Indian Journal of Obstetrics and Gynecology Research

303-306

Authors: Iram Shabir, Sheikh Ishaq, Arif Akbar Bhat, Roohi Ashraf, Sabhiya Majid

Plasma levels of AMH in women serves as an important biomarker of ovarian reserves and indicates the small follicular growth. The reproductive span in healthy women is predicted by progressive age related decline of plasma AMH levels. The values are low in the clinical condition of diminished ovarian reserve, indicating the presence of few remaining follicles within the ovary. Recent studies have also shown the importance of this hormone in various pathological conditions of ovary including PCOS. In women with PCOS, the small ovarian antral follicles increase and AMH secreted by these developing follicles can be used as an important marker to detect follicular impairment. It is suggested that the increased secretion of LH and/or testosterone may have a positive effect on the secretion of AMH by the ovarian follicles. A positive correlation has also been found between high AMH levels and androgen over-production due to intrinsic defects of thecal cells. In conclusion, high AMH levels have been predicted as a response to various treatments of PCOS, while improvement in various clinical and biochemical parameters have been associated with decline in AMH, thus supporting a very important role of AMH in diagnosis and treatment of PCOS.

314-317

Authors: Abhijeet Madhukar Patil, Ajit Subhash Patil

The primary objective of the study was to evaluate whether formal communications skills training improves the quality of written informed consent. The secondary objective was to evaluate the patient satisfaction index. Methods: Group 1 was subjected to communication for written informed consent by untrained Post-graduate residents. The session evaluated by Objective Structured Clinical Examination (OSCE). The post graduate residents were then given a communications skills training. Pre-test and post-test were obtained for the educational intervention. Group 2 was subjected to a communication skills training for the purpose of written informed consent by the same post-graduate residents after communication skills training and evaluated by Objective structured clinical examination. The data was analyzed by Paired `T` test and Student `T` test. Result: OSCE data of group 1 was 4.05 as compared to 8.85 of group 2, t = – 15.46 the P value < 0.0001 was highly significant. Communications skills (group 1) training post-test (9.33) was highly significant with t = -13.61, p < 0.0001. The patient satisfaction levels showed an increase from (group 1) 7.95 to 9.25 (group 2). The t value = -4.57 and p < 0.0001 was found to be highly significant. Conclusions: The communications skills training received a very good post test score and confirmed our belief in the use of role-play. The OSCE evaluation of both study groups revealed that the scores were improved significantly in group 2 and that a structured training definitely improved the quality of written informed consent. It also led to an increased patient satisfaction index in our hospital.

322-325

Authors: Dhananjaya BS, Omkara Murthy K, Anitha MS, Chaitra R, Rajesh SS

Induction of labour is one of the most important interventions done in obstetric practice. To compare between extra amniotic saline infusion and PGE2 for cervical ripening. Extra amniotic saline infusion achieved a greater number of favourable Bishop score and lead to shorter induction delivery interval and less painful, less chance failure of induction with good perinatal outcome. Hence EASI is one of the effective, safe and economical method of induction of labour. Objective: To compare the induction delivery interval between the two groups, the mode of delivery in two groups and to compare the APGAR score in both the groups. Materials and Methods: A prospective study of all case of pregnant women who got admitted to labour ward requiring induction of labour were randomly assigned to EASI or PGE2 between October 2010 to April 2012. The study was done in 80 women counseling was done regarding both the methods of induction and the choice was given them. 40 women were assigned to extra amniotic saline infusion and 40 women assigned to PGE2 were randomly recruited. Results: results were comparable in terms of maternal age, indication for induction in majority of cases, pre induction bishop score, mode of delivery, intrapartum complications and side effects, neonatal complications, pain scoring by VAS and APGAR score. The mean post induction Bishop score was higher in extra amniotic saline infusion group by an average of 10. The induction delivery interval was prolonged by an average of 3 hrs in PGE2 gel group. EASI was less painful compared to PGE2. Conclusion: For pre induction cervical ripening the extra amniotic saline infusion is valid alternative for the application of intracervical PGE2 gel. The induction delivery was prolonged (an average of 3 hrs) in PGE2 gel group.

330-333

Authors: Manju Yadav, Garima Sharma, Saurabh Bhargava, Seema Sharma, Manju Maheshwari

Women with GDM are at increased risk for adverse obstetric and perinatal outcome. Hence, it is imperative that an early detection and management of the disease is done to ensure better maternal and fetal outcomes. Aims: To determine the incidence of gestational diabetes mellitus using single step diagnostic test at our centre and to evaluate the maternal & fetal outcome and complications. Materials and Methods: This study was carried out in 200 patients attending the antenatal outdoor. These patients were given 75 g oral glucose irrespective of the meals and their plasma glucose was estimated at 2 h. Patients with plasma glucose values > 140 mg/dl were labelled as GDM. All GDM patients were followed up and treated with diet and/or insulin therapy till delivery to know maternal and fetal outcomes. Results: The prevalence of GDM in this study was 13.5%. Maternal and fetal complications in the GDM group were much higher than non-GDM group. Polyhydromnios, oligohydromnios, Hypertension, were the common maternal complications, while fetal distress, NICU admission, macrosomia and stillbirths occurred in the fetuses. Conclusion: GDM as a disease entity adversely affects maternal and fetal outcomes. This also builds a strong case for following DIPSI guidelines in diagnosis and management of GDM.

339-342

Authors: Fatima Zahra Shaik Mohammed, Juveria Jahangir

To study and analyse the neonatal outcome and appropriate route of delivery in oligohydramnios of AFI < 5 cm at or beyond 34 weeks gestation. Methods: In this prospective case control study of 50 women (study group) with ultrasound diagnosis of oligohydramnios of AFI < 5 cm at or beyond 34 weeks of gestation was compared with 50 women (control group) with AFI > 5 cm and less than 25 at or beyond 34 weeks matched for age, parity, gestational age. Women with PROM, gestational age < 34 weeks and greater than 40 weeks, congenital anomaly, PIH, multiple gestations were excluded from this study. Pregnancy was assessed with respect to antepartum, intrapartum and neonatal outcome measures. Results: In our study we found that oligohydramnios was associated with increased rate of non reassuring fetal heart rate (20% Vs 4%), labor induction (28% Vs 2%), cesarean delivery (56% Vs 8%), low birth weight (62% Vs 24%), IUGR (18% Vs 2%) and admission to NICU (18% Vs 4%). No difference in occurrence of meconium stained liquor, Apgar score < 7 at 5 minutes was found. There was no neonatal death in the study. Conclusion: Pregnancies with isolated oligohydramnios (AFI <5 cm) at or beyond 34 weeks are associated with increased incidence of fetal distress (non reassuring fetal heart rate), caesarean delivery, and low birth weight. Induction of labor was associated with increased rate of caesarean section for fetal distress. No appropriate route of delivery can be recommended for isolated oligohydramnios.

