bluuebunny/crossref_metadata_2025 huggingface dataset:
Compare the effect of amniotomy and oxytocin infusion in duration of labour
Authors: Jyothi Katta , Shakunthala Senadhipathi
Published: July 2019

Background: Labour is a unique experience in a women’s life, it is a physiological but painful event. It is a dynamic and continuous process which cumulates in the birth of a healthy baby followed by expulsion of the placenta and the membranes. The objective of this study was to determine the effectiveness of amniotomy and oxytocin in terms of duration of labour, mode of delivery and maternal and fetal outcome.Methods: A non-randomized comparative study of accelerating effect of  oxytocin and amniotomy has been studied, in the age group of 19-30 years, who are admitted in obstetric ward 200 primigravidae were studied out of which 100 belongs to control group and 100 study group.Results: In the study series 93 cases had labour lasting less than 4 hours when compared to only. The mean total duration of labour is reduced in study group with a difference of 204 minutes. Quantity and duration of blood loss is significantly less in study group when compared to control group. There was no significant difference in terms of mode of delivery, maternal and foetal outcome between the two groups.Conclusions: Oxytocin infusion combined with amniotomy is safe and effective in accelerating the first and second stage of labour in apparently normal cases. No statistically significant adverse effects were noted with oxytocin infusion and amniotomy.
Study of prevalence and determinants of polycystic ovarian syndrome among adolescent girls in rural area: a prospective study
Authors: Laddad Manisha M. , Kshirsagar Nitin S. , Shinde Gauri P. , Shivade Vaishnavi S.
Published: July 2019

Background: Polycystic ovarian syndrome (PCOS) is the most frequent endocrinological disorder affecting 5-10% of women in the reproductive age. This prevalence ranging from 2.2% to 26% in adult women from 18-45 year. In a recent study the prevalence of a confirmed diagnosis of PCOS in adolescents aged 10 to 19 years was 5-15%, which increased to 10-22%. When undiagnosed cases with documented symptoms qualifying for PCOS according to NIH (National institute of Health) criteria were included. PCOS is a complex endocrine disorder which is most common in women of reproductive age. PCOS may first present in adolescence, but the incidence of PCOS in adolescence is not known, as diagnostic criteria for PCOS in the adolescent age-group is still not defined, PCOS symptoms tend to overlap with normal pubertal changes making the diagnosis even more challenging. The objective is to study prevalence and symptomatology of polycystic ovary syndrome (PCOS) in adolescent girls.Methods: Prospective Cross sectional study between April 2018 and March 2019. 150 adolescent girls aged 10 to 19 years attending OPD with oligomenorrhea, irregular menstrual cycle, obesity and/or hirsutism were advised for biochemical, hormonal, and ultrasonographic evaluation for diagnosis of PCOS on the basis of Rotterdam's criteria at the Department of Obstetrics and Gynaecology, Krishna Institute of Medical Sciences, Deemed University, Karad, Maharashtra, India.Results: Prevalence of PCOS in the study was 17.33% in the study group.Conclusions: PCOS is increasingly encountered during adolescence, although the overall prevalence is low and evaluation of PCOS in adolescents is challenging. At this age, lifestyle modification is imperative to prevent long-term metabolic and reproductive complications.
Retrospective analysis of indications of primary caesarean sections done at a tertiary care hospital
Authors: Datta Kamna , Singh P. , Chopra Namita
Published: July 2019

Background: Caesarean section rates have globally risen above the levels that can be considered medically necessary. The aim of the study is to analyze the rate and indications of caesarean sections for primigravidae in the period 2016 to 2018 at a tertiary care hospital in Delhi.Methods: It is a retrospective observational study conducted in the Department of Obstetrics and Gynaecology at PGIMER and Dr RML Hospital, New Delhi. A total of 552 caesarean deliveries in primigravidae were studied.Results: The total deliveries during the study period were 3346 and the total caesarean section rate observed was 30.66%. The caesarean section rate among primigravidae was 29.1%. The rate of caesarean section in primigravidae rose from 22.7% in 2016 to 39.3% in 2018 with 17% increase. Majority of them belonged to the age group 20-30 years (79.34%) and 2.53% were elderly primigravidae. Out of the total number of primigravidae caesarean deliveries, 67.2% were performed in emergency and 32.7% were performed electively. Among the emergency caesarean sections performed, 64% of patients had induced labor and 22% had spontaneous labor. The most common indication of caesarean section was fetal distress (19.77%) followed by arrest of labor (17.87%) and malpresentations (8.9%). The short-term caesarean morbidity rate was 25.4% including one mortality. Wound infection was the most common complication.Conclusions: Various reasons like changing maternal risk profile increased IVF pregnancies, scientific advances, personal choice and medico legal considerations have been cited for increased caesarean rate. Following evidence-based labor protocols, judicious use of cardiotocography, proper patient selection for labor induction and patient education will contribute in reduction of caesarean sections and related complications.
A study evaluating knowledge of and attitude towards hepatitis B among pregnant women at a teaching hospital in Nellore, India.
Authors: Munivenkatappa Swetha , Govindaraj Srinivas M.
Published: July 2019

