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International Journal of Reproduction, Contraception, Obstetrics and Gynecology
Number of Followers: 16  

  This is an Open Access Journal Open Access journal
ISSN (Print) 2320-1770 - ISSN (Online) 2320-1789
Published by Medip Academy Homepage  [12 journals]
  • Association of cortisol serum levels as a prognostic factor in threat of
           pre-term birth

    • Authors: Francisco R. Joya, Jose Daniel Gonzalez Ortiz, Cindy R. Bandala, Marlene de la Peña Gutierrez, Maria Isabel Tolentino Sosa, Arturo B. Vilchis
      Pages: 825 - 829
      Abstract: Background: Prematurity is one of the leading causes of death in children. In Mexico there is a frequency of 12% of preterm birth and this leads to significant maternal-fetal complications comprising 31.5% of neonatal morbidity and mortality. The patient who receives obstetric care in the gynecology service at the naval medical center requires prevention, diagnosis and treatment of threat of preterm birth to reduce perinatal and neonatal complications. Serum cortisol levels was determined as a prognostic factor for the threat of preterm birth in patients with obstetric care at the Naval Medical Center, it is a relatively easy parameter to obtain and would support a timely treatment.Methods: We used a quantitative, non-experimental, retrospective descriptive study of 30 patients with risk factors to develop preterm birth threats in gynecology service of the naval medical center from January to December 2018, which were taken 3 milliliters of peripheral blood to measure serum cortisol concentrations for later analysis. For statistical analysis of the present study, it was used Shapiro Wilk test. Likewise, Pearson's test was performed to measure the degree of association between the dependent and independent variable. Student's t-test was implemented to compare cortisol levels of pregnant women.Results: A total of 30 patients of these were analyzed, the mean age was 30.4 years (SD±5.184). The gestation weeks the average value was 30.63 weeks (SD±4.781). A student t test was performed where the cortisol values of pregnant women were compared with an average value of 2,586 (95% CI 0.45-472) and a t value=2,476 and a p=0.019 lower value of the significance value of 0.05 rejecting the null hypothesis. Which indicates that cortisol levels can be used as a predictive marker of the threat of preterm birth, considering it as an independent factor for this situation to occur in pregnant patients. The variables of the cortisol level and the weeks of gestation Pearson=-0.061 and a significance of p=0.747 were correlated (there being no strong enough relationship between the study variables). Regarding the triggers, it is observed that the highest factor was for urinary tract infection 40% n=12, abnormal uterine activity 20% n=6, followed by premature membrane rupture 16.7% n=5.Conclusions: The risk factors associated with the threat of preterm birth can be multiple, encompassing them in three important areas such as socioeconomic, psycho-emotional and clinicopathological, of the latter, nine of which are most frequent in our population are urinary infection, abnormal uterine activity and premature rupture of membranes. Regarding the association of cortisol levels as a prognostic factor for the threat of preterm birth taking it into account as an independent factor, it can be concluded that it is not statistically significant, however, according to what is reported in the literature, It should be considered as one of the multiple risk factors, considering this timely premise to boost the development of new research in the field.
      PubDate: 2021-02-24
      DOI: 10.18203/2394-6040.ijcmph20210500
      Issue No: Vol. 10, No. 3 (2021)
       
  • Prevalence and characteristics of polycystic ovarian syndrome in women
           attending in outpatient department of obstetrics and gynecology of
           Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh

    • Authors: Kaniz Fatema, Tripti Rani Das, Rezaul Karim Kazal, Sharmeen Mahamood, Hasna Hena Pervin, Farah Noor, Bidisha Chakma
      Pages: 830 - 835
      Abstract: Background: Polycystic ovary syndrome (PCOS) is a heterogenous, multifactorial, complex genetic disorder. Most commonly, it affects the females of reproductive age. This is one of the most widespread diseases across the world and if left untreated, may result in infertility and even uterine cancer. Methods: A cross sectional observation study of 100 PCOS patients was carried out from August 2018 to July 2019 in gynecology out-patient department of Bangabandhu Sheikh Mujib medical university, Dhaka. In this study clinical, biochemical and hormonal profile of these patients were analyzed and correlation was done between clinical features and biochemical and hormonal profile. Results: The prevalence of PCOS was 6.11% in the gynecology out-patient visits and 35.39% among infertile women. The mean age group of the patients was 24.3±5.16 SD. The mean BMI was 24.66±5.34 SD. The mean duration of infertility was 5.17 years. The prevalence of metabolic syndrome in our study was 15.0%. In this study menstrual irregularity was the most common complaint. Spearman’s correlation between various clinical and laboratory parameters showed positive correlation exists between BMI and testosterone (r=0.4824; p<0.0001).Conclusions: The study showed that most of our polycystic ovary syndrome subjects were present with oligomenorrhea. Hirsutism and central obesity were also common presentation. Obese women with PCOS had more severe ovulatory dysfunction and need more attention for their appropriate management. 
      PubDate: 2021-02-24
      DOI: 10.18203/2320-1770.ijrcog20210469
      Issue No: Vol. 10, No. 3 (2021)
       
  • Methylen tetrahydrofolate reductase enzyme gene C677T and A1298C mutations
           in primigravida with first trimester missed abortion: cross-sectional
           study

    • Authors: Nermeen Mohamed Hefila
      Pages: 836 - 841
      Abstract: Background: This work aimed to correlate between MTHFR C677T and A1298C genes (methylenetetrahydrofolate reductase) mutation and first trimester missed abortion in primigravida to identify pregnant ladies who need anticoagulation therapy to improve pregnancy outcome. The conducted study was a cross-sectional study. Data were collected from females recruited from EL Shatby hospital, Alexandria, Egypt. The present study was done on 40 primigravida females recruited from EL Shatby hospital. Methods: All participating women were primigravida in their first trimester with missed abortion. Blood specimens were collected from all cases involved in the study for DNA extraction and genotype analysis based on PCR and reverse hybridization. The mutations studied are the MTHFR C667T and A1298C genes. Main outcome measures: The MTHFR C667T mutations in our study is not significantly related to abortion in primigravida while MTHFR A1298C mutations prevalence were appeared significantly have a relation to abortion.Results: In the current study, the prevalence of MTHFR A1298C mutations was in 52.5% of cases, with homozygosity in 15 % of cases and heterozygosity in 37.5% of cases. However, the total prevalence of the MTHFR C667T gene mutations was 30% of cases only and all are heterozygous. Four cases were prevalent with combined thrombophilia (MTHFR C677T and A1298C) in the participating cases. Finally, the number of individuals were assessed for each of the gene mutations based on of homozygous or heterozygous. No homozygous cases were detected for MTHFR C667T gene mutation.Conclusions: In this current study, there is an association between miscarriage and thrombophilia.
      PubDate: 2021-02-24
      DOI: 10.18203/2320-1770.ijrcog20210492
      Issue No: Vol. 10, No. 3 (2021)
       
  • Management outcomes of ectopic pregnancy depending on different treatment
           modalities: a cohort study

    • Authors: Shawqi H. Alawdi, Mayada Roumieh, Marwan Alhalabi
      Pages: 842 - 847
      Abstract: Background: Ectopic pregnancy is the most common cause of maternal morbidity and mortality during the first trimester of pregnancy. The present study aimed to review and evaluate the management outcomes of ectopic pregnancy in Damascus University Maternity Hospital, Syria.Methods: A retrospective cohort study was performed on women referring to Damascus University Hospital of Obstetrics and Gynecology (OBGYN) for ectopic pregnancy. Patients were assigned into groups by method of treatment: expectant management (Group 1), single-dose methotrexate regimen (Group 2), two-dose methotrexate regimen (Group 3), and surgical intervention (Group 4). Parameters assessed were risk factors for ectopic pregnancies, transvaginal ultrasonography findings, serum human chorionic gonadotropin (hCG) levels on Days 0, 4, 7, and types of surgical intervention in women that underwent any surgical intervention. A treatment modality was considered successful when hCG levels declined to less than 5 mIU/L without further administration of methotrexate dose or need for surgery.Results: Seventy-seven women with ectopic pregnancy were admitted to the hospital during the study period. Groups 1, 2, 3, and 4 constituted 20.8%, 13.0%, 6.5% and 59.7% of the patients respectively. The most common encountered risk factors for ectopic pregnancy in the patients were history of previous intra-abdominal or pelvic surgery (57.1%) and history of miscarriage (41.6%). A statistically significant difference in the serum hCG concentrations measured on day 0, day 4, and day 7 were observed between the groups.Conclusions: The success rate in ectopic pregnancy treatment was 56.25% for the expectant management, 70% for the single-dose methotrexate regimen, and 40% for two-dose methotrexate regimen.
      PubDate: 2021-02-24
      DOI: 10.18203/2320-1770.ijrcog20210531
      Issue No: Vol. 10, No. 3 (2021)
       
  • Breast cancer in adolescent and young adult Ivory coast women:
           epidemiological and clinical features and molecular subdivision

    • Authors: Edele Kacou Aka, Apollinaire Horo, Abdoul Koffi, Mohamed Fanny, Coulibaly Didi-Kouko, Guy Nda, Alain Abouna, Mamourou Kone
      Pages: 848 - 852
      Abstract: Background: To describe the anatomy and clinical features and then determine the histological and molecular profile of Ivorian women under 40 years.Methods: This is a retrospective multi-centre study descriptive and analytic performed over a period of 20 months. It involved 76 women on 355 selected in the Ivoirian cancer registry. An additional immunohistochemical analysis to assess hormone receptors and HER overexpression in a single unit.Results: Adolescents and young adults represented 20.3% of women with breast cancer. The average age of women was 35 years. (∂=3.4 years, 95% CI=[2.6415 to 4.1785]). 15.8% of patients had a good socioeconomic level with a stable job, well paid and 28.9% had a university degree. The discovery circumstances were a breast nodule (53%) followed by locoregional complications (21%) and breast self-examination (20%). The consultation delay was less than three months in 34.2% of cases. 78% of cancers were diagnosed in stage II and III. The most common histological subtypes were respectively RP (+) / Her (-) (41%) followed by triple negative (30%).Conclusions: This study showed that 20,3% of women under 40 years. The most tumors were classified as stage II and III of tumors at diagnosis. the most common histologic subtypes are the Luminal A (41%) and triple-negative (30%). This disease is more aggressive with a poor prognosis in this age group.
      PubDate: 2021-02-24
      DOI: 10.18203/2320-1770.ijrcog20210698
      Issue No: Vol. 10, No. 3 (2021)
       
  • Severe malaria during pregnancy at the maternity ward of the municipal
           medical center of Ratoma, Guinea-Conakry

    • Authors: Mamadou H. Diallo, Ibrahima S. Baldé, Alpha B. Barry, Ibrahima Sylla, Fatoumata B. Diallo, Christine Sagno, Namory Keita
      Pages: 853 - 857
      Abstract: Background: Gestational malaria remains a major public health problem in malarious areas. The objectives of this work were to describe the socio-demographic, clinical, paraclinical, therapeutic and prognostic characteristics of patients who developed severe malaria during pregnancy.Methods: It was a descriptive prospective study carried out in the maternity ward of Ratoma municipal medical center, which was carried out over a period of 6 months from 01 October 2018 to 31 March 2019. This study involved all pregnant women who had presented severe malaria according to WHO criteria.Results: The incidence of severe malaria during pregnancy was 7%. The average age of our patients was 22.4 years with extremes of 15 and 47 years. The symptomatology that motivated the consultation was variable, the most frequent signs were: hyperthermia (100%), headache (79%), vomiting (99%). The general examination at admission objectified a fever with an average temperature of 39°C with extremes of 38-40.4°C. All patients had a positive rapid diagnostic test (RDT) as well as their thicker drop. The hemogram revealed the existence of a more or less severe anemia in 89.9% of cases. All patients were treated with parenteral quinine (100%). Maternal lethality was 1.8%. After severe malaria, 70 patients (62.5%) carried their pregnancy to term and 40 delivered an eutrophic child (35.71%), 30 (26.78%) delivered a hypotrophic child, 20 (17.85%) had a spontaneous abortion, premature delivery was observed in 10 patients (8.9%), and fetal death in utero was observed in 12 patients (10.71%).Conclusions: All patients had received parenteral quinine curative therapy. Maternal and perinatal complications were common. To improve this prognosis, intermittent preventive treatment and the use of insecticide-treated nets, which are the most effective prevention method at this time, must be further promoted in anticipation of the much hoped-for vaccine.
      PubDate: 2021-02-24
      DOI: 10.18203/2320-1770.ijrcog20210699
      Issue No: Vol. 10, No. 3 (2021)
       
  • Analysis of burden of sexual assaults at Abuja: a 4-year retrospective
           study

    • Authors: Malachy Emeka Ayogu, Habiba Ibrahim Abdullahi, Nathaniel D. Adewole
      Pages: 858 - 864
      Abstract: Background: Sexual assault is a worldwide crime associated with traumatic experience and largely affects women and girls. It is greatly underreported, more especially in the low income countries due to our peculiar culture.Methods: A retrospective study of sexual assault victims managed at the Hospital from January 1, 2015 to December 31, 2018. Case notes were retrieved and relevant data extracted and analyzed.Results: A total of 58 cases were seen and mostly involving pupils/students 44 (75.9%) and singles 52 (89.7%). The ages ranged from 3 to 37 years with a mean of 14.1±7.8. The assailants were known to the victims in 63.8% of cases. Sexual assault through vaginal route was the commonest type 57 (98.3%) and perpetrated by one person in majority of cases (79.0%). Physical force (43.1%) was major method used to subdue victims. About 60.3% of assaults occurred during the daytime and mainly occurred (60.4%) at home/office. The time interval between assault and presentation in the hospital ranged from 6 hours to 96 hours; majority presented within 24 hours (59.6%). Only 35 (60.3%) reported to the police. About 48.3% received post exposure prophylaxis. About 37.7% eligible for emergency contraception received it. Only 32.8% of the victims completed 3- month follow-up.Conclusions: Sexual assault is common in our environment with most victims being less than 14 years of age and assailants were mostly persons known to them. Some victims presented late.
      PubDate: 2021-02-24
      DOI: 10.18203/2320-1770.ijrcog20210700
      Issue No: Vol. 10, No. 3 (2021)
       
  • Prediction of chronic endometritis using 2D and 3D transvaginal ultrasound
           examination in infertile women

    • Authors: Tamer H. Said
      Pages: 865 - 870
      Abstract: Background: Chronic endometritis is a pathology of continuous and hidden inflammatory process characterized by the infiltration of plasma cells into the endometrial stroma. Transvaginal bi-dimensional ultrasonography is in need to be evaluated in prediction of chronic endometritis in women with delayed pregnancy or infertility as a non-invasive, cheap, acceptable, and safe tool of diagnosis. Previously, 3D ultrasonography had been described as a novel for diagnosis of chronic endometritis and correlation of the images with hysteroscopic view results. Objectives were to predict the presence of chronic endometritis in infertile women during their reproductive age through examination of the uterine cavity by 2D and 3D transvaginal sonography to elicit proposed ultrasonographic signs of endometritis.Methods: This observational prospective study took place at Shatby university hospital, Alexanderia universtiy and was done on two hundred infertile women. Women were assigned for ultrasonographic evaluation as a part of pre-treatment assessment. Detailed history was taken from all the patients included in the study. General examination and routine laboratory investigations were done according to hospital protocol. All patients were asked to do ultrasound examination immediately postmenstrual and at the time of ovulation. We used 2D transvaginal ultrasound to predict chronic endometritis, we searched for 1) presence of persistent endometrial focal or diffuse thickening postmenstrual, 2) presence of focal echogenic foci in the triple line endometrium during ovulation. The 3D ultrasonography was done as confirmatory examination. Office hysteroscopy as the main method for diagnosis of endometritis was performed to all patients either after menses if the first sign was detected or at the time of ovulation if the second sign was detected.Results: The combination of persistent endometrial shreds and/or endometrial focal thickening or echogenicity can significantly predict presence of endometritis as the sensitivity and specificity of the combination were 94.90 and 81.37, respectively.Conclusions: Bi-dimensional ultrasonography done to infertile women at 2 phases of the menstrual period can predict the presence of chronic endometritis as a subtle cause of infertility and might be an indication for hysteroscopic evaluation for these patients.
      PubDate: 2021-02-24
      DOI: 10.18203/2320-1770.ijrcog20210701
      Issue No: Vol. 10, No. 3 (2021)
       
  • Birth and emergency preparedness and associated factors among postnatal
           mothers at Base Hospital Balangoda, Sri Lanka

    • Authors: Nadeeka Perera, Sampatha E. Goonewardena
      Pages: 871 - 878
      Abstract: Background: Birth and emergency preparedness is a cost effective and evidence based intervention recommended by the current WHO maternal care model and used in maternal care package in Sri Lanka. The aim of the study was to describe the birth and emergency preparedness and its associated factors among postnatal mothers at Base Hospital, Balangoda, Sri Lanka.Methods: A descriptive cross sectional study was conducted among 427 postnatal mothers delivered after completion of 37 weeks of period of amenorrhoea. Participants were recruited by systematic sampling. Data was collected using a pre tested interviewer administered questionnaire. Data was analysed using SPSS version 21. Descriptive statistics and multiple logistic regression analysis were done to calculate the adjusted Odds ratio and 95% confidence interval. A probability of p<0.05 was considered significant.Results: Majority 84.3% (n=338) had registered at antenatal care before 12 weeks and 89.3% (n=358) had received domiciliary care during antenatal period. Majority of the mothers (59.4%,n=238) were well prepared for birth and emergencies. Univariate analysis showed a significant association with well preparedness were ethnicity (p<0.001), religion (p<0.001), married mothers in union (p<0.05), higher educational qualifications by both partners (p<0.01), receiving adequate maternity social support (p<0.001), received domiciliary care by PHM (p<0.05) and participation at antenatal classes by mother (p<0.05). After adjusting for confounders, attained higher educational qualifications by mother (OR=1.89, 95% CI=1.27-2.93) and having received social support (OR=2.64, 95% CI=1.43-4.87) were significant factors associated with birth preparedness.Conclusions: The overall preparedness for birth and emergencies was satisfactory. Modifiable significant associated factors need due attention.
      PubDate: 2021-02-24
      DOI: 10.18203/2320-1770.ijrcog20210702
      Issue No: Vol. 10, No. 3 (2021)
       
