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

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Intl. J. of Advances in Medicine     Open Access   (Followers: 5)
Intl. J. of Basic & Clinical Pharmacology     Open Access   (Followers: 4)
Intl. J. of Clinical Trials     Open Access   (Followers: 5)
Intl. J. of Community Medicine and Public Health     Open Access   (Followers: 8)
Intl. J. of Contemporary Pediatrics     Open Access   (Followers: 11)
Intl. J. of Otorhinolaryngology and Head and Neck Surgery     Open Access   (Followers: 1)
Intl. J. of Reproduction, Contraception, Obstetrics and Gynecology     Open Access   (Followers: 17)
Intl. J. of Research in Dermatology     Open Access   (Followers: 1)
Intl. J. of Research in Medical Sciences     Open Access   (Followers: 7)
Intl. J. of Research in Orthopaedics     Open Access   (Followers: 1)
Intl. J. of Scientific Reports     Open Access   (Followers: 4)
Intl. Surgery J.     Open Access   (Followers: 5)
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International Journal of Reproduction, Contraception, Obstetrics and Gynecology
Number of Followers: 17  

  This is an Open Access Journal Open Access journal
ISSN (Print) 2320-1770 - ISSN (Online) 2320-1789
Published by Medip Academy Homepage  [12 journals]
  • Vaginal birth after previous caesarean section in women at Al-Wahda
           hospital Derna, Libya

    • Authors: Soad Ajroud, Raga A. Elzahaf, Fawzia A. G. Arhaiam
      Pages: 4337 - 4342
      Abstract: Background: Vaginal birth after caesarean section is one strategy that has been developed to decrease the rate of caesarean section.Methods: The prospective observational study was carried out over a period of 01 January 2017 to 31 December 2018 years. VBAC was routinely offered at Al-Wahda hospital Derna to women fulfilling the criteria for trial of scar, according to the hospital protocol.Results: A total of 5018 deliveries took place in the study duration, there were 1039 (20.7%) had previous one caesarean section, out of which 319 (30.7%) were the number of underwent repeat caesarean section and 720 (69.3%) were the number of VBAC. The indications for emergency repeat caesarean section at Al-Wahda hospital was (29.3%) malpresentation, (24.45%) FD, (13.47) postdate, (11.59) obstracted lab and abruptiopl (5.95%). Anemia and difficult intubation were observed in repeated caesarean section.Conclusions: This study concluded that there is a high chance of success in a trial of labor. These findings might help clinicians and women in the decision-making for the mode of delivery when it comes to pregnancy with a previous caesarean section. Women are explained about the option of trial of scar and told about the risk associated with a repeat CS, so many CSs can be avoided.  
      PubDate: 2021-11-25
      DOI: 10.18203/2320-1770.ijrcog20214625
      Issue No: Vol. 10, No. 12 (2021)
       
  • Risk assessment and thromboprophylaxis for venous thromboembolism in the
           puerperium in a tertiary health facility in Nigeria

    • Authors: Mkpe Abbey, Kinikanwo I. Green, Roseline Iheagwam, Chris Akani
      Pages: 4343 - 4351
      Abstract: Background: Venous thromboembolism (VTE) is a leading cause of maternal morbidity and mortality in the puerperium. Unfortunately in Nigerian tertiary institutions, there is paucity of information about its risk factors, screening for it, and its prophylaxis. The aim of the study therefore was to review the VTE risk and thromboprophylaxis in the puerperium at the University of Port Harcourt Teaching Hospital (UPTH), Nigeria.Methods: A retrospective cross-sectional study carried out at the University of Port Harcourt Teaching Hospital (UPTH). The following data were extracted from the notes of 424 consecutive inpatients postnatal women who delivered from the 1st of January to the 30th of April 2020: history/demographic characteristics, risk factors for VTE using the RCOG Green top guideline No. 37a.of 2015 as a benchmark, thromboprophylaxis, diagnosis and treatment of VTE. Women with a VTE event in the preceding 4 months before pregnancy were excluded. Data was analysed using a statistical package for social science (SPSS) software, version 18.Results: Risk assessment for VTE and its prophylaxis in the puerperium were not routine practice at the UPTH. 420 (99.06%) out of the total 424 postpartum women that were assessed were at significant risk of developing VTE and therefore needed to be on thromboprophylaxis with low molecular weight heparin. Irrespective of the high prevalence of risk factors and the fact that 100 (23.58%) of the patients had symptoms and signs of VTE, no case of VTE was recorded in the study population. Paucity of information and lack of knowledge about the diseases may be responsible for that.Conclusions: 420 (99.06%) out of the total 424 puerperal women were at significant risk of developing VTE and therefore needed to be on thromboprophylaxis in the puerperium. It was therefore recommended that a national guideline on VTE in the puerperium be written, taking into consideration local disease topography, ethnic diversity and the level of economic development in Nigeria.
      PubDate: 2021-11-25
      DOI: 10.18203/2320-1770.ijrcog20214626
      Issue No: Vol. 10, No. 12 (2021)
       
  • Study of prevalence of endometrial cancer in patients with adenomyosis
           uteri

    • Authors: Ahmad Abdel Azim Essmat
      Pages: 4352 - 4356
      Abstract: Background: The aim of the study was to evaluate the prevalence of adenomyosis in endometrial cancer patients and to determine the frequency of adenomyosis and endometrial cancer at hysterectomy specimens.Methods: This study was carried out retrospectively on pathologic specimens of hysterectomies. A total of 98 women in the period May 2020 to January 2021enrolled to the study. All pathologies seen in hysterectomy specimens were noted. The frequency of adenomyosis and the accompanying pathologies were determined. These women were categorized into two groups according to the cause of hysterectomy. The incidence of adenomyosis was analyzed together with the endometrial cancer.Results: The incidence of adenomyosis was 22% at hysterectomy specimens. There was no statistically significant difference between the mean age of the two groups (p=0.002*). There were 22 cases with adenomyosis and the only pathologic finding was adenomyosis, in 22.7% of cases. The most common accompanying pathologies with adenomyosis were uterine myomas in 95% and on significant association was found in cases of endometrial carcinoma.Conclusions: There is no evidence that adenomyosis increases the risk of endometrial cancer as there is no statistically significant difference found between the group with and the group without adenomyosis in terms of coexistence with endometrial carcinoma. 
      PubDate: 2021-11-25
      DOI: 10.18203/2320-1770.ijrcog20214627
      Issue No: Vol. 10, No. 12 (2021)
       
  • Does female genital mutilation/cutting have any effect on normal
           birth'

    • Authors: Esra Tamburaci, Özer Birge
      Pages: 4357 - 4360
      Abstract: Background: World Health Organization’s (WHO) defines female genital mutilation (FGM) as all procedures involving the total or partial removal of female external genitalia without any medical reasons. It is estimated that about 100 million women worldwide are circumcised. After circumcision compications such as bleeding, infection, shock, menstrual irregularity, dysuria, frequent urinary tract infections, pelvic pain and difficulty in sexual intercourse occur with varying frequencies.Methods: In this article, we aimed to discuss normal vaginal delivery results of 45 term pregnant cases with 3 types of  female genital multilation/circumcision. We know that the vaginal entrance is closed as a result of adhesions in the genital area due to circumcision and secondary complications may develop.Results: The mean age of 45 patients included in the study was 26.2±8.78 years. Considering the postpartum complications, bilateral labial tissue ruptures in 15 cases, followed by vaginal hematoma in 9 cases, anal sphincter damage in 11 cases, deep episiotomy tears in 8 cases, periurethral tears in 8 cases, deep cervical tears in 8 cases, vulvar epidermoid cyst ruptures in 4 cases and 4 cases. perineal body ruptures were seen in 4 cases, vulvar hematoma in 4 cases, and vaginal mucosal damage in 9 cases.Conclusions: It has been shown once again that FGM/C is a method that completely changes the female vaginal anatomy and has very serious delivery complications. It is obvious that serious educations and studies need to be done in the countries where this method is applied.
      PubDate: 2021-11-25
      DOI: 10.18203/2320-1770.ijrcog20214628
      Issue No: Vol. 10, No. 12 (2021)
       
  • Influencing factors of unmet needs for child spacing among selected
           countries experiencing high maternal-mortality in sub-Saharan Africa

    • Authors: Abayomi T. Olarinmoye, Olanrewaju D. Eniade, Olariike O. Kayode, Abimbola A. Abiola, Modupe O. Onifade, Sarafa O. Odewale, Bode Kayode
      Pages: 4361 - 4371
      Abstract: Background: Maternal complication and death has been implicated in unintended pregnancy. The indicator for measuring the risk of unintended pregnancy is unmet need for family planning (FP). It is necessary to explore the current situation of unmet need for child spacing (UNCS) as well as its influencing factors among countries that are experiencing high maternal mortality ratio. We aimed to unveil the prevalence of UNCS and its associated factors in Nigeria, Liberia and Sierra Leone.Methods: We analysed the data from DHS phase VII survey, a cross- sectional study conducted from year 2017 to 2018 across several countries. Total records of 25,539, 5,553, and 10,050 were extracted for Nigeria, Liberia and Sierra Leone respectively. Explored variables were UNCS, demographic characteristics and husband’s partners profile. Data was analysed using SPSS version 25. Descriptive statistics, test of association (chi-square) and binary logistic regression were used during the data analysis (α0.05).Results: UNCS was high in Nigeria (15.9%), Liberia (22.5%) and Sierra Leone (21.9%). In Nigeria, Liberia and Sierra Leone, 40%, 37% and 49.1% were uneducated respectively. The proportion of married women were 89% in Nigeria, 32% in Liberia and 70.2% in Sierra Leone. Also, female headship of household (OR: 1.29, 95%CI: 1.09-1.54) was associated with UNCS relative to male headship of household.Conclusions: UNCS was high in the three countries. Factors like educational status of women, age, as well as women as head of the households should be given much attention in the efforts to reduce UNCS as identified in this study.
      PubDate: 2021-11-25
      DOI: 10.18203/2320-1770.ijrcog20214629
      Issue No: Vol. 10, No. 12 (2021)
       
  • Emergency caesarean section and its sequelae in a tertiary hospital in
           Niger Delta, Nigeria

    • Authors: Rose Sitonma Iwo-Amah, Felix Chikaike Clement Wekere, Simeon Chijioke Amadi, Joseph Ngozi Kwosah
      Pages: 4372 - 4376
      Abstract: Background: Caesarean section (CS) is one of the most common surgical procedure in obstetrics. It involves a surgical incision made through the abdominal and uterine walls to deliver the foetus and placenta after the period of foetal viability.Methods: This was a cross-sectional study aimed at reviewing emergency caesarean section in Rivers State University Teaching Hospital (RSUTH) over a 5-year period, to determine the prevalence and sequelae. Data were analysed using IBM Statistical Product and Service Solution (SPSS) version 25.0 (Armonk, NY).Results: During the review period, there were 13516 deliveries and 3699 cases of emergency CS, giving the prevalence of emergency CS as 27.4% or 274 per 1000 deliveries. Majority (90%) of the parturient were unbooked. The most common complication in women that had emergency caesarean section was fever (56.4%), followed by endometritis (14.7%), absconding from hospital (8.8%), urinary tract infection (7.1%) and wound infection (6.1%). There was a statistically significant association between types of CS and their sequelae, χ2=1153.9, p<0.001, (95% CI: 0.000, 0.000). Women that had emergency CS were 101 times more likely to have a complication compared to those that had planned CS.Conclusions: The rate of emergency caesarean section is high in RSUTH and with more complications compared to planned caesarean section. Booking for antenatal care, early presentation for delivery, birth preparedness and complication readiness will enhance improved maternal and perinatal outcome. 
      PubDate: 2021-11-25
      DOI: 10.18203/2320-1770.ijrcog20214630
      Issue No: Vol. 10, No. 12 (2021)
       
