bluuebunny/crossref_metadata_2025 huggingface dataset:
Analysis of obstetrics hysterectomy in tertiary care centre
Authors: Ahirwar Neetu , Wadhwani Rekha
Published: May 2018

Background: Emergency peripartum hysterectomy (EPH) is an uncommon obstetric procedure, usually performed as a life-saving measure in cases of intractable obstetric hemorrhage. Obstetrics hysterectomy is performed on gravid uterus during pregnancy labor puerperium. It is a catastrophic inevitable lifesaving emergency procedure in cases of rupture uterus, uncontrollable post-partum haemorrhage, morbidly adherent placenta, and some cases of trauma, sever infection of pregnant uterus. Newer drug like prostaglandins, antibiotics and blood transfusion has brought down the incidence of obstetric hysterectomy.Methods: This retrospective study is performed in department of obstetrics and gynaecology SZH Gandhi medical college Bhopal. Retrospective analysis of record done.Results: In this study there were 51867 deliveries and 99 0bstetric hysterectomy giving the incidence as 1 in 524 deliveries. There were 17113 cesarean section performed hence the incidence as 1 in 173 cesaren section. Majority of patient belong to group para 4 and above i.e. 32.32%. Least incidence is among nullipara patient i.e. 2.02%. The most common indication of obstetric hysterectomy in this study was morbidly adherent placenta, 52 cases i.e. 52.52%% Rupture uterus was second common indication accounting for 36.36% of cases. Most common additional surgical procedure done during obstetric hysterectomy was repair of bladder tear and salpingoophrectomy done in 7 cases i.e. 7.07% of each. Repair of bowel injury done in 1 case i.e. 1.01%.Conclusions: Incidence of maternal mortality in cases of obstetric hysterectomy was 9.09%. most common cause of maternal mortality was haemorrhagic shock accounting for 55.55.
Trend of caesarean section at two Government Medical College in Madhya Pradesh, India over one year of time period: a retrospective comparative study
Authors: Mathur Poonam , Patel Alka
Published: May 2018

Background: There is a massive public interest and debate on both the cause and appropriateness of increasingly employing a surgical procedure to short circuit or entirely bypass labour and delivery. The indications of caesarean sections vary among institutions as there is no standard classification system exists for indications of C-Section. Present study analysed pattern of caesarean section at two tertiary centre in Madhya Pradesh, India.Methods: A structured proforma was filled up for every case and results were recorded on excel sheet. All the cases included in study were further divided in group 1 (deliveries conducted in year 2014-2015 at Govt. Medical College Indore, M.P.), group 2 (deliveries conducted at Govt. Medical College Rewa at same time. Comparative analysis between study group1 and group 2 was done using Pearson Chi square test.Results: In group 1 there were 10525 deliveries out of which 3705 were delivered by caesarean section (35.2%), in group 2 there were 8674 deliveries out of which 1182 were delivered by caesarean section (13.6%). This difference in caesarean section at both medical college may be due to the more no. of referrals from the periphery to the medical college Indore and having more no of private institutions and district hospital which cater the normal delivery.Conclusions: There is a reliable and reproducible framework is required for audit and analysis of Caesarean section trends in specific obstetric subgroups to permit comparisons of practice between different institutions and over time in the same institution.
The predictors of post-partum depression in a tertiary centre
Authors: Unnisa Sadiq , Lavanya Poluri Seetha
Published: May 2018

Background: The present study was undertaken to evaluate the association of different socio-demographic, obstetric and pregnancy outcome as predictor of PPD among the postnatal women during early puerperium and thus can be provided with special care. Objective was to evaluate the different predictors of post partum depression.Methods: A prospective study was conducted in the department of obstetrics and gynaecology, Yenepoya medical college hospital Mangalore. A total of 200 postnatal mothers in their 3rd - 7th postpartum day were interrogated using Edinburgh postnatal depression scale (EPDS). Socio-demographic factors like age, parity, literary, socio economic status, family structure, obstetric outcome was recorded. Results were statistically analyzed with chi-square test.Results: A prospective study was conducted in the Department of Obstetrics and Gynaecology, Yenepoya Medical College Hospital, Mangalore. A total of 200 postnatal mothers in their 3rd - 7th postpartum day were interrogated using Edinburgh postnatal depression scale (EPDS). Socio-demographic factors like age, parity, literary, socio economic status, family structure, obstetric outcome was recorded. Results were statistically analyzed with chi-square test.Conclusions: Risk of PPD is more with the birth of a female baby, women who had CS, low S.E status, unemployment could predict higher risk for PPD. PPD screening should be an integral part of postnatal care using E PDS routinely. A multidisciplinary approach including obstetrician and psychiatrists can be jointly care of the depressed mothers.
Prevalence of vitamin D deficiency in Indian women
Authors: Garg Ruchika , Agarwal Vishy , Agarwal Prabhat , Singh Saroj , Malhotra Neharika
Published: May 2018