  • Medical management of ectopic pregnancy in a low resource setting: the
           role of methotrexate

    • Authors: Simon Birame Ndour, Mamour Gueye, Abdoul Aziz Diouf, Moussa Diallo
      Pages: 879 - 884
      Abstract: Background: Medical treatment using methotrexate. However, its indications and the protocol of administration are still under discussion. Even if follow-up problems are often raised in developing countries, medical treatment of ectopic pregnancy remains a reasonable option that we practice and share our experience here.Methods: We performed a retrospective cohort study of patients managed for an unruptured ectopic pregnancy in two university hospital facilities in Dakar: the Centre Hospitalier National de Pikine and the Centre de Santé de Philipe Maguilen Senghor. The data of this study are spread over a period of 10 years, from 2010 and 2019. We planned to evaluate maternal age, parity, gestational age, diagnosis circumstances, medical management, monitoring, and outcome. A single dose protocol was used. Data extracted from the registries were transferred to Microsoft Excel 2019, Mac version and then moved to SPSS (Statistical Package for Social Sciences, 26.Results: Over ten years, we had registered 18 patients who had received medical treatment out of a total of 263 ectopic pregnancies treated in the two facilities, i.e., a frequency of 6.8%. The average age was 28.8 years. The average initial HCG level was 10,460 mIU/ml. Treatment succeeded in more than 6 out of 10 patients (61.1%). However, we noted 5 cases of failure that had secondarily benefited from salpingectomy by laparotomy.Conclusions: Methotrexate is now part of the therapeutic arsenal in the management of unruptured tubal ectopic pregnancies. However, in developing countries, particularly in Senegal, there is a reluctance to use this therapeutic method, which, however, when a personalized follow-up is carried out, is achievable with a success rate comparable to other therapeutic methods.
      PubDate: 2021-02-24
      DOI: 10.18203/2320-1770.ijrcog20210703
      Issue No: Vol. 10, No. 3 (2021)
       
  • Prospective study to compare abdominal hysterectomy versus non- descent
           vaginal hysterectomy at a tertiary care hospital

    • Authors: Paresh N. Sheth, Prema Ram Choudhary
      Pages: 885 - 888
      Abstract: Background: Hysterectomy can be performed by vaginal, abdominal and via laparoscopic route. In the current scenario of importance of non-invasive surgery there has been increase in interest and requirement of vaginal hysterectomy for non-prolapsed uterus i.e. Non-descent vaginal hysterectomy (NDVH) due to scarless surgery. Gynecologist across the world continue to use the abdominal approach for a large majority of hysterectomies that may be performed vaginally despite well documented evidence which says that vaginal hysterectomy do have better outcome. This study aimed to find out to compare outcomes of NDVH and Abdominal hysterectomy (AH).Methods: The study is conducted at department of Obstetrics and Gynecology, at a tertiary care hospital Gujarat, India, between the periods of May 2018 to December 2019 of 100 patients. 50 Patients who underwent hysterectomy by abdominal route are taken as study group A and 50 Patients who underwent hysterectomy by vaginal routes are taken as group B.Results: Out of 100 women we have studied, duration of surgery, intra operative blood loss, intra operative complications, postoperative morbidity and duration of hospital stay, time required to resume normal work are less in group B (NDVH).Conclusions: It can be concluded that NDVH is feasible, safe and better alternative to abdominal hysterectomy for benign gynecological conditions. It also provides greater efficacy and safety with minimal invasiveness.
      PubDate: 2021-02-24
      DOI: 10.18203/2320-1770.ijrcog20210529
      Issue No: Vol. 10, No. 3 (2021)
       
  • Maternal and neonatal outcomes in teenage pregnancy: an observational
           study from Odisha

    • Authors: Arabinda Nepak, Surendra Nath Soren, Ashish Kumar Karjee
      Pages: 889 - 892
      Abstract: Background: With changing socio-demographic landscape of India, teenage pregnancy has become an important public health issue. The present study was conducted to assess the incidence of teenage pregnancy in Berhampur, Odisha and various maternal and neonatal outcomes of these pregnancies.Methods: This observational study was conducted on 564 antenatal mothers aged 16 to 19 years, who from October 2018 to September 2020. Demographic information of the mothers was noted. Maternal complications during antenatal, intrapartum and postpartum period were noted. Neonatal outcomes, mode of delivery, complications and need for intensive care unit admission was noted. The data collected was described in tabulated form.Results: The incidence of teenage pregnancy at our centre was 4%. Of the 564 teenage pregnancies, 214 were anaemic, pregnancy induced hypertension in 74 and 129 had preterm labour. The caesarean section rate was performed in 51.9%, and the most common indications for caesarean section were fetal distress and cephalopelvic disproportion. Of the 553 live births, 1.04% of them weighed <1.5 kg, 29.16% weighed 1.5 till 2.5 kg, 65.5% weighed between 2.5 to 3.5 kg and 5.2% weighed >3.5 kg. NICU admission was required for 26.9% of the neonates and the most common complication was neonatal jaundice, which was observed in 14.3%.Conclusions: Teenage pregnancies represent a high-risk. The present study demonstrated the various maternal as well as neonatal complications in teenage pregnancies. Those who experience teenage pregnancy should be given extra attention and care.
      PubDate: 2021-02-24
      DOI: 10.18203/2320-1770.ijrcog20210470
      Issue No: Vol. 10, No. 3 (2021)
       
  • Thyroid dysfunction among Indian pregnant women and its effect on the
           maternal and fetal outcome

    • Authors: Aditi Jain, Raksha M., Kanakalatha D. Nakum
      Pages: 893 - 898
      Abstract: Background: Screening of thyroid disorders in antenatal women during first trimester, to recommend management of thyroid disorder during pregnancy and to know the maternal and fetal outcome of such pregnancy.Methods: This is a prospective study for the incidence of thyroid disorder in early pregnancy and the outcome of such pregnancy. 100 cases were randomly selected from the antenatal clinic at a tertiary care hospital in India and after fulfilling the inclusion criteria they were subjected to screening for thyroid disorder till 13 weeks of pregnancy. TSH is often considered the “gold standard” for assessing thyroid function. If the participant had normal value then she was not subjected to follow up, but if abnormal, then follow up was done after 4-8 weeks, thyroid profile was repeated and if values were altered, they were medically managed and closely monitored. The obstetric and perinatal outcome of the pregnancy was noted.Results: In this screening study to detect and manage thyroid disorder, 100 antenatal women were selected randomly, from which 49 women where primigravidae and 51 women were multi-gravidae, 17 of them were of <20years, 54 were between 21 to 25 years. There was 5 percent incidence of thyroid disorder in the study group. There were 3 cases of hyperthyroidism and 2 cases of overt hypothyroidism which had poor fetal and maternal outcome on follow up.Conclusions: Our study shows that the evaluation of thyroid disorders in early pregnancy and timely intervention will lead to a decrease in the complications thereby improving the maternal and fetal outcome.
      PubDate: 2021-02-24
      DOI: 10.18203/2320-1770.ijrcog20210528
      Issue No: Vol. 10, No. 3 (2021)
       
  • Making caesarean myomectomy safe and feasible: a 12 year single center
           experience

    • Authors: Priti Agrawal, Rishi Agrawal, Anandi Lobo, Jyotirmay Chandrakar
      Pages: 899 - 904
      Abstract: Background: To standardize our protocol of caesarean myomectomy to make it safe and feasible for all patients.Methods: This prospective study was conducted in Aarogya Hospital and test tube baby Centre, Raipur from 1st January 2008 to 1st August 2020. Total 45 patients who had documented fibroid in index pregnancy and consented for the procedure were included. B- Lynch sutures were prophylactically applied in all cases to prevent PPH.Results: Our maximum patients were between the age of 20-30 years (66.67%) and 75.56% were primigravida. 44.45% cases were of intramural fibroids and in 53.34% cases the size of myoma was >5 cm. Malpresentation was seen in 15.56% cases. 62.22% myomas were removed through single incision. 33.33% patients had uneventful second CS with us with excellent scar healing in 93.33% cases. 20% cases had secondary infertility and are advised further evaluation to find cause of infertility.Conclusions: The decision to proceed with elective myomectomy at time of CS should be approached with proper pre-operative evaluation of the patient, thorough counseling for hysterectomy if required, expert team, arrangement of blood and adequate correction of medical factors like anemia, hypertension, and diabetes mellitus. Prophylactic application of B -Lynch sutures in all the cases made a dramatic improvement in tone of uterus which we observed intra operatively.
      PubDate: 2021-02-24
      DOI: 10.18203/2320-1770.ijrcog20210704
      Issue No: Vol. 10, No. 3 (2021)
       
  • A prospective observational study of foetal outcome in twin pregnancy
           delivering at a tertiary health care center of South Gujarat

    • Authors: Heny K. Jariwala, Falguni B. Patel, Minal R. Chaudhari, Anjani Shrivastava
      Pages: 905 - 908
      Abstract: Background: Worldwide increased incidence of twin gestation. The rates of twin gestation have a direct effect on the rates of preterm birth and its co-morbidities. Importantly, this increased risk applies to each fetus and is not simply the result of more foetuses.Methods: This prospective study was carried out in department of obstetrics and gynaecology. 100 consecutive subjects fulfilling inclusion criteria   admitted to labour room and obstetrics intensive care enrolled over a period of around 1 year.Results: In this study twin delivery accounted for 1.3% of all delivery at our institute. On analysing neonatal morbidities Prematurity was commonest 65%, VLBW (23% first twin, 30% second twin), RDS (9% first twin, 13% second twin), birth asphyxia (7% first twin, 12% second twin), neonatal hyperbilirubinemia (7% first twin, 8% second twin). 34% of first twin and 40% of second twin required NICU admission. Early neonatal death observed in 6% of first twin and 8% of second twin. It was observed that proportion of neonatal complications was more in MCDA as compared to DCDA and in un-booked subjects as compared to booked subjects. This difference is statistically significant among both twin (p value<0.05).Conclusions: Twin pregnancy is associated with high perinatal morbidity. Specialized obstetrics and Intensive Neonatal care can decrease neonatal morbidity and mortality in twin gestation. We need to be extra vigilant in monochorionic twins and twin pregnancy with inadequate antenatal care.
      PubDate: 2021-02-24
      DOI: 10.18203/2320-1770.ijrcog20210705
      Issue No: Vol. 10, No. 3 (2021)
       
  • Clinical and microscopic correlation of abnormal vaginal discharge

    • Authors: Usharani N., Swetha D.
      Pages: 909 - 914
      Abstract: Background: Vaginal discharge in the reproductive age group is the most common complaint encountered everyday both by gynaecologists and general practitioners. The prevalence of vaginal discharge in India is estimated to be 30%. Bacterial vaginosis is the most common cause, followed by Candidiasis and Trichomonasis. Aims and objectives of the study were to correlate clinical and microscopic methods for diagnosing abnormal vaginal discharge and to find out the most common cause of abnormal vaginal discharge in our set up.Methods: The study was carried out in Gynaecological OPD of VIMS, Ballari. After thorough history and gynecological examination, three samples were collected from the posterior fornix of vagina using sterile cotton swabs. The first swab was used to detect trichomonas vaginalis using wet mount microscopy. The second swab was used to determine amine/fishy odour (Whiff test). The third swab was used for gram staining to diagnose Bacterial vaginosis and Candida. The Gram-stained slides was evaluated using Nugent’s scoring system for detection of BV.Results: Bacterial vaginosis constitutes the most common cause of vaginal discharge, followed by Candidiasis and then Trichomoniasis in our set up. The sensitivity of clinical diagnosis is 71.93%, 88.9%, and 33.3% and specificity are 54.65%, 92.15% and 99.49% for Bacterial vaginosis, Candidiasis, and Trichomoniasis respectively.Conclusions: The most ideal approach is the microbiological approach for the etiological diagnosis of symptomatic vaginal discharge. The most common cause of abnormal vaginal discharge is Bacterial vaginosis followed by Candidiasis and Trichomoniasis.
      PubDate: 2021-02-24
      DOI: 10.18203/2320-1770.ijrcog20210706
      Issue No: Vol. 10, No. 3 (2021)
       
  • Maternal death audit at tertiary care centre: changing trends

    • Authors: Sudha Sivakumar, Sophia G. Xavarina, Ashmitaa Srianand
      Pages: 915 - 919
      Abstract: Background: The aim of the study was to analyse the trend in maternal mortality ratio in a tertiary care centre.Methods: This was a four-year retrospective analysis of maternal deaths that occurred at Government Rajaji Hospital, Department of Obstetrics and Gynaecology, Madurai from January 2017 to December 2020. Cases were stratified based on cause of death. Epidemiological data was collected from the hospital register.Results: The total number of maternal deaths at GRH during the study period is 228, in which death due to obstetric cause was 82 (36%) and non-obstetric cause was 146 (64%). The most common cause in each year was PIH (23%-2017, 29%- 2018), heart disease (22%- 2019) and infection (46%- 2020).Conclusions: We concluded by this study that the maternal death due to non-obstetric causes were more than the obstetric causes due to improved antenatal, post-natal care, institutionalized deliveries and timely referral to the CEmONC (comprehensive emergency obstetric and new-born care) centres and management.
      PubDate: 2021-02-24
      DOI: 10.18203/2320-1770.ijrcog20210707
      Issue No: Vol. 10, No. 3 (2021)
       
  • Feto-maternal outcome study in hypertensive disorders of pregnancy:
           primigravida vs multigravida

    • Authors: Jaydeb Mandal, Dibyendu Roy
      Pages: 920 - 924
      Abstract: Background: Approximately 7-10% of all pregnancies are complicated by some form of hypertensive disorders. Hypertensive disorders of pregnancy (HDP) are major cause of maternal morbidity and mortality as well as fetal complications. This study is aimed to determine and compare the maternal and perinatal outcomes of hypertensive pregnancies in between primigravida and multigravida.Methods: After taking college ethical committee permission a prospective comparative study was done in our medical college from January 2017 to April 2017 with 300 women having HDP from 3658 admitted patients in that time. They were enquired and followed up as per questionnaire till their discharge from the hospital. Among study women 174 women were primigravida, 126 were multigravida. The prevalence of maternal events and complications like eclampsia, IUGR, preterm labour (PTL), HELLP syndrome DIC, mode of delivery and fetal events like Apgar’s score, birth weight were studied and compared among primigravida and multigravida. All the events related to pregnancy outcomes were analyzed statistically.Results: Our study shows prevalence of HDP was 8.2% of total admitted patients, of them 58% were primigravida, 42% multigravida. Primigravida compared to multigravida had a higher tendency to have IUGR, PTL. DIC is also slightly more in primigravida but placental abruption and PPH were more in multigravida. Fetal outcome study showed babies born with low birth weight is significantly more in primigravida and higher incidence of severe asphyxiated babies were born in primigravida. More than 40% primigravida were terminated by caesarean section, most of them had emergency indication.Conclusions: Primigravidas are more sufferer to HDP and its complications. Comprehensive antenatal care at the same time strict vigilance during delivery and quality postnatal care of high risk patients specially primigravida group could significantly reduce maternal morbidity and mortality and improves fetal outcome.
      PubDate: 2021-02-24
      DOI: 10.18203/2320-1770.ijrcog20210708
      Issue No: Vol. 10, No. 3 (2021)
       
  • Antenatally diagnosed congenital anomalies-trend in tertiary care hospital

    • Authors: Kamal Kishore, Madhusudan Dey, Ashisha Gaba, Shijith K. P., Reema Kumar Bhatt
      Pages: 925 - 928
      Abstract: Background: Antenatally diagnosed, congenital abnormalities of the fetus are frequently offered antenatal surgical consultation in all tertiary care hospitals to adequately counsel prospective parents. We aimed to assess the current trends in antenatally diagnosed congenital malformations of fetus in patients who had presented to our hospital for reassessment or surgical consultation and these patients were counselled and prognosticated after confirmation of anomaly at our centre accordingly.Methods: This was a retrospective study of all the cases diagnosed antenatally with fetal abnormalities. All cases were referred to either pediatric surgery outpatient department or fetal medicine subunit of a tertiary care centre from January 2017-December 2018. The complete records of these pregnant women were perused, presence and type of anomaly confirmed at our centre and trends about types of anomalies analysed.Results: A total of 209 women were analyzed for antenatal anomalies, out of these patients medical termination of pregnancy was offered to 27 (12.9%) patients, in which 38 anomalies were detected and in 182 (87%) patients pregnancy was continued to delivery. A total of 223 anomalies were detected in this group with some patients having fetuses with more than one anomaly. Gastrointestinal abnormalities were present in 94 (51.6%) patients of those who delivered and accounted for the most common anomaly followed by CNS abnormality which accounted for 39 (21.4%) of total abnormalities and genitourinary abnormalities contributed to 28 (13.3%) of abnormalities. A total of 85.2% of patients were referred after 20 weeks.Conclusions: The significant number of patients with major congenital anomalies are still diagnosed at a date later than permissible time for termination of gestation (20 weeks). There were cases where anomaly scan was done at a later gestation and then there were others where inadequate counselling made patient to present late for prognostication. However, there are certain anomalies that are picked up late and are likely to be missed in the routine anomaly scan. Therefore, antenatal detection and early referral helps in offering early counselling and better outcome for pregnancy. 
      PubDate: 2021-02-24
      DOI: 10.18203/2320-1770.ijrcog20210709
      Issue No: Vol. 10, No. 3 (2021)
       