Background: Hepatitis B infection is a common and preventable infection in India. Mother to child transmission is the most common method of infection in our country. Awareness regarding hepatitis B among pregnant women is important to take preventive measures like screening during pregnancy, vaccination of child. Studies evaluating knowledge, attitude and practice (KAP) towards hepatitis B among the pregnant women in our country are sparse.Methods: A cross sectional survey was conducted to evaluate KAP towards hepatitis B among pregnant women was conducted after handing over an information hand-out. Data was collected using a standard questionnaire with three sections: i) Demographic data ii) Knowledge questions iii) Attitude and Practice questions.   Results: 42% of the 350 participants were aware about hepatitis B infection. The mean knowledge score was 6.33 (±2.86). Only 33.3% were aware that hepatitis B is transmitted by unprotected sex and 8.2% were knowledgeable of mother to child transmission. The mean attitude/practice score was 2.97 (±1.69). Only 30% would insist on safe equipment and blood/blood products. 84% would hesitate to have casual contact with hepatitis B infected persons. Most feared the stigma associated with hepatitis b infection than its health consequences. 70% would vaccinate their child to prevent hepatitis B infection. Women with greater knowledge about hepatitis B had better attitude/practice towards its prevention.Conclusions: Knowledge about HBV among pregnant women was poor and needs to be improved to prevent mother to child transmission. Educational programs need to be tailored for the target population for better uptake.
Elective versus emergency caesarean section: differences in maternal outcome
Authors: Sharma Anshu , Acharya Rajiv , Pehal Yashika , Sharma Bhawna
Published: July 2019

Background: Caesarean section is a life-saving surgical procedure when certain complications arise during pregnancy or labour. The use of CS worldwide has increased worldwide unprecedented levels although the gap between higher- and lower-resource settings remains. The present study evaluates the difference in maternal outcome in elective versus emergency caesarean sections in our institute.Methods: The study included first 65 cases of emergency caesarean section (group A) and during the study period, first 65 elective caesarean section (group B) if they fulfilled the inclusion criteria. Various intra operative and postoperative events were recorded which included intra operative complications, postpartum haemorrhage and transfusion indices.Results: The most common indication of caesarean section in group A was fetal distress (27.7%). In group B most caesarean sections were classified under 5 followed by class 6, the most common indication being previous caesarean section (27.6%). It was observed that pre-operative mean haemoglobin in group A was 10.6 g/dl and in group B was 11.2g/dl. A drop of 1.36 g/dl in group A and 1.10 g/dl in group B was observed in the post-op period. Cross match / transfusion ratio 1.5 in group A and  2 in group B, transfusion probability ratio was 60 % in group A and  66.7%  in group B and transfusion index was 1 in group A and  group B. There was significantly higher contraception acceptance in group B compared to group A.Conclusions: Elective caesarean section has more favourable maternal outcome as compared to emergency caesarean section as the former is done under controlled and planned circumstances.  However, there should be stringent audit to scrutinise indication of caesarean section, outcome of caesarean and blood transfusion practices.
A study of prevalence, severity, stages, conception rate and associated problems in patients with endometriosis
Authors: Y. Swapna , Yousuf Ali Asma Mohammed
Published: July 2019

Background: Endometriosis should be suspected in women with sub-infertility, dysmenorrhea, dyspareunia or chronic pelvic pain. However, these symptoms can also be associated with other diseases. Endometriosis may be asymptomatic even in some women with more advanced disease. The objective of this study was to prevalence, severity, stages, conception rate and associated problems in patients with endometriosisMethods: Present study was retrospective and prospective study from January 2007 to September 2012 which included 200 infertile patients who underwent laparoscopy and were diagnosed with endometriosis in the Department of Obstetrics and Gynecology at Owaisi Hospital and Research Centre, Hyderabad, Telangana, India.Results: Majority of the patients belonged to the age group of 18-25 years i.e. 45.5%. The most common symptom with which the women presented to the hospital was abnormal uterine bleeding seen in 26% of the cases. Out of total cases, 64% had primary infertility and remaining i.e. 36% had secondary infertility. Ovarian endometrioma was seen in 22% of the cases. Majority of the patients had dysmenorrheal in 62% of the cases. Majority were found out to be present in the stage one or minimal endometriosis i.e. they constituted 78 women which amounted at 39% of the total cases. As the severity of the endometriosis increased, the symptomatic relief rate after laparoscopy decreased. As the severity of the endometriosis increased, the conception rate following laparoscopic laser fulguration decreased.  As the severity of the endometriosis increased, the requirement for ART increased.Conclusions: Laparoscopy is considered to be better than laparotomy since there is less morbidity and less adhesions and tissue trauma.
Postpartum intrauterine contraceptive device: evaluation of acceptance and complications
Authors: Gaur Sindhu S. , Mendiratta Suman
Published: July 2019

Background: Postpartum intrauterine contraceptive device is inserted within 10 minutes to 48 hours of expulsion of placenta. The objective of the study was to determine acceptability, safety and complications of PPIUCD in tertiary care center.Methods: This is a retrospective study conducted at Zenana Hospital, SMS Medical College, Jaipur over a period of 1 year from April 2018 to March 2019. Women were followed after 6 weeks and their complaints and various parameters were analyzed.Results: 5653 women were inserted PPIUCD during 1 year period. Acceptance rate was 29.26% and higher in multipara (54.30%) and between 18 to 25 years of age (50.29%). The main complaints at follow-up were pain and bleeding which were dealt mainly by reassurance. Main cause of removal was bleeding, pain and family pressure.Conclusions: The acceptance was high in this study group. PPIUCD is safe, effective and acceptable with negligible side effects. PPIUCD has abundant scope in India where accessibility for contraception is lower during interval period and women do not come for follow-up after delivery.
A longitudinal study of near-miss and maternal mortality at a tertiary centre in rural Uttarakhand: addressing the fourth delay
Authors: Mangla Mishu , Nautiyal Ruchira , . Deepmala
Published: July 2019

