Indian Journal of Obstetrics and Gynecology Research

5-10

Authors: Hemant Deshpande,Chandrakant S Madkar*,Apurva Singh,Akanksha Allahbadia

Episiotomy is most commonly performed surgery for assisting vaginal delivery in indicated cases. Mediolateral episiotomy is most commonly performed in view of its benefits over other types. Postoperative complications and morbidity of patients is most important which should be given thought. One of the factor that plays a major role is type of suture material used. In our study we are comparing traditionally used chromic catgut with the fast acting polyglactin 910. Materials and Methods: The new prospective study and randomized control study compares long term and short term results of suturing episiotomy with Chromic Catgut 1.0 and polyglactin 910 (2.0). The parameters taken into consideration were pain and analgesia, gaping, dyspareunia etc. Total sample size was 560 consisting of 280 pts in each group. Results: The present study showed that the results of fast acting polyglactin 910 was definitely better than chromic catgut. Also morbidity in relation to pain, wound healing and other complications was found to be lesser in group of polyglactin 910. Conclusion: The present trend of suturing episiotomy with polyglactin is definitely better in terms of results and reduced morbidity.

15-19

Authors: Fasiha Tasneem*,Vijayalakshmi Shanbhag

Introduction: Invasive cervical cancer is the second most common cancer in women worldwide, but 80% of cases occur in developing countries. If detected early cervical cancer is usually curable. The papanicolaou smear is a reliable, inexpensive and effective screening test for cervical cancer. This study aimed to determine the knowledge, attitudes and practice of women in Nanded towards pap smear, barriers for their participation in the screening and also relationship between the knowledge, attitudes and practices. Materials and Methods: This study was carried out on 200 outpatient married women attending outpatient department in Dr. SCGMC, Nanded, a rural tertiary health care center in Maharashtra, India. Results and Observations: In our study done on rural population only 44% had heard about pap smear and 35% had got pap smear taken at least once, but 70% of the patients were ready to get pap smear done upon explaining about pap smear. Only 11% knew that cancer cervix could be detected before onset of symptoms and 100% were of the opinion that cancer cervix awareness program has to be conducted. Conclusion: Clearly there is a need for reformations at the grassroot level to have an appeal to the people of rural areas to help them utilize the screening tests available for early detection and treatment of the deadly disease like cancer which shows a higher prevalence in the people of rural areas with lower educational level and low socio-economic status.

24-28

Authors: Divya Pandey,Monika Gupta

Objective: To evaluate seroprevalence of Rubella infection in antenatal patients with bad obstetric history (BOH), pregnancy outcome of seropositive cases and incidence of congenital malformations in maternal Rubella infection. Materials and Methods: This was a prospective case control study done at a tertiary teaching institute over duration of one year. One hundred and seventy four antenatal women with BOH were studied against one hundred and six control cases. Their serum sample was subjected to ELISA test for Rubella IgG and IgM antibodies estimation at their first antenatal visit. Interconception interval i.e. the time interval between the previous pregnancy loss and current pregnancy was noted. All women were followed to know the pregnancy outcome. Apparent congenital anomalies in the newborns were evaluated. Chi square test was applied for statistical analysis. Result: Seropositivity for Rubella IgG antibodies, IgM antibodies and both IgG and IgM was 48.3%, 25% and 3.5% respectively in study group. Abortions, preterm delivery and stillbirths were seen in 56.8%, 18.3% and 4.5% of IgM positive cases. 2.24% with IgG positive had abortion while 4.5% with both IgG and IgM antibodies had fetal congenital malformation. Incidence of congenital anomalies in the form of Neural Tube Defects was 4.48%. Abnormal pregnancy outcome in present pregnancy was seen in 59.1% of women with interconception interval less than 3 months. Conclusions: Seropositivity of IgM Rubella antibodies was significantly higher in women with Bad Obstetric History. Incidence of Neural Tube Defects was higher with Rubella infection if exposure occurs in first few weeks of pregnancy. There is need for immunization against Rubella, of adolescent girls and seronegative prospective mothers. A proper (more than 3 months) interconception interval should be recommended after acute Rubella infection in pregnancy causing obstetric loss in that pregnancy.

33-37

Authors: Vibha Rani Pipal,Narendra Mahavar*,Seema Yadav,Dharmendra Kumar Pipal

Introduction: In the present study, we assessed the safety and efficacy of PGE? gel for labour induction and augmentation by Oxytocin injection in women attempting VBAC after caesarean section and thus reducing the rate of c-section in patients having previus c-section for non-recurring cause. Aims and Objectives: We aimed at to evaluating the safety and efficacy of prostaglandin (PGE?) gel for induction of labour in previous c-section delivery and correlate Bishop’s Score with pregnancy outcome in women attempting VBAC. Materials and Methods: This is a prospective study of women admitted in Rajkiya Mahila Chikitsalya, Ajmer over a period of one year from July 2011 to June 2012 with singleton live pregnancy of >34 weeks of gestational age with previous one caesarean delivery and willing for VBAC. Result: Success rate of VBAC was more in induced than spontaneous group (57.33% to 50.0%), and in patients with previous vaginal delivery after caesarean sectioned patients who were having Bishop’s score >6. Rate of uterine rupture in induced group was more than spontaneous group but it was statistically insignificant. Admission in NICU was more in spontaneous group while APGAR score <5> Conclusions: In spontaneous and induced group there was no significant difference in distribution of group according to ANC visit, age, parity, gestational age, rate of uterine rupture, rate of uterine dehiscence, still birth, APGAR score <5>

41-45

Authors: Sujata Dhaded,Roopa C*,Siddesh B.S

Introduction: Vaginal discharge is a normal physiological discharge which is usually white or clear, non-offensive and varies with menstrual cycle. Abnormal vaginal discharge if untreated can lead to cervicitis, pelvic inflammatory disease, urinary tract infection and also infertility. As abnormal vaginal discharge presents vaguely in a clinical set up, diagnosis is made by laboratory confirmation for rapid identification of causative pathogens and appropriate treatment. Materials and Methods: This is a retrospective study where records of clinically suspected vaginitis/cervicitis cases from Jan 2016 till June 2018 were studied. History, general examination findings, per speculum and pelvic examination findings, investigations performed and treatment given were collected for these cases and the data was analyzed. The amount, odor, color, pH and consistency of vaginal discharge were noted. Three high vaginal swabs were taken from every patient using sterile swab sticks and labeled. The tests include: saline wet mount, KOH mount and Grams stain. Bacterial vaginosis was diagnosed using the Amsel's clinical criteria and standard microbiological techniques. The collected samples were also cultured on MacConkey’s agar, Blood agar and Sabouraud’s Dextrose agar for aerobic bacterial and fungal cultures respectively. The antibiotic sensitivity testing of all isolates was performed by Kirby Bauer’s disc diffusion method on Muller Hinton agar and interpreted as per CLSI guidelines. Results: This is a retrospective study where records of clinically suspected vaginitis/cervicitis cases were studied. A total of 1680 clinically suspected vaginitis/cervicitis case records were collected in this study. Out of 1680 cases, only 475 (28.27%) cases were positive for growth of a pathogen and the remaining 1205 (71.72%) cases either showed no growth or no pathogens were isolated. Bacterial vaginosis was diagnosed in 120 (7.14%) cases and trichomoniasis was diagnosed in 51 (3.03%) cases. Out of the 475 samples positive for growth, most common isolate was Escherichia coli (195, 41.05%), followed by Coagulase negative staphylococcus (130, 27.36%). Conclusion: Escherichia coli was the most common organism causing infection in our study population followed by Coagulase negative staphylococcus. Clinical diagnosis along with complete microbiological evaluation is necessary to determine the causative agents of vaginal infections for appropriate management.

51-57

Authors: Priyanka Roy,Indranil Dutta*,Arati Biswas

Introduction: Over the past several years it has been proved that maternal thyroid disorders influence the outcome of mother and fetus, during and also after pregnancy. The most frequent thyroid disorder in pregnancy is maternal hypothyroidism. Overt hypothyroidism (low serum free T4 & high TSH level) complicates from 2 to 3 pregnancies per 1000 whereas subclinical hypothyroidism (high serum TSH but normal free T4 level) is seen in 2.3% cases.2 Endemic iodine deficiency accounts for most hypothyroidism in pregnant women worldwide whereas chronic autoimmune thyroiditis is the most common cause of hypothyroidism in iodine sufficient parts of the world. Objectives: (1) To detect cases of overt or subclinical hypothyroidism in antenatal mothers in early weeks of gestation by screening methods, (2) To start early treatment in positive cases for reduction of deleterious effects on maternal and fetal outcome, (3) To study the maternal complications during antenatal, intranatal and postnatal period in hypothyroid mothers in comparison to euthyroid pregnancy. (4) To note any difference in incidence of low birth weight babies and early neonatal complications in hypothyroid women. Material and Methods: A prospective clinical study was conducted department of Obstetrics and Gynaecology, Calcutta National Medical College and Hospital, Kolkata, Study population included all pregnant mothers attending antenatal clinic in Calcutta National Medical College and Hospital, Study period was one year (June 2012-May 2013), Sample size is 500 in number. Results: Cases (hypothyroid, TSH>2.3 µU/ml) constituted 4.4% of the screening population, in which the incidence of overt hypothyroid (free T4<0>4 within normal range) was 4.4%. Controls (euthyroid, TSH<2>

63-67

Authors: Piyusha Chandrayan,Varsha Shah,Niraj Pandit*,Ruhi Varghese

Aim: Study aimed to identify prevalence of risk of anemia in pregnancies in institutional antenatal coverage. Materials and Methods: study performed hospital based cross sectional analysis of 8065 antenatal women, who had attended antenatal care programme from Jan 2016-Dec 2016. High Risk factors were identified based on age, multiparity, High blood pressure (SBP>120 mmHg, DBP>80 mmHg), weight of mother at first antenatal visit, lower Hb level (<11> Results: Out of total 8065 pregnant women attending antenatal care clinic, 2525 women (31.31%, 95% CI 30.3% - 32.34%) were identified to be anemic- a major risk factor in the study. The study population’s mean age was 23.5+-3.5 years with majority of adolescent age group. Significant associations were observed between anaemia, literacy level of mother, economic status and location. The prevalence for sickle cell population was 2.43% (95% CI 2.11%-2.8%). Conclusion: This study presented anemia as major risk factor in antenatal women, imposing greater need of targeted clinical attention. It is recommended to promote awareness on iron deficiency and its implications to avert cases of anemia.

71-77

Authors: R K Saxena*,Noor Fathima Tameem Ansari,Anju Balan

Introduction: World medical community has raised concerns over the rising caesarian rates. Materials and Methods: This was a prospective, cross-sectional, hospital-based study to determine factors responsible for a woman’s choice of delivery, that is, caesarian delivery (CD) or vaginal delivery (VD). Pregnant women attending antenatal clinics, were interviewed with a structured questionnaire, and data was analyzed. Results and Discussion: 266 responses were analyzed, wherein, 186 women preferred VD and 80 women preferred CD. The characteristics of women who chose CD as their preferred mode of delivery, were compared with the women who chose VD as their preferred mode of delivery. Age, religion, occupation, and economic status did not influence a women’s choice of delivery. Factors strongly related included educational status, wherein, more educated women were likely to prefer CD. Contrary to popular perception gravida, para, number of miscarriages or living children did not influence the choice of delivery. 90% of women who had previous CD, preferred CD for this delivery, they were not aware of the option for trial of labour after caesarian. 49% (n = 45) of the 91 patients delivering in private hospitals underwent CD, as compared to only 13% (n = 11) of the 85 patients delivering in government hospitals. The high caesarian rates in private hospitals is partly driven by caesarian delivery on maternal request. Conclusion: Counsel the pregnant women regarding the process and benefits of normal VD, as well as the risks of unnecessary CD can influence patient decision-making and decrease CD rates.

83-86

Authors: Dhanasekar Karukkupalayam Ramasamy,Gomathy Nachimuthu,Trayambak Dutta*

Menopausal syndrome is marked by an array of psychosomatic as well as vasomotor symptoms such as hot flushes and night sweats. Amongst vasomotor symptoms of menopause, hot flushes are the most common. It consists of sudden sweating and periodic flushing with palpitations, chills, anxiety, choking and nausea. Depletion of estrogen is in part a cause for these symptoms, but not entirely. Neuronal origin of menopausal symptoms is gaining significance for better understanding the pathophysiology of vasomotor symptoms. There is significant change that occurs in the thermoregulation due to menopause. An important neuronal theory is narrowing of thermoneutral zone due to elevated central sympathetic activation. The first line therapy such as lifestyle changes, either alone or combination with dietary isoflavones, do not effectively control the vasomotor symptoms in severe cases. In such individual hormone therapy is inevitable, albeit it’s higher risk for coronary artery disease, breast carcinoma and pulmonary embolism. Therefore, it is imperative that the therapeutic target should be directed towards the central origin of symptoms and it should be devoid of these adverse effects. Medicinal plants and complimentary therapies have proved to be of great therapeutic advantage for patients with menopausal syndrome. Amongst medicinal plants studied extensively so far for reduction of menopausal symptoms, Valeriana Officinalis, Passiflora incarnata and Humulus lupulus are particularly important. Valeriana Officinalis binds to the beta subunit of the GABA-A receptor which leads to chloride channel mediated anxiolysis. It also decreases the metabolism of GABA thereby potentiating its effect. Passiflora incarnata acts by increasing the level of serotonin via modulating the content of mono-amine oxidases. Humulus lupulus increases the level of GABA thereby exerting its sedative and anxiolytic effect in menopause. The GABA mimetic action of these three ingredients controls the psychosomatic and vasomotor symptoms of menopause mediated by central sympathetic action. Clinical trials with these three herbs in European post menopausal women have led to active control and reduction in menopausal symptoms. This review delineates their role in the management of menopausal syndrome.

