bluuebunny/crossref_metadata_2025 huggingface dataset:
Comparative study of fetal and maternal outcomes of prelabour rupture of membranes at term
Authors: Mukharya Janhavi , Mukharya Simmi
Published: December 2016

Background: Premature rupture of membranes (PROM) refers to the loss of integrity of membranes before onset of labor, with resulting leakage of amniotic fluid and establishment of communication between the amniotic cavity and the endocervical canal and vagina. The aim of the study was to compare the fetal and maternal outcomes of actively managed and expectantly managed term PROM in a rural setup.Methods: In this prospective study we included 200 women with diagnosed prelabour rupture of membranes. All women had gestational age >37 weeks and <41 weeks with singleton pregnancy and vertex presentation. Study excluded all patients with previous uterine scar or with any medical or surgical disorder. They were randomly divided in two groups with 100 women each: Group A which was induced with PGE1 or oxytocin depending on their cervical score and Group E which was managed expectantly and late induction after 24 hours was done. Both the groups were given intravenous antibiotics. They were evaluated on the basis of fetal and maternal outcomes.Results: In this study we found that 70% women who were managed expectantly went in labour within 24 hours of PROM. But PROM to delivery interval was longer in expectantly managed as compared to actively managed or induced group. Rate of cesarean was more in induced group but was statistically insignificant when compared in both the groups. So was NICU admission more in expectant group but was statistically insignificant when compared in both the groups.Conclusions: Expectant managed can be done in patients with term PROM to reduce the cesarean rate in rural setup. There was no significant difference in maternal and fetal outcomes of the management.
Study of correlation between maternal body mass index with maternal and perinatal outcome
Authors: Tharihalli Chandrashekhar , Thathagari Varija
Published: December 2016

Background: To study the correlation between maternal body mass index (BMI) with maternal and perinatal outcome in women admitted to labour ward in Department of OBG, VIMS, Ballari.Methods: This observation study was conducted in Department of OBG, VIMS, Ballari for a period of one year between 1st October 2014 to 30th September 2015. All women admitted to labour ward with full term singleton pregnancy were included in the study. The cases were classified into four groups as under-weight (BMI <20kg/m2), normal (BMI 20-24.9kg/m2), over-weight (BMI 25-29.9kg/m2) and obese (BMI >30kg/m2). The maternal and perinatal outcome noted and studied in the above groups.Results: A total of 500 cases were included during the study period of one year, out of which 15% were under-weight, 68% were normal BMI, 12% were over-weight and 5% cases were obese(BMI >30kg/m2). The patients with low BMI had higher incidence of low birth weight (40%) and perinatal deaths. Increased BMI category was associated with higher incidence of PIH (25-28%), operative deliveries (50-68%), PPH (12%), microsomal babies (32%), low APGAR (24%) and perinatal deaths (12%).Conclusions: Adverse maternal and perinatal outcomes are significantly related to extremes of BMI categories and least complications were seen in normal BMI group.
Role of cardiotocography in high risk pregnancy and its correlation with increase cesarean section rate
Authors: Gupta Manisha , Gupta Punit
Published: December 2016

Background: FHR monitoring plays the most important role in management of labouring patient when incidence of fetal hypoxia and progressive asphyxia increases. Now a day’s cardiotocography (CTG) become a popular method for monitoring of fetal wellbeing and it is assisting the obstetrician in making the decision on the mode of delivery to improve perinatal outcome. The aim of the study was to assess the effect of cardiotocography on perinatal outcome and its correlation with caesarean section rate.Methods: In this prospective observational study 201 gravid women with high risk pregnancy in first stage of labour were taken. Result was assessed in the form of Apgar score at five minute, NICU admission, perinatal mortality and mode of delivery. Statistical analysis is done by using Chi square test and p<0.05 is considered as statistically significant.Results: Perinatal morbidity in the form of NICU admission is higher in nonreactive group as compare to reactive group (75.7% v/s 22.8%). Cesarean section rate for fetal distress were higher in nonreactive group (87.8%) in comparison to reactive group (20.5%). So this study suggest that there is significant difference in mode of delivery with increasing chances of caesarean section in cases belong to non-reactive traces (p<0.001).Conclusions: Admission test is non-invasive and the best screening test to evaluate the fetal health and to predict the perinatal outcome but it also associated with increase caesarean section rate.
Comparative study of oral iron and intravenous iron sucrose for the treatment of iron deficiency anemia in pregnancy
Authors: Garg Apurva , Agarwal Manju , Shankar Uma , Shetty Shrikant
Published: December 2016

Background: The aim of this study was to compare the efficacy and safety of iron sucrose with oral iron in the treatment of iron deficiency anemia of pregnancy.Methods: An interventional comparative study was conducted at Jhalawar Medical College, Jhalawar involving 80 pregnant women with iron deficiency anemia from March 2016 to August 2016. Inclusion criteria were gestational age between 24-32 weeks with established iron deficiency anemia, with hemoglobin between 7-10g/dl. Target Hemoglobin was 11 g/dl. In intravenous iron sucrose group iron sucrose dose was calculated from following formula: total iron dose required (mg) = 2.4 x body weight in Kg x (target Hb – Patient’s Hb g/dl) + 500. In oral iron, group patient received ferrous-sulphate 335 mg daily BD. Hb level were reviewed at 2, 4, 6 weeks.Results: Change in Hemoglobin level from baseline significantly higher in IV iron group than oral iron group. In IV iron, group mean value of baseline Hb was 8.07±0.610 g/dl and in oral iron group was 8.48±0.741 g/dl. At the end of 6-week mean hemoglobin in IV iron sucrose was 10.66±0.743 g/dl and in oral iron group was 10.08±0.860 g/dl.Conclusions: Intravenous iron sucrose elevates more Hb than oral iron, with less adverse effects.
The correlation of visual inspection, Pap-smear and immunocytochemistry of human papilloma virus in detection of cervical cytology
Authors: Khemka Anuradha , Jajoo Shubhada
Published: December 2016