Background: Vitamin D is the widespread nutritional deficiency in India yet it has been widely undiagnosed and untreated. Nowadays its deficiency has become the widely investigational topic as the role of vitamin D deficiency has been identified in various disorders.Methods: In order to study the prevalence of vitamin d in our study (level <20 ng/ml) the 1052 women attending the clinic are taken into the consideration and the levels of vitamin d are done in them irrespective of the symptom.Results: In our study the 1052 women attending the clinic were taken and it was found that the prevalence of vitamin D level <20 ng/ml was 64.06% and the level of vitamin D <30 ng/ml was 98.75% and it was higher in younger (65.51%), illiterate (89.92%), housewife women (70%) and its prevalence was higher in women residing in rural areas (69.94%) and also having an income <10,000 (61.96%).Conclusions: Thus it was concluded the cut off level for the vitamin D deficiency level should be revised in according to the need of the people of India as the high prevalence of vitamin D deficiency in our study could be the result of our being over concerned and the internationally set up criteria for its deficiency and also ICMR should also revise the recommend daily allowance to include daily recommendation of vitamin D level.
Cesarean scar pregnancy: an upcoming challenge
Authors: Juneja Sunil K. , Tandon Pooja , . Bhanupriya
Published: May 2018

Background: Cesarean scar pregnancy (CSP) is a type of ectopic pregnancy implanted in the myometrium at the site of previous cesarean scar. Incidence of cesarean deliveries are increasing globally, leading to rise in incidence of cesarean scar pregnancy. Caesarean scar pregnancies are associated with some life-threatening complications such as scar rupture, haemorrhage, disseminated intravascular coagulation, requiring lifesaving hysterectomy. We present our experience with 11 patients with cesarean scar pregnancy, diagnosed using transvaginal colour doppler ultrasound during 3-year period and treated conservatively to preserve the uterus with successful outcome in all patients.Methods: This was a retrospective study, conducted in the Department of Obstetrics and Gynecology of DMC&H, Ludhiana from January 2015 to December 2017. Out of total deliveries (4278), 3.9% (171/4278) were diagnosed as ectopic pregnancy. 6.43% (11/171) of them were diagnosed as cesarean scar ectopic pregnancy. After counseling, all patients underwent conservative management. Injection methotrexate 50mg was administered intramuscularly and beta- HCG was monitored after 4 days and then weekly till it was <1.Results: 2 patients had an increase in beta HCG levels on day 7 and required second dose of methotraxate. 8 patients required blood transfusion due to excessive bleeding on admission. In 9 patients beta HCG levels reduced to <1 in 7 weeks post first methotraxate dose administration, and in remaining 3 it returned to <1 after 8 weeks . No patient required any surgical intervention.Conclusions: Cesarean scar pregnancy, a type of ectopic pregnancy can be safely managed conservatively if diagnosed early.
Prevalence of voiding and defecatory dysfunction in postmenopausal women with pelvic organ prolapse: a prospective observational study
Authors: Saravanan Nanthini , Ebenezer Emily Divya , Londhe Vaibhav , Varghese Lilly , Kekre Aruna N. , Jeyaseelan Vishalakshi , Kekre Nitin
Published: May 2018

Background: Primary objective of this work was to study the prevalence of voiding and defecatory dysfunction in women with pelvic organ prolapse and correlate the stage and compartment of prolapse with voiding and defecatory dysfunction. The secondary objective was to correlate stage of prolapse with flow rate and post void residue and to study the voiding dysfunction in pelvic organ prolapse.Methods: A prospective observational cohort study in 120 post-menopausal women scheduled for vaginal hysterectomy pelvic floor repair. Short form of pelvic floor distress inventory (PFDI-20) and International prostate symptom questionnaire I-PSS score for Lower urinary tract symptoms (LUTS)was employed.Results: The prevalence of voiding dysfunction in this study was 78% and defecatory dysfunction was 77%. Higher stage of prolapse had significant correlation with voiding dysfunction. (P value was 0.028). Women with posterior compartment defect had more voiding dysfunction with the significant P value (p value was 0.04). Pre-operative voiding dysfunction resolved post operatively in 86%, the p<0.000 which was highly significant.Conclusions: Women with pelvic organ prolapse had high prevalence of voiding and defecatory dysfunction. Stages of prolapse have positive correlation with voiding dysfunction. Pre-operative voiding dysfunction resolved after vaginal hysterectomy and pelvic floor repair.
Combination of mifepristone and misopristol in early fetal demise
Authors: Dhillon Atmajit Singh , Dhillon Karminder Kaur
Published: May 2018

Background: Generally misopristol alone is used in cases of early fetal demise successfully. However to further enhance the success rate a combination of mifepristone along with misopristol can be used. This results in avoiding anesthesia, surgery and operating theater resources, thus being economically viable and results in an overall greater patient satisfaction levels also. Globally, there is a general trend to grant patient greater autonomy in their treatment plan, minimize intervention levels, shorter hospital stay and quicker return to normal schedule and enhanced patient satisfaction levels.Methods: 100 patients with early fetal demise, who reported to a tertiary care service hospital were prospectively evaluated. An oral dose of mifepristone 200 mg stat and 48 hours later misoprostol 800 μg was inserted vaginally. Three hours following the first dose, two further doses of 400 μg misoprostol, was administered vaginally at 3 hours intervals. Repeat medical regime was offered with misoprostol patients who failed to pass products of conception. Success was defined as complete uterine evacuation within 3 days, without the need for surgical evacuation.Results: The overall success rate of medical management was 84%. Mifepristone alone induced natural expulsion of products of conception in (40%) patients complained of heavy bleeding within 48 hours of mifepristone administration alone and in 29 (29%) patients complete miscarriage was confirmed on ultrasound scan. Of the 68 women who were symptomatic at presentation the medical regime failed in 28 (41%), compared with five (16%) failures of the 32 who were asymptomatic. Of the 25 women who had surgical evacuation, eight required an emergency curettage for bleeding.Conclusions: Combination of oral mifepristone along with vaginal misopristol is a simple, safe and effective means of treating early fetal demise, and is an effective alternative method to expectant and surgical options.
Vitamin E in the treatment of primary dysmenorrhoea
Authors: S. Vilvapriya , S. Vinodhini
Published: May 2018