  • Analysis of the relationship between premature rupture of membranes with
           delivery method and newborn asphyxia

    • Authors: Azizah Nurdin, Haizah Nurdin, Rahmayanti ., Mutmainnah Sari
      Pages: 4377 - 4382
      Abstract: Background: As many as 20% of maternal deaths are caused by premature rupture of membranes (PROM). The high rate of PROM is believed to affect newborn asphyxia. In addition, the high rate of cesarean section is one of the reasons or most frequent indications of PROM. Therefore, researchers were interested in knowing how the relationship between PROM and delivery method and newborn asphyxia was.Methods: This study was an analytical study conducted with a cross-sectional approach by taking secondary data from patients through medical records of pregnant women who experienced PROM in January 2020 to July 2021.Results: This study found that the incidence of PROM was more dominant in multiparous women 55.4%, in term pregnancy 79.2%, duration of PROM ≥12 hours 55.4%, have normal leukocyte levels 76.2%, the incidence of asphyxia (mild asphyxia) 90.1% and the rate of cesarean section as much as 24%. The bivariate analysis found a significant relationship between the length of PROM and the method of delivery (p value 0.049) and the duration of PROM with newborn asphyxia (p value 0.040) and there was no significant relationship between maternal leukocyte count and newborn asphyxia (p value 0.444).Conclusions: The longer the duration of PROM with delivery, the greater the chance of infection for the mother and fetus. The length or duration of PROM will have an impact on the method of delivery and increase the likelihood of asphyxia in newborns. 
      PubDate: 2021-11-25
      DOI: 10.18203/2320-1770.ijrcog20214631
      Issue No: Vol. 10, No. 12 (2021)
       
  • Study of mode of delivery and maternal morbidity in preterm and term
           COVID-19 positive pregnant women

    • Authors: Saksha Dholakiya, Pooja S. Singh, Jaishree Bamniya, Haresh U. Doshi
      Pages: 4383 - 4387
      Abstract: Background: Pregnant women are likely to represent a high-risk population during current coronavirus 2019 pandemic caused by severe acute respiratory syndrome coronavirus-2. The aim and objective of this study was to evaluate how COVID-19 pandemic has affected the mode of delivery and whether complications of the disease and mortality rate are higher in pregnant women than in non‐pregnant women.Methods: This ambispective observational study was conducted in department of obstetrics and gynaecology of our institute. Pregnant women diagnosed with positive for COVID-19 via the SARS-CoV-2 RT-PCR test in the third trimester and all neonates with complete COVID-19 testing and delivery data. This data was analysed.Results: Out of total 66 cases studied, 48 patients (72.7%) were asymptomatic, while 13 (19.7%) had mild respiratory or gastro intestinal symptoms on initial assessment at admission, including cough, sore throat, fever, weakness or diarrhoea. Cesarean sections were performed in 57.6% of cases. There were no cases of maternal or neonatal mortality.Conclusions: The study revealed that COVID-19 positive pregnant women are usually asymptomatic or mild-moderately symptomatic, similar to COVID-19 positive non-pregnant women. There was a noted rise in the rate of caesarean sections as a mode of delivery. 
      PubDate: 2021-11-25
      DOI: 10.18203/2320-1770.ijrcog20214632
      Issue No: Vol. 10, No. 12 (2021)
       
  • Role of safe space in improving menstrual awareness and menstrual hygiene
           practices among adolescents in Zamfara: a case study of REACH project
           intervention

    • Authors: Yakubu Lawali, Murtala Bello, Rahinatu Adamu Hussaini, Chanan Solomon Jongshwan
      Pages: 4388 - 4391
      Abstract: Background: Menstrual awareness and hygiene practices have been a challenge for adolescent girls in African countries and Nigeria inclusive which subsequently affects their health, and wellbeing. The aim of the study was to evaluate the effects of REACH project intervention in improving knowledge and practice of menstrual care among adolescent girls.Methods: A post-test only non-equivalent groups quasi-experimental design was adopted with Kaura Namoda and Talata Mafara as the intervention Local Government Authorities (LGAs) and Bungudu and Maru as the control LGAs conducted between August 2021 to October 2021. Quantitative approach was employed using self-developed questionnaire for data collection. Multi-stage sampling technique was used. A total of 400 questionnaires were administered with 200 each for control and intervention LGAs.Results: The result of the study shows that, adolescents in the REACH Project intervention communities have higher level of awareness and more likely to practice menstrual hygiene as compared to non-REACH intervention communities. Therefore, it is recommended that, safe space strategies should be adopted in any matters related to adolescents sexual and reproductive health.Conclusions: Safe space is effective in improving adolescents sexual and reproductive health.
      PubDate: 2021-11-25
      DOI: 10.18203/2320-1770.ijrcog20214633
      Issue No: Vol. 10, No. 12 (2021)
       
  • Impact of COVID-19 pandemic on postpartum contraception services in women
           delivering at a tertiary care centre in South India

    • Authors: Parvathi T. Naik, Sujithra D. Radhakrishnan, Rupesh B. Murugan, Haritha Sagili, Subitha Lakshminarayanan, Priyadarshini Muruganandhan, Aishwarya T. Puliyullaveettil, Sathish Rajaa
      Pages: 4392 - 4396
      Abstract: Background: Contraception and sexual health are a fundamental human right and an integral part of women’s health services. Postpartum period is the unique opportunity for counselling and availing contraception. COVID-19 pandemic hindered routine and special services like postpartum clinics has negative impact on family planning services. Objectives were to assess the effect of the COVID-19 pandemic on postpartum contraceptive care services received and to describe the challenges faced in availing these services among pregnant women delivering at a tertiary care centre in South India.Methods: A descriptive study carried out in 422 women who had delivered at our hospital from July 2020 to October 2020. Data was collected in Epicollect version 5 and analysed using Stata version 14.2.Results: A total of 422 women were interviewed. Only one-third of the participants received contraceptive counselling in the antenatal period compared to 90% postpartum. 39% (primiparous-34%/multiparous-5%) had adopted barrier methods followed by post-partum intrauterine uterine contraceptive devices in 33% (primiparous-19.6%/multiparous-13.4%) and 5% had sterilisation concurrent with caesarean section. Around 30-40% of women faced challenges in accessing the family planning methods due to closure of elective services like postpartum clinics, operation theatres, nationwide lockdown, and non-availability of field health workers.Conclusions: Contraceptive choices for postpartum women appear to be largely restricted to temporary methods with additional challenges of availing these services during the pandemic. With the ongoing COVID-19 crisis and continuous need for contraception, there is a need to refocus and motivate eligible couples for long-acting reversible contraceptive methods (LARC) with significantly lower failure rates.
      PubDate: 2021-11-25
      DOI: 10.18203/2320-1770.ijrcog20214444
      Issue No: Vol. 10, No. 12 (2021)
       
  • Post cesarean pregnancy and its outcome

    • Authors: B. Jeyamani, B. Sowmiya
      Pages: 4397 - 4401
      Abstract: Background: Though in recent years lower segment cesarian section (LSCS) procedure is the major reason for the reduction in the mortality rate for both mother and baby, inappropriate indications may affect the outcome of pregnancy. Thus, this study was done with the aim of assessing the prevalence of outcome of delivery among women who underwent caesarean section (CS) and to assess the factors associated with that outcome.Methods: This study was conducted with a sample of 98 pregnant mothers. After acquiring informed consent, those mothers who were indicated for CS (both elective and emergency) were enquired about the questionnaire containing two parts. Part one is about the history regarding previous birth and the next part is about age, parity, and outcome of current pregnancy (both mother and baby).Results: The mean age of the study participants is 27 years. Among the study participants, about half of them (51%) were in gravida one and 37 percent have one abortion. About four-fifths of the study participants (81%) were undergone elective LSCS. About one-fourth of the baby needs neonatal intensive care unit (NICU) admission and two percent have the complication of neonatal sepsis. The factors significantly associated with NICU admission of babies delivered after LSCS are more number of the previous history of abortions (p=0.004) and emergency LSCS (p=0.001) by using the chi-square test.Conclusions:  The indication of previous LSCS for LSCS among pregnant mothers is in a rising trend that needs holistic commitment to reduce the prevalence of LSCS. 
      PubDate: 2021-11-25
      DOI: 10.18203/2320-1770.ijrcog20214445
      Issue No: Vol. 10, No. 12 (2021)
       
  • Efficacy and safety of ferric carboxymaltose in Indian pregnant women with
           iron deficiency anemia

    • Authors: Vidya Bhat, Brunda Kiran, Girish Deshmukh, Ketan Kulkarni, Ajinkya Rodge
      Pages: 4402 - 4406
      Abstract: Background: Iron deficiency anemia (IDA) is a significant problem worldwide particularly in women. The aim of the study was to evaluate the effectiveness of intravenous ferric carboxymaltose (FCM) in in Indian pregnant women with anemia.Method: This was a single centre, prospective, observational, open label, clinical study at real life scenario with 4 weeks follow up. Fifty pregnant women with IDA and visiting to the Radhakrishna multispecialty hospital, Bangalore, for antenatal care were enrolled for the study. IV FCM was given as per the standard protocol. Change in the laboratory parameters such as hemoglobin, mean corpuscular volume (MCV), mean corpuscular hemoglobin concentration (MCHC), packed cell volume (PCV) level at baseline and after 4 weeks of completion of parenteral iron therapy was recorded and fatigue score was assessed. The pregnant women were monitored for the adverse events. Results: All pregnant women received a single IV infusion of FCM 1000 mg. A significant increase in the hemoglobin of 2.37±0.51 g/dl (p<0.001) was noted at 4 weeks, MCV rise of 19.89±21.94 (p<0.001) was noted at 4 weeks, MCHC rise was of 2.56±5.65 and PCV rise was of 4.45±2.67 (p<0.011) at over 4 weeks. Significant improvement in fatigue score was observed at 4 weeks after single FCM infusion. No adverse effects were observed in any pregnant woman throughout the duration of the study.Conclusions: This real-life observational study highlights IV FCM is effective in management of IDA in pregnant women and well tolerated. Trial registration number: CTRI/2021/02/030874 
      PubDate: 2021-11-25
      DOI: 10.18203/2320-1770.ijrcog20214471
      Issue No: Vol. 10, No. 12 (2021)
       