Background: Carcinogenicity presents as a major challenge to scientists and society.. Cervical cancer ranks fifth in the world and is the second cause of death in developing countries like India and China. The rate of death due to cervical cancer is greatest in India. At any time women are at risk of harboring HPV infection, which has been seen to cause cervical cancer. Clinical judgment should be used in spite of all high quality modalities available for screening and diagnosis, as initiated by WHO (World health organization) the Down Staging of cervical cancer, VIA, VILI, Pap smear introduced by George Papanicolaou in 1940s , HPV testing by Immunocytochemistry (ICC) and  HPV DNA , Colposcopy , are other modalities to screen cervix. The study aims to evaluate the correlation between Pap smear, visual inspection and Immunocytochemistry of Human papilloma virus (HPV).Methods: All 100 consecutive women were subjected to visual inspection of cervix, Pap smear and immunocytochemistry of HPV. Pap smear was done by conventional method.Results: it was seen that out 100 consecutive cervico-vaginal, ears for Pap and Immunocytochemistry, only 33 were abnormal, 24 were ASCUS, 6 were LSIL, 2 were HSIL, 1 was SCC and 67 were NILM out of which 3 were reactive for ICC. And all 33 were reactive for ICC.Conclusions: The p16 immunostaining performed on conventional smears can become alternative or addition to l HPV DNA tests. The Bethesda System (TBS) 2001 for reporting cervical cytology diagnosis is of high value in detecting abnormal cervical cytology. It is further concluded that the ancillary screening for HPV in NILM category seems to be not advisable as percentage of detection of HPV in this category is low.
Anti-thyroid peroxidase antibody positivity and other obstetric complications in women with recurrent miscarriage
Authors: Jaiswal Sneha , Bag Tarasankar
Published: December 2016

Background: Thyroid dysfunction and autoimmunity are relatively common in women of reproductive age group and has been associated with various adverse pregnancy outcomes such as recurrent miscarriage, preeclampsia and preterm labour. The aim of this study was to find out association between anti-tpo antibody and recurrent miscarriage and to evaluate obstetric complications such as preeclampsia and preterm labour in them.Methods: This case control observational study was carried out from July 2014 to June2015 on 110 pregnant mothers out which 55 with history of recurrent miscarriage were cases and 55 without such history were controls.Results: The mean age of the cases were 24.18 yrs. Majority of pregnancy losses occurred between 9-14wks.The prevalence of anti-tpo antibody positivity in the study population was 15.45%.out of 55 cases 12 were positive for anti-tpo antibody(21.8%).Positive anti-tpo antibody was associated with high TSH level than the negative anti tpo antibody(p<.000).The prevalence of preeclampsia and preterm labour in recurrent miscarriage patients were 9.09% and 5.45% respectively which was not significantly higher than background risk.1 out of 5 patients with preeclampsia had anti-tpo positive and none with preterm labour had anti-tpo antibody positivity.Conclusions: The prevalence of thyroid autoimmunity was higher in patients with history recurrent miscarriage history than the control population. Even in women with biochemically normal thyroid function there was relationship between recurrent miscarriage and thyroid autoimmunity. Thus anti-tpo antibody could be risk marker for RSM. Screening for subclinical hypothyroidism (TSH >2.5 but<10) and anti-tpo antibody can be suggested as these identify women with increased risk of miscarriage.
Comparative study of labetalol and nifedipine in management of hypertensive disorders in pregnancy
Authors: Hangarga U. S. , D. Rita , Harshitha K.
Published: December 2016

Background: Hypertensive disorders complicate 5 to 10 percent of all pregnancies, and together they are one member of the deadly triad, of haemorrhage and infection.Methods: The Present study was conducted at Navodaya Medical College, Hospital and Research Centre, Raichur from January 2014 to December 2015. The efficacy of labetalol verses nifedipine in management of hypertensive disorders of pregnancy was studied. The study consisted of 100 antenatal patients irrespective of parity and gestational age from 20-40weeks patients, with severe PIH with imminent eclampsia. Heart diseases, Hematological disorders, Liver diseases renal diseases and Bronchial asthma were excluded from the study.Results: In the study, fall in mean arterial pressure of >20mm Hg was noted 6hrs after initiation of treatment in nifedipine group which is statistically significant; no statistical significance was observed in both groups at 12hrs. A fall of mean arterial pressure to normal was noted at 48hrs and 72 hrs in labetalol, which is statistically highly significant.Conclusions: The present study indicates labetalol to be a better anti-hypertensive in terms of control of hypertension, mode of vaginal delivery and fetal outcome.
Comparative study of single dose versus multiple doses of antibiotic prophylaxis in caesarean delivery
Authors: S. Prathima , C. Savitha , KK Tejeswini , GS A
Published: December 2016

