bluuebunny/crossref_metadata_2025 huggingface dataset:
Maternal and foetal outcome of eclampsia in a referral hospital
Authors: Ghosh Mousumi Das , Singh Vinita , Ray Alokananda
Published: February 2017

Background: Eclampsia is a life-threatening condition, common in developing countries with high fatality rate. It is a cause of maternal and foetal mortality and morbidity. The aim of the study is to determine the maternal and foetal outcome in Tata Main Hospital, Jamshedpur, Jharkhand, India.Methods: All cases of eclampsia were analysed from January 2012 to December 2014 from admission to discharge or death of the patient.  Age, parity, antenatal care, interval between attack and admission, blood pressure on admission, gestational age and mode of delivery were  taken into account. There were 135 cases of eclampsia out of 14572 deliveries. Only singleton pregnancies were analysed.Results: The incidence of antepartum eclampsia was 84.4%, intrapartum 3% and postpartum 12.5 %. 83% patients were primigravida, 33% less than 20 yrs,42% had no antenatal checkup and 45% had < 4 visits. Only 15% patients received magnesium sulphate before referral to the hospital. There were four maternal deaths and twenty-one perinatal deaths. Eleven patients needed ventilatory support, four developed pulmonary oedema,  two patients had respiratory depression and three patients had renal failure.Conclusions: Hypertensive disease in pregnancy requires proper antenatal care, early recognition and referral, adequate treatment and timely delivery.
Maternal and perinatal outcomes in cases of antepartum haemorrhage: a 3-year observational study in a tertiary care hospital
Authors: Samal Sunil Kumar , Rathod Setu , Rani Reddi , Ghose Seetesh
Published: February 2017

Background: The leading cause of maternal mortality in world is obstetric haemorrhage. Antepartum haemorrhage (APH) is defined as bleeding from or into the genital tract after 28weeks of pregnancy and before delivery of the baby. The aim of the present study is to study the demographic profile, type of antepartum haemorrhage (APH), maternal and perinatal complications in cases of APH and to formulate preventive guidelines so as to reduce maternal and perinatal complications in cases of APH.Methods: The study was a retrospective observational study conducted in Mahatma Gandhi Medical College & Research Institute, Pondicherry from November 2013- October 2016 [3 years]. Cases of pregnancy complicated with APH were taken. Cases with bleeding before 28 weeks and after delivery of the baby were excluded. Data collected from the records present in Labour ward complex and Medical record section.  Statistical analysis done by using SPSS software version 21.Results: Total 218 cases were presented with APH and the incidence was 2.9%. Among these 49.5% were Placenta Praevia, 42.2% were abruption placentae, 6.8% cases were indeterminate (3 cases of vasa praevia and 12 cases of excessive show) and 1.5% cases were of extraplacental cause(Local causes). Most cases were multipara with most common age group was 26-30 years (42.2%). Pregnancy in most of the cases was terminated during 34-36+6 weeks of gestation (73.0%). Most common associated risk factors found were previous caesarean section, preeclampsia, previous history of curettage, malpresentation and anaemia. Postpartum haemorrhage was found in 42.2% cases while in 4 cases peripartum hysterectomy done. Most common perinatal complications were due to low birth weight (66.5%).Conclusions: The morbidity and mortality in pregnancies complicated with APH can be achieved by early diagnosis, proper antenatal planning and terminating the pregnancy in a well-equipped tertiary health care centre.
Fetal heart rate patterns in patients with thick meconium staining of amniotic fluid and its association with perinatal outcome
Authors: Desai Dharna , Maitra Nandita , Patel Purvi
Published: February 2017

Background: This study assesses the role of abnormal fetal heart rate tracing patterns in patients with thick meconium staining of the amniotic fluid and its association with perinatal outcomes.Methods: Prospective unmatched case-control study on 2 groups of 136 subjects each- cases had thick MSAF and controls had clear liquor with abnormal fetal heart rate tracings on cardiotocography.Results: Gestational age (GA) >40 weeks, was found to have a significant association with MSAF (p value 0.01556 CI 95%). Premature Rupture of membranes at term (PROM) showed a significant association with MSAF with an OR of 2.25 (95% CI 1.37, 3.7); Post datism had significantly higher odds for being a risk factor for MSAF with an OR (3.194) (CI 95% 1.003-10.165). MSAF was not found to be significantly associated with abnormal trace on CTG. Neonatal morbidity (MAS, birth asphyxia, sepsis, HIE) had statistically higher odds in cases 1.669 (0.884-3.150) as compared to controls.Conclusions: No particular cardio-tocograph pattern can be considered to have a poor prognostic value in the presence of thick MSAF and the decision to deliver and the mode of delivery should be based on the overall assessment and the stage and progress of labor. While management should be individualized, a higher Caesarean section rate in thick MSAF can be justified to ensure a better outcome for the neonate even in the presence of a normal CTG trace.
A study of prevalence of thyroid disorders in patients with abnormal uterine bleeding
Authors: H. S. Ashok Kumar , S. Saravanan , S. Saravanan
Published: February 2017

