International Journal of Reproduction, Contraception, Obstetrics and Gynecology

A rare urogenital malformation “Herlyn-Werner-Wunderlich syndrome” (Ohvira syndrome) discovered during an acute pelvic pain

2023-01-29T23:37:17+00:00

The Herlyn-Werner-Wunderlich syndrome (OHVIRA syndrome) is a rare urogenital malformation, characterized by a blind hemivagina, a didelphic uterus, and homolateral renal agenesis, it results from a defect in the development of the muller and Wolf ducts during the embryonic period, of unknown origin, the diagnosis is most often made at puberty during the first menstruation, sometimes late, particularly for non-obstructive forms: infertility or obstetrical complications, the diagnosis is based on pelvic ultrasound especially with 3D reconstructions and pelvic magnetic resonance imaging (MRI) which remains the standard gold for the detection of mullerian anomalies, laparoscopy can also play a double diagnostic and prognostic role in order to study the consequences of the blood reflection (hematosalpinx, inflammatory pelvis, endometriosis. In this work we report the case of an OHVIRA syndrome diagnosed late at the age of 36 years in a multiparous woman with acute pelvic pain simulating the picture of a torsion of the adnexa, we will discuss through this case the clinical, diagnostic and therapeutic aspects of this uterine malformation.

A rare case report of a cyclopian malformation

2023-03-04T17:03:50+00:00

A rare form of median faciocerebral dysplasia, characterized by a single central orbital fossa with a tubular nose-like appendage above the orbit is known as cyclopian malformation/monster. It is the most severe form of alobar holoprosencephaly. Since most of these cases are sporadic, incompatible with life, and due to the limited literature knowledge, the exact etiology of this condition remains undetermined. However, various risk factors implicated include genetic factors and chromosomal anomalies (mostly trisomy D). Here we present a case of stillborn male cyclopian fetus born to a 34 year old 3^rd gravida by caesarean section. There was no history of any drugs or alternative medicine intake (except iron-folic acid, calcium, thyroxin), radiation exposure, or a significant family history or consanguinity. Her only 33-week scan (done at a peripheral center) failed to identify any fetal abnormality. This case is reported because cyclopia is a rare/uncommon developmental anomaly especially with the advancement in antenatal ultrasonography to identify malformed fetuses early in pregnancy.

Case report of serial pleural effusion managed with good fetal outcome

2023-02-03T10:31:55+00:00

Fetal pleural effusion is a rare congenital anomaly that occurs when some amount of fluid surrounds the fetal lung without concomitant hydrops. It may remain the same or progress more. We present here a case of a 32-year-old lady with primary infertility who conceived naturally. She presented to us for her routine term pregnancy evaluation. At 17 weeks her targeted imaging for fetal anomalies (TIFFA) scan revealed left side severe fetal hydrothorax. Again at 29 weeks left pleural effusion was noted. A C-section was performed at 38^th week of pregnancy and a male child weighing 2.995 grams was born, with no need for ventilator support.

Wernicke’s encephalopathy: obstetric diagnostic challenge! (a rare complication of hyperemesis gravidarum): a case report and review of literature

2023-02-21T06:37:57+00:00

Wernicke’s encephalopathy (WE) is an acute neurological disorder caused by a deficiency in thiamine. It is characterized by triad of altered mental status, ataxia and ophthalmoplegia. Most of the cases reported were secondary to long-term alcohol use. We reported a rare case of WE due to hyperemesis gravidarum in a 29-year-old P1L1A1 women at 22 weeks of gestation who had spontaneous abortion. Patient manifested with features of mental confusion, nystagmus, and gait ataxia. Diagnosis was established after MRI findings suggestive of WE in thalamus. Patient clinically improved after treatment with thiamine. We emphasize the importance of thiamine supplementation to women with hyperemesis to prevent life threatening complications.

A rare case of ruptured caesarean scar pregnancy

2023-02-03T18:51:35+00:00

Caesarean scar pregnancy (CSP) is a rare form of ectopic pregnancy. The incidence is approximately 1:2000 pregnancies and has potentially life-threatening complications. Ours is a rare case of scar ectopic pregnancy who had taken medical termination of pregnancy (MTP) kit while being unaware of her pregnancy location and presented with uterine rupture and hemoperitoneum. A 24-year-old female, P2L2A1, with previous two caesarean section (CS), presented with the complaint of bleeding per vaginum with acute pain abdomen and history of MTP kit intake at 7 weeks’ period of gestation (POG). She received symptomatic treatment at local hospital without any diagnosis being made but brought an ultrasound showing anterior myometrium defect with scar site hematoma and free fluid. She presented with moderate pallor, tachycardia and suprapubic tenderness. She was subsequently taken up for laparotomy in view of probable ruptured CSP. Intra-operatively, actively bleeding scar ectopic was seen with hemoperitoneum. The contents were scooped out and repair done with bilateral tubal ligation. She was resuscitated with adequate blood products. Embryo implantation in the region of a previous CS scar is rare and a delay in either diagnosis or treatment can have catastrophic complications like haemorrhage, rupture and significant maternal morbidity as seen in our case. Therefore, we should have a high index of suspicion of scar pregnancy especially in cases of previous CS so that timely intervention can be done preventing maternal morbidity. Unwarranted use of misoprostol can be deleterious when site of implantation is unknown, particularly in CSP.

An interesting case of disseminated hydatid disease with paraovarian hydatid cyst and endometriotic cyst occurring in the same ovary

2023-02-07T14:18:30+00:00

Hydatid disease is a parasitic disease which affects the liver and lungs mostly. Involvement of the pelvic organs is rare and presents with varying symptoms which often make it difficult to diagnose. In this report, we present a case of disseminated hydatid disease with cysts in the liver, spleen peritoneum as well as a paraovarian hydatid cyst concomitantly occurring with an ovarian endometriotic cyst on the same side.

Management of primary infertility in a patient with Kartagener’s syndrome: a case report

2023-02-11T08:08:30+00:00

Kartagener's syndrome (KS) is a subgroup of primary ciliary dyskinesia (PCD), an autosomal recessive hereditary condition characterised by chronic sinusitis, bronchiectasis, and situs inversus. The fundamental pathophysiologic issue in Kartagener's syndrome is abnormal ciliary structure or function, which results in decreased ciliary motility. The patient in the present case was a 31-year-old female with a twelve-year history of primary infertility. In vitro fertilization and embryo transfer (IVF-ET) was performed and the patient conceived successfully. PCD should be strongly considered in women whose main infertility is accompanied by persistent respiratory symptoms. In women with PCD, superovulation and intrauterine insemination would not improve the likelihood of conception. In infertile women with PCD, IVF-ET is considered to be the best therapeutic option.

Giant placental chorioangioma presenting as severe polyhydramnios: a case report

2023-02-15T16:17:39+00:00

Chorioangiomas are the most common non-trophoblastic, benign, vascular tumour of the hemochorial placenta. Small chorioangiomas are usually symptomless, and of no clinical significance while giant ones more than 4 cm in diameter may be complicated by polyhydramnios, foetal cardiomegaly, hydrops fetalis, and foetal growth restriction. We present a case of a 32-year-old primigravida referred to us at 30 weeks of gestation with large placental chorioangioma causing polyhydramnios which was treated by amnioreduction twice over 1 month. On referral the tumour size was about 56 mm size with severe polyhydramnios with amniotic fluid index of 57 cm, with breathlessness and pain abdomen. After relevant investigations and informed consent, she was taken up for caesarean section. 2 litres of clear liquor drained. She delivered a live female baby weighing 1.2 kg with Apgar score of 7 and 8. Patient stood the operation well. Gross and microscopic examination of the placenta confirmed the diagnosis of chorioangioma. Chorioangioma should be considered as differential diagnosis in cases of hydrops fetalis or polyhydramnios. Doppler ultrasound is the method of choice to detect chorioangioma and its vascularity. Giant chorioangiomas complicating pregnancy can be managed conservatively with close surveillance, foetal monitoring and timely intervention to prevent maternal and foetal morbidity and mortality.

A rare case scenario of didelphic uterus with ovarian serous cystadenocarcinoma: an unusual clinical finding

2023-02-13T08:23:04+00:00

Uterine didelphys in women is uncommon. The improper development of the Mullerian ducts during the intrauterine period leads to congenital abnormalities of the female genital system. Mullerian duct canalization or improper fusion leads to a didelphic uterus. About 60% of ovarian neoplasms are epithelial in origin, and the surface epithelium is typically most affected. This case report describes the management of a patient who had previously undergone two caesarean sections for a rare gynecological case of didelphic uterus with unilateral serous cystadenocarcinoma of the ovary.

A case report on advanced undiagnosed secondary abdominal pregnancy

2023-02-17T06:50:16+00:00

Abdominal pregnancy is a rare form of ectopic pregnancy that involves implantation within the peritoneal cavity, exclusive of fallopian tubes, ovaries, broad ligament and cervix. Secondary abdominal pregnancy results from implantation of blastocyst into peritoneal cavity that was originally located elsewhere. It is associated with high maternal and fetal morbidity and mortality. Here, we have discussed about a 32 year old second gravida para one post caesarean section (last CS 2 years back) at 24+ weeks of gestation with rupture uterus with advanced secondary abdominal pregnancy with intrauterine death. Exploratory laparotomy with repair of rupture uterus with bilateral tubectomy was done.

A case of caesarean scar ectopic pregnancy presented as post medical termination of pregnancy with cervical hematoma

2023-02-21T17:16:02+00:00

A 36 years old woman (P2L2MTP2 with previous 2 LSCS) came with complaints of pain in abdomen and bleeding per vaginum with severe anaemia. Patient had a history of surgical MTP done 3 weeks back. USG was suggestive of hematoma at the isthmico-cervical junction. A provisional diagnosis of post-surgical MTP ruptured/perforated uterus with hypovolemic shock was made. A laparotomy was carried out. Intraoperatively, the isthmico-cervical junction was ballooned up and after incision over the isthmic scar of previous LSCS a large blood clot was retrieved. Histopathology of the scar tissue confirmed the diagnosis of scar ectopic pregnancy. In all cases of previous caesarean scar uterus, ultrasonography must be performed before first trimester surgical MTP to rule out the caesarean scar ectopic pregnancy. If USG is not performed preoperatively and with persistent postoperative vaginal bleeding, then always rule out the partial disruption of unknown caesarean scar ectopic pregnancy by USG and serum Beta hCG levels.

Medical management of ovarian ectopic pregnancy- a case report

2023-02-23T16:36:42+00:00

Primary ovarian ectopic pregnancy is a rare type of ectopic pregnancy which has an estimated prevalence ranging from 1:7000 to 1:70,000 accounting for almost 3 % of all ectopic cases. A 37-year-old woman was referred to our hospital intermittent vaginal spotting, recurrent abdominal pain that was getting worse, and 3 days of vaginal bleeding with clot passage. Her general condition was good and her vital signs were normal. She felt tenderness in an abdominal examination and had a small amount of vaginal bleeding. Transvaginal ultrasonography showed an ectopic gestational sac, in her right ovary. Our final diagnosis was ectopic ovarian pregnancy and we successfully treated her with methotrexate. After 3 doses of methotrexate administration her beta human chorionic gonadotropin was negative and a sonographic examination was completely normal. Approximately 3% of all ectopic pregnancies are located in the ovaries. Preoperative diagnosis of this extremely rare condition is challenging, because the ectopic pregnancy often resembles cysts of the corpus luteum.

A drowning abdomen-a case report on acute urinary retention due to retroverted gravid uterus

2023-01-27T05:19:36+00:00

Acute urinary retention due to retroverted gravid uterus is a rare condition, but serious complication of pregnancy. It usually occurs between 10 and 16 weeks of gestation. We report a case of 26 year old primigravida at 13 weeks of gestation presented to OPD with the complaints of abdominal distension for 30 days and lower abdominal pain associated with burning micturition for 10 days. On examination, abdomen is uniformly distended corresponding to 30 to 32 weeks of gestation which is tense and cystic, on per vaginal examination -features of retroverted uterus felt. Scan showed single intrauterine gestation corresponding to 13 weeks+5days with full bladder. Patient was catheterised and 2.5litre of urine drained. Patient was asked to lie in prone position at least 3-4 times a day. After 1 week patient was symptomatically better, on per vaginal examination uterus returned to midposition.

Cryptomenorrhea due to imperforate hymen presenting with urinary retention

2023-01-15T08:03:24+00:00

Cryptomenorrhea is a condition where menstruation occurs but is not visible due to obstruction of the outflow tract. One of the most common causes causing primary amenorrhoea and cryptomenorrhea include imperforate hymen. This condition usually presents in adolescent girls with cyclical abdominal pain and primary amenorrhoea. Though it usually presents as an isolated abnormality it may be associated with genetic conditions such as Mayer-Rokitansky-Kuster-Hauser syndrome. The diagnosis is usually confirmed on the basis of grayscale ultrasound however magnetic resonance imaging may be required to diagnose associated mullerian abnormalities. Once the diagnosis is confirmed the management is usually consist of virginity preserving hymenotomy. We here present case of an adolescent girl who presented with primary amenorrhea, abdominal pain and urinary retention. The clinical examination showed well developed secondary sexual characters (Tanner stage 4), distended abdomen and bulging introitus. Grayscale ultrasound and magnetic resonance imaging showed hematocolpos. Patient was planned for resection of hymen and ac cruciate incision was given over the hymen and around 700 ml of collected blood was drained. Eversion and suturing of edges of incision was done to maintain patency of outflow tract. During follow up visit at 3 months patient was symptom free with regular menses.