  • Thyroid function in women with polycystic ovary syndrome

    • Authors: Bharti Patidar, Rekha Sapkal
      Pages: 929 - 934
      Abstract: Background: This study aimed to assess the serum thyroid stimulating hormone (TSH) levels in women with polycystic ovary syndrome (PCOS), and its variation with obesity, insulin resistance and LH:FSH ratio.Methods: This was a facility based cross sectional study conducted for a period of 18 months on a total of 165 females with PCOS diagnosed based on Rotterdam 2003 criteria. A thorough history and clinical and anthropometric examination was conducted for all females. USG abdomen and serum TSH levels and fT4 were also done and the findings were recorded on questionnaire.Results: Subclinical hypothyroidism was documented in 17% females with PCOS. No statistically significant difference in mean values of LH:FSH ratio, insulin resistance, and obesity parameters were noted among euthyroid and subclinical hypothyroid females with PCOS (p>0.05). TSH levels in present study showed a statsitcally significant positive correlation with BMI.Conclusions: The proportions of thyroid disorders are higher in females with PCOS and they both may present with various similar clinical features. BMI in females with PCOS has significant positive correlation with TSH levels. However, it is not clear whether thyroid dysfunction has significant effect on insulin resistance.
      PubDate: 2021-02-24
      DOI: 10.18203/2320-1770.ijrcog20210710
      Issue No: Vol. 10, No. 3 (2021)
       
  • A comparative study on the outcome of mattress sutures and subcuticular
           sutures in caesarean and hysterectomy in obese patients

    • Authors: Padmavathi Narahari, Anilasre Atluri
      Pages: 935 - 938
      Abstract: Background: Selection of method of suturing is very important for a surgeon as it should be cosmetic, less painful, cost-effective and with less post -operative complications. Wound complications are comparatively more in obese than in non-obese patients. This has led to an increase in hospital stay and health cost for the patient. Hence selection of proper suture technique which would result in most favourable outcomes with least complications is of utmost importance. This study aimed to compare the outcome of subcuticular and mattress suture in obese patients.Methods: This was a retrospective study on 50 obese patients who underwent primary caesarean or hysterectomy with no previous surgeries in the past. Purposive sampling method was used for selection of patients. The wound was assessed by induration, wound discharge, infection, gaping, need for resuturing. All the patients underwent standard post-operative care. Statistical analysis was done by descriptive and inferential statistics.Results: Among the patients with subcuticular sutures, 15(60%) had wound induration with severe pain, 10 (40%) developed wound discharge, 6 (24%) had wound gaping and 6 (24%) required resuturing. Among the group with mattress sutures, 7 (28%) had wound induration, 3 (12%) developed wound discharge, 1 (4%) had wound gaping and required resuturing.Conclusions: Not only was wound induration and pain higher among the patients with subcuticular skin sutures but these patients had a significant increase in wound gaping and resuturing also when compared to the patients who had undergone closure with mattress skin sutures.
      PubDate: 2021-02-24
      DOI: 10.18203/2320-1770.ijrcog20210711
      Issue No: Vol. 10, No. 3 (2021)
       
  • Factors affecting stillbirth: prospective study

    • Authors: Balaji Jadhav, Shweta Avinash Khade, Ganesh Shinde, Shilpa Chandan
      Pages: 939 - 945
      Abstract: Background: Stillbirth is defined by WHO as the birth of a baby with a birth weight of 500 gm or more, 22 or more completed weeks of gestation or a body length of 25 cm or more, who died before or during labour and birth.Methods: This was prospective observational study of factors affecting stillbirth was conducted in tertiary hospital for a period of 1 year from 1st June 2014 to 31st May 2015. During the study period, 200 parturient of gestational age 28 weeks or more and fetal weight 1000 gm or more with or without medical disorders were included.Results: The total number of births during study period was 11,951. Stillbirth rate in the present study was 16.73 per 1000 births. Most of stillbirths were seen in the antepartum period (76%) when compared to intrapartum period (24%). Maximum stillbirths occurred in gestational age of 36 weeks and above (52%) and fetal weight between 2001-2500 gm (27.50%). Patients with inadequate antenatal care, less than three visits had 86% stillbirths.Conclusions: Proper antenatal care, prompt referral services and availability of emergency obstetric care will provide a pivotal role for reduction of stillbirths.
      PubDate: 2021-02-24
      DOI: 10.18203/2320-1770.ijrcog20210712
      Issue No: Vol. 10, No. 3 (2021)
       
  • Revisiting depot medroxyprogesterone

    • Authors: Sumita Mehta, Ekta Kale, Fatima Rashid
      Pages: 946 - 949
      Abstract: Background: Injectable contraceptives form an important part of method mix of effective contraceptives used by women worldwide. Depot medroxyprogesterone (DMPA) is a long acting contraceptive which is safe, reversible and does not require any user action to maintain its efficacy.Methods: This was a prospective questionnaire based study conducted on 84 women who were acceptors of DMPA. The women were interviewed by the same health worker in the local language using a preset questionnaire which included questions regarding the demographic profile, contraceptive choices and positive and negative experiences related to usage of Injection DMPA.Results: Majority of the women were multiparous, between 25-30 years and were housewives. 19% women had started depo-provera after having one child while 87% started DMPA after their second child. The most common source of information about the contraceptive method was health care worker in 51.1% followed by friends in 30.9% and media in 17.8%. 53 women in the study group chose injection DMPA as it was convenient and safe. The most common side effect seen was amenorrhea followed by irregular bleeding, weight gain and pain abdomen. 91.6% women were satisfied with it and would recommend it to other women.Conclusions: Addressing the unmet need of family planning requires not only recruiting new clients but also assuring that women continue to use the contraceptive. Method related myths and concerns are an important reason for high discontinuation rates which need to be addressed during counselling sessions.
      PubDate: 2021-02-24
      DOI: 10.18203/2320-1770.ijrcog20210713
      Issue No: Vol. 10, No. 3 (2021)
       
  • A comparative study of magnesium sulphate and isoxsuprine as a tocolytic
           in preterm labour

    • Authors: Gayatri Mathuriya, Ritu Tarware
      Pages: 950 - 954
      Abstract: Background: Preterm birth is a significant health problem across the world because of associated neonatal mortality and short-and long-term morbidity in later life. The incidence in India is higher than developed countries.Methods: The present study conducted in the Department of Obstetrics and Gynaecology, MGM Medical College and M. Y. Hospital. Indore, (Madhya Pradesh). The patients selected from labour rooms.100 antenatal women of gestational age between 28 weeks to 37 weeks presenting with preterm labor, 50 in each group. Group A consisted women receiving magnesium sulphate, group B had women receiving isoxsuprine. Efficacy of the two tocolytics, prolongation of pregnancy and neonatal outcome in preterm labour was assessed.Results: Intravenous magnesium sulphate was much effective in postponement of preterm labour for at least 48 hours (74%) as compared to isoxsuprine (50%). As a cervical dilatation, effacement increased the success rate of both the drugs came down. Magnesium sulphate side effects were better monitored clinically and tolerated. Also, better neonatal outcome and lesser perinatal mortality were noticed in this group (24%) compared to isoxsuprine (54%).Conclusions: Prematurity is the one of the major risk factor determing perinatal outcome. There is no ideal tocolytic, short term prolongation till steroid coverage for lung maturit with minimum side effects and to achieve better perinatal outcome recommended. The number of nursery admissions of preterm babies with better perinatal outcome were observed with magnesium sulphate. Also, the number of nursery admissions of preterm babies were less when treated with magnesium sulphate as tocolytic (also found to have neuroprotective effects in various studies), as compared to isoxsuprine.
      PubDate: 2021-02-24
      DOI: 10.18203/2320-1770.ijrcog20210714
      Issue No: Vol. 10, No. 3 (2021)
       
  • A comparative study of intravenous hydration and amnioinfusion for IUGR
           associated with oligohydramnios in pregnant women and fetomaternal outcome
           

    • Authors: Garima Kumari
      Pages: 955 - 959
      Abstract: Background: Ultrasound assessment of amniotic fluid has significant implication in obstetric care and it has become an integral and important component of pregnancy assessment.Methods: A prospective study done in all pregnant women (n=30) who had been diagnosed with oligohydromnios (with AFI<8 by Phelan’s method) by ultrasonography will be attending in obstetric gynecology department SMS Medical College, Jaipur will be selected according to inclusion or exclusion criteria (as per sample size) after written informed consent.Results: Higher incidence of preterm delivery in the i.v. infusion group as compared to the amino acid group and difference was significant (p value <0.05). In amnioinfusion group 3 cases (20.0%) had LSCS and in i.v. infusion group 6 cases (40.0%) had delivered by LSCS. The distribution of delivery mode did not differ significantly across two intervention groups (p value >0.05). Significantly higher proportion of cases from amino acid group had larger birth weight and significantly higher proportion of cases from i.v. infusion group had smaller birth weight (p value <0.001).Conclusions: This study points towards the use of intravenous hydration and amnioinfusion in increasing the liquor in oligohydramnios associated with IUGR and proves useful in reducing perinatal morbidity and mortality.
      PubDate: 2021-02-24
      DOI: 10.18203/2320-1770.ijrcog20210715
      Issue No: Vol. 10, No. 3 (2021)
       
  • Surgical outcomes of patients with early cervical cancer treated with
           radical hysterectomy in a tertiary care hospital

    • Authors: Rameshkumar R., Namrata Kulkarni, Anuriti Sharma, Chaitra Kulkarni
      Pages: 960 - 964
      Abstract: Background: This study was undertaken to evaluate the surgical outcomes of patients with early cervical cancer treated with radical hysterectomy.Methods:  A total of 50 patients who underwent modified radical hysterectomy between April 2006 and April 2016 at Shri Dharmasthala Manjunatheswara medical college and hospital, Dharwad, Karnataka were retrospectively reviewed. The analysis included clinical and pathologic variables including age, tumour size, clinical stage, lymphovascular space involvement, tumour type and grade, lymph node metastases, surgical margin involvement, intraoperative and postoperative complications and pattern of adjuvant therapy were analysed. Results: The median age of the patient who underwent radical hysterectomy was 47.8 years, the mean parity being 3.6. Histologically, the most common type of malignancy encountered was squamous cell carcinoma of the cervix, which occurred in 42 patients (84 %). 8 (16%) showed involvement of 1 or more lymph nodes and evidence of lymphovascular invasion. Involvement of the resected vaginal margins was noted in 11 patients (22%). The average hospital stay was 19.8 days, the prolonged stay resulting from postoperative morbidity. Postoperative concurrent chemoradiation with cisplatin was administered in eight (16%) cases due to pelvic lymph node metastases. Postoperative vaginal brachytherapy was given in 11 (22%) cases because of positive vaginal margins.Conclusions: The present study shows that general gynaecologists with significant experience in general gynaecologic surgery may, with adequate but abbreviated training, become competent in performing a modified radical hysterectomy. 
      PubDate: 2021-02-24
      DOI: 10.18203/2320-1770.ijrcog20210716
      Issue No: Vol. 10, No. 3 (2021)
       
  • Inflammatory cytokine profile of VEGF and IL-6 from the endometrium of
           women with and without endometriosis

    • Authors: Ashish Ashish, Kusum Kusum, Sangeeta Rai, Kulsoom Zahra, Surendra Pratap Mishra, Gunjan Rai, Radha Chaube, Royana Singh
      Pages: 965 - 970
      Abstract: Background: Endometriosis affects an estimated 176 million women worldwide, which constitutes 10% of the total female population causing debilitating symptoms of pelvic pain and infertility, which limits the quality of reproductive life of affected women. The present study aimed to assess the serum level of VEGF and pro-inflammatory marker IL-6 in cases and normal healthy control groups.Methods: VEGF and IL-6 serum levels were measured by competitive sandwich enzyme-linked immunosorbent assay (ELISA) from 34 subjects with surgically confirmed endometriosis, 16 subjects with adenomyosis and 18 similar  age matched healthy controls with no clinical evidence of the disease or detectable endometriotic lesions at the time of surgical examination. Patients were characterized in terms of their socio-demographic and clinically diagnosed characteristics, including the validated infertility and chronic disease registries.Results: The mean serum level of VEGF was significantly (p<0.0001) higher in case of endometriosis (3887 ng/l) followed by adenomyosis (2588 ng/l) group and lower in case of normal healthy control (665 ng/l) group. The mean serum IL-6 was found to be highly significant (p<0.0001) in case of endometriosis (90.49 pg/ml) followed by adenomyosis (70.37 pg/ml) group and lower in case of normal healthy control (22.97 pg/ml) group.Conclusions: VEGF and IL-6 seems to play a crucial role in the implantation and development of endometriotic lesions, and the disease is associated with significant modulations in the serum levels of VEGF. IL-6 can be a reliable non-invasive diagnostic marker for endometriosis.
      PubDate: 2021-02-24
      DOI: 10.18203/2320-1770.ijrcog20210717
      Issue No: Vol. 10, No. 3 (2021)
       
  • Second trimester termination of pregnancy with misoprostol alone and
           misoprostol with isosorbide mononitrate: a comparative study

    • Authors: Pinkee Saxena, Neha Jaiswal, Shashi Lata Kabra, Vijay K. Kadam, Vidushi Saxena
      Pages: 971 - 974
      Abstract: Background: Aim of the study was to compare the efficacy of misoprostol   alone and misoprostol with isosorbide mononitrate in reducing the induction abortion time interval in second trimester termination of pregnancy.Methods: A randomized control prospective study was conducted. Patients seeking second trimester abortions were randomized in to two groups. Group A received 400 ugm of misoprostol per vaginum every 4 hours up to maximum of 5 doses. Group B patients received 400 ugm of misoprostol and 40mg of isosorbide nitrate intravaginally. Repeat dose of 400 ugm misoprostol and 20 mg of isosorbide mononitrate was given every 4 hours up to a maximum of 5 doses. The induction to abortion interval and side effects of the drugs used were noted.Results: A total 71 women seeking second trimester termination between 12 to 20 weeks gestation were recruited for the study. In group A, there were 36 patients and in group B there were 35 patients. In group A the mean induction abortion interval was 14.8±4.16 hours while in group B the mean induction-abortion interval was 12.45±3.9 hours. Patients treated with isosorbide mononitrate and misoprostol combination had statistically significantly lower induction abortion time interval when compared with misoprostol alone (p value 0.018).Conclusions: The study demonstrates that the combination of isosorbide mononitrate and misoprostol is more effective for termination of second trimester pregnancy than misoprostol alone. 
      PubDate: 2021-02-24
      DOI: 10.18203/2320-1770.ijrcog20210718
      Issue No: Vol. 10, No. 3 (2021)
       
  • Hysterectomy for benign conditions in a tertiary care centre: a clinical
           audit

    • Authors: K. Hymavathi, P. V. Sreeleena Madhuri, Maddipudi Brahmini, Sakthi Madhubala
      Pages: 975 - 981
      Abstract: Background: This clinical audit is to determine the indications, type, and outcome of hysterectomy performed for benign gynaecological conditions in two years and to identify the problem or issue (if any) in planning the hysterectomy for benign conditions.Methods: The present study is a hospital-based prospective study conducted in the Department of Obstetrics and Gynaecology, Narayana Medical College and Hospital, a tertiary care centre, Nellore, AP. Six hundred women, who underwent the hysterectomy during the study period are recruited into this study after obtaining hospital ethical committee approval and informed consent. Among the total of 50,450 women attended our OPD for gynaecological complaints, 600 patients underwent the hysterectomy. Thus 9.6% of total gynaecological admissions ended up with the hysterectomy.Results: The mean age group of the study is 49.07±8.0 years. Majority of women belonged to low socio-economic status. Predominant age group underwent hysterectomy was 40-49 years. Majority (78.2%; 469 cases) of hysterectomies were done in multiparous women. Chief complaints were menstrual irregularities. Abnormal uterine bleeding -leomyoma (AUB-L) (228 cases; 38%) was the most common indication for hysterectomy. Most commonly done procedure was total abdominal hysterectomy TAH (60.5%; 363 cases). 306 cases (51%) had oophorectomy  (beyond the age of 45 years).The various complications (hemorrhage, sepsis etc..) found to happen mainly in hysterectomies done through abdominal route. 95% of hysterectomised histopathological specimen’s histopathology reports correlated with the pre-operative biopsy reports.Conclusions: In proved benign conditions, women were counselled and encouraged for medical and conservative methods. Hysterectomies should be decided in those situations where the above measures fail and also where it was found to be the definitive management in the first instance. Woman’s option has also to be considered in certain cases. The route of hysterectomy has to be decided case to case basis and choice of the attending clinician. Oophorectomy was decided in the premenopausal women depending on the condition of the ovaries witnessed at the time of surgery.
      PubDate: 2021-02-24
      DOI: 10.18203/2320-1770.ijrcog20210719
      Issue No: Vol. 10, No. 3 (2021)
       
  • Role of dual biomarkers and uterine artery doppler study in predicting PIH
           and IUGR in antenatal patients registered in a tertiary care centre

    • Authors: Alka C. Bapat, Rupesh Kashikar, Shashi R. Goyal
      Pages: 982 - 987
      Abstract: Background: The incidence of IUGR is between 3 to 7%, whereas that of Hypertensive disorders of pregnancy is about 10% of pregnant women around the world. These conditions are associated with a high rate of perinatal morbidity and mortality, posing a need for the detection of the potential causes of maternal and foetal morbidity and mortality and for the prediction of these conditions early during pregnancy.Methods: Patients with first antenatal visit before 10 weeks gestation underwent routine NT scan between 11–13 weeks with bilateral UAD-RI of the maternal uterine arteries. The placental volume was assessed. Serum dual biomarker test (β hCG and PAPP-A) was performed after this scan and analysed as multiples of median (MoM). Blood pressure was recorded at every ANC visit till 2 weeks after delivery. Neonatal head and chest circumference, birth length and weight were recorded.Results: The mean values of PAPP-A levels of Non-PIH and PIH groups were 1.32±0.91 MoM and 0.68±0.39 MoM respectively, showing statistically significant difference.  The serum PAPP-A levels showed statistically significant difference between Non-IUGR and IUGR groups (1.24±0.87 MoM and 0.46±0.20 MoM respectively).Conclusions: In our study, PAPP-A level is observed as a good indicator for possible prediction of PIH and IUGR whereas levels of β hCG and UAD-RI were not good predictors. The role of Placental volume in prediction of IUGR needs to be explored further with larger sample size. Future studies are needed with a larger group with inclusion of measurement of PI values.
      PubDate: 2021-02-24
      DOI: 10.18203/2320-1770.ijrcog20210720
      Issue No: Vol. 10, No. 3 (2021)
       
