bluuebunny/crossref_metadata_2025 huggingface dataset:
Prevalence and cause of gestational diabetes mellitus in a tertiary care center in Kolar district: a population based study
Authors: Tummala Poojita , M. Munikrishna , P. Kiranmayee
Published: June 2019

Background: Gestational diabetes mellitus (GDM) is carbohydrate intolerance at the onset of pregnancy which induces pathological short term or long term outcomes for both mother and baby. The aim of the present study was to know the prevalence of GDM in pregnant women who were attending the antenatal care (ANC) center at a tertiary care hospital in Kolar, Karnataka, India.Methods: This prospective study was conducted in Department of Obstetrics and Gynecology, Sri Devaraj Urs Medical College, a constituent of Sri Devaraj Urs Academy of Higher Education and Research, Kolar, Karnataka, India. The duration of the study was two months. In this study, 108 pregnant women above 24 weeks of gestation were screened for GDM by oral glucose tolerance test. Fasting 2 milli liter blood was collected and were given 75 grams of glucose in 200 milli liters of water and asked to drink within 5 minutes. Again 2 milli liters venous blood was collected after 1 hour and 2 hours from all participants. Plasma sample was used for the estimation of glucose by glucose oxidase and peroxidase (GOD-POD) method.Results: Out of 108, 12 women (11.1%) were diagnosed with GDM. The prevalence rate was higher in the age group of 26-30 years (41.6%).  Among 12 diabetic women, five (47.2%) exercised regularly and seven (58.3%) did not doing exercise. Out of 12 GDM subjects, eight of them had family history of diabetes in first degree relatives; among which one was hypertensive and five were suffering from thyroid problems.Conclusions: In the present study, the prevalence of GDM was found to be 11.1%. Prevalence of GDM might be influenced by increasing age, pre pregnancy weight, family history of diabetes, past history of pregnancy complications, status of literacy and exercise.
Study of antenatal prevalence of HIV and its trend in a tertiary care hospital
Authors: Anand Nikhil A. , Patel Seema K.
Published: June 2019

Background: HIV/AIDS has become a global problem since first detection in 1981.Women of childbearing age constitute nearly half of the 30 million adults currently living with HIV/AIDs worldwide. Pregnant women are considered as low risk for HIV so estimating prevalence in such low risk people provides us a good basis for long term strategy for implementation of HIV/AIDS control programme. The objective of this study was to study acceptance of antenatal HIV testing during routine ANC checkups using opt in strategy. To study prevalence of antenatal HIV and its trend.Methods: Observational and analytic study. Antenatal women coming for routine antenatal care in obstetric OPD were counseled and blood sample were taken according to guidelines for HIV testing from period 1/1/2014 to 31/12/2018.Results: Out of total 23907 women attending antenatal clinic 23841 accepted HIV testing, Out of these 72 were found positive, making HIV seroprevalence rate of 0.30. 42 spouses were also found positive.Conclusions: Though seroprevalence of HIV in antenatal women is low, slowly rising trend worths a caution for us.
Knowledge and awareness of the cause, prevention and control of cervical cancer amongst female undergraduates and faculty of health sciences: a cross sectional survey
Authors: Tandon Abhishek , Raja Snigdha , Pai Mangala M. , Unnikrishnan B. , Kanchan Tanuj
Published: June 2019

Background: Carcinoma cervix is the second most common cancer in women worldwide, and the most common in India. In this study, the current knowledge of female undergraduates and faculty of health sciences regarding the various parameters like risk factors, symptoms, screening tests and vaccinations pertaining to cervical cancer was assessed.Methods: A cross-sectional, self-administered anonymous questionnaire-based survey was carried out, in a medical college in Mangalore, which included 260 staff and students. Non random sampling was done and the study was carried out only after gaining institutional Ethical community approval and written informed consent from the subjects.Results: Majority of the participants 185 (71.4%) were aware that cervical cancer is one of the most wide- spread gynecological cancers in Asia. The awareness of causative agents of cervical cancer was known to 53.9% of the undergraduates and 50% of the faculty members. 73% of the total study groups have heard of HPV and around 68% agreed that it was detectable. 71% of the study sample had heard about the Pap smear test and 42% have undergone the test. The questions pertaining to the preventive measures of cervical cancer had good faculty preponderance with 91.8% giving a positive response. 84.1% of the students and 79.5% of the faculty members knew that abnormal vaginal bleeding was a symptom.Conclusions: In this study an attempt has been made to study the correlates of knowledge of cervical cancer in a cohort which consisted of health care undergraduate and faculty. Majority of our study group was well aware of the various risk factors of cervical cancer and its preventable nature however awareness regarding the association between diets, multiple pregnancies and use of tobacco was poor.
Antibiotic susceptibility pattern of group B streptococcal isolates from maternal genital tract
Authors: Sharmila Vijayan , Babu Thirunavukkarasu Arun
Published: June 2019

