International Journal of Reproduction, Contraception, Obstetrics and Gynecology

Examining the impact of HIV-related stigma in people living with HIV: a systematic literature review

Thu, 26 Sep 2024 00:00:00 +0530

The last 20 years have seen an improvement in access to anti-retroviral (ARVs) drugs for people living with HIV leading to improvement in health outcomes. However, despite achieving this milestone HIV stigma has continued to hamper the health outcomes of people living with HIV. This study aimed to undergo a systematic review exploring the impact of HIV stigma on people living with HIV. A systematic literature review of both quantitative and qualitative studies published between 2017 and 2021 was undertaken using the following databases: CINAHL Plus, Embase, Google Scholar, Medline, and Scopus. Reference lists from relevant studies and websites of relevant sexual health and HIV organisations were also searched. The primary search terms were “HIV and stigma” combined with “impact” or with “discrimination”, “internalised stigma” and “lack of esteem”, or “mental health” or “caused by HIV sigma” in communities, “HIV and discrimination”, “impact of HIV stigma”. Six articles were included for review and analysed using constant comparative analysis. The review identified six broad themes (lack of adherence, internalised HIV stigma, discrimination, lack of self-esteem, public stereotyping, and non-disclosure) factors having a significant influence on people living with HIV. Perceived stigma towards people living with HIV has a negative effect on health outcomes of people living with the condition. The findings of our study highlight that public stereotyping and perceived stigma in the community are the major factors impacting people living with HIV.

Obstetric anal sphincter injuries care bundle: innovative approach to improve perineal care in maternity setting

Umber Fatima, Ifeoluwa Ajayi, Menatalla Fayed, Karen Watts, Amita Sahare — Thu, 26 Sep 2024 00:00:00 +0530

Perineal injuries during vaginal delivery are a prevalent issue, and obstetric anal sphincter injuries (OASI), which include third and fourth-degree perineal tears, pose significant challenges for maternal health due to potential complications such as faecal incontinence, sexual dysfunction, and impaired quality of life. The OASI care bundle (OASI-CB) was developed in 2015 in response to a concerning rise in the incidence of OASI in the UK. It was implemented in 16 NHS trusts between 2015 and 2017. The results of this implementation were extremely promising, as it was found to significantly reduce the OASI incidence while providing high-quality care to women. Through a comprehensive review of clinical data, patient outcome, and current practice in our unit, we carried out an audit with a goal to meet the standard of the care bundle by improving risk factor identification, improving clinical practices, and offering recommendations to enhance women’s care and further decrease the overall incidence of OASI.

Cervical cancer in pregnancy: a case report

Aravinda Hariram, Matthew Koomson — Fri, 06 Sep 2024 00:00:00 +0530

Cancers during pregnancy are uncommon, with the latest mothers and babies: reducing risk through audits and confidential enquiries across the UK (MBRRACE) report (2023) indicating cancers account for 2% of maternal deaths, highlighting the need for early detection. Cervical cancer, the most common gynecological malignancy in pregnancy, has an incidence of 0.1 to 12.0 per 10,000 pregnancies. The human papillomavirus (HPV) vaccination is expected to significantly reduce cervical cancer rates. We present a case of a 37-year-old multiparous woman with cervical cancer who declined investigations during pregnancy. A white-British woman in her mid-30s presented at 19 weeks gestation with vaginal bleeding. She had low compliance with cervical screening. Despite multiple referrals, she declined urgent colposcopy. At 38 weeks, she had a spontaneous rupture of membranes but did not progress in labor. A cesarean section revealed no tumor in the lower segment. Postnatal examination identified invasive cervical cancer extending to the anterior vagina. Magnetic resonance imaging (MRI) and positron emission tomography-computed tomography (PET-CT) confirmed stage IIIC1r cervical cancer. The patient underwent successful cisplatin-based chemoradiotherapy and was tumor-free at the three-month review. Cervical screening is crucial for early cancer detection and intervention. Reduced participation in screening programs increases the incidence of advanced-stage cervical cancer. Managing patients who decline screening requires a compassionate approach and strategic efforts to encourage compliance. Physiological changes during pregnancy can obscure cancer symptoms, leading to delayed diagnoses and limited treatment options due to fetal risks. Advanced cervical cancer treatment during pregnancy often involves chemotherapy, with radical surgery considered for patients responding well to induction chemotherapy. Evolving follow-up strategies suggest prolonged monitoring due to delayed recurrences when chemotherapy is incorporated.

A case report of trisomy 16 with mosaicism with intrauterine growth restriction

Raisham Saleem, Rabia Mehboob, Jean Aupont, Mustafa Ahmed — Fri, 06 Sep 2024 00:00:00 +0530

Trisomy 16 is one the common cause of miscarriages in the 1^st and 2^nd trimesters. Trisomy 16 mosaicism is rarely detected by amniocentesis in the second trimester. Intrauterine growth restriction (IUGR) is one of the common outcomes of mosaic trisomy 16. Hence, we report a case of trisomy 16 mosaicism diagnosed by the cytogenetic analysis of amniotic fluid cells. The baby had an intrauterine growth restriction and interestingly her karyotype was normal. As trisomy 16 mosaic fetuses does not have a characteristic phenotype, it is recommended to inform the possibility of mosaicisms including this trisomy 16 mosaicism during prenatal genetic diagnosis and genetic counselling for parents.

A rare case scenario of transection of cervix during laparoscopic adenomyomectomy for a cervical fibroid: a nightmare of gynecologist

Kalyani Sai Dhandapani, Madhubala Kalidoss — Thu, 26 Sep 2024 00:00:00 +0530

We are reporting a case of complete cervical transection during adenomyomectomy, a disconnection between uterus and cervix which is a rare complication of myomectomy procedure. A 32-year-old presented with secondary subfertility with heavy menstrual bleeding. Ultrasound showed a large cervical adenomyoma of posterior lip for which adenomyomectomy was performed. During enucleation of the myoma, cervical transection encountered. Successful reconstruction of the uterus to cervix done following which MRI performed six months later showed complete reanastomosis of uterus to cervix followed by regular establishment of periodic menstruation.

A rare variant of uterine leiomyoma-lipoleiomyoma

Lipsy Goyal, Divya Phool, Chanchal Jain — Thu, 26 Sep 2024 00:00:00 +0530

Lipoleiomyoma is a benign variant of uterine leiomyoma characterized by admixture of fat cells and smooth muscle cells. This entity can coexist with other malignancies in uterus, ovaries and fallopian tubes. Lipoleiomyoma is typically found in post-menopausal women with incidence of 0.03-0.20%. The 58 years old postmenopausal women presented to gynaecology outpatient department (OPD) with complaints of chronic lower abdominal pain. Her clinical examination and blood investigations were normal but her imaging showed a large heterogenous solid mass at uterine fundus. She underwent TAH and BSO. Diagnosis of lipoleiomyoma was confirmed on histopathological examination. Left ovary showed serous cystadenomatous cystic lesion and left fallopian paratubal cyst. Lipoleiomyoma is rare entity with excellent prognosis when asymptomatic so its awareness is important to avoid unnecessary surgeries.

A rare case of angioleiomyoma of cervix: a case report

Kankana S. Talukdar, Sunil S. Patil, Sanjaykumar G. Tambe, Yuga M. Jamdade — Thu, 26 Sep 2024 00:00:00 +0530

Angioleiomyoma or vascular leiomyoma are smooth muscle tumors. They typically present as a firm, rounded mobile nodule. They account for 4.5% of all benign soft tissue tumours. Leiomyoma is one of the common benign tumors of female genital tract. Angioleiomyoma is extremely rare as till date 15 cases of angioleiomyoma of uterine corpus and 6 cases of uterine cervical angioleiomyoma have been described in literature. They are encapsulated, multiloculated and contains numerous vessels. The diagnosis of AL is dependent on histopathological reports. It is painful in over half of the cases. It should be considered in the differential diagnosis of painful nodular lesions of the extremity. Preoperative diagnosis is rarely possible. Increased awareness of this tumour and judicious use of ultrasound and/or MRI should help in most cases for diagnosis. It causes minimal morbidity, and excision is usually curative.

An unusual case report on necrotising fascitis following episiotomy

Deepa Mathews, Vaishnavi Rajaraman — Thu, 26 Sep 2024 00:00:00 +0530

Necrotizing fasciitis is a rare but serious condition with high morbidity and mortality. It is identified by extensive fascial necrosis with relative sparing of the skin and adjacent muscle. Herein, we report a case of 35-year-old, para 2 living 2, who underwent normal vaginal delivery with dextrolateral episiotomy, and was discharged on post-natal day-4 asymptomatic. She was referred to our centre, on post-natal day 9 with excruciating pain and abnormal discharge from episiotomy site, after initiation of broad-spectrum antibiotics. Upon arrival, routine thorough clinical examination done revealed extensive sloughing of tissue at the episiotomy site. Laboratory work up were done, along with which infective markers were also sent. After routine pre-op work up, patient was taken up for emergency surgical debridement. Multi-staged debridement was done during the subsequent days, until healthy granulation tissue was seen. Pus and wound culture were sent, and culture sensitive antibiotics were continued. Post-operatively, patient was continued on antibiotics, sitz bath given and regular wound dressing done for next 5 weeks. She was discharged on post-op day 34. On 12 months follow up, patient was completely asymptomatic, examination revealed a completely healed vulva with minimal disfigurement.

Steroid cell tumour-a rare ovarian tumour: a case report

Ranjana Balathil, Ajitha Pulpra, Rabiyabi Vethavayal, Ani Praveen — Thu, 26 Sep 2024 00:00:00 +0530

Steroid cell tumours of the ovary are sex cord stromal tumours which are rare, of all ovarian tumours. Case: Here we present a case of 35-year-old lady who presented to us with complaints of amenorrhoea. With thorough history taking, diagnostic workup and postoperative histopathological evaluation found to have a rare kind of ovarian tumor steroid cell tumor.

Prolonged neuroglycopenia in a type 1 diabetic pregnancy: a case report

Thu, 26 Sep 2024 00:00:00 +0530

Hypoglycemia in pregnancy is a metabolic abnormality associated with substantial morbidity. Here we report the adverse events triggered during pregnancy in a primi with type 1 diabetes. A 19-year-old primi, type 1 diabetic since 13 years of age and history of recurrent seizures since fourth month of pregnancy presented at 28 weeks with severe hypoglycemia. Clinico-radiological impression of a metabolic encephalopathy secondary to prolonged neuroglycopenia was kept. She underwent preterm caesarean section and delivered a 1.86 kg baby. She was weaned off the ventilatory support and discharged on POD 38 on tracheostomy T piece. After that she continued treatment from local hospital, and expired 2 weeks later. presently her child is 4 years old, healthy with age-appropriate milestones.

High risk pregnancy with sacrococcygeal teratoma

Snigdha Sharma, Arti Sharma, Madhukar Maletha — Thu, 26 Sep 2024 00:00:00 +0530

Sacrococcygeal teratoma (SCT) is the most common tumor of the newborn period. Most cases are diagnosed prenatally during ultrasound imaging. If fetal hydrops develops, urgent intervention is done to minimize fetal morbidity (or mortality). Management depends on fetal lung maturity and tumor size. Most cases are benign and require only minimal intervention. Once fetal maturity is achieved at 37 weeks, scheduled delivery is planned. Complete resection of tumor including coccyx is vital to prevent malignant recurrence. Strict follow up and AFP monitoring is important. Small percentage become malignant and can occur even after tumor removal.

Scar endometriosis: a rare case report

Hetvi Somaiya, Tushar Palve, Rajashree Thatikonda, Ankita Kumari — Thu, 26 Sep 2024 00:00:00 +0530

Endometriosis is a challenging topic in gynaecology, and its diagnosis necessitates a high level of suspicion, particularly when it presents at extra-pelvic sites. Extra-pelvic endometriosis, though relatively rare, can manifest in various forms, with cutaneous endometriosis being the most common. Scar endometriosis is an uncommon manifestation of endometriosis where endometrial tissue is located within the abdominal wall following a caesarean section. This case report details a 30-year-old female with scar endometriosis and reviews the current literature on its management. Scar endometriosis often poses a diagnostic challenge due to its ability to mimic other conditions, including malignancy. Accurate diagnosis requires a combination of clinical evaluation, imaging studies, and histopathological examination. Multidisciplinary approaches are crucial for effective management. This case underscores the importance of considering scar endometriosis in patients with post-caesarean section abdominal wall masses. A thorough diagnostic workup and surgical intervention are key to resolving symptoms and preventing recurrence.