Background: The aim of this study was to compare the low dose of vaginal misoprostol and dinoprostone gel for the induction of labour at term of pregnancy.Methods: Retrospective comparative study was undertaken on 300 subjects with 2 parallel treatment groups. Data were analyzed using Graphpad Instat 3 McIntosh software by Student’s t test, Mann–Whitney U test, the Chi-squared test or fisher’s exact test.Results: Comparatively narrow spectrum low cost cefotaxime is as effective as more expensive commonly used amoxicillin-clavulanic acid with no significant difference of infectious morbidity.Conclusions: Less costly cefotaxime should be preferred compared to more costly triple drug regimen for prophylaxis at caesarean section.
The role of Sevista (ormeloxifene) in the management of dysfunctional uterine bleeding
Authors: Gandotra Nikita , Sharma Preeti , Sharma Abhinav , Rizvi Syed Masuma
Published: December 2016

Background: Dysfunctional uterine bleeding (DUB) is a common gynaecological disorder that usually ends up in hysterectomy and causes psychological and physiological stress. Medical management with hormones and NSAIDS has inherited side effects. Ormeloxifene, a selective estrogen receptor modulator, is emerging as a safe and effective agent for dysfunctional uterine bleeding. The objective of the study was to evaluate the role of ormeloxifene in medical management of dysfunctional uterine bleeding.Methods: 30 patients, on whom diagnosis of dysfunctional uterine bleeding was made, were included in the study. Patients were given ormeloxifene 60mg twice a week for 12 weeks and then once a week for 12 weeks. The primary outcome measures were menstrual blood loss (assessed by pictorial blood assessment chart score), hemoglobin concentration and endometrial thickness. The secondary outcome measures were acceptability and side effects of ormeloxifene.Results: There was a significant reduction in mean PBAC score from 316 to 52 after six months of treatment. The mean hemoglobin concentration increased significantly from 8.4 to 9.8 gms/dl with a rise of 1.4gm/dl (p <0.05). The mean pretreatment endometrial thickness was 10.8mm and it decreased significantly to 8.1mm after 6 months of treatment with ormeloxifene (p < 0.05). 76.7% of the women showed marked subjective improvement in symptoms. The most common side effect reported was amenorrhea (13.3%).Conclusions: Ormeloxifene can be considered as an effective and safe therapeutic option for the medical management of dysfunctional uterine bleeding.
Prevalence and outcome of asymptomatic bacteriuria in early pregnancy
Authors: Radha Sreekumary , Nambisan Bindu , Prabhakaran Nisha Kizhekkepurakkal , Jamal Shahida
Published: December 2016

Background: Bacteriuria is a major risk factor for developing symptomatic urinary tract infection which is associated with significant maternal and fetal risks. Various studies have put a prevalence of asymptomatic bacteriuria between 2-10% in pregnancy. Maternal and fetal complications like gestational hypertension, anaemia, premature delivery, IUGR, and low birth weight are commonly associated with pyelonephritis which occurs as a result of undiagnosed or inadequately treated infections of the urinary tract. The primary objective was to find out the prevalence of asymptomatic bacteriuria in pregnancies less than 28 weeks gestation in our hospital and to study the various adverse pregnancy outcomes in the study group.Methods: This was a cross sectional study done over a period of 12 months at this tertiary care centre in Government sector in Trivandrum, Kerala. A sample size was calculated statistically and 400 women with gestational age less than 28 weeks attending the outpatient department were included in this study. A structured proforma, urine microscopy and urine culture and sensitivity were the study tools.Results: Prevalence of asymptomatic bacteriuria in our study population was 8.25%. Commonest pathogen isolated was E.coli in 57.14% cases. Maternal morbidity was higher in women with asymptomatic bacteriuria (24.2%) than those without (12.5%). Fetal morbidity in women with asymptomatic bacteriuria was 24% whereas it was 12.5% in those without it. Preterm labour, preeclampsia and prematurity were the common morbidities noted.Conclusions: Since pregnant women with asymptomatic bacteriuria were at an increased risk of adverse maternal and fetal outcome, routine screening for asymptomatic bacteriuria preferably in the first trimester is highly recommended.
Evaluation of pre induction scoring by clinical examination vs transvaginal sonography
Authors: Sharma Sonali Kaur , Nagpal Madhu , Thukral CL
Published: December 2016

Background: The aim of the study was to find out pre-induction cervical length by TV Sonography, determine Bishops score and to co-relate the obstetric outcome with these two variables.Methods: A study was done on 100 women with singleton pregnancies at 37-42 weeks of gestation, admitted for induction of labour in the Department of Obstetrics and Gynaecology at SGRDIMSR, Vallah, Amritsar, Punjab, India. All women underwent cervical assessment by both transvaginal ultrasound and Bishop Score and the outcome of labour induction was determined.Results: Of the 100 women, 53 women had vaginal delivery and 47 landed into LSCS. Bishop score < 6 and cervical length > 3 cm are cut off values of cervical unfavourablity. Successful induction was achieved among 87.5% and 78% women with favorable cervix according to Bishop Score and Cervical length respectively .Among the 92 and 50 women with unfavourable cervix according to Bishop score and cervical length, 48 (52.17%) and 14 (28%) had vaginal delivery respectively.Conclusions: Hence, cervical length by transvaginal ultrasound is a better predictor for the success of induction of labour as compared with assessment by Bishop Score alone.
Validation of a new ovarian malignancy suspicion index for preoperative evaluation of adnexal masses
Authors: Hebbar Shripad , K. Vijaya Bharathi
Published: December 2016