Background: Group B streptococcus (GBS) is one of the important cause of early onset neonatal sepsis in developed countries leading to increased neonatal morbidity and mortality. Penicillin and Ampicillin are the drugs of choice for prevention of GBS infections. Antibiotic resistance amongst GBS isolates is an emerging health problem affecting neonates. Hence, this study was performed to determine the antibiotic susceptibility pattern of Group B Streptococcus (GBS) in a population of pregnant women.Methods: A prospective study was done to screen pregnant women for vaginal and rectal GBS colonization during their regular visits to antenatal clinic. Todd-Hewitt broth, an enrichment medium for GBS was used for isolation. The antibiotic susceptibility pattern of the isolates were studied.  Results: A total of 300 pregnant women were screened for GBS colonization. GBS colonization rate in our study was 2.3%. The antibiotic susceptibility pattern of the isolates revealed that none of the isolates were resistant to penicillin or clindamycin, while resistance was noted to erythromycin (14.3%) and   tetracycline (71.4%).Conclusions: GBS continues to remain sensitive to Penicillin which is the drug of choice for prevention and treatment of GBS.  Consistent surveillance of antibiotic sensitivity pattern of GBS as well as for other organisms implicated in new born sepsis and maternal infections is required to formulate guidelines for prevention and treatment.
Knowledge, attitude and practices of contraception amongst married women
Authors: Lamba Jyotsana , Gandotra Nikita , Prashar Nivedita
Published: June 2019

Background: Aim of current study was to assess the knowledge, attitude and practices of contraceptives amongst married women of reproductive age group.Methods: A cross sectional study was conducted in obstetrics and gynaecology out door patient department (OPD) of SMGS hospital Jammu. 100 married women aged between 15-45 years were included in this study. Along with the sociodemographic characteristics of the women, their knowledge, attitude /86*and practices on contraception were evaluated with the help of predesigned questionnaire.Results: It was observed that out of 100 women, majority of them were Hindu (58%), higher secondary educated (21%), housewives (45%) and belonged to low socio economic status (36%). 88% females had knowledge about contraceptive methods that was mainly obtained from health workers (59%) followed by media (23.8%) and social circle (14,7%). 38% women were practicing contraceptive methods, out of which most of them were using condom (39.4%) followed by Oral Contraceptive Pills (OCPs) (21.05%), intra uterine contraceptive device (15.7%) etc. Though most of the women had knowledge about contraceptive methods majority (62%) had negative attitude towards family planning.Conclusions: In spite of having good knowledge, utilization of contraceptives was less because of religious myths and beliefs, fear of side effects, cultural and political barriers.
A prospective study of the incidence and outcomes of eclampsia in a tertiary care hospital and teaching institute in India
Authors: Gandhi Garima , Chandnani Kavita
Published: June 2019

Background: Eclampsia is a common cause of maternal and foetal morbidity and mortality in India and the rest of the world accounting for nearly 10% of all maternal deaths. However, there is a relative scarcity of outcome data for patients with eclampsia in India. Our goal was to estimate the incidence of eclampsia, the maternal and foetal outcomes of patients presenting with eclampsia, and predictors of clinical outcomes in these patients. Objective of this study was to estimate the incidence of eclampsia in patients who delivered at a single tertiary care institution over a 2-year period and to study the maternal and perinatal outcomes in those patients.Methods: Prospective cohort study conducted from September 2008 to August 2010 on all patients with eclampsia admitted during the study period at Lok Nayak Hospital, New Delhi, India.Results: The incidence of eclampsia among total deliveries was 0.45%.  About 97% of these patients received parenteral magnesium sulphate as the primary anticonvulsant therapy. Caesarean section was performed in 22.7% and majorities were done for foetal distress. Maternal complications were encountered among 17% of patients. There were 2 maternal deaths (2.3%), 13 stillbirths (14.1%) and 7 early neonatal deaths (7.9%).Conclusions: The incidence of eclampsia among all deliveries over a 2-year period at a tertiary care centre in India was 0.45%. Parenteral magnesium sulphate was effective in the vast majority of these patients in controlling the seizures. Further studies to evaluate whether early registration for antepartum care improves maternal and foetal outcomes in patients with eclampsia are warranted.
Prevalence and risk factors of postpartum depression at a tertiary care institute
Authors: Sivapragasam Vanithamani , Manjappa Anitha A. , Patil Aruna B. , Kalaimani Monicka
Published: June 2019

Background: Up to 85% of the women experience some type of mood disturbance in the postnatal period. Postpartum depression affects bonding with infant which may lead to malnutrition and other complications in the infant. This article focuses on the prevalence of depression among postnatal women attending a tertiary care institute in Chennai and to identify the risk factors that affect postpartum depression.Methods: This study was a cross sectional study, performed over a period of three months from January 2019 to March 2019. 200 postnatal mothers were recruited for the study, who were in postpartum period from 1 to 6 weeks after delivery. Specially designed proforma was used to record various determinants to assess the risk factors which could contribute to postpartum depression. The Edinburgh Postnatal Depression Scale was used to detect the depressive symptoms in postnatal mother.Results: A total of 200 cases were studied. Prevalence of postpartum depression was found to be 25%. Primi gravida, history of miscarriage and unplanned pregnancy were associated with increased risk of developing depression in the postnatal period. Fear regarding gender of the child and failure of lactation were not contributing risk factors to postpartum depression. Spacious house and partner support were found to be protective factors to combat depression in postnatal women.Conclusions: Prevalence of postpartum depression was 25%. Significant association was found between primi gravida, history of miscarriage, unplanned pregnancy and postpartum depression. Early screening of the women will reduce the adverse outcomes among both mother and the child.
Genital tuberculosis in infertile women: role of hysterolaparoscopy and tuberculosis polymerase chain reaction
Authors: Gandotra Nikita , Sharma Abhinav , Sharma Preeti
Published: June 2019

