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.

127-131

Authors: Ravinder Pal Singh, Megha Pravin Khobragade, Anil Kumar, Achhelal Ramashankar Pasi

Background: decreasing sex ratio is an issue of major concern in India and has long-term social and demographic consequences. A community based cross-sectional study was conducted to explore the reasons and perceptions of people regarding decreasing sex ratio and gender inequalities. Objectives: to assess the knowledge, attitude and practices regarding gender preference, gender inequality and female infanticide. Material and Methods: study was conducted in 30 villages of Kathua district of Jammu & Kashmir. Study participants were eligible couples of the selected villages. Villages and study participants were selected by systematic random sampling. Data on knowledge, attitude and practice was collected using a standard questionnaire. Results: out of 300 couples 30% were illiterate. Overall 70% & 66% of the couples were aware of the decreasing sex ratio & its social consequences respectively. Though 75% of the respondents knew that sex determination is a crime, 17% reported that they would go for prenatal determination of sex and 11% of women were in favor of doing female feticide. A total of 79% couples reported preference for son. Antenatal USG was conducted in 60% of pregnancies, 61% of women reported to have experienced family pressure for son and 31% sought divine intervention to have son. Conclusion: over all study population had good knowledge of declining sex ratio, its social consequences and illegality of prenatal sex determination including female infanticide. Prenatal sex determination and female feticide was not preferred by majority of the study population. Most of the couples had perceived preference for son and majority had faced family pressure for the same. Recommendations: strengthening the ongoing IEC and BCC activities to promote gender equalities in the rural part of northern India. Implementation of policies & programs for overall development of girls. Keywords: sex determination, gender preference, gender inequalities, female infanticide, Jammu & Kashmir

137-148

Authors: K.Ramalingam, Devisrimurari, Mounica. Bollu, Shaik. Faizan Ali

Background: Gestational diabetes is associated with significant metabolic alterations, increased maternal and perinatal morbidity and mortality. Indians fall into high risk ethnic group for diabetes mellitus. Objectives: The objective of this study is early detection and treatment of gestational diabetes mellitus(GDM) in pregnant women and to assess perinatal outcome in a well controlled and poorly controlled gestational diabetes mellitus patients. Materials and Methods: Sample: All pregnant women attending to outpatient department in obstetrics and gynaecology department at NRI medical college hospital in Chinakakani Guntur(Dt) universally screened for GDM in all three trimesters. Methods: single step oral glucose tolerance test(OGTT) with 75 grams glucose. This test is performed by asking the patient to come with overnight fasting. after collecting fasting venous sample from patient, solution made of 75 grams glucose mixed with 150 ml water is given. patients with fasting plasma glucose value ≥90 mg/dl and 2nd hour plasma glucose value≥140mg/dl are diagnosed to have gestational diabetes. Results: Out of 71 pregnant women diagnosed as GDM, the commonest risk factors are age≥25 years(61.9%),followed by past history of abortion(33.8%), obesity(32.39%), overweight(32.39%), past history of GDM(16.9%), family history of diabetes to mother(22.5%),father(19.7%),both parents(4.2%). 9.8% of GDM patients were diagnosed ≤ 12 weeks, 61.9% between 13-28 weeks,22.5% between 29-34 weeks and 5.6%≥35 weeks. OGTT was carried out in all three trimesters for all antenatal women, so that GDM cases diagnosed in late weeks of gestation are not missed.GDM patients were followed up with 75 grams OGTT after 6 weeks, and 16.9% of women were positive for the test. Conclusion: Single step OGTT with 75 grams glucose with cut-off values of fasting plasma sugar≥90mg/dl and 2nd hour plasma sugar≥140 mg/dl is very useful in diagnosing GDM. Universal screening for GDM is superior to selective screening(based on risk factors) for detecting more cases, facilitating early diagnosis and treatment of a disorder that carries an adverse prognosis in antenatal women with no symptoms of GDM. The criteria recommended by WHO are simple and cost effective and it is practised in many centres. Further assuming that effective treatment is available, WHO criteria of 2nd hour plasma sugar levels≥140mg is useful in identifying a large number of cases and may have greater potential for prevention.one step procedure of WHO serves dual purpose for screening and diagnosis

