bluuebunny/crossref_metadata_2025 huggingface dataset:
Hysteroscopic evaluation of postmenopausal bleeding patients and its correlation with histopathological examination
Authors: Mansingh Sudhir , Dhillon Atmajit Singh , Sood Sandeep , Anne Sirisha , Godi Prema
Published: July 2020

Background: Menopause is defined according to WHO as the permanent cessation of menstruation resulting from the loss of ovarian follicular activity. It is defined as uterine bleeding occurring after at least 1 year of amenorrhoea. Considering the high accuracy of hysteroscopy in evaluation of postmenopausal bleeding, the present study was carried out with an aim to evaluate hysteroscopic findings in women with postmenopausal bleeding in order to assess the causes of PMB and to determine their prevalence in our population.Methods: This was a prospective observation study, comprising of total number of 50 postmenopausal women attending gynae OPD at department of obstetrics and gynecology, Command Hospital (CH), Lucknow, Uttar Pradesh. The data obtained for the purpose of study was fed into computer using Microsoft excel 2013 software.Results: A total of 50 women with complaints of postmenopausal bleeding were enrolled in the study. Maximum number of women had achieved menopause between age 46 and 50 years. Hysteroscopy had an accuracy of 94% for detection of polyps. Hysteroscopy had an accuracy of 90% for detection of atrophy. For fibroid, hysteroscopy had an absolute sensitivity, specificity, positive predictive, negative predictive and accuracy value (100%).Conclusions: The findings of present study suggested that hysteroscopy has a useful role in evaluation of postmenopausal bleeding especially in the diagnosis of polyps and fibroids. Given fewer number of cases, the usefulness of hysteroscopy in evaluation of endometrial cancer and hyperplasia could not be established adequately. Further studies on larger number of sample size will help in providing more useful and confirmatory information.
Postdated pregnancy: its maternal and fetal outcome
Authors: Singh Neetu , Misra Devyani , Srivastava Shubhi
Published: July 2020

Background: Postdated pregnancy is one of the commonest obstetric conditions. Pregnancy is called term when it lies between 37 weeks to 42 weeks from the last menstrual period. If the pregnancy exceeds 40 weeks it is called as postdated pregnancy. The overall incidence of post term pregnancy is 7% of all pregnancies.Methods: This observational study was carried out in the department of obstetrics and gynecology in Dr Ram Manohar Lohia Institute of Medical Sciences, Lucknow, Uttar Pradesh, India from September 2019 to February 2020. Total 100 postdated pregnancy enrolled in the study those willing to participate and fulfilling the inclusion and exclusion criteria. Aim is to assess maternal and fetal outcome in postdated pregnancy.Results: In present study, incidence of postdated pregnancy was found to be 5% and number of normal deliveries was 66 (66%), LSCS were 32 (32%) and 2 (2%) were instrumental delivery. Maternal complications were seen in 14 (14%) cases and fetal complications were found in 23 (23%) cases.Conclusions: Postdated pregnancy was associated with perinatal complications like fetal distress, meconium aspiration syndrome and fetal asphyxia. There was increased risk of obstetrics complications like postpartum haemorrhage (PPH), perineal tear, cervical tear and shoulder dystocia. Management of postdated pregnancy is a challenge to obstetrician and a careful advice and monitoring can alleviate maternal anxiety and untoward complications.
Non-descent vaginal hysterectomy in previous cesarean section: a retrospective study
Authors: Jacob K. J. , B. Divya M.
Published: July 2020

Background: Non-descent vaginal hysterectomy (NDVH) is removal of uterus through vagina in non-prolapsed uterus. As there is an increase in caesarean section, hysterectomy in women with previous caesarean section is also increasing. The objective of this study is to assess the feasibility and safety of non-descent vaginal hysterectomy in patients with previous caesarean section.Methods: This is a retrospective study conducted in the department of obstetrics and gynecology, Government Medical College, Thrissur from January 2017 to December 2018. Non-descent vaginal hysterectomy in 24women with previous caesarean section was studied. Details regarding age, parity, number of caesarean sections, indication of surgery, intraoperative and postoperative complications were evaluated.Results: All 24 women underwent non-descent vaginal hysterectomy successfully. 10 women (41.7%) were between 46-49 years. Commonest indication of hysterectomy was fibroid uterus (41.7%) and most common complaint was heavy menstrual bleeding (79%). There was bladder injury in one woman with history of previous 2 caesarean section. 3 women developed UTI in postoperative period.Conclusions: Vaginal hysterectomy is associated with lower complications and more rapid recovery. A successful NDVH in previous caesarean section depends on the expertise and experience of the surgeon. NDVH in previous caesarean is safe in expert hands.
Clinical profile of maternal deaths due to postpartum haemorrhage
Authors: Bangal Vidyadhar B. , Jondhale Parikshit , Gavhane Satyajit , Mange Krupa
Published: July 2020

