bluuebunny/crossref_metadata_2025 huggingface dataset:
Serum uric acid as marker of severity of pre-eclampsia
Authors: Toshniwal Shirish , Lamba Aakriti R.
Published: October 2017

Background: In pre-eclampsia, there is increased uteroplacental resistance and reduced foetal perfusion due to inadequate invasion of spiral arterioles by trophoblast cells. This causes impaired foetal growth and foetal hypoxia. To assess the usefulness of foetal Doppler in predicting adverse perinatal outcome in preeclampsia.Methods: All the women with preeclampsia from 30 weeks onwards were enrolled in the study. The umblical artery (UA) Systolic-diastolic (S/D) ratio >2 standard deviation (SD) or UA - Pulsatility Index (PI) and UA - Resistive Index (RI) >2 SD were taken as abnormal. The middle cerebral artery (MCA) was visualised and cerebroumblical PI ratio calculated. MCA-RI <2SD was taken as abnormal.Results: There were 107 women in the study. Major adverse outcomes 11. Umbilical artery - S/D ratio >2SD (RR 4.46, 95%, CI 1.40-14.17) and RI >2SD (RR 3.36, 95%, CI 1.03-10.61) and MCA RI <2SD (RR 4.46, 95% CI 1.4-14.17) had a high relative risk to predict adverse major perinatal outcome. 39 babies were admitted in neonatal nursery and no parameters could predict them. Though UA - PI >2SD predicted acute foetal distress in labour (RR 2.33, 95% CI 1.21-4.47), there was no association on multivariate regression analysis.Conclusions: This study showed UA-S/D ratio and UA-RI >2SD are significant predictors of perinatal deaths and immediate neonatal resuscitation in preeclampsia. Acute foetal distress in labour or neonatal nursery admission could not be predicted.
Elevated 1st trimester serum uric acid - a risk for gestational diabetes mellitus among South-Indians: a prospective observational, longitudinal study
Authors: Rao Chetana N. , Uthraraj Kannaki
Published: October 2017

Background: Mildest carbohydrate intolerance during pregnancy may increase the risk of maternal and foetal complications. Studies suggest interesting relationships between elevated 1st trimester SUA and development of GDM, but they have not been consistent and as per our literature search we did find only one or two such studies carried out on South-Indian women in whom, the food habits, genetics, environmental factors differ from rest of the world.Methods: 124 pregnant women were studied with an aim to prospectively evaluate relation between 1st trimester SUA levels with development of GDM. Continuous data were analyzed for average/mean, median and standard deviation; and categorical variables using chi-square, independent t-test, Pearson’s correlation coefficient and ANOVA.Results: 36% of the study sample had risk factors for GDM with an incidence of 22.6%. Pearson correlation with 1st trimester SUA concentration of 3.2 mg/dl as a cut-off point for predicting GDM risk was found to be statistically significant. At cut-off levels of 3.98 mg/dl, risk of women developing GDM requiring insulin therapy in addition to diet was statistically significant.Conclusions: Along with other risk factors, elevated 1st trimester SUA levels is an independent risk factor for development of GDM. If diagnosed early and properly monitored, GDM usually doesn’t affect pregnancy outcome in our population.
Comparative study of post-partum intrauterine contraceptive device in vaginal and intra caesarean insertion
Authors: Kanwat Babita , Salodia Lakshmi , Chauhan Madhubala , Rastogi Radha
Published: October 2017

Background: Institutional deliveries have increased all over the country, thereby providing opportunities for quality postpartum family planning services. In this period, women are highly receptive to accept family planning methods. Objective of this study was to evaluate CuT Multiload 375, in terms of acceptance, safety, efficacy, continuation rate, removal rate and to find out PPIUCD complications e.g. bleeding irregularities, perforation, expulsion and discontinuation due to various reasons.Methods: Prospective analytical study was conducted from February 2016 to June 2016 in the department of Obstetrics and Gynecology, at RNT Medical College, Udaipur, Rajasthan, India.100 patients in each vaginal and cesarean group were selected randomly. Multiload 375 was inserted after obtaining written consent.Results: Missing threads were detected more in cesarean group (22.8%) than vaginal group (12.9%). Cumulative expulsion rate was 15.2% in vaginal group and 10.8% in cesarean group. Heavy Bleeding PV with or without the pain was the main reason for removal of CuT in both the groups. Removal rate for vaginal and cesarean group was 15.2% and 10.8% respectively.Conclusions: PPIUCD is very effective, safe and reversible contraceptive method which provides contraceptive effect soon after birth. Although there is relatively high incidence of expulsions and removal in the both group still the continuation rate was 69.4% in vaginal group and 78% in cesarean group.
Comparative study of maternal and foetal outcome in instrumental vaginal deliveries
Authors: Ahmed Mariyam S. , Bhalerao Anand N.
Published: October 2017