Background: Thyroid gland is the most vital endocrine organ which plays a major role in growth, development, metabolism and function of almost every organ of our body. Both hypothyroidism and hyperthyroidism can result in menstrual irregularities. Abnormal Uterine Bleeding (AUB) is one of the most common, yet complicated clinical presentation. It occurs in 10-20% of women between 15-50 years of age. Timely detection of thyroid dysfunction in patients presenting with AUB and their proper management can prevent unnecessary surgical interventions. This study was done to analyze the prevalence of thyroid dysfunction in patients with AUB and also to look for different menstrual patterns associated with thyroid dysfunction.Methods: This is a prospective study conducted at Department of Obstetrics and Gynecology, Government Medical College, Manjeri, Kerala, India. Total 200 patients were recruited into present study after satisfying all inclusion and exclusion criteria. Complete history was taken followed by a thorough examination. Baseline investigations and T3, T4, TSH was performed in all patients. Results were analyzed.Results: As per present study, majority of the patients with AUB were from the age group of 35-49 years (43%). In patients with AUB with thyroid dysfunction, prevalence of subclinical hypothyroidism was most common followed by hypothyroidism. According to our study thyroid dysfunction was most commonly seen in the age group of 35-49 years, and the most common presentation being menorrhagia.Conclusions: Timely diagnosis and proper management of thyroid dysfunction in women with AUB can avoid variety of non-specific and ineffective diagnostic and therapeutic procedures.
Utility of second trimester beta HCG levels in prediction of gestational hypertension: a prospective cohort study
Authors: Chowdhary Heena , Khurshid Rabia , Parveen Shameema , Yousuf Shagufta , Tali Showkat Hussain , Shah Zafar Amin
Published: February 2017

Background: Gestational hypertension is a significant threat both to maternal and fetal health. However, it is still a distant dream to predict accurately its occurrence in early pregnancy. Objective was to find out if β HCG levels determined between 13 to 20 weeks of gestation can be used as a predictor for gestational hypertension.Methods: This prospective observational cohort study was conducted from August 2014 to January 2016. Serum β HCG levels were determined at 13 to 20 weeks of gestation of 190 normotensive pregnant women attending the antenatal clinics. They were followed for the development of gestational hypertension till 40 weeks of gestation or delivery.Results: Out of the total 190 women, 25 (13.1%) developed gestation hypertension. Of those who developed gestational hypertension, 22 (88%) were having β HCG levels >2 MOM (p<0.001). Absolute β HCG levels (Mean±SD) were also significantly higher (54907±29509 V/S 41095±19103; p<0.001) in subjects who later developed gestational hypertension. Sensitivity, specificity, positive predictive value and the negative predictive value for β HCG at >2 MOM were 83.3, 96.9, 80.0 and 97.5 respectively (95% CI).Conclusions: Pregnant women with high Beta HCG levels in early pregnancy have significantly higher risk for development of gestational hypertension.
Assessment of foetal cardiac function by myocardial tissue doppler in foetal growth restriction
Authors: Basu Barnali , Shetty Ranjan , Gupta Krishnendu
Published: February 2017

Background: One of the consequences of IUGR is the development of cardiac diastolic dysfunction in fetuses. Tissue doppler in echocardiography is a new technique to detect myocardial tissue function and can act as a useful tool in the identification of this complication. Hence we decided to undertake this study to assess the utility of myocardial tissue doppler in detecting foetal cardiac dysfunction in IUGR. It was a prospective case control study in a tertiary care teaching hospital.Methods: Foetal cardiac function in the third trimester of pregnancy was evaluated with the help of myocardial tissue doppler and compared between IUGR and normal growth babies and correlated with vessel doppler findings and neonatal outcomes.Results: There were sixty two IUGR and fifty eight normal growth babies in the study. In babies with IUGR, particularly the ones with severe IUGR, abnormal vessel doppler and adverse neonatal outcomes, right ventricular MPI was found to be significantly lower. However, the variable had a poor sensitivity (40%) in detecting fetuses at risk for poor neonatal outcomes.Conclusions: Myocardial tissue doppler shows right sided cardiac dysfunction in IUGR babies in comparison to normal growth babies It is however not a sensitive indicator of adverse perinatal outcome in IUGR babies.
Maternal determinants affecting perinatal mortality: a multivariate statistical approach
Authors: Agrawal Manish , Bhatnagar Kriti
Published: February 2017