348-351

Authors: Nupur Ahuja, Pushpa Dahiya

Late intrauterine death is an unwanted consequence of pregnancy. The estimated global still birth rate is 18.9 per 1000 births. For a physician confronted with IUFD the management poses a dilemma as to which regimen to follow for effective and safe delivery of the dead fetus. This problem is magnified in cases where prostaglandins are contraindicated but the various methods described and followed worldwide incorporate the use of prostaglandins for induction of labour. This study was conducted to show the efficacy and safety of medical management using mifepristone alone for induction of labor. Methods: We included 60 patients with late IUFD and divided the patients randomly into two groups each containing 30 patients. Group I was given only mifepristone at a dose of 200mg three times a day for two days while Group II was given a combination of mifepristone and misoprostol. Results: In Group I, 19 patients with previous cesarean were included. The success rate was 90% in group I and 96.6% in Group II. The mean induction to delivery interval was 48.63±25.1 hrs in group I while it was 68.87±21.1 hrs in group II. 3.2% of patients in group I had side effects while 70% of patients in group II had side effects in the form of nausea, vomiting, fever and shivering. Conclusion: Thus use of mifepristone alone provides a good alterative regimen in the management of late intrauterine fetal death.

356-360

Authors: Pooja Bansal, Abhyuday Verma, Akhil Bansal, Deepika Verma

Identification of a high risk pregnancy by Coopland score helps the obstetrician to identify patient at high risk and also elaborate a prognosis of pregnancy. Objective: The present study was conducted to evaluate maternal outcomes in high and low risk pregnancies. Methodology: In the present study of 100 cases of high risk caesarean section were evaluated and compared with 100 cases of low risk caesarean sections over a period of two years. Results: 96% cases in the high risk group (study group) and 98% cases in low risk group (control group) were between the age group of 17-35years. In the study group there were 42% primigravida, 56% multigravida and 2% grandmultipara, while in the control group respective figures were 46%, 52% and 2%. 54% of the study group and 58% of the control group were operated as emergency cases. 62% of the cases in the study group and 14% cases in the control group had intraoperative complications. 50% in the study group and 12% in the control group had postoperative maternal morbidity. 4% and 2% cases in the study group had hospital stay between 10 to 15 days and more than 15 days respectively. In the control group, all the cases had hospital stay less than 10 days. The average duration of surgery in 90% cases of the study group was less than 1 hour. Conclusion: We suggest Coopland risk scoring for every case admitted for a caesarean section, which will be definitely helpful in predicting and evaluating the eventual maternal outcomes. Appropriate timely care and referral can have a positive impact in lowering the maternal mortality and morbidity and possibly better neonatal outcome.

366-369

Authors: Priyanka Rai, Girija Kumari, Kalpana Kumari, Rajani Rawat, Neelam Swaroop

To evaluate the effect of amino acid infusion in pregnant mothers with suspected Intra Uterine Growth Restriction diagnosed in antenatal period – whether perinatal morbidity and mortality reduced or not by this treatment. Material and Methods: 80 cases were taken up for the study, patient were grouped into 2 groups. Group 1: Comprised 40 patients with IUGR who were only observed and no intervention was tried and served as control group. In this group of patient fundal height measurement and ultrasonographic evaluation 4 weekly done in 28-32 weeks of gestation and 2 weekly in patient of more than 32 weeks of gestation. Group 2: Comprised 40 patients with IUGR who received amino acid infusion followed by 10% dextrose for 3 consecutive days. Repeat infusion were done 4 weekly in 28-32 weeks of gestational age and 2 weekly in patient of more than 32 weeks of gestation. Both grouped were followed till term and delivery. Ultrasonography parameters at 36 weeks of gestation in both groups were compared. Result: Mean abdominal circumference at 36 weeks in study group was 321mm and 294mm in control group. Fetal weight at 36 weeks of gestation in group 1 was 2255 gm and 2588 gm in group 2. Mean AFI at 36 weeks of gestation were 9 cm and in control group it was 5 cm. In study group 90% babies born with apgar score more than 5. Conclusion: Fetal weight gain was significantly higher in group 2 than group 1, which indicates that the curative effect of amino acid combined with routine therapy is greater than that of routine therapy alone in late onset IUGR.

375-378

Authors: Sanchita Karmakar, Hemant Deshpande

Background/ Objectives: To study predisposing factors, management options, maternal & fetal outcome of placenta previa. Methods: The present study was carried out on 30 diagnosed cases of placenta previa admitted in Padmashree. Dr. D. Y. Patil Hospital and Research centre, Pimpri, Pune from 2008 to 2011. Results: In our study it was found that advancing age, parity, previous cesarean section, abortion were associated with placenta previa. Maternal morbidity and surgical interventions were significantly associated with amount of blood loss and type of placenta previa (P<0.0001). In our study perinatal mortality and morbidity was mainly due to prematurity. Expectant management was significantly associated with better maternal and fetal outcome indicated by APGAR score (<0.0001). Conclusion: Expectant management, good neonatal care and timely surgical intervention improve maternal and perinatal outcome in placenta previa.

383-387

Authors: Vrunda Choudhary, Sonali Somani, Shashikant Somani, Rajesh Kaul

Objective: Present study was done to analyse the distribution of benign ovarian tumours in different age groups and to correlate their clinic-histopathological patterns. Materials and Method: In present retrospective study histopathologically proven 63 cases of benign ovarian tumours were analysed. The tumours were classified according to WHO classification after thorough examination of slides and their distribution in different age groups was noted. Results: Surface epithelial tumours were commonest (65.08%) followed by germ cell tumours (26.97%) and sex cord stromal tumours(7.95%). Maximum 34.93% ovarian tumours were found in 31-40 years age group. Most of the patients (33.34%) were asymptomatic and were diagnosed incidentally. Commonest tumour was serous cystadenoma (38.09%) followed by mucinous cystadenoma (25.389%) and benign cystic teratoma (17.45%). Conclusion: Ovarian tumours are common in forth decade. Most common histopathological presentation was surface epithelial tumours with preponderance of serous cystadenomas. Most of them remain asymptomatic, therefore clinicohistopathological diagnosis still remains gold standard which is helpful for early detection and proper management.