Rare case of active lupus nephritis with mixed connective tissue disease in pregnancy

2023-02-21T06:47:45+00:00

This was a case report of a 32 years old pregnant woman with 9+6 weeks of gestation presented with hyperemesis gravidarum who was diagnosed of lupus nephritis with mixed connective tissue disorder (MCTD) 7 months back. Renal biopsy-lupus nephritis class 4 with activity score of 9/24 and chronicity score of 0/12. She was advised contraception in view of active lupus nephritis with MCTD but she presented to us with 9+6 weeks gestation with conception being within 20 days of her last dose of cyclophosphamide. She was managed with oral immunosuppressants by constant supervision of obstetricians and nephrologist. The management of MCTD and lupus nephritis in pregnancy presents a diagnostic and therapeutic challenge for providers. Women with prior lupus nephritis and MCTD can have safe, successful pregnancies with excellent, immaculate, collaborative care between obstetricians, nephrologists, and multidisciplinary staff.

Alpha casozepine and L-theanine in ameliorating stress levels in infertile couples: a review

2023-01-24T06:17:52+00:00

Globally, the fertility rate has decreased significantly in the last two decades. Infertility can lead to psychological and emotional stress, particularly for couples who have been married for a long period. According to the literature, stress can alter the metabolic environment and reduce the likelihood of pregnancy. The fertility treatments involving assisted reproductive technology put additional physical, mental, and financial strain on patients, especially women who are frequently subjected to invasive procedures as part of the process. Stress affects the hypothalamic-pituitary-adrenal (HPA) axis, the concentration of reproductive hormones (FSH, GnRH, and LH), and other biological processes through a variety of mechanisms. Alteration of glucocorticoid hormone levels in the blood was observed because of stress in infertile couples. Moreover, the males also get affected by stress as per the semen parameters and quality analysis. Available evidence strongly suggests that stress reduction should be the first step in a fertility therapy regimen. Further, managing stress can boost ovarian function and semen parameters. The current review focuses on the state-of-the-art research on stress-induced reproductive dysfunction as well as the positive effects of alpha-casozepine, an anxiolytic-like bioactive decapeptide and L-theanine, an amino acid found primarily in green tea on reducing stress levels and improving treatment outcomes in infertile couples.

Assessment of placental thickness as a predictor of gestational age and fetal weight in second and third trimester of pregnancy

2023-02-16T06:18:05+00:00

Background: Estimation of precise gestational age as well as fetal weight is important and is usually done by ultrasound assessment of fetal biometry. Recently estimation of placental thickness as a marker of fetal maturity as well as fetal weight has become a topic interest amongst obstetricians because of the accuracy with which placental thickness can be used for estimation of gestational age. We undertook this observational study to find out whether placental thickness can be used for estimation of gestational age and fetal weight in healthy singleton pregnancies.

Methods: This was a prospective observational study in which 210 patients in second and third trimester of pregnancy who has undergone antenatal ultrasound examination were included on the basis of a predefined inclusion and exclusion criteria. First gestational age estimation was done using fetal biometry (head circumference, biparietal diameter, abdominal circumference and femur length). Placental thickness was measured at the level of cord insertion. Correlation between placental thickness and gestational age as well as fetal weight as determined by biometry was analyzed by pearsons coefficient. P value less than 0.05 was taken as statistically significant.

Results: Mean age of studied cases found to be 24.62±4.12 years. Mean gestational age of the studied cases was found to be 28.19±6.90 weeks. The most common location of placenta was anterior which was seen in 99 (47.14%) patients followed by posterior (32.38%) and fundal (10.95%). Analysis of mean placental thickness in studied cases showed that at 12 weeks of gestation the mean placental thickness was 12.96 mm. Mean placental thickness at 37 weeks found to be 36.82 mm and this value was determined to be cut-off value for differentiating between full term and preterm gestation. There was strong positive correlation between placental thickness and gestational age between 12-38 weeks. Similarly positive correlation also existed between placental thickness and gestational age between 14-37 weeks.

Conclusions: Placental thickness can be used for estimation of gestational age as well as fetal weight in cases where fetal biometry can not be entirely relied upon.

Feto-maternal outcome of second stage cesarean section in B. P. Koirala institute of health sciences: a retrospective study

2023-02-28T18:20:37+00:00

Background: Cesarean section (CS) is a common surgical procedure performed in obstetrics. The rate of rise of CS can be attributed to the increase in safety of the procedure, enhanced surgical techniques, improved antibiotics, increase in number of women requesting for CS. In general, caesarean delivery is associated with more severe maternal complications compared to vaginal deliveries. The stage of labour at which CS is undertaken has been shown to influence the rate/risk of complication.

Methods: It was an observational and retrospective study that depended on some clinical records related to more than 37 weeks’ gestation. The study was conducted in BP Koirala institute of health sciences, Dharan Nepal from 2021 December to 2022 December. The neonatal as well as maternal outcomes have been evaluated for CS among those who were observing the second stage in their labor period. The test statistics used to analyse the data were descriptive statistics chi-square test.

Results: The total delivery was 16131 out of which there were 6748 cesarean deliveries. Out of 6748 CS 65 patients had cesarean in second stage of labour. The most common cause of CS in second stage of labor was arrest of descent and dilatation (40%), followed by meconium-stained liquor (15.38%), occipito-posterior position (12.30%), and obstructed labour (3.07%) Being the least cause. One patient had to undergo peri-partum hysterectomy and the most common complication of second stage CS was prolong foleys catheterization (15 patients), post-partum febrile illness (20 patients out of 65), followed by wound infection, PPH, blood transfusion. The neonatal admission for NICU were birth asphyxia and respiratory distress were 50% each.

Conclusions: CS in the second stage of labor is correlated with considerably improved neonatal and maternal rate of morbidity along with expanded neonatal mortality. A proper judgment and skilled obstetrician are required to perform a second-stage CS. CS in the second stage of labor is a technically demanding procedure with an increased risk of maternal and neonatal morbidity compared to the CS in the first stage of labor.

Risk factors and complications in pregnancies associated with placenta previa among admitted cases in FMCH

2023-02-07T07:53:16+00:00

Background: Placenta previa is a leading cause of antepartum haemorrhage. Placenta previa present a significant clinical problem and patients are at risk for significant haemorrhage, needing blood transfusion. The risks are increased in women with previous placenta previa, endometrial damage caused by DE and C, caesarean delivery, myomectomy, multiparity, alcohol cocaine use during pregnancy, smoking during pregnancy.

Methods: Admitted patients were selected with convenience sampling type of non-probability sampling type of non-probability sampling technique. The primary end point was to determine the risk factors of placenta previa and its complications. The secondary end point was to determine maternal morbidity and mortality of placenta previa.

Results: Incidence of placenta previa was 2.03% out of 2459 patients, 70% were associated with risk factors. Among them 42% had history of caesarean section, 14% had history of abortion, 10% had history of manual removal, 48% patients were more than 25% years old, 36% were more than 30 years. Placenta previa occurred in gravida 3^rd or more. Forty two percent patients belonged to lower socioeconomics group. Only 12% patients had regular antenatal checkup. Malpresentations were present in 24% cases. In this study 50% patients were associated with central placenta previa. Eighty percent patients were in shock, only 2% patients were asymptomatic. Regarding management 76.34% patients were managed actively, 12% patients had expectant management. Only 2% patients delivered vaginally, 82% patients delivered by caesarean section. Maternal mortality rate was 02%. Regarding fetal outcome, 76% babies were alive and there were 20% perinatal deaths.

Conclusions: Although etiology of placenta previa largely remain obscure and speculative. There is a strong association between advanced maternal age, multiparity, history of caesarean section and abortion with subsequent development of placenta previa. Women aged >30 years, grand multipara, previa and must be monitored carefully. Hence the study advocates proper antenatal care early referral to hospital and prompt management of patients after proper selection can reduce maternal morbidity and mortality.

Obstetric fistula and related factors: assessing pattern and quality of life among women in Southwest Nigeria

2023-02-22T17:28:32+00:00

Background: Obstetric fistula remains major contributor to maternal morbidity in low resource countries. Study examined quality of life and related factors among women with obstetric fistula in Southwest Nigeria.

Methods: A cross-sectional study, involving 159 purposively selected women receiving care at the fistula centre, Wesley Guild Hospital, Ilesa, Southwest Nigeria. An adopted interviewer-administered World Health Organization Quality of Life Scale, WHOQOL-BREF was employed to examine quality of life. Data was processed and analyzed using IBM statistical product and service solutions (SPSS) software version 25. Analysis was done at univariate, bivariate and multivariate levels. Fisher’s exact, Analysis of Variance, Independent t-test and Regression analysis examined association and significance, p<0.05.

Results: Findings shows that 64.20% of the women had vesicovaginal fistula, 17.60% had rectovaginal fistula, 10.70% had uterovaginal fistula while 7.5% had ureterovaginal fistula. The mean scores for physical, psychological, social relationship and environmental health domains were 48.92 ±14.89, 39.91±17.42, 68.71±30.85, 42.75±18.60 respectively. Overall quality of life had mean score of 19.89 ±26.51 while 82.4% of the women had low quality of life, 2.5% had moderate and 15.1% had high quality of life overall. Regression analysis shows significant association between low quality of life and primipara (p=0.002, RRR=32.55, CI=3.73-284.19), multipara (p<0.001, RRR=23.20, CI=5.12-105.13), middle socio-economic status (p=0.02, RRR=4.62, CI=1.29-16.59).

Conclusions: Significant proportion of the women studied had low quality of life. Parity and socio-economic status were main predictors of quality of life. Holistic management of obstetric fistula should take cognizance of these variables for optimal outcomes.

Place of the antenatal care in the prevention of a premature delivery

2023-01-22T09:25:44+00:00

Background: Prematurity constitutes a source of morbidity and mortality neonatal. The objective of this study is to determine the place of the antenatal care in the prevention of a premature delivery.

Methods: It is an analytical retrospective study, type “cases-controls” realized at CHU GOB, on 01 January to 31 December 2014.

Results: The frequency of the premature delivery during the time of study was 6%. The risk factors significantly associated with the premature delivery were the primigestity, the primiparity and the antecedents of miscarriage. About the antenatal care, not followed pregnancy (p=0.01; OR=6.2; [IC 95% 1.3-29]), insufficient antenatal care (p<10-10; OR=6.7; [IC 95% 4.0-15]) and the antenatal care carried out in the basic health center (p=0.00002; OR=3,5; [IC 95% 1.8-6.5] influenced significantly with occurred of a premature delivery. While the realization of antenatal care 4 times and more and the realization of antenatal care at Universities Hospital Center protected the patients in occurred of a premature delivery.

Conclusions: The improvement of antenatal care’s quality and the medical infrastructures at basic health center, as well as the sensibilization to the population on the importance of antenatal care constitutes a priority in order to prevent effectively occurred of a premature delivery.

Determinants and effects of sexual exploitation among female students of tertiary institutions in Rivers State

2023-01-15T20:48:34+00:00

Background: Labor induction methods are continuously evolving to ensure safer and more effective outcomes for both mother and neonate. The present study aimed to assess the effectiveness and safety of combined use of misoprostol with intracervical catheter for labor induction.

Methods: This single-blinded, parallel-group randomized control trial conducted at Shaheed Suhrawardy Medical College, Dhaka, Bangladesh, included 200 women with term gestation and Bishop score ≤6. Participants were divided into two groups: the intervention group (group B) received misoprostol juice and Foley’s catheter, while the control group (group A) received misoprostol in the posterior fornix.

Results: In Group A, 58% had vaginal deliveries, while in Group B, 65% had vaginal deliveries. Group B experienced a longer mean length of labor in the 1st stage (13.25±1.095) compared to Group A (12.98±1.982, p=0.008). The 3rd stage was shorter for Group B (10.00±0.000) than Group A (12.02±2.469, p<0.001). The most common induction reason was labor pain with an unfavorable cervix (31 in Group A and 33 in Group B). Group B had a higher percentage of inductions at less than 12 hours and a lower percentage at more than 24 hours. Neonatal outcomes were generally better for Group B. The Cox regression hazard model showed a lower likelihood of positive outcomes in Group B (hazard ratio 0.337, 95% CI 0.243-0.469, p=0.000), indicating a statistically significant difference between the groups.

Conclusions: The combined use of misoprostol with Foley’s catheter for labor induction is safe and effective, resulting in shorter labor duration and higher rates of vaginal delivery compared to misoprostol alone.

Effectiveness of combined use of misoprostol with intracervical catheter for induction of labour: a randomized control trial

2023-02-01T06:46:29+00:00

Knowledge and practice of the ideal birth interval amongst parturients attending primary health centre Aluu, Rivers State, Nigeria

2023-02-12T18:51:45+00:00

Background: Birth interval is a period for the mother to heal completely from the events of pregnancy. Short birth interval (<24 months) is associated with grave consequences on maternal and child health and the impact is more on families with poor socioeconomic status. Aim was to assess the knowledge and practice of ideal birth interval amongst parturients at primary health centre- Aluu.

Methods: This was a descriptive cross-sectional study to assess the knowledge and practice of ideal birth interval and its health benefits among parturients attending primary health centre, Aluu in September, 2021. The data was collected using structured self-administered questionnaires, analysed with SPSS version 23.0 and presented in tables and charts.

Results: Knowledge of ideal birth interval among the respondents was 68.3%. Regarding its benefits, 34.2% of the respondents knew that it replenishes lost nutrients, 20.2% knew it prevents anaemia, 24.7% knew it improves pregnancy outcome while 67.7% knew that it helps in financial planning. Only 42.86% of the respondents practised ideal birth interval, 47.6% had discussed it with their health worker and 89.1% said it should be included in the routine antenatal teachings. Many (41.8%) of the respondents did not use any form of contraception.

Conclusions: There was poor knowledge of the health benefits of ideal birth interval and less than half of the respondents practiced ideal birth interval and contraceptive use. Therefore, there is need for more education by health care workers on ideal birth interval and its benefits and the use of modern contraceptive methods during routine antenatal teachings.

Evaluation of the effect of sildenafil on nitric oxide secretion and improvement of endometrial receptivity in fresh ICSI cycles

2023-02-13T19:05:56+00:00

Background: Endometrial receptivity is a chain of events that promotes embryo implantation and is regulated by a variety of substances, such as cytokines, growth factors, and steroid hormones. The study’s objective was to assess how vaginally delivered sildenafil in ICSI patients affects pregnancy outcome, endometrial thickness, subendometrial resistance index, and pulsatility index.

