Indian Journal of Obstetrics and Gynecology Research

307-313

Authors: Rakhee R. Sahu, Anjali Sonawane

Prostaglandins E1 and E2 have been extensively used for cervical ripening and induction of labour. The objective of our study is to compare the efficacy of sublingual route of misoprostol along with intracervical Dinoprostone gel as induction method. Methods: This is a randomized prospective interventional study conducted in 100 full term pregnant women. Group1- 50 cases- Tablet Misoprostol 50 mcg sublingual followed by tablet Misoprostol 25 mcg sublingually 4 hourly, to maximum of 200 mcg. Group 2 – 50 cases - PGE2 gel (0.5mg, 6 hourly two gels) intracervical application followed by tablet Misoprostol 50 mcg sublingual followed by Tab. Misoprostol 25mcg sublingually 4 hourly, to maximum of 200 mcg. Results: There was no significant difference between group 1 and 2 for demographic characteristics, gravidarum, Bishop’s score. The mean duration of latent phase for Group 1 was significantly shorter (11hrs 40 min) than that in Group 2 (21hrs 36 min). There was no significant difference in mean duration of active phase of labour between the 2 groups. In our study the mean induction to delivery interval (IDI) for Group 1 was 15 hrs 16 min (6.33), whereas the mean induction to delivery interval for Group 2 was 25 hrs 3 min (7.43) which was statistically significant (P value <0.0001). There was no significant difference in mode of delivery and fetal Apgar score between the 2 groups. Conclusion: Misoprostol alone was more efficient than Dinoprostone followed by Misoprostol in terms of short Induction to Delivery interval.

318-321

Authors: Kamala Verma, Girish Chandra Baniya, Sudesh Agrawal, Shailendra Lomrod

eclampsia continues to be a major obstetric emergency particularly in developing countries such as India and is a major contributor to maternal and perinatal mortality hence the importance of continued effort in monitoring and reviewing each eclamptic patient and to analyse factors affecting the maternal and fetal outcome. Aim & Objective: To study the Maternal and perinatal outcome in eclampsia patients and the various factors associated with occurrence and complication of eclampsia. Material and Method: The present study was a prospective study. A total number of 130 patients of tonic-clonic convulsion with pregnancy diagnosed as eclampsia were included in the study. All eclamptic patients either antepartum, intrapartum or postpartum were included in the study irrespective of their age, gestational age, parity and status of booking on admission. Results: During the study period incidence of eclampsia at our Centre was .82%. Total maternal death due to eclampsia was 8 and perinatal death was 49. It is concluded that good antenatal care, timely identification of signs and symptoms of pre-eclampsia intensive monitoring, earlier and meticulous termination of pregnancy can help in improving maternal and fetal outcome in eclampsia patients.

326-329

Authors: Jitendra P. Ghumare, AP Morey

Stillbirth rates are unacceptably high in developing countries. India accounts for the highest stillbirth rate in the world. Occurrence of stillbirths poses difficult situation and remains big challenge to health care system. Present study was conducted to understand the incidence, maternal & foetal characteristics and etiological factors for stillbirth. Material and Methods: The present retrospective record based study conducted at a tertiary care hospital of a Government Medical College, Maharashtra, India. The study includes stillbirths during the period of April 2014-March16. Variables like age, gravida, parity, etiology, birth weight etc. recorded from the indoor papers of stillbirths. All data entered, cleaned and analyzed using Microsoft Excel. Results: During the study period there were 19085 deliveries out of 978 were still births. The incidence of still births was 51 per thousand births. Maternal characteristics shows 442(45.9%) from the age group of 21-25 yrs, pre term(66.1%), prime gravid 51.39%, while macerated 634(64.8%), &65.5% low birth weight babies observed. Pregnancy induced hypertension [259(26.48%)], Prematurity [184(18.81%)], Medical disorder including Severe anemia [135(13.8%)] & IUGR [89(9.1%)] were most common etiology found among stillbirth. Conclusion: Progress in reducing Still birth remains at slow rate. Adequate antenatal care including nutrition, identification of risk pregnancies, timely referral of high risk cases will help to reduce the still birth rate. High quality intrapartum care at tertiary care centre located at rural area will certainly reduce the substantive number of still births.