Background: The currently available ovarian malignancy probability scores incorporate biochemical markers such as CA 125 (Carbohydrate Antigen 125), which is not routinely available in peripheral centers. There is a need for tumour marker independent prediction model to differentiate malignant ovarian masses from their benign counterparts in order to plan appropriate surgery. To formulate and prospectively validate a new Ovarian Malignancy Suspicion Index (OMSI) independent of serum CA 125 level, in preoperative evaluation of adnexal masses admitted for surgery.Methods: This was a combined retrospective and prospective cohort study conducted in a tertiary referral hospital over a period of one and half years. Retrospective sample included 100 subjects who had undergone surgery for adnexal masses and who had definite histopathological report. Detailed data were obtained with respect to age, menopausal status, sonographic findings including solid areas, ascites, mean diameter, bilateralism, and presence of septa. A logistic multivariate regression analysis was carried out to find the best prediction score (OMSI - Ovarian Malignancy Suspicion Index). This model was further evaluated prospectively in 60 subjects for its diagnostic ability to identify benign and malignant ovarian pathology.Results: OMSI at the cut off value of 3.9 differentiated effectively malignant ovarian mass from benign variety with a good diagnostic performance (Sensitivity 100%, Specificity 90.5%, Positive Predictive Value 81.8% and Negative Predictive Value 100%) as good as currently recommended RMI (Risk Malignancy Index) score. It was also found that OMSI > 3.9 was associated with positive ultrasound evidence for ovarian malignancy such as presence of thick septae (90%), solid areas within the tumour (93.8%), papillary projections (100%), bilaterality (90%) and ascites (100%).Conclusions: This study shows that it is possible to derive ovarian malignancy prediction model such as OMSI without including CA 125 with diagnostic ability in par with risk scoring systems such as WHO recommended RMI. Using this model, physicians working in peripheral centers without facilities for estimating serum tumour markers can arrive at the possible diagnosis and plan appropriate management strategies.
Seroprevalence of Hepatitis B infection among pregnant women in South India
Authors: Rajendiran Sathiyakala , Gopalan Ushadevi , Jayakumar Karthika
Published: December 2016

Background: Vertical transmission of infection from mother to infants is a very important route of transmission of hepatitis B virus. Hepatitis B virus infection in pregnant women usually goes undetected. The hepatitis B surface antigen in serum is the first seromarker to indicate active HBV infection. This study was done to determine the seroprevalence of HBsAg in healthy asymptomatic antenatal women.Methods: It was a hospital based study over a period of two years. A total of 1282 antenatal patients were tested for hepatitis B surface antigen.Results: The prevalence rate of HBsAg was found to be 1.01 %( 13 positive out of 1282 cases). Highest prevalence was in age group 26-30(46%) followed by age group 31-35(30.8%) followed by age group 20-25 yrs (23.1%).Conclusions: Screening of all pregnant women for HBV irrespective of risk factors will reduce the prevalence and risks of HBV infection.
Outcome of singleton pregnancy following in-vitro fertilization: a prospective study
Authors: Kumar Vipin , Bandhu Garish Chandra , Dey Madhusudan
Published: December 2016

Background: It is observed that any spontaneous pregnancy does not always result in healthy baby and healthy mother. The aim of the study was to study the obstetrical outcome of singleton pregnancies following in vitro fertilization and embryo transfer (IVF-ET).Methods: All cases undergoing IVF-ET at ART Centre were followed up after Day18 (of ET) for estimation of serum beta HCG and trans-vaginal ultrasound done on day 21 and 5th week. The selected singleton pregnancies were followed for the various parameters to be studied and the data was statistically analyzed. A resultant 73 patients with single intrauterine gestational sac was followed up.Results: In our study population of 73 post IVF-ET singleton pregnancies, 13.69% underwent first and second trimester abortions. They had increased risk of developing hypertensive disorders in pregnancy. Study also showed increased incidence of gestational diabetes mellitus. Yet another important outcome also included pregnancy with intrauterine growth restriction. Preterm birth was noted in 10 singleton pregnancies. Out of 73 followed up patients one third underwent caesarean delivery and another few underwent instrumental delivery. One in four babies accounted for weight more than 2.5 kgs. Out of followed up 73 cases of singleton IVF-ET pregnancies, 5 cases had congenital anomalies. Most common indication for NICU admission was respiratory distress. The incidence of small for gestational age came out to be significant.Conclusions: Outcome of singleton pregnancy after IVF-ET is associated with adverse pregnancy outcomes. Couples should be made aware that even singleton pregnancies resulting from ART are at increased risk for obstetric complications.
Study of factors affecting maternal and fetal outcome in HIV positive women
Authors: Yadav Sumitra , Joshi Ruchi , Kale Vishal
Published: December 2016