  • Fetomaternal outcome in multiple pregnancy

    • Authors: Senthilpriya Sundaram, Keerthana Govindaraj
      Pages: 4407 - 4411
      Abstract: Background: Multiple pregnancies are more common in recent days than in the past. Increased maternal age at conception due to delayed childbearing trend has resulted in multifetal gestations. Twin gestation imposes greater demand on the maternal physiological system than does singleton pregnancy. The incidence of multifetal gestation has increased mainly because of advanced maternal age and assisted reproductive technology. Multiple pregnancy is considered as high-risk pregnancy as it contributes significantly to adverse maternal and perinatal outcomes.Methods: In this prospective observational study conducted in obstetrics and gynaecology department VMKVMCH, Salem for 6 months period, around 50 cases of multiple pregnancy were taken into consideration and patients were followed up from admission till delivery and neonatal outcome analysed. Main outcome measures were maternal complications (anaemia, pre-eclampsia, post-partum hemorrhage, gestational diabetes mellitus (GDM), perinatal mortality and morbidity.Results: Higher incidence of twin gestation was noted between the age group of 20-25 years and maximum were of spontaneous conception. None of them had family history of twins or past history of the same. We noted that maximum were preterm deliveries and majority of the patients underwent lower segment caesarean section (LSCS). Twin specific complications were noted according to their chorionicity. Most of the babies weighed between 1.5-2.5 kg. Perinatal mortality was 7.5% and no maternal mortality noted.Conclusions: The knowledge of maternal and fetal risks associated with multiple gestation helps in prevention of adverse outcome and better surveillance.
      PubDate: 2021-11-25
      DOI: 10.18203/2320-1770.ijrcog20214446
      Issue No: Vol. 10, No. 12 (2021)
       
  • A prospective study of clinical and diagnostic methods of ovarian tumors
           admitted in a tertiary care hospital and its correlation with
           histopathology

    • Authors: Silika Madria, Vineeta Ghanghoriya, Kavita N. Singh, Manisha Lokwani, Ranu Tiwari
      Pages: 4412 - 4417
      Abstract: Background: Aim of the study was to study demographic profile and diagnostic modalities of ovarian tumors and their correlation with histopathological report (HPR).Methods: Prospective observational study conducted in NSCB medical college, Jabalpur from February 2019 to July 2020 on subjects with ultrasonographically diagnosed ovarian tumors. Relevant history obtained, gynecologic examination, investigations recorded. Subjects followed up to collection of HPR and correlation with histopathology done.Results: Out of 120 cases of ovarian tumors, 39.16% were malignant and 60.83% were benign ovarian tumors. Out of 80 premenopausal females, majority (78.75%) had benign ovarian masses. Amongst 40 postmenopausal females, 75% of ovarian masses were malignant. CA125 had sensitivity 76.59%, specificity 76.71% and accuracy 76.66% in diagnosing ovarian malignancy. Amongst 4 RMI scores, RMI 1 has the highest sensitivity and specificity 85.10%, 86.30% respectively. Sensitivity, specificity, and accuracy of ultrasound score was 65.21%, 86.30% and 77.5% respectively. Sensitivity and specificity of clinical diagnosis was 83% and 95.89% respectively and ROC analysis showed clinical diagnosis can accurately predict benign and malignant ovarian tumors in 89% cases.Conclusions: RMI 1 score has the highest sensitivity and specificity in our study. When all 4 methods of diagnosis i.e., RMI Score, ultrasound score, CA125 and clinical diagnosis were compared, clinical diagnosis has highest prediction of malignancy.
      PubDate: 2021-11-25
      DOI: 10.18203/2320-1770.ijrcog20214460
      Issue No: Vol. 10, No. 12 (2021)
       
  • Study of mode of delivery and fetal outcome in pregnancies with
           oligohydramnios

    • Authors: Lavanya B., A. Prajwala
      Pages: 4418 - 4423
      Abstract: Background: The significance of amniotic fluid volume as a marker of fetal status is an ongoing turn of events. Oligohydramnios causes adverse fetal outcomes like meconium-stained liquor, meconium aspiration syndrome, fetal heart rate abnormalities, poor APGAR scores, fetal growth restriction and fetal prematurity. It is associated with maternal hypertension, infections, and placental insufficiency. It causes maternal complication because of increased incidence of induction of labour and operative intervention.Methods: Hundred cases of oligohydramnios were included in our study conducted at the Navodaya medical research, hospital and research centre, during a period of two years after obtaining the informed consent of patients and institutional ethical clearance. All gravidas were included with a gestational age greater than 28 weeks with singleton pregnancies with oligohydramnios. Associated fetal and maternal risk factors were observed. The amniotic fluid index (AFI) was measured by ultrasound. The nonstress test, the fetal biophysical profile and the Doppler study were carried out to evaluate the fetal condition. Then we have observed for delivery and fetal outcome.Results: Incidence of oligohydramnios was 2.85% in our study. The 53% of cases had LSCS while 47% had normal delivery. Fetal distress was the commonest indication for LSCS. Poor neonatal APGAR score was 16.9% in LSCS while 36% in vaginal delivery.Conclusions: From the above study, the caesarean delivery seems to be a safer mode of delivery than vaginal delivery because it is associated with a good perinatal outcome.
      PubDate: 2021-11-25
      DOI: 10.18203/2320-1770.ijrcog20214634
      Issue No: Vol. 10, No. 12 (2021)
       
  • A study to identify clinical and laboratory parameters in cases of
           excessive vomiting in early pregnancy

    • Authors: Dyuti Dubey, Usha Agrawal, Rekha Sapkal
      Pages: 4424 - 4428
      Abstract: Background: Around half of all pregnant women experience vomiting, and more than 80% of women experience nausea in the first 12 weeks. Women with severe nausea and vomiting during pregnancy may have hyperemesis gravidarum (HG), an entity distinct from nausea and vomiting of pregnancy (NVP), which if left untreated may lead to significant maternal and foetal morbidity. In our study, we studied, clinical and laboratory parameters in patients presenting with excessive vomiting. The study may help in evaluating what is the major clinical problem encountered during treatment and how many days of care are needed in such cases.Methods: The study design was a prospective observational study. Patients attending the ANC clinic and emergency indoor cases at Peoples college of medical sciences, Bhopal were considered as study population. 100 patients who satisfied inclusion and exclusion criteria were included in the study. Patient’s sociodemographic variables, detailed obstetric history, clinical and laboratory parameters were recorded. Results obtained were analysed and tabulated.Results: Persistence of vomiting in the first trimester leading to dehydration and hospitalization was documented in 12% of patients. The 5% of then had metabolic acidosis and 1% required correction of starvation ketoacidosis, but there was not significant weight loss observed in any of the case. Liver function test were normal in almost in all cases except 9% had raised serum alkaline phosphatase levels.Conclusions: All cases with vomiting in early pregnancy should receive attention and exclusion of all emergency clinical conditions. Patient should be screened for urine tract infection and diabetes in all cases. 
      PubDate: 2021-11-25
      DOI: 10.18203/2320-1770.ijrcog20214635
      Issue No: Vol. 10, No. 12 (2021)
       
  • Menstrual pattern amongst adolescent girls: a cross sectional study from
           Raichur, Karnataka

    • Authors: Pavani M., Monisha Deepika R., Lavanya B., Anant A. Takalkar
      Pages: 4429 - 4433
      Abstract: Background: Menstrual disorders in adolescent age are quite different than in adult women, both for diagnostic and therapeutic management. We need to take into account the problems in normal initiation of menarche, hematological problems, general endocrine problems, and fragile emotional status at this tender age. The objective of the study was to study the patterns of menstrual disorders in adolescent girls.Methods: Cross sectional observational study was carried out in 200 adolescent girls, aged 12 to 19 years, among the students of S.R.P.S PU college and the district government Girls’ school in Raichur during the period of January 2017 to December 2017. A pre-structured questionnaire was used and data was analysed using Statistical package for social sciences (SPSS) 23.0 version.Results: Majority of the girls in our study were from 17-18 years age group (55%). The mean age of menarche was 13.2±0.9 years. Cycle length of <21 days was found in 4 (2%) of cases, 143 (71.5%) had 21-35 days cycle and 10 (5%) had >35 days cycle length. Majority had normal cycle length. Dysmenorrhea was found in 84 (42%) students. Premenstrual symptoms like tiredness were noted in 14 (7%) of cases, pain in the legs in 10 (5%), irritability in 8 (4%), lack of interest in work and play in 7 (3.5%), low back pain in 6 (3%), low/depressed mood in 6 (3%), anger in 4 (2%), anxiety in 4 (2%), difficulty in concentrating in 2 (1%), nausea\vomiting were noted in 2 (1%).Conclusions: Prevalence of dysmenorrhea was 42%. Premenstrual symptoms like tiredness were noted in majority of the girls 7%, pain in the legs in 5%, irritability in 4%.
      PubDate: 2021-11-25
      DOI: 10.18203/2320-1770.ijrcog20214636
      Issue No: Vol. 10, No. 12 (2021)
       
  • Is there any role of antibiotic as a post procedure prophylaxis in
           dilatation and curettage' A comparative single centre study at
           tertiary care centre

    • Authors: Kamalpriya Thiyagarajan, Vaishali Chaudhary, Yogini Patil, Vijaykumar Gawali
      Pages: 4434 - 4437
      Abstract: Background: Dilatation and curettage (D and C) is one of commonest procedure in the gynaecology. There are still two schools of thoughts pertaining to whether to administer antibiotic as a pre and post procedure prophylaxis or not to administer and hence study planned to evaluate the incidence of infection in patients after dilation and curettage with and without prophylactic antibiotics.Methods: Adults (>18 years) (n=100) who underwent dilatation and curettage procedure for any indication were included and patients with prior history of infection were excluded from the study. Patients were divided into 2 groups; group 1 (n=50) received prophylactic antibiotics and group 2 (n=50) received no prophylactic antibiotics as per the discretion of treating doctor.Results: Infection in both the groups was 2% and there is no statistically significant difference between the groups (p>0.349).Conclusions: Appropriate use of antibiotics can be a cost-effective strategy which can minimize the chances of development of antibiotic resistance and other side effects. Antibiotic are not necessary for pre and post procedure prophylaxis in D and C.
      PubDate: 2021-11-25
      DOI: 10.18203/2320-1770.ijrcog20214637
      Issue No: Vol. 10, No. 12 (2021)
       
  • Effect of melatonin addition in ovulation induction protocols with
           clomiphene citrate in management of infertility

    • Authors: Anjali Chaudhary, Aditi Agarwal, Meenakshi Tanwar, Parul Singh, Priyanka Negi
      Pages: 4438 - 4442
      Abstract: Background: About 10-12% of couples are unable to conceive by natural means despite concerted efforts and these figures have risen in past few decades. In recent years, effect of oxidative stress on the fertility has been widely recognised. Oxidative stress has been known to affect both male and female fertility reducing sperm count and motility in men, and affecting ovum reserve and quality in women. Melatonin is the secretion of the pineal gland responsible for circadian sleep rhythm has also shown to be good antioxidant. Aim and objective of current study was to study effect of melatonin addition to clomiphene citrate for induction of ovulation with a view to improve conception rates.Methods: This was a retrospective analysis of 52 women with infertility who were given clomiphene citrate with melatonin. Ovulation, conception rates and pregnancy outcomes were noted.Results: We observed 77.8%ovulation rates, and a significantly better conception and live birth rates.Conclusions: Melatonin, as an anti-oxidant may improve, conception and live birth rates when added to clomiphene citrate induction protocols.
      PubDate: 2021-11-25
      DOI: 10.18203/2320-1770.ijrcog20214638
      Issue No: Vol. 10, No. 12 (2021)
       
  • Cord blood levels of uric acid, lipid profile and HOMA-IR in pregnancy
           induced hypertension

