bluuebunny/crossref_metadata_2025 huggingface dataset:
Caesarean section in a tertiary care centre
Authors: Patel Rina V. , Shani Divyanshi J. , Shah Parul T. , Pandey Dipali
Published: July 2020

Background: Caesarean section constitutes a major surgical procedure characterized with morbidity even if it is performed a planned procedure. Postoperative infection in obstetrics continues to affect the practice of every surgeon. Infection can cause an increase in patient’s stay in the hospital, create discomfort, cause disfigurement and lead to morbidities to the patient. Thus, preventive measures need to be constantly evaluated and updated and hence authors have to study and analyse prevalence of postoperative infectious morbidities.Methods: The study was conducted in an Urban Based Medical College Hospital in Ahmedabad. It was a retrospective cross-sectional study of 50 cases of patients who suffered infectious complications post caesarean from 1st March 2019 to 31st March 2020.Results: The prevalence rate of surgical site infection in my study is 5.9% whereas of post-operative puerperal sepsis is 0.6%, of post-operative urinary tract infection is 1.09%, of post-operative breast abnormalities is 0.16%. The most common infectious morbidity amongst all was surgical site infection (surgical site) infection and its prevalence was 5.9%.Conclusions: The development of post-operative infection is an important event that can be prevented by taking proper precautions and following prescribed guidelines. There should be specific use of antibiotics in the post-operative period. In the event of early signs of sepsis antibiotics should be administered properly as per culture sensitivity report. The decrease in infection rate also indirectly reduce the health costs involved in treating them post operatively.
Covid 19, the Kerala experience: an observational, single centre retrospective study of outcome in covid positive pregnancies
Authors: Nambiar Sabnam S. , S. Ajith , P. Reshmi V.
Published: July 2020

Background: Covid 19 has spread across the world at an alarming rate. Approximately 4.05 million people have got infected worldwide resulting in around 279,000 deaths. Over 1 million people have recovered worldwide. Aim of this study was to determine whether course and severity of covid 19 is altered in pregnant women and whether covid 19 seemed to worsen the prognosis in pregnant women.Methods: Around 50 covid positive patients were admitted to this study hospital, a tertiary care referral hospital and medical college, between march and May 2020, 11 were pregnant. Authors collected their data retrospectively to understand the course of their disease till the period of recovery.Results: There were 6 patients above 31 weeks of whom one had elective repeat caesarean section, one had full term vaginal delivery, one is under follow up. Three patients had foetal distress necessitating emergency caesarean section. Of the remaining 5 patients with periods of gestation between 9-13 weeks, 1 of 24 weeks, 6 patients above 31 weeks, one had a miscarriage. Rest pregnancies are continuing and under follow up. 6 women had been symptomatic at admission, with mild symptoms of low-grade fever, sore throat and rhinitis. All were treated with hydroxychloroquine (HCQs). Those with respiratory symptoms like cough were also treated with oseltamivir. In view of high prevalence of H1N1 in the region. None of the women developed severe disease. The disease did not appear to worsen prognosis in pregnant women. The rate of recovery in pregnant women was similar to that seen in non-pregnant women and also men under the age of 40 years admitted in this study hospital.Conclusions: Covid 19 did not seem to worsen the prognosis in pregnant individuals when compared to rest of the population. The foetal outcomes also seemed favorable. However larger studies are required before concrete guidelines could be formulated for management of the disease in pregnancy.
A study of maternal serum calcium and serum magnesium levels in pre-eclamptic and normotensive pregnancies
Authors: Gupta Pranshi
Published: July 2020

Background: Hypertensive disorders are major factors responsible for morbidity and mortality in pregnancy and pre-eclampsia is the leading cause. The etiopathology of pre-eclampsia is not known even after significant research done on it. A strong strategy in its management is to try to reduce the incidence and severity by predicting its occurrence. In this study, the effect of serum calcium and serum magnesium levels is being investigated with occurrence pre-eclampsia.Methods: Total 120 pregnant patients attending Tirath Ram Shah Hospital were included in the study. They were divided into two groups namely normotensive and hypertensive of 60 each. The serum calcium and serum magnesium levels were estimated and the correlation of these levels was studied with the pre-eclampsia related factors. The data was analysed by application of statistical test of significance.Results: Mean serum calcium level in the normotensive group was 10.119±1.27 mg/dl while mean serum calcium level in the hypertensive group was 9.461±1.164. Mean serum magnesium level in the normotensive women in the study was 1.979±0.405 mg/dl. In the hypertensive women, mean serum magnesium level was 1.723±0.414 mg/dl.Conclusions: This study shows that low levels of calcium and magnesium are found in serum of pre-eclampsia patients as compared to normotensive cases of the study population. The severity of pre-eclampsia is inversely proportional to the levels of serum calcium and magnesium.
Cholestasis of pregnancy: effects on maternal and fetal outcome
Authors: Hassan Nazia , Khurshid Rabia , Muzamil Mudasir , Parveen Shameema
Published: July 2020