  • Prevalence and risk factor analysis for postpartum depression: a cross
           sectional study at tertiary care center, Mangalore

    • Authors: Vatsala Kamath, Disha Ajila, Shashirekha H. D.
      Pages: 988 - 992
      Abstract: Background: The overall pooled estimate of the prevalence of Postpartum depression in Indian mothers is 22%. In India, women who deliver at a health facility often stays less than 48hrs after delivery and this leaves little opportunity for health personnel to counsel the mother and family members on the signs and symptoms of Postpartum depression (PPD) and when to seek care. So, it is important to screen the postpartum woman for depression. Edinburgh Postnatal Depression Scale is used as an effective tool to assess the level of postnatal depression. The objective of the study was to assess the prevalence and risk factors associated with postpartum depression in the postnatal mothers using EDPS scale.Methods: This study was conducted at A. J. Institute of Medical Sciences and Research Center from January 2019 to May 2020. A total of 950 postnatal mothers were interviewed using Edinburgh Postnatal Depression Scale.Results: A total of 950 cases were studied. Prevalence of Postpartum depression was 15.78%. Increased incidence was seen in the primigravida (12.2%) compared to multigravidas (3.57%). This study showed 1.89% mothers belonging to upper middle class, 5.05% belonging to lower middle class had PPD and 7.26% belonging to upper lower class and 1.57 % patients belonging to lower class had PPD. In our study, 9.26% patients who underwent normal vaginal delivery had PPD and 6.52% of patients who underwent lower segment caesarean section had PPD. In the present study, it was found that 1.05% mothers having IUD babies and 5.2% (96/950) mothers who required NICU admission developed PPD.Conclusions: In this study, the prevalence of postpartum depression was 15.78%. Risk of PPD is more with primigravida, belonging to lower middle class status, mothers who had NVD and mothers of IUD babies. Postpartum depression screening should be an integral part of postnatal care using EPDS scale. A multidisciplinary approach including obstetrician and psychiatrists and counsellor can jointly take care of the depressed mothers. Early screening of the women may reduce the adverse outcomes among both mother and child. Proper counselling should be done to all the pregnant women and the family members for the birth preparedness.
      PubDate: 2021-02-24
      DOI: 10.18203/2320-1770.ijrcog20210721
      Issue No: Vol. 10, No. 3 (2021)
       
  • Comparative study of non-descent vaginal hysterectomy and total
           laparoscopic hysterectomy performed for benign gynaecological conditions

    • Authors: Harshal Nimbannavar, Amey Chugh, Amulya Rama, Himadri Bal
      Pages: 993 - 998
      Abstract: Background: Hysterectomy is a common surgical procedure frequently performed in the day-to-day practice of gynaecology. Non-descent vaginal hysterectomy (NDVH), which is an art of gynaecological surgeons, has established its place in the realm of gynaecological surgeries. Total laparoscopic hysterectomy (TLH) has a steep learning curve, requires modernized OT set-up including special endoscopic instruments and may not be available in all centres. Non-decent vaginal hysterectomy is a viable alternative in such a scenario. Hence these two surgeries have been compared in this study.Methods: A total 40 patients undergoing hysterectomy for various benign indications, were included for the study. They were divided into two groups of 20 each. One group underwent TLH and the other NDVH. Demographic profile and other perioperative events were compared and statistically analysed.  Results: NDVH group experienced more pain and required a greater number of analgesic doses. The intraoperative blood loss was more in NDVH group and duration of surgery was significantly higher in NDVH group. Rest of the parameters were by and large comparable. The incidence of bladder injury was more in the TLH group as compared to NDVH group.Conclusions: Both NDVH and TLH have their pros and cons. In a given case the final decision will depend on a number of variables like human, financial and medical.
      PubDate: 2021-02-24
      DOI: 10.18203/2320-1770.ijrcog20210722
      Issue No: Vol. 10, No. 3 (2021)
       
  • Blood transfusion practices in obstetrics and gynecology: study of
           indications as a measure to prevent maternal morbidity and mortality

    • Authors: Neeta Chaudhary, Natasha Tyagi, Smita Tyagi, G. S. Manchanda, Malvika .
      Pages: 999 - 1004
      Abstract: Background: This is a study of rational use of blood transfusion in a tertiary care center. So, this study was done to find out the indications of blood transfusion in department of obstetrics and gynaecology and measures to minimize the requirement of blood transfusion to reduce maternal mortality and morbidity.Methods: This is a retrospective study in department of obstetrics and gynaecologyin Muzaffarnagar Medical College, Muzaffarnagar, U.P. in collaboration with the department of pathology including blood bank for the duration of 1 year i.e. 1st January, 2017 to 31st December, 2017.  Total transfusions in 1 year were 706 of which 406 were in obstetrics and 300 were in gynecology.Results: In our study maximum 16.20% blood transfusions were given during cesarean section in third trimester in unbooked cases who came with severe anemia in labour. Others were APH (12%) and abortions (13.05%). This shows that anemia is still a major cause of maternal mortality and morbidity in India. In Gynecological cases blood transfusion was more in third parity and above indicating that perimenopausal women were also more susceptible for anemia due to disease of perimenopausal age group like AUB and fibroid.Conclusions: Maximum number of transfusions specially PRBC in obstetrics were of moderate to severe anemia, mainly to the patients who were term or in labor and of high-risk pregnancies, who were unbooked with no antenatal care. In Gynecology cases, blood transfusion was of perimenopausal or menopausal group with moderate anemia. This comes to the conclusion that all preventive measures should be taken in females from womb to tomb to correct anemia and this will indirectly help to prevent maternal and perinatal morbidity and mortality.
      PubDate: 2021-02-24
      DOI: 10.18203/2320-1770.ijrcog20210723
      Issue No: Vol. 10, No. 3 (2021)
       
  • Immunohistochemical expression of P53 and Ki-67 on epithelial tumors of
           ovary

    • Authors: Ipsita Mohapatra, Nikku Harshini, Subha Ranjan Samantaray, K. Anantha Sahitya
      Pages: 1005 - 1010
      Abstract: Background: Ovarian cancer is the third most common gynaecologic cancer and it is well known for its late presentation at advanced stage. Epithelial tumors of the ovary (EOT) are commonest of all ovarian neoplasms and their malignant forms represent about 90% of ovarian cancers. The determination of cell proliferation has been reported to be of diagnostic and prognostic significance. Over expression of p53 and Ki-67 has been claimed to be a marker of poor prognosis in epithelial ovarian tumors. Aim this study was to evaluate the biological significance of p53 and Ki-67 and their antigen expression in epithelial ovarian cancer.Methods: This is an observational study of 52 cases of ovarian tumors which were diagnosed and operated at Dept of Gynaecology, Prathima institute of medical sciences in South India, between August 2018 to July 2020.Results: The mean age of diagnosis for benign, borderline and malignant epithelial tumors was 42years, 49 years, 56years respectively. Most common histological type was serous epithelial tumors (50%). Highest p53 and Ki-67 immunoreactivity was seen in malignant tumors. Their co-expression was seen in 46.2% of the cases.Conclusions: Epithelial tumors and their malignant forms are common ovarian cancers, which are well known for its lethality and late presentation. Immunohistochemical markers p53 and Ki-67 frequently over expressed in epithelial tumors and has a prognostic role in determining the biologic tumor behaviour which further helps in planning the treatment.
      PubDate: 2021-02-24
      DOI: 10.18203/2320-1770.ijrcog20210724
      Issue No: Vol. 10, No. 3 (2021)
       
  • Maternal and perinatal outcome in severe pre-eclampsia and eclampsia: a
           study of 120 cases at a tertiary health care center in Western India

    • Authors: Akash J. Patel, Babulal S. Patel, Akshay C. Shah, Shashwat K. Jani
      Pages: 1011 - 1016
      Abstract: Background: Hypertensive disorders of pregnancy are a leading cause of maternal and perinatal mortality and morbidity worldwide. Pre-eclampsia accounts for the majority of referrals in a tertiary care center as it stands one of the major causes of maternal and perinatal morbidity and mortality. It complicates 6-10% of all pregnancies. In India, they account for the third most important cause of maternal mortality. Patients with PIH are at a greater risk of abruptio placenta, cerebrovascular events, organ failure and DIC. Fetuses are at a greater risk of IUGR, preterm birth, small for gestational age and IUD. This study aimed to determine the maternal and perinatal outcomes of hospitalized pregnant cases with severe preeclampsia and eclampsia.Methods: This was a single year retrospective study conducted in a tertiary care center of Western India from May 2019 to May 2020. Maternal and perinatal outcomes were analyzed among the severe preeclampsia and eclampsia groups.Results: A total 52 (43.33%) of the cases were in the age group of 21-25 years, 64 (53.33%) were primigravidae and the majority were referred from peripheral hospitals. Liver function tests were deranged in 26.68% of the patients and 32.5% had abnormal renal function. Labetalol was the most commonly used antihypertensive and magnesium sulphate was the anticonvulsant used in all the cases. Lower segment caesarean section was the mode of delivery in 62 (51.67%) of the cases. Commonest maternal complication was atonic PPH (12.5%). There was one maternal mortality due to aspiration pneumonia. 85 (70.83%) of the babies needed NICU admission. There were 5 (4.16%) perinatal deaths.Conclusions: Accessible health care and health education and awareness regarding antenatal check-ups for all women will lead to early detection of severe preeclampsia. Prompt treatment and management of its complications will certainly improve the maternal and fetal outcome.
      PubDate: 2021-02-24
      DOI: 10.18203/2320-1770.ijrcog20210725
      Issue No: Vol. 10, No. 3 (2021)
       
  • Role of dinoprostone gel in induction of labour

    • Authors: Meet S. Patel, Shashwat K. Jani, Babulal S. Patel, Akshay C. Shah
      Pages: 1017 - 1021
      Abstract: Background: Labour induction is one of the most common intervention in obstetric practice. A simple application of PGE2 intracervical gel can ripen the cervix effectively and improve Bishop’s score there by helping in successful vaginal delivery. Considering its good performance, the dinoprostone slow-release vaginal insert is the first choice for elective induction of labour in postdate pregnancy and in patients with term pregnancy of premature rupture of membranes.Methods: This was a single year retrospective study conducted in a tertiary care center of western India from May 2019 to May 2020.Results: In group I women who delivered within 24 hours were included, in group II women who required re-instillation were included. The most common indication for induction in both the groups was past dates (accounting for 36.1% in group I and 47.3% in group II). The success rate in group I was 68.1% while in group II was 36.8%.  The rate of cesarean delivery in group I was 25.9%, while in Group II, it was 60.1%. Negligible maternal and neonatal complications were seen in both the groups.  Conclusions: The study showed that intracervical application of prostaglandin E2 is an effective, safe and acceptable method for induction of labor in women with unfavorable cervix and indications for induction. All these effects were achieved without increasing maternal and neonatal morbidity 
      PubDate: 2021-02-24
      DOI: 10.18203/2320-1770.ijrcog20210726
      Issue No: Vol. 10, No. 3 (2021)
       
  • A prospective study on feto-maternal outcome in patients with premature
           rupture of membranes at tertiary care center

    • Authors: Patil S. A., Gaikwad B. H., Purohit P., Chintan Upadhyay
      Pages: 1022 - 1026
      Abstract: Background: PROM is associated with increased risk of chorioamnionitis, unfavorable cervix and dysfunctional labour, increased cesarean rates, postpartum hemorrhage and endometritis in the mother. Possible neonatal outcomes in cases of PROM may include respiratory distress syndrome, hypothermia, hypoglycemia, intraventricular hemorrhage, broncho pulmonary dysplasia etc. Objective of this study the maternal and perinatal outcomes in premature rupture of membranes at term.Methods: This prospective study was done among 100 pregnant women with premature rupture of membranes after 37 completed weeks visited at department of obstetrics & Gynecology in RCSM Hospital, Kolhapur during June 2014 and June 2015. Inclusion Criteria was Gestational  age  of  >37  weeks  confirmed  by  dates,  clinical  examination  or ultrasound, cervical dilatation of <3 cms, Lack of uterine contractions for atleast 1 hour from PROM, Single live pregnancy in vertex presentation and PROM confirmed by Direct visualization or Litmus.Results: Present study found highest number of cases among age group 20-24 years and mean age was 22 years. Almost 70% cases were un-booked. Average duration to PROM to hospital admission was 9.6 hours. Most common maternal outcome was febrile illness Most common perinatal outcome was birth asphyxia and 3 perinatal death.Conclusions: Pregnancies complicated with PROM should have supervised labor preferably in an institution. Management of each case has to be individualised. A combined effort of obstetrician and neonatalogist is necessary. A good neonatal intensive care unit can be instrumental in reducing the perinatal morbidity and mortality.
      PubDate: 2021-02-24
      DOI: 10.18203/2320-1770.ijrcog20210727
      Issue No: Vol. 10, No. 3 (2021)
       
  • Mifepristone safety and efficacy in preinduction of labor: an
           observational study

    • Authors: Thota Sai Tejaswi, Shailaja R. Bidri
      Pages: 1027 - 1030
      Abstract: Background: When the continuation of pregnancy adversely affecting the mother and fetus, termination of pregnancy is planned. Mifepristone as a method of pre-inducing agent in late pregnancy by increasing sensitivity of the uterus to the actions of prostaglandins and increasing uterine contractility. Objective of this study is to know the efficacy of mifepristone as a preinduction cervical ripening and induction of labor.Methods: In this prospective randomized study, 130 pregnant women are included and divided into two groups i.e. study group(n=65), has received tab mifepristone 200 mg and control group (n=65) has not received any drug.  After the end of 24 hours, Bishops score in both the groups are assessed and those not in labor or with unfavourable cervix are administered with intracervical dinoprostone gel every 6 hourlies for maximum of 3 doses or until pregnant woman entered into active labor. Statistical analysis regarding improvement in Bishops score, induction active phase interval, induction delivery interval is observed.Results: After 24 hours, observation in the mean Bishops score has showed significant improvement in the study group (72.33%), when compared to control group (54.58%). % woman has gone into spontaneous labor in study group (61.5%), and in control group (75.4%). Induction to active phase time duration is less in study group with mean (10.53), and in control group (17.4). Induction to delivery time duration is also less in study group with mean (15.100) when compared to control group (22.100). 67.7% of patients has delivered by vaginally in study group, and in control group 41%.Conclusions: Tab. mifepristone 200 mg has a pre inducing agent for cervical ripening, shown better improvement in Bishops score within 24-48 hours and decreases time duration from induction to active phase and induction to delivery.
      PubDate: 2021-02-24
      DOI: 10.18203/2320-1770.ijrcog20210728
      Issue No: Vol. 10, No. 3 (2021)
       
  • The impact of high maternal body mass index on obstetric and perinatal
           outcomes

    • Authors: Natasha Sharma, Manasi Patnaik
      Pages: 1031 - 1035
      Abstract: Background: The incidence of obesity has increased to pandemic proportions over the last 20 years. Maternal obesity is associated with a wide array of adverse maternal pregnancy outcomes and increased risks in the offspring. The aim of the study was to find the effect of obesity on maternal and perinatal outcome in obese women in comparison to those of normal weight women.Methods: The study was designed as a case-control study. Antenatal women with first trimester body mass index (BMI) of more than 30 kg/m2 constituted the cases and those with BMI between 18 and 24.9 kg/m2 formed the controls.Results: There was increased incidence of antepartum complications in obese women. Obese women had a significant history of prior treatment for infertility (p<0.00001). The incidence of gestational diabetes (OR 4.76, 95%CI 1.267-17.72 p=0.014), gestational hypertension (OR 3.05, 95%CI 1.01-9.20 p=0.04), induction of labor (OR 2.5, 95%CI 1.0-6.28 p=0.04), preeclampsia (OR 2.38, 95%CI 1.0-5.64 p=0.04, Caesarean section (OR 1.98, 95%CI 1.24-3.14 p=0.003), postpartum haemorrhage (OR 8.57, 95%CI 1.07-76.15 p=0.04) and wound infection (OR 8.57, 95%CI 1.07-76.15 p=0.04) and adverse neonatal outcomes such as higher mean birth weight (p<0.0001) and requirement of NICU (OR 2.79, 95%CI 1.33 -5.84 p=0.006) was higher in obese women.Conclusions: Obesity is an independent risk factor for adverse pregnancy outcomes and hence, interventions directed towards weight loss and prevention of excessive weight gain must begin in the preconception period. 
      PubDate: 2021-02-24
      DOI: 10.18203/2320-1770.ijrcog20210729
      Issue No: Vol. 10, No. 3 (2021)
       
  • Experience of managing first fifty COVID-19 positive peripartum women in a
           tertiary care centre in North India