Endometrioid carcinoma arising from the remnant ovarian tissue

Thu, 26 Sep 2024 00:00:00 +0530

Endometrioid carcinoma of ovary is a subtype of epithelial tumours of the ovary. It can be distinguished from serous and mucinous tumours by presence of tubular glands resembling that of malignant endometrium. Traditionally, Ovarian carcinoma treatment involves the combination of cytoreductive surgery and platinum-based chemotherapy. Fortunately, because of a better overall understanding of ovarian tumorigenesis and advancements in the disease’s epigenetic and molecular profiling, a paradigm shift has emerged with the identification of new disease biomarkers and the proposal of targeted therapeutic approaches to postpone disease recurrence and decrease side effects, while increasing patients’ survival. It is usually associated with poor prognosis due to late clinical presentation allied with the common acquisition of chemo resistance and a high rate of tumour recurrence. The chemotherapy backbone for patients with high-grade advanced epithelial ovarian cancer (HG-AOC) is carboplatin and paclitaxel followed by a maintenance therapy either with bevacizumab, with a PARP inhibitor, or with a combination of both, which is defined by the presence of a Homologous Recombination Deficiency (HRD) and by the BRCA1/2 status (This case showed a negative HRD and BRCA1/BRCA2 mutation status). Hence effective screening, accurate diagnosis and personalised multidisciplinary treatments are crucial for improving patient’s survival and quality of life. We report a case of endometrioid carcinoma of ovary arising from the remnant ovarian tissue in a 53year old women who underwent TAH+BSO done 12 years back for a benign cause and aims to summarize molecular studies involved in endometroid ovarian carcinoma pathogenesis as potential therapeutic targets.

A rare case of giant endometrioma-with ultrasound features mimicking malignancy

Ruby Bhatia, Pooja Shah, Rishu Goel, Vidushi Tewari, Sanjum Malik — Thu, 26 Sep 2024 00:00:00 +0530

Ovarian endometriomas are common in women of reproductive age but rarely exceed 6 cm in diameter. Ovarian endometrioma exceeding 10 cm in dimension are referred as giant endometrioma. They are rare and pose a major diagnostic dilemma to the clinicians. We present a rare case of ovarian endometrioma of 18.7 cm in largest diameter, with internal septations, with a solid component, with low grade neovascularization on ultrasonography having RMI I score of 294 suggesting risk of malignancy, and IOTA simple rules suggesting the mass as inconclusive in nature, and the diagnosis of a benign mass was made on frozen section and confirmed as endometrioma on postoperative histopathologic examination. The challenges in making diagnosis of a huge ovarian endometrioma are highlighted and various literature on giant ovarian endometrioma are reviewed.

Giant cervical fibroid in a perimenopausal women: a rare case report

Jaya Rakini K., Vidhya Ravichandran — Thu, 26 Sep 2024 00:00:00 +0530

Uterine leiomyomas, are smooth muscle neoplasms and the most common benign gynaecological tumour prevailing in 70-80% of women reaching 50 years. Fibroids contribute to 40-60% of hysterectomies performed all over the world. Most of the fibroids are situated in the body of the uterus, but only 1 to 2% of cases, they are confined to cervix. Most of the patients remain asymptomatic but in patients with large fibroids mostly present with pressure symptoms depends upon location of fibroid. Cervical leiomyoma is mostly single and are subserous or interstitial in origin. They arise either from vaginal or supra-vaginal portion of cervix. We report a case of cervical fibroid in perimenopausal parous women with anaemia proceeded with laparotomy after anaemia correction. It showed a huge fibroid arising from the posterior cervix with uterus pushed anteriorly. Enucleation followed by abdominal hysterectomy was done. Large cervical fibroids are rare, presenting with surgical difficulties. Careful dissection by expert hands is needed in the management of such cases. Patient had an uneventful post-operative recovery.

Myxoid leiomyosarcoma-decoding the puzzle in the Pandora’s box-pre to post operative

Thu, 26 Sep 2024 00:00:00 +0530

Myxoid leiomyosarcomas (MLMS) are a rare form of uterine cancer developed from the smooth muscles of the uterus. It is a very aggressive tumour and usually presents as abdomino pelvic mass. This is a case report of a 47-year-old parous, perimenopausal lady with huge abdominopelvic mass mimicking ovarian cancer preoperatively, but postoperatively turned out to be MLMS. It was a tumor of size 40×30×9 cm, weighing 12 kg. Histopathological examination revealed myometrial neoplasm composed of atypical spindle to stellate cells disposed as loose sheets within an abundant myxoid stroma. Immunohistochemically, SMA and Ki-67 were positive, which clinched the diagnosis. Postoperatively, chemotherapy was decided for the patient, and she is presently doing well after a year of surgery.

A rare case of twin fetal papyraceous in triplet pregnancy: clinical challenges and insights

Mamta Agarwal, Saurabh Jindal — Thu, 26 Sep 2024 00:00:00 +0530

The occurrence of twin papyraceous foetuses in triplet pregnancy is rare. A papyraceous foetus is found almost exclusively in multiple gestation. Twin fetal papyraceous occurs when one or more fetuses die in utero with retention of the fetus for a minimum of 10 weeks resulting in mechanical compression of the small fetus and loss of fluid such that it resembles parchment paper. This condition can have serious implications for the remaining fetuses and the overall pregnancy. Understanding the causes, potential complications, and management strategies for triplet pregnancies complicated by twin fetal papyraceous is crucial for ensuring the best possible outcomes for both mother and babies. We report here a case of a 24 year female with triplet pregnancy with two foetus papyracei who delivered a healthy baby at 34 weeks.

A case of acute abdomen-ruptured ovarian cysts

Poojashree Gundluri, Ushadevi Gopalan, Sowmiya Ravi — Thu, 26 Sep 2024 00:00:00 +0530

Ovarian cyst rupture can lead to a spectrum of clinical presentations, from mild symptoms to life-threatening emergencies. This case report discusses a 26-year-old female who presented with lower abdominal distension and intermittent pain after a spontaneous incomplete abortion. Initial ultrasound revealed a large right adnexal cyst managed conservatively. During hospitalization, the patient developed acute abdominal pain with hypotension and tachycardia, prompting emergency laparotomy. Intraoperatively, a ruptured ovarian cyst with hemoperitoneum was identified and managed surgically. The case underscores the need for prompt differentiation between ovarian torsion and cyst rupture and highlights the role of surgical intervention in severe cases.

A novel approach - letrozole in the management of retained products of conception: a case report

Ishwarya Chandran Chandran, Ushadevi Gopalan, Karthika Mayilvahanan — Thu, 26 Sep 2024 00:00:00 +0530

Miscarriage affects 15-20% of pregnancies, often in the first trimester, with 1-5% involving retained products of conception (RPOC). Traditional management includes misoprostol or surgical evacuation. WHO guidelines suggest oral letrozole, an aromatase inhibitor, as an alternative for first-trimester medical termination of pregnancy (MTP). This case reports on the effectiveness of letrozole in treating RPOC.A 20-year-old primigravida with persistent vaginal bleeding post-MTP presented with RPOC. Despite prior misoprostol treatment, bleeding continued. Ultrasound revealed RPOC (3.20×2.57 cm) with vascularity. Letrozole 5 mg daily for 5 days was administered after informed consent. Follow-up ultrasound showed complete resolution of RPOC, with no significant side effects. Letrozole, a third-generation aromatase inhibitor, has shown potential in managing RPOC by inhibiting estrogen production, thus facilitating expulsion. This case supports its efficacy and tolerability as an alternative to surgical intervention or traditional medical treatments. Letrozole effectively resolved RPOC in this case, highlighting its potential as a non-invasive treatment option. Further research is needed to validate its standard use for RPOC.

Interest of the sentinel node in the case of infiltrating T1 luminal a breast carcinoma: retrospective study at the gynaecology department of the Francois Quesnay Mante-La-Jolie hospital, France

Thu, 26 Sep 2024 00:00:00 +0530

Background: During these last twenty years, technic of sentinel lymph node (SLN) stayed the gold standard for axillary exploration, an alternative to axillary dissection in the surgical management of breast cancer. Objective of the study was to make an inventory of the technic of the sentinel lymph node technique in forms T1 Luminal A breast cancers.

Methods: It was a retrospective, descriptive and analytical study over a period of one year (March 2022 to March 2023) in the Gynecology department, François Quesnay hospital, in Mantes-La Jolie (France). Out of 103 files studied, we included 50 patients who had undergone sentinel lymph node excision for T1 luminal A breast cancers with non-palpable and non-detectable lymph nodes on imaging. The parameters studied were epidemiological data, clinical data and paraclinical data. The Chi² test (α=5%) made it possible to compare the groups (p<0.05 and CI=95%).

Results: The sentinel lymph node excision rate was 48.5%. The median age was 59 years. The epidemiological profile was as follows: Postmenopausal patients (70%), with family history of breast cancer (36%). The circumstances of discovery were: The perception of a breast mass (94%) and the screening examination (34%). The histological lesions were infiltrating ductal carcinomas in 94% of cases and 60% located in the right breast. There were 12 (24%) lymph node metastatic lesions, including 5 macrometastases and 7 micrometastases. There was no link between metastatic involvement of sentinel lymph nodes and age, menopause, family history of breast cancer, concept of screening, histological type. The Chi square was respectively 0; 1.34; 0.05; 0.41; 1.01. There was a link when the cancer was located in the right breast (chi²=10.52 and p=0.001), [CI = (12.16-35.84)].

Conclusions: There was no link between metastatic involvement of sentinel lymph nodes and luminal histological type A, T1. Furthermore, there was a link between metastatic involvement of the sentinel lymph node and the right-sided location of breast cancer. Is this linked to the predominance of cancer in the right breast?

Predictors of electrolyte derangement among women with obstructed labor delivering from referral hospitals in rural western Uganda: a multicenter cross-sectional study

Thu, 26 Sep 2024 00:00:00 +0530

Background: Obstructed labor is regarded as one of the major causes of maternal morbidity and mortality, particularly in environments with minimal resources, including Uganda. We aimed to determining the prevalence and predictors of electrolyte derangement among women with obstructed labor delivering from Referral Hospitals in western Uganda.

Methods: We conducted a cross-sectional study from labor suits of Hoima and Fortportal regional referral hospitals from May to August 2023. 295 mothers were consecutively recruited and structured questionnaire was used to get data used for analysis. Descriptive statistics followed by binary logistic regression were conducted to achieve the study objectives using Stata version 14.2.

Results: Out of 295 respondents, 182 (62%) had electrolyte derangement. The most common pattern of electrolyte derangement was hyponatremia 138 (43%) followed by hypocalcaemia 67 (21%). Primary level of education (OR=0.4; 95%CI: 0.199-0.752; p=0.045), fasting in labor (OR=4.2; 95%CI: 2.281-7.996; p=<0.001) and herbal medicine use in labor (OR=4.3; 95%CI: 1.875-9.924, p=0.001) were independently associated with electrolyte derangement.

Conclusions: The prevalence of electrolyte derangement was high compared to the reported national prevalence. Hyponatremia was the most common pattern of electrolyte derangement. Herbal medicine uses in labor, fasting during labor and maternal education were predictive for electrolyte derangement. There is a need for routine assessment of electrolytes in patients with obstructed labor. Attempts to correct hyponatremia should be made in a situation where electrolyte assessment cannot be done.

Elagolix as GnRH antagonist in controlled ovarian stimulation for intrauterine insemination

Thu, 26 Sep 2024 00:00:00 +0530

Background: Controlled ovarian stimulation with gonadotropins may be complicated by premature luteinizing hormone surge and premature luteinization. Premature LH surge and premature luteinization can be inhibited by GnRH antagonists so that gonadotropin stimulation can be extended, enabling the appropriate development of more than one follicle. Elagolix is an oral GnRH antagonist used in treatment of endometriosis. Elagolix, like injectable GnRH antagonists, may be applied for preventing premature luteinization. Objective was to compare the effects of elagolix with no elagolix on preventing premature luteinization in ovarian stimulation with intrauterine insemination, on the day of trigger.

Methods: This quasi-experimental study was conducted on a total of 60 infertile women selected for ovarian stimulation and intrauterine insemination. The women were given ovarian stimulation with tab letrozole and injectable gonadotropins. Transvaginal ultrasound for folliculometry was done from day 8 onwards. When the leading follicle was at least 14 mm, the women were assigned into two groups. Elagolix 150 mg once daily was added and continued to the day of trigger in the intervention group. Patients in the control group did not receive elagolix as described above. Premature LH surge (serum LH≥10) and premature luteinization (serum LH≥10 IU/l and serum progesterone ≥1 ng/ml) were assessed on the day of trigger.

Results: Twenty-six women in the elagolix group and 26 in the control arm completed the study. There was total absence of premature LH surge and premature luteinization in the elagolix group as compared to the 30.8% and 23.1% respectively in the control group. There was no statistically significant difference in clinical pregnancy rates.

Conclusions: Elagolix, an oral GnRH antagonist, when applied to controlled ovarian stimulation for intrauterine insemination, eliminate premature luteal surge and premature luteinization. But there is no improvement in clinical pregnancy rate.