Background: Intrahepatic cholestasis of pregnancy (ICP) typically occurs in late pregnancy affecting 1.5-2% pregnancies. Limited data is available regarding its fetal and maternal implications. This study aims to assess the impact of ICP on maternal and fetal outcome.Methods: A total 200 patients with pruritus in later half of pregnancy were studied over a period of 18 months out of which 135 were diagnosed as ICP. Clinical and biochemical parameters like serum aspartate aminotransferase, alanine aminotransferase, alkaline phosphatase, total protein, and gamma glutamyl transferase was recorded. Maternal and fetal outcome was noted in the form of LSCS rate, preterm births, fetal distress and neonatal ICU admissions.Results: In this study, most common symptom was pruritus. Most of cases had onset of symptoms between 32-36 weeks. High LSCS rates were seen among cases. Intrapartum complications viz. meconium staining of amniotic fluid (57.8%), preterm delivery (11.9%), fetal distress (42.2%) were significantly higher in study population and there was high incidence of NICU admissions (49. 6% neonates) among cases mostly due to meconium aspiration and prematurity.Conclusions: ICP increases maternal morbidity and is associated with adverse perinatal outcome viz. increased risk of fetal distress, preterm births and sudden IUD at term as evidenced in this study. A timely intervention at 37-38 weeks will reduce the adverse outcomes.
Study of ovarian cancer at a tertiary care centre
Authors: Mulik Jayashree , Khadse Swapnil
Published: July 2020

Background: Despite major advances in case management, ovarian cancer continues to have the highest case fatality rate of all gynaecologic malignancies. There is paucity of meaningful screening and diagnostic protocols. Present study was planned with the objective of assessment of the prevalence of ovarian cancer and the associated risk factors at a tertiary care centre.Methods: The present prevalence study was conducted at a tertiary care government hospital and entailed analysis of data of 73 patients of ovarian cancer. All the participants were subjected to comprehensive history taking, followed by general, systemic, per-speculum and per-vaginal examination. Serum tumour markers of the patients were assessed. Imaging studies including ultrasound, CT or MRI abdomen/pelvis were done as per need. Final diagnosis was confirmed on histopathology and the cases were classified according to histological classification of World Health Organization.Results: Majority (41, 56.2%) were aged more than 45 years and above, most of them with one to two previous issues (64.3%). The disease was observed to be more common in postmenopausal women (65, 89%). Three fourth participants had negative family history of ovarian or breast cancer. Out of 73 patients, 31 had value of CA 125 between 150-400 U/mL and 42 had values >400 U/mL. Epithelial ovarian cancer (serous- 33, 45.2%, mucinous- 18, 24.7%) was observed to be the commonest histological type.Conclusions: To diagnose ovarian tumours early using multipronged approach with focussed risk factor identification and screening with CA-125 is very important and is strongly recommended.
Vaginal progesterone after tocolytic therapy in threatened preterm labour
Authors: Mishra Aparajita Ashok , Chaudhari Shilpa N.
Published: July 2020

Background: Currently preterm labour is one of the most challenging problem faced by both obstetricians and perinatologists, this episode in the course of woman’s pregnancy takes a heavy tool for perinatal mortality which accounts for approximately 50-75%. The incidence of preterm labour is estimated to be 5-10% of all pregnancies.Methods: It was a prospective randomize control trail over a period of 3 year at department of obstetrics and gynecology, tertiary care hospital Pune, Maharashtra, India. Total 100 subjects were randomized into two groups with group one receiving vaginal micronized progesterone and group two control group receiving only tocolytics and steroids. Subsequently authors compared the safety and efficacy of vaginal micronized progesterone versus placebo as a maintenance therapy in preventing preterm labour.Results: This analysis showed that women who randomized to progesterone prophylaxis had a significantly increase in duration of pregnancy. The mean of birthweight in Group A and Group B was 2963±36 gm and 2567±49 gm and respectively which confirmed the positive effects of progesterone on increasing infants’ weights at birth.Conclusions: Authors concluded that progesterone therapy had acceptable efficacy in the prevention of preterm labor in terms of prolongation of delivery and by increasing gestational age at delivery.
Rupture uterus: a one year review to find out the causative factors
Authors: Gupta Beena , Bhagat Prabhat Kumar , Karim Rezaul
Published: July 2020

Background: Rupture uterus is a life-threatening obstetric emergency associated with high perinatal mortality. This study aims to find out the common factors associated with this catastrophic condition so as to help in decreasing the incidence of this condition in this study set-up. The objective of this study was to determine incidence, socio-demographic factors, etiology, types of presentation, patterns of management and maternal and fetal outcome in cases of rupture uterus presenting in this study hospital in one year.Methods: In this retrospective study 40 cases of ruptured uterus admitted in the hospital between January to December 2016 were analyzed. Detailed history of relevant socio-demographic factors, prior obstetric and surgical history, clinical findings, nature of management done, fetal and maternal outcome were thoroughly analyzed from the record.Results: A total 40 cases of ruptured uterus during this one-year period out of total 1220 deliveries constituted an incidence of 3%. The commonest age group is 25-30 years (47%). Majority of patients of rupture uterus were those with previous scarred uterus trying for vaginal delivery in hands of dais, untrained birth attendants and midwives. Repair was possible in the majority of cases. There were no maternal deaths but fetal mortality was 92.5%.Conclusions: Proper antenatal care, transportation facilities, good counseling of patients with history of previous uterine surgery for institutional delivery can help in reducing the incidence of rupture uterus in developing countries like India. Prompt surgical intervention can help in reducing the maternal morbidity and mortality associated with rupture uterus.
Prevalence and outcome of gestational diabetes mellitus in women from rural population attending antenatal clinic at a teaching hospital, Tamil Nadu, India
Authors: Muthuramalingam Vidhya , Kumar Amar Nagesh
Published: July 2020