Background: Postpartum haemorrhage is one of the dreadful complications that occur during delivery. It is often un-anticipated and occurs suddenly and un-expectedly. It is responsible for 20 percent of maternal deaths in developing countries. These deaths are largely preventable. The objective of the study was to find out the clinical profile, associated co-morbid conditions and contributory factors and treatment modalities used in the management.Methods: Retrospective observational study of maternal deaths due to postpartum haemorrhage (PPH) was carried out at tertiary care hospital. The data of maternal deaths for seven years from year 2013 to 2019 was reviewed, compiled and analyzed to draw conclusions.Results: There were 18 maternal deaths (19%) due to PPH out of total 86 maternal deaths. The average age of the woman who died due to PPH was 24 years. Ninety five percent of the cases of PPH were due to atonic uterus. Seventy percent of the cases had reported in advanced stage of shock with average blood loss of more than two to three litres. Poor general condition due to delay in reaching to tertiary care hospital was predominant feature. Sixty percent women underwent obstetric hysterectomy. Massive blood transfusion was given in fifty percent cases. Severe pregnancy induced hypertension, severe anaemia and severe concealed accidental haemorrhage were common associated factors in sixty percent of maternal deaths.Conclusions: Postpartum haemorrhage is still a common cause of maternal death. Early detection, prompt aggressive management, adequate blood replacement, use of uterine balloon tamponade and non-pneumatic anti-shock garment, timely transfer to higher centre and timely decision for surgical interventions can prevent maternal deaths.
Maternal and fetal outcome in placenta previa: our experience
Authors: Maiti G. D. , Adhikary M. , Lele P. R. , Gupta Shilpa , Saha M. , Maiti Swagata
Published: July 2020

Background: Placenta previa contributes substantial maternal and neonatal morbidity including management challenges for obstetrician. This study was to evaluate the potential risks factors and feto-maternal, outcome in placenta previa. This study was done with the intent of developing insight into risk factors, clinical presentation, various interventions and management for overall improvement in maternal and fetal outcome in placenta previa.Methods: A prospective observational study, where 30 cases of placenta previa confirmed after 28 weeks POG, treated in a public sector tertiary care hospital from June 2016 to June 2018 were included. Authors analyzed the data to evaluate the potential risks factors and maternal and fetal outcome in placenta previa.Results: In this study, major contributing risk factors for placenta previa were associated with multiparity (76.7%), maternal age >30 in 50%, previous LSCS in 46.7%, repeated uterine procedure like suction evacuation/curretage. There was a high rate of maternal morbidity mainly due to haemorrhage. Perioperative uterine artery embolization (UAE) in 3 (10%), intra-operative procedures namely devascularization, internal iliac ligation in 66.6% cases, peripartum hysterectomy in 2 (6.66%) were done to control haemorrhage. Blood and blood products transfusion required in 26.7% of cases. Fetal morbidity included prematurity in 9 (33.3%), NICU admission in 11 (36.6%) majority of which included 8 (26.7%) babies of birth weight <2000 grams.Conclusions: Placenta previa contributes to significant maternal and neonatal morbidity. Multiparity, post LSCS pregnancy constitute major factor for placenta previa. Management requires high-risk obstetrical care with frequent antenatal visits. Serial ultrasonography in reported cases of low-lying placenta to mandatory exclude overdiagnosis or migration. All cases of placenta previa need to be managed in a higher centre facility of blood component therapy and neonatal intensive care unit. Prematurity and low birth weight remain a significant cause for neonatal morbidity.
Thyroid disorders in the first trimester of pregnancy: a cross-sectional study
Authors: Shankarappa Rashmi , Parvathreddy Spoorthy
Published: July 2020

Background: Thyroid disorders in pregnancy are common and are associated with adverse maternal, fetal and neonatal effects. When the prevalence of thyroid disorders is high, then screening for thyroid disorders in early pregnancy can help improve the obstetrical outcome.Methods: Five hundred and fifty women in their first trimester of pregnancy were studied. They were investigated for estimation of free triiodo thyronine (FT3), free thyroxine (FT4) and thyroid stimulation hormone (TSH). The upper normal limit for TSH considered was 4.0 mIU/L.Results: Prevalence of thyroid disorders in the study was 12.6%. Hypothyroidism (12%) was more common than hyperthyroidism (0.6%). Subclinical hypothyroidism was present in 10%.Conclusions: Screening of thyroid disorders is to be considered for all pregnant women. As the prevalence of thyroid disorders is high, early recognition and treatment shall reduce maternal and fetal morbidity.
A comparative study of serum magnesium levels in preterm labour and term labour
Authors: T. Malathi , Maddipati Sowmya Sampurna
Published: July 2020

Background: The objective of present study was to measure the serum magnesium levels in preterm labor patients, to measure the serum magnesium levels in term labor patients and to correlate the serum magnesium levels in preterm and term labor patients.Methods: It is a prospective case control study conducted in the department of obstetrics and gynecology, KIMS hospital and research Centre, Bengaluru, Karnataka, India. A venous blood sample is drawn from patients admitted to labor room who fulfill the inclusion and exclusion criteria out of which 50 patients belong to the Group-A (preterm labor) and 50 patients belong to Group-B (term labor). Serum magnesium level is measured in both the groups.Results: Women with preterm labor had a significantly reduced serum magnesium level with a mean serum magnesium level of 1.59 mg/dl with a SD of 0.83 whereas the patients with term labor had a mean serum magnesium level of 2.55 mg/dl with a SD of 0.40. The difference of serum magnesium levels observed between the study population and control population is independent of factors like maternal age, parity, gestational age, and socio-economic factors. In this study, it is found that serum magnesium levels are lower in early and late preterm compared to preterm between 33-34+6 weeks.Conclusions: Serum magnesium level can be used as a predicting tool for preterm labor. Preterm labor can be avoided by simple supplementation of Magnesium which might provide an easy and inexpensive means to decrease the problems related to preterm labor. There is a further scope for research on serum magnesium levels based on gestational age.
Respectful maternity care for positive birthing experience at Pravara Rural Hospital
Authors: Bangal Vidyadhar B. , Vikhe Sangita , Borhade Shobha , Thorat Ujjwala
Published: July 2020