Background: India has made considerable progress over the last two decades in the area of maternal and child health, through innovative and comprehensive health packages that covers the spectrum of Reproductive Child Health (RCH). Awareness of the special vulnerability of the cohort of mothers with ‘high risk factor’ has led to the popular recognition of ‘risk approach’, involving the optimal use of existing MCH services, providing essential obstetrical care for all with early detection of complications and emergency services for those who need it, thus reducing the need for intensive care along with reduction in perinantal mortality. The objective was to assess the prevalence of various maternal risk factors in pregnant women in hospital admissions and their correlation with perinatal mortality.Methods: The present study was carried out on 2050 consecutive deliveries from 1st April 2015 to 31st March 2016 at Department of Obstetrics and Gynecology and Department of Pediatrics, Muzaffarnagar Medical College, Muzaffarnagar Uttar Pradesh, India. All the pregnant women were interviewed and examined in detail at the onset of labor regarding various biosocio-economic characteristics, history of past and present medical and obstetrical complications.Results: The PNMR (93.66/1000 birth) observed in present study was still at a higher level and comparable to that in other studies done by various authors in past in this region. A significantly higher PNMR was observed with increase in maternal age and parity (3 times higher PNMR at >35 years and 2 ½ times higher PNMR at parity >5). Similarly, medical illnesses (3 times higher PNMR) and obstetrical complications (1.5 times higher PNMR) during present pregnancy were showing significant effect on perinatal outcome. In a multivariate analysis, residence (rural /urban), place and number of antenatal visits, gestational age and type of delivery remained as most significant maternal risk factors (p<0.005) after multiple logistic regression of other factors viz. maternal age, height, weight, parity, education, socio-economic status and antepartum anemia.Conclusions: It is heartening to observe that highest risk is associated with simple and easily identifiable factors like, unbooked cases, <3 antenatal visits, severe anemia, age >35 years, parity >5, weight <40 kg, height < 140cm , poor dietary calories, medical and obstetrical complications. These can identified from history only by grass root workers like traditional birth attendants and even elderly female family members. These risk determinants, labeled as simple but ‘high’ high risk are associated with poor perinatal outcome. If these factors are timely identified at community level and appropriately referred by grass root workers, it will significantly reduce perinatal mortality and improve neonatal survival.
Conservative management options for morbidly adherent placenta
Authors: Satia Meena N. , Gandhi Animesh , Shilotri Manali P.
Published: February 2017

Background: Morbidly adherent placenta is still a very significant cause of obstetric hemorrhage.Methods: A retrospective, descriptive study was undertaken over a period of one and a half year in a tertiary care hospital of all diagnosed cases of morbidly adherent placenta which were managed conservatively and the maternal and perinatal outcomes were noted. Preparation for conservative management of cases of adherent placenta in the antenatal period included informing interventional radiologists and placement of internal iliac balloon catheters just before classical caesarean section. Post-operative methotrexate was used in a few patients.Results: 11 cases of morbidly adherent placenta diagnosed on Doppler ultrasound scan, and confirmed by MRI were identified. All patients underwent classical caesarean section. 9 patients had internal iliac balloon placement. 5 patients received methotrexate. 3 patients required obstetric hysterectomy. 1 maternal and 2 perinatal mortalities were noted.Conclusions: Interventional radiology and methotrexate can be used to avoid peripartum hysterectomy and to optimize maternal and perinatal outcome.
Classification of stillbirths by relevant condition at death (ReCoDe): a cross sectional study at a rural tertiary care centre in Kerala, India
Authors: K. K. Ajini , K. R. Radha , R. P. Reena
Published: February 2017

Background: Stillbirths account for a major proportion of   perinatal deaths. The cause for a large number of stillbirths, remain unexplained. The ReCoDe system (classification of stillbirths by relevant condition at death) has helped to improve our understanding of the causes of stillbirths. We evaluated stillbirths and classified them by the ReCoDe system. The objective was to identify factors associated with stillbirths and to classify the causes of stillbirths using the ReCoDe system.Methods: We recruited all women admitted to a tertiary care centre with a diagnosis of intrauterine fetal death after 22 weeks of gestation. Maternal sociodemographic characteristics and relevant antenatal and intrapartum investigations were studied. We examined the stillborn babies, placenta and umbilical cord and classified them according to the ReCoDe system.Results: There were177 women with intrauterine fetal death admitted during the 2 year study period. The stillbirth rate was 38.56 per 1000 live births. We could explain the cause of stillbirth in 87.58% of   cases by using the ReCoDe system.  Intra uterine growth restriction (41.8%) was the commonest cause followed by hypertensive disorders (27.68%), congenital anomalies (15.81%) and diabetes (14.68%) in present study.Conclusions: We found the ReCoDe system useful in classifying the cause of stillbirths in resource limited settings.
The study of maternal and perinatal outcome in prolonged pregnancy
Authors: Singh Shivani , Gupta Hem Prabha , Verma Urvashi , Yadav Gunjan
Published: February 2017

Background: Prolonged pregnancy or post-dated pregnancy is that pregnancy which has exceeded duration considered to be upper limit of normal pregnancy that is above 40 completed weeks or 280 days from the first day of last menstrual period. The objective was to evaluate the maternal and perinatal outcome of post-dated pregnancy.Methods: A prospective case control study was conducted on antenatal women for 18 months period from May 2014- October 2015 admitted to the Obstetrics and Gynecology Department, Era’s Lucknow Medical College and Hospital, Lucknow, Uttar Pradesh, India. The study group was comprised of antenatal women having pregnancy beyond 40 weeks, and the control group was represented with antenatal women between 37-40 weeks admitted for delivery during this period.Results: The prevalence of post-dated pregnancy was found to be 17.6% and of post-term was 5.69%. Among post-dated subjects LSCS rate was 56.50% and in term (37-40 weeks) patient it was 34.18%. The NICU admission for birth asphyxia was 6.09% among term (37-40 weeks) patients and 17.6% in post-dated pregnancies.Conclusions: Any pregnancy that crosses expected date of delivery, Foetal well-being must be assessed and induction of labour should be considered to decrease the risk of perinatal morbidity and mortality.
Two different timing of intra uterine insemination in patients of unexplained infertility: a randomized clinical trial
Authors: Elsersy Mervat A.
Published: February 2017