Background: India is a signatory of the sustainable development goals and is committed to reduce the maternal mortality ratio to less than 70 per lakh live births. Review of maternal deaths and near miss cases is a very important step towards achieving this aim.Methods: A prospective observational study was carried out in a tertiary care centre in rural Uttarakhand for a period of one and half year using WHO criteria for maternal near-miss, in an attempt to assess the quality of obstetric care in the region and to identify the possible delays leading to this.Results: Haemorrhage was the most common cause leading to severe maternal outcome, followed by early pregnancy complications and hypertensive disorders of pregnancy. The mortality index was 15% and maternal near miss to mortality ratio was 7:1. We could identify some type of delay in at least 70% of near miss and mortality cases. Although delay in seeking healthcare was the most common, lack of community participation was identified as an important fourth delay.Conclusions: For substantive reduction of maternal mortality in this region of Uttarakhand, the main action needed is strengthening of primary health care, educating the patients regarding warning signs of pregnancy and strengthening the social status of women in society, increasing community support in women health care.
Review on oral methotrexate in medical management of ectopic pregnancy: a 2 years experience in hospital Shah Alam
Authors: Jabarudin Wan Nurul Ezyani Wan , Som Normala Mohammad , Mohammad Daud Afidatul Mardhiah , Shamsuddin Nor Dalila , Yaacob Nazian Hanna , Omar Hamidah
Published: July 2019

Background: The objective of this study is to determine the success rate of oral methotrexate in Hospital Shah Alam for the past 2 years.Methods: This is a cross-sectional study using secondary data obtained from medical record office in Hospital Shah Alam on patients with ectopic pregnancy. A total of 35 patients who fulfilled the criteria for medical management were selected. They were prescribed with oral methotrexate with the dose of 60 mg given in 3 divided doses every 2 hours using the standard tablet of 2.5mg. Follow up was done at day 4, day 7 and till HCG level achieve less than 20 iu/litre.Results: 29 patients were successfully treated with oral methotrexate 60 mg (82.8%). Another 6 patients had to undergo laparoscopic surgery with confirmed leaking, ruptured tubal pregnancy. 4 patients needed second dose of Methotrexate due to rising HCG level and all of them were successfully treated after the second dose. The side effects of oral methotrexate were tolerated well by all patients. There are numbers of predictors for success which are the level of HCG <4000 iu/litre, size of mass <4cm, no abdominal pain during early presentation and decrease of HCG level in between day 4 to day 7 after oral methotrexate.Conclusions: The success rate of oral methotrexate for stable ectopic pregnancy is good making it a suitable option for clinical settings which has no specialised equipment to handle cytotoxic drugs.
Obstetric outcome in pregnancies with borderline versus normal amniotic fluid index
Authors: Augestine Tony , Palakkan Saphina , N. Umadevi
Published: July 2019

Background: Amniotic fluid is an indicator of placental function on the fetal development. It is regulated by several systems, including transmembraneous pathway, fetal production (fetal urine and lung fluid) and uptake (fetal swallowing), and the balance of fluid movement via osmotic gradients. The amniotic fluid index is the most commonly used method of measuring amniotic fluid. An AFI between 5 to 8 cms is borderline oligohydraminos. To compare the fetal and maternal outcome in pregnancies with borderline amniotic fluid index (5 to 8 cms) and normal AFI.Methods: This prospective cohort study was carried out on 94 pregnant patients attending the antenatal clinic of MES Medical College, Perinthalmanna between January 1st and December 31st 2016. Women with a singleton pregnancy in the third trimester were enrolled into the study. Of these 47 cases were in the normal AFI group and 47 cases in the borderline group. Adequate information was obtained from the patient’s medical record and the groups were compared on maternal and fetal complications.Results: The study results showed that more cases with borderline AFI had their non stress test to be nonreactive (59.6% versus 23.4%) and was associated with more fetal heart rate abnormalities (51% versus 17%). The number of meconium stained amniotic fluid (48.9% versus 19.1%) and caesarean deliveries (51.1% versus 21.2%) were also more among the borderline group.Conclusions: Findings indicated that there are more adverse fetal and maternal outcome among the borderline AFI group.
Focussed antenatal care a possible opportunity towards safe motherhood
Authors: A. Sunkad M. , Kadakol Rajeshwari , Shetty Darshit , B. Javali S. , Dhamankar Satish
Published: July 2019