Association of serum copper, zinc level in invasive cervical cancer in a tertiary hospital

Thu, 26 Sep 2024 00:00:00 +0530

Background: Cervical cancer remains a significant global health concern. The present study was conducted to assess the relationship between serum copper and zinc levels in individuals diagnosed with cervical cancer. The aim of this study was to assess the association between serum copper and zinc levels in invasive cervical cancer in a tertiary hospital.

Methods: This case-control study was conducted among 122 women, aged 25-65, attending the outpatient department and Colposcopy Clinic of the Department of Gynecological Oncology, BSMMU, Dhaka, from April 2022 to March 2023. The cases (n=61) had histopathologically confirmed cervical cancer, while the controls (n=61) had normal cervixes. Serum copper and zinc levels were measured at the Laboratory of Biochemistry and Molecular Biology, BSMMU. Data were analyzed using Microsoft Excel and SPSS v27.0.

Results: The study revealed that cervical cancer cases had significantly higher serum copper levels and a 6.4 times higher risk when copper levels were ≥140.0 mcg/dl. Serum zinc levels were significantly lower in cases, with a 3.9 times higher risk when zinc levels were <68 mcg/dl. Additionally, the Cu/Zn ratio was higher in cases, and a ratio >1.87 conferred a 4.5 times higher risk of cervical carcinoma.

Conclusions: Elevated copper, reduced zinc, and a higher copper-zinc ratio were observed in cervical cancer patients, suggesting a potential association with cervical cancer risk and warranting further investigation for clinical applications in early detection and management.

Incidence and indications of peripartum hysterectomy among patients admitted in Dhaka medical college hospital

Rumana Afroz, Farhana Dewan, Manjuman Ara Sarker, Rifat Ara — Thu, 26 Sep 2024 00:00:00 +0530

Background: Peripartum hysterectomy is a mutilating surgery in obstetrics. Peripartum hysterectomy remains one of the important procedures to reduce maternal mortality and morbidity in Bangladsh. The study aimed to determine the incidences of peripartum hysterectomy in patients admitted to Dhaka medical college hospital (DMCH) by thorough evaluation of cases.

Methods: This was a cross-sectional clinical study carried out in the department of obstetrics and gynaecology, DMCH. The duration of the study was one year, from July 2008 to June 2009. About 42 patients with peripartum hysterectomy took part in it. All patients who underwent peripartum hysterectomy with no other chronic illness, matched with age criteria, and gave consent were among the inclusion criteria. Data were collected and analyzed with the software SPSS.

Results: Incidence of 6.25 per 1000 deliveries. Majority age group 29-34 years (38.09%). P/V bleeding with shock (23.81%), P/V bleeding without shock (35.71%), term pregnancy with labor pain (21.43%), and ruptured uterus (19.05%). The primary indication was uterine rupture (57.14%), followed by postpartum hemorrhage (26.19%) and sepsis (4.76%). Subtotal hysterectomy was performed in 88.09% of cases. Intraoperative complications included severe hemorrhage (23.81%) and urinary bladder injury (14.28%). Postoperative complications included febrile morbidity (42.85%), wound infection (23.81%), and paralytic ileus (28.57%). Maternal mortality was 16.67%, and perinatal outcomes included 61.9% stillbirths, 9.52% early perinatal deaths, 4.76% requiring ICU support, and 28.57% alive.

Conclusions: Through effective antenatal care, reduced primary cesarean section rate, identification of patients at risk, enhancement of blood transfusion facilities, together with improvement of surgical skills the morbidity associated with the operation and mortality rate can be reduced.

Knowledge and decision making in the choice between caesarean section and vaginal delivery

Thu, 26 Sep 2024 00:00:00 +0530

Background: The decision-making process regarding the choice between caesarean section (CS) and normal vaginal delivery (NVD) is influenced by various socio-demographic, cultural, and healthcare factors. This study aims to explore these factors among antenatal patients in Bangladesh.

Methods: This prospective observational study was conducted at the institute of child and mother health, Matuail, Dhaka, Bangladesh, from January 2023 to June 2023. A total of 200 antenatal patients attending the antenatal care (ANC) clinic were included. Data were collected through structured interviews and medical record reviews, focusing on socio-demographic variables, healthcare access, cultural influences, and perceived safety regarding delivery methods. Statistical analyses included descriptive statistics, chi-square tests, and logistic regression.

Result: The majority of participants were aged 21-30 years (68%), predominantly Muslim (93.5%), and from urban areas (62%). Most were homemakers (75%) with secondary (37.5%) or higher secondary education (28%). Economic status showed 78.5% had a monthly income of 10,001-50,000 BDT. Early marriage (≤18 years) was prevalent (44.5%), with 31% having their first pregnancy at or before 18 years. Most pregnancies were planned (80.5%) and spontaneous (89%), with 88% receiving regular antenatal care. Decision-making for delivery methods involved relatives alone (21%) and husbands alone (19%), with 78% preferring NVD and 22% preferring CS.

Conclusion: The study reveals that socio-demographic and cultural factors significantly influence delivery method preferences among pregnant women in Bangladesh. There is a need for educational interventions to promote informed decision-making and enhance maternal healthcare services.

Ultrasonographic measurement of cervical length versus Bishop score for prediction of successful induction of labor

Thu, 26 Sep 2024 00:00:00 +0530

Background: Induction of labor is a commonly used procedure by obstetrician which denotes artificially stimulating uterine contraction and initiating labor. This study aims to compare transvaginal measurement of cervical length and Modified Bishop score for the prediction of successful labor induction.

Methods: This was a prospective cross-sectional study done at Paropakar maternity and Women’s Hospital, Kathmandu, Nepal from September 2021 to August 2022. 274 term pregnant women admitted for induction of labor were included in the study. Transvaginal sonography and Modified Bishop scoring were done within 24 hours prior to induction. Vaginal delivery within 24 hours of labor induction was considered as successful.

Results: Among 274 patients that were included in the study, 203 (74.08%) of the induced patients had vaginal delivery within 24 hours and 70 (25.9%) had induction failure. Majority of the patient belonged to the reproductive age group of 19-35 years (239, 85.9%) and most of them were primigravida 157 (56.7%). The sensitivity and specificity of transvaginal cervical length and Modified Bishop Score was 72% and 66.8% vs 24% and 85%. The overall accuracy of prediction of successful labor induction was higher for transvaginal cervical length (72% vs 35%).

Conclusions: Transvaginal measurement of cervical length is more accurate in predicting success of labor induction in compared to Modified Bishop Score.

The role of maternal serum homocysteine level in early onset preeclampsia for prediction of severity of disease

Halima Akter, M. Tofazzel Hossain, Shirin Shabnam — Thu, 26 Sep 2024 00:00:00 +0530

Background: This study was conducted to observe the relationship between high serum homocysteine levels and preeclampsia with severe features among preeclamptic pregnant women of 20-34 weeks of gestation.

Method: This study was a hospital based a prospective cohort study and was conducted in Department of Obstetrics and Gynaecology in Dhaka Medical College. A total of 110 preeclamptic pregnant women of 20-34 weeks of gestational age were taken and data were collected after taking an informed written consent. After diagnosis of preeclampsia, I gave them some investigations like CBC, SGPT, S. Creatinine and S. Homocysteine. The patients were divided into two groups that is normal homocysteine level (Group-I) and elevated/high homocysteine level (Group-II) and then the patients were followed up by me at 2 to 4 weekly interval or more frequent if needed.

Result: Among 110 preeclamptic women, mean age of the them was 27.2±6.84 (SD) years and gestational age was 28.0±2.58 (SD) weeks when patients developed preeclampsia without severe features. Majority were nullipara (51.8%) and overweight (54.5%). The mean BMI of the preeclamptic women were 28.2±3.46 kg/m². The median (IQR) Homocysteine level was 11.4 (6.7-16.8) μmol/l and Hyperhomocysteinemia was reported in 31.8% of pregnant women. A cut-off value of homocysteine level≥15.3 μmol/l showed sensitivity, specificity, NPV, PPV and accuracy 91.3%, 83.9%, 60%, 97.3% and 85.4%, respectively to correctly predict preeclampsia with severe features. Homocysteine level was significantly associated with preeclampsia with severe features (p<0.05) and was higher in severe preeclamptic women (91.3%). The homocysteine level was higher in patients with severe features, median-18.3 (17.6-19.4) than without severe features median 9.14 (6.68-13.5). Women with Hyperhomocysteinemia had also greater fetal complications, FGR 20%, oligohydramnios 22.9%). The relative risk ratio of development of preeclampsia with severe features was 22.5, among the preeclamptic women having S. homocysteine level ≥15.3 µmol/l.

Conclusion: The study shows that increased maternal serum homocysteine level at 20-34 weeks gestation in preeclampsia without severe features pregnant lady is a predictor of subsequent development of preeclampsia with severe features.

Comparative analysis of surgical versus medical management in alleviating pain in endometriosis patients

Thu, 26 Sep 2024 00:00:00 +0530

Background: Endometriosis is a prevalent gynecological disorder associated with chronic pelvic pain and infertility. Management typically involves surgical or medical interventions. Aim of this study was to compare the effectiveness of these approaches in alleviating pain and improving fertility outcomes.

Methods: This comparative study was conducted with patients who received treatment at the department of obstetrics and gynecology, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh, from February 2022 to January 2023. Seventy-six women with endometriosis were randomly assigned to either the surgical group (n=38) or the medical group (n=38). Pain relief, recurrence rates, side effects, and fertility outcomes were assessed over 12 months.

Results: The surgical group showed significantly greater pain relief, with 78.9% achieving ≥50% pain reduction compared to 47.4% in the medical group (p=0.003). Recurrence of pain was lower in the surgical group (21.1%) compared to the medical group (52.6%) (p=0.003). Surgical complications occurred in 7.9% of patients, while 36.8% of the medical group experienced hormonal side effects. Regarding fertility, 50.0% of patients in the surgical group achieved pregnancy, compared to 31.3% in the medical group, though this difference was not statistically significant (p=0.262).

Conclusions: Surgical management of endometriosis provides more effective and sustained pain relief and lower recurrence rates compared to medical management.

Missed opportunities for antenatal syphilis testing and its associated factors among mothers delivered at fort portal regional referral hospital, Uganda: a cross-sectional study

Thu, 26 Sep 2024 00:00:00 +0530

Background: The global effort to eradicate mother to child transmission (MTCT) of syphilis concentrated on attaining antenatal syphilis screening and treatment; nevertheless, there is lack of data about the accessibility of prenatal screening and treatment in Sub-Saharan Africa (SSA). This study aimed at determining the proportion of missed opportunities for antenatal syphilis testing and associated factors among mothers in rural western Uganda delivered at Fort Portal Regional Referral Hospital (FRRH).

Methods: A cross-sectional study was conducted from postnatal ward of FRRH from April to July 2022. Consecutive sampling of 381 participants was done. A structured pretested questionnaire was used to obtain Sociodemographic details and other factors required for analysis. Using SPSS version 22.0, descriptive statistical analysis was done and binary logistic regression was computed to determine factors associated with missed opportunities for antenatal syphilis testing with a significance level of 5% and 95% confidence interval.

Results: The proportion of missed opportunities for syphilis testing was 124 (32.5%). lack of syphilis test counseling (aOR= 4.3 [2.009-9.438], lack of knowledge of syphilis MTCT (aOR= 3.1 [1.120-8.903], lack of transport (aOR= 10.7 [3.116-36.810] and fear of testing (aOR= 4.3 [1.075-17.484] were found to be independently associated factors after multivariate analysis.

Conclusions: Our study findings demonstrated the need of sensitization of healthcare providers including antenatal care (ANC) staff about the role of identifying mothers who missed antenatal syphilis testing while in postnatal ward for education, counselling and testing.

Clomiphene citrate prevents premature luteinization in stimulated intrauterine insemination cycles

Thu, 26 Sep 2024 00:00:00 +0530

Background: Approximately 13-36% of ovarian stimulation and intrauterine insemination cycles are complicated by premature luteinizing hormone (LH) surge. Gonadotropin releasing hormone (GnRH) agonist or antagonist has been traditionally used to prevent a premature LH surge and premature luteinization in ovarian stimulation cycles. Clomiphene citrate, which competitively inhibits estrogen binding to estrogen receptors, may be used to prevent premature luteinization and premature LH surge in ovarian stimulation with gonadotropins prior to intrauterine insemination (IUI). The objective was to compare the effects of clomiphene citrate with placebo on prevention of premature luteinization in ovarian stimulation with intrauterine insemination cycles.

Methods: This randomized controlled study was conducted from July 2021 to December 2022. A total of 76 participants had ovarian stimulation with tab letrozole and injection r-FSH. Transvaginal ultrasound for folliculometry was done from day 8 onwards as needed. When the leading follicle was at least 14 mm, women were randomly assigned to clomiphene citrate group (n=38) or placebo group (n=38). They were given clomiphene citrate 150 mg or placebo daily up to the day of trigger. Premature LH surge and premature luteinization were assessed on the day of trigger.

