bluuebunny/crossref_metadata_2025 huggingface dataset:
Fetal outcome of HIV positive pregnant women taking highly active antiretroviral therapy at Yaoundé Central Hospital: a cross sectional analytic study
Authors: J. H. Fouedjio , Ntani Loweh Limyuy , Florent Fouelifack Ymélé , Mbu Robinson Enow Mbu Robinson
Published: October 2017

Background: HIV infection in pregnant women is delicate both for the mother and her child. With the adoption of option B+ treatment plan by Cameroon’s ministry of public health, there has been a marked decrease in the vertical transmission of HIV from mothers to their babies. There is a dearth of evidence in sub-Saharan Africa, especially in Cameroon, on the effects of highly active antiretroviral therapy (HAART) on pregnancy and foetal outcomes with respect to the time from onset of treatment. We therefore carried out this study to determine the foetal outcome of women on HAART. We hypothesized that the foetal outcome is poorer for pregnant women starting HAART during pregnancy compared to those starting HAART prior to conception.Methods: We carried out an analytic cross-sectional study which spanned from the 1st February to 30th April 2017 at the Yaoundé Central Maternity. We included consenting hospitalised HIV infected women who just terminated a pregnancy (abortion or delivery), and who started HAART at least four weeks before termination of pregnancy. Data was analysed using EPI info 7.2.1.0. SPSS version 20.0. Odds ratio (OR) was used to assess the degree of association that could exist between qualitative variables. The threshold of statistical significance was set at a p-value of 0.05.Results: A total of 121 participants were recruited in the present study. The mean age of the participants was 31.3±5.3 years for those who started HAART before pregnancy and 29.4±5.5 years for those who started during pregnancy (p=0.07). The viral loads means for those who started taking HAART before pregnancy 34.6±21.5 cells/mm3 and those who started during pregnancy 60±14 cells/mm3 (p = 0.01). Overall there were not any significant adverse fetal outcomes caused by taking HAART before or during pregnancy (p >0.05).Conclusions: Despite the fact that the viral load was more elevated in women starting HAART prior pregnancy compared to those started during pregnancy, there was no significant adverse foetal outcome related to time of initiation of HAART treatment by pregnant HIV positive in Yaoundé central Maternity. We suggest that the implementing of the test and treat strategy will have a positive impact on the vertical transmission of HIV.
Placenta accreta and emergency cesarean delivery correlates to cervical length and transcervical placental thickness measurement
Authors: Shady Nahla W. , Sallam Hany F. , Abbas Ahmed M.
Published: October 2017

Background: The study aims to evaluate the effect of cervical length and the transcervical placental thickness measurement at 28-30 weeks gestation in predicting the risk of antepartum haemorrhage (APH) and emergency preterm caesarean delivery (CD) in women with placenta previa accreta.Methods: A prospective cohort study conducted at Aswan university hospital from June 2015 to April 2017 included one hundred and five cases diagnosed as placenta previa accreta by transvaginal ultrasound (TVS) between 28-30 weeks gestation were divided into three groups according to their cervical length which measured by TVS: group I (cervical length >30 mm), group II (cervical length 20-30 mm) and group III (cervical length <20 mm). Also, placental thickness measurement was done. Cervical length and placental thickness and correlated with the clinical outcome regarding to gestational age at delivery, APH, emergency CD due to massive haemorrhage, the need for blood transfusion and caesarean hysterectomy.Results: APH and emergency CD due to massive bleeding were significantly higher in cases with short cervical length and thick placenta. APH occurred in 6 cases (15%) in group I, 14 cases (40%) in group II and 24 cases (80%) in group III, (p=0.0001). Emergency CD in group I was performed in 5 cases (12.5 %), 12 cases (34.3 %) in group II and 24 cases (80%) in group III, (p =0.0001). The incidence of APH was higher in thick placenta [6 cases (42.9 %) compared to none with thin placenta in group I (p=0.001), 13 cases (68.4%) compared to one case (6.2%) in group II (p=0.0001) and 21 cases (100%) compared to 3 cases (33.3%) in group III (p=0.0001)].Conclusions: Short cervical length and increased placental thickness may predict the risk of APH and emergency preterm CD in patients with placenta accreta.
Study of clinical profile of cervical cancer patients: a hospital based study
Authors: Umate Preeti , Thengal Dhuldev S. , Kurdukar Dhundiraj
Published: October 2017

Background: As a consequence of growing and ageing populations, developing countries are disproportionately affected by the increasing number of cancers. Though the situation in India is gradually improving there still exists a disparity between the availability of quality cancer care. With this view, the present study was planned to undertake in this tertiary care institute to find out symptoms, clinical staging, complications and management of cases of carcinoma of cervix.Methods: This was a prospective observational study of carcinoma of cervix carried out at a tertiary care hospital catering services to the people of Maharashtra and neighbouring states. A thorough history including presenting complaints, demographic details, educational status and occupational details, details of menstrual and obstetric history along with any significant past history were recorded on a standard proforma.Results: Most common symptom was per vaginal bleeding which was found in 29 (69.04%). In the present study almost two third of cases i.e. 28 (66.6%) had advanced stage (IIB, III, IV) at the time of admission while the number of cases diagnosed at early stage were only 14 (33.3%). For Wertheim’s hysterectomy, most commonly used approach was transperitoneal 08 (61.53%) while 05 (38.46%) were operated by extraperitoneal approach. Pelvic lymph nodes were positive in 03 (23.07%).Conclusions: A high proportion of patients presented in stages III and IV. This emphasizes the need for early detection of Gynecological cancers in our population. Accordingly, the importance of detection of the pre-clinical stage of the diseases by considering the possibility of initiating cost-effective screening measures needs to be emphasized.
Influence of hospital policy on partograph use in tertiary care facilities in India: a cross sectional survey
Authors: Singh Shalini , Singh Vishwajeet , Thakur Tushita , Radhika A. G. , Mittal Pratima , Kashyap Jyotika A. , Gupta Abhilasha , Aggarwal Neelam
Published: October 2017