Background: The Primary Health Care Setting gives a challenging opportunity for the clinicians to deal with pregnancy into favorable outcomes solely based on the clinical skills in view of innumerable socio-cultural-economic barriers. The Pregnant women make satisfactory progress-  to  full term, deliver  with  minimal morbidity, no loss of life and healthy baby-How to ensure? This is the objectives of our study. Suppose Obstetricians spare time, use checklist, Prioritize and provide care will it make any difference in saving mothers? Objectives: Describe in detail the process of Focused Antenatal Care as practiced in Primary Health Care setting and Minimize mortality and morbidity due to pregnancy by 25 percent from 169. (Maternal Mortality Rate (MMR 169).Methods: This is a community based descriptive, prospective, cohort study about a group of pregnant women till their delivery, using multiple cluster random sampling of 251 high risk pregnant women and subsequent follow up over 3 months with focused care. Compilation of data and analysis using SPSS Version 20.Results: Total Study participants 251 represented all the sections of target population with regard to socio-economic and cultural background. The participants attended FANC giving a response rate of 100%. These participants had one or more risk factor. All but 10 participants attended 4 or more FANC clinic visits 241 (96%). In these participants the commonest manageable morbid conditions are underweight (20%), anaemia (14%) preeclampsia (8%), eclampsia (2%) and gestational diabetes. In our finding 87% mothers completed full term pregnancy, 11.5% preterm (>28 but < 37 weeks) while 1.5% Post term. There were 241 live births, 87% Baby weight > 2.5Kg, 13% Baby weight < 2.5 Kg. with an average of 2.9Kg.Conclusions: We are able to describe the Focused ANC and able to help improve the quality of life and to minimize morbidity and mortality in pregnant women.
The significance of expression of Her2neu in squamous cell carcinoma of uterine cervix
Authors: Yadav Shakti Kumar , Verma Alekh , Singh Sompal , Sarin Namrata
Published: July 2019

Background: Cervical cancer is one of the leading causes of cancer related deaths among females. It arises from precursor lesions i.e. squamous intraepithelial lesions which are closely associated with infection by HPV. The ERBB2 protooncogene encodes for a cellular transmembrane protein (erb-b2) which has tyrosine kinase activity and has been implicated in the regulation of cellular growth and proliferation in various cancers. Application of monoclonal antibodies against Her2neu has shown higher response and improved survival. The aim of the study was to evaluate the expression of Her2neu in squamous cell carcinoma of cervix in relation to tumor characteristics and to compare the expression with normal control subjects.Methods: It was a cross-sectional analytical study. Paraffin embedded tissue blocks from 30 cases of squamous cell carcinoma were obtained from the archives. Twenty age matched cases of normal cervix removed for lesions other than that related to cervix (like leiomyoma) were taken as control. Tumour characteristics were noted from the records. Her2neu immunostaining was done. Her2neu expression was scored as positive or negative according to the American Society of Clinical Oncology and the College of American Pathologists (ASCO/CAP) scoring system for Her2neu. The Chi-square test was used to compare and find association between the variables. Student t-test was used to compare the variable between cases and controls.Results: Her2neu was positive in 20% and negative in 80% cases of the study group. Her2neu positivity is not associated with size, histological grade and FIGO stage of the tumor. We found that all Her2neu positive cases showed no lymph node metastasis. This association between Her2neu positivity and lymph node status was statistically significant.Conclusions: Her2neu immunoexpression is variable across various categories of squamous cell carcinoma. Her2neu positivity might be negatively associated with lymph node metastasis. However, a more comprehensive study encompassing various factors related to Her2neu overexpression is required to validate these results.
Evaluation of Podocalyxin level in pre-eclampsia with severe features' patients: a cross-sectional study
Authors: Amin Ahmed F. , Abou-Taleb Hisham , Gamal Mustafa , Thabet Marwa M. , Azoz Nashwa , Abbas Ahmed M.
Published: July 2019

Background: This study aims to evaluate the level of podocalyxin (PCX) in preeclampsia with severe features patients and correlate it with the results of laboratory tests.Methods: The current study was a cross-sectional study conducted in Assiut Women Health Hospital between April and October 2018.  The study included 60 patients divided into two groups; Group (A): 30 patients diagnosed to have preeclampsia with severe features and Group (B): 30 patients as normal control group. Complete laboratory investigations with measurements of the PCX level was performed for all study participants.Results: No statistically significant difference between the study group and control group according to blood urea (p= 0.339) and serum creatinine (p= 0.801).There was statistically significant difference between the study group and control group according to PCX level (p= 0.001); the mean PCX was 3340.0 ± 2394.6 in the study group versus 1083.5±1400.2 in the control group. Univariate analysis revealed podocalyxin was not correlated with clinical data or laboratory investigations.Conclusions: Podocalyxin levels were significantly elevated in preeclampsia.
The comparison of the efficacy of intra-peritoneal instillation along with local infiltration with bupivacaine versus placebo for post-operative analgesia after laparoscopic tubal ligation
Authors: Kakade Aniket S. , Dudam Naval , Panchanadikar Tushar M.
Published: July 2019

Background: Intra-peritoneal instillation of local anesthetics has been shown to minimize post-operative pain after laparoscopic surgeries. The present study was undertaken with the following aim to compare the efficacy of intra-peritoneal instillation and local infiltration with bupivacaine versus placebo for post-operative analgesia after laparoscopic tubal ligation. To correlate the advantages and side effects of the drugs during the procedure. To establish a protocol for the use of bupivacaine instillation and infiltration for post-operative analgesia after laparoscopic tubal ligation.Methods: A prospective study was carried out in a tertiary care hospital attached to a teaching medical institute. Institutional ethics committee approval was obtained for this randomized control study (double blind) including 50 women who will be divided in two groups. Group A will be administered intra-peritoneal bupivacaine along with local infiltration. Group B will be administered normal saline. Post-operative pain will be monitored by a blind observer and rescue analgesia will be administered at visual analogue score of 3.Results: Both the groups were comparable with respect to age and BMI. The mean duration of analgesia in Group A with bupivacaine was 315.60±79.9 min (Median 300 min).  The mean duration of analgesia in Group B with normal saline was 138.20±46.97 min (Median 150 min, p value <0.001).Conclusions: The study depicts a significant pain relief after use of bupivacaine. Bupivacaine instillation in the peritoneal cavity along with local infiltration of the drug gives prolongs pain relief as compared to normal saline.
Fetal evaluation of post partum intrauterine contraceptive device versus interval intrauterine contraceptive device insertion
Authors: Godhani Hiral P. , Patel Dhaval K.
Published: July 2019