Results: Premature luteinization was significantly lower in patients given clomiphene citrate compared to women given placebo (16.7% versus 47.1%, p<0.01). Premature LH surge was also lower in participants given clomiphene citrate but the difference was not statistically significant (47.2% versus 52.9%, p<0.811). Pregnancy rate with clomiphene citrate was higher (11.1% versus 2.9%) than that with placebo.

Conclusions: The addition of clomiphene citrate to gonadotropins in mid to late follicular period decreases the risk of premature luteinization and improves pregnancy rate.

Influence of body mass index on clinical estimation of fetal weight

Sabeena Parveen, Balwani Manishaben, Priya Ballal K. — Fri, 20 Sep 2024 00:00:00 +0530

Background: Estimation of fetal weight is essential for prenatal care and delivery management. Clinical methods, such as symphysiofundal height (SFH) assessment, and ultrasound-based techniques are commonly used for this purpose. Maternal body mass index (BMI) can influence fetal weight estimation accuracy, particularly in obese patient. In periphery where ultrasound facilities are not available clinical estimation of fetal weight plays very important role in antenatal care. This study was aimed to examine the impact of maternal BMI on the accuracy of clinical fetal weight estimation.

Methods: This cross-sectional study included 800 pregnant women. Anthropometric measurements were collected, including weight, height, SFH, abdominal girth, and double abdominal fold thickness (DAFT). Fetal weight was estimated using clinical methods and compared with actual birth weight. Statistical analysis was performed using statistical package for the social sciences (SPSS) version 26.0.

Results: Participants had a mean weight of 46.4 kg, height of 154.5 cm, and body mass index of 19.4 kg/m². SFH×AG method yielded a mean birth weight estimation of 3.0 kg with an absolute error of 136 grams, while Johnson's formula estimated 3.3 kg with an absolute error of 478 grams. double abdominal fold thickness measurements also showed variations in fetal weight estimation accuracy across different ranges. It was observed that as body mass index increased, the absolute error also increased. It was also noted that the SFH×AG formula was more accurate compared to Johnson's formula.

Conclusions: Relying solely on clinical estimation of fetal weight, especially in mothers with high body mass index, may be limited in accuracy. The SFH×AG method outperformed Johnson's formula, particularly in cases influenced by body mass index. Complementary methods, such as ultrasound-based techniques, are recommended to enhance accuracy, especially in obese pregnant women.

Effectiveness of the OZiva® plant-based HerBalance supplement in the management of polycystic ovary syndrome: a real-world evidence study

Ratna Upadhyay, Mihir C. Gadani, Nikita S. Tendulkar — Thu, 26 Sep 2024 00:00:00 +0530

Background: Polycystic ovary syndrome (PCOS) is a complex heterogeneous endocrine disorder that is characterized by polycystic ovaries, chronic anovulation, and hyperandrogenism. We evaluated the efficacy and safety of OZiva® Plant Based HerBalance for PCOS (HBPCOS) supplement therapy on females suffering from symptoms and signs of PCOS.

Methods: This study employed a retrospective, questionnaire-based design to gather real-world evidence. A total of 153 female participants between the age range of 20-50 years diagnosed with PCOS or related symptoms were enrolled in this study. Primary data was collected using an electronic diary, capturing demographic characteristics and pre- treatment and post-treatment statuses of PCOS clinical signs and symptoms.

Results: In this, Female participants, with an average age of 28.70 ± 5.34 years. years and a history of PCOS for an average duration of 3 months, were recruited. Of the female participants, >87% of those with menstrual cramps, >92% with menstrual bleeding issues, 80% with acne, 64% with excess facial hair, 74% with weight management issues, 61% with difficulty conceiving, and >68% with irregular menses experienced complete or partial resolution of their symptoms after three months of consuming OZiva® HBPCOS. There was a statistically significant improvement in symptoms across the participants.

Conclusion: This study shows that PCOS-related infertility, obesity/difficulty managing weight, menstrual issues, and dermatological symptoms/signs have been significantly reduced after consuming OZiva® HBPCOS product for 3 months.

Indications and risk factors of blood transfusion in obstetrics and gynaecology

Poonam Laul, Akhila B. Sampath, Urvashi Miglani, Rikita Jindal, Usha Yadav — Thu, 26 Sep 2024 00:00:00 +0530

Background: Blood transfusion services are vital to maternal health because obstetric hemorrhage has been the foremost cause of maternal mortality in India. The purpose of the study is to study the indications and risk factors of transfusion of blood products in patients of obstetrics and gynaecology. The secondary objective is to study the type of early post blood transfusion reactions and percentage of patients referred from peripheral centre due to non-availability of blood transfusion centres

Methods: A prospective cohort and observational study at Deen Dayal Upadhyay hospital, a New Delhi, India.

Results: 21 to 30 years was the most common age group to receive blood transfusion. The 86.70 percent of the subjects requiring transfusion were of low socioeconomic status. 57.60 percent were not booked at any institute. The 60% of the patients were referred from elsewhere. Chronic anemia was most common associated haematological comorbidity (15.20%). The 85% received single component therapy transfusion. Amongst the patients receiving transfusion 11.2% had gynaecological disorder. The most common indication for transfusion was anemia in pregnancy. The 98.40% of the patients had no immediate or delayed blood transfusion reaction.

Conclusions: Anemia in pregnancy is most common and important cause of transfusion of blood in antenatal population in Northern India. Anemia is a preventable condition. Operational blood storage systems at peripheral centres can reduce referral to tertiary care centre for blood transfusion. Transfusion of cross matched and screened blood components under supervision is extremely safe.

A comparison of buccal versus vaginal misoprostol for induction of labour at term to correlate maternal and foetal outcome

Jasvir Kaur, Satwant Kaur — Thu, 26 Sep 2024 00:00:00 +0530

Background: Induction of labour with prostaglandins offers the advantage of promoting cervical ripening with stimulation of myometrial contractility. The use of prostaglandin preparations with or without oxytocin infusion, widely recognized and accepted as a standard method of labour induction, has been shown to reduce induction time and the risk of failed induction.

Methods: The present study was a prospective observational study undertaken in the obstetrics and gynaecology department of Adesh Medical College and Hospital, Kurushetra, Haryana, India from 01 June 2023 to 30 November 2023. Total 100 patents were randomly allocated to either group A (n=50) who receive 25 µg misoprostol buccally four hourly upto maximum of four doses, group B (n=50) who receive 25 µg misoprostol vaginally four hourly upto maximum of four doses. Various parameters noted were time interval from induction to vaginally delivery, mode of delivery, maternal adverse effect, and neonatal outcome.

Results: The mean induction delivery interval in group I was 14.17 hours and 12.9 hours in group II. The mean number of doses in group I was 1.58±0.36 and 1.26±0.28 in group II. The mode of delivery in group I (buccal) patients was full-term vaginal delivery (FTVD) in 33 of patients, instrumental (forceps) 2 of patients and lower segment caesarean section (LSCS) in 15 of patients. While as in group II (vaginal) patients 35 of patients had FTVD, 1 had instrumental (forceps) and 14 had LSCS. The results of present study were indicated that participants who were treated with buccal misoprostol were suffering from gastrointestinal experiences and tachysystole which was the result of misoprostol dosage.

Conclusions: Misoprostol in either buccal or vaginal route has proven to be equally effective for inducing labour in women at term pregnancy. This study found that the women who are treated with buccal misoprostol are suffering from gastrointestinal experiences more than vaginal misoprostol. However, easy intake is observed if the drug is administered buccally outweighs its advantages over the vaginal misoprostol.

Awareness of HIV and prevention of parent-to-child transmission among antenatal mothers, Solur, Magadi Taluk, Ramnagara district, Karnataka

Thu, 26 Sep 2024 00:00:00 +0530

Background: Globally, 4,30,000 children aged under 15 years were infected with HIV in 2008. Most of the cases were reported in developing countries, of which more than 90 percent are the result of mother-to-child transmission during pregnancy, labour and delivery or breast feeding. Parent-to-child transmission accounts for about 4.3 percent of the overall HIV transmission in the country. This study was conducted to assess the awareness of HIV and its vertical transmission in pregnancy and its determinants among pregnant women availing care at a rural maternity hospital in Karnataka.

Methods: A hospital-based cross-sectional study in Ramnagara district, in which 231 pregnant women were recruited by consecutive sampling and administered a face-validated structured questionnaire. A 55-item questionnaire to assess awareness about HIV and prevention of parent to child transmission was administered. Women were given knowledge scores based on answers to the questionnaire and women securing more than 70% of the total score, were considered to have good awareness.

Results: The study population included 132 (57%) primigravida. The mean age of the study population was 23.8±3.67 years. Among the study participants, only 93 (42%) women were aware of vertical transmission of HIV-AIDS. Awareness regarding HIV in pregnancy was found to be significantly associated with type of family (p=0.024) and age of study participant (p<0.002).

Conclusions: Awareness regarding prevention of HIV-AIDS and parent-to-child transmission of HIV-AIDS among antenatal mothers is poor. A significant association was found between type of family and age of study participant and knowledge regarding HIV-AIDS among the study participants. This can be improved by addressing different myths and misconceptions regarding transmission of HIV in routine health education programmes.

Clinical outcomes of COMOC-MG modified B-lynch stitch technique for preventing postpartum haemorrhage in a tertiary care teaching hospital

Haresh A. Chaudhary, Bipinchandra R. Shah — Thu, 26 Sep 2024 00:00:00 +0530

Background: Postpartum haemorrhage (PPH) remains a leading cause of maternal morbidity and mortality worldwide. Effective management often involves uterotonic drugs, but surgical interventions like the B-Lynch suture are crucial when medical treatments fail. The COMOC-MG modified B-Lynch stitch technique offers promising improvements in controlling atonic PPH. This study aimed to evaluate the clinical outcomes of the COMOC-MG modified B-Lynch stitch technique in managing PPH among high-risk obstetric patients undergoing caesarean sections at a tertiary care teaching hospital.

Methods: A prospective study was conducted from January 2021 to June 2022 at C.U. Shah Medical College and Hospital, Surendra Nagar. Fifty antenatal women undergoing emergency or elective lower segment caesarean section (LSCS) with identified high-risk factors for PPH were included.

Results: Participants were predominantly aged 26-30 years (52%), with 40% primigravidae and 60% multigravida. The majority of patients (94%) experienced no maternal complications, and only 6% required ICU admission. Fetal distress (36%) was the leading indication for LSCS. Anaemia was the most prevalent high-risk factor (22%). However, 88% did not require postoperative blood transfusions. Haemoglobin levels decreased significantly from a mean of 9.90 g/dl preoperatively to 8.70 g/dl postoperatively (p<0.05). The prophylactic COMOC-MG modified B-Lynch suture alone was successful in 82% of cases, with only 2% requiring hysterectomy.

Conclusion: The COMOC-MG modified B-Lynch stitch technique is effective in preventing PPH in high-risk caesarean section patients, demonstrating low complication rates and favourable maternal outcomes. These findings support the technique's use in managing atonic PPH and highlight the importance of comprehensive obstetric care.

Comparison between digital vaginal examination and ultrasound parameters to assess fetal head station and position in labour

Yashaswi Pandey, Apernapriya G. C., Rajarajeshwari K. S., Kalyani S. — Thu, 26 Sep 2024 00:00:00 +0530

Background: The aim was to study the comparison between digital vaginal examination and ultrasound parameters to assess fetal head station and position in labour. The objective was to determine the level of agreement and to compare the findings of clinical examination with intrapartum ultrasound in the determination of fetal head station and position in labour.

Methods: A prospective cohort study was done over a period of 12 months in a tertiary centre. 86 patients were followed up by digital vaginal examination and intrapartum ultrasound for determining the fetal head position and station in active labour. Categorical variables were presented in number and percentage, and continuous variables presented as mean±SD and median. Qualitative variables were correlated using Chi-square test. A p value of <0.05 was considered statistically signiﬁcant.

Results: The absolute agreement between DVE and intrapartum USG for determining FHP was 43.02% in labour with a composite agreement of 66.67%. The absolute agreement between DVE and Intrapartum USG for determining fetal head station was 68.6% in labour. Accuracy of ultrasound to correctly diagnose fetal head position in labour was found to be 82.14%.

Conclusions: DVE is a subjective tool which can fail to detect the correct fetal head position and station in labour in presence of certain conditions like caput succedaneum and moulding during active labour.

Prevalence of fetal ultrasonographic soft markers in antenatal women and their pregnancy outcomes: a cross-sectional study

Shaily Agarwal, Monica Sahu, Renu Gupta, Pavika Lal — Thu, 26 Sep 2024 00:00:00 +0530

Objectives: Estimating soft marker prevalence during first and second trimester ultrasound scans and determining the relationship between nuchal translucency (NT) measurements and sociodemographic variables in the antenatal population receiving care at our facility.