    • Authors: Priyadharshini R., V. Vijayakumari
      Pages: 4443 - 4447
      Abstract: Background: Cardiovascular diseases (CVD) is a major global health burden that results in the greatest number of deaths worldwide. Epigenetic changes induced by pregnancy related complication in umbilical cord blood may appear as a result of dysfunctional placenta and impaired maternal cardiovascular function and may cause later onset of cardiovascular diseases in offspring.Methods: A prospective case control study was conducted at ESIC medical college, Bangalore in 100 PIH women with gestational age 37 to 40 weeks. The study aimed to find the correlation of cord blood uric acid, lipid profile and HOMA -IR in gestational hypertension mothers.Results: We found a strong positive correlation between uric acid and total cholesterol in cases and a moderate positive correlation among uric acid and LDL in cases whereas a strong negative correlation among uric acid and HDL. In addition, mean HOMA-IR value was statistically significant in cases.Conclusions: HOMA -IR values are found to be more in newborns of PIH mothers and cord blood uric acid is a good predictor of lipid metabolism and the glucose homeostasis in neonates.
      PubDate: 2021-11-25
      DOI: 10.18203/2320-1770.ijrcog20214639
      Issue No: Vol. 10, No. 12 (2021)
       
  • A prospective observational study on maternal near miss cases in a rural
           teaching hospital

    • Authors: Mamta Mahajan, Anjali Soni, C. D. Sharma, Shelley Moudgil
      Pages: 4448 - 4453
      Abstract: Background: Women who have survived complications during pregnancy and child birth have been studied and termed Maternal near miss (MNM). All near misses should be interpreted as free lesson and opportunities to improve the quality of service provision. The aim of the study was to know the incidence, risk factors and underline causes of MNM in our setup as there is limited data from Himachal Pradesh.Methods: The present study was a prospective observational study that was carried out in the department of Obstetrics and Gynecology, Dr. Rajendra Prasad Government Medical College Kangra at Tanda (HP), from 1st January 2018 to 31st December 2018. The patients in this study were, pregnant women who nearly died but survived a complication that occurred during pregnancy, child birth or within 42 days of termination of pregnancy as per WHO MNM criteria 2009.Results: A total of 9690 live births, 5 maternal deaths and 116 MNM cases were reported during the study period.  Incidence of MNM observed was 12%. Hypertensive disorders of pregnancy 39.6% cases were most common cause for MNM followed by obstetric hemorrhage 31.03% cases. Majority of neonates i.e.; 58% were admitted to NICU and only 52.7% survived the postnatal complications.Conclusions: Critical analysis of MNM cases will help us in identifying the deficiencies in obstetric care. Maternal mortality and morbidity can be reduced if timely and effective care can be given to women experiencing acute pregnancy related complications. There is need for validation of ‘MNM’ criteria at peripheral levels which will enable them in early identification and timely referral of such cases to tertiary centers.
      PubDate: 2021-11-25
      DOI: 10.18203/2320-1770.ijrcog20214640
      Issue No: Vol. 10, No. 12 (2021)
       
  • Analysis of maternal mortality at tertiary care centre

    • Authors: Hemalatha S. V., Manickadevi M. S.
      Pages: 4454 - 4459
      Abstract: Background: The aim of the study was to analyse the causes of maternal mortality at a tertiary care centre and find measures to reduce it.Methods: A retrospective study of maternal deaths from January 2018 to December 2020 that occurred at Government Vellore Medical College and Hospital, a tertiary care hospital in Tamil Nadu. Data collected from case records and death reviews.Results: There was total of 71 deaths at the tertiary care hospital during the period January 2018 to December 2020 out of 31407 live births giving Maternal mortality rate of 226/1,00,000 live births. The MMR is high as it is a tertiary hospital catering referral from six districts. Most of the cases were due to late referrals. The majority of the deaths occurred in primigravida (50.7%), in the age group of 21 to 25 years (35.2%) and around term gestational age (49.3%). The most common cause of death in our study was hypertensive disorders of pregnancy (29.5%) followed by PPH (14.08%).Conclusions: From our study we concluded that the most common causes of maternal death were due to direct obstetric causes like severe pre-eclampsia, eclampsia and post-partum haemorrhage. Early identification of high-risk cases, early identification of GHT, anaemia and its correction, early referral of high-risk cases to tertiary centre can prevent most of the deaths. 
      PubDate: 2021-11-25
      DOI: 10.18203/2320-1770.ijrcog20214641
      Issue No: Vol. 10, No. 12 (2021)
       
  • Review of thyroid profile in patients with heavy menstrual bleeding in a
           tertiary care hospital

    • Authors: Pooja R., Tushar Palve, Sneha Mutyapwar, Payal Saha
      Pages: 4460 - 4463
      Abstract: Background: Heavy menstrual bleeding (HMB) is defined as excessive menstrual blood loss which interferes with a woman's physical, social, emotional and/or material quality of life. It can occur alone or in combination with other symptoms. Thyroid hormone affects menstrual pattern. The objective of this study was to evaluate thyroid function in women with menorrhagia (HMB).Methods: It is a type of journal article. Study design- retrospective study. The present study was conducted in the Department of obstetrics and Gynecology, cama and albess hospital, Mumbai, Maharashtra, India, from a period of January 2021 to July 2021, 51 women of reproductive age group between menarche-menopause with HMB. Quantitative determination of T3, T4 and TSH by CLIA estimated in autoanalyser.Results: About 51 women participated in the study in which most of the subjects belong to 45-49 years of age group. Maximum patients are multipara. Commonest cause of menorrhagia is fibroid. Most females with menorrhagia are euthyroid. Most of patients with HMB are O +ve. In most of the patients, anaemia due to HMB is treated by blood transfusion.Conclusions: Biochemical evaluation of thyroid function tests should be compulsory in all patients with menorrhagia to detect thyroid dysfunction. Most females with menorrhagia are euthyroid.
      PubDate: 2021-11-25
      DOI: 10.18203/2320-1770.ijrcog20214642
      Issue No: Vol. 10, No. 12 (2021)
       
  • Role of diagnostic hysteroscopy in evaluating patients with abnormal
           uterine bleeding in a tertiary care centre

    • Authors: Apeksha M. Mohite, Deepali S. Kapote, Michelle Fonseca
      Pages: 4464 - 4470
      Abstract: Background: Abnormal uterine bleeding is one of the commonest conditions amongst patients attending gynaecology OPD which also leads to significant disruption in a normal lifestyle. The causes of abnormal uterine bleeding are heterogeneous and complex. A systematic evaluation with detailed history and physical examination is foremost important in reaching diagnosis. Hysteroscopy is not only safe, quick and observes entire uterine cavity but also helps in precision in sampling and increases accuracy of diagnosis. It is also curative in conditions such as polyps, fibroids, uterine synechiae, menorrhagia and lost intrauterine contraceptive device. The aim of the study is to evaluate the role of hysteroscopy as a screening method in patients with AUB & compare to their USG findings and to the histopathological reports of the endometrial biopsy.Methods: This is a prospective observational study conducted at a tertiary healthcare centre over a period of 18 months, in 50 females belonging to pre, peri and post-menopausal age group. Sampling was done based on selection criteria after obtaining valid consent from the study group.Results: Hysteroscopy has a definitive role in evaluation of patients presenting with abnormal uterine bleeding with high sensitivity, specificity, PPV and NPV with immediate results.Conclusions: The above study concludes that the accuracy of diagnosing the cause of abnormal uterine bleeding is more with hysteroscopy followed by D and C then USG combined with D and C.
      PubDate: 2021-11-25
      DOI: 10.18203/2320-1770.ijrcog20214643
      Issue No: Vol. 10, No. 12 (2021)
       
  • A comparative review of maternal and neonatal outcome among pregnant women
           with COVID-19 in first and second wave in a tertiary care centre of South
           Rajasthan

    • Authors: Divya Chaudhary, Madhubala Chauhan, Diksha Gupta, Shivraj Jat
      Pages: 4471 - 4477
      Abstract: Background: Corona virus disease 2019 has taken a huge toll over health infrastructure and care all across the world. This article depicts our experience of COVID-19 in pregnant women and analyses maternal and neonatal outcome of same in first and second wave of this pandemic. Aim and objectives of the study were to compare the demographic characteristics, presenting features and fetomaternal outcome in COVID positive pregnant women in first v/s second wave in a tertiary care hospital.Methods: The RTPCR COVID-19 positive pregnant women admitted during the period April-2020 to March-2021 were considered in 1st wave of COVD-19 and that from April-2021 till June-2021 as 2nd wave of COVID-19. Data like baseline characteristics, past medical, obstetric history, clinical presentation, laboratory results, imaging findings, management modalities, maternal and neonatal outcome were analysed and compared.Results:  Peak of 1st wave of COVID-19 was found during the months of July-September 2020, while of 2nd in April-June 2021. Most women presented with COVID-19 RTPCR positive were asymptomatic both in 1st and 2nd wave. Though most patients were managed on room air in both waves, 6.52% and 9.38% were on oxygen, 1.09% and 10.94% were managed with mechanical ventilation and BIPAP in 1st and 2nd wave respectively. There was significant (p<0.05) increase in maternal deaths in the 2nd wave (7.03%) as compared to 1st wave (1.09%).Conclusions: A significantly large number of patients were affected in 2nd wave of COVID-19 pandemic with more morbidity and mortality. Neonatal population remained relatively unaffected in both waves.
      PubDate: 2021-11-25
      DOI: 10.18203/2320-1770.ijrcog20214644
      Issue No: Vol. 10, No. 12 (2021)
       
  • Correlation of cervical pap smears with histopathological diagnosis in
           cervical lesions

    • Authors: Ruksana Farooq, Azhar-un-Nisa Quraishi, Shahida Mohammad
      Pages: 4478 - 4481
      Abstract: Background: Cervical cancer is the most common genital cancer in India. In India alone,almost,130000 new cases occur with the death toll of 70000 everywhere. Objective of current study was correlation of pap smear with histopathological diagnosis.Methods: A retrospective study was conducted in tertiary care hospital in 130 sexually active women. Pap smears were taken and histopathological diagnosis was performed in all such patientsResults: From pap smear findings, out of 130 patients, maximum number of cases, 74 (56.9%) were categorized as. Out of epithelial cell abnormality, ASCUS was seen in 25 patients (10.2%), LSIL in 17 patients (13.1%), HSIL in 11 patients (8.5%). SCC was seen in 2 patients (1.5%) and adenocarcinoma in 1 patient (0.8%). From cervical biopsy reports, 51 cases(39.2%) were diagnosed as chronic cervicitis, 34 cases (26.2%) were diagnosed as chronic cervicitis with squamous metaplasia, CIN I in 31 patients (23.8%), CIN II in 8 patients (6.2%) and CIN III in 3 patients (2.3%), squamous cell carcinoma in 2 patients (1.5%) and adenocarcinoma in 1 patient (0.8%). The sensitivity, specificity, positive predictive value, negative predictive value and accuracy of pap smear test was 91.1%, 82.4%,73.2%, 94.6% and 85.4%, respectively.Conclusions: Pap smear has excellent correlation with histopathological diagnosis. Therefore it should be encouraged as effective tool for cervical cancer screening program to reduce incidence and mortality caused by cervical cancer. 
      PubDate: 2021-11-25
      DOI: 10.18203/2320-1770.ijrcog20214645
      Issue No: Vol. 10, No. 12 (2021)
       
  • A comparative study of the technical feasibility of complete salpingectomy
           versus tubal ligation as a method of tubal sterilisation during caesarean
           delivery