Background: HIV virus infection was detected first time in India in Tamil Nadu in April 1986; India has the third largest HIV epidemic in the world. In 2013, HIV prevalence in India was an estimated 0.3 percent. The pregnant women and her unborn child who are HIV reactive are mostly innocent bearers of the brunt of the infection. Mother-to-child transmission of HIV is a major route of new infections in children. Without any intervention, the risk of transmission of HIV from infected pregnant women to her child is estimated to be around 20- 45%.Early diagnosis of children born to HIV positive mother using HIV DNA PCR and treating children who are diagnosed HIV-positive with antiretroviral drugs within their first 12 weeks of life reduces mortality by 75%.Methods: This retrospective data analytic study of HIV positive pregnant women who attended antenatal clinic and delivered at M.Y. Hospital, Indore from January 2011 to December 2013 .For screening of ANC patients ELISA method was used. For the children, HIV DNA was done by sending the dried blood smear on blot paper and was sent to the reference laboratory Kasturba Hospital, Mumbai and used for diagnosis at 6 week and 6 month.Results: Only 50% of HIV positive children were started on ART, 20% died, 20% loss to follow up and 10% were not willing for follow up. Also 30% mothers practiced mixed feeding. Neonatal mortality rate was 54.87 per thousand live births which is more than the seronegative mothers.Conclusions: First HIV DNA testing can be done at 72 hours to detect antenatal HIV transmission. Early testing can pick up these cases early and ensure treatment. Mixed feeding should be strongly discouraged by counseling and modern methods of communication.
An analytical study of 50 women presenting with an adnexal mass
Authors: Bhagde Anand Dipak , Jani Shashwat Kamal , Patel Megha Snehal , Shah Sushma Rakesh
Published: December 2016

Background: The aim of this study was to detect and determine the origin of adnexal mass and to narrow down the diagnosis. Also, to determine the reliability of the bimanual pelvic examination in diagnosing adnexal mass and to determine clinical, radiological and histopathological co-relation of adnexal mass. Adnexal mass lesions are fairly common among women (with a prevalence of 0.17% to 5.9% in asymptomatic women and 7.1% to 12% in symptomatic women) of all age group but very common among reproductive age. Differential diagnosis of adnexal mass is difficult and complex. Recognition of the severity of the problem, appropriate and timely evaluation and treatment with good outcome is the goal.Methods: Prospective, observational study of 50 patients with suspected various adnexal masses were conducted for a period of 1.5yr i.e. from November 2014 to May 2016. All patients underwent pelvic and ultrasonography examination. All patients later underwent surgery. Results were correlated later.Results: The patient ages ranged from 19 to 58 with a mean age of 31.5. Most common site of origin of adnexal masses is the Ovary (Rt. 38% and Lt. 34%) Most common adnexal masses on histopathological diagnosis are mucinous cyst adenoma (20%), Benign and mature cystic teratoma (16% and 6%) and serous cyst adenoma (10%). About 92% patients with adnexal mass presents with abdominal pain as a chief complaint.Conclusions: Although bimanual palpation of the adnexal masses may not allow a very specific diagnosis, clinically useful information can usually be obtained and hence it is particularly useful as a first step in assessment of adnexal masses and as an adjunct to morphological assessment of ovarian lesions. Ultrasonography is an important noninvasive investigation and is helpful in diagnosing most of these cases, but the histopathological examination of specimen obtained from laparotomy of adnexal mass is the gold standard for confirming the diagnosis.
Implications of combined endocrinopathy of diabetes mellitus and hypothyroidism on pregnancy
Authors: P. Amudha , A. Karthika Devi , B. Manochithra , J. Delphin Supriya
Published: December 2016

Background: Hypothyroidism and diabetes are the endocrine disorders commonly observed in pregnancy and each has been associated with adverse maternal and fetal outcomes. Our objective was to study the implications of combined endocrinopathy of hypothyroidism and DM on pregnancy and its outcome.Methods: This prospective cohort study included 150 pregnant women with singleton gestation and who were screened for and diagnosed with DM and /or hypothyroidism. They were then divided into 3 groups: 1) Diabetes (n=69) 2) Hypothyroidism (n = 53) 3) DM and hypothyroidism (n=28). Perinatal and neonatal characteristics were compared among the 3 groups and statistically analysed.Results: Women with both DM and hypothyroidism had higher rates of first trimester abortions, preeclampsia, polyhydramnios, placental abruption, preterm deliveries, caesarean sections, postpartum haemorrhage and intrauterine fetal deaths when compared to other groups. On the contrary, rates of labour induction, fetal macrosomia and LBW new-borns were not statistically significant among the groups.Conclusions: Women with both DM and hypothyroidism are at high risk of developing perinatal complications and need intense surveillance for the same during their pregnancy for better outcome. Pregnant women diagnosed with one of these endocrinopathies should be screened for the other.
Outcome of gestational trophoblastic disease in a rural tertiary centre of Haryana, India
Authors: Lakra Pinkey , Sangwan Vijayata , Siwach Sunita , Kansal Richa , Mahendru Rajiv , Sharma Anjali
Published: December 2016

