Indian Journal of Obstetrics and Gynecology Research

206-212

Authors: Meena Armo, Kavita Babbar

Objective: To determine the factors responsible for maternal morbidity and mortality in women who underwent an unsafe second-trimester medical abortion so that it would help health professionals to revise abortion policies and practices to reduce it. Method: A retrospective record based data analysis was performed on patients with history of unsafe second-trimester medical abortion carried out at location other than our college hospital, during the period of June 2009 to May 2014. Results: Out of 758 cases of abortion observed, 123 (16.22%) women had undergone an unsafe second-trimester medical abortion and admitted in obstetrics & gynaecology department with complications. Majority of patients were rural, illiterate, from very low socioeconomic background. Most frequent complain for admission was severe bleeding. The most common reason for the termination was unintended pregnancy. Of total 123, 19(15.44%) women sought abortion due to sex preference. Majority of provider were either paramedics or quacks. Complications observed in 86(69.91%) cases. Majority of 101(82.11%) patients required surgical interventions. Of total, 4 (3.25%) patients couldn’t survive despite of all resuscitative measures. Conclusion: Abortion right as well as safe abortion service is still a distant dream in rural areas of our state. Declining sex ratio could be an alarming sign which needs immediate attention and action.

218-226

Authors: Lakshmi Garuda, Suhasini Kambham, Neelohita B

Background: This study examines the factors responsible for acceptability of the post placental intracaesarean insertion of IUCD among the clients in the study and evaluates the safety and efficacy and occurrence of complications like bleeding, missing strings, infection, pregnancy and expulsion and their incidence of occurrence after a follow up of 6 months post insertion. Aim: To assess the acceptability, efficacy, feasibility and safety of IUCD insertion immediately after expulsion of the placenta in a caesarean section. Materials and Methods: We have conducted a study on 220 patients delivering by caesarean section at our hospital, Kakatiya Medical College, Warangal, INDIA. After taking informed consent and explaining the patients about the advantages and limitations, we have succeeded in inserting intrauterine device cu-t380A immediately after expulsion of placenta in patients delivering by caesarean section in 220 patients and followed up the patients at 2-6 weeks and 6weeks-6months period to evaluate the safety, efficacy and complications occurring and their incidence of occurrence. Results: Total women counseled were 480, Accepted in 231, Declined in 249. Intrauterine cesarean insertion was done in 220 patients and deferred in 11 patients due to post partum hemorrhage. Out of 220 patients, 28 patients lost to follow up, Removal rate was 20 and continued in 160. The total complications are 68 (Expulsion 12,Bleeding 20, Strings not visible 32,Infections 4,Pregnancy 0),These results were comparable to other national and international studies. We compared complications between elective and emergency intracesarean insertions and their statistical significance were evaluated. Conclusion: Advantages of immediate post-partum insertion include high motivation, assurance that the woman is not pregnant, and convenience. However, expulsion rates appear to be higher than with interval insertion. The popularity of immediate post-partum IUCD insertion in countries as diverse as China, Mexico, and Egypt support the feasibility of this approach. Early follow-up may be important in identifying spontaneous IUD expulsions.

