC induced cycle with or without hCG trigger and finally the conception rate.Methods: Study was conducted in the department of OBG, LLRM medical college Meerut on women with anovulatory infertility. All women were given 50-100 mg CC. Follicular study from D-9 was done till follicle rupture. Women in group A were observed without any trigger and women in group B were given inj. hCG trigger 10,000 IU when follicle size reached 20-22 mm.Results: Conception rates were 25% Vs 31% in group A and group B. Follicle rupture was seen in 84% cases in group A and 71% in group B. Results were comparable in both the groups.Conclusions: By adding inj. hCG for ovulation trigger does not increase the conception rate. LH surge is already there in CC induced cycles. It is having role only in cases where no LH surge is there. 
      PubDate: 2021-07-26
      DOI: 10.18203/2320-1770.ijrcog20212970
      Issue No: Vol. 10, No. 8 (2021)
       
  • Outcome and complications of self-administration of over-the-counter
           abortion pills: an observational study in a tertiary care hospital of a
           medical college in New Delhi

    • Authors: Anjali Singh, Sruthi Bhaskaran, Anshuja Singla
      Pages: 3148 - 3152
      Abstract: Background: Due to unrestricted free availability of abortion pills, despite of national policies, guidelines and medical termination of pregnancy (MTP) act, unsafe abortions by self-administration of these drugs for termination of unwanted pregnancies without prescription are becoming common in our country, leading to associated morbidity and mortality.Methods: A prospective Observational study was done at Guru Teg Bahadur hospital, university college of medical sciences, New Delhi, from November 2019 to April 2020, in the department of gynecology and obstetrics, on women visiting the outpatient department and casualty department with the history of self-administration of medical termination pills without prescription. This study was done to study the outcome and complications occurring due to self-administration of over-the-counter abortion pills that are freely available in the market. 95 women were included in study and data was collected regarding age, education level, parity, presenting complaints, complications and their management. Descriptive analysis of the collected data was done.Results: In this study 95 women were included 71.6% took pills before 8 weeks of gestation, 1% took in second trimester. 46.3% landed up in incomplete abortion and 33.68% needed surgical evacuation, 8.42% had ectopic out, 2.1% had scar site pregnancy and 7.36% needed laparotomy, 1.05% had rupture uterus followed by abortion pill intake while 1.05% suffered from acute kidney injury (AKI). There was no ICU admission nor any mortality.Conclusions: There is urgent need of strict legislation to curtail this bad practice and free availability of over-the-counter abortion pills which leads to unexpected morbidity and mortality, such drugs should be given only by health care providers under supervision, there is need of community level awareness so as to impart knowledge regarding this problem. 
      PubDate: 2021-07-26
      DOI: 10.18203/2320-1770.ijrcog20212971
      Issue No: Vol. 10, No. 8 (2021)
       
  • Fetal foot length for assessment of gestational age: a cross sectional
           study

    • Authors: Vaibhav Sharma, Ruchi Saxena, Priyanka Gaur
      Pages: 3153 - 3157
      Abstract: Background: Fetal age actually begins at conception and an equivalent term is conceptional age. Uncertain gestational age (GA) has been associated with adverse pregnancy outcomes independent of maternal characteristics. The objective was to evaluate the accuracy of fetal foot length (FFL) in estimation of gestational age.Methods: It was a cross sectional study. Trans abdominal ultrasound on 150 pregnant women with normal singleton pregnancies between 16 to 40 weeks was done to measure FFL. The relationship between GA and FFL was analysed by simple linear regression.Results: A linear relationship was demonstrated between FFL and GA. (GA (in weeks)=7.490+0.393×FFL (in mm)) with significant correlation (r=0.985, p<0.001).Conclusions: Ultrasonographic measurement of FFL is a reliable indicator of gestational age and can be a useful alternative to estimate GA when other routine biometric parameters are not conclusive.
      PubDate: 2021-07-26
      DOI: 10.18203/2320-1770.ijrcog20212972
      Issue No: Vol. 10, No. 8 (2021)
       
  • Pap smear screening in antenatal women: an opportunistic way to save life

    • Authors: Sana Siddiqui, Suhailur Rehman, Imam Bano, Sayeedul H. Arif
      Pages: 3158 - 3163
      Abstract: Background: Cancer cervix is the most common genital tract malignancy encountered in developing countries. In India, first visit to the gynaecologist for most women is during pregnancy and it may be the only visit. Hence, prenatal care offers an excellent opportunity to implement cervical screening in patients of young age, especially in women who do not seek routine health care. Therefore, this study was conducted to know the prevalence of abnormal Pap smear among the ante-natal women and to evaluate the result in relation to various risk factors.Methods: Cross sectional observational study conducted on 425 ante-natal women attending the antenatal clinic using questioner addressing various socio-demographic variables. Measures of central tendency calculated and result was tabulated by using chi-square test.Results: Maximum number of cases in our study was NILM i.e.314 (74%) followed by 68 cases of Candida (16%), 30 cases of Bacterial vaginosis (7.1%) and 10 cases of Trichomonas vaginalis (2.4%). Only 3 cases of abnormal Pap smear was reported i.e. 2 of ASCUS and 1 of LSIL. Thus, prevalence of abnormal Pap smear was 0.7%.Conclusions: In country like India where organised screening programme are not available, as well as the awareness and uptake of available services by the target population is also poor; screening in pregnancy is worthwhile and may be a viable option to reduce the burden of cervical carcinoma. 
      PubDate: 2021-07-26
      DOI: 10.18203/2320-1770.ijrcog20212973
      Issue No: Vol. 10, No. 8 (2021)
       