91-93

Authors: Durga K,S Yuvarajan*

Introduction: Community acquired pneumonia (CAP) is recognized as a common problem that carries a substantial morbidity and mortality in preantibiotic era. With the advent of newer diagnositics and advanced antimicrobials there is reduction in morbidity and mortality, but in era of MDR pathogens its often difficult and challenging to manage CAP. However, pneumonia in younger individuals can be severe and fatal. Pneumonia in the pregnant patient is the most frequent cause of life threatening non-obstetric infection. Aims and Objective: The aim of this study was to assess the pattern of community acquired pneumonia among pregnant women in tertiary care hospital. Materials and Method: 32 pregnant ladies presented with signs, symptoms & radiological findings consistent with community acquired pneumonia were selected from out patient’s clinics of obstetrics and gynecology department. Results: The present study included 32 pregnant ladies with community acquired pneumonia, who were selected from out patient’s clinics of obstetrics and gynecology department. Their ages ranged from 20–40 years old with mean age of 25.32 years old (±4.20 SD). Cough (90%) was the most common symptom followed by fever (70%) among the patients. Chest x ray done with abdominal shield showed pulmonary infiltrates in (65%). The most common radiological findings are consolidation (75%) nodular infiltrates (20%), cavity (3%), pleural effusion (2%). The most common organisms isolated were streptococcus pneumonia, hemophilus influenza, staphylococcus aureus mycobacterium tuberculosis. Conclusion: Morbidity and mortality in pregnant patients with pneumonia continue to pose a significant challenge. Early recognition of the diseases process and appropriate antibiotic treatment are required to ascertain an optimal outcome. The treatments in the gravid patients generally follow standard guide lines for the treatment of pneumonia in adults. Concern for fetal outcome should not delay any treatment strategies as improvement in maternal oxygenation and status is the best way to ensure fetal protection.

97-100

Authors: Henry Owuor*

Introduction: Uterine papillary serous carcinoma (UPSC) is a clinically aggressive type of endometrial carcinoma. They represent about 10% of endometrial carcinomas and are responsible for 40% of deaths and recurrences associated with endometrial cancer. Patient Presentation: JM is a 75 year old woman who presented with eight months’ postmenopausal vaginal bleeding, loss of weight and low abdominal pain. Except for obesity and bilateral pitting edema, she had normal findings on physical examination. Management and Outcome: Pelvic ultrasound showed an intra-uterine mass of increased echo (4×4 cm) and a pelvic CT scan showed a bulky uterus bulky with prominent endometrium. Visual inspection with acetic acid and Lugol’s iodine was negative for cervical cancer whereas Pipelle biopsy indicated endometrial cancer. She had total hysterectomy with bilateral salpingo-oophorectomy. She is due to start chemotherapy. Conclusion: Even though endometrial biopsy using a Pipelle is highly sensitive for detection of high-grade endometrial carcinomas, it is less accurate at predicting UPSC. Patients undergoing surgery for endometrial cancer should therefore have a comprehensive surgical staging as the patient may have UPSC. Due to the risk of recurrence, adjuvant chemo-radiation should be administered after surgery.

105-107

Authors: Naina Kumar*,Himani Agarwal

Malignant mixed mullerian tumour of uterus also called carcinosarcoma is a very rare and also very aggressive type of tumour involving both epithelial and mesenchymal component thus is considered as a metaplastic carcinoma. Common presentation of these patients is post-menopausal bleeding with uterine enlargement. Here we present the case of 55 year old women with post-menopausal bleeding. Total abdominal hysterectomy with good vaginal cuff with bilateral salpingo-oophrectomy with bilateral pelvic lymphadenectomy was done and a diagnosis of malignant mixed mullerian tumour with Genital Tuberculosis was made

110-112

Authors: K J Swathy*,Usha V

Clear cell carcinoma in pregnancy is a rare event, accounts for less than 1%. Here we present a 29year old women who was incidentally diagnosed to have an abdominal mass corresponding to 24 week size on her first trimester visit, Ca 125 was 49, MRI pelvis showed large complex ovarian cyst probably cystic ovarian neoplasm. Patient underwent fertility preserving staging laparotomy. Intraoperative right salphingo-ovariotomy was performed. Histopathology reported as Clear cell carcinoma of ovary. The couple decided to undergo Medical termination of pregnancy after multidisciplinary team counselling provided by Medical oncologist and obstetrician. After six months of adjuvant chemotherapy with paclitaxel and carboplatin patient improved symptomatically better and is on regular follow up.

116-118

Authors: Dhwani Mehta*,Charmi Pawani,Nimish Pandya

Witnessing Multigravida, Grand Multigravida and Great Grand multigravida pregnancy is very usual and common in the Kacchch district of Gujarat, India. Kachchh happens to be the largest District of India with majority of population living in the rural area who are illiterate and believe in the norm of “Home delivery: Safe delivery”. In the era of 20th century where a majority of us are happy with normal labour conducted by a skilful obstetrician at the hospital with the simultaneous assessment by the paediatrician there occurs a significant population nesting in rural corners who still abide by the traditional birth practices with “The Normal Dia Labour” unaware of its aftermath. A 59 year old, Widow, Female Patient P5L2D3 with all full term normal vaginal delivery conducted at Home presented to G.K. General Hospital (the only tertiary referral centre in the entire district) with inability to pass urine and with something coming out per vaginum. On examination it was a case if long standing procidentia with decubitus ulcer with purulent exudation and simultaneous contamination of it with pus and faecal matter from the surrounding rectal prolapse. Surgical correction by vaginal hysterectomy and repair of rectal prolapse was done with building up of perineum - a surgery which was a difficult nut to crack for the Gynaecologists and Surgeons. With increased parity and poor interval spacing with improper perineal support during the labour, the perineum becomes lax and the ligament and supports of the uterus become asthenic, flaccid. This shall present with pelvic organ prolapse in the peri-menopausal age, menopausal and post-menopausal age group. The ladies in the rural Indian setting believe it to be a social stigmata and thus rarely these cases reach the hospital for intervention.

447-453

Authors: Anthony Wanjala*,David Kaihura,Benjamin Chemwolo,Kays Muruka

Introduction: Effects of 40mg of Hyoscine butylbromide (HBB) in reducing duration of active phase of labor are well documented. However effects of 60mg have not been well studied despite the fact that it is often used. Objectives: To compare the effect of 60mg and 40mg of HBB on the duration of labor. Materials and Methods: A single-blind randomized controlled clinical trial was carried out at Moi Teaching and Referral Hospital from January to April 2014. At the onset of active phase of labor (4–5 cm) they were randomized into two arms. Those in the control arm received 40mg of HBB intravenously while those in the study arm received 60mg. Information on progress of labor; mode of delivery, amount of blood loss and neonatal APGAR scores was recorded. Results: A total of 114 primigravid women were recruited into the study and randomized into the control arm (n=59) and study arm (n=55). The 40mg and 60mg arms were comparable for socio-demographic and obstetric characteristics. Injection to delivery time was 340 (223–483) minutes in the 40mg arm and 305 (253–475) minutes in the 60mg arm, a difference that is not statistically significant (p=0.905). Seven (12?%) and five (9?%) of patients in the 40mg and 60mg arm respectively needed delivery via caesarean section (p=0.602). 5 minute APGAR scores were 9.7 in the 40mg arm and 9.8 in the 60mg arm (p=0.727. Estimated blood loss was 300mls in the 60mg arm and 350mls in the 40mg arm (p=0.152). Conclusion: Head to head, 60mg of parenteral HBB is not superior to 40mg on their effects on duration of labor and feto-maternal outcomes.

458-464

Authors: Atombosoba Adokiye Ekine*,Fülöp István,Rucz Árpád,Tekse István,Nyéky Boldizsár

The aim, is to share our experience on the efficacy of combined laparoscopic and hysteroscopic surgical treatment of isthmocele, and the possible link with endometriosis. 28 patients with isthmocele, who underwent combined laparoscopic and hysteroscopic repair were retrospectively analysed. Presenting symptoms were; bleeding disorder, infertility, lower abdominal pain, dysmenorrhea and chronic vaginal discharge. All noticeable changes observed in the preoperative symptoms, were evaluated at 1, 3, and 6 months postoperatively, while fertility return within the first 24 months postoperatively was also evaluated. Average age of the patients was 36.9±4.5, fertility return after surgery was 82.4% (n=14/17), post menstrual bleeding disorders was almost completely resolved in all the patients in the 1, 3, and 6 months after surgery, mean bleeding duration was significantly shorter than the preoperative period 3.6±1.1 days as against 10.3±1.7days. There was significant resolution of the other symptoms like dysmenorrhea, chronic vaginal discharge and suprapubic pain at 6 months after surgery. Endometriosis was found in 16 (57.1%) patients, which is remarkably high in patients who had no previous history or diagnosis of endometriosis. The overall patient satisfaction rate was 92.9% (26/28). Our experience shows that, the combined used of hysteroscopy and laparoscopy is very effective in the management of isthmocele with minimal complications. Our findings also suggests a possible link between endometriosis and isthmocele. Further large scale studies may be required to ascertain these findings.

471-475

Authors: Hemavathi. G,Jagruthi C*

Abortion procedure is one of the commonly practiced procedure in practice thereby demanding a safe and effective method of abortion. Objective: Objective of study was to compare successful abortion rate and to compare the mean induction-abortion interval. Materials and Methods: The present was undertaken among the patients admitted to hospitals attached to J.J.M. Medical College; Bapuji hospital, women and children hospital and Chigateri general hospital Davangere during the study period from November 2016 - October 2017. Patients are randomized in two groups. Patients coming for second trimester abortion to above mentioned hospitals were assigned serial number from one to eighty and all patients with even number will be allocated to group 1 and all patients with odd number will be allocated in group 2, each group comprising 40 women each. Results: In the present study the mean induction abortion interval for group 1 was 19.56±1.82 hours and group 2 was 14.13±2.72 hours. This was statistically significant. Of the 40 cases in each group, 37 had complete abortion i.e. 92.5% 3 cases (7.5%) from both the groups had incomplete abortion and was supplemented with check curettage in both groups. Conclusion: Ethacridine lactate instilled extra­amniotically then by vaginal misoprostol is safer and acceptable, has short I-A interval than mifepristone – misoprostol for 2nd trimester termination of pregnancy.

481-484

Authors: R S Sushmita Upadhy,Saswati Tripathy*,Satyajit Mohapatra

Purpose of Study: India already has highest number of patients with type 2 diabetes mellitus globally and rapid rise of the incidence of obesity in children is the prime reason for increasing insulin resistance, the metabolic syndrome, dyslipidemia and polycystic ovarian syndrome. Prevalence of this syndrome in our community remains unknown. Objective: The study was done to determine the prevalence of PCOS among students in Tamil Nadu, India due to sparsity of PCOS prevalence data in the state. We attempted to find its prevalence in students, aged between 17-23 years in a tertiary care teaching hospital. Materials and Methods: A cross sectional study with sample size 246 was done. Students of aged 17-23 years were randomly selected from various batches of medical and paramedical courses. Presence of hyper androgenic features and menstrual irregularities were assessed and they were physically examined to validate the self-assessed mFG scoring. The diagnosis of PCOS was made on the basis of Rotterdam’s criteria. Results: Seventy nine students (32.11%) met the criteria to be diagnosed as polycystic ovarian syndrome. Thirteen students (5.2%) had a history of thyroid dysfunction. The other clinical features of hyperandrogenism among those who had PCOS were like oily skin (13.82%), acne (8.53%), increased hair growth (5.69%), male pattern thinning of hair (9.75%), high degree of intolerance to cold and heat (3.25%) and galactorrhoea (0%). Conclusion: PCOS can be thought of as a precursor syndrome that, if screened for, can help in early identification of risk of highly morbid conditions, in adolescent girls and women in their early twenties.

489-495

Authors: Romana Khursheed,Anita Dalal*,Arpita Reddy,Aditya Gan

Introduction and Aim: Globally, rising caesarean section rates have become public health concern. Cesarean section analysis and audits using Robson ten group classification system have identified the main drivers of Cesarean section rates (CSR) are the gravidas with previous CS and the nulliparous with term singleton foetus with vertex presentation (NTSV).1-10 Given the low rates of vaginal birth after a cesarean section, once a woman undergoes her first CS, she is extremely likely to have repeat CS in subsequent pregnancies. This increases the burden of high risk pregnancies and increased CS rates subsequently. Reducing primary cesarean sections in NTSV is the key for improving overall health statistics of the institutions. Hence, this one year prospective study was conducted to know the factors contributing to CS in NTSV population in a tertiary care hospital in South India. Materials and Methods: The study is prospective observational study which is conducted in labour wards of department of Obstetrics & Gynaecology at teaching hospital attached to KLE Academy of Higher Education’s Jawaharlal Nehru Medical College, Belagavi, from January 2016 to December 2016. Results: Total number of gravidas who delivered during study period, were 6236, out of which 2494 (40%) were NTSVs. The CS among NTSVs were found to be 849(34.01%). The main indications for emergency cesarean sections in NTSV were fetal distress, non-progress of labour, failed induction i.e. 44.76%, 16.65% and 15.31%, respectively. Conclusion: The primary cesarean sections among the NSTV is an important contributor to the overall cesarean sections of the health institute. The main indications of CS were fetal distress, non-progress of labour and failed induction. There is a need to develop standard clinical protocols for management of these conditions and emphasise vaginal delivery in NTSVs. Also strategies like training the obstetricians in interpretation and management of suspicious and non-reactive CTG traces, use of cervical ripening agents prior to induction, use of partogram in monitoring patients in labour, should be included in routine practice to improve vaginal birth rates in this low risk population.