Background: Partograph is an effective, but underutilized tool for monitoring labour. This study examined the influence of hospital policy on the knowledge, attitude, practice and skills of doctors towards partograph plotting.Methods: A cross-sectional survey among doctors posted in labour rooms of tertiary care public teaching hospitals of India was carried out, using self-administered questionnaire to assess knowledge, attitude and practice; and labour case scenarios were provided to assess partograph plotting skills. Chi-square test or Fisher’s exact test were employed to test the significance of association between knowledge, attitude, practice and skills of 150 doctors working in hospitals with (n=3) and without (n=2) policy of routine partograph plotting.Results: The majority of doctors in both groups had correct knowledge about different partograph components. However, doctors working in hospitals with a policy of partograph use, demonstrated significantly better skills using case scenarios for plotting partographs (p<0.01), and a positive attitude towards plotting partograph and its use as a decision support tool (p=0.000) as compared to doctors working in hospitals without a routine partograph plotting policy.Conclusions: Hospital policy of routine partograph plotting may positively influence utilization of partograph in tertiary care public hospitals in India.
Epidemiology of MTP in a tertiary care center over a period of 3 years
Authors: Sharma Bhawna , Saxena Namrata , Sharma Anshu , Arora Neetu
Published: October 2017

Background: Medical termination of pregnancy was legalized in India under the MTP act of 1971 which states that all the women can legally have an abortion up to 20 weeks of gestation if indicated. This study is a retrospective analysis of incidence, indication, the age group availing the facility, socio-demographic and obstetric profile of MTP seekers and the method of contraception followed after MTP.Methods: A retrospective 3-year data was analyzed by MTP register of the hospital as a reference.Results: The incidence rate of MTP is 96/1000 live births in the institute. The main reason for MTP is failure of contraception which highlights the unmet need of contraception and counselling. Majority of the age group availing MTP belonged to 16-20 years. Most of the women were   from urban slums, were illiterate and belonged to class IV and V according to Prasad’s classification. Mostly MTP seekers were parous, having ≥2 living children, and maximum no. of them went to private hospitals for their previous MTP. Medical method was the most favoured method of the care giver as well as of the patient. OCP was the choice of contraception after MTP. Religious difference is still very evident in availing   MTP services which can be minimized by tactful counselling. Conclusion: MTP act of 1971 opened new horizons for the unwanted pregnancies. Young population opting for MTP indicates the unmet need of contraception and counselling suggesting that implementation and integration of MTP services should be at the root level.
Partograph versus no partograph: effect on labour progress and delivery outcome: a comparative study
Authors: Ahmed Benazir , Jain Meena , Bharwani Hema
Published: October 2017

Background: Abnormal labour which includes prolonged labour and obstructed labour remain major causes of maternal morbidity. The major reason for neonatal mortality, birth asphyxia and subsequent morbidity is essentially the repercussion which occurs when a complicated labour is not intervened at the right time. A Partograph provides a graphic overview of the progress of labour and records information about maternal and fetal condition during labour. It is considered to be a very effective tool to monitor labour progress and prevent prolonged and obstructed labour.Methods: This prospective randomised comparative study was conducted in the Department of Obstetrics and Gynaecology, JLN Hospital and RC, Bhilai, Chattisgarh, from January 2015 to June 2016. Pregnant women were randomly assigned to two groups, of 200 each, after satisfying the inclusion and exclusion criteria. Women assigned to Group 1 had their active labour modified using modified WHO partograph whereas those assigned to Group 2 were not monitored using the partograph.Results: Use of Partograph (group 1) significantly reduced the duration of active phase of labour (p <0.0001), duration of second stage (p <0.0001) and thus the total duration of labour (active phase plus second stage) (p <0.0001). Requirement of augmentation was also significantly reduced (p <0.05). Group 1 also had significantly more spontaneous vaginal deliveries (p <0.01) with lesser requirement of operative interventions like LSCS or instrumental deliveries like forceps. Use of partograph also significantly improved neonatal outcome with significantly lesser newborns with Apgar <7 (p <0.05). However, there was no significant difference between the two groups with regard to NICU admissions (p>0.05).Conclusions: The use of Partograph, when compared to no Partograph plotting in active labour, is associated with better monitoring of labour progress as well as delivery outcome in the form of a healthy mother and a healthy child.
Cardiac diseases in pregnancy: clinical profile and feto-maternal complications
Authors: Mehta Latika R. , Shah Jagruti
Published: October 2017