Background: Prevalence of gestational diabetes mellitus shows wide variation across our country. From the recent studies, it is observed that incidence of gestational diabetes mellitus in antenatal women is increasing globally and India is not an exception from this. Gestational diabetes mellitus should be considered as a serious risk factor for both mother and baby as it affects two generations by having chance of developing diabetes and its related complications in future.Methods: A total of 585 pregnant women with 24 to 28 weeks of gestational age were recruited for the study. The study population was divided into four groups based on the age range; Group I include antenatal women with age <20 years, Group II includes antenatal women of age range 21-24 years, Group III includes antenatal women of age range 25-29 years, and Group IV includes antenatal women of age range ≥30 years.Results: In the present study GDM was diagnosed in 94 women among 585 antenatal women screened for GDM (16.06%). Majority of the studied population are in the age range of 20-29 years (441/585, 75.38%). The mean age of participants was 27.54±3.58 years (range 18-34 years). The prevalence of GDM was higher in the group of women aged ≥30 years (Group IV) followed by ≤20 years (Group I) (23.21% and 15.62% respectively) compared to the groups II and III (14.78% and 13.74% respectively). This observation was found to be statistically significant (p<0.001). Among 585 patients, delivery outcome was 100% successful, all delivered live babies, among them 64 patients delivered babies with macrosomia (11%).Conclusions: The study showed GDM prevalence of 16.06% from the neighboring rural villages attending our teaching hospital.
A comparative study of perinatal outcome in primary caesarean in multiparous women to that in nulliparous women
Authors: Kokate Surabhi , Kokate Abhishek
Published: July 2020

Background: To compare indication, incidence, complication, fetal and maternal morbidity and mortality in primary caesarean section in multiparous women and nulliparous women. Objective of this study was to compare perinatal outcome of caesarean section in multiparous women to that in nulliparous women.Methods: It is a prospective observational study conducted in a tertiary care centre during April 2017 to April 2018. All patients who delivered vaginally and abdominally were noted during study period. All patients undergoing primary caesarean section were noted. Their indication, incidence and complication throughout stay were noted. Statistics were calculated separately for multiparous women and primiparous women. Statistical analysis was done using chi square test.Results: Total 150 primary caesarean section in primiparous women and 100 primary caesarean section in multiparous women were done.  Fetal distress and meconium stained amniotic fluid forms the most common indication in study. Birth weight of babies was more in multiparous women. Need of blood and blood products was more in multiparous women compared to nulliparous women. Complications like postpartum fever and wound gape was more in multiparous women.Conclusions: In the study population significant difference was seen between the indication and complication between multiparous and nulliparous women.
Evaluation of serum lactate dehydrogenase in hypertensive disorders of pregnancy and its comparison with normal pregnancy
Authors: Kumar Anil , Pathania Kushla , Kandoria Meenakshi
Published: July 2020

Background: Hypertensive disorders of pregnancy and their complications rank as one of the major causes of maternal morbidity and mortality. The objective of the study was to compare the level of serum LDH in normotensive and hypertensive pregnant women and to correlate the levels with maternal and foetal outcome.Methods: Study was conducted in department of obstetrics and gynecology Kamla Nehru State Hospital for Mother and Child, Indira Gandhi Medical College, Shimla w.e.f. 15th July, 2014 to 14th July, 2015. Pregnant women enrolled in the study were divided into following groups: - Group 1- Age and parity matched 202 normotensive pregnant women. Group 2- 202 women with hypertensive disorders of pregnancy as per the inclusion and exclusion criteria. Subjects were also divided according to the serum LDH levels into following groups: LDH <600 IU/L, LDH-600-800 IU/L and LDH >800IU/L. The maternal and foetal outcome was correlated with the serum level of LDH. One-way analysis of variance (ANOVA) and the chi-square test were used to compare the results. Differences were considered significant when p<0.05.Results: Severely preeclamptic and eclamptic patients were significantly younger, with low gravidity and parity. The symptoms and complications of preeclampsia and eclampsia along with perinatal mortality were increased significantly in patients with LDH >800 IU/L as compared with those who had lower levels.Conclusions: Lactate dehydrogenase is a useful biochemical marker that reflects the severity of and the occurrence of complications of preeclampsia and eclampsia. Identification of high-risk patients with elevated levels of lactic dehydrogenase, their close monitoring, and prompt, correct management may prevent these complications, with a subsequent decrease in maternal foetal morbidity and mortality.
Screening for perceived stress among pregnant women availing antenatal care at a tertiary care teaching institution in Kerala, India
Authors: T. Heera Shenoy , K. Remash , T. Sheela Shenoy
Published: July 2020