232-237

Authors: Hema Gayathri Arunachalam, Savitri Subramanyam, Mala Vijayakrishnan

Background: Throughout developing world there is a large gap between people desire to space and their use of contraception (UNMET NEED) and this end up in unwanted pregnancy. In India 20 % of pregnancies are unwanted and more than half undergo unsafe abortion contributing to 8% of maternal death. ‘You cannot die from a pregnancy you don’t have’. India being the second populous, to combat unmet need is a national emergency, and post abortal counselling is an effective tool. Aim: This prospective observational study was conducted to assess the impact of post abortal contraception counselling and to determine the acceptability of concurrent contraception. Material and Method: All258 women who had abortion and who had been provided post abortion counselling between October 2007 and September 2009 were the main source of study. The women were enquired about any contraception use and compliance, before abortion. Following post abortion counselling, the number of women who accepted to use contraception in the immediate post abortal period were determined. Women who accepted concurrent contraception were followed up by phone call 5months later, with emphasis on practices towards contraception and perseverance. Statistical data: Calculated by simple percentage, p value, odds ratio. Result: Following post abortal counselling the contraceptive acceptance increased remarkably by 74.2% and use of modern method increased by 2 fold (79.5% compared to 29.2 % prior counselling). Extended follow up after 5 months showed that women persevered with contraceptive usage when it was initiated in the immediate in the post abortal period (p 0.0). 10.3 % discontinued in the interval period. Besides increase awareness in multiparous (76%), unplanned pregnancy was high (76.48%) due to poor compliance (41.76%) and the rest of patients discontinued due to fear of side effects and myth about contraception. In my study education and socio-economic class did not significantly affect the acceptability of contraception (p 0.239, p 0.730). Conclusion: Women having had an unplanned pregnancy and abortion is anxious to avoid repeating it again and also more receptive. Hence post abortion period is an opportune time for health professionals to have a major impact on reproductive health outcomes.

242-245

Authors: Swati Agrawal, Veena Agrawal, Sunita Yadav

Background: Amniotic fluid is an indicator of placental function on the fetal development. The amniotic fluid index is the most commonly used method of measuring amniotic fluid. Objective: The purpose of this study was to study amniotic fluid index in normal and high risk pregnancy (PIH) at term (37-40 weeks) and to correlate amniotic fluid index with foetal outcome. Materials and Methods: The present study of assessment of Amniotic Fluid Index in high risk cases of pregnancy was carried out in the Department of Obstetrics and Gynaecology, Gajra Raja Medical College, Gwalior. The ultrasonic examination was performed in the radio diagnosis department of Gajra Raja Medical College, Gwalior. This comparative study was carried out on total 200 patients admitted to Kamla Raja Hospital from July 2006 to March 2007. Scans were performed from 37 weeks to 40 weeks earlier if indicated. Results: This study showed that maximum numbers of cases admitted in both the groups were ranged between 37-39 weeks of gestational age. It was also seen that maximum patients in high risk (100) and control (100) groups were in 21-30 years age and minimum patients belong to age group > 37 years. Most of the patients were from antenatal clinic, 60 patients in control group and all 100 patients in PIH group attended antenatal clinic regularly. It was also seen in both groups that maximum patients were primigravida (40.5%). The amniotic fluid volume as measured by amniotic fluid index was within normal limits (86%) in low risk group patients. Incidence of congenital anomaly in high risk group was 20% and with oligohydramnios was 7.41%. We found one case of renal agenesis and one of multiple anomalies with oligohydramnios, also incidence of IUGR was very high in both groups. Conclusion: This study showed that, amniotic fluid volume estimation by ultrasonography is a good method of estimation of foetal wellbeing. Amniotic fluid volume is altered in high risk (PIH) pregnancies; it reflects intrauterine growth retardation and congenital malformations in few cases.

250-254

Authors: Kavita Sambharam, Anand Bhalerao

Objective: To study the associated factors for the development of urinary problems in post-menopausal women and the appropriate investigations, management and regular follow up of such cases. Methods: A total 121 post-menopausal women with urinary symptoms attending the gynaecology OPD as well as in patients were enrolled in the study. These patients were studied and evaluated based on history, clinical examination, investigation and follow up. The data was then subjected to statistical analysis and conclusions were drawn. Results: Burning micturition was the most common urinary symptom in the present study, seen in 85.12% post-menopausal women followed by urinary frequency (59.50%), urinary incontinence (28.92%), urinary urgency (27.27%) and mass per vaginum (25.61%). Escherichia Coli was the most common organism found in 45 post-menopausal women on urine culture and sensitivity. Local estrogen therapy provided relief of symptoms more than those who did not receive any local estrogen therapy. Conclusion: In modern era, a woman spends almost 1/3rd of her life is the in post-menopausal age group. Hence we need to concentrate on the various health aspects of menopause including urinary problems. As shown in this study, most of these problems can be treated medically, though few may require surgical treatment.

