bluuebunny/crossref_metadata_2025 huggingface dataset:
Fetal Doppler for prediction of adverse perinatal outcome in preeclampsia in a low resource setting
Authors: Sahu Ekta , Modi Jyoti Nath
Published: May 2018

Background: Diagnostic laparoscopy and hysteroscopy are considered the gold standard for diagnosing pelvic pathology in women among couples with infertility or subfertility. Knowledge of common pathologies in these patients would help plan investigations and deliver better care especially in resource limited settings. The current study was carried out to analyse the clinical-demographic profile and operative findings among women with subfertility undergoing diagnostic laparoscopy-hysteroscopy over a 4 years period.Methods: A retrospective record-based study conducted in the Department of Obstetrics and Gynaecology of People’s Hospital, PCMS and RC, Bhopal from 1st January 2013 to 31st December 2016 (4 years).Results: Sixty-two records of women with primary/ secondary infertility who underwent diagnostic laparoscopy-hysteroscopy during the study period satisfied the inclusion and exclusion criteria and were analyzed. Among these, 54 (87.09%) couples had primary infertility and 8 (12.9%) had secondary infertility. The mean age of women was 27.1 years (range 20-38 years; SD4.43). One third of women had more than 5 years duration of infertility. Eight (13%) had menstrual abnormalities. One or more tubal abnormality was found on diagnostic laparoscopy in 33.8% of all cases (31.4% of women with primary infertility and 50 % of women with secondary infertility). Pelvic adhesions (25.8%), endometriosis (24.2%) and evidence of acute or chronic pelvic inflammatory disease (19.3%) were the other leading abnormalities.Conclusions: While it is possible to suspect many abnormalities by a detailed history, a good examination and preliminary investigations such as the pelvic ultrasonography, a significant proportion of abnormalities such as the tubal abnormalities, endometriosis and pelvic adhesions can only be detected with certainty on laparoscopy. Hence it is recommended that diagnostic laparoscopy should be an early part of infertility work up.
Reducing morbidity in second stage cesarean section by Patwardhan’s (shoulders first) method of delivery
Authors: Kumari Archana
Published: May 2018

Background: To evaluate Patwardhan’s method of delivering shoulders first during second stage cesarean section.Methods: 154 consecutive cases of cesarean section for second stage arrest or obstructed labor over a period of one year (July 2016 to June 2017) were included in the study. 77 cases delivered by Patwardhan’s method comprised of study group and 70 cases delivered by vertex, 7 cases delivered by breech served as control. Fetal and maternal outcomes were compared in these two groups.Results: Obstetric features like parity, maternal height, duration of pregnancy, hemoglobin levels, fetal weight were comparable in both groups. Perinatal outcomes were almost similar in both the groups. Extension of the uterine incision occurred in only 4 cases (5.19%) in the study group compared to 16 cases (20.77%) in control group. Excessive bleeding, uterine artery injury, need for blood transfusion and hysterectomy were also less in the study group.Conclusions: Morbidity due to extension of uterine incision occurs commonly during second stage cesarean section, when hand is forcibly introduced in the pelvis to deliver impacted head, since lower uterine segment is edematous and fragile. Patwardhan’s technique avoids this and hence should be practiced more widely. Its beauty lies in near absence of extension of uterine incision.
Clinical profile and pregnancy outcome following tubal recanalisation
Authors: S. Vilvapriya , K. Veeraragavan
Published: May 2018

Background: Female sterilization by tubal ligation accounts for 36% of all methods of family planning used in our country. Almost half of tubal ligations are done in women younger than 25 years. These women want reversal of tubectomy subsequently, in circumstances like death of children, remarriage. This study aims to evaluate various factors affecting the outcome of pregnancies following microsurgical tubal recanalisation.Methods: It is a prospective observational study carried out at Govt Kilpauk Medical College for a total number of 50 patients who have undergone tubal recanalisation during 2011 and 2012. They were followed up till December 2016.Results: 84% of women (n-42) opted for recanalisation were in young reproductive age (<30 years) group. Conception rate was higher in younger age group (52.9% in 21-25 years). Death of children (n-37, 74%) and remarriage (n-12, 24%) were the common indications for tubal recanalisation. Outcome is better if reversal surgery is done within 4 years after sterilization (69.6%, n-16 out of 23) than after 4 years (30.4%, n-7out of 23). Conception rate (55.3%, n-21) was higher and statistically significant in subjects with final length of tube more than 4 cms (P value -0.0193). Conception rate was higher within 1 year of recanalisation (n-13, 26%), followed by 16% (n-8) in 2nd year and statistically significant (p- 0.00001). Overall pregnancy rate in our study was 46% (n-23). Out of the 23 women who conceived, 14 (61%) resulted in live birth, 3 (13%) abortions and the remaining 6(26%) had ectopic pregnancies.Conclusions: Proper selection of patients and meticulous tuboplasty technique can yield successful pregnancy outcome comparable to ART.
Clinical significance of unexplained elevated maternal serum alpha feto-protein in second trimester of pregnancy
Authors: Karya Urmila , Kumari Sweta , Rani Anupam , Singh Shakun
Published: May 2018