Background: The objective of this study is to determine the efficacy of Vitamin E in the treatment of primary dysmenorrhoea compared to the placebo.Methods: Sixty women, aged 17-25 years old who suffered from primary dysmenorrhoea, among 1000 Women attending the gynec OPD in Kilpauk Medical College. 30 women were given 200 units of vitamin E (each tablet twice daily) and 30 were given a placebo tablets (each tablet twice daily). The treatment began two days before the beginning of menstruation and continued through the first three days of bleeding. The severity of pain and duration of pain before and after the treatment was studied. Treatment in both groups was carried out in three consecutive menstrual periods.Results: As to the findings, the mean age of the participants was 22.6 years. There was a significant difference between the pre- and post-treatment periods in terms of pain severity (P=0.72 and P=0.002, respectively) and pain duration (P=0.514 and P=0.027, respectively) in Vitamin E group. There was a significant difference observed between the Vitamin E group and placebo group regarding the mean of pain severity and duration (P=0.002 and p=0.027 respectively).Conclusions: Vitamin E helps to relieve pain in primary dysmenorrhoea. As this is a relatively easier method for control of pain with lesser amount of side effects and as it is cost effective, it can be considered as a universal drug in the treatment of primary dysmenorrhoea.
Early onset and late onset preeclampsia-maternal and perinatal outcomes in a rural teritiary health center
Authors: E. Gomathy , Akurati Lahari , Radhika Kondareddy
Published: May 2018

Background: Preeclampsia is main cause of morbidity and mortality both mother and fetus. Preeclampsia occurs in 10-17% of pregnancies. Preeclampsia was divided into early onset preeclampsia is occur at less <34 weeks of gestation age and late onset preeclampsia is occur at >34 weeks of gestation age. Early and late onset preeclampsia have different etiology and should be considered as different disease as there are difference in clinical manifestation, maternal and perinatal outcome, prognosis and complication.Methods: An analytic observational study involving retrospective data done at RL Jalappa Hospital, Sri Devaraj Urs Medical College, Kolar. 217 women with singleton pregnancies with Pre eclampsia who were admitted and delivered in our hospital between June 2016 and May 2017 were recruited for this retrospective study.Results: The results showed that the incidence of EOPE (27.6%) was lower than LOPE (72.4%). Diastolic blood pressure is significantly higher in EOPE compared to LOPE. Complications in perinatal outcomes such as low birth weight (<2500 gram) are more in EOPE (98.3%) compared to LOPE (45.2%) and asphyxia is more on EOPE (11.7%) compared to LOPE (1.3%). Stillbirth in EOPE (15%) is more than LOPE group (3.2%).Conclusions: It is observed that EOPE incidence rate is lower than LOPE. Maternal and perinatal complications are greater in the EOPE group.
Comparative study of peri-operative outcome following laparotomy versus laparoscopic technique of abdominal hysterectomy for benign gynaecological lesions
Authors: Gavhane Satyajit P. , Bhavsar Dhruval K. , Bangal Vidyadhar B. , Gagare Swati D. , Kodlikeri Amey R.
Published: May 2018

Background: Laparoscopic technique of hysterectomy is becoming increasingly popular in developing and developed world. Laparoscopic hysterectomy is a minimal access procedure that allows patients to recover faster. The study was undertaken to assess the impact of two abdominal techniques (laparoscopic and conventional laparotomy) on various variables like operative time, hospital stay, complications and convalescence period.Methods: An observational longitudinal study was carried out at tertiary care centre. Two hundred and ten women, as per inclusion and exclusion criteria, who had undergone abdominal hysterectomy for benign uterine pathology, either by laparotomy (Group A) or by laparoscopic technique (Group B) during study period were included. Data was analyzed and compared by using different variables between two methods of hysterectomy, using percentages and Chi square test for normal distribution. P value less than 0.05 was considered significant.Results: The mean duration of surgery was 100 minutes in group A and 175 minutes in Group B. There were two cases (1.90%) of minor injury to urinary bladder in Group A and one case (0.95%) of thermal injury to urinary bladder in Group B. The mean blood loss was around 240 ml and 70 ml in Group A and B respectively. The need for postoperative analgesia was observed in 100% cases from Group A and 38.09% from group B. The average duration required for out of bed ambulation was 25 hours and 14 hours in Group A and B respectively. The mean hospital stay in group A and B was 7.5 days and 3.5 days respectively.Conclusions: Following laparoscopic hysterectomy, women had less morbidity, less need for post-operative pain relief, had early ambulation, short hospital stay and early resumption of routine activities at home as compared to women who had undergone abdominal hysterectomy by conventional method.
Condom tamponade in the management of atonic postpartum hemorrhage
Authors: Santhanam Ramya , Viswanathan Radhamani Mavunkal , V. Priya
Published: May 2018

