bluuebunny/crossref_metadata_2025 huggingface dataset:
Chorioamnionitis at the Befelatanana university hospital centre of obstetric gynecology in Antananarivo Madagascar: epidemiology, taken care and forecast
Authors: Martial Rakotonirina , A. Rainibarijaona L. N. , Besaina Rakotozanany , Romuald Randriamahavonjy , L. Tsifiregna R. , Ibrahim Housni , A. Hery Rakotovao
Published: June 2020

Background: The chorioamnionitis corresponds to an infection of the ovular cavity. She puts game neonatal and maternal forecast. This study had as objectives to describe the epidemiological aspects, the taking care and the forecast of the chorioamnionitis to the gynecology teaching hospital and obstetrics Befelatanana, Madagascar.Methods: It is about a descriptive, retrospective and transverse study, during a period of 6 months going from January, 2016 till July 2016. The pregnant women introducing a premature break of membranes (RPM) complicated with chorioamnionitis hospitalized in CHU-GOB during this period had been included.Results: Authors found 35 cases of chorioamnionitis, that is 38.1% premature breaks of membranes. The medium age of the patients was 20±5, 16 years old (extreme from 17 to 36 years). Primiparous was found in 82.9%. The chorioamnionitis had happened in 68.5% cases after 37 weeks of amenorrhea. The delay between RPM and happened of chorioamnionitis was of 6 hours. The picture of chorioamnionitis was complete in 54.3%. Delivery was by low way in 33.3%. Authors had found 88.60% case of endometritis, 8.6% case of parietal suppuration post caesarian section but without any maternal decease. Neonatal complications were marked by a score of Apgar <7 - five minutes in 74.3%, neonatal infection in 25.7% and precocious neonatal decease in 11.4%.Conclusions: The chorioamniotite concerned primiparous especially young urgent. The application of the protocol of taking care of the premature break of membranes is necessary for the reduction of the happening of the chorioamniotitis.
A study on pattern of placentation in post caesarean pregnancy
Authors: S. Deepthi P. , Devasia Neena
Published: June 2020

Background: It appears that the rate of caesarean delivery has been increasing over the past two decades. Various western studies have shown that with previous caesarean section, increased risk of placenta previa, adherent placenta, and greater incidence of antepartum haemorrhage. Nonetheless, the extent to which previous caesarean delivery predisposes women to the development of placenta previa is unclear from earlier studies. Also, there are not many Indian studies regarding the association of placenta previa and previous caesarean section. This study aims to find the association between prior caesarean delivery and subsequent development of placenta previa and adherent placenta.Methods: A descriptive study was conducted on 600 antenatal women with post cesarean pregnancy in a tertiary care centre. Similar number of women with previous normal delivery was included in comparison group and placental location was studied. Those patients with previous caesarean were further divided into those with placenta previa and without previa to study the determinants of previa in those with previous caesarean section.Results: Placenta previa was found in 2.8% of the study group compared to 1.2% of comparison group. Adherent placenta was found only in post caesarean group. In the post caesarean group, the incidence of anterior previa was 41.2% compared to posterior previa (29.3%). In those with post cesarean pregnancy, determinants of placenta previa found were multiparity (35.3%), previous history of abortions (35%), multiple previous caesarean sections (29.4%), interpregnancy interval <2 years (35.29%).Conclusions: In post cesarean pregnancy, the risk of placenta previa is 2 times compared to those with a previous normal delivery. Anterior previa occurred with sufficient frequency in post-caesarean pregnancy to warrant ultrasonic placentography prior to surgical entry into lower segment. When the combination of previous caesarean and placenta previa occurs the risk of adherent placenta is 17.6%.
An audit of caesarean section rate based on Robson’s ten group classification system
Authors: Jose Jishma , Arumugam Sendhil Coumary , Habeebullah Syed
Published: June 2020

Background: Caesarean section (CS) rates are rising worldwide and is a major public health concern. There is lack of evidence supporting the maternal and neonatal benefits with the increasing CS rates. Robson’s ten group classification system serves as an initial structure with which caesarean section rates can be analysed. RTGCS helps us to analyse and allow us to bring changes in our practice.Methods: This was a hospital based cross sectional study conducted over a period of 10 months during the year 2018, which involved 1478 pregnant women, out of which 693 underwent CS, those who underwent CS were grouped according to Robson’s Ten group classification system and the data was collected and analyzed.Results: 693 women underwent CS and the overall section rate was 46.88%. Group 5 (previous LSCS) and Group 2 (nulliparous, >37 weeks, induced) contributed the maximum to the overall CS rates (33.9% and 26.3% respectively). The most common indication for caesarean section was previous LSCS (38%), fetal distress (19.2%) and meconium stained liquor (13.7%).Conclusions: Robson’s ten group classification system helps us in auditing the caesarean section rates. Group 5 and 2 contributes the maximum for caesarean section rates. Encouraging and adequate counselling for VBAC, proper training of obstetricians in CTG interpretation would reduce the caesarean section rates.
A retrospective study of obstetric hysterectomy cases at tertiary care centre
Authors: Joshi Khushi P. , Shah Sapana R. , Agrawal Saumya P. , Goswami Vishwa
Published: June 2020