Background: The art of instrumental vaginal delivery is fading as more and more obstetricians resort to caesarean sections. Instrumental deliveries are deliveries accomplished with the use of vacuum device or forceps. Once either is applied to the foetal head, outward traction generates forces that augment maternal pushing to deliver the foetus vaginally. Objective of present study was to compare the maternal and foetal outcome of forceps versus ventouse delivery.Methods: It was a prospective observational study conducted in Sassoon Hospital between January 2014 to January 2015. A total of 120 cases, 60 each of forceps and ventouse, admitted in labour room were included in the study. Maternal and neonatal morbidity were compared in terms of perineal lacerations, episiotomy extension, post-partum haemorrhage, Apgar score, instrumental injuries. Chi square test and z test of proportion was used to analyze the data.Results: Maternal morbidity, namely episiotomy extension as well as perineal tears were significant in the forceps group. With regards to neonatal morbidity, no statistically significant difference was noted.Conclusions: Vacuum and forceps should remain appropriate tools in the armamentarium of the modern obstetrician. However, ventouse may be chosen first (if there is no foetal distress) as it is significantly less likely to injure the mother.
Complications of emergency obstetric hysterectomy in Gujarat, India
Authors: Chauhan Bhoomika R. , Patel Aarti J.
Published: October 2017

Background: Emergency obstetric hysterectomy is defined as extirpation of uterus either at the time of cesarean section or following vaginal delivery, or within the puerperium to stop life threatening obstetric hemorrhage when all other measures fail. This study was conducted to study complications of emergency obstetric hysterectomy.Methods: Out of 28552 patients, 45 patients operated for Emergency obstetric hysterectomy in Vadilal Sarabhai Hospital of Ahmedabad, Gujarat; during May 2010 to October 2012 were included in the study. Complications of the procedures were identified and analyzed.Results: Hemorrhagic shock was the most common complication followed by fever. 15.55% (7 out 45) mothers were not saved even after the emergency obstetric hysterectomy.Conclusions: Improvising procedural skill and post-operative care can reduce the complications of emergency obstetric hysterectomy.
Maternal mortality in a tertiary care hospital: a five-year review
Authors: Kaur Manjeet , Mohi Manjit K. , Aggarwal Sangeeta , Kaur Balwinder
Published: October 2017

Background: This study was aimed at analyzing the maternal mortality ratio over five years, the causes leading to maternal deaths in a tertiary care hospital and factors which are preventable.Methods: The records of maternal death from August 2010 to July 2015 (5 years) were collected and analyzed. Various factors like maternal age, parity, literacy, place of residence, antenatal registration, admission-death interval, mode of delivery and causes of deaths were reviewed.Results: The mean maternal mortality ratio (MMR) was 1039. The direct causes of maternal mortality were hemorrhage (22.4%), eclampsia (21.2%), sepsis (18.78%) and amniotic fluid embolism (8.48%). Indirect obstetric deaths were due to hepatitis (10.9%), anemia (3.6%), respiratory diseases (6.06%), heart diseases (3.03%), CNS disease (5.45%).  Most of the deaths (69.7%) occurred in age group 20 and30 years. 63.6% were multigravida and 85.4% were unbooked cases.Conclusions: Antenatal care, screening and management of high risk pregnancies are most important to prevent complications and maternal deaths by timely detection and intervention.
Prevalence and symptomatology of polycystic ovarian syndrome in Indian women: is there a rising incidence?
Authors: Choudhary Anjali , Jain Shweta , Chaudhari Priyanka
Published: October 2017

Background: Polycystic ovarian syndrome [PCOS] is a complex ill understood hormonal disorder resulting in myriads of symptoms like irregular menses, hyperandrogenism, metabolic disturbances and infertility. It occurs in about 8-11% of reproductive age group women. Recently changing lifestyles and rising obesity worldwide have contributed to rise in the incidence of PCOS. Objective of the present is to study the prevalence and symptomatology of PCOS in Indian women.Methods: 170 women in reproductive age group, with irregular menstrual cycles attending OPD, voluntarily participated in a cross sectional study. All were subjected to detailed history, examination and investigated with a battery of lab tests to confirm PCOS. Out of 170 women investigated 70 women with features of PCOS were included in the study (diagnosed as PCOS by NIH criteria).Results: The overall prevalence of PCOS in the study population was, 41%. It was 16% in married women and 24 % in unmarried girls. Common menstrual irregularity was-oligomenorrhea (40%), Menorrhagia (12.8%) amenorrhea (11%). Common symptoms were hirsutism, acne, infertility and alopecia.Conclusions: PCOS is rising in young women and to some extent the changing lifestyle in urban women may be linked to it. There in a world-wide increase in the incidence of obesity, diabetes mellitus and metabolic syndrome, PCOS and its accompanying insulin resistance is contributing to it. Treating PCOS and its complications is adding to health care burden.
Demographic and clinical analysis of post sterilization failure cases in a tertiary care hospital, Chennai, Tamil Nadu, India
Authors: Meena T. S. , Ramya K. S. , Mothilal R.
Published: October 2017

Background: The most common permanent method of family planning accepted in India is female tubal sterilization as it has a very low failure rate of 0.1- 0.8% in the first year and over all pregnancy chances of 1 in 200. It can be done by open method but laparoscopic method has now gained wide popularity.Methods: Ours was a retrospective study of post female sterilization failure cases admitted to the Department of Obstetrics and Gynecology, Government Kilpauk Medical College Hospital within a 10 year time period between April 2007 and March 2017.Results: Over a decade we had 134 post sterilization failures. 71 patients presented with intrauterine pregnancy whereas 63 presented as ectopic pregnancy following sterilization. Majority of patients belonged to 26-30 year age group and the median age was 28 years. 40.3% ectopic presented at 5-6 weeks gestational age. Over 90% of sterilization failures were done by open method and around 35.8% were done during caesarean section. Around 65.0 % sterilization failures were seen within 5 years of sterilization but 2 patients presented as late as 17 years post sterilization. In four cases (3%) failure was due to improper surgical procedure.Conclusions: Female sterilization may result in failure even after years of sterilization. In the present study, pregnancy after sterilization is higher in the youngest age group (15-30) years than for the age group (31-35) years and stabilized in the oldest age group (36-49) years. Open sterilization had a higher failure rate than laparoscopic sterilization. The most common mode of sterilization failure was intrauterine pregnancy than the ectopic pregnancy and it was almost equal to each other. Therefore, patients undergoing sterilization must be counselled about chances of failure; even though it is a permanent method, and to consult immediately if missed period else at a later stage they may go in for rupture ectopic leading to high maternal morbidity and mortality.
Increasing rates of cesarean section, an upcoming public health problem: an audit of cesarean section in a tertiary care center of North India based on Robson classification
Authors: Das Vinita , Kumar Namrata , Kumari Varsha , Agarwal Anjoo , Pandey Amita , Agrawal Smriti
Published: October 2017