  • Study of association of socio-demographic characteristics with the
           knowledge about sex determination and preconception and prenatal
           diagnostic technique act among pregnant women

    • Authors: Seema Dwivedi, Garima Gupta, Sudha Kumari, Bandana Sharma
      Pages: 3164 - 3168
      Abstract: Background: Preconception and prenatal diagnostic technique Act was amended in year 2003 which provides for prohibition of sex selection before and after conception and for regulation of prenatal diagnostic technique.Methods: A cross sectional study was carried out in antenatal ward of GSVM Medical College Kanpur during the period of January to December 2019. A total of 2500 pregnant women were included and predesigned and pretested questionnaire was used to get information regarding socio-demographic details of pregnant women. They were asked regarding the knowledge and attitude towards the PC-PNDT Act. Data were collected and analyzed using Microsoft excel and SPSS-12. Results: In the present study, out of 2500 women, 2125 (85%) knew about sex determination while 125 (5%) knew about PNDT Act. There was significant association of occupation, education and annual income with knowledge. Majority of women know about PC-PNDT act from health staff and ultrasonography was the main technique they know to detect sex determination. Conclusions: The falling ratio of girl child is a matter of grave concern. Effective implementation of the PNDT Act in addition to spreading awareness about this act among people is the need of the hour. Educating the community will prevent the decline in sex ratio and female feticide through PC-PNDT Act.
      PubDate: 2021-07-26
      DOI: 10.18203/2320-1770.ijrcog20212974
      Issue No: Vol. 10, No. 8 (2021)
       
  • Fetomaternal outcome and effect of ursodeoxycholic acid in patients of
           obstetric cholestasis

    • Authors: Poonam Laul, Soma Kumari, Urvashi Miglani, Anish Laul, Shalini Gandhi, Sanjeev Miglani
      Pages: 3169 - 3173
      Abstract: Background: The objective of this study was to determine fetomaternal outcome and effect of ursodeoxycholic acid in patients of obstetric cholestasis.Methods: This study was prospective observational descriptive study of 130 women, which was conducted in the department of obstetrics and gynaecology, Deen Dayal Upadhayay Hospital, New Delhi. Statistical analysis was performed using the z test when appropriate. A p value of <0.05 will be considered statistically significant.Results: Spontaneous onset of labour was present in 48.5% of patients, induction was done in 31.5% of patients and in rest 20% of patients LSCS was indicated. Normal vaginal delivery occurred in 97 of 130 patients while emergency LSCS done 33 of 130 patients. Emergency LSCS was done in 16 of 33 patients due to foetal distress. Pre-term delivery and PROM occurred in 8.5% and 9.2% of patients respectively while PPH occurred in 12.3% of patients. Among the 130 cases included in present study 34 patients (27.2%) had fetal distress, 41 patients (31.5%) had MSL and 40 neonates (32.0%) required NICU. 16 neonates out of 130 (12.8%) had birth weight below 2.5 kg. Apgar score was <7 after 5 min in 31 neonates.Conclusions: Ursodeoxycholic acid (UDCA) is useful in relieving symptoms and decreasing the biochemical markers. 
      PubDate: 2021-07-26
      DOI: 10.18203/2320-1770.ijrcog20212975
      Issue No: Vol. 10, No. 8 (2021)
       