500-503

Authors: Vibha Kumari*,Shalini Singh,Amrita Chaursia

Objective: To evaluate the association, if any, between serum CRP levels in first and early second trimester of pregnancy and adverse pregnancy outcomes. Materials and Methods: The present study was carried out in 300 antenatal cases attending the department of Obstetrics and Gynaecology at Swaroop Rani Nehru Hospital & Kamla Nehru Hospital (Motilal Nehru Medical College Allahabad), over a period of one year. Inclusion Criteria: Pregnant women < 20> Exclusion Criteria: Multiple gestation, previous H/O PTL or mid trimester abortions, endocrine disorder, medical illnesses, HIV infection and substance abuse. Serum C-Reactive protein levels were tested and the participants were divided into 2 groups. Group1 included all pregnant ladies with CRP level > 5mg/L (Study Group) and Group2 with CRP level < 5mg> Result: Raised level of serum CRP had positive correlation with adverse pregnancy outcomes and effect of elevated CRP level was maximum on PPROM (p value-0.002), preeclampsia (p value-0.004) and low birth weight (p value-0.002). Elevated CRP had no significant impact on still birth (0.06). Conclusion: Early detection of higher level of serum CRP in pregnancy can be used as predictor of inflammation and may help in early intervention and follow up of the patients to minimize adverse maternal and fetal complications.

511-515

Authors: Urmila Tripathi,Durga Sahu*

Introduction: Immediate postpartum intrauterine contraceptive device insertion is an excellent family planning method which provided safe effective, long term and reversible contraception to women in the delivery setting. Hence, the present study was undertaken to assess the clinical outcome of immediate postpartum insertion of intrauterine contraceptive device in terms of safety and efficacy and to compare the two routes of insertion i.e. in vaginal deliveries and cesarean section. Objective: 1. To study awareness level of PPIUCD among parturient. 2. To study safety and efficacy of PPIUCD insertion. Materials and Methods: A cohort of 100 vaginal and 100 cesarean deliveries with PPIUCD insertion were studied over a period of 1 year and followed for three months in this prospective interventional study. Outcome measures of safety were perforation, irregular bleeding, unusual vaginal discharge and infection. Outcome measures of efficacy were pregnancy, expulsions, discontinuation and incidence of coiled up/ undescended strings. The data was compiled and analyzed. Results: In the present study only 34.5% (N=69) of the study sample were aware of the PPIUCD while the rest 65.5% were unaware. No serious complications such as pregnancy or perforation were encountered in our series. Most common complication reported in both the groups was excessive bleeding PV followed by pain in lower abdomen. Spontaneous expulsion of the device was noted in 3% of vaginal insertions and none in the cesarean insertion. Conclusion: PPIUCD is an excellent method to limit or space child births. It is offered to a woman in a setting when she is highly motivated and genuinely needs it.

520-524

Authors: A N. Srivastava,J S. Misra

Introduction: Inflammatory smears are frequently seen in cervical cancer screening and they have been widely implicated as precursor of premalignancy of cervix. In the present study, attempt has been made to find out correlation between inflammation and different predisposing factors to cervical carcinogenesis in the rural context. Materials and Methods: Cervical cancer screening is in progress in the rural population of West Lucknow, India since May 2013 under the auspices of Era’s Lucknow Medical College and Hospital, Lucknow, India and till March 2018, cervical smears of 2563 women have been cytologically examined. Results: The incidence of inflammation was found to be 33.7% in the present series. It was non-specific in 91.3% and was associated with either Candida albicans or Trichomonas vaginalis in 8.2% of cases. The inflammation was associated with low grade squamous intraepithelial lesions of cervix (LSIL) in 176 cases (20.1%) which were mostly asymptomatic (36.1%) and some had cervical lesions on the cervix (11.2%). The inflammatory smears were mostly seen in women complaining of vaginal discharge (47.1%) or vague pain in the lower abdomen (31.9%). The inflammation was more common in younger sexually active women between 21-40 years and was seen rising with increasing parity. Conclusion: The accumulated data points out that the clinical lesions of cervix and multiparity have some impact in the initiation of inflammatory changes in the cervical epithelium. The inflammatory smears, whenever, reported should be adequately treated and smears are repeated after 6 months to rule out any persistence of inflammation or development of any premalignancy.

530-534

Authors: Kusumam V.N*,Naseema Beevi Ahamad Khan,Sruthi V.G

Second trimester medical abortion with mifepristone followed by misoprostol is effective and is associated with considerably shorter induction abortion interval. This study is a comparison of the effectiveness, safety profile and side effects of mifepristone- misoprostol and mifepristone-Foley’s EAS combinations in second trimester termination. The patients were grouped into two, first group received oral mifepristone 200 mg followed by vaginal misoprostol 800 mcg after 48 hours and then 400 mcg misoprostol vaginally 3 hourly up to a maximum of 4 further doses. Second group were induced with oral mifepristone 200 mg followed by extra amniotic saline instillation through a Foley’s catheter after 48 hours. The success rates were comparable between the two groups. But the 6 hour expulsion rates (36.4% Vs 0%) as well as 12 hour expulsion rates (56.36% Vs 3.6%)(p value=0.001) were significantly high in mifepristone – misoprostol group compared to mifepristone-Foley EAS group. Mean induction abortion interval was shorter in the first group (14.64hrs vs 18.4hrs)(p=0.026).But the incidence of complaints after administration of misoprostol was significantly high. 7 patients from Group 1 and 5 patients from Group 2 required surgical evacuation for retained placenta. The study revealed that mifepristone-Foley’s EAS induction can be used as an effective alternative to mifepristone-misoprostol combination with similar success rates and significantly reduced side effects but with significantly increased induction abortion interval. The results of this study can be extrapolated to cases where prostaglandins are contraindicated like in previous cesarean section cases

539-543

Authors: Anupma Kumari,Ra Kumar*

Introduction: Abnormal Uterine Bleeding (AUB) is a term which refers to menstrual bleeding of abnormal frequency, duration or quantity. It is a common gynecological complaint accounting one third of outpatient visits to gynecologist. It is caused by wide variety of organic or non-organic causes. The aim of this study was to find out incidence of abnormal uterine bleeding with respect to aetiopathology, age, parity, marital status, treatment options and other medical disorders. Materials and Methods: This study included prospective study of randomly selected 180 cases of abnormal uterine bleeding between 40–55 years of age during April 2015 to July 2016, in the Dept. of Obstetric & Gynaecology, NMCH, Patna. Details of each patient’s were recorded and analysed with respect to aetiopathology, age, parity, marital status, socioeconomic status, treatment options and other medical disorders. Patients were evaluated with menstrual history, physical examination, laboratory tests, imaging studies and histological examinations. Patients were followed up from 3 to 8 months with an average of about 4.5 months. Results: Most common age group presenting with AUB was 40–45 years (65.55%) and mostly (68.33%) belonged to low socioeconomic status. Most of the women were multiparous and menorrhagia was most common presentation. In 51.66% cases, cause was non-organic (dysfunctional uterine bleeding) and among organic causes fibroid (28.88%) uterus was most common. Bulky uterus was found in 41.11% of cases and 43.33% had proliferative endometrium. Majority of patients had mild anemia. Maximum number of patients (70.55%) were treated surgically and 27.77% got medical treatment. Conclusion: Abnormal uterine bleeding (AUB) is a common gynecological complaint associated with considerable morbidity and significantly affects the patient's family, personal and social life. Perimenopausal women’s health and quality of life can be maintained and improved through preventive care, life style modification, early diagnosis of risk factor or disease and appropriate treatment.

549-552

Authors: Vishal M. Sharma*,Bhavesh B. Airao,Ravi A. Zala,Manish R. Pandya

Aim of the Study: To know the frequency of different structural congenital anomalies in C.U. Shah medical college and hospital, Surendranagar. Materials and Methods: This study was carried out in Department of Obstetrics and Gynecology, C.U. Shah medical college and hospital, Surendranagar for a period of two year by using ultrasound sonography in second trimester pregnancy, 150 patients who had diagnosed congenital anomalies of fetus were included in this study. Results: The incidence of congenital anomalies in this study was 2.48% of the total number of fetus and babies born after 12 weeks of gestation in our hospital during a period of two year. Most common anomaly is CNS anomaly (84%) followed by CVS anomaly (11.4%). In craniospinal system most common congenital anomaly is Anencephaly (26%). Conclusion: In spite of high institutional deliveries in Surendranagar, India, rate of congenital anomalies remains very high. Increased awareness about preventable risk factors may help in decreasing the rate of congenital anomalies.

559-562

Authors: Jayaraman Nambiar M*,Keerthi Somu

Objectives: To find out the effect of tranexamic acid on blood loss after vaginal delivery. Materials and Methods: In this observational study, 100 women with a singleton pregnancy were allocated to receive one gram intravenous tranexamic acid or no drug in addition to 10 units of oxytocin after delivery of the fetus. Blood loss calculated by a graduated blood bag. Pre and post-delivery hemoglobin and hematocrit are determined. Results: The mean blood loss (245ml vs 327 ml, p=<0> Conclusions: Tranexamic acid helps to reduce the amount of blood loss in vaginal delivery.

567-569

Authors: Dhwani Mehta*,Kritika ,Akansha ,Nimish Pandya

Conjoined Twin – “An extremely rare phenomenon “has its incidence from 1 in 49,000 to 1 in 1,89,000 with higher incidence in south east Asia and Africa. Its fetal and maternal outcome depends on the age of gestation, the site of fusion and most of them are still birth babies with the survivors being the female ones. Khavda district of Kacchach (Bhuj, Gujarat, India) witnessed such a delivery of a Cephalothoracophagus conjoined twin in a multigravida who developed traumatic post partum haemorrhage after a normal vaginal delivery and was referred to our hospital which is the only tertiary care centre of Kacchchh district, i.e Bhuj. Case: A 35 year old female patient P7L6D2, presented with severe post partum haemorrhage after vaginal delivery of a full term conjoined twin at community health centre, Khavda. On examination it was a case of traumatic post partum haemorrhage with right colporrhexis with traumatic rupture of uterus. Patient was taken for exploration of tear and colporrhexis and obstetric Hystrectomy was performed. She was saved at the cost of her uterus which bore her a Boon. Where illiteracy prevails; prevails the tradition of multigravid pregnancy with unawareness regarding prenatal screening and antenatal visits which at times costs the patient her life.

573-575

Authors: Jennia Michaeli*,Ella Kitroser,Alexander Ioscovich,Arnon Samueloff,Hen Y. Sela

Introduction: Disseminated intravascular coagulation following single fetal demise in a twin pregnancy is a rare event. As such, the diagnosis and management of such cases are complicated and require the assistance of various laboratory tests. Case: 26 years old patient, carrying dichorionic diamniotic twin pregnancy was complicated by single fetal demise at 21+6 weeks and preterm premature rupture of membranes (PPROM) at 24+5 weeks. Pregnancy was managed conservatively until 30+4 weeks gestation when abnormal laboratory tests including dysfibrinogenemia and pathological thromboelastogram (TEG) indicated the development of disseminated intravascular coagulopathy (DIC) while the patient remained asymptomatic. A multidisciplinary team decided on prompt delivery by cesarean section. Cesarean delivery (CD) was uneventful, yet post-operative course was complicated by worsening laboratory tests and post-partum hemorrhage that were treated by uterotonics and blood products resulting in clinical and laboratory normalization. Conclusion: DIC following single fetal demise in a twin pregnancy is rare. A new laboratory test, TEG, may aid in diagnosis and management of DIC.

579-581

Authors: Manish Pandya*,Jiten Senta,Shrina Shah,Ishita Mehta

Congenital left ventricular aneurysm is a rare but potentially lethal condition. We describe a case of isolated congenital left ventricular aneurysm diagnosed at 28 weeks of gestation. In addition to standard imaging, we utilized color-coded transthoracic tissue Doppler techniques to further evaluate the aneurysm postnatally.

318-321

Authors: A. Mangala Geetha

Infertility accounts to nearly one-third of the patients who seek the medical advice of a gynecologist. Infertility or otherwise sub fertility is the failure of a couple to conceive after 1 year of regular, unprotected intercourse. Amongst the various causes for female infertility ovulatory dysfunction is the most common and accounts to 30-40% of all cases.1 The capacity of an ovary to produce egg cells that are capable for fertilization is known as ovarian reserve. Tests done to asses quantitative ovarian reserve of a woman desirous of pregnancy includes Day 3 FSH, AMH, Antral follicular count and ovarian volume measurement. Antral follicular count is referred as a number of oocytes and follicles in ovaries which is morphologically healthy. Anti mullerian hormone is produced by healthy ovarian follicles and serves as a marker of quantity of healthy follicles and oocytes in ovaries. Ovarian volume assessed by ultrasound can be used as a marker of functional ovarian potential. The aim of this study is to compare the ovarian reserve of fertility proven women with women presenting with sub-fertility using the sonographic tests like antral follicular count and ovarian volume measurement in a tertiary care teaching hospital in Thoothukudi, Tamil Nadu, South India and thence to asses if they are corresponding to standard cut-off values of other parts of the globe.