Background: Stress during pregnancy can have serious adverse outcomes on the mother, the foetus and the new-born. It can lead to low-birth-weight, preterm births and neuro-psychological effects such as anxiety and depression during pregnancy and puerperium. This cross-sectional research aims to assess the severity of stress among postnatal women in Kerala. This study analysed socio-demographic, obstetric, family dynamics, neonatal characteristics and psychiatric determinants of postpartum stress using perceived stress scale (PSS) among postnatal women in a tertiary hospital in Kerala state, India.Methods: 119 women between 2 to 6 weeks of postpartum period were subjected to a pre-tested pre-structured standard questionnaire. Terminal illness, still birth delivery and comorbid psychiatric illness was excluded. Screening and diagnosis of postpartum stress was done based on perceived stress scale (PSS) and graded as mild 0-13, moderate 14-26, severe 27-40.Results: Study findings indicated a statistically significant association between postpartum stress and risk factors such as unplanned/unwanted pregnancy. The mean age of women was 27±4.8 years. Support from spouse and in-laws was a negative predictor of developing both postnatal stress and depression. Family income, education of couple and husbands’ occupations were non-determinant factors (p>0.05) in this study. Psychiatric illness in the family and past history of psychiatric illness also contributed to postnatal stress. The most important variable which influenced perceived stress during pregnancy was lengthier NICU stay. Even breastfeeding problems and associated neonatal issues worsened the stress scales significantly in the immediate postnatal period.Conclusions: This research concluded that stress detection and timely counselling along with mental and physical support will mitigate stress and postpartum depression.
A study to compare the diagnostic accuracy of GeneXpert MTB/RIF/assay and its comparison with liquid culture in clinically suspected cases of genital tuberculosis attending outpatient department of tertiary center
Authors: Pathak Anu , Yadav Divya , Verma Urvashi , Gautam Yogita
Published: July 2020

Background: Tuberculosis is a major health issue globally despite a declining trend in mortality with effective diagnosis and treatment, an estimated 10.4 million persons developing active TB each year with 1.33 million deaths. Objective of this study was to evaluate role of GeneXpert MTB/RIF/assay in diagnosis of female genital tuberculosis in suspected cases of tuberculosis.Methods: It was a cross sectional study done in department of obstetrics and gynecology in S. N. Medical college Agra for a period of 2 year (July 2017 to October 2019). 70 cases were selected from OPD of department of obstetrics and gynecology, S. N. Medical College Agra who met the inclusion and exclusion criteria after taking proper consent. In all selected cases endometrial biopsy sample was taken using endometrial biopsy curette in premenstrual period. All samples of endometrial biopsy were taken under all aseptic precaution from both corneal ends, anterior and posterior wall and lower part of uterus using endometrial biopsy curette and sample was collected in two separate sterile vials having normal saline and was sent for GeneXpert MTB/RIF/assay and liquid culture simultaneously.Results: Out of total 70 clinically suspected cases of female genital tuberculosis in between 20-45 years of age cough with expectoration 94% was the most common respiratory symptom followed by fever 81%, weight loss 56% and anorexia 54%. Prevalence of genital tuberculosis in active pulmonary tuberculosis patients was 30%. Irregular menstruation, vaginal discharge and pelvic pain were present in 69%, 60% and 52% patients respectively.Conclusions: The overall sensitivity of CBNAAT was 22% and specificity was 77%. The overall sensitivity of liquid culture was 28% and specificity was 71%.
Changing trends in the indication of caesarean delivery in multigravida- experience from a referral center in Eastern India: a prospective study
Authors: Sebastian Nikhil , Pradhan Anup , Lucksom Pesona Grace
Published: July 2020

Background: Caesarean delivery is one of the commonly performed surgical procedures in obstetrics in today's practice. The objective of this study was to estimate the overall incidence and indications of primary caesarean delivery among multiparous women and to study the immediate maternal and perinatal outcome.Methods: It was a prospective observational study done in Sikkim Manipal Institute of Medical Science, Sikkim, India. It included all pregnant women after 28 weeks of gestation who had normal vaginal delivery in previous pregnancy but underwent caesarean delivery during current pregnancy (n=120) from January 2016 to December 2016. Authors collected data using a pro forma. Relevant history including demographic details, relevant clinical, laboratory and radiological examination, indication for caesarean delivery, details of delivery and neonate, and duration of hospital stay were noted. Data was described using descriptive data like mean and percentages.Results: Out of 1646 deliveries conducted, 49% were by caesarean section. It included 7.29% primary caesarean delivery in multigravida.  Majority of women (27%) were in the age group 25-29. Maternal request was the commonest indication for caesarean delivery (21.66%). Atonic PPH was the commonest intraoperative complication (2.5%). Surgical site infection was the commonest post-operative morbidity (3.33%). There were 51 perinatal morbidity and 2 perinatal mortality. There was no maternal mortality.Conclusions: Caesarean section rates in this study was higher than WHO recommendation (15% versus 49.69%). This shift in trend can be attributed to higher number of maternal request for caesarean delivery which can be avoided by good analgesic facility and good counselling.
Study of hundred cases of infertility in polycystic ovarian syndrome and its management outcome
Authors: Deliwala Kruti J. , Patel Zalak J. , Shah Parul T. , Dholakiya Dhruvit
Published: July 2020