Background: Postpartum hemorrhage (PPH) remains a leading direct cause of maternal death in both developed and developing countries. Millennium development goal of reducing maternal mortality rate cannot be achieved unless the prevention and treatment of PPH is prioritized. Objectives of the study were to study the efficacy of condom tamponade to arrest bleeding in cases of atonic PPH unresponsive to uterotonics.Methods: Prospective study conducted in the Kottayam Medical College where mothers who develop atonic PPH following childbirth unresponsive to uterotonics (after ruling out traumatic PPH) were included in study. Condom tamponade was applied in them and inflated with normal saline until the bleeding stops. Intrauterine drain was fitted with this to find out ongoing bleeding with tamponade in situ. The Condom tamponade was kept for 12-24 hrs and gradually deflated when bleeding ceased. Outcome measures were (1) Ability of condom catheter to stop bleeding; (2) Cases requiring further intervention; (3) Time required to stop bleeding and (4) Subsequent morbidity in terms of infection.Results: Of the 487 cases of atonic PPH, 61 required condom tamponade; bleeding controlled in 59 cases (96.7%); two patients (3.3%) needed further surgical intervention. No cases of maternal mortality due to PPH. No clinical evidence of intrauterine infection.Conclusions: The hydrostatic condom tamponade controls PPH quickly and effectively. It is simple, inexpensive, easily available, needs less expertise and life saving. Any healthcare provider may use this procedure as a timely measure to save the life of patients especially during referral to decrease ongoing loss.
Two year review of maternal mortality at a tertiary care hospital of GMERS, Valsad, Gujarat, India
Authors: Patel Darshna M. , Patel Mahesh M. , Salat Vandita K.
Published: May 2018

Background: According to the WHO, 80 of maternal deaths in developing countries are due to direct maternal causes such as haemorrhage, hypertensive disorders and sepsis. These deaths are largely preventable. Maternal mortality ratio (MMR) in India is 167/100,000 live births.Methods: This retrospective observational study was conducted at GMERS, Valsad. Data regarding maternal deaths from January 2016 to December 2017 were collected and analyzed with respect to epidemiological parameters. The number of live births in the same period was obtained from the labour ward ragister. Maternal mortality rate and Mean maternal mortality ratio for the study period was calculated.Results: The mean Maternal mortality rate in the study period was 413.3/100,000 births. The maternal mortality ratio (MMR) in India is 167/100,000 live births. More than half of maternal deaths were reported in multiparous patients. More maternal deaths were observed in women from rural areas (67.3%), unbooked patients (73.3%) and illiterate women (65.3%). Thirty six (69.3%) maternal death occurred during postpartum period. Most common delay was first delay (60.0%) followed by second delay (40.0%). Postpartum haemorrhage (28.8%), preeclampsia (17.3%), sepsis (13.46%) were the major direct causes of maternal deaths. Indirect causes accounted for one third of maternal deaths in our study. Anemia, hepatitis and heart disease were responsible for 13.4%, 5.7%, and 1.9% of maternal deaths, respectively.Conclusions: Majority of maternal deaths are observed in patients from rural areas, unbooked, and illiterate patients. Hemorrhage, eclampsia and sepsis are leading causes of maternal deaths. Most of these maternal deaths are preventable if patients are given appropriate treatment at periphery and timely referred to higher centers.
The role of modified biophysical profile in predicting perinatal outcome in high risk pregnancies
Authors: Borade Jankidevi S. , Sharma Sushma P.
Published: May 2018

Background: The goal of antepartum fetal surveillance is early identification of the compromised fetus and timely intervention when the fetus is at risk, but still in an uncompromised state. Modified Biophysical Profile (MBPP) includes Amniotic Fluid Index (AFI) and non stress test (NST). AFI is a marker of long term placental function and NST is a marker of short term fetal condition. The aim of this study is to assess the role of Modified Biophysical Profile in high risk pregnancies and assess perinatal outcome and to study the impact of NST and AFI individually in high risk pregnancies.Methods: 100 ANC patients with high risk factors were evaluated with modified biophysical profile 37 week onwards with non stress test (NST) for 20 mins and amniotic fluid index (AFI) with 4 quadrant technique. High risk pregnancies include preeclampsia, IUGR, oligohydramnios, postdated pregnancy, etc. and various parameters were assessed to determine perinatal and maternal morbidity. All parameters were statistically analyzed.Results: The above study states that need for LSCS, intrapartum fetal distress, meconium stained liquor, APGAR score, need for neonatal resuscitation and perinatal morbidity were definitely higher in cases with abnormal MBPP.Conclusions: Thus MBPP is an easy, cost effective and time saving measure and hence can be used as a primary antepartum fetal surveillance test to predict perinatal outcome and provide timely intervention in high risk pregnancies.
A prospective, parallel group, open label, observational study to compare efficacy and feto-maternal outcomes in treatment of pregnancy induced hypertensive patients
Authors: Afreen Shaistha , A. Rishtha , P. Swathi , Nasreen Atiya Tara , Goud Surya Aditya , Tabassum Khaleequa , Nadeem Md. Tarique
Published: May 2018