393-396

Authors: Sujindra Elamurugan, Bupathy Arounassalame

Prevalence of diabetes including gestational diabetes mellitus has been increasing recently due to wide differences in living conditions, socio-economic levels and dietary habits. Hyperglycemia during organogenesis negatively influences fetal development leading to adverse perinatal outcome. Hence this study was planned to study the awareness about GDM among antenatal mothers. Methods: Total of 200 antenatal mothers were included in the study, who filled in a close-ended questionnaire. The questionnaire comprised of 13 questions (6 on knowledge about GDM and its risk factors, 4 about GDM screening and treatment and 3 about the consequences of GDM). All questions were given categorical responses (yes and no) and were applied with an item score of ‘1’, ‘0’ respectively for positive knowledge. The data was analyzed and results were entered using simple means and percentage. Results: 100% response rate was present. Mean age was 28±3.2 years. 44.5% of mothers were primigravida and 15.5% of mothers had history of GDM either in present or previous pregnancy. The total knowledge score about gestational diabetes was 7.72. The score for knowledge on GDM and its risk factors was 4.65. The knowledge score for awareness on screening and treatment was 1.78 and a consequence of GDM was 1.29. Conclusion: The knowledge of our women on GDM was just average. Health education and awareness programs should be conducted to improve knowledge of antenatal mothers for better utilization of health services.

400-406

Authors: Hemlata Panwar, Ujjawal Khurana, Karuna Gupta, Sumita Shrivastava, Ayushi Jain, Kalpana Sankhla

Cervical cancer is the commonest cancer in women in developing countries. Cost effective screening methods with optimum diagnostic accuracy can help in reducing the global burden. Methods: This prospective study was carried out on 100 patients with suspected lesions of the cervix. Cervical biopsy was taken as gold standard to compare the performance of visual inspection with aceitic acid(VIA) and cytology (Conventional pap smear). Various parameters like age, clinical and sexual history were noted. Genotyping of HPV 16 and 18 of preneoplastic cases was done with real time PCR-based method. All statistical analysis was done at alpha-error 5% and power 80%. Results: Out of 100 cases, 78 were carcinoma cervix (78%), 19% cervical intraepithelial neoplasia (CIN) (CIN I-8, CIN II-3 and CIN III-8), and 3 had inflammation (3%). Accuracy of cytohistological correlation was highest for Carcinoma cervix (94.64%), 72.72% and 75% each for High grade squamous intraepithelial lesion (HSIL) and Low grade squamous intraepithelial lesion (LSIL). The sensitivity and PPV of VIA came out to be 93.32%, 95% respectively. HPV16 genotype was found in 25% cases of CIN I, 66.66% cases of CIN II and 62.2% cases of CIN III. HPV 18 genotype was detected in only one case (12.5%) of CIN III. Conclusions: Positive VIA formed a good clinical screening method for picking up Carcinoma Cervix and a promising alternative to Pap smear in precancerous lesions. HPV16 integration status has the potential to be a good marker for risk assessment of CIN progression.

410-413

Authors: Deepa Joshi, Kamal Gajria, Sukreeti Dixit, Satish Saroshe

To compare application of subcuticular sutures, with three mattress sutures for pfannenstiel incision closure. Materials and Methods: Cross sectional study comparing subcuticular sutures to three mattress sutures for pfannenstiel wound closure was done in tertiary hospital from January 2012 till December 2013 on 100 patients with 50 in each group. All women undergoing primary elective and emergency caesarian section or hysterectomy through pfannenstiel incision were included after due informed consent. Sutures were applied using monofilament vicryl 3-0 for subcuticular skin closure. Mattress sutures were applied by using Nylon 3-0. A total of 3 sutures were applied with one suture at each end of the incision and one in the middle. Results: Average suture application time was less in mattress suture group as compared to subcuticular suture group. Cost of suture was less in 3 mattress suture group due to usage of nylon sutures. Post-operative pain analyzed was more in subcuticular suture group with 56 % patients requiring additional analgesia versus 20 % in three mattress suture group. Post-operative infection rate was similar in both groups. Conclusion: The use of mattress sutures gives advantage over subcuticular sutures on less severity of pain, shorter duration of pain, lower requirement of additional analgesia, cost of suture and significantly lesser time required for skin closure. Application of three mattress sutures is skill independent and can be used in limited resource settings also.

418-421

Authors: Rashmirani Senapati, Bhagyalaxmi Nayak, Shantanu Kumar Kar, Bhagirathi Dwibedi

Stage at diagnosis and factors associated with late diagnosis of cervical cancer have been analyzed in this study. Materials and Methods: It is a hospital based cross sectional study carried out enrolling 246 cervical cancer patients attending outpatient department of tertiary cancer hospital of Odisha, India. The patients were interviewed and histopathological observations were recorded from investigation reports. Factors for late stage presentation were analyzed by using multivariate logistic regression analysis. Results: 56 (21.96%) cases were presented for diagnosis at early stage (I&IIA) and 194(78.04%) at late stage (IIB and above). Late stage diagnosis was associated with higher age i.e., ≥40years (OR=2.54 95% CI=1.11-5.83), poor treatment seeking behavior (OR=2.23, 95% CI=1.001-5.23), lack of awareness (OR=1.91, 95% CI=.43-8.41), lower education level (OR=1.59, 95% CI=.73-2.45) and initial symptoms with painless bleeding/discharge (OR=7.38, 95% CI 3.22-16.89). Conclusion: In the absence of screening programme prevalence of late stage diagnosis of cervical cancer was significantly higher. This could be attributed to higher age at presentation, low education, low awareness about the disease and its symptoms and poor treatment seeking behavior. Specific health programme is suggested for women emphasizing cervical cancer screening and awareness regarding signs and symptoms of cervical cancer to enhance health seeking behavior among them.

426-429

Authors: Rupita Kulshrestha, Pankaj Singh, Krishna Gopal Paul, Deepti Verma

Herlyn –Wener- Wunderlich Syndrome is a rare congenital mullerian anomaly. It consists of uterus didelphys, obstructed hemivagina, and ipsilateral renal agenesis. It is also called OHVIRA (Obstructed Hemivagina with Ipsilateral Renal Agenesis) Syndrome. Few case reports are mentioned earlier which have conservatively managed the case with the resection of vaginal septum. Failure of this procedure in our case led us to do an extensive abdominal surgery involving resection of uterine septum followed by unification of both uterine horns.

196-198

Authors: Sunita Mishra, Sunita Sudhir

To study the efficacy of combined diagnostic hystero-laparoscopy in evaluation of causes of female infertility. Methods: Ours was a retrospective study conducted in the Department of Obs & Gyn from January 2013 to May 2016. Patients of age-group 20-40 years were included in the study. Results: Of the 100 patients, 64% were cases of primary infertility and the rest 36% had secondary infertility. Laparoscopic abnormalities were more than hysteroscopic abnormalities in both the groups. Laparoscopy detected abnormalities in 36% of cases while hysteroscopy was helpful in diagnosing 20% of abnormalities. Combined diagnostic hysterolaparoscopy detected abnormalities in 28% of the infertile patients in both groups. Enlarged poycystic ovaries accounted for the most common laparoscopic abnormality(9%) followed by endometriosis (7%) and tubal pathology(6%). Myomas were seen in 4% cases, adenomyosis and adnexal pathology were detected in 3% of cases each. 20% cases had uterine causes of infertility. By Hysteroscopy the most common intrauterine malformation was a partial septum which was seen in six cases in the primary infertility group. Endometrial polyp, myoma and synechia were also diagnosed by hysteroscopy in both the groups of infertility. Post procedure two cases had port site infection, for which they were appropriately treated and followed up. Rest of the cases had no major surgical or anaesthetic complications. Conclusion: Combined hysterolaparoscopy can be safely employed for evaluation of infertility to diagnose & appropriately treat lesions of pelvis and uterus. This procedure can be used as a first line investigation for evaluation of female infertility.