Background: Polycystic ovarian syndrome (PCOS) is relatively common endocrine disorder in reproductive aged women, which leads to reproductive, metabolic and endocrine abnormality. About 70 to 80% patients with PCOS have complained of infertility due to anovulation. Due to advanced diagnostic facility by endoscopic evaluation in infertility, incidence of PCOS has increased now a days.Methods: This is study of 100 cases of infertility with polycystic ovarian syndrome and its pregnancy outcome. In this study, from May 2019 to April 2020, 100 cases of infertility with PCOS were studied at tertiary care hospital. Hormonal assay, ultrasound and laparoscopy were used as diagnostic technique. Clomiphene citrate, letrozole, metformin, and laparoscopic ovarian drilling were used as treatment modalities.Results: The maximum number of patients in the study group are seen in the age group of 21-25 years. Menstrual irregularities are the most common presenting symptom affecting 70% females. Primary infertility is most commonly associated with PCOS. In PCOS, there is increased LH:FSH ratio. On USG examination, there are enlarged ovaries in 82% cases.Conclusions: PCOS is an emerging disease of new generation with high prevalence in infertile women. After proper diagnosis, management with lifestyle modification, pharmacotherapy with clomiphene citrate, letrozole and metformin are used as per necessities. Operative laparoscopy with ovarian drilling is the main treatment which results in good conception rate.
Evaluation of serum paraoxonase, 1 and its association with serum cholinesterase as a cause of congenital anomalies
Authors: Ghosh Abhra , Bhardwaj Jagriti , Singh Robin , Baruhee Divya
Published: July 2020

Background: Birth defects are conditions of prenatal origin that are present at birth, potentially impacting an infant's health, development, and/or survival. Several environmental toxins affect the growth of the fetus during the intrauterine period by affecting various cellular components. Pesticides and industrial chemicals are known toxins that can hinder the developmental process. In this study, authors are evaluating the relation of cholinesterase and paraoxonase-1 with visible congenital anomalies.Methods: Sixty babies delivered in the labor room were selected for the study. They were divided into two groups. Thirty newborns with visible congenital anomalies were included in Group I. Only babies with visible congenital anomalies were taken as inclusion criteria for this group. This group was compared with Group II, which were taken as controls and consisted of 30 healthy newborns without any congenital anomalies. Serum cholinesterase and serum paraoxonase-1 were estimated and statistical tests were applied.Results: Serum cholinesterase and serum paraoxonase-1 were significantly low in the babies with visible congenital anomalies. Serum cholinesterase levels showed a statistically significant positive correlation with serum paraoxonase 1 level in both the groups.Conclusions: Decrease in acetylcholinesterase by various environmental toxins and the associated decrease in serum paraoxonase level imposes significant oxidant stress and the resultant risk of developing congenital anomalies.
Maternal outcome in thyroid dysfunction in admitted antenatal women in tertiary care centre: an observational study
Authors: Agarwal Juhi , Kesaraju Deepika , Badkur Poorva
Published: July 2020

Background: Thyroid disorders constitute one of the most common endocrine disorders in pregnancy. Aim of this study was to identify thyroid dysfunction as a maternal health problem. Objective of this study was to study the maternal outcomes in these patients.Methods: The main source of data are the patients admitted in Sultania Zanana Hospital, GMC Bhopal. The study was an observational prospective study conducted from March 2018 to February 2019.Results: The present study was conducted in department of obstetrics and gynecology, Gandhi Medical College and associated Sultania Zanana Hospital Bhopal for the period of 1 year. The study could enroll 400 females fulfilling the inclusion criteria during the study period.Conclusions: In developing countries like India where there is prominent micronutrient deficiency, iodine deficiency further aggravates the condition and carries a great potential to show deleterious impacts on maternal and fetal outcomes, thus serving a major health problem. Considering the substantial increase in short term as well as long term perinatal morbidity, a felt need for creating awareness not only on adverse outcomes but also detection of the disorder in first trimester is required. The desired perinatal outcome can be achieved by early detection and prompt treatment of the disorder. Henceforth, universal screening of all antenatal women in the first trimester rather than targeted case finding should be recommended at all the health care facilities.
A comparative study of two layer versus three-layer repair of mediolateral episiotomy
Authors: Gaikwad Manasi V. , Sree M. Vijaya , Bobde Swapnil V.
Published: July 2020

Background: Since majority of the women attending study hospital are belonging to lower socioeconomic strata and active involvement of paramedical staff in providing obstetric care, this study was undertaken to find the utility of a two-layer repair of mediolateral episiotomy and compare it with the standard method of closure in relation to its simplicity, cost-effectiveness and superiority if any, over the traditional three-layered repair of episiotomy.Methods: This was a prospective interventional study comparing 100 women who underwent two-layer closure with 100 women who underwent three-layer closure of episiotomy in a tertiary care hospital in Pune, India over a period of 2 years from October 2012 to October 2014. The parameters assessed were operative time, number of suture materials required, immediate post procedure pain and complications at follow-up. Qualitative and quantitative data was analysed using unpaired t-test, chi square test and Fisher exact test.Results: Both the groups were comparable in terms of hospital stay and wound complications such as oedema, dehiscence, hematoma, requirement of resuturing, cosmesis and long-term complications such as dyspareunia. However, two-layer repair required less operative time, lesser number of suture materials and decreased pain during hospital stay as there was statistically significant difference observed between the two groups.Conclusions: In this study experience, it can be concluded that two-layer repair of episiotomy is faster, with less post-operative pain and more cost effective. Hence it provides mother with better services.
A retrospective study on the prevalence of urinary tract infections in a tertiary care hospital in Sangareddy district of South India
Authors: Mendem Sowjanya , Vinyas M. , Faraz Md Aqib Ali , Swamy M. Vishwanath , Shubham Patil
Published: July 2020