Background: Pregnancy in woman with heart disease increases the risk of maternal and fetal complications. About 1% of pregnant women have concomitant cardiac disease. The present research was conducted to study the profile of cardiac diseases in pregnancy and its associated complications.Methods: A prospective analysis was carried out of 55 pregnancies of women with cardiac disease from at a tertiary care center. Standard Ante-natal care was furnished to all patients subjective to their requirements. Condition of patient during labour as well as the progress of labour was closely monitored. Fetal and maternal outcome after delivery as well as development of any complication was noted and treated accordingly. Data was analyzed using SPSS software ver. 21.0.Results: In present study, RHD constituted 71% cases while CHD constitutes 11% of all cases of heart disease. Other etiologies were dilated cardiomyopathies (DCM) (12.7%), IHD (3.6%) and arrhythmias (18%). Most common anomaly associated with RHD cases was mitral stenosis (75%) either isolated or along with other valvular pathologies. Most common CHD was atrial septal defect seen in 4 out of 6 cases. A total of 8 patients (16%) developed complications of which, 4 had postpartum hemorrhage, 2 developed pulmonary oedema, 1 had arrhythmia and 1 patient developed septic shock and multi organ failure. A total of 74% babies were healthy while IUGR and intrauterine deaths were seen in 22% cases and 4% cases respectively.Conclusions: Rheumatic heart disease is the predominant type of cardiac disease in pregnancy. Maternal and perinatal outcome can be improved by team approach at tertiary care center. Counselling for contraception and family planning and follow up during subsequent pregnancies is mandatory.
Colposcopic evaluation of unhealthy cervix and it’s correlation with Papanicolau smear in cervical cancer screening
Authors: Kalyankar Vijay Y. , Kalyankar Bhakti V. , Gadappa Shriniwas N. , Kute Supriya
Published: October 2017

Background: In present study colposcopic evaluation of unhealthy cervix was donr and it’s correlation with Papanicolau smear in screening of Cancer cervix. Objective of present study was to critically evaluate the sensitivity and specificity of PAP smear with that of Colposcopy in screening of Cancer Cervix in women with unhealthy cervix.Methods: 100 women with clinically unhealthy cervix on naked eye examination and / or abnormal symptoms attending Gynaecology Out patient department in 2 years period were subjected to PAP smear, Colposcopy, biopsies under Colposcopic guidance and findings correlated with Histopatholgy at Govt. Medical college, Aurangabad, Maharashtra. India. The sensitivity and specificity of PAP smear with that of Colposcopy in screening of Cancer Cervix was evaluated.Results: Both PAP smear and Colposcopy can be reliably used to screen women with premalignant lesions of Cancer cervix.Conclusions: Colposcopy is a better tool for diagnosis of precursors of Cancer Cervix than PAP Smear and Histopathology of suspected lesion remains the gold standard for final diagnosis.
Endometrial patterns in abnormal uterine bleeding: a retrospective study
Authors: R. Sajeetha Kumari , M. Anuradha
Published: October 2017

Background: Abnormal uterine bleeding (AUB) is a common reason for women of all ages to consult their gynecologist and is one of the most common debilitating menstrual problems ending up in hysterectomy in developing countries. The aim of the present study was to determine the clinical spectrum and frequency of pathologies in endometrial biopsy of patients with AUB in our population. We also tried to observe the incidence of various pathologies in different age groups presenting with abnormal uterine bleeding.Methods: The study was conducted in SRM Medical College Hospital and Research Centre, Tamil Nadu over a period of eight months. This was a retrospective study done on 217 patients presenting with abnormal uterine bleeding who underwent endometrial sampling in our hospital. The pattern of endometrial changes were studied and classified.Results: Age of the patients in our study ranged from 25 years to 68 years with maximum in the age group of 41-50 years. The commonest clinical feature was menorrhagia followed by metrorrhagia. Evaluation of the endometrium revealed various histopathological patterns like proliferative endometrium, secretory endometrium, disordered proliferative endometrium, pill endometrium, shedding endometrium, simple hyperplasia, complex hyperplasia, atrophic endometrium, endometrial polyp, carcinoma endometrium etc.The incidence of malignancy was 1.84%.Conclusions: Histopathological examination of the endometrium showed a wide spectrum of pathological changes ranging from normal endometrium to malignancy thus emphasizing the importance of endometrial sampling as an important diagnostic tool in the management of abnormal uterine bleeding. Accurate analysis of endometrial samplings is the key to effective therapy and optimal outcome.
Evaluation of perinatal factors in neonatal sepsis at tertiary centre
Authors: Kumar Raju , Kumari Anita , Kumari Anjili , Verma Neelam
Published: October 2017

Background: Neonatal mortality in India continues to remain a major health problem. Neonatal infections are one of the major contributor to neonatal mortality causing approximately one-quarter of the deaths. The signs of neonatal sepsis may be non-specific and easily missed, especially in the early stages. A high index of suspicion and identification of both maternal and neonatal risk factors is an important for early identification and prompt treatment.Methods: This is prospective study done at Patna medical college and hospital Patna from February 2014 to January 2015 in department of paediatrics. All inborn and out born neonates who had clinical signs of sepsis were included in the study.Results: During the 1-year study period, there were a total of 910 admissions in the NICU, out of which 175 were admitted due to neonatal septicaemia. Incidence of neonatal septicaemia was approximately 20%. Mean age at presentation was 4.8±6.38). Low birth weight (60%), preter delivery (60.57%), male gender (66.85%) and low APGAR score at1 minute were common foetal risk factor and prolonged labour (41.14%) and multiple vaginal examination (36.57%), PROM in 28%, MSL (25.71%) were common maternal risk factors. Present study documented a culture positivity rate of 42.28%. E. coli (37.83%) was the most common isolated organism in early as well as LOS. Staphylococcus aureus (20.27%) was the most common isolated Gram-positive bacterium. Mortality rate was 45.14%. Mortality was more in preterm babies (57.54%) which was statically significant p value <0.001.Conclusions: Neonatal septicemia is common and serious condition with high mortality rate. Since the condition starts with vague clinical signs, one has to keep very high index of suspicion to diagnose neonatal sepsis. Diagnosis and treatment at the early stage is very important for favorable outcome. Proper antenatal care, and institutional delivery may decrease neonatal sepsis.
Role of insulin sensitising agents in altering PSA level in PCOS
Authors: Panigrahy Rajashree , Singh Bratati , Pattnaik Tapan K. , Misra Sanjukta
Published: October 2017