203-208

Authors: Roy Bibhash, Prabhdeep Kaur, Amitabha Dan, Achhelal Pasi, Kunal Kanti De

Neonatal mortality is the main barrier to reduction of infant mortality in West Bengal. Home based simple newborn care by mothers in the neonatal period can reduce neonatal mortality. The practices of mothers in this aspect in Nadia are not known. A cross sectional survey of mothers of Nadia with the objectives of describing their neonatal care practices, determine factors associated with it. Methods: Nadia district has a population of 5 million and estimated pregnancies of 74000. We used PPS method cluster sampling technique. We needed 575 mothers in 23 clusters assuming 52% prevalence at 5% precision, 95% Confidence interval and design effect 1.48.Structured questionnaire was used for data collection on different socio-demographic and health system related factors and mothers’ newborn care practices. Data was analysed using Epi info 3.5 software. Results: Among 575 mothers, 518 (90.1%) kept the neonates cord stump clean. Delaying the first bath of the neonate was least practiced 292 (50.8%). Only 39 (6.8%) mothers had all safe practices. Living below poverty line (Adjusted OR 5.2, C.I. 3.4-7.8), not registering in the first trimester (Adjusted OR 2.6, C.I 1.6-4.2), maternal education not more than secondary level (Adjusted OR 2.3, C.I. 1.3-3.9) and having home delivery(Adjusted OR 3.2, C.I. 1.5-6.8) were significant factors for non-adoption of at least five safe practices. The overall neonatal morbidity rate was 57 per 1000 live births (33 /575) and neonatal mortality rate was 10 per 1000 live birth (6/575). Median contacts with the health system in the mothers having unsafe practices was 6 (range 0-11) compared to 10(range 1-11) in the other group. Out of 33 sick neonates 26(78.8%) were from mothers with unsafe practices. Conclusion: Poor and uneducated were unaware of safe newborn care practices especially for hypothermia. They had more neonatal sickness and deaths. They had less contact with the health system. There is a need to reach out to such vulnerable group and improve their coverage in existing facilities. Training of ASHA in Home based newborn care and educating mothers can be cost effective option for this section to save neonates by promoting best neonatal practices.

212-215

Authors: Deepti Verma, Manju Lata Verma

The aim of this study is to analyze indications, type and complications of hysterectomies done in the two rural tertiary level teaching institutes in Northern India. Materials and Methods: It was a retrospective study in which the detailed analysis of demographic data of the patients, surgical indications, route of surgery and complications of the patients undergoing hysterectomy in one year (January 2015-December 2015) in Mayo Institute of Medical Sciences and Hind Institute of Medical Sciences in Barabanki, Uttar Pradesh, India was done. Results: Out of the total 157 cases of hysterectomy performed in two institutes, the incidence of vaginal hysterectomy was significantly higher (69.43% vs 30.57%, p<0.05) as compared to the abdominal hysterectomy. Pelvic organ prolapse was the most common indication for hysterectomy in the study group. Fibroid uterus, dysfunctional uterine bleeding, ovarian mass, chronic pelvic inflammatory disease and cervical intraepithelial neoplasia were the other indications. Hemorrhage during abdominal hysterectomy was the most common complication encountered (n= 6, 3.82%). Conclusions: Lack of equipment’s and technical support, unawareness of the patient, and financial constraints are the major factors leading to hysterectomy rather than resorting to minimal invasive techniques for benign gynecological complains. Moreover, the incidence of pelvic organ prolapse in the rural population should be reduced by promoting institutional deliveries, awareness about the benefits of adequate post-partum rest and nutrition, and effective contraception to avoid repeated child births. This will further help in reducing the rate of hysterectomy in rural population.

220-224

Authors: Nagendra Prasad N, Sarojamma C, Nagarathanamma R, Savitha C

To evaluate efficacy and ease of use, of bidirectional barbed suture in laparoscopic myomectomy. Methods: One hundred and twelve cases of laparoscopic myomectomy were performed by a single surgeon over five years period. Most of the cases were for management of infertility. A bidirectional barbed suture was used for myoma bed closure. Assessment was made about the ease of use of barbed suture, time taken to suture hysterotomy wound and intra operative blood loss. Results: The operator found huge difference in the ease of use of bidirectional barbed suture in the closure of hysterotomy incision compared to intermittent suturing with intra corporal knotting, using conventional suture. Operative time as well as intra operative blood loss decreased with the use of barbed suture. Conclusion: Bidirectional barbed suture is a safe and effective material to close the myomectomy incision. It greatly reduces the difficulty in endosuturing and hence allows more people to practice laparoscopic myomectomy. It also reduces the time required for endosuturing.

229-233

Authors: Sarojamma Chunchaiah, Nagendra Prasad Nagothi, Roopakala BM, Nagarathnamma Rangaiah

Urinary tract infections are one of the common infections during pregnancy. Asymptomatic bacteriuria is one of the risk factor and clinical manifestation of urinary tract infections. Detection of asymptomatic bacteriuria during pregnancy is important as subsequently 25% of infected women progress to chronic urinary tract infections resistant to chemotherapy. These infections leads to various pregnancy associated maternal complications like pregnancy induced hypertension, maternal anemia, preterm labor and fetal complication like low birth weight which can be prevented by detecting and treating asymptomatic bacteriuria. Aims and Objectives: This study was carried out to detect the prevalence of asymptomatic bacteriuria in antenatal women attending outpatient department in Rajarajeswari Medical College & Hospital, to identify the common causative organisms responsible for asymptomatic bacteriuria and antimicrobial sensitivity pattern of pathogens isolated. Material and Methods: 500 asymptomatic pregnant women who attended outpatient clinic in Ob & G department Rajarajeswari Medical College & Hospital Bangalore, Karnataka, India were enrolled. Mid stream of urine was collected by clean catch technique into a sterile container and then subjected to culture& antimicrobial sensitivity test. Results: Our study showed 12% (60/500) prevalence of asymptomatic bacteriuria among antenatal women. Insignificant bacteriuria in 4% (20/500), growth of contaminants 6% (30/500) and sterile urine 78% (390/500) were seen in samples cultured. Lower socio-economic status, lower level of education, multiparity, advancing maternal age and advancing gestation period were associated with high risk for asymptomatic bacteriuria. The most common organism grown was Escherichia coli (E. coli) in 40/60 cases (66.66%), followed by Klebsiella in 8/60 cases (13.66%), Enterococcus in 7/60 (11.66%) and Staphylococcus aureus in 3/60 cases (5%). The most effective antimicrobial agent against the isolated organisms was Nitrofurantoin & the least effective were Ampicillin, Amoxicillin & Cotrimoxazole.

