International Journal of Reproduction, Contraception, Obstetrics and Gynecology

Ovarian collision tumour: a rare case of serous cystadenoma with granulosa cell tumor of ovary

Veena M. Vernekar, Prashanth F. Gollar, Syeda Sana, Sreelatha Sampath Kumar — Fri, 26 May 2023 00:00:00 +0000

A collision tumor is the coexistence of two distinct tumours without any histological intermixing in the same organ or tissue. Each component of collision tumors occurs coincidently and biologic behaviour depends on their own tumor characteristics. A 48 year aged P2L2 women with pain abdomen since 15 days, on abdominal examination-a cystic mass occupying left iliac fossa present, bimanual examination a cystic mass measuring 13x10x8 cm in size, felt separately from the uterus. Sonography of abdomen and pelvis revealed a large cyst in the right adnexa 11.5x10.5x9.5 cm extending upto umbilical region. The serum tumor markers were within the normal range. Patient complained of severe pain abdomen on next day. Emergency laparotomy was done. Left ovarian cyst measuring 13x12x7 cm in size with one loop of torsion seen. Left salphingo-ophorectomy done and specimen sent for frozen section. It reported as serous cystadenoma of left ovary. Then proceeded to total abdominal hysterectomy with right salphingo-oophorectomy. Histopathology reported Serous cystadenoma with focal Granulosa cell tumour- left ovary. Patient was followed up with serum inhibin and CECT abdomen. The demographic factors, presentations and diagnosis of collision tutors are as similar as with single ovarian tumours. It is important for gynaecologist, radiologist and pathologist to be aware of occurrence of collision tumours. Histopathogical diagnosis of such neoplasms becomes very important, to provide appropriate treatment based on the individual biological characteristics of each component of collision tumours.

Placental polyp after normal vaginal delivery: a rare diagnostic dilemma

Fri, 26 May 2023 00:00:00 +0000

Placental polyp is retained placental tissue within the endometrial cavity, which forms a nidus for inflammation and bleeding. Placental polyp is a rare entity with an incidence of less than 0.25% of all pregnancies as reported. Here, we report a case of 23-year-old P2L2 woman with complaints of intermittent vaginal bleeding since her recent normal vaginal delivery, 1.5 months back. A polypoid mass (51×41 mm) with abundant vascularity was detected as retained products of placenta (RPOC) within the endometrial cavity by imaging studies. A combination of polypoidal mass within the endometrial cavity with normal beta human chorionic gonadotropin (hCG) of <2.0 mIU/ml raising the suspicion of retained products of placenta or trophoblastic neoplasms. After yielding an unsatisfactory biopsy containing only fibrin deposition, total hysterectomy was performed due to profuse bleeding during biopsy. The uterus specimen showed slight globular enlargement with presence of a red-coloured polypoid mass within the endometrial cavity with rough outer surface and fragile consistency. The histological specimen of the protruding lesion, from the exaggerated placental implantation site, showed intermediate trophoblastic cells infiltrated into the myometrium, which might lead to the diagnosis of placental polyp. However, since placental polyp and uterine arteriovenous malformation have similar clinical characteristics, it is important to accurately identify and differentiate between them to ensure optimal treatment therapy. Definite diagnosis is ultimately made by histopathological examination. We report here a case that is suggestive of either a placental polyp or uterine arteriovenous malformation and will discuss the differential diagnoses and treatments for both diseases, based on a literature review.

Successful detection of an incidental sigmoid injury during laparoscopic surgery by air saline test in a patient of endometrial carcinoma

Pooja Sharma, Jyoti Mishra — Fri, 26 May 2023 00:00:00 +0000

Laparoscopy has many advantages over open surgery including less post-operative pain, earlier return of normal bowel function, shorter hospital stay, and earlier recovery. Bowel injury is a serious complication of gynecological laparoscopy. The most common site of bowel injury is the small bowel, followed by the large bowel and stomach. This is in agreement with a recent systematic review which has shown that the incidence of bowel injury in gynecologic laparoscopy is 1 in 769.3. Air saline test performed to check bowel integrity by inserting the rectal probe and filling the cavity with normal saline. After performing total laparoscopic hysterectomy with bilateral salphingoopherectomy with retroperitoneal lymphnode dissection done initially after pushing air from rectal probe into the bowel, no bubble was noted but after pushing sigmoid into the pool of saline, escape of air was seen. After suction, a 2×2 cm incidental sigmoidal injury was detected. Bowel injury is a serious complication in laparoscopic surgeries and routine intraoperative checking of bowel integrity by air saline test with the help of rectal probe is a useful modality of intraoperative bowel repair.

A rare case of broad ligament fibroid in Mayer-Rokitansky-Küster-Hauser syndrome

Arpit Choudhary, Navneet Takkar, Dilpreet Kaur Pandher, Mohit Satodiya — Fri, 26 May 2023 00:00:00 +0000

Mayer-Rokitansky Kuster Hauser (MRKH) syndrome with lieomyoma is a rare disorder. Women with this syndrome have normal 46 XX karyotype, normal secondary sex characteristics and primary amenorrhea. There is a scarcity of cases in the literature where fibroid develops in women suffering from MRKH syndrome. Here, we present a case of an ectopic broad ligament fibroid found in a 41-year-old woman with MRKH syndrome type II. A 41-year-old married nulliparous female diagnosed with MRKH syndrome 20 years back, presented with an abdominal mass. Trans-abdominal ultrasound suggested a large mass on right side arising from paracolic area with heterogeneous echo texture. However, the ovarian vs leiomyoma origin of mass was of diagnostic dilemma. CEMRI confirmed the same findings and ruled out ovarian origin of the mass along with the presence of rudimentary uterus. Following this, the patient was taken for laparotomy followed by total abdominal hysterectomy with bilateral salpingoopherectomy, the fibroid was found to be arising from broad ligament and was removed along with the hypoplastic uterus and bilateral Fallopian tubes and ovaries. The case we presented exhibits the development of leiomyomas in patients with MRKH syndrome, although rare, is always a possibility and should be kept in mind as a differential diagnosis while evaluating an abdominopelvic mass. MRI is an accurate modality both for delineating the mass, confirming its origin as well as diagnosing MRKH syndrome.

A case report on dealing with complications of hypertension during child birth

Arti Kaparwan, Pooja Godiyal — Fri, 26 May 2023 00:00:00 +0000

Hypertensive disorder in pregnancy is a major source of morbidity and mortality worldwide. This is a disease unique to pregnancy typically characterized by blood pressure ≥140/90 mm of Hg after 20 weeks of pregnancy and associated with proteinuria 300 mg/24 hours or 1+ dipstick. If left untreated the disorder often leads to serious maternal and perinatal complications. Here there is a case report of women with undiagnosed hypertension during pregnancy which complicates life of both mother and fetus by complicating labour and birth with precipitate labour and postpartum haemorrhage. This is a preventable complication by educating women about importance of routine antenatal visits.

A rare case report of Sertoli Leydig cell tumour of ovary

Rita D., Ravali G. — Fri, 26 May 2023 00:00:00 +0000

Sertoli-Leydig cell tumor (SLCTs) of the ovary, also known as androblastoma, is a rare neoplasm from the group of sex cord-stromal tumors of the ovary. They account for less than 0.5% of all ovarian tumors. They typically occur in young and reproductive women and the patients usually present with abdominal swelling or pain. A case of 35-year-old multiparous female presented with abdominal mass, ultrasonography revealed a large abdomino-pelvic complex solid cystic mass lesion arising from left ovary. She underwent staging laparotomy followed by total abdominal hysterectomy with left salpingo-ovariotomy and right salpingo-oopherectomy with partial omentectomy. Histopathological examination (HPE) revealed features suggestive of moderately differentiated SLCT of left ovary (with heterologous elements).

Chronic non-puerperal incomplete uterine inversion

Agam Sofat, Sunita Dubey, Rimpy Tandon, Alka Sehgal, Purnima Aggarwal — Fri, 26 May 2023 00:00:00 +0000

Chronic non-puerperal uterine inversion is an extremely rare diagnosis especially in younger women. The diagnosis commands high level of clinical suspicion supplemented with imaging. An emergency admission of a 35-year-old para 1 with submucosal fundal fibroid presenting with excessive menstrual flow with hemodynamic instability requiring multiple blood transfusions is presented. On abdominal examination slight suprapubic tenderness was made out with no palpable mass. Bimanual examination revealed a non-pediculated mass in upper vagina with a circular constriction around it. On ultrasound, cupping of fundus suggested uterine inversion. Pelvic MRI reaffirmed the findings of a highly vascularized intracavitary leiomyoma protruding through the cervix. After optimization patient underwent myomectomy and Haultain’s procedure followed by total abdominal hysterectomy with bilateral salpingectomy. Post-operative period was uneventful. Inversion is generally associated with fundal fibroid polyp but can rarely follow submucosal leiomyoma. Imaging helps preoperative planning of management.

Sad fetus syndrome: a rare case report

Mamatha K., Lekha Prakash Gawda — Fri, 26 May 2023 00:00:00 +0000

Gestational trophoblastic disease (GTD) is a condition that develops from abnormal proliferation of placental trophoblasts. A rare division of GTD is a partial mole with a co-existing live fetus-a condition also referred to as “sad fetus syndrome” We report a rare case of a 24-year-old, primigravida with 26 weeks of gestational age with single live intrauterine gestation coexisting with partial molar pregnancy who had a spontaneous preterm delivery at 27 weeks. The post-natal period was uneventful and patient was followed up till βhcg normalised. The diagnostic challenges and dilemma associated with the management of molar pregnancies with an apparently normal fetus, especially in the second trimester, remains challenging.

A rare case of acute non puerperal complete uterine inversion in nulliparous virgin female

Saurabh V. Bhangale, Ashok Kumar, Mamta Sharma, Naina Arora — Fri, 26 May 2023 00:00:00 +0000

Non-puerperal uterine inversion (NPUI) is extremely rare and accounts for 17% of all uterine inversion cases. A few more than 150 cases have been reported amongst which 10-15 have been reported in nulliparous females and 3-4 have been reported in virgin females from 1914 till date. A 40 years unmarried nulliparous female denying sexual activity presented to our hospital with acute non puerperal complete uterine inversion with something coming out per vaginum of sudden onset while straining at defecation, lower abdominal pain and minimal bleeding per vaginum with history of uterine fibroid and chronic constipation. Diagnosis was confirmed with ultrasonography and examination under anaesthesia after written informed valid consent. After detailed counselling and obtaining written informed valid consent, the patient underwent exploration with a combined abdominal-vaginal approach. Following vaginal myomectomy, the uterus was repositioned using Haultain procedure after a failed attempt of Huntington procedure. Total abdominal hysterectomy with bilateral salpingectomy with vaginal vault suspension was done sparing bilateral ovaries. Diagnosis requires a high index of suspicion and their management is a challenge to gynaecologists due to its rare occurrence, distorted pelvic anatomy and associated pelvic organ injuries during surgery. Good anatomical and clinical knowledge along with surgical skills is of utmost importance for successful outcomes.

Schizencephaly: a rare case with early diagnosis, management and review of literature

Fri, 26 May 2023 00:00:00 +0000

Schizencephaly or split brain is an uncommon congenital disorder of cerebral cortical development, belonging to the group of cell migration defects. It is characterized by the presence of a cleft in the brain extending from the surface of the piamater to the cerebral ventricles. A 21-year-old primigravida at 19+2 weeks of gestation was referred to our Outpatient department with a level-2 ultrasound done at 18+2 weeks suggestive of schizencephaly. First trimester genetic screening was not done. Quadruple testing was normal. After genetic consultation and poor prognostication by neonatologist, decision for medical termination of pregnancy was taken. Patient underwent medical termination with mifepristone -misoprostol regimen. A female abortus weighing 200 gm was delivered. Gross examination showed only facial malformation in the form of cleft lip and hypoplastic nose. Infantogram did not reveal any skeletal deformity. On fetal autopsy, findings were consistent with the diagnosis of schizencephaly (type 1). Schizencephaly is a rare disorder in prenatal medicine with grave prognosis. Majority of cases are either diagnosed at late gestation or present in the first decade of life. Hence with periodic surveillance during antenatal care and help of ultrasonography, such rare and serious congenital malformations can be diagnosed and managed at an early stage.

Uterosacral ligament fibroid: a rare occurrence yet a major diagnostic challenge

Tejasa Mishra, Madhu Jain, Shivi Jain — Fri, 26 May 2023 00:00:00 +0000

Fibroid is a common benign neoplasm more often located in the uterus and less commonly seen in the adnexa and other supporting structures of uterus like broad and uterosacral ligament. The incidence of extra uterine leiomyomas is <1%. A 48-year-old female para one live one presented with chief complaints of mass per abdomen for 2 years and prolonged heavy bleeding for 15 days. Based on the clinical and radiological findings, a diagnosis of tubo-ovarian mass was made. The patient underwent staging laparotomy. However, intraoperatively, she was diagnosed with uterosacral ligament fibroid of size approximately 40×45 cm. Total abdominal hysterectomy with bilateral salpingo-oophorectomy was done. There was no associated complication. Histopathology confirmed the mass to be leiomyoma. Uterosacral ligament fibroid is encountered very rarely. Our case report intends to bring to light the necessity of keeping the various possible locations of leiomyoma in mind and in considering adnexal mass as an important differential diagnosis of leiomyoma and vice-versa before operating. Leiomyoma is often confused with ovarian mass or neoplasm posing a diagnostic difficulty to a gynaecologist as well as radiologist thereby posing a challenge to the operating surgeon while performing surgery.

Headache and seizure on postpartum day 7: late postpartum eclampsia: a case report

Aman Deep Raj, Abhinav Dixit — Fri, 26 May 2023 00:00:00 +0000

Historically, convulsions beginning more than 48 hours, but less than 4 weeks, after delivery, known as late postpartum eclampsia, was thought to be uncommon; however, recent evidence suggests that its incidence is increasing. In addition, the presentation of late postpartum preeclampsia-eclampsia may differ from that occurring during the pregnancy. About 40% of late eclampsia has no premonitory symptoms. This contributes to difficulty in diagnosing late postpartum preeclampsia-eclampsia in an emergency department setting. Greater awareness and knowledge of this disorder by ED physicians should improve outcomes in these potentially life-threatening cases. The authors present a case of new-onset seizures occurring 07 days postpartum. The patient presented with headache, hypertension, and generalized tonic-clonic seizures to the emergency department. Postpartum eclampsia was diagnosed and IV magnesium sulphate was administered. The patient had no further seizures and did not require long-term anticonvulsants.

Large mucinous cystadenoma in pregnancy: a rare case report

Varsha Arya, Shubhra Mukherjee — Fri, 26 May 2023 00:00:00 +0000

Presence of ovarian tumors in pregnancy is uncommon. In most cases, they are benign, torsion is the most common complication. Management can be conservative or surgical depending on the size, clinical presentation, gestational age, available resources etc. advances in imaging techniques have made the decision making easier. We present a case of primigravida aged 24 years, with 18 weeks’ pregnancy with pain in abdomen. She had a large mass arising from the pelvis. Full work up was done. Imaging was suggestive of mucinous cystadenoma with bilateral hydronephrosis due to mass effect. Laparotomy was done and a 20 kg tumor was removed, histopathology confirmed a huge cystadenoma. Patient was discharged in a stable condition. The management of ovarian tumors in pregnancy can be challenging. Although the safety of antepartum surgical intervention is accepted, abdominal surgery will carry some risk to the pregnant woman and the unborn fetus. Surgery becomes necessary in the presence of rupture, torsion or malignancy.