Background: Family planning is important not only for population stabilization, but it has been increasingly recognized as central tool to improve maternal and neonatal health. Aim of current study was to compare interval and post partum intrauterine contraceptive device (IUCD) insertion in terms of effectiveness and safety.Methods: This was a prospective observational cohort study, done in the department of Obstetrics and Gynecology, GMERS Medical College, Sola, Ahmedabad, from August 2015 to April 2017 was taken for evaluation. 80 women in each group who were inserted IUCD after delivery and in the interval period were studied. Outcome was measured by expulsion rate, continuation rate, and incidence of dysfunctional uterine bleeding (DUB), Pelvic inflammatory disease (PID), failure rate and effect on puerperium.Results: Expulsion rate in PPIUCD group was 8.75% while in interval IUCD group it was 1.25%. Continuation rate following Postpartum intrauterine contraceptive device (PPIUCD) and interval IUCD insertion was 86.25% and 95% respectively. Incidence of bleeding per vaginum (menorrhagia) was 7.5% in PPIUCD group while 8.75% in interval IUCD group. There was one case 1.25% of PID in interval IUCD group while no case in PPIUCD was noted. Failure rate was nil in both the group. There was no effect on puerperium following PPIUCD insertion group during present study.Conclusions: PPIUCD is an effective and safe spacing method of contraception as compared to interval IUCD insertion. There is no statistically significant change in incidence of expulsion rate, continuation rate and other complications in both the group.
Congenital anomalies in a tertiary care hospital in North East region, India
Authors: Praneshwari R. K. , Singh N. Nabakishore , Devi Akoijam Tamphasana , Priya Jyoti , Singh L. Ranjit
Published: July 2019

Background: Congenital anomalies are important cause of morbidity and mortality in newborns and are defined as structural and functional abnormalities including metabolic disorders present at birth. These defects are of prenatal origin resulting from defective embryogenesis or intrinsic abnormalities in the process of development and are associated with various risk factors.Methods: Our study is a cross sectional study done at Regional Institute of Medical Sciences, Imphal over period of 3 years from January 2015 to December 2017. Aim of study was to find out incidence of congenital anomalies and proportions of different types of congenital anomalies. Outcome was studied in relation to maternal age, religion, parity, and gestational age, sex of the baby, outcome and sex of the baby.Results: Total numbers of congenital anomalies were 257 babies out of 29879 births giving the incidence of 0.86%. Most common congenital anomalies in this study are musculoskeletal followed by craniospinal, genitourinary, cardiovascular and gastrointestinal. It was more common in preterm babies and parity 1-3, more common in 21-30 years of maternal age. Consanguinity was seen in 7 out of 257 patients.Conclusions: Congenital malformations are a major cause of still births and infant mortality. Targeted scan should be done at 18-20 week to find out anomalies and reduce the prevalence. There should be widespread education in the community regarding the common congenital malformations, their outcomes and possible available mode of treatment
Postpartum Implanon/Nexplanon continuation rates and associated factors among women who ever used Implanon/Nexplanon in a tertiary hospital in Accra, Ghana
Authors: Mumuni Kareem , Asah-Opoku Kwaku , Ganu Vincent , Samba Ali
Published: July 2019

Background: Postpartum Implanon use serves as an important conduit to bridge the wide gap of unmet need for contraception. The study sought to determine the continuation rates of postpartum Implanon/Nexplanon use and factors associated with it.Methods: A retrospective review of electronic data of 391 women who had received postpartum Implanon/Nexplanon insertions from January 2012 to December 2015 was conducted at a family planning hospital in Accra, Ghana. Continuation rates and factors associated with discontinuation at 6 months, one year and two years post-partum were determined. Data were analysed using IBM Statistical Package for Social Science (SPSS) version 20.Results: A total of 391 postpartum Implanon/Nexplanon insertions were done during study period. Their mean age was 28.51±5.29 years and median parity was 2.0. Continuation rates of postpartum Implanon/Nexplanon at 6 months, 1 year and 2 years post uptake were 94.9%, 92.8% and 86.4% respectively. Women with tertiary level education were 64% less likely to continue Implanon/Nexplanon use at one-year post uptake (OR=0.36, CI=0.16-0.85). Women with education up to Senior High School were 62% less likely to continue postpartum Implanon/Nexplanon use at 2 years after uptake (OR=0.38, CI=0.18-0.81). Women between ages 20 and 29 years were 53% less likely to continue postpartum Implanon/Nexplanon use at 2 years (OR=0.47, CI=0.26-0.86). Reasons for discontinuation of postpartum Implanon/Nexplanon use were wishes to get pregnant and side effects of the method.Conclusions: Post -partum Implanon/Nexplanon continuation rates are high and remain as a viable choice for reduction of unplanned pregnancies post- delivery.
Obstetric and perinatal outcomes in pregnancies occurring as a result of Fresh and Thawed frozen embryo transfer
Authors: Shah Nishita , Jayakrishnan K.
Published: July 2019