Methods: The sixty women who participated in this controlled randomised trial (interventional experimental research) at the High Institute of Infertility Diagnosis and Assisted Reproductive Technologies underwent IVF/ICSI cycles. Patients were split into two groups: study group: from the day of the last menstrual period to the day of the hCG injection, thirty (30) infertile women got four (4) doses of vaginal sildenafil 25mg tablets daily. Thirty (30) infertile ladies who weren’t given sildenafil therapy made up the control group.

Results: Nitric oxide levels in the study group's serum were significantly significant. In the subendometrial Doppler research, the mean pulsatility index was considerably lower in the study group whereas the mean resistance index and mean systolic to diastolic ratio did not change statistically between the control and study groups. Between the control and study groups, there was no statistically significant difference in the mean endometrial thickness. The sildenafil group had a greater pregnancy rate, although the difference was not statistically significant.

Conclusions: By enhancing subendometrial blood flow by lowering the pulsatility index and raising the nitric oxide (NO) factor, the use of vaginal sildenafil in a new ICSI cycle improves endometrial receptivity.

Incorporating Robsons classification in analysis of caesarean section at rural territory centre for 18 months

2022-12-19T04:49:12+00:00

Background: With the rise of caesarean sections (CS) over the last five decades, World Health Organization (WHO) proposed that health care facilities to use the Robsons 10 group classification system to audit their caesarean sections rates. This classification would help understand internal structure of the CS rates at individual health facilities identify population groups, indication in each group and formulate strategies to reduce these rates.

Methods: This is a retrospective study for a period of 18 months at tertiary care hospital in rural area at department of obstetrics and gynaecology, Dr. PSIMS & RF, Chinnoutpalli, Vijayawada, Andhra Pradesh. Women who delivered during this period were analysed and classified into Robsons group 10 classification and percentages were calculated for the overall rate, the representation of groups, contribution of groups and caesarean percentage in each group in rural territory centre during the period of January 2021 to June 2022.

Results: From January 2021 to June 2022 there were total of 547 deliveries. Out of which 224 had caesarean section accounting for a caesarean delivery rate of 40.9%. When data was analysed according to Robsons 10 group classification maximum contribution of caesarean section was with Robsons group 5.1 (36%), which comprised of patients with term cephalic multiparous with one previous scar. Followed by group 2A (21%), which comprised of patients with term cephalic nulliparous with labour induced. Breech pregnancies are completely undergoing caesarean section (groups 6 and 7).

Conclusions: We identified the contribution of each group to the overall CS rate as well as the CS rate within each group. Women with previous caesarean delivery contribute to the increasing proportion of caesarean deliveries. Use of Robson criteria allows standardized comparisons of data and identifies clinical scenarios in caesarean rates. All institutes to audit themselves to evaluate quality of caesarean section rates and to rationalize caesarean rates. Impact of interventions to reduce caesarean rates should be studied and documented. Evaluation of existing management protocols and further studies into indications of CS and outcomes in our setting will helps us to design strategies and improve outcomes.

Post caesarean section complication and its management in Dhaka medical college hospital

2023-02-07T07:58:32+00:00

Background: The increase in the rate of caesarian sections globally is intimately related to the development of the women access to this procedure when required. But it is still related to the indiscriminate use without medical indication. This has fulminated in the recent efforts to reduce these rates while incorporating the obstetric preferences of women. Objective of the current study was to find out the predisposing factors for caesarian complications and to observe its management pattern.

Methods: This was a cross sectional observational and descriptive study performed in the department of obstetrics and gynecology, Dhaka medical college hospital, Dhaka from January2019 to June 2019. All mothers admitted for elective and emergency cesarean section were selected by purposive sampling. Thereafter, they were scrutinized according to eligibility criteria and 100 patients were finalized. A pre-tested, observation based, peer-reviewed data collection sheet was prepared before study. Data regarding clinical, biochemical and surgical profile were recorded.

Results: The mean age of the respondents was 25.96±4.43 (age range: 17-39) years. Among 100 mothers, 59% underwent elective and 41% underwent emergency cesarean section. 67% had uneventful outcome after LSCS. Rest 33% had post cesarean section complications. Among them 33% mother who had complications, 19 (57.57%), 12 (36.36%), 10 (30.30%) and 8(24.24%) had wound gap, UTI, GIT complications and haemorrhage respectively. 3 (9.09%) each suffered from thromboembolic complications and septic thrombophlebitis. Only one (3.03%) experienced DIC. Out of 33 complicated cases; 27 (81.81%) required treatment with injection oxytocin, blood transfusion, condom catheterization and 10 (30.30%) required secondary closure. Among them 4 (12.12%) underwent mass closure and received antithrombotic drug. One (3.03%) each underwent excision sinus tract and re-laparotomy.

Conclusions: Caesarean section complications can result in death or morbidity. Despite advances in technology and expertise, wound infection or wound gap remains the most common post-c-section complication. It is critical to successfully manage complications after cesarean section in order to reduce morbidity and mortality among mothers.

Role of hydroxychloroquine in preconception period of recurrent miscarriage patients

2023-01-16T15:59:24+00:00

Background: Three or more times of embryonic or fetal losses is termed as recurrent pregnancy loss (RPL). 1-2% women globally suffer from RPL which in turn causes physical and emotional devastation in such women. A deregulation of immune cells and cytokines is observed in women with RPL. Immunomodulatory drugs like hydroxychloroquine (HCQ) could thus be a justifiable line of therapy for normal conceiving in women who encountered RPL. Thus, the objective of current study was to evaluate whether oral administration of HCQ 200 mg twice a day in preconception period would improve conception and pregnancy outcome in RPL patients or not.

Methods: Total 50 women with history of RPL and difficulty in conception were given 200 mg bd of HCQ orally twice a day along with once a day 5 mg dose of folic acid. To the above treatment protocol low dose ecosprin was added immediately after positive pregnancy test. After 20 weeks, HCQ dose was terminated while ecosprin was continued. Iron, calcium and protein supplements were continued in all patients.

Results: 36 patients out of 50 who received HCQ conceived easily. Majority of patients who received the treatment protocol remained asymptomatic and exhibited no severe adverse effects. Out of 36 patients who conceived total 15 patients had normal delivery while 8 patients underwent lower segment caesarean section (LSCS) at term end and 5 patients had to undergo preterm delivery.

Conclusions: HCQS use in preconception period facilitate conception and prevent miscarriage in refractory cases of RPL.

Comparison of intravenous tranexamic acid versus sublingual misoprostol in reducing blood loss in patients undergoing caesarean section-an analytical observational study

2023-01-31T06:51:00+00:00

Background: Preventing postpartum haemorrhage using uterotonics or other antifibrinolytic drugs is need of the hour among women undergoing caesarean section (CS). This study is to compare the effectiveness of intravenous Tranexamic acid versus sublingual misoprostol in reducing blood loss by assessing intraoperative and postoperative blood loss in patients undergoing CS.

Methods: Analytical observational study was conducted in department of obstetrics and gynaecology at sri Devaraj URS medical college, among 118 pregnant women admitted for CS. Study was conducted between January 2020 to June 2021. The sample was divided equally into intravenous tranexamic acid and sublingual misoprostol groups. Number of mops, pads soaked, suction volume excluding the amniotic fluid, preoperative and post-operative haemoglobin, any complication were recorded.

Results: The mean of mops counts in the misoprostol, TXA group were noted as 4.73±1.27, 3.2±1.45 respectively. Around 8.47% of the participants in the misoprostol group required uterotonics, whereas, 15.25% in the TXA group required uterotonics. The preoperative and postoperative haemoglobin in misoprostol group were identified as 11.67±1.37, 10.78±1.12 respectively, whereas it was identified as 11.76±1.43, 11.17±1.4 in TXA group. The common side effects identified in the misoprostol group was chills, vomiting and fever with 47.46%, 13.56% and 11.86% while, it was 11.86%, 5.08% and 3.39% in the TXA group.

Conclusions: Both intravenous tranexamic acid, sublingual misoprostol could be prescribed as standard therapy to significantly control blood loss and increase the quality of surgery with better outcomes. But the use of TXA proved slightly better as there were lesser side effects and significantly lesser blood loss in uncomplicated cases.

A study on cardiotocography for predicting fetal prognosis in high-risk pregnancy

2023-03-01T13:27:30+00:00

Background: The admission cardiotocography (CTG) in high-risk obstetrics patients for continuous monitoring of fetal heart rate (FHR) has become crucial in the modern obstetric practice. It is not only a good screening and inexpensive test but also non-invasive, easily performed and interpreted.

Methods: This was a prospective observational study conducted in department of obstetrics and gynaecology, Pannadhay Rajkiya Mahila Chikitsalaya at RNT medical college, Udaipur from April 2022 to September 2022. A total of 100 high risk obstetrics patients were subjected to cardiotocography (CTG). The Women eligible for the study were those who had gestational age ≥32 weeks with cephalic presentation in first stage of labour with singleton fetus in vertex presentation and categorised as high-risk during the time of admission.

Results: A total of 100 high risk obstetric patients were subjected to CTG. Out of these common high-risk factors in our study consisted of postdated pregnancy (21%) followed by pre-eclampsia (19%), oligohydramnios (16%) cord around neck (13%). Majority of them (47%) fall under 20-25 years and constituted by primigravida (59%). CTG was reactive in (65%), non-reactive in 25% of cases and 10% patients had suspicious tracings. The incidence of neonatal intensive care unit (NICU) admission, fetal distress and APGAR score less than 7 was significantly higher with suspicious and nonreactive CTG than reactive CTG.

Conclusions: CTG test is a simple, non-invasive screening test should be used in high risk pregnancy as admission test. The heavy load of constant monitoring and adverse perinatal outcome can be reduced by CTG monitoring in high-risk obstetrics patients.

Adverse effects of spinal anaesthesia for caesarean section

2023-03-02T11:53:47+00:00

Background: Obstetric anaesthetists while providing anaesthesia for caesarean sections, provide care for both the mother and the unborn baby. This study was performed to evaluate the adverse effects of spinal anaesthesia for Caesarean section.

Methods: The present study is a prospective observational study carried out on 100 full-term, low risk pregnant patients who had caesarean section under spinal anaesthesia at Varun Arjun medical college, Shahjahanpur, U. P., India from January 2022 to December 2022.

Results: In our study, 43 (43%) patients were between 26-30 years, 32 (32%) patients were between 31-35 years, 16 (16%) patients were between 36-40 years. The 62 (62%) patients were primigravida while 38 (38%) patients were multigravida. The 66 (66%) patients were delivered by emergency caesarean section while 34 (34%) were delivered by emergency caesarean section. In our study, adverse anaesthetic effects were less. 12 (12%) patients had spinal hypotension, 11 (11%) patients had spinal headache, 10 (10%) patients had pruritus, 9 (9%) patients had shivering, 5 (5%) patients had nausea and vomiting, 4 (4%) patients had less visceral pain and neonatal Apgar score each, 3 (3%) patients had failed regional anaesthesia, 3 (3%) patients had bradycardia while 2 (2%) patients had high spinal anaesthesia, 10 (10%) patients had visceral pain.

Conclusions: In our study, combination of bupivacaine and a low dose of fentanyl (0.25 μg/kg) provided excellent surgical anaesthesia with short-lasting postoperative analgesia. There were very few adverse side effects.

A study on role of low dose mifepristone in the management of fibroid in reproductive age group women

2023-03-16T09:02:12+00:00

Background: Uterine fibroids are the most common benign uterine tumors occurring in 20-50% of women with maximum incidence between 35-45 years of age. Majority of fibroids are asymptomatic. When symptomatic, they present with abnormal menstrual bleeding, dysmenorrhea, chronic pelvic pain, abdominal heaviness, pressure symptoms etc. It is the commonest indication of hysterectomy worldwide. Mifepristone, an antiprogesterone is being widely used as one of the medical managements in potential symptomatic patients (mostly 10-20 mg daily doses).

Methods: An institute based prospective study including 100 reproductive aged women with symptomatic single uterine fibroid, was conducted over one-and-a-half-year period. They were administered 10 or 25 mg mifepristone daily for 3 months depending on fibroid size. Clinical parameters were assessed at initiation and at the end of their treatment.

Results: Our results showed that mifepristone (both 10 and 25 mg) led to symptomatic relief, with 96% reduction in menstrual blood loss and reversible amenorrhoea in 87% of the patients. Intramural fibroids responded more than submucosal fibroids in terms of relief of menorrhagia and improvement of haemoglobin (Hb) levels, with similar reduction in fibroid volumes of both intramural and submucosal locations.

Conclusions: Low dose mifepristone is an effective and safe drug for the medical management of uterine myoma. Due to the benign nature of fibroids, conservative management should be considered wherever feasible. Several clinical trials using 5‑50 mg of mifepristone have been conducted over variable durations between 3-12 months but the exact dosage and treatment duration are yet to be decided.

A comparative study of insulin levels in lean versus obese polycystic ovarian syndrome patients

2023-03-12T18:26:49+00:00

Background: Polycystic ovary syndrome (PCOS) is one of the most common endocrine disorders in women of reproductive age group. PCOS has been frequently associated with insulin resistance and obesity. Although most of the cases with PCOS are obese or overweight, a significant proportion of patients have normal body mass index (BMI≤25 kg/m²) that makes diagnostic work up and therapeutic approach more difficult. These cases are referred to as “lean PCOS.”

Methods: This hospital based prospective, comparative cross-sectional study was conducted to estimate the insulin levels and insulin resistance in lean versus over-weight or obese PCOS patients and to evaluate the correlation of BMI with clinical parameters, serum insulin levels, and hormone profile in these patients. Patients were grouped according to their BMI: Lean group-(n=46) BMI<25 kg/m² and obese group-(n=40) BMI≥25 kg/m².