Background: Pregnancy induced  hypertension (PIH) is defined as  elevation in blood pressure 140/90 mmHg or greater after 20 weeks of gestation  on two occasions more than 4 hours apart in a newly diagnosed patients. Complications of pregnancy are the major health problems leading to maternal and perinatal mortality and morbidity. Some anti-hypertensive drugs are commonly used to control hypertension.Methods: A prospective, parallel group, open label observation study was carried out at SVS Medical Hospital, Mahabubnagar. Patients were divided into three groups based on severity of hypertension and the drug used for treatment.Results: Of 120 patients diagnosed with PIH majority (50%) of women were in the age group of 21-24 years with 33-37 gestational age. In the present study there was a significant reduction in BP after the treatment with Labetalol when compare to Nifedepine and Methyldopa. Although, all the three groups have shown significant reduction in BP during 24 hrs treatments and the mean time to achieve target BP was shown less in Labetalol group when compare to Methyldopa and Nifedepine and the maximum doses required to achieve target BP was in between 4-6 doses/day. 40% of complication observed was HELLP syndrome.Conclusions: Our study coincides with the previous findings that labetolol is an efficacious and safer drug for use in control of PIH and mean time required to achieve target BP is low when compared to nifedipne and methyldopa.
Feto-maternal outcomes following caesarean section: a prospective comparative study at tertiary care centre in North-Western Rajasthan
Authors: Kuntal Neha , Bhat Madhu Patni , Nimawat Amit , Yadav Munmun , Verma Mahendra Kumar
Published: May 2018

Background: Caesarean section (CS) is employed when vaginal delivery is not feasible or hazardous to the mother and/or her baby. The procedure, however, is not without risk. We determined the fetomaternal outcomes of CS conducted at P.B.M Tertiary hospital situated in the North-Western region of Rajasthan.Methods: This is a Hospital based prospective comparative study of all CSs performed for various indications at the Dept. of Gynaecology and Obst., S.P. Medical College and P.B.M Hospital, Bikaner, India, from August 01, 2016, to July 31, 2017. All patients who had CS at any time within the 24 h period were noted and followed up until discharge. The sociodemographic data, types of CS, indications, and feto-maternal outcomes were documented in a proforma. Statistical analysis was carried out using the SPSS version 24.Results: There were 16386 deliveries out of which 4456 (27.1%) were by LSCS. The age range of the group A was 21-25 years while in group B it was 26-30 years. The mean age group A was 22.4, and group B it was 27.9 years. Total 6572 primigravida patients delivered and 32.1% had LSCS. Total 9814 multigravida patients delivered and 12.6% had primary LSCS. In group A, 119(79.3%) LSCS were elective as compared to group B where only 19(12.7%) were elective and this difference was found statistically highly significant (p<0.001). Indication of LSCS is different in both the groups. Fetal distress was most common indication in group A (53.3%) while in group B most common indication was APH (35.9%). Perinatal mortality/morbidity was significantly higher in group B (7.3%) as compared to group A (2.7%).Conclusions: The CS rate in this study was 27.1%. Although primary caesarean section in multipara constitutes only a small percentage of total deliveries and caesarean, they are associated with high maternal and perinatal morbidity. The reason for these complications is many. Beside obstetrical causes, factors like lack of antenatal care, low socioeconomic status, anaemia, malnutrition and illiteracy also play a major role obstructed labor and previous CS among Maternal and perinatal complications were more frequent with emergency CS and in the referred cases.
Assessment of incidence of post-operative wound infection in women undergoing caesarean section: a retrospective study
Authors: Sangavi Radha , K. S. Rajkumari
Published: May 2018

Background: The surgical site infection is the second most common infectious complication occurring after caesarean section. Infections occurring after caesarean section represent a considerable burden to the healthcare systems and preventing these complications is a priority of healthcare systems especially in developing countries. The aim of this study was to determine the incidence of SSI in patients undergoing a LSCS at a RIMS teaching hospital, Raichur, and to identify risk factors, common bacterial pathogens and antibiotic sensitivity.Methods: The present retrospective study was conducted in RIMS Institute, during a period of 3 years i.e. from 2013-2016. In this study a total of 50 cases were collected from MRD department. They were divided into two groups- cases and controls, each having 50 subjects each. Wound infection was defined as inflammation or sepsis with or without positive bacterial cultures. With SSI, there may be fever, redness, swelling and/or pain in the area around the incision site. Complete information regarding demographic data, the type and indication for caesarean section, duration of labour, duration of surgery and rupture of membrane were recorded. Wound infections occuring after 30 days of LSCS & other gynaecological surgeries were excluded. All the results were analyzed by SPSS software 16.0. Chi-square test and student t test were used for the assessment of level of significance. Probability value of less than 0.05 was considered significant.Results: A total of 100 subjects were included in the present study, out of which, 50 were cases and the remaining 50 were controls. The mean age of the subjects was 37.45 years. There were 7 cases and 13 controls who were aged between 20-24 years. There was no significant difference amongst cases and controls regarding age. There was a significant difference in the haemoglobin levels amongst cases and controls. The third criterion that was assessed was duration of labour. Majority of the cases had prolonged labour whereas in majority of the controls, the duration of labour of labour was less than 6 hours. There was a significant difference in duration of labour amongst cases and controls (p<0.05). Elective c section was done in 2 cases and 6 controls. C section was performed in an emergency in 48 cases and 44 controls. There was a significant difference in the operation time between cases and controls (p<0.05). E.coli infection occurred in 15 cases in the present study followed by Actinobacter species which occurred in 13 cases. Absence of growth was seen in 5 cases.Conclusions: The risk factors associated with SSI in our study were, haemoglobin levels, prolonged labour, duration of operation. The most common organisms isolated were E. coli and Actinobacter species.
Therapeutic efficacy of low dose (Dhaka regimen) versus high dose (Pritchard regimen) magnesium sulphate for management of eclampsia and impending eclampsia
Authors: Bhagat Nisha , Bedi Preet Kamal , Pal Davinder , Saini Arunima
Published: May 2018