Background: The reported incidence of GTD varies widely worldwide, from a low of 23 per 100,000 pregnancies (Paraguay) to a high of 1,299 per 100,000 pregnancies (Indonesia). The reported incidence of GTD in India is inconsistent therefore we planned to do an analysis of the GTD at our institute which is a referral tertiary center of Haryana.Methods: Records of patients of GTD admitted from January 2014 to June 2016 were analyzed and incidence per 1000 deliveries was calculated. The demographic profile, clinical presentation, management and complications were studied.Results: There were 38 patients of GTD with an incidence of 2.3 per 1000 deliveries. Out of 38 patients 33 (86.8%) were of molar pregnancy and 5 (13.16%) had GTN. Out of 33 molar patients 27 (81.8%) had complete mole and 6 (18.2%) had partial mole. All cases of GTN were low risk and received single agent methotrexate based chemotherapy. The mean age was 23.02±2.96 years and 47.4% were primigravida. The mean gestational age of presentation was 13.84 ± 3.24 weeks. There were no mortalities and no recurrences. Education in more than half i.e. 57.1% patients was below primary and 7 of the 19 patients with GTD, who could be followed telephonically, were found to have not followed the contraceptive advice and conceived within 6 months of the treatment of molar pregnancies, 5 had vaginal deliveries of live babies one of which was preterm and rest 2 had spontaneous abortions.Conclusions: In view of poor reporting from developing countries there is a need for a nodal centre exclusively for GTD in each state. Poor compliance and contraceptive practice due to uneducated population especially in rural India, warrants a need for prophylactic chemotherapy in high risk cases.
Torsion of term gravid uterus with a large leiomyoma
Authors: Çetin Berna Aslan , Bahat Pınar Yalçın , Dikmen Selin , Şimşek Erkan , Aydın Alev
Published: December 2016

Torsion of gravid uterus is a rare obstetric event and it is almost always diagnosed during cesarean section. Leiomyomas and previous cesarean sections are predisposing risk factors. We report a case of 180 degree torsion of a term gravid uterus with only symptom of hematuria.
Degenerated fibroid - a diagnostic challenge
Authors: Bhuyar Sonal , Sontakke Bhavana , Rajbhara Pooja Mukund
Published: December 2016

Leiomyoma of the uterus is the most common type of tumor affecting the female pelvis and arises from uterine smooth muscle. The size of leiomyoma varies from microscopic to giant; giant myoma is exceedingly rare. We report an unusual case of a large, cystic, uterine leiomyoma mimicking a primary malignant ovarian tumor on sonography and CT. A 39 year old infertile nulliparous woman presented with a history of lump in abdomen since 2 years and 6 months of amenorrhea. Sonography and CT examination showed a large mass that filled the abdomen. A preoperative diagnosis of a primary malignant ovarian tumor was made. The patient underwent laparotomy with total abdominal hysterectomy preserving tubes and ovaries. The histology revealed a leiomyoma with extensive hyaline degeneration. The current established management of uterine fibroids may include expectant, surgical, or medical management or uterine artery embolization or a combination of these treatments. A surgical approach is preferred for management of giant leiomyomas. Leiomyomas should be considered in the differential diagnosis of a multilocular and predominantly cystic adnexal mass.
Cervical ectopic pregnancy presented with massive life threatening haemorrhage: a case report
Authors: Medhi Robin , Patel Jatinkumar Vishnubhai , Mishra Asmita
Published: December 2016

Here we report a case of a cervical ectopic pregnancy presented with massive life threatening haemorrhage and its subsequent management. After an unsuccessful attempt to stop the bleeding with balloon catheter and vaginal tamponade, a total abdominal hysterectomy was performed, this is the procedure of choice for treatment of cervical pregnancy under conditions of urgency and life-threatening bleeding.
Therapeutic plasma exchange for early aggressive management of post-partum hemolytic uremic syndrome: a tertiary care centre experience
Authors: Mishra Vineet , Agarwal Himani , Goel Sugandha , Choudhary Sumesh , Aggarwal Rohina , Roy Priyankur
Published: December 2016

Postpartum hemolytic uremic syndrome is an unusual condition of obscure origin that manifests with hemolytic anemia, thrombocytopenia and acute renal failure after delivery. We describe a case of 28 year old woman referred to our hospital in view of severe renal failure, 24 hours after the delivery by caesarean section for scar rupture and placental abruption. She was in a delirious state and had anuria, severe anemia and moderate thrombocytopenia. After many diagnostic dilemmas, a final diagnosis of hemolytic uremic syndrome was made. Aggressive treatment with plasma exchange in conjunction with hemodialysis was started. Fresh frozen plasma was used for replacement and four consecutive plasmapheresis sessions were instituted. Simultaneously steroids and anti-hypertensive drugs were given. Two weeks later, quick clinical and laboratory response was noted. There was significant improvement in renal functions along with resolution of signs of active hemolysis. This case collaborates with the ideal scenario involving prompt diagnosis and early aggressive treatment with plasma exchange in a postpartum hemolytic uremic syndrome patient.
An unusual case of septate uterus with double cervix and longitudinal vaginal septum simulating uterus didelphys
Authors: Vijay Alka , Salve Archana , Murdia Kshitij , Chandra Vipin
Published: December 2016

Rare mullerian anomalies not falling in any present classification are sometimes reported. A 27-year‐old woman came to our hospital with history of secondary infertility. She was found to have a longitudinal vaginal septum, cervical duplication and two endometrial cavities, separated by a complete septum. Laparoscopic examination revealed a relatively intact uterine fundus with both patent fallopian tubes. Hysteroscopic exam confirmed the presence of double vagina and double cervix, as well as complete uterine septum. It was a rare variant of complete septate uterus with double cervix, which could be successfully treated by hysteroscopic operation. Diagnosis and management of this unusual Müllerian anomaly are discussed in the context of a literature review.
Embryonal rhabdomyosarcoma of the uterine cervix: a rare case report
Authors: Gomes Ariana R. , Leite Pedro B. , Rocha Juliana S. , Enes Pedro V. , Carvalho Joana I. , Pinto Ana R. , Costa Fernanda M.
Published: December 2016