Background: Postpartum haemorrhage (PPH) is a life-threatening condition. The objective of this study was to determine the incidence, demographic characteristics, indications, and feto-maternal outcomes associated with obstetric hysterectomy in a tertiary care centre.Methods: This is a retrospective analytical study conducted over a period of six years, from March 2014 to April 2020. A total of 68 cases of obstetric hysterectomy were studied at tertiary care centre in Ahmedabad, Gujarat, India.Results: Present study reported 68 obstetric hysterectomies per 44663 total deliveries (incidence - 0.15%), out of them 20 following 26446 vaginal deliveries (0.07%) and 48 following 18217 caesarean section (0.26%). Morbidly adherent placenta (29.41%) was the most common indication followed by atonic postpartum haemorrhage (25.00%) and uterine rupture (17.64%). The most frequent sequelae were disseminated intravascular coagulation (26.47%) and febrile morbidity (10.29%), maternal mortality was 16.17% whereas neonatal mortality was 26.47%.Conclusions: The incidence of obstetric hysterectomy has been found to be more following caesarean sections. There is a change in the indications of obstetric hysterectomy in the past two decades with placenta accreta spectrum being the commonest in present study. This is because of rising number of caesarean sections. Patients who underwent emergency obstetric hysterectomy due to atonic PPH had a higher mortality.
Effectiveness of forceps delivery in modern day obstetrics
Authors: Pitale Devdatt Laxman
Published: June 2020

Background: There has been an alarming rise in number of caesarean sections all over the world. Instrumental delivery plays an important role to reduce this trend globally. Forceps delivery though proper training and expertise can definitely reduce the rising caesarean section rates in the modern-day obstetrics. The aim of this study is to study the effectiveness of forceps delivery in modern obstetrics.Methods: In the present observational study, 20 cases of forceps delivery were studied for maternal and foetal outcomes including postpartum hemorrhage, perineal tears, Apgar score, NICU admissions, birth injury, and mortality.Results: The most common indication for forceps application was maternal exhaustion (80%) followed by foetal distress. All the cases of forceps application in the present study were associated uneventful vaginal delivery. No any adverse maternal outcomes including perineal tears, post-partum hemorrhage was observed in this study. Average birth weight in the present study was 3.2 kgs and Apgar scores at birth and five minutes was within normal limits. No any birth injury was noted in any of the newborns.Conclusions: Forceps delivery is a safe and effective option in modern day obstetrics to reduce the alarming rise in rates of caesarean section globally. Training should be encouraged to develop the expertise of this art of forceps delivery.
Knowledge, attitude and practice of contraception complications among hospitalized women following self-induced medical abortion at tertiary hospital
Authors: Pal Aparajita , Baidya Jahar Lal
Published: June 2020

Background: Unwanted pregnancies in women and complications of induced abortions are an important health problem in the world. There is recent trend of self-induced medical abortion pill use over the counter without knowing the recommendations. Objectives of this study were to study socio demographic profile, presentations, management of hospitalized women for medical abortion related complications. To explore out contraceptive practices in those women. To way out the reasons for choosing medical abortion by women.Methods: Women of reproductive age group (15-45 years) who admitted in department of Obstetrics and Gynaecology Medical College with the complications following self-induced medical abortion were enrolled. Patients’ demographic profile, socio-economic status, obstetric profile, KAP of contraception, logical reasons for self-induced abortion were studied. Management of each case was done according to hospital protocols.Results: The total number of patients that were enrolled for the study period was 100. 37% of hospitalized women were between 18-25 years age group and 45 % of them had marriage at early age (15-20 years) and 46% were belonged to lower middle-class group. Majority of women with single living child with their last child <1-year age had taken abortion pills for unplanned pregnancy (49%). 74% women had taken abortion pills over the counter for the first time and 88% women did have idea about contraception but never used. 70% of the women had to undergo surgical evacuation and six of them had undergone emergency laparotomy for ruptured tubal ectopic pregnancy. Post abortion counselling successfully convinced to accept combined oral contraceptive (31%), followed by IUCD and permanent sterilization and 16% of women by medical abortion pill refused to accept contraception.Conclusions: Pregnancy termination should be done by qualified medical personal with accurate information about safe medical abortion. Counselling of each couple is must to enhance continuous and consistent use of family planning methods.
Role of endometrial thickness in natural and stimulated cycles in infertility
Authors: Dhama Vandana , Kumari Kiran , Chaudhary Rachna , Singh Shakun
Published: June 2020

Background: The endometrium plays an important role in infertility. The growth of endometrium depends on serum oestradiol level and blood flow to the uterus. A thin endometrium is defined as a lining of less than 7 mm which is associated with infertility. The endometrium is best seen on Transvaginal scan (TVS). The purpose of this study was to evaluate the role of endometrial thickness and its outcome in natural and stimulated cycles in infertile women.Methods: This prospective cohort study was conducted from June 2018 to May 2019 in LLRM Medical College Meerut, Uttar Pradesh, India. Total 150 infertile women of age less than 35 years presented with either primary or secondary infertility were enrolled. Each patient was undergoing transvaginal scan (TVS) to measure endometrial thickness follicular monitoring.Results: The endometrial thickness and pregnancy rate was higher in letrozole induced group as compared to clomiphene with estradiol valerate and clomiphene with sildenafil citrate induced group.Conclusions: Letrozole had better effect on endometrial thickness and pregnancy rate as compared to clomiphene citrate with estradiol valerate and clomiphene citrate with sildenafil citrate.
A study on diagnosis and management of arteriovenous malformation of uterus
Authors: Patel Nidhi B. , Shah Sapana R. , Parikh Purvi M. , Chudasama Tanmay J.
Published: June 2020