327-330

Authors: Sujithra. D., Sukanya Mukherjee, Sudha S

Introduction: The prevalence of Gestational diabetes mellitus (GDM) is high in Asian subcontinent. As per current guidelines, the routine screening for GDM is at 24 to 28 weeks of gestation.30 to 50% of GDM cases may remain undiagnosed until such period of screening. This study aims to investigate HbA1C levels at as early as 12 weeks of pregnancy as a predictor of GDM. Materials and Methods: This prospective study included 100 patients enrolled at their first antenatal visit, or before 12 weeks of gestational age, who attended OPD. At the time of enrolment for HbA1c and routine antenatal investigations were done. A 75 gm GTT was done at 22 to 26 weeks of gestation. HbA1c cutoff was taken as ?5.7 & ?6.4 and patients having value ?5.7 were taken as abnormal. Subjects with HbA1c ?6.5, overt diabetes, hemoglobinopathies, anaemia, chronic renal diseases and multiple pregnancies were excluded from the study. Results: It is found that women >28 years had higher levels of hbA1C in comparison to patients <28> Conclusion: The study concludes that women with higher HbA1c (?5.7) were more likely to develop GDM than those women with lower HbA1C (?5.7). HbA1c can be done routinely in early pregnancy (1st trimester). Women with higher HbA1c (?5.7) can benefit from early interventions early in pregnancy thereby prevent GDM and adverse perinatal and pregnancy outcomes.

335-338

Authors: Shaifali Patil, Anup Kapse

Introduction: Abruptio placenta is a serious obstetric complication which is characterised by the premature separation of the placenta. It is also associated with premature deliveries, maternal and fetal morbidities. Multiple factors are known to be associated with increased risk of placental abruption as alcohol and cocaine use and cigarette smoking, and nutritional deficiencies etc. Materials and Methods: It was a retrospective study conducted among 47 cases of abruptio placentae admitted under the department of obstetrics and gynecology, in MGM Hospital, Kalamboli, Navi Mumbai, for a period of 2 years (December 2015 to December 2017). Results: The mean age of presentation was reported to be 26.59 years. The incidence of abruptio placentae was found to be least after the age of 35 years (Table 1). Majority of cases were multigravida, while 32% cases presented with AP were primigravida. Among the multigravida cases, the majority of cases were of gravida 2 and 3 and the mean gravida order was 2.4. Conclusions: From the current study, we can conclude that multiparty, cesarean section, previous abortion, and placental abruption can be considered at high risk of placental abruption.

344-348

Authors: Shaifali Patil, Shivali Tripathi, Siddharth Shah

Introduction: Vitamin D is a fat-soluble vitamin which comes primarily from exposure to sunlight, and only few foods acts as a source of it. Vitamin D deficiency is a preventable health problem. Research shows that during pregnancy, adequate vitamin D intake is necessary for maternal, fetal and child health. This study was conducted to determine prevalence of vitamin D deficiency in pregnant women and neonates and will also help us to determine if 400IU daily recommended dose is sufficient to treat hypovitaminosis D. Materials and Methods: The study was carried out for 1 ½ years on 100 pregnant, divided in two groups in which one group was given supplementation and 2nd group was of unregistered patients. Results: The prevalence of Vitamin D deficiency was observed as 82% in present study. On supplementing the subjects with 400IU vitamin D with calcium 1000 mg daily, the prevalence reduced to 14% while normal levels were achieved in 58% as compared to 8% during the first trim which was significant with p value of <0> Conclusion: We recommend evaluation of the status of vitamin D in all pregnant women along with D3 supplementation. Routine supplementation of pregnant mothers with 400IU vitamin D with calcium 1000 mg daily resulted in significant improvement of vitamin D levels in study group, but sufficient levels were reached in just over half of the females. We thus propose further research on the daily dosage recommendations along with other factors affecting vitamin D levels in pregnant females like eating pattern, compliance to prescribed drugs and sun light exposure.

353-356

Authors: Vasudha Sawant, Sreesti Jaiswal, Manjiri Desai

Introduction: The Aims of this study were to identify the prevalence of reproductive tract infection in married women of reproductive age group (18-45 years), to analyse the impact of socioeconomic and demographic factors on reproductive tract infections, to treat the underlying cause. Materials and Methods: Total of 500 women were examined, out of those 300 women was found to have reproductive tract infections and were enrolled for further study and evaluation. Appropriate antibiotics were given to them and then followed. Results: The study results showed a high prevalence of RTI (60%). The highest prevalence was found among the age group between 26-29years followed by 30-33years and 34-37 years. The most affected women were from rural population (80%), low socioeconomic group (63.4%) and illiterate (59%). Conclusion: The present study showed high prevalence of RTI. It needs further depth study on their literacy and economic factors to evaluate and analyse the impact of these factors on reproductive tract infections.

361-364

Authors: Vipul S. Patel

Objectives: To compare empirical treatment with fosfomycin and nitrofurantoin in uncomplicated lower urinary tract infection during pregnancy. Materials and Methods: Patients were recruited from OPD of obstetrics and gynecology presenting with symptoms of lower (UTIs) urinary tract infection. Patients were divided randomly alternately in two groups. Fosfomycin therapy was given in group 1 (n=60) and seven days nitrofurantoin therapy was given in group 2(n=60). Patients were evaluated for symptoms improvement, compliance, side effects and cost of treatment. Results: Efficacy of fosfomycin on day 7 post treatment is 98% compare to nitrofrantoin I s83.3%. Side effect is 15% in fosfomycin group as compare to 28.3% in nitrofurantoin group. Compliance is 100% in fosfomycin group as compare to 96.6% in nitrofrantoin group. Cost of therapy in fosfomycin group is 300 Rs average while 170 Rs in nitrofurantoin group. Conclusion: Fosfomycin is first line empirical treatment of uncomplicated UTIs during pregnancy because it is safe, effective, less resistance, higher patient’s compliance with fewer side effect and equal cost of therapy.

372-376

Authors: Varun Gaitonde, Supriya Patil, Sanjaykumar Patil, Yamini Patil

Introduction: Pathophysiology of PCOS reveals excessive ovarian and/or adrenal androgen secretion results in hyperandrogenism and is associated clinical manifestations ranging from hirsutism, acne, male-pattern baldness to irregular menses, infertility. This study aims at assessing the prevalence and clinical presentations of PCOS among women of the reproductive age group attending the OPD of a tertiary care centre. Materials and Methods: The study was carried women of reproductive age group (15-45yrs) attending Obstetrics and Gynaecology OPD of a tertiary care hospital presenting with relevant symptoms from July 2015 to July 2017. Results: In the present study, the average age of participant was 22.47 + 3.44 years, we also found that menstrual abnormalities were observed among all the study participants followed by skin discolouration (32.4%). Average BMI in kg/m2 was 22.22 + 2.22. Conclusions: PCOS in a common disorder among young women. Menstrual problems are the commonest reason for gynecological OPD consultation among adolescent girls. Evaluation of bleeding problems in adolescents is justified, before considering them as normal physiological transitio

381-383

Authors: Sowmya Gopinath, Dhananjaya B S, Chandhana Krishna

Introduction: Pregnancy and child birth though considered as physiological process can become lethal for any woman. Childbirth was considered as rebirth to a woman in olden era. The atmost duty of an Obstetrician is to identify the abnormal events at the earliest, intervene appropriately and avoid the catastrophe. The importance of partogram is to prevent the maternal and perinatal complications. The World Health Organisation has simplified the partogram for its use by skilled birth attendants. Aims and Objectives: To study the progress and outcome of labour using modified WHO partogram in pontaneous labour in primigravidas. Materials and Methods: A cross sectional study of 200 women primigravidas admitted to Sree Siddhartha Medical College from December 2016 to November 2017 with spontaneous onset of labour at term with no high risk factors were recruited for the study using modified WHO Partogram. Augmentation of labour requirement, duration of active labour, mode of delivery, maternal and perinatal outcome were studied. Patients were divided into 2 groups – Group 1 and Group 2. Group 1- cervical dilatation and descent curve falling to the left of the alert line. Group 2- cervical dilatation and descent curve falling to the right of the alert line. Though Group 3 with women to right of action line was planned, there were no patients in group 3.Results: Most women belonged to age group of 21-25 years. The mean gestational age was 38.2 weeks. In Group 1, the mean duration of active phase of first stage of labour was 4.52±0.10 hours, where as it was 5.94±1.46 hours in Group 2. In Group 2, the mean duration of second stage of labour was 45.44±1.94 mins but it was 34.42±16.41mins in Group 1study subjects. Mean rate of cervical dilatation is 1.2 cm/hr. Seventy seven percent had normal delivery, 11% had caesarean delivery and 12% had instrumental delivery. Patient crossing the alert line had longer duration of labour. Augmentation was significantly higher in Group 2 (92.3%) than in Group 1 (67.8%). In the study group, there were no maternal and perinatal deaths. Conclusion: The partograph is an inexpensive and easily accessible tool that can effectively monitor the progress of labour. The WHO simplified partograph is highly useful in identifying when to intervene and also reduces perinatal and maternal mishaps.

389-391

Authors: Sudha .R, Umashankar, Dharmavijay

Introduction: Hysterectomy is one of the commonly performed gynaecological surgery. Vaginal hysterectomy is a natural orifice surgery where as laparoscopic hysterectomy is a minimally invasive procedure. Vaginal hysterectomy is associated with less morbidity, less operative time, short duration of hospital stay and reduced cost compared to laparoscopy. With increasing containment of health care costs and epidemic increase of non communicable medical disorders there is a need for performing vaginal hysterectomy in benign non prolapsed uteri especially in rural settings. Aims and Objectives: The objective of this study is to know the intra operative factors and to study the short term outcomes associated with non descent vaginal hysterectomy {Heaney,s hysterectomy}. Materials and Methods: This is prospective observational study conducted at MVJ Medical College and Research Hospital located in rural setting from January 2012 to December 2012. All the patients requiring hysterectomy for benign conditions not associated with uterine descent underwent non descent vaginal hysterectomy. Intra operative factors like blood loss, difficulty in delivery of uterus, bowel and bladder injuries, and conversion rates to laparotomy were noted. Post operative complications were noted. Results: Seventy two patients were planned to undergo non descent vaginal hysterectomy for various benign conditions. Vaginal hysterectomy was done successfully in 70 patients. The mean age was 45.6±3.4 and mean parity was 2.2±0.45. Dysfunctional uterine bleeding (55%) was the most common indication. Average duration of surgery was 45- 80 min. The requirement of post operative analgesia was minimal by the patient as there was no abdominal incision. Post operative complications were less. The duration of hospital stay was 3-5 days. Conclusions: Non descent vaginal hysterectomy is less invasive surgery. Less morbidity, lesser duration of hospital stay, cost effectiveness makes vaginal route as the choice for women in rural settings

395-398

Authors: V.S. Prasanna Kumar Reddy, V. Manasvi, Aradhana Giri

Introduction: Pre-eclampsia and intrauterine growth restriction are important causes of maternal and perinatal morbidity and mortality. Gestational age at the onset of pre-eclampsia will determine the degree of fetal compromise. Hence, early detection of preeclampsia is important to improve maternal and perinatal outcome. Utero placental circulation can be non-invasively assessed by Doppler analysis of uterine arteries. Aims and Objectives: The aim of our study is early prediction of pre-eclampsia and Intra uterine growth restriction by Doppler assessment of uterine artery. Materials and Methods: 100 antenatal women of singleton pregnancy at 16-24 weeks of gestation were selected for study in the department of Obstetrics and Gynecology at MNR Medical College, Sangareddy from May 2015 to April 2016. Doppler evaluation of uterine artery along with routine biometry was done. Results: Out of 100 cases studied, 19 patients showed abnormal uterine artery Doppler results and among these 16(84.2%) developed preeclampsia, 8(42%) had intrauterine growth restriction, 6(31.5%) babies required NICU admission and 2(10.5%) intrauterine fetal deaths were noted. Sensitivity and specificity to detect pre-eclampsia was 84.2% and 83% respectively and that of intrauterine growth restriction was 42% and 96% respectively. Conclusion: Uterine artery notching, high PI, RI in uterine artery Doppler analysis can be a good screening tool for early prediction of pre-eclampsia and intrauterine growth restriction.

405-408

Authors: Uma Pandey, Stephen Lindow

Introduction: Oligohydramnios is associated with intrauterine growth restriction, congenital anomaly, neonatal and maternal morbidities. The outcome in cases of borderline oligohydramnios is less clear. This study was performed to document fetal, neonatal and maternal outcome in cases of borderline oligohydramnios among those women who delivered in our unit. Materials and Methods: The duration of the study was July 2013-June 2016 and a total of 66 women who were more than 37 weeks gestation were included. The data was compared with 66 control women from the same institution. Results: Overall 45.4%% cases were delivered normally while 62.5% of the control group had a vaginal delivery (p=0.02). Emergency caesarean section cases were due to fetal distress in 35.29% of cases compared to 8.6%in the control group (p=0.02).The fetal and neonatal outcome was far better in the control group as there was 45 versus 8 cases where there was a neonatal problem (p< 0> Conclusions: Cases of borderline oligohydramnios at term have a higher risk of perinatal complications and operative delivery and should be monitored during labour. Delivery should preferably be in a unit where excellent neonatal facilities are available.