Background: Urinary tract infections (UTI) affect the portion of the urinary tract including kidneys, ureters, bladder, and urethra, and are among the commonly acquired nosocomial infections. Diagnosis based on the culture and sensitivity profile of the organism is highly beneficial for appropriate antimicrobial therapy of the individual.Methods: A retrospective study of culture isolates obtained from urine samples from different departments of a tertiary care hospital was performed in the period January 2018 to March 2020 in the district of Sangareddy, Telangana, India.Results: A total 204 samples of 1886 exhibited significant growth of organisms i.e., ≥105 colony-forming units of bacteria per millilitre (CFU mL-1). The most common pathogen isolated was Escherichia coli (47.05%), followed by Klebsiella pneumoniae (15.68%), Staphylococcus aureus (10.78%), Pseudomonas aeruginosa (10.78%), Enterobacter spp. (7.84%) and, Candida albicans (7.84%). The presence of Gram-negative organisms was found to be more than Gram-positive organisms among the samples cultured. Resistance was found to be more towards Amoxicillin (57.14%), followed by oxacillin (34%), cefotaxime (23.62%), clarithromycin (12.08%), erythromycin (12.08%), azithromycin (9.34%), linezolid (3.84%) and vancomycin (2.19%).Conclusions: Increasing levels of antimicrobial resistance by uropathogens emphasize the importance of therapy based on the culture and sensitivity of the organisms. Many uropathogens exhibit multi-drugs resistance. Regular surveillance and monitoring are useful in controlling the increasing resistance.
An observational study of abnormal findings in fetus during 11-13+6 weeks and targeted imaging for fetal anomalies ultrasonography
Authors: Patel Amrita D. , Shingadia Janki B. , Patel Devang
Published: July 2020

Background: Congenital anomalies are responsible for a of 14.2% of perinatal mortality in India. This study focuses on incidence of structural fetal abnormalities detected during 1st and 2nd trimester sonography. Aim of this study was to evaluate the need for targeted fetal scans.Methods: This study is an observational study conducted at Gujarat fetal medicine Centre, Ahmedabad, Gujarat, super specialty antenatal radiology centre where exclusively antenatal USGs and prenatal procedures are performed. All pregnant female coming for 1st and 2nd trimester USG were included. All fetal abnormalities in form of soft markers and structural abnormality were included.Results: Out of 2122 total ANC scans, 183 cases (8.6%) had structural abnormality and 235 cases (11%) had significant soft markers. 1185 cases (55.84%) came in late 2nd trimester for TIFFA scan and 468 (22%) were seen in 1st trimester scan. The incidence of fetal anomaly in this study was higher than general population as it is an exclusively fetal medicine centre and majority of patients were diagnosed with anomaly in late 2nd trimester.Conclusions: There is immense need for early diagnosis and timely intervention before 20 weeks in case of prenatal detection of fetal abnormality.
Colposcopy in evaluation of suspected cervical cancer: a prospective, observational study
Authors: Desai Ashwini Sudhir , Panchbudhe Shruti
Published: July 2020

Background: Cervical cancer is the fourth most frequent cancer in women according to World Health Organization. In India the incidence is approximately 1 in 53 compared with 1 in 100 women in more developed regions of the world. Cervical cancer is eminently preventable by early detection using various screening tests like Pap smear, colposcopy, HPV testing. In this study we aim to evaluate the use of colposcopy in early detection of cervical cancer and also assess risk factors for the same. Primary objective was to study the correlation between colposcopic findings and histopathological analysis with a secondary objective to assess risk factors for development of cervical neoplasia.Methods: The study was carried over a period of 2 years (October 2016 to October 2018) with a sample size of 60 in the department of obstetrics and gynecology at tertiary care centre. Participants who fit the inclusion criteria were included in the study after taking a written and informed consent. The colposcopy findings were correlated with the histopathological findings of the cervical biopsy that was undertaken.Results: Colposcopy impression had sensitivity of 93.8% in predicting the histopathology, specificity was 77.3%, positive predictive value was 60%, negative predictive value was 9% and the diagnostic accuracy was 81.7%. On analyzing the risk factors, it was found that the odds of malignant histopathology were 0.55 times decreasing with each unit increase in age (at first intercourse) (p value<0.05).Conclusions: Colposcopy gives immediate and accurate results and its value as a diagnostic test is undisputable.  The sensitivity of colposcopy is high and hence in high risk population or remote places where women do not turn for regular screening tests, colposcopy can be used primarily as the screening test.
Evaluation of urea and creatinine levels in vaginal wash fluid for the diagnosis of premature rupture of membranes
Authors: Sharma Abha , Sharma Richa , Agarwal Tannavi
Published: July 2020