A case of large leiomyoma arising from rudimentary horn in Mayer Rokitansky-Küster-Hauser syndrome, managed by minimally invasive surgery

Rusheetha R. Katkam, Rachana D. Dalmia — Fri, 26 May 2023 00:00:00 +0000

Mayer-Rokitansky-Küster-Hauser (MRKH) syndrome is a congenital disorder marked by aplasia or hypoplasia of the uterus and vagina as a result of arrest in the development of the müllerian ducts. Prevalence being 1 in 4000–5000 live births of females. Leiomyoma is the most common uterine tumor, their occurrence from rudimentary uterus in females with MRKH syndrome is very rare and only a few cases have been documented in the literature. Here we report a 38-year-old female, known case of MRKH syndrome presenting with USG suggestive of 7.9x7.4x6.0 leiomyoma in proximity to the hypoplastic uterus, undergoing a laparoscopic removal of fibroid with right ovarian cystectomy (incidental finding). Therefore, it is important to consider such unusual diagnosis of fibroids originating from primitive horns while treating these patients for gynecological symptoms as well as infertility, and consider them managing endoscopically.

First trimester uterine rupture-a rare but catastrophic event: a case report

Suchita Tripathi, Sugandh Srivastava, Shruti Gupta, Renu Gupta, Neena Gupta — Fri, 26 May 2023 00:00:00 +0000

Uterine rupture is a rare but life threatening obstetrical emergency. It often occurs at term during trail of labour but rarely may occur during early pregnancy in first trimester. Here, we report a case of 28 years, G2P1+0L0 at 3 months of pregnancy with fundal rupture in shock with history of previous caesarean section. Ultrasound report revealed massive hemoperitoneum (2 litres) with dead fetus lying outside the uterine cavity. Emergency laparotomy was performed and uterine repair was done. The differential diagnosis for hemoperitoneum is early pregnancy includes bleeding corpus luteum, heterotropic pregnancy or ectopic pregnancy and molar pregnancy with secondary invasion. The possibility of uterine rupture should also be kept in mind. Prompt diagnosis and early management is important to reduce the morbidity and mortality.

Success story of acute abdomen in pregnancy-torsion ovary

Kalyani Saidhandapani, Sadhana Karthikeyan — Fri, 26 May 2023 00:00:00 +0000

Torsion ovary is one of the acute emergencies in pregnancy with prevalence of 2.7-3% with high maternal and fetal mortality rates. Delay in diagnosis leads to hemorrhage, infarction and necrosis resulting in loss of ovary or fetal loss. Although 26% adnexal torsion can occur in apparently healthy adnexa, exact etiology remains unknown, predisposing factors include larger cyst size, free mobility and long pedicle. Acute onset of pelvic pain followed by nausea and vomiting is the most common presenting symptom. High levels of clinical suspicion along with ultrasound and doppler aids in diagnosis. We present a case of 18 weeks multipara with acute abdomen diagnosed as ovarian torsion, emergency laparotomy was done and salphingo-oophorectomy was proceeded without disturbing gravid uterus. Pregnancy continued and an alive term baby delivered by normal vaginal delivery. Once torsion ovary is suspected, surgical management remains the treatment of choice.

Presence of fibroids in the absence of uterus- Mayer-Rokitansky-Küster-Hauser syndrome with fibroids: a case report

B. Ramesh, Nayana M. Shivalingappa, Kiran R. Konda, Priya Suryanarayana — Fri, 26 May 2023 00:00:00 +0000

Mayer-Rokitansky-Küster-Hauser (MRKH) syndrome is rare congenital anomaly with complete absence of uterus and upper part of vagina. Fibroids are one of the most common benign tumours arising in women. Fibroids arising from Mullerian remnants are very rare. These fibroids often pose difficulty in diagnosis and management. Here, we report a rare case of fibroids arising from Mullerian remnants in MRKH syndrome and the treatment provided for the patient.

Incidental finding of unilateral partial agenesis of fallopian tube with complete agenesis of ipsilateral ovary during caesarean section with neonatal outcome

Pooja Prajapati — Fri, 26 May 2023 00:00:00 +0000

Congenital unilateral absence of fallopian tube with ipsilateral ovarian agenesis is a rare occurrence with a suggested incidence of 1:11240.Unilateral ovarian agenesis (UOA) and fallopian descent problems are other very rare congenital entity. We presented a case report, detailing one such patient where unilateral partial fallopian tube and ipsilateral ovarian agenesis was seen with neonatal outcome. Our case describes 28 years old G5P2L2A2 un booked case with an obstetric history of 2 spontaneous abortion and two previous full term institutional normal vaginal deliveries (both female child) presented at 37 weeks of gestation with borderline oligo hydramnios (USG suggestive of AFI- 9.1 cm), Posterior placenta, EFW- 2003 g, single loop of cord around fetal neck. On repeat scan USG suggestive of AFI-7.7cm, with discrepancy of >2 weeks between POG and LMP IUGR. Elective caesarean section done after patient and relatives counselling and informed consent done. During C- section unilateral partial agenesis of right fallopian tube and complete agenesis of right ovary found incidentally. The left fallopian tube and ovary was normal. A male baby with birth weight 2.2 kg, well cried was born. USG abdomen of baby was performed to rule out any congenital genitourinary abnormalities. USG revealed, a small aplastic left kidney, for which baby was referred to higher center for further renal function workup. This case was unique since the incidental diagnosis of right ovary and right fallopian tube agenesis occurred during C section instead of imaging.

A rare case report of amniotic band syndrome associated with gastroschisis and limb body wall complex

Rita D., Pushpalatha V. S. — Fri, 26 May 2023 00:00:00 +0000

The amniotic band syndrome can cause a wide range of anomalies and the most common associated anomalies include amputations, constriction bands, encephalocele, acrania, syndactyly, craniofacial defects, club feet and cleft lip. Vertebral and abdominal wall defects such as gastroschisis and scoliosis are extremely rare. A 19-year-old female, G1P0 (primi) presented to our outpatient department for her first antenatal visit at 14 weeks + 6 days’ period of gestation according to her LMP. Ultrasonography (USG) features suggestive of limb body wall complex/ amniotic band syndrome, undergone MTP after counselling. In amniotic band syndrome there is no known inheritance pattern. The prognosis in case of amniotic band syndrome is dependent on the specific anomalies present. Severe and complex malformations as seen in this case are incompatible with extra uterine life and are an indication for termination of pregnancy. This condition is diagnosable prenatally. It can also lead to lethal deformation of vital internal organs in rare cases. Because limb body wall complex is incompatible with life, early diagnosis is crucial for parental counseling.

Role of imaging modalities in diagnosis of silent caesarean scar ectopic pregnancy after ovulation induction: a case report

Fri, 26 May 2023 00:00:00 +0000

There has been an increased prevalence of ectopic pregnancies in the present scenario attributing to 1.5-2% of all pregnancies. Caesarean scar pregnancies are rare, occurring in approximately 1 in 2000 pregnancies, although the incidence is increasing. The increasing rate of caesarean scar ectopic pregnancies mirrors the increasing rate of caesarean delivery. Disruption of the endometrium and myometrium after caesarean delivery predisposes to improper implantation at the site of the prior hysterotomy. Without normal surrounding myometrium, untreated caesarean scar ectopic pregnancies can result in uterine rupture with severe maternal hemorrhage and death. Although ultrasound remains the primary imaging modality for this diagnosis, MRI may be useful in the setting of equivocal cases and also may aid in the detection of possible placental implantation or bladder wall invasion. An MRI may provide additional confirmation of the ultrasound findings and characterize the myometrial interface if the pregnancy is difficult to distinguish from other pregnancy complications such as a cervical ectopic pregnancy or consideration for expectant management of pregnancy is considered.

Monoamniotic twins with complications and their outcome: case series

Tuhina Mital, Kirti Rachwani — Fri, 26 May 2023 00:00:00 +0000

Monoamniotic twins are identical twins sharing the same amniotic sac and placenta, with two separate umbilical cords. Although uncommon, monoamniotic twins are associated with high antenatal and perinatal morbidity and mortality. We present here a series of three cases of monoamniotic twin gestations with fetal complications who delivered in our hospital over a period of one month. Our first case Mrs. ABC with 33 weeks of gestation with Monoamniotic twins presented with twin anemia polycythemia sequence, second case, Mrs XYZ presented as primigravida with 35 weeks of gestational age with monoamniotic twins with severe preeclampsia presented with Cord entanglement who went into postpartum hemorrhage and was conservatively managed for the same. Our third case, Mrs. DEF G2P1L1 with previous scar 1.5 years back with 23 weeks of gestation with monoamniotic twins presented with Twin reversal arterial perfusion sequence and underwent medical termination of pregnancy.

Early diagnosis, a step towards reducing mortality in placenta accreta spectrum: a case series

Fri, 26 May 2023 00:00:00 +0000

The worldwide incidence of placenta accrete spectrum (PAS) is increasing day by day, mostly due to the increasing trends in caesarean section (CS) rates. PAS is accountable for high maternal morbidity and mortality as it is associated with extensive haemorrhage, which often requires hysterectomy, multiple blood and blood product transfusions, ureteric and bladder injuries and prolonged ICU stay. The aim of this case series is to highlight the importance of early diagnosis and high degree of suspicion of PAS for a planned management in decreasing maternal morbidity and mortality. Antenatal patients who were associated with PAS and managed in obstetrics and gynaecology department, Kalinga institute of medical sciences, Bhubaneswar during the time period of 2 years were critically reviewed and are being presented as case series. High degree of suspicion, pre operative radiological diagnosis, well preparedness and multidisciplinary approach help us in reducing the maternal mortality and morbidity significantly. Conservative management of PAS can preserve future fertility but should only be done in hospitals with 24 hour emergency care and enough expertise as it carries high chances of maternal complications.

Needs of laboring women: tools for training desired birth companion

Papa Dasari — Fri, 26 May 2023 00:00:00 +0000

Presence of a birth companion through labour, childbirth and postpartum is one of the universal rights of child bearing women. Not only that, the choice of birth companion is also one of the components of respectful maternity care. The characteristics of the birth companion of women’s choice [desired birth (DBC)] is well spelt by WHO as well as govt, of India. In practice it is observed that most of the DBC companions (DBC) who were relative, friends of the birthing women are unaware of their roles and responsibilities and are not well prepared to render the necessary maternal support. Trained birth companions or on call birth companions (OBC/Doulas) are not available in developing countries like India and all women cannot afford the costs of OBCs and the Govt hospitals do not encourage the participation of Doulas. Hence there is a need to train the DBC with resources in the health care system. This review is intended to search literature regarding the tools for training the DBCs. The literature search showed very few studies regarding the same and the workshops in training DBC are not implemented across the health care facilities.

Exploring the effectiveness of various screening criteria used in gestational diabetes mellitus

S. Keerthana, Usha Devi Gopalan — Fri, 26 May 2023 00:00:00 +0000

Hyperglycemia during pregnancy leads to fatal maternal and perinatal outcomes. Gestational diabetes mellitus (GDM) is diagnosed by 75 grams oral glucose tolerance test at 24-28 weeks of gestational age as insulin resistance increases during the second trimester. Increased prevalence of diabetes mellitus, sedentary lifestyle, Family history of DM predisposes women, particularly the Indian women to develop GDM. Existence of multiple criteria like IADPSG (International association of diabetes and pregnancy study groups), WHO (World health organisation), ADA (The American diabetes association criteria, DIPSI (Diabetes in pregnancy study groups criteria) creates serious confusion in screening of GDM. Therefore, there is a need to find a effective single screening criteria.

Decision to delivery interval in cesarean delivery for suspected fetal distress: the risk factors and outcomes

Zahar Azuar Zakaria, Maria Muhammad — Fri, 26 May 2023 00:00:00 +0000

Background: This study was to evaluate the differences in the neonatal outcomes after caesarean sections (CS) for suspected fetal distress in groups with decision to delivery interval (DDI) of 30 minutes or less and longer than 30 minutes. Factors associated with these intervals were also investigated.

Methods: Data were retrospectively collected from all emergency caesarean deliveries for fetal distress in 2021. Maternal demographic data, the procedure characteristics and the neonatal outcomes were analyzed according to the DDI groups; 30 minutes or less and more than 30 minutes. Time interval for different stages of DDI and related factors were also analyzed.

Results: A total of 115 cases were included for analysis with the mean DDI of 40.1 minutes. Only 24/115 (20.9%) of the cases had the DDI of 30 minutes or less. Maternal and surgical characteristics were similar between the 2 study groups, and there were no differences in the proportion of neonatal acidosis, low Apgar score, intubation, NICU admission and the mean umbilical cord pH or base excess. Regression analysis demonstrated that level of surgeon’s experience, operations during the normal working hours or CS for fetal bradycardia were significantly associated shorter DDI. Experienced surgeon and unscarred uterus were associated with shorter incision to neonatal delivery interval.

Conclusions: The longer DDI in caesarean deliveries for suspected fetal distress is not associated with significant adverse neonatal outcomes. Despite so, identifying the factors influencing the DDI is still an important aspect in the constant work to improve the obstetric service.

Socio-demographic and clinico-pathological analysis of cervical cancer patients at a tertiary care centre in South-south Nigeria

Justina O. Alegbeleye, Solomon Nyeche, Merry A. Jaja — Fri, 26 May 2023 00:00:00 +0000

Background: Cervical cancer is a significant public health burden in low- and middle-income countries where access to screening and treatment is limited. It is the leading cause of cancer deaths in women in Africa, often due to late presentation and diagnosis. Aim of this study was to determine the socio-demographic and clinical profile of cervical cancer patients and their relationship with tumour related factors.

Methods: This was a retrospective review of all cases of histologically confirmed cervical cancer patients managed at the University of Port Harcourt Teaching Hospital, Port Harcourt, over a 5-year period. A data collection form was used to obtain socio-demographic characteristics and clinical profile from the patients’ case records.

Results: The mean age of the women was 53.3±8 years, with the highest prevalence in the 55-64 age group 26 (33.3%). Majority 59 (74.4%) of the women were multiparous, and 50 (64.1%) were married. Most 32 (41%) had primary education and about one-third 24 (30.8%) were farmers. The most common clinical features were vaginal bleeding, foul-smelling vaginal discharge, pelvic pain, and weight loss 46 (59%), while squamous cell carcinoma (SCC) was the predominant histological type 56 (71.8%). Only 9 (11.5%) had any form of screening for early detection of cervical cancer. Most 31 (39%) of the patients presented with stage III disease, with a median hemoglobin level of 6.8 (2.3) g/dl before treatment. About two-third 54 (69%) of them had severe anaemia. There was significant association between marital status and histological type (X² = 42.096, p-value = 0.001). Use of oral contraceptive pills (X² = 7.602, p-value =0.04) and menopausal state (X² = 6828, p-value =0.05), were significantly associated with cancer stage.