Background: Increasing rates of cesarean section during last three decades has become a cause of alarm since and a need for ongoing studies. Objective of present study was to investigate cesarean section rates as per modified Robsons Criteria and to determine area of concern which requires maximum focus to decrease overall caesarean rateMethods: This cross sectional study was conducted over a period of one year (From January 2016 to December 2016) in the Department of Obstetrics and Gynecology at King George’s Medical University, Lucknow.Results: Total number of deliveries for one year was 8526. Out of them, 4275 (50.1%) were vaginal and 4251 (49.9%) were abdominal. Overall maximum caesarean section rate was contributed by group 5 of modified Robsons criteria i.e. previous section, singleton, cephalic, ≥37 weeks (17.7%).Conclusions: Robson 10 group classification provides easy way in collecting information about Cesarean section rate which obtains good insight into certain birth groups. It is important that efforts to reduce the overall CS rate should focus on reducing the primary CS rate (group 1 and 2) and on increasing vaginal birth after CS (group 5). The caesarean rate is commonest in group 5 that is previous section (17.7%).
Comparative evaluation of composite and simplified who partograms in a tertiary care centre in North India
Authors: Sethi Prachi Sarin , Sharma Sujata , Chawla Indu
Published: October 2017

Background: Early detection of abnormal progress and prevention of prolonged labour can significantly improve the outcome of labour. Partograph is an inexpensive tool which can provide a continuous pictorial overview of labour and is essential to monitor and manage labour. The objectives were to study the course of normal and abnormal labour and to evaluate the maternal and perinatal outcome using simple and composite WHO partogram.Methods: This was a randomized study conducted at Department of Obstetrics and Gynaecology, Government Medical College, Amritsar, a tertiary care centre in North India. 200 women with term, singleton, vertex gestation, in spontaneous labor were included in the study. In 100 cases composite partograph was plotted and in rest 100 cases simple partograph was plotted. The following outcomes were compared: labor crossing the alert and action line, augmentation of labor, rate of cesarean section, perinatal and maternal outcome.Results: The partogram crossed the alert line (p 0.008) and action lines (p 0.017), causing increased need for augmentation (p 0.034) in the composite partogram which was statistically significant. The numbers of vaginal deliveries were high (p<0.001) and decrease number of cesarean sections (p 0.007) and instrumental deliveries (p 0.009) in the simplified group. NICU admissions were also higher in the composite group (p<0.05), though most of the NICU admissions were due to hyperbilirubinemia and low birth weight and was not directly related to monitoring of labour.Conclusions: It was observed in the present study that labour can be managed without the latent phase being plotted on the partograph. The interventions were higher when the latent phase was included, with increased number of labours crossing the alert and action lines, increased no. of augmentations and larger number of caesarean sections. Our study favours the use of the WHO modified partograph, which should become routine practice in monitoring labour for better maternal and perinatal outcome.
Randomized comparative study of safety and efficacy of oral and vaginal misoprostol in the termination of second trimester pregnancy at tertiary care institution
Authors: S. Lujimmala , E. Anitha
Published: October 2017

Background: A prospective randomized study was conducted in 72 pregnant women, with gestational period between 12 and 20 weeks, to compare the efficacy and safety of oral versus vaginal administration of misoprostol for second trimester pregnancy termination. The study was conducted in the Department of Obstetrics and Gynaecology, Government Kilpauk Medical College and Hospital (KMCH), Chennai, South India from November 2012 and November 2013.Methods: Women aged 18-38 years requesting MTP for maternal reason, foetal congenital anomalies and intrauterine foetal demise were randomly assigned into two groups.  Group A (n=36) had misoprostol orally while the Group B (n=36) received misoprostol by vaginal route. Dosage regimen was similar in both the groups that was 200µg every 4 hrs until the abortion occurred, maximum up to 6 doses. Efficacy included induction to delivery interval and safety included maternal complications and side-effects like nausea, vomiting, diarrhoea, fever and abdominal pain and results were compared.Results: The percentage of women who delivered was significantly higher in the vaginal group than the oral group (94.44% versus 66.67%, P <0.03018) within 24 hours. The induction to delivery interval and incidence of side-effects were noted.Conclusions: Vaginal administration of misoprostol resulted in a higher success rate and misoprostol is safe and effective drug for second trimester pregnancy termination.
TMC (Thrissur Medical College) modified Robson criteria for caesarean sections
Authors: Jacob K. J. , Jayaprakash Megha , K. P. Hibina
Published: October 2017