Background: Many women in developing countries experience disrespect and abuse during labour and delivery. Respectful maternity care (RMC) is considered as one of the basic reproductive health rights of the women. It is one of the essential components of LaQshya programme of Government of India. The aim of the study was to highlight the important components of the RMC, its implementation and its impact on patient turnover in the maternity unit of Pravara Rural Hospital Loni and review the literature on the subject.Methods: A prospective observational study was conducted for a period of one year from January 2019 to December 2019 at tertiary care hospital. The implementation of RMC was observed and important findings were documented. The patient turnover and cliental satisfaction was noted.Results: It was observed that all components of RMC were strictly followed in maternity unit of Pravara Rural Hospital Loni. The staff and doctors were trained and oriented towards importance of RMC. The patient turnover has increased exponentially year by year. The patient feedback system about the quality of care in labour and delivery ward shows overall satisfaction score of 4.3 on the 5-point Likert scale. There was a surveillance system that supervises and closely monitor the quality of care in labour room in general and RMC in particular.Conclusions: RMC is one of the important components of LaQshya certification process. Respectful maternity care is implemented at Pravara Rural hospital in its true spirit. It has resulted in gaining the faith and trust of the community, which is reflected through exponential rise in the number of deliveries taking place in the hospital.
Comparison of pregnancy outcome between clomiphene citrate and sequential clomiphene citrate+human menopausal gonadotropin in intrauterine insemination
Authors: Singh Ankita , Palshetkar Rohan , Singh Namrata , Rege Awyay
Published: July 2020

Background: Intrauterine insemination (IUI) has been widely used as a common treatment for infertile couples. This study compares the sequential clomiphene citrate (CC) treatment with CC and human menopausal gonadotropin (hMG) treatment in women undergoing IUI. Therefore, this study was designed to determine the effects of addition of gonadotropin (CC+hMG) would improve the pregnancy rate in women undergoing IUI. And also compare the sequential CC+hMG treatment with CC treatment in women undergoing IUI.Methods: A cross-sectional study design was conducted at D. Y. Patil Fertility Centre, D.Y Patil Hospital, Navi Mumbai from September 2018 to August 2019. Source populations were all patients who live in Mumbai, Maharashtra, India. A total of 67 patients were enrolled in this study. (It consisted of 67 sub fertile couples undergoing ovarian stimulation for IUI cycles). Results: There was no significant difference between the two studied groups regarding endometrial thickness (8.3±2.1 versus 9.7±2.8, respectively), number of mature follicles on the day of hCG injection (3.3±1.2 versus 3.5±1.1, respectively) and, but there was significant difference between the CC+hMG group and CC group regarding the total dose of gonadotropins used in ovulation induction (305±23.8 versus 655±192; total IU, respectively) p<0.05.Conclusions: Women undergoing IUI, ovarian stimulation CC combined with hMG, significantly improved the pregnancy and live birth rates as compared to that of CC group. In women undergoing ovarian stimulation and IUI, there are no significant differences in pregnancy and live birth rates among the various stimulation protocols.
Evaluating the factors influencing perinatal outcome in breech presentation
Authors: Raut Dharmendra , Tadru Srividya , Patil Bhupendra , Koranne Prachi
Published: July 2020

Background: The objective of this study was to analyse the current obstetric practice regarding breech presentation, document the incidence, perinatal outcome and the factors influencing perinatal outcome in breech deliveries.Methods: It was a retrospective observational study including 252 cases of breech presentation during January 2018 to December 2019 in a tertiary teaching institute in Vidarbha region of Maharashtra.Results: Total number of breech deliveries 252 (incidence is 2.5%). Caesarean section for breech presentation 95 (37.6%). With vaginal deliveries the Apgar score at 5 min below 7 were among 48 out of 157 breech deliveries whereas with LSCS it was only amongst 7 out of 95 deliveries. The maximum percentage of perinatal mortality is seen with birth weight below 2000 gm. Maximum mortality is seen prior to 32 weeks and in babies who delivered by vaginal route. Respiratory distress with prematurity and severe birth asphyxia are the common causes of perinatal deaths. Total 32 (12.69%) babies were transferred to NICU. 20.38% of the total vaginal breech deliveries and 5.26% of the total LSCS were transferred to NICU. Out of total 32 NICU admissions 22 are for the preterm babies and babies with birth weight below 2000 gm.Conclusions: The perinatal outcome does not depend only on the mode of delivery, it is also affected by the weight of the baby, its maturity, associated congenital anomalies, equipped neonatal intensive care unit and also substantially on the expertise of the obstetrician and the neonatologist.
Emergency obstetric care among referrals in more than 24 weeks gestation at a tertiary care teaching institution in Kerala, India
Authors: T. Heera Shenoy , T. Sheela Shenoy , K. Remash , Simon Sony
Published: July 2020