413-418

Authors: Kusum Lata Mathur, Manu Sharma, Devanshi Sharma, Shikha Talati

Introduction: Premenstrual dysphoric disorder (PMDD) is a severe and debilitating form of Premenstrual syndrome (PMS) affecting women in their reproductive age. There is paucity of Indian research in this area among adolescents. Aims: To determine the prevalence of PMDD in adolescent school students, and to study relationship between PMDD and anxiety, depression, self-esteem and quality of life (QOL). Materials and Methods: A cross-sectional survey was conducted on 100 adolescent students of an urban school. The Premenstrual symptom screening tool for adolescents (PSST-A), Hamilton anxiety (HAM-A) and Depression (HAM-D) Scale, Rosenberg self esteem scale (RSES) and The women’s quality of life questionnaire were employed. Results: All participants reported at least one PMS symptom of minimal severity and 68% had at least one PMS symptom of moderate-severe intensity. Twenty five percent of the participants had ‘moderate-to severe’ PMS. None of the participants qualified for PMDD. Disruption of daily activities was reported by 35% while 22% missed school due to PMS. A statistically significant relationship was found between PSST scores and HAM-D score (p<0> Conclusion: Although PMS and PMDD pose a difficulty, majority of adolescents do not have significant anxiety, experience positive self-esteem and good quality of life. There is a need for multi-centric and multi-disciplinary research to further elucidate the factors associated with PMS and PMDD in this population.

424-428

Authors: Jiten Senta, Imran Badi, Mo Anish Hingora, Jignashu Kanziya, Manish Pandya

Fetal hydrothorax were diagnosed during ultrasound examination in asymptomatic women in the second trimester of pregnanancy.1 Fetal hydrothorax is a condition in which fluid accumulates in the fetal chest, in the space between the lungs and the chest wall (known as the pleural space). This fluid may also be referred to as “pleural effusion.” Fetal hydrothorax usually develops when there are leaky or obstructed veins or lymphatic channels. occasionally, the fluid leakage may result from a mass (such as a lung mass), infection or chromosome problem, but in many instances no specific cause for the leaky fluid may be found.

433-435

Authors: Mily Pandey, Monu Singh, Achla Batra, B. Preethi, Inlo Miuli

Pregnancy in a caesarean scar is a rare entity where the pregnancy is implanted into a prior caesarean delivery uterine scar and located outside the normal uterine cavity. We report a case of caesarean scar ectopic pregnancy occurring in the scar of a previous caesarean section, diagnosed by ultrasonography and Doppler and the surgical management of such a case following failure of medical therapy. We present history, clinical findings and imaging of our case followed by discussion about, diagnosing and management of such a case and the options available.

438-441

Authors: Trisha Arora, Naina Kumar

Endometrial carcinoma is one of the commonest gynecological cancers of female genital tract, usually occurring after menopause. Supraclavicular lymph node is one of the rare sites of metastasis in the endometrial carcinoma. The present article illustrates the typical and atypical metastasis, surgical staging and role of lymph node dissection in patients with endometrial carcinoma. Typical sites are pelvic, the para-aortic nodes, the peritoneum, and lungs. Atypical sites are extra-abdominal lymph nodes, brain, bones, liver, soft tissue and adrenals. It is therefore important for the radiologists to recognize typical & atypical sites of metastases seen in patients of endometrial carcinoma so as to facilitate early diagnosis and treatment.

176-179

Authors: Ritesh Sondawale, Dhwani Desai, Ragini Verma

Introduction: Pregnancy is not a disease state but sometimes it leads to severe morbidity and carries risk for mortality. Maternal death not only affect family but it also has an impact on society as well as nation. Maternal mortality rate is reflection of the quality of health care services provided by the country to the women population. Materials and Methods: This is a retrospective study of maternal deaths using facility based maternal death review forms supplied by Ministry of Health and Family Welfare Government of India filled by doctor on duty at that time as a baseline document. Results: This study shows that major cause of maternal mortality in tertiary care centre was hypertensive disorders of pregnancy however hypertensive disorder of pregnancy alone was not the only cause of maternal death, it was complicated with different other causes like ARDS, APH, HELLP syndrome, PPH, Sickle cell disease, ARF, DIC, severe Anaemia and many others. Hypertensive disorders of pregnancy contributed 33% of all deaths whereas Sepsis (12%), Hepatitis (10%), Haemorrhage (8%), Heart Disease (7%), Anaemia (5%), ARDS (5%), Sickle Cell Crisis (4%), Amniotic Fluid Embolism (2%), Diabetes Mellitus (2%) and others (12%). Conclusion: Most maternal deaths are preventable by optimum antenatal, intranatal and postnatal care. Early referral of high risk pregnancies to tertiary care centre will definitely change the outcome

186-189

Authors: Jalpa K. Bhatt

Introduction: Infertility affects 8-12% couples during their reproductive life. The number of infertile couple is on rise in India. The common reason for infertility may be female factor, male factor, unexplained or combined. IUI is a frequently indicated therapeutic modality for couples with male factor infertility, unexplained infertility and women with cervical mucus problems and mild endometriosis. Materials and Methods: This is a retrospective study performed at fertility clinic. The patients attending the outdoor department for infertility treatment, those who underwent ovarian stimulation along with IUI cycles were enrolled in the study. Results: Maximum 55 (52.88%) patients were of 26-30 years age group. 85(81.73%) Participants were having complain of primary infertility whereas 19 (18.26%) were having secondary infertility. Out of 30 conceptions achieved, 18 (60%) were stimulated by gonadotrophins along with IUI. Conclusion: IUI along with controlled ovarian stimulation gives higher pregnancy rate.

195-198

Authors: Nisha Bhatia, Krishna Kumari Meka, Manick Dass .S., DVLK Swetha

Introduction: Vaginal discharge is the most common complaint with which women of reproductive age group present to the gynecological outpatient. WHO syndromic approach algorithm helps in identifying the etiology based on the gross appearance of discharge but it often fails to detect the etiology correctly. Addition of simple microbiological tests helps to diagnose the etiology accurately. Objective: To compare the diagnosis of symptomatic vaginal discharge based on WHO syndromic algorithm and microbiological tests. Materials and Methods: 100 Women in the age group of 18 to 45 years with symptomatic vaginal discharge attending the gynecological OPD of Apollo Institute of Medical Science and Research, Hyderabad were examined in the outpatient and a clinical diagnosis made using WHO syndromic algorithm for vaginal discharge. Under aseptic precautions, vaginal discharge was collected and subjected to simple lab tests such as Gram’s stain and direct microscopy (wet mount). The lab results were compared with the clinical diagnosis. Results: Among 100 women, bacterial vaginoses was the most common diagnosis. In 55% of patients etiological agent could be identified by lab investigations. By WHO syndromic approach, bacterial vaginosis was over diagnosed (70 vs. 44 cases confirmed by lab) and candidiasis was slightly under diagnosed (8 vs. 10 cases by lab). The sensitivity of WHO syndromic approach in diagnosing bacterial vaginosis is 100% while specificity is only 53%. The difference in diagnosis rate of candidiasis clinical versus microbiological diagnosis was marginal (10% vs. 11%). Trichomoniasis was accurately diagnosed by WHO syndromic approach. Conclusions: WHO syndromic algorithm for vaginal discharge over diagnoses bacterial vaginosis but has a high sensitivity and specificity in diagnosing candidiasis and trichomoniasis. Simple microbiological test such as Gram stain and wetmount will increase the accuracy in diagnosis thereby preventing overtreatment.

203-208

Authors: Hemanta Kumar Pradhan, Pratibha Singh, Garima Yadav, Meenakshi Gothwal

Introduction: The aim of this study is to accesses the use of the syndromic approach towards managing sexually transmitted infections (STIs) in north western part of India and to make recommendations about the strengths and weakness of syndromic management algorithms and to determine if evidence supports its continued use. Materials and Methods: Total of 412 patients diagnosed as STI based on clinical and physical examination were treated based on syndromic approach and finally 240 patients were recruited in the study. Diagnosis was made based on signs, symptoms and examination. Every symptomatic patient suggestive of STI was managed on the basis of algorithms of the syndrome approach and patients were again followed up after completion of treatment for assessment of clinical improvement/deterioration of signs and symptoms. Results: Vaginal discharge (48.5%, 194 out of 400) followed by lower abdominal pain (46.75%, 187 out of 400) were the most common complaints. On cervico-vaginal smear cytology, 31.70%, 12.19% and 4.87% tested positive for bacterial vaginosis, leptothrix and candidiasis respectively. Syndromic approach for patients of STIs with symptoms of pain abdomen, white discharge P/V and itching P/V are statistically highly significant (Chi-Square Value~86.44 and its p value <0.0001) but for genital ulcer and urinary tract infection is statistically not significant. (Chi-Square Value~0.55 and its p value is>0.05). Conclusion: Syndromic management may be an effective method for clinical management of symptomatic STIs in low resource setting as illustrated in our finding. But further research is needed to determine the cost-benefit ratio of introducing laboratory-based screening into a comprehensive public health program for the control of commonly seen STIs in populations at risk for STIs.

215-218

Authors: Uma Pandey

Objective: Prospective observational study of indications of hysterectomy and postoperative complications was done among benign gynaecology cases attending the outpatient department of Obstetrics and Gynaecology, Sir Sunder Lal Hospital, Banaras Hindu University, Varanasi, UP, India. Materials and Methods: Those women attending the outpatient department of Obstetrics and Gynaecology, Sir Sunder Lal Hospital, Banaras Hindu University, Varanasi, UP, India who had hysterectomy done were given questionnaire to fill or member of health care team filled questionnaires on their behalf if they were illiterate. The study duration was from July 2011 to June 2016. We included only those patients in whom hysterectomy was done at less than 30 years of age and total abdominal hysterectomy was done. Patients were asked regarding indication of hysterectomy, their understanding of their illness, postoperative recovery and current problem. Results: Total of 45 women gave information about their hysterectomy and their current health and they were all married. The 25-30 years age women were 93% in this observational study, 84% were from low socioeconomic status. In our questionnaire survey 71% of cases of Total Abdominal Hysterectomy (TAH) was done for the complaint of vaginal discharge. These women disliked the wetness of their undergarments (even if mild); they thought it as a harbinger of some severe illness. Fibroid was second most common cause (15%) in our group followed by heavy menstrual bleeding, then abdominal pain and prolapse. The most important observation of this study is presenting complain of the patients in this study. It is remarkable that 71% of women were operated for persistent vaginal discharge, while in 51% it was persisting at the time of presentation. When they were examined they had physiological discharge from the vaginal wall. 8% patients had persistent granuloma, which was causing post coital bleeding and discharge, and was treated. 15 % patients complained dyspareunia although no pathological cause could be elicited. Last and the most important questions which was asked, whether women understood her illness? Why did she need operation? Was she told of the complications? Only 11% patients knew it (e.g. had fibroid). This is not surprising. Vaginal discharge and indication of hysterectomy was not discussed with them. They were probably not offered medical treatment. Whether it was due to ignorance or some other factor, we could not elicit. Conclusion: This study shows higher rate of hysterectomy among patients with vaginal discharge. Majority of these women did not have medical treatment for their complain of vaginal discharge. Most important feature is that, in spite of hysterectomy these women continued to have vaginal discharge, which could perhaps indicates that their hysterectomies were unnecessary and their discharges were physiological. Education to health care workers and gynaecological patients is of utmost importance.

223-227

Authors: Bhagyalakshmi Manthri, Nina. V. Kate

Introduction: Post-term pregnancy is one that extends to or beyond 42 weeks of gestation, Patients at 40 weeks can either undergo induction or can be managed expectantly. At 41weeks of gestation the perinatal mortality rate is 9 per 1000 live births, and it continues to rise thereafter. Labour induction at 41 weeks gestation for otherwise uncomplicated singleton pregnancies reduces caesarean delivery rates without compromising perinatal outcomes. Study Design: 200 Low risk primigravida at 40 weeks of gestation were included and randomized into two groups. Group I=Induction group (n=100) Patients were admitted at 40 weeks and were induced at 40+0 to 40+6 Weeks. Patients in Group II the Expectant group which was further subdivided into 2 groups. Group IIa=Those who went into labour or had PROM or any omnious event during the Expectant period till 41weeks. Group IIb=Patients who reached 41weeks and then were induced. Results: Expectant management till 41weeks and then inducing labour at 41weeks resulted in a significantly higher number of patients having vaginal delivery when compared with patients who were induced at 40weeks. The incidence of meconium stained liquor, caesarean section, non-reassuring CTG, maternal complications and neonatal morbidity was high in Group I when compared to Group II. Conclusion: Labour induction in uncomplicated pregnancies at 41 weeks is not associated with increased rates of operative delivery, maternal and neonatal morbidity.