Background: Arteriovenous malformation is abnormal connection between an organ’s arterial and venous circulation. In acquired AVM, history of uterine procedure seems inevitable. Their clinical feature is usually vaginal bleeding. It is diagnosed by 2-D ultrasonography combined with colour doppler. Most of the time they resolve spontaneously; however, if left untreated, uterine artery embolization or hysterectomy comes in hand. The purpose of this study was to evaluate the role of TVUS and colour doppler in the diagnosis and follow-up of treated cases of uterine AVM. This study also aims to evaluate different modalities to manage uterine AVM.Methods: This was a retrospective study done at tertiary care centre from January 2018 to December 2019 to assess the presentation, treatment, and clinical pictures of patients with uterine AVM that were diagnosed with TVUS. Authors reviewed both (1) clinical data (2) ultrasound data of patients. The diagnostic criteria were “subjective” with a rich vascular network in the myometrium with the use of colour Doppler images and “objective” with a high PSV of 20 cm/sec in the vascular web.Results: Thirteen patients met the diagnostic criteria mentioned above. Out of that 100% presented with on and off bleeding per vaginum. Recent and remote history of uterine procedures were in found in 84.6% (n=11) of cases. UAE was done in 53.8% (n=7) cases. Thirty-three (33%) (n=5) cases spontaneously resolved when closely monitored with serial imaging and serum beta- HCG levels. Hysterectomy was needed in 7.4% (n=1) of patients of AVM.Conclusions: Uterine AVM occurred after unsuccessful pregnancies or uterine procedures. Triage of patients for expectant treatment, hormonal treatment vs intervention with uterine artery embolization based on their clinical status, which was supplemented by objective measurements of blood velocity measurement in the AVM, appears to be a good predictor of outcome.
Effectiveness of modified mattress suture closing technique over conventional lower segment caesarean section closing technique
Authors: Singh C. P. , Pitale Devdatt Laxman
Published: June 2020

Background: The objective of this study was to compare the thickness of the scar and relative thinning of the uterinewall following conventional LSCS closing technique versus new closing technique (modified mattress Suture) and any additional surgical procedure in each group.Methods: A total of sixty patients undergoing primary caesarean for obstetric indications and who were willing for the study were included. In 30 patients uterus was closed by conventional double layer technique (the first layer is suturing with absorbable suture in a continuous running fashion. After first layer is complete, a second continuous stitch is used to invert the first layer, inverting stitch may be horizontal or vertical using same suturing material) and in 30 patient uterus was closed by new modified mattress technique. In both groups same suture material (vicryl 1-0) was used. Measurement of the thickness of scar site and corresponding posterior wall thickness was done following 6 months of caesarean section.Results: The possible parameters of better technique i.e., the mean scar thickness is more and relative as well as percentage thinning is less with this new technique of uterine closure although statistically not significant. Conclusions: Modified mattress suture technique is a single step procedure and gives the feel of double layer uterine closure. Hence the time taken, material. Used and the cost involved will be less along with excellent hemostasis.
Evaluation of efficacy of injection ferric carboxymaltose in pregnant women
Authors: Sabale Rupali M. , Wani Reena J. , Jalvee Rashmi
Published: June 2020

Background: Iron deficiency anaemia (IDA) continues to be a very common problem in developing countries leading to a spectrum of adverse events in pregnant women. The objective of this study was to determine the efficacy, side effects and tolerance of ferric carboxymaltose as compared to available iron preparations for the prophylaxis and treatment of mild to moderate iron deficiency anaemia during pregnancy.Methods: One-year clinical study (from June 2017 to May 2018). A total 100 patients were enrolled after matching inclusion and exclusion criteria. The efficacy assessment was performed during 4, 8, and 12 weeks of starting therapy. If the patient is not responding to therapy in either arm as documented by no rise or fall in haemoglobin levels patients may be removed from study for other therapy. Treatment duration up to 12 weeks. Safety and efficacy follow-up visit at 4, 8 and 12 weeks. Institutional ethics committee permission was taken.Results: On intra-group comparisons there was significant increase in haemoglobin levels at 8 and 12 weeks in oral iron group as compared to day 1 haemoglobin levels while there was significant increase in haemoglobin levels at 4, 8 and 12 weeks in IV iron group as compared to day 1 haemoglobin levels. On intergroup comparisons between oral and IV iron group, there was significant increase in haemoglobin levels at 4, 8 and 12 weeks in IV iron group as compared oral iron group haemoglobin levels.Conclusions: Intravenous iron therapy with ferric carboxymaltose causes significant improvement in haemoglobin more quickly and more effective in correcting iron deficiency anaemia in pregnancy compared to oral treatment in terms of increase in haemoglobin levels at 4, 8 and 12 weeks. Intravenous ferric carboxymaltose is safe and effective option for pregnant women with iron deficiency anaemia.
A retrospective study of various factors affecting infertility in Rajasthan, India
Authors: Singh Preksha T. , Choudhary Saroj , Singhvi Shreyans D.
Published: June 2020