Background: Genital tuberculosis is an important cause of female infertility in developing countries like India. It is one of the major causes for severe tubal disease leading to infertility.Methods: A prospective study was conducted in which 100 women presented to hospital with infertility were subjected to hystero-laparoscopy over 1 year. Endometrium sent for tuberculosis polymerase chain reaction (TB-PCR) and HPE and results were formulated.Results: Out of 100 women, 28% were diagnosed with Genital tuberculosis (GTB) using accepted clinical criteria, TB-PCR and endometrial HPE. 25 of these 28 were diagnosed by hysterolaparoscopy (89.24%) alone, 16 by positive endometrial TB-PCR (57.14%) and another 2 by HPE (7.14%).Conclusions: In country like ours where TB is endemic, a multi-pronged approach to diagnosis increases the chances of successfully diagnosing this destructive disease.
Associated comorbidities with obesity in pregnancy and its feto-maternal outcome
Authors: Jain Rupam Sanjay , Shirodkar Sneha D.
Published: June 2019

Background: Obesity is an evolving risk factor in the modern day - a rising global epidemic reported to cause many problems in the pregnant woman - causing ill effects to both the mother and the fetus. Managing the comorbidities associated with obesity is a challenge in obstetric care.Methods: This prospective observational cohort study was conducted at a tertiary care institute over a period of 2 years. 50 antenatal patients fulfilling the inclusion criteria were studied after taking informed consent. The various maternal, fetal and neonatal outcomes were noted to examine the magnitude and significance of the effect of BMI.Results: Obese women have a higher prevalence of infertility and are considered a high-risk state because pregnancy is associated with a higher risk of pre-eclampsia, gestational diabetes mellitus, preterm labour, increased operative and caesarean deliveries, post-partum haemorrhage, post-partum infectious morbidities and a higher incidence of anesthetic and post-operative complications in these deliveries. Neonatal complications include congenital anomalies, fetal macrosomia leading to birth injuries, preterm births and still births. Technical difficulties are faced by the obstetricians while operating and by the anesthesiologists while induction.Conclusions: Considering the adverse effects of obesity on pregnancy outcomes, pre-pregnancy counseling should be done for all overweight and obese females planning conception signifying the negative impact of obesity on maternal and fetal outcome.
Incidence and risk factors of polycystic ovary syndrome among women in reproductive age group attending a tertiary health care hospital in Western Maharashtra
Authors: Shinde Khushboo Suresh , Patil Sunil Somnath
Published: June 2019

Background: Polycystic Ovary Syndrome (PCOS) is an endocrine disorder affecting women of reproductive age group. Though its incidence is markedly increasing, the awareness is still low; as a result it remains undiagnosed. Aim of this study was to find the incidence and risk factors of PCOS among women in reproductive age group, so as to encourage young women to seek timely treatment and prevent its long term complications.Methods: A study was conducted over a period of 1 year amongst 100 women attending the Gynecology OPD using a paper based questionnaire. General examination and the required laboratory tests were done to confirm the diagnosis.Results: It was found that the incidence of PCOS among the study population was 21%. Risk factors include lack of physical activity, irregular menstrual cycle, body mass index more than 25, and Waist-hip ratio above 0.86.Conclusions: It is seen that there is a need to educate women at an early stage to prevent the development of this syndrome and its early detection by them. This will facilitate the health professionals to start the treatment at a stage where the complications have not yet set in.
A study of rate, indications and maternal morbidity associated with cesarean delivery in a tertiary care hospital
Authors: Nigar Asma , Ahmad Ausaf , Khan Khashia
Published: June 2019

Background: Cesarean section is one of the most commonly performed surgical procedures in obstetrics worldwide. Over  the last three decades, a tremendous increase in cesarean section rates has been observed globally, which is a cause for concern as procedure is associated with higher morbidity and mortality compared to vaginal delivery. This study was done to analyze the rate and indications for cesarean section and associated maternal morbidity and mortality.Methods: This retrospective study was conducted over a period of 6 months from 1st October 2017 to 31st March 2018 in the department of Obstetrics and Gynecology, Integral Institute of Medical Sciences and Research, Lucknow, India. Data of patients who were admitted for delivery in department of Obstetrics and Gynecology in OPD or emergency were recorded. Statistical analysis of various parameters namely, the cesarean section rates, its indications, the patient’s morbidity and mortality was done.Results: The total numbers of women delivered over the study period were 577, out of which 210 patients underwent cesarean sections. The overall cesarean section rate in our study was 36.39%. Previous cesarean section was the leading indication of cesarean section (31.9%) followed by arrest of labor (18.1%), CPD (14.2%), and fetal distress (12.9%). Breech presentation (5.2%), failed induction of labor (4.8%), pregnancy induced hypertension (PIH) (3.8%), oligohydramnios (3.3%), obstructed labor (2.4%), APH (1.4%), multiple pregnancy and BOH accounted for 0.95% of cesarean sections. 9% patients had few complications mainly minor wound infection (2.4%) and postpartum hemorrhage (2%). There was no mortality during this period.Conclusions: Previous cesarean section has been found to be the main indication for cesarean section. So primary cesarean section should be reduced to decrease the overall cesarean rates. A comprehensive, evidence based approach needs to be introduced to monitor indication of all cesarean section.
Clinical study of ectopic pregnancy at tertiary care center in Haryana, India
Authors: Chaudhary Sushila , Chauhan Meenakshi B. , Gupta Anjali , Dalal Monika
Published: June 2019