Background: Alpha-fetoprotein (AFP) is the major serum protein in the embryonic stage and in the early fetal stage. The aim of this study was to measure maternal serum AFP levels in second trimester between 15-20 weeks of gestation and to determine whether unexplained elevated MSAFP levels is an effective predictor of adverse pregnancy outcome among Indian population.Methods: This study was a prospective observational study, carried out on 400 pregnant women. Maternal serum alpha-fetoprotein (MSAFP) was measured between 15 and 20 weeks of gestation after excluding congenital malformation or birth defects. MSAFP level was determined by using a radio-immunoassay technique. Women with MSAFP level >2.0 MoM was considered as abnormal while MSAFP level≤ 2.0 MoM was considered as normal. All women were followed up till delivery and pregnancy outcomes were noted and compared between two groups.Results: Women with elevated MSAFP had significantly higher adverse pregnancy outcomes (75.4%) compared to women with MSAFP ≤2.0 MoM (26.1%) (p<0.0001 with relative risk of 2.89, 95% confidence interval 2.276 -3.667).Conclusions: Unexplained elevated MSAFP has high sensitivity, specificity, positive predictive value and negative predictive value in predicting adverse pregnancy outcomes. It would, therefore be worthwhile screening pregnant women in second trimester for maternal serum alpha-fetoprotein levels as it would help to identify high risk pregnancies and allow close antenatal survillence for better pregnancy outcome.
Comparison of intravenous hydralazine and intravenous labetalol in the management of severe hypertensive disorders of pregnancy: a tertiary care centre study
Authors: Verma Manvi , Gupta Shashi , Bhagat B. R. , Mahajan Aakanksha , Kaur Baseerat
Published: May 2018

Background: Severe hypertension in pregnancy (SBP ≥160 mmHg &/or DBP ≥ 110 mmHg) must be treated judiciously to prevent maternal and fetal complications. The study was conducted to compare the efficacy, adverse effects, maternal and fetal outcome between Hydralazine and Labetalol which are the most commonly used drugs for the purpose.Methods: In a prospective study, 130 pregnant patients each with severe hypertension presenting to SMGS Hospital Jammu were randomized in 2 groups and administered hydralazine or labetalol intravenously. The efficacy of the two drugs was measured in terms of number of doses required to obtain target BP and the timing to achieve the same. The incidence of adverse effects, maternal and fetal outcomes were also compared. Comparisons among the two groups was performed by using independent Student’s t test for normally distributed variables, Fishers’ exact test, and Pearson Chi Square test for categorical variables. The level of significance was set at p<0.05 for all analysis.Results: There was no statistical difference between the two drugs in terms of efficacy. Significantly more low-birth weight infants were born in the hydralazine group. Also, the adverse effects were significantly more in the hydralazine group.Conclusions: Both hydralazine and labetalol can be used to treat hypertensive emergencies of pregnancy but hydralazine is associated with more side effects.
Impact of vitamin A supplementation in anaemia during pregnancy: a randomized double blind controlled clinical trial
Authors: Singh Shakun , Chaudhary Rachna , Dhama Vandana , Singh Anu , Karya Urmila
Published: May 2018

Background: To study the impact of Vitamin A supplementation in anaemia during Pregnancy and thus improving maternal and fetal outcome a Randomized double blind controlled clinical trial was conducted in Department of Obstetrics and Gynaecology, L.L.R.M. Medical college Meerut involving 250 pregnant women in late pregnancy 18-28 weeks with haemoglobin levels <11 g% (7-11 g%)..Methods: The study subjects were divided into two groups: Group A (n=125): Received daily supplement containing Iron (60 mg elemental iron) + Folate (500 mcg) + Vitamin A 20,000 IU weekly for a minimum of 12 weeks. Group B (n=125): Received daily supplement containing iron (60 mg elemental iron) + Folate (500 mcg) for a minimum of 12 weeks.Results: Maximum patients were uneducated belonging to low socioeconomic status. The mean haemoglobin values in Group A and Group B increased from 9.674±1.05 and 9.53±1.04 to 12.2±0.89 and 10.82±1.06 respectively after supplementation. Similarily Serum Ferritin levels increased from 15.96±2.94 and 15.70±2.83 to 78.40±17.82 and 58.64±11.93. Mean corpuscular volume, packed cell volume and red blood cell counts also increased significantly. Maximum haemoglobin levels were achieved with both vitamin A and iron supplementation. The proportion of women who became non anaemic was 97.17% in Group A vs 68.69% in Group B.Conclusions: Vitamin A supplementation improves anaemia and also dramatically improves iron stores in anaemic pregnant women.
A retrospective analysis of the risk factors leading to perinatal mortality at a tertiary care hospital of Sikkim, India
Authors: Rai Chanda , Kharka Latha V. , Dutta Sudip , Kumar Nishant
Published: May 2018