Background: Unexplained infertility is diagnosed when the basic infertility workup is found to be normal. The objective was to compare between the results of IUI performance at 24 hours or 36 hours after hCG injection in couples with unexplained infertility.Methods: A prospective comparative study was conducted on 250 patients diagnosed with unexplained infertility who were randomly allocated in two equal groups. Each patient received ovulation induction. Follicular growth scanning was performed, patients received 10.000 hCG injection when there was mature follicle equaled to or more than 18mm. Then they randomly allocated to either group 1 who underwent IUI 24 hours after hCG injection or group 2 who underwent IUI 36 hours after hCG injection.Results: The positive qualitative serum β -hCG test was higher in group 1 who received IUI  24 hours after hGC injection, 24%, while in group 2 who received IUI  36 hours after hGC injection, it was 16.8% but no statistical differences between the two studied groups  could be observed. The most important finding in this study is that the clinical pregnancy rate in group 1 was significantly higher than in group 2.Conclusions: Earlier IUI procedures increased the clinical pregnancy rate in patients with unexplained infertility during ovulation induction with gonadotropins. Correct timing of insemination is essential.
Assessment of labor and delivery in pregnant women on sulfadoxine-pyrimethamine regimen in Yaoundé gynaeco-obstetric and paediatric hospital: a comparative study of 313 cases
Authors: Foumane Pascal , Essiben Felix , Dohbit Julius Sama , Tongn Carine Yondjeu , Meka Esther Juliette Ngo Um , Ojong Samuel , Mboudou Emile Telesphore
Published: February 2017

Background: Malaria is still a major public health problem in sub-Saharan Africa. The aim was to determine the prevalence of malaria infection at the onset of labor and the resulting complications.Methods: We carried out a five-month cross-sectional study at the Yaoundé Gyneco-Obstetric and Pediatric Hospital.  We used results from the rapid diagnostic test (RDT) to compare two groups of pregnant women admitted into the labor room. Women who tested positive were assigned to the exposed group versus negative to the non-exposed group. Independent factors associated with malaria infection were investigated by the logistic regression method.Results: Up to 79.6% (249/313) of women had received the sulfadoxin-pyrimethamine regimen with 32.9% (82/249) receiving at least 3 doses.  Malaria infection was detected in 32.2% (101/313) of women. Only 14.9% (15/101) of the exposed group had received 3 doses of SP versus 31.6% (67/212) of the non-exposed group. After univariate analysis, malaria infection at the onset of labor was associated to premature rupture of membranes (OR=1.39; CI=1.01-1.94), fever during labor (OR=73.37; CI=64.80-681.95), non-reassuring fetal status (OR=2.08; CI=1.36-3.20), low birth weight (OR=1.65; CI=1.23-4.13), prematurity (OR=2.79; CI=2.12-367), a poor Apgar score at the 1st minute and postpartum fever (OR=3.19; CI=2.56-4.00). Linear logistic regression indicated that the occurrence of fever during labor (aOR=63.09), and low Apgar score at the first minute (aOR=6.27) remained significant and malaria infection was significantly associated to the single marital status (aOR=2.56) and a history of malaria during the current pregnancy (aOR=2.56).Conclusions: Systematic RDTs is thus recommended at the last antenatal consultation to avoid identified complications.
Association of increased platelet distribution width and red cell distribution width with recurrent pregnancy loss
Authors: Meena Rajani , Meena Mohan Lal , Meena Priyanka , Meena Renu
Published: February 2017

Background: Recurrent pregnancy loss is defined as three or more consecutive pregnancy losses at or less than 20 weeks of gestation or with a fetal weight less than 500 grams. The aim was to compare platelet distribution width and red cell distribution width between pregnant women with a history of recurrent pregnancy loss and pregnant women without a history of pregnancy loss.Methods: This was a prospective study to the evaluation of 70 pregnant women with a history of recurrent pregnancy loss and 70 pregnant women without a history of pregnancy loss in the first trimester.Results: When compared pregnant women with a history of recurrent pregnancy loss and 70 pregnant women without a history of pregnancy loss, the pregnant women with a history of recurrent pregnancy loss had significantly higher platelet distribution width and red cell distribution width (p≤0.001 for both). There was no statistically significant difference between the two groups in terms of age, BMI, Hemoglobin, TLC, hematocrit, platelecrit, mean corpuscular volume, mean corpuscular haemoglobin, mean corpuscular haemoglobin concentration (p>0.05).Conclusions: An increased platelet distribution width and red cell distribution width with recurrent pregnancy loss.
Relation of serum 25(OH) D with variables of thyroid and lipid profile in perimenopausal women
Authors: Rani Poonam , Gupta Seema , Gupta Gaurav
Published: February 2017