239-252

Authors: Alka Pawalia, Satya Savant, Sivachidambaram Kulandaivelan, Vikram Singh Yadav

Obesity is a modifiable risk factor associated with many complications in human beings. Objective: To find and report the articles dealing with BMI on maternal (prenatal and perinatal) and child (perinatal and postnatal) complications with specific emphasis on Indian studies. Data source: Pubmed and Google Scholar were searched with key terms within the limit of studies between 2008 and 2015. Study eligibility criteria: Studies with at least 4 complications were compared with BMI classification, both cross-sectional and case-control studies; both prospective and retrospective studies were included. Participants and intervention: Pregnant women, who were classified according to BMI criteria, were compared with prenatal, perinatal and immediate postnatal complications in both mother and child. Study appraisal and synthesis methods: Since Pubmed is the primary source of selection of articles there was no separate appraisal of included studies other than eligibility criteria. 37 articles which met the eligibility included for results review and discussion. Results: Odd ratio (OR) of gestational diabetes (4.62), pregnancy induced hypertension (3.23), cesarean section (2.88), preeclampsia (2.69), microsomia (4.65), macrosomia (3.95), NICU admission (3.39), perinatal death (3.17) in obese/overweight Indian mother is either equal or higher than western counterparts. Limitation: Present study neither did meta-analysis nor did any inferential statistics. Conclusion and implications of key findings: Present study concretely supports that obesity was associated with many pre, peri and postnatal complications in both mother as well as child. So, primary and secondary prevention measure has to be taken to control the weight in reproduction age females

257-263

Authors: Shikha Joshi, Sarita Dheeraj, Sunita Fotedar

To compare efficacy and safety of induction with transcervical Foley’s catheter and low dose intravenous oxytocin for labor induction in a case of previous LSCS. Methods: One hundred women at term gestation with one previous LSCS with no contradictions for VBAC, Bishop’s score < 6, willing for VBAC (after consent) were selected and divided into two groups of 50 each. Group A was induced with transcervical Foley’s catheter and group B of another 50 was induced with intravenous oxytocin. Results: In foleys group induction-delivery interval was less 24.54±6.0 hrs compared to oxytocin group 27.88±7.08 hrs. Successful induction rate significantly higher (80% vs 66%) with foley’s as compared to oxytocin group. 76% women delivered within 24 hours of induction in foleys group whereas in the other group 64% delivered within 24 hours. Both methods are safe for labor induction. No significant systemic complications like rupture uterus noted in both groups. Neonatal outcome was similar in both the groups. Conclusions: Foleys induction and oxytocin induction are cheap, safe, easy methods with least systemic side effects like rupture or uterine hyperstimulation for labor induction in a case of previous cesarean compared to PGE2 gel though failure rates are more with only oxytocin.

267-269

Authors: Umashankar Km, Shivakumar Hc

The earliest evidence of a Vvf was found in 1923, when Derry examined the mummified body of henhenit, a lady in the court of mentuhotep of the 11th dynasty who reigned around 2050 Bc. The urinary fistulas involving female genital tract result from complications of child birth, and pelvic diseases and their treatment. In developing countries like ours, obstetrical causes are the leading causes of Vvf. Objectives: To determine the major causal factor of vesicovaginal fistula (Vvf) and the outcome of treatment. Methods: This retrospective study was conducted from 1st January, 1994 to 31st December, 2006. At Vijayanagara Institute of Medical Sciences Bellary. Total number of patients included in the study was 40. They were analyzed with regard to age, parity, causal factor, mode of treatment, and the outcome. Results: Obstetric complications were the leading causes of Vvf. Majority of the cases were treated surgically by layered method of closure vaginally. Success at primary attempt was 93.33%. Conclusions: Vesicovaginal fistula mainly results from low level of intrapartum care and improperly conducted deliveries. Primary closure is successful in 93.33%.

279-282

Authors: Maya Menon, Vinodha M

Gestational age is frequently estimated based on last menstrual period and on ultrasonography. Many people are unaware of their last menstrual period due to irregular menstruation and ultrasonography is bound to have a bias, thereby posing difficulties in the estimation of gestational age. Placenta is a fetal organ which provides the physiological link between pregnant women and her fetus. Placental growth can be estimated by measuring the thickness and estimating its volume. Placental thickness is directly related to the gestational age of the fetus till certain weeks of pregnancy. Objectives: To study the correlation between ultrasonographic placental thickness and gestational age of the fetus. Methods: This is an observational study done at ESIC Medical College & PGIMSR Chennai. 333 cases were recruited for the present study to determine the normal placental thickness for various gestational age and to study the correlation between ultrasonographic measurement of placental thickness and gestational age of the fetus. Results: Placental thickness for gestational age 11-40 weeks calculated, it gradually increased from 14.6 mm at 11weeks to 38.9mm at 40 weeks gestation. Correlation coefficient is 0.98 and p value <0.0001.There is a significant positive correlation of placental thickness with other fetal biometry parameters like BPD, FL, AC, HC and CRL.(p < 0.0001) for BPD, FL, AC and HC and (p=0.02) for CRL. Discussion: There appears to be a linear relationship between gestational age and placental thickness. Thus, placental thickness can be reliably used to estimate gestational age importantly for mothers whose clinical history is not reliable, who come for antenatal booking in second half of pregnancy and in conditions where BPD measurements becomes less reliable.

289-291

Authors: Niranjan Chavan, Pradnya Changede, Natasha D’Souza, Y.S. Nandanwar

Adnexal torsion constitutes approximately 3% of Gynaecological emergencies and is one of the causes of acute abdominal pain in a woman.1 Here we present a rare case of a gangrenous hydrosalpinx which presented with acute abdominal pain and was clinically diagnosed as a twisted ovarian cyst.

294-296

Authors: Ramesh Babu, Mahendra G, Vindhyashree S

Isolated congenital Megacystitis represents a rare variant of fetal Megacystitis without other associated anomalies. The aetiology is not clear. Various methods of management have been described in literature. We report a case of isolated congenital Megacystitis, Considerations for the evaluation and management of this rare entity are discussed.

148-152

Authors: Pradnya Rajendra Changede, Parikshit Tank.