155-158

Authors: Savita Rani Singhal, Veenu Kadian2, Sunita Singh, Veena Singh Ghalaut

Background: To compare the efficacy and side effects of ferrous sulphate, fumarate, ascorbate, sodium feredetate and ferrous bisglycinate in the treatment of iron deficiency anemia in pregnancy. Material and methods: The study is a prospective, randomized, comparative clinical study comprising of 250 antenatal women with hemoglobin between 7-10 gm %. The patients divided into five groups I, II,III,IV and IV of fifty each, by systematic randomization and were treated with ferrous sulphate (100mg), ferrous fumarate (100mg), ferrous ascorbate (100mg), ferrous bisglycinate (30 mg), sodium feredetate (33 mg) respectively. Hemoglobin estimation was done at day 0, 30 and 60 and serum ferritin levels were done on day 0 and 60. Results: There was significant and comparable rise in hemoglobin on day 30 and day 60 in all the five groups (p<0.001). Ferrous ascorbate and ferrous bisglycinate showed significantly (p<0.05) more rise as compared to ferrous sulphate. Maximum side effects were with ferrous fumarate (51) followed by ferrous sulphate (40), ferrous bisgylycinate (26), ascorbate (18) and sodium feredetate (10). Conclusion: Ferrous ascorbate and bisglycinate are more effective than ferrous sulphate in treatment of iron deficiency anemia in pregnancy. Sodium feredetate had minimum side effects. Keywords: Ferrous ascorbate, Ferrous bisglycinate, Ferrous fumarate, Ferrous sulphate, Sodium feredetate, Anemia, Pregnancy

163-168

Authors: Mital Joshi, Sirimavo Nair

Objective: The study was designed to determine the prevalence of menopausal symptoms during menopausal transition in middle age (30-60 years) women in Vadodara (N=1000). Method: They were interviewed by means of standard Menopause Rating Scale questionnaire (MRS) to report on the menopausal symptoms which were divided into somatic, psychological and urog. A predesigned questionnaire was used to assess their knowledge associated with menopause along with self-reported health profile. Results: The mean age of the study population was 42 + 5.1; where mean age of premenopausal group was 40.07 + 3.79, peri menopausal group was 41.72 + 4.28 and post-menopausal group was 46.4 + 5.32. The women reported pain in hands or legs as the most prevalent symptom (73.6%), followed by anxiety (67.4%), physical and mental exhaustion (66.8%). Other symptoms like dryness of vagina (48.5%), heart discomfort (45%), mood swings (35.5%) and irritability (32.8%) were reported by nearly half of the population. Severity of symptoms were observed for anxiety (2.7%), heart discomfort (2.3%), sleep disturbances (2.3%), bladder problems (2.1%). The mean total MRS was found to be rising up during transition from premenopause (4.60 + 3.07) to perimenopause (6.53 + 3.93) and showed a decline during transition from perimenopause to postmenopause (5.78 + 3.03). Amongst the three subscales of MRS, the mean of the Psychological domain (2.59 + 1.91) was higher followed by somatic symptoms (2.03 + 1.54) and least by the urogenital symptoms (0.92 + 0.99). A similar trend was observed during all stages of reproductive life, i.e. premenopausal, perimenopausal or postmenopausal (p<0.001) in these subjects. Knowledge of participants regarding the menopause and related health issues was very poor. Conclusion: The study concluded that, the time span between different menopausal transitions are very short and clashes with the time when a woman is already barring the highest degree of family responsibilities in her life. Therefore this raises a call for measuring and improving health- related quality of life of women during transition stages

174-175

Authors: Kartikey R. Shastri, Nalini I. Anand, Bhakti M. Ganatra

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. IJOGR publishes original research work in all relevant areas of reproduction, contraception, obstetrics and gynaecology that include reproductive endocrinology, reproductive physiology, assisted reproductive technologies, cloning, environmental effects on reproductive health, infertility, family planning, sexual health, obstetrics, prenatal diagnosis, maternal-fetal medicine, midwifery, perinatology, gynecological urology, gynecological oncology, gynecological endocrinology, general gynaecology and menopause.

179-184

Authors: Rakhee R Sahu, Anjali Sonawane

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. IJOGR publishes original research work in all relevant areas of reproduction, contraception, obstetrics and gynaecology that include reproductive endocrinology, reproductive physiology, assisted reproductive technologies, cloning, environmental effects on reproductive health, infertility, family planning, sexual health, obstetrics, prenatal diagnosis, maternal-fetal medicine, midwifery, perinatology, gynecological urology, gynecological oncology, gynecological endocrinology, general gynaecology and menopause.