Background: Deficiency of vitamin D is quite prevalent among elderly population or postmenopausal women worldwide and may affect various function of the body. The status of its deficiency with their relation with other variables are not well explored in perimenopausal women.Methods: 100 perimenopausal women from the department of obstetrics and gynaecology were selected without having known risk of thyroid disorder and cardiovascular disease. The age group criteria for these women were 40 to 50 years. Thyroid profile including TSH, T3, and T4 were estimated by using enzyme linked immunesorbent assay. Serum levels of 25(OH) D3 was estimated by using spectrophotometric method. Lipid profile including TC, TG and HDL-C were estimated CHOD-POD method, GPO-PAP method, and CHOD-POD/Phosphotungustate method. LDL-C was calculated by friedewald formula.Results: There 58 women were presented with insufficient amount of vitamin D. They were characterised with increased BMI, elevated thyrotropin alongwith lower concentrations of T3 and T4. Increased levels of TC, TG and LDL-cholesterol alongwith lower concentration of HDL-C were also observed in women with vitamin d deficiency. Women having vitamin D deficiency were presented with overweight (OR-18.0, p-value=<0.001) and dyslipidemia (OR-12.13, p-value≤0.001). Vitamin D was negatively correlated with variable i.e. BMI, TSH, TC, TG and LDL-C. This negative association was significant (<0.001) while HDL-C and T4 were positively correlated with vitamin D levels in this study population.Conclusions: Vitamin D deficiency frequently occurs in middle aged perimenopausal women. Negative correlation of it with BMI, TSH and lipid variables may suggest the development of cardiovascular disease and hypothyroidism in coming years. Vitamin D supplements or vitamin D containing diet and regular exposure to sun is highly recommended to perimenopausal women.
First B-HCG predict pregnancy outcome after in-vitro fertilization
Authors: De Oliveira Sofia Andrade , Seguro de Carvalho Fernanda Silveira , Júnior Julio Elito
Published: February 2017

Background: About 22% of IVF-conceived pregnancies result in spontaneous abortion. Therefore, it is important to predict the complicated and poor pregnancy outcome. Serum human chorionic gonadotrophin levels after 2 weeks of embryo transfer is a reliable marker to predict the pregnancy outcome in patients of IVF. Objective was to correlate the evolution curve of B-HCG after embryo transfer in assisted human reproduction techniques and the pregnancy outcome.Methods: A prospective and observational study. In patients who underwent embryo transfer, a collection of quantitative B-HCG in 12th day after transfer was made. In patients who had beta-HCG positive value (beta-HCG>5.0 mUI/ml), there were two new collections of beta-HCG 48 hours and 72 hours after the first collection. All results have been filed and all pregnancies were accompanied to the final outcome.Results: It was found that B-HCG values above 139.5 mIU / ml were associated with a good prognosis gestational.Conclusions: Larger studies are needed to improve these findings and give better information regarding the prognostic value of early pregnancy hCG levels.
Prediction of perinatal outcome with umbilical artery Doppler in IUGR fetuses- a prospective analytical study in a tertiary medical college in Tamilnadu, India
Authors: R. Rajarajeswari , Thendral V.
Published: February 2017

Background: Umbilical artery Doppler blood flow studies were a better predictor of neonatal outcome than estimated fetal weight alone in intrauterine growth restricted (IUGR) fetuses. Perinatal mortality and morbidity are increased if the umbilical artery Doppler abnormality worsens.Methods: This study was conducted in Department of Obstetrics and Gynaecology, Thanjavur medical college from August 2015 to August 2016. One hundred singleton pregnancies complicated by IUGR beyond 32 weeks were subjected for Doppler study of umbilical artery. Perinatal outcome in terms of baby outcome, birth weight, early neonatal death, admission in NICU and duration of admission in NICU were analysed.Results: The main indication of termination of pregnancy was oligohydramnios (70%). The other causes of termination were 8% for uncontrolled hypertension and 4 % for post term. 60 % were delivered vaginally and 40% by lower segment cesarean section. Various indication for LSCS were Non-reactive CTG, fetal distress, severe oligohydramnios and failed induction. 92% were delivered alive babies and 8% still born babies. Birth weight of the babies varied from 900gm to 2.5Kg. But patients with absent or reversed end diastolic flow in umbilical artery Doppler, 80% of the babies weighed less than 1.5Kg. Perinatal mortality in our study is 19% which includes 8% of intrapartum mortality and 11% of neonatal mortality and perinatal morbidity is 24%. When the diastolic flow in the umbilical artery is, absent or reversed, it is associated with increased perinatal mortality of 80%.Conclusions: The results of present study clearly demonstrated the efficacy of umbilical artery Doppler in predicting the fetal outcome. To improve the predictive value of this tool, a better method is needed to assess the wellbeing of the IUGR fetuses such as integrated antenatal test which combines BPP and Doppler study employing other vessels.
A cross sectional study of liver function tests in normal pregnancy during third trimester: a treasure from the past
Authors: Singh Nirpaul , Yousuf Shagufta , Tali Showkat H.
Published: February 2017

Background: During pregnancy, a lot of changes do occur and affect every organ system in the body. Objective of the study was to find out expected variations, if any, in liver function tests (LFT) in normal pregnancy during the third trimester.Methods: A total of 75 women aged between 20 to 35 years were enrolled in the study of which 25 were non-pregnant women (control group) and 50 were pregnant women in their third trimester (study group).Results: In the study group, there were no changes in SGPT, serum albumen and serum globulin values in any of the subjects. However out of 50 subjects, a rise in serum alkaline phosphatase could be demonstrated in as many as 44 (88%) subjects. In 10 (20%) subject Serum Bilirubin was high and in 6 (12%) subjects each a rise in SGOT and fall in Serum Proteins could be demonstrated.Conclusions: Except for a significant change in serum phosphatase levels, there is no significant variation in any of the liver function tests in third trimester of pregnancy.
A comparative study of total laparoscopic hysterectomy and non-descent vaginal hysterectomy for treatment of benign diseases of uterus
Authors: Chattopadhyay Shibram , Patra Kajal Kumar , Halder Madhusudan , Mandal Apurba , Pal Preetam , Bhattacharyya Shritanu
Published: February 2017