Background: Ovarian androgen production can be promoted by insulin resistance which leads to reproductive abnormalities in Polycystic Ovarian Syndrome (PCOS). A wide variety of female tissues can synthesize and secrete Prostate Specific Antigen (PSA). Androgens may take part a significant role in PSA secretion in PCOS. As insulin resistance stimulates androgen production, the baseline value of PSA may decline by insulin sensitising agents in PCOS. Present study is an attempt to measure the function of PSA as a marker of androgen excess in PCOS and to assess the role of insulin sensitising agent metformin in altering PSA level in PCOS.Methods: The study was undertaken to assess the insulin resistance, testosterone and PSA level in 45 women diagnosed as PCOS and 45 healthy controls. Alteration of insulin resistance, serum testosterone and PSA levels by metformin was also analysed.Results: A significant increase in testosterone, PSA level and insulin resistance was observed in PCOS cases when compared with control (p<0.001). When metformin was given for 4 months, improvement in insulin resistance and testosterone level was found in cases, but PSA values observed no change. Correlation was not found linking insulin resistance with PSA level prior to and after therapy.Conclusions: Serum PSA level could be detected in high significant concentration in PCOS women. Various researches explain that insulin resistance and BMI may perhaps control serum PSA level, but our result demonstrate no effect of insulin sensitising agent on serum PSA value.
Psychiatric morbidity in newly diagnosed carcinoma cervix and its comparison with benign condition
Authors: Raj Rajnish , Bhagat Nisha
Published: October 2017

Background: To study the psychiatric morbidity among newly diagnosed carcinoma cervix and its comparison with benign gynaecological diseases of cervix. Cervical cancer is the second most common cancer in the world and ranked first in India. It is mainly caused by sexually transmitted infection (STI) of human papilloma virus (HPV).Methods: It was an open labeled, cross-sectional and extended phase study that screened 158 patients in the age group of 18-70 years who fulfilled both inclusion and exclusion criteria and screened positive on liquid based cytology (LBC), as per guidelines of Bathesda system in Government Medical College, Patiala. 13 patients dropped out of study and finally 145 patients were enrolled. They were further divided after biopsy into two groups as per histopathological examination (HPE) i.e., Group-1, N=47 women HPE positive for cervical intraepithelial neoplasia (CIN) as Cases and Group-2, N=98 HPE negative as Control. and anxiety and severity on Hamilton Rating Scale for Depression (HAM-D) and Hamilton Rating Scale for Anxiety (HAM-A) and Hospital Anxiety Depression Scale (HADS) was used to screen psychiatric morbidity for depression.Results: Mean age of Group-1 was 38.45±11.22 SD years and Group-2 was 36.67±8.54 SD years. Psychiatric morbidity in Group-1 was 65.95% whereas Group-2 was 21.42%. P value obtained on comparing HADS score of two groups was significant (p <0.050). After active intervention there was a significant reduction in psychiatric morbidity of two groups (72% in Group-1 and 81.3% in Group-2).Conclusions: The study revealed that the breaking of bad news has a significant psycho-social impact on patients suffering from carcinoma cervix than benign group.
To study the outcome of previous one cesarean pregnancies in a rural tertiary center of Haryana, India
Authors: S. Siwach , P. Lakra , V. Sangwan , Shivani . , R. Kansal , R. Mahendru
Published: October 2017

Background: Rising rates of caesarean section is a matter of great concern and TOLAC is an attractive alternative. Analysing outcome of previous one caesarean pregnancies will provide an insight for reducing the caesarean rates and formulating protocols and policies for TOLAC.Methods: A retrospective study of patients of previous one caesarean pregnancy was done from February 2015 to January 2016 and 3 groups were made, ERCS group, failed TOLAC group and successful TOLAC group. The rates of elective repeat caesarean, failed TOLAC, successful TOLAC, maternal complications, neonatal morbidity and mortality in all three groups were studied.Results: There were 5177 total deliveries with 488 (9.43%) previous one caesarean pregnancies. Out of 488 patients 161 (33%) underwent elective repeat caesarean and 327 (67%) underwent trial of labour. Out of 327 patients 234 (71.56%) had a successful TOLAC and 93 (28.44%) had failed TOLAC. Breech (23%) followed by foetal distress (20%) were the most common indications of previous caesarean. Commonest indication of elective repeat caesarean was short interval (33%) and that of failed TOLAC was foetal distress (38.7%) followed by failed induction (23.6%). There were 4 morbidly adherent placentas (0.82%), 1 scar rupture, 3 scar dehiscence, no maternal mortality and 10 neonatal deaths.Conclusions: Previous one caesarean section is not only a risk factor for repeat caesareans and complications like morbidly adherent placenta, uterine rupture but also a financial burden on health facilities. Encouraging the patients for trial of labour and emphasizing the usage of contraception is the need of the hour.
Abnormally invasive placenta: an overview of diagnosis and management options
Authors: Rajora Parveen , Singh Amanjot
Published: October 2017