188-190

Authors: Gangadhara Rao Koneru, Rekha Prabhu, Hema Gayatrhi A, Haritha P, Prabha Devi Kodey

Psoas Abscess is a rare association with pregnancy. A 24 years old primi gravida with term pregnancy presented with PROM, oligo hydramnios, fever, tachycardia and inability to move both lower limbs. On examination, membranes were intact, there was bleeding PV with excess vaginal discharge. There was foetal tachycardia (180/min). To exclude abruptio ultrasound was done. Intra Uterine Death was diagnosed. That time patient was in early labour which was accelerated with syntocinon. Suddenly she became hypoxic and was ventilated. She delivered a stillborn baby. In the puerperial period patient suffered fever for more than a month. As fever was not controlled for long period (one month) CT was done which showed hypodense areas in right psoas muscle. CT guided Percutenous drainage was failed. By MRI investigation, it was diagnosed as multiple abscesses with sacro illitis and was drained extra peritoneally. As fever is not controlled with broad spectrum antibiotics, montox skin was done which was strongly positive. Hence treatment with anti tuberculosis drugs was planned. Finally fever was controlled by antituberculosis drugs ISONIAZID 300 mg/day, REFAMYCIN 600 mg/day, ETHAMBUTOL 800mg/day, Inj. STREPTOMYCIN 1 gm/day as a thereuptic trail.

198-201

Authors: Joylene D’Almeida, Prashanth Hegde, Sujaya V Rao

Cervical ectopic pregnancy is defined as the implantation of an ectopic pregnancy in the cervix. The actual incidence is < 1%. Though rare, it requires a strong degree of clinical suspicion combined with ultrasound evidence to arrive at the diagnosis. The management of a cervical ectopic includes medical and surgical options. Medical options include using durgs like methotrexate and etoposide. Surgical options primarily include curettage and tamponade. Hemorrhage is a dreaded complication of a cervical ectopic and a torrential haemorrhage warrants an emergency hysterectomy.

59-61

Authors: Bhakti Ganatra, Kartikey Shastri, Nalini I. Anand

Objectives: This study was carried out to study the incidence of DIC in various obstetric conditions and to study the role of component therapy and its effects on the deranged coagulation profile and maternal outcome in patients with deranged coagulation profile. Materials and Methods: An observational retrospective study design was selected for this study. A total of 100 cases that had presented to labour room of our hospital between January 2013 and January 2014 with deranged coagulation profile were studied for improvement in maternal outcome after giving component therapy. All the antenatal women admitted and having alteration in any of the following laboratory parameters were included in the study (Hb, Platelet, PT, INR, aPTT, Sr. fibrinogen). Patients having jaundice due to obstetric condition (excluding any infective etiology like hepatitis or other hepatic conditions) were included. Any patient having just altered hemoglobin suggestive of anemia and transfused with red cell concentrate for the same were excluded. Any patients with medical condition like ITP, SLE, and Dengue etc. that can alter coagulation profile were excluded. Results: 21 patients tested positive for D- dimer i.e. 21 patients had DIC among 100 patients with deranged coagulation profile during study period. Incidence of DIC in our study was 0.002%. Out of patients with DIC, 42.85% had IUFD, 42.85% severe pre-eclampsia, 30.49% abruptio placenta, 19.04% eclampsia and 14.28% had PPH. Incidence of DIC in PPH- 60%, abruptio placenta 23.07%, severe pre-eclampsia 23.07%, eclampsia 22.22% and 20.8% in IUFD.

65-68

Authors: Reema Sircar, Geetanjali Pawar

Objective: To determine the frequency, causes and outcome of liver disease in pregnant women. Setting: Tertiary care teaching hospital. Method(s): All pregnant women with liver disease attending the inpatient or outpatient services of the Department of Obstetrics and Gynecology over a period of 3 years were evaluated and followed up till delivery or death. Results: The study included 40 patients of Cholestatic jaundice, 38 patients of viral hepatitis, 15 patients of sepsis, 5 patients of HELLP syndrome and 1 patient each of hyperemesis gravidarum, amoebic abscess, enteric hepatitis & acute cholecystitis with pancreatitis. Intra hepatic cholestasis of pregnancy was the most common and least detrimental cause of liver disease in pregnancy. Number of preterm deliveries and incidence of LSCS was highest with HELLP Syndrome. ICU admissions were maximum with diagnosis of Hepatitis E and NICU admissions highest with HELLP Syndrome. Both HELLP Syndrome and Hepatitis E were responsible for maximum maternal and perinatal deaths. Conclusions: Liver disease in a pregnant woman needs to be treated with caution.

73-91

Authors: Manish R. Pandya, Dharmesh K. Golwala, Kalpana Khandheria

Background: To evaluate the clinical efficacy and safety effect of Ovaryl tablet a marketed herbal formulation of Mercury Laboratories Ltd., in Poly cystic Ovarian Syndrome. Methods: 58 women patients’ age range between 20 to 40 years, suffering from Poly cystic Ovarian Syndrome symptoms like hirsutism, irregular periods, ovulation, volume of ovary, weight and serum insulin levels. Results: A significant improvement was observed in clinical symptoms like hirsutism, irregular periods and ovulation after MOT medication.Laboratory investigation showed decrease in Serum Insulin levels. A minimum decrease of 2.87% and 36.73% maximum decrease of serum insulin levels were observed on 90th day of MOT treatment. 22.06% maximum and 1.55% minimum decrease of ovary volume in Right Ovary. 24.39% maximum and 1.37% minimum decrease of ovary volume in Left Ovary was observed. Upper Abdomen USG was normal in all the 58 patients, no cyst was reported. Conclusion: Poly cystic Ovarian Syndrome symptoms like hirsutism, irregular periods, ovulation, and volume of ovary, weight and serum insulin levels were taken care off.