Background: In vitro fertilization is a known independent risk factor for adverse perinatal outcomes. To explore obstetric and perinatal outcomes in pregnancies occurring as a result of fresh and thawed frozen embryo transfer.Methods: Retrospective observational study with 208 patients. A period of 2 years from October 2015 to October 2017. Tertiary care Fertility, Laparoscopy and research centre. All pregnancies conceived by IVF (n= 208) between the study period were included. The patients were grouped by fresh (n= 108) versus frozen (n= 100) embryo transfer. Patients conceived with donor embryo transfer were excluded. Primary outcomes were missed abortions, ectopic pregnancy, live births. Incidence singleton pregnancies and multiple gestations, preterm delivery, birth weight, an obstetric complication includes gestational hypertension, preeclampsia, gestational DM, placenta previa.Results: A total 208 patient analyzed who conceived with IVF treatments, among them 108 patients were in Fresh ET group and 100 were in Frozen ET group. The incidence of Ectopic Pregnancy was more in fresh ET as compared to Frozen ET (14.8%, 02% respectively, p value <0.05) whereas that of missed abortions were more in Frozen ET (22% versus 11.1%, p value 0.03). There were no significant differences in obstetric and perinatal outcomes in both groups.Conclusions: In this study of IVF pregnancies, adverse obstetric and neonatal outcomes did not differ between fresh and frozen embryo transfers. Literature tells that there may be an increased risk of preeclampsia and large for gestational age babies in pregnancies conceiving after frozen embryo transfer. So freeze all policy should be applied to only indicated cases and not to all because both the groups having similar outcomes.
Ovarian teratomas: clinicopathological study at tertiary care center
Authors: Jagtap Sunil Vitthalrao , Kshirsagar Nitin S. , Jagtap Shubham S. , Boral Saswati , Nasre Nitesh
Published: July 2019

Background: Teratomas are belonging to a group of germ cell tumors. It is also referred to as dermoid cyst. Teratomas are most common germ cell tumor of the ovary. Teratomas are composed of various histological types. In this article we are presenting various morphological patterns, its clinical manifestation and its clinical significance.Methods: This is prospective study for a period of 3 years from March 2016 to February 2019 at tertiary care hospital. It consists of total evaluation of 82 cases of ovarian lesions which were surgically excised for clinically or radiologically suspected of ovarian neoplasm.Results: A total of 82 cases of ovarian specimen were included out of which 18 cases were of ovarian teratoma. In these 17 cases were benign teratomas, 1 case of immature teratoma. All the cases of mature teratoma were predominantly of cystic type with focal solid areas. Right sided ovary was involved in44.5% cases while left sided in 55.5% cases. The tumor size ranges from 2.5 cm to 20.8 cms. The age range in this study was from 20 to 60 year. The common age observed for ovarian teratoma was in group of 31-40 years, having 6 cases. The clinically most of cases were asymptomatic or presented with unexplained abdominal pain or palpable mass. USG finding in most of cases were diffuse or partial echogenic mass lesion with cystic nature and echogenic bands.Conclusions: In our study showed mature cystic teratoma is the most common type of ovarian teratomas. The immature and monodermal types are rare. The histopathological examination plays important role in final diagnosis   and patient management.
Evaluation of patients with polycystic ovarian syndrome at a tertiary care center
Authors: Y. Swapna , Srilakshmi V.
Published: July 2019

Background: It has been estimated that prevalence of PCOS ranges from 5-10% in reproductive females. Thus, it becomes most common endocrinopathy in this age group. Lack of ovulation and androgen over activity are key features of PCOS. The objective of this study was to patients with polycystic ovarian syndrome at a tertiary care center.Methods: Present study was following up study with 200 cases of PCOS. Rotterdam criteria were used for the diagnosis of the PCOS. This criterion includes three things. First is woman having in last year <6 periods of menstruation. Second is testosterone value >0.6 ng/ml and third is each ovary having >12 follicles with increased size and volume. Those cases with hypothyroidism, adrenal tumors, congenital adrenal hyperplasia etc were excluded from the present study. Those on steroid therapy were also excluded. Detailed history and clinical examination were carried out for included cases as well as required investigations.Results: Overall incidence of infertility was found as 27.9%. Out of these 200 cases, 44 (22%) had PCOS. Majority cases belonged to 20-24 years of age. Hirsutism was most common findings in clinical hyperandrogenism. Risk of insulin resistance syndrome was 4.79 times higher in obesity compared to not obese. Age, BMI, duration of infertility, ovarian volume, and menstrual pattern had effect on ovulation rate following laparoscopic ovarian drilling. Increasing duration of infertility and BMI had lower ovulation rate. Ovulation rate was highest when treated with clomiphene citrate alone than the combination therapy.Conclusions: Women with obesity have more chances of having PCOS as seen from the present study.
Role of IV administered Iron sucrose with recombinant erythropoietin in the treatment of moderate and severe iron deficiency anemia in the third trimester of pregnancy
Authors: Sandhu Namrita , Singh Sanjay
Published: July 2019