Background: Infertility is seen fairly common in these days and it cause not only reproductive but also psychological impairment of the parents. Infertility leads to multitude of personal as well as societal repercussions. There are various advances in technology which help the parents suffering from infertility. Infertility is defined as the failure to conceive after one year of regular intercourse in women <35 years not using contraception and after six months in women >35 years.Methods: A retrospective study of 400 females and their husbands’ coming to the department of gynecology, Umaid Hospital, Jodhpur, Rajasthan was undertaken from February 2020 to March 2020. A structural self-constructed questionnaire was used in the study. A well-informed verbal consent was taken by the participants of the study. It had open and closed ended questions. Further, an ultrasound sonography (USG) was performed to check the reproductive organs of the patient, to find the cause of infertility, as well as biochemical examination on male sperm, was performed to find out the sperm abnormality, ejection disorders and other long-term illness.Results: In our study, we found multiple factors affecting infertility issues in females. These factors were- menstrual cycle abnormally, bleeding abnormality and years of active married life. We also found Polycystic ovarian disorder as a major underlying cause of female infertility and sperm abnormality as a major cause of male infertility.Conclusions: Authors recommend frequent female routine checkups to asses early case of infertility and treat it as early as possible.
Comparative study of effectiveness of Papanicolaou smear and visual inspection using acetic acid and visual inspection using Lugol’s iodine for screening of premalignant and malignant lesions of cervix
Authors: Attri Apra , Thakur Sita , Verma Ashok , Singh Suman , Sharma Priyanka
Published: June 2020

Background: In developing and resource-limited countries alternative screening methods like VIA, VILI, and Pap smear are used in detection of premalignant and malignant lesions of cervix. The aim of our study was to compare the efficacies of VIA, VILI, and Pap smear in detection of premalignant and malignant lesions of cervix.Methods: The study was conducted for a period of one year in the department of obstetrics and gynaecology, Dr. Rajendra Prasad Government Medical College, Kangra at Tanda, Himachal Pradesh. Women who attended the outdoor patient department of obstetrics and gynecology were subjected to collection of Pap Smear, VIA followed by VILI and a thorough pelvic examination.Results: Among the 350 women studied, 59 women (16.9%) had abnormal VIA, 64 women (18.2%) had abnormal VILI. On pap smear, 10 women were reported as ASCUS, 11 as L-SIL and 1 as H-SIL. Cervical biopsy was done in 98 women, out of which 70 had one or more abnormality on VIA, VILI, or Pap, and 28 women who had normal results. Sixteen women (16.3%) reported as CIN-1 and 2 women (2.07%) as CIN-3. VIA and VILI had a higher sensitivity as compared to pap. However, pap was more specific. The PPV of pap was also much higher as compared to VIA and VILI, whereas there was no difference in NPV of the three.Conclusions: Authors observed that VIA presented the best sensitivity (88.8%), followed by VILI (83.3%), and Pap (72.2%). Pap smear had the highest specificity of 97.2%. The positive predictive value of Pap was higher as compared to VIA and VILI, whereas there was no difference in NPV of the three. VIA and VILI have good sensitivity, with reasonable specificity and because of their cost effectiveness and ease of availability, these can be an alternative screening modality for cervical cancer screening.
Evaluation of endometrial causes of postmenopausal bleeding with it's correlation with endometrial thickness and hysteroscopy findings and endometrial tissue histopathology
Authors: Bhangale Saurabh V. , Sharma Shailja , Patil Asmita , Kumari Beena
Published: June 2020

Background: Postmenopausal bleeding (PMB)accounts for 5% of gynecology visit. All with unexpected uterine bleeding should be evaluated for endometrial carcinoma since this potentially lethal disease is the cause of bleeding in approximately 10 percent patients (range 1 to 25 percent, depending upon risk factors). The aim of the study was to evaluate endometrial causes of postmenopausal bleeding (PMB) with it's correlation with endometrial thickness (ET)and hysteroscopy findings and endometrial tissue histopathology.Methods: A total 50 consecutive cases of PMB fulfilling the inclusion and exclusion criteria and giving informed consent were selected. Each patient was subjected to transvaginal sonography (TVS) in which uterus, adnexa and endometrial thickness (ET) was assessed. Then hysteroscopy and/or dilation and curettage was scheduled at subsequent visit. Endometrial sample was sent for histopathological examination. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and diagnostic accuracy was calculated for ET by TVS and hysteroscopy findings, considering histopathological diagnosis as the gold standard.Results: Most common endometrial cause of PMB was atrophic endometrium (44%). The other causes were endometrial carcinoma (18%), endometrial hyperplasia (18%), endometrial polyp (12%), endometritis (4%), and leiomyoma (4%). The diagnostic accuracy of ET by TVS at a cut-off point of 5 mm was 94% with sensitivity 89.3%, specificity 100%, PPV 100% and NPV 88%. The diagnostic accuracy of hysteroscopy was 98% with sensitivity 96.4%, specificity 100%, PPV 100% and NPV 95.7%.Conclusions: Being relatively cheap, easily accessible, non-invasive, TVS with ET measurement should first line investigation in the evaluation of women with postmenopausal bleeding with suspected endometrial pathology. Although hysteroscopy is more specific and sensitive, in poor resource settings it should be limited to cases with ill-deﬁned endometrial lining, recurrent/ persistent bleeding and cases with endometrial thickness greater than 5 mm irrespective of endometrial echotexture.
A study of maternal outcome in term premature rupture of membranes in a tertiary care hospital
Authors: Jain Aayushi , Paul Mohini
Published: June 2020