Background: To compare the efficacy of low dose (Dhaka regimen) vis-a vis high dose (Pritchard regimen) magnesium sulphate in management of eclampsia and impending eclampsia.Methods: The open-label, comparative study was conducted on 90 pregnant patients. They were admitted to emergency Department of Obstetrics and Gynaecology, Government Medical College, Amritsar with eclampsia or impending eclampsia. 10 patients dropped out at various stages of study and finally, 80 were enrolled and randomized (1:1 ratio) into two groups. Group-1, N=40 were given low dose MgSO4 (Dhaka regime) and Group-2, N=40 were given high dose MgSO4 (Pritchard). Termination of pregnancy was done as per Bishop’s score, gestation age, maternal and fetal status. Primary outcome measure was therapeutic efficacy of equivalence for control of seizures whereas secondary outcome was adverse side-effects of both the regimens.Results: Mean age in Group-1 was 24.90±4.02 years and that of Group-2 was 25.67±3.79 years. Antepartum eclampsia was the most common diagnosis among groups i.e., 47.5% and 55% respectively. After treatment, the seizure control was 97.5% in Group-1 and 100% in Group-2 with comparable results (𝑥2=1.013; p=0.314). However, highly significant difference was observed among dosage of MgSO4 that was required for control of seizure (23.75±2.71 gm versus 41.35±4.76 gm; p<0.001). Group-1 showed lower incidence of side-effects that is, loss of deep tendon reflex as compared to Group-2, but neonatal outcomes were comparable in both groups.Conclusions: Low dose (Dhaka regimen) was equally effective in control of seizures as compared to high dose (Pritchard regimen) with lower incidence of side-effects.
Comparison of titrated oral misoprostol solution versus vaginal misoprostol for induction of labour in term obstetric patients for obstetric and neonatal outcomes: a randomized controlled trial
Authors: Mahajan Puneeta , Shitole Rajendra Popatrao
Published: May 2018

Background: With more than 15% of all gravid women requiring prostaglandins in cervical ripening and labour induction. However, evidence is not clear about the preferred route or dose of the drug. So this study was designed with objectives to compare the induction delivery interval and safety of titrated oral misoprostol solution with vaginal misoprostol for labour induction in term primigravida women.Methods: In this randomised controlled trial out of 576 eligible women, 220 women as per inclusion criteria between 37 and 42 weeks of gestation with an unfavourable cervix (Bishop score <6) with indication for labour induction were randomly assigned (110each) to receive titrated oral solution of 20 mL misoprostol solution (1 mcg/mL) every 1 hour for four doses and then were titrated against individual uterine response or vaginal misoprostol 25 mcg every 4 hours. Vaginal delivery within 12 hours was the primary outcome. The data were analyzed by intention-to-treat.Results: Vaginal delivery occurred within 12 hours in 56 (50.9%) women in the titrated oral group and 24 (21.8%) women in the vaginal group with significant p-value (<0.001). The incidence of caesarean, hyper stimulation, low apgar score was less in the titrated oral group. More women experienced nausea in the titrated oral group.Conclusions:Titrated oral misoprostol is safe and effective for labour induction in primigravida patients with unfavourable cervix.
Intraoperative findings in primary caesarean section for non-reassuring fetal status and its correlation with cardiotocography
Authors: Bhatia Nisha , M. Krishna Kumari
Published: May 2018

Background: Cardiotocography plays an important role in diagnosing nonreassuring fetal status during labour, which is a leading cause for caesarean section among primigravida. These abnormal cardiotocographic traces may or may not translate into intraoperative findings of meconium stained liquor or low APGAR at birth. Hence a study is warranted to understand their correlation, thereby demonstrating the utility of cardiotocography in diagnosing nonreassuring fetal status. The objective of the study was to assess the correlation of intraoperative findings and neonatal outcome in primigravida undergoing emergency caesarean section for nonreassuring fetal status with cardiotocography.Methods: A retrospective analysis of 104 case records of primigravida undergoing emergency caesarean section for fetal distress at Department of Obstetrics and Gynecology, Apollo Institute of Medical Sciences and Research, Hyderabad, was done. Their CTG traces were correlated with their intraoperative findings such as meconium stained liquor; nuchal cord and APGAR score at birth.Results: Out of these 104 primigravida who underwent emergency caesarean section for nonreassuring fetal status, 63.4% had CTG with decelerations-Non reactive, 28% had a CTG trace with persistent decreased variability while 7.6% had a reactive CTG with meconium stained liquor. Among patients with CTG trace showing decelerations 54.5% had meconium stained liquor, 28.7% had cord around the neck and 43.9% had low APGAR scores at birth. Among the group of patients with decreased variability 63.4% had meconium stained liquor, 30% had cord around the neck and 30% had low APGAR scores at birth. There were 8 patients who had reactive CTG with meconium stained liquor, among them only 3 had low APGAR scores.Conclusions: Cardiotocography positively correlates with meconium stained liquor and APGAR scores at birth, but not with the presence of nuchal cord. Hence, judicious interpretation of CTG and introduction of another noninvasive, cost effective and acceptable test to detect non reassuring fetal status is warranted to prevent unnecessary caesarean sections.
Evaluation of outcome of pregnancy complicated by intrahepatic cholestasis of pregnancy
Authors: Sinha Abha Rani , Kiran Sneh
Published: May 2018