Background: The Robson system is the most widely accepted classification system available for analysing characteristics of delivering women worldwide. Several authors have tried modifications in the existing system. The objective of this study was to modify the existing system with relevance to caesarean section rates in various obstetric population and to identify major factors contributing to it.Methods: This study was performed in Government Medical College, Thrissur from January 2017 to June 2017. All women delivered during this period were classified according to the modified system consisting of 8 groups using their maternal characteristics and obstetric history. Each major group were sub classified into 3: women who went into spontaneous labour/ induced labour/ CS done before labour. For each group, we calculated the contribution to overall CS and Primary CS separately. Women with Previous CS were analyzed as a separate group. This classification was intended to directly estimate primary as well as repeat CS rates and indirectly the VBAC rates. Results: Out of total 1337 women delivered, 413 underwent CS (30.8%). The contribution made by previous CS group to overall CS was 61.5%, and the repeat section rate was 91.3%. The primary CS rate was 15% and the maximum contribution was made by term induced primigravida followed by Primigravida with Breech presentation. VBAC rate was 8.6%.Conclusions: Our modified Robson system can be effectively utilized in analysing delivering women and provide valuable information regarding the delivery characteristics with particular relevance to Caesarean sections.
Metabolic syndrome and insulin resistance in PCOS phenotypes
Authors: Sobti Sheena , Dewan Rupali , Ranga Sunil
Published: October 2017

Background: Polycystic ovary syndrome(PCOS) is an endocrine metabolic disorder which is rapidly gaining epidemic proportions. Hyperinsulinemia and insulin resistance (IR) are thought to be key pathological factors. This study was undertaken to characterize the phenotypes of PCOS and to determine the prevalence of metabolic syndrome (MetS) and insulin resistance in them.Methods: This observational cross-sectional study was undertaken to assess the distribution of the Rotterdam PCOS phenotypes and to report the prevalence and risk factors for MetS syndrome and insulin resistance using homeostasis model assesment for insulin resistance (HOMA-IR). 90 women aged 18-35 years newly diagnosed with PCOS were classified into one of the four potential PCOS phenotypes based on history, examination and investigations.Results: Phenotype A was the most prevalent phenotype (45.5%). Prevalence of insulin resistance in our study was 31% using HOMA- IR cutoff of 2.5, with highest prevalence in phenotype A and least in phenotype D. The overall prevalence of MetS was 36% with a two- to six-fold higher prevalence in hyperandrogenic phenotypes compared to the non-hyperandrogenic phenotype. Highest mean hs- CRP was found in phenotype A which could possibly indicate greater cardiovascular risk in future. Univariate logistic regression for predictive association of MetS parameters was significantly high for deranged parameters i.e. WC≥80cm, fasting plasma glucose ≥100mg/dl, HDL ≤50mg/dl and WHR ≥0.85. Strong positive association was found with all these parameters (p<0.001) Hirsutism (modified Ferriman Gallwey score ≥8) was strongly associated with MetS (p=0.005).Conclusions: An appropriate diagnosis of PCOS and accurate dentification of phenotype is important as it has long-term health implications for women. We recommend screening all hyperandrogenic PCOS women for IR and metabolic abnormalities. This study has shown that HOMA-IR is a valuable tool in identifying PCOS women with metabolic syndrome and also serve to identify PCOS subtype at high risk of future metabolic syndrome.
Study of perinatal outcome in twin gestation in rural referral hospital in Maharashtra (India): a cross sectional study
Authors: Asalkar Mahesh , Kasar Bijal , Dhakne Swapnil , Panigrahi Patit Paban
Published: October 2017

Background: Incidence of twin pregnancy is increasing all over the world. It can occur after Assisted Reproductive Technology (ART) or spontaneously and associated with increased maternal and neonatal complications both in the developed and developing countries.Methods: A descriptive (Cross sectional) study of 64 cases of twins was undertaken between January 2013 till December 2015. Data collection was done prospectively from the patients admitted to the hospital with twin gestation. Inclusion criteria: All pregnancy with twin gestation more than 28 weeks of gestation. Twin pregnancies with both fetuses alive are included. Exclusion criteria is multiple gestation other than twins, cases with congenital malformation and intrauterine death (in one or both twins) were excluded. Data included thorough antenatal history, demographic details and intrapartum and postpartum maternal and neonatal details.Results: Prevalence of twins in our study was 1.61% (95% CI 1.3-2%). Out of 69 cases of twin pregnancy 64 cases fulfilled the inclusion criteria. History of ovulation induction was associated with 23% cases. Commonest complications observed were preterm labour (56.5%) anaemia (43.4%) and PIH (22.3%). 30.2% cases delivered vaginally whereas 69.8% patients required c. section, malpresentation being commonest indication. No intrapartum still birth was recorded. Early neonatal death was seen in eight cases, causes were prematurity, hyaline membrane disease and neonatal jaundice. Diamnoitic-dichorionic twins were 90% and 3% cases were monoamniotic monochorionic. Zygosity was calculated by Weinbergs formula and 84% cases were dizygotic while 16% cases were monozygotic. No maternal mortality related to twin pregnancy was reported in present study.Conclusions: All twin pregnancy should be considered as high risk pregnancies and should have mandatory hospital delivery. Early diagnosis, adequate antenatal, intrapartum and postpartum care as well as good NICU back up are the key factors in reducing the complications and improving the perinatal outcome in twin pregnancies.
A prospective study on pregnancy complicated with jaundice with special emphasis on fetomaternal outcome
Authors: Choudhary Neha , Sen Sangeeta , K. Varalakshmi
Published: October 2017