334-338

Authors: Meenakshi Kanwar Bharadwaj, Ganga Sagar Tiwary

It has been reported that worldwide, one in 10 pregnancies is associated with diabetes, 90% of which are GDM. In India rates of GDM are estimated to be 10-15% with it expected to increase to 20%. There is a significant positive association between maternal hyperglycemia and adverse maternal outcome with the strongest association been found for hypertension in pregnancy. The present study is an effort to bring out the association between GDM and hypertension in pregnancy. Method: A prospective observational study was carried out on 1059 pregnant women. Amongst them, 129 who met the revised IADPSG criteria were diagnosed with GDM and rest included in normoglycemic group. Women with preeclampsia and gestational hypertension were included in the pregnancy associated hypertension (PAH) group. The risk of PAH in women with normoglycemia and GDM was calculated and maternal demographic factors associated with it identified. Result: There were 60 (3.8%) women with PAH. Normoglycemic women had lower rate of PAH, as compared to women with GDM (5.4% vs 7.8%, p>0.05). The risk of GDM patients developing pre-eclampsia was significantly more than normoglycemic women developing it (p<.05). Also, women with GDM and PAH had the highest rates of pregnancy after 35years, obesity, primiparity, and cesarean sections. Conclusion: This study demonstrates that GDM is associated with a higher incidence of PAH. There is a pre-pregnancy predisposition to dysfunction of beta cells which may be unmasked by the progressive insulin resistance of pregnancy and this is the common pathophysiology postulated with both GDM and hypertension in pregnancy. There is a necessity for early diagnosis and intensive monitoring of women with GDM for the development of PAH.

343-347

Authors: Naina Kumar, Prem Singh, Samar Rudra

The Papanicolaou test (Pap test) is most sensitive and widely used screening test for early diagnosis of various cervical lesions including infections. Objectives: To know the utility of Pap smears in diagnosing cervical infections and to study the pattern of infections on Pap smears occurring in this region of India. Material and Methods: Retrospective analysis of Pap smear reports of 5725 women who attended the Out Patient Department of Obstetrics and Gynecology with various complaints and for routine Pap smear screening during the period of January 2010 to December 2015 were collected from the Pathology Department of a rural tertiary care centre of Northern India after proper Institutional Ethical approval. The reporting of Pap smears was done by Bethesda 2001 system and by wet mount preparation of slides for diagnosis of various infections. Final analysis of data was done by using SPSS-20 version software. Results: Of 5725 Pap smears examined retrospectively, 4448 (77.69%) cases were benign epithelial patterns, 580 (10.13%) abnormal epithelial patterns and remaining 697 (12.17%) were unsatisfactory. Of 4448 benign cases, 1292 had infectious patterns on Pap smear with bacterial vaginosis (68.73%) being most common followed by Trichomoniasis (20.05%) and candidiasis (11.07%). HPV infection was noted in only 2 cases (0.15%). Majority of women belonged to 41-50 years of age group. Conclusion: Pap smear is one of the most simple and quick test for diagnosing cervical infections. However, for confirmation of Pap smear reports for infections, other tests like vaginal culture are required.