Results: Serum insulin levels in obese PCOS patients were significantly higher than in lean PCOS patients (p<0.001). Overweight or obese PCOS women achieved significantly higher HOMA-IR than lean PCOS patients (p<0.001). The difference in fasting blood sugar levels in lean versus obese PCOS patients were not significantly different. Comparisons of the two groups showed no statistical differences in gonadotrophins (LH and FSH) values and LH/FSH ratio. The serum testosterone level was significantly higher in the obese group compared with the lean group (p=0.043).

Conclusions: We conclude that the overweight/obese PCOS patients had higher tendency to develop insulin resistance and elevated fasting insulin levels as compared to their lean counterparts. Thus, weight reduction and metformin therapy hold great potential in managing a patient with insulin resistance in PCOS but will not have much effect on hormonal profile of a patient with PCOS but will not have much effect on hormonal profile of a patient with PCOS.

Knowledge and Attitude regarding menstrual cups among young women

2023-03-13T14:26:19+00:00

Background: Menstruation is cyclic vaginal bleeding that occurs physiologically as a result of the shedding of the endometrium. The maintenance of adequate perineal hygiene during menstruation is very important. One product which is gaining quite a popularity over few years is a flexible, reusable cup that is inserted inside the vagina to collect blood during menstruation known as a menstrual cup. The benefits of a menstrual cup are numerous which include comfort, hygiene, cost-effectiveness and eco-friendliness. The acceptance of menstrual cups among women in India is varied due to personal and sociocultural factors. The objective of this study was to assess the knowledge and attitude regarding menstrual cups among young women.

Methods: A descriptive study design was adopted for the study. 200 young women were selected using non-probability convenient sampling technique. The study tool was administered to assess the knowledge and attitude regarding menstrual cups.

Results: Among 200 young women, 49% of young women had adequate knowledge, 43.5% had moderately adequate knowledge and 7.5% had inadequate knowledge regarding menstrual cups. 64.5% of young women had neutral attitude, 31% had positive attitude and 4.5% had negative attitude regarding menstrual cups.

Conclusions: Though young women are aware of menstrual cups but majority of them are skeptical towards its use. The findings suggests that mass in-depth awareness programmes for nurses and other health professionals should be organised and support groups need to be created to provide adequate information and counselling to the public regarding the use of menstrual cups.

A comparative study to assess the efficacy of oral versus vaginal route of misoprostol in missed first trimester abortion

2023-03-01T16:38:54+00:00

Background: Aim of the study to contrast the effectiveness of misoprostol taken oral vs vaginal method, for the management of missed abortion in the early trimester, and to acknowledge misoprostol value in cervical dilatation before any surgical pregnancy termination,

Methods: Comparing the efficacy of misoprostol, by vaginal and oral routes, for termination of first trimester missed abortion was conducted in the department of obstetrics and gynaecology, at DR B. R. Ambedkar medical college and hospital, Bangalore. 2 groups were made as group A and group B which had 24 participants in each group and a total of 48 participants, in which group A was given misoprostol 400 mcg orally, maximum up to 3 doses and group B was given misoprostol 400 mcg maximum up to 3 doses and outcome was documented. Primary outcome expecting drug-induced complete expulsion of products of conception (POCs). Secondary outcomes measured were induction expulsion interval, number of doses required, classification of failures, cervical canal permeability in women requiring surgical evacuation, side effects.

Results: Both oral and vaginal routes are highly effective (oral=75%, vaginal=91.7%, p=2.400), safe and acceptable with tolerable side effects. The mean time to expulsion was longer (10.55 hours) in the oral than vaginal group (8.09 hours). All unsuccessful cases, 2 in vaginal group and 6 in oral group had permeable cervices prior to surgical evacuation. Most of the side effects were tolerable in both groups.

Conclusions: Vaginal route of misoprostol is more effective than oral misoprostol for first trimester missed abortion.

A study on the association of diabetes and semen quality in and around Chennai, Tamil Nadu, India

2023-03-18T06:29:45+00:00

Background: Globally prevalence of diabetes is gradually increasing in individual at reproductive stage. Uncontrolled blood sugar affects biological systems including reproductive. Thus, this study was aimed to analyze the association of diabetes and male infertility in and around Chennai.

Methods: Fifty-four male participants who visited the fertility clinic was grouped in two based on the sugar value. An anthropometric measurement, clinical, blood, seminal parameters and life style behaviors was analyzed. All study variables was analyzed to examine the association of diabetes and semen quality.

Results: Study results shows that people with diabetes had abnormal semen parameters as compared to non- diabetic study participants. Pearson’s correlation between the semen parameters and blood sugar value of the study participants showed semen parameters: volume (r=-0.28, p<0.05), count (r=-0.22, p<0.05), and motility (r=-0.23, p<0.05), has a significantly week negative correlation with blood sugar level. Scatter plots also showed semen parameters: volume (r²=-0.079), count (r²=-0.048), and motility (r²=-0.053), had a significantly week negative linear correlation with blood sugar level.

Conclusions: From the study it was concluded that the uncontrolled blood sugar levels affect the reproductive health of the study participants.

Clinical study on the relationship of scar tenderness with scar integrity at repeat caesarean section

2023-02-07T08:04:55+00:00

Background: Caesarean section is an operative process whereby the fetuses after the end of 28^th weeks are delivered through an incision on the abdominal and uterine wall. This excludes delivery through an abdominal incision where the fetus lying free in the abdominal cavity following uterine rupture or in secondary abdominal pregnancy. The first operation carried out on a patient is referred to as an primary caesarean section. When the operation is carried out in subsequent pregnancies, it is referred to as repeat caesarean section. Caesarean section is used in cases where vaginal delivery is not either feasible or would impose undue risks on mother or baby. The aim of the study to assess the Relationship of Scar Tenderness with Scar Integrity at repeat caesarean section.

Methods: This is an observational study. The study used to be carried out in the admitted patient’s Department of Obstetrics and Gynecology, Dhaka Medical College Hospital, Dhaka, Bangladesh. The duration of the period from April 2017 to October 2017.

Results: This study shows that the according to age of 50 Patients aged 20 to 35 years. Here out of 50 mothers the highest 23(46%) mothers belonged to 21-25 years age group. Subsequently, 15(30%), 9(18%), 2(4%) and 1(2%) belonged to 26-30 years, ≤20 years, 31-35 years and >35 years respectively. The mean age of the respondents was 23.16±5.79 (age range: 17-38) years.

Conclusions: The scar complications are highly associated with the intensity of scar tenderness. Henceforth, it can be concluded here that scar tenderness is a vital factor responsible for scar complications.

Incidence and risk factors of post-molar gestational trophoblastic neoplasia: a prospective study

2022-11-03T00:53:00+00:00

Background: Gestational trophoblastic disease (GTD) is a group of disorders arising from abnormal trophoblastic cells. Gestational trophoblastic neoplasia (GTN) is a malignant counterpart of GTD. In the earlier era, morbidity and mortality associated with GTD was very high, 90-95% presenting with metastatic GTN in 1980’s.

Methods: This is a prospective study to analyze the incidence and to identify the risk factors of post-molar GTN and to evaluate the role of Beta-hCG level as a predictive factor of post-molar GTN, conducted in the department of Obstetrics and Gynecology, Institute of Maternal and Child Health (IMCH), Government Medical College, Kozhikode, on patients attending the vesicular mole(VM) clinic. Group A (remission group - was diagnosed after 6 months of follow-up with undetectable Beta-hCG values) and Group B (post-molar GTN). The two groups were compared for identifying risk factors.

Results: There were 79 cases of molar pregnancy registered in VM clinic with an incidence of 4.87/1000 deliveries. Of the 79 patients with GTD, 17 were diagnosed to have GTN during follow-up with an incidence of 21.51% of GTD. Incidence of post-molar GTN were significantly more among patients with history of previous molar pregnancy. The median Beta-hCG level at 2 weeks post-evacuation and the ratio of Beta-hCG levels at 1week to 2 weeks post-evacuation was found to be highly predictive of post-molar GTN.

Conclusions: Incidence of GTD was higher compared to international studies. The ratio of post-evacuation Beta-hCG at 1 week to Beta-hCG at 2 weeks is the most reliable predictor of post-molar GTN.

Transvaginal sonographic cervical length during mid-trimester in predicting preterm labour in asymptomatic singleton pregnancies

2022-12-29T22:55:31+00:00

Background: Worldwide, preterm birth is the main contributor to perinatal mortality and morbidity. Preterm birth causes 50% of long-term morbidity, contributes 75% of neonatal deaths (after accounting for fatal abnormalities), and becomes 85% of newborn deaths. Cervical length measurement has been linked to predicting the preterm labour in mid-trimester by various studies.

Methods: This study was carried out to evaluate the strength of cervical length as a predictive factor for pre-term labour. This is a prospective observational study conducted at MIMS, Vizianagaram on 100 antenatal mothers. The cervical length is measured by transvaginal ultrasound. If the length was <25 mm, then the patients were advised a second scan during 28th week and follow-up was done till delivery.

Results: Out of the 100 patients, 21 were multigravida, whereas 79 were primigravida. 20 had pre-term delivery and 80 had term delivery. The mean age of the population was 25.2±4.5 years. 40% of cases with cervical length <25 mm had pre-term delivery, as compared to 33.33% in patients with cervical length 26-30 mm, 13.63% in 31-35 mm, 5.88% in 36-40 mm and 16.66% in patients with cervical length >40 mm. The p value<0.05. Area under ROC curve is 0.79. Sensitivity is 60%, specificity is 8.75%, positive predictive value is 57.14%, negative predictive value is 89.87%.

Conclusions: Transvaginal sonography is a reliable diagnostic test in mid-trimester in predicting pre-term delivery in singleton pregnancy.

Maternal and perinatal outcome in instrumental vaginal deliveries over 5 years: a retrospective study

2023-01-03T14:56:58+00:00

Background: Due to fear of trauma and less skill, use of instrumental vaginal delivery (IVD) is decreasing every year and incidence of caesarean section is increasing. Caesarean section is a major surgery associated with increased morbidity and mortality. This study evaluates the incidence of instrumental vaginal delivery and associated maternal and perinatal outcome.

Methods: This observational retrospective study was carried out in full term antenatal patients in labour with vertex presentation who had undergone operative vaginal deliveries during the study period from January 2017 to December 2021 at G.C.S. Hospital. Data were obtained from the hospital records and analysed which included the age, parity, incidence, indication, the APGAR scores of the babies and complications in the patient.

Results: Incidence of instrumental deliveries was found to be 1.98%. Most common indications for IVD were prolonged second stage of labour followed by foetal distress and post-dated pregnancy. Most common maternal complication was perineal tears and most common perinatal complication was neonatal intensive care unit (NICU) admission.

Conclusions: The decision to proceed with an operative vaginal delivery when a spontaneous vaginal delivery is not possible must be based upon maternal and foetal factors. Most common maternal complications were perineal tears, cervical tears, episiotomy extension, vaginal laceration and atonic postpartum hemorrhage (PPH). Most common neonatal complications were NICU admission most commonly for neonatal hyperbilirubinemia.

Evaluation of screening efficacy of IL6, IL8, CRP and salivary progesterone in predicting preterm pregnancy

2023-01-05T06:09:55+00:00

Background: According to WHO preterm birth defined as births occurring before completion of 37 weeks, in a pregnancy beyond 20 weeks of gestation. As reported by W.H. O preterm birth has incidence of about 9.6% of all the live births, preterm births have high neonatal morbidity and mortality. In this review we look at association between CRP, IL6, IL8 and salivary progesterone in predicting the preterm delivery.

Methods: A hospital based prospective study to be conducted in a group of 100 women of 20- 24 weeks of gestation, they were analysed for IL6, IL8, CRP and salivary progesterone and followed them till delivery.

Results: On assessment of the biomarkers to predict the preterm and term pregnancy, we assessed for the blood level of CRP, IL6, IL8 and salivary progesterone among the pregnant women at 20-24 weeks of gestation and followed till the pregnancy outcomes. Among which 46% were with preterm pregnancy and 54% with term pregnancy during delivery. Among them, 20% had the previous preterm pregnancy and 80% were not. We found 70% with normal vaginal delivery, 24% with emergency LSCS and 6% with elective LSCS.

Conclusions: The present study documented the significant higher efficacy of IL6, IL8, CRP and salivary progesterone in predicting the preterm pregnancy. Progesterone levels in the saliva was markedly lower among the pregnancy with preterm delivery compared to term delivery outcome. The fetal outcome among the preterm delivery was significantly with morbidity and mortality compared to term delivery. The ROC curve showed the estimation of IL6, IL8, CRP and salivary progesterone at 20-24 weeks of gestation can predict the outcome of preterm pregnancy.

COVID-19 and pregnancy outcomes: a retrospective study from a tertiary health care center of Uttarakhand, India

2023-01-07T08:57:24+00:00

Background: Information regarding the effects of COVID-19 on pregnancy outcomes evolved rapidly in the recent years. This study aims to present the outcomes in COVID-19 positive pregnant women.

Methods: This retrospective cohort study was conducted in a tertiary health care center of Uttarakhand, India from April 2021 to June 2021. The maternal and neonatal data for the included cases were extracted from hospital records and appropriately analysed.

Results: The positivity rate of COVID-19 among obstetric population was 7.9% by universal screening protocol. 55.2% participants were in the age group of 25-30 years. Gestation age at presentation ranged from 6 weeks to 41 weeks. 47.3% participants had pre-existing comorbidities. 26.4% study subjects had pregnancy related comorbidities, the most common being gestational diabetes mellitus (14.7%), followed by pre-eclampsia (8.8%). Only 21.1% participants were symptomatic at presentation. Most common presenting symptom was fever (87.5%) followed by breathlessness (62.5%). 7.5% required invasive ventilation and 10.5% cases required intensive care unit (ICU) admission and 76.5% participants underwent caesarean section which was done for obstetric indications only. 3.9% participants died due to COVID-related complications. Nearly 35% neonates were preterm, 29.4% had low birth weight and 24.1% needed neonatal intensive care unit (NICU) admission. Nasopharyngeal swab for COVID reverse transcriptase-polymerase chain reaction (RT-PCR) after 24 hours of birth was negative in all neonates. There were 10 (14.7%) stillbirths.