Background: Iron deficiency Anemia in pregnancy is one of the most common and intractable nutritional problems in the world today. The objective of this study was to investigate the therapeutic efficacy and safety of rHuEPO combined with IV iron sucrose, in the treatment of pregnant women in third trimester with moderate and severe iron deficiency anemia and whether addition of erythropoietin will increase the rate of rise of Hb without compromising on the safety of the therapy.Methods: 60 pregnant women in the third trimester, diagnosed as cases of moderate and severe iron deficiency anemia were enrolled in this study with 30 subjects in each of the 2 groups. Recombinant Erythropoietin 2000 IU s/c and Inj Iron sucrose 100 mg slow intravenously in 100 ml 0.9% NS over 1 hr on alternate days was administered to the case group and the control group was administered only iron sucrose slow IV in the same dose on alternate days till target Hb (11gm%) was reached. Efficacy measures were reticulocyte count, increase in Hb/week, time to target Hb level and need for continued therapy after 4 weeks.Results: In the case group, the increases in Hb were greater after 1 week of treatment and this was found to be significant (P < .01), the median duration of therapy was shorter in the case group (22 versus 34 days), with more patients reaching the target hemoglobin level by 4 weeks as opposed to 7 weeks in the control group. Average rise in Hb/week was much more in the case group. The groups did not differ with respect to maternal and fetal safety parameters.Conclusions: Iron sucrose plus rhEPO is an effective treatment for iron deficiency anemia in pregnancy probably because of a synergistic action, with rhEPO stimulating erythropoiesis and iron sucrose delivering iron for hemoglobin synthesis.
Dysmenorrhea among students in Yaounde, Cameroon: associated factors and socio-cultural aspects
Authors: Fouedjio Jeanne Hortence , Fouelifack Florent Ymele , Fouogue Jovanny Tsuala , Etame Lionel , Fouelifa Loic Dongmo , Mbu Robinson Enow
Published: July 2019

Background: Dysmenorrhea is very common disorder. It affects the quality of life and is the main cause of school absenteeism’s among teenagers. The goal of this study was to determine socio-cultural aspects of dysmenorrhea among students in Yaounde and factors associated with it.Methods: Authors carried out a cross sectional analytic study in 2 secondary schools and a higher institute in Yaounde, from December 1, 2017 to June 30, 2018 (7 months). Authors included all students aged at least 15, in form 5 and above. In the higher institute, sampling was consecutive, while it was stratified into 2 clusters in the secondary schools.  Odds ratios were determined to assess association between variables and P-value ˂0.05 was considered significant.Results: Of the 1059 participants, 800 had dysmenorrhea (prevalence: 75.5%). Mean age was 18.88±3.62 years (range: 15-45 years). Family history of dysmenorrhea (OR: 4.20 (95% CI: 3.02-5.83)) and stress ((OR: 2.16 (95% CI: 1.55 - 3.02)) were significantly associated with dysmenorrhea. A duration of menses ≤3 days was protective ((OR: 0.31 (95% CI: 0.12-0.82)). Dysmenorrhea remains a taboo for 23.6% of participants.Conclusions: Family history of dysmenorrhea and stress are risk factors for dysmenorrhea which remains a taboo for almost a fourth of affected women. Authors recommend educating women about dysmenorrhea and control psycho-social stress.
One step procedure for screening and diagnosis of gestational diabetes mellitus by diabetes in pregnancy study group of India
Authors: L. Dwarakanath , R. Hema K. , P. Hemashree
Published: July 2019

Background: In the Indian context, screening for Diabetes is essential in all pregnant women, as the Indian women have an eleven-fold increased risk of developing glucose intolerance during pregnancy. For this, we need a simple procedure which is economical and feasible. Hence this study was undertaken as a screening as it is acceptable, economical and feasible to perform. Aim of this study was to assess the feasibility of one step procedure for screening and diagnosis of Gestational Diabetes Mellitus by Diabetes in Pregnancy Study Group of India (DIPSI).aim of the study was to study the occurrence of Gestational Diabetes mellitus, Tumkur, to assess the sensitivity and specificity of glucose challenge test, to assess the need for universal screening and to study the maternal and perinatal outcomes in patient with Gestational Diabetes Mellitus.Method: Type of study was prospective study. this study included 200 pregnant women attending the antenatal OPD in Sri Siddhartha Medical College, Tumkur. Data collection was in a predesigned proforma. Pregnant women with 24-28 weeks of gestation were given 75 grams of oral glucose load, irrespective of their meal and venous blood sample drawn after 2 hours. If blood glucose value was ≥140mg/dl, the screening was considered as DIPSI positive. These patients underwent OGTT.Results: Incidence of GDM was found to be 3.5% in the patients studied. 40% of cases did not have risk factors, hencethere is a need for universal screening. DIPSI was positive in 10 cases, of which 7 were OGTT positive. Patients were managed with diet and insulin. The maternal and perinatal outcome of pregnancy was good.Conclusion: For universal screening, DIPSI performed irrespective of last meal timing with 75g glucose load is a patient friendly approach. This method recommended by WHO serves both as a one-step screening and diagnostic procedure & is easy to perform besides being economical.
Gestational hyperglycemia on diet and medication: impact on placental pathology and pregnancy outcomes
Authors: Natarajan Lalitha , UmaMaheswari G.
Published: July 2019