Background: Jaundice defined as yellow discolouration of skin, sclera and mucus membrane resulting from increased serum bilirubin concentration. It is usually clinical visible when plasma bilirubin exceeds 3mg/dl. This study aimed at determining maternal and foetal outcome in women with jaundice complicating pregnancy.Methods: This prospective study was conducted on 58 cases of pregnant women with jaundice (serum bilirubin ≥3 mg%) admitted at Panna Dhaya Zanana Hospital (PDZH), RNT Medical College, Udaipur, Rajasthan from January 2016 December 2016.Results: The incidence observed in this study was 0.28%. 77.59% cases in this study were in third trimester of pregnancy. Serum bilirubin was >20 mg% in 5.18% cases. Haemolysis, elevated liver enzymes, low platelets (HELLP) syndrome, acute fatty liver of pregnancy, intrahepatic cholestasis of pregnancy, viral hepatitis and malaria were the causes of jaundice. HELLP syndrome was the most common cause of jaundice. Of 58 women 38 delivered vaginally and 12 were LSCS for obstetrical indication and 8 were undelivered. The disease is associated with high incidence of preterm labour, IUGR, birth asphyxia and foetal distress. Perinatal mortality was 38%. Maternal mortality in 11 cases i.e. 18.96%. Main causes of maternal mortality were hepatic encephalopathy, DIC followed by shock due to PPH, DIC followed by multiple organ dysfunction syndrome.Conclusion: Jaundice and pregnancy having a grave prognosis, resulting in a very high perinatal as well as maternal morbidity and mortality, and requires an early diagnosis and careful management.
Twin pregnancy-maternal and fetal complications its association with mode of delivery: a study in a tertiary center
Authors: Pyrbot Jupirika E. , Agarwal Manika
Published: October 2017

Background: Twin pregnancies are associated with many complications. Hence the mode of delivery and its effect on the maternal and foetal outcome is important.Methods: A retrospective study of twin pregnancies carried out from April 2015 to March 2017 in a tertiary hospital in north east, India. The maternal, foetal outcome and the mode of delivery data collected and analysed.Results: A total of 50 twin pregnancies studied. The prevalence of twin was 20/1000 deliveries. Most common age group was 20-29 years with a mean age of 28±5.7 years. A total of 24 (48%) had vaginal delivery and 26 (52%) had LSCS, 2 (4%) had the first twin as vaginal delivery and second twin LSCS. A statistical significance was seen in the mode of delivery of twin pregnancies conceived after ovulation induction, (p<0.05). The most common indication for LSCS was foetal malpresentation (14.58%) followed by foetal distress (12.5%) and elective LSCS (10.42%) on patient’s request. The most common complication was anaemia (28.08%) and PIH (27.08%). In the neonate prematurity was the most common morbidity. There was no association between the mode of delivery and the foetal outcome in the form of Apgar at 5 minutes, NICU admission and perinatal mortality.Conclusions: There is a rise of caesarean delivery in twin pregnancies, maternal request becoming one of the causes. Regular antenatal check-ups of pregnant women with counselling regarding the mode of delivery should be carried out.
A study of maternal and fetal outcome in cardiac disease in pregnancy at tertiary care center
Authors: Pujitha Kurra Sai , R. Sheela S. , S. Naga Jyothi
Published: October 2017

Background: Cardiac disease complicating pregnancy is an indirect cause of maternal mortality. The incidence of cardiac disease during pregnancy has remained stable for many years even with significant decrease in the occurrence of rheumatic heart disease (RHD) as this decrease is being compensated by significant increase of pregnancy in women with congenital heart disease (CHD). Therefore, in this study we aim to analyse the incidence of cardiac disease in pregnancy and to assess the obstetrical outcome.Methods: A retrospective study carried out in 32 women with cardiac disorders at a tertiary care centre during the period of 5 years.Results: In the present study the incidence of cardiac disease in pregnancy was observed to be 0.21%. With 62.6% rheumatic, 21.8% congenital being and 15.6% peripartum cardiomyopathy. Among rheumatic valvular heart disease, mitral valve stenosis was most common followed by mitral regurgitation and tricuspid regurgitation. Non-cardiac complications like pre-eclampsia and anaemia were also noted. No of vaginal delivery were higher compared to caesarean (26 versus 6). Adverse perinatal outcomes in form of preterm, NICU admission and perinatal death were also noted.Conclusions: A cardiac disease has a major impact on pregnancy. It is a multidisciplinary teamwork to have optimal maternal and foetal outcome in women with cardiac disease. Hence, constant vigilance is required throughout antenatal, intrapartum and postpartum period to avoid adverse outcomes.
Selective cauterization of supporting ligaments at Non Descent Vaginal Hysterectomy (NDVH)
Authors: M. Jayaraman Nambiar , Pai Muralidhar V. , Poojary Vidyashree , Upadhay Rekha
Published: October 2017

Background: The objective of the study was to study the use of electrocautery selectively for cardinal uterosacral ligament complex during NDVH.Methods: We performed a series of NDVH where electrocautery was used selectively for the uterosacral cardinal ligament complex. Rest all stumps were clamped, divided and ligated.Results: We did a series of 21 cases using this technique and found this as a very effective method of doing NDVH. There were no major complications.Conclusion: Selective use of electrocautery for uterosacral and cardinal ligament complex makes NDVH easy.
Gestational diabetes: know your risk by simple and single step criteria (DIPSI)
Authors: Guin Gita , Dadhich Ruchita
Published: October 2017