Background: Hysterectomy is the most common performed major gynaecological surgery and the decision depends on indications for operation, surgeon’s training and preference, uterine size, adnexal pathologies and patient choice. To avoid laparotomy either total laparoscopic hysterectomy (TLH) or non-descent vaginal hysterectomy (NDVH) is the recently practised option. Objectives of the present study are to compare duration of operation, blood loss, ambulation time, post-operative pain and complications between TLH and NDVH.Methods: Patients undergoing above operation during January 2014 to December 2014 at N.R.S. Medical College, Kolkata, were included under the study. All patients were thoroughly examined and investigated and malignancies were excluded by Pap smear and or D&C. All patients were observed minutely during pre-operative, intra operative and post-operative period for any complications.Results: NDVH requires less operative time than TLH but intra operative blood loss, post-operative pain and ambulation time are slightly more.Conclusions: TLH requires infrastructural set up, greater surgical expertise, longer operative time and major intraopertive complications as compared to NDVH. In our low resource government hospital NDVH is better choice for removal of uterus in uncomplicated benign conditions.
A study of male friendly approach in obstetrics and gynaecology outpatient department
Authors: Bhatt Jalpa K. , Desai Malini R.
Published: February 2017

Background: Involvement of male relative in management of female reproductive disorders is low in many countries including India. Active participation of male relatives by establishing male friendly approach in Obstetrics and Gynecology (OBGY) outpatient department is a novel concept. This study explores the perceptions of male relatives accompanying the patients regarding male friendly approach which constitutes attitude of medical and paramedical staff towards them, involvement of male relatives in counseling and their role in decision making in obstetrics and gynecology outpatient department.Methods: This prospective study was carried out over three months in Obstetrics-Gynecology outpatient department of a tertiary care teaching hospital. Male relatives accompanying the patient were enrolled in the study. The participants were allowed to remain present at the time of history taking and post examination counseling. They were also asked to be part of the decision making whenever required. Feedback from the male relatives was obtained using a questionnaire.Results: Out of 450 patients attending the OBGY Outpatient Department (OPD) during the three months study period 100 were accompanied by male relatives. Participation in decision making was the commonest reason for accompanying the patient (36%). All the male relatives involved in this study were satisfied with the approach of doctor and paramedical staff and 85% were willing to accompany their female relative at every visit.Conclusions: Making health services for women more male friendly would increase participation of male relative in healthcare of female reproductive disorders. This can improve women’s health and eventually reduce maternal and neonatal morbidity and mortality.
Intrauterine levobupivacaine for pain control during intrauterine device insertion
Authors: Akgun Nilufer , Keskin Esra , Kalem Muberra Namlı , Bakirarar Batuhan
Published: February 2017

Background: Safe, effective, long term and a reversible contraception method is offered by intrauterine devices (IUDs).  The objective was to determine the potency of intrauterine administration of 5 cc levobupivacain for pain relief with IUD insertion, when compared with saline placebo.Methods: This was a prospective randomized, double blind placebo-controlled trial undergoing İUD insertion. The trial medication was intrauterine anesthesia, either 5 mL 0.9% saline (control group), or 5 mL 0.5% levobupivacaine. Our primary outcome was self-reported pain scores on a 10 cm visual analogue scale (VAS) immediately following IUD insertion.Results: 95 women were enrolled, and data for 88 women were analyzed. In IUD insertion procedure, no difference was observed between groups during teneculum placement and solution administration, in the course of VAS scores (p=0.349, p=0.396). There was a significant difference in the VAS scores measuring pain suffering during and after IUD procedure (p=0.001).Conclusions: Intrauterine instillation of 5 cc of levobupivacaine along with saline solution reduces pain with IUD insertion when compared to intrauterine saline placebo. Broad deviation in pain scores and persistent pain after IUD insertion recommends that patient would benefit from more functioning method of pain control than before at IUD insertion and during the post interval.
Combined transurethral and laparoscopic partial cystectomy for the treatment of bladder endometriosis
Authors: Algreisi Fahad , Badr Hattan , Alturkistani Daniya , Vilos George
Published: February 2017

We present a case of a 22-year-old nulliparous woman, initially investigated by a urologist after she presented with a history of urinary tract symptoms including catamenial hematuria and suprapubic pain.  Ultrasonographic and cystoscopic findings suggested a bladder mass suspicious for endometriosis. Further MRI revealed a 3 X 4 cm mass in the bladder, and the diagnosis of endometriosis was confirmed by the biopsy. Consequently, the patient was offered treatment options including combined laparoscopic and transurethral resection of the bladder lesion for definitive diagnosis and treatment. Using a combination of hydrodissection and CO2 laser energy laparoscopically and monopolar electro-surgery cystoscopically, the lesion was resected uneventfully and the bladder defect was repaired laparoscopically. The patient was discharged on the same day with a Foley catheter, which was removed 10 days later. After 8 weeks follow up period, she remained free of symptoms. Histopathology confirmed endometriosis. We conclude that this combined approach is feasible, safe and effective therapy for intramural bladder endometriosis.
Pregnancy with lupus nephritis: a case report
Authors: Mishra Vineet , Goel Sugandha , Aggarwal Himani , Choudhary Sumesh
Published: February 2017