Conclusions: COVID-19 in pregnancy was associated with higher risks of gestational diabetes mellitus, preeclampsia and higher rates of invasive ventilation, ICU admission, caesarean sections, maternal mortality specially in women with pre-existing comorbidities, stillbirths, preterm births and NICU admission.

Retrospective study on prevalence of severe anemia in pregnant women and its outcome

2023-01-31T17:01:31+00:00

Background: Anemia is one of the most common nutritional deficiency disorders affecting the pregnant women in the developing countries. Anemia during pregnancy is commonly associated with poor pregnancy outcome and can result in complications that threaten the life of both mother and fetus. The study aimed at analyse the maternal and perinatal outcome of pregnant women with severe anemia (Hb <7 gm%) in pregnancy. Aim and objective were to study the prevalence of anemia among pregnant women and to determine its association with maternal and fetal outcomes.

Methods: A hospital-based retrospective study on the prevalence of anemia among the antenatal women for 6 months duration from February 2022 to July 2022 in department of obstetrics and gynecology Cheluvamba hospital, Mysore Medical College and Research Institute, Mysore.

Results: Out of 4291 deliveries during the study period 76 (1.7%) patients were severely anaemic. There were 55 (72.3%) multigravida. Maternal complications were preterm labour 15 (16.8%), pre-eclampsia and eclampsia 10(13.1%), abortions 22 (28%). Neonatal outcome was analysed in terms of prematurity (16.8%), LBW (22.4%), NICU admission (17.9%), still birth (0.03%), neonatal deaths (0.05%).

Conclusions: Severe anemia during pregnancy is associated with adverse maternal and perinatal outcome. It is one of the preventable indirect causes of maternal mortality. Education to adolescents, regular antenatal check-ups, early diagnosis and treatment, prevention of too late too early too frequent too many pregnancies. Educating the women regarding safe abortion services available thus avoiding unwanted pregnancies. Promotion of good nutrition practices thus reaching optimum haemoglobin before conception. Along with these active participation of health workers at grass-root level might help in bringing down the prevalence.

Maternal and perinatal outcome in term singleton breech presentation at term pregnancy

2023-01-25T10:30:39+00:00

Background: Breech presentation is defined as a fetus in a longitudinal lie with the podalic at the pelvic brim. There are three types of breech presentations: frank breech, complete, incomplete breech. The incidence of breech presentation decreases from about 20% at 28 weeks of gestation to 3-4% at term, as most babies turn spontaneously to the cephalic presentation. Studies have shown that the prevalence of term breech presentation varies globally. In India the incidence was shown to be, 2.1%, and in other Asian countries it was found to be around 2.9 -4.5%. Its incidence is around 25% at 28 weeks of gestation and it reduces to 4% by term. If patients are carefully selected, breech presentation can be delivered vaginally. However, the risk of neonatal complications still persists. sometimes the planned vaginal delivery has to be converted into emergency cesarean section. Such probability varies from 17.4 to 51%.

Methods: This was a prospective observational study conducted in department of obstetrics and gynaecology department of SAMC and PGI, Indore, Madhya Pradesh from 1^st April, 2021 to 31^st October 2022. Ethical approval was taken from the institutional review committee. All term pregnant women (≥37 weeks) aged 18 years and above, admitted to the maternity and labor ward with the diagnosis of singleton breech presentation during the study period were included in the study. The patients were identified as having breech presentation on admission using physical examination and ultrasound. Those women who presented with antepartum hemorrhage, uterine rupture, fetuses with major congenital anomalies and intrauterine deaths were excluded from the study. After through exclusion sample of 70 people were included in study.

Results: During the study period, 896 deliveries were conducted in this hospital. Among them, 70 (7.86%) of the deliveries were singleton breech delivery. The age of the participants in the study ranged from 16 to 45 years, with a mean age of 27.07±8.56 years. Most of them had elective cesarean section, and few had emergency cesarean section. The most common indication for emergency cesarean section was footling presentation. Most of the new-borns were males, mean weight of new-borns 2.75±0.5 kg. 21.9% neonates required admission in neonatal intensive care unit, 2.8% mothers developed wound infection and 10% had post-partum haemorrhage.

Conclusions: Proper guidance, education and strict adherent to principles and steps of breech delivery, like monitoring taking up call for emergency c-sections, having proper NICU setup, trained doctors will help in reduction of complications. A protocol for the management of breech delivery and a regular training facility for junior health professionals to conduct assisted vaginal breech delivery are highly recommended.

Doppler sonographic evaluation of intrauterine growth restriction of fetus and its correlation with perinatal outcomes among the population of riverine (char) areas of Barpeta Assam

2023-01-22T17:28:26+00:00

Background: Intrauterine growth restriction (IUGR) also known as fetal growth restriction (FGR), has been associated with a variety of detrimental perinatal outcomes. FGR is defined as estimated fetal weights (EFW) or abdominal circumference (AC) that fall within the third, or tenth percentiles with abnormal doppler parameters. FGR affects 10-15% of all pregnancies around the world.

Methods: Prospective observational study of singleton pregnant women complicated by FGR were enrolled during the study period from September 2021 to August 2022. 100 patients were included in the study.

Results: Abnormal umbilical artery flow was seen in 30% of cases, out of which 83% (25) had abnormal perinatal outcome. Out of 100 cases, live births were reported in 94%, stillbirths in 4%, and IUDs in 2%. There were 16 neonatal deaths and 15 neonatal complications among the adverse perinatal outcomes. Intraventricular hemorrhage and neonatal sepsis were the two leading causes of death. Neonatal sepsis, necrotizing enterocolitis and hypoxic ischemic injury was the leading cause of morbidity. Reverse end diastolic umbilical artery Doppler and bilateral uterine artery notch had 100% mortality. The sensitivity, specificity, positive predictive value, negative predictive value and accuracy of umbilical artery in predicting perinatal outcome in IUGR were 80.65%, 92.75%, 83.33% 91.43% and 89.47% respectively.

Conclusions: Umbilical artery PI is the most sensitive parameter and had highest positive and negative predictive value and Accuracy in relation to adverse perinatal outcomes.

The role of serum beta-human chorionic gonadotropin as a predictor for pregnancy induced hypertension in 12-20 weeks of pregnancy

2023-01-23T15:57:14+00:00

Background: Pregnancy-induced hypertension occurs in approximately 3 to 5% of pregnancies and is still a major cause of both fetal and maternal morbidity and mortality worldwide. Pre-eclampsia is risk factor for stillbirth, intrauterine growth restriction (IUGR), low birth weight (LBW), preterm delivery, respiratory distress syndrome, and admission to neonatal intensive care unit. Overall, the incidence of preeclampsia ranges from 5 to 15% in India. This study conducted to assess the predictive value of raised beta-human chorionic gonadotropin (β-hCG) levels in development of pregnancy-induced hypertension in antenatal women and follow up the risk patients and reduce both maternal and perinatal morbidity and mortality.

Methods: The present study was conducted in the department of obstetrics and gynaecology, L.L.R.M Medical College and associated SVBP Hospital, Meerut during the period of January 2021 to December 2021 on 400 antenatal women with 12 to 20 weeks of gestation. Estimation of serum beta hCG level was done by enzyme linked fluorescence immunoassay. The cases were followed up in antenatal clinics, 4 weekly till 28 weeks, fortnightly up to 34 weeks and thereafter weekly till delivery for the development of PIH.

Results: From the study it was found that women with elevated beta hCG values in 12-20 weeks were at increased risk of developing PIH. The sensitivity of β-hCG for development of PIH was found to be 90%. It was found that specificity, positive predictive value (PPV), negative predictive value (NPV) of β-hCG for development of PIH was 82%, 41.7%, 98.3% respectively. However, p value of β-hCG for development of PIH is 0.001 which is highly significant.

Conclusions: From this study we found that that measuring second trimester serum beta-hCG levels is a good predictor of pregnancy induced hypertension and showed association with elevated levels of beta hCG with development and severity of PIH, but sensitivity and positive predictive value of beta hCG are low in this study to be useful for mass screening marker on its own.

A prospective study of effect of delayed cord clamping in term babies as well as in preterm babies

2023-03-16T09:00:48+00:00

Background: Delayed cord clamping (DCC) is lengthening the time between delivery of newborn and the clamping of their umbilical cord. It is usually performed 25 seconds to 5 minutes after birth, which increases the newborn’s iron storage, vital for healthy brain development.

Methods: This prospective observational study was conducted on 100 late preterm and term newborns delivered in the obstetrics and gynaecology department of Calcutta national medical college and hospital, Kolkata over a period of one and half years (March 2019 to August 2020). The umbilical cord was clamped between 60 to 90 seconds after birth of baby. Babies’ weight measurement and blood investigations (Haemoglobin (Hb) level, total serum bilirubin (TSB) and serum ferritin) were performed at birth, after 24 hours of birth and at 6 weeks of age.

Results: In this study after DCC, there is significant increase in Serum Ferritin levels after 24 hours and 6 weeks as compared to the birth values. As far as the values of TSB and hemoglobin is concerned, the values first showed increment after 24 hours and then decreased at 6 weeks, which is statistically significant (p=0.001). Birth weight which first decreased after 24 hours, increased at 6 weeks. None of the babies needed blood transfusion during the study period. Out of 100 cases, 9 were admitted in NICU and required phototherapy which was not directly associated with umbilical cord clamping time or bilirubin values at birth.

Conclusions: Based on the results of this study, we conclude that newborns with DCC had statistically significant higher levels of Hb and ferritin after birth. This may ensure better iron status throughout infancy along with reduced need of blood transfusion and its related adversities. Delaying cord clamping seems to be beneficial in late preterm and term neonates without causing additional morbidities in the first 6 weeks of life.

Retrograde study of patients with adenomyosis at tertiary health centre, a spectrum from clinical presentation to its final diagnosis and treatment

2023-01-26T17:54:51+00:00

Background: Adenomyosis is a disease where ectopic endometrial glands affect the muscular wall of the uterus. It is considered a specific entity in the PALM-COEIN FIGO (polyp; adenomyosis; leiomyoma; malignancy and hyperplasia; coagulopathy; ovulatory dysfunction; endometrial; iatrogenic; and not yet classified- International Federation of Gynaecology and Obstetrics). Aims and objectives were to diagnose adenomyosis accurately with help of data of clinical findings and imaging modalities.

Methods: It was a retrospective study done at tertiary hospital, Junagadh from June 2022 to November 2022. The HPE reports and case records of all the hysterectomy specimen were reviewed. Data regarding age, parity, symptoms, obstetric history, examinations, co-morbidities, investigation findings and treatment modalities were noted. They were tabulated and analysed.

Results: Out of the 50 patients, 30 patients (60%) were in the age group of 41-50 years. The prevalence of adenomyosis in our study was only 6% in post-menopausal women when compared to the age group 41-50 years (60%). Multiparous women had 92% incidence of adenomyosis. 62% had menstrual disturbances. Dysmenorrhea and dyspareunia were the next common symptoms. Fibroid was the commonest associated pathology 44%. 32% had endometrial hyperplasia, whereas 68% had no pathology. Imaging picked up only 36% of cases contrary to 28% of clinical diagnosis and was raised to 64% with gross examination of specimen and 100% with HPE.

Conclusions: Better modality to diagnose adenomyosis is clinical presentation. USG failed to diagnose all the cases. Gold standard modality is histopathological examination.

Role of serum folic acid and vitamin B12 levels in abruptio placentae and the fetomaternal outcome

2023-01-28T07:10:21+00:00

Background: Over the course of pregnancy, there is a steady decline in maternal plasma folate concentration and vitamin B12 concentration about 50%of non pregnant levels. Insufficient folate and vitamin B12 status has been associated with many reproductive complications including abruption, IUGR, pre eclampsia, early pregnancy loss. The aim of the study was to determine the role of serum folic acid and vitamin B12levels in patients with abruptio placentae and to study the feto-maternal outcome in these patients. Feto maternal outcome is seen in terms of mode of delivery whether vaginal or caesarean, period of gestation whether term or preterm, need of blood transfusion, stillbirths.

Methods: In this prospective observational study conducted in a tertiary hospital from 2018-2020, 50 pregnant women with abruptio placentae were included and their serum folic acid and vitamin B12 levels were measured by ELIZA method using commercially available kits.

Results: Serum folic acid levels were not low in the cases of placental abruption with range= 25 ng/ml to 80.5 ng/ml. Mean folic acid level ±SD is 47.98±13.15 ng/ml and median is 48 ng/ml. In this study vitamin B12 levels were low in the cases, range 14 pg/ml to 70 pg/ml. Mean vitamin B12 value ±SD is 27.15±11.63 pg/ml and median is 25 pg/ml.The rate of caesarean section was 44%, preterm delivery was 64% and stillbirth was 38% in these cases with mean folic acid levels of 48.7±15.4 ng/ml, 46.94±13.85 ng/ml and 46.03±8.13 ng/ml respectively and mean vitamin B12 levels of 23.34±6.74 pg/ml, 28.73±13.44 pg/ml and 28.32±11.75 pg/ml respectively. There was a significant association (p=0.006) between vitamin B12 and mode of delivery. No other significant association was seen between serum folic acid and vitamin B12 levels and the different fetomaternal outcome.

Conclusions: Low levels of vitamin B12 is seen in cases with abruptio placentae. The rate of caesarean section, preterm delivery, stillbirth and need of blood transfusion is high but no significant association is seen.

A prospective study of maternal outcome of labor and perinatal outcome in premature rupture of membranes

2023-01-29T07:51:49+00:00

Background: Premature rupture of membranes refers to rupture of fetal membranes prior to the onset of labor. PROM is of two types viz. term PROM and preterm PROM. The incidence of PROM is at an average of 10%. In 70% of the cases, it occurs in pregnancies at term. Preterm PROM- defined as PROM prior to 37 weeks of gestation- complicates 2% to 4% of all singleton and 7% to 20% of twin pregnancies. It is the leading identifiable cause of premature birth and accounts for approximately 18% to 20% of perinatal deaths.