  • Fetomaternal outcome in pregnancies complicated by fibroid

    • Authors: Leimapokpam Roshan Singh, Kaushik Mahajan, Nandeibam Balchand Singh, Wairokpam Prabinkumar Singh, Kabita Athokpam, R. K. Jinaluxmi
      Pages: 3174 - 3179
      Abstract: Background: Fibromyoma (leiomyoma) is the most common benign tumour of the uterus. Approximately 10% to 30% of women with uterine fibroids developed complications during pregnancy. The aim of the study was planned to ascertain the fetomaternal outcome in pregnancies complicated by fibroid.Methods: A hospital based cross-sectional study was conducted among pregnant women with documented uterine fibroid who was admitted for any complication or delivered in the department of obstetrics and gynaecology, RIMS, Imphal from September 2017 to August, 2019 in the department of obstetrics and gynaecology in collaboration with department of paediatrics, Regional institute of Medical Sciences, Imphal. Detailed clinical history and socio-demographic profile were recorded in pre-designed proforma. General physical examination and systemic examination and obstetrical examination was carried out for the participants.Results: Major proportions was in the age group of 30-39 years (73.9%). Fibroids were more frequent in primigravida (76.1%) followed by P1 (15.2%) and ≥P2 (8.7%). Out of 46 patients 43 (93.5%) delivered by CS (69.76%), NVD (25.58%) and instrumental delivery (4.65%) while 3 patients (6.5%) undergo spontaneous abortions. Most common myoma found in this study was intramural (47.8%) followed by submucous (34.8%) and subserosal (17.4%). Out of 43 deliveries most common complications found was atonic PPH (6.97%) and placenta previa (6.97%) followed by degenerations (2.32%), abruptio placentae (2.32%), malpresentations (2.32%). Out of 43 deliveries 6.9% baby born with low birth weight, IUGR (6.9%), IUFD (4.6%), NICU admission (4.65%) and early neonatal death (2.32%).Conclusions: Pregnancies with fibroids are considered as high-risk pregnancy associated with complications during the antepartum, intrapartum, postpartum period. Pregnant women with myoma can be advised for regular ANC along with TAS for early diagnosis and management of complication.
      PubDate: 2021-07-26
      DOI: 10.18203/2320-1770.ijrcog20212976
      Issue No: Vol. 10, No. 8 (2021)
       
  • Histopathological evaluation of endometrial sampling in perimenopausal
           women with abnormal uterine bleeding

    • Authors: Bhavani L. Nair, Lency S. Kuriakose
      Pages: 3180 - 3185
      Abstract: Background: Abnormal uterine bleeding (AUB) is one of the common symptoms in the gynaecology outpatient department. About one third of women are affected at some time in their lives. The perimenopausal women show significant number of underlying organic pathology. The evaluation of endometrium and/or organ histopathology has the dual advantage of finding the cause of AUB and to rule out endometrial cancer or the potential for cancer in future like endometrial hyperplasia with atypia. The aim of the study was to determine the histopathological pattern of endometrial sampling in perimenopausal women with AUB and to follow them up for a period of six months after the procedure.Methods: The prospective observational study was conducted at the department of obstetrics and gynaecology at Sree Gokulam Medical College and Research Foundation, Venjaramood, Thiruvananthapuram, Kerala, for a period of one year from December 2019 to December 2020. The study was conducted on 116 perimenopausal women 41-52 years who presented with AUB and had undergone endometrial sampling. These ladies were subsequently followed up for six months post procedure to assess the response to medical treatment or the need for any surgical intervention like hysterectomy.Results: A total 39.65% patients had heavy and prolonged menstrual bleeding and 18.16% patients had irregular bleeding. 14.65% patients had prolonged flow, 8.6% had heavy flow, 6.8% had infrequent with prolonged flow, 6% had prolonged, infrequent with heavy bleeding. Non-structural (COEIN) causes contributed to about 60.4% of AUB in perimenopausal women and 39.6% had structural (PALM) causes. 49% cases were secretory endometrium. 29.3% had disordered proliferative endometrium, 4.3% had proliferative endometrium, 5.2% each had polyp or hyperplasia without atypia. 18 (15.5%) cases underwent hysterectomy, 3 patients who had adenocarcinoma underwent staging laparotomy, 2 patients had LNG IUS insertion and 40 patients were on follow up requiring either no treatment and 53 (45.68%) patients were given antifibrinolytics or hormonal therapy.Conclusions: Heavy and prolonged menstrual bleeding was the most common presenting symptom. COEIN contributed to about 60.4% of cases. Evaluation of the endometrium showed that, secretory endometrium was commonest (49%) followed by disordered proliferative endometrium (29.3%). On follow up for six months, 15.5% patients underwent hysterectomy, 2 patients had insertion of levonorgestrel IUD, 45.68% patients had medical management with antifibrinolytics or hormones and were on follow up. The responsibility of gynaecologist in the management of AUB in perimenopausal women is to exclude hyperplasia of endometrium and endometrial cancer.
      PubDate: 2021-07-26
      DOI: 10.18203/2320-1770.ijrcog20212977
      Issue No: Vol. 10, No. 8 (2021)
       
  • Comparative study of single versus double time application of dinoprostone
           E2 gel on the induction of labor in term pregnancy and it’s fetomaternal
           outcomes