352-355

Authors: Omkara Murthy K, Dhananjaya BS, Jamuna R, Chaitra R

To study the effect of IV labetalol in hypertensive emergencies in pregnancy and their effects on maternal and Perinatal outcome. Pregnant women with blood pressure >160/110 mmHg were subjected to the trial. Patients were randomized to receive intravenous labetalol injection (in an escalating dose regimen of 20, 40, 80, 80 and 80 mg) every 15 minutes until the target blood pressure of <150/100 mmHg was achieved. Addition of nifedipine treatment was done if the initial treatment regimen was unsuccessful. Primary and secondary outcomes like the time interval and number of doses required to achieve a blood pressure of ≤150/100 mmHg and adverse effects of the antihypertensive agents were reported. IV Labetalol is effective in sustaining therapeutic level. Objective: To study the efficacy of IV Labetalol in management of hypertensive emergencies in pregnancy and adverse effects of labetalol. Materials and methods: A prospective observational study of 60 cases with hypertension in pregnancy, treated with Labetalol, was conducted over a period of one and half years. Results: The effective control of blood pressure with the use of Labetalol in the dosage used, was observed in cases of moderate to severe pregnancy induced hypertension. Conclusion: Intravenous labetalol is an effective and safe drug in the management of hypertension in pregnancy.

361-365

Authors: Bharti Sahu, Poorva Badkur

Aims and Objectives 1. To study five years maternal mortality in the tertiary referral hospital of MP. 2. To find out various causes of these maternal deaths. Method: A retrospective analysis of maternal deaths from hospital records and death summaries of five years between Jan 2010 to Dec 2014 at NSCB Medical College and Hospital, Jabalpur in Madhya Pradesh. Results: During the review period, there were 349 maternal deaths and 22,260 live births direct causes were 69% (n = 243), of which 49.2% (n = 174) from pregnancy induced hypertension and 8.8% (n = 30) from hemorrhage, were the leading causes of mortality. Out of total, indirect causes were 30.37% (n=106) of which severe anemia 20.06% (n=70) had topped. Of all, 94% (n=340) women were unbooked, 83% (n=290) were resident of rural areas, 82% (n=286) belong to age group 20-30 years and 56% (n=197) were primigravidas, 80% (n=281) were referred, and 62% experienced delay in care. Conclusion: The load of maternal mortality was found to be intolerably huge. Most women died of direct causes and experienced delay in care. Improvement in the quality of skilled maternity care, need to avail good, proper and effective antenatal care, timely referral, prompt transportation, provision of family planning services, among other factors, can drastically curtail the maternal deaths.

370-374

Authors: Ranjana Desai, Parihar Priyanka, Jodha Bhanwar Singh, Kiran Mirdha, Rakesh Karnawat

Objective: To evaluate the post-surgical maternal deaths and to make recommendation & design a protocol for decreasing future mortality. Design Retrospective analysis of post-surgical maternal mortality. Methods Analysis of all post-surgical maternal deaths between January 2006 and December 2010. Results and Discussion: During the study period there were 95413 deliveries in the institute. The total number of maternal deaths from January 2006 to December 2010 were 285. Out of this, 88(30.88%) were post-surgical deaths. Amongst the victims majority were unbooked (75%), multiparous (43.18%), Hindu (79.55%), coming from rural (68.18%) area. (67.05%) belongs to age group between 21 to 30 years. (72.73%) were serious at the time of admission and (42.04%) patients had haemoglobin level below 7 gm%. More than half (60.22%) died within 24 hours of hospital admission. (48.86%) patients were taken for surgery within 4 hrs. (21.59%) deaths occurred within 4hrs after surgery, (38.64%) deaths within 4-12 hrs, (21.59%). Cesarean was done in (56.83%) cases. In (28.41%) cases hysterectomy was done for postpartum hemorrhage. Out of this (10.23%) were normal vaginal delivered, (9.09%) were rupture uterus, (5.68%) were cesarean hysterectomy, (1.14%) after forcep delivery and (2.27%) after evacuation & curettage. The most common indication for caesarean was antepartum eclampsia (20%) followed by obstructed labour (12.73%). Direct causes were responsible for 84.09% and indirect causes for 15.91% deaths. Majority (38.64%) were attributable to hemorrhage, hypertensive disorders (20.45%), pregnancy related sepsis (11.36%), pulmonary embolism (9.09%) and (2.27%) were anesthesia related. Other causes were anemia, jaundice, acute respiratory distress syndrome, heart disease, chronic hypertension, aspiration pneumonitis and HELLP syndrome.(25%) patients were given whole blood and in (38.64%) patient’s blood with platelets and fresh frozen plasma given. All the patients were associated with risk factors and lack of proper antenatal care, lack of knowledge, illiteracy, poor transport and late referral further increases the surgical risk. Conclusions: Good antenatal care, high risk screening, comprehensive emergency obstetric services, hospital delivery and incorporation of obstetric drills decreases the post-surgical deaths.