    • Authors: Taru Gupta, Divya Baruhee, Sunaina Agarwal
      Pages: 4482 - 4487
      Abstract: Background: Recent theory on ovarian malignancy suggests its origin from primary foci in fallopian tubes. Prophylactic salpingectomy may benefit in risk reduction of ovarian cancer. The aim of the study was to compare the feasibility of complete salpingectomy with bilateral tubal ligation was made during caesarean delivery in women desirous of permanent sterilisation.Methods: We conducted a prospective interventional randomized control study in department of obstetrics and gynaecology, ESI-PGIMSR Basaidarapur, New Delhi from October 2018 to February 2021. 70 women participated in this study desiring permanent sterilisation during caesarean delivery. Patients were randomized into two groups who either underwent bilateral tubal ligation [group A (N=35)] or complete bilateral salpingectomy [group B (N=35)].Results: Procedure was completed in 91% patients in group A and 77% in group B (p >0.05) making both the procedures feasible.  Total operative time (min) in group A and B were 47 and 55 respectively (p<0.01). Mean sterilisation procedure time (min) in group A was 5 and group B was 6 (p=0.13). No significant difference was seen in intra-operative blood loss (400 ml in group A vs 300 ml in group B), percentage decrease in post-op haemoglobin (g/dl) (4.56±2.96 in group A vs 3.91±2.7 in group B), post-operative serum Anti-mullerian hormone (AMH) levels (ng/ml) (group A-0.965±0.12 vs 0.7±0.09 in group B) in the two groups.Conclusions: Salpingectomy as an alternative to tubal ligation should be discussed with suitable patients desirous of permanent sterilisation during caesarean delivery. 
      PubDate: 2021-11-25
      DOI: 10.18203/2320-1770.ijrcog20214646
      Issue No: Vol. 10, No. 12 (2021)
       
  • A randomized comparative study of effect of intramuscular valathemate
           bromide (epidosin) and intramuscular camylofin dihydrochloride (anafortan)
           on cervical dilatation in labour

    • Authors: Dinesh Mehra, Madhubala Chouhan, Shatendra Goyal
      Pages: 4488 - 4492
      Abstract: Background: Our aim is to search for a good cervical dilating agent which is not only more efficacious in cervical dilatation but also effective in relieving pain during labour with no or very little harmful effects on mother and foetus.Methods: The type of study was simple randomized comparative study. The present study was conducted in R. N. T. Medical College, Udaipur between October 2019 and December 2020. 118 patients were selected randomly. Two groups were made each consisting of 59 patients. First group received intramuscular camylofin dihydrochloride, second group received intramuscular (IM) valethamate bromide. Patients included in study group were: primigravidae/multigravidae, singleton full term gestation (37-40 weeks) with vertex presentation, cervical dilatation of ≥3 cm and patient excluded from study group with preclampsia, eclampsia, antepartum haemorrhage, any obstetric complications: cephalo pelvic disproportion, abnormal presentations.Results: Mean duration of active phase of first stage of labor was shorter in group I (313.17 minutes) than in group II (356.3 minutes) but not statistically significant. Mean cervical dilatation rate was significantly more in group I (2.02 cm/hour) than group II (1.81 cm/hour). Anafortan was effective in pain relief with mean pain score 5.31±1.06 while mean pain score for epidosin group was 7.37±1.07.Conclusions: In our study we observed that intramuscular camylofin dihydrochloride (anafortan) was more efficacious than IM valethamate bromide (epidosin) in shortening the duration of labor as well as in pain relief.
      PubDate: 2021-11-25
      DOI: 10.18203/2320-1770.ijrcog20214647
      Issue No: Vol. 10, No. 12 (2021)
       
  • Role of oral inositol supplementation in women with polycystic ovarian
           syndrome

    • Authors: Najma Malik, Navneet Dubey
      Pages: 4493 - 4498
      Abstract: Background: PCOS is one of the most common endocrine disorder in women of reproductive age, it affects about 5-10% of women of reproductive age. It is characterized by chronic anovulation, hyperandrogenism, and insulin resistance. 30-40% of PCOS women have impaired glucose tolerance.Methods: This was prospective observational study carried out on 100 patients of PCOS visiting outpatient Department of Obstetrics and Gynecology, BRD Medical College, Gorakhpur from 1st July 2018 to 30th June 2019. Patients were diagnosed as PCOS on basis of Rotterdam criteria. In these 100 patients, oral inositol 2 gm twice daily was given for 3 months to 6 months depending upon the response of the patient and patients were examined every 4 week for menstrual regularity, acne improvement, hirsutism, spontaneous ovulation and pregnancy.Results: With inositol supplementation, menstrual abnormality corrected in 80% cases, 45% cases having acne improved. Ovulation occurred in 75.5% cases and 66.6% cases conceived with inositol supplementation.Conclusions: Insulin resistance is the basic pathophysiology for PCOS hence inositol supplementation is supposed to be very good medicine for management of PCOS to improve insulin sensitivity. Inositol leads to improvement in regularity of menstrual cycle, insulin resistance, hyperandrogenic features like hirsutism, acne, restores ovulation and improves oocyte quality.
      PubDate: 2021-11-25
      DOI: 10.18203/2320-1770.ijrcog20214648
      Issue No: Vol. 10, No. 12 (2021)
       
  • A study of maternal and fetal outcome in meconium-stained amniotic fluid-a
           prospective hospital-based study

    • Authors: Aparna U. Dandale, Amarjeet Kaur Bava, Nikhil R. Shinde
      Pages: 4499 - 4507
      Abstract: Background: Meconium is a collection of secretions and desquamated cells from the digestive tract, and waste products from ingested amniotic fluid. It is a viscous, dark-green substance composed of intestinal epithelial cells, lanugo, mucus, and intestinal secretions. Intra uterine passage of meconium occurs in case of fetal distress; Important causes of in utero passage of meconium are oligohydramnios, placental insufficiency, preeclampsia.Methods: The present prospective observational study is conducted at department of obstetrics and gynecology of tertiary care centre, Lokmanya Tilak municipal medical college and hospital, Mumbai. All antenatal women attending hospital in active phase of labour who fulfilled the inclusion criteria of single term pregnancy in cephalic presentation were included. A predesigned pretested interview schedule questionnaire was prepared in accordance with study objectives and was conducted in the language which they best understood. Permission was obtained from the institutional ethics committee. Maternal outcome: Increased incidence of cesarean and instrumental deliveries, wound infection, post-partum hemorrhage. Perinatal outcome: Birth asphyxia, meconium aspiration syndrome (MAS), respiratory distress syndrome (RSD), septicemia.Results: Maximum women 71% were having gestational age of 37-40 weeks. most common maternal high-risk factors were post-dated pregnancy (29%) followed by oligohydramnios (19%). Deliveries by caesarean section were more (71.4%), most common indication being fetal distress (44.7%). Perinatal complications were birth asphyxia, MAS, RDS, low Apgar score.Conclusions: Early identification of meconium-stained amniotic fluid (MSAF) in labouring women during intra-partum monitoring and availability of operation theatre for immediate intervention is required to reduce the perinatal morbidity and mortality.
      PubDate: 2021-11-25
      DOI: 10.18203/2320-1770.ijrcog20214649
      Issue No: Vol. 10, No. 12 (2021)
       
  • Psychological effects of isolation on antenatal women during COVID-19
           pandemic

    • Authors: Chandramathy Kamalakshy, Mini Chenicheri, Lakshmi Chirayil Ratheesh, Ragesh Gangadharan
      Pages: 4508 - 4511
      Abstract: Background: Pregnancy is a time of increased vulnerability for the development of anxiety and depression. This study evaluated the psychological effect of isolation on antenatal women admitted with COVID-19 disease.Methods: A cross-sectional study conducted at Government medical college Kozhikode from 1 November 2020 to 31 January 2021. One hundred antenatal women with COVID-19 disease admitted in isolation ward in quarantine were randomly selected. Clinical and demographic data collected at the time of admission. After one week of admission, mental health assessment done using following mental health assessment tools. They were general anxiety disorder-7 (GAD-7), perinatal anxiety screening scale (PASS), patient health questionnaire-9 (PHQ-9).Results: Out of the 100 women selected, 74 responded with the questionnaires. All of them were educated, 62% studied up to plus two. Majority from joint family contributed 68.9% and 85.1% were home makers. Mean age was 26 years. Primigravidae were 48.6% and mean BMI of 25.71 kg/m2. Commonest medical comorbidity was diabetes mellitus present in 28.4%. Mental health assessment done using 3 sets of questionnaires, PHQ-9, GAD-7 and PASS showed that women in our study did not have any increased risk of depression, general anxiety or perinatal anxiety. Infact they reported of feeling safer and more comfortable at the hospital compared to home.Conclusions: Present study showed that antenatal women with COVID-19 disease admitted in hospital did not have any increased risk of general anxiety, depression or perinatal anxiety. 
      PubDate: 2021-11-25
      DOI: 10.18203/2320-1770.ijrcog20214650
      Issue No: Vol. 10, No. 12 (2021)
       
  • Seroprevalence of rubella in pregnant women

    • Authors: Sumeet R. Tripathy, Aruna Menon, Bikram Bhardwaj, Mohammed Ashraf Ali S. Namaji, Nilesh A. Khardenavis, Neha Gupta
      Pages: 4512 - 4516
      Abstract: Background: Rubella is a droplet infection characterized by self-limiting illness. However infection during pregnancy may result in miscarriage, congenital birth defects leading to long term morbidity. The aim of the study was to estimate the seroprevalence of rubella immunity in pregnant women.Methods: Antenatal patients, irrespective of period of gestation, fulfilling the inclusion criteria were tested for rubella IgG antibodies.Results: A total of 258 pregnant women were included in the study. The estimated seroprevalence of immunity against Rubella infection was 70.5% (n=182) whereas 29.5% (n=76) were seronegative and thus susceptible to rubella infection. The distribution of seroprevalence of rubella immunity based on age group and gravidity were also evaluated.Conclusions: The results reveal high level of rubella sero positivity, which indicates continued transmission of rubella infection in the community. 
      PubDate: 2021-11-25
      DOI: 10.18203/2320-1770.ijrcog20214651
      Issue No: Vol. 10, No. 12 (2021)
       
  • Pregnancy associated plasma protein A: an early predictor of fetal growth
           restriction

    • Authors: Pavan Bhargava Chandramohan, Sarita Agrawal, Chandrashekhar Shrivastava, Sarita Rajbhar, Prasanta Nayak, Vinita Singh
      Pages: 4517 - 4521
      Abstract: Background: The aim of our study was to determine the association of low levels of pregnancy associated plasma protein-A (PAPP-A) levels estimated at 11-13+6weeks of gestation with fetal growth restriction (FGR).Methods: A prospective observational study of a total of 203 pregnant women with PAPP-A levels were followed up and the outcome data were collected at childbirth.Results: The incidence of FGR was 7.3%. A significant association was found between low levels of PAPP-A MoM (≤0.49) with FGR (p=0.000) with unadjusted odds ratio of 11.6. At PAPP-A multiples of median (MoM) ≤0.49, FGR had a median (Q1, Q3) of 0.46 (0.42, 1.54) versus 1.87 (0.59, 3.11) which was statistically significant (p=0.05) with moderate strength of prediction [minus 0.58 (95% CI, minus 1.113, minus 0.055), p=0.03]. At the cut-off considered in our study i.e., ≤0.49 MoM, sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) were 73%, 81%, 23%, and 97% respectively with a positive LR of 3.82 and negative LR of 0.32. Karl Pearson’s correlation showed positive correlation (r=0.308, p<0.001) between PAPP-A MoM and birthweight and showed that for every unit increase in PAPP-A MoM, birthweight increased by 0.082 times (approximately 90 gm). We also found an association of low PAPP-A with pre-eclampsia, preterm delivery and increased caesarean delivery births.Conclusions: We conclude that low PAPP-A MoM levels are good reflectors of placental function and adverse outcomes. PAPP-A, a part of the dual marker, may be extrapolated for suspecting FGR. This could guide in instituting appropriate feto-maternal surveillance.
      PubDate: 2021-11-25
      DOI: 10.18203/2320-1770.ijrcog20214652
      Issue No: Vol. 10, No. 12 (2021)
       