    • Authors: Santosh Khajotia, Manoj Gupta, Mool Chand Khichar, Madhuri Sharma, Kavita Choudhary
      Pages: 3186 - 3191
      Abstract: Background: Labor is defined as a cascade of effective uterine contractions leading to progressive effacement and dilatation of cervix resulting in the expulsion of the fetus, placenta and the membranes. The aim of the study was to evaluate the effect of single time and double time application of dinoprostone E2 gel and to compare fetomaternal outcomes after single and double application of dinoprostone E2 gel and its complications.Methods: This was a prospective observational study conducted on 200 pregnant females with a period of gestation ≥37 completed weeks between 1st January 2020 to 31st January 2021. Group A included females undergoing single time application of PGE2 gel and in group B, second dose applied after 6 hrs of first dose if there was no improvement in Bishop score. If necessary, oxytocin for augmentation of labor was started only 6 hrs after the last dose.Results: Mean age in group A was 24.38±4.37 years and in group B was 24.02±3.76 years and this difference was not found statistically significant (p>0.05). Majority of cases had vaginal delivery. In group A, 28% cases had LSCS delivery while in group B, 17% cases had LSCS delivery (p>0.05). There was significant increase in mean Bishop score after second dose of PGE2 gel in double application group by 3.24 assessed at 12 hours after induction. Double times application of gel resulted in a smaller number of failed inductions i.e.; 23 out of 100 cases in single application group and 7 out of 100 cases in double application group. Main maternal complication was nausea and vomiting which was 5% cases in group A and 11% cases in group B.Conclusions: Double times application of dinoprostone gel resulted in improved Bishop score, facilitates the process of induction, increased number of successful inductions, shortened application delivery interval and decreased cesarean section rate compared to single application. There was slight increase in maternal and fetal complications with double times application.
      PubDate: 2021-07-26
      DOI: 10.18203/2320-1770.ijrcog20212978
      Issue No: Vol. 10, No. 8 (2021)
       
  • Meta-analysis on maternal deaths and assessing significant factors for
           heterogeneity between states of India during 2016

    • Authors: Vanamail Perumal
      Pages: 3192 - 3196
      Abstract: Objective of the study was to provide a more precise estimate of maternal mortality (MM), maternal mortality ratio (MMR) and to identify significant factors contributing for heterogeneity between the states in India. “Metaprop” procedure in STATA software, which are specific to binomial data was applied on state wise MM data published by sample registration system (SRS) during 2014-16. An overall MM estimate and potential sources of heterogeneity could be identified using meta-regression. Corrected estimates of MMR by states were compared. SRS published the MM data by 17 Major states. Overall reported MM was 8.8 per 100, 000 women. Estimate obtained by random effect model was 8.3 (95% CI: 5.9-11.1) per 100,000 women. Heterogeneity between states was very high (I2-statistics =91.9%), and egger regression revealed no reporting bias (p=0.672). Meta-regression analysis indicated that the percent women attending full antenatal care (ANC) visits found to be highly significant (p<0.001) for MM with inverse relationship implying that the states with a higher percentage of women with full ANC visits are likely to have lesser MM. While the estimate of MMR by SRS was 130 per 100,000 live births, corrected MMR was 123 (95% CI: 87-164) accounting for 26% reduction from previous estimate 167 obtained in 2013. This paper provided a precious estimate of both MM and MMR adjusted for sampling weight. Further, the importance of either full ANC visits or four ANC visits could be demonstrated for reduction in MMR on achieving the Millennium development goal (MDG) in the country. 
      PubDate: 2021-07-26
      DOI: 10.18203/2320-1770.ijrcog20212979
      Issue No: Vol. 10, No. 8 (2021)
       
  • Pure dysgerminoma of the ovary: a study of 31 cases

    • Authors: Hasna Salhi, Mohamed Ali Ayadi, Imen Bouraoui, Riadh Chargui, Khaled Rahal
      Pages: 3197 - 3203
      Abstract: Malignant germ cell tumors of the ovary are rare tumors characterized by their heterogeneity and occurring mostly in young women. Dysgerminoma is the most common type of these tumors. This was a retrospective study of 31 patients with pure dysgerminoma of the ovary diagnosed in Salah Azaiez institute of Tunis in Tunisia between 1970 and 2012.The median age was 22 years old. Abdominal pain was the most complaint in 45.1% of cases. An abdomino-pelvic mass was found in 83.8% of cases. Surgery was performed in all patients. The median tumoral size was 13.7 cm. Sixty four-point five percent of the patients underwent a conservative surgery. The tumor was classified stage I in 51.6% of the cases, stage II in 9.7% of the cases, stage III in 35.5% of the cases and stage IV in 3.2% of the cases. Fourteen patients received platinum-based adjuvant chemotherapy, and 10 patients had a radiotherapy. We have noticed 2 cases of recurrence and 2 cases of metastasis. Five-year and ten-year overall survival was 89.4%. Five-year disease free survival was 85.2% and ten-year disease free survival was 66.3%. Dysgerminomas of the ovary have a good prognosis. The two significant prognostic factors are the stage and the postoperative residual disease.
      PubDate: 2021-07-26
      DOI: 10.18203/2320-1770.ijrcog20212980
      Issue No: Vol. 10, No. 8 (2021)
       
  • Maternal and perinatal outcome in rupture of unscarred uterus: a case
           series