379-382

Authors: Shachi Ashit Joshi

Hysterectomy–abdominal or vaginal or laparoscopic assisted vaginal hysterectomy is the most commonly performed elective major gynaecological surgery. The present study was conducted in our institute in 120 hysterectomy patients admitted for hysterectomy from February 2015 to July 2015. Objective: The objective of this study was to compare the intra operative and post-operative complications following vaginal hysterectomy for non descent uterus and abdominal hysterectomy for similar indications. Methods: A prospective comparative randomized study was carried out on 120 cases out of which 60 undergoing vaginal hysterectomy for non-descent uterus and 60 undergoing abdominal hysterectomy for similar indications. Results: The most common indication was fibroid uterus; there was a statistical highly significant difference in blood loss. Postoperatively, complications were more common in those who underwent abdominal hysterectomy. Postoperatively, patients who underwent vaginal hysterectomy ambulated earlier and were discharged earlier. Conclusion: Vaginal hysterectomy is a safe, least invasive route and is associated with lesser complications.

388-392

Authors: Shikha Saxena, Ranjana Gupta, Lata Agarwal, Prem Chandra Srivastava, Ayaz Khurram Mallick

Thyroid dysfunction and high prolactin levels can affect fertility due to anovulatory cycles, luteal phase defects and sex hormone imbalance. The study was designed to evaluate the status of Thyroid stimulating hormone (TSH) and prolactin in female infertility after exclusion of tubal factor and male factor infertility, and to determine the degree of association of TSH with prolactin in cases of infertility. Material & Methods: The study design was a randomized case control study conducted at Rohilkhand Medical College & Hospital, Bareilly, U.P. The study subjects included 50 infertile and 50 normal fertile women in the age group of 20- 40 years attending Gynaecology OPD during one year study period. The TSH and prolactin hormones were assayed using Enhanced Chemiluminescence Immunoassay and Enzyme Linked Immunosorbent Assay. Student’s t-test, Analysis of variance and Pearson’s correlation were used to analyze the data, with the significant p-level set at <0.05. Results: We found significantly higher mean TSH and prolactin levels in infertile females when compared with the normal fertile females. The mean TSH values were significantly higher in both primary and secondary infertility cases whereas mean prolactin level was significantly increased in primary infertility cases only. TSH and prolactin levels showed significant positive correlation in both primary and secondary infertility cases. Conclusion: There is a greater propensity for thyroid dysfunction and a higher prevalence of hyperprolactinemia in infertile women than the fertile ones and therefore, estimation of thyroid profile and prolactin should be included in the workup for infertile women.