Background: Premature rupture of membranes (PROM) remains a subject of great clinical relevance. The present study was conducted to study maternal morbidity and its relationship with PROM-delivery interval in patients with term PROM as compared to patients without PROM.Methods: A prospective case control study was conducted in the department of obstetrics and gynecology, Kasturba Hospital, New Delhi. 100 pregnant patients presenting to the labor room with features of PROM at term (POG>37 weeks) were taken as cases and 100 term pregnant women (age and parity matched) with intact membranes were taken as controls and compared in terms of maternal outcome.Results: This study reported maternal morbidity rate of 21% in term PROM cases which was significantly higher than in control group (5%). The major cause was febrile morbidity which occurred in 16% of cases indicating ascending infection. Other complications were abdominal and episiotomy wound infection (4%), chorioamnionitis (2%), postpartum hemorrhage (2%) and puerperal sepsis (1%). There was an increased rate of operative delivery in the case group (33%) as compared to 18% in patients without PROM. Duration of PROM-delivery interval had a significant direct proportional impact on the maternal morbidity. The duration of combined hospital stay of mother and neonate was also increased.Conclusions: Patients with term PROM have significant maternal morbidity which was mainly due to infection. The duration of the hospital stay was also significantly increased.
Hysterolaparoscopy as a one-time approach in infertility: a prospective study
Authors: Sutaria Rini , Singh Richa , Gopal Sriram
Published: June 2020

Background: The prevalence of infertility ranges from 3.5% to 16.7% in more developed nations and from 6.9% to 9.3% in less developed nations, with an estimated overall median prevalence of 9%. The present study was aimed to evaluate the role of hysterolaparoscopy in the study of primary and secondary infertility, to identify the various pathological conditions in female reproductive tract leading to primary/ secondary infertility, to develop a plan for therapy and management at the same time.Methods: This is a one-year prospective study conducted in obstetrics and gynecology department at D. Y. Patil hospital, Navi Mumbai, Maharashtra, India. All infertility patients seen in outpatient department, who were medically fit, willing for surgery and willing to get enrolled for study were included in this study.Results: Out of total 120 cases for infertility evaluated, tubal factor is the most common cause (28.3%) in both primary (23.3%) and secondary (43.3%) infertility group as seen on laparoscopy. Followed by ovarian factors (28.3%), peritoneal (11.6%) and uterine factors (10.8%). In 27 cases (22%), there were no detectable pathology at laparoscopy. In this study, hysteroscopy findings show 5.8% cases to have submucous fibroid uterus, 3.3% submucous polyp, 1.6% subseptate uterus, 0.8% septate uterus, 0.8% intrauterine adhesions, 0.8% bicornuate uterus and cervical stenosis 1.6% of patients.Conclusions: From this study, it is concluded that the diagnostic hysteroscopy and laparoscopy is an effective and safe tool in evaluation of female infertility. It provides direct and magnified view of all pelvic organs.
Knowledge, attitude and practice towards cervical cancer screening and human papilloma virus vaccine at a tertiary care facility in North India
Authors: Misra Devyani , Mahajan Charu , Bansal Bhumika
Published: June 2020

Background: Cervical cancer continues to be a major health care problem and most common cause of cancer deaths. Many screening methods are available to detect the disease in precancerous stage. Cervical cancer is the only cancer that is preventable with HPV vaccine against the causative agent responsible for this condition. Knowledge and attitude of women determine the likelihood of women undergoing screening procedures and HPV vaccination which will have implications for the future generations. This study was conducted to determine the knowledge, attitude and practice of women towards cervical screening and HPV vaccine.Methods: This is a facility based observational cross-sectional study conducted at Dr. RMLIMS, Lucknow, over a period of 3 months - January 2019 to March 2019. Women attending gynecology OPD were enrolled after verbally consenting for the study and were required to fill a pre-structured questionnaire which was then analyzed and assessed.Results: A total of 368 participants answered the questionnaire. Overall, 154 subjects (41.8%) had adequate knowledge regarding cervical carcinoma risk factors, symptoms, screening for cancer and HPV vaccine. Favorable attitude was seen in 315 (85.5%) participants. Ninety-six participants (26.0%) had ever had a cervical cancer screening and 23 participants (6.2%) had ever received HPV vaccine which was very low. Lack of knowledge and cost factors were the main reasons cited for these low screening and vaccination rates among the participants.Conclusions: The study shows that knowledge was inadequate and screening and vaccination rates were very low in the study population. This highlights the need to educate the community regarding cervical cancer prevention and to make these services readily available at affordable costs to achieve the ultimate goal of elimination of cervical cancer.
Comparison of pelvic floor dysfunction in primiparous and nulliparous women and its relation to pelvic floor muscle strength
Authors: Naghma Shahida , Batra Achla , Kumar Deepak
Published: June 2020