Methods: This hospital-based observational study, conducted from January 2020 to November 2021, included 300 pregnant women receiving antenatal care at our institute. Soft markers studied included NT and absence of nasal bone for the first trimester and echogenic intracardiac focus (EICF), hyperechogenic bowel, choroid plexus cyst (CPC), mild renal pyelectasis, and limb shortening for the second trimester. For ultrasonographic examination, a HITACHI –ALOKA -6 USG equipment was used via transabdominal route. Wherever applicable, independent sample t test, chi-square test, and fisher's exact test were used to examine demographic factors and NT. To analyse the data, S.P.S.S version 23 was utilized.

Results: The mean age of the participants was 24.96 years, and 41% (n=123) were primigravida and 59% (n=177) were multigravida. Most pregnant women (79%, n=237) were low-risk. Prevalence of Increased NT was 2.66% (n=9), hypoplasia or absence of NB was none, EICF was 2.33% (n=7), Hyperechogenic bowel was 0.33% (n=1), CPC was none, mild renal pyelectasis was 0.66% (n=2), and limb shortening was 0.33%. Relationship between obstetric risk factors and increased NT (2=12.22, p=0.006) and mean age of participants with increased NT (t=-2.625, p=0.009) was statistically significant.

Conclusions: First-trimester fetal NT screening should be done for pregnant women over 30 and multigravida. Soft markers in pregnant women need a thorough diagnostic evaluation to rule out fetal abnormalities.

An assessment of knowledge regarding hospital acquired infection prevention among health care workers in a government medical college, UP, India

Rashmi Gupta — Thu, 26 Sep 2024 00:00:00 +0530

Background: This study aimed to assess the status of knowledge and practice aspects regarding infection control and prevention among Health care workers in a tertiary health care facility of Uttar Pradesh.

Methods: It was an observational cross section study conducted between April 2023 to June 2023 in a government medical college involving 179 health care workers. Data was collected on the basis of pre tested questionnaire through interview of health care workers. Questionnaire was divided into three-part, first part containing question related to demographic parameter of study participants and second and third part contained questions regarding knowledge and practice of standard infection control measures respectively.

Results: Majority of participants were above 34 years (66.66%) female health worker (73.6%).72% participants were in the category of faculty member and nursing staff with average experience of more than 9 year. Study shows that100% of faculty members, resident doctors, and nursing staff were having the knowledge regarding steps of hand wash before surgical procedure and hand hygiene procedure before and after patient care. 100% of faculty members, resident doctors and nursing staff said that they perform all steps of hand wash before surgical procedure, perform hand hygiene before and after patient care.

Conclusion: This study demonstrates a commendable level of adherence to infection control measures among healthcare workers. The high levels of compliance observed in our study may be attributed to institutional policies, ongoing training, or other factors unique to our setting.

Study of knowledge, attitude and practice about polycystic ovarian syndrome among PCOS patients

Ranjana S. R., Sreelekshmy B. S., Bincy Babu — Thu, 26 Sep 2024 00:00:00 +0530

Background: Polycystic ovarian syndrome (PCOS) is a common endocrine disorder with hormonal imbalance affecting the reproductive age. Adequate knowledge and attitude play a vital role in practice of disease. This study was conducted to assess the knowledge, attitude and practice about polycystic ovarian syndrome among PCOS patients in south Kerala.

Methods: This was a hospital based descriptive study carried out among PCOS patients in a tertiary care hospital for a period of 4 months which included data collection. The 200 subjects were classified based on inclusion and exclusion criteria out of which 38 subjects were lost to follow up hence a total of 162 patients were included in the study.

Results: Majority of subjects had good knowledge (85.8%), attitude (69.8%) and practice (53.7%) towards the PCOS. There was a statistically significant association between knowledge towards PCOS and demographic characteristics (education) and there is also significance in case of association between attitude and education. Hence, there is no association between practice and demographic details. The knowledge and attitude, knowledge and practice, attitude and practice were found to have a positive association between them towards PCOS. There was no link between age groups and medication adherence levels.

Conclusion: The presents study provides variable insights into the knowledge, attitude and practice towards PCOS among PCOS patients, offers guidance and resource for the future study. The healthcare providers should consider effective communication with PCOS patients. These findings help in implementing awareness towards PCOS and its early detection.

Ultrasound evaluation of caesarean section uterine scar and its correlation to intraoperative scar thickness

Anusha Leelapalli, Barsha Priyadarshinee — Thu, 26 Sep 2024 00:00:00 +0530

Background: The number of caesarean sections performed has skyrocketed in recent decades. The most frequent indication for a caesarean section is a previous caesarean birth. The goal of the current study was to compare the lower uterine scar thickness in pregnant with history of previous caesarean delivery as determined by sonography with the actual scar condition at the time of surgery.

Methods: The study involved 100 pregnant women between gestational age of 35 completed weeks and 38 weeks with history of previous caesarean delivery and were attended to OPD for antenatal checkups in the department of obstetrics and gynaecology, SCBMCH, over a period of one year from 1st June 2019 till 31st June 2020. Who underwent transabdominal ultrasonography. The lower uterine segment [LUS] thickness was measured by measuring the interphases between the myometrium, the Chori amniotic membrane, and the bladder wall. The patients were followed up and correlated ultrasound findings of lower uterine segment thickness with intra-operative finding of lower uterine segment thickness. Pearson correlation is the statistical method used to measure correlation.

Results: Correlation of ultrasound scar thickness and intra-operative scar thickness was evaluated by correlation coefficient (r value) i.e., 0.405 and p value i.e., 0.001.

Conclusion: According to the current study, decreased uterine scar thickness, as determined by sonography, is a reliable indicator of scar defect in women who have had prior caesarean operations. Thus, sonographic measurement of the thickness of the lower uterine segment can properly assess scar status and the choice to offer women a trial of vaginal birth and precautions can be taken.

The effect of previous and current COVID-19 infections on amniotic fluid index

Sarah Muayad Al-Musawi — Thu, 26 Sep 2024 00:00:00 +0530

Background: COVID-19 infection had a multisystem effect. Although it does not cross the placenta, it can cause conformational changes that affect placental function, with the possibility of a change in amniotic fluid index and the development of oligohydramnios. The aim of the study is to estimate the effect of COVID-19 previous and current infections on the amniotic fluid index.

Methods: A prospective case-control study was conducted in a major maternity hospital from the 1st of April 2021 to the 1st of October 2021. 125-term pregnant ladies early in labor and had been diagnosed with COVID-19, either current or previous infection (according to serology testing IgG and IgM) were considered the case group, and 125-term pregnant ladies in labor but without COVID-19 infection as a control group. A transabdominal ultrasound was done to measure the amniotic fluid index for comparison between groups.

Results: Cases of previous infection had a reduced level of amniotic fluid index (mean 9.98±4.93), which is statistically significantly lower than both the current infection and control, and the amniotic fluid index of the current infection was not different statistically from the control. Finally, it is 4.48 times more common to develop oligohydramnios if the patient had previous COVID 19 infection (odd ratio 4.48, 95% CI 10.87-1.85).

Conclusion: The previous COVID-19 infection is significantly associated with decreased AFI.

Acarbose is as effective as metformin in reducing central obesity in infertile women with polycystic ovary syndrome

Thu, 26 Sep 2024 00:00:00 +0530

Background: Polycystic ovary syndrome (PCOS) in infertile women is frequently associated with insulin resistance and obesity. Optimization of the patient by reducing weight and insulin resistance improves clinical, biochemical & endocrine parameters and consequently increases the chance of successful ovulation and pregnancy. Acarbose is an alpha-glucosidase inhibitor which acts by reducing and slowing down intestinal absorption of glucose, with a reduction of the postprandial glucose wave and a consequent reduction of insulin secretion. The objective of this study was to evaluate the efficacy of acarbose compared to metformin, in reducing central obesity in infertile women with PCOS.

Methods: This randomized controlled trial study was conducted on a total 60 infertile, overweight and obese women with PCOS. The women were allocated randomly to two treatment arms: one group receiving acarbose 100 mg three times daily with meal for 3 months and another group receiving metformin 500 mg three times daily after meal for 3 months. The main outcome variables were changes in central obesity and insulin resistance.

Results: Mean weight, BMI, waist circumference and waist hip ratio was significantly decreased in both acarbose and metformin group. Reduction of fasting blood sugar, fasting insulin and HOMA-IR were also significant. The reduction was more in acarbose group, but the difference was not statistically significant. Gastrointestinal side effects were more in the women given metformin.

Conclusion: There is significant reduction in central obesity or insulin resistance parameters in infertile PCOS women given acarbose or metformin over three months. However, there is no statistically significant difference between the two groups. Acarbose has less gastrointestinal side effects, so can be a suitable alternative to metformin in those who are intolerant to metformin.

A mixed method study on menopause-related quality of life and health-seeking behavior in urban Telangana, India

Sai Madhuri Rangaraju, Nirupama A. Y., S. T. P. Lakshmi Prasanna — Thu, 26 Sep 2024 00:00:00 +0530

Background: Perimenopause is the body's natural transition to menopause, signaling the end of the reproductive years. Changes in a woman's menstrual cycle, vasomotor changes, psychological changes, and vaginal health and sexuality are all symptoms of menopause. This study's objectives are to describe perimenopausal women's quality of life, and enumerate the health-seeking behavior, and determine the prevalence of various perimenopausal symptoms.

Methods: A Cross-sectional study was conducted in the urban settlements of Telangana in 2022. Using an online questionnaire, data was collected from 200 participants, who were identified by convenient sampling followed by snowball sampling. For data collection, a questionnaire was developed from focus group discussions along with standardized MEN-QOL questionnaire.

Results: Common perimenopausal symptoms observed were hair loss (47%), fatigue (48%) and body/joint pain (46%). (54%) participants approached family doctor, 40.5% prefer private healthcare facilities, 39.5% prefer modern medicine. Mean total MEN-QOL score is 3.13±0.37.QOL is low in the physical domain (mean=3.93). Age has a statistically significant relationship with all three domains of MEN- QOL (p<0.05).

Conclusions: Hair loss, fatigue, and body/joint pains are prevalent perimenopausal symptoms. Physical domain has poor QOL. Most participants approached family doctors, visits private healthcare facilities and prefers modern medicine.

Perinatal mortality audit in a tertiary healthcare center in Uttar Pradesh: a retrospective study

Bandana Sharma, Himani Malviya, Anchal Malik, Neha Swayam — Thu, 26 Sep 2024 00:00:00 +0530

Background: Perinatal mortality remains a significant global health issue, reflecting the quality of maternal and neonatal care. In Uttar Pradesh, India, where healthcare challenges are pronounced, understanding the specific factors contributing to perinatal mortality is crucial. This study aims to analyse and evaluate the patterns, causes, and contributing factors of perinatal mortality in a tertiary healthcare center in Kanpur.

Methods: This retrospective observational study was conducted at GSVM Medical College, Kanpur, from April 1, 2023, to March 31, 2024. Data on maternal and fetal characteristics were collected from hospital files and neonatal outcomes from the NICU. Inclusion criteria included stillborn babies born after 28 weeks of gestation and newborns who died within the first 7 days of life. Cases were excluded if they were preterm, of low birth weight, or delivered outside the hospital. Descriptive statistics were used to analyze the data.

Results: Among 6,123 deliveries, 212 perinatal deaths were recorded, yielding a perinatal mortality rate of 3.46%. The mean maternal age was 27.67 years. A majority of perinatal deaths (75.5%) involved women with no antenatal care. The leading causes of death were prematurity (23.5%), asphyxia (15.6%), and respiratory distress syndrome (11.8%). Hypertensive disorders, antepartum haemorrhage, and severe anemia were the most common maternal complications. The study revealed significant risks associated with multiparity, lack of prenatal care, and low birth weight.

Conclusions: Reducing perinatal mortality in Uttar Pradesh requires a comprehensive approach, including improved access to antenatal care, strengthened healthcare infrastructure, and community education. Addressing these factors is essential for enhancing maternal and neonatal health outcomes and reducing perinatal mortality rates.

Maternal and fetal outcome in women experiencing first trimester vaginal bleed: a multicentric approach

S. Chandrakala, M. Gokul Reshmi — Thu, 26 Sep 2024 00:00:00 +0530

Background: Vaginal bleeding before 12 weeks of gestation is relatively common obstetric event complicating nearly 25% of all pregnant women. In this study we examined the maternal and fetal outcomes of pregnant women who experienced bleeding throughout the first trimester of their pregnancy.

Method: A multicentre prospective cohort study was carried out at the Institute of Obstetrics and Gynaecology, Egmore and Department of Obstetrics and Gynaecology, Sri Venkateshwara Medical College Hospital and Research Centre, Puducherry from June 2023 to May 2024. In a one-year period, 200 cases were chosen, with 100 pregnant women with first trimester haemorrhage and 100 women with no bleeding serving as control groups. Following informed consent, women were recruited into the study.