Background: Evaluation of urea and creatinine levels in vaginal wash fluid for the diagnosis of premature rupture of membranes.Methods: The study was conducted on150 pregnant patients, 50 in each group. Confirmed PROM and unconfirmed PROM. Per speculum examination was done to look for pooling, pH tested using the Pehanon paper and vaginal wash fluid was collected. Vaginal wash fluid urea and creatinine levels were tested by a kit based on spectrophotometry.Results: The mean urea levels were 26.35 mg/dl in the study Group 1 and 3.12 mg/dl in the control group. ROC curve was plotted and the cut off value of vaginal wash fluid urea was found to be 8.55 mg/dl. The vaginal wash fluid urea levels of >8.55 mg/dl detected PROM with a sensitivity, specificity, negative and positive predictive value of 100%. The mean creatinine levels were 0.62 mg/dl in study Group 1 and 0.20 mg/dl in the control group. ROC curve was plotted and the cut off value of vaginal wash fluid creatinine was found to be 0.405 mg/dl. Vaginal wash fluid creatinine levels detected PROM with a sensitivity of 76% and specificity of 100%. The negative predictive value and positive predictive values were 80.4% and 100%.Conclusions: Urea can be used as a definite marker of PROM and creatinine can be used as a supportive marker.
Uterine torsion in pregnancy, expect the unexpected: case report
Authors: Mokhtar Huda Nabihah , Faridz Sumayyah Mohammed , Ismail Rohana , Yaacob Nasuha , Ramli Roziana
Published: July 2020

Uterine torsion in pregnancy is a rare condition, but potentially life-threatening. The non-specific clinical features make preoperative diagnosis difficult and most cases are discovered during caesarean deliveries done for other obstetric indications. Authors present 2 cases of uterine torsion with different clinical presentation and outcome. Case 1 was a G3P2 at 36 weeks with twin pregnancy presented in active labour with a prolapsed cord. A 180 degrees uterine torsion was discovered only after delivery of the foetuses, resulting in inadvertent posterior uterine wall incision. Case 2 was a G6P5 at 35 weeks who presented with an acute abdomen and went into shock. At laparotomy, a 360 degrees uterine torsion was discovered complicated with placental abruption, causing a fresh stillborn baby. These cases highlight uterine torsion as a rare but important diagnosis in obstetrics, which could be associated with potentially devastating outcome.
First delivery of a COVID-19 positive patient in Cameroon
Authors: Ngaha Junie Y. , Fouelifack Florent Y. , Ngo Dingom Madye A. , Kemme Marileine K. , Wandji Brigitte , Essiben Felix , Ngate Anicet , Fouedjio Jeanne H. , Sone Charles E. , Arrey Philemon N. , Temkou Serge , Libend Gilles T. , Bissemou Jean J. , Eko Filbert E. , Momo Joel T. , Essomba Larissa O. , Djoulatou Ahmadou H. , Isseini Ache , Kutnjem Monkaree B. , Bisong Colbert E. , Gouanfo Winnie T. , Tonye Rebecca , Mballa Georges E. , Ongolo-Zogo Pierre , Sobngwi Eugene , Fouda Pierre J. , Mbu Robinson E.
Published: July 2020

Since its appearance in China in December 2019, COVID-19 which is caused by the SARS-CoV-2 virus has become a real global health problem. Pregnant women are not immune to this novel infection, which makes it difficult for proper management of pregnancy and childbirth. Authors present here the first case of childbirth in Cameroon of a 19-year-old adolescent tested positive for COVID-19.
Xanthomatous oophoritis, a rare pathology: case report with review of literature
Authors: Hota Basanta Manjari , Bakshi Kavitha , Movva Naimisha , Pandirla Swathi
Published: July 2020

Xanthomatous oophoritis is a rare chronic inflammation of ovary characterized histologically with infiltration of lipid laden foamy macrophages, lymphocytes, plasma cells leading to tissue destruction. Though exact cause is not known, uterine artery embolization, gloves dusting powder and altered lipid metabolism are hypothesized to cause the pathology. A 28-year-old parous lady with history of multiple laparotomies, known case of hypothyroidism under treatment and history of adequately treated pulmonary tuberculosis was diagnosed to have right ovarian dermoid cyst, while undergoing investigation for secondary infertility. On examination she had pallor, healthy abdominal scar, and small tender fixed mass in right fornix on internal examination. She was subjected to laparotomy and right salpingo oophorectomy with left salpingectomy was performed. Histopathological examination of the resected specimen revealed to be xanthomatous oophoritis of right ovary. As this condition mimics tuberculosis and malignancy, clinical assessment, investigation and intra operative findings with the suspicion of inflammatory aetiology help to limit the extent of surgery. Hence, this case is presented for its rare occurrence as well as its need to be differentiated from other conditions like tuberculosis and malignancy of ovary.
A rare case of symplastic leiomyoma: case report
Authors: . Sharanya , Thomas Julie
Published: July 2020

Symplastic leiomyoma is an unusual variant of leiomyoma. Malignant transformation accounts for 0.2% of all cases of leiomyoma. Atypical and bizarre leiomyoma synonymous with symplastic leiomyoma are rare smooth muscle tumors that contain cells with moderate to severe cytological atypia, still cell necrosis is absent and mitotic index is fewer than 10/10 HPF. A 42-year P1L1A3 with no comorbidities came with complaints of lower abdominal pain for one year and heavy menstrual bleeding for eight months, LMP- 15/2/19, regular cycles, changes 4-5 pads/day, clots (+) (+), dysmenorrhoea (+). Parity score of P1L1A3, LCB-24 years, not sterilized. On examination - moderately built and nourished, pallor (+). Per abdomen examination - uterus - 22 weeks size, irregular mass, arising from pelvis - no tenderness, lower border not made out. Per speculum examination - cervix and vagina healthy. Per vagina examination - cervix firm, posterior, left fornix: mass felt, non-tender. The patient underwent Abdominal hysterectomy and B/L salpingo-oophorectomy under CSEA. Intraoperative findings - uterus - 20 weeks size, enlarged, a posterior wall subserosal fibroid with degeneration of 6×8 cm. Microscopic appearance - uterus - myometrium shows changes in adenomyosis. Sections of smaller mass reveal structure of leiomyoma. Nuclei are large, hyperchromatic, and show coarse chromatin clumps. Many giant-sized cells with multiple large nuclei were seen. It showed large chromatin clumps. Stroma showed myxoid change. Diagnosis - symplastic leiomyoma, adenomyosis. Symplastic leiomyoma is an unusual variant of leiomyoma. Malignant transformation accounts for 0.2% of all cases of leiomyoma. The regularity of the tumor margins, low mitotic activity, and absence of nuclear atypia or necrosis should be made for the exclusion of malignancy.
Uterine leiomyosarcoma: an unusual presentation
Authors: B. Preethi , Singh Monu , Singh Sarita , Singh Pallavi
Published: July 2020