Background: This study helps to assess the burden of perinatal mortality at a tertiary referral hospital in Sikkim known for its hilly terrain which makes health services difficult to access. The aims and objectives were to determine the various causes and risk factors leading to perinatal mortality in order to formulate preventive strategiesMethods: All perinatal deaths over a year between August 2016-2017 were included and analysed in our study.Results: A stillbirth rate of 14 per 1000 total births and early neonatal death rate of 8 per 1000 live births was found in 1855 total births. Complications related to pregnancy like pre-eclampsia (16%), eclampsia (8%), ante-partum haemorrhage (15%) and medical disorders (13%) were major contributors to stillbirths while pre-maturity (53.3%), sepsis (20%), birth asphyxia due to meconium aspiration (13.3%) were notable factors leading to early neonatal deaths. In majority of the cases, factors like poor literacy, low socio-economic status, increased basal metabolic index and inadequate ante-natal care caused increased perinatal losses.Conclusions: Perinatal grief continues to surround women who have suffered perinatal deaths and  serious efforts should be made to bring down the mortality rates by improving health , nutrition of all expecting mothers  and increase their awareness to seek ante-natal health services in order  to avoid any catastrophe in terms of maternal and fetal loss.
Study on post partum intrauterine contraceptive device practices and causes for discontinuation of PPIUCD at follow up in a tertiary hospital
Authors: Chethan Radhika , G. S. Anitha , C. Savitha
Published: May 2018

Background: Post partum contraception is the best evidence based intervention in prevention of pregnancy and abortion related maternal morbidity and mortality in the developing countries. The unmet need for contraception among women in the postpartum period can be effectively fulfilled by post partum insertion of IUCD, in a single visit under the Government scheme of providing free maternity services during institutional delivery. Despite optimal efforts by family planning program, very few couples are opting for spacing methods and lack of awareness has resulted in discontinuation of family planning methods particularly PPIUCD. This study is designed to study the practices of PPIUCD and causes for discontinuation at follow up in our hospital. The objectives of the study were study PPIUCD practices at Vanivilas hospital; causes for discontinuation of PPIUCD.Methods: Prospective study done at Vanivilas hospital attached to Bangalore Medical College and Research Institute from January 2014 to December 2014. Women admitted and delivered at VVH, were counselled. CuT 380A was inserted in accepters who fulfilled the Medical Eligibility Criteria and had no contraindications for PPIUCD. They were followed up till June 2016.Results: There were 2072 PPIUCD insertions in one year, out of which 1244 were post placental, 139 were in immediate postpartum and 689 were intra caesarean insertions. Fifty four (54) women discontinued PPIUCD during follow up .Main causes for removal were menstrual abnormalities (19), pain abdomen (13), wanting sterilisation procedure (12) and marital disharmony.Conclusions: PPIUCD is an effective, safe, reversible method of long term contraception with high reported expulsion and low perforation rate, compared to interval insertion. More research is needed in the field of PPIUCD to enhance awareness and acceptance in the community. Awareness and counselling the eligible couples during ante natal care can improve acceptance and compliance of PPIUCD continuation rates.
Knowledge and practice regarding menstrual hygiene among adolescent girls of rural field practice area of RIMS, Raipur (C. G.), India
Authors: Agarwal Neerja , Soni Nutan , Singh S. P. , Soni G. P.
Published: May 2018

Background: Adolescent age group among girls have been recognized as a special period which signifies the transition from girlhood to womanhood. Menstruation is generally considered as unclean in the Indian society. Most of the adolescent girls had incomplete and inaccurate information about the menstrual physiology and hygiene as reported by many Indian studies. Very few authors have included the detailed aspects of the menstrual practices among adolescent girls.Methods: The current Community based cross sectional study was conducted by department of obstetrics and Gynaecology in connection with department of community medicine, Raipur Institute of Medical Science, Raipur (C.G), India. Among the adolescent school going girls in the field practice area of the Rural Health Unit and Training Centre during study period of 6 month from July 2017 to December 2017. 263 girls from the above mentioned schools, of the 8th and 9th standards, were selected for the study.Results: Majority of the school going adolescent girls belongs to 13 and 14 year of age. 50.95% , 21.67% and 12.93% girls reported that they had their menarche at the age of 13 year, 12 year and 14 year respectively. Majority of the girls were using cloth (49.81%) and only 17.87% were using sanitary napkins. Cleaning of external genitalia was not satisfactory in 32.70% of the girls. Only 58.17% girls used both soap and water for cleaning the genitalia. Pain in abdomen (59.70%) was found to be the most frequent complaint during menstruation.Conclusions: Knowledge on menstruation is sub-optimal and the practices are unacceptable for proper hygiene among study subjects. Menstrual hygiene is an important issue needs to be ensured.
Analysis of indications and route of hysterectomy for benign conditions
Authors: Patne Smita S. , Upadhye Aditi J. , Upadhye Jayshree J.
Published: May 2018

Background: Hysterectomy is the most common operation performed by gynecologist, next to caesarean section. The primary focus of this study was to review the indications and surgical technique of hysterectomy.Methods: This retrospective study was performed in the department of Obstetrics and gynecology, in collaboration with Department of Pathology.  All women in the reproductive age group and post-menopausal age who underwent hysterectomy with or without salpingo-oophorectomy were included in this study.Results: In our study, out of 100 patients, clinical indication was fibroid in 45 (45%) patients, menorrhagia in 15 (15%) patients, adenomyosis in 25 (25%) patients, uterovaginal prolapse in 5 (5%) patients, endometrial polyp in 5 (5%) patients and ovarian tumor in 5 (5%) patients. Histo-pathological diagnosis was leiomyoma in 55 (55%), adenomyosis in 30 (30%), endometrial polyp in 5 (5%), endometrial hyperplasia in 5 (5%) and serous cystadenoma of ovary in 5 (5%). Abdominal hysterectomy was performed in 46 (46%) patients, vaginal hysterectomy in 44 (44.33%) patients while laparoscopic hysterectomy was performed in 5 (6.66%) patients.Conclusions: In this study, most common indication for hysterectomy was fibroid uterus and it was correlated well with histopathology. Abdominal & vaginal hysterectomies were performed in almost equal number.
Serum beta hCG in early second trimester as a predictor of gestational hypertension
Authors: Rajesh Aparna , Muralidharan Vandana
Published: May 2018

