Indian Journal of Obstetrics and Gynecology Research

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