233-238

Authors: Puneeta Mahajan, Vinita Gupta, Aarushi Chaudhary, Shinky Mehta

Introduction: Hypertensive disorders during pregnancy may cause damage to liver which may manifest biochemically as a deranged liver function test and subsequent maternal morbidity and mortality any elevation in liver enzymes in a pre-eclamptic patient is significant and influences fetomaternal outcome this study evaluates the liver enzymes as a diagnostic and therapeutic tool in the management of preeclampsia and establishes a correlation between severity of liver function test derangement and severity of fetomaternal complications and use it as a predictive tool of severity of preeclampsia and for termination of pregnancy. Aim was to evaluate maternal and neonatal outcome in pre-eclamptic mothers with and without transaminitis. Primary objective of the study was to compare the maternal and neonatal outcome in pregnant women with preeclampsia in singleton pregnancies with gestational age >24 weeks with and without transaminitis. Secondary objective was to correlate the severity of liver enzyme derangement in preeclamptic mothers with adverse maternal and / or fetal outcome and use it as a predictive tool of severity of preeclampsia and for termination of pregnancy Materials and Methods: This prospective cohort study was conducted on 281 patients after approval by the institute ethics committee informed consents were taken from patients inclusion and exclusion criteria were met all enrolled patients were classified into mild, moderate and severe hypertension and managed as per standard guidelines. Specific investigations were performed if during any visit ast >25 iu/l and/or alt >32iu/l and/or alp > 418 iu/l, patients were called again after a week and blood pressure and fetomaternal well-being was assessed termination of pregnancy was done as per standard guideline statistical analysis done and hypothesis established. Results: From the present study it can be derived that at ast >66 iu/l and alt > 64 iu/l poor maternal outcome is expected with ast >60 iu/l and alt>64 iu/l adverse fetal complications are likely to occur. Conclusion: From the present study it can be concluded that severity of liver function test derangement is directly related to severity of preeclampsia which in turn is related to severity of fetomaternal complications.

242-246

Authors: Fareha Khatoon, Garima Maurya, Nagma, Parul Sinha

Introduction: India, with 1.34 billion people is the second most populated country in the world, while china is on the top with over 1.41 billion people. Total fertility rate of India is 2.2 and the current total fertility rate of U.P is 3.72 which is still lagging behind other states like Kerela, Tamilnadu. Since the inception of program, several knowledge, attitude and practices studies have been conducted. Materials and Methods: A cross sectional descriptive study was done in department of obstetrics and gynaecology, Era’s Lucknow medical college, Lucknow, Uttar Pradesh. The study group include 523 married women of reproductive age group attending Gynaecology OPD. The results are presented in frequencies and percentages. Chi-square test is used for comparisons. The p-value<0.05 was considered significant. All the analysis was carried out on SPSS 16.0 version (Chicago, Inc., USA). Results: Among the 523 women of reproductive age group maximum respondents belong to age group 21-30 years (78.77%). Most of the contraceptive non-users belongs to age below 20 years (64.7%) which is statically significant (p value=0.008). among respondents majority were Hindus (64.2%). Majority of respondents belongs to lower class (49%). Among lower class 67% respondents were non-contraceptive users. Among the temporary methods, condom is the well – known method, 78.8% and second most is oral contraceptives 76.1% followed by intrauterine devices (75.5%). Only 9.9% women knew about injectables. 77.8% women had positive attitude towards contraceptive usage and they would like to encourage others also for contraceptive usage. 64.9% women not practicing any family planning methods because of lack of knowledge while 18.7% women not using any contraceptive methods because of fear of side effects. Conclusion: In our study we observed that with increasing educational status and socioeconomic status contraceptive practices is increasing. We need more services to improve women’s education and proper family planning counseling to allay the anxiety and fear about contraceptive usage. Also, women should be educated regarding available modern contraceptive methods.

253-258

Authors: Prinka Bajaj, Sandhya Jain, Seema Pundir, Ritu Khatuja

Objective: To study the role of intravaginal micronized progesterone in preterm labour in prolonging the pregnancy up to term and thus improving neonatal outcome Materials and Methods: A prospective randomized study wherein 100 pregnant women between 26-34 weeks of pregnancy admitted to labour ward with s/s of preterm labour were included in the study. After initial management with tocolytics and antenatal steroids, when the labour got arrested these women were randomly divided into two groups 1and 2. Group 1 received 200 ug of intravaginal micronized progesterone from inclusion in the study to 36 weeks or till delivery whichever was earlier. Group 2 received only supportive therapy. None of women received oral tocolytics after initial arrest of labour. All women were followed up till delivery and obstetric outcome noted Primary variables were prolongation of pregnancy from inclusion in study to delivery interval, gestation age at delivery. Neonatal outcome variables were birth weight, need for NICU transfer, length of stay in NICU and neonatal complications The results observed were subjected to statistical analysis by SPSS-13 unpaired student t-test, Mann-Whitney for quantitative variables and Chi-square/fisher exact for qualitative variables Results: The two groups were comparable in term of age, parity and rural/urban status. Baseline presentation characteristics of the two groups such as period of gestation, number of uterine contractions per 10 minutes, cervical dilatation and, cervical effacement were also comparable (p value <0.05). Mean gestational age at delivery in group 1 was significantly more than group 2 (36.808 weeks vs. 34.078 weeks). Patient delivering beyond 37 weeks of gestation were significantly more in group 1 (60%vs 14%). Prolongation of pregnancy was significantly more in group 1, mean no. of days being 34±15.25 and 24.22±12.73 in group 1 & 2 respectively. Neonatal outcome in terms of birth weight was significantly better in group 1.mean birth weight being 2675.2±382.20 and 2393.2±378.05 in group1 and 2 respectively. Neonatal complications in terms of need for NICU admission, RDS, sepsis and mechanical ventilation were more in group 2. Conclusion: In preterm labour once the labour is arrested with tocolytics, intravaginal micronized progesterone therapy is effective in prolonging the pregnancy and thus increasing the gestational age at delivery. Neonatal outcome is improved because of increased birth weight and lesser complications.

263-266

Authors: Roopam Singh, Sonia Singhal, Shweta Saini

Introduction: One of the most common medical problems in pregnancy is iron deficiency anemia throughout the developing world1-5 with the burden of disease impacting in both mother and newborn. Anaemia affects nearly half of all the pregnant women in the world. Data shows that it affects approximately 52% patients in the developing and 23% patients in the developed world. Materials and Methods: A prospective study conducted on pregnant women in 26 to 34 weeks of gestation which comes under inclusion criteria. Duration of the study was 18 months.100 patients were taken 50 in each group, Blood indices such as Hb, MCV, serum ferritin, reticulocyte count and adverse drug reactions were compared. Results and Conclusion: Both intravenous and oral iron supplements were associated with increment of blood indices although rise was significantly higher intravenous group. Also intravenous iron is better tolerated compared to oral group. Thus, it can be concluded that IV iron therapy is much more effective in improving iron deficiency in pregnancy than oral.

272-277

Authors: Dolly Chawla, Rashmi Khatri, Shylaja T, Menka Verma

Introduction: Unintended pregnancy is still a major concern in India. It can be only prevented by effective contraceptive measures especially if it is used in postpartum period as it is highly vulnerable period to unintended pregnancy. The immediate postpartum period, after birth but before discharge from hospital is an important but underutilized time frame to initiate contraceptives specially long acting contraceptives like intrauterine contraceptive device. The study was conducted to evaluate the efficacy, side effects, continuation rates, and reasons for removal along with effects of expertise on complication rate between post partum IUCD, intra cesarean IUCD and interval IUCD insertion. Materials and Methods: study was prospective randomized conducted on 300 women for one year. IUCD insertion was done in three groups; group A (post-placental), group B (intra cesarean), group C (interval IUCD). All the groups were evaluated and compared with respect to the efficacy, side effects, continuation rates, and reasons for removal along with effects of expertise on complication rate Results: Most of women were of middle socioeconomic status and second gravida of age group 25-30 years of age. In all groups overall continuation rate after 6 weeks of insertion, 6 month and one year was 56.7%, 51.7% and 51.7% respectively. Complication rates are more after 6 weeks than 6 months and 1 year. Most common reason for removal was missing threads (16%).Complications needing removal were less when inserted by consultants than residents. Conclusions: We concluded that IUCD (Cu T 380 A) is an effective and safe reliable long term, reversible and convenient method of contraception which if properly implemented can help the unmet need of contraception to a greater extent even in postpartum period.

282-286

Authors: Rajendra P. Maurya, Tanmay Srivastav, Soni Chaudhary, Priyanshi Awasthi, Mamta Rajan

Aim: To determine the prevalence and pattern of retinal vascular disorders in pregnant women. Materials and Methods: This hospital based, prospective observational study was conducted over a period of two years. Patients were selected from outpatient department and antenatal ward of Department of Obstetrics and Gynecology and outpatient department of Ophthalmology, SS Hospital, IMS, BHU, Varanasi. In all cases detailed obstetric history including age, gravida, gestational age, general and antenatal examination and relevant pathological investigations like blood sugar, blood urea, serum creatinine and urinary protein were carried out. After taking ocular history, detailed ocular examination including visual acuity and fundus examination under mydriasis with 1% tropicamide eye drop was carried out. All the findings were recorded on a data sheet and were analyzed using SPSS programme. The Chi-Square test was used to evaluate the association between the various antenatal factors and retinal vascular changes. Results: Of 210 patients 38.09% patients were primigravida and 28.57% were second gravida. 28.57% had pregnancy induced hypertension (PIH), 13.33 % had gestational diabetes mellitus, 12.38% had preexisting diabetes mellitus. Fundus abnormalities were observed in 110 (52.38%) cases among them commonest retinal pathology was hypertensive retinopathy 38 (34.55%) followed by diabetic retinopathy (32.73%), retinal vein occlusion (16.36%) and central serous chorioretinopathy (7.27%). Out of 60 cases of PIH 38 (63.33%) had retinal abnormalities. Retinal vascular disorders were seen in > 80% cases of severe pre-eclampsia and about 90% cases of eclampsia. Majority (68.42%) of PIH patient had grade I hypertensive retinopathy. The commonest retinal change was arterial attenuation (28.57%) followed by dot and blot hemorrhage (21.90%), A-V crossing changes (20.48%), hard exudates (19.05%), flame shaped hemorrhage (42.56%) and macular edema (18.10%). However in 5.71% cases papilledema and in 5.24% cases ischemic optic neuropathy was observed. Conclusion: The most common vision threatening retinal vascular disorders in pregnancy was hypertensive retinopathy (34.55%) followed by non proliferative diabetic retinopathy (32.73%), pregnancy associated venous occlusive disorders of retina (16.36 %) and central serous chorioretinopathy (7.27%). Other retinal abnormalities seen in pregnancy included optic neuritis, papilledema and macular edema. Pregnancy may be one of the risk factors for retinal vasculopathy and temporary visual impairment. Thus, ocular fundus examination may be a valuable and necessary routine investigative procedure in pregnancy.

290-292

Authors: 290-292

Introduction: Huge borderline ovarian tumour are rare in modern medicine because of the awareness, earlier medical consultation and available ultrasound facility even in rural area. Here we report a case of huge ovarian mass proved to be borderline malignant. Case Report: A 38 years old female presented with abdominal distension of rapid onset within 3 months. On examination, there was a cystic mass of 30×20 cm arising from pelvis with variegated consistency. Ultrasound and CECT evaluation illustrated a well-defined cystic lesion with solid component arising from right ovary. With the working diagnosis of ovarian tumour, staging laparotomy was performed with total abdominal hysterectomy with bilateral salpingo oophorectomy. Histopathological examination revealed the tumour as borderline mucinous cystadenocarcinoma of ovary, without any local spread.

297-300

Authors: Shobha Lalit Lad, Vijayan Vela, Ruey Soon

Fryns et al described a syndrome in the year 1979.1 Fryns syndrome is characterized by diaphragmatic defects, facial dysmorphism including coarse face, hypertelorism, broad and flat nasal bridge, with thick nasal tip, long philtrum, tented upper lip, wide mouth, micrognathia, low set and poorly formed ears and distal digital hypoplasia, pulmonary hypoplasia and others.2 We report a case of fryns syndrome in twenty- nine years old, Chinese, primigravida diagnosed during antenatal ultrasound scan at 26 weeks of gestation. The diagnosis has been confirmed by clinical finding, ultrasound, X-ray chest, CT brain, and ECHO at the postnatal period.

303-305

Authors: Shashikala Karanth, A.P. Roshini, Sheela C N, Rajalakshmi T

‘Steroid cell tumors not otherwise specified (SCT-NOS)’ are rare sex cord-stromal tumors of the ovary with malignant potential, accounting for less than 0.1% of all ovarian tumors with the highest incidence in premenopausal women. These tumours represent a unique cause of female virilization. We present a case of a 48-year-old post-menopausal lady with bleeding per vagina and a 2-year history of truncal obesity and hirsutism. Past history was unremarkable. Examination revealed feature of obesity, virilization and clitoromegaly. Serum testosterone was 3.62 µg/L& CA-125 was 40.67. CECT gave the evidence of adnexal tumor, but histopathology confirmed SCT-NOS. Total abdominal hysterectomy(TAH) and bilateral salping-oophorectomy(BSO) was performed. Post-operative period was uneventful. This case is being reported for its rarity of occurrence and challenges faced in diagnosis of this case.

308-310

Authors: Jayesh R Shah, Jiten Senta, Shrina Shah, Dhruv Patel, Manish Pandya, Kalpana Khanderiya

Leiomyomas are the most common benign tumor of the uterus and affect 40 % to 50% of women older than 35yrs of age. Usually they are asymptomatic(70% to 80%).approximately 5% of leiomyoma are of submucosal type being least common but usually are more symptomatic. symptomatic leiomayomas are managed with either medical therapy or surgical management in the form of myomectomy or hysterectomy. multiple submucosal fibroid in pregnancy is a rare and often complicate with a fetal morbidity and mortality.1

5-8

Authors: CH Prasanna Kumari, A. Ashwini, K. Aparna, N. V. R. Murty.