Background: Hypertensive disorders of pregnancy complicate upto 10% of pregnancies worldwide, and constitute one of the greatest causes of maternal and perinatal morbidity and mortality. The goal of this study is to evaluate the serum beta hCG levels in pregnant women as a predictor of gestational hypertension.Methods: This is a prospective study done at K. S. Hegde Medical Academy during the month of November 2015 to January 2017. Serum beta hCG was estimated between 14-20 weeks of gestation in 90 women with singleton pregnancy irrespective of parity. Regular follow up of the cases were done till delivery. Results were analysed statistically.Results: Out of 90 women, 81 women were followed till term and 12 (14.8%) cases developed gestational hypertension. β HCG levels (Mean±SD) were higher (69808.66±54764.7 vs. 38126.49±97419.2; p<0.28) in subjects who developed gestational hypertension. Serum beta hCG (median >32726 mIU/ml) has a sensitivity of 75%, specificity of 72.5% and accuracy of 72.8%.Conclusions: Our study indicate an increased risk of gestational hypertension in women with elevated levels of serum beta hCG. As yet there are no practically acceptable and reliable screening tests for gestational hypertension, serum beta hCG seems to be good noninvasive early predictor for the development of gestational hypertension.
Success of medical management of tubal ectopic pregnancy with Methotrexate in a tertiary hospital in North India
Authors: Juneja Sunil K. , Jain Kanupriya
Published: May 2018

Background: Unruptured ectopic pregnancy can be managed with surgery as well as systemic methotrexate. We aimed to study efficacy of medical management and factors affecting success in strictly selected patients.Methods: It was a three-year prospective observational study. 171 patients with ectopic pregnancy were screened and those fulfilling the strict study criteria were given systemic methotrexate. The single dose regimen was followed. Patients were observed for side effects and signs of rupture. Serial measurement of HCG levels was done to determine success or failure. Various factors were studied which had potential bearing on results.Results: Thirty-one patients received methotrexate. We had an overall success rate of 93%. Two of the participants had surgery due to failure. No major side effects were observed.Conclusions: Carefully selected patients of unruptured ectopic pregnancy can be safely and successfully treated with systemic methotrexate.
Association of thyroid dysfunction with abnormal uterine bleeding
Authors: M. Lakshmi Manjeera , Kaur Prabhneet
Published: May 2018

Background: Abnormal uterine bleeding is a common complaint for women being referred to the gynaecologist and is associated with an array of symptoms. The objective of this study was to detect association of thyroid dysfunction in patients with menstrual irregularitiesMethods: This non-interventional prospective study was done over a period of one and half years in a private medical college in Mangalore. All patients in age group of 15-55 years who presented with history of menstrual disturbances were enrolled and evaluated in the study. Patients with structural causes of AUB or using IUCDs or hormonal steroids were excluded. Total of 85 patients were hence evaluated. These 85 patients were subjected to routine investigations like Hb, BT, CT and platelets (to rule out coagulation defects) along with TSH, T3, T4 estimation. Ultrasound abdomen and pelvis with endometrial thickness was done to rule out structural causes.Results: The most common menstrual disturbance was menorrhagia (47 patients: 55.3%). Thyroid abnormalities were found in 29 of the 85 patients with AUB (34.11%). Of the 29 patients with thyroid dysfunction, 24 were hypothyroid and 5 patients were found to be hyperthyroid.Conclusions: Thyroid abnormalities are frequently associated with menstrual irregularities. Hence Thyroid Function Tests are extremely valuable in patients with provisional diagnosis of AUB and should be made mandatory to avoid unnecessary hormonal or surgical treatment in such patients.
A comparative study between active and expectant management of premature rupture of membranes at term on fetomaternal and perinatal outcome in rural population
Authors: Rawat Rajani , Divedi Pragati , Debbarma Sukla , Vishwakarma Soniya , Mittal Nupur
Published: May 2018

Background: Premature rupture of membranes at term (PROM) is defined as a spontaneous rupture of membranes after 37 completed weeks of gestation and before the onset of regular painful uterine contractions. PROM occurs in 5-10% of all pregnancies of which approximately 80% occur at term. The study aimed to compare the maternal and neonatal outcome in patients with term PROM receiving active induction versus expectant management.Methods: The present study was a prospective randomised controlled trial, conducted on 100 term antenatal women with PROM in the Department of Obstetrics and Gynaecology, UPUMS, Saifai from January 2016 to June 2017. 50 antenatal women received immediate induction with oral misoprostol while another 50 antenatal women were expectantly managed for 24 hours. The latency period, PROM delivery interval, maternal and neonatal outcome were compared and subjected to statistical analysis.Results: 42% of active management group and 30% of expectant management group had a latency period of 12-20 hours and results were found to be statistically significant (p value = 0.005). There was no statistically significant difference in the rate of caesarean section, maternal and neonatal morbidity in both the groups.Conclusions: Immediate labour induction in patients with term PROM resulted in significant shortening of latent period and PROM to delivery interval without any increase in caesarean section rate as compared to expectant management group.
Non-descent vaginal hysterectomy in women with previous caesarean section scar: our experience
Authors: Maiti G. D. , Pillai Ashok , Jose Tony , Lele P. R.
Published: May 2018