    • Authors: Vijay Zutshi, Neha Mohit Bhagwati, Alka .
      Pages: 1036 - 1041
      Abstract: Background: SARS-CoV-2 has caused significant morbidity and mortality worldwide. Analysis of the clinical profile of COVID-19 positive pregnant women is important to understand the pathophysiology, transmission and outcome of the disease in Indian population.Methods: It is a retrospective observational study of first fifty pregnant patients tested positive for COVID-19 by qRT PCR admitted for delivery in our hospital.Results: In this audit, first fifty COVID-19 pregnant women were studied and the mean age of the patients in this study was 26 years. 98% of these women were admitted for obstetric indications. Seventy two percent of these women were admitted with spontaneous onset of labour. Based on disease severity, 49 (98%) were either asymptomatic or exhibited mild disease and only 1 (2%) had severe disease who succumbed to her illness. Forty six percent patients delivered vaginally and 54% required cesarean delivery. The most common indication for LSCS was fetal distress (43%). Eighteen percent had preterm delivery. Among the newborn babies, one died due to severe birth asphyxia. Sixteen percent babies required NICU stay. Five babies tested positive for COVID-19 of which one baby was positive on day one of life.Conclusions: As per our results, majority of the COVID-19 positive pregnant women had mild disease. There has been increase in cesarean section rate as compared to the previous hospital figures. Only one baby tested positive within 24 hours of delivery so the possibility vertical transmission can not be commented upon as of today.
      PubDate: 2021-02-24
      DOI: 10.18203/2320-1770.ijrcog20210730
      Issue No: Vol. 10, No. 3 (2021)
       
  • Assessment of the pregnancy rates using sequential day 3 and day 5 embryo
           transfer in IVF/ ICSI patients

    • Authors: Priti Agrawal, Rishi Agrawal, Anandi Lobo
      Pages: 1042 - 1045
      Abstract: Background: To assess the pregnancy rates using sequential day 3 and day 5 embryo transfer in IVF/ ICSI patients.Methods: This prospective study was conducted in Aarogya Hospital and test tube baby Centre, Raipur from 1st January 2013 to 30th November 2019. Total 100 patients undergoing IVF/ICSI in the study period were offered sequential transfer.Results: Our fertilization rates were 80% with 85.7% grade I embryos on day 3. Blastocyst formation rate was 71.42%. Cycle cancellation rates were nil. Clinical pregnancy rates per retrieval cycle were 50% and implantation rates were 24% with acceptable multiple pregnancy rates of 12%.Conclusions: We advocate that this technique is useful in all patients having good quality embryos in adequate number for double transfer as this optimizes the chance of selection of the most viable embryo for transfer which is probably the key for a successful IVF program. 
      PubDate: 2021-02-24
      DOI: 10.18203/2320-1770.ijrcog20210731
      Issue No: Vol. 10, No. 3 (2021)
       
  • Maternal and neonatal outcome in premature rupture of membranes: a
           retrospective study

    • Authors: Shery Angel Rajakumar, Sindhura Myneni, Ajay Nickson Samuel
      Pages: 1046 - 1049
      Abstract: Background: Premature rupture of membranes (PROM) is one of the most challenging and controversial obstetric dilemma which occur even in low risk pregnancies. This study was done to analyse the maternal and neonatal outcomes in PROM cases.Methods: This was a retrospective study conducted in the department of Obstetrics and Gynaecology at Chettinad Hospital and Research Institute, during a period of 3 years from August 2017 to August 2020. All the women who admitted with PROM were included in the study. The data regarding parity, gestational age, number of fetuses, presentation, duration of PROM, PROM to delivery interval, mode of delivery, weight of the baby, NICU admission was collected from the hospital records and analysed.Results: A total of 115 cases of PROM were recorded. High incidence is found in the age group of 20-30 years. Among them 73.04% were admitted at term. 71.3% were primigravida. 58.26% of them delivered vaginally where as 41.74% delivered by LSCS. Majority of them admitted within 6 hours of PROM. Majority of them delivered within 12 hours of PROM. High APGAR scores in majority of the cases. Most of the babies had birth weight >2.5 kg. 16 babies were admitted in NICU. There was no maternal mortality in our study though we had one neonatal mortality.Conclusions: Careful identification of present or impending complications and individualizing the management based on gestational age and presence of complications holds good in optimising fetomaternal outcome in PROM. 
      PubDate: 2021-02-24
      DOI: 10.18203/2320-1770.ijrcog20210732
      Issue No: Vol. 10, No. 3 (2021)
       
  • Thrombocytopenia in pregnancy

    • Authors: Jui Manish Shah, Rakesh Anand
      Pages: 1050 - 1052
      Abstract: Background: Thrombocytopenia in pregnancy is defined as platelet count of less than 150,000/µl. It may be inherited or idiopathic, acute or chronic in onset, either primary or associated with other disorders. Gestational thrombocytopenia is the most common type which is diagnosed usually in the last trimester. When there is severe thrombocytopenia, it is usually pathological in origin. The goal of this study was to identify thrombocytopenia in early stages of pregnancy and evaluate the risk factors involved. Aim was the evaluation of thrombocytopenia in pregnancy.Methods: This was a prospective observational study conducted in the Obstetrics and Gynecology Department of a tertiary care centre from 1st January 2020 to 31st December 2020. Data was collected and analyzed by SPSS version 17.Results: In the current study, 71.1% of cases were mild thrombocytopenia and 64.4% were picked up in the third trimester. Out of the 90 cases taken, 64% of the cases were due to the most common cause i.e., gestational thrombocytopenia. The second most common cause of thrombocytopenia was pregnancy induced hypertension which accounted for 18% of the total number of cases. Symptomatic thrombocytopenia of moderate and severe degree was seen in cases of PIH and ITP. 37.5% of the cases had underlying hypertension.Conclusions: Timely identification and management of the cause of thrombocytopenia is crucial in the antenatal group of women. Although it is an incidental finding in most cases, when there is an underlying cause, severity of thrombocytopenia increases tremendously and has dire consequences. Every pregnant woman should undergo complete blood count examination once in each trimester to avoid maternal and fetal complications.
      PubDate: 2021-02-24
      DOI: 10.18203/2320-1770.ijrcog20210733
      Issue No: Vol. 10, No. 3 (2021)
       
  • Correlation between male and female genital tuberculosis: a prospective
           analytical study

    • Authors: Aarushi Chaudhary, Prabhjot Kaur, Richa Kansal, Vikas Dhillon, Isha Bansal
      Pages: 1053 - 1056
      Abstract: Background: Genital tuberculosis is an unusual extrapulmonary manifestation of tuberculosis, often seen in middle-aged men with renal or pulmonary disease. The most common male genital sites of tuberculous infection are the epididymis and prostate. It is also an important cause of female infertility in the world, especially in developing countries. Majority of infertility cases are due to involvement of the fallopian tubes. Hardly any study has been done to establish correlation between male and female genital TB. We have evaluated the same in severe oligospermic/ azoospermic males and established a definite correlation. Objective was to establish a definite correlation between female and male genital tuberculosis in patients with male factor infertility.Methods: 100 severe oligozoospermic/azoospermic males presenting with infertility between April 2011 and January 2016 were enrolled and worked up for genital tuberculosis. Their female partners were worked up for female genital TB and correlation established.Results: Out of 100 patients with severe oligospermia or azoospermia who tested positive for TB quantiferon gold test. 18% female partners tested positive for TB quantiferon gold test.Conclusions: Tubercular work up of both partners is desired in couples with male factor infertility especially in long standing infertility to achieve optimum pregnancy outcome with ART.
      PubDate: 2021-02-24
      DOI: 10.18203/2320-1770.ijrcog20210734
      Issue No: Vol. 10, No. 3 (2021)
       
  • Depression, anxiety and stress among COVID positive pregnant women

    • Authors: Simi Kurian, Ajith S., Malini Raghavan
      Pages: 1057 - 1061
      Abstract: Background: Impact of the news that patient is covid positive may increase the risk of depression and anxiety among the vulnerable population such as pregnant women. Aims of the study were to estimate the prevalence of depression, anxiety and stress among covid positive pregnant women. To evaluate the demographic and obstetric factors contributing to the psychological manifestations in covid positive pregnant women.Methods: A cross sectional descriptive study was conducted at a tertiary hospital of North Kerala from July to August 2020. The demographic and factors were recorded and DASS 21 self-reported questionnaire was used to assess depression, anxiety and stress.Results: We found that using the DASS 21 scoring system, 37.5% out of the 120 study subjects were having psychological symptoms either of depression, anxiety or stress. Depression was seen in 32 (26.7%), anxiety in 29 (24.2%) and stress in 14 (11.7%) of the study participants. The psychological symptoms of depression and anxiety were more pronounced in those with low education, unemployed and in the first and third trimester of pregnancy.Conclusions: The current study shows that COVID-19 positive pregnant women have a high prevalence of depression and anxiety. Our findings can be used to formulate psychological interventions to improve mental health and psychological resilience during the COVID-19 pandemic.
      PubDate: 2021-02-24
      DOI: 10.18203/2320-1770.ijrcog20210735
      Issue No: Vol. 10, No. 3 (2021)
       
  • A study of prevalence of urogenital problem among menopausal women
           attending the OPD at tertiary care hospital in Bhopal

    • Authors: Malini Bhardwaj, Tarani Shinde
      Pages: 1062 - 1065
      Abstract: Background: The interest in menopausal problems has increased in recent years, due to the expansion of human life span. Women are spending more than one-third of their lives in menopausal period. Due to this fact, estrogen deprivation can cause vaginal atrophy symptoms and vasomotor symptoms, which critically diminish quality of life (QOL) in postmenopausal women.Methods: This study is a retrospective observational/analytical study conducted in the menopausal specialty clinic in J. K. Hospital, L. N. Medical College, Bhopal over a period of 1 year. All the women who attained menopause either naturally or surgically who presented first time to the clinic for any complaints were evaluated for the UG symptoms with the help of face to face interview.Results: Out of the 300 women with menopausal symptoms, 182 i.e. 60.6% were married and 52% (156) were illiterate. The most prevalent menopausal symptom in present study was vaginal dryness 240 (80%).Conclusions: There is association with lower educational levels. Hence efforts should be made educate women about the symptoms and provide care at all the levels of health care delivery. 
      PubDate: 2021-02-24
      DOI: 10.18203/2320-1770.ijrcog20210736
      Issue No: Vol. 10, No. 3 (2021)
       
  • Changing trends and determinants of caesarean section using robson
           criteria in a government tertiary level hospital

    • Authors: Anjali Singh, Renuka Malik
      Pages: 1066 - 1072
      Abstract: Background: Robson Ten group classification system (TGCS) was proposed by World Health Organisation in 2014 for assessing, monitoring and comparing caesarean section rate between and within healthcare facilities. This tool was used in this study to analyse the determinants of caesarean section and compare with data of past.Methods: This observational comparative study was conducted at tertiary level hospital and included in study group A, 300 women delivered by caesarean section from November 2018 to November 2019 and in study group B, 300 women delivered by caesarean section from November 2015 to December 2016. The caesarean sections were classified as per TGCS to determine relative and absolute contribution made by each group to the overall caesarean section rate. The results were analysed to for determinants and change in trend.Results: In this study, the caesarean section rate in group A was 29.32% and group B was 28.03%. Group 2, 5, 1, 10 made the maximum contributions to overall caesarean section rate in both study groups. Group 2 was the largest contributor (25.00%) in study group A and 27.33% in study group B to overall caesarean sections.Conclusions: Implementing Robsons TGCS can help in comparing caesarean in an institution over a period of time and also among different institution at national and international level as a method of internal auditing, paving a way to rationalise and decrease Caesarean rate. 
      PubDate: 2021-02-24
      DOI: 10.18203/2320-1770.ijrcog20210737
      Issue No: Vol. 10, No. 3 (2021)
       
  • Prospective study to assess the obstetric and perinatal outcome in fibroid
           complicating pregnancy

    • Authors: Shalaka Dilip Mhatre, Ayushi Vazirani, Vidhya Selvam
      Pages: 1073 - 1076
      Abstract: Background: Fibroids are the most common benign tumour of the uterus. Complications ranges from approximately 10-40% in fibroid complicating pregnancy. The objective of the study was to assess obstetric and perinatal outcomes in fibroid complicating pregnancy.Methods: A prospective study was carried out over a period of 01 June 2019-30 October 2020 on 42 women diagnosed with fibroid uterus in pregnancy. The study was conducted in the Obstetrics and Gynaecology department of Sree Balaji Medical College and Hospital, Chennai. Routine basic investigations were done. Ultrasonogram was done at booking visit and during subsequent visits to assess the increase in the size of the fibroid and degeneration and other obstetric complications such as malpresentation and placenta previa.Results: Major proportion was in the younger age group of 25-35 years. Fibroids were more frequent in multigravidae 34 (80.96%), and primigravidae were 8 (19.04%). The reported incidence of fibroid in pregnancy ranges from 0.01%-10.7%. 27 (64.28%) women were asymptomatic during pregnancy. Out of 42 women, 10 (23.80%) were known cases of fibroid became pregnant, remaining 32 (76.19%) were diagnosed as having fibroid during routine antenatal visits. 2 women (22.22%) had pain, 3 of them (7.14%) had preterm labor, 3 (7.14%) had spontaneous miscarriage, 6 (14.2) had threatened abortion, and 1(2.3%) had abruption placentae and 1(2.5%) had placenta previa. Out of 39, 27 (69.23%) women had vaginal delivery of which 2 (7.40%) women had assisted vaginal delivery. Lower segment cesarean section done in 12 women (30.76%). 32 babies delivered (82.05%) appropriate for gestational age infants, 3 (7.69%) had LBW, and 4 (10.25%) were IUGR.Conclusions: Fibroid complicating pregnancy are associated with complications during the antepartum, intrapartum, and postpartum period hence a regular follow up and evaluation is a must. Most pregnancies with fibroids are asymptomatic but may adversely affect the obstetric and perinatal outcome. 
      PubDate: 2021-02-24
      DOI: 10.18203/2320-1770.ijrcog20210738
      Issue No: Vol. 10, No. 3 (2021)
       
  • Awareness regarding the strategies to bring down the pandemic among
           general population: a questionnaire based study

    • Authors: Varsha Christy Rani Balaji, Nithya R.
      Pages: 1077 - 1088
      Abstract: Background: The behavior of the general public will likely have an important effect on how the coronavirus disease 2019 (COVID-19) epidemic spreads, especially when the first wave is diminishing. The aim of the study is to determine the awareness regarding the strategies to bring down the pandemic among the general population of Tamil Nadu in South India.Methods: A cross-sectional online survey conducted in October 2020. A sample of consenting 500 adult, healthy caregivers of patients attending a tertiary medical institute who were representative of the general population formed the study group. They filled a pre-formed questionnaire. All data entry and analysis were performed using SPSS (version 24). Descriptive statistics and chi-square test were performed between the various sociodemographic factors of age, gender, occupation, and education, and COVID-19 exposure in the family. P≤0.05 was taken to be significant.Results: It was observed that age had a significant influence on the wearing of masks and the use of hand sanitizer. Gender, age and education are the important determinants for use of hand sanitizer, wearing a mask, practicing social distancing, avoid traveling to the infected areas as well as washing hands often and always using a facemask to prevent COVID-19 were statistically significant.Conclusions: The dynamics of the impact of the awareness campaign and public participation are understood by the results. There is a need for a training program with respect to locale-specific scenario targeted to a specific cluster of population emplaning upon their respective lifestyle, to improve the knowledge and compliance about risk and preventions. 
      PubDate: 2021-02-24
      DOI: 10.18203/2320-1770.ijrcog20210739
      Issue No: Vol. 10, No. 3 (2021)
       
  • Study on awareness, perceptions, experiences in decision process of
           hysterectomy in women presenting to Goa Medical College

    • Authors: Manjusha Jindal, Viraj Ramesh Naik, Mrinalini Sahasrabhojanee, Jagadish Cacodcar, Manojkumar S. Kulkarni, Smita Naik
      Pages: 1089 - 1094
      Abstract: Background: Hysterectomy (removal of uterus) has many indications like fibroids, dysfunctional uterine bleeding, uterine prolapse and chronic pelvic pain. The purpose of this study is to know the level of awareness of women about hysterectomy, to study their experiences, to assess their involvement in decision making process and to develop a suitable protocol, counselling and education material to ensure women’s involvement.Methods: This is a cross sectional study using validated semi-structured interview questionnaire over 6 months (1st December, 2018 to 31st May, 2019) in Goa Medical College. Data was entered in epidata manager and analysed using SPSS 22 version. Categorical variables were expressed in percentages and proportions and quantitative variables in mean±SD. Significance was checked using Chi square test and association between dependent and independent variables was assessed by using bivariate analysis. P value <0.05 was taken as significant.Results: A total of 149 women were recruited into the study who were admitted for hysterectomy. The mean age of women was 49.3 years. The awareness with respect to various aspects of hysterectomy was good in 23.4% subjects and poor in 76.6% subjects. The awareness was significantly related to level of education (p=0.002), urban location (p=0.016) and socioeconomic status (p=0.028). Education was significant factor in decision-making process (p< 0.05). It was observed that good experience had positive correlation to their perception about hysterectomy.Conclusions: It was concluded that awareness about hysterectomy was significantly related to education, urban location and socio-economic status of women. Pre-operative education would help to reduce the post-operative symptoms for a women undergoing hysterectomy.
      PubDate: 2021-02-24
      DOI: 10.18203/2320-1770.ijrcog20210740
      Issue No: Vol. 10, No. 3 (2021)
       
  • Preemptive use of adjunctive IV lidocaine for enhanced recovery after
           abdominal hysterectomy for overweight and obese women: a prospective,
           randomized, double-blind, placebo-controlled study

    • Authors: Nahla Waer Shady, Hassan Ahmed Farouk, Hany Farouk Sallam
      Pages: 1095 - 1101
      Abstract: Background: This investigation planned to evaluate the clinical results of adjunctive IV lidocaine bolus dose plus infusion for one hour after surgery in patients who underwent an abdominal hysterectomy in obese and overweight women.Methods: We performed a double-blind, placebo-controlled study, (ClinicalTrials.gov identifier: NC03748108), with patients undergoing abdominal hysterectomy divided into 2 groups: one group received intravenous lidocaine single bolus dose preoperatively and IV infusions till one hour after the surgical procedure, and the opposite received normal saline infusion (placebo). We assessed postoperative results, including pain scores rankings on a visual analog scale (VAS) in rest and movement, administration frequency of pethidine. Postoperative nausea and vomiting, the period of hospital stay (LOS), time to ambulate, and patient satisfaction at forty-eight hours had been evaluated. Chi-square test and Monte Carlo test have been used for comparison among groups.Results: There were 120 patients in our study. The visual analog scale (VAS), pain scores, length of hospital stay (LOS), and administration frequency of pethidine were significantly lower in the lidocaine group. The total amount of consumed pethidine was significantly lower in the lidocaine than the placebo group. There was a significant reduction in post-operative pain which was assessed by visual analog scale (VAS) after 2,4,8,12, and 24 hours either during movement or during rest in the lidocaine group compared to the placebo group, p=(0. 0001,0.0001,0.0001,0.0001 and 0.0001).Conclusions: The administration of adjuvant intravenous lidocaine infusion reduces pain during the postoperative period after abdominal hysterectomy, is associated with early recovery, decreased postoperative opioid analgesic requirement, and better patient satisfaction in overweight and obese women undergoing abdominal hysterectomy. 