Background: Ectopic pregnancy is a life threatening condition in the first trimester of pregnancy. Diagnosis can be done by clinical examination, serum β-HCG and ultrasonography. This retrospective study was done to know the incidence, risk factors, and management of ectopic pregnancy.Methods: It was a retrospective study conducted on 75 patients of ectopic pregnancy admitted at tertiary care hospital in Haryana from February-2017 to January-2019. Data collected from record room and analysis done.Results: Total deliveries were conducted were 5064. The incidence of ectopic pregnancy was 1.48%, majority of the women were in the age group of 21-30 (68%), multi-parous (77.32%). The most common risk factor was abortion 33.33%, f/b tubal ligation was 13.13%, medical management of ectopic pregnancy done in 30.66%, 8% were managed by laproscopically and 58.66% by laparotomy.Conclusions: Safe sexual practices can reduce pelvic infections and ectopic pregnancy incidences. Early diagnosis before tubal rupture can reduce morbidity and mortality in ectopic pregnancy.
A study on bacterial vaginosis in pregnancy and its effect on pregnancy outcome
Authors: Chikicherla Sai Deepthi , Sitalakshmi V.
Published: June 2019

Background: Bacterial vaginosis is an extremely prevalent vaginal condition and one of the causes of vaginitis among both pregnant and non pregnant women and associated with severe sequelae. Fifty percent of the women are asymptomatic. Current studies have found that the prevalence of BV ranges from 15% to 30% among non-pregnant women and 10% to 41% among pregnant women.Methods: This is a prospective study conducted among 150 pregnant women who attended the antenatal outpatient and inpatient clinic in the Department of Obstetrics and Gynaecology at Narayana Medical College and Hospital, Nellore over a period of two years from Oct 2016 to Oct 2018. Obstetric cases fulfilling the inclusion and exclusion criteria were enrolled in the study by convenient sampling technique. They were followed till the outcome of pregnancy. The data was subjected to usual statistical analysis by employing the chi-square tests.Results: Prevalence of the bacterial vaginosis was 20% in the present study. BV was significantly (p<0.05) associated with preterm delivery, PPROM, low birth weight, low APGAR and neonatal jaundice. Neonatal sepsis and congenital abnormalities showed no statistically significant difference (p>0.05) between BV positive and negative women.Conclusions: Considering the vast spectrum of maternal and fetal morbidity associated with this infection, and the availability of rapid inexpensive diagnostic tests it may be prudent to screen BV in pregnancy, so that it may be treated early and hence prevent the adverse pregnancy outcomes.
Vaginal birth after cesarean
Authors: Gupta Shilpa , Ganatra Hina
Published: June 2019

Background: A heightened awareness must be present among the clinicians while taking the decision to perform the first cesarean section, as it decides the future obstetric career of the women. Because of the rise in cesarean section rate in recent decades, the question of how to manage the subsequent deliveries becomes important. Vaginal birth after cesarean (VBAC) has long been proposed as an alternative measure to reduce repeat cesarean rate. Our present study aims to assess the predictive factors of successful VBAC and study the risks and benefits involved.Methods: A prospective observational study was conducted to assess the success of VBAC and its outcome in GMERS Medical College and Hospital, Ahmedabad. A total of 100 pregnant women with history of previous one cesarean section who fulfilled the criteria for vaginal delivery were recruited for study and the outcome was analyzed.Results: The success rate of VBAC was 58% while failed TOLAC which ended up in emergency repeat cesarean section was 42%. Vaginal delivery either before or after the history of previous cesarean section, neonatal birth weight between 2.5-3kg, and admission during active phase of  labour were associated with successful VBAC. There were 2 cases of partial scar rupture diagnosed peroperatively. The commonest indication of repeat cesarean section was non progress of labour (45.2%) followed by fetal distress (16.7%). The neonatal morbidity rate was similar in both groups due to limited prolonged unsuccessful trial in our study. There was no maternal and neonatal mortality.Conclusions: To reduce the escalating rate of total cesarean section worldwide, VBAC is an alternative option which should be encouraged in carefully selected patients. However, it should be carried out in a well equipped institute with close fetal monitoring and availability of blood and trained personnel. Thus “once a cesarean section, always a hospital delivery” and not, “once a cesarean section, always a cesarean section”.
A study of prevalence of asymptomatic bacteriuria in pregnant women from rural areas attending to Obstetric Department in Akash Hospital, Karnataka, India
Authors: S. Rohini N. , N. Ravishankar S. , K. Kala , R. Rakshith N.
Published: June 2019