    • Authors: Ancy M. Kurian, Indrani Roy, Neelotparna Saikia, Kerlin Mihsill
      Pages: 3204 - 3207
      Abstract: Uterine rupture is one of the main contributory factors of maternal morbidity and fetal mortality. The aim of this study was to study the maternal and perinatal outcome in rupture of unscarred uterus and to identify the etiology, risk factors, diagnosis and management in a tertiary care centre. This case series study was often cases of rupture of unscarred uterus conducted at the department of obstetrics and gynecology, Nazareth hospital, Shillong, Meghalaya from July 2018 to February 2021. During the study period there were 7840 deliveries and ten patients presented with rupture of unscarred uterus, the incidence being 0.127 %. The patients were referred from different primary health centres and all patients presented with history of trial of home delivery. All patients were multigravida and the highest parity was a patient with para 11. The cases were between the gestational age of 39 to 41 weeks. Rupture was observed in the lower uterine segment in 5 patients, left lateral wall in 3 and right lateral wall in 2 patients. Five patients underwent hysterectomy, and 4 patients had repair of the rupture. There was one maternal death. Grand multipara and trial of home delivery were the most common identifiable risk factors along with obstructed labour. Identifying high risk women, prompt diagnosis, early referral from periphery and active management is the key factor to avoid adverse maternal and perinatal outcome.
      PubDate: 2021-07-26
      DOI: 10.18203/2320-1770.ijrcog20212981
      Issue No: Vol. 10, No. 8 (2021)
       
  • Clinicopathological profile of patients with brain secondaries from Ca
           cervix: a case series of five patients from tertiary cancer centre in
           North India

    • Authors: Jyoti Sharma, Mrinalini Upadhyay, Manish Gupta, Vikas Fotedar
      Pages: 3208 - 3211
      Abstract: Ca cervix is a common gynaecological cancer in daily practice but secondaries in brain after ca cervix as primary is a rare occurrence. As the survival of ca cervix patients has improved, we are able to encounter secondaries in unusual sites like brain. Prognosis is usually dismal due to presence of extra cranial mets along with brain secondaries which limits the use of new radiotherapy techniques like Stereotactic radiosurgery. We present a case series of five patients who presented to us post radical treatment of cancer cervix and treated with whole brain radiation therapy and best supportive care.
      PubDate: 2021-07-26
      DOI: 10.18203/2320-1770.ijrcog20212982
      Issue No: Vol. 10, No. 8 (2021)
       
  • A rare case of utero-vaginal prolapse seen at third trimester: case report
           and review of literature

    • Authors: Adebayo Awoniyi, Aloy Okechukwu Ugwu, Sunusi Rimi Garba, Nneoma Kwemtochukwu Aniugwu, Augustine Egba, Olabisi Olanrewaju, Oluwaseun Emmanuel Familusi, Olayemi Emmanuel Olumakinwa, Kehinde Okunade
      Pages: 3212 - 3214
      Abstract: Pelvic organ prolapse (POP) is an infrequent cause of morbidity in pregnancy. We presented a case of stage three uterovaginal prolapse that was first noticed in the third trimester. Management of POP is individualized and its determined by the severity of the symptoms, stage of the prolapse, gestational age, patient’s desire and expertise of the gynaecologist. Different options of management have been proposed ranging from conservative to laparoscopy, hysterectomy in women with no desire for further child bearing. Vaginal delivery is an option; however, most obstetricians opt for elective caesarean section at term. 
      PubDate: 2021-07-26
      DOI: 10.18203/2320-1770.ijrcog20212983
      Issue No: Vol. 10, No. 8 (2021)
       
  • Radical vulvectomy for a rare case of squamous cell carcinoma vulva: a
           case report

    • Authors: Kirty Nahar, Nikita Nahar
      Pages: 3215 - 3222
      Abstract: Cancer of the vulva is the fourth most common malignancy of the female genital tract. Vulvar carcinoma is a rare and aggressive gynecological malignancy. It affects elderly females, with the mean age at diagnosis being 55-60 years. Regional metastasis to inguinal lymph nodes is common. There is a high incidence of pelvic node involvement, especially in those with pathologically positive inguinal nodes. Surgery appears to be the only curative treatment option in the early stages of the disease. But in most patients, surgery is associated with considerable morbidities and psychosexual issues. Hence, in the quest for a less morbid form of treatment, multimodality approaches with various combinations of surgery, chemotherapy, and radiation therapy have been suggested for advanced vulvar cancers. Due to the low incidence of the disease, the level of evidence for the success of these treatment modalities is poor. Mrs. X, a 54-year-old female, P2L2 A0 presented at Apollo hospitals, Ahmedabad with a giant vulvar tumor of about 8x7 cm in size arising from anterior half of vulva involving clitoris and both labia minora. The vulval growth was initially small and had attained present size in last 15 days. She had complaints of postmenopausal bleeding per vaginum for 8 days, foul smelling discharge and itching vulva on and off for 1 month. Biopsy revealed moderate to well differentiated squamous cell carcinoma (SCC). MRI pelvis with contrast found suspicious lymph node in bilateral iliac vessel region and bilateral inguinal region. She underwent radical vulvectomy with bilateral inguinal lymph node dissection, and bilateral pelvic lymph node dissection. Early diagnosis, timely intervention and prompt surgical management could save the patient’s life. Histopathological report showed well differentiated SCC of vulva with no lymphnodes involvement. Depth of tumor was 12 mm and there was no lymphovascular and perineural invasion. All surgical margins and base of growth were free of tumor. According to TNM stabilization patient had SCC vulva stage IB (T1bN0M0). This patient was disease free after 18 months of follow-up. Vulvar cancer incidence is significantly high in post-menopausal and multiparous women. The most important prognostic factors are tumor stage and lymph node status. Oncological resection should be equated with functional outcome. The multidisciplinary team approach should be sought for this rare gynecological malignancy.
      PubDate: 2021-07-26
      DOI: 10.18203/2320-1770.ijrcog20212984
      Issue No: Vol. 10, No. 8 (2021)
       