Background: One of the biggest barriers confronting efforts to reduce maternal mortality through increased skilled delivery is access to emergency obstetric care. This study aimed to look into the profile of emergency obstetric referrals. Referral-decision interval, reasons and morbidities of referral were analysed and their neonatal outcomes assessed.Methods: This observational study reviewed 90 emergency obstetric referrals over 3 years from June 2013 to February 2016.Results: In-labour referrals constituted the majority of emergency obstetric referrals. Preterm obstetric referrals needed emergency interventions in view of medical/obstetric indications and it was statistically significant. Referral- decision and referral-arrival interval was significant in emergency group (p-value-0.001). Babies born to mothers who were obstetric emergency referrals had extended NICU stay (p-value-0.001). There was a maternal death and four near-misses in this research.Conclusions: Timely decisions taken during interhospital emergency referrals resulted in better perinatal outcomes by prompt maternal interventions.
Diagnostic value of saline infusion sonohysterography for detecting endometrial lesion and comparing it with hysteroscopy and histopathology in postmenopausal bleeding
Authors: Saini Suwaram , Jain Shweta , Saini Sarla , Bhardwaj Manish
Published: July 2020

Background: Different diagnostic tools are available to evaluate endometrial lesion such as hysteroscopy, sonohysterography and transvaginal ultrasound. The present study aimed to determine the diagnostic value of saline infusion sonohystrography (SIS) in diagnosis of intrauterine lesions in women with postmenopausal bleeding (PMB).Methods: This cross-sectional study recruited 100 married women with chief complain of PMB referred to gynecologic clinics at the Zenana hospital, Jaipur from March 2019 to February 2020. All participants were in the post-menopausal period that showed abnormal endometrial thickness (>4 mm) or endometrial focal lesions through transvaginal ultrasound. Participants underwent SIS, hysteroscopy plus endometrial biopsy in order. The gold standard was the histopathology of endometrial specimen reported by pathologist.Results: Mean age of women was 57.14 years. It is evident that sensitivity, specificity, positive predictive value and negative predictive value of SIS for the diagnosis of endometrial atrophy was 79.16%, 100%, 100% and 83.87% respectively which is higher than that of hysteroscopy and equivalent to histopathology. SIS and hysteroscopy are equally efficient in diagnosing endometrial polyp and submucous fibroid. And are better than histopathology. Histopathology is better than SIS and hysteroscopy for the diagnosis of endometrial proliferation.Conclusions: Findings show that, SIS probably is a proper method for detecting endometrial focal lesion including polyps and myomas. Future studies may help to define further advantages of this procedure.
Comparative study between vaginal natural progesterone and oral dydrogesterone in prevention of red degeneration of uterine fibroid in pregnancy
Authors: Hefila Nermeen M. , Karkour Tarek A. , Elghareeb Sara M. , Abdeldaiem Tamer M.
Published: July 2020

Background: Uterine leiomyomas are highly prevalent benign monoclonal tumors, arising from the smooth muscle of the myometrium; they occur in up to 50-60% of reproductive age women, causing significant morbidity in up to 30% of women. The most serious complication of uterine fibroids; is red degeneration that causes severe pain, and may lead to preterm labour, miscarriage, fetal and maternal morbidity and mortality. Objective of this study was designed to compare between the effect of vaginal natural MP and oral dydrogesterone in prevention of red degeneration of uterine fibroid during pregnancy.Methods: Patients were recruited from El-Shatby Maternity University Hospital. They were 50 pregnant females, diagnosed having a uterine fibroid more than 3 cm in size then there were divided into two groups, Group A: twenty-five treated by vaginal natural progesterone, Group B: twenty-five treated by oral dydrogesterone. All patients at 14-15 weeks of gestational age underwent complete history taking, clinical examination and ultrasound examination for mean gestational age and assessment of the type and uterine fibroid.Results: Results showed that there were no statistically significant differences as regards age, obstetric history (gravidity and parity), number, Site, grade and size of the fibroid. There was a significant difference between the two studied groups, regarding the acute abdominal pain, it occurred to only 3 cases (12%) in Group A, versus to 16 cases (64%) in Group B. Regarding occurrence of red degeneration, it occurred only to 3 cases (12%) in Group A, while in Group B it occurred to 15 cases (60%).Conclusions: Vaginal natural micronized progesterone is more effective than oral dydrogesterone in prevention of red degeneration of uterine fibroid in pregnancy with fewer complications. Vaginal natural progesterone daily dose of 200 mg is recommended to all pregnant females with uterine fibroids.
A retrospective analysis of ectopic pregnancies in tertiary care hospital of Western India: two year study
Authors: Chudasama Tanmay J. , Shah Sapana R. , Vyas Rupa C. , Parikh Purvi M.
Published: July 2020