Background: Hysterectomy is one of the common gynaecological major surgeries performed worldwide. In spite of technological advancement with laparoscopic and robotic hysterectomy conventional hysterectomy through vaginal route of nonprolapse uterus popularly known as, Non-Descent Vaginal Hysterectomy (NDVH) remains a justifiable cost effective, cosmetically appealing option especially in resource-crunched developing country. NDVH in post caesarean scarred uterus too a technically challenged procedure requiring skills and expertise.Assessment of technical feasibility and safety of non-descent vaginal hysterectomy in women with previous caesarean section scar were studied.Methods: The study was a prospective observational study of 72 patients with LSCS scar requiring hysterectomy for benign conditions were selected based on the inclusion and exclusion criteria carried out from June 2012 to May 2017. Operating time, blood loss, surgical techniques, intra/postoperative challenges, conversion to laparotomy or laparoscopic assistance and length of hospital stay were recorded for each case. Patients were followed up till 03 months of surgery.Results: Vaginal hysterectomy was successful in all cases. Morcellation, bisection or myomectomy, were done in 86% cases. Two patients had bladder injury, which was repaired vaginally, two cases required support of laparoscopy.  No patients needed blood transfusion. None of the patients were converted to laparotomy.Conclusions: Vaginal hysterectomy is a safe and effective procedure for benign non-prolapsed uteri in women with previous caesarean section scar when uterine size is less than 14 weeks. Standby operating laparoscopy provides added advantages to surgeon in doubtful or difficult cases to avoid conversion laparotomy.
Intracaesarean forceps application
Authors: Verma Mansi , Keskar Jagruti , Bhalerao A. N.
Published: May 2018

Background: In a time when repeat caesarean deliveries are becoming more frequent, more elective LSCS are being performed and floating vertex are commonly encountered. Sometimes fundal pressure is not adequate, and the physician needs to use instrument (vaccum/forceps) to deliver the head. The objective of the present study is to evaluate maternal and neonatal complications of intracaesarean forceps applicationMethods: This was an interventional study which was conducted in OBGY department of Sassoon General Hospital, Pune for 1 year. 75 cases including both emergency and elective sections were included in the study, in which intracaesarean outlet forceps was applied.Results: Out of 75 cases, maternal complications were seen in 5 cases with uterine incision extensions being the commonest (4%). Neonatal complications were seen in 3 cases, with minor facial injuries due to pressure of forceps being commonest (2.6%).Conclusions: Intracaesarean forceps when applied skillfully can be effective, fast and safe technique of delivering fetal head in this rising trend of caesarean sections.
A comparative study of maternal outcome between vacuum extraction and outlet forceps delivery
Authors: Singh Shilpi , M. Munikrishna , S. R. Sheela
Published: May 2018

Background: Instrumental delivery is an art that is fading and may disappear in the near future as more and more obstetricians are resorting to caesarean sections. Instrumental vaginal deliveries comprise the use of vacuum assisted devices and /or forceps to assist in delivering a fetus, offering the alternative to accomplish vaginal delivery in properly selected cases thereby reducing maternal morbidity in terms of blood loss and increase hospital stay which is a consequence of cesarean sections. The objective of the present study is to compare the maternal morbidity with vacuum and outlet forceps delivery.Methods: A prospective comparative study was conducted in women delivering at department of obstetrics and gynaecology, in SDUMC, R L Jalappa Hospital, Kolar from March 2016 - March 2017 for a period of one year. A minimum of 180 patients were taken up for study. 90 women delivered by outlet forceps delivery and 90 women by vacuum delivery. Cases which require instrumental vaginal delivery and fulfilling the inclusion criteria for forceps or vacuum were taken up for the study, after taking informed consent. Maternal outcomes including episiotomy wound and extension, perineal tear, post-partum hemorrhage, hospital stay was analyzed and compared.Results: Mostly forceps and vacuum were applied for age group of 26-30 years and primigravida, which showed a statistical significance. Extension of episiotomy was more with forceps that is 21.1% and with vacuum being 4.4%. This difference was statistically significant. Postpartum hemorrhage was also more common in forceps group that is 13.3%compared to vacuum 11.1% but the difference was not statistically significant. The need for blood transfusion was seen more in cases of forceps that is 11.1% cases whereas in vacuum i.e. 6.7% cases but was not statistically significant.Conclusions: With the expertise and appropriate decision on the indication and meticulous handling of the instrument whether outlet forceps or vacuum, especially in a tertiary care centre, the maternal outcome is equally good with both the instruments.
Comparative effectiveness of simultaneous administration of mifepristone and misoprostol versus interval regimen of mifepristone followed by misoprostol 12 hours apart in second trimester medical abortion
Authors: Saini Arunima , Bedi Preet Kamal , Bhagat Nisha
Published: May 2018