Background: Abnormally invasive placenta, also known as morbidly adherent placenta, is a broad term that describes abnormal adherence of placenta to the underlying myometrium. Clinical risk factors include placenta previa and prior uterine surgery, including caesarean delivery. The diagnosis and management of women at risk is not only based on clinical parameters, but also driven by imaging, namely ultrasound and more recently magnetic resonance (MRI) imaging.Methods: This is a retrospective analysis of 10 cases of abnormally invasive placenta undertaken at Guru Gobind Singh Medical College and Hospital, Faridkot.Results: Hysterectomy done in six cases and uterus was preserved in four cases. Foetal outcome was on average side. Four foetal losses noted two because of prematurity and two due to excessive blood loss admitted with intra uterine foetal death. Two babies needed NICU care but successfully discharged.Conclusions: Newer approaches should be considered investigational until larger prospective series to become available, until then hysterectomy should remain the stay of treatment specially when the family is complete and there is life threatening Haemorrhage.
An audit of extra-uterine pregnancy in a tertiary care facility in Northern India
Authors: Marwah Sheeba , Rani Kumari Usha , Mishra Archana
Published: October 2017

Background: Ectopic pregnancy is the most frequent lethal gynaecological predicament, befalling worldwide in all strata of reproductive women. It remains the leading cause of pregnancy-related first trimester deaths. Though prompt diagnosis has furthered a decline in associated morbidity, an upsurge has been seen in its prevalence owing to a rise in predisposing risk factors. The objectives of this study were to identify incidence, risk factors, and outcome in patients presenting with ectopic pregnancy in a tertiary care hospital.Methods: This two-year retrospective study was conducted in Department of Obstetrics and Gynecology in Vardhaman Mahavir Medical College and Safdarjung hospital, on patients presenting with a diagnosis of ectopic pregnancy (either ruptured or un-ruptured). The primary outcome was incidence of ectopic pregnancy. Secondary outcomes noted were demographic characteristics, predisposing risk factors, clinical presentation and management course in hospital. Data was recorded on a predesigned proforma and deciphered later.Results: Incidence of ectopic pregnancy was 0.82%. Significant causative factors were previous history of PID (29.28%), TB (21.4%), previous pelvic surgeries (18.57%) and preceding ectopic pregnancy (12.14%).Conclusions: Increase awareness and knowledge of risk factors amenable to modification and features will aid early diagnosis of extra-uterine pregnancy, besides planning conservative treatment if possible, and devising effective risk-reduction strategies.
Study of acceptance of intra caesarean IUCD as method of contraception
Authors: Gupta Deepti , Sharma Swati , Kanhere Anjali , Jahan Ishrat
Published: October 2017

Background: Worldwide around 115 million women have unmet needs of family planning. Increasing rates of institutional deliveries create opportunities for providing quality postpartum family planning services thus helps to overcome the unmet needs. PPIUCD appears an ideal method for limiting and spacing births. The present study was a prospective study, undertaken to assess the efficacy, safety and outcome of Postpartum Intrauterine Contraceptive Device (PPIUCD) in cesarean case.Methods: A prospective study was done on 50 patients undergoing cesarean section for various indications after getting approval from the Ethical Committee of the institution This study was conducted at CMCH hospital Bhopal, India from August 2016 to July 2017. Women were counseled and those who fulfilled the medical eligibility were provided the PPIUCD services. IUCD was placed after delivery of placenta in case of caesarean section. These clients were followed at 6 weeks, 3 months and 6 months interval.Results: Total acceptance rate in our study was 44%. Majority belonged to age group of 21-30 years (76%) with mean age of 25.5 years, 54% were para 2, 94% of clients were literate, 86% urban and only 70% of the clients were familiar with the intracaesarean IUCD, 54.5% cases returned for follow-up while 18.2% of cases were lost to follow-up and expulsion was the main problem (27.3).Conclusions: Intracaesarean IUCD seems to be a safe long acting highly effective, easily accessible, reversible and cost effective contraceptive method for most postpartum women specially lactating women.
Maternal and perinatal outcome in eclampsia complicated by posterior reversible encephalopathy syndrome; a three years’ experience in a tertiary care hospital
Authors: Karanth Shashikala Karanth , Gonsalves Kavitha , C. N. Sheela , Mathew Reena , Sarma G. R. K. , Phillip Babu , Sumithra .
Published: October 2017