Background: The pelvic floor muscles (PFM) play an important role in supporting the pelvic and abdominal organs and controlling urinary and fecal continence, in addition to their role in the sexual function. The objective of this study was to compare pelvic floor muscle strength in primiparous 6 months after delivery and nulliparous women, to evaluate pelvic floor dysfunction (PFD) in these women and to find the association of PFD with pelvic floor muscle strength (PFMS).Methods: A total of 100 women were recruited in the cross-sectional study which included 28 nulliparous and 72 primiparous women 6 months after delivery. The assessment included general physical examination (GPE), POP-Q and assessment of pelvic floor muscle strength by modified oxford score and perineometer.Results: Endurance of PFMS measured by duration of contraction and number of contractions/min was higher in nulliparous. Mean of the duration of contraction was significantly higher in nulliparous group as compared to primipara i.e., 28.61 seconds and 23.9 seconds in nulliparous and primiparous group respectively (p=0.005). Mean of the number of contractions performed in one minute was significantly higher in nulliparous group as compared to primipara i.e., 31.04 and 19.97 in nulliparous and primiparous group respectively (p<0.0001). None of the nulliparous women had any PFD symptoms, while 4.17% of the primiparous patients had PFD in the form of bladder symptoms and 1.39% of them had PFD in the form bowel symptoms. Vaginal squeeze pressure was found to be affected by mode of delivery. It was lowest in instrumental delivery. It was 39.78±13.33 cmH20 in vaginal delivery, 51.42±12.88 cmH2O in Caesarean section and 31.67±14.36 cmH2O in instrumental delivery (p-0.039).Conclusions: Endurance of PFMS measured by duration of contraction and number of contractions/min was higher in nulliparous. Vaginal squeeze pressure was found to be affected by mode of delivery. It was lowest in instrumental delivery.
Comparing difference in mean total protein, albumin and globulin based on severity of rhesus isoimmunization: a prospective study
Authors: Yadav Vikas , Deka Dipika , Sharma Aparna , Dadhwal Vatsla
Published: June 2020

Background: Maternal RBC alloimmunization results from exposure and response to a foreign RBC antigen. Transplacental fetal to maternal hemorrhage is the most common cause of alloimmunization. Rh incompatibility can lead to either fetuses with hydropic features or non-hydropic. The precise mechanism leading to the development of hydrops is uncertain. Biochemical markers have the potential to be used to assess the severity of problem. But of the mechanisms proposed none have been able to totally explain the phenomenon or predict the prognosis. Objective of this study wads to compare the difference in mean total protein, albumin and globulin bases on severity of isoimmunization and comparing it with normal controls.Methods: A Total of 40 pregnant patients were enrolled which included 10 hydropic fetuses of Rh isoimmunised mothers, 10 non hydropic fetuses of Rh isoimmunized mothers. Control group included 18 Rh positive women without any fetal complication and 2 fetuses in women undergoing cordocentesis. Blood sampling was done at time of intrauterine transfusion and sent for estimation of total proteins, albumin, globulin in fetal blood. Pregnancies were followed up till delivery and fetal outcome noted.Results: Mean total protein, albumin and globulin between hydropic, non hydropic group and control group (3.25, 2.17 and 1.18 g/dl) in hydropic, (4.14, 2.70 and 1.44 g/dl) in non hydropic and (4.42, 2.95 and 1.47 g/dl) in control group respectively. Mean total protein, albumin and globulin between mild hydropic (3.43, 2.30 and 2.10 g/dl) and severe hydropic group (2.59, 1.6 and 1.3 g/dl) respectively.Conclusions: There was significantly lower levels of serum total proteins, albumin and globulin in hydropic fetuses as compared to non hydropic fetuses. Thus, hypoproteinemia can be considered a strong marker for development of hydrops in Rh isoimmunized fetuses.
A rare case report of ovarian torsion with sigmoid volvulus
Authors: Mevada Shraddha A. , Bhosale Archana A. , Mehendale Madhuri A.
Published: June 2020

Ovarian torsion results from twisting of the ovary about the suspensory ligament, which contains the ovarian artery and vein, lymphatic’s, and nerves. Volvulus is a torsion of a segment of the alimentary tract, that often leads to intestinal obstruction. Ovarian torsion leading to sigmoid volvulus is the rarest complication which authors found in this case. Hence the case was presented. A 28-year-old women presented with acute pain in abdomen since 14 hours, followed by 2 episodes of vomiting, abdominal distension since 10 hours. Plain X-ray Abdomen erect was done which showed ‘Coffee bean’ sign with multiple air fluid levels suggestive of sigmoid volvulus. On laparotomy, after opening the peritoneum, large right ovarian cyst around 12×11×10 cm with solid and haemorrhagic content with long pedicle around 8 cm with 3 turns of torsion was noted. Abutting the ovarian mass, sigmoid colon was seen twisted around its mesentery including the twisted ovarian pedicle. Hence, the twisted component included the twisted ovarian pedicle and twisted sigmoid mesentery. Stepwise detorsion of ovarian pedicle followed by oophorectomy was done. For sigmoid volvulus, resection of vascular compromised sigmoid colon and descending colon stoma was done. Reanastomosis was done later after 3 months post operatively.
An encounter with alobar holoprosencephaly: a case report
Authors: Venugopalan Prasanna , Mithilag Fathima , Nair Vidhu V.
Published: June 2020