Background: Cervical dystocia is caused by cervical spasm due to prolonged labor. Maternal complications can arise due to this such as intrapartum infection, pathological retraction ring (Bandls ring), maternal morbidity and it may also contribute to perinatal morbidity and mortality. Various spasmolytic drugs can help to relieve the cervical spasm and facilitate cervical dilatation during the first stage thereby decreasing the rate of cervical dystocia. Methods: This was a prospective study conducted in a tertiary center over a span of 1 year. 60 patients were randomly allotted in 2 groups. 1. 30 patients (15 primigravida and 15 multigravida) – control group 2. 30 patients (15 primigravida and 15 multigravida) – Injection Hyoscine butyl bromide (Buscopan) group. Injection Hyoscine butyl bromide 20 mg intramuscular was given at 3cm cervical dilatation. No further dose was given. A statistical test, ‘unpaired t test’, was used to test the results for statistical significance. A x2 (chi square) test was used to test results of side effects for statistical significance. Results: The duration of active first stage of labor was shorter in the Hyoscine butylbromide group (170.3 min) as compared to control group (216.7 min) in primigravida and multigravida (hyoscine butyl bromide group 120.9 min and control group 153.3 min). An unpaired t test showed p value of 0.011 in primigravida patients and p value of 0.003 in multigravida patients). No significant maternal and neonatal side effects were noted in the drug arm when compared to the control group (p value > 0.05). Conclusions: The rate of cervical dilatation under the influence of hyoscine butylbromide is significantly higher as compared to control group. The rate of dilatation is faster in multigravida patients as compared to primigravida. Hyoscine butylbromide is a safe drug with no fetal side effects or any significant maternal side effects. Keywords: Labor, Hyoscine butyl bromide, Cervical dilatation, Active first stage of labor, Prolonged labor

157-166

Authors: Manish R Pandya, P. Gopeenathan, P.M. Gopinath, S.K. Das, Meenakshi Sauhta, Veena Shinde.

Abstract Background Progestogens have been considered as a viable therapeutic option for the treatment of miscarriage for more than half a century. Aim: The aim of the present review is to provide a comprehensive view of the literature regarding the clinical efficacy and safety effects of progestogens for preventing recurrent miscarriages and managing threatened miscarriage during early pregnancy. Methods: A literature search was performed using electronic databases like Pubmed/ Medline to identify from 1953 to 2015. The search yielded around 27 original studies and review articles. Results: Dydrogesterone (oral) and various micronized progesterone (MCP) given orally, vaginally and intramuscularly are the most commonly used progestogens for the treatment of recurrent and threatened miscarriages. Pharmacokinetic profile of dydrogesterone exhibits better bioavailability, receptor affinity, quick onset of action and a better half-life imparting long and stable effect. Dydrogesterone exhibits 47% and 29% statistically significant reduction in odds ratio of threatened and recurrent miscarriage when compared to standard of care. While, literature supports use of MCP (vaginal), recent findings suggest no statistically significant difference in live birth rate when compared to placebo (65.8% vs. 63.3%). MCP (vaginal) is associated with vaginal discharge and irritation whereas dydrogesterone (oral) avoids vaginal discharge and no birth defects have been associated with its use. Conclusion: Treatment with dydrogesterone and other progestogens in general suggest dydrogesterone has number of advantages over other progestogens in terms of pharmacokinetic parameter clinical efficacy and safety profile. However, further studies are warranted to establish and promote the role of these progestogens in management of threatened and recurrent miscarriage. Key Words: Progestogens, Recurrent miscarriage, Threatened miscarriage Key Messages: Bioavailability · Oral bioavailability of dydrogesterone is approximately 5.6 times better than oral MCP.32,37,82 · Dydrogesterone is selective for progesterone receptor with 1.5 times better affinity than oral MCP.32 · Dydrogesterone exhibits quick onset of action reaching peak absorption levels within 30 minutes with a half-life of 5-7 hours imparting long and stable effect.37 Efficacy and safety · Based on PROMISE study data vaginal MCP therapy did not significantly improve live birth rate in women with unexplained recurrent miscarriage compared to placebo.57 · Dydrogesterone leads to a 47% statistically significant reduction in the odds of a threatened miscarriage.38 · Dydrogesterone leads to 29% statistically significant reduction in the odds of a recurrent miscarriage.39 · Clinical experience with dydrogesterone does not provide evidence of a causal link between maternal dydrogesterone use during pregnancy and birth defects.41 · Use of medroxyprogesterone and hydroxyprogesterone in the management of miscarriages has not been supported in literature. They are indicated as contraceptive and for preventing preterm labor; respectively.61,62,73 Recommendations · Dydrogesterone has been approved for pregnancy indication including threatened miscarriage, habitual miscarriage, and infertility.81 · Dydrogesterone has been recommended for the treatment of threatened and recurrent miscarriage by FOGSI and EPC guideline.79,80 Oral MCP is not indicated for threatened and/or recurrent miscarriages.81

172-176

Authors: Ramadoss Kabilan Vidhyalakshmi, Sareena Gilvaz, Annie V Thadicaren.

Background & Objectives: Asymptomatic bacteriuria during pregnancy is one of the risk factor for preterm delivery if untreated. The aim of this study is to find out the prevalence of ASB in pregnant women presenting with preterm labour pain and also to determine the common pathogenic micro-organisms associated and their antibiotic sensitivity. Methods: This is a prospective case- control study carried out in the Jubilee Mission Hospital, Thrissur, Kerala from Oct 2013 to March 2015. Cases (50) are those who came with preterm labour and patients in the control (50) group are those who do not present with preterm labour pain between 24-37 weeks. Patients were selected with specific inclusion and exclusion criteria. They were followed till delivery and treatment was given accordingly. Both maternal and fetal outcomes were noted. Results: Asymptomatic bacteriuria was present in 11 patients whoc presented with preterm labour pain and hence the prevalence of asymptomatic bacteriuria in preterm labour in the study population was 22%. Most common pathogenic organism found was E.coli (20%) followed by Klebsiella (2%). Mixed growth suggestive of contamination was found in both case (14%) and control (12%) group. Sensitivity to nitrofurantoin was seen in 4 cultured samples (36.36%) of the patients with ASB. Conclusion: Asymptomatic bacteriuria is a common infection in pregnancy and they are at an increased risk for adverse maternal and fetal outcomes which could be prevented by antimicrobial therapy. Hence pregnant women should be screened for bacteriuria and treated with appropriate antibiotics according to the sensitivity. Keywords: Asymptomatic bacteriuria, UTI, Pregnant women, Preterm labour, E. Coli

181-184

Authors: Anshika Lekhi, Navin Bhatia, Manju Lal.