Background: PRES can be associated with number of medical conditions and was observed frequently in patients with preeclampsia and eclampsia. Neuroimaging is important for the diagnosis of PRES. Study was conducted to find out the maternal and perinatal outcome in patients with eclampsia complicated by posterior reversible encephalopathy syndrome (PRES).Methods: This is a retrospective study done at St. Johns Medical College Bangalore, between October 2013 and October 2016. We reviewed case records of all the patients with eclampsia who underwent neuro imaging studies and a diagnosis of PRES was made. The maternal and perinatal outcomes in these women were studiedResults: In the past three years we had 55 cases of eclampsia who underwent neuroimaging studies for persistent neurological symptoms after 24 hours of MgSO­4 treatment. Of these women 30 were diagnosed to have PRES. In the present study PRES was common in multiparous women and more in patients with antepartum eclamptic women. Mean age at diagnosis of PRES was 26±5.1 years. Common presenting symptoms were headache (93.3%) and vomiting (53.3%). The mean SBP/DBP was 180/110 mmHg. All patients who had recurrent seizures were controlled with MgSO­4 alone. 53.3% of our patients had eclampsia related complications and 36.7% required ICU care. There were 3 maternal deaths (10%). Perinatal mortality was 20%.Conclusions: Neuroimaging in eclamptic patients with persistent neurological symptoms could help in early diagnosis of PRES and multidisciplinary approach in management could contribute significantly in reducing the maternal mortality and morbidity.
Obstetric outcome in pregnancy complicated by ovarian cysts
Authors: S. R. Sheela , P. N. Sreeramulu , L. Poonguzhali , K. Arulselvi
Published: October 2017

Background: Ovarian masses are diagnosed in 0.5-1% pregnancies. During pregnancy ovarian cysts can undergo: resolution of the cyst, change of ultrasound pattern, occurrence of ovarian torsion and intra-cystic haemorrhage or rupture. Ovarian masses (esp torsion) is a cause of pain abdomen during pregnancy. The choice of treatment is mainly conservative, provided the patient is asymptomatic. Dilemma in management arises when the patient is symptomatic. Optimal timing for a planned surgery is the second trimester as it is shown to have least neonatal outcome. The objective of this study was to evaluate management options for ovarian cyst in pregnancy and its effect on outcome of pregnancy.Methods: This study was conducted for 2 years from June 2014 to June 2016, at RL Jalappa Hospital, Kolar. A total of 46 pregnant women were included. The pregnancy outcome and the management used were studied. Also studied were the complications most likely to occur in pregnancies complicated by ovarian masses ovarian masses.Results: Out of 46 patients, 2 (4.3%) patients with ovarian cyst torsion underwent emergency laparotomy. 8 patients underwent surgery (6 in 2nd trimester and 2 at term) for various complications. Only one patient had miscarriage and remaining patients continued till term. Histopathological report of all the masses excised were obtained and 6 were reported to be benign serous cystadenomas,1 benign mucinous cystadenoma and 3 simple cysts.Conclusions: Optimal management for ovarian cyst is conservative in pregnancy provided patient remain asymptomatic and characteristic of cyst are consistent with benign pathology. Surgical management is to be reserved for symptomatic patient.
Prospective study of fetomaternal outcome in epilepsy in pregnancy in a tertiary care hospital
Authors: C. Raji , D. Sekar
Published: October 2017

Background: Epilepsy is the second most common neurological disorder in obstetrics after migraine. There are conflicting reports about the effect of epilepsy on pregnancy. Objective of present study was to evaluate fetomaternal outcome in patients with epilepsy.Methods: This prospective study was conducted in Government Thanjavur medical college hospital, Tamil Nadu, India over a period of 15 months from January 2015 to March 2016 in all epilepsy cases. Total 110 epilepsy cases were admitted. In all cases maternofetal outcome were noted.Results: This study showed that the incidence of epilepsy in pregnancy in our hospital is 0.6%. 86.36% of patients were treated with antiepileptic medications during their pregnancies.  Pregnancy complications were anemia, gestational diabetes mellitus, gestational hypertension, intrauterine growth retardation, premature rupture of membrane, and vaginal bleeding. Live birth rate was 91.82%.  Low birth weight babies were recorded in 24 (21.82%) infants. Only one baby had congenital anomaly of cleft lip and palate.Conclusions: There was no significant increase in the risk of complications of pregnancy or delivery.Frequency of cesarean section is not increased in epileptic patients. There is no undue risk to pregnancy and childbirth in most of the cases.
Maternal haemoglobin and perinatal outcome in a tertiary care hospital in Jammu city, India
Authors: Kaul Indu , Sunil Isha , Gupta Aakriti
Published: October 2017

Background: Maternal anemia is a common problem worldwide. The objective of this study was to assess the prevalence of anemia in women attending a tertiary care centre in their third trimester of pregnancy and to study the relation of maternal hemoglobin with perinatal outcome.Methods: This study was conducted in the Department of Obstetrics and Gynecology, SMGS Hospital, Jammu for a period of one year from Nov. 2015 to Oct. 2016. A total of 767 women in their third trimester (>28 weeks) were enrolled and were followed till delivery. Their hemoglobin levels were noted and its association with adverse maternal and fetal outcomes was studied.Results: It was seen that out of 767 patients, 193 (25.16%) were non-anemic and 574 (74.83%) were anemic out of which 343 (44.71%) were mildly anemic, 160 (20.86%) had moderate anemia and 70 (9.12%) had severe anemia. There was increased incidence of preterm delivery, PPH, preeclampsia, eclampsia, CCF, mortality & blood transfusions in the anemic group as compared to the non-anemic group. Among the adverse fetal outcomes, there was increased incidence of intrauterine deaths, intrauterine growth restriction, NICU admissions, meconium stained liquor, low birth weight babies and APGAR scores <7/10 among the anemic group as compared to the non-anemic group.Conclusions: Maternal anemia is a significant risk factor for adverse maternal and perinatal outcome and its prevalence continues to be high especially in developing countries like India. So, correction of maternal anemia still remains one of the most important step towards better obstetrical care.
Intraperitoneal analgesia for postoperative pain relief after laparoscopic gynecological surgeries
Authors: Pati Basant Kumar
Published: October 2017