Background: Obstetric cholestasis (OC), also known as intrahepatic cholestasis of pregnancy (ICP), is a hepatic disease unique to pregnancy which presents with intense generalized pruritus without any skin rash. The aim is to study the outcome of pregnancy both maternal and fetal complicated by OC.Methods: This retrospective case control study was conducted at the Department of Obstetrics and Gynecology, Patna Medical College and Hospital, Patna. The medical records of all women with OC who delivered between Jan 2015 and Jan 2016 were reviewed.Results: The incidence of OC was 8.2%. The most common symptom was generalized pruritus which appeared after 28 weeks in 73.3% cases. The cesarean section rate was 93.3%. A higher incidence of meconium staining in amniotic fluid at delivery (17.1% vs 1.1%, p<0.005) and preterm premature rupture of membranes (8.9% vs 1.1%, p<0.01) was noted without an increase in preterm delivery rate (24.4% vs 15.6%). There was no statistically significant difference in the following parameter - pathological cardiotocography, 1-5 minuteApgar score <7, intrauterine growth restriction, neonatal intensive care admission or perinatal mortality. There was no case of postpartum hemorrhage.Conclusions: The incidence of OC is high in the Indian population. Perinatal outcome is good in actively managed women, although at the cost of a high intervention rate.
Prevalence of metabolic syndrome among postmenopausal women in South India
Authors: K. Jeyasheela , Ebenezer Emily D. , Londhe Vaibhav , Paul Thomas V. , Yadav Bijesh , Kekre Aruna N.
Published: May 2018

Background: As the average life expectancy of women extends 20-30 years after menopause, the medical impacts of changes leading to metabolic syndrome on postmenopausal women are significant. The menopausal state has been noted to be an independent risk factor for the occurrence of metabolic syndrome. This study was conducted to look at the prevalence of metabolic syndrome in postmenopausal women.Methods: A prospective cross sectional study was done and postmenopausal women were assessed for metabolic syndrome using the International Diabetes Federation Criteria.Results: The prevalence of metabolic syndrome was found to be 64%. Women with metabolic syndrome had a higher systolic blood pressure and larger waist circumference, however did not differ in terms of diabetes and dyslipidemia. There was no significant difference with regards to frequency and severity of menopausal symptoms between women with and without metabolic syndrome.Conclusions: The increased prevalence of metabolic syndrome in postmenopausal women may be directly due to ovarian insufficiency and indirectly due to metabolic consequences of central fat redistribution with estrogen deficiency.
Rising rates of caesarean section: an indicator of defensive medicine practiced by obstetricians
Authors: Bhatara Urvashi , . Padmasri
Published: May 2018

Background: Defensive medicine can be in the form of excessive tests, procedures, surgeries, or visits by the doctors to primarily reduce their exposure to legal liabilities. It also includes avoidance of high risk patients or procedures.  Medical profession has been included under consumer protection act which has led in developing hostile environment for medical practitioners.  This has led to increase in defensive medicine. In obstetrics and gynaecology incorporation of defensive medicine can be scrutinized by observing trends in caesarean section.Methods: It is a retrospective study carried out for 1 year from January 2015 to December 2015. All patients in whom caesarean section was done were included in this study. Indications for which Caesarean section was done were studied and results were compared with similar studies in other hospitals.Results: Overall rate of caesarean section observed in this study was 43.3%. Incidence of caesarean section in primigravidae was 59.5%. Only 2.1% of the patients underwent trial of scar resulting in vaginal birth. Foetal distress was one of the most common indicatorsfor caesarean section and its detection was based on foetal cardiotocograph readings. Out of all patients taken for caesarean section due to foetal distress only 28.5% of the babies required neonatal intensive care admission. Rising trend towards caesarean section on maternal request was also seen.Conclusions: Current climate of high professional liability is detrimental to good patient care as defensive medicine provides less benefit and much harm. Practice of medicine should be safe and hassle free. For this, standard protocols should be made and followed and if practitioners are abiding with standard protocols they should be protected against litigation.
Assessment of present awareness on reproductive health and evaluation of a tool designed for reproductive health education among school going adolescent girls
Authors: A. Vanusha , K. Parvathavarthini
Published: May 2018

Background: Reproductive health is an important area of concern in adolescent health. Assessment of unmet needs of unmarried adolescent girls during past five years revealed the felt needs are mostly unmet in areas related to menstrual hygiene, knowledge on consequences of early marriage, risk of teenage pregnancies, sexually transmitted infections, HIV and AIDS, unsafe abortions and breast feeding. This study is carried out to assess the knowledge of adolescent girls regarding menstruation, pregnancy, contraception, STD’s, AIDS, and breast feeding and to study the effect of health education program in terms of improvement in their knowledge.Methods: This study was carried out among adolescent girls from randomly selected government girls higher secondary schools of Pondicherry from class 8 to class12. A total of 300 students were included in the study. A pretested questionnaire (English/Tamil) was administered to students. This was followed by an interactive session with the students to clarify doubts. Students was asked to fill an immediate post-test questionnaire to evaluate the effect of intervention (health education). After a minimum period of six months the students was reassessed by a same pretest and post-test questionnaire.Results: There was a statistically significant improvement in knowledge scores in various aspects of reproductive health following periodic health education intervention program.Conclusions: The knowledge on reproductive health and responsible sexual behaviour among school going adolescents is inadequate. Appropriate strategy to reach this vulnerable group has to be formulated by health care professionals with coordination and support from school authorities.
Comparative evaluation of laparoscopic hysterectomy and non-descent vaginal hysterectomy in women with benign gynaecological disease
Authors: Gupta Amita , Braroo Sagrika , Singh Gagan , Gupta Aakriti
Published: May 2018