Conclusions: There is an urgent need to scale up advocacy for regular screening for cervical cancer and vaccination, to ensure increased awareness, early detection, and prevent the progression of early disease.

Audit of the first caesarean section in a reference hospital in the African environment

Fri, 26 May 2023 00:00:00 +0000

Background The practice of a first caesarean section can condition the future obstetric prognosis. The aim of this work was to study the indications of the first caesarean sections at the Yalgado Ouedraogo Teaching Hospital in Ouagadougou.

Methods: This was a cross-sectional study with prospective collection. The data were collected from 1 March to 30 May 2018. The women who benefited from caesarean section for the first time were the study population. The review of the documents, the interview with the patients and the expert opinion were the techniques used. The expert opinion made it possible to determine whether or not the caesarean section was preventable.

Results: The first caesarean sections accounted for 62.5% (280/448) of all caesarean sections and 34.6% (280/810) of all childbirths in the period. Caesarean section was urgently performed in 95% of cases. It was mostly an obstetrical indication. Probable fetal asphyxia was the first major indication (27.5%) followed by preeclampsia/eclampsia (15.7%) and uterine pre-rupture syndrome (8.9%). Caesarean section was found to be avoidable in 53 cases (18.9%). Probable fetal asphyxia was the most common indication (22.4%) of these preventable caesarean sections.

Conclusions: The good management of preeclampsia, the strengthening of the birth room in fetal and maternal monitoring equipment, the close coaching of physicians in specialization and the periodic audits of practices would reduce the preventable caesarean sections.

A 5-year review of contraceptive uptake among women attending family planning clinic at Dalhatu Araf Specialist Hospital, Lafia, North-Central Nigeria

Fri, 26 May 2023 00:00:00 +0000

Background: Rapidly rising population in Africa is of great concern, most especially in Nigeria because of its impact on social stability. Family planning is an indispensable tool for population control and also in preventing unwanted pregnancy and its complications. Women and men at any given point in their lifetime should be able to choose the most appropriate contraceptive methods from many available options, as this is an important contributor to the successful use of contraception. Aim of the study was to determine the uptake and trend in contraceptive use from 2014-2018 in the family planning unit of a specialist hospital in the North central, Nigeria.

Methods: It is a retrospective, descriptive study of contraceptive uptake of women attending family planning clinic of Dalhatu Araf Specialist Hospital (DASH), Lafia, Nasarawa State, Nigeria from 2014 to 2018.

Results: Of the 5448 women accessing family planning services in the hospital within the study period, 5277 folders were retrieved with complete data. A vast majority of the women were married (99.6%) with the mean age of the subjects being 28.8±6.0 years. Contraceptive uptake was 43.2% of deliveries in the hospital. Implants (65.4%) remained the preferred contraceptive choice, followed by injectables (20.7%) and intrauterine devices (IUDs) (10.3%). Less popular were bilateral tubal ligation (BTL) (0.2%), Sayana press (0.1%) and Standard Days Methods (SDM) (0.0%). Implants, injectables and IUDs consistently remained the preferred contraceptive choices yearly throughout the studied years.

Conclusions: Implants is the most popular contraception in DASH. Contraceptive uptake is relatively high among the women but there is still need to increase access to effective contraception and if possible make them freely available at all levels of health care.

The evaluation between vitamin D level and pelvic organ prolapse in post-menopausal women

Fri, 26 May 2023 00:00:00 +0000

Background: Vitamin D is important for skeletal integrity and optimal muscle function. The high incidence and prevalence of vitamin D deficiency and pelvic organ prolapse have been found in postmenopausal women, raising the question of whether the entities are related. The aim of the study was to evaluation between vitamin D level and pelvic organ prolapse in post-menopausal women.

Methods: This case control study has been designed and conducted in the Department of Obstetrics and Gynecology, BSMMU to investigate the level of vitamin D in patients with and without pelvic organ prolapse to explore the association of vitamin D with pelvic organ prolapse. After taking informed written consent the serum vitamin D level of all participants was measured by CMIA technology with flexible assay protocols at Biochemistry and Molecular Biology department of the same institute. Statistical analysis of the results was obtained by using window-based computer software devised with Statistical Packages for Social Sciences (SPSS-24).

Results: The study population was divided into two groups, a case group (n=74) consisting of patients with pelvic organ prolapse and a control group (n=74) comprising of women without pelvic organ prolapse. A total 148 participants of 52 years or older attending the out or inpatient department were enrolled in the study. Mean±SD level of Vitamin D in the case group was 13.96±5.18 ng/ml and in the control, group was 21.08±5.77 ng/ml respectively. The difference was statistically significant (p<0.05). Moreover, the vitamin D levels were inversely proportionate with the severity of pelvic organ prolapse.

Conclusions: Vitamin D deficiency may be an important systemic factor associated with pelvic organ prolapse. Measuring vitamin D levels in postmenopausal women and replenishing deficiencies may also be important for the pelvic floor.

Severe pre-eclampsia: epidemiological, diagnostic, therapeutic and prognostic aspects at Hospital Principal Dakar from January 2019 to December 2020

Fri, 26 May 2023 00:00:00 +0000

Background: Preeclampsia, major public health problem, is one of the leading causes of maternal and infant mortality. It is increasingly frequent in our referral health centers, especially in its severe form.

Methods: Retrospective descriptive and analytical study about severe preeclampsia at the Maternity of Hospital Principal Dakar, from 01 January 2019 to 31 December 2020.

Results: Frequency of severe preeclampsia was 3.09%. Medical evacuation (70.59%) was the most frequent mode of admission. Patients were in average 29.8 years and primipare. Personal medical history was dominated by high blood pressure (16.29%). The average gestational age was 34+2 days, but pregnancy was carried to term by the majority of patients. Functional signs were dominated by headache (40.65%). Blood pressure was greater than or equal to 160/90 mmHg (90.32%). Hyperuricemia was the most frequent biological anomaly after proteinuria (45.1%). Complications were dominated by retroplacental hematoma (4.49%) and intrauterine growth retardation (IUGR) (28.48%). Calcium channel blockers (81.88%) were the main antihypertensive agents administered. Caesarean section was the most common delivery method (80.46%). The maternal prognosis was good, with no maternal deaths recorded. Perinatal mortality was 173.9%.

Conclusions: Preeclampsia remains a fearsome pregnancy’s pathology. Raising awareness of pregnant women during ANC on the risks of pre-eclampsia, retraining of health personnel, close and early monitoring of women at risk and management in a multidisciplinary setting help to improve the maternal-fetal prognosis.

Maternal and fetal outcome in primigravida with unengaged head at term in labour

Reshma L., Sujatha Prabhu, Kusuma Naik M. V. — Thu, 11 May 2023 00:00:00 +0000

Background: Unengaged head in a primigravida at term gestation at the onset of labor is considered as an obstetric risk factor for dysfunctional labor. Careful monitoring of the progress of labor and timely medical intervention reduced the risk of dysfunctional labor and Cesarean delivery. This study was to assess the effect of unengaged head on course of labor, duration of labor, its maternal and fetal outcome in primigravida at term in labor.

Methods: This prospective cross-sectional study was conducted in 100 primigravida with term gestation, unengaged head with spontaneous onset of labor meeting the inclusion criteria admitted to labor ward, Department of Obstetrics & Gynecology, ESIC-MC & PGIMSR Hospital, Bengaluru during January 2019 to June 2020. After detailed clinical evaluation, labor monitored partographically and CTG for fetal surveillance and when necessary, interventions like augmentation of labor and operative vaginal or cesarean delivery performed.

Results: Among 100 primigravidae, 19% had floating head, 53% at -3 and 28% at -2 station at the time of onset of labor. The mean duration of 1^st, 2^nd stage and total duration of labor was higher in freely floating head compared to -3 and -2 station. The need for augmentation of labor was 100% with freely floating head than with -3 and -2 station. 77% delivered vaginally and 23% by LSCS, arrest disorders being the main indication. There was no significant difference in maternal morbidity or APGAR score at 5 min. 88% of the babies delivered with good APGAR and 12% required NICU admission

Conclusions: Our study demonstrates that higher the fetal head station at the onset of labor, greater the duration of labor and the need for augmentation. Unengaged head per se is not an indication for LSCS as 77% of them delivered vaginally with partographically monitored labor.

Comparison of targeted management versus syndromatic management for abnormal vaginal discharge and the common microorganisms sensitivity associated with it

Mamta Singh — Sat, 20 May 2023 00:00:00 +0000

Background: Abnormal vaginal discharge usually occurs in women of reproductive age group. There are many etiologies related to abnormal vaginal discharge. Abnormal vaginal discharge is second most frequent issue, behind menstrual problem in women. The main aims and objectives of this study were to compare the targeted management to syndromic management in achieving the complete cure for vaginal discharge; and to find out the common organism in vaginal discharge, in high vaginal swab culture and sensitivity.

Methods: The study was a randomized control trial, where 200 patients were enrolled. The study participants were divided into 2 groups, A and B. Group A was given treatment according to the lab results. Group B was treated according to the syndromic management of vaginal discharge.

Results: In group A, 88% patients having bacterial infection were cured, 10 patients were partially cured by antibiotics. 40% patients in sub group B1 were cured, 40% patients with their partners cured in subgroup B2, 37% in sub group B3 were cured. In group A, 94 patients out of 100 had organism detected on lab test. 14 patients on per speculum examination had vaginitis with cervicitis, but in lab test only vaginitis was present.

Conclusions: We can conclude that syndromic management of vaginal discharge is not an efficient approach for treatment. Low response in syndromic management is due to low sensitivity of clinical examination in diagnosing the nature of vaginal discharge. Development of simple and affordable diagnostic tests that can be used is of highest priority.

Obstetric and perinatal outcome of multiple pregnancy: a retrospective study

Sri Sushma Nagasuri, Savita Konin, Neeta Harwal — Thu, 11 May 2023 00:00:00 +0000

Background: Obstetricians and paediatricians are concerned about multiple pregnancy because of its high association with maternal and perinatal morbidity and mortality. This study aims to determine the obstetric and perinatal outcome of multiple pregnancy at a teaching hospital in Southern India.

Methods: This retrospective study was conducted in the department of obstetrics and gynecology, Basaweshwar teaching and general hospital, and Sangmeshwar teaching and general hospital, attached to Mahadevappa Rampure medical college, Kalaburagi from August 2020 to August 2022. The analysis included data on 36 women between 20 and 35 years of age, with ≥ 24 completed weeks gestation, having multiple pregnancy during the study period after applying the exclusion criteria. The data was retrieved from the hospital medical records that included demographic details, complications of pregnancy, and maternal and neonatal outcomes. The data was expressed as frequencies, percentages, mean and standard deviation. Statistical data was analyzed using SPSS 20.0 software. Qualitative data of the maternal problems during intrapartum and postpartum period was done using the test of proportion and chi-square test was applied for significance. Quantitative data was analyzed by t test considering a p value less than 0.05 as statistically significant.

Results: There were a total of 36 women with multiple pregnancy with the overall incidence of 12.5 per 1,000 births (1.25%) during the study period. Preterm labour complicated 27.7% of multiple pregnancies, 13.8% of the multiple pregnancies were complicated by severe preeclampsia, 11.1% were complicated by imminent preeclampsia, 8.3% had intrauterine death in 1 of the twins, and 2.7% had oligohydramnios. 33.3% had iron deficiency anaemia, 22.2% had gestational hypertension, and 13.8% had hypothyroidism. There was no maternal morbidity. Majority (55%) were delivered by LSCS, whereas 44.4% were delivered vaginally. Postpartum haemorrhage complicated 5.5% of twin deliveries. The total fetal loss was 2.4%. There was no maternal mortality in our study.

Conclusions: There is higher incidence of adverse maternal and perinatal outcomes among multiple pregnancies than singleton pregnancies. This mandates adequate counselling about risks and required monitoring to avoid adverse outcomes.

Correlation of maternal age and combined assessments on risk of chromosomal anomaly during prenatal screening

Tue, 09 May 2023 00:00:00 +0000

Background: Prenatal detection of genetic abnormalities is one of the biggest challenges of current fetal medicine. Prenatal screening for chromosomal abnormalities can be done using biochemical tests. The screening is a risk estimation test and not a diagnostic test.

Methods: Statistical data treatment had been performed on a sample of 362 pregnant women for prenatal screening. This was a retrospective data analysis study undertaken at the National Reference Laboratory, Redcliffe Labs.

Results: Nine (2.48%) women out of 362 were screen positive for chromosomopathy. The point biserial correlation between variables (Free β-hCG - Free Beta Human Chorionic Gonadotrophin, PAPP-A- pregnancy associated plasma protein-A and NT-(nuchal translucency) amongst patients with positive and negative screen test was statistically significant. There was a positive correlation between positive screen for chromosomopathy and hCG, MoM, NT MoM whereas a negative correlation between them and PAPP-A. This study indicates that higher values of hCG and lower values of PAPP-A MoM as seen in the positive screen patients is associated with a significant risk of chromosomopathy. A positive correlation between age and screen positive cases was seen. The McNemar’s test indicated a significant reduction in screen positive cases when biomarkers were added to screen for Trisomy 21 in women aged >35 years (n=86). 81 women eventually screened negative.

Conclusions: The analyses stresses on the importance of using state-of-the-art, prenatal noninvasive screening software to help provide a predictive outcome, individualized for that pregnant woman.

Clinical study on feto-maternal outcome in teenage pregnancy in a tertiary care institute

Sushma V. Dev, Mythreyi Kadambi — Mon, 15 May 2023 00:00:00 +0000

Background: Pregnancies that occur below the age of 20 years are called teenage pregnancies. Teenage pregnancy is a common public health problem worldwide which is detrimental to the health of both the mother and the new-born. This study aims to evaluate the obstetric and perinatal outcomes of teenage pregnancy in the Indian rural and semi urban population.

Methods: A retrospective observational study was undertaken in the department of obstetrics and gynecology, Mysore Medical College and Research Institute, Mysore, for a period of one year from August 2021 to September 2022. All the teenage mothers during the study period were included in the study. Data was analysed included various maternal parameters, fetal parameters, and the outcome of pregnancy.

Results: Study showed the incidence of teenage pregnancy is 12.6%. About 88.3% were primgravida, 74% were booked cases. 51.6% of the teenage mothers had varying grades of anaemia, 29.09% of teenage mothers had spectra of hypertensive disorders if pregnancy, 27.92% had PROM. Caesarean section rates were 25%, Fetal distress being the most common indication in 47.3% followed by fail induction in 29.8%. Preterm delivery rates were as high as 13.6%. Postpartum complications included postpartum hemorrhage in 2.5%, puerperal pyexia in 1.9%, postpartum eclampsia in 1.38%. Respiratory distress was seen in 17.6% neonates, prematurity in 15.49%, IUGR in 13.6%, 2.99% were stillborn send 3.36% succumbed due to pre-maturity, respiratory distress, and sepsis.