Background: Ectopic pregnancy (EP) is the leading cause of maternal morbidity and mortality in the first trimester and major cause of reduced reproductive potential. Early detection of EP by improved ultrasonography modalities has decreased the rate of rupture and consequent maternal morbidity. Aim was to study the predisposing risk factors in modern scenario and choose the appropriate management available.Methods: A retrospective study on clinical diagnosis and management of EP of patients was carried out between January 2018 to February 2020. Investigations included CBC, UPT, serum β-hCG and TVS. Management was decided after thorough evaluation.Results: Out of 7,780 deliveries, 70 were EP (0.9%). Women with age 21-30 year had highest incidence (85.7%). Common symptoms were abdominal pain (94%), amenorrhea (87%), bleeding per vagina (48%). Most common risk factor associated with EP was PID (28.5%). Tubal EP was most common (84.2%) involving ampulla (66%), isthmus (15%), fimbria (12%), interstitial (7%). Scar ectopic was reported in 10% of cases and ovarian, rudimentary horn and abdominal pregnancy in 1.4% each. About 52.8% of ectopic was ruptured and salpingectomy was done in 74.3% and salpingo-oophorectomy in 2.8%. Five cases of scar EP required hysterotomy and 1 case was managed by methotrexate (MTX).Conclusions: EP remains a major challenge to the obstetrician worldwide. A high index of suspicion is required for early diagnosis and timely intervention in the form of medical or surgical treatment will definitely help in reducing the morbidity and mortality.
Colposcopy in postmenopausal women: a challenging procedure
Authors: Kaur Arshdeep , Singh Gursewak
Published: July 2020

Background: Introduction-carcinoma of cervix is the commonest cancer in Indian women. It constitutes 14%of the total population above age of 50 years. Atrophic changes in the genital tract causes problems in Pap smear as well as in the colposcopy.Methods: This is prospective observational study conducted in the department of obstetrics and gynecology of SGRDIMSR, Sri Amritsar, which comprised 30 cases of postmenopausal women referred for colposcopy. Inclusion criteria were complaints of post-menopausal bleeding, abnormal vaginal discharge, post coital bleeding, an abnormal PAP smear, an unhealthy-looking cervix. Women with history of any surgery on the cervix in the past three months or with obvious cervical cancer were excluded.Results: Patient with age group of 44-70 years were included, and maximum number of patients had complaint of post-menopausal bleeding (50%). 9 (30%) patients were positive for malignancy on histopathology, while with 9 (30%) false positive patients on colposcopy. Problems encountered while performing colposcopy includes cervix flushed with vagina, atrophy of introitus, bleeding from the cervix and relaxed vaginal walls. Use of various corrective measures were helpful to overcome the problems of colposcopy.Conclusions: It is an essential part of cervical screening programme, but it has some limitations and pitfalls which can lead to error in the diagnosis.
A study to compare acceptability, safety and continuation rates of combined hormonal pill and centchroman as post abortion contraceptives
Authors: Miuli Inlo , Dewan Rupali , Agarwal Kavita
Published: July 2020

Background: Centchroman a non-steroidal selective estrogen receptor modifier (SERM). It is highly effective contraceptive which is devoid of side effects of COCs and there is prompt return of fertility upon discontinuation. Data in terms of its acceptability and continuation rates is limited when compared to combined oral contraceptive (COC). Therefore, the study was planned to study the acceptability, efficacy and continuation rates of centchroman and compare it with the combined oral contraceptives.Methods: The study was a prospective interventional comparative randomized study carried out in the department of obstetrics and gynecology VMMC and SJH, New Delhi, for a period of 18 months from November 2018 to April 2019.Results: A total of 945 women were screened and finally 240 women who met the criteria were recruited in 2 study groups of 120 women each. Majority were in the age group 18-28 years in either groups. Patients were followed up at 2nd week and then at 1st, 3rd, 6th and 12th months after initiation of the OCP with no loss to follow up. The pearl index in this study was 0.83 for ormeloxifene. The study showed statistically significant differences with higher level of satisfaction reported with 77.5% in the ormeloxifene compared to 65% of COCs. The continuation rates for ormeloxifene and COC users were in decreasing trend with increase in duration. No untoward events were reported with either formulation.Conclusions: Both the hormonal, combined hormonal contraceptive [combined oral contraceptive (COC), MALA-N] and the non-hormonal, centchroman (ormeloxifene) oral contraceptive pills are safe, effective, well tolerated and not associated with adverse outcomes when used immediately after abortion. Continuation rates of the pills in both the groups decrease in trend with time.
Screening of gestational diabetes mellitus using one-step versus two-step method: a comparative study
Authors: Khenwar Deepti , Agarwal Juhi , Shriastava Sushruta
Published: July 2020

Background: Gestational diabetes mellitus (GDM) is defined as carbohydrate intolerance of variable severity with onset or first recognition during the present pregnancy. It affects 7% of all pregnancies worldwide and in India it ranges from 6 to 9% in rural and 12 to 21% in urban area. The aim of this study was to compare the DIPSI criteria with the two-step method (Carpenter and Couston criteria.) and to study merits and demerits of one step and two step tests for GDM.Methods: A total 400 pregnant women of gestational age between 24-28 weeks attending antenatal clinic at this study tertiary care center were enrolled in this study. 200 pregnant women were enrolled in each of the study group (Group I OGTT and Group II DIPSI).Results: In Group I (OGTT) screening 47 (23.5%) were tested positive. In Group II cases, screening test results were found positive among 44 (22%). Out of 95 high-risk pregnant women 38 (40%) were positive for GDM by OGTT and 34 (35.78%) were positive by DIPSI. Out of 305 non high-risk pregnant women, 9 (2.95%) were positive for GDM by OGTT and 10 (3.27%) were positive by DIPSI.Conclusions: Present study concludes that DIPSI is the test which can predict GDM in population comparable to another test like OGTT. Also, India’s major population reside in rural areas, ANC are mostly conducted by ANM, therefore screening test should be easy to perform and interpret.
A prospective clinical trial to evaluate the prevalence of thyroid disorder among pregnant women and obstetrical and fetal outcome in a tertiary health centre located in central India
Authors: Jain Manjari G. , Jain Neeraj K. , Mazumdar Mita
Published: July 2020