Embryonal rhabdomyosarcoma of the female genital tract is a rare tumour. It tends to occur during childhood in the vagina and, rarely, it can arise in the uterine cervix, with a peak incidence in the second decade. We report a case of a 18-year-old female with an embryonal rhabdomyosarcoma (sarcoma botryoides) presenting himself as a cervical polyp. This tumour consisted of rhabdomyoblasts with miscellaneous differentiation surrounded by a loose, myxoid stroma. The patient was successfully treated with cervical conization and adjuvant chemotherapy. She is now disease-free at the 28th month follow-up. Awareness of this uncommon lesion in the cervix and its clinical implications is important to prevent misdiagnosis. Therapy has recently inclined to conservative and fertility-sparing treatment.
Decidual cast
Authors: Gupta Smriti , Tyagi Mamta , Rana Renu , Gupta Anjali
Published: December 2016

Decidual cast describes the spontaneous sloughing of endometrium as an entire piece while retaining the shape of endometrial cavity. 15 year old girl presented to the outpatient Department of Obstetrics and Gynaecology, Subharti medical college in September 2015 with complaints of heavy menstrual bleeding since the onset of menstruation. On examination her vitals were stable and there was mild pallor. Systemic examination was found to be normal. All her investigations were within normal limits. She was give iron supplementation and was started on low dose combined oral contraceptive pills. Every woman should obtain detailed information about the possible side effects of hormonal therapies including endometrial cast discharge.
Case series of paediatric adnexal torsion: rare yet urgent entity
Authors: Mishra Vineet , Hokabaj Shaheen , Roy Priyankur , Aggarwal Rohina , Vyas Bhumika , Mehta Neha
Published: December 2016

Ovarian torsion is a true emergency which warrants early diagnosis and timely surgical management to avoid the catastrophic consequences of further adnexal injury. In paediatric population, this is especially dangerous as the condition can go undiagnosed because of its rarity and nonspecific presentation of disease. This leads to delay in surgical exploration and loss of ovarian function. We encountered 6 cases of ovarian torsion in paediatric age group during a period of 2 years, at a tertiary care hospital in Ahmedabad. After enquiry of the symptoms and a series of investigations, a provisional diagnosis of torsion ovary was made and they were taken up for surgery. Intra-operatively all the patients were found to have non-salvageable ovary and fallopian tube on the affected side, and subsequently they underwent salpingo-oophorectomy. Diagnosis of ovarian torsion requires clinician awareness and a high degree of suspicion. Conservative surgery, in the form of ovarian detorsion can be tried in cases of ischemia but if ovarian necrosis has occurred, then salpingo-oophorectomy is performed as the last resort.
Congenital absence of a part of the fallopian tube: a case report
Authors: Agarwal Mukta , Sinha Hemali H. , Anamika .
Published: December 2016

Congenital malformations of female genital tract are frequently seen in Gynaecological clinics, incidence being upto 5-6% in cases of infertility. Most of these anomalies are related to uterus and vagina, abnormalities related to ovaries and fallopian tubes are of rare occurrence and the exact incidence of these anomalies are not known, only a few incidental case reports are available in literature. Here, we present a rare case report of absent mid- tubal segment of fallopian tube in a patient of infertility.
OHVIRA syndrome: a rare variant of mullerian duct anomaly
Authors: Rudra Samar , Dahiya Nidhi
Published: December 2016

OHVIRA is a rare variety of congenital anomaly of mullerian duct. The syndrome includes uterus didelphys, obstructed hemivagina and ipsilateral renal anomaly, also known as Herlyn-Werner-Wunderlich (HWW) syndrome. A 15yrs old girl was referred to our department with regular menstrual period and cyclic pain in lower abdomen of 5-6 months duration. USG and MRI established the final diagnosis of OHVIRA syndrome. Drainage of hematocolpos of obstructed hemivagina and excision of septum was done and patient was discharged under satisfactory condition to come for follow-up. Patient had her normal menses on 28/8/2015. A repeat USG was done which showed didelphus uterus with no collection in endometrial cavity.
Successful pregnancy outcome in grade IV lupus nephritis and secondary antiphospholipid antibody syndrome with recurrent pregnancy failures - challenging achievement of motherhood
Authors: Reddy Kaliki Hymavathi , Kumar Kolla Praveen , Tadisetti Surekha , Pusarla Divya
Published: December 2016

Systemic lupus erythematosus (SLE) is a chronic multisystem autoimmune disease that occurs predominantly in women of childbearing age. The risk of complications and adverse fetal outcomes in pregnant women with lupus is high viz., increased risks of preterm birth, hypertensive diseases of pregnancy and lupus flares both during pregnancy and in the postpartum period. An additional association with Antiphospholipid antibody (APLA) syndrome is expected to multiply the pregnancy complications. Though improved understanding of the disease nature and greater number of therapeutic options in the treatment of SLE, made the medical community regard these patients with less trepidation, the risk of significant morbidity to both the mother and the fetus still exist. We report an interesting case of grade IV Lupus nephritis (LN) with secondary APLA syndrome and h/o recurrent pregnancy failures for twenty times but had a successful pregnancy and delivery in the 21st attempt though pregnancy was absolutely contraindicated in view of her medical illness. Many complications were encountered during her pregnancy which could be successfully tackled and a live male baby was delivered by Caesarean section.
An interesting rare case of spontaneous pregnancy with imperforate hymen and high transverse vaginal septum with bicornuate uterus
Authors: KR Bharathi , S. Vijayalakshmi , N. Divya Alamelu
Published: December 2016