      PubDate: 2021-02-24
      DOI: 10.18203/2320-1770.ijrcog20210741
      Issue No: Vol. 10, No. 3 (2021)
       
  • Study of incidence and severity of menopausal symptoms in women of sub
           Himalayan region, using the Greene Climacteric Scale

    • Authors: Geetika Syal, Neha Mohindroo, Anshul Rana, Rita Mittal
      Pages: 1102 - 1105
      Abstract: Background: Identifying and measuring menopausal symptoms using Greene Climacteric Scale and calculating the mean age at menopause to find out the frequency of the menopausal symptoms so that can be used for better perimenapausal and menopausal care to females.Methods: A cross-sectional study was conducted in a tertiary care center in northern India. All menopausal women in gynaecology outpatient department were enrolled in study, over six months from May 2019 to October 2019. A total of 206 women fulfilled the inclusion criteria and were interviewed using the 21 points Greene Climateric Scale (GCS) Questionnaire. Analysis was done using SPSS 20 Windows software. Descriptive statistics included computation of percentages, means and standard deviations. Level of significance was set at P≤0.05.Results: The mean age of menopause was 47.9±3.42 years. About 90.3% of the menopausal women studied belonged to the rural population. The most frequently perceived symptoms by females were muscle joint pain (100%), vaginal dryness and pruritus vulvae (84%), lower abdominal pain (79.6%), hot flushes (50.5%).The most frequently reported symptoms as per the GCS were muscle and joint pains, loss of interest in sex, headaches, feeling tired or lacking in energy, difficulty in concentrating, attacks of anxiety, difficulty in sleeping and hot flushes. The mean total score was 17.61.Conclusions: Menopausal symptoms were common in this study group but women seeking help for the same was less. Therefore menopause clinics and care programmes need to be developed and strengthened to promote better health and higher quality of life in menopausal women.
      PubDate: 2021-02-24
      DOI: 10.18203/2320-1770.ijrcog20210742
      Issue No: Vol. 10, No. 3 (2021)
       
  • Analysis of indication of caesarean sections according to Robson’s ten
           group classification system at a tertiary care teaching hospital in South
           Rajasthan

    • Authors: Saroj Saharan, Radha Rastogi, Deepti Chyaunal
      Pages: 1106 - 1110
      Abstract: Background: The objective of this study was categorization and evaluation of the caesarean section rate at our institute as per Robson’s formula.Methods: This retrospective study was conducted at department of obstetrics and gynecology, RNT Medical college, Udaipur, a tertiary care teaching hospital in South Rajasthan. The data was collected retrospectively from December 2020 to February 2020 over a period of 2 months and percentage were calculated in various groups as per Robson’s ten group classification system.Results: Among a total of 1195 women delivered during study period, 420 (35.14%) delivered by CS. Women with previous CS (group 5) contributed maximum (35.95%) to the total number of CS followed by group 2 (27.14%).Conclusions: Standardization of indication of caesarean deliveries, regular audits and definite protocol in hospitals will aid in curbing the rate of caesarean deliveries in hospitals.  
      PubDate: 2021-02-24
      DOI: 10.18203/2320-1770.ijrcog20210743
      Issue No: Vol. 10, No. 3 (2021)
       
  • Prevalence of thyroid disorders among pregnant women at a tertiary care
           hospital in Rajasthan

    • Authors: Shalini Singh, Pragya Shree, Vaibhav Kanti, Kalpana Kumari, Rajeev Suchdeva
      Pages: 1111 - 1115
      Abstract: Background: Hormonal changes and metabolic demands during pregnancy result in profound alterations in the biochemical parameters of thyroid function. Screening for thyroid disorders and initiation of its management at the earliest stage during first trimester is essential as maternal thyroid failure during the first half of pregnancy has been associated with several pregnancy complications and intellectual impairment in offspring. Aim was to evaluate the prevalence of thyroid dysfunction during the first and second trimester of pregnancy among women of Rajasthan state in India.Methods: The study comprised a cohort of 313 consecutive pregnant women in the first and second trimester that attended the OPD and were admitted as pregnant women in Obstetrics and Gynecology Department of the NIMS Medical College and Hospital, Jaipur, Rajasthan. Thyroid stimulating hormone (TSH) levels and free T4 (fT4) were estimated. The subjects were grouped into six groups based on the value of serum TSH and fT4.Results: Out of 313 antenatal women enrolled in the study, 213 (68%) attended antenatal clinic in first trimester of pregnancy and 100 (32%) women in their second trimester. The prevalence of thyroid dysfunction was 15.97% (overt hypothyroidism 1.28%, subclinical hypothyroidism 4.79%, isolated hypothyroxinemia 4.47%, overt hyperthyroidism 1.92%, and subclinical hyperthyroidism 3.51%). The women with overt hypo- or hyperthyroidism and subclinical hypothyroidism were older than euthyroid women. Maternal weight was high in pregnant women with overt hypothyroidism (58.22±6.18 kg) and subclinical hypothyroidism (52.04±2.94 kg). Gravid status was high in pregnant women with overt hypothyroidism, subclinical hypothyroidism and isolated hypothyroxinemia, but low in hyperthyroid group. History of miscarriage was high in pregnant women with subclinical hypothyroidism.Conclusions: With this study, it was concluded that there is high prevalence of thyroid dysfunction in pregnancy predominantly in rural population of Rajasthan. Majority among these being subclinical hypothyroidism and hypothyroxinemia.
      PubDate: 2021-02-24
      DOI: 10.18203/2320-1770.ijrcog20210744
      Issue No: Vol. 10, No. 3 (2021)
       
  • Prospective study to compare the efficacy of vaginal misoprostol for first
           trimester MTP before six weeks and up to 9 weeks

    • Authors: Paresh N. Sheth
      Pages: 1116 - 1119
      Abstract: Background: Misoprostol is prostaglandin E1 analogue that has been used for medical abortion. MTP has been legalized in India since 1971. Medical abortion refers for early pregnancy termination performed without any primary surgical interventions, usually before 9 weeks (63 days) gestational age. This prospective study was conducted to compare the efficacy of vaginal misoprostol for abortion in women at a gestational age of <6 weeks (42 days) and in woman up to 9 weeks (63 days) gestational age.Methods: This is a prospective study of total 130 women seeking medical termination of pregnancy up to 9 weeks (63 days) gestational age at obstetrics and gynecology department, at a tertiary care hospital Gujarat, India, from May 2018 to May 2019.Results: In result study the overall complete abortion rate was 91.54% In Group A (<6 weeks) complete abortion occurred in 93.3% women. Whereas in Group B (6 to 9 weeks) complete abortion occurred in 90% of women. The two groups did not differ significantly with respect to side effects. Overall, 91.3% women were satisfied with this method and will choose it again if required.Conclusions: This study shows that vaginal misoprostol alone regimen is highly effective and well tolerated method in Indian women requiring MTP up to 63 days gestational age. However better efficacy maybe achieved at gestational age < 6 weeks (42 days). 
      PubDate: 2021-02-24
      DOI: 10.18203/2320-1770.ijrcog20210530
      Issue No: Vol. 10, No. 3 (2021)
       
  • Prevalence of occult gynecological cancer in women undergoing surgeries
           for benign indications in a tertiary healthcare center of Chhattisgarh

    • Authors: Abha Singh, Avinashi Kujur, Renuka Gahine, Rashmi Tiwari
      Pages: 1120 - 1127
      Abstract: Background: Hysterectomy, the surgical removal of uterus, is 2nd most frequently performed major surgical procedures on women,with90% of hysterectomies are performed for benign indications. However, there may be cases in which malignancy or premalignant lesions which are only confirmed on histopathology are defined as occult malignancy.Methods: We conducted a prospective observational study on a cohort of women undergoing various gynaecological surgeries for benign indications in a time period of January 2019 to January 2020 in the Department of obstetrics and gynaecology, Dr. BRAM hospital and Pt. J. N. M. medical college, Raipur (C.G) to find out the prevalence of occult pre malignant and malignant lesions.Results: Of 132 women who underwent surgeries for benign gynecological indications, based on final histopathological report, prevalence of occult premalignant lesion was 11.36% (95% CI 5.7-16.3%) and prevalence of occult malignancy was 2.27% (95% CI 0.2 -4.8%). Prevalence of occult premalignant lesion of corpus uteri and cervix uteri was 2.3 and 9.1% respectively. No occult premalignant lesion of ovary was found. Prevalence of occult malignant lesion of corpus uteri and ovary was 1.5 and 0.75% respectively.Conclusions: We observed that even after complete preoperative workup only 72.7% of the preoperative clinical diagnoses were correlated with their histopathological diagnosis. Thus, while making the diagnosis, risk factors along with standard preoperative approach should be strongly adhered to prevent misdiagnosis and to prevent missing of any pre malignant or malignant findings. 
      PubDate: 2021-02-24
      DOI: 10.18203/2320-1770.ijrcog20210745
      Issue No: Vol. 10, No. 3 (2021)
       
  • Evaluation of categories of intrapartum fetal heart rate tracings in
           pregnancies complicated with fetal growth restriction and its relation to
           perinatal outcome

    • Authors: Bhavya H. U.
      Pages: 1128 - 1133
      Abstract: Background: Intrapartum FHR monitoring is widely used during labour as changes in FHR precede brain injury, so timely response to abnormal FHR patterns might be effective in preventing it. There is a strong association between stillbirth and FGR which warrants intensive intrapartum fetal surveillance for optimal perinatal outcome. In this study we aimed to classify intrapartum FHR tracings into different categories in FGR pregnancies and correlate with perinatal outcome.Methods: A total 100 singleton pregnant women >34 weeks gestation with FGR were included in study. FHR tracings were followed throughout first and second stage of labour. FHR tracing were categorized into NICHD 3-tier classification as category I, II and III. Maternal and neonatal outome in each category were analysed.Results: Mean duration of category I tracings was 9.05 hours, category II was 7.66 hours and that of category III was 0.49 hours. During late active phase 25/95 patients with category I FHR tracings had vaginal delivery, 62/95 had category II FHR tracings, of which 95.1% had vaginal delivery and 4.9% had instrumental. 8/95 with category III FHR tracings required caesarean section. All patients with category I tracings had normal neonatal outcome, among patients with category II FHR tracings, 74.6% had normal whereas 25.4% had adverse outcome, all with category III FHR tracings had adverse outcome.Conclusions: Categorizing FHR tracings is helpful to distinguish neonates who are likely to have normal outcome from those who are at risk for fetal hypoxia. When the category II tracings are present, it requires more vigilant monitoring and decision taking.
      PubDate: 2021-02-24
      DOI: 10.18203/2320-1770.ijrcog20210746
      Issue No: Vol. 10, No. 3 (2021)
       
  • Outcome of expectantly managed small-for-gestational-age pregnancies with
           normal Doppler parameters- a prospective cohort study

    • Authors: Sneha Mishra, Krishna Agarwal
      Pages: 1134 - 1137
      Abstract: Background: SGA foetuses with normal Dopplers are not at risk of IUD. However, there is lack of consensus about timing of delivery of SGA foetuses. Clinicians commonly induce all SGA pregnancies at 37 weeks. Expectant management of SGA foetuses beyond 37 weeks is not well studied.Methods: We followed up women with clinically suspected growth restriction with foetal biometry, Doppler and biophysical profile. Pregnancies with foetal AC between 10th to 3rd centile with normal Dopplers were recruited in the study group. The women were allowed to go in spontaneous labor till 39+6/7 weeks or were induced at 39+6/7 weeks. The outcome of such cases was compared with controls who were induced at 37+0/7 weeks.Results: Spontaneous labor occurred in 42% subjects in study group whereas in control group all were induced. Mean gestation at delivery in the study group was increased (39.57±0.71 versus 37.0±0.0, p value <0.001). Almost 81% of the subjects in study group delivered after 39 weeks. The rate of caesarean section was significantly lower in study group (3% versus 22%, p value-0.024). Also, the risk of intrapartum foetal distress was lower in study group (3/36 versus 1/36).The mean birth weight in the study group was higher (2426.5±154.1 gm versus 2297.9±101.4 gm, p value <0.001.Conclusions: Expectant management of SGA pregnancies with normal Doppler parameters leads to a significant increase in gestational age at birth and the mean birth weight and a significant reduction in caesarean section rate. 
      PubDate: 2021-02-24
      DOI: 10.18203/2320-1770.ijrcog20210747
      Issue No: Vol. 10, No. 3 (2021)
       
  • Survey on common practice in management of preeclampsia by obstetricians

    • Authors: Komal Chavan, Niranjan Chavan, Hitendrasing D. Rajput, Hera Mirza, Sneha Venkateswaran, Shalini Mahapatra
      Pages: 1138 - 1142
      Abstract: Background: Approximately 72,000 pregnant women all over the world die every year due to direct or indirect complications related to eclampsia and severe preeclampsia. Incidence of hypertensive disorders in pregnancy in India is found to be 10.08% as per the data collected by the National Eclampsia Registry (NER). Here we present the results of a survey conducted among obstetricians in India to know the common practices in the management of pre-eclampsia followed in our country.Methods: Observational study of survey which was conducted for the period of 1 month from 22nd May 2020 to 22nd April 2020. Questionnaire was prepared on surveyheart.com and sent to obstetricians via Social media platforms to the members of FOGSI. all answers 'collected' and results were prepared from given answers. The survey was answered online by 289 obstetricians.Results: For mild to moderate pre-eclampsia Labetalol is still first line antihypertensive agent being used by many of the obstetricians. In our study also we found out Tab Labetalol 100mg BD is the most preferred type (278, 96.19%) of first line anti-hypertensive in cases of pre-eclampsia followed by Cap Nifedipine 5mg QID and Tab Amlodipine 5mg OD respectively.Conclusions: Comprehensive educational efforts and skill building modules are need of hour to keep every practicing obstetrician regarding recent advances in standard practice protocols.With close monitoring of all cases and well selected anti-hypertensive treatment, it is possible to achieve favourable outcomes for the mother and the baby.
      PubDate: 2021-02-24
      DOI: 10.18203/2320-1770.ijrcog20210748
      Issue No: Vol. 10, No. 3 (2021)
       
  • COVID-19 and pregnancy: the fruitful experience of the university hospital
           of Tangier Morocco with hydroxychloroquine and anti-retroviral treatment

    • Authors: Karima Aouali, Houda Moustaid, Houda Moustaid, Saad Benkirane, Saad Benkirane
      Pages: 1143 - 1147
      Abstract: The coronavirus disease 2019 (COVID-19) caused by the emerging virus, severe acute respiratory distress syndrome coronavirus 2 (SARS-CoV-2), was announced as a pandemic by the World Health Organization as a global public health emergency. Since the first case of COVID-19 was declared the Moroccan government set up drastic preventative measures to deal with the spread of the virus such as compulsory containment, telework, distance education, use of masks in public places, and many other preventive measures. Pregnant women require special attention in relation to prevention, diagnosis and management. We herein reported a prospective observational study that aims to evaluate the security and effectiveness of hydroxychloroquine on pregnant women with corona virus disease. Our study is a prospective study performed in the three hospitals specialized on corona virus disease 2019 in tangier morocco. We included pregnant women hospitalized with COVID-19 and reproductive-aged. Most cases took the hydroxychloroquine treatment. The maternal outcomes under hydroxychloroquine appear good in most cases for both mother and child and seemed to be safe according to several studies on its use for rheumatic diseases. In the absence of more robust data, this treatment might be best practice in countries that can’t afford the expensive antiviral treatment in this outbreak especially in emergency situations.
      PubDate: 2021-02-24
      DOI: 10.18203/2320-1770.ijrcog20210749
      Issue No: Vol. 10, No. 3 (2021)
       
  • Pregnancy with adnexal masses: an institutional experience and review of
           the literature

    • Authors: Anupama Bahadur, Modalavalasa Swetha Sri, Rajlaxmi Mundhra, Latika Chawla, Megha Ajmani, Tuba Afreen, Payal Kumari, Shloka Sharma
      Pages: 1148 - 1153
      Abstract: Adnexal masses in pregnancy are not uncommon. We prospectively analysed all cases with adnexal masses detected during pregnancy presented to our antenatal outpatient department from January 2019 to August 2020. Herein we report six such cases with their pregnancy outcome. Among the 6 cases, 3 were diagnosed during first trimester of pregnancy, 2 in third trimester and 1 was found incidentally during caesarean section. The mean age of the cases was 25.33+2.33 years. Two cases underwent oophorectomy and rest had ovarian cystectomy. In terms of histopathological findings, one was endometriotic cyst, two were borderline tumors (mucinous and serous variety) and three were mature cystic teratomas. There was no perinatal mortality, but 2 babies required NICU admission for observation. Mature cystic teratoma was the most common adnexal mass detected in our series. Timing of surgery depends on urgency of situation. Asymptomatic/small/unilocular cyst with low suspicion should be kept under observation and follow up throughout pregnancy.
      PubDate: 2021-02-24
      DOI: 10.18203/2320-1770.ijrcog20210750
      Issue No: Vol. 10, No. 3 (2021)
       