Background: Gestational diabetes mellitus (GDM) has associations beyond the index pregnancy, identifying two generations at risk of future diabetes. Thus, detection of gestational diabetes mellitus becomes an important public health issue. This study aimed to estimate the prevalence of gestational diabetes mellitus by using simple and single step DIPSI criteria (Diabetes in pregnancy study group India) and risk factors associated with GDM.Methods: This cross-sectional study was carried out in 800 antenatal patients attending the antenatal clinic. These patients have given 82.5 gm mono-hydrous (75 gm anhydrous) oral glucose irrespective of the meals and their plasma glucose was estimated at 2 hr. Patients with plasma glucose value ≥140 mg/dl were diagnosed as GDM.Results: The present study estimated that the prevalence of GDM was 14.75% at their 1st visit. We found a positive association of GDM by age, BMI, hypertension and family history of diabetes. Older women had 4.5 times greater risk of GDM than younger women, obese women had 52 times higher risk of GDM than underweight women and hypertensive pregnant women had 4 times greater risk of GDM.Conclusions: It was realized that the test (DIPSI) could be easily performed in high volume hospitals comfortably and the patient were at ease as they were not fasting. Simple, cost effective tests, if made universal and available in developing country like ours will surely aid health care providers to screen, diagnose GDM and offer preventive and treatment measures at the earliest.
Referrals revisited: a clinical audit
Authors: Dubey Swati , Mehta Sumita , Singh Sonam , Rohatgi Anshul
Published: October 2017

Background: Pregnancy and childbirth are physiological processes; however, severe maternal morbidity can complicate certain pregnancies, deliveries and puerperium. To prevent maternal/ neonatal morbidity and mortality, the high-risk category needs timely identification and intervention and if required, prompt referral to higher centres where HDU/ICU level of care is provided. The present study was a clinical audit of obstetric referrals.Methods: A clinical audit of all obstetrics referrals done at BJRM (secondary level facility) from 1st May to 31st October 2016. The cases were analysed with respect to demographics, indications for referral and barrier to services.Results: Referral rate of our hospital was 6.52%. Mean age of women referred was 24.16 years. The associated risk factors were PIH in 36.17%, anaemia in 34.04%, followed by thrombocytopenia and diabetes in pregnancy. Majority of referrals were done in women during labour 93.94% while only 3.03% referrals during post-partum period. Most common indication was MSL with foetal distress 20.96%, followed by hypertensive disorders in pregnancy 16.93%. Other indications were APH, malpresentation, 2nd stage arrest and cord prolapse. The main barriers to providing services at our institute were unavailability of 24 hours OT services, blood bank and ICU care.Conclusions: Standard referral protocol and well-defined linkages need to be established so as to have better co-ordination between the referral units and tertiary centres.
The study of antiphospholipid antibodies in recurrent pregnancy loss
Authors: S. Sheela H. , M. Lakshmidevi , Koganti Babitha , Venkatesh Shreedhar
Published: October 2017

Background: Around 15% of clinically recognised pregnancies in women less than 35 years old result in spontaneous miscarriage. However recurrent pregnancy loss (RPL) is encountered in 5% of couples with two or more losses and in around 1–2% of couples with three or more losses. In view of the increasing burden of recurrent pregnancy loss in the society and in view of Anti-phospholipid syndrome being one of the undisputed treatable cause for recurrent pregnancy loss, this study aims to evaluate the significance of the antibody profiles of APS in relation to RPL in OBG dept of VIMS and RC.Methods: Patients coming to the Obstetric and Gynaecology department of Vydehi Institute of Medical Sciences and Research Centre, Bangalore, from December 1st 2014 to June 30th 2016. A detailed history of patients was taken based on set questionnaires. Detailed general and gynaecological examination findings were taken. Routine blood investigations were sent along with investigations for aPLAs which included: - Lupus Anticoagulant (LA) - Anti Cardiolipin Antibody (ACA) - Anti β2 glycoprotein 1 (Anti-β2GP1Ab). Final results are statistically evaluated.Results: A total of 56 patients of recurrent miscarriage with two or more prior pregnancy losses were considered. Out of the 56 patients, 23 patients were excluded as per the exclusion criteria and 33 patients were included in the present study. The mean age of the study group was 24.63 years (Range: 20-32 years). Overall, seven patients (21.21%) were seen to have positive antiphospholipid antibody titers amongst the 33 patients, with repeat testing done after 12 weeks to confirm the positivity. Five patients (15.15%) were positive for ACA antibody. Four (12.12%) patients were positive for LA and B2GP1 each. Two patients (6.06%) were positive for both LA and ACA antibodies. Two patients (6.06%) were positive for LA and B2GP1 antibodies and two other (6.06%) patients were positive for ACA and Anti-β2GP1Ab. There was a statistically significant association noticed between ACA positivity and POG at 1st pregnancy loss. However, the overall association of APLA positivity and POG at pregnancy loss was not statistically significant.Conclusions: There was a significant difference of POG at first pregnancy loss in ACA positive patients as compared to the ACA negative patients. However, when all the APLA positive patients were considered the difference was not statistically significant.
A case of post-caesarean vesico-uterine fistula: A rare entity becoming common?
Authors: P. Pallavee , Behera Jeetendra , Samal Rupal
Published: October 2017