Alobar holopresencephaly is a rare embryonic condition where there is anomalous fusion of cerebral hemispheres. The key features include neurological impairment and facial dysmorphism like cyclopia, ocular hypertelorism with divided orbits and a proboscis. Obstetric ultrasound and foetal MRI are the diagnostic modalities. Majority of cases are sporadic in origin while a genetic association is also described. A small recurrence risk is noted in cases with sporadic origin. Early diagnosis and pregnancy termination are advisable for the condition since the survival rate is very low.
Tuberous sclerosis in pregnancy: a rare genetic disease requiring multidisciplinary approach in pregnancy
Authors: Madan Shikha , Kumar Pardeep , Anand Smriti , Sangwan Neetu
Published: June 2020

Tuberous sclerosis complex (TSC) is a multisystemic, autosomal dominant genetic disorder with complete penetrance, that can evolve with hamartomas in multiple organs, such as skin, central nervous system, kidney and lung. Penetrance in genetics is the proportion of individuals carrying a particular variant (or allele) of a gene (the genotype) that also express an associated trait (the phenotype). Due to the wide phenotypic variability in TSC, the disease is often not recognized. The diagnostic criteria for tuberous sclerosis were reviewed in 2012, at the second International tuberous sclerosis complex consensus conference. The diagnosis is based on genetic criteria, by the identification of inactivating pathogenic mutation of tumour suppressor genes TSC1 and TSC2, and clinical criteria, including cutaneous, renal, pulmonary, cardiac and neurological manifestations. Authors present with a rare case report of a patient with TSC presenting at term.
Silent uterine rupture in second trimester: a differential diagnosis to remember
Authors: Mundhra Rajlaxmi , Bahadur Anupama , Kunwar Kiran , Mishra Juhi , Yadav Ankita , Das Debashish
Published: June 2020

Spontaneous silent uterine rupture is a life-threatening emergency situation requiring immediate laparotomy. High index of suspicion is key to prevent maternal mortality as at times the presentation can be nonspecific. Authors herein present a case of spontaneous silent uterine rupture during second trimester of pregnancy wherein the diagnosis was initially missed. To the best of authors knowledge, only a few cases with spontaneous fundal second trimester uterine rupture have been recorded so far.
Can pleural packing be an effective solution for uncontrollable intra or post-operative hemorrhage
Authors: Zribi Hazem , Ammar Abderrahmen , Abdelkbir Amina , Bouacida Imen , Maazaoui Sarra , Mestiri Tahar , Marghli Adel
Published: June 2020

Background: Uncontrollable bleeding during thoracic surgery has been a challenging problem faced by surgeons. The aim of this study was to clarify the usefulness of pleural packing as a good alternative to control hemorrhage and to deduce the common point between those patients.Methods: This was a retrospective case series study of eight patients who underwent thoracic surgery with uncontrollable intrathoracic haemorrhage and shock which required intrathoracic packing from January 2014 to December 2019.Results: During the study period, eight patients underwent thoracic surgery with uncontrollable intrathoracic haemorrhage and needed packing.  Successful hemostasis was achieved in all cases after pleural packing. The mean age was 58.5 years and six patients were males. The common point was the history of pulmonary tuberculosis which was with invasive pulmonary aspergillosis for two patients. Incision was a posterolateral thoracotomy in all cases and six patients required pulmonary resection (five lobectomy and one bilobectomy), one patient required decortication, and one had tumorectomy of a paragonglioma located in the Barety’s space. The unpacking took place right after 48 hours. An arrest of the bleeding was noticed in all the remaining patients. The mean time of the mechanical ventilation was 11 days. Complications included atelectasis and infectious pneumonitis. We noted one case of death.Conclusions: Intrathoracic packing may be an effective and feasible technique in managing uncontrollable post-operative hemorrhage when the life of patients is in danger. This technique should always be considered for patients with tuberculosis history.
Persistent diarrhea in living donors after donor hepatectomy: natural course and analysis of predisposing risk factors
Authors: Wang Szu-Han , Lin Ping-Yi , Chen Yao-Li , Huang Mei-Feng , Hsieh Chia-En , Chen Chih-Cheng
Published: June 2020