Objectives: To identify the risk factors for meconium stained amniotic fluid (MSAF) and it’s impact on perinatal outcome. Materials and Methods: This prospective, observational study was conducted in labour room & operation theatre of St. Theresa’s Hospital from May 2015-May 2016. A total of 110 women who were found to have meconium on spontaneous or artificial rupture of membranes were monitored with fetal heart rate abnormalities,5 minute APGAR score and neonatal complications like meconium aspiration syndrome(MAS) as outcome variables. Results: The results of the study were analysed statistically using Windostat Version 9.2. The incidence of MSAF was 12.01%. Based on this study, it is evident that the incidence of MSAF was more in women with Oligohydramnios , Prolonged pregnancy , Diabetes complicating pregnancy , Hypertensive disorders in pregnancy, Fetal growth restriction and in women with induced labour. The Chi Square test was applied between Grades of Meconium and APGAR Score. p value< 0.05 which was statistically significant. Also, the study between Grades of Meconium and Cardiotocograph (CTG) pattern proved to be significant with p value < 0.05. Conclusion: MSAF alone is not associated with an adverse neonatal outcome, 78.18% of abies remained asymptomatic. Increasing grade of meconium is associated with increased adverse outcome. Association of MSAF with abnormal CTG is associated with poor outcome, increased caesarean section rate, increased neonatal complications. The presence of thick meconium is associated with increase in the perinatal morbidity and mortality and hence its presence should not be overlooked.

15-19

Authors: Deepika. N, Arun Kumar.

Objective: To study the efficacy of oral mifepristone in pre induction cervical ripening and induction of labour in term pregnancy. Materials and Methods: This is a single blind randomised control trial. 200 women with term pregnancy and bishop score < 6 were recruited and randomly allocated into two groups. Women who received tablet mifepristone 400 mg were assigned to study group (n=100) and who received placebo orally were assigned to control group (n=100). At the end of 48 hours, change in the bishop was assessed and accordingly induction/ augmentation of labour was done. Analysis regarding safety and efficacy of the drug was done with regards to maternal and perinatal outcome. Results: Among 200 women, 100 received mifepristone and 100 received placebo. In mifepristone group, 75% patients entered into labour within 48 hours of induction as compared to 48% in placebo group. The mean time interval between induction to start of labour pains was 28 hours 54 min in group A and 42 hours 18 min in group B. This difference was statistically significant. (p=0.000). In the study group 70% patients delivered within 48 hours of treatment as compared to 38% patients in control group. Mean induction delivery interval was 35 hours 38 min in study group and 49 hours 52 min in control group (p=0.000). There were fewer caesareans in the mifepristone treated group (10%) than placebo group (20%) particularly for failed induction (2 versus 6) and non progress of labour (2 versus 5). There was no statistically significant different in perinatal outcome between two groups. Conclusion: Mifepristone has modest affect on cervical repining when given 48 hour prior to labour induction and appears to reduce need for further induction compared to placebo. Mifepristone is a simple and effective method of inducing labour in women with term pregnancy and unripe cervix. The use of Mifepristone provides an interesting new alternative to classic uterotonic agents when induction of labour is necessary.

27-30

Authors: Hanumant V Nipanal, Susmitha Shivanna Reddy, Dilip Kumar Mauryya, Ravindra P. Nagendra.

Introduction: The present study is a retrospective analysis of vulval cancer patients who had been treated with surgery as primary mode. The cases studied were in tertiary care hospital south India of March 2008 to February 2013. Total number of patients was 11. Materials and Methods: The medical records of all patients studied retrospectively with reference to stage of the disease, surgery performed, prophylactic antibiotics, intra-operative and postoperative complications. Results: Among 11 patients 9 were postmenopausal. Ten patients histopathology showed stage 1b cancer for whom simple vulvectomy was performed, one patient had co-existing HGSIL( High Grade Squamous Intraepithelial Lesion) and positive right inguinal nodes, requiring TAH+ BSO+ right groin dissection and posterior colporrhaphy was done in one patient with rectocele. One patient presented with stage 2 disease for which radical vulvectomy with bilateral groin lymph node dissection was carried out. Postoperative radiotherapy was given for 8 patients with tumor positive margins. Conclusion: Even though many modifications in surgical methods of vulval cancer still morbidity is high. Particularly surgical complication of wound infection. This delay will further add up for delay in starting adjuvant treatment. Hence there is a need of further modifications of surgical treatments like minimally invasive approach. A team of oncology surgeons, medical oncologists, radiotherapists is needed to manage this rare cancer. With multidisciplinary approach Surgery for early stage vulval cancer has acceptable morbidity.

37-40

Authors: Jyoti Bindal, Sujata Bhargava, Anuradha Gupta.

Introduction: Mismanagement of postpartum haemorrhage (PPH) is the major reason for the maternal morbidity and mortality throughout the world, highest incidence is found in developing countries. Aims and objective: To study the various methods used to control PPH in all the deliveries that took place at the study place. Materials and Methods: Prospective study was performed on 402 PPH patients in the Department of Obstetrics and Gynecology, Kamla Raja Hospital, GR Medical College, Gwalior from Sept., 2014 to Aug., 2015. All the patients were divided in to atonic PPH and traumatic PPH. Patient’s detailed history including obstetric history, menstrual history and history of drug allergy were recorded in pre-approved excel format. Patients were managed either by catheterization and uterine massage, using uterotonic drugs, uterine packing and surgical intervention such as internal iliac ligation and/or hysterectomay. Results: Out of total 7977 deliveries, 62.09% were vaginal and 37.91% were caesarean section. Out of that 402 (5.03%) developed PPH. Mean age of study population was 23.3±1.37 years. Out of 402 PPH patients, 75% were having atonic PPH whereas 19.65% were having traumatic PPH. Most of the patients with atonic PPH were managed by uterotonic drugs (69%) followed by cathererization with uterine massage (25%). Most of the patients with traumatic PPH were found to be due to hematoma or tear and were managed by haematoma drainage (58%) followed by perineal with vaginal repair (33%). Conclusion: Uterotonic drugs were the most commonly used for the management of atonic PPH whereas haematoma drainage was mostly used in patients with traumatic PPH.

44-48

Authors: P. Thulasi, Balakrishnan R., Shanthi M..

Abnormal Uterine Bleeding (AUB) affects 50% of peri-menopausal women. It is common during the extremes of reproductive life, following pregnancy and also during lactation. About 10-15% of women experience AUB sometime during reproductive years of their lives.Irrespective of their age most of the women experience abnormal uterine bleeding at some or the other time. Objectives of the study: To ascertain the effectiveness of trans-vaginal ultrasound (TVS) to determine the endometrial thickness and its correlation with histopathology in abnormal uterine bleeding. Materials and Methods: This was a prospective study carried out in the department of Obstetrics and Gynecology with contribution from the department of Radiodiagnosis also, at P K Das Institute of Medical Sciences over a period of one year. The study included 75 women in the peri-menopausal and postmenopausal period who had presented with chief complaints of abnormal uterine bleeding. Patients were selected from OPD. Trans-vaginal sonography was done. Endometrial thickness was measured and was correlated with histopathology report after dilatation and curettage. Results: The age distribution of patients, clinical presentation, endometrial thickness by trans-vaginal ultrasound, endometrial hyperplasia as estimated by endometrial thickness and various histopathological patterns of endometrium on 75 patients were analyzed. Majority of the patients were between 40-45 years in the present study. Among 75 patients, menorrhagia was present in 30 cases [40 %]. Endometrial thickness between 8 to 10 mm was seen in 35 patients (46.66%), endometrial thickness between 10 to 15 mm was seen in 15 cases (20%), whereas, only 4 cases (5.33%) had endometrial thickness more than or equal to 15mm. Endometrial hyperplasia was seen in 30 patients (40%) followed by proliferative endometrium in 25 patients (33.33%). Among 30 patients of endometrial hyperplasia, only 2 patients (6.66%) had atypical hyperplasia. Majority 66.66% had simple hyperplasia. Conclusion: In peri-menopausal and postmenopausal AUB, trans-vaginalsonography should be the first investigation of choice. In peri-menopausal women, dilatation and curettage is recommended if endometrial thickness exceeds 10mm to rule out any hyperplastic process. Endometrial thickness of 5 mm should be taken as the upper limit for postmenopausal women.

54-58

Authors: Mirshad P.V, Mumtaz P, Jithesh T.K, Jaideep Mahendra, Prema Gurumurthy.

Introduction: Metabolic syndrome (MS) is a group of metabolic risk factors for cardiovascular diseases (CVD). Postmenopausal women may have an increased risk of MS and CVD. Vitamin-D (Vit-D) is believed to have an important role in the progression of CVD. Hence the study was conducted to assess the link between Vit-D and MS among postmenopausal Kerala population. Materials and Methods: A cross-sectional study was carried out in 298 postmenopausal women. Anthropometric measurements were measured using the standard procedure. Blood samples were collected and Vit-D levels of all participants were estimated. The study population was further grouped into three based on the Vit-D status as Vit-D deficient, Vit-D insufficient Vit-D normal group. Other parameters such as blood glucose, TC, TG, HDL, and LDL were measured and metabolic syndrome was identified. Result: There was a significant difference in the prevalence of MS between the groups. The one way ANOVA between the groups showed a significant difference (p≤0.05) for the components of MS such as waist circumference, BP, FBS, HDL-C. The Triglycerides levels did not show a significant difference between the groups. The Person correlation test indicated a negative correlation between Vit-D and the components of MS except for HDL-C. Conclusion: Vitamin-D deficiency was highly prevalent in Kerala menopausal women and serum Vit- D levels were significantly correlated with the prevalence of MS in postmenopausal women; this finding indicates that Vit-D could be an important factor for the development of MS and further CVD in Kerala postmenopausal woman.

64-67

Authors: Keshav Ram Benipal, Anita Pal, Manish Thakur, Anoop Sharma, Atul Sharma.

Introduction: The levonorgestrel- releasing intrauterine system (LNG-IUS) is the best tool for the non-surgical treatment for uterine bleeding and endometriosis. Materials and methods: Fifty-two women between the age 32 – 55 years were studied over a period of three years. Results: LNG-IUS caused 85% decrease in the amount of menstrual blood loss at 6 month and complete amenorrhea at two years. Conclusion: LNG-IUS was the best and effective to surgical management and other modes of medical treatment of abnormal uterine bleeding. The patient showed better compliance and satisfaction to the LNG-IUS.

72-76

Authors: Mohamed Abdelmoaty Elsamra.

Introduction: Pregnancy is a condition in which women undergo distinct physiological changes and stress. Also accompanied by unique physical and psychological demands, Yoga is thought to alter nervous system regulation and physiological system functioning (e.g. cardiovascular, gastrointestinal, endocrine and immune systems). It improves psychological wellbeing (e.g. frequency of positive mood states) and physical fitness (e.g. strength, flexibility). Patients and Methods: 250 primigravida females selected from the antenatal clinic of El-Shatby Maternity University Hospital, and allocated into two groups; group A: 125 females who will practice Yoga exercises and group B: 125 females who will not practice any kind of exercises. Results: Both groups are matched in age, height (p>0.05). Pulse, systolic, diastolic blood pressure and respiratory rate are matched in both groups (p>0.05). Incidence of edema, varicose vein, sleep disturbance, mood changes were significantly higher in group B (p<0.05). All women in group A had smooth course (p=0.000). Abnormal ultrasound findings, puerperium problems and mild postpartum hemorrhage were statistically significantly higher in group B (p<0.05). Conclusion: Prenatal Yoga is an excellent choice for any healthy woman to use in order to prepare herself physically and emotionally for child birth.

82-85

Authors: Alpana Bansal, Meena Saxena, Mukesh Bansal.

Introduction: Thyroid dysfunction is a common endocrine disorder in pregnancy. Thyroid hormones are necessary for development of fetal brain during pregnancy. Thyroid dysfunction during pregnancy has significant adverse effects such as preterm delivery, preeclampsia, miscarriage and low birth weight. In India one of the common health issues is hypothyroidism in pregnant patient. There is lack of data regarding prevalence of hypothyroidism in pregnancy while the problem is increasing day by day. Aim & Objective: 1. To study the prevalence of Hypothyroidism in rural population of Pilkhuwa, Hapur; 2. To study the age and trimester of pregnancy in relation to Hypothyroidism; 3. To Early diagnosis of disease so as to reduce morbidity & mortality; 4. To suggest corrective measures based upon the information gathered in the study. Materials and Methods: A study was conducted at Yashoda clinic Pilkhuwa Hapur. Patients attending antenatal clinic and checkup were included and TSH reports were collected. Observation: A total of 101cases were included in the study that came for antenatal check-up. Out of 101 cases, 59 are euthyroid. 16 cases had TSH between 2.5 -3.0. 26 cases had TSH from 3.0 -7.5. None of the patient had TSH equal to or above 10 units. Result: In first trimester 7 cases out of 81 which required treatment with eltroxin and needed follow up. 32 out of 81 cases required only follow up. In second trimester 3 cases out of 15 which required treatment with eltroxin and follow up. 7 cases out of 15 required follow up. In third trimester none of the cases in third trimester required treatment or follow up. Conclusion: Hypothyroidism is an important health issue among pregnant women which can cause several complications in ongoing and future pregnancies like recurrent abortions, infertility, PIH, preterm labour APH, PPH. All pregnant women and ladies who are planning pregnancies should be screened for thyroid disease.