Conclusions: From the present study we infer that the prevalence of teenage pregnancy is still high in rural and semi urban population and they suffered from a significant number of complications in pregnancy including anemia pre-eclampsia and preterm labour, neonatal respiratory distress and early onset sepsis. To surmount these problems a multidisciplinary team involving health and social workers, obstetrician and gynaecologist are required to improve adolescent reproductive health.

Hysteroscopic evaluation of menorrhagia and correlation with saline infusion sonography and histopathology of the endometrium

Rahul K. M. Padval, Duraiya Gulamali — Sat, 20 May 2023 00:00:00 +0000

Background: This study aimed to evaluate and compare the diagnostic utility of hysteroscopy and saline infusion sonography in patients presenting with abnormal uterine bleeding, using the International Federation of Gynaecology and obstetrics classification system.

Methods: The study included 97 women with menorrhagia attending the department of obstetrics and gynaecology, R. D. Gardi Medical College, Ujjain, from September 2011 to February 2013. All the participants underwent hysteroscopy, saline infusion sonography (SIS), and endometrial histopathology. The sensitivity, specificity, positive predictive value, and negative predictive value of each diagnostic method was calculated and compared.

Results: Both hysteroscopy and SIS demonstrated high sensitivity and specificity in detecting structural lesions from the PALM group of abnormal uterine bleeding (AUB) aetiologies. For endometrial polyps, hysteroscopy had a sensitivity of 89.47% with a specificity of 87.17%, while SIS had a sensitivity of 100% and specificity of 88.46% (p<0.01). For submucous fibroids, hysteroscopy had a sensitivity of 82.35% and specificity of 91.25%, while SIS had a sensitivity of 88.23% and specificity of 88.75% (p<0.01). However, neither method was as effective for endometrial hyperplasia and the COEIN group. Hysteroscopy-guided biopsy could improve the sensitivity and specificity of hysteroscopy in detecting endometrial hyperplasia.

Conclusions: Hysteroscopy and SIS are valuable tools in the diagnosis and management of AUB, with both methods demonstrating significant efficacy in detecting structural lesions, such as endometrial polyps and submucous fibroids. Further research is needed to refine these techniques and determine their optimal use in clinical practice, especially for the detection of endometrial hyperplasia and conditions within the COEIN group.

Bacteriological profile and antibiogram of uropathogens isolated from obstetrics and gynaecology patients in a tertiary care hospital

Gargi Mudey, Akoijam N. Devi, Gaurav Sahu, Sheetal Mahajan, Supriya Meshram — Fri, 26 May 2023 00:00:00 +0000

Background: Urinary tract infection (UTI) is a common complication occurring in obstetric patients, posing adverse risks to both the mother and fetus. The aim of this study is to analyse the bacteriological profile and antimicrobial susceptibility pattern of uropathogens in obstetrics and gynaecology ward for the effective treatment.

Methods: A total of 404 urine samples from pregnant women with different gestational age were processed for the isolation of uropathogens and tested against ten classes of antibiotics. Uropathogens from significant bacteriuria cases were isolated and identified by standard procedures from January 2020 to December 2021. Antibiotic susceptibility was studied by Kirby Bauer disk diffusion method.

Results: Significant bacteriuria in 16.3% samples, Escherichia coli (E. coli) was the most common uropathogens followed by Enterococcus sp. and Klebsiella pneumoniae (K. pneumoniae). E. coli showed highest resistance to ceftazidime, cotrimoxazole and ciprofloxacin while exhibiting high sensitivity to imipenem, meropenem, and amikacin. Moreover, major proportion of isolates of K. pneumoniae were resistant against ceftazidime, ciprofloxacin, and nitrofurantoin; and for Enterococcus species against penicillin and gentamycin, but 100% sensitive to vancomycin and teicoplanin, and 92.3% to linezolid.

Conclusions: There is a need for screening of antenatal patients for UTI and it is recommended that pregnant women should undergo periodic screening for UTI, so as to monitor the sensitivity pattern of the uropathogens and for the development of specific antibiotic policies based on local susceptibility patterns.

Impact of respectful maternity care and its outcome in a childbearing woman

Shwetha K., Anjalee Yadav, Jeetu — Fri, 26 May 2023 00:00:00 +0000

Background: Respectful maternity care (RMC) is an individualised approach which emphasises on moral values and respect for human rights, and encourages behaviours that take into account women's preferences and the needs of both pregnant women and new mothers. The Indian Government has recently undertaken RMC under LaQshya to give respectable attention and care to the pregnant patients at medical facilities.

Methods: It is a cross sectional study conducted in the department of obstetrics and gynaecology at a tertiary care hospital in Bhopal. Pregnant women who came for labour and delivery services were included in the study and all pregnant female–healthcare provider interactions during childbirth were taken for assessment.

Results: Patient satisfaction survey of labour room done consecutively for 3 months revealed PSS score of 4.55, 4.51 and 4.51 in month 1, 2 and 3. Similarly, patient satisfaction survey of maternity operation theatre (OT) done consecutively for 3 months revealed PSS score of 4.59, 4.56 and 4.50 in month 1, 2 and 3.

Conclusions: The study's results show that respectful maternity care is still in its budding stage despite the fact that women are noticing and reporting positive changes in maternity care practises. In order to improve maternal health outcomes for all women, there is a need for increased action, discussion, research, and advocacy on this crucial public health and human rights problem.

Efficacy of an alginate versus proton pump inhibitor in the symptomatic relief of gastroesophageal reflux symptoms in pregnant women

Jayanthy T., Vayyala P. Reddy — Fri, 26 May 2023 00:00:00 +0000

Background: Gastroesophageal reflux disease (GERD) is frequently seen during pregnancy with prevalence of 80%. Proton pump inhibitors (PPI) are the most effective drugs used in the treatment of reflux symptoms. Alginates are natural polysaccharide polymer which builds a non-systemic barrier against acid and food reflux in the oesophagus. Aims and objectives were to compare the efficacy of alginate versus PPIs in pregnant women, and to determine the time to onset of decrease in the pain intensity of alginate to PPIs.

Methods: This is a prospective randomised study conducted in pregnant women with symptoms of heartburn comparing the efficacy of alginates to PPIs in Kempegowda Institute of Medical Sciences. After subjects have signed the consent, two sachets of 10 ml liquid preparation alginate were given to the alginate group while 40 mg intravenous pantoprazole to the PPI group.

Results: Among 40 patients studied, 20 were given alginates and 20 were given PPIs. 7 presented in the 1st trimester and 33 in 2nd trimester. Onset of action is faster with alginates when compared to PPIs, it was 30 min to 1 hour in patients taking alginates and 6-12 hours in patients taking PPIs, duration of action was longer for PPIs than alginates, with alginates it’s observed that it attains 24-hour symptom free interval in shorter time when compared to PPIs.

Conclusions: ¬Alginates to be used for rapid symptom relief in patients with acute symptoms as an induction agent, PPIs to be used for longer duration of action as maintenance.

A cross sectional knowledge, attitude and practice study for copper IUCD in a tertiary care centre in New Delhi

Arpita Mohapatra — Fri, 26 May 2023 00:00:00 +0000

Background: The postpartum period is one of the most sensitive period in a woman’s life. To prevent unwanted pregnancies and promote optimal interpregnancy interval, effective contraception should be discussed and offered at that time. The aim of this study was to assess the knowledge, attitude and practice of postpartum intrauterine device in antenatal patients attending OPD.

Methods: A cross sectional, hospital based descriptive study was conducted from the month of September to November 2021 in the department of Obstetrics and Gynaecology in Maulana Azad Medical College, New Delhi. The total number of patients recruited in the study were 750. A total of 600 patients delivered and 150 were lost to follow up. The antenatal patients attending the OPD were provided with a structured questionnaire to assess the knowledge and attitude to copper IUCD usage.

Results: Most of the patients belonged to the age group of 20-25 years. The majority of the patients were Illiterate and multigravidas (65%). Around 71% of the patients attending OPD were aware of Copper IUCD as a method of contraception. Whereas only 31% of patients were convinced of the safety of Copper IUCD. About 62% were apprehensive to use Copper IUCD. Of the 600 patients delivered in our hospital, PPIUCD was inserted in 216 (36%) patients.

Conclusions: The study reveals good knowledge and favorable attitude of patients for PPIUCD as method of contraception. But it also depicts a low acceptance and usage of the same. The various reasons for this are mainly illiteracy, ignorance, social and religious taboos etc. Hence it is suggested that community education, addressing unwarranted fears of patients, incorporation of family planning in maternal and child health services etc. should be done to improve the acceptance and thereby usage of PPIUCD in patients.

A comparison of spot urinary protein-creatinine ratio with 24-hour urine protein in quantification of proteinuria in women with hypertensive disorders of pregnancy

Ankita Chaudhary, Divyansh Agarwal, Rashmi Agarwal, Sanjay Agarwal — Fri, 26 May 2023 00:00:00 +0000

Background: Proteinuria is a major indicator of hypertensive disorder of pregnancy. The gold standard for diagnosis of significant proteinuria is based on a 24hour urine collection which is cumbersome, time-consuming, and inconvenient to patients. A need, therefore, exists for a rapid, valid, and accurate test to identify significant urinary proteinuria.

Methods: We conducted an observational cross-sectional hospital-based study wherein a total of 150 pregnant women who met the criteria of preeclampsia were taken. Spot urine samples for calculating the urine P/C ratio were taken immediately before 24hr urine collection. Correlation between 24hour urine protein and spot PCR was then determined by Pearson’s correlation coefficient(r).

Results: The correlation coefficient (r) between 24hr urine protein and spot PCR was found to be 0.734 (n=150) which was highly significant with p<0.001. In this study, population the ROC curve analysis revealed the sensitivity of 90.3% and specificity of 97.3% with AUC 0.958 for a cut-off value of spot PCR as 0.43 to detect significant.

Conclusions: Spot PCR is an accurate, valid, steady fast, reliable, and time-saving test which may be used as an alternative method for determining significant proteinuria in patients with pregnancy-induced hypertension.

Clinico-radiological and histopathological study of ovarian masses at a tertiary care centre

Shravya Monica K., Rathnamma P., Kalyani R. — Fri, 26 May 2023 00:00:00 +0000

Background: Counselling and rapid referral to a specialised facility might be improved with the use of a scoring system that could diagnose ovarian cancer. The relative simplicity of the Risk of Malignancy Index (RMI) scoring technique and the ease with which it may be applied make it a strong candidate to use as a primary diagnostic tool for individuals with pelvic masses.

Methods: Prospective observations study conducted on women diagnosed with ovarian mass by clinical examination and confirmed by ultrasonography, undergoing surgery at RL Jalappa Hospital, Kolar from January 2021 to December 2022. Histopathological report was considered as Primary outcome parameter. Age group, Parity, Menstrual history, Risk Malignancy Index, etc., were considered as explanatory parameters.

Results: A total of 40 subjects are included among which 22.50% are aged ≤40 years and 77.50% are aged >40 years. Using a cut off of 25, majority (88.2%) of those with malignancy had RMI≥25 and in benign histopathology report 56.5% had ≥25 RMI. Histopathology report, there was a statistically significant (p<0.05) difference in RMI values. The RMI had a sensitivity of 88.24% in predicting malignancy with specificity 43.48%, positive predictive value 53.57%, negative predictive value 83.33% with a total diagnostic accuracy of 62.50%.

Conclusions: Results from RMI and histopathology correlate positively. The results of this research show that RMI is a reliable and practicable method for assessing patients with pelvic masses at the commencement of therapy and identifying those who are good candidates for centralised surgical treatment.

The effect of preventive measures to reduce the decision to delivery interval in women undergoing emergency caesarean section

Donthireddy L. Sahithi, Manju A. Talathi, Vaishali S. Taralekar — Fri, 26 May 2023 00:00:00 +0000

Background: Time interval between the decision to perform an emergency caesarean (ES) section and the actual delivery is known as decision delivery interval (DDI). A third phase delay in the delivery of emergency obstetric care is caused by prolonged DDI. In an effort to reduce maternal morbidity and neonatal morbidity and mortality, it is essential to implement interventions designed to reduce DDI.

Methods: This study was carried out to reduce DDI by setting benchmarks for all categories according to Royal College of Obstetricians and Gynaecologists (RCOG) guidelines 2010, in our setup. The study carried out in 2 phases; first phase was a pilot study comprising of 143 women who underwent ES section. The deviation in DDI with possible causes were noted. The benchmarks were set to 8%, 30% and 20% for categories 1, 2, and 3 respectively. Corrective actions were taken including both hospital and patient causes for delay and were discussed at each level. Second phase included total 460 women from January to December 2021 and evaluated for DDI.

Results: Out of 460, 87 (18.91%) women had deviated from the set DDI. The percentages in individual categories 1, 2 and 3 were 17.22%, 30.50%, and 29.50%, respectively. The deviation percentage of DDI in category 2, was achieved as per benchmark set in a pilot study, however, it was not achieved for other categories.

Conclusions: Since the result that was obtained didn’t reach the set deviation percentage, we have observed that achieved deviation cannot be further reduced as our clinical setup is a teaching institute.

Outcome of advanced epithelial ovarian cancer: a tertiary care centre study

Fri, 26 May 2023 00:00:00 +0000

Background: Ovarian cancer is the fourth most common cancer in Indian women with an incidence of 4.9 cases per 100,000. Epithelial ovarian cancer is a silent killer disease as it presents at an advanced stage with minimal signs and symptoms.

Methods: It is a type of research article. The present study was conducted in Department of Obstetrics and Gynecology, Cama and Albless Hospital, Mumbai, Maharashtra, India, from a period of January 2018 to July 2019, during which 53 cases of EOC were studied.

Results: Out of 53 cases of EOC, 45 cases were advanced stage EOC, they were either operated as PDS-ACT or NACT- IDS.

Conclusions: NACT is recommended wherein optimal cytoreduction appears unlikely, or in patients where upfront surgery is high risk and extensive causing high morbidity post-surgery. Places where there is non-availability of special surgical expertise and hospital resources, there too NACT-IDS is recommended.

Introduction of clinical audit in obstetrics for undergraduate medical students

Seema Grover, Shashi Kant Dhir, Nishi Garg, Balpreet Dhaliwal, Dinesh Badyal — Fri, 26 May 2023 00:00:00 +0000

Background: Clinical audit is becoming increasingly important in the healthcare system to ensure a high quality of patient care. Involving the undergraduate medical students in the audit process will help them to understand the subject better and will stimulate them to critically appraise a medical issue. Clinical audit is a hands-on practice of data collection, comparison of current clinical practice with standard and find root cause analysis-based intervention to implement change ideas. Aim and objectives of current study were to introduce audit as a teaching tool in clinical posting of obstetrics and evaluate its impact and acceptability.

Methods: Final year MBBS students were enrolled for the study. The caesarean section was selected as the topic for audit. A pre-test was given before the introduction of Clinical audit. Participants were trained to do a systematic clinical audit including analyzing the collected data. They worked in small groups along with a faculty supervisor. A post-test was taken after one month. Likert scale was used to evaluate the acceptability of this tool by students.

Results: A total of 50 MBBS students of the final semester completed the pre-test, training to use clinical audit and the post-test. The results of pre-test and post-test were compared and a statistically significant improvement was found in the performance of students. This method was found to be an acceptable tool for clinical teaching by 98% of the students.