Vesicouterine fistula (VUF) is rare, with an incidence estimated at 1-4% of all genitourinary fistulas. We report a case of VUF which was referred to our institute on the 6th postoperative day following an emergency repeat lower section caesarean section (LSCS) at 39 weeks, with complaints of hematuria and watery discharge per vaginum for further management. Patient had stable vitals with slight abdominal distension and tenderness and watery discharge per vaginum having an ammoniacal odour. USG examination showed Foley’s bulb inside uterine cavity. CT abdomen confirmed the findings and showed presence of contrast inside uterine cavity. Patient was re-operated on 9th postoperative day in concurrence with urologists. Cystoscopy showed a 2 cm size fistulous opening. Intra-operative findings revealed a fistulous track between posterior wall of bladder and uterine incision. Appropriate reparative surgery was done. Obstetricians need to be aware of this condition particularly while operating on previous caesarean sections.
Spontaneous heterotopic pregnancy with tubal rupture
Authors: J. C. Spandana , S. Kanakannavar Suresh , K. M. Umashankar , N. Manuja
Published: October 2017

Heterotopic pregnancy is the coexistence of intrauterine pregnancy (IUP) and extrauterine gestation. It is a rare and dangerous life-threatening condition that is difficult to diagnose and easily missed. The incidence in the general population is estimated to be 1 in 30,000. We report a case of a 24-year-old multigravida who was seen in the emergency department with a diagnosis of a ruptured ectopic pregnancy. A careful ultrasound assessment led to the diagnosis of a heterotopic pregnancy despite lack of any notable risk factors. Immediate surgical intervention with supportive measures resulted in a successful outcome. An obstetrician should keep in mind the occurrence of a heterotopic pregnancy while dealing with pregnant females. It also demonstrates that early diagnosis is essential in order to salvage the intrauterine pregnancy and avoid maternal morbidity and mortality.
Misplaced IUCD: a case report
Authors: Varun Neha , Nigam Aruna , Gupta Nidhi
Published: October 2017

In a developing country like India where population census is crossing the limits, contraceptive methods are the necessary measures for the population control. Intrauterine Contraceptive devices (IUCDs) are the second most commonly used method of contraception after sterilization. Misplaced IUCDs usually present with the missing thread and remain asymptomatic in most of the cases. A case of a misplaced IUCD in the pouch of Douglas is reported which was managed laparoscopically.
Acquired vaginal stenosis following caesarean delivery: a case report
Authors: Ray Das Chandana , . Alakananda , Bora Rakhi , Das Bonani
Published: October 2017

Postpartum genital tract adhesions are infrequent and their reason has not been appraised. Though, severe dystocia and frequent pelvic examinations have been projected as possible causes. Here, we report a case of vaginal adhesions following caesarean section for obstructed labour that presented as irregular menstruation with desire to remove the PPIUCD. The patient was successfully treated with surgical resection.
Valsalva retinopathy in pregnancy: an obstetric dilemma
Authors: Kaveri Vismaya , S. K Manjula , Pawar Bhargavi
Published: October 2017

Valsalva retinopathy is a unilateral or bilateral condition that occurs when increased intra-thoracic or intra-abdominal pressure transmitted to the eye causes a sharp rise in the intraocular venous pressure, and rupture of superficial retinal capillaries. Pregnancy is known to be a risk factor for Valsalva retinopathy. A 29-year-old G2A1 at 38 weeks of gestation previously normotensive presented with unilateral sudden decrease in vision of 1-day duration. Fundoscopy revealed pre-retinal and vitreous hemorrhage of right eye. A diagnosis of Valsalva retinopathy of pregnancy was made after excluding other probable causes for hemorrhage. She had an elective cesarean section with no further deterioration of vision or recurrence of hemorrhage.
Asymptomatic postmenopausal endometrial tuberculosis:a rare case report
Authors: M. Priyadharshini , V. K. Shantha
Published: October 2017

Tuberculosis remains a global health problem, primarily in developing countries. Genital tuberculosis is common in young women mostly detected during infertility work up. Mycobacterial infection in postmenopausal women is an extremely rare disease. After menopause, tuberculosis of the endometrium is a rare possibility probably because of thedecreased vascularity of the tissues. We present here a case of asymptomatic postmenopausal woman who was suspected as endometrial carcinoma initially by abnormal endometrial pattern in ultrasound done as a part of regular health check-up. In endometrial biopsy we found pus draining. Diagnosed as endometrial tuberculosis by pathologic examination and polymerase chain reaction. She was put on anti-tuberculosis treatment. After completion of treatment, she was doing well. Thus, we conclude saying endometrial tuberculosis should also be suspected in postmenopausal women with abnormal endometrial pattern.
Common tumor at a rare site
Authors: Murugesan Anuradha , Prabhu Karthiga
Published: October 2017

Extrauterine leiomyomas are rare and are a great diagnostic challenge. Leiomyoma and fibroma are the most common mesenchymal tumours of the vagina. 51-year-old multiparous lady presented with vulvovaginal swelling. On examination, a lobulated firm vulvovaginal mass measuring 6×7 cm, occupying the right posterolateral part of labia majora extending into the lateral vaginal wall was seen. Histopathology was suggestive of Leiomyoma. Leiomyoma should be considered as one of the differential diagnosis of solid vaginal mass.
Las relaciones políticas de las empresas exportadoras y su impacto en la gestación de políticas públicas en Chile: el ejemplo de la sociedad Hube y Achelis (1898-1906)
Authors: Muñoz Sougarret Jorge E.
Published: October 2017