Methods: This study was conducted in the tertiary care teaching institute in the state of Jammu and Kashmir, India. After taking an informed consent, a proforma was filled on subject history, examination and investigations. These subjects were followed until delivery and then neonates were also followed.

Results: Incidence of PROM was 8.76% of which 54.7% were primigravida and 45.3% were multigravida. Most of the patients (70.4%) were term, only 29.6% were preterm with gestational age of <37 weeks. Incidence of PPH was 2.8%, puerperal pyrexia occurred in 9.8%. The incidence of RDS in neonates was 8.9% while the incidence of neonatal sepsis was 6.7%. There was 1.1% perinatal mortality.

Conclusions: From this study it can be concluded that basic aim of obstetrician should be to identify the risk factors leading to PROM, to treat complications and implement strict aseptic precautions to prevent maternal and neonatal morbidity.

The association of pre-pregnancy body mass index and risk of pre-eclampsia

2023-01-29T16:37:13+00:00

Background: Preeclampsia is a pregnancy-related condition characterized by new-onset hypertension and proteinuria. Preeclampsia is responsible for 20% to 80% of mortality among pregnant in developing countries. Preeclampsia may cause prematurity and fetal growth restriction. It is the most serious complication affecting 2-8% of all pregnancies. The mortality and morbidity rates among the babies of pre-eclampsia mothers is five times higher than that among babies born to healthy mothers. Objective: To find the association between pre-pregnancy Body Mass Index (BMI) and gestational weight gain with incidence of pre-eclampsia.

Methods: Cross sectional Observational study was conducted among 140 cases. The study was conducted after obtaining approval from the ethics committee.

Results: In this study, in 27.9% of cases overweight, and in 12.1% of cases obesity were seen. In 60.7% of cases severe preeclampsia, and 39.3% of cases mild preeclampsia was reported. Preeclampsia had no significant association with age, marital life, parity, but had a significant association with liquor, birth weight, and NICU admission.

Conclusions: Pre pregnancy weight and Gestational weight gain were associated with high risk of preeclampsia.

Modified biophysical profile in high-risk pregnancy-association with neonatal APGAR score

2023-01-30T17:17:43+00:00

Background: MBPP is used for evaluating fetal health and predicting fetal outcomes, which can help to minimize perinatal morbidity and death. It combines the non-stress test, an indicator of acute fetal hypoxia, with AFI, the second indicator of persistent fetal problems. Each patient has a non-stress test and an ultrasonic examination of liquor volume. A non-stress test that is reactive will reveal a healthy fetus. Hence, an attempt has been made to study the MBPP in high-risk pregnancies in predicting fetal outcome.

Methods: Hospital-based prospective clinical study on 200 high-risk pregnant women more than 37weeks of gestation are screened using a modified biophysical profile. High-risk factors in the study include Gestational Hypertension, Preeclampsia, IUGR, Post-term pregnancy, Oligohydramnios, PROM, and Anemia. The study was conducted in the department of obstetrics and gynaecology, Narayana medical college and hospital, Nellore, Andhra Pradesh.

Results: In the present study, a total of 200 patients, 76.0% had both (NST, AFI) normal, 5.0% had both (NST, AFI) abnormal, 10.0% had Normal in NST and abnormal in AFI, 9.0% had abnormal in NST, and normal in AFI. The individual association between NST and AFI with the neonatal outcomes ie., APGAR at 1 min and 5min have been studied and have been found to be statistically significant.

Conclusions: In the present study, we concluded that MBPP is an effective antepartum fetal surveillance test in high-risk pregnancies in predicting perinatal outcome.

Knowledge and attitude towards contraceptive use among Juang men: a particularly vulnerable tribal group in Odisha, India

2023-01-31T08:51:09+00:00

Background: Empirical evidence on knowledge and attitude toward contraception among particularly vulnerable tribal groups is rare in India. This study unearths the knowledge and attitude towards contraceptive methods among the Juang men, a PVTG in Odisha, India.

Methods: Data for the present study comes from a cross-sectional mixed-method study conducted in 2020-21, following a three-stage sampling design. The present analysis is based on the quantitative data of 100 men and the qualitative interviews (12 Focus group discussions and 12 Key informant interviews). The quantitative data were analyzed using Stata (V16), and we used NVivo (V12) to analyze the qualitative data. We calculated an attitude scale categorized into favorable, neutral, and unfavorable.

Results: Knowledge of contraceptive methods was found inadequate- 43% knew any modern spacing methods & 65% knew any modern limiting methods. About two-fifths (44%) of the men had a less favourable attitude towards contraception, 32% had a moderately favourable attitude, and 24% had a highly favourable attitude towards family planning. A higher percentage of educated men, exposed to mass media, do not consume alcohol and tobacco, and married after 18 years had a favourable attitude towards contraception. Qualitative data reveal that contraception was never perceived as an essential issue, and male involvement in family planning is culturally discouraging.

Conclusions: Contraceptive method knowledge is not universal among Juang men, and many have a negative attitude toward using family planning methods. Results indicate inadequate program outreach and suggest customized intervention for contraceptive knowledge and its benefits among Juang men.

Histopathological pattern of endometrial biopsy in abnormal uterine bleeding

2023-02-01T16:19:15+00:00

Background: Abnormal uterine bleeding is a common complaint in most women of different ages that prompts seeking gynaecologic care. This study aimed to determine the type of endometrial patterns of the different age categories of women who presented as a case of abnormal uterine bleeding.

Methods: This was a retrospective study conducted on 72 patients who were presented with abnormal uterine bleeding and had endometrial biopsy done in our hospital. The data on their age, presenting complaints, and comorbidities of all the women were collected. The patterns of endometrial changes were studied and classified in accordance to the FIGO classification.

Results: Seventy-two women with abnormal uterine bleeding demonstrated a fluctuating pattern of ten endometrial pathologies distributed among five age groups in the range of 31 to 65 years. Maximum number of cases of AUB were noted in the age group of (36-50) years (56 cases, 77.7%). Most common observed histopathological pattern in this study was normal cyclical patterns including proliferative endometrium (29.16%) and secretory endometrium (22.22%).

Conclusions: Histopathological examination of the endometrium shows a clear-cut differentiation between physiological and malignancy changes in the endometrium. Hence, endometrial sampling is considered the golden tool for accurate analysis of the endometrium.

Correlation between prolactin, thyroid, LH, FSH, estradiol and progesterone in the infertile women

2023-02-04T15:47:27+00:00

Background: An important global health issue, infertility affects a couple’s social, psychological, economic, and sexual well-being. A variety of issues stemming from abnormal hypothalamus pituitary ovarian axis dysfunction make up the hormonal diseases of the female reproductive system. The aim of the study was to find correlation between prolactin, thyroid, LH, FSH, estradiol and progesterone in the infertile women.

Methods: Present study was hospital based descriptive, cross-sectional study. 150 infertile women were required in sample size. Serum LH, FSH, estradiol was measured on day 2 of menstrual cycle and also serum TSH and serum progesterone on day 21.

Results: Around one third (38%) of the cases was married since more than 10 years. Majority 108 (72%) had primary infertility and 50% of the women had history of irregular menstrual cycles. There was significant positive correlation between TSH and prolactin (p value <0.05) and significant negative correlation of TSH with FSH and LH (p value <0.05) and there was insignificant negative correlation of TSH with estrogen (D2) and progesterone (D21). The mean value of TSH in our study was 7.47±1.82 μIU/ml.

Conclusions: TSH has strong positive co-relation between prolactin, FSH and LH indicating role in female infertility. These hormonal evaluations allow a routine etiological approach to the diagnosis of infertility.

A retrospective study on ectopic pregnancy: incidence, clinical presentation, risk factors, treatment and morbidity and mortality associated with ectopic pregnancy- one year study

2023-02-13T12:27:16+00:00

Background: Diagnosis of ectopic pregnancy was frequently missed and rising trend in incidence of ectopic pregnancies necessitates awareness about risk factors, resultant morbidity and mortality. to determine the incidence, clinical presentation, risk factors, treatment and morbidity and mortality associated with ectopic pregnancy. Aims and Objectives were to determine the incidence, clinical presentation, risk factors, treatment and morbidity and mortality associated with ectopic pregnancy.

Methods: Retrospective analysis of ectopic pregnancy was done in Government Medical College Baroda, from September 2021 to August 2022. The following parameters: age, parity, gestational age, risk factors, clinical presentation, diagnostic methods, mode of treatment and morbidity were noted.

Results: Out of 7521 deliveries, 74 were ectopic pregnancies (0.98 %). Women with age 20-30 years had highest incidence (62.16%) and with least below 20 years (4%). Ectopic pregnancies were common in multiparous women (78.3%) than primigravida (21.62%). Common symptoms: abdominal pain (82.4%), amennorhea (78.4%), bleeding per vaginum (63.3%), adenexal tenderness (46.2), asymptomatic (12%) patients. Urine pregnancy test positive in 96.4%. Etiology was pelvic infection (15.78%), infertility (7.01%), previous ectopic (8.33%), contraception failure (8.71%), surgeries including LSCS and tubal surgeries (4%). Right sided ectopic was more common. Site of ectopic was common in fallopian tube- ampullary region (88%), cornu (4%) followed by others (8%) then caesarean scar, rudimentary horn pregnancy. About 81.08% of ectopic was ruptured, 3/4^th of these patients presented with shock at the time of presentation. Tubal abortions were seen in 4.01% of patients. Most of cases being ruptured ectopic pregnancies, salpingectomy in 72.9% and salpingo-opherectomy in 6.7%. Morbidity was blood transfusion (76.31%), wound complications 4.38 and no mortality.

Conclusions: Early diagnosis, identifying of underlying risk factors and timely intervention in the form of conservative or surgical treatment will help in reducing the morbidity and mortality associated with ectopic pregnancy.

Single dose versus multiple doses of antibiotics in women undergoing caesarean section: a randomized non-inferiority trial

2023-02-07T15:46:13+00:00

Background: The study aimed to compare the rates of surgical site infection in women undergoing caesarean section, given either a single dose of antibiotic 30-60 minutes before giving skin incision or multiple doses. There is enough evidence available from high-income countries supporting a single dose of prophylactic antibiotic. However, there is scanty data from middle- and low-income countries.

Methods: An open-ended randomized trial was undertaken on 400 women undergoing caesarean section. Women in the intervention group were given one dose of intravenous cefazolin before skin incision. Women in the comparison group were given intravenous ceftriaxone before skin incision, and intravenous ceftriaxone plus metronidazole for forty-eight hours after caesarean.

Results: There was no significant difference between the single and multiple-dose regimen of antibiotic prophylaxis in caesarean sections when compared for postoperative surgical site infections. Secondary outcome variables, that is, side-effects of antibiotics were significantly more in the multiple-dose group.

Conclusions: A single-dose regimen for antibiotic prophylaxis is as effective as a multiple-dose regimen, in low-risk women undergoing caesarean section, both elective and emergency.

Comparison of oral misoprostol versus intramuscular oxytocin for active management of third stage of labour: a single centre randomised controlled study

2023-02-08T15:59:11+00:00

Background: This study was conducted to compare the efficacy and safety of oral misoprostol against intramuscular oxytocin in the active management of the third stage of labour, so that it can be widely used in the areas of limited resources to contribute in preventing post-partum haemorrhage and thus decreasing maternal mortality ratio.

Methods: This was a prospective randomised controlled clinical study. Two hundred patients fulfilling inclusion criteria were randomized to receive either oral misoprostol (600 mcg) or intramuscular oxytocin (10 IU) in the active management of third stage of labour. Primary outcome measured was mean blood loss and incidence of primary PPH.

Results: The mean blood loss during third stage of labour in oral misoprostol group and oxytocin group was 239.16±22.78 ml and 240.19±19.70 ml respectively with p value-0.7331 which was insignificant. Similarly mean fall in haemoglobin was also not significant. There was no significant differences between the two groups with regard to the incidence of PPH (3% vs. 2% respectively; p=0.651). Women experiencing side effects like shivering and fever were significantly higher among misoprostol group than in oxytocin group.

Conclusions: In this study, oral misoprostol was found to be comparable to intramuscular oxytocin regimen, in terms of amount of blood loss, occurrence of postpartum hemorrhage, duration of third stage of labour, fall in hemoglobin and fall in blood pressure. However, shivering and fever were more common with misoprostol, but no other serious side effects were noted.

Maternal mortality: a 6-year experience of the triumph achieved and the hardships faced in a tertiary care centre of Chhattisgarh

2023-02-09T19:57:49+00:00

Background: Maternal death reflects the health care system of a country and majority of them are preventable. India’s MMR declined to 103 in 2017-19. However, SDG3 targets of reducing MMR to 30 is still far and a lot has to be done to achieve it.

Methods: In this retrospective study, a 6-year analysis of the trends of maternal mortality for age group, booking status, parity, referral status, obstetric and non-obstetric causes of maternal death and the challenges faced in their management have been observed. The data obtained was tabulated and analysed for trends in maternal mortality over past 6 years.

Results: Hypertensive disorders of pregnancy remains the major obstetric cause of death with significant decline in septic abortions. Liver and respiratory disorders have surpassed anemia as the major non-obstetric cause of death. A gradual shift from pulmonary edema to emergence of AKI and CVA as the immediate cause of death has been observed.

Conclusions: Knowledge about fluid therapy, aggressive resuscitative measures and critical care management resulted in decline in cases of pulmonary edema. Improvement in anaemia at the cost of medical disorders was seen due to improved coverage of Iron folic acid prophylaxis, deworming and easy availability of blood banks. Trainings for ANMs and medical officers, early detection of warning signs, timely referrals, adolescent health clinics, improved booking status and increased institutional deliveries have led to reduction in MMR. Regular auditing of each maternal mortality can improve the scenario.