97-100

Authors: Seema Sharma, Manju Maheshwari, Shubhra Gupta

Objective: To study the role of uterine artery notch on color Doppler ultrasound in prediction of PIH. Methods: This observational prospective longitudinal study was conducted in Department of Obstetrics and Gynaecology Mahatma Gandhi Medical College and Hospital, Jaipur. Study sample comprised of 100 antenatal patients with 20-28 weeks of gestation attending OPD of Department of Obstetrics and Gynaecology Mahatma Gandhi Medical College and Hospital, Jaipur from august 2013-14 and studied for the presence of Doppler changes during antenatal period. Results: The primary outcome was that uterine diastolic notch shows sensitivity 60%, specificity 100%, PPV 100 % and NPV 85.37% in predicting PIH. Conclusion: After analysing all the results, it has been concluded that uterine artery Doppler notching is good predictor for PIH.

103-107

Authors: Anushree. D. Patil, Sushil K Shinde, Geetanjali M. Sachdeva, Achhelal R. Pasi, Shanta M. Chitlange,

Introduction: Diagnosis of endometrial tuberculosis is often carried out by using commercially available molecular diagnostic tests on endometrial biopsy samples and menstrual blood samples of infertile women in many infertility clinics. Aim: To determine whether menstrual blood is a good alternative sample for diagnosis of endometrial tuberculosis. Methods: Women (n=123) presenting with infertility were investigated for endometrial tuberculosis by testing menstrual blood samples as well as endometrial aspirates with GEN-PROBE AMPLIFIED Mycobacterium Tuberculosis Direct (MTD) test which is a Nucleic Acid Amplification Test (NAAT) and VersaTREK culture. Results of the two tests for detection of M. Tuberculosis were compared in menstrual blood and endometrial aspirate samples. Results: Out of 123 menstrual blood samples tested M. tuberculosis was detected by culture in only 0.8 per cent of women. Mycobacterium other than Tuberculosis (MOTT) was detected in 2.43 per cent samples of menstrual blood on culture reports and was identified to be Mycobacterium inter medium. Conclusion: Menstrual blood was not found as a good alternative sample for diagnosis of endometrial tuberculosis. Results of MTD tests on menstrual blood sample for diagnosis and management of endometrial tuberculosis (as is widely used in infertility clinics) should be interpreted with caution. Pathological significance of Mycobacterium inter medium in female infertility, though a possible contaminant, needs further research.

117-119

Authors: Prashant Joshi, Linthoi Rajakumari

Intrauterine contraceptive device has been widely used and is commonly used as contraception in developing countries due to lower failure rate and the cheap cost with millions of women using it worldwide. The case report shows a missing Cu-T found in the abdominal cavity with its vertical stem penetrating into the rectum in a 20year old woman. Laparotomy with closure of rectal injury and uterine perforation with retrieval of the Cu-T was successfully done.

123-126

Authors: Mehul A Sangani, Manish R Pandya

The death of a formed fetus is one of the most emotionally devastating events for parents and clinicians. It is psychological and emotional shock to parents when they know that their baby has suddenly died in utero. Aims and Objectives: To know the causes of IUD and determine the risk factors and minimize the complications of IUD and maternal morbidity and mortality. Method: A prospective study was done to study 110 cases of IUD. On admission, patient's detailed history was taken, examination, investigations and ultrasonography was done and the case was managed accordingly. Results: A total 110 cases of IUD were studied over one year in our institute. Out of them 70 had not taken any antenatal visits, 96 patients were aged below 30 years, 11 patients were aged between 31 to 35 years and 3 patients above 35 years. 56 were primigravida, 40 were second gravida and 14 were multigravida. Of 28 cases causes were unknown, 18 cases had abruptions, 8 cases had PIH, 15 cases had preeclampsia, 11 cases had eclampsia, 12 had cord accidents, 3 had oligohydraminos, 2 had jaundice, 1 had rupture uterus and 8 patients had congenital anomaly. 28 patients delivered spontaneously, 75 delivered by induction of labor and 7 patients required caesarean section. 5 patients developed PPH and 7 patients developed DIC.

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.