Background: Asymptomatic bacteriuria (ASB) in pregnancy is a significant risk factor for developing upper urinary tract infection and pyelonephritis which is associated with significant maternal and fetal risks. The aim of this study was to know the prevalence of asymptomatic bacteriuria in pregnancy, to identify the organisms and their antibiotic susceptibility patterns and to formulate a single or combined rapid screening method as an acceptable alternative to urine culture.Methods: A total of 375 pregnant women aged between 18 to 45 years were included in this study. Clean catch mid-stream urine samples were collected. Screening tests done were gram staining of uncentrifuged urine, pus cell count, nitrite test and leukocyte esterase test. Identification of pathogens and antibiotic sensitivity tests were performed as per standard urine culture and sensitivity methods.Results: Out of the 375 pregnant women, 31 (8.4%) had significant bacteriuria. High percentage of women with ASB were primigravidas (51.38%) and in 2nd trimester (43.86%). The most common organism isolated was E.coli (56.14%). In screening tests, gram staining of uncentrifuged urine had a sensitivity of 85.71%. Sensitivity of 71.42% was found in Nitrite and leucocyte esterase tests. However, the combination of these two tests, with either test positive, showed sensitivity and negative predictive value of 90.47% and 99.09% respectively.Conclusions: Early detection and treatment of ASB in pregnancy can prevent complications. ASB can be identified by simple and combined rapid screening methods and urine culture along with antibiogram. Therefore, screening and treatment of ASB may be incorporated as routine antenatal care for safe motherhood and healthy newborn.
Towards safe motherhood to - are we moving in the right direction?: experience from an urban health facility in South India
Authors: Thangavelu Ramya , Natarajan Lalitha
Published: June 2019

Background: This study was designed to evaluate the institutional Maternal Mortality Ratio (iMMR) in our institution, a tertiary private medical college hospital and to suggest recommendations and possible interventions to reduce it.Methods: This retrospective descriptive study was conducted by reviewing the hospital records over a period of ten years from January 2009-December 2018. The case records were reviewed for maternal demographic characteristics and complications.Results: The total number of deaths during the study period was 21, giving an iMMR of 85.268 per 100000 live births. Most of the maternal deaths (>80%) occurred postpartum. Obstetric causes contributed to 57% of the deaths with hypertension and hemorrhage topping the list. Other causes were sepsis and non obstetric causes including one case of maternal suicide. 52.38% of the women died more than 48 hours after admission to the hospital, while 28.57% succumbed in less than six hours. Secondary complications noted were ICU admission, extended intubation, massive transfusion, operative intervention and multi organ dysfunction.Conclusions: The classical triad of Hypertension, Hemorrhage and Sepsis continues to be the major determinant of maternal mortality and are potentially preventable by promoting universal access to quality health care, strengthening of health services and ensuring accountability.
Helicobacter pylori infection and hyperemesis gravidarum: a prospective pilot study in India
Authors: V. Akhila M. , R. Padmasri
Published: June 2019

Background: About 80% of all pregnant women experience some form of nausea and vomiting during their pregnancy. Hyperemesis gravidarum, the commonest indication for admission to hospital in the first half of pregnancy affects approximately 0.3%-2.0% of pregnancies. Helicobacter pylori infection has been implicated in the cause of nausea and occasional vomiting in early pregnancy. The objectives of this study are to determine the proportion of H. pylori seropositivity among women with hyperemesis gravidarum (HG) and determine its relation with socio-economic status.Methods: This was a prospective study conducted in a tertiary hospital in Bangalore among 60 pregnant women with HG for a period of 12 months. Venous blood samples were obtained and serum IgG for H. pylori was measured using enzyme-linked immunosorbant assay (ELISA). Details regarding socioeconomic status, recurrence of symptoms and severity were noted.Results: The proportion of H. pylori seropositivity among pregnant women with hyperemesis in our study was 70%.There was a significant increase in severity and recurrence of vomiting among seropositive cases. Women belonging to rural areas had 1.17 times the risk of infection compared to women with urban area. We also found women belonging to the lower socioeconomic status had 0.52 times more risk to develop Helicobacter pylori infection.Conclusions: This study suggests that H. pylori is an independent risk factor for vomiting in pregnancy. Effective treatment and eradication of H pylori infection may help reduce severity and recurrence of vomiting among positive cases thus reducing its adverse consequences.
Uterine scoring system for reproduction scoring correlation with pregnancy rate in infertility patients undergoing intracytoplasmic sperm injection and embryo transfer
Authors: Shivtare Mamta Vijay , Lad Nikita , Vishwekar Pallavi , Shetty Pradnya
Published: June 2019