Background: Though laparoscopic gynaecological surgeries are less invasive and produces less post-operative pain, post-laparoscopy pain is still a concern. Intraperitoneal (IP) instillation of local anaesthetics has been shown to minimize the postoperative pain after laparoscopic surgeries. This study was conducted to compare the efficacy of intraperitoneal instillation of dexmedetomidine with bupivacaine and bupivacaine alone in reducing postoperative pain.Methods: 60 patients, enrolled for gynaecological laparoscopic surgeries were divided randomly into two groups of 30 each. Group B: Bupivacaine (30 ml, 0.25%) with 2 ml normal saline was instilled prior to removal of trocars, and Group BD: Bupivacaine (30 ml, 0.25%) with dexmedetomidine (1 mcg/kg, diluted to 2 ml) was instilled prior to removal of trocars. In postoperative period, Visual Analogue Score (VAS) was recorded up to 24 hours. Postoperative analgesic requirements, and side effects were recorded.Results: The Visual Analogue Score (VAS) during the first postoperative 24 hours was significantly lower in group BD compared to group B. Time to first analgesia required was delayed and total analgesic consumption was lower in group BD compared to group B which was statistically significant.Conclusions: Intraperitoneal instillation of dexmedetomidine with bupivacaine is an effective and safe method for reducing pain after laparoscopic gynaecological surgeries.
Menstrual disorders associated with thyroid dysfunction
Authors: R. Ramya M. , Parvathavarthini . , Savery Darshan , Sankareswari R.
Published: October 2017

Background: Present study was done to evaluate the thyroid function in patients presenting with varying menstrual patterns of reproductive age group from 15 to 45 years of age.Methods: This prospective study was carried out in obstetrics and gynecology Department of Sri Venkateshwaraa Medical College, Pondicherry, India on 155 women, clinically given the provisional diagnosis of dysfunctional uterine bleeding (DUB). All these patients were investigated for T3, T4, TSH (Thyroid stimulating hormone) levels and grouped according to that.Results: Among the 155 women (58.7%) were normal thyroid function, (41.3%) had hypothyroid and (1.3%) had subclinical hypothyroidism.Conclusions: There is a high prevalence of thyroid disorders in cases which are clinically diagnosed as DUB. Evaluating for thyroid and treating it medically which was most accurate and cost effective and unnecessary surgery was avoided. Hence the thyroid function evaluation should be mandatory in cases of DUB to detect thyroid dysfunction and these cases should be referred to physician for further medical treatment.
Single tertiary care centre experience of ovarian granulosa cell tumour in Chennai, India: a retrospective analysis
Authors: T. Deenadayalan , Narasimhan S. Lakshmi , Kalaichelvi K. , Ramkumar B. , Padmanabhan Kanchana Madurai
Published: October 2017

Background: Granulosa cell tumours of ovary are rare sex-cord stromal tumours characterized by long natural history and favourable prognosis. The present study was done to evaluate the clinical presentation, treatment, outcome, and prognostic factors for patients diagnosed as granulosa cell tumours.Methods: A Retrospective study of Granulosa cell tumour of the ovary was done for a period of five years from January 2011 to December 2015 at a tertiary care centre, Institute of Obstetrics and Gynaecology, Madras Medical College, Chennai. The clinical data and the treatment details were retrieved from the records of medical oncology department and the data were analysed.Results: Twenty five patients were diagnosed as granulose cell tumours of ovary during the study period. The median patient age was 48 years. The most common clinical presentation at diagnosis was vaginal bleeding (76%) followed by abdominal pain (40%). Mean tumor size was 9.6cm. The majority of patients were diagnosed in FIGO stage Ia (84%, n = 21). Thirteen patients (52%) underwent complete staging laparotomy. Twenty three patients (92%) had Adult Granulosa cell tumour. Two patients (8%)had juvenile Granulosa cell tumour. After surgery, all patients were put on observation except two patients who received adjuvant chemotherapy (EP: Etoposide, Cisplatin). The median followup period was 48 months. Five patients (20%) had recurrence; The average time to relapse was 29.6 months. Patients who had tumour size more than 9.7cm had more recurrence events (Hazard Ratio(HR):1.058), but their association is not significant (P value-0.839). The association between menopausal status, torsion of tumour mass, tumour stage with recurrence rate were not significant. The estimated mean overall survival was 84.8 months. Following univariate Cox regression modeling, survival appeared to be independent of age range, post operative residual tumour and the FIGO stage.Conclusions: Granulosa cell tumours of ovary are rare, often diagnosed in early stage. Patients who had tumour size of more than 9.7cm had more recurrence events. A prolonged post therapeutic follow-up is necessary to pick up the late relapses.
Evaluation of tubal patency by sonosalpingography is as good as hysterosalpingography in infertile women
Authors: Lakshmi C. Santhana , Sampath Kumara , Vardani Parvatha
Published: October 2017