Background: Diarrhea is a frequent but overlooked complication of living liver donation. Thus, this retrospective study aimed to report the natural course of diarrhea and examined predictors of persistent diarrhea after living donor hepatectomy.Methods: We enrolled 79 donors who underwent living donor hepatectomy between 2010 and 2015 at a single medical center and had diarrhea symptoms after hepatectomy. The Chinese version of the gastrointestinal quality of life index (GIQLI) was applied to evaluate the effect of diarrhea on quality of life.Results: The onset of diarrhea was post-donation 1.1±0.3 months. According to their duration of diarrhea, donors were further classified into two groups: the healed and the persistent diarrhea group, the ratio was 36 to 43 (45.6% versus 54.4%). A donor who followed a low-fat diet had a protective effect on persistent diarrhea (odds ratio [OR] =0.18, 95% confidence interval: 0.04-0.66). Compared to healed diarrhea donors, donors with persistent diarrhea had lower GIQLI scores in the domains of physical (2.3 versus 1.9) and social functions (2.5 versus 2.3). Receiver operating characteristic curves for the duration of diarrhea after liver donation indicated that a donor was likely to develop a persistent diarrhea status if the duration of the diarrhea reached 12.5 months.Conclusions: A donor not following a low-fat diet can be independently predictive for persistent diarrhea after living donor hepatectomy. Besides, a donor with persistent diarrhea after hepatectomy is more likely to report lower GIQLI scores in physical and social functions.
Role of laparoscopy in incisional hernia and relative benefit of the laparoscopic incisional hernia repair to the open incisional hernia repair
Authors: Pal Sudhir Singh , Mourya Azad Kumar
Published: June 2020

Background: Incisional hernia is a common complication of abdominal surgery. Historically the open repair with or without mesh was the mainstay of treatment. However, many recently published laparoscopic repair studies have challenged surgeons to re-evaluate which technique provides the best short and long term outcomes.Methods: The study was conducted on 50 patients admitted at GMC Bhopal with approval from college ethical committee.Results: In 50 cases 21 were male and 29 were female. 7 male (14%) and 15 female (30%) patients had undergone laproscopic mesh repair (LMR) and 14 male (28%) and 14 female (28%) patients had undergone open mesh repair (OMR). Total complication in OMR group is 10 (35%) and in LMR group is 2 (9.09%). Mean duration of hospital stay in LMR group was 6.6 days and in OMR group was 15.57 days. Post-operative patients of LMR group returned back to the work early (mean 12 days) compared to OMR group (mean 20.7 days). Mean post-operative day of movement in LMR group was 1 day and in OMR group was 2.03 days. Pain measured using visual analogue score on 3rd post-operative day showed decreased pain score in laparoscopic group (mean 2) compared to open group (mean 5.35).Conclusions: Laparoscopic incisional hernia repair provides lesser post-operative pain, lesser complications, shorter hospital stay and lesser economic impact as they returned to work early. Thus patients have less morbidity and improved quality of life.
Quality of life assessment in patients who have undergone oncologic resection of rectum: a retrospective, three arms, single centre, observational study
Authors: Bambora Quresh , Shingade Mangesh , Sankhla Mamta , Rajpara Atul
Published: June 2020

Background: Quality of life (QOL) analysis following cancer surgery is a sensitive issue among patients. The present study tried to find the status of these QOL parameters in patients who had undergone oncogenic resection of rectum.Methods: Patients were given the short form 36 (SF-36), The European Organization for Research and Treatment of Cancer (EORTC) QLQ-C30 and the EORTC QLQ-C29 questionnaires to fill at three time points in their treatment (prior to surgery, 3 months and 6 months following surgery). The prospectively collected questionnaires were analysed retrospectively.Results: On comparing SF-36 questionnaire, there was significant improvement as we proceeded from baseline to first and second visit except for the energy level. On EORTC-30 questionnaire, there was significant improvement in all scales as we proceeded from baseline to first visit and then to second visit. On comparing EORTC-29 questionnaire, among all visits of abdominoperineal resection (APR), symptoms like pain and blood or mucus in stools significantly improved, low anterior resection (LAR) showed significant improvement in all 4 scales, high anterior resection (HAR) patients showed worst micturition complaints during first visit and gradually improving scores for other scales from baseline to first and second visit.Conclusions: The three-questionnaire used in the study comprehensively included all issues from general health after cancer surgery to problems faced by the patients specifically after various modalities of rectal surgery. Such studies should be planned routinely to assess comprehensive outcome of oncogenic surgeries.
Neurobehavioral sequelae of moderate traumatic brain injury
Authors: Joseph Jijo Joseph , Asher Prasanth , Pendro Varun Singh , Peethambaran Anilkumar , Prabhakar Rajmohan Bhanu
Published: June 2020

Background: The goal of providing neurobehavioural rehabilitation of traumatic brain injury (TBI) survivors still remains largely unachieved, as the problem is still neglected. This study analysed the change in behavioural sequelae in TBI patients over a period of twelve months, so that appropriate measures may be taken for their adequate rehabilitation.Methods: All patients admitted with moderate TBI, aged between 15 and 60 years, during the study period of one year, or until the sample size (n=118) was reached, were included in the study. The initial details regarding the mechanism of injury and the initial Glasgow coma scale (GCS), number of days in intensive care unit (ICU), and so on were recorded. At follow up periods of six months and one year, the neuro behavioral rating scale was used in the review clinic to assess the change in neuro behavioral status. Data was analyzed using SPSS.Results: Out of the 118 subjects included in the study, there was statistically significant improvement in inattention, disorientation, expressive deficit, memory deficit, inaccurate insight, depressive mood, hallucinatory behaviour, unusual thought content, comprehension deficit, speech articulation defect, and so on. There was worsening of anxiety, guilt, tension, etc. There was no much change in somatic concern, hostility and so on.Conclusions: In view of significant worsening of behavioural components, this study has highlighted the need for individualized regimens for overall rehabilitation of the victims, thereby lessening burden on the patient, family and society.