Uterine leiomyosarcomas are rare aggressive tumors, with high recurrence rates, even when confined to the uterine corpus at the time of diagnosis. It arises from smooth muscle of uterus and is a rare tumor that accounts for 2-5% of all uterine malignancies. These tumors typically spread hematogenously. Patients present with vague symptoms similar to those of patients with leiomyomas. Most patients are diagnosed with leiomyosarcoma postoperatively. Although prognosis remains dismal, various ongoing studies are investigating the role of advanced imaging, multimodality treatment, prognostic nomograms, and unique biomedical pathways to increase understanding of leiomyosarcoma and improve therapeutic options for patients. 46 years old para2 live2 postmenopausal (since 1.5 year) female presented to outpatient clinic with complaints of bleeding per vaginum, foul smelling discharge, unquantified weight loss and something coming out of vagina since 1.5 months. On abdominal examination, an irregular midline mass arising from pelvis corresponding to 20 weeks gestational size of uterus was present. On vaginal examination, 3 infected vaginal growths were present in vagina maximum 4x4cm. Intra-operatively, uterus was nearly 20 weeks size with irregular surface. A 3×3 cm subseroal fibroid with necrotic surface was present on posterior wall of uterus. Cut section of the operative specimen showed myohyperplasia which was compressing the uterine cavity, some necrotic areas were also present. Vaginal growths - 4×4 cm on left vaginal wall near introitus with necrotic surface, 3×3 cm on right vaginal wall, 1×1 cm on right upper vaginal wall present. Excision of vaginal growth was done and was sent for histopathology. Histopathologic examination of sections of uterus showed all features were suggestive of leiomyosarcoma uterus.
The comparison of effects of Roux-n-y gastric bypass and sleeve gastrectomy on excess weight loss in morbidly obese patients
Authors: Akturk Okan Murat , Yildiz Baris Dogu
Published: July 2020

Background: Obesity an important health problem which has become a worldwide epidemic that effects both developed countries and developing countries. Bariatric surgery is the most efficient cure for morbid obesity. Authors retrospectively reviewed the results of different techniques in bariatric surgery to assess the efficiency of initial operations.Methods: The medical files and operation notes and the one-year follow-up of patients were reviewed. The outcomes of sleeve gastrectomy (SG) and gastric roux-n-y bypass (RYGBP) operations were reviewed and their effects on excess weight loss were investigated.Results: Overall, there were 97 patients included in the study, the majority of which were female (87/97, or 90%). The mean age of the SG group was 42.01±8.48 years versus 36±8.32 years in the RYGBP group, with p=0.007. Excess weight loss percentages were 51.7% and 57% for sleeve gastrectomy and RYGBP, respectively, p=0.491. Both operations are effective in reducing comorbidities.Conclusions: In the RYGBP procedure there is more excess weight loss than the results of SG procedure but the difference is not statistically significant. In both procedures, the initial results on weight loss and reduction of comorbidities are comparable. Because SG is less traumatic and relatively easier to perform, it can be the preferred operation for morbid obesity.
The efficacy of alpha-lipoic acid and/or gabapentin on the oxidant-antioxidant system in patients with diabetic polyneuropathy
Authors: Komurcu Hatice Ferhan , Baran Pervin , Erel Ozcan , Anlar Omer
Published: July 2020

Background: Diabetic peripheral sensorimotor polyneuropathy is the most common complication seen in patients with diabetes mellitus (DM). Oxidant system plays a crucial role in its physiopathology. We investigated the changes in the serum levels of total antioxidant status (TAS), total oxidant status (TOS), paraoxonase-1 (PON1) and oxidative stress index (OSI) to evaluate the antioxidant efficacy of alpha lipoic acid (ALA) and/or gabapentin in patients with diabetic polyneuropathy (DPN).Methods: Sixty-three type 2 DM patients with diabetic polyneuropathy (DPN) were enrolled in the study. Patients with DPN were divided into four groups in terms of their treatment: Group 1 consisted of treatment-naive patients; patients treated with ALA, gabapentin or combination of ALA and gabapentin comprised groups 2, 3, and 4, respectively. The patients received the medications for at least six weeks.  Serum levels of TAS, TOS, PON1 and OSI were analyzed.Results: No significant difference was observed between the groups according to the oxidative stress parameters studied.Conclusions: The use of ALA and/or gabapentin in patients with DPN did not significantly affect the oxidative stress parameters, including TAS, TOS, PON1, and OSI.