Conjoined twin is an unusual congenital anomaly having severe mortality and morbidity. We are reporting a rare case of conjoined cephalothoracopagus janiceps twins diagnosed by ultrasonography at 30 weeks when they presented to our department for the first time. Two live male conjoint babies were delivered by caesarean section. They died in half an hour after birth. Mother was discharged from hospital at 7th post natal day. This case is extremely rare because of following features: (a) presence of separate hearts (b) male sex (c) bony fusion at the level of the base of skull. Literature suggests that early diagnosis by a combination of ultrasound is essential for management. It gives an opportunity for viability and process of surgical separation. With this early counseling of parents and termination can be done if indicated. Key words: Conjoined Twins, Cephalothoracopagus, Janiceps

187-189

Authors: Rachna Chaudhary, Haripriya Bajwa.

Vulval growths though rare, may be cause of discomfort as well as social withdrawal. The patient usually complains only of swelling or of bleeding and discharges from it. The treatment is excision and removal, recurrence is rare. We present a rare case of a fibroma of the labia majora with coexistent uterine fibroid in a postmenopausal woman. Keywords: vulvar fibroma, uterine fibroma, postmenopausal

194-195

Authors: Kamala Verma, Girish Chandra Baniya.

Diagnosis of ectopic pregnancy in a sterilized female may be missed many times and it is associated with greater risk of maternal morbidity and mortality. Risk of ectopic pregnancy after failure of tubal ligation is not only limited to initial years but also seen many years after the procedure. So due consideration should be given to ectopic gestation as a part of the differential diagnosis in acute abdomen of reproductive age group female even in the presence of tubal ligation history. Keywords: Tubal ligation; Ectopic pregnancy; Sterilization failure

1-6

Authors: Amitabha Dan, Bhatnagar Tarun, Achhelal Pasi, M Jalaluddin

Background: National Rural Health Mission introduced ‘Nischay Yan’, a free assured referral transport, since 1st April 2011 in Nadia district, West Bengal, India to reduce neonatal mortality rate (NMR). We conducted a cross sectional study to estimate the prevalence of awareness and utilization of the scheme along with factors associated with its use in mothers and to describe the strengths and gaps in the scheme. Method: A total of 575 mothers of children born between 1st July and 31st December 2011 in 23 clusters were surveyed. Univariate and multivariate logistic regression was done to study the determinants of awareness and utilization of Nischay Yan services. Result: Out of 575 mothers, 77.9% were aware of Nischay Yan and knew the number 102.Majority of the mothers (96.9%) got the information from ANM and ASHA. Only 187 of 575 (32.5%) mothers had availed the services of Nischay Yan. Of the187 mothers who availed Nischay Yan, 164 (87.7%) utilized it for delivery and 23(12.2%) for the purpose of neonatal care. ASHA escorted only 42 (22.4%) of 187 mothers. Of the187 mothers who utilized Nischay Yan, 77% availed the ambulance from doorstep and (82.4%) had to wait up to one hour to get the Nischay Yan. Half of 187 mothers reached a facility in two hours. One hundred seventy one (44%) of 388 mothers did not utilize Nischay Yan because of non availability of the ambulance. On Univariate analysis mothers characteristics such as age (OR=2.9, 95% C.I=1.8 -5.1), living in nuclear family (OR=1.7, 95% C.I=1.03-2.8), Knowing the telephone number102 (OR=43.9,95% C.I=4.7-410.3), Knowing the danger sign for referral of pregnant woman(OR=6.5, 95% C.I=3.01-14.07), having three antenatal check-ups (OR=21.9, 95% C.I=2.2-219.5) and Possessing functioning mobile or landline phone (OR=12.44, 95% C.I=1.3-112.4) were significantly associated with use of Nischay Yan. Conclusion: Majority of the mothers were aware of Nischay Yan scheme while only one third utilized it. Mothers who knew the number 102 and had functioning telephones were more likely to use Nischay Yan ambulance. Major cause of non use of Nischay Yan was non-availability of ambulance. The ambulance density was adequate as per programme but less as per requirement.

13-17

Authors: Ravindra.S.Pukale, Prashant S. Joshi, Arathi M.S.

Introduction: The incidence of caesarean section is increasing with each passing decade without remarkable decrease in maternal and perinatal mortality. This study is an attempt to reduce the rates of caesarean sections by adopting various measures and also to know the prevalence and incidence of caesarean section in SAH&RC. Materials and methods: This is a Descriptive study conducted in Sri Adichunchanagiri Hospital & Research Centre, BG Nagara, A Rural Medical College in Mandya District, Karnataka. The study was done for a period of 18 months including all cases admitted in Labour Room in the hospital. Results: Total 2000 cases of deliveries were included out of which 939 cases underwent caesarean section for various indications. Prevalence rate of caesarean section was 46.95%.Previous caesarean was the most common indication for caesarean delivery.

23-27

Authors: Garg Seeru, Soni Anita

Objective: To study effectiveness of LNG IUS (levonorgestrel releasing intrauterine system) insertion for patients with Abnormal uterine bleeding and to assess whether the LNG IUS can provide a conservative alternative to hysterectomy in the treatment of AUB. To correlate the cost effectiveness, symptomatic relief and psychological relief achieved with LNG IUS insertion. Materials and methods: It was a prospective non-comparative study with patients who had heavy menstrual bleeding and/or dysmenorrhea and diagnosed as adenomyosis or Idiopathic AUB (According to the FIGO PALM-COEIN Classification of AUB1). Thirty patients had LNG IUS insertion whereas another thirty patients opted for hysterectomy. We analyzed them in terms of symptomatic relief, cost effectiveness and psychological relief. Results: After LNG IUS insertion 93.33% of patients had significant decrease in blood loss and 76.6% had significant decrease in pain analyzed on visual analog score (VAS). Forty % of patients complained of inter-menstrual spotting but only 6.6 % had irregular heavy bleeding and only 2 patients out of 30 requested hysterectomy post LNG IUS insertion. 90% patients developed amenorrhea after 1year and only 1 woman required removal of LNG IUS as she was dissatisfied due to vaginal discharge. Hospital stay for LNG IUS was only 6-8 hours while it was 48-72 hours for patients who underwent hysterectomy. Conclusion: There is a significant relief in symptoms along with significant decrease in cost with LNG IUS insertion with a psychological satisfaction of conserving the uterus. Thus the LNG IUS is an excellent and cost effective alternative to surgical management in AUB

32-37

Authors: Rajeswari, Shobha

Objectives: The aim of the study was to help generate information and knowledge regarding the causes and complications leading to maternal deaths in an Urban tertiary care hospital, to find if any of them are potentially preventable and to use information thus generated to save lives. Method: The Medical records of all maternal deaths over a period of 5 years between June 2009 to May 2014 were reviewed and analysed for maternal age, antenatal registration, mode of delivery, parity, admission date interval and causes of death. Results: The maternal mortality rate ranged between 448 to 750 / 100000 births in the study period. The causes of death were eclampsia - pregnancy induced hypertension (39.4%) haemorrhage (35%), Sepsis(6%), Hepatitis (6.5%), Anaemia (13%), Heart Disease (2.6%). Maximum deaths occurred between 21-30 years of age is 84.6%. Mortality highest in post natal mothers 158 (69.2%). Unbooked cases constituted 204(89.4%) of Maternal deaths and included 157(68.8%) of referred cases. Overall mortality was 544/100000 of maternal deaths due to direct obstetric deaths 181 (79.3%) and indirect obstetric deaths 47 (20.6%). Conclusion: The classical triad of causes of maternal mortality in our study remained eclampsia, haemorrhage, sepsis in that order. Haemorrhage and sepsis are considered potentially preventable causes of maternal deaths.