Conclusions: Final year MBBS Students performed better when clinical audit was used as a teaching tool, which was also well accepted by them.

Feto maternal outcome in placenta previa and morbidly adherent placenta

Somy Khan, Rajendra Prasad Rawat, Santosh Meena — Fri, 26 May 2023 00:00:00 +0000

Background: Placenta forms the most important link between the developing foetus and the mother. The placenta's health is crucial for the foetus' proper growth and development. The outcome of pregnancy is changed when there is a change in the placental location or architecture for both the mother and the foetus. No matter the cause, placenta previa increases maternal and foetal risks by several times. Aim and objectives of current study are to investigate the incidence of placenta previa in hospital obstetric patients and the maternal and fetal outcome in cases of placenta previa.

Methods: 100 patients delivered in the Govt. Medical College, Kota with cases of placenta previa. Risk factors like Gestational age at the onset of bleeding, expectant management, gestational age at delivery and the mode of delivery. The birth weight and APGAR score of the newborn were observed.

Results: The risk of placenta previa is 3 time higher in multigravida than primigravida. 52% chances of placenta previa with male babies. Peak incidence of bleeding is noted around 34-36 weeks. 92% of placenta previa cases were delivered LSCS. PPH was main morbidity out of all morbidities. 55% of babies were less than 2.4 Kg. 44% were anterior, 38% posterior and rest 6% central placenta previa.

Conclusions: Placenta previa poses a serious risk to both the mother and the foetus, whether it is accidentally discovered by ultrasound or as a result of a clinical emergency like a haemorrhage in the mother. The best outcome can be achieved with an accurate diagnosis, prudent expectant management, blood transfusion as necessary, and prompt delivery.

Predictive value of admission and intrapartum cardiotocography in normal and high risk antenatal women

Anuradha Nagpal, Mamta Tyagi, Smriti Gupta, Manvi Gupta — Fri, 26 May 2023 00:00:00 +0000

Background: Cardiotocography is the most common method for assessing fetal health and reveals brain oxygenation. This study is done for admission and intrapartum cardiotocography in high- and low-risk pregnancies and its correlation with neonatal outcome.

Methods: All high-risk and normal antenatal women with more than 34 weeks of pregnancy and vertex presentation who came to the labor room were included in the study. 200 cases were taken, 100 were in the "high risk group," and the remaining 100 were in the "low risk group." On admission CTG and intrapartum CTG tracing were taken after written and informed consent, neonatal outcomes were observed, and adverse neonatal outcomes were noted.

Results: Admission CTG results were unsatisfactory for 9% of women in the high-risk group and none in the low-risk group. Intrapartum NST was non reassuring in 51% of high-risk women and 6% of the low-risk group. Of the total number of neonates admitted to the NICU, 14 were from the low-risk group, while 50 were from the high-risk group.

Conclusions: On admission NST in both low and high-risk women, the absence of category III NST predicted the absence of an adverse neonatal outcome most accurately. Even during labor in both high-risk and low-risk women, the absence of category III reassured the fetal well-being most precisely.

Association of breast feeding in ovarian malignancy: is breastfeeding a boon? a single institutional experience

Subbiah Shanmugam , Sathiyaseelan Balakrishnan — Fri, 26 May 2023 00:00:00 +0000

Background: There are many risk factors which can attribute to ovarian cancer. Oral contraceptive pill (OCP) usage, salpingo-oophorectomy, and high parity are considered as protective factors for ovarian cancer. Lactation (breastfeeding), incomplete pregnancies, and sterilization may offer a weak protection against ovarian cancer. There are only few modifiable risk factors beyond oral contraceptive use exist. Hence identifying additional modifiable factors is needed to tailor prevention strategies.

Methods: In our institution, we analyzed 250 patients who underwent treatment for various malignancies from 2020 to 2022. Among those patients, 128 patients were treated for ovarian malignancy who were compared with 122 control patients (patients with malignancy other than ovarian cancer). We collected data of these patients from medical records. We analyzed the association of breast feeding, and the duration of breast feeding with ovarian malignancy.

Results: A total of 128 women with ovarian malignancy; mean (SD) age, 53.3 (7.7) years and 122 controls; mean (SD) age, 51.6 (8.0) years were included. Breastfeeding was associated with a 26.4% lower risk of invasive ovarian cancer in patients who breastfed their children for cumulative period of more than one year.

Conclusions: Breast feeding is associated with significant reduction in ovarian malignancy when the duration of breast feeding exceeds more than one year. Thus, encouraging breast feeding and increasing the duration of breast feeding may help in reducing the incidence of ovarian malignancy.

A comparative study of efficacy and side effects of nifedipine with nifedipine along with dydrogesterone in management of preterm labor

Sapna Singh, Preeti Tyagi, Deepak Anand, Nitika Gupta, Rashmi Gupta — Fri, 26 May 2023 00:00:00 +0000

Background: Preterm labor remains one of the major cause of neonatal morbidity and mortality. Different tocolytics have been studied for prolongation of pregnancy, role of progesterone in increasing latency period remains controversial. Aim of the study was to compare efficacy of nifedipine with nifedipine along with dydrogesterone as a tocolytic agent in case of preterm labor and find its impact on maternal and neonatal outcome.

Methods: This study was conducted in 100 women who presented with symptoms of preterm labor, patients were then randomized to nifedipine plus dydrogesterone therapy or nifedipine treatment. Group I received Nifedipine plus dydrogesterone 10 mg and group II received only nifedipine.

Results: There was significant difference in latency period between group I and group II polongation beyond 1 week was observed in 58% in group I and 32% in group II. There is significant difference in APGAR score at 1 minute and 5 minute between patients of group I and group II. In group I, 57.4% neonates have APGAR >7 whereas in group II 31.9% neonates have APGAR >7 at 1 minute. In Group I, 89.4 % neonates have APGAR >7 whereas in group II 68.1% neonates have APGAR >7 at 5 minutes. The mean birth weight in group I was 1.86 with SD 0.35 whereas in group II it was 1.72 with SD 0.34 which is statistically significant. However, no significant difference was found between admission in neonatal intensive care unit or neonatal complications and adverse effects between 2 groups.

Conclusions: This study found dydrogesterone along with nifedipine is more effective as tocolytic in comparison to nifedipine alone.

A randomized double-blind study to evaluate asurgeon-based technique to reduce post-operative pain in minimal gynecological surgery

Fri, 26 May 2023 00:00:00 +0000

Background: The study aims to evaluate whether instillation of levo-bupivacaine intraperitoneally decreases post-operative pain after laparoscopic gynaecological surgeries, using VAS pain Scale.

Methods: Randomized placebo controlled double blinded study conducted at tertiary care hospital in New Delhi. 90 ASA I & II women scheduled to undergo elective laparoscopic gynaecological surgeries. 20 ml 0.5% levo-bupivacaine diluted with 40ml normal saline (total 60ml) intraperitoneally at the end of surgery before closure of ports along with port site infiltration of levo-bupivacaine (3-5 ml) in intervention group and 60 ml normal saline intraperitoneally in control group.

Results: Mean pain scores were significantly lower (p<0.01) in the intervention group when compared to the control group for initial 4 hours of the study after that mean pain score was lower in intervention group than control group but it was statistically not significant. The requirement of rescue analgesia was also significantly lesser in intervention group compared to control group.

Conclusions: Levo-bupivacaine is an easy, cheap and non-invasive method which provides good analgesia in the immediate postoperative period after laparoscopic gynaecological surgery, without adverse effects, especially in the early postoperative period. This improves patients experience and should be made an integral part of all minimal gynaecological endoscopic surgery.

Use of low dose misoprostol for induction of labour in a secondary hospital setting: a retrospective cohort study of a unique induction protocol

Fri, 26 May 2023 00:00:00 +0000

Background: Induction of labour is a procedure often used in pregnant women where there are clear medical indications. There are various modalities of induction of labour which differ in outcomes and complications. Our aim was to look at how effective our protocol using misoprostol was in achieving delivery within 24 hours of the start of induction, the induction delivery interval, Caesarean section rates and its indications using Robsons classification, uterine hyperstimulation with FHR changes and oxytocin augmentation and its duration.

Methods: This was a retrospective study which looked at the mode of induction and outcomes of women during the period from 1st February, 2021 to 31st July,2021.

Results: There were 2574 deliveries in the period February 1st, 2021 to July 31st, 2021. We found more nulliparous women and obese women in the induced group. The main indication for induction was past dates and the mean induction to delivery interval among the women being induced was 32 hours (SD: 22.58). There were significantly higher women who experienced PPH and Caesarean sections were 2.100 (1.577- 2.793) times higher among women who were induced.

Conclusions: Induction protocols need to be developed taking into consideration the advantages as well as complications associated with it and then tailor it according to infrastructure and personnel available.

Association of maternal serum triglycerides at term and macrosomia in gestational diabetes mellitus

Fri, 26 May 2023 00:00:00 +0000

Background: Aim of the study was to determine association of maternal serum triglycerides (TG) at term and macrosomia in gestational diabetes mellitus (GDM).

Methods: A cross sectional study was carried out in the department of obstetrics and gynaecology, RIMS, Manipur. The study was conducted for 2 years duration from September 2019 to August 2021 and 85 singleton term pregnant women with GDM were included. All the patients were subjected to check fasting serum TG, FBS, PPBS. Descriptive statistics like mean, standard deviation and Inferential statistics like Chi-square test was used for comparing study variables between large for gestational age (LGA) and non LGA group. T-test was used to compare the mean values of age, pre-pregnancy BMI, pregnancy weight gain, OGTT, FBS, PPBS, fasting serum TG between LGA and non LGA group.

Results: The observed mean TG values in LGA and non LGA group in our study was 262.35±26.08 and 158.18±13.24 mg/dL respectively. The serum TG values in the LGA group mothers was significantly higher when compared to the non LGA group. The mean weight gain in pregnancy 15.17±1.82 and 9.60±1.47 in LGA and non LGA respectively. The mean BMI comparison among LGA and non LGA are 27.7±1.74 and 22.94±1.6 respectively.

Conclusions: It is observed that maternal fasting serum TG may be a strong predictor of foetal size irrespective of the glycemic status. Our study clearly pointed out the usefulness of measuring serum TG in GDM pregnancy. In addition to maternal hypertriglyceridemia, pre-pregnancy BMI, excessive weight gain in pregnancy significantly associated with foetal macrosomia in GDM mothers.

Induction of labour using transcervical Foley's catheter with extra amniotic saline infusion versus intracervical prostaglandin E2 gel at term gestation: a comparative study

Madana Jyotsna Priya, Vasantha Kumar S., Nandini S. — Fri, 26 May 2023 00:00:00 +0000

Background: The intentional commencement of cervical ripening and uterine contraction for the purpose of achieving delivery prior to the onset of spontaneous parturition is known as induction of labour. When the benefits to the mother or the foetus surpass the benefits of extending the pregnancy, it is indicated. The purpose of this study was to assess the efficacy of a transcervical foley's catheter with extra amniotic saline infusion against intra cervical prostaglandin E2 gel for inducing labour in term pregnant women.

Methods: From January 2020 to June 2021, a comparative study was undertaken at R.L. Jalappa Hospital and Research Centre. The study enrolled a total of 72 individuals. After obtaining informed consent from the patients who were admitted, and meeting the inclusion criteria, detailed history was collected, baseline investigations were done. After clinical examination of the patient, by using the simple lottery method, patients were divided into group A (Extra amniotic saline infusion group with Foley’s catheter) and group B (Dinoprostone (PGE2 gel) group).

Results: Prolonged gestational age, hypertensive disorders in pregnancy, and oligohydramnios were the most frequent causes for induction in the EASI group, accounting for 38.89%, 38.89%, and 22.22%, respectively. The dinoprostone group has 36.11%, 33.33%, and 25%, respectively. After induction, the majority of patients in the EASI group had a modified Bishop's score of 2.

Conclusions: Our research found that PGE2 and EASI were equally effective in inducing labour.

Significance of maternal hemogram parameters as new inflammatory markers for prediction of threatened preterm labor and preterm premature rupture of membranes

Anupam Rani, Urmila Karya, Sakshi Nehra — Fri, 26 May 2023 00:00:00 +0000

Background: Non-invasive, inexpensive and easily available simple markers are needed for timely prediction of preterm labor and preterm premature rupture of membranes (PPROM) in women at risk. Aims and objectives of current study was to study the significance of maternal hemogram parameters i.e., NLR, PLR, MPV, PDW and plateletcrit in TPL, PPROM.

Methods: A total number of 150 pregnant women, 50 with PPROM (group 1), 50 with TPL (group 2) and 50 gestation matched healthy controls (group 3) attending antenatal clinic and labor room in SVBP Hospital and associated LLRM Medical College, Meerut were recruited in study. Complete blood count was done from blood sample collected in EDTA vials using 5-part automated cell analyzer device. Hematological parameters like NLR, PLR, MPV, PDW and plateletcrit were measured from CBC.

Results: Patients with PPROM had increased NLR, PLR, MPV, PWD and plateletcrit than patients with threatened preterm labor group and healthy control group.

Conclusions: NLR, PLR, MPV, PDW, and Plateletcrit were significantly increased in both PPROM group and TPL group compared to healthy control group and have a predictive value in PPROM and TPL. Monitoring of these parameters can be promising and cost-effective methods in prediction of TPL and PPROM.

Frequency of gestational diabetes mellitus and associated risk factors amongst women attending antenatal clinic at a tertiary care hospital of West Bengal, India

Tousif Rabi, Kausik Bandyopadhyay, Shiuli Roy Adak — Fri, 26 May 2023 00:00:00 +0000

Background: Women with gestational diabetes are associated with adverse pregnancy outcomes. This study was conducted to evaluate prevalence of gestational diabetes mellitus and associated risk factors amongst women attending antenatal clinic of a tertiary care hospital of west Bengal, India.

Methods: Universal screening for gestational diabetes mellitus was done in 215 women with estimated gestational age between 24 weeks to 28 weeks. They were requested to drink 75 gram of glucose dissolved 300 ml of water irrespective of their last meal. Gestational diabetes mellitus was diagnosed if 2 hour plasma glucose value was ≥ 140 mg/dl. Relevant history was taken and associations with risk factors like age, parity, pregnancy body-mass index, bad obstetric history, family history of diabetes and history of previous macrosomia were analysed statistically.

Results: This study found that prevalence of gestational diabetes mellitus was 14.9%.Statistically significant association was found between glucose tolerance in pregnancy and maternal age, pregnancy body-mass-index, bad obstetric history, family history of diabetes and history of previous macrosomia.

Conclusions: Prevalence of gestational diabetes mellitus was 14.9% which can be considered alarming and its associations with risk factors were statistically significant.

A retrospective study on ectopic pregnancy aspiration by transvaginal ultrasound at Institute of Kidney Diseases And Research Centre

Vineet V. Mishra, Priyanka Rane, Rohina S. Aggarwal, Kunur N. Shah — Fri, 26 May 2023 00:00:00 +0000

Background: Majority of the reports suggest that the frequency of ectopic pregnancies have grown in the last 30 years, especially in patients conceived through artificial reproductive techniques (ART). To prevent severe morbidity and mortality its prompt diagnosis and appropriate management is important. In a select patient population, most of the unruptured, live ectopic pregnancies can be successfully managed without surgical intervention using trans-vaginal ultrasound guided aspiration and instillation of local injection KCl or administration of systemic Inj. Methotrexate.