Background: Infertility is defined as failure to conceive a clinical pregnancy after 12 months or more of regular unprotected intercourse. The birth of Louis Brown opened door to whole new world. Science of reproduction unfolded with better understanding of physiology and pharmacology of gonadotropins. Improved stimulation protocol, and lab facilities are available for IVF and intracytoplasmic sperm injection (ICSI). The objective of this study was to study relation between uterine scoring system for reproduction (USSR) scoring and pregnancy rate in patients undergoing ICSI and embryo transferred.Methods: A prospective observational study was conducted. Study comprised 48 women visiting with infertility for ICSI and embryo transfer. Baseline scan done on day2 of menses. Patients started on estradiol valerate for endometrial preparation. Transvaginal sonography done on 10th day of menstrual cycle for USSR scoring. USSR scoring includes parameters such as endometrial thickness, endometrial layering, myometrial contractions, myometrialechogenecity, uterine artery Doppler flow, endometrial blood flow, myometrial blood flow.Results: Out of total 48 infertility patients for embryo transfer 22 conceived, which gives 45.83% pregnancy rate. No patients had a perfect score of 20. Patients with score of 17-19 had pregnancy rate of 66%. Endometrial thickness of 10-14mm gave optimum result of 52%. Pulsatality index <2.19 was associated with pregnancy rate of 66%.Conclusions: USSR scoring is highly indicative of good pregnancy outcome in patients undergoing ICSI and embryo transfer. Endometrial morphology and thickness was strongly correlated with successful pregnancy outcome.
Studying prevention of parent to child transmission services, interventions, coverage and utilization
Authors: Patel Seema , Anand Nikhil
Published: June 2019

Background: Human immunodeficiency virus (HIV) infection is increasing at an alarming rate globally. Apart from heterosexual route, mother to-child transmission is the next most important route of HIV transmission accounting for over 90% of infections in children. The present retrospective study is undertaken to evaluate the effectiveness of implementation of PPTCT programmed in GMERS Medical College, Sola, Ahmedabad, Gujarat, India.Methods: At ICTCs, registered ANCs are counseled and tested for HIV. HIV+ve ANCs are linked to services and followed-up for institutional delivery. Antiretroviral prophylaxis with nevirapine was given to seropositive mother-baby pairs during delivery and children testing. HIV+ve ANCs since 2014 to 2016 subsequently delivered till December 2018 and their exposed children followed up till 18 months for confirmation of their seropositivity status in PPTCT were study at GMERS medical college, sola, Ahmedabad, Gujarat, India.Results: 13595 ANCs registered, 100% were counseled pre-test, and 99.5% of them tested, 79.5% were counseled post-test.  CD4 testing was carried out in all HIV+ve ANCs. 55 ANCs were detected HIV+ve inclusive of 37 new registered, 16 re-pregnancy and 2 unregistered cases. 55 pregnancy outcomes reported institutionally total 85.9% delivered at institute out of them 26.5% were caesarian sections and 62.4% delivered vaginally. Out of 48 live births, 47 sdNVP-MB-Pair were given. 48 children were traced till 18 months, 82.5% of live births were alive, and 68.75% of live births were tested. 1 was found HIV+ve with history of adherence to all prescribed PPTCT guidelines.Conclusions: PMTCT services - counseling and testing should be provided to all ANCs. EDD-based tracking, institutional deliveries, postnatal counseling to be encouraged along with complete MB pair coverage, capacity building of concerned staff regarding delivery of HIV+ve ANCs and exposed children tracking.
Advanced ovarian pregnancy: an elusive diagnosis
Authors: . Bhanupriya
Published: June 2019

Primary ovarian ectopic is a rare variant of ectopic pregnancies. It is commonly confused with tubal pregnancy aborted over ovary, hemorrhagic ovarian cyst, ruptured corpus luteal cyst. The women with ovarian ectopic generally presents early because of early onset hemorrhage in ovary. This is a rare case where woman with ectopic pregnancy presents at 13 weeks. The clinical picture is also highly unusual with just spotting and fainting attacks at the end of first trimester to make a diagnosis of ectopic pregnancy. The laparotomy done showed an unruptured ovarian ectopic pregnancy and with 350 cc hemoperitoneum. Salpingoopherectomy was done and the ectopic mass was removed as hardly any ovarian tissue was left to conserve the ovary. Hence, clinicians should be cautious enough to keep a differential diagnosis of ectopic even at advanced gestation.
Infected delayed puerperal hematoma complicated by retention of urine: a case report and literature review
Authors: Ratsiatosika Tanjona A. , Romuald Randriamahavonjy , . Faisoaly , Lantonirina Rainibarijaona A. , Martial Rakotonirina , Ando-Miora Rakotonirina , Rakotovao Andrianampanalinarivo H.
Published: June 2019

The puerperal hematoma corresponds to a tissue cleavage, most often paravaginal or vulvar, in which the vascular wounds, linked to the detachment, have no spontaneous tendency to haemostasis. The aggravation of this pathology is progressive. Diagnosis and management must be an obstetric emergency. Author report a case of infected puerperal hematoma complicated by rectal compression and acute retention of urine. This is a 26-year-old patient with a history of chronic hypertension. Labor was induced by misoprostol. The delivery was uneventful at 37 weeks vaginally. Ten days after delivery, she returned to the obstetrical emergency service for acute urine retention. The examination with the vaginal speculum showed a tumefaction of six centimeters on the left lateral side of the vagina. Surgical treatment has been performed. The suite was without particularity. The diagnosis of puerperal hematoma must be early. Even for the delayed form, the complications are identical. Blood loss, compression of proximity organs and infection are the most common complications. The care must be multidisciplinary. Resuscitation of the patient associated with haemostasis of the vessel is the main treatment in cases of large hematoma with hemodynamic instability.
Footprint lesion: a mirror image of an endometrial polyp
Authors: Shah Nitin H. , Joshi Aditi V. , Mourya Sunita
Published: June 2019

