Indian Journal of Obstetrics and Gynecology Research

1-6

Authors: Chandrakant Madkar, Jayalakshmi Musale, Hemant Deshpande, Rajendra Shitole

Objective: The placenta weight/birth weight (PW/BW) ratio has been shown to be associated with certain long-term fetal outcomes; however, its association with short-term outcomes has not been evaluated. Our aim was to assess the correlation between the PW/BW ratio and short-term adverse obstetrics outcomes in full-term, appropriate-for-gestational-age (AGA) newborns. Design: Prospective, randomized. Setting: Dr. D.Y. Patil Medical College & Hospital, Pimpri, Pune Methods: In our study, three groups of full-term neonates have been taken, according to their PW/BW ratio (high, normal and low) and are compared. Our primary outcome includes the admission rate to the neonatal intensive care unit (NICU) and secondary outcomes included an Apgar score < 7 at 5 minutes. Results: Our study showed that the high PW/BW ratio group was associated with increased rates of admission to the NICU and Apgar scores < 7 at 5 minutes as compared to normal PW/BW ratio. The low PW/BW ratio group showed decreased rates of NICU admission. A high PW/BW ratio is significantly correlated with short-term adverse perinatal outcomes. Conclusion: The possibility of short term health risks for newborns can be predicted by the PW/BW ratio.

11-15

Authors: Khan Arshiya, Saxena Shivi

Introduction: Gestational Diabetes Mellitus (GDM) has public health importance far beyond its immediate effect on the mother and child. Pregnancy is a diabetogenic state and GDM is a major driver of the Type 2 diabetes epidemic. About 1% - 3% of all pregnant women will show glucose intolerance. GDM is the most common metabolic complication that affects pregnant women. The frequency of GDM and its associated maternal, prenatal and long term morbidity emphasizes the importance of screening method. Aim: To study the role of 50 gm glucose challenge test for screening of gestational diabetes Method: Two hundred and fifty antenatal patients between 24-28 weeks of gestation were screened for gestational diabetes by 50 gm oral glucose challenge test. Those in whom plasma glucose was 130 gm /dl or higher were considered positive and then subjected to Glucose tolerance test (GTT 100 gm: 3 hour). Those with risk factors but negative GCT at 24-28 weeks were again screened at 32 –34 weeks. Comparison was made among normal patients and patients diagnosed with gestational diabetes regarding risk factors, clinical examination, routine and special investigations and pregnancy outcome Results: Out of 250 patients 150 had no risk factors while 100 had one or more risk factors. 10 patients (4%) were diagnosed as having gestational diabetes. 8 patients were detected at 24-28 weeks and 2 were detected from the risk factor group at 32-34 weeks. Conclusion: Universal screening of all pregnant patients during 24-28 weeks with glucose challenge test is simple, convenient, cheap and easy to organize instrument to identify women with GDM. In India we recommend universal screening of all pregnant women, as they have 11 fold increased risk of developing glucose intolerance during pregnancy compared to Caucasian women.

28-35

Authors: Neha Palo Chandel, Vidya V Bhat, R S Bhat, Sidharth S Chandel

Introduction: Heavy Menstrual Bleeding is a major factor affecting the quality of life and work performance in the perimenopausal women. In a country like India, especially in the rural settings, females hesitate to report to clinicians for gynecological problems like HMB, which affect their life significantly. And even if they do report, they are made to undergo unnecessary hysterectomies, despite there being alternative methods to manage such conditions. Methods: We initiated a prospective therapeutic study from July 2012 to July 2014, where we screened 2106 patients with menorrhagia to study the role of TCRE in these patients, 179 patients fulfilled the inclusion criteria, gave consent and were operated with TCRE to study its outcomes. These patients were cases of Mirena failure or those not willing for Mirena, histopathological diagnosis of simple hyperplasia as well as cystoglandular hyperplasia and especially the poor-follow up cases and rural patients with HMB. Results: TCRE has success rate of 85.5% as assessed by the patients’ satisfaction after the procedure and improvement in their bleeding pattern.11.2% reported with recurrence of menorrhagia, out of which 7.3% received exogenous progesterone therapy later, and were relieved with it, while 3.9% underwent a hysterectomy as the last resort. Haematometra was observed post–operatively in 3 cases(1.7%), Fluid overload was observed in 2 cases(1.1%) and ‘False- passage’ was encountered in 1 case (0.5%), where the procedure was abandoned and was performed after a month. Conclusion: Hysteroscopic TCRE is an effective modality, avoids unnecessary hysterectomy in the perimenopausal women and allows early return to work. The cost-effectiveness, improved quality of life and work performance provides TCRE an edge over the ‘conventional’ hysterectomy.

39-42

Authors: Prashant Joshi, Raksha Madhu

A 40 year old lady P3L3 tubectomised, presented to us in routine gynaec OPD with complaints of mass per vagina since 2 years. Patient is a known case of HTN & DM on treatment. On examination, moderately built and nourished lady, on per speculum examination second degree uterine descent with cystocele, on bimanual examination uterus retroverted, mobile, atrophic, bilateral fornices free, cervical mobility non tender. On ultrasound uterus is retroverted, postmenopausal status, ovaries normal. Impression – prolapsed uterus. Patient underwent Vaginal Hysterectomy with cystocele repair. Intraoperatively, we found a cyst 7Χ7 cm arising from the uterine fundus, cyst containing serous fluid, no continuity with endometrial cavity with congested blood vessels seen on the inner surface. Uterus, tubes and ovaries was normal. Histological examination showed cyst arising from serosal surface of uterine fundus, uniloculated. One of the cut sections of the cyst showed fallopian tubal epithelium embedded in the cyst wall. Uterine endometrium shows senile cystic atrophy and cervix shows chronic polypoidal endocervicitis. A diagnosis of “Cystic Endosalpingosis of the uterus” was made. The case is reported because of its great rarity and difficult diagnosis.

46-49

Authors: Kamal Singh, Sita Thakur, Monika Sharma

Ovarian torsion is an infrequent diagnosis in the paediatric age group but can be catastrophe especially if ovarian salvage is not possible. The clinical picture is nonspecific, and children cannot always articulate their symptoms, which often make the diagnosis a challenge. Because of its nonspecific manifestations, torsion has been confused with other conditions, such as appendicitis. Due to this cases often reported late, as in our case. A 7 yr old Fch presented with acute abdomen after two days. Imaging shows left adnexal mass with doubtful vascularity. So exploratory laparotomy followed by left salpingoopherectomy performed. We are reporting this case, as left sided ovarian torsion is a rare presentation of adnexal torsion in this age group.

56-58

Authors: Savita Rani Singhal, Deepmala Mittal

Nuchal cords at term are present in 15 to 34% of births for single loop and 5-6% for multiple nuchal cords. Despite the good prognosis in most of the cases, nuchal cord is associated with variable fetal heart rate deceleration, decreased fetal movements, fetal distress, and intrauterine fetal demise in few cases. Diagnosis of nuchal cord is by colour doppler which has senstivity of 60%- 95%. Multiple nuchal cord, especially four or more loops, demands special care due to the risk of intermittent cord compression. We present a rare case of gravid four para three woman, in which intra uterine death (IUD) occurred due to the six tight loops of cord around neck, which was not detected in the antenatal period.