  • Adnexal mass in pregnancy

    • Authors: Marilia Lima Freixo, Elisa Soares, Maria Liz Coelho, Fernanda Costa, Ana Rita Pinto
      Pages: 1154 - 1156
      Abstract: Adnexal masses in pregnancy are a rare finding. The majority of these masses are discovered incidentally during routine follow-up. The differential diagnosis of adnexal masses discovered during pregnancy is broad and the management of such lesions has been a subject of debate for years with no consensus regarding the best management plan. We report a case of a 38 year-old pregnant woman who was diagnosed at the time of the first trimester ultrasound with a multilocular solid arising form the right ovary. A laparoscopy followed by left oophorectomy was performed at 22 weeks and the definitive histology revealed a borderline ovarian cyst/proliferative mucinous atypical cyst. The patient delivered via vaginal at 38 weeks of gestation. This case was discussed and a secondary staging surgery (peritoneal washing, total abdominal hysterectomy, salpingo-oophorectomy, omentectomy, appendectomy, and peritoneal biopsies) was performed with no evidence of disease found. The surgical approach is controversial due to the increased risk of complications. In the absence of large prospective randomized trials it is difficult to know which are the best management practices and especially to determine the right moment during pregnancy to perform surgery in these patients. 
      PubDate: 2021-02-24
      DOI: 10.18203/2320-1770.ijrcog20210751
      Issue No: Vol. 10, No. 3 (2021)
       
  • A successful full term delivery in a case of robotic assisted insertion of
           transabdominal cerclage in an obese woman with multiple uterine fibroids

    • Authors: Y. H. Tan, S. Durai, K. Devendra, N. Ravichandran
      Pages: 1157 - 1161
      Abstract: Cervical incompetence is not an uncommon presentation in an obstetric emergency unit. Some of these patients will be managed with a cervical cerclage. While the management of patients presenting with first time cervical incompetence is relatively established, the management of patient with repeated cervical incompetence might require an abdominal cerclage. Abdominal cerclages can be inserted traditionally via laparotomy or via a minimally invasive approach (MIS). We present a case of an obese patient presenting with 3 previous second trimester miscarriages despite 2 cervical cerclage complicated by multiple uterine fibroids who underwent a robotic assisted insertion of transabdominal cerclage (RTAC) pre-pregnancy. She subsequently conceived spontaneously and carried the pregnancy to term and delivered a healthy baby via caesarean section. There have been multiple published studies showing that an MIS approach for abdominal cerclage insertion is safe and viable. Robotic assisted procedures allow for better visualisation and manipulation of tissue especially in patients anticipating a complex procedure. For our patient we feel that a robotic assisted procedure would be more beneficial given her profile and the complexity of her case.
      PubDate: 2021-02-24
      DOI: 10.18203/2320-1770.ijrcog20210752
      Issue No: Vol. 10, No. 3 (2021)
       
  • Pregnancy in a didelphic uterus: a case report of an unusual phenomenon
           and review of literature

    • Authors: Emmanuel Ekanem, Lalrinawmi Lalrinawmi, Anita Sinha, Tamer Abdelrazik
      Pages: 1162 - 1168
      Abstract: Mullerian anomalies are defects in the embryological development of the urogenital systems as these organs begin to form at about the 5 and 6th week of intrauterine life. Uterine didelphys is one of the Mullerian or paramesonephric duct anomalies occurring as a result of duplication of the uterine canal with two cervical canals and a single vagina. The incidence uterine didelphys has been quoted as 1 in 2000 women.  This case report elucidates the presentation of a multiparous lady with uterine didelphys who has a had a previous successful pregnancy in of the uterine canals but presented in the second pregnancy with a missed miscarriage at 12 weeks gestational age.  She also has a single right kidney. These were all diagnosed on ultrasound scan. She had an initial unsuccessful surgical management of miscarriage with uterine perforation of one of the uterine cavities, hysteroscopy and diagnostic laparoscopy and subsequently had a repeat examination under anaesthesia and second attempt at evacuation of retained products or a laparoscopy plus hysterotomy.  This was particularly challenging as the cervix was flushed with the vaginal vault making delineating and dilatation of the cervical OS difficult hence sustaining a perforation of the left uterine cavity.  The second attempt of surgical management was successful, and she was subsequently discharged. This is one of the few case reports in literature and will further add credence to the body of knowledge of a different aspect to the presentation and management of cases of Mullerian anomalies.
      PubDate: 2021-02-24
      DOI: 10.18203/2320-1770.ijrcog20210753
      Issue No: Vol. 10, No. 3 (2021)
       
  • Uterine torsion in a case of previous two caesarean section mimicking
           uterine rupture: a case report

    • Authors: Priti Agrawal, Rishi Agrawal, Jyotirmay Chandrakar
      Pages: 1169 - 1171
      Abstract: Uterine torsion (UT) is defines as a rotation of the uterus of more than 45 degree on its long axis. The predisposing factors for UT can be uterine asymmetry due to fibroids or mullerian anomalies, foetal malpresentation, pelvic adhesions and abdominal or ligamentous laxity other possible causes include external cephalic version, maternal trauma and abdominal massage. The clinical presentation of UT is non-specific. We report a case of previous 2 CS where we suspected rupture uterus but intraoperatively it was UT with unruptured fibrosed scar of previous CS. A 31 years old, G3P2 presented in emergency department with history of amenorrhea 9 months and severe abdominal pain for 5-6 hours. She had previous 2 CS done for contracted pelvis. We immediately suspected rupture of previous CS scar. On laparotomy dense intra-abdominal adhesions were found. After adhesiolysis we could find any sign of previous scar on the visible uterine wall. Entire uterine wall seemed as if we were doing CS in a primiparous patient. This made us suspicious of UT. UT is considered rare and has been referred to as an ‘obstetrician’s once in a lifetime diagnosis’. Recently cases have been reported with no associated pelvic factors although a common feature in all these cases had been previous CS. UT is a potentially dangerous complication of pregnancy both to the mother and to the foetus. Maternal mortality in modern era highly unexpected event but maternal morbidity can occur because of complications like uterine rupture, uterine abruptio, sepsis, pulmonary embolism and iatrogenic complications like injury to blood vessels, urinary tract and rectum. During laparotomy where correction of UT is not possible, a deliberate posterior hysterotomy can be done for delivery of foetus. Bilateral plication of the round ligaments can be done to prevent immediate postpartum recurrence of UT. UT though rare should be kept in mind while performing CS in cases of previous CS, associated myomas, ovarian tumour, malpresentations of foetus. Clinical symptoms may be absent or nonspecific and the diagnosis may be intraoperative.
      PubDate: 2021-02-24
      DOI: 10.18203/2320-1770.ijrcog20210754
      Issue No: Vol. 10, No. 3 (2021)
       
  • Imperforate hymen: a case report

    • Authors: Kalaivani V., Ushadevi Gopalan
      Pages: 1172 - 1173
      Abstract: Imperforate hymen is one of the rare causes of primary amenorrhea due to uterovaginal developmental anomaly. We report a case of imperforate hymen in a 14-year girl with primary amenorrhea who presented to us with cyclical abdominal pain, mass abdomen and dysuria. Local examination showed bulged and bluish hymen. Ultrasonography showed hematocolpos. She underwent hymenotomy through a cruciate incision and recovered well postoperatively. Hematocolpos should always be considered in a prepubertal girl who presents with primary amenorrhea, mass abdomen and urinary problems.
      PubDate: 2021-02-24
      DOI: 10.18203/2320-1770.ijrcog20210755
      Issue No: Vol. 10, No. 3 (2021)
       
  • A rare case of a gigantic myxoid liposarcoma of vulva: case report

    • Authors: Tanudeep Kaur, Ravinder P. Singh
      Pages: 1174 - 1176
      Abstract: Vulval malignancies per se are very rare and a liposarcoma in this location is rarer still. The literature consists only of case reports of patients, often with a very limited follow up. We present a rare case of a young 30 year old unmarried nulliparous woman presenting with a giant vulval mass of 30×20 cm and weighing nearly 6 kilograms. Ultrasonography, Computed Tomography, Magnetic Resonance Imaging and biopsy were done. Local resection with adjuvant radiotherapy was given. Histopathology was suggestive of myxoid liposarcoma and the patient is presently recurrence free with over 8 years of follow up. Though rare, myxoid liposarcoma should be kept in differential diagnosis of vulval soft tissue mass. Management includes a combination of surgery and radiation. Excision of lymph nodes is not recommended. Strict prolonged follow up for recurrence or metastasis is mandatory, and any new complaints should be addressed promptly. This is particularly true in the setting of liposarcoma, which may exhibit unusual patterns of spread and recurrence.
      PubDate: 2021-02-24
      DOI: 10.18203/2320-1770.ijrcog20210527
      Issue No: Vol. 10, No. 3 (2021)
       
  • Laparoscopic excision of accessory cavitated uterine mass and its vaginal
           retrieval in toto

    • Authors: Mani Kanmani, Chinnasamy Kasthuri
      Pages: 1177 - 1179
      Abstract: Accessory cavitated uterine mass (ACUM), a rare cause of dysmenorrhoea, has to be diagnosed with essential criteria and is to be treated with appropriate surgery. Hereby, presenting the surgical approach by laparoscopy and vaginal retrieval of the specimen in toto as a perfect tool. We report a rare case study of ACUM, a mullerian anomaly in a 27 years old female with severe dysmenorrhoea with secondary infertility, evaluated and diagnosed as ACUM. Preoperative diagnosis and surgical plane evaluation are made by ultrasound and magnetic resonance imaging. Hysteroscopic examination of the cavity was normal and laparoscopic excision of an ill-defined mass in the anterior and right lateral wall of 3×2 cm followed by retrieval of the specimen through a pouch of Douglas. Myometrial defect sutured. Cut section showed chocolate coloured fluid in the endometrial cavity and the same confirmed by histopathology. This is the first case report doing vaginal retrieval of ACUM in toto.
      PubDate: 2021-02-24
      DOI: 10.18203/2320-1770.ijrcog20210503
      Issue No: Vol. 10, No. 3 (2021)
       
  • Placental site trophoblastic tumor unprecedented by conception: a very
           rare presentation

    • Authors: Sanjay Badesara, Kiran Jakhar
      Pages: 1180 - 1182
      Abstract: Placental site trophoblastic tumour is the rare variant of gestational trophoblastic neoplasia with incidence rate of approximately 1/100,000 of all pregnancies. Histologically it is characterized by intermediate trophoblastic cells with few syntical elements. The index report depict a 20 years old unmarried female with no history of conception presenting with abnormal uterine bleeding and mildly elevated serum β-HCG level. Multi-modality treatment was given and she had fair outcome. 
      PubDate: 2021-02-24
      DOI: 10.18203/2320-1770.ijrcog20210484
      Issue No: Vol. 10, No. 3 (2021)
       
  • Systemic infection of Staphylococcus aureus in postnatal woman: a unique
           finding

    • Authors: Annie Prasanthi, Jiji Elizabeth Mathews, Muruga Bharathy, Swati Rathore
      Pages: 1183 - 1184
      Abstract: Staphylococcus bacteraemia is the leading cause of hospital acquired and community acquired bacteraemia. Complications associated are difficult to recognise. Mortality is 20 to 40%. This is a unique case discussing the metastatic spread of Staphylococcus infection following a wound infection. An informed consent was taken from the patient before publishing this case report.
      PubDate: 2021-02-24
      DOI: 10.18203/2320-1770.ijrcog20210756
      Issue No: Vol. 10, No. 3 (2021)
       
  • Familial treacher collins syndrome- from an obstetrician’s view

    • Authors: Chesta Saini, Kishore Rajurkar, Rizul Saini
      Pages: 1185 - 1187
      Abstract: A number of genetic syndromes have been identified and can be diagnosed antenatally using ultrasonography signifying the importance of antenatal care. We report a rare case of familial treacher collins syndrome diagnosed postnatally that shows difficulties faced by an obstetrician to safely manage such cases. 
      PubDate: 2021-02-24
      DOI: 10.18203/2320-1770.ijrcog20210757
      Issue No: Vol. 10, No. 3 (2021)
       
  • A case of amniotic fluid embolism and its sequelae during COVID-19
           pandemic: a success story

    • Authors: Anish Kumar Vishal, Dinesh Bhasin, Krishna Prasad
      Pages: 1188 - 1191
      Abstract: Amniotic fluid embolism (AFE) is an unforeseeable, life-threatening complication of pregnancy with an extremely high mortality rate. This is a complex disorder classically characterized by the abrupt onset of hypoxia, hypotension and consumptive coagulopathy. We experienced a patient who underwent caesarean delivery because of sudden cardiovascular collapse. Intra op she had DIC and was hemodynamically unstable. Surgery was able to complete with inotropes and vasopressors. In subsequent post op period, she had sepsis with MODS. The diagnosis of amniotic fluid embolism was made after other differential diagnosis had been ruled out.  The successful outcome in our case is attributable to early recognition with immediate delivery of the fetus, high-grade resuscitation, timely hysterectomy and aggressive treatment of coagulopathy by blood and blood-products, involvement of multidisciplinary team, constant supervision by nursing staff with positive approach. From a grim situation of near death, the final outcome was a successful story. 
      PubDate: 2021-02-24
      DOI: 10.18203/2320-1770.ijrcog20210758
      Issue No: Vol. 10, No. 3 (2021)
       
  • Fertility preservation in non-seminomatous germ cell tumor: a case report

    • Authors: Nayana Patel, Niket Patel, Molina Patel, Yuvraj Jadeja, Harsha Bhadarka, Harmi Thakkar
      Pages: 1192 - 1194
      Abstract: Testicular germ cell tumors (TGCTs) are the most common malignancy in young men in their peak fertility years. It can intrinsically and permanently affect fertility potential of an individual. Clinicians are advised to offer Fertility Preservation before initiating the treatment. We present one such case of presence of Neoplasm in testis, where semen was cryopreserved before operating it for fertility preservation and biological pregnancy was achieved. On further investigations, presence of neoplasm on left testis was diagnosed. However, neoplasms of the testes are unique in that way they affect men at a young age and also have a high survival rates. Cryopreservation of ejaculated or surgically retrieved sperm is currently the only established method of fertility preservation for post-pubertal man. The incidence as well as rates for testicular cancers have remained relatively low and if presented early on, can be cured and has good survival rates. Fertility awareness must be raised amongst the oncologist, gynecologist and patients.
      PubDate: 2021-02-24
      DOI: 10.18203/2320-1770.ijrcog20210759
      Issue No: Vol. 10, No. 3 (2021)
       
  • Genital tuberculosis mimic as a genital malignancy in post menopausal
           women

    • Authors: Monalisa Mahajan
      Pages: 1195 - 1197
      Abstract: Genital tuberculosis tends to be an indolent infection and the disease may not manifest for year after initial seeding. The most common presentation reported in general population are pelvic pain, postmenopausal bleeding, ascites, abdominal mass, ovarian mass. The diagnosis is made by histopathological examination. Surgery is indicated as presence of abdominal pelvic mass with severe pain. Preoperative diagnosis of genital tuberculosis is often difficult because of confusion with ovarian malignancy. A 60 years old women present with weight loss, palpable abdominal mass with ascites, prominent bilateral ovaries and increase level of CA125. Pelvic malignancy was initially suspected but a diagnosis of tuberculosis was made following postoperative peritoneal wash biopsy. Patient managed with surgical laparotomy under a provisional diagnosis of ovarian malignancy but the final diagnosis was genital tuberculosis followed by anti tubercular regimen. Genital tuberculosis with high level of CA125 mimicking ovarian carcinoma. 
      PubDate: 2021-02-24
      DOI: 10.18203/2320-1770.ijrcog20210760
      Issue No: Vol. 10, No. 3 (2021)
       
  • Successful laparoscopic management of accessory cavitated uterine mass: a
           rare case

    • Authors: Dinesh D. Pratapwar, Sarika Pramod Zunjare, Fasiha Tasneem
      Pages: 1198 - 1201
      Abstract: Accessory cavitated uterine mass (ACUM) is a rare and unique congenital anomaly. The dysmenorrhea presented by these patients is almost never resolved by any medications but only by surgical line of management. Herein, we are discussing a case of ACUM who had medically refractory dysmenorrhea and treated by laparoscopic excision and repair. ACUM is the newly identified popping up cause of dysmenorrhoea requiring surgical line of management only. Fewer than 40 cases, worldwide, have been reported in the literature with the youngest case being a 13-year-old girl. Laparoscopic excision has shown good postoperative results. Dysmenorrhea is a significant cause of reduced quality of life. High degree of suspicion, early investigations and identification of such cases help in appropriate management and reduce the duration of symptoms and thus the seamy side of life can be made better. 
      PubDate: 2021-02-24
      DOI: 10.18203/2320-1770.ijrcog20210761
      Issue No: Vol. 10, No. 3 (2021)
       
  • Incidental diagnosis of granulosa cell tumour in a 25-year-old woman

    • Authors: P. G. Paul, Sanghamitra Thakur, Anjana Annal, George Paul, K. Anusha Chowdary
      Pages: 1202 - 1204
      Abstract: A 25-year-old woman presented with backache of 2 weeks duration and had 45-60 days menstrual cycle. On transvaginal sonography (TVS), her left adnexa showed a heterogenous solid mass of 5.3×4.2 cm and moderate vascularity on color doppler. Serum inhibin B was raised to 2249 pg/ml. MRI showed 5.5× 4.5 cm solid mass in the left ovary with lobulated margins suggestive of sex cord-stromal/ germ cell tumor. Laparoscopy showed an enlarged left ovary with intact surface. Left adnexectomy with staging biopsies and infracolic omentectomy was performed. Histopathology showed adult granulosa cell tumor with intact ovarian capsule. One-month post-surgery, inhibin B level was 44 pg/ml. She wishes to conceive after six months follow-up. 
      PubDate: 2021-02-24
      DOI: 10.18203/2320-1770.ijrcog20210762
      Issue No: Vol. 10, No. 3 (2021)
       