Endometrial polyps may present with a variety of symptomatology. They are mostly benign and commonly encountered in the reproductive age group. Hysteroscopy is an emerging tool for diagnostic as well as a therapeutic purposes. We report a case of endometrial polyp diagnosed on hysteroscopy, with a “footprint”, that is contact lesion visible. This is a relatively rare phenomenon, and there is sparse information and literature regarding this entity. Hence the true nature of its effects is yet unknown.
Episiotomy site endometriosis: a rare case report
Authors: Usmani Fatima , Gupta Rashmi
Published: June 2019

Endometriosis is defined as the presence of endometrial tissue apart from its usual location. Scar endometriosis is an infrequent type of extra pelvic endometriosis. Viable decidual endometrial cells are likely to be transplanted in the episiotomy wounds during normal delivery and subsequent growth may occur. We present here a case of 22 year old female with perineal endometriosis at the episiotomy site. The clinical, operative and pathological findings are reported.
Congenital cystic adenomatoid malformation, antenatal diagnosis: about one case
Authors: Adama Dembélé , Issa Ouédraogo , Sibraogo Kiemtoré Sibraogo , Moussa Bambara
Published: June 2019

Antenatal ultrasound screening of fetal malformations requires for management, the immediate nature of which at certain birth, conditions the survival of the newborn. The Objectives Describe a case of pulmonary cystic adenomatoid malformation discover during antenatal ultrasonography. It was a 36 years old primary patient, referred to the maternity of Lafontaine hospital (France) for the presence, on obstetrical ultrasound screening, of suspected lesions on the foetal right lung’s field in a 21 weeks gestation pregnancy. After successive obstetric ultrasound scan, it was discovered that the left lungs were big with some parenchymal cysts of different sizes more than 3 mm in diameter. We made a diagnosis of type I left pulmonary cyst adenoma with excess amniotic fluid, without associated anomalies. The pregnancy progressed to 40 weeks gestation and a caesarean section was done with extraction of a live female new born weighing 2730 gr. The new born had 40 days later a successful surgical lobectomy for a cystic adenomatoid dysplasia. Histological examination revealed type I Stocker congenital pulmonary cystic adenomatoid malformation. During obstetrical ultrasound screening, we paid more attention to the brain, the heart, the face. Through this study we realised that during routine antenatal ultrasound for morphology, we should also pay more attention to the lungs.
Aggressive angiomyxoma of broad ligament: an uncommon mesenchymal tumor
Authors: Jagtap Sunil Vitthalrao , Nasre Nitesh , Kshirsagar Nitin S. , Jagtap Shubham S.
Published: June 2019

Aggressive angiomyxoma is a rare mesenchymal tumor occurring predominantly in the pelviperineal region. Authors present a case of a 70 years female presented with history of distention of lower abdomen with recurrent pain since 6 months. On clinical examination there was suspicion of fibroid. On USG it was reported as huge fleshy, soft tissue mass measuring 20x10x9 cm in lower abdominal flanks and pelvis with vascular pedicle attached to right parametrium. Pan-hysterectomy was performed. Right broad ligament showed mass measuring 18.5x10x6 cm. On histopathological examination it was diagnosed as a case of Aggressive angiomyxoma of broad ligament. We are presenting this case for its extreme rarity, clinicohisto-pathological and radiological findings.
Full term broad ligament pregnancy: a case report
Authors: Shah Vidhi J.
Published: June 2019

A broad ligament pregnancy is extremely rare form of ectopic pregnancy with high maternal and perinatal mortality. The eventuality of such pregnancies reaching full term is even rarer. Although ultrasonography is helpful in making diagnosis, but it is mostly established during laparotomy. Our patient is an unbooked case, G2P1 reported to us at 39 weeks of pregnancy with abdominal pain. Ultrasonography showed viable foetus with severe intrauterine growth restriction (estimated fetal weight of 1.98 kg), transverse lie, severe oligohydramnios with complete placenta praevia. Patient was taken for caesarean section. Intraoperative diagnosis of left broad ligament pregnancy was made, foetus was removed alive and broad ligament along with placenta, left fallopian tube and ovary was excised. Post-operative period was uneventful.
A rare case of Meckel Gruber syndrome
Authors: Chandra Rudrika , Singh Bhanu Pratap , Singh Sanjay
Published: June 2019

Meckel Gruber syndrome (MGS) is a rare lethal autosomal recessive disorder.  It is characterized by triad of features having occipital meningoencephalocele, polycystic kidneys and post-axial polydactyly. We report an antenatal patient detected with occipital meningoencephalocele in foetus on early anomaly scan at 15 weeks of gestation followed by foetal MRI which revealed the typical triad features strongly suggestive of MGS. The patient opted for medical termination of pregnancy and the abortus was autopsied, with the permission of the patient, for detailed evaluation of anomalies which were consistent with MGS. This case highlights the importance of a detailed foetal evaluation antenatally to detect anomalies which are incompatible with life and proper diagnosis as it has bearing on patient’s future obstetric outcome.
Case reports for embryo banking: for women who want their own
Authors: Vora Amishi Vijay , Nadkarni Purnima , Singh Pooja Nadkarni , Nadkarni Vaibhav , Nadkarni Aditi
Published: June 2019