Background: In second trimester abortion, medical methods are preferred. Prostaglandins are the most widely used. Amongst them, misoprostol is the most commonly used. Thus, the study was conducted to delineate the effectiveness of simultaneous administration of mifepristone and misoprostol versus interval regimen mifepristone followed by misoprostol 12 hours apart in second trimester medical abortion.Methods: It was a prospective, single centered, comparative study conducted on 50 patients in Department of Obstetrics and Gynaecology, GMC, Amritsar coming for second trimester abortion, either elective or emergency, with gestational age between 12-20 weeks. Initially, 53 patients were enrolled in the study, 3 patients dropped out at different stages of study. Finally, 50 patients were enrolled and divided into two groups of 25 patients each by 1:1 randomization. In Group-A, mifepristone 200 mg orally along with misoprostol 600µg vaginally were given simultaneously, followed by 400 µg vaginal misoprostol every 4 hours for a maximum of five doses in 24 hours. Group-B initially received mifepristone 200 mg per oral followed by 12 hours later misoprostol 400µg vaginally and then 400µg vaginal misoprostol every 4 hours for a maximum of five doses in 24 hours. Primary outcome measure was effectiveness of regimen in complete abortion, which was confirmed on pelvic ultrasound 1-week after the last dose. Secondary outcome measure was to compare the induction abortion interval (IAI), dose of misoprostol required and adverse drug reaction (ADR) among both the regimens. P-value <0.05 was taken as statistically significant.Results: Mean age in Group-A was 25.68±3.79 years while in Group-B was 23.40±2.73 years. Both the regimens had success rate of 76% for complete abortion. However, IAI in Group-A was 5.9±4.47 hours whereas in Group-B was 9.6±5.07 hours, which was statistically significant (p= 0.009). A statistically significant difference was also observed in the mean dose of misoprostol between two groups that is, 1000±200µg and 1425±437.41µg respectively (p=0.01). Gestational age was related to IAI from 13 to 17.6 weeks in both groups (p=0.01) while no significant relation was seen between them in more than 17.6 weeks of gestation (p=0.63).Conclusions: Simultaneous administration of mifepristone and misoprostol showed better results than interval regimen in term of significant lesser induction abortion interval, lower dosages of misoprostol required with comparable success rates.
Obstetric and perinatal outcome of twin pregnancy: a prospective study in a tertiary care hospital in North India
Authors: Bhalla Shivali , Bhatti Seema Grover , Devgan Shalini
Published: May 2018

Background: Multiple pregnancy constitutes an important portion of high risk pregnancies and is a matter of grave concern to obstetricians and paediatricians owing to maternal and perinatal morbidity and mortality associated to it. Objective of present study was to evaluate maternal and perinatal outcome of twin pregnancy.Methods: This observational study included 50 women with twin pregnancy with gestational age of 26 weeks or more. Maternal and perinatal outcomes were studied.Results: The incidence of twin pregnancy was 2.8 % with maximum incidence in age group of 20 -29 years and in multigravida. Mean gestational age was 34.2 weeks. Vertex - vertex fetal presentation was most common presentation. Most frequent mode of delivery was ceserean section (54%). Preterm labour was most common maternal complication (74%), followed by anaemia (62%). Complications in perinatal period were birth hypoxia (58 %), intrauterine growth restriction (15 %), hyper-bilirubinemia (11%) and neonatal sepsis (10 %). 88% of the newborns were LBW. Perinatal mortality in our study was 17%.Conclusions: Twin pregnancies are associated with significant maternal and perinatal morbidity which is more so for second twin. Effective antenatal care planned delivery and good pediatric facilities help decrease the complications. Managment of twin pregnancy requires multidisciplinary approach and involvement of skilled obstetricians and paediatricians.
Surgical site infections post cesarean section
Authors: Devi Sundari Lakshmi , Durga D. V. K.
Published: May 2018

Background: Surgical site infections are among the most common hospital acquired infections. They make upto 14-16% of inpatient infections. Objective of present study was to evaluate the risk factors associated with surgical site infections and the bacteria causing wound infections in obstetric operations and the antibiotic sensitivity and resistance pattern of the pathogens isolated.Methods: 100 women with wound infection during hospital stay or within 30 days following surgery. Pus samples were collected from the wound site with help of sterile swabs under aseptic precautions and immediately transported to microbiology laboratory for culture and sensitivity.Results: Most of the patients belonged to the age group of 21-25 years, contributing to 55% of the cases. Majority of the women are from rural areas (71%). 57% of the cases were unbooked. 90% of the SSI were seen in emergency surgeries. Anaemia (48%) was the most common medical risk factor followed by hypertensive disorders 25%. The risk of post operative infection has been shown to be proportional to volume of blood loss during cesarean section and duration of surgery. Staphylococcus aureus to be predominant organism of wound infection of which 21% were MRSA followed by Klebsiella and E.coli. The gram negative isolates were 100% resistant to ampicillin followed by 22.5% to third generation cephalosporins and aminoglycosides.Conclusions: Proper assessment of risk factors that predispose to SSI is critical for the development of strategies for reducing the incidence of SSI and for identifying high risk patients requiring intensive postoperative surveillance.
An unusual case of massive vaginal eversion complicated by obstructive uropathy
Authors: Sanyal Urmi , P. B. Hiremath , Ghosh Shilpa , N. R. Indu , M. R. Ramya , Hiremath Reshma
Published: May 2018