Background: A prospective clinical trial to evaluate the prevalence of thyroid disorder among pregnant women and obstetrical and fetal outcome was done in a tertiary health centre (RKDF Medical College and Research Centre, Bhopal) located in central India.Methods: This prospective study was carried out in antenatal women in their first trimester attending antenatal OPD in RKDF Medical College and Research Centre, Bhopal, Madhya Pradesh to know the prevalence of thyroid disorder and its association with pregnancy outcome.Results: In this study prevalence of thyroid disorder was 12.4%, subclinical hypothyroidism 7.2%, overt hypothyroidism 3.4%, subclinical hyperthyroidism 1.4%, overt hyperthyroidism 0.4%. Thyroid disorder is responsible for several obstetrical and fetal complication like pre-eclampsia, preterm delivery, abortion, IUGR and low birth weight.Conclusions: Thyroid disorder associated with poor obstetrical outcome and fetal complication. so timely diagnosis and treatment is required. Universal screening should be preferred over high-risk screening because of high prevalence of the disease in India.
An observational study of clinical profile and outcome of syphilis infection during pregnancy in the tertiary care center
Authors: Gangwar Pooja , Jhinwal Arti , Gupta Preksha , Dixit Eshu , Bajaj Suchita
Published: July 2020

Background: Syphilis is a sexually transmitted disease (STD) caused by the bacterium treponema pallidum, but little is known about its mechanism of action. In pregnancy it leads to adverse outcomes among more than half of the women with active disease, including early fetal loss, stillbirth, prematurity, low birth weight, neonatal and infant death.Methods: It is an observational study in the department of obstetrics and gynecology Mahatma Gandhi Memorial Medical College Maharaja Yashwant Rao Hospital, Indore between January 2014 to December 2015 total 20870. In Include written informed consent, All the patients attending STI/RTI clinic with clinical diagnosis of STD. In Exclusion criteria include patients not give informed consent. Case definition: All VDRL + TPHA positive patients.Results: Out of 20870 females on which VDRL was performed 77 (0.036%) were found to be positive. The seroprevalence at study hospital thus came out to be 0.036%. These were further confirmed by TPHA and 73 (94.8%) out of 77 samples were positive. A total agreement was seen between TPHA and VDRL with a titer of 1 in 8 and above. Among total 20870 screened females, 77% (16101) were ANC patients of which 26 cases out of 77 that is 33.76% females were syphilis positive.Conclusions: Low prevalence of syphilis in pregnant women and adult general population is very encouraging. participation of people and public health approach to promote awareness of syphilis among physicians and populations at risk in India are very urgently needed to avoid the adverse consequences which could result from undiagnosed or improper treatment.
A study of gestational diabetes mellitus and fetal outcome in a tertiary care center
Authors: Mashkaria Aashka M. , Patel Babulal S. , Mashkaria Aastha M. , Shah Akshay C. , Jani Shashwat K. , Patel Adwait B. , Mehta Raj M.
Published: July 2020

Background: Modern desk-bound lifestyle and unhealthy dietary changes have brought a rise in the prevalence of obesity and gestational diabetes mellitus (GDM). It is associated with severe hazards to the mother and the baby. It is mandatory that early diagnosis ensues and timely and congruous management is undertaken.Methods: In this observational study, 1250 women were included. A standardized questionnaire was formed and their details were noted. Tests for glucose levels, complete blood picture, urine examination were performed. An oral glucose tolerance test was performed on all the patients. Neonatal outcomes in terms of birth weight and the presence of complications were noted.Results: A total 201 (16.1%) of all women were having gestational diabetes mellitus (GDM). Most mothers were in the 25-30 age group. The majority of the women had a BMI between 26-30. 21.9% of babies were having weight >3.5 kgs. 11.4% of babies were <2.5 kgs. Out of 201 neonates, 90 babies were having complications. Major complications in neonates were macrosomia and respiratory distress. Therefore, early diagnosis, glycemic control, and timely and congruous management are advantageous to both mother and baby.Conclusions: GDM complicating the pregnancy results in a higher prevalence of complications in the mother and the neonate. Therefore, appropriate control of the sugar level in mothers is necessary and it decreases the morbidity and mortality rates in the babies as well as the mothers.
Analysis of caesarean sections at a tertiary care centre according to Robson’s criteria
Authors: Mohapatra Ipsita , Samantaray Subha Ranjan , Vivekanand Achanta , Manjula Anandala , Priyanka Buyyani
Published: July 2020