89-92

Authors: Sapna B. Jain, Nishi Mitra, N. Singh, Sangam Jha

Introduction: Prior to medical advances in yester years VH was limited to uterine prolapse but in present techno-medical era the techniques and indications of vaginal hysterectomy have changed to give an excellent health care to women cosmetically at a reasonable cost with minimum invasion and maximum safety and satisfaction. Aims and objective: The aim of the study was to find out the answer of the question, IS REALLY TLH LESS INVASIVE THEN NDVH? By analyzing these two commonly performed procedures to find out the differences to decide whether NDVH is a simpler, less invasive, quicker, cost effective, environment friendly technique then TLH in the similar gynecological indications. Materials and Methods: A retrospective study was done on 120 randomly selected patient of Hysterectomy for various reasons between March 2016 till September 2017 in Dept. of Ob/Gyn LNMC JKH, Bhopal. Patients' original files and surgery reports of the TLH and VH were analyzed and compared retrospectively for the indication of surgery, patients' age, weight, parity, uterus size, time taken for surgery, blood loss, post-operative analgesia, hospital stay, Intra and post op complications. A stastical analysis of the data was performed using independent t test and p value of less than 0.01 was considered statically significant. Results: The mean time taken to perform TLH was significantly longer i.e. 184.83 minutes compared with NDVH, i.e. 83.5.minutes (p<0.004). Rate of conversion to AH was more with TLH due to haemorrhage in 3 and bladder injury in one of our cases, in comparison two cases in NDVH due to rectal and bladder injury. Blood loss in both the surgery was comparable as mean post op Hb in both group were 9.5 & 9.8 with no significant p value. Mean Pain score measured by VAS after 24 hours of surgery in TLH was 5.4+-2.02 and in NDVH was 3.57 +-1.3 after test of significance the p value was significant[<0.001] Proves that pain was less in NDVH than TLH. Duration of stay in the hospital was almost the same for both groups. Cost of surgery was more with TLH in comparison to NDVH. Conclusion: NDVH was as less invasive as TLH with the advantages of no visible scar on the abdomen, done under regional anaesthesia with routine instruments, less pain, less medication, less operative time, thus faster recovery so should be the first option whenever minimally invasive scar less hysterectomies is desired for similar indications.

98-103

Authors: Shashikala Karanth, Shruthi K., Sheela C. N., Cecil Ross.

Introduction: Thrombocytopenia can result from a wide range of conditions with several of them being pregnancy related. Obstetricians manage most cases of pregnancy-associated thrombocytopenia. Thus, a working knowledge of the clinical features and management of thrombocytopenia in pregnant women is important. The objective of the study was to evaluate the causes of thrombocytopenia and its effect on maternal and neonatal outcome in parturient women and also evaluate the obstetric risk factors, complications, and outcome of pregnancies complicated by thrombocytopenia. Materials and Methods: A prospective study of 100 antenatal women with thrombocytopenia who delivered at St John’s Medical College Hospital during a one and a half year period. The blood samples of pregnant women in labor room were collected at the time of admission. These women were followed up till they deliver. Results: The main causes of thrombocytopenia were hypertensive disorders: preeclampsia (15%), Hemolysis, elevated liver enzymes, and low platelets (24%) and eclampsia (4%); idiopathic thrombocytopenic purpura (16%), gestational thrombocytopenia (11%). Women with hypertensive disorders had higher rates of cesarean delivery (65%), intrauterine growth restriction (30%) and preterm deliveries (31%). Hemorrhagic complications are common in rarer causes of thrombocytopenia. Conclusion: The adverse outcome is specifically attributed to preeclampsia, HELLP syndrome and rare causes. While the perinatal outcome of GT and ITP is basically favorable. Careful surveillance is required for these women in high-risk units for early detection and treatment of possible complications, in order to reduce adverse maternal and neonatal outcomes.

109-111

Authors: Uma Pandey.

Introduction: Autoimmune congenital heart block (CHB) of the fetus is the severest manifestation of neonatal lupus, and it is damage of AV node of the fetus that is the root cause problem. Congenital heart block is mainly associated with maternal Systemic Lupus Erythematous (SLE) and anti-Ro and anti-La positive maternal status. This observational study was done to know the incidence of congenital heart block in patients of Systemic Lupus Erythematous who had ANA, anti-Ro/SSA and anti-La/ SSB levels positive. Materials and Methods: A prospective observational study was done in a University teaching hospital of North India (Banaras Hindu University). The study duration was between January 2014 to December 2016 and 9 cases of SLE were identified and diagnosed. All these patients were tested for ANA, anti-Ro/SSA and anti- La/SSB antibodies, were found to be positive. Three fetuses had confirmed fetal heart rate abnormalities/congenital heart block. Our neonatologist treated fetuses with heart block as per their protocols. Mothers were counseled regarding recurrence of congenital heart block in the next pregnancy. Results: All patients of SLE were positive for ANA, and had anti-Ro/ SSA- and anti-La/SSB-positive status. Three fetuses/neonate had congenital heart block, and one fetus required pacemaker after delivery. Conclusions: Delivery should be organized in tertiary referral center and with multidisciplinary care. Treatment with pacemaker insertion is life saving. These fetuses can be salvaged if they are given proper care although couple should be explained the prognosis.

118-123

Authors: C. S. Madkar, Garima Sinha, Shankar Burute, Mangal S. Puri, Pankaj Salvi.

Introduction: A variety of neurological disorders may be encountered during pregnancy and puerperium. These disorders may be unrelated to the pregnant state (e.g., tuberculous meningitis) or peculiar to or more prevalent during pregnancy which are still a cause of significant maternal morbidity and mortality in rural India (e.g., eclampsia and cortical venous thrombosis). Aim: To study the clinical profile of patients presenting with primary and secondary neurological disorders during pregnancy and puerperium and their outcome. Materials and Methods: This study was carried out at the Mamata Medical College between january 2009 and december 2013. All antenatal patients, postabortal or postpartum period requiring neurological consultation were included in this study. Women with eclampsia were excluded. Results: There were 75 women included in this study, with 45 cases of primary and 30 of secondary neurological disorders. The former included epilepsy,21 CNS infections,12 cerebrovascular disorders,9 intra cranial tumour,1 post traumatic paresis1 and encephalomyelitis.1 The latter included hepatic encephalopathy,28 enteric encephalopathy1 and polyneuropathy.1 In patients of epilepsy, the seizures had an equal distribution in all the trimesters and post-partum period, they were mainly of generalized type (77.27%) and were controlled in the majority (90.9%). No fetal congenital malformations were seen. Tubercular meningitis,8 pyogenic meningitis3 and viral encephalitis1 were the CNS infections encountered and pregnancy outcome was good in most cases. All cases of CVT presented in the postpartum period with fever and neurological signs following delivery. Among them 2 patients recovered completely, one patient had residual deficits, another had persistent seizures. We had one maternal death. HE affected patients mainly during the latter half of pregnancy or the post-partum period and was associated with 64.3% mortality. Conclusion: The incidence of neurological disorders in pregnancy and puerperium was very high especially in our hospital since it is a tertiary care referral centre. Epilepsy and hepatic encephalopathy were the commonest primary and secondary neurological disorders respectively found in our study.

129-130

Authors: G. Sravani, M. Jyothsna.

Introduction: Pregnancy luteomas are non-neoplastic tumor like masses found in the ovary. These pregnancy luteomas spontaneously regress after delivery. Luteomas are usually asymptomatic and found incidentally during cesarean section or radiological imaging. Materials and Methods: A two year prospective study was done on 450 pregnant women while undergoing cesarean section. While doing cesarean section surgeons found ovarian masses of varying size in a few patients, these masses we suspected to be an ovarian neoplasm. salpingo-oophorectomy was performed in these pregnant women. Post operatively the excised ovaries with fallopian tube were sent for histopathological examination. Results: Out of 450 cesarean section, ovarian mass were found incidentally in 16 (3.5%) cases out of which 3 (0.6%) were luteomas. Conclusion: Recognition of these luteomas is important during cesarean section, so that unnecessary oophorectomy is avoided which is risky and can prevent unnecessary complication for both the mother and the fetus.

136-138

Authors: Manish Raj Kulshrestha, Rupita Kulshrestha.

Vitamin D is a steroid hormone which is fat soluble and activated in kidneys. It plays multiple roles including regulation of cellular growth and differentiation, metabolic modifications, immunity, insulin resistance, cardiovascular disease, malignancies and also various reproduction related states like preeclampsia, preterm birth and gestational diabetes, along with calcium and phosphorous regulation in the body. In present study, we analyzed serum vitamin D levels in 100 women of reproductive age group (15-45 years). Surprisingly, only 7% of the women were found to have sufficient vitamin D level while 19% had insufficient level and 74 % were deficient. Such alarming community wide deficiency raises concern. Especially in this reproductive age group the women are liable to have rickets, osteoporosis, osteomalacia, low fertility and increased risk for adverse pregnancy outcomes. Pre-conception vitamin D supplementation is simple, easy, and inexpensive method which can prevent such grave outcomes.

143-147

Authors: Shivani Singh, Hemprabha Gupta, Kumkum Shrivastava, Vasudha Rathi, Uma Gupta.

Objective: To determine the efficacy and safety of misoprostol administered sublingually and vaginally for induction of labour. Material and Method: A randomized control trial was conducted on antenatal women for 18 month period from 1st Jan 2015 - 30th June 2016 admitted to Obstetrics & Gynaecology department of Era’s Lucknow Medical College and Hospital Lucknow. Total 120 antenatal women of 37 weeks or more gestational age fulfilling the inclusion criteria were enrolled in the study and they were randomly divided in to two groups (60 women in each group) sublingual group where they received 25 microgram misoprostol sub lingual and vaginal group where25 microgram of misoprostol was administered per vaginally .Same dose was repeated every four hour until 3 or more uterine contraction of 40sec duration occur over 10 minutes, or when a maximum of six doses i,e 150 microgram was reached and labour outcome was noted. Result: In our study the mean induction –delivery interval in sub lingual group was 13.28 hour and12.96 hour in vaginal group. The rate of caesarean section in the sublingual group was31.7% and invaginal group it was found to be 20%. However, it was not statistically significant. No significant side effect of misoprostol was seen during the study. Conclusion: Sublingual route of misoprostol administration is as efficacious and safe as vaginal route for induction of labour.

154-156

Authors: Humaeel Ali, M. B. Swami

Ovarian fibroma comprises 3% of all ovarian neoplasms and their malignant counterpart is very rare. Till today only 100 cases have been reported in the literature.1 Woman aged 60 years, postmenopausal, reported with pain in abdomen from 3 years. A 10 x 6 cm mobile, firm ovarian mass was felt through left fornix with no other significant findings was noted in general and systemic examination. All tumor markers were within normal limit. USG detected left ovarian mass. Laparotomy showed white, firm, solid mass arising from left ovary of 10x7cm size. No evidence of metastases. Histopathology examination revealed ovarian fibrosarcoma.

161-162

Authors: Jaydeep Pol, Yash Kale, Madhura Phadake, Girish Kadkol.

Uterus – like ovarian mass is a rare entity of uncertain histogenesis. A 30 year old female had a Left ovarian mass. Her preoperative serum CA 125 was 700U/ml. So a clinical diagnosis of Carcinoma ovary was made. We received left salpingo-opherectomy specimen for intraoperative frozen consultation. On gross examination, left ovarian mass measured 10x8x6.5cm. External surface was smooth and showed congested blood vessels. On cutting, mass was partly solid and partly cystic showing small cystic cavities filled with blood mixed fluid. The cyst wall surrounding the cavities was remarkably thickened. Microscopic examination of frozen section revealed a lesion predominantly composed of benign spindle cells. So we gave a diagnosis of benign cystic non neoplastic lesion on frozen section. Formalin fixed paraffin embedded sections followed. Microscopic examination of formalin fixed paraffin embedded sections revealed a cystic mass lined by endometrial type of lining and stroma surrounded by remarkable smooth muscle hyperplasia. In areas, haemorrhage, infiltration by hemosiderophages and hemorrhagic corpus luteum were also seen. So we gave a final diagnosis of uterus like ovarian mass. To the best of our knowledge, only 15 cases of extrauterine uterus like masses have been reported in the literature. Of these, 5 cases were of ovarian origin. This report documents a sixth case of uterus-like ovarian mass.

167-171

Authors: Kalpana Khandheria, Manish R. Pandya.

Introduction: Palliative care is an approach that improves the quality of life of patients and their families facing the problems associated with life-threatening illness, through prevention and relief of suffering by means of early identification, assessment and treatment of pain, and other problems – physical, psychosocial, and spiritual. Objective: The goal of Moments of Life: Made Possible by Hospice “SAMVEDANA” is to make aware the public about the choices we all have when facing a life-limiting illness and start having benefit of it to reduce their agony. The Aim is “To put life into their days and not just days into their life” - The idea is to help the person have a meaningful life, not just to live somehow till deaths concerned with quality of life. Materials and Methods: This was achieved with a study of 21 patients attended day care hospice during three- month study period. McGill quality of life questionnaire, and a new measure of patient satisfaction with hospice care were used. Result: All patients were getting appropriate psychosocial and spiritual support in addition to the medical / nursing interventions. Palliative care at Hospice Samvedana Affirms: 1. Life and regards dying as a normal process. 2. Neither hastens nor postpones death. 3. Provides relief from pain and other distressing symptoms. 4. Is a team approach. 5. Is individual specific – depends on assessment of patient and family needs. 6. Shifts emphasis from technology to people – “high touch-low tech”. 7. Is a partnership between the patient & the team. Conclusion: It can be concluded that satisfaction with hospice care was associated with quality of life more than symptoms. Patients can assess their care and can provide valuable information for improving palliative care. Training of medical officers and health care professionals, and sensitization of the public through awareness campaigns are vital to improve the scope and coverage of palliative care. Process of translating palliative care plan into action requires strong leadership, competent management, political support and integration across all levels of care.