Pelvic organ prolapse is the descent of the pelvic organs (uterus or bladder or rectum) from their normal anatomical position, in varying combination, into or beyond the vagina as a result of failure of the ligamentous and fascial supports. Sometimes the resulting vaginal eversion or protrusion is so massive it may cause outflow obstruction of one or both ureters. Here authors present a case of a 62 year postmenopausal woman having massive vaginal eversion leading to obstructive uropathy and chronic renal insufficiency. The prolapse was corrected by Sacrohysteropexy.
NT scan: can it prevent second trimester MTP complications?
Authors: Johncy Anne , Rohini G. , Shri Lekha
Published: May 2018

The NT scan (11 to 13 weeks+6 days) is used as dating scan and genetic scan. Now it is emerging as a basic checklist for examination of the whole fetal anatomy and also to identify congenital anomalies in early trimester. Arnold-Chiari malformation type II is the most common which is characterized by displacement of cerebellar tonsils, parts of the cerebellum- fourth ventricle, pons and medulla oblongata through the foramen magnum into the spinal canal. This is usually associated with hydrocephalus and myelomeningocele. This can be prevented by preconceptional folic acid supplementation. Second trimester MTP complications can be prevented if we diagnose congenital anomalies in first trimester itself.
An increasing trend of bilateral tubal ectopic gestation reported over the past two decades: a case report and review of literature
Authors: Ahuja Mayuri , Mehta Archana , Goel Neerja , Jamal Shehla
Published: May 2018

Bilateral tubal ectopic pregnancies which are spontaneously conceived are of rare occurrences. Generally, they are diagnosed intra-operatively. There are no guidelines published till date for their management. There has been a reported increase in the incidence of such cases. We present a review of such cases reported over the last two decades and report a similar case which presented to our hospital with acute abdomen and USG suggested hemo-peritoneum with further intraoperative diagnosis of bilateral tubal ectopic managed by left salpingectomy and right salpingostomy
Spontaneous broad ligament haematoma following a normal vaginal delivery: a case report
Authors: Yalla Dheeraj , Nadar Alka N. , Rani G. Usha
Published: May 2018

Broad ligament haematoma is a rare complication following a normal vaginal delivery. We report one such case of a woman who developed this complication within 3 hrs of normal vaginal delivery. She is G2P1L1, 38 wks GA, in active labour. Pt was allowed for spontaneous progression of labour, following which she delivered vaginally. Within 3 hrs patient looked clinically very pale with vitals being deranged and complains of inability to void urine, severe perineal pain. On basis of clinical examination and transabdominal ultrasound features a diagnosis of right sided broad ligament haematoma was made. Based on patients haemodynamic instability surgical management in the form of obstetric hysterectomy was done.
Understanding unmet need for family planning
Authors: Singh Srishti , Kalhan Meenakshi , Malik J. S. , Jangra Anuj , Sharma Nitika , Singh Srijan
Published: May 2018

Unmet need represents the gap between women’s reproductive intentions and their contraceptive behavior. There are some 225 million women in the world who want to use safe and effective family planning methods are unable to do so. Control over fertility is very important not only because of its far-reaching implications on prosperity and overall growth of the nation, but also because of its impact on the freedom of young women to lead life of their own choice. Reduction in unmet need for family planning is critical for the overall development of the society. Combination of the mutually reinforcing effects of investments in education, health and family planning programmes is needed.
Placentophagy: a controversial trend
Authors: Bosco Cleofina B. , Díaz Eugenia G.
Published: May 2018

This work presents the latest scientific results of research in placenta, highlighting the description of the organ’s associated microbiotic, whose possible deleterious effects will be of greater magnitude in a hemomonochorial placental barrier, as is the case in the human species. We want to make solid scientific evidence available to Health Professionals in the delivery and post-delivery care area, so that they may adequately inform their patients that the supposed benefits of the placentophagy are not supported by scientific studies. On the contrary, they are based on misguided popular beliefs spread on social media and untrustworthy maternity/health blogs and internet pages. None of these sources warn mothers about the fact that placentophagy involves a potential risk of exposure of the baby to vertically transmitted infections, risk of the mother developing a thromboembolism due to the estrogen content in the organ, or that the accumulation of heavy metals and/or environmental toxins in the placenta could prove poisonous to mother and baby. It is also of great concern that the presence of normal prions in the placenta has been reported lately, because, normal prions can be transformed into the infective forms albeit by a mechanism that yet remains unclear. This adds another risk to those previously described. Therefore, it is imperative that Health Professionals warn their patients that placentophagy is not a safe practice and can constitute unnecessary risks for both mother and baby.
Impressive journey of TAVI so far, but miles to go
Authors: Shah Rikin , Dave Bhargav
Published: May 2018

Valve replacement is mandatory for AS patients owing to its progressive nature leading to continuous valve degeneration. However, surgical replacement cannot be opted for majority of patients due to old age and affiliated co-morbidities. Over the recent years, AS treatment in high-risk patient population favors a newer, less-invasive method of transcatheter aortic valve implantation (TAVI). The main objective of this review is to revisit all the relevant aspects of TAVI to treat AS in high-risk patients and to assess its possibility as a first-line treatment approach even for low-risk AS patients. We searched PubMed, Google Scholar, Medline and ClinicalTrials.gov to identify all the relevant randomized controlled trials (RCTs) assessing the outcomes of TAVI vs. surgical mode of valve replacement. This method is found to be very safe and reproducible in many landmark clinical trials involving high-risk patients, demonstrating superior or, at least, comparable outcomes vs. surgical mode of treatment. This led to a trend of testing TAVI in lower-risk patient population as well to expand its treatment indication profile.
Neonatal morbidity and mortality in the pediatric ward at the Ambohimiandra Antananarivo Madagascar hospital
Authors: Razanamanana Safidisoa N. , Ravelomanana Lovaniaina , Andriatahirintsoa Emilson JPR , Ravelomanana Noeline
Published: May 2018