Background: Hysterectomy is one of the most frequently performed gynaecological operative procedure all over world, second most to caesarean section in United States. The aim of study was to compare the intraoperative and postoperative complications in patients undergoing non-descent vaginal hysterectomy (NDVH) and Laparoscopic hysterectomy (LH) for benign gynaecological disease.Methods: The prospective one-year study was conducted on 156 patients who required hysterectomy for benign gynaecological conditions. After applying inclusion and exclusion criteria, 75 patients assigned to Group A (NDVH) and 75 to Group B (LH) and both groups were compared.Results: On comparing the two groups there was statistically significant decrease in the duration of surgery (p<0.01, t = 11.65), pain score (p<0.01, t = 2.75) and blood transfusion requirement (p = 0.03, χ2 = 4.80) in group A, while blood loss (p = 0.73, t = 0.33), uterine volume (p = 0.15, t = 1.43), time taken to ambulate (p = 0.06 , t = 0.21), duration of hospital stay (p = 0.07, t = 1.80), conversion to laparotomy (p = 0.13, χ2 = 2.56), febrile morbidity (p = 0.27, χ2 = 1.34), infection (p = 0.42, χ2 = 1.11) and visceral injury was found statistically insignificant.Conclusions: Vaginal hysterectomy is an easier technique with shorter duration of surgery and with minimal infrastructure required and for fixed uterus or huge adnexal mass laparoscopic hysterectomy (LH) should be preferred.
Analysis of various types of ectopic pregnancies: a five-year review
Authors: S. Maheswari , C. Poornima , N. Lalitha , Panicker Seetha
Published: May 2018

Background: Ectopic pregnancy (EP) is a common, life threatening emergency during the first trimester and a significant cause for maternal morbidity and mortality. In any woman of reproductive age presenting with abdominal pain and vaginal bleeding, ectopic pregnancy should be considered. The objectives of the present study is to determine the incidence, risk factors, clinical presentation, type of ectopic pregnancy, treatment, morbidity and mortality.Methods: Retrospective analysis of case sheets of patients admitted with ectopic pregnancy at PSGIMSR, Coimbatore during the period July 2011 to June 2016 was done. The details noted were age, parity, risk factors {previous abortion, previous EP, previous pelvic surgery, intrauterine contraceptive device, tubectomy, history of pelvic inflammatory disease}, treatment for infertility, clinical presentation, ultrasound findings, investigations including beta HCG value and hemoglobin level, treatment offered, need for blood transfusion, operative findings and morbidity.Results: During the five year, there were 12,407 deliveries at our hospitals and 88 cases of ectopic pregnancies were managed. The incidence is 6.6/1000 deliveries. Among them 44% belonged to the age group of 25-30 years and multi gravida were 73.8%. Most common risk factors were previous abortion (23.8%) and previous surgeries including caesarean section, tubectomy, appendicectomy, tubal microsurgery (23.8%). Most common presentation was pain abdomen (85.2%). Out of the 88 cases, 73 patients were managed surgically (82.9%) and 11 cases were managed successfully with methotrexate (12.5%). Three of them underwent conservative management and one had Uterine Artery Embolization.Conclusions: Early diagnosis based on risk factors and timely intervention plays a main role in reducing morbidity and mortality associated with ectopic pregnancy.
Is hysterolaparoscopy a real theranostic approach for anatomical barriers in female fertility? A future argument
Authors: Agrawal Namita , Yadav Poonam , Fayyaz S. , Kaur Brinderjeet
Published: May 2018

Background: Hysterolaparoscopy is a modality that provides the real time abdomino-pelvic view during diagnosis in infertile female patients and any pathology is noticed can be tackled at the same time. So we investigate the theranostic application of hysterolaparoscopy in structural causes of female infertility in present study.Methods: Authors prospectively evaluate 157 female patients (mean age 27.7 years) diagnosed as infertile, underwent hysterolaparoscopy during diagnostic work-up.  All the enlisted patients fulfilled the criteria of infertility. The noticed anatomical abnormalities in the hysterolaparoscopy were tackled at the same time if possible.Results: Of the 157 infertile female patients, 93 (~59.2%) were of primary infertility and remaining 64 (~41.8%) were secondary infertility patients. Hysterolaparoscopy showed abnormalities in 125/157 (~85.0%) patients. The detected hysterolaparoscopic abnormalities were distributed in 77/93 (~82.8%) primary and 48/64 (~75.0%) secondary infertility patients. Of the 125 patients with abnormal hysterolaparoscopic findings, 121 (~96.8%) experienced for active therapeutic interventions. All of the 48 secondary infertility patients with hysterolaparoscopic abnormalities experienced for active hysterolaparoscopic interventions. Of 77 patients with hysterolaparoscopic abnormality in primary infertility group, 73 (~94.8%) experienced active intervention. Only four patients with streak ovaries and hypoplastic uterus, few tiny fibroids and adenomyosis did not undergo for active hysterolaparoscopic intervention.Conclusions: Authors concluded that hysterolaparoscopy has a better theranostic approach for the anatomical barriers of female fertility so it can be performed in the initial phases of the infertility diagnostic work-up.