  • An interesting case of intrauterine torsion of ovarian cyst in a female
           fetus

    • Authors: Jaya Barla, Vaishali K. Nayak, Kalpesh Patil
      Pages: 3223 - 3225
      Abstract: Fetal ovarian cysts are usually benign and managed conservatively. We report an interesting case of fetal ovarian cyst diagnosed in the antenatal period. Post-delivery, neonate was operated for torsion of the ovarian cyst. The baby recovered well. 
      PubDate: 2021-07-26
      DOI: 10.18203/2320-1770.ijrcog20212985
      Issue No: Vol. 10, No. 8 (2021)
       
  • Endometrioma mimicking ovarian malignancy in a post-menopausal woman

    • Authors: Vijay Zutshi, Shreshtha Gupta, Charanjeet Ahluwalia, Monica R.
      Pages: 3226 - 3228
      Abstract: Endometriosis is an estrogen dependant disorder of reproductive-age women. It is uncommon after menopause, however, peripheral estrogen production may account for endometriosis in post-menopausal women. We reported a case of a 68 year old post-menopausal woman with an adnexal mass suspected malignant ovarian tumor on imaging and normal serum CA 125 levels. Total hysterectomy with bilateral salpingo-oophorectomy was done. The final histopathology revealed the diagnosis of ovarian endometriosis. Rarely, ovarian endometrioma can mimic ovarian malignancy in a post-menopausal woman.
      PubDate: 2021-07-26
      DOI: 10.18203/2320-1770.ijrcog20212986
      Issue No: Vol. 10, No. 8 (2021)
       
  • Recurrent cornual pregnancy: a case report

    • Authors: Neelotparna Saikia, Sukalyan Halder, Punam Jain
      Pages: 3229 - 3231
      Abstract: Cornual ectopic pregnancy accounts for 2-4% of all the ectopic pregnancies with a mortality rate 6-7 times higher than that of the ectopics in general. It is a diagnostic and therapeutic challenge to the clinician with a significant risk of rupturing and bleeding. As of yet, the incidence of recurrent cornual ectopic pregnancies is unknown. This report described the case of a patient who developed two cornual ectopic pregnancies within a span of 3 years with an intervening full term normal vaginal delivery. The 1st cornual ectopic was successfully managed by laparoscopic resection, which was followed by an uneventful postoperative course. The following contralateral cornual ectopic was managed by laparotomy since the patient presented with large hemoperitoneum.
      PubDate: 2021-07-26
      DOI: 10.18203/2320-1770.ijrcog20212987
      Issue No: Vol. 10, No. 8 (2021)
       
  • Vesico-cervical fistula following normal vaginal delivery: case report and
           management overview

    • Authors: Vijaya Koothan
      Pages: 3232 - 3235
      Abstract: Vesico-uterine fistula is an uncommon pathological communication developing between the uterus or cervix and the urinary bladder especially in traumatic caesarean sections. We presented a case of vesico-cervical fistula who presented after 18 years of occurrence of fistula and successful repair. Clinical diagnosis may be delayed due to varied presentations and evaluation may require more than one modality of investigation. The choice of treatment surgical or conservative management depends on the location size and number of the fistula. Surgical outcomes of open laparotomy, laparoscopic and robotic surgery have been successful. Obstetric outcomes of post repair patients have had successful pregnancies.
      PubDate: 2021-07-26
      DOI: 10.18203/2320-1770.ijrcog20212988
      Issue No: Vol. 10, No. 8 (2021)
       
  • An unusual presentation of Gossypiboma associated with secondary
           infertility: a case report

    • Authors: Eshwarya J. Kaur, Ganesh Saravagi
      Pages: 3236 - 3238
      Abstract: Gossypibomas are a rare cause of surgical morbidity and mortality. When unrecognised in the perioperative period, they can present later with a myriad of abdominal complications. We present an unusual case of gossypiboma that was discovered as a cause of secondary infertility, misdiagnosed as a complex adnexal mass. After a definitive diagnosis was made, the removal of gossypiboma restored fertility in the patient successfully.
      PubDate: 2021-07-26
      DOI: 10.18203/2320-1770.ijrcog20212989
      Issue No: Vol. 10, No. 8 (2021)
       