Results: In this study we observed maternal outcome of preterm delivery (37% vs 12%), LSCS (41% vs 14%), 2nd trimester abortion (12% vs 3%), PPROM (13% vs 2%), anaemia (32% vs 27%), PPH (25% vs 7%) and PIH (24% vs 12%) were observed significantly higher in study group than control group (p=<0.05). Regarding fetal complications Low birth weight (32% vs 8%), NICU admission (33% vs 8%), APGAR <7 (25% vs 6%), premature baby (22% vs 4%) was observed significantly higher in study group (p=<0.05)

Conclusion: We concluded from this study that during the first trimester, women with vaginal bleeding face a higher chance of undesirable pregnancy outcomes and require more care and consultation. These instances should be regarded as high-risk pregnancy and treated accordingly, or referred to better-equipped medical clinics to lessen the chance of difficulties.

A comparative study of spontaneously conceived twin pregnancies vs. twins conceived by assisted reproductive techniques and their maternal and perinatal outcomes: a prospective observational study

Sarah Nazneen, Vijayalakshmi Kandasamy, Ranoji V. Shinde — Thu, 26 Sep 2024 00:00:00 +0530

Background: The utilization of assisted reproductive techniques has led to a notable increase in the incidence of twin pregnancies. Neonates from multifetal gestations also make up a disproportionate percentage of very-low-birthweight newborns and have increased risks of having congenital malformations and preterm birth. This study was done to compare the maternal and and perinatal outcomes of spontaneously conceived twins and those twins conceived by assisted reproductive techniques.

Methods: The present hospital based observational study was done at Chettinad Hospital and Research Institute, Chennai, India over a period of 36 months between February 2021 to January 2024 among pregnant women with twin gestation attending the outpatient department during the study period. 50 antenatal mothers with twin pregnancy and 50 pairs of twins were studied. Convenient sampling technique was adopted. The subjects were followed up from the booking visit, till the postpartum discharge day. Any adverse maternal, foetal, neonatal outcomes and the treatment given were studied.

Results: The mean birth weight among those with spontaneous conception and assisted reproductive techniques conception was 2.23±0.46 kgs and 2.02±0.51 kgs, respectively. Both the groups were similar with regard to the birth weight. 6.6% babies from the spontaneous conception group and 5% from the assisted reproductive techniques conception group were admitted for respiratory distress and rest from both the groups got admitted for sepsis. The mean duration of hospital stay was 3.58±2.40 days for the spontaneous conception group and 3.75±2.71 days for assisted reproductive techniques conception.

Conclusions: This study concludes that the maternal and fetal outcomes of twin deliveries conceived spontaneously or through assisted reproductive techniques do not differ significantly in their outcome.

Retrospective observational study to assess clinical impact of ferric pyrophosphate supplementation in antenatal settings of India (FEMINA study)

Thu, 26 Sep 2024 00:00:00 +0530

Background: Globally, anemia during pregnancy is a major public health concern. Conventional iron supplements limit their effectiveness due to poor absorption, water solubility and untoward GI side effects. This study assessed the clinical impact and safety of Micronized Microencapsulated Ferric Pyrophosphate (MMFP) supplementation in an antenatal setting of India.

Methods: Real world, cross-sectional, single-arm, observational study in 814 patients from 122 clinics across India. Study done with central IEC approval in accordance with ICH-GCP and Helsinki Declaration. Descriptive and analytical statistics applied for study endpoints using SPSS ver. 29.0.1.0(171).

Results: 814 pregnant women data was analysed with a mean age (29.39±3.98 years) and weight (59.48±8.14 kg). 61.79% patients were multiparous. 50.12% women were in their second trimester of pregnancy. Thyroid diseases were commonest comorbidity (21.25%). Mild anemia (37.35%) and moderate anemia (50.49%) were more prevalent. Hemoglobin levels showed significant improvement from 9.46±1.27 g/dl to 10.95±1.47 g/dl at 12 weeks (p<0.0001). Mean corpuscular volume (MCV) and serum ferritin also showed significant improvement from 85.31±9.49 fl to 90.93±8.51 fl and from 103.06±61.91 ng/ml to 164.42±79.61 ng/ml at 12 weeks (p<0.0001) respectively. Consistent improvement seen in three parameters irrespective of diet patterns or anemia severity at baseline. 12 weeks MMFP supplementation showed significant surge in patients having Hb (>11 g/dl) to 62.03% from 9.58% at baseline. Furthermore, MMFP demonstrated favourable safety profile, with only five mild adverse events observed, unrelated to the treatment.

Conclusions: MMFP supplementation is a valuable therapeutic option for managing iron deficiency anemia in pregnant women.

Awareness and acceptance of postpartum intrauterine contraceptive devices amongst women in reproductive age group in an urbanized village of South Delhi

Suresh M., Shalini Smanla, Namita Srivastava — Thu, 26 Sep 2024 00:00:00 +0530

Background: In India, grappling with a population surge, about 48.1 million pregnancies are unintended, highlighting the critical need for effective postpartum family planning (PPFP) to prevent adverse outcomes. Despite the postpartum intrauterine contraceptive devices (PPIUCD) benefits as a non-hormonal, reversible contraceptive, its uptake is hindered by various barriers. This study examines the awareness and acceptance of PPIUCD among women in the reproductive age group of South Delhi.

Methods: This observational cross-sectional study was conducted at the field practice area under the Department of Community Medicine, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi. Under this study, 190 women of reproductive age groups were included. The data was collected regarding awareness and acceptance of PPIUCD. The reason for acceptance and non-acceptance was collected. Data entered and analysed in Microsoft excel.

Results: Out of 190 women of reproductive age,73% were aware of PPIUCD, and only 28% had accepted the PPIUCD. A statistically significant association between awareness and acceptance of PPIUCD was found. The most common reason for not accepting the PPIUCD was lack of awareness, followed by fear of complication. The reason for acceptance of PPIUCD was exposure to counselling and awareness that it was long-acting and reversible. The most common reason for the removal of PPIUCD is abdominal pain followed by bleeding. The statistically significant association between place of delivery and awareness and acceptance of PPIUCD was found.

Conclusion: During the present study, it was found that Awareness and acceptance of PPIUCD was 73% and 28% of the women of reproductive age, respectively.

Outcome of recanalization and factors affecting it: a retrospective study at tertiary care center

Niyati Jain Shah, Ritu Sharda, Neha Agarwal, Shraddha Daksha — Thu, 26 Sep 2024 00:00:00 +0530

Background: In spite of availability of multiple methods of contraception, tubectomy remains most popular method of contraception in India, especially in rural population. For restoration of fertility, maximum patients prefer tubal recanalization over in vitro fertilization. Primary objective of our study was to evaluate pregnancy rate after recanalization surgery and to analyze factors affecting it.

Methods: A retrospective observational study conducted in the Department of Obstetrics and Gynecology at Amaltas Institute of Medical Science, Dewas from April 2021 to April 2023 with a one year follow up.

Results: Total 14 Patients of sterilization reversal were considered for the study. Commonest cause for reversal in our study was second marriage (57.14%). Pregnancy rate in our study was 57.14%; all were intra uterine pregnancies. Majority of the patients who got conceived belonged to the age group of 26-30 years. Patients with history of laparoscopic tubectomy had 87.5% conception rate as compared to 16% with history of open tubectomy. Maximum number of patients who conceived had interval of 3-6 years between sterilization and reversal (63.6%). Conception rate was 70% with final tubal length being more than 4 cm and 85% with isthmo-isthemic anastomosis.

Conclusions: Patients who want tubal sterilization should be counselled about alternative spacing methods of contraception. Tubectomy should be done at isthmus through laparoscopic method as it causes minimum damage to tube. Final tubal length (>4 cm) and site of anastomosis (lsthmo-isthemic) are important factors for success of a recanalization surgery.

Dydrogesterone use in recurrent pregnancy loss and luteal phase insufficiency: a knowledge, attitude, and practice survey amongst Indian obstetricians and gynaecologists

Thu, 26 Sep 2024 00:00:00 +0530

Background: Oral dydrogesterone is effective in treating reproductive disorders such as recurrent pregnancy loss (RPL) and is a better option than progesterone for luteal phase support (LPS) after in-vitro fertilization (IVF). This study aimed to assess the attitude, knowledge, and practice of obstetricians and gynecologists (ObGyns) across India towards the usage of dydrogesterone in RPL and LPS in real-life setting.

Methods: A validated questionnaire-based survey was conducted among Indian ObGyns and results were expressed in percentages.

Results: 393 ObGyns participated in the survey. 61.3% of ObGyns agreed RPL is the three consecutive pregnancy losses prior to 20 weeks from the last menstrual period. With the use of dydrogesterone in RPL patients, 82.6% of ObGyns found ˃40% of patients having successful pregnancy outcomes. 37.2% of ObGyns mentioned that dydrogesterone is useful in ongoing pregnancy rates while 33% reported benefits in the live birth rate. At the risk for preterm delivery before 34 gestational weeks, 57% of ObGyns see benefits of dydrogesterone. More than 95% of ObGyns observed benefits of dydrogesterone over micronized progesterone such as good efficacy, fewer side effects, better tolerability, and improved patient compliance. 51.9% of ObGyns reported that they used dydrogesterone in combination with progesterone in LPS.

Conclusions: The present KAP survey highlights the observation, perception, and practicing behaviour of ObGyns on RPL and LPS. It also highlights the usage of dydrogesterone in aforesaid indications.

Development of new localised formula basis for birthweight estimation: single variable and single constant coefficient based clinical formula

Preet S. Kantharia, Rutwa Patel — Thu, 26 Sep 2024 00:00:00 +0530

Introduction: The OBGY professionals’ primary goal is the well - being of fetal and mother. And, to achieve this, accurate fetal weight assessment is of prime importance. The prevalent fetal weight assessment formulas are of western origin and developed several decades ago, and hence its applicability throughout the world is always under debate.

Methods: Present study of analytical formula basis development was carried out at the OBGY Department of a semi-urban cum rural tertiary care hospital, Dhiraj Hospital, SBKS MRC, at Gujarat. The study was undertaken over total of 50 pregnant women at full term pregnancy, till delivery. The actual localised birthweight data of these cases were collected and analysed, to derive a new formula basis and named as ‘SHF as singular kinematic’ (SSK). Same is verified, validated and compared using prevalent Johnson’s formula, for its significance, accuracy / error and positive predictive value. The Microsoft office, excel was used for the calculations and analysis and for graphs.

Results: The new linear formula basis for birthweight estimation is BW(e-ssk)=(SFH-5.8)/8.588, is developed and got validated for its accuracy and predictive value. In comparison to prevalent clinical method Johnson and Toshach formula (JT), it was derived that new SSK formula has identical p value and higher PPV. Also, weighted average PPV % of the study using new SSK formula has resulted higher than, that of PPV % of Similar studies using prevalent formula.

Conclusion: This study concludes that for clinical birthweight estimation, for pregnancy at term, using the newly derived formula basis “SFH as Singular Kinematic–SSK”, provides better accuracy for birthweight estimation over prevalent formula, while simultaneously solving the purpose of easy to learn and easy to use method for all concerned, even including non-medical persons and expecting mothers, at their own with basic training.

Efficacy of combined hysteroscopy and laparoscopy in the evaluation and management of female infertility at a tertiary care center

Thu, 26 Sep 2024 00:00:00 +0530

Background: Infertility, defined by the World Health Organization (WHO) as the inability to achieve pregnancy after one year of unprotected intercourse, is a significant health concern. The study aimed to assess the efficacy of combined hysteroscopy and laparoscopy in diagnosing and managing female infertility, focusing on their impact on pregnancy success rates in a tertiary care setting.

Methods: A retrospective observational study was conducted on 170 infertile women aged 20 to 40 years at GSL Medical College from January 2022 to December 2023. Diagnostic and therapeutic hysterolaparoscopy was performed to identify and treat intrauterine and tuboperitoneal abnormalities. Data were analyzed to determine the prevalence of different infertility factors and the effectiveness of these procedures in enhancing fertility outcomes.

Results: Of the 170 cases, 129 (75.8%) were diagnosed with primary infertility, and 41 (24.1%) with secondary infertility. The most common abnormalities detected included tubal infertility (19.4%) and endometriosis (14.1%). The overall pregnancy success rate was 31.18%, with significant contributions from ovulation induction, IUI, and in vitro fertilization (IVF). Spontaneous pregnancies were infrequent, highlighting the importance of medical intervention.

Conclusions: Combined hysteroscopy and laparoscopy are effective tools for evaluating and managing female infertility. These procedures are particularly valuable in diagnosing and treating conditions like tubal infertility, endometriosis, and uterine anomalies, leading to improved pregnancy outcomes.