Background: To evaluate the placental morphology and perinatal outcome in patients with gestational hyperglycemia on diet and medication.Methods: Placental examinations performed at the Department of Pathology between August 2016 to August 2018 were retrospectively reviewed. Of the received 140 placentas, 35 of gestational diabetes (GDM) and pre gestational diabetes were identified and segregated into hyperglycemia on diet and on medication. The clinical details, placental findings and perinatal outcome of patients in both the groups (gestational hyperglycemia on diet and medication) were collected and analyzed.Results: Among the 35 cases, there were 24 cases of mild gestational hyperglycemia controlled with diet and 11 cases of hyperglycemia on medication (oral hypoglycemic drugs ± insulin).Most of the placentae in both the groups weighed less than tenth centile. The cord abnormalities such as hyper coiling, velamentous /marginal insertion and furcate cord were observed more in women with GDM on diet. There was no significant gross placental lesion in those on medication. Placental histological features most consistently associated with both the groups include, disturbances of villous maturation (DVM), Derangements in uteroplacental / foetoplacental circulation and villous capillary lesions. Small for gestational age and intrauterine foetal death were found in both the groups, but more commonly in patients with hyperglycemia on medication.Conclusions: Villous maturation defects, uteroplacental / foetoplacental malperfusion are the essential placental changes which can result in adverse perinatal outcomes in women with hyperglycemia irrespective of the diabetic control.
Maternal serum βhCG level and uterine artery doppler studies as predictors of pregnancy induced hypertension and intra uterine growth restriction: a prospective study
Authors: Sheth Vishal S. , Nakum Kanaklata D. , Patel Mehul D. , Lunagariya Mayank R.
Published: July 2019

Background: PIH, a pregnancy-specific disorder, is one of the major causes of maternal and perinatal morbidity and mortality worldwide.PIH and fetal growth restriction are important causes of perinatal and maternal morbidity and mortility.Methods: Hundred Indian pregnant women in their second trimester (13-20 weeks) and in their late second trimester (24-28 weeks) investigated for their serum β-hCG level and uterine artery Doppler studies respectively, attending OPD/IPD in Sir T. hospital, Bhavnagar from June 2014 to June 2015.Results: There is no clinical significance between parity and occurrence of PIH (p=0.2) and FGR (p=0.7). Out of 77 patients with their β hCG level ≤2 MoM, 2 patients (2.59%) developed PIH and FGR. And from 12 patients with their β hCG level ≥2 MoM 10 patients (80%) developed PIH and FGR which is highly significant (p<0.001). The study establishes the validity of beta HCG as a predictor of PIH and FGR with the sensitivity of 83.3%, specificity of 97.5%.Conclusions: This study can be concluded by there is a strong association between high maternal serum ß-hCG level, abnormal uterine Doppler studies with predicting adverse outcome of pregnancy like PIH and FGR. There is also a good association between high maternal serum ß-hCG level and rising severity of the disease.
Comparison of efficacy of buccal versus vaginal misoprostol in first trimester induced abortion
Authors: Khan Nida , Kant Anita M. , Thukral Pooja C. , Saquib Mohammad
Published: July 2019

Background: To compare the effectiveness, side effects, and patient satisfaction of buccal versus vaginal misoprostol administration in first trimester abortions.Methods: Women opting for first trimester abortion received oral Mifepristone followed 48 hours latermisoprostol. Group A received Misoprostol via buccal route whereas group B received Misoprostol vaginally. A comparative analysis using SPSS was done.Results: Giving 800µg Misoprostol by either buccal or vaginal route after oral Mifepristone have comparable efficacy in terms of complete abortion rate (96% in buccal group versus 98% in vaginal group; p value = 0.495), failure rate being statistically similar (4% versus 2%). Drug abortion interval was comparable in the two groups. (11.16 hour in buccal group and 12.32 hours in vaginal group). Few side effects like nausea and vomiting, shivering, diarrohea was significantly higher with vaginal Misoprostol while abdominal cramps, altered taste were found more with the buccal group.Conclusions: Buccal Misoprostol is comfortable and easier to administer when compared to other routes and it has potential to be developed as a self-administered regimen. Buccal Misoprostol is as efficacious as vaginal Misoprostol with significantly lesser side effects up to 7 weeks of period of gestation.
Broad ligament term pregnancy in an unscarred uterus: misdiagnosis and the challenges
Authors: Singh Shalini , Chauhan Madhubala
Published: July 2019

A broad ligament pregnancy is a rare condition, but full term broad ligamnet pregnancy especially in an unscarred uterus is extremely rare. It is often misdiagnosed and usually finally diagnosed during surgery. Here is case of full term broad ligament pregnancy, which remained undiagnosed throughout her pregnancy, unfortunately had IUFD. Patient was referred to our hospital in view of failure of induction with increased BP records. No ultrasound was available on admission. On clinical assessment it appeared as transverse lie with IUFD. So cesarean was decided as a mode of delivery. Emergency ultrasound could just confirm IUFD with pelvic mass? Fibroid (actually deviated uterus). On laparotomy the broad ligament pseudosac had occupied entire abdomen. After delivery of baby, anatomy was found completely distorted. Highly vascular omental adhesions on fundus with difficulty in placental removal. Placenta could be traced reaching abdomen posteriorly. The first clinical impression was suspicion of placenta percreta. Uterus appeared non salvageable and hysterectomy was decided. Placenta was found lying in abdomen, adhered to bowel, omentum and fundus of uterus. The final diagnosis of broad ligament pregnancy could be made after the cut section of the uterus and anatomic evaluation. Patient required blood transfusions preoperatively .She remained stable and discharged on postoperative day nine. This case holds importance because may be outcome was different if it was a booked and investigated pregnancy. May be baby and uterus were salvageable with better outcome.