  • Bleeding abdominal scar endometriosis-a case report

    • Authors: Badal Das, Malay Sarkar, Debobroto Roy, Krishna Pada Das, Nazmin Khatun, Aritrick Moulick
      Pages: 3239 - 3241
      Abstract: Presence of functional endometrial tissue anywhere outside the uterine mucosa is called endometriosis. It is hormone dependent and almost exclusively it affects the women of reproductive age. Abdominal scar endometriosis is a rare condition and it is due to deposition of endometriotic tissue in the wound site during various obstetric or gynecological operative procedures. Scar endometriosis followed by lower segment caesarean section (LSCS) is very rare and presents with co-menstrual pain and bleeding. Our case presented with active bleeding from abdominal LSCS scar during menstruation which is extremely a rare presentation. Wide excision and histo-pathological examination confirm the diagnosis. A 28-year-old lady with previous history of LSCS 2 years back presented with complaining of swelling and bleeding from the previous LSCS scar during menstruation, persisting for 4-5 days, repeatedly in every menstrual cycle for last 6 months. On examination a swelling with active bleeding from it was noted over the previous LSCS scar. Routine investigation and coagulation profile was with in normal limit and on ultrasonography a firm mass was noted. After wide excision and histo-pathological Examination, the diagnosis was confirmed. Co-menstrual swelling, pain and bleeding from the previous LSCS scar should not be neglected and may be due to scar endometriosis.
      PubDate: 2021-07-26
      DOI: 10.18203/2320-1770.ijrcog20212990
      Issue No: Vol. 10, No. 8 (2021)
       
  • Optimized outcome of pregnancy in a woman with Glanzmann thrombasthenia
           with multidisciplinary approach

    • Authors: Sujithradevi Radhakrishnan, Gowri Dorairajan, Murali Subbaiah, Jyotsna Sharma
      Pages: 3242 - 3244
      Abstract: Glanzmann thrombasthenia (GT), an autosomal recessive disorder of defective platelet aggregation due to abnormalities of platelet receptor GPIIb/IIIa, can result in complication of bleeding during pregnancy. We report multidisciplinary management of a case with optimized outcome. 23 years old short statured (142 cm) primigravida was referred for contracted pelvis at term in labour. She was diagnosed with GT at 12 years of age during evaluation of gum bleeding, easy bruising, and prolonged post traumatic bleeding. She was born of a second-degree consanguineous marriage. At admission she was hemodynamically stable but moderately pale. Her hemoglobin was 8.7 g%, with 4.6 lacs platelets and clotting time of 15 minutes. Multidisciplinary team of hematologist, transfusionist and anesthetist was activated. Arranging single donor platelets in a short notice was challenging. Emergency cesarean section under general anesthesia was performed after transfusing two units packed red blood cell and 2 single donor platelets to deliver an alive male baby of 3.3 kg. Hemostasis was secured with cautery and ligatures. Tranexamic acid infusion and sublingual misoprostol was given prophylactically. she was transfused another 4 random donor platelets during operation and postoperatively. The case details will be presented. GT have normal to high platelet counts though they are normal morphologically, they are dysfunctional. This fact needs to be recognized and referred early to equipped centres. We used component transfusion, active management of third stage and tranexamic acid for optimizing outcome due to haemorrhage. At present, there is lack of consensus regarding optimum treatment of post-partum hemorrhage in patients with GT.
      PubDate: 2021-07-26
      DOI: 10.18203/2320-1770.ijrcog20212991
      Issue No: Vol. 10, No. 8 (2021)
       
  • A case of placenta increta in placenta previa: a rare case report

    • Authors: Badal Das, Debobroto Roy, Malay Sarkar, Krishna Pada Das, Nazmin Khatun, Aritrick Moulick
      Pages: 3245 - 3248
      Abstract: Placenta increta, one type of morbidly adherent placenta, is characterized by entire or partial absence of the decidua basalis, and by the incomplete development of the fibrinoid or Nitabuch’s layer and villi actually invading the myometrium. When the internal os is covered partially or completely by placenta, it is described as a placenta previa. Simultaneously these two complications occurring in a post LSCS scarred uterus is a very rare scenario and anticipated frequently to cause catastrophic obstetric outcome. A 32-years-old woman of second gravida, para 1, with previous history of LSCS 7 years back, with living issue one, admitted in our hospital at 35 weeks 5 days gestation with asymptomatic placenta previa with placenta increta. The case was diagnosed effectively by ultrasonography. Intra-operatively, compression sutures and bilateral uterine artery ligature was tried to control hemorrhage which were failed and a quick decision of caesarean hysterectomy was done. Preserving both ovaries, total hysterectomy was the only option to save the mother in our case. Other options attempting to preserve uterus could have ended up with grave consequences in this case. This was a very rare case of asymptomatic placenta previa with placenta increta in a post LSCS scarred uterus and it was successfully managed by judicious caesarean hysterectomy.
      PubDate: 2021-07-26
      DOI: 10.18203/2320-1770.ijrcog20212992
      Issue No: Vol. 10, No. 8 (2021)
       