  • Obstetric hysterectomy: a retrospective study

    • Authors: Savita N. Kamble, Yuga M. Jamdade
      Pages: 4522 - 4526
      Abstract: Background: Obstetric hysterectomy (OH) is last resort usually opted to save life of a mother in critical obstetric conditions compromising her reproductive potential. With increasing caesarean deliveries incidence of morbidly adhered placenta is increasing, thus increasing need of OH. We aimed to study socio-demographic factors, incidence, indications, complications and feto-maternal outcomes associated with obstetric hysterectomy. Also, we aimed to study factors which affect the maternal and fetal outcome in obstetric hysterectomy case so as to minimize maternal and neonatal mortality and morbidity.Methods: We conducted a retrospective analytical study of 2 years 6 months in Department of Obstetrics and Gynecology at a tertiary and teaching institute of western Maharashtra.Results: The incidence of obstetric hysterectomy was 0.4%. Majority of women were between 25-35 years age group and parity two or more. Most common indication was postpartum haemorrhage (PPH) (41.1%) followed by uterine rupture (29.4%) and adhered placenta (23.5%). Most common risk factor found was previous caesarean delivery. Most common complication was need of intensive care unit (ICU) and vasopressor support.Conclusions: Proper antenatal care, screening for high-risk obstetric cases and registration of those patients at a well-equipped hospital and early referral and delivery at tertiary hospital by expert surgeon with timely decision, timely and adequate transfusions can prevent maternal and fetal complications.
      PubDate: 2021-11-25
      DOI: 10.18203/2320-1770.ijrcog20214653
      Issue No: Vol. 10, No. 12 (2021)
       
  • Efficacy of ultrasonography for structural categorisation of abnormal
           uterine bleeding

    • Authors: Jyoti Rathi, Girija Wagh
      Pages: 4527 - 4535
      Abstract: Background: Abnormal uterine bleeding (AUB) is defined as bleeding from the uterine corpus endometrium to be precise, the bleeding is abnormal in regularity, volume, frequency, or duration. The international federation of gynecology and obstetrics (FIGO) categorized AUB based on structured medical history, laboratory tests, ultrasound, and or hysteroscopy-based techniques.The classification is based on the phrase "PALM- COEIN", (pronounced “pahm-koin”) of which "PALM" represents polyp, adenomyosis, leiomyoma, malignancy (and hyperplasia) and defines structural pathologies that can be assessed visually. Transvaginal ultrasound (TVS) is the first-line imaging test for the evaluation of abnormal uterine bleeding in both premenopausal and postmenopausal women. The purpose of this study was to estimate the diagnostic effectiveness of two-dimensional ultrasound (TAS and TVS) in assessing the structural causes of AUB and to compare the histopathological and intraoperative findings with ultrasound.Methods: It was a prospective observational study. A total of 200 women presenting with abnormal uterine bleeding between the age group of 18-55 years were included in study. All patients were subjected to routine investigations for AUB and ultrasonography (USG). Wherever appropriate the findings of USG were compared with intra-operative and histopathology findings.Results: Diagnostic accuracy of USG was 78.1% with sensitivity and specificity of 88.5% and 60%. Positive predictive value (PPV) and negative predictive value (NPV) was 79.4% and 75%. USG is a simple, safe, fast, efficient and tolerable procedure. In diagnosing structural uterine pathology responsible for abnormal uterine bleeding, it has outstanding diagnostic accuracy and should be followed in all such cases.Conclusions: We cannot be definitive in our approaches always, USG act as a wonderful modality to help us not only in identifying the structural causes but also the functional causes. However, the gold standard of identifying endometrial pathology is histopathology and it can’t be replaced by anything.
      PubDate: 2021-11-25
      DOI: 10.18203/2320-1770.ijrcog20214654
      Issue No: Vol. 10, No. 12 (2021)
       
  • Fetomaternal outcomes in pregnancy complicated by epilepsy: a
           retrospective study

    • Authors: Chithra R., Siddhi Shree Dixit, Janu M. K., Sandhya .
      Pages: 4536 - 4540
      Abstract: Background: This study is conducted to find out possible course and complications of epilepsy and its treatment in mother and fetus as many women will be anxious regarding this high-risk condition.Methods: This is a retrospective study conducted in department of obstetrics and gynaecology, AIMS Kochi from 2012-2019. Out of a total of 7045 deliveries during that period, we identified 64 patients with epilepsy complicating pregnancy. Antepartum, intrapartum and postpartum details of 57 patients whose data was available in electronic medical records was collected and analysed using SPSS 17 software.Results: In this study we noted that the incidence of epilepsy was 0.009%. the 50% of patients were in 25-30 years age group. More than 98% were on long term antiepileptic drugs. Majority were on monotherapy, most commonly on leviteracetam and were well controlled with monotherapy. The 38.5% had recurrence of seizures during pregnancy, mostly in latter half of pregnancy. Patients with seizure free interval of 9 months prior to pregnancy did not have any further epilepsy episodes. The incidence of other medical and obstetric complications was found to be similar to general population. There was 10% incidence of IUGR and fetal anomaly.Conclusions: The seizures were well controlled with monotherapy and we found that generally pregnancy and delivery is well tolerated and overall neonatal outcomes were good.
      PubDate: 2021-11-25
      DOI: 10.18203/2320-1770.ijrcog20214655
      Issue No: Vol. 10, No. 12 (2021)
       
  • Serum lactate dehydrogenase as a biochemical marker for maternal outcome
           in pre-eclampsia

    • Authors: Gitanjali Kumari, Vaishali Taralekar, Suchita Dabhadakr
      Pages: 4541 - 4544
      Abstract: Background: LDH is a cytoplasmic intracellular enzyme present in the heart, kidney, muscle, leukocytes and erythrocytes, of all major organ systems. The presence of LDH in extracellular space points towards cellular damage, endothelial dysfunction. Preeclampsia is a multisystem disorder during pregnancy causing cellular damage or death. Hence, serum LDH levels can be helpful in determining the extent of cell damage and the seriousness of this disease. The present study aimed to correlate the maternal serum lactate dehydrogenase levels with maternal and perinatal outcomes in women with pre-eclampsia.Methods: It was a prospective observational study. A total of 120 antenatal patients diagnosed with hypertensive disorder of pregnancy were included in this study. Serum LDH levels were estimated by enzymatic method on the autoanalyzer. Patients were grouped into 3 categories according to serum LDH levels: a) <600 IU/l, b) 600-800 IU/l c) >800 IU/l. Clinical manifestation of development of complications of hypertensive disease and its relation with serum LDH in respective patients were analyzed.Results: An LDH level of more than 800 IU/l was seen in 19.2% while between 600 to 800 IU/l was seen in 16.7% cases. A significant association was observed between incidence of maternal complications with high LDH levels (p<0.01). High LDH levels were observed to be associated with development of ante-partum haemorrhage, eclampsia and requirement of ICU admission. No significant association was found between different categories of LDH and deep tendon reflexes, levels of proteinuria at the time of admission in these preeclamptic women.Conclusions: Close monitoring and early intervention of the preeclampsia patients with elevated serum LDH levels can help avoid adverse effects of the disease and thereby help improve maternal and perinatal outcomes in pregnant women with preeclampsia.
      PubDate: 2021-11-25
      DOI: 10.18203/2320-1770.ijrcog20214656
      Issue No: Vol. 10, No. 12 (2021)
       
  • Maternal and neonatal outcome of twin pregnancy at a tertiary care center

    • Authors: Vaishali Chaudhary, Kamalpriya Thiyagarajan, Yogini Patil, Vijaykumar Gawali
      Pages: 4545 - 4548
      Abstract: Background: Twin pregnancies occurs in 2 to 4% of the total number of births. Also the perinatal mortality and morbidity associated with it is five to six times higher in comparison with singleton pregnancy. In developing countries, 287,000 annual maternal deaths and 3 million neonatal deaths contributes to 99% of such mortality as per records of the World Health Organization (WHO) estimates that 99% of the world's annual occur in developing countries.Methods: This observational study included 50 women with twin pregnancy with gestational age of 26 weeks or more. Maternal and neonatal characteristics in twin deliveries at a tertiary care center were analyzed. High risk factors and it’s association with maternal and perinatal outcomes was analyzed.Results: Pregnancy induced hypertension (32%) was the commonest, Preterm rupture of membranes (PROM, 22%) was in the next order. Invitro fertilization (44%), malpresentation (26%) main indicators for lower segment cesarean section. Mean weight of first twin was 1.9±0.43 kg and for second twin it was 1.89±0.47kg (Table 1). Most of twins were diamniotic dichorionic (78%).Conclusions: Twin pregnancies are hazardous to both for the mother and the neonate. It is certainly high risk factor which needs early identifications of complications and timely management. Perinatal outcome largely depends on gestational age, birth weight, presentation, mode of delivery.
      PubDate: 2021-11-25
      DOI: 10.18203/2320-1770.ijrcog20214657
      Issue No: Vol. 10, No. 12 (2021)
       
  • Case series on uterine rupture depicting the atypical presentations in the
           labour room

    • Authors: Srishti Aggarwal, Monika Jindal, Santosh Minhas
      Pages: 4549 - 4552
      Abstract: Uterine rupture is the complete division of all the three layers of uterus. Most uterine ruptures occur during labor in pregnant women, most commonly seen in previously scarred myometrium. Consequences of uterine rupture depend on the time between diagnosis of uterine rupture and intervention, and can be as grave as fetal and maternal death. Vigilance and avid action by the obstetrician can lead to better outcomes. Case 1 represented a 28-year-old moderately anemic G4P2L2A1 having previous 2 LSCS at POG 39 weeks 1 day presented in COVID emergency in active labour and was found to have a uterine scar rupture (5 cm rent) extending towards bladder wall with shoulder presenting on rent. A live female baby with thick meconium staining was delivered and uterine repair along with bilateral tubectomy was performed. Case 2 represented a 21-year-old primigravida with breech presentation at a gestation of 34 weeks 6 days with preterm labour pains who had been referred to our centre. Decision for LSCS was taken and on entering the abdomen rupture uterus with an inverted T-shaped rent in the upper segment extending up to the fundus was seen. A stillborn male fetus was delivered through the rent, followed by successful uterine repair. In spite of massive blood loss, the mother had survived. Case 3 represented a 30-year-old grand multipara at a gestation of 38 weeks 3 days with ultrasound documented fetal demise with fetal hydrocephalus and holoprosencephaly with labour pains was taken up for laparotomy due to suspicion of uterine rupture based on examination findings. Intra-operatively, baby was found lying in the peritoneal cavity with an unsalvageable uterus with a rupture in lower uterine segment and left lateral wall extending upto round ligament above and cervix below. A stillborn male fetus was delivered and peripartum subtotal hysterectomy with left salpingoophorectomy and right salpingectomy was done with a good maternal outcome. The above series suggest that the signs and symptoms of uterine rupture are usually variable and nonspecific, hence posing a challenge for the diagnosis. Early diagnosis and timely intervention by the obstetrician, can help us to improve the fetal and maternal outcome drastically.
      PubDate: 2021-11-25
      DOI: 10.18203/2320-1770.ijrcog20214658
      Issue No: Vol. 10, No. 12 (2021)
       