Congenital anatomic disorders of the female reproductive tract may result from genetic mutation, developmental arrest and abnormal hormonal exposure during embryonic development. These anomalies have a huge impact on the woman’s menstrual, sexual and reproductive functions. Pregnancy with these anatomic disorders is quite challenging. Here we present a rare interesting case of spontaneous pregnancy with multiple anatomic disorders namely- imperforate hymen, high transverse vaginal septum and bicornuate uterus.
A near-miss case of obstetric haemorrhage managed successfully
Authors: Satia Meena N. , Panchbudhe Shruti , Shilotri Manali P.
Published: December 2016

Functioning of health systems with respect to maternal health were previously audited using indicators like maternal mortality ratio. However, maternal morbidity as a consequence of pregnancy-related complications is not accounted for in these indicators. Thus, the World Health Organization (WHO) has formulated a maternal near-miss approach to pregnancy complications for a more thorough evaluation of health care systems across the world. In practical terms, women are said to be maternal near-miss cases when they survive lethal conditions during pregnancy or in the postpartum period. We report one such case of traumatic variety of postpartum haemorrhage subsequent to a lower segment caesarean section with immediate post-operative removal of cervical cerclage threads that resulted in a maternal near-miss case.
Forgotten Lippes loop in menopausal woman left in utero for 45 years: a case report
Authors: Mishra Vineet , Goel Sugandha , Agarwal Himani , Choudhary Sumesh , Roy Priyankur , Hokabaj Shaheen
Published: December 2016

Intrauterine contraceptive devices are extremely effective and long lasting. They were intended for long term use and were retained for year’s altogether. Menopausal ladies often present with Lippes Loop in situ either deliberately or forgotten. We report a case of 80 years old patient who came with complaints of pain in lower abdomen and vaginal discharge and had Lippes Loop insitu, which was inserted 45 years back. The inserted Lippes Loop thread was not seen in clinical examination but visualized on Transvaginal Ultrasonography along with pyometra. It was removed under hysteroscopic guidance.
Incarcerated foreign body in the vagina of a postmenopausal lady
Authors: Poojari Vidyashree G. , Vasudeva Akhila , Mundkur Anjali S. , Kumar Pratap
Published: December 2016

Vaginal foreign bodies retained for long duration are uncommon in present day scenario. When a female presents with recurrent foul smelling vaginal discharge, foreign body should be suspected. Here is a report of foreign body in the vagina of a postmenopausal lady.
Conformal radiotherapy in rectal cancer: a dosimetric review
Authors: Simson David K.
Published: December 2016

It has been a decade since preoperative chemoradiotherapy is the standard of care in the treatment of rectal cancer. Even though the main picture remains the same, there were many refinements that happened in delivery of chemotherapy, radiotherapy and, of course, surgical skills. Technical advancements in radiotherapy helped us to precisely deliver radiotherapy with minimal side effects. Nevertheless, none of these have been studied in detail to assess the effectiveness and bad effects. It has been noted that modern radiotherapy techniques even though reduces high doses to the critical organ doses, but increases the volume of normal tissues receiving low dose radiation, the adverse effects of the same need to be assessed. There hadn’t been any consensus whether to treat with 3D Conformal Radiotherapy (3DCRT) or Intensity Modulated Radiotherapy (IMRT). This article reviews various dosimetric parameters of various techniques of radiotherapy presently being used in our department which includes conventional, 3DCRT and IMRT.
Single layer versus double layer closure of enteric perforation- a comparative study
Authors: Pipal Dharmendra Kumar , Verma Vijay , Kothari Saurabh , Pipal Vibha R. , Sharma Latika
Published: December 2016

Background: Small intestine perforation and gastrointestinal haemorrhage are the most common and dreadful complications of enteric fever. There are different operative procedures available for enteric perforation repair. In the present study attempts should be made to find out which operative procedure (either single layer or double layer closure) should be planned in enteric perforation by comparing these, in terms of morbidity, mortality and cost effectiveness.Methods: This study was carried out on 50 patients of either sex. They were divided in two groups Group- A     (conventional double layer repair in 25 patients) and Group- B (single layer interrupted sutures in 25 patients). After analysing the result of this study, it can be concluded that single layer repair for enteric perforation can be constructed in less time and with less complication rate compared with the conventional two layer repair technique, it also recovers the patient early and causing earlier bowel activity than two layer repair.Results: 50 patients were studied in the present study and results were in favour of single layer group as time taken for perforation repair and overall surgical time was less in this group. Moreover, single layer repair also helps early bowel activity and early recovery to the patient than double layer technique.Conclusions: Double layer closure of enteric perforation offers no definitive advantage over single layer repair in terms of faecal fistula formation, operative time, returns of bowel movements and other complications like wound abscess formation, wound dehiscence, respiratory complications etc. Less operative time and other factors in favour of single layer repair makes it the choice of procedure for most of the surgeons.