Out of the many challenges in management of female factor infertility, poor responders and low response to stimulation in aged and even younger women, seems to be a common problem. It is very difficult to offer one particular management strategy or treatment protocol for optimum outcome in this group of women of poor responders. In a low resource set up, IVF (In vitro Fertilization) specialist doctors usually face a challenge in treating women with poor/ low ovarian reserve as ovum / gamete donation is considered as a taboo in various sections of society even today. Hence women insist on having an offspring of "their own" and vehemently deny ovum / gamete donations. In this article we discuss 2 cases of poor ovarian reserve retrospectively, who underwent multiple cycles of controlled ovarian hyperstimulation for embryo banking and ultimately achieved pregnancy. Both patients achieved pregnancy with the method of embryo banking. Embryo banking should be considered and discussed. Various articles have discussed the advantages and disadvantages of embryo banking or even oocytes accumulation. The advantages of this technique is patients with poor/low ovarian reserve get a chance to be pregnant with their own oocytes and also have a chance for vitrification of residual embryos. Another advantage in such patients is that the embryos can undergo PGS (Preimplantation Genetic Screening) techniques in cases of suspected genetic disorders. The disadvantage in a low resource set up like India is the cost of the treatment. Nevertheless, embryo banking and accumulation of oocytes should be given as an option for treatment of poor/ low ovarian reserve and could be considered as a ray of hope for all future mothers hoping for a child of "their own".
Vaginal ligation of descending branch of uterine artery in the management of massive secondary post-partum haemorrhage
Authors: Chandra Rudrika , Singh Sanjay
Published: June 2019

A 25 year old lady presented on day 22 of an uneventful caesarean delivery, in a state of class IV haemorrhagic shock, secondary to sudden onset of vaginal bleeding without any inciting cause. Immediate resuscitation was initiated and the cause for massive secondary post-partum haemorrhage (PPH) was identified as an actively bleeding vessel at 3 ‘O’ clock position on a visibly healthy cervix with a well contracted uterus. This was the descending branch of left uterine artery, which was ligated after pulling the cervix with a sponge holder towards the introitus and application of Vicryl No 1-0 suture. The bleeding decreased significantly post vascular ligation. Further exploration of vagina and cervix did not reveal any active bleeding or laceration and no retained placental tissue was found inside uterine cavity on ultrasound examination. This is a rare case of Massive Secondary PPH in a post-caesarean patient due to spontaneous giving way of descending branch of uterine artery.
Prolongation of a pregnancy with second trimester severe oligohydramnios to term: a case report
Authors: Bapat Alka C. , Paidhungat Nitin P
Published: June 2019

The occurrence of oligohydramnios complicating a pregnancy is seen in 0.8 to 5.5 % of pregnancies. Severe Oligohydramnios, though not clearly defined, but clinically with an AFI of less than 5 cm appears to be an important predictor for an abnormal fetal outcome. In general, the prognosis of mid trimester oligohydramnios is still poor. Hence we report a case with a very favourable neonatal outcome following severe oligohydramnios documented in early pregnancy. The aim of this case report is to add our experience to the currently limited literature regarding the best treatment of this unique obstetrical problem.
Cryptomenorrhoea due to imperforate hymen: a case report
Authors: Bansal Romi , . Priyanka , . Sneha
Published: June 2019

Imperforate hymen is a rare obstructive congenital anomaly of the female genital tract which arises as a result of complete failure of canalisation of the inferior end of the vaginal plate at the junction between the urogenital sinus and the vagina. Its prevalence is 0.05%-0.1%. We are presenting a case of 14 years old girl who came with complaints of lower abdominal pain since 10 days not associated with nausea, vomiting and diarrhoea. She had not attained menarche but her secondary sexual characters were developed with breast, pubic and axillary hair in tanner stage 4. MRI revealed hematocolpos and hematometra with imperforate hymen. Hymenotomy was performed and 300-400 ml of thick tarry colour blood was drained. Her postoperative period was uneventful, and patient was discharged in satisfactory condition. On follow up after 1 month, patient resumed normal menses.
Obstructive mullerian anamolies: a case series
Authors: Miglani Urvashi , Laul Poonam , Kadam V. K. , Miglani Sanjeev
Published: June 2019

AIM of the study was to review the heterogeneous clinical presentations and management options for some of the obstructive mullerian anomalies through a case series. Background: Müllerian duct anomalies (MDAs) are a miscellaneous group of entities that result from the non-development, defective vertical or lateral fusion, or resorption failure of the müllerian ducts due to genetic mutation. 5 cases of obstructive mullerian anomaly are reviewed. Cases of OHVIRA (obstructed Hemivagina with Renal Agenesis) syndrome, transverse vaginal septum, imperforate hymen and obstructed rudimentary horn of unicornuate uterus are included. Results: We found that cyclical abdominal pain was the most common presenting complaint. There is a high incidence of associated renal anomalies. Psychosocial counselling before treatment is necessary to address the functional and emotional aspects of the patient. Surgical management was done in all patients with good postoperative outcome. Conclusion: Obstructive mullerian anomalies need to be evaluated by a meticulous examination and imaging studies to reach the diagnosis with precision. The treatment has to be tailored to the specific anomaly.