Background: The 28 firsts days of life have high-risk of diverse aggression. To achieve the goal of ODD3 in reducing preventable neonatal death, our study was to evaluate main pathologies of newborn, newborn’s mortality.Methods: This is a retrospective descriptive and analytical cross-sectional study extending over a period of 8 months, December 2014 to July 2015.Results: We collected 132 newborn, the sex ratio was 1.13. Main newborn’s pathologies are neonatal infection (59.85%). Mortality rate was 14.39% and majority of neonatal death occurs early (73.68% of all deaths). Main causes of death are neonatal infection by septic shock. The most lethal pathology was hypoxic-ischemic encephalopathy. We have identified as a risk factor for neonatal death: admission age of 24 hours or less (OR 7; 95% CI 2.5-20.10; p = 0.00006), presence of resuscitation at birth (OR 3.48, 95% CI 1.28-9.44, p = 0.01), Apgar index less than 7 at the fifth minute (OR 4.22, 95% CI 2.25-14.87, p = 0.03) and birth weight less than 2500g (OR 3.80, 95% CI 1.39-10.36, p = 0.006).Conclusions: The mortality rate remains high. The prevention of low birth weight, asphyxia and infections has shown strategies to reduce neonatal morbidity and mortality.
Relationship between resistance to antibiotics and insusceptibility to biocides of Staphylococcus aureus and Pseudomonas aeruginosa isolated in Indonesian hospitals
Authors: Aulawi Khudazi , Junko Nishio , Okada Shinobu
Published: May 2018

Background: Several studies have shown that bacteria acquiring resistance to biocides may acquire resistance to antibiotics simultaneously. This study aimed to evaluate the relationship between resistance to antibiotics and insusceptibility to biocides of S. aureus and P. aeruginosa isolated in Indonesian hospitals.Methods: 61 isolates of S. aureus from nurses’ nasal cavities and 46 isolates of P. aeruginosa from hospital environments were divided into those with higher minimum inhibitory concentration (MIC) (Higher MIC group) and those with lower MIC (lower MIC group) depending on growth in MIC of chlorhexidine gluconate (CHG) and benzalkonium chloride (BZK) of each standard strain. Afterwards, susceptibility to antibiotics of the 2 groups was compared.Results: Increases in MICs of CHG were found in both species. Some of P. aeruginosa also had higher MICs of BZK. Relationship between antibiotic resistance and insusceptibility to biocides differed among species, biocides and antibiotics. In S. aureus, isolates in the Higher MIC group tended to be more resistant to ampicillin (0.167). In P. aeruginosa, resistance to aminoglycosides was observed more frequently in the Higher MIC group for CHG and it was significant in amikacin (p = 0.002). Further analysis is necessary to determine the mechanisms of the relationship between aminoglycoside resistance and CHG insusceptibility in P. aeruginosa.Conclusions: Increase in insusceptibility to biocides was found in isolated S. aureus and P. aeruginosa and a relationship between insusceptibility to CHG and resistance to aminoglycosides was observed in P. aeruginosa.
Cytopathological patterns of tuberculous lymphadenitis: an analysis of 126 cases in a tertiary care hospital
Authors: Bhatta Sushama , Singh Samir , Regmi Chalise Sangita
Published: May 2018

Background: Tuberculous lymphadenitis is one of the most common causes of lymphadenopathy in developing countries. Fine needle aspiration cytology (FNAC) has important role in the diagnosis of tuberculous lymphadenitis. The objective of this study was to evaluate the cytopathological patterns of tuberculous lymphadenitis and to correlate with Ziehl-Neelsen (ZN) staining.Methods: FNAC of 126 cases diagnosed as tuberculous lymphadenitis over a period of three years were reviewed. FNAC findings were categorized into three patterns: pattern A- epithelioid granuloma without caseous necrosis, pattern B- epithelioid granuloma with caseous necrosis, pattern C- caseous necrosis without epithelioid granuloma. Chi-square test was done to correlate cytopathological pattern and acid fast bacilli (AFB) positivity.Results: Tuberculous lymphadenitis was most frequent in the age group of 21-30 years (40.5%). Most common lymph node involved was cervical lymph node (82.53%). The most common pattern observed was Pattern B- Epithelioid granuloma with caseous necrosis in 53.17% cases. Overall AFB positivity was seen in 34.92% cases. Maximum AFB positivity was seen in Pattern C- Caseous necrosis without epithelioid granuloma in 81.81% cases. Serum adenosine deaminase (ADA) was elevated in 66.66% patients.Conclusions: FNAC is safe and cost effective diagnostic tool for the diagnosis of tuberculous lymphadenitis. Ziehl-Neelsen stain for Acid fast bacilli and Serum ADA can be used as an adjunctive tool for the diagnosis of tuberculous lymphadenitis.