Methods: This study is a hospital based retrospective cohort study from January 2014 to December 2022 on patients who presented to Institute of Kidney Diseases and Research Centre (IKDRC) with unruptured ectopic pregnancy confirmed with ultrasound and β HCG. All the patients were analyzed according to history, clinical presentation, investigations, treatment and complications.

Results: β-HCG day 1 or 2 post procedure dropped in all cases but in variable levels ranging from 1.3% to 85.88%, while the drop during days 7-10, was more significant and reassuring; ranged from 48.69% to 98.95%.

Conclusions: By aspiration of ectopic gestational sac transvaginally under ultrasonographic guidance it is able to preserve the integrity of uterus and fallopian tube and thus the future fertility. The study will educate other healthcare professionals.

Comparision of efficacy of visual inspection of cervix with acetic acid, Pap smear and colposcopy for prevention of cervical cancer

Rajkumar, Himantika Kumawat, Mamta Sharma, Aushima Vijay — Fri, 26 May 2023 00:00:00 +0000

Background: Cervical cancer is second most common cancer in women globally. Overall 80% cases occurs in developing countries. An important reason for the high incidence of cervical cancer in developing countries is the lack of effective screening programs to detect precancerous conditions and treat before it progresses to invasive cancer due to severe restrictions on the availability of infrastructure, resources and funding. Aim of this study was to compare the sensitivity, specificity, PPV, and NPV of VIA, Pap smear and colposcopy with colposcopic directed biopsy (as a gold standard).

Methods: This prospective analytical study was conducted on 200 women’s (age>19 years) with abnormal cervix in the Department Of Obstetrics and Gynaecology, Government Medical College Kota from 1 august 2020 to 31 July 2022 who fulfil the Inclusion criteria. All the Symptomatic patients with symptoms like vaginal discharge postcoital bleeding, itching, and other gynaecological problems along with asymptomatic patients with accidental finding of bad cervix (cervical erosion).

Results: Maximum cases had common complaint of discharge per vaginum (60.55%), followed by post coital bleeding (11.5%). VIA when compared with HPR, had sensitivity 94.85% and specificity 74.76% and corresponding PPV 78% and NPV 94%. Paps smear when compared with HPR, the sensitivity was 62.89% and specificity was 89.32% and corresponding PPV 84.72% and NPV 71.88%. Colposcopy when compared with Histopathological report, the sensitivity was 70% and specificity was 91.26% and corresponding PPV 88.3% and NPV 76.4%.

Conclusions: Best result for early detection of pre-invasive lesions could be with combined use of Pap smear, VIA, colposcopy and colposcopy guided biopsy rather than any individual diagnostic procedure. It will immensely reduce the morbidity and mortality.

A study of fetomaternal outcome in cases of severe anemia in labor at a tertiary care center

Megh M. Anadkat, Kamal D. Goswami — Fri, 26 May 2023 00:00:00 +0000

Background: In India, the prevalence of anemia is high because of fewer intakes of iron, folic acid and food sources that prevent iron absorption, coupled with poor bioavailability of iron is the major factor responsible for prevalence of anemia. More than iron deficiency, zinc, vitamin B12 and folate deficiency was highly prevalent due to ascariasis infestation.

Methods: This study was carried out in the department of obstetrics and gynaecology at PDU medical college and hospital Rajkot, Gujarat from May 2021 to April 2022.

Results: The study was conducted on 83 cases, the prevalence rate of severe anemia in the study population of PDU Medical College Rajkot was found to be 1.6% during this study period. 57.83% of cases delivered before term. Most of the patients 85.54% in the study group suffered from iron deficiency anemia. Most of the patients 49.40% were managed by transfusion of 2-pint PCV. Most common complications associated with anemia in pregnancy are atonic PPH, pulmonary oedema and surgical site infections in this study. A 67.46% of new-borns were of <2.5kg birthweight. High number of new-borns 39.75% with moderately abnormal APGAR scores were delivered. In this study, 75 patients were delivered vaginally, 5 instrumental deliveries were conducted to cut short the second stage of labor, 3 patients underwent LSCS due to major degree placentae previa and foetal distress.

Conclusions: Severe anemia during labor affect the maternal and foetal outcome to a large extent. The major step in improving these outcomes is prevention of anemia which could be done at pre-pregnancy stages of a woman’s life, measures such as food fortification, deworming, mass haemoglobin screening among adolescent girls helps in this cause.

A study on primary caesarean section in multigravida patients at a tertiary care center

Sneha A. Mendapara, Kamal Goswami — Fri, 26 May 2023 00:00:00 +0000

Background: Historically, most caesarean delivery took place because of or in association with obstetric complications or medical illness. However, rates of elective primary caesarean deliveries with no clear medical or obstetrical indication are rising dramatically. The most common indication for primary c-section include in order of frequency labor dystocia, abnormal or indeterminate fetal heartrate tracing, fetal malpresentation, multiple gestation, fetal macrosomia. Many other factors that have contributed to the increasing rate of caesarean include improved surgical technique and patient demand and pressure on caregivers to practice “defensive medicine”. The increasing rate of caesarean section is a matter of international public health concern as it increases the caesarean related maternal morbidity and fetal complications as well as the cost of health care as compared to normal delivery.

Methods: This study was carried out in the Department of Obstetrics and Gynecology at PDU Medical College and Hospital Rajkot, Gujarat from January 2021 to June 2022.

Results: The study was conducted on 234 cases, the percentage of primary caesarean section in the study population of PDU Medical College Rajkot was found to be 2.96%. In this study, 38.46% of patients belonged to 26-30 year age group. In this study, 78.63% of multigravida patients were 2^nd and 3^rd para. There were 41.45% of cases underwent LSCS for foetal distress, 12.39% for antepartum haemorrhage, 12.82% for malpresentation and rest for various other indications. 33.33% of the study population in this study belonged to Robson’s group 3, 26.92% were included in category 4a, 15.81% belonged to category 4b. Among all deliveries 94.87% were live births whereas 5.98% were still births.

Conclusions: Many unforeseen complications occur in women who previously had a normal vaginal delivery. It is recommended that all antenatal patients must be booked and receive proper and regular care. Also 100% deliveries in multigravida should be institutional deliveries in order to reduce maternal and perinatal morbidity and mortality.

Comparison of diagnostic performance of simple international ovarian tumor analysis rules versus subjective pattern recognition for triage of adnexal masses

Fri, 26 May 2023 00:00:00 +0000

Background: Accurate and early diagnosis of adnexal masses is essential for optimal clinical decision-making. The aim of the study was to compare the diagnostic performance of simple international ovarian tumor analysis (IOTA) rules vs subjective pattern recognition, to discriminate between benign and malignant adnexal mass, and to establish the diagnostic utility of IOTA rules as a standardized examination tool in early diagnosis of ovarian malignancy.

Methods: A prospective cohort study was conducted at a tertiary care hospital between November 2017 and March 2019 on 100 women with adnexal masses. All adnexal masses detected on ultrasound were classified according to IOTA rules by the trainee, followed by subjective pattern recognition by experts. These observations were further correlated with histopathology/intraoperative findings/ follow-up examination. Diagnostic efficacy was assessed by comparing sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy.

Results: Among the 100 patients, 81 had benign, and 19 had malignant masses on final diagnosis. The sensitivity, specificity, PPV, NPV, and accuracy for the detection of malignancy using IOTA rules by trainee were 100%, 95.59%, 81.82%, 100%, and 95.65%, and by subjective evaluation by experts were 100%, 97.5%%, 90.5%, 100%, and 98% respectively. No statistically significant difference was found between the diagnostic accuracy of the two methods.

Conclusions: Simple IOTA rules are as accurate as subjective evaluation by experts in the characterization of adnexal masses. Their inherent simplicity and reproducibility make them ideal for use by less experienced sonographers.

Assessment of maternal factors and fetomaternal outcome in pregnant women conceived by artificial reproductive techniques

Deepika Jatav, Nootan Chandwaskar, Madhuri Arya — Fri, 26 May 2023 00:00:00 +0000

Background: Infertility is a major issue and a source of social and psychological suffering for many couples. Introduction of assisted reproductive technology (ART) leads to great relief for couples nowadays.

Methods: This present observational cross-sectional study was conducted at OBGY Department at Sri Aurobindo Medical College and Post Graduate Institute, Indore and who satisfy the inclusion criteria was studied from 1st April 2021 to 30th September 2022 (18 months). After approval from Institutional ethical committee. Each patient fulfilling the inclusion criteria was included in the study. Informed written consent was taken.

Results: The mean age of women in this study was 37.6 years and the most common age group was between 30-50 years. Infertility was mostly unexplained (40%), followed by female factor (33.33%), male factor (16.67%), and combined (10%). 63.33% were singletons, 36.67% twins. Preterm labor (43.33%) was most common. Preeclampsia/eclampsia (33.33%), gestational hypertension, renal failure, gestational diabetes, cardiomyopathy, hepatic failure, HELLP syndrome, and DIC were other complications. 60% were caesarean-sectioned and 40% vaginal delivery. 90.24% of neonates had 5-minute Apgar scores above 7 and 9.76% below 7. 4 stillbirths (9.76%) and 75.68% of live births required NICU admission. 5 neonatal deaths (12.2%) and 21.95% perinatal mortality.

Conclusions: There are numerous maternal and perinatal complications linked to ART. Couples should therefore be counselled about these risks while offering them ART as a mode of conception.

Maternal near miss: a surrogate indicator of obstetrics care

Fri, 26 May 2023 00:00:00 +0000

Background: A maternal near miss (MNM) is an event in which a pregnant woman is on the verge of dying but doesn't die. Despite the fact that most maternal deaths can be avoided, efforts to reduce maternal mortality have not always been successful. This study aimed to identify and analyze the frequency of maternal near-misses (MNMs) cases and causes of maternal near miss due to severe obstetric complications.

Methods: A retrospective observational study was carried out at Department of Obstetrics and Gynecology, Heritage Institute of Medical Sciences, Varanasi. The study duration was from January 2021-June 2022. Purposive sampling was used to collect the total of 2053 samples.

Results: The study involved in total of 56 maternal near miss cases which includes total of ten maternal deaths. The majority of the respondents have more than 20 years of the age (82.1%) where near miss cases were higher in multiparous women (73.2%). First delays (delay in women seeking help) were almost a third in numbers to affect the maternal mortality and morbidity. Hypertension (32%). hemorrhage (20%) and anemia (14%) were the major leading cause of obstetrical complications. About 66% of the maternal near miss cases needed the interventional management that was ICU admission, mechanical ventilation (41.1%) and blood transfusion (32.1%).

Conclusions: Pregnancy hypertension, postpartum hemorrhage, and severe anemia continue to be important determinants of maternal morbidity. First-referral unit facilities and training should be improved so that they can better respond to basic obstetric emergencies such as hypertension, anemia and hemorrhage.

KAP study on emergency contraception among women of reproductive age group attending JNUIMSRC OPD, Jaipur, India

Pragati Meena, Seema Meena, Richa Choudhary, Bharti Sharma — Fri, 26 May 2023 00:00:00 +0000

Background: Unintended pregnancy, unplanned birth and unsafe abortion have been a major challenge to the reproductive health of women worldwide. Despite the availability of highly efficient contraceptive technologies, there are still many undesired pregnancies that put women at a higher risk of mortality, frequently as a result of unsafe abortion. Emergency contraceptive pills can be used to prevent these unwanted pregnancies. Aim of this study was to assess the knowledge, attitude and practice of use of emergency contraception among women of reproductive age group attending JNUIMSRC OPD, Jaipur, India.

Methods: Institution based cross-sectional study was conducted among 100 females of reproductive age group attending JNUIMSRC OPD, Jaipur, India. Data was collected using pretested semi-structured questionnaire after written informed consent. Descriptive and inferential statistics were used to analyse the data generated.

Results: Among respondents who were aware of ECPs, 64% had good knowledge of it, 90% had positive attitude towards ECPs and 63% have used earlier. A significant association was found between age, residence, educational level and occupational status with awareness of ECPs.

Conclusions: Awareness and utilization of emergency contraceptive pills is low among females of reproductive age group attending OPD at JNUIMSRC. Thus awareness should be enhanced through formal education, communication from healthcare professionals and media that can offer trustworthy and accurate information on ECPs.

Assessment of maternal and fetal outcome in eclampsia patients getting admitted in Bundelkhand Medical College, Sagar, India on basis of general condition of patient at time of admission and induction delivery interval

Deepti Kelkar, Jagrati Kiran Naagar, Sheela Jain — Fri, 26 May 2023 00:00:00 +0000

Background: Eclampsia is the convulsive and most severe manifestation of the hypertensive disorders of pregnancy. Eclampsia is defined by new-onset tonic-clonic, focal, or multifocal seizures in the absence of other causative conditions.

Methods: It is a prospective observational study conducted in BMC Sagar, Madhya Pradesh, India of duration one year, according to inclusion and exclusion criteria with 72 eclampsia patients.

Results: Most patients had vaginal deliveries 62.5%. There were 4.2% maternal deaths. 65.4% patients’ babies were shifted to mother’s side. Lesser no. of SNCU referrals were seen in cases of LSCS as compared to vaginal deliveries, in cases where patients had GCS more than 8 at time of admission, where admission delivery interval was less than 12 hrs.

Conclusions: The results of the current study indicated that better the general condition of patient at time of admission, lesser the induction/admission delivery interval-better is the fetal maternal outcome. Eclampsia could have been prevented in patients by regular antenatal visits and early detection in pre-eclampsia/gestational hypertension stage.

A cross sectional study on the frequency of thyroid disorders in pregnancy and the asssociated obstetric complications

Sreelakshmy K. — Fri, 26 May 2023 00:00:00 +0000

Background: Thyroid disorders have a yet unclear impact on obstetric complications. The studies have been varied and mostly contradictory. The aim of the study was to examine the pattern of thyroid disorders and its obstetric complications.

Methods: This cross-sectional study enrolled 334 pregnant women of less than 12 weeks of gestation. After routine clinical and ultrasound evaluation of all cases, all baseline investigations and TSH was done. In all cases with low TSH free T3 and free T4 was done. All patients were followed up till delivery and the obstetric events were recorded. The data collected were analysed using chi-square test.

Results: Of the 334 enrolled the data on pregnancy related events were available for 276 patients. Subclinical hypothyroidism was detected in 10.1% of the population while 3.6% were having overt (clinical) hypothyroidism. Anaemia was more in subclinical hypothyroidism (39.3%) and overt hypothyroidism (40%). Pre-eclampsia was seen 17.85% with subclinical hypothyroidism and 30% with overt hypothyroidism. Eclampsia was seen in 3.7% of subclinical hypothyroidism and 10% of clinical hypothyroidism. Gestational diabetes mellitus (GDM) was more in patients with subclinical hypothyroidism (25%) and overt hypothyroidism (20%). Oligohydramnios and IUGR were higher in the subclinical hypothyroidism (21.42%, 10.7%) and overt hypothyroidism (20%, 10%). There was no difference between the euthyroid, subclinical hypothyroidism and overt hypothyroidism groups with respect to any of the other variables.