Background: Tubal pathology is one of the causes of infertility in sub fertile couples. Therefore, evaluation of fallopian tubes forms an essential part of evaluation in a sub fertile woman. The aim of the study was to compare the efficacy of sonosalpingography which is a less invasive method when compared to hysterosalpingogram for evaluation of utero-tubal factor in females.Methods: A total of 95 patients 69 with primary infertility and 26 with secondary infertility attending our Obstetrics and Gynecology department were recruited for the study from June 2016 to July 2017. All the study subjects underwent Sonosalpingography on day 5th to 7th and Hysterosalpingography on 7th to 9th day of the menstrual cycle. Data was collected and compared to assess the sensitivity and specificity of sonosalpingography over hysterosalpingography. Statistical analysis was done by using SPSS software version 16.0.Results: Sonosalpingography (SSG) has 97% sensitivity and 94% specificity in comparison to hysterosalpingography (HSG). Analysis of the raw data gave positive predictive value of 98.3% and negative predictive value of 75%. From the results of this study it clear that there is no statistically significant difference (p = 0.237) between the results of the two methods (SSG and HSG).Conclusions: As sonosalpingogrpahy has high sensitivity and specificity and is less invasive. It should be used initially to assess tubal patency in cases of infertility. SSG is found to be a reliable, relatively less expensive diagnostic and therapeutic procedure in the management of infertility in females. Easy availability and accessibility of ultrasound in all primary health care centers definitely can prove superior to conventional method of diagnosis of tubal patency in such patient.
Polyflagellated macrocephalic spermatozoa: failure factor in IVF/ICSI
Authors: Mohamed Fanny , Jean-Marc Dia , Stephane Adjoussou , Founzegue Coulibaly , Minata Fomba , Edele Aka , Abdoul Koffi , Mamourou Kone
Published: October 2017

The authors report two cases of male infertility characterized by spermatic abnormalities of polyflagellated macrocephalic spermatozoa type affecting the entire gametes population. They demonstrate, on the one hand, the technical limitations of microinjection with such spermatozoa due to the large volume of their head and, on the other hand, the unfavourable outcome of the IVF-ICSI with this type of spermatozoa carrying abnormalities constituent. Molecular analysis of the somatic DNA of these subjects revealed a homozygous c.144delC mutation of the Aurora Kinase C gene. Consanguinity at the level of these subjects’ parents appears to be the main risk factor.  This situation constitutes a factor of failure of the IVF and leads to direct the couple towards the donation of gametes or the adoption as solution to the parental project.
A case report of successful retrieval of missing Cu T from peritoneal cavity in a case of pelvic Tuberculosis
Authors: Moitra Bratati , Bhagat Megha
Published: October 2017

The incidence of missing IUCD is 0.5-2%. Usually the cause is either expulsion or perforation of uterus. Sometimes the perforated IUCD remains asymptomatic for years and found incidentally later. We are hereby presenting a case of 35 years female P3 L3 who had Cu T insertion 3 years back. She was asymptomatic for more than 2 and ½ years and then presented with severe pain abdomen for which she was evaluated and exploratory laparotomy was done and Cu T was found embedded in the serosa of rectosigmoid colon which was covered by dense omental adhesions
Mixed Mullerian tumor: a case report
Authors: Nazneen Mahrukh , Wankhede Uma N.
Published: October 2017

Malignant mixed Müllerian tumor, also known as malignant mixed mesodermal tumor, MMMT and carcinosarcoma, is a malignant neoplasm found in the uterus, the ovaries, the fallopian tubes and other parts of the body that contains both carcinomatous (epithelial tissue) and sarcomatous (connective tissue) components. A 50-year female P1L1A1 with complaints of pervaginum bleeding and pain in abdomen was diagnosed to have carcinosarcoma endometrium for which hysterectomy with bilateral salphingo-opherectomy was done.
Ruptured corpus luteum cyst in women on anticoagulant: conservative or surgical management a clinical dilemma
Authors: Agarwal Manika , E. Prybot Jupirika , Dhirasaria Ashish
Published: October 2017

Ruptured corpus luteum cyst is a common finding in women of the reproductive age group, but hemoperitoneum in a case of reputured corpus luteum cyst in women on anticoagulants is an uncommon finding. Thus, management in such cases can be done by dose adjustment of anticoagulants. A woman had come to the emergency with complaints of pain distention of abdomen. Her USG showed adenexal mass with hemoperitoneum. She was on anticoagulants. Her coagulation profile was deranged. Patient was managed conservatively with dose adjustment and transfusion of blood and fresh frozen plasma. Hemoperitoneum due to ruptured corpus luteum cyst in reproductive age group have a similar presentation with ectopic pregnancy. In women in this age group pregnancies should be ruled out. Patients on anticoagulants may not require laparotomy and can be managed conservatively.
Pregnancy in uterus didelphys delivered by caesarean section: a case report
Authors: Sawai Devyani , Sharma Susheel Kumar , Sawai Devashish Singh , Sawai Uttkarsha , Sharma Sangeeta , Sharma Ajay
Published: October 2017

The aim of this study is to report a rare case of pregnancy in uterus didelphys. Mullerian duct anomalies are congenital defects of the female genital system that arise from abnormal embryological development of the Mullerian ducts. A didelphys uterus, also known as double uterus is one of the least common amongst the various Mullerian duct anomalies. It results from complete failure of fusion of Mullerian ducts. There is presence of double uterine bodies with two separate cervices and often double or septate vagina. We report the case in our institute of a pregnancy in the left sided body of a didelphys uterus, delivered by caesarean section. Patients with uterus didelphys belong to high risk group and complications are increased in malformed uterus. Such cases need a meticulous prenatal care. It is a rare Mullerian anomaly and can present with varied obstetrical and gynaecological complications. Prompt and accurate diagnosis of uterine malformations and appropriate surgical intervention are essential to prevent complications.