Enhancing postpartum depression screening and management in tertiary care: a comprehensive approach

Lokeshwari Jayaraman, Sathish Dev, Suganthavalli, Amar Nagesh Kumar — Thu, 26 Sep 2024 00:00:00 +0530

Background: Postpartum depression (PPD) is a significant public health issue affecting a substantial number of new mothers. Despite its prevalence, PPD often goes undiagnosed and untreated due to inconsistent screening practices and lack of standardized management protocols. This research project aimed to enhance the screening and management of PPD in a tertiary care hospital through the implementation of a comprehensive and evidence-based approach.

Methods: The study was conducted in several phases: assessment of current practices, development and implementation of an enhanced screening protocol, systematic screening to assess prevalence, improvement of early detection and referral systems, evaluation of management strategies, awareness and education campaigns, and follow-up studies. Data collection involved surveys and interviews with healthcare providers, screening of 500 postpartum women using the Edinburgh Postnatal Depression Scale (EPDS), and patient satisfaction surveys. Statistical analyses were performed to determine PPD prevalence and evaluate the effectiveness of management strategies.

Results: The assessment of current practices revealed that only 35% of healthcare providers routinely screened for PPD, with no standardized protocol. The enhanced screening protocol, integrated into routine care, achieved a 100% screening rate among postpartum women. The prevalence of PPD was found to be 15%, with higher rates among women with low socio-economic status and lack of social support. The streamlined referral process ensured that all women who screened positive were referred to mental health services, with an 87% follow-up attendance rate. Management strategies, including cognitive-behavioral therapy (CBT) and pharmacotherapy, led to significant improvement in 85% of women receiving CBT and 92% receiving both CBT and medication. Patient satisfaction surveys indicated a 90% satisfaction rate with the screening and management process. Long-term follow-up studies showed sustained improvement in 85% of women at six months postpartum.

Conclusions: The comprehensive approach to PPD screening and management significantly improved detection, referral, and treatment outcomes in a tertiary care hospital. Standardized screening protocols, effective referral systems, and integrated care models are essential for addressing PPD. The project's success highlights the importance of early detection, targeted interventions, and continuous care to promote maternal mental health and well-being. Future efforts should focus on refining and expanding these protocols to ensure sustained improvements and support for postpartum women.

Diagnostic comparison of hysteroscopic guided biopsy with histopathology of hysterectomy specimen in abnormal uterine bleeding

Srushti S. Raut, Kavita Babbar — Thu, 26 Sep 2024 00:00:00 +0530

Background: The objective of the study is to do diagnostic comparison of hysteroscopic guided biopsy with histopathology of hysterectomy specimen in evaluation of abnormal uterine bleeding.

Methods: An observational prospective study is conducted amongst 114 women between age of 30 years to 80 years with abnormal uterine bleeding admitted for diagnostic hysteroscopy and underwent hysterectomy for relief of symptoms at obstetrics and gynecology department, Apollo Hospital, Bilaspur, Chhattisgarh from January 2023 to July 2024 over a period of 1.5 years.

Results: Leiomyoma and adenomyosis are best diagnosed by histopathology of hysterectomy specimen. Diagnostic accuracy of hysteroscopic guided biopsy in endometrial polyp, atrophic endometrium, endometrial hyperplasia and endometrial carcinoma is equal to diagnostic accuracy of histopathology of hysterectomy specimen in evaluating abnormal uterine bleeding.

Conclusions: Hysteroscopic guided biopsy should be done in every case to find exact cause of abnormal uterine bleeding and rule out malignancy. It helps in avoiding unnecessary hysterectomy. It helps to select route of hysterectomy whether abdominal, vaginal or laparoscopic should be preferred.

Improving outcomes by effective communication with would-be mothers with gestational diabetes at tertiary care center

Pooja Baradia, Narmada Prasad Patel — Thu, 26 Sep 2024 00:00:00 +0530

Background: Gestational diabetes mellitus (GDM) is a metabolic disorder characterized by carbohydrate intolerance detected for the first-time during pregnancy. It may result in various complications in both the mother and child. The purpose of this study was to assess their knowledge about diabetes, doubts about safe pregnancy and misconceptions regarding treatment. It helped us in creating awareness amongst patients, their caregivers and of fellow doctors involved in patient care.

Methods: Each patient was started on a treatment protocol and compliance of medical nutrition therapy (MNT) in patients and calorie requirement were recorded. They were counselled regarding the care they need to execute and provided sample diet chart modified according to their needs, as per the guidelines laid down by ministry of health and family welfare, government of India 2018.

Results: Majority of the GDM women were obese (65%). Majority of the patients had calorie requirement of 2080 (37.50%) followed by 1750 (25%) and 2580 (22.50%). The compliance of MNT in present study was 68.33%.

Conclusions: Patients were unaware about diabetes, had fear for their unborn child, of a safe pregnancy and delivery. Patients were educated about gestational diabetes, its consequences, and how we can together prevent them. The guidelines for gestational diabetes care and assessment during ANC checkup has to be inculcated at grass root level. Patients, their care takers, nursing staff, doctors have to be involved as a team in providing care and implementing these guidelines.

A prospective cross-sectional observational study of acute pelvic pain in gynaecology

Yajnaseni Banerjee, Kevin K. Rambhia — Thu, 26 Sep 2024 00:00:00 +0530

Background: The diagnosis of acute pelvic pain is challenging and is based on clinical history, symptoms, physical examination and radiological findings. The various causes of acute pelvic pain may be gynecological, obstetrical, urological or gastrointestinal which can sometimes present with overlapping features and is difficult to diagnose. Objectives were to study the etiology of acute pelvic pain among different age groups and to study the mode of diagnosis of patients. 3)To study the mode of management.

Methods: This is a prospective non-interventional cross-sectional observational study where patients presenting with acute pelvic pain of less than 3 months duration fulfilling the criteria of the study were included and analyzed. The sample size was 210.

Results: 35.7% patients belonged to age group of 23-32 years while 13% patients belonged to age group 43 and above. 47% cases presented with acute pain for less than 10 days. 13.8% of the patients were pregnant when they presented with pain. 24% cases reported vaginal bleeding with acute pelvic pain and only 10 patients presented with fever. The 18 patients were diagnosed with ruptured tubal ectopic pregnancy and 1 patient had scar ectopic pregnancy. 22 patients had ovarian torsion. Seven patients had complex adnexal cyst and 10 had tubo-ovarian mass. 6 cases of hematometra, 2 of pyometra, 1 of bicornuate uterus with hematometra and 2 of uterine horn collection were observed. The 17 patients had no gynaecological cause of pain. The 73.8% patients had undergone surgical management for acute pelvic pain while17.6% were managed medically. In 8.1% cases medical management was followed by surgical management.

Conclusions: Ruptured tubal ectopic, ovarian torsion, ovarian cyst and pelvic inflammatory diseases were the most common causes. Detailed history, examination and radiological studies are equally important in the diagnosis of acute abdominal pain. Early diagnosis is critical to prevent significant morbidity and mortality.

Fetomaternal outcome of referred obstetrics patients in tertiary care centre

Seema Dwivedi, Monica Sahu, Himani Malviya — Thu, 26 Sep 2024 00:00:00 +0530

Background: Pregnancy is a natural physiological process, with most cases being low-risk and managed safely at primary healthcare centers. However, the timely referral of high-risk pregnancies to specialized care is crucial to prevent complications and reduce maternal and neonatal morbidity and mortality. In India, particularly in rural areas, the referral system’s efficiency is vital in improving feto-maternal outcomes. Despite improvements in maternal mortality rates, the referral system faces challenges, such as poor coordination and delayed referrals, undermining further reductions in maternal mortality. This study examined the outcomes of emergency obstetric transfers to a tertiary hospital, focusing on the reasons for these transfers and the impact of specialized care on maternal and neonatal health.

Methods: A retrospective observational study was conducted at GSVM Medical College, Kanpur, over a six-month period from January 1, 2024, to June 31, 2024. Data were collected on maternal and fetal demographic characteristics, clinical and obstetric conditions, and neonatal outcomes from hospital records. The study population included all obstetric cases >28 weeks referred to the department of obstetrics and gynecology.

Results: Out of 2459 deliveries, 718 cases (29.2%) were referred, with the majority (78.6%) in the 21-30 age group. Most referrals were multipara (54.4%) and from district hospitals (43.8%) and CHCs (41.4%). The main reasons for referral were pre-eclampsia (13.6%), previous caesarean sections (11.4%), and anemia (12.4%). Maternal morbidity was observed in 244 cases (34%), with anemia, postpartum hemorrhage, and eclampsia being the most common complications. Maternal mortality occurred in 12 cases, primarily due to hypertensive disorders, coagulopathy, and sepsis. Among 735 births, 81.2% of babies were discharged without complications, 14.5% required NICU admission, and 4.3% were stillborn.

Conclusions: Timely referral and specialized care are critical in managing high-risk pregnancies and improving maternal and neonatal outcomes. Strengthening first referral units (FRUs) and training healthcare workers are essential steps to enhance the referral system and reduce the burden on tertiary care facilities.

A study of maternal and foetal outcomes in eclampsia: at a tertiary care centre

Priyanka Gaikwad, Prabhakar S. Gawandi, Vijaysinh Sathe — Thu, 26 Sep 2024 00:00:00 +0530

Background: Eclampsia is a life-threatening emergency that continues to be a major cause of maternal and perinatal mortality worldwide. In India figure ranges from 8-14% and perinatal mortality ranges from 14.6% to 47.4%. The present study was done with 260 cases of eclampsia who got admitted in our institute.

Methods: It was a prospective observational type of study which was conducted on all pregnant women with more than 20 weeks of gestation having eclampsia who were admitted at our tertiary care centre from October 2018-October 2019.

Results: In our study most of the pregnant mother belongs to the age group of 20-24 years (51.2%.) 85% did not have proper antenatal checkups. The 65.8% eclamptic patients were primi gravida and 44.4% had gestational age less than 37 weeks. More than half patients underwent caesarean for delivery and 48.15% required ICU care. The incidence of maternal mortality in the present study was 4.16% and the common causes for death were pulmonary edema, DIC, status eclampticus with aspiration pneumonia and acute kidney injury. In our study according to maturity of babies almost 56% cases were term and 35.2% babies had birth weight in the range of 2000-2500 gm. The perinatal mortality was 27.7% and corrected perinatal mortality, excluding cases of absent FHS at admission was 22.8%.

Conclusions: Eclampsia continues to be an enigma in spite of great advances in the field of obstetrics. With better antenatal care, early recognition and hospital treatment of severe pre-eclampsia patients, the incidence of eclampsia can be decreased.

Association of low PAPP-A with the timing of delivery in babies with IUGR, babies showing suboptimal growth on serial scans, and well-grown babies

Ayesha Fathima, Faizan Syed, Syeda Ayesha Siddiqua — Thu, 26 Sep 2024 00:00:00 +0530

Background: The ideal timing for delivering babies with pre-eclampsia or small for gestational age is clear. There is agreement on delivering babies with pre-eclampsia and small for gestational age, but not for normally growing babies with low PAPP-A. Aim was to study the association of low pappa with adverse pregnancy outcomes and ideal delivery timing in a well-grown baby with low pappa as a risk factor.

Methods: A retrospective study analyzed 3240 singleton pregnancies with first-trimester Down syndrome screening at local hospitals from January 2022 to April 2023. Among these, 130 singleton pregnancies had PAPP-A levels at the 5^th centile, along with risk estimations and documentation.

Results: In NCIC Trust births, 3280 women were assessed for low PAPP-A. Of these, 130 had low PAPP-A levels. It revealed that 46.9% used aspirin, with a high down screen risk found in 11.5%. In this study, 13.1% experienced PIH. 2 resulted in intrauterine fetal death (1.5%). 9 women (6.9%) experienced pre-term births. The study identified 8 newborns (6.25%) with birth weights below the 10^th centile after >39+6 weeks, and 6 (4.6%) <3^rd centile after 37+6 weeks.

Conclusions: The study linked low PAPP-A to poor APGAR scores, stillbirth, growth issues, and special care unit admissions. Babies with low PAPP-A showed higher morbidity and mortality after 41 weeks. The findings indicate that delivery should occur between 40+0 and 40+6 weeks. Further research is needed to create an antenatal protocol for optimal delivery timing for babies with low PAPP-A.

Knowledge and stated practice of contraception among adult married males in Bishnupur-II block, South 24 Parganas, West Bengal

Thu, 26 Sep 2024 00:00:00 +0530

Background: Contraception is pivotal in reproductive health and family planning, yet knowledge gaps persist among married males, impacting public health outcomes. This study aimed to evaluate contraceptive knowledge and practices and identify determinants among 127 married males in Bishnupur-II block, South 24 Parganas.