Maternal and fetal outcome among gestational diabetes mellitus mothers treated at a tertiary care maternity hospital

2023-02-10T10:21:59+00:00

Background: Incidence of gestational diabetes mellitus (GDM) in India is alarming. The present study was designed to determine the association between the maternal and fetal outcome with the blood sugar control status at the time of delivery.

Methods: It was an analytical follow up study that included 180 antenatal women who met the criteria for GDM with singleton pregnancy irrespective of age, gestational period, parity were included into the study. Those with pre-existing diabetes mellitus, scarred uterus, multiple pregnancy, chronic medical disease and ante partum hemorrhage were excluded. Based on the blood sugar level at the time of delivery GDM mothers were classified into four groups excellent control, optimal control, poor control and no control group. The maternal and fetal outcomes were compared between groups.

Results: Nearly 7500 antenatal women were screened and 198 eligible GDM women were selected. Of which 180 cases were successfully completed the follow up. Among the 180 cases of GDM, 74 (41.1%) were in excellent control group, 40 (22.2%) under optimal control, 41 (22.8%) belonged to poor control and 25 (13.8%) were not controlled at the time of delivery. There was statistically significant positive association between poor glycemic control and bad maternal and fetal outcome.

Conclusions: Bad maternal and fetal outcomes were statistically higher among mothers with poor and no glycemic control. Strict glycemic control during antenatal period is mandate to avoid bad outcomes. Neonatal care center needs to be well equipped where GDM mothers seek care for delivery.

Vaccine hesitancy: a major hurdle even among women healthcare workers

2023-02-11T05:35:54+00:00

Background: One of the major threats to the COVID-19 vaccines rollout and successful mitigation of the pandemic is vaccine hesitancy. Vaccine hesitancy refers to delay in acceptance or refusal of vaccination despite availability of vaccination services. The COVID-19 vaccine trials generated very limited data on safety and efficacy for pregnant women and children, since pregnant women were not included in any of the phase I/II or III trials. Hence the authors made an attempt to understand vaccine hesitancy among women healthcare and frontline workers with a focus on vaccination during pregnancy and lactation.

Methods: The recruitment of participants was done by purposive snowballing technique over a period of 15 days. The data collection was done through an online questionnaire generated with the help of Google forms. After excluding women who exceeded the age criteria and incompletely filled questionnaires, 101 responses were considered for analysis. Data analysis was done using SPSS software version 22.

Results: From a total of 101 responses for analysis, 26% had comorbidities. Of the 9 women who were pregnant, majority was in the second trimester (55.6%). Majority of the women, 63.6% had been feeding for more than six months. Of the respondents who had refused vaccination, most wanted to wait longer for further research on safety and efficacy (47.8%).

Conclusions: The reasons for pregnant women to decline COVID-19 vaccination during pregnancy even if the vaccine were safe and free were that they did not want to expose their developing baby to any possible harmful side effects, would like to see more safety data among pregnant women and unclear recommendations from the healthcare provider. As HCWs are envoys for evidence based medical interventions, and they are critical in promoting vaccine acceptance amongst the general population, it is important to design effective strategies to improve vaccine acceptance amongst this population.

A prospective study of simultaneous myomectomy with cesarean section at a tertiary care hospital

2023-02-13T08:26:24+00:00

Background: Simultaneous surgical removal of a previously diagnosed myoma during cesarean section is preferred these days to reduce multiple operative procedures. The aim of present study was to determine the safety, cost effectiveness and complications of myomectomy at the time of cesarean delivery and its related peri-operative morbidity.

Methods: This prospective study was conducted in total 50 pregnant cases during the period of 6 months. The analysis focused on age and gender, the number, size and location of fibroids, the need for hysterectomy and blood transfusion.

Results: The mean age of patient was 28.2 years. Out of the 50 patients, 66% were primiparous and only 17% were multiparous. 56% patients underwent caesarean section for indications like primigravida head floating, IUGR, oligohydroaminos. 48% patients had myoma size 2-4 cm. Most of the myomas were located anteriorly (64%). The most common type of leiyomyoma found was subserosal (31%) and 17% with intramural fibroid. Only one patient required post operative blood transfusion whereas none of the patients underwent hysterectomy.

Conclusions: Cesarean myomectomy is a safe and effective procedure and it is a feasible undertaking in experienced hands.

Salivary uric acid as a non-invasive marker of early onset preeclampsia

2023-02-14T18:28:10+00:00

Background: Preeclampsia is one of the most common complications in pregnancy and is a major cause of maternal and perinatal morbidity and mortality. Early prediction of preeclampsia is crucial in proactive management of the patient. Uric acid is a biomarker of hypertension.

Methods: A prospective study was done on 200 pregnant females in their first or early second trimester of pregnancy and were followed till one week of delivery or termination of pregnancy. After taking socio-demographic details, detailed medical and obstetric history was taken. Blood pressure of the patients was routinely measured and mean arterial pressure was calculated. Blood and saliva samples were taken and were analysed following standard protocol for serum and salivary uric acid levels respectively. Participants were classified into normotensive and preeclampsia groups depending on the criteria met.

Results: Preeclampsia group participants had significantly more adverse and feto-maternal outcomes. Salivary uric acid is a promising diagnostic predictor of preeclampsia in pregnant women by the virtue of being a non-invasive investigation with cut off value 4.86 mg/dl having a sensitivity of 70.8%, specificity of 45.7% and a PPV of 81.3%. Salivary uric acid level and mean arterial pressure were found to be better predictors of preeclampsia as compared to salivary uric acid level.

Conclusions: Salivary uric acid is a reliable predictor of preeclampsia in pregnant females in first and early second trimester of pregnancy. Further largescale studies are warranted to establish an accurate cut off value with good diagnostic properties for Indian population.

Role of IDH as a prognostic marker in preeclampsia/eclampsia: a comparative case control study

2023-02-17T10:50:25+00:00

Background: Preeclampsia is a multisystem disorder which complicates 5-8% of all pregnancies. LDH is an intracellular enzyme and its level is increased in these women due to cellular death. Serum LDH levels can be used to assess the extent of cellular death and thereby the severity of disease in this group of women.

Methods: It was a prospective case control study. Data was analysed using SPSS 16.0. The sample comprised of approximately 154 cases. All patients were of gestational age 28 weeks and above. They were divided into three groups 45 normotensives, 40 mild pre-eclamptics, 41 severe pre-eclamptics and 28 eclamptics.

Results: Serum LDH levels consistently increased with increasing systolic and diastolic blood pressure, more so with diastolic blood pressure with a p value of <0.001. Most of the women with severe preeclampsia and eclampsia had severe proteinuria and serum LDH significantly increased with the severity of proteinuria (p<0.00). The incidence of operative delivery was moderately elevated with increased LDH level. The mean gestational age at the time of delivery in patients with serum LDH less than 600, 600 to 800 and more than 800 are 37.94 35.36 and 33.87 weeks. The mean baby weight in patients with serum LDH less than 600, 600 to 800 and more than 800 was 2.80, 2.62 and 1.81 kg.

Conclusions: Serum LDH values were significantly high in pre-eclamptic patients depending on the severity of the disease. Serum LDH levels had a good correlation with all the diagnostic components of preeclampsia like SBP, DBP and proteinuria, similarly with maternal and fetal morbidity and mortality.

A retrospective observational study on effect of sperm morphology on embryo development after intracytoplasmic sperm injection

2023-02-15T08:55:37+00:00

Background: The process of embryo development requires the contribution of both male and female gametes. However, abnormal sperm development can hinder the fertilization process, leading to infertility. To overcome these male fertility issues, intracytoplasmic sperm injection (ICSI) was developed. This technique has proven to be effective, resulting in about 80% of live births in ICSI cycles.

Methods: It is a retrospective cohort study was conducted in department of reproductive medicine, Komali fertility centre a unit of Dr. Ramesh Cardiac and multispeciality hospital P Ltd, Guntur, Andhra Pradesh, India. The study was conducted during period of January 2022 to December 2022. Total 120 subjects were included based on our inclusion and exclusion criteria.

Results: This study used the chi-square test and Pearson's correlation to evaluate the relationship between sperm morphology and various parameters, revealing that poor sperm morphology may contribute to low fertilization, cleavage, and pregnancy outcomes. Individuals with 3% sperm morphology exhibited higher mean fertility rates and lower negative pregnancy rates compared to those with 2% and 1% morphology, highlighting the importance of good sperm morphology for successful fertilization and pregnancy outcomes.

Conclusions: In summary, the study highlights a strong correlation between sperm morphology, fertilization and cleavage rates, while a weak and no correlation was observed between sperm morphology and pregnancy outcome after ICSI. The findings suggest that an improvement in sperm morphology leads to increased fertilization and cleavage rates.

Total laparoscopic hysterectomy in patients with previous caesarean section: experience at a tertiary care center in India

2023-02-15T10:37:06+00:00

Background: With a surge in the rate of caesarean deliveries, the number of patients undergoing hysterectomy with a previous caesarean section for gynecological complaints has also increased. The presence of intra-abdominal and bladder adhesions to the uterus is the main concern in such cases, resulting in higher complication rates. This study aimed to determine the challenges and complications encountered during TLH in patients with previous caesarean sections.

Methods: We conducted a retrospective study analysing data from the medical records of 243 patients who had undergone TLH for various gynecological conditions in a single tertiary care center from January 2018 to January 2021. Patients were categorized into two groups namely no previous CS (n=193) and previous CS (n=50). The surgical outcomes of those patients including major complications were measured.

Results: The clinical characteristics of the two groups were comparable except for the patient’s age with younger patients in the previous CS group (p=0.001). There was no difference in terms of surgical indications, intraoperative and postoperative complications, and hospital stay between the groups. Operating time was significantly more in the previous CS group (p=0.001). One patient sustained a bladder injury in a previous CS group. The conversion rates to laparotomy in the previous CS and no CS groups were not statistically significant. Significant hemorrhage requiring blood transfusion was noted in two patients (4%) in the previous CS group and one (0.51%) patient in the no CS group (p=0.108).

Conclusions: TLH can be safely performed with lower complication rates by an experienced surgeon in patients with prior history of caesarean section.

Analysis of caesarean sections with the Robson’s ten group classification system

2023-02-16T04:29:08+00:00

Background: Caesarean section rates are increasing globally. For feedback and audit of the caesarean section rate and its optimization in clinical setups worldwide, there was a lack of a classification tool that can be used internationally for which WHO recommended the Robson classification as a tool for monitoring and auditing caesarean delivery rates in 2016.

Methods: All women who underwent caesarean section in our institute were included in our study. Exclusion criteria include all mothers who underwent vaginal delivery in our institute and those women with missing records. The study population included 82 women who underwent caesarean in our hospital during the January 2022 to December 2022 period.

Results: History of previous section was seen in 45 (54.88%) women. Distribution of all deliveries performed during the study period in accordance to Robsons criteria showed majority of women (29.7%) belonged to category 5a and category 10, followed 21 (25.61%) women in category 1. Data did not categorize any women in category 3 and 7. The most common indication for caesarean seen in our study was previous LSCS seen in 39 (47.56%) women.

Conclusions: According to Robsons criteria group 5 and group 10 were the groups found to be majorly contributing the most to the caesarean section in our study. There is a need to evaluate existing management protocols and further studies need to be conducted into the indications of CS and outcomes in our setting are needed to design tailored strategies and improve outcomes.

Efficacy of MgSO4 to prevent eclampsia in women with severe pre-eclampsia and impending eclampsia

2023-02-17T11:05:01+00:00

Background: Preeclampsia is a multi-system disorder that is frequently accompanied by proteinuria and new-onset hypertension. Poor placental perfusion and a general disease process that may affect multiple organ systems are the hallmarks of the syndrome. While eclampsia is a complicated condition brought on by cerebral dysrhythmia due to various pathogenesis steps that include abnormal trophoblastic invasion which led to vasospasm, endothelial dysfunction, and platelet aggregation. Maternal complications of severe preeclampsia/eclampsia can lead to maternal, fetal, and neonatal morbidity and mortality. One of the anticonvulsants MgSO₄ is known to reduce the risk of eclampsia. The present study was conducted with the aim to analyse the effect of MgSO₄ to reduce the incidence of eclampsia in pregnant women with preeclampsia and impending eclampsia.

Methods: A total of 114 women with preeclampsia and impending eclampsia were included in present study. Mgso₄ was given as a loading dose and the Zuspan regimen as required. Women were categorised based on raised blood pressure (>140/90 mmHg), deranged lab parameters which includes renal function tests (urea, uric acid, creatinine), coagulation profile (PT, APTT, INR, LDH, platelet count), liver function tests (total bilirubin, SGOT/SGPT) and clinical symptoms which include headache, blurring of vision, epigastric pain. The incidence of eclampsia even after a dose of MgSO₄ was calculated.

Results: The mean age of the women was 28.17±4.69 years. The diagnosis of pre-eclampsia was made based on systolic and diastolic blood pressure. Out of 114 pregnant women with severe preeclampsia or impending eclampsia who were given a dose of MgSO₄, only 2 women have developed eclampsia.

Conclusions: The incidence of eclampsia after the dose of MgSO₄ among women with preeclampsia or impending eclampsia was reported to be only 1.75% which confirms MgSO₄ therapy as an effective tool in preventing perinatal morbidity and mortality.

Road to fertility: comparison of letrozole and clomiphene citrate-estradiol valerate for ovulation induction in female with unexplained infertility to see ovulation and conception rate

2023-02-18T05:13:09+00:00

Background: Clomiphene citrate was considered as first line of treatment for ovulation and induction in patients with unexplained infertility, but there are differences in results which can be explained by anti-estrogenic effect of CC resulting in estrogen receptor depletion. Letrozole is potent non-steroidal aromatase inhibitor which increases gonadotrophin secretion with ovarian follicle stimulation. Research question was that which drug is more efficacious for ovulation and induction in patients with unexplained infertility.