261-263

Authors: T.Vijaya Krishna, Archana Singh, M.Sumina, H.Anupama

Objectives: To compare the changes in lipid profile in women with pre-eclampsia to normotensive pregnant women. Method: This prospective observational study conducted in 300 patients, 150 being normotensive pregnant women and 150 hypertensive pregnant women. Lipid profile was estimated and compared. Results: There is a significant increase in triglycerides, total cholesterol, LDL & VLDL in the cases group but no significant difference in HDL between both groups. Conclusion: Pregnancy is associated with physiological hyperlipidemia. But abnormal increase in triglycerides, total cholesterol, LDL & VLDL could contribute to promotion of oxidative stress and vascular injury leading to pre-eclampsia.

270-275

Authors: Pavithra.I, Sheila.K.Pillai, Jaya Vijayaraghavan

Background and objectives: Gestational Diabetes Mellitus is an important medical disorder in pregnancy which is amenable to treatment thereby improving the maternal and neonatal morbidities to a great extent. Insulin has been the gold standard for management of GDM but has many demerits as far as patient acceptance and compliance are concerned. Oral hypoglycemic agents if proven safe can revolutionise the treatment of GDM. The present study aims to compare the efficacy of insulin and glibenclamide in the treatment of GDM and also to analyse the maternal and neonatal outcomes. Methods: It is a prospective observational study carried out in our institution. 100 antenatal patients diagnosed as GDM by standard criteria were recruited and randomized to two study arms of 50 each. Group A was started on insulin and Group B was started on glibenclamide upto a maximum dose of 20 mg per day. Capillary blood glucose levels were monitored and patients were followed up till delivery and neonatal outcomes also were analysed. Results: One week after starting treatment 72% of Group A and 68% of Group B achieved target levels of blood glucose and the difference was not statistically different. Before delivery 88% in Group A and 86% in Group B had values within normal range. The reduction in fasting blood glucose levels in glibenclamide group before delivery was statistically significant. The incidence of maternal and neonatal morbidities was comparable in both the groups.8% of patients had treatment failure with glibenclamide and were switched over to insulin. Conclusion: Glibenclamide appears to be an effective treatment agent in GDM with maternal and neonatal outcomes comparable with insulin. Studies involving more number of patients are still needed before glibenclamide can be considered as an effective alternative to insulin.

283-288

Authors: Manish R Pandya, Zeel V Gajera, Ravi R Vachhani

Obstetrics & Gynaecology is the medical and surgical specialty that focuses on the research prospectus of reproductive system in females.Indian Journal of Obstetrics and Gynaecology Research is a peer-reviewed journal that publishes articles on all aspects of basic and clinical research in the fields of obstetrics and gynaecology and related subjects, with emphasis on matters of worldwide interest. The journal publishes invited and submitted reviews and original articles about clinical topics and basic research; case reports; and preliminary communications from all sub-specialties in gynaecology and obstetrics.

294-296

Authors: Maya Menon, T. A. Sridevi

Moyamoya disease is a rare cerebrovascular occlusive disorder characterised by bilateral stenosis of terminal portion of the internal carotid artery near circle of Willis.This is a case of 28 yrs primigravida diagnosed as childhood stroke secondary to Moyamoya disease with left hemiparesis on antiepileptic drugs booked under combined care of obstetrician and neurologist was started on anticoagulant along with iron, calcium and folic acid. Antenatal period was uneventful. Patient had spontaneous on set of labour and had a assisted vaginal (vacuum) delivery, alive female baby was delivered with Apgar score of 8/10. Care was taken to avoid dehydration and hypotension during the peripartum period. There are no prospective trials that address the safest mode of delivery for women with MMD. Pregnant patient should be counselled about the risk and potential benefit of medical and surgical treatment and managed by multidisciplinary team of obstetrician, neurologist, neurosurgeon and anesthesiologist.