Background: There has been a considerable increase in the rate of caesarean sections in the past few decades. Some demographers have argued that this increase is largely affected by the uprising trend of new medically indicated caesarean sections. M. S. Robson proposed a ten-group classification of caesarean sections in year 2001 which was appreciated by WHO in 2014 and FIGO in 2016. This classification is known as Robson’s classification which has ten groups.Methods: This is a retrospective study which was carried out at Civil Hospital, Karimnagar. The study group included all live births and still births of at least 500 gm birth weight or at least 28 weeks of gestation at Civil Hospital, Karimnagar during the period from October 2019 to December 2019. The data collected was analysed using simple statistical methods like percentage and proportion. The data was grouped according to the Robson’s 10 group classification system. The overall caesarean section rate, size of each group and the relative contribution of each group to the overall CS rate were calculated.Results: The total number of deliveries during the study period was 2493. Out of these, the number of caesarean deliveries was 1345. The caesarean section rate was calculated to be 53.95%. The group 5 (multiparous with at least one previous uterine scar with single cephalic pregnancy ≥37 weeks of gestation) contributed to 38.07% of the total caesarean section rate which is the highest.Conclusions: A regular audit into the number and indications of caesarean sections will definitely help in decreasing the primary and repeat caesarean sections.
A study to determine socio demographic corelates of reproductive tract infection amongst women of reproductive age group
Authors: Gupta Anmol K. , Thakur Anita , Chauhan Tripti , Chauhan Nidhi
Published: July 2020

Background: Reproductive tract infection (RTI) is a public health problem, especially in developing country like India. The associated odium with this reproductive morbidity is often a stumbling block in seeking health care. The aim was to study the prevalence of RTI symptoms and its socio-demographic corelates.Methods: A cross-sectional study was undertaken in the rural field practice area of department of community medicine, Indira Gandhi Medical College, Shimla, Himachal Pradesh, India, from July 2018 to September 2018. Total sample size calculated was 410. Random sampling was used to select eligible couple to whom a predesigned, pretested, semi-structured and anonymous interview schedule was administered after taking consent.Results: The prevalence of self-reported reproductive tract infections was found to be 41.2%. The prevalence was more in lower socio-economic classes, and it was statistically significant. Other socio-demographic corelates (age, education, occupation) did not showed any significant association.Conclusions: The reproductive tract infections prevalence is found to be considerably high in the women of reproductive age group. The frequency was higher among multigravida women and those using cloth during menstrual periods. RTIs are usually spurned by women and even the health care providers, so there is a need to give due consideration to this aspect of reproductive health.
Imaging resemblance but diagnostic disparity in cervix cancer: a rare case report
Authors: Agrawal Namita , Jain Tarun Kumar , Charan Abhishek , Sharma Sanjay , Malhotra Hemant , Khuteta Nitin , Yadav Ajay
Published: July 2020

F-18 FDG PET-CT is an establish modality for staging of cervical cancer. The high uptake value in PET with no evidence of necrosis in CECT is generally understood malignant pathology in known cancer patients. A 47 year-old-female with cervix carcinoma underwent staging FDG PET-CT. It showed FDG avid primary lesion in cervix with FDG avid pelvic, retroperitoneal, mediastinal and supraclavicular lymph nodes. USG guided FNA from the supraclavicular lymph node revealed tuberculosis. Now patient scheduled for ATT and chemotherapy.
Maternal congenital complete heart block in pregnancy: a rare case report
Authors: Sood Reena , Kaur Harmandeep , Mohan Gaurav , Nagpal Madhu
Published: July 2020

Complete heart block comprises complete absence of AV conduction - none of the supraventricular impulses are conducted to the ventricles. Perfusing rhythm is maintained by a junctional or ventricular escape rhythm. Typically, the patient will have severe bradycardia with independent atrial and ventricular rates. The incidence is 1 in 15,000 to 20,000 live births. Authors present the case report of a primigravida, aged 30 years who presented with amenorrhoea of 35 weeks. She was diagnosed as complete heart block by cardiologist. She had no history of syncopal attacks during childhood or antenatal period. She had a heart rate of 50-52 bpm. ECG showed ventricular escape rhythm with narrow QRS complexes. Echocardiography showed no structural defects. Her elective LSCS was done at 39 weeks after consultation with cardiologist. Patient underwent temporary pacemaker insertion just prior to surgery and she delivered a healthy female baby of weight 3 kg with Apgar 9/10 at 5 mins. She remained asymptomatic during the postoperative period and pacemaker was removed after 30 hours. She was discharged under satisfactory condition on day 6. Patient was counselled for follow up with cardiologist. This case lays emphasis on proper history taking, vitals monitoring, early recognition of undiagnosed cardiac disorders and team work for good maternal and fetal outcome.
Volvulus, gangrene and perforation of transverse colon in an antepartum eclamptic pregnant patient post caesarean: a case report
Authors: Behura Jharna , Kumar Sanjiva , Bagga Poonam , Sinha Maruti
Published: July 2020

Transverse colon volvulus leading to gangrene and perforation is an extremely uncommon acute surgical complication in pregnancy and puerperium, with a very high rate of mortality and morbidity. Surgical resection is the only treatment. Authors present a case of a 20 years. old women, with antepartum eclampsia, who underwent caesarean section for fetal distress. She complained of abdominal pain from second post-operative day. The pain increased in severity and on the third postoperative day, she developed sudden abdominal distention and appeared pale. Ultrasound revealed free intraperitoneal fluid suggestive of hemoperitoneum. An emergency laparotomy was performed. There was about a litre of blood in the peritoneal cavity with clots. The caesarean incision site, uterus adnexa and broad ligaments were all intact. On further exploration, volvulus of the transverse colon was seen along with gangrene and perforation of the middle part of transverse colon. Resection of the gangrenous part was done with closure of the distal loop. Proximal loop was brought out as colostomy. The patient had an uneventful postoperative course thereafter and was discharged on regular diet on 12th postoperative day. Volvulus of transverse colon leading to gangrene is rare in pregnancy and puerperium, but must form part of clinician’s differential diagnosis when encountering a patient with persistent abdominal pain and bowel distention. Early diagnosis and timely surgical intervention could significantly improve the outcome of this catastrophic condition.
Ruptured pyogenic liver abscess in pregnancy: a case report
Authors: Shambharkar Smruti , Mundle Shuchita
Published: July 2020