Conclusions: There was a high frequency of thyroid disorders among pregnant women in our study and this had adverse obstetric consequences.

Hypertensive disorders of pregnancy: a manifestation of insulin resistance

Fri, 26 May 2023 00:00:00 +0000

Background: Pregnancy is a unique physiological diabetogenic state characterised by increased insulin resistance that ensures adequate supply of nutrients to the developing fetus. The insulin sensitivity falls to upto 50 percent in the late pregnancy. Thus insulin resistance and the resultant hyperinsulinemia are the characteristics features that are evident in the normal pregnancy during third trimester. In Hypertensive disorders of pregnancy (HDP), there is exacerbation of the physiological insulin resistance that occurs in normal pregnancy resulting in increased fasting serum insulin level.

Methods: This is a case control study conducted on 90 antenatal women, during the study period of one and half years (from December 2020 to June 2022) in IMS and SUM Hospital, Bhubaneswar. With informed written consent and after fulfilling the criterias, 60 normotensive patients were chosen as controls and 30 pregnant patients with hypertensive disorders of pregnancy were chosen as cases. After 8 hours of overnight fasting, 2ml of blood is drawn and processed by CMIA technology to detect fasting serum insulin levels. The mean fasting serum insulin levels were compared between the cases and the controls.

Results: The mean fasting serum insulin level of controls was found to be 9.27 and the mean fasting serum insulin level of cases was found to be 15.01 which was higher than controls. This was found to be statistically significant with a P value of 0.000.

Conclusions: Increased fasting serum insulin level is observed in women with HDP than normotensive pregnant women.

Study on epidemiology of endometriosis in North East India

Kalpana S. Udupa, Pranay Phukan, Nabajyoti Saikia, Aparna Dutta — Fri, 26 May 2023 00:00:00 +0000

Background: Endometriosis is the presence of endometrial glands and/or stroma outside the uterus, predominantly in reproductive age. The prevalence is around 10% in women of reproductive age and is caused by combination of multiple genetic and environmental factors. Characterization of endometriosis can be learnt from epidemiological factors of the patients which influence on disease development and thus helpful in clinical diagnosis. Histological pictures after surgery may vary considerably and sometimes over diagnosis of the disease is not uncommon. The purpose of the study was to study the epidemiology of endometriosis in North East population of India and correlation of clinical and histopathological diagnosis.

Methods: It was a hospital based observational descriptive study carried out in Department of Obstetrics and Gynecology, AMCH, Dibrugarh, Assam, India. Detailed history and clinical presentations were elicited and relevant investigations were done. Operative findings and biopsy reports were correlated. All the findings were tabulated and statistically analyzed.

Results: Women in age group 30-39 years (48.31%) with mean BMI of 24.44±4.06 kg/m², nulliparous (31.46%) or para 1(33.71%) formed the majority of study population. Majority had early age at menarche (11.45±1.24), irregular cycles, shorter cycle length, longer duration of flow. Majority (79.78%) had dysmenorrhea followed by dyspareunia (59.55%). Only 62.92% had biopsy proven endometriosis.

Conclusions: Epidemiological factors and clinical presentations guide in diagnosing endometriosis and should be given importance. Clinical diagnosis of endometriosis may not always correlate with histopathologic diagnosis and many other pathologies mimic endometriosis.

Effect of timing of cord clamping (early vs delayed) on hemoglobin level among newborns: an Indian study

Bikramjit S. Jafra, Sunil K. Mehendiratta, Pooja R. Jafra, Anudeep Jafra — Fri, 26 May 2023 00:00:00 +0000

Background: Aim of the current study was to evaluate effect of delayed cord clamping on hemoglobin level among newborns and look for any adverse effects following delayed cord clamping.

Methods: Total 60 newborns were enrolled in the study and were randomly allocated to either control (early cord clamping 15 secs) and cases (delayed cord clamping 3 mins). Samples were collected in labor room, during birth to check the hemoglobin, billirubin and hematocrit levels in two groups. Follow up data were collected in postnatal ward, 24 hours after birth to estimate hemoglobin, hematocrit and billirubin levels and infants were assessed for the presence of respiratory distress.

Results: Hb levels among cases were significantly higher compared to controls at birth. The mean Hb at birth among controls was 14.90±1.28 g/dl and among cases was 16.06±2.37 g/dl (p value 0.023). Hb levels among cases were significantly higher compared to controls at 24 hours. The mean Hb at 24 hours among controls was 16.16±1.70 g/dl and among cases was 19.28±2.16 g/dl (p value <0.001).

Conclusions: Hemoglobin and hematocrit levels were significantly increased at birth as well as at 24 hours of age in delayed compared to early clamping group with no significant adverse effects seen in the group with delayed clamping.

Induction of labour in pregnancies with fetal demise: a randomised control trial

Fri, 26 May 2023 00:00:00 +0000

Background: The present study aims at comparing efficacy and safety of two different regimens of induction of labour (IOL) in pregnancies with fetal demise.

Settings and Design: A randomised controlled trial was conducted on 100 eligible pregnant women diagnosed with intrauterine fetal demise who were admitted in the labour ward of a tertiary care hospital.

Methods: All participants were randomly divided into two groups in group A and group B. In Group A, IOL was done with transcervical foley’s catheter and vaginal misoprostol while in group B, mifepristone with vaginal misoprostol were used for IOL. During intrapartum period the mode of delivery, induction-delivery interval, total dose of induction agent used and amount of total blood loss were noted. Any side effect if present was also noted.

Results: Comparing both the groups, Induction delivery interval was less in group A as compared to group B.

Conclusions: Use of mifepristone with misoprostol as well as Foley’s with misoprostol were found to be equally safe and effective methods.

The trends of isolation and antimicrobial susceptibility of group B Streptococcus in urine culture: a 7-years cross sectional study

Fri, 26 May 2023 00:00:00 +0000

Background: Group B Streptococcus (GBS)/Streptococcus agalactiae (S. agalactiae) is a common rectovaginal colonizer, thereby a potential agent of neonatal and maternal infection. This study estimates the trends of isolation of GBS, its antimicrobial profile in urine culture and the demographic characteristics of these patients over a 7-year period.

Methods: A record-based study was conducted, which included all the urine culture reports of GBS/S. agalactiae from January 2014 to December 2020. The trend of occurrence of GBS bacteriuria, demographic characteristics and antimicrobial susceptibility pattern were analyzed.

Results: Out of 137 urine samples which grew GBS/S. agalactiae, 55(40.15%) were from antenatal women. Most of the isolates were from females (72.26%), with a male preponderance noted among the elderly population (age>60 years). The predominant age group affected were adults between 20 to 59 years. The majority of the isolates (60.58%) were susceptible to all the four tested antibiotics, namely, ciprofloxacin, nitrofurantoin, ampicillin and vancomycin. Ciprofloxacin resistance was observed in 32.85% (45/137) isolates, 5.84% (8/137) isolates were resistant to ampicillin and 2.92% (4/137) were resistant to nitrofurantoin.

Conclusions: All the isolates were susceptible to vancomycin. GBS/S. agalactiae is an important agent of bacteriuria in antenatal women as well as in non-pregnant population, especially the elderly males. Emerging resistance to various group of antibiotics warrants routine susceptibility testing.

Fetomaternal outcome in pregnant women with derranged thyroid function

Sangeeta Popli, Jandrasupalli Shreshta, Suman Dath S., Manisha Sharma — Fri, 26 May 2023 00:00:00 +0000

Background: Thyroid dysfunction is the second most common endocrine disorder observed during pregnancy after diabetes. Universal screening of thyroid disorders is recommended in the first trimester of pregnancy. The present study aims to determine the fetomaternal outcome in women with thyroid dysfunction.

Methods: The study was a prospective observational study conducted at Department of Obstetrics and Gynaecology, Hindu Rao Hospital and North DMC Medical College, Delhi from January 2019 to June 2022. It was approved by Institutional Ethics Committee. Pregnant women aged 18 to 40 years up to 20 weeks of gestational age with singleton pregnancy were included in this study. All the data was entered in pre designed proforma. The data analysis was done by statistical package for Social Sciences (SPSS) version 21.0.

Results: A total of 110 pregnant women were included in the study. 55 pregnant women with thyroid dysfunction were taken as study group and 55 euthyroid pregnant women were taken as controls. With respect to maternal complications, neonatal birth weight and Apgar score in the study group are significant.

Conclusions: Timely screening for thyroid dysfunction during pregnancy will reduce fetomaternal complications.

A prospective study of risk factors and feto-maternal outcome of preterm labor in OG department of tertiary care centre of South Gujarat

Neha V. Prajapati, Saral Bhatia — Fri, 26 May 2023 00:00:00 +0000

Background: Every year globally, an estimated 15 million babies are born preterm and this number is rising over major parts of the world. Severe morbidity is common in neonates born before 32-34 weeks of gestation. Management of prematurity is a team approach by the obstetrician and the pediatrician.

Methods: This prospective observational study was conducted in the Department of Obstetrics and Gynecology, NCH, Surat from October 2019 to October 2020. 120 consenting consecutive subjects fulfilling inclusion criteria were enrolled.

Results: The most common risk factor for preterm labor in my study was PPROM (premature rupture of membranes). 27% subjects were diagnosed with threatened preterm labor. 22% subjects delivered preterm due to advanced labor. Labor arrest with tocolytic drug nifedipine was attempted in 30 subjects without any complications, which was successful in 19 subjects. The most common maternal complication in preterm labor was postpartum hemorrhage. All neonates were admitted to NICU, amongst them 45 developed complications. The most common complication in preterm neonates was respiratory distress. The rate of early neonatal death was 6.6%.

Conclusions: Inspite of advances in antenatal care and neonatal services, preterm birth remains a burden to families. Strengthening of referral systems to make sure that high risk patients are managed at tertiary care centers with NICU facilities will improve the neonatal outcome.

Study of fetomaternal outcome in pre-eclampsia at tertiary care centres, South Gujarat

Fri, 26 May 2023 00:00:00 +0000

Background: Hypertensive disorders are among the most common medical disorder during pregnancy and continue to be a serious challenge in obstetric practice. It affects about 7-15% of all gestations. In India it accounts for the third most important cause of maternal mortality. Aim if this study was to study the prevalence of pre-eclampsia and feto-maternal outcome in cases of pre-eclampsia.

Methods: This was a descriptive observational study conducted over a period from February 2019 to July 2021. This study enrolled 106 cases of pre-eclampsia, cases were selected by inclusion and exclusion criteria, data were entered and analysed by using SPSS version 20.

Results: A total of 106 patients were analysed. It was observed that it was more common in age group of 26 to 30 years 51%, 56% were unbooked patients. Maximum number of patients were primigravida 60%, 96% patients were from lower socioeconomic class, 37% patients had normal vaginal delivery, 63% had caesarean delivery. The most common maternal complication was eclampsia (12%), HELLP Syndrome 12%, abruptio occurred in 8% of patients. Maternal mortality occurred in 4 cases. Out of 106 babies 37 (34.93%) babies had normal outcome while 29% (27.35%) had low birth weight, 16 (15.09%) babies were IUGR, 15 (14.5%) babies were IUFD, 7 (6.6%) babies had RDS and 2 (1.8%) babies were stillbirth 40 (44.94%) babies were admitted in NICU.

Conclusions: This study concludes that foetal and maternal outcome were markedly affected by pre-eclampsia and also the grave complications were more common in pre-eclampsia. So proper antenatal care, early diagnosis of pre-eclampsia and timely intervention will decrease maternal perinatal morbidity and mortality.

Maternal near miss and maternal death among women with hypertensive disorders in pregnancy: an observational study in a selected hospital in West Bengal

Sima Maity, Snehamay Chaudhuri, Pramit Ghosh — Fri, 26 May 2023 00:00:00 +0000

Background: Aim of the this study was to assess the prevalence of hypertensive disorder in pregnancy and the incidence of maternal death and maternal near miss from the hypertensive disorders of pregnancy and utilization of maternal health care services by them.

Methods: An observational study was performed at Purba Medinipur District Hospital, West Bengal from 1^st April 2018 to 31^st December 2020. The main outcome measures included incidence of potentially life threatening conditions, life threatening conditions maternal near miss cases and mortality developed due to PIH/preeclampsia/eclampsia and utilization of maternal health care services by them.

Results: Present study reflected that the prevalence of hypertensive disorder in pregnancy was 9.01% (3543/39310) of total admission. The incidence of maternal mortality due to complication of hypertensive disorder was 7 out of total maternal mortality 30 during that period i.e. 23.3% of total mortality and incidence of MNM was 82 out of total 249 MNM cases during the same period i.e. 32.9% of total MNM cases. Utilization of maternal health care services revealed that there is a scope to increase the service delivery.

Conclusions: Health care programmes need to enhance the existing efforts to improve timely health seeking behavior of women. There is a need of better quality antenatal care and extra resources are needed for identification and transportation of the women to reach hospital when the women develops complications. There is also a need of improvement of critical care in women who are suffering from life threatening condition.

A prospective observational study of post-partum intrauterine contraceptive device acceptance in a tertiary care centre

Nitin Bavdekar, Preeti F. Lewis, Shusmita Sanjay Gupta — Fri, 26 May 2023 00:00:00 +0000

Background: Provision of PPIUCD is being rapidly scaled up in India with facilities in at least 19 states offering the method in 2013. According to National Family Health Survey (NFHS)-3, the prevalence of modern method of contraceptive use is 48.5% and all methods 56% in India. PPIUCD placement remains a viable option for patients who wish to use a long-acting reversible contraceptive (LARC) method and to have it placed at the time of their delivery. Hence, we planned this study with an aim to evaluate acceptability PPIUCD at tertiary care centre.

Methods: It was an observational and prospective study of acceptance of PPIUCD as a method of contraception in patients who delivered within the study period in our institute Grant Medical Hospital and College, Mumbai. Data analysis was done with statistical software SPSS V 25.0.

Results: A total of 2014 patients were enrolled in the study. The mean age was noted to be 25.87 years. Frequency of ANC visits among the patients was 4 to 6 (39.87%). Commonest obstetric history finding was previous live birth history in 59.38% cases. Pregnancy outcome was vaginal delivery noted in 63.01% of the females. 879 (43.65%) cases accepted PPIUCD. For those who did not accept PPIUCD, commonest cause was tubal ligation in 34.19%, followed by fear of pain in 18.94%, partner’s refusal in 10.31%.

Conclusions: The acceptance rate in study for PPIUCD was 43.65% which was higher than most of the published evidence. The common reasons for not accepting PPIUCD were tubal ligation.