Systemic lupus erythematosus (SLE) is an autoimmune connective tissue disorder that commonly affects women of childbearing age. Lupus nephritis in pregnancy increases risk of maternal and fetal morbidity and mortality. Active disease during pregnancy and disease flares can lead to poor outcome. Higher rates of fetal loss, preterm birth, intra-uterine growth restriction (IUGR), and neonatal lupus syndromes, gestational diabetes, osteoporosis, avascular necrosis, hypertension, preeclampsia, ecclampsia, stroke, HELLP syndrome, and maternal death are major issues. There is difficulty in recognizing disease flare because of normal physiological changes during pregnancy. Preeclampsia mimics disease symptoms of lupus nephritis and presents confusion in diagnosis. Management option is limited to few safer drugs. Lupus nephritis with antiphospholipid antibodies presents with refractory fetal loss and complete heart block associated with anti-Ro antibodies. A multidisciplinary approach, with close medical, obstetric and neonatal monitoring, is essential for optimal outcomes. Our aim is to report a case of primigravida 37 years old with controlled lupus nephritis.
A case of strongyloidiasis in pregnancy
Authors: Prasad Madhva , Chauhan Anahita , Chamariya Sumit , Kuyare Sunil , Koticha Avani
Published: February 2017

Helminthic infections such as Strongyloides stercoralis occurs commonly in immunocompromised states. However, they can rarely occur in normal individuals also. A 23 year old multigravida presented at 39 weeks gestation with watery diarrhoea. She was evaluated and diagnosed of strongyloidiasis. Medical management was given and pregnancy outcome was successful. This case is reported because strongyloidiasis is a rare and underreported occurrence in pregnancy, which can occasionally be fatal.
Brenner tumor of ovary: an incidental finding: a case report
Authors: Jodha Bhanwar Singh , Garg Richa
Published: February 2017

Brenner tumor of the ovary is very rare, mostly benign, small, and unilateral. Malignant brenner tumor is much rarer. Malignant brenner tumor of ovary closely resembles the transitional cell carcinoma of ovary. These tumors are believed to arise from urothelial metaplasia of ovarian surface epithelium. However the latter has a worse prognosis. Here we present a case of Brenner tumor of ovary in a postmenopausal woman treated surgically and its features are briefly discussed.
Traumatic avulsion of female urethra: a case report
Authors: Mishra Vineet , Goel Sugandha , Agarwal Himani , Shah Kunur
Published: February 2017

Traumatic female urethral avulsion in the absence of a pelvic fracture is an exceedingly rare entity. We report a case of 26 years old lady with crescentic tear of anterior urethra from pubic symphysis. Management consisted of primary urethral repair.
Spontaneous uterine rupture in primigravida at 15 weeks
Authors: Ghosh Mousumi Das , Singh Vinita
Published: February 2017

This is a very rare and interesting case of primigravida with sonographic evidence of intrauterine pregnancy presenting with acute abdomen at 15 weeks. With the diagnosis of uterine rupture, emergency laparotomy was done. The defect was repaired and post-operative recovery was good. This shows that spontaneous uterine rupture can occur in primigravida and should be kept in mind during diagnosis of acute abdomen.
Choriocarcinoma with uterine rupture presenting as acute haemoperitoneum and shock
Authors: Gueye Mamour , Gueye Mame Diarra Ndiaye , Thiam Ousmane , Toure Youssou , Cisse Mor , Wade Mouhamadou , Diouf Aliou , Mbaye Magatte , Moreau Jean Charles
Published: February 2017

Choriocarcinoma is a rare neoplasm and a malignant form of gestational trophoblastic disease. Invasive mole may perforate uterus through the myometrium resulting in uterine perforation and intraperitoneal bleeding. But uterine perforation due to choriocarcinoma is rare. We present a case of a young woman who presented 1 year after uterine evacuation of a molar pregnancy with invasive choriocarcinoma complicated by a uterine rupture and haemoperitoneum.
Uterine conserving surgery in a case of cervicovaginal agenesis with cloacal malformation
Authors: Mishra Vineet , Saini Suwa Ram , Roy Priyankur , Aggarwal Rohina , Verneker Ruchika , Hokabaj Shaheen
Published: February 2017

Cervico-vaginal agenesis (MRKHS) with normally formed uterus along with cloacal malformation is a very rare mullerian anomaly. We report a case, of a 13-year-old girl who was admitted at our tertiary care center with complaints of primary amenorrhea and cyclical lower abdominal pain for 3 months. Clinical examination and radiological investigations revealed complete cervico-vaginal agenesis with normal uterus with hematometra with horse shoe kidney. Vaginoplasty was done by McIndoe’s method with uterovaginal anastomosis and neocervix formation. Malecot’s catheter was inserted in uterine cavity. Vaginal mould was kept in the neovagina. Mould was removed after 10 days under anaesthesia and repeat hysteroscopy with insertion of a small piece of malecot’s catheter was performed under hysteroscopic guidance into the uterine cavity through neocervix and lower end fixed to the vagina. After 3 months, the malecot’s catheter was removed. During follow up, she was menstruating normally at 6 months post-operatively and had a completely healed vaginal mucosa. Earlier hysterectomy was considered as a definitive surgery for this condition; however, it has been replaced with more conservative approach, like uterovaginal anastomosis with creation of neovagina. In literature, successful pregnancy has been reported in these patients who underwent conservative surgery.
Dysgermgerminoma in a 14 year old girl: a case report
Authors: Kurude V. N. , Thorat Sukanya
Published: February 2017