Pyogenic liver abscess during pregnancy is an extremely dangerous condition, both from general as well as obstetric point of view. An interesting case of 24-year primigravida reported at 28 weeks gestation with high grade fever and chills with features of peritonitis is being presented here, which on investigations subsequently was diagnosed to be a case of ruptured pyogenic liver abscess. The case was managed successfully with higher antibiotics and percutaneous drainage of the abscess. The obstetric outcome was successful as well, with spontaneous preterm delivery of 920 gm male child which cried immediately after birth and was managed with appropriate care in premature baby unit.
Ectopic pregnancy in a case of congenital mullerian anomaly: a diagnostic dilemma
Authors: Brahmbhatt Sanjay , Makhija Amrita , Brahmbhatt Jayna , Patel Yagnesh V.
Published: July 2020

Ectopic or extrauterine pregnancy occurring in a case with mullerian defect is very rare and poses diagnostic challenges. Undescended and non-communicating fallopian tubes are extremely rare mullerian anomalies. Here authors present a case of ectopic pregnancy occurring in an undescended non-communicating fallopian tube in a patient with unicornuate uterus with absent horn, which was managed laparoscopically. A 32-year-old lady, diagnosed case of left unicornuate uterus with absent right horn, was referred to us with the suspicion of ruptured ectopic pregnancy. The abdominopelvic ultrasound showed a soft tissue lesion of size 32×24 mm, towards the right lateral pelvic wall near the iliac vessels, with increased vascularity on colour flow doppler.  The patient underwent laparoscopy which showed left sided unicornuate uterus with normal left tube and ovary. The right uterine horn was absent.  An undescended right ovary and tube were found attached to the peritoneum at the level of pelvic brim along the right lateral pelvic wall.  Right sided tubal ectopic pregnancy with rupture was present along with 300-350 cc of hemoperitoneum. The patient was treated with laparoscopic right sided total salpingectomy. In patients with unicornuate uterus and atypical presentation, ectopic pregnancy should be ruled out in an undescended non-communicating fallopian tube. Salpingectomy of incidentally diagnosed non-communicating fallopian tubes is recommended to prevent future ectopic pregnancy.
Vertical transmission of SARS-CoV-2: a brief literature review
Authors: Mounir Moukit , Ouardi Assia El , Babahabib Abdellah , Hassani Mehdi El , Kouach Jaouad
Published: July 2020

As COVID-19 virus is still spreading, more infections in pregnant women are likely to be seen. At this time, very little is known about vertical transmission of SARS-COV-2 from infected pregnant woman to her infant. Authors reviewed the risk of vertical transmission of COVID-19 by using data of published articles and official websites up to May 11, 2020. The searches revealed 16 articles (12 case reports/series and 4 retrospective studies) collectively comprising 194 infected pregnant women with COVID-19. 140 cases of neonates delivered from pregnant women with COVID-19 were collected. The SARS-COV-2 nucleic acid test, in day 2, was positive in 4 newborns. Based on limited data, there is no evidence for vertical transmission of COVID-19. Some studies suggestive of maternal-fetal transmission deserve careful evaluation before a definitive finding.
Concept of cervical ectopy/Quruhal Rahim in Unani system of medicine: a review
Authors: Fahad Tooba , Shameem Ismath
Published: July 2020

Cervical ectopy is one of the commonest gynecological conditions seen in OPD’s, about 80-85% of women suffer from cervical ectopy during their life time. Many a times, it is an accidental finding in an asymptomatic woman coming for routine gynecological examination. Although it is a benign lesion, but may predispose to complications like infertility, cervical intraepithelial neoplasm, risk of various sexually transmitted infections like C. trachomatis, N. gonorrhoea, human papilloma virus, human immunodeficiency virus, cytomegalovirus and shows malignant changes as it progresses. Ectopy occurs when the columnar epithelium lining the endocervix, extends onto the ectocervix. As the disease takes 10-20 years to progress from pre invasive to invasive disease, preventive measures such as screening and treatment modalities should be adopted. Early diagnosis of cervical ectopy is important for its effective management and for prevention of its long-term sequel. The treatment option available in conventional medicine includes surgical procedure either electro or, cryocautery, but have their own complications. Hence, this treatment is limited due to its complications and contraindications and need for safer alternate therapy. In Unani system of medicine, various formulations are available as treatment of quruhal rahim, which have been recommended to be used locally in the form of humool for immediate healing of wound, exhibiting the properties of anti-inflammatory (muhallile warm), desiccant (mujaffif), wound healing (mundamile qurooh), sedative (musakkin), antiseptic (dafa’e ta’ffun) etc. This review article gives a detailed description of cervical ectopy as mentioned in classical Unani text including its etiopathogenesis, clinical presentation and principles of treatment as well as evidence-based Unani medicine.