Indian Journal of Obstetrics and Gynecology Research

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.