Immunohistochemical expression of p16INK4a in premalignant lesions and malignant tumours of cervix

Parminder J. S. Sandhu, Sarita Nibhoria, Vaneet K. Sandhu, Harpreet Kaur — Fri, 26 May 2023 00:00:00 +0000

Background: Cervical carcinoma is the third most common cancer in women worldwide and firth most common cause of cancer related deaths. Human Papilloma virus, the most common cause of cervical cancer, causes functional inactivation of pRb, resulting in overexpression of p16INK4a. The overexpression of p16INK4a correlates well with the degree of cervical dysplasia and neoplasia. The present study is done to determine the IHC expression of p16INK4a so that it may be used as a biomarker for HPV and may play a role in the prevention, diagnosis and prognosis of cervical neoplasm.

Methods: The present study was conducted on 60 formalin-fixed, paraffin-embedded specimens of cervical neoplasms, which comprised 47 cases of squamous cell carcinoma followed by 8 cases of adenocarcinoma, 3 cases of HSIL and 2 cases of LSIL. These were then subjected to IHC by p16INK4a. Cytoplasmic and nuclear positivity for p16INK4a was noted.

Results: Overall 95% cases were positive for p16INK4a expression, 100% cases of adenocarcinoma, 98% cases of squamous cell carcinoma, 100% cases of HSIL and 0% cases of LSIL were positive for p16 expression.

Conclusions: The present study showed statistical correlation of immunoreactivity of p16INK4a with histological type was clinically significant (p value <0.0001). In our study, p16INK4a immunohistochemical expression increased with increasing degree of dysplasia and with presence of cervical carcinoma.

A study on fetomaternal outcome in prelabour rupture of membrane conducted at tertiary health care centre at Rajkot, Gujarat, India

Kavita Dudhrajia, Tinjal Chauhan — Fri, 26 May 2023 00:00:00 +0000

Background: Prelabour rupture of membrane is defined as a rupture of membrane before onset of labour and in the absence of uterine contraction. When it occurs before 37weeks it defined as a preterm PROM. One of the most common complication is preterm delivery approximately 7-10% and account for 1-2% of foetal death. Most commonly associated with subclinical UTI.

Methods: A prospective study was conducted from (June 2021-June 2022) at a tertiary health care hospital. All female with spontaneous rupture of membrane after 28weeks of gestation.

Results: In present study total 200 cases taken and incidence of department was 6.76%,varies between 2% to18% commonly involved age groups belongs to 20-24 years, at 35 -36 weeks (52%) and with high vaginal delivery rate (approximately) with average baby weight between 2.1-2.5 kg with more than 7 APGAR score, more in multigravida.

Conclusions: Incidence of prelabour rupture of membrane can be reduced by early diagnosis of subclinical UTI in antenatal visits.

Knowledge on respectful maternity care among staff nurses: a descriptive survey

Dhanya Devassy, Sangeetha X. — Fri, 26 May 2023 00:00:00 +0000

Background: Pregnancy is an especial, rousing and often blissful period in a woman’s life. Women may undergo various physiological changes during antepartum, intrapartum and postpartum period. The birthing room environment and health care provider’s attitude are important to minimize the pain and offer a positive childbirth experience. Across the world, women endure disrespect and abuse (D&A) during childbirth. Dearth of Respectful Maternity Care (RMC) from medical professionals like doctors and midwives may cause patients to feel unsatisfied with the healthcare system and lessen their obligation to seek antenatal (ANC), delivery, and postnatal care services. Objective of the study was to assess the existing knowledge on RMC among staff nurses working in the labour room.

Methods: A non-experimental descriptive survey design was used to assess the knowledge on Respectful Maternity Care among staff nurses working in the labour room. Non-probability convenient technique was used to select 69 staff nurses from Ramaiah Medical College Hospital, Ramaiah Memorial Hospital, Motherhood Hospital, Lakshmi Maternity and Surgical Center and Aveksha Hospital, Bengaluru from April 2022 to May 2022. Structured knowledge questionnaire was used to assess the knowledge on respectful maternity care.

Results: The overall knowledge score shows that 65.5% had moderately adequate knowledge on Respectful Maternity Care. The overall knowledge score mean was 16.72 with mean percentage of 64.30 and SD of ±3.438.

Conclusions: Assessment and improvement in nurses’ knowledge will improve the quality of care as a means of enhancing safety during childbirth and positive childbirth experience.

Histological spectrum and diagnostic challenges in endometrial carcinoma of the uterus

Teena V. Chandwani, Dharitri M. Bhat, Archana H. Deshpande — Fri, 26 May 2023 00:00:00 +0000

Background: Endometrial carcinoma is the most common type of malignancy of the uterine corpus accounting for 95% of all primary malignancies. Epidemiological studies have proved the role of unopposed estrogen as an important factor in pathogenesis of endometrial carcinoma. Pathologists play an important role not only in the histological confirmation of the diagnosis, but in subtyping, grading and staging of the tumor. Current study is undertaken to study the histological spectrum in endometrial carcinomas.

Methods: Present study includes histologically confirmed cases of endometrial carcinoma of uterine corpus over a period of 24 months (July2020 to June 2022) in a tertiary health care center in central India. After gross examination, and standard sectioning, all these tumors were subtyped on histology and grading, staging was done as per WHO and FIGO recommendations. In cases with diagnostic dispute and overlapping features, IHC markers were applied.

Results: Amongst total 30 confirmed cases of endometrial carcinoma, endometrioid type was most common (25) followed by villoglandular and serous type of adenocarcinoma. Architectural and nuclear grading was done in all cases. Staging could be done in hysterectomy specimens only. Difficulties encountered while grading and staging are discussed.

Conclusions: Endometrial carcinoma was the most common type of malignancy. Other types were villoglandular and serous adenocarcinoma. Various additional histological features were also observed. Grade I tumors were commonly seen. Depth of myometrial invasion was measured in hysterectomy specimens. Various diagnostic challenges encountered are discussed.

Effect of adolescent pregnancy on maternal and foetal health

Preeti F. Lewis, Vedangee R. Nakhare, Nitin Bavdekar — Fri, 26 May 2023 00:00:00 +0000

Background: Adolescence is a time when structural, functional, and psychosocial developments occur. Pregnancy during teenage can adversely affect the health of both the mother and the foetus as the adolescent female concerned is yet to attain her full growth potential. Adolescent pregnancy is a global phenomenon with serious health, social and economic consequences.

Methods: It was a single centric, prospective, observational study. 211 Patients who attended the inpatient or outpatient department of obstetrics and gynaecology in an urban tertiary care hospital and followed up till outcome.

Results: As per the study conducted, almost 83% of teenage mothers conceive by 19 years of age. Owing to the increasing awareness regarding maternal and foetal wellbeing, majority of the teenage mothers were booked. Teenage mothers and their babies are prone to intrapartum and postpartum complications as well as stillbirths. The most common comorbidity associated in teenage mothers was pregnancy induced hypertension (PIH) spectrum disorders followed by anaemia. The rate of neonatal intensive care unit (NICU) admission for babies of teenage mothers was 10%.

Conclusions: Adolescent mothers and their babies are at a risk of complications than other mothers in the twenties. The need of the hour are comprehensive measures and convergence among various departments to address all the needs of adolescents. Robust measures and policies to end teenage marriages and consequent pregnancies are exactly what the developing nations need at present.

Comparison of ferric carboxymaltose and iron sucrose for treatment of iron deficiency anemia in pregnancy at tertiary care centre, Western India

Twinkle D. Papaniya, Mehul T. Parmar, Harsha M. Solanki — Fri, 26 May 2023 00:00:00 +0000

Background: Iron deficiency anemia is the most common haematological health problem among pregnant women but can be prevented by effective measure. The study aimed to evaluate the efficacy and safety of intravenous ferric carboxymaltose (FCM) in comparison with intravenous Iron sucrose (IS) for treatment of iron deficiency anemia in pregnancy.

Methods: A prospective interventional comparative study was conducted from (June 2021-June 2022) at a tertiary care hospital. Pregnant women diagnosed with moderate to severe iron deficiency anaemia were screened for the study. One hundred patients were randomized to receive either intravenous FCM or IS. Treatment effectiveness was assessed by repeat Haemoglobin (Hb) and RBC indices measurement after 4 weeks of completion of therapy. Safety was assessed by analysis of adverse drug reactions during infusion and 2 hours after infusion.

Results: Mean rise in Hb at 4 weeks was significantly higher in FCM group (1.67±0.47 Vs 1.07±0.25; p<0.0001) as compared to IS group. There was also rise in other biochemical parameters like MCV and MCHC in both groups. Numbers of visits were significantly less in FCM group. No serious adverse events were noted in either group.

Conclusions: Intravenous ferric carboxymaltose is more effective and safer as compared to intravenous iron sucrose in the management of anemia during pregnancy. It has advantage to administer large dose in single sitting which reduce overall cost of therapy and hence will lead to better compliance in community setting.

Study of clinical profile and outcome in pregnancy related acute kidney injury

Jagruti Brahmbhatt, Kirti Devada, Manishkumar Patel — Fri, 26 May 2023 00:00:00 +0000

Background: Acute kidney injury (AKI) is a clinical syndrome characterized by a sudden decrease in glomerular filtration rate leading to decreased excretion of nitrogenous waste like urea, creatinine and other uremic toxin. Even minor changes in serum creatinine are associated with increased in-patient mortality. To study various etiological factors responsible for AKI to do better management of condition for prevention of adverse effects on maternal and fatal outcome. To study outcome of disease in form of recovery, morbidity and mortality. To record maternal and foetal outcome.

Methods: A prospective, observational study of 50 patients conducted at department of obstetrics and gynaecology, Medical College Baroda and Sir Sayajirao General Hospital from the time period of 1 year.

Results: There was no significant association of initial serum creatinine with maternal outcome. However, there was significant association of last serum creatinine and Percentage Improvement in serum creatinine with maternal outcome as last serum creatinine was significantly lowest in completely recovered patients as compared to dead and discharged on request patients and percentage Improvement in serum creatinine was significantly high in completely recovered patients as compared to dead and discharged on request patients. There was no significant association of initial and last serum creatinine with fetal outcome; however, percentage improvement in serum creatinine was significantly high in alive fetuses as compared to aborted, dead and undelivered fetuses.

Conclusions: Pregnancy-related AKI is a common medical problem and understanding its association with various etiopathologies has significant impacts on maternal and fetal outcome.

Assessment of outcome of trial of labour after caesarean in a tertiary hospital based setting: prospective observational study

Mahak Bhardwaj, Shalini Gainder, Seema Chopra, Rashmi Bagga — Fri, 26 May 2023 00:00:00 +0000

Background: Aim of this study was to determine the success rate of vaginal birth after caesarean (VBAC) in Indian women, identify the factors that predict its success, and assess the maternal and neonatal outcomes following a trial of labour after caesarean (TOLAC).

Methods: A prospective observational study involving women with one previous lower segment caesarean section (LSCS) who were admitted for TOLAC between January 2019 and June 2020 at Department of Obstetrics and Gynaecology, Post Graduate Institute of Medical Education and Research, Chandigarh, India. There were 124 women with previous LSCS who opted for TOLAC.

Results: During the study period, 124 women with previous LSCS who opted for TOLAC were included, of whom 68 (54.8%) had successful VBAC and 56 (45.2%) had failed TOLAC. The induction of labour (IOL) rate in the study was 69.4%, and 30.6% of women had spontaneous onset of labor. VBAC rates were significantly higher in women who went into labour spontaneously (84.2% vs. 15.8%). Maternal complication rates were comparable, whereas the neonatal complication rate was significantly higher in neonates born by CS (51.7% vs. 30.8%), with a greater incidence of low birthweight (LBW) and transient tachypnea in the newborn (TTNB).

Conclusions: TOLAC can be considered a safe option for women with a previous caesarean when combined with vigilant and stringent labour monitoring, despite the use of IOL agents.

Clinical safety and efficacy of atosiban brief duration 14-hour treatment regimen in delaying preterm labor

Bhupesh Dewan, Siddheshwar Shinde — Fri, 26 May 2023 00:00:00 +0000

Background: For preventing preterm labor, the recommended duration of atosiban infusion is 48 hours and the patient has to be hospitalized during the course of treatment. The treatment consists of administering one vial of 0.9 ml as a bolus and then an infusion at a rate of 300 mcg/min for 3 hours followed by 100 mcg/min for the next 45 hours, utilizing nine vials of 5 ml. The objective of the study was to evaluate an alternative brief duration (14-hour) of atosiban treatment involving a bolus dose of 0.9 ml followed by an infusion of 300 mcg/min for 2 hours and 100 mcg/min for the next 12 hours utilizing 3 vials of 5 ml. The advantage being that the treatment could be completed in an outpatient setup and be convenient for the patient as well as for the healthcare staff. This would also reduce the overall cost of the treatment. This prospective single-center study was conducted to evaluate the efficacy and safety of an atosiban brief duration (14-hour) treatment regimen to prevent preterm labor.

Methods: A total of 50 patients with symptoms of preterm labor were enrolled in the study. The efficacy of tocolysis was determined by the percentage of patients who remained undelivered up to 48 hours after atosiban therapy initiation and the follow-up of the patients was done up to delivery. Safety was assessed in terms of the number of maternal and fetal adverse events reported.

Results: The mean gestational age at the enrolment was 32.1±2.6 weeks and the delivery were delayed by a mean of 18.13±17.97 days (range 1-62 days). Thirty-five (70%) patients remained undelivered at 48 hours and 29 (58%) at 7 days. No maternal or fetal adverse events were reported during the study.

Conclusions: A favourable safety and efficacy profile of a brief duration atosiban regimen was observed resulting in ease of administration and a shorter stay in the healthcare facility providing convenience to both patient and hospital staff. The overall cost of the therapy was also reduced. Further clinical trials with larger sample size are required to confirm the findings.

Obstetric hysterectomy in a tertiary centre: a 3-year retrospective study

Fri, 26 May 2023 00:00:00 +0000

Background: Obstetric hysterectomy (OH) is a life-saving procedure and involves removal of uterus in cases of intractable hemorrhage. This study includes 21 cases of OH in a period of 3 years at a tertiary centre. We sought to understand the prevalence, indications and outcomes of emergency obstetric hysterectomy.

Methods: This is a retrospective, observational study, conducted with the means of hospital delivery records in a tertiary care centre in Navi Mumbai. We included all patients who underwent obstetric hysterectomy in a span of 3 years between 1^st April 2020 to 31^st March 2023, in Dr. D.Y. Patil Hospital, Navi Mumbai, India.

Results: Twenty- one OH were done in the period of study. The incidence of obstetric hysterectomy was 0.45% (452 OH per 100,000 deliveries). It was more prevalent in patients with caesarean section compared to vaginal delivery. Women between the age 25-35 years group comprised of 57.15% cases. Out of the 21 women in the study 7 women were primigravida (33.33%). Most common cause for OH was observed to be uterine atony (42.85%) followed by adherent placenta (28.57%). Maternal morbidity like admission to intensive care unit and need for blood and blood product transfusion was noted in most patients, mortality was observed in only 1 case. Neonatal mortality was nil in this study but, admission to neonatal intensive care unit was required in 7 patients.

Conclusions: Although, obstetric hysterectomy kills the future reproductive prospect for a woman, it is life saving for her. Timely decision for OH can not only prevent mortality but, also morbidity for the woman. Previous caesarean section and multigravida have higher incidence of OH. Atonicity is the predominant cause for obstetric hysterectomy in this study.