  • Dysgerminoma presenting at fifty, consequence to undiagnosed Swyer
           syndrome

    • Authors: Sapna Vinit Amin, Aswathy Kumaran
      Pages: 3249 - 3253
      Abstract: Swyer syndrome or XY complete gonadal dysgenesis (CGD) is a rare disorder of sex development (DSD) characterized by presence of dysgenetic gonads in a phenotypically female patient with a male karyotype. Usually Swyer syndrome is diagnosed following appropriate evaluation for amenorrhea in adolescence and prophylactic gonadectomy is done as these patients have high risk of developing malignancy in their dysgenetic gonads.  Here we presented patient who presented later in life with ovarian malignancy which turned out to be a consequence of undiagnosed Swyer syndrome. Her case exemplifies that fact that improper evaluation of primary amenorrhea in adolescence and omission to do prophylactic bilateral gonadectomy led to her presenting with malignancy at this advanced age. Therefore, be aware to not let Swyer syndrome go undiagnosed and mismanaged.
      PubDate: 2021-07-26
      DOI: 10.18203/2320-1770.ijrcog20212993
      Issue No: Vol. 10, No. 8 (2021)
       
  • Prosthetic mitral valve thrombosis in a known case of rheumatic heart
           disease at 37 weeks pregnancy: a case report

    • Authors: Kirty Nahar, Nikita Nahar
      Pages: 3254 - 3260
      Abstract: Pregnancy with prosthetic valve is a challenging situation since this is a hypercoagulable state and maintenance of anticoagulation for prosthetic valves becomes difficult due to the teratogenic effects and altered pharmacokinetics of anticoagulant drugs. Despite adequate anticoagulation, the incidence of prosthetic valve thrombosis has been estimated as 4% to 14% during pregnancy. Management decisions for this life-threatening complication are complex. Open-heart surgery has a very high risk of maternal mortality and fetal loss, especially in early pregnancy. Furthermore, bleeding and embolic risks associated with thrombolytic agents, the limited efficacy of thrombolysis in certain subgroups, and a lack of experience in the setting of pregnancy raise important concerns.  Mrs. X, a 36-year-old, gravida 3, para1+1 with 37 weeks pregnancy presented at Apollo hospitals, Ahmedabad in emergency department with complaints of severe dry cough and breathlessness for 24 hours. On through workup, she was diagnosed as mitral valve thrombosis in a known case of rheumatic heart disease post mitral valve replacement at 37 weeks pregnancy with late onset fetal growth restriction. After multi-speciality consultation she underwent thrombolytic therapy followed by high-risk emergency caesarean section. She delivered healthy male child, weight 2.21 kg and was discharged on 4th post-op day. Management of pregnant patients with mechanical valves is complex, especially when valve thrombosis and other complications occur. Multidisciplinary approach is essential and, in this case, led to successful maternal and foetal outcome.
      PubDate: 2021-07-26
      DOI: 10.18203/2320-1770.ijrcog20212994
      Issue No: Vol. 10, No. 8 (2021)
       
  • Changing trends in the management of corpus luteum haemorrhage

    • Authors: Avantika Gupta, Deepthi Nayak, Purnima Tiwari
      Pages: 3261 - 3265
      Abstract: Corpus luteal haemorrhage usually causes only mild symptoms and resolve spontaneously, however, it can cause massive bleeding in certain patients with coagulation or bleeding disorders. Over a decade, the management of corpus luteum haemorrhage has shifted from surgical to conservative management. This article focuses on selection of patients for conservative management so that the morbidities associated with the surgery can be avoided. Conservative management includes optimization of oxygen carrying capacity of blood, correction of coagulopathy and appropriate analgesia. It can be recurrent in certain high-risk group of patients who will need long term suppression of ovulation.
      PubDate: 2021-07-26
      DOI: 10.18203/2320-1770.ijrcog20212995
      Issue No: Vol. 10, No. 8 (2021)
       
  • Newer modalities for treatment of severe COVID-19 infection and their use
           in pregnancy-boon or bane'

    • Authors: Shivani Anand, Avir Sarkar
      Pages: 3266 - 3267
      Abstract: We are into the second year of the COVID-19 pandemic which is caused by an RNA virus, belonging to the severe acute respiratory syndrome (SARS) family. Though the mainstay of COVID management continues to be mainly symptomatic, many new management options are coming up. Due to ethical reasons, pregnant and lactating women are never included in the clinical trials used to test drug safety and efficacy, but COVID-19 is here to stay and we should begin to analyse the effects of the various proposed drugs in its management in pregnant population.
      PubDate: 2021-07-26
      DOI: 10.18203/2320-1770.ijrcog20212996
      Issue No: Vol. 10, No. 8 (2021)
       
 
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