  • Endometrioma masquerading an ovarian carcinoma

    • Authors: Amanat Sidhu, Ripan Bala, Pooja Tandon, Rajdeep Chhina
      Pages: 1205 - 1206
      Abstract: Endometriosis is the presence of endometrial tissue outside the uterus. Endometriosis affects 10-15% of all women in reproductive age group and 70% of the women with chronic pelvic pain. The risk of malignant transformation in an endometrioma has been reported to be low, though there is an increased risk for certain gynecological as well as non-gynecological carcinomas with endometriosis. We present a case diagnosed as having endometrioma transforming into a malignant tumor in a young female. We intend to emphasize that all the clinicians should make their patients aware of the malignant potential of endometriosis and a strict follow up of all cases being treated conservatively should be a must.
      PubDate: 2021-02-24
      DOI: 10.18203/2320-1770.ijrcog20210763
      Issue No: Vol. 10, No. 3 (2021)
       
  • Is genetic diagnosis a bliss or a bane in indian society' An impact on
           nuclear family: a case report of foetal skeletal dysplasia

    • Authors: Inder Mohan Singh Sandhu, Simranpreet Kaur, Madhu Nagpal
      Pages: 1207 - 1209
      Abstract: Genetic counseling has been becoming an integral part of reproductive medicine practice. In area of feto-maternal medicine findings of ultrasonography are very important. Genetic counselor tries to link dots between USG findings and their genetic base. If abnormality is found, after the legal termination of pregnancy, for clinicians and patients, main concern is about its recurrence in future pregnancies. But the question arises about the acceptability of genetic risk calculations by concerned patient and her family. As in society like ours, the genetically literate population is quite low and generally not well prepared to accept and understand the risks related to genetic abnormalities. This thing makes work of genetic counselors much difficult when the genetic aberration is found in the concerned couple. This raises a question about the social acceptance of genetically different individuals who are phenotypically normal but if they open up about their abnormal genetic status there will be a risk of decrease in their social acceptability. Hereby we present a case report which forced us to pause and think about the level of depth at which we as a society reached so far to accept genetic analysis as one of the diagnostic tool in routine clinical practice. 
      PubDate: 2021-02-24
      DOI: 10.18203/2320-1770.ijrcog20210764
      Issue No: Vol. 10, No. 3 (2021)
       
  • Surgically assisted medical management of interstitial ectopic pregnancy

    • Authors: Lekshminarayanan Thulasi Devi, Sangeet Kumar
      Pages: 1210 - 1215
      Abstract: An interesting case of interstitial ectopic pregnancy in a primigravida managed by surgically assisted medical management with intracardiac instillation of KCl and methotrexate. It was diagnosed based on transvaginal and transabdominal ultrasound and procedure was done as USG guided under local anaesthesia in OPD by transabdominal route and immediate disappearance of foetal cardiac activity was noted on Doppler. She was followed up with serial sβ-hCG and TVS. She had no post procedure complication and was discharged on day 2 of procedure. 
      PubDate: 2021-02-24
      DOI: 10.18203/2320-1770.ijrcog20210765
      Issue No: Vol. 10, No. 3 (2021)
       
  • Impact of chronic kidney disease on fetomaternal outcome: a case report

    • Authors: Neha Khairnar, Ananya Bora, Amarjeet Kaur Bava
      Pages: 1216 - 1218
      Abstract: Chronic kidney disease is a heterogenous group of disorders resulting from anatomical and physiological alterations in the kidney. Pregnancy might accelerate the renal disease-causing progression of renal failure, development of preeclampsia, anemia. This increases the risk of adverse fetomaternal outcomes including prematurity, fetal growth restriction, fetal deaths and development of hypertension, nephrotic syndrome, renal failure in the mother. Chronic kidney disease affects approximately 3% of pregnant women. This study was carried out to assess the course of chronic kidney disease in pregnancy and the effect it has on the fetal outcome. A case of chronic kidney disease presenting to the OBGY emergency unit was studied. a detail history was taken and examination was done. Baseline antenatal investigations were carried out. Special tests including renal Doppler, ophthalmoscopic examination, ECG, were done to assess the renal function. Treatment was started for control of hypertension and further progression of the disease. Pregnancy has adverse outcome when associated with acute kidney injury. Maternal hypertension and proteinuria are the major predisposing factors. Prematurity is one of the commonest fetal complications apart from growth restriction. Chronic kidney disease in pregnancy requires a multidisciplinary approach involving experienced obstetricians, nephrologists, radiologists, intensivists and neonatologists. The etiology, degree of renal dysfunction, development of additional obstetric complications determines the prognosis. Supportive therapy in the early course of the disease and timely definitive management as per the etiology is found to improve the feto-maternal outcome. 
      PubDate: 2021-02-24
      DOI: 10.18203/2320-1770.ijrcog20210766
      Issue No: Vol. 10, No. 3 (2021)
       
  • Isolated fallopian tube torsion

    • Authors: Bandamma N. S., Prema Prabhudev, Pooja .
      Pages: 1219 - 1220
      Abstract: Fallopian tube torsion is a rare cause of acute abdomen, occurring commonly in females of reproductive age. It lacks pathognomonic symptoms, signs, or imaging features, thus causing delay in surgical intervention. Current study report one case of isolated fallopian tube torsion in adolescent girl. In this case a 13 year old patient presented with acute pain in the right iliac region associated with 3 episodes of vomiting for one day and severe tenderness on examination. Laparoscopy revealed right sided twisted fallopian tube associated with gangrenous fimbrial end. The tube was untwisted and salpingectomy done. Salpingectomy was done as the tube was gangrenous. Fallopian tube torsion, though rare, should be considered in women of reproductive age with unilateral pelvic pain. Early diagnostic laparoscopy is important for an accurate diagnosis and could prevent the rupture of the gangrenous tube. 
      PubDate: 2021-02-24
      DOI: 10.18203/2320-1770.ijrcog20210767
      Issue No: Vol. 10, No. 3 (2021)
       
  • Post salpingectomy intraluminal endometriosis in a premenopausal lady - an
           incidental finding often paid less attention to

    • Authors: Kanna Sandhyarani, Archana Shetty, Bhargavi Kalburgi Nagabhushan, Aparna Muralidhar, Jessica Minal, Nikhil Moorchung
      Pages: 1221 - 1223
      Abstract: Endometriosis of the fallopian tube is often incidentally picked up in hysterectomy specimens that are sent for histopathological examination for other obvious pathological conditions. Post-salpingectomy endometriosis is one such entity that is known to occur in the tip of the proximal stump of the fallopian tube years after tubal ligation. As mere visualization of the endometriotic lesions is inadequate for an accurate diagnosis, histopathologic analysis of the biopsy samples becomes mandatory for confirmation. We report a case of post salpingectomy endometriosis which was incidentally discovered in a peri menopausal lady who was operated for multiple fibroids of the uterus. This case not only highlights an entity which is challenging to visualize radiologically and suspect clinically, but is also underrecognized, as very little attention is given to the fallopian tube during routine grossing. 
      PubDate: 2021-02-24
      DOI: 10.18203/2320-1770.ijrcog20210768
      Issue No: Vol. 10, No. 3 (2021)
       
  • A case benign struma ovarii

    • Authors: P. G. Paul, Anjana Annal, K. Anusha Chowdary, George Paul, Manali Shilotri
      Pages: 1224 - 1226
      Abstract: Struma ovarii is a rare ovarian tumor and a monodermal variant of dermoid tumors of the ovary in which thyroid tissue components constitute more than 50% of the mass. Struma ovarii accounts for 0.5–1.0% of all ovarian tumors and 2-5% of ovarian teratomas. Most cases are benign, but malignant transformation is found in a small percentage. It usually presents as a unilateral adnexal mass at fifth and sixth decades of life, with symptoms like other ovarian tumors. The definitive diagnosis is made by histological examination. Adnexectomy remains the standard line of treatment for benign disease. A 41-year-old lady presented with pain in abdomen for 3 months. On ultrasonography and MRI, a multiloculated solid cystic lesion of 7×6 cm with internal echoes was found in the right adnexa. Laparoscopic right adnexectomy was performed. Histopathology was consistent with struma ovarii. Due to its vague clinical manifestations and diverse imaging characteristics, pre-operative diagnosis is challenging. 
      PubDate: 2021-02-24
      DOI: 10.18203/2320-1770.ijrcog20210769
      Issue No: Vol. 10, No. 3 (2021)
       
  • Urethral prolapse- case report and photographs

    • Authors: Arun R. Mahale, Anil P. Sakhare
      Pages: 1227 - 1228
      Abstract: A report on menopausal age group urethral prolapse with illustrative photographs, its treatment and related literature review is presented.
      PubDate: 2021-02-24
      DOI: 10.18203/2320-1770.ijrcog20210770
      Issue No: Vol. 10, No. 3 (2021)
       
  • An unusual case of interstitial pregnancy: a case report

    • Authors: Nikhil Sebastian, Abhishek Radhakrishnan, Vennila Murugesan
      Pages: 1229 - 1231
      Abstract: Ectopic pregnancy (EP) has been found to be a common cause of morbidity, and on occasion, mortality among women in the reproductive age groups. The incidence of EP is 1-2% of all pregnancies. 93-97% of EP are tubal with the interstitial type consisting only 3-4%. A 31-year-old female patient with primary infertility underwent IVF (In Vitro Fertilization). Pregnancy was confirmed by βHCG (beta human chorionic gonadotropin). Her ultrasonography reported a mass in the right cornual region. The uterine cavity was empty. Laparoscopy was performed followed by resection of the right cornua with tubes. Histopathology report confirmed the diagnosis of Interstitial Pregnancy (IP). The patient had an uneventful post-operative period and was discharged the next day. EP is a common complication seen in cases undergoing IVF, and IP is a rare form of EP. Hence, early diagnosis and prompt intervention is required to avoid a potentially life-threatening situation.
      PubDate: 2021-02-24
      DOI: 10.18203/2320-1770.ijrcog20210771
      Issue No: Vol. 10, No. 3 (2021)
       
  • Thanatophoric dysplasia- a rare cause of stillbirth and perinatal
           mortality: a case report

    • Authors: Priti Agrawal, Rishi Agrawal, Anandi Lobo
      Pages: 1232 - 1235
      Abstract: Lethal skeletal dysplasia is estimated to occur in 0.95 per 10,000 deliveries. Thanatophoric dysplasia affects about 1in 25000 to 50000 births. The term thanatophoric is Greek word for “death bearing”. Children with this condition are usually stillborn or die shortly after birth from respiratory failure. We report a case of LSD (Thanatophoric dysplasia), in an unbooked patient where previous two children and couple were absolutely normal.  Our patient, 31 years old, unbooked case presented with history of amenorrhea 8 months and unable to perceive fetal movements. Her husband’s age was 33 years. This was her third pregnancy. She had previous 2 deliveries by LSCS. Ultrasonography revealed single intrauterine live fetus in breech presentation with multiple fetal anomalies. There was shortening and deformity of all four limbs (micromelia) with poor mineralization of all bones. Thorax was pear shaped with short horizontal ribs and abnormal cardiothoracic ratio. LSCS was done in emergency for impending rupture of previous LSCS scar. Post-delivery examination and X-ray of the fetus revealed decreased skull mineralization, frontal bossing, hypoplastic nasal bone, midface hypoplasia, mandibular hypoplasia, pear shaped chest, protuberant abdomen, micromelia, dumbbell shaped appearance of all long bones. TD is caused due to mutation of the fibroblast growth factor receptor 3 gene (FGFR3), which is located on the short arm of chromosome 4. Type I TD is characterized by marked underdeveloped skeleton and short-curved long bones. Conventional radiographic examination remains the most useful means of studying the dysplastic skeleton. Bony evaluation is best done on X-rays or ultrasonography. The diagnosis of TD can be established with ultrasound and molecular confirmation in the second trimester can help in genetic counselling and termination of such lethal pregnancies. LSD’s are rare event. If our patient had undergone anomaly scan in second trimester of pregnancy, this defect could have been detected earlier. The outcome of fetus is lethal but maternal morbidity can be reduced if diagnosed early.
      PubDate: 2021-02-24
      DOI: 10.18203/2320-1770.ijrcog20210772
      Issue No: Vol. 10, No. 3 (2021)
       
  • Ovulation induction in polycystic ovarian syndrome - basics for
           gynecologist

    • Authors: Punita Yadav
      Pages: 1236 - 1240
      Abstract: Polycystic ovarian syndrome (PCOS) is the most common problem related to infertility among women. This review looked into the evidence and options available for ovulation induction. The management protocol and their respective efficacy was looked into during the write up of the review. Weight reduction, along with metformin therapy are the initial and efficient way to regain ovulation among obese female. This should be complemented by use of first line medicine like aromatase inhibitors and selective estrogen receptor modulators. The first line is effective in significant proportion of female to induce ovulation and increase live birth rate. However, for those not responding should initially undergo the use of gonadotropins and ovarian drilling. Finally, controlled ovarian stimulation and in vitro fertilization should be considered as it is an invasive, expensive and there are risks of ovarian hyperstimulation and multiple gestation.
      PubDate: 2021-02-24
      DOI: 10.18203/2320-1770.ijrcog20210773
      Issue No: Vol. 10, No. 3 (2021)
       
  • HIV in pregnancy

    • Authors: Gauri S. Kore
      Pages: 1241 - 1246
      Abstract: HIV is a disease caused by retrovirus (HIV-1 or HIV-2) the that attacks the immune system of the body, leaving it susceptible to various dangerous infections. HIV can have profound effects on pregnancy and pregnancy may in turn cause an aggravation of signs and symptoms HIV.A pregnant woman living with HIV can pass on the virus to her baby during pregnancy, childbirth and through breastfeeding. This is called Vertical transmission of HIV. Without any intervention, the rate of vertical transmission of HIV is as much as 15-45%. National PPTCT program of India run by NACO (National AIDS Control Organization) aims at preventing HIV transmission from mother to child. Women who are known HIV positives or those who are diagnosed as HIV positive for the first-time during pregnancy, are given Triple Dose Anti Retro-viral therapy comprising of Tenofovir, Lamivudine and Efavirenz. Special precautions are taken during their delivery. Whether LSCS is to be performed depends on the indications and on which guidelines are followed. Infant- feeding is advised to be carried out as per the guidelines stated in the PPTCT act so as to minimize the chances of HIV transmission to the infant.
      PubDate: 2021-02-24
      DOI: 10.18203/2320-1770.ijrcog20210774
      Issue No: Vol. 10, No. 3 (2021)
       
  • Metabolic syndrome in polycystic ovary syndrome: a review

    • Authors: Kalaivani V., Ushadevi Gopalan
      Pages: 1247 - 1250
      Abstract: Polycystic ovary syndrome is one of the most common endocrine abnormalities in women. It affects both reproductive life and overall health of the women including metabolic abnormalities. A multidisciplinary approach is needed in those with metabolic variations to prevent them from the long-term complications like cardiovascular diseases and diabetes mellitus. The objective of this article is to review the association between PCOS and metabolic syndrome.
      PubDate: 2021-02-24
      DOI: 10.18203/2320-1770.ijrcog20210775
      Issue No: Vol. 10, No. 3 (2021)
       
  • Prediction of success of induction of labour: Bishop’s score versus
           transvaginal sonographic parameters

    • Authors: Papa Dasari, Sutharshika Thiyagalingam
      Pages: 1251 - 1258
      Abstract: Bishop’s score is a standard method of pre-induction assessment of parameters to predict induction of labour. It is subjective and has interobserver variability and it does not take in to account the supra-vaginal cervix which forms more than 50% of cervical length. During the past 3 decades studies undertaken to find out a better predictor of labour induction found ultrasonographic assessment of cervix to be a better method. Cervical length, posterior cervical angle and head position are some of the parameters that were studied and compared with Bishops score. Among these posterior cervical angles of >1100 and cervical length of <2 cm are the best predictors for success of induction of labour. These parameters would help to explain the chances of vaginal delivery and the risk of undergoing caesarean section in an objective way. 
      PubDate: 2021-02-24
      DOI: 10.18203/2320-1770.ijrcog20210776
      Issue No: Vol. 10, No. 3 (2021)
       
  • Pulmonary hypertension in pregnancy

    • Authors: K. Durga, S. Yuvarajan, R. Praveen, Antonious Maria Selvam, Yashoda ., Karthiga V.
      Pages: 1259 - 1265
      Abstract: Pulmonary hypertension is defined as an increase in mean pulmonary arterial pressure (mPAP) ≥25 mmHg at rest as assessed by right heart catheterisation. Pulmonary hypertension in pregnancy is known to be associated with significantly high morbidity and mortality rate which ranges between 30% and 56%. So during pregnancy, efforts to be made to diagnose common medical ailments that can be complicated by pulmonary hypertension. Bedside 2D Echo and thoracic ultrasound are the strongly recommended in these patients to diagnose early and prevent the devastating complications. Relevant blood investigations need to be sent to diagnose the underlying etiology and to assess the prognosis. Cardiac catheterization is the gold standard investigation of choice for pulmonary hypertension. But it is 1 performed in very few cardiac centres in developing countries. In India diagnosis largely depends on echocardiography. It should be made clear to women at the time of their PAH diagnosis that pregnancy is not recommended due to the high maternal and fetal risks. If a woman with known PHT become pregnant, counselling should be given for therapeutic abortion. If they are willing for therapeutic abortion, it should be done before 22 weeks of gestation. All women with PHT should be initiated on PAH specific therapies (prostanoids, ccbs, phosphodiesterase inhibitors) except endothelin receptor blockers as it is teratogenic. Pregnancy in PAH is difficult to manage and needs mutidisciplanary team. Pregnancy is not recommended in women with PAH and appropriate counselling to be done to the mother and their relatives. 
      PubDate: 2021-02-24
      DOI: 10.18203/2320-1770.ijrcog20210777
      Issue No: Vol. 10, No. 3 (2021)
       
 
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