An accurate diagnosis of ovarian dysgerminoma is crucial as, as its management differs from other ovarian tumours. We report a case of ovarian dyegerminoma in a 14 year old girl who presented with abdominal distention.  Examination revealed a huge intra-abdominal mass causing displacement of bowel loops laterally. On ultrasound, a solid heterogeneously hyperechoic lesion of size 18 x 9.4 cm with few cystic and necrotic areas within most likely, left adnexa reaching upto the umbilicus and shows vascularity within both ovaries not seen separately from the lesion. On CT (A+P), a heterogenous hypodense polycystic mass of size 8.5x1.4x16.7 with multiple irregular hypodensities seen in the lower abdomen and pelvis. The mass was removed after laparotomy under general anaesthesia. Finally, the diagnosis of ovarian germ cell tumor (Dysgerminoma was made. Present case presented with marked abdominal distention, without any loss of weight, appetite or any menstrual problem. Such a presentation may be unusual for such a large malignant ovarian mass.
Ovarian huge serous cystadenoma with torsion in adolescent girl: a case report
Authors: Khade Shweta Avinash , Shirodkar Sneha
Published: February 2017

In adolescent Ovarian cysts are an extremely common gynaecological problem. Majority of ovarian cysts are benign with few cases being malignant. Ovarian serous cystadenomas are rare in children. A 14-year-old presented with severe abdominal pain and abdominal distention. She underwent emergency laparotomy and surgical removal, the mass was found to be torsion of ovarian serous cystadenoma-fibroma on histology. In conclusions, germ cell tumours the most important causes for the giant ovarian masses in children. Epithelial tumours should not be forgotten in the differential diagnosis.
Ovarian hyperstimulation syndrome and pulmonary edema – a rare complication
Authors: Mishra Vineet , Roy Priyankur , Choudhary Sumesh , Aggarwal Rohina , Hokabaj Shaheen , Saini Suwa Ram
Published: February 2017

Background: Ovarian Hyperstimulation Syndrome (OHSS) is a life-threatening complication of controlled ovarian stimulation almost exclusively associated with gonadotropins but occasionally with clomiphene citrate. Prevention of this syndrome lies in the recognition of risk factors and individualizing the treatment regimens. Causes of respiratory distress in patients with OHSS are pleural effusion, pulmonary embolism, and acute respiratory distress syndrome (ARDS). Pulmonary edema is rare but a grave complication of OHSS.Case report: We report, a case of severe OHSS with tense ascites and anasarca after controlled ovarian hyperstimulation (COH) for IVF. She was managed conservatively followed by paracentesis after which she developed pulmonary edema during the course of the treatment.Conclusion: OHSS is an iatrogenic complication which can be prevented by individualizing stimulation protocols and should be managed urgently with a multidisciplinary approach.
Anaplastic ganglioglioma becoming symptomatic in the third trimester of pregnancy
Authors: Pikis Stylianos , Petrosyan Tigran , Diamantopoulou Kalliopi , Kelesis Christos
Published: February 2017

Intracranial tumors are rare in pregnancy and may present a diagnostic and therapeutic challenge. We report on a 34-year-old female who presented with new-onset partial seizures hours following delivery due to a left frontal space occupying lesion. Urgent surgical resection of the lesion was performed and histopathologic evaluation revealed anaplastic ganglioglioma. Post-operatively the patient received radiotherapy and temozolamide chemotherapy. She reported a three-month history of progressive headache and nausea which were falsely attributed to pregnancy both by the patient and her treating physician leading to a delay in diagnosis and management. In the pregnant patient presenting with neurological symptoms a high index of suspicion and a thorough physical examination is required to identify those patients at risk of intracranial pathology.
Fillet flap method of ear keloid repair and its cosmetic outcome: our experience
Authors: G. Rajalakshmi , Arif Mohammed , M. Sanjana
Published: February 2017

Background: Formation of keloid after cosmetic or traditional ear piercing is a very distressing condition for the patient. Ear lobe keloid has been treated with excision followed by primary suture, healing by secondary intention, skin graft or local flap. Fillet flap technique has come up with good cosmetic result, late combined with other medications.Methods: 20 patients were treated by fillet flap technique. Included in the study were huge, sessile, recurrent keloids. Pedunculated and small (<1 cm) keloids were excluded.Results: All cases, except one flap survived completely with good primary healing. All patients were women and developed their lesions after cosmetic earlobe piercing. The lesions were unilateral in 16 (80%) patients and bilateral in four (20%) patients. After 1 year, major response was observed in fifteen cases (75%) and moderate response in four cases (20%); one case had a relapse 10 months after the surgery.Conclusions: Many methods of coverage of defect after surgical excision have been described but each has its own disadvantages. So, fillet flap technique covers the defect and gives very good cosmetic outcome.Fillet flap method of ear keloid repair and its cosmetic outcome:                     our experience