  • Primary malignant melanoma of the nipple: a case report

    • Authors: Moukit Mounir, Aziz Bazine, Mohammed Rahmoune, Ismail Allilou, Bouchra Elmoubakkir, Amine Ennouhi, Omar Laghzaoui
      Pages: 4553 - 4554
      Abstract: Primary melanoma origi­nating on the female nipple remains an extremely rare variant of malignant melanoma and only a few cases haves been reported in the literature. We describe a case of a patient admitted for a black pigment deposition on the left nipple. Surgical resection of the left nipple and areola with clear margins and an axillary lymph node dissection was performed confirming the diagnosis of non-invasive superficial spreading melanoma.
      PubDate: 2021-11-25
      DOI: 10.18203/2320-1770.ijrcog20214659
      Issue No: Vol. 10, No. 12 (2021)
       
  • A case report on placental chorioangioma

    • Authors: Kalyani P. Barde, Gautam S. Aher, Urmila G. Gavali
      Pages: 4555 - 4557
      Abstract: Chorioangioma is the term used to describe an abnormal proliferation of vessels arising from chorionic tissue, which is most commonly observed in the third, and less frequently in the second trimester of pregnancy as a solitary nodule or, less commonly, as multiple nodules. We here report a case of placental chorioangioma which presented as a case of preterm labour. 21 year old primigravida presented to us at 26 weeks of gestation with history of PV leak and pain in abdomen. Ultrasound showed a single live foetus corresponding to 24-26 weeks of gestation with amniotic fluid index (AFI): 5 cm (oligohydramnios) there was evidence of 58×42 mm heterogeneously hypoechoic lesion noted over placenta likely s/o chorioangioma. Patient went into spontaneous preterm labour on day 5 and delivered vaginally. Placenta weighted 700 gm. A globular mass of size 6×7 cm was attached to foetal surface of placenta with a pedicle with confirmed the finding of ultrasonography. Placental chorioangioma is associated with high rates of perinatal complications. Most complications may appear early and delivery is problematic due to prematurity. Thus better prenatal investigations and regular follow up is required for early diagnosis and treatment.
      PubDate: 2021-11-25
      DOI: 10.18203/2320-1770.ijrcog20214660
      Issue No: Vol. 10, No. 12 (2021)
       
  • Intrauterine contraceptive device migration to the urinary bladder

    • Authors: Urmila G. Gavali, Mayuri D. Pawar, Gautam S. Aher, Suhas S. Shinde
      Pages: 4558 - 4560
      Abstract: Intravesical migration represent as uncommon complication of intrauterine device insertion. We present a case of an IUD that migrated to the urinary bladder and impacted in urinary bladder wall, causing significant urinary symptoms. A 44 years old woman presented with menorrhagia, lower abdominal pain and urinary symptoms since past 1 year. She reported an IUD insertion 10 years back. Imaging detected the presence of IUD in the urinary bladder wall with large fibroid in uterus. Under anaesthesia, total abdominal hysterectomy with bilateral salphingoophorectomy is performed and IUD was removed out of the bladder without any complications. In her follow-up evaluation after 2 week, she had no urinary symptoms. A regular follow-up of IUD for visible thread would help in earlier detection of misplaced IUD and prevent the complications such as intravesical migration.
      PubDate: 2021-11-25
      DOI: 10.18203/2320-1770.ijrcog20214661
      Issue No: Vol. 10, No. 12 (2021)
       
  • Successful maternal and fetal outcome in an uncorrected case of tetralogy
           of fallot

    • Authors: Aditya R. Nimbkar, Shruti A. Panchbudhe, Prasad Y. Deshmukh, Arun H. Nayak
      Pages: 4561 - 4565
      Abstract: Tetralogy of Fallot (ToF) is the most common congenital heart defect which is associated with systemic cyanosis. Pregnancy and delivery cause dramatic alterations in cardiovascular physiology and pregnancy in women with unrepaired TOF may have a worsening in right to left shunt with an increase of the cyanosis. This possesses an elevated risk of maternal and foetal morbidity and even mortality. We report and discuss a case of a 24 years old Primigravida with uncorrected ToF. A multidisciplinary team was involved in the management of the case with the aim to minimize maternal and foetal complications. The target of the management was to perform adequate maternal surveillance by maintaining an adequate oxygen saturation and good haemoglobin levels and perform timely foetal surveillance tests in the form of Obstetric doppler. A caesarean section was performed at 35 weeks and 5 days of gestation without any maternal or fetal complications. Without optimal obstetrical or medical management, prognosis of pregnancy in patient with uncorrected ToF is poor.
      PubDate: 2021-11-25
      DOI: 10.18203/2320-1770.ijrcog20214662
      Issue No: Vol. 10, No. 12 (2021)
       
  • Takotsubo cardiomyopathy in peripartum period: a case report

    • Authors: Chitramani Sundararajan, Thamizh Naveena, Priya Kubendiran
      Pages: 4566 - 4569
      Abstract: Cardiomyopathy is a group of disorders characterised by structural and functional abnormalities in the myocardium in the absence of other cardiac diseases of myocardial abnormality. Its occurrence in pregnancy is uncommon and exact incidence is unknown even though some studies shows that the incidence of peripartum cardiomyopathy is 1 in 1000 to 4000 births. Here we have discussed about a 34 years primigravida with twin pregnancy conceived after 12 years of married life by assisted reproductive technique (ART), admitted with preterm premature rupture of membranes (PPROM) at 28 weeks of gestation who developed a rare condition called Takotsubo cardiomyopathy (TC) in the peripartum period. She was managed in intensive care unit with oxygen supplementation, beta blockers, diuretics and heparin. Patient had an excellent recovery in the early postoperative period.
      PubDate: 2021-11-25
      DOI: 10.18203/2320-1770.ijrcog20214663
      Issue No: Vol. 10, No. 12 (2021)
       
  • Partial HELLP syndrome: case report

    • Authors: Sheetal Dagar, Monika Gupta, Vrinda Shekhawat, Santosh Minhas
      Pages: 4570 - 4572
      Abstract: HELLP syndrome is a complication in pregnancy clustered by haemolysis, elevated liver enzymes, and a low platelet count. It is seen as a serious complication of preeclampsia and eclampsia. Serious manifestations like haemorrhage, infarction, rupture and other hepatic manifestations are usually associated with it. In this case study, 29 years old primigravida is a booked case admitted in ward at 39 weeks 1 day with decreased fetal movement for 2 days. No history of pain abdomen, bleeding per vaginum, discharge per vaginum. Her blood pressure records at the time of admission was 110/72 mmHg and she was normotensive throughout pregnancy. Urine routine examination was negative for urinary protein. However, blood tests showed platelet count of 66,1000/cumm, with ALT of 174 U/L and AST of 123 U/L on peripheral blood film. RBC were predominantly normocytic, normochromic with few macrocytes. WBC has normal morphology. Platelets were reduced on smear. Giant platelets were seen. Ursodeoxycholic acid 300 mg 12 hourly were given to the patient and 3 doses of vitamin K I/M 24 hourly. She was delivered by cesarean section which was performed due to failure of progression of labor with a deflexed head. There was presence of retroplacental clot of 4×3 cm indicating placental abruption, a complication of HELLP syndrome. From this we conclude that we should be careful in suspecting complications of full blown diseases even when the patients are asymptomatic but have atypical laboratory findings.
      PubDate: 2021-11-25
      DOI: 10.18203/2320-1770.ijrcog20214664
      Issue No: Vol. 10, No. 12 (2021)
       
  • Puerperal Group A Streptococcal sepsis: a case report

    • Authors: Nithya J., Sathyamurthy G., Balavinoth R.
      Pages: 4573 - 4577
      Abstract: Group A Streptococcal (GAS) sepsis in puerperium is one of the recognised causes of maternal mortality. Though the onset is often insidious, it can progress rapidly to a life-threatening invasive infection, toxin-mediated shock, and end-organ failure, even before clinical signs become apparent. We report a case of puerperal GAS sepsis that was successfully managed. 24-years-old para 1 was readmitted to the intensive care unit requiring non-invasive ventilation on postnatal day 6 with clinical and biochemical features of sepsis. Blood culture, episiotomy wound swab, and high vaginal swab grew GAS. Broad-spectrum antibiotics initiated. She developed ascites that progressively increased and needed therapeutic paracentesis. She was discharged after four weeks of hospitalization. Early identification and prompt treatment are the keys to prevent severe morbidity and maternal mortality.
      PubDate: 2021-11-25
      DOI: 10.18203/2320-1770.ijrcog20214665
      Issue No: Vol. 10, No. 12 (2021)
       
  • Risks and challenges in multiple pregnancy

    • Authors: Aditi Agarwal, Arti Sharma, Neeta Bansal, Neha Panwar, Shweta Singh, Swati Kohli
      Pages: 4578 - 4580
      Abstract: Because of breakthroughs in reproductive medicine, multiple pregnancies have become more common in the industrialized world. As a result, obstetric care for women with multiple pregnancies and neonatal care for the same has become more demanding. Multifetal pregnancies are linked to an elevated risk for both the mother and child. There is increased incidence of obstetric complications such as spontaneous abortion, hypertensive disorders, placenta previa, and fetal malformations. Perinatal outcome is also affected which is attributable to increased incidence of fetal complications like prematurity, congenital malformations, growth discordance and cord accidents. We are presenting 2 cases, one of MCMA twin pregnancy with fetal congenital anomaly and another of a triplet pregnancy and their perinatal outcomes.
      PubDate: 2021-11-25
      DOI: 10.18203/2320-1770.ijrcog20214666
      Issue No: Vol. 10, No. 12 (2021)
       
  • Severe megaloblastic anemia in twin pregnancy mimicking partial hemolysis,
           elevated liver enzymes and low platelet count syndrome: a case report

    • Authors: S. Momon Singh, Vaidehi Thakur, P. Manisana Singh
      Pages: 4581 - 4584
      Abstract: Vitamin B12 is well known cause of megaloblastic anemia. However, it is uncommon in pregnancy, occurs in 10-28% of uncomplicated pregnancies, and is associated with few complications. Present case of 32 years old woman with twin-pregnancy at late gestation who was diagnosed with severe anemia in a local private clinic. On arrival to medical center, lab findings together with her clinical picture warranted the concern for differential diagnosis of partial hemolysis, elevated liver enzymes and low platelet count (HELLP), but later it was found to be a case of vitamin B12 deficiency since additional lab findings. Blood transfusions were given, and patient responded well to B12 supplementation. Pregnancy was carried to term and delivered twin live babies but otherwise well at birth and had normal developmental milestones thereafter. Our case emphasizes the importance of screening for B12 deficiency in pregnancy, especially in at-risk women (twin-pregnancy in pure vegetarian women) with unexplained anemia/r thrombocytopenia.
      PubDate: 2021-11-25
      DOI: 10.18203/2320-1770.ijrcog20214667
      Issue No: Vol. 10, No. 12 (2021)
       