Methods: This comparative study was conducted at OBGYN OPD of RMCH and RC, Kanpur. Patients were 50 females with unexplained infertility randomly divided into 2 groups. Group A received letrozole 2.5 mg from D3-D7 of menstruation. Group B received CC 50 mg from D3-D7 plus 2 mg estradiol valerate BD on D8-D14 of menstruation. Female aged 18-35 years with complete fertility workup i.e. D3 FSH, LH, prolactin, serum TSH, HSG, USG-pelvis, mid luteal phase progesterone, semen analysis within normal limits are included in study. Patients with male infertility, hyperprolactinemia, thyroid disorders and BMI>30 kg/m² were excluded.

Results: There was statistically significant difference in endometrial thickness (ET) between two groups, (p value <0.03) as mean ET was 9.3±1.7 in group A (L) and 8.3±1.5 in group B (CC+E). The number of follicles after stimulation were better with CC+E 2.9±1.1 and L 2.1±1.2 showing statistically significant difference with p value <0.01 but clinical pregnancy rate was higher with letrozole as compared to CC-E without statistically significant difference.

Conclusions: Letrozole has better effect on endometrial thickness with statistically significant difference. CC+E had advantage towards multifollicular development with statistically significant difference, but there was no significant difference in case of clinical pregnancy rate, abortion, ectopic, multiple gestation.

Evaluate the effect of maternal obesity on fetal outcome: an observational study in tertiary health care centre

2023-02-17T14:55:26+00:00

Background: Excess weight gain during transitional period leads to an adolescent girl at increased risk of maintaining unhealthy levels of body fat in childbearing years. Prevalence of obesity increases among reproductive age group female and so in pregnant women also with current estimate 20 to 36%. Obesity during pregnancy affects its outcome. It puts mother as well as fetus into complication. Objectives were to find out the effect of obesity on fetal outcome and to study the demographic profile of obese women.

Methods: This observational cross-sectional study was conducted during January 2021 to April 2021 for four months in department of obstetrics and gynecology. As per convenient sampling technique 50 women were enrolled as study participants. Data regarding fetal outcome were collected like baby weight, NICU admission, indications for NICU and its outcome. Percentage was used to analyze data.

Results: The 16% newborn was having birth weight more than 3.5 kg. 26% new borne were needed NICU admission due to complications like fetal distress, jaundice, prematurity, IUGR, septicemia etc.

Conclusions: maternal obesity affects fetal outcome and also one of the risk factor for maternal complications. Pregnancy with high BMI is high risk pregnancy; these should be managed at tertiary health care center with well-equipped HDU and neonatal intensive care unit.

Addition of gonadotropin releasing hormone antagonist for women undergoing intrauterine insemination: a randomized controlled trial

2023-02-18T06:01:49+00:00

Background: Intrauterine insemination (IUI) is a widely acceptable fertility treatment modality. GnRH antagonists have been proven effective in restricting the LH surge. The aim of the study was to assess whether the addition of gonadotropin releasing hormone antagonist (Cetrorelix) would improve clinical pregnancy rate in women undergoing IUI.

Methods: This prospective randomized controlled trial was conducted at a Sudha fertility center where 730 women with primary or secondary infertility were subjected to controlled ovarian stimulation with tablet letrozole 5mg once daily for 5 days and then human menopausal gonadotrophins 75 IU/150 IU administered intramuscularly for both the groups and for study group alone Cetrorelix (0.25 mg/day, started when the leading follicle was ≥16 mm; GnRH antagonist) was given additionally. A double insemination was performed at 36 hours and 60 hours after hCG was given (5,000 IU, intramuscularly) in both groups. Chi-square and independent t test was done.

Results: Baseline characteristics in both the groups were almost equal without any statistically significant difference. Significant difference (p=0.017) was found on calculating with statistics among both groups on analyzing LH on hCG day. Clinical pregnancy rates (29.3%) were higher among the study group compared with the control group (21.7%).

Conclusions: From the present study results it shows that addition of GnRH antagonists to controlled ovarian stimulation IUI significantly decreases the incidence of premature luteinization and increases the clinical pregnancy rates and live birth rate.

Role of hysteroscopy and transvaginal sonography and its correlation with histopathological examination in perimenopausal abnormal uterine bleeding

2023-02-21T13:21:34+00:00

Background: Abnormal uterine bleeding is any abnormal uterine bleeding outside normal volume, duration, regularity or frequency. Transvaginal sonography allows detailed assessment of anatomical abnormalities of the uterus and endometrium pathologies of the myometrium. Visual assessment can be done by hysteroscopy and cellular assessment by histopathology.

Methods: This descriptive prospective cross-sectional study was conducted in Rama medical college hospital & research centre, Kanpur. 103 Perimenopausal women of 40-45 years of age with AUB attending gynecology OPD of RMCH were included. Particulars of woman regarding menstrual history, obstetric history were asked for. Systemic examination, gynaecological examination and Specific investigations like TVS, Hysteroscopy were also done.

Results: The mean ET by TVS for endometrial hyperplasia >15.59±6.22mm, uterine leiomyomas >13.5±2.12 mm, normal endometrium >7.57±3.28 mm and polyp >10.17±3.55 mm. The endometrium- normal on TVS 73 women (70.88%) followed by endometrial hyperplasia 22 women (21.36%), Uterine polyp 6 (5.82%) and Uterine leiomyoma 2 women (1.94%).

Conclusions: Causes of AUB- hormonal imbalance, endometrial polyp, endometrial hyperplasia, and leiomyomas were other causes of AUB in perimenopausal women. Hysteroscopy can detect endometrial pathology with varying accuracy which was better than TVS in detecting endometrial pathology. In the present study more than 50% women had normal findings on TVS and hysteroscopy.

Comparison study of metformin versus insulin in the treatment of gestational diabetes during pregnancy

2023-02-21T05:57:30+00:00

Background: Gestational diabetes was traditionally treated with insulin. Metformin is a peroral drug used worldwide in the treatment of type 2 diabetes and also in a few studies on patients with gestational diabetes. This study aimed to analyze and compare insulin and metformin in the treatment of gestational diabetes and to compare their effects on the pregnancy outcomes.

Method: This comparative prospective observational study was conducted at Deen Dayal Upadhyay Hospital, New Delhi, a tertiary care teaching hospital. The data was collected over a period of 15 months (April 2021 till June 2022). So pregnant females in the age group 18-45 years with 20-30 weeks period of gestation, are diagnosed with gestational diabetes as per the diabetes in pregnancy India (DIPSI). The study group was divided into 2 groups of 40 each, one receiving oral metformin and the other group receiving insulin for treatment.

Results: Metformin was found to be a better drug in controlling blood sugars vis a vis insulin in our study. GDM patients controlled on insulin were found to be associated with; higher weight gain, higher incidence of neonatal hypoglycemia, hyperinsulinemia and higher and longer ICU admission

Conclusions: Metformin was better in controlling blood sugar in GDM than insulin, with better neonatal outcome.

Fetal and maternal outcome of severe pre-eclampsia remote from term: expectant versus interventional management

2023-02-21T14:17:10+00:00

Background: This study was conducted to compare the safety and effect on maternal and perinatal outcome of expectant versus interventional management in women with preterm severe preeclampsia with gestational age between 28 to 34 weeks.

Methods: This was a non-blinded prospective analytical study carried out in the department of obstetrics and gynaecology, SSG hospital, Vadodara from January 2021-December 2021. 40 women diagnosed with severe pre-eclampsia remote from term meeting the inclusion criteria were divided in two groups (20 in each). First group comprised of women undergoing interventional management i.e. prompt delivery and the second group comprised of women undergoing expectant management till 34 completed weeks. The women in the expectant management underwent pregnancy termination before 34 weeks if any complication arises (e.g. anhydramnios, abruption, eclampsia etc).

Results: The mean prolongation of pregnancy in the expectant management group was 11.45 days (range: 4-35 days). There was no increase in incidence of maternal complications (p value: 0.003). The fetal outcome was favourable in the expectant management group in terms of higher gestational age at delivery (33 versus 31 weeks; p value: 0.001), higher birth weight (1.7 versus 1.5 kg; p value: 0.05), higher APGAR score at 1 minute (7.5 versus 7; p value :0.05), lesser incidence of neonatal complications (55% versus 95%; p value 0.003).

Conclusions: Considering the results of this study, it can be concluded that expectant management is recommended in patients with severe preeclampsia remote from term with intensive monitoring.

Trends in maternal mortality in a tertiary hospital in West Delhi

2023-02-22T17:19:38+00:00

Background: Aim of current study was to find out incidence, causes and complications leading to maternal deaths in a tertiary care hospital and possible prevention of maternal deaths.

Methods: Individual records of all maternal deaths over a period of five years from January 2006 to December 2010 were studied and causes of death and avoidable factors in each case were studied.

Results: Major causes of maternal deaths were same throughout the study. The causes of maternal deaths were Hemorrhage (19.21%), Sepsis (15.76%), PIH (12.80%), Jaundice (8.37%). Direct obstetric causes contributed to 65.51% of cases. Indirect causes of maternal death contributed to 45.81%. Anemia alone accounted for 26.1% deaths. Maternal Mortality Ratio (MMR) was 362.57/100000 live births. There were 31.03% referred cases and 44.8% cases were admitted to ICU. Unbooked cases accounted for 84.72% of maternal deaths and these were mostly uneducated.

Conclusions: Interventions for reduction of MMR are regular antenatal care, risk screening, skilled personnel at childbirth, good transport facilities, family planning services and safe abortion services. These facilities not only reduce burden on tertiary hospitals but also help in improving maternal prognosis.

Clinicopathological correlation of abnormal uterine bleeding according to PALM-COEIN classification in reproductive age group in a tertiary care center, North India

2023-02-23T09:02:26+00:00

Background: AUB is a common problem encountered by women of reproductive age group with increased risk during perimenopausal period. International Federation of Gynecology and Obstetrics (FIGO) has designed a new classification system PALM-COEIN in order to standardize the causes of AUB. Aims and Objectives were to stratify causes of AUB in women of reproductive age group in context to PALM-COEIN classification system. To establish a clinico-pathological correlation among causes of AUB taking aid of radiology wherever required.

Methods: All women of reproductive age group presenting with complaints of AUB in department of gynecology from January 2018 to December 2021 were included in the study. The cause were classified based on PALM-COEIN classification both clinically and histopathologically. Radiological investigation was carried out wherever required.

Results: Total 560 women of reproductive age group were registered. Majority 321 (57.32%) women were between 41-50 years of age and commonest complaint was heavy menstrual bleeding in 401 (71.60%). PALM and COEIN groups accounted for 40% and 60% respectively. Among structural causes, leiomyoma was the commonest cause 153 (27.32%) of AUB whereas among the functional causes most common was endometrial 188 (33.57%). The clinico-histopathological correlation was statistically significant in cases of AUB-P, AUB-A, AUB-O and AUB-E.

Conclusions: The PALM-COEIN classification system helps to understand the causes of AUB and gives simpler terminology, diagnosis and investigations of the causes of AUB and offers better patient management. It can provide better means of quality assurance and appropriateness of treatment.

Advanced maternal age: maternal and perinatal outcomes

2023-02-24T11:38:14+00:00

Background: Advanced maternal age is significantly associated with adverse obstetrical outcomes like pregnancy-induced hypertension and preterm Delivery. Caesarean delivery is also increased in those mothers. Advanced maternal age pregnancy was also found to be a major risk factor for low birth-weight and perinatal death.

Methods: A hospital based observational study was conducted with 100 patients on attending antenatal-OPD patients at K. J. Somaiya Medical College and Research centre to evaluate the risks involved with advanced maternal age, the obstetric performance with neonatal outcomes of elderly gravidas aged 33 years or older.

Results: The most common maternal complication was gestational diabetes mellitus (16%), pregnancy induced hypertension (13%), pre-eclampsia (11%), malpresentation (8%), oligohydramnios (6%), placenta previa (2%) and post-partum haemorrhage (2%). Caesarean Section in 39% cases and vaginal delivery in 61% cases. (78%) were term deliveries, (22%) were preterm deliveries. (9%) neonates were very low birth weight [<1.5 kg, (34%) neonates were low birth weight (1.5-2.5 kg)] (36%) and (21%) neonates were in the range of 2.6-2.9 kg and ≥3 kg respectively.

Conclusions: Advanced maternal age is significantly associated with adverse obstetrical outcomes like pregnancy-induced hypertension and preterm delivery. Caesarean delivery was increased in those mothers. Advanced maternal age pregnancy was found to be a major risk factor for low birth-weight, perinatal death. Therefore, it is better for health care providers to counsel couples, who seek to have a child in their later ages, about the risks of advanced maternal age pregnancy.

Gender identity disorder: role of the gynecologist

2023-01-27T07:05:55+00:00

Gender dysphoria refers to distress that is caused by a sense of incongruity between an individual's self-identified gender and natal sex. Over 1.4 million adults are identified as transgender. Transpatients face many barriers when it comes to basic health needs including education, housing, and health care. Because of these barriers, many patients do not receive proper health care that they need. Additionally, because of certain high-risk behaviours as well as long-term hormonal therapy, transpatients have different routine health care needs that should be addressed in the primary care setting. Diagnosis is made in accordance with the diagnostic and statistical manual of mental disorders and treatment first involves psychiatric therapy, which can help determine a patient's true goals in regards to achieving gender identity. Patients who wish to undergo transition to the opposite sex must undergo a supervised real-life test and often are treated with hormonal therapy to develop physical characteristics consistent with their gender identity. Many of these individuals have undergone, or plan to undergo, gender-affirming surgery. While not all gender-affirming surgeries are provided by obstetricians and gynecologists (OBGYNs). It is a multi-disciplinary team which involves psychiatrist, endocrinologist, gynecologist and plastic surgeon. OBGYNs are uniquely skilled to perform certain gender-affirming surgeries such as hysterectomies, bilateral oophorectomies. In this case report we discuss the medical and surgical options available for the transgender population. In addition, it also highlights the role of gynecologists in having care for this population, and should be knowledgeable about the general principles of transgender health.