Esta investigación propone observar las relaciones entabladas por una empresa de capitales extranjeros con los Estados nacionales de Argentina y Chile, preeminentemente con este segundo. Metodológicamente hemos optado por ahondar en las motivaciones que tuvo el mundo político para apoyar a esa empresa, más que detenernos en las exposiciones discursivas de la empresa. Eso nos permitió observar los intereses del mundo político por acercarse a las empresas, colocando a disposición de ellas los bienes estatales a cambio de apoyos acotados y coyunturales.
La evolución del ciclo ganadero argentino en la segunda fase del modelo sustitutivo de importaciones
Authors: Arceo Nicolás
Published: October 2017

El abandono del modelo agroexportador en la década de 1930 es frecuentemente asociado con el inicio de un supuesto proceso de estancamiento de la producción agropecuaria pampeana y, en particular, de la producción ganadera, proceso que se habría intensificado desde mediados de la década de 1940. A lo largo de este trabajo se intentará demostrar que la ganadería pampeana, lejos de ingresar en un periodo de franca decadencia, accedió a una fase de crecimiento como consecuencia de la expansión del mercado local.
Reforma agraria y práctica política en el contexto del desarrollo y la modernización, Argentina, 1955-1975
Authors: Lázzaro Silvia B.
Published: October 2017

Analizar desde una perspectiva histórica las instancias que se fueron forjando en torno a la necesidad de generar una reforma agraria en Argentina, en el marco de los procesos de políticas agrarias de los diferentes regímenes  que se sucedieron a partir de la caída del peronismo en 1955; en los que predominaron el absoluto pragmatismo y la permanencia de una ideología que rechazaba de plano la posibilidad de transformaciones estructurales en la distribución de la tierra, en favor de una línea de política productivista que, de hecho, desligaba los problemas de los bajos rendimientos y de la condición social de los sectores menos concentrados, del tamaño y calidad de las explotaciones. A pesar de esta limitación, la preocupación por lo que denominaron sistemáticamente reforma agraria, estuvo presente en la agenda política de los gobiernos de turno
Etapas históricas de la relación entre el Fondo Monetario Internacional y América Latina (1944-2015)
Authors: Nemiña Pablo , Larralde Juan
Published: October 2017

El trabajo propone un análisis de historia económica sobre la relación entre el Fondo Monetario Internacional (fmi) y los países de América Latina en el periodo que va desde 1944 hasta 2015. Existen importantes antecedentes del estudio sobre la relación a escala nacional, no obstante, se observa una vacancia en lo que respecta al análisis del vínculo a escala regional. Se plantea que la orientación política del fmi y los gobiernos, el contexto macroeconómico y las ideas económicas reinantes constituyen elementos decisivos para comprender la configuración que asume la relación entre el fmi y las naciones latinoamericanas. Pueden identificarse seis etapas históricas en función de los lineamientos centrales de las políticas económicas y las características de los créditos y condiciones que exigía el organismo, algunas de intenso acercamiento, como sucedió en las décadas de 1980 y 1990, y otras de mayor distancia, como la década pasada.
Los negocios de la casa Hainsworth y Compañía en Tacna y Arica, 1841-1868. Una mirada al comercio regional
Authors: Rosenblitt Jaime
Published: October 2017

Este artículo recorre las actividades de la casa Hainsworth y Compañía, para explicar las razones de su éxito comercial y cuáles fueron los elementos que la distinguieron de otras empresas y mercaderes extranjeros que actuaron en la región Tacna-Arica en la misma época. En la narración aparecen inversionistas con intereses a lo largo de la costa del Pacífico sudamericano, comerciantes medianos en busca de oportunidades para ocupar un lugar en la minería, vendedores al menudeo, arrieros y empresarios mineros de distintos niveles técnicos. Todos ellos en busca de fortuna.
La distribución de la riqueza en el Buenos Aires rural entre finales de la colonia y la primera mitad del siglo XIX. ¿Una desigualdad moderada y en declive?
Authors: Gelman Jorge , Santilli Daniel Víctor
Published: October 2017

Este artículo parte de la hipótesis de que el cambio de orientación económica de Buenos Aires tras la crisis de orden colonial debe haber incidido de manera pronunciada en el valor de los recursos y en su distribución entre las personas y grupos, por lo que reconstruye series que permiten medir esas transformaciones. En este caso se utiliza la información de algunos censos rurales de 1789 para ponerlos en relación con la información disponible sobre las décadas centrales del siglo XIX. Se analiza la propiedad de la tierra y del ganado, en tres jurisdicciones de la época(Magdalena, Pilar y Areco). La propuesta incluye la aplicación de herramientas utilizadas con anterioridad, de manera tal que sus resultados puedan ser comparables con otros periodos.
Assessment of patient's opinion towards tobacco cessation program in various de-addiction centers of Hyderabad, India: a cross sectional survey
Authors: Krishna Sai
Published: October 2017

Aim: To assess the opinion of patients towards the tobacco cessation program that were enrolled / attending various tobacco de-addiction centers in Hyderabad.Material and Methods: Data were collected from a sample of 128 tobacco users through a well-designed questionnaire which includes information on demographic data, duration and frequency of tobacco use, type of tobacco use etc.Results: Sixty-eight percent of the participants recommended this program to those who wants to quit tobacco use. Fifty-four percent of the participants were satisfied with the tobacco cessation program.Conclusions: Majority of the patients were satisfied with the counseling given to them in the de-addiction center. Periodic counseling is needed for the tobacco users to cease the habit.