  • Rare case of two siblings with complete androgen insensitivity syndrome

    • Authors: Ambika Shankar, Oby Nagar, Suwaram Saini, Babita .
      Pages: 4585 - 4589
      Abstract: Androgen insensitivity syndrome (AIS) also called testicular feminizing syndrome is a rare X linked disorder of sexual differentiation caused by mutation in the androgen receptor (AR) gene, which is located on the X chromosome (Xq11-q12). In the reported cases, individuals with complete androgen insensitivity syndrome (CAIS) presented with a female appearance and normal breast development, absence of uterus and ovaries, bilateral undescended testis, and elevated testosterone levels. The syndrome is usually detected on evaluation of a phenotypic female with primary amenorrhea who presents for treatment of infertility. Here, we report 2 cases of CAIS in siblings 21 and 19 years of age who presented to us with primary amenorrhea. The elder sibling presented to us with primary amenorrhea, thelarche +, absent adrenarche, blind pouch of vagina, b/l inguinal masses suggestive of undescended testes, raised serum testosterone and absent uterus on USG. While the younger sibling also presented with similar findings but had history of b/l orchidectomy at the age of 14 years. Both the sisters were admitted in our unit and the elder sister underwent b/l orchidectomy and McIndoe’s vaginoplasty. While the younger sister underwent McIndoe’s vaginoplasty on the same day. Post-operative recovery was uneventful and they were given hormone replacement therapy (HRT). AIS is a rare X linked disease caused by mutation in the AR gene. which when diagnosed early can be treated appropriately. Precise diagnosis requires clinical, hormonal and molecular investigation and is of great importance for appropriate gender assignment and management in general. With timely gonadectomy, vaginoplasty or vaginal pouch deepening, hormone replacement and appropriate psychological support help the person live a healthy and almost normal life.  
      PubDate: 2021-11-25
      DOI: 10.18203/2320-1770.ijrcog20214668
      Issue No: Vol. 10, No. 12 (2021)
       
  • A huge mesenteric teratoma in reproductive age woman: a case report

    • Authors: Ruchi Kishore, Pratibha Lambodari, Kritika Verma, Anjum Khan, Neelam Singh
      Pages: 4590 - 4592
      Abstract: The incidence of dermoid ovarian cyst is 15-20% of all ovarian neoplasm, which is a common entity. Mesenteric cyst are one of the very rare entities with incidence of 1 in 2, 50, 000. Dermoid cysts rarely present as mesenteric cysts. Mesenteric dermoid cyst have good prognosis. Here, we report a rare abdominal tumor which was initially diagnosed clinically as an ovarian dermoid cyst but operative and histology revealed it to be mesenteric dermoid cyst. A 36 year-old, multiparous presented with abdominal mass, gradually increasing in size since 1 year with recent onset of abdominal pain. Physical examination revealed abdominal mass of 22×20 cm size, globular, non-tender, mobile, and cystic to solid in consistency. Contrast-enhanced computed tomography (CECT) showed 23×21×14.4 cm heterogeneous enhancing mass lesion with areas of fat density and calcifications within, suggestive of neoplastic mass lesion, likely teratoma. Tumor markers were within normal limit. Patient was managed surgically. Laparotomy findings revealed a huge solid mesenteric mass (22×20 cm) weighing 6.5 kgs. Histopathology showed mature cartilage, osteoid formation, fibro-adipose connective tissue, focal lymphoid aggregates, congested blood vessels and focal mature neuronal component and no immature elements seen, confirming dermoid cyst. Mesenteric cyst are rare intra-abdominal tumor found most commonly in ileum (60%) next is ascending colon (40%). However, if a mesenteric cyst locates within the pelvic cavity, as in this case, it may be misdiagnosed as an ovarian cyst.
      PubDate: 2021-11-25
      DOI: 10.18203/2320-1770.ijrcog20214669
      Issue No: Vol. 10, No. 12 (2021)
       
  • Multiple urinary bladder calculi: a rare cause of irreducible uterovaginal
           prolapse

    • Authors: Manjit Kaur Mohi, Manjeet Kaur, Balwinder Kaur, Satinder Pal Kaur, Sangeeta Aggarwal
      Pages: 4593 - 4595
      Abstract: A case of irreducible prolapse with multiple bladder calculi in a 65-years-old multiparous, postmenopausal woman is reported. Inability to walk, constipation and urinary incontinence were her primary complaints. Routine ultrasound of the abdomen and pelvis failed to reveal multiple vesical calculi as the prolapse was lying outside the pelvis. However, targeted plain X-ray of the prolapsed mass showed multiple vesical calculi. The patient was managed with single-stage vaginal hysterectomy and laparotomy. First vaginal hysterectomy was done then prolapsed cystocele was reduced and extraperitoneal vesicolithotomy done. Currently, the patient is relieved of all symptoms. Management of an irreducible procidentia and a hard mass in the anterior compartment, as in this case, can be challenging and requires a diligent effort to confirm the diagnosis and to execute the appropriate surgical protocol to achieve optimal outcome with minimal intra- and post-operative complications.
      PubDate: 2021-11-25
      DOI: 10.18203/2320-1770.ijrcog20214670
      Issue No: Vol. 10, No. 12 (2021)
       
  • Misplaced intrauterine contraceptive devices: a case report

    • Authors: Nidhi D. Thakkar, Jaydeep D. Hindocha
      Pages: 4596 - 4598
      Abstract: Contraception is a new topic gaining attention in country like India and a new proposed area of research. Intrauterine contraceptive devices (IUCDs) are one contraceptive method requiring less efforts and having more efficacy. ‘Misplaced IUCD’ is one of the rare and the most dreadful complication of IUCD insertion. Clinically, it can present as having pain, bleeding, recurrent pregnancy loss or can be asymptomatic. This is a case report of a 40 year old P4A1L4 female who presented to us with suspicion of misplaced IUCD without clinical symptoms. Clinical examination and radiological investigations made a diagnosis of misplaced IUCD and laparoscopy confirmed it. Laparoscopically misplaced IUCD was removed. 
      PubDate: 2021-11-25
      DOI: 10.18203/2320-1770.ijrcog20214671
      Issue No: Vol. 10, No. 12 (2021)
       
  • A rare case of uterine myxoid leiomyosarcoma

    • Authors: Shirish S. Dulewad, Varsha Narayana Bhat, Prachi V. Koli
      Pages: 4599 - 4601
      Abstract: Myxoid leiomyosarcoma is an uncommon tumour and in most cases, it is recognised only after the surgery. A 65 years old female patient got admitted at our hospital with history of rapidly growing abdominal mass with pain in abdomen since last 3 months. During abdominal examination 32 weeks huge mass was noted and on prevaginal examination mass couldn’t be separated from uterus. LDH was elevated, USG suggestive of vascular tumour of with neoplastic etiology of ovarain origin. CECT was done and findings suggestive of uterine adenocarcinoma with peritoneal carcinomatosis. Exploratory laparotomy with total abdominal hysterectomy with bilateral salphingoopherectomy with omentectomy with debulking surgery was performed. HPR reports suggestive of myxoid leiomyosarcoma with mitotic index of 10 with tumour cell necrosis suggestive of poor prognosis. Post-operative period patient had developed sudden myocardial infarction and shifted to ICU where she died due to ventricular fibrillation. 
      PubDate: 2021-11-25
      DOI: 10.18203/2320-1770.ijrcog20214672
      Issue No: Vol. 10, No. 12 (2021)
       
  • Von Willebrand disease in pregnancy: a case report

    • Authors: Rashmi A. G., Riya Kumar, Dayamayi A. S., Spandana Nallapilli
      Pages: 4602 - 4605
      Abstract: Von Willebrand disease (VWD) is a hereditary bleeding disorder that can be severe and potentially life-threatening, particularly in pregnant women during labor and subsequently during early puerperium. There is no optimal treatment or management for this disorder. Hence, all efforts aim at early diagnosis and the focus is mainly on minimising and controlling blood loss. We described the case of a woman in the post-partum period with severe VWD, admitted in the obstetrics and gynaecology ward at Rajarajeswari Medical College and Hospital, Bangalore. Prompt diagnosis, initiation of pre-partum and intra-partum Von Willebrand factor (VWF)/clotting factor replacement therapy, vigilant post-partum monitoring of blood loss and systematic follow up will help expedite recovery and prevent adverse outcomes.
      PubDate: 2021-11-25
      DOI: 10.18203/2320-1770.ijrcog20214673
      Issue No: Vol. 10, No. 12 (2021)
       
  • Inadvertent laparoelytrotomy in second stage of labour: a case report

    • Authors: Shristy Mohanty, Satyabhama Marandi, Bhismadev Chhatria
      Pages: 4606 - 4608
      Abstract: Laparoelytrotomy is the accidental delivery via a vaginal incision during caesarean section in second stage of labour. It refers to the inadvertent delivery of the foetus through a transverse incision given over the vagina during a caesarean section (C-section). It is a rather uncommon complication of C-section encountered at advanced dilation which can lead to maternal complications such as traumatic postpartum hemorrhage, injury to bladder, ureters and difficult reconstruction of vagina. Here, we present a case report of inadvertent laparoelytrotomy during C-section.
      PubDate: 2021-11-25
      DOI: 10.18203/2320-1770.ijrcog20214674
      Issue No: Vol. 10, No. 12 (2021)
       
  • Safe obstetric anesthesia practice-COVID-19

    • Authors: Sunil Thakur, Sushruti Kaushal, Harpreet Kaur, Asmita Kaundal
      Pages: 4609 - 4613
      Abstract: COVID-19 or Corona virus disease 2019 was declared a pandemic by the WHO on 11th March 2020. Cesarean delivery is a commonly performed major surgery around the world. Important considerations while performing a cesarean section on a confirmed or suspected case of COVID19 are safety of the woman and the fetus; and prevention of transmission of SARS-CoV2 infection to the fetus as well as the healthcare providers. Woman and her birthing partner should be screened for the symptoms of COVID-19 before scheduled admission. Cesarean section in a woman suffering from COVID-19 should be managed by a multidisciplinary team consisting of anesthetists, obstetricians, labor and delivery nurses, neonatologist, critical care experts and infectious disease specialists, all members working in tandem with each other. General changes in workflow, reorganization of obstetric anesthesia services and proper use of personal protective equipment (PPE) are required for safe delivery of obstetric anesthesia during the COVID pandemic. Regional anesthesia is the preferred method of anesthesia for cesarean delivery. Using regional anesthesia reduces the need of aerosol generating procedures and avoids the use of mechanical ventilation. It also decreases the possibility of exacerbating the respiratory complications due to intubation. General anesthesia is recommended when a COVID-19 parturient presents with desaturation (oxygen saturation≤ 93%) for emergency cesarean delivery. Use of mechanical barriers around patient’s head during intubation and extubation might reduce exposure. The patient should be allowed to remain in the operating room itself till sufficiently recovered to be shifted directly to the isolation room.
      PubDate: 2021-11-25
      DOI: 10.18203/2320-1770.ijrcog20214675
      Issue No: Vol. 10, No. 12 (2021)
       
 
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