Methods: This community-based cross-sectional study utilised simple random sampling. Data were collected via house-to-house visits using a semi-structured questionnaire and analysed with SPSS version 21.0.

Results: Participants exhibited significant knowledge gaps, notably among those with lower education levels. Age, religion, education, and comfort in discussing contraception with partners emerged as associated factors. Participants comfortable discussing contraception showed higher knowledge and practice odds.

Conclusions: Addressing knowledge gaps and enhancing contraceptive practices necessitate multifaceted interventions emphasising education, partner communication, counselling, and targeted initiatives. Implementation of these recommendations is expected to bolster reproductive health outcomes and community well-being.

Single rod subdermal implant: acceptance and problems associated with it at a tertiary care centre in Southern Rajasthan

Noorani Zainab, Radha Rastogi, Syed Nikhat — Thu, 26 Sep 2024 00:00:00 +0530

Background: The government of India expanded the contraceptive basket under national family planning program by the inclusion of subdermal contraceptive implants (single rod) in the year 2023. In our institute, RNT medical college and attached hospitals, Udaipur, the insertion and use of the implant, after adequate training sessions, began in September 2023. Since then, there has been slow, but sure acceptance of the Implant as a contraceptive. This study aims to provide demographic data of its users, data of the follow up, and the problems encountered by users as well as data on early removal of implant and the reasons for it.

Methods: This is a prospective cohort study, conducted at the department of obstetrics and gynaecology at RNT medical college and attached hospitals, Udaipur. Study conducted from September 2023 to July 2024 time period.

Results: The implant was introduced in our institute as a contraception option in September 2023. No particular trend could be detected with regard to numbers of insertion of the implant. The mean age of the users is 27.9±11.3 years, with majority of its users belonging to the age group of 25-29 years and maximum number of insertions happened immediately post-partum, before the patient was discharged from hospital. The mean number of living children was 2. A majority of women had 2 living children at the time of insertion (regardless of parity).

Conclusions: Large number of women are accepting of the implant as a method of contraception. From our findings, limited though they may be, we conclude that the average user of the implant is a woman between 25-29 years of age with two living children. The biggest problem, we face at present, is lack of follow up.

Menstrual hygiene and its awareness among adolescent girls-a study from an urban area

Shreya Anne, Vijayalakshmi K. — Thu, 26 Sep 2024 00:00:00 +0530

Background: Menstrual hygiene management is vital for the health and well-being of adolescent girls, especially in developing countries like India, where menstruation is surrounded by cultural taboos and stigmas. These societal attitudes can impact physical and psychological health, making MHM crucial for dignity, comfort, and infection prevention. In urban areas of India, despite better access to education and healthcare compared to rural regions, many girls still face challenges such as limited access to sanitary products, inadequate school facilities, and insufficient menstrual health education. Addressing these issues is essential for achieving Sustainable Development Goals related to health, education, gender equality, and sanitation.

Methods: This cross-sectional study aimed to evaluate menstrual hygiene awareness and practices among 500 urban adolescent girls aged 11-16 years who had attained menarche. A structured questionnaire developed by Chettinad Hospital's Department of Obstetrics and Gynecology was used, covering awareness of menstruation, hygiene practices, and access to products.

Results: The study found that most of the participants had good knowledge when it came to awareness of menstruation, but faced limitations in understanding it’s management and the social restrictions associated with it.

Conclusions: This study shows that there is progress in menstrual hygiene management but also reveals ongoing challenges. Effective interventions should focus on improving menstrual education, providing resources, and combating cultural stigmas to support adolescent girls to manage menstruation with dignity and confidence.

Ultra-low dose oral contraceptives: a game changer in managing puberty menorrhagia-a case series

Muwaffika Taj, Ushadevi Gopalan, Divya Ayyanar — Thu, 26 Sep 2024 00:00:00 +0530

Puberty menorrhagia, characterized by excessive menstrual bleeding during adolescence, often results from an immature hypothalamic-pituitary-ovarian axis. Effective management is crucial, yet compliance with traditional combined oral contraceptives (COCs) is often low due to side effects like nausea and breakthrough bleeding. This case series investigates the use of ultra-low dose COCs (ULDCOCs) containing 15µg ethinyl oestradiol and 60µg gestodene in five adolescents aged 13-16 years with puberty menorrhagia. The patients presented with prolonged bleeding, irregular cycles, and underlying conditions like polycystic ovarian syndrome (PCOS) and hypothyroidism. Treatment with ULDCOCs resulted in significant improvements: menstrual bleeding reduced, Pictorial Blood Assessment Chart (PBAC) scores dropped from a mean of 103 to 40, and haemoglobin levels improved. Common side effects included mild nausea, breast tenderness, and occasional breakthrough bleeding, which decreased over time. This series suggests that ULDCOCs provide effective cycle regulation and symptom relief with a favourable safety profile in adolescents with puberty menorrhagia. The reduced estrogen content offers fewer side effects while maintaining efficacy. Larger studies are warranted to confirm these findings and establish ULDCOCs as a standard treatment for adolescence-related menstrual disorders.

Evaluation of outcome of medical and surgical management in cesarean scar pregnancy in a tertiary health care institute of Northen India

Thu, 26 Sep 2024 00:00:00 +0530

A rare form of ectopic pregnancy known as caesarean scar pregnancy (CSP) is associated with high rates of morbidity and mortality. When a growing conceptus is pathologically implanted into the site of a prior caesarean section, CSP ensues. Transvaginal ultrasonography (TVS) and transabdominal ultrasound are the main diagnostic methods for CSP. It was a series of clinical cases diagnosed over a period of 1 year. The clinical characteristics included in the study were maternal age, gravidity, number of prior caesarean sections, number of abortions, interval between CSP and caesarean sections, gestational age, mean size of the residual gestational tissue before intervention, serum β-hCG levels before and after intervention. All cases were detected timely in the first trimester itself on USG evaluation. Amongst all cases, ß hCG levels at the time of admission varied between 266 mIU/ml-56,265 mIU/ml. 30% patients were treated with medical management only with inj. methotrexate and inj. folinic acid out of which 60% of cases had failed medical management and had to undergo further surgical procedure. 30% of cases with failed medical management were planned for hysteroscopic curettage, 20% underwent dilatation and curettage (D and C) while only 1 patient who was diagnosed with early placenta accreta required hysterectomy. CSP is a rare yet life threatening obstetric condition. Medical management should be used as the first line of treatment in patients with hemodynamic stability. Laparotomy and embolization are invasive procedures that should only be used in patients with failed medical management or patients with severe bleeding.

Effect of transcutaneous electrical nerve stimulation and maternal positioning on pain and satisfaction of labour among primigravida women during the first stage of labour: an analytical case series

S. Christy Sopna, Beulah D. Jebakani, Sabita P. — Thu, 26 Sep 2024 00:00:00 +0530

Labour is a physiological process in which mechanical and hormonal events influence the foetus expulsion through uterine contraction. Labour is commonly divided into three different stages. The first stage, or dilatative stage, is the phase when the dilatation of the uterine cervix occurs. This study aims to find out the effect of transcutaneous electrical nerve stimulation (TENS) and maternal positioning on pain and satisfaction among women undergoing labour. This is a case series based on convenience sampling among 12 primigravida women in the labour department, Indira Gandhi Medical College and Research Institute, Puducherry. The participants were divided into two groups based on patient convenience. Group A received conventional treatment and Group B received TENS and maternal positioning during the first stage of labour in addition to conventional treatment. The post-interventional assessment is taken in both the groups and results are interpreted. There was a reduction in the pain intensity and improved maternal satisfaction in the intervention group than the control group. Transcutaneous electrical nerve stimulation (TENS) and maternal positioning are feasible, affordable methods of reducing pain and improving maternal satisfaction that can be used to lower the fear of pain among primigravida, increase maternal mobility during labour, enhance maternal care, have a positive experience in labour, and improve women's quality of life.

Contribution of various factors to male infertility: a prospective review

Amrit Kaur Bansal — Thu, 26 Sep 2024 00:00:00 +0530

Infertility is becoming a serious problem among present generation. It causes emotional instability and mental stress in affected couples. In half of the analysed cases, male factor infertility is the major contributor. Despite numerous efforts by researchers to identify various causes of male infertility, about 70 % causes remain unknown. This is due to lack of understanding of mechanisms involved in male infertility. The present review focuses on the abnormalities in male reproductive structures and contribution of endocrinological, immunological and developmental factors to male factor infertility.

Strategies for managing epithelial ovarian cancer in elderly patients: a comprehensive review

Sumedha Gupta, Dheer Singh Kalwaniya — Thu, 26 Sep 2024 00:00:00 +0530

The management of epithelial ovarian cancer in elderly patients presents distinct challenges due to age-related factors and comorbidities. Developing optimal strategies requires a careful balance between treatment efficacy and the potential side effects. This review aims to evaluate current management approaches specifically tailored to elderly patients with epithelial ovarian cancer. It focuses on the effectiveness and safety of various treatments, including surgery, chemotherapy, and targeted therapies, and considers how age-related factors influence treatment decisions and outcomes. Additionally, the review explores the importance of geriatric assessment and supportive care in optimizing treatment for this demographic. The findings suggest that managing epithelial ovarian cancer in elderly patients demands a multifaceted approach that considers both the effectiveness of the treatment and the patient's overall health and quality of life. By recognizing and addressing the unique needs of elderly patients, clinicians can refine treatment strategies, thereby improving outcomes for this vulnerable population. This approach emphasises the importance of individualized care that is responsive to the specific challenges posed by ageing and associated comorbidities, ultimately leading to better health outcomes for elderly patients with epithelial ovarian cancer.

Effect of mobile telephony on male reproduction: a review

Jayram, Mukesh Kumar, M. S. Srinivasa — Thu, 26 Sep 2024 00:00:00 +0530

Mobile telephony is not very old phenomenon, it functions based on electro-magnetic-radiation (EMR). Mobile telephony has eased the communication. Almost ninety percent work are done using mobile telephony. Therefore, use and users of mobile telephony are increasing rapidly and significantly daily. Recently, some published research studies show that mobile telephony affects the human health and reproductive system too. Percentage of cancer and tumor cases have also enhanced significantly all over the world. In animal it is well established that electro-magnetic radiation (EMR) affects male reproductive system and fertility. Articles being published recently also suggested that over-use of mobile telephony affects the semen profile of human. But contrary to this, some researchers have claimed that mobile telephony does not adversely affect the human male reproductive system. Therefore, this article reviews all important published research studies on effect of mobile telephony on male reproductive system and future direction to fight this invisible environmental pollution (if it is really affecting).

Fundamentals of prenatal care: a comprehensive guide to essential visits, screenings, and key guidelines for a healthy pregnancy

Fiza Amin, Tavseef Ahmad Tali, Huda Amin, Rifat Ara — Thu, 26 Sep 2024 00:00:00 +0530

Prenatal care is essential for a healthy pregnancy and the best outcomes for both the mother and the baby. This page provides a thorough review of the key prenatal checkups, screenings, and guidelines that are required for effective prenatal care. It describes the standard schedule of prenatal visits, including the essential assessments and evaluations performed at each visit. The page also discusses several screenings and diagnostic tests that are widely used to monitor fetal development and mother health, such as blood tests, ultrasounds, and genetic screenings. Furthermore, it discusses standard guidelines and best practices for sustaining a healthy pregnancy, including nutrition, exercise, and lifestyle changes. This review is a great resource for healthcare practitioners and expectant parents, as it synthesizes current guidelines and recommendations.

Updates on postpartum hemorrhage: prediction, early detection and management

Khushpreet Kaur, Seema Grover, Sonal Garg, Anamika Sharma, Ravinder Ravi — Thu, 26 Sep 2024 00:00:00 +0530

Postpartum hemorrhage (PPH) continues to pose a significant threat to maternal health worldwide, despite advancements in obstetric care. This article provides an overview of recent updates in the management of PPH, focusing on strategies aimed at enhancing outcomes and minimizing complications. Current guidelines underscore the importance of early identification and immediate intervention in the management of PPH. Machine learning models (MLMs), E-motive approach, estimation of serum fibrinogen levels and ABL estimation Active management protocols advocate for the administration of carbetocin and use of negative intrauterine pressure suction device in high-risk cases to mitigate blood loss. In cases where initial pharmacological interventions fail to control bleeding, alternative measures such as balloon tamponade or uterine artery embolization (UAE) may be necessary. Innovations like the Bakri balloon, NASG, UAE have revolutionized the management of atonic PPH by offering a non-surgical option for hemorrhage control. Permissive resuscitation, recombinant active factor seven (VIIa), desmopressin acetate (DDAVP) and lyophilized fibrinogen concentrate have proven to be beneficial in refractory PPH. Efforts are ongoing to develop less invasive techniques that prioritize maternal fertility and minimize morbidity. Furthermore, the integration of multidisciplinary teams and simulation training plays a pivotal role in enhancing PPH management.