43-50

Authors: Rajalekshmi M, Chithra Jayakrishnan, Nithya R, Vijay Narayanan S

Background: A screening test is ideally needed at the time of onset of labour which can detect the already existing compromise on the foetus and which can also predict its well-being for following hours in labour, which will pave way for timely intervention that will curtail the neurological damage and death. Assessment of foetal wellbeing in labour ward through admission cardiotocography (CTG) helps us to look for already prevailing high risk factors vigilantly and also new factors that have recently appeared. Aim: To ascertain admission CTG as an effective tool in predicting the foetal outcome and mode of delivery. Materials and Methods: In this study 400 women’s Admission CTG’s will be compared for pregnancy and neonatal outcomes such as mode of delivery, APGAR score, admission into neonatal intensive care unit (NICU) and duration of stay in NICU. Statistical analysis is done using Chi square test and p<0.05 is considered as statistically significant. Sensitivity, specificity, positive and negative predictive values, diagnostic accuracy of the admission CTG is also measured. Results: There is a statistically significant co-relation between the admission CTG and the mode of delivery, APGAR score and NICU stay of the neonates. Conclusion: We conclude that the admission test can be used as a useful tool to analyse CTG tracings of women in early labour to give quality care and to predict the mode of delivery and foetal outcome.

55-58

Authors: Hemant G. Deshpande, Chandrakant S Madkar, Kavya K. Patel.

Introduction: Obstetric hemorrhage is a much dreaded and dangerous complication. Prevention of postpartum hemorrhage depends on proper management of second stage and third stage of labor. This study attempts to evaluate the effect of oxytocin instillation through umbilical vein in reducing the blood loss and time taken for placental separation in caesarean section. Methods: The study was an interventional study. Two hundred cases of caesarean section conducted at DR D. Y. PATIL HOSPITAL, PUNE were taken for the study. Patients undergoing caesarean section were divided into two groups randomly and allocation done on the basis of lottery system. Based on allocation one group was subjected to 20 units of intraumbilical oxytocin and other group received 20 units intra venous oxytocin drip in500ml normal saline. Observer was blind (blood loss in ml and time for expulsion of placenta was measured by other). 100 cases of elective and 100 cases of emergency caesarean section were included in the study. Amount of blood loss and time taken for placental separation were observed. Results: amount of blood loss and the time of placental separation was significantly less in the intraumbilical group compared to intravenous group. Conclusion: oxytocin is a gold standard oxytocic drug and newer route of administration of 20 units in 20 ml normal saline intraumbilically, immediately after the delivery of the baby in both elective and emergency caesarean section, reduce the duration of third stage of labor and reduces blood loss significantly.

65-67

Authors: Prameela, Kavya D Sharma

Pelvic inflammatory disease (PID) is one of the most frequent infections seen in reproductive age group and is associated with major clinical and pelvic health problem. It is Infection & inflammation of upper genital tract organs typically involving fallopian tubes, ovaries & surrounding structures. PID is polymicrobial in nature and is associated with different etiological agents. Clinical presentations may vary from mild to severe. No specific signs and symptoms are pathognomic of PID. Laboratory tests are also poor predictors of PID. There may be subclinical symptoms and patient later may present with infertility. CDC recommends treatment for even mild cases of PID. Therapeutic goal in management of PID is to prevent chronic residual disease. Failure of antibiotic therapy to prevent sequelae of salpingitis reflects the emphasis of additional therapy along with antibiotics. Placentrex is a drug containing Peptides (FNP-III, CRF), Nucleotides (PDRN) & Glutamate and is derived from an extract of fresh term, healthy, human placenta. It has significant anti inflammatory effect involving chemical mediators of immunological response. Effect of placentrex is well documented in wound healing1 and in treatment of burns and radiation effects 2. It has been recommended for prescription for PID but there is not much data in literature regarding the efficacy in PID. So we conducted a trial to find efficacy of placentrex in comparision with azithromycin for the treatment of PID.

73-75

Authors: Anusha Kamath

We report 2 cases of carcinoma cervix treated at our institution where a window to detect malignancy at an early stage was available, yet missed. Case 1: A 38 year old nulligravida, post-renal transplant patient, reported with abnormal discharge per vaginum and inter-menstrual bleeding. She was found to have Squamous Cell Carcinoma of Cervix Stage Ib2 on evaluation. A decision to start IMRT was taken. The patient didn’t continue further treatment at our institute and was lost to follow up. Case 2: A 47 year old lady presented with 4 months postpartum bleeding. She had undergone caesarean delivery post-IVF 6 months ago. She was found to have Squamous cell carcinoma Stage IIa on evaluation, for which she underwent Radical Hysterectomy with bilateral pelvic lymph node dissection. She received Postoperative radiotherapy along with Intracavitary Radiotherapy.

78-79

Authors: Ambarisha Bhandiwad, Surakshith L Gowda, Anupama N K

Fallopian tube prolapse is a rare complication of hysterectomy and can be easily mistaken as vaginal granulation tissue or vaginal adenocarcinoma. We are presenting a case of post vaginal hysterectomy fallopian tube prolapse in a 63 year old lady which was managed effectively by vaginal route. By combining routine salpingectomies with hysterectomy can prevent this condition and also provide an additional protection against tubal and ovarian cancers.

83-85

Authors: Nayana H. Patel, Jayprakash Shah, Niket H. Patel, Nilofar R. Sodagar

Uterine fibroids are very common non-cancerous (benign) growths, occurring in 20% - 30% of women of reproductive age that develop in the muscular wall of the uterus. The sonographic diagnosis of uterine fibroids generally is accepted as accurate with transvaginal sonography. In women who have pelvic masses of unknown cause, unusual manifestations of fibroids such as necrosis or degeneration may simulate a carcinoma or hydrometra resulting in problems with image interpretation. We report a case of an unsuspected large degenerated uterine fibroid in a lady mistakenly diagnosed as didelphysbicolis uterus on ultra sonography.