Indian Journal of Obstetrics and Gynecology Research

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.