397-399

Authors: Khushpreet Kaur, Parneet Kaur, Surya Malik

To study relative preponderance of critical obstetrical emergencies with various maternal factor like quality of antenatal care during pregnancy, regular antenatal checkup during pregnancy, socioeconomic status, education and area wise distribution and to study the contribution of each emergency to maternal mortality and morbidity and fetal outcome. Methods: The present study was conducted on a prospective basis for one year, from 1st Feb 2011 to 31st Jan 2012 in the department of Obstetrics and Gynecology Govt. Medical College and Rajindra Hospital, Patiala. All the cases referred as critical emergency from nearby areas during their antenatal period or within 42 days of delivery were included in the study. A detailed history including age, parity, gestational age, antenatal care during pregnancy, socioeconomic status, obstetrical history, medical or surgical disorders was taken into account. Attention was paid on the management received by each case including blood transfusion, surgical interventions, ICU admission etc. Results: Total deliveries during this period were 2223. Total obstetric emergencies came out to be 252. Thus the incidence of obstetric emergencies came out to be 11.3%. Various obstetric emergencies that were encountered – Hemorrhage (47.97%), Hypertensive disorders of pregnancy (35.32%), obstructed labor (12.3%), P. sepsis (3.18%), Rupture uterus (2.78%). Maternal mortality came out to be 8.8% Hemorrhage was leading cause of death in 36.36% cases followed by P. sepsis (13.64%), Hypertensive disorders of pregnancy (13.64%), Rupture uterus (9.09%). There were 70.2% Live births and 29.8% still births. Conclusions: It was concluded that obstetric emergencies are more common in unbooked cases and women with low socioeconomic status with poor access to antenatal care

407-409

Authors: Vasavi Kolluru, Anantha Reddy

High risk pregnancy refers to pregnancy with an increased risk of adverse outcome in mother or the baby. Scoring the risk, will identify mothers at risk earlier, so that proper resource allocation, planned management or timely referral to higher centers is facilitated and thereby perinatal mortality or morbidity can be reduced. Methods: 200 pregnant women with term gestation, admitted to labour room were evaluated. The risk factors in each case were assessed and their individual risk scores were determined using a simple scoring system. Subsequently their perinatal outcomes were compared to their respective risk scores. Results: It was found that there was a significant association between poor perinatal outcome and high risk pregnancies predicted by this scoring schedule. 20% of the cases belonged to high risk group, out of which 32.5% cases had maternal complications. Significant association between high risk score and perinatal mortality and birth asphyxia was found. Conclusions: There was a significant correlation between high risk and poor perinatal outcome. So a simple scoring system, such as the one used in our study, can be adopted at primary and rural health centers as a screening tool to predict pregnancies at high risk for poor perinatal outcome. Thereby facilitating early referral of these women to tertiary care centres.

414-417

Authors: Vasundhara P, Satya Sowjamya K

Globally the incidence of infertility is increasing. Infertility affects 10-15% of couple of reproductive age group. 12% of the female population of reproductive age were reported infertile in 2002 national survey of family growth. Infertility is a social stigma and psychological trauma to the couple. The couple should undergo battery of investigations to diagnose their cause for infertility. Most of the time, the work up is cumbersome and time consuming. Once diagnosis is achieved treating that cause takes some more time. To avoid this problem we need a proper test to diagnose and treat the problem early. Diagnostic hystero-laparoscopy is such a type of test to diagnose accurately and to treat properly at the same time. Aim of the study: The Primary aim of the study is to detect the anatomical abnormalities in the reproductive organs in infertile women by doing diagnostic hystero- laparoscopy, and also to compare the results with other modalities of diagnostic procedures like hysterosalpingography, transvaginal ultrasonography, Secondary aim is to treat the anomalies while doing hystero-laparoscopy.

422-425

Authors: Batiston Decruse Waanbah, Swati Rathore, Santosh Joseph Benjamin, Beena Kingsbury

Takayasu’s Arteritis is more common in women than men (8:1) with the peak incidence in the second and third decades, although a minority may present in their teens. The exact etiology remains unknown but it may have an autoimmune basis. It affects the aorta and its branches, leading to stenosis, thrombosis and the formation of aneurysms. During pregnancy it is associated with a number of fetal and maternal complications. The mode of delivery in patients with TA is determined by the haemodynamic status of the mother. A multidisciplinary collaboration of rheumatologists, cardiologist along with obstetricians is necessary to improve maternal and fetal outcome.

430-432

Authors: Monika Gupta, Swaraj Batra

The prevalence of congenital uterine anomalies among females of reproductive age group has been reported as 1:200 to 1:600. One such rare congenital uterine anomaly is rudimentary horn. The prevalence of unicornuate uterus with rudimentary horn is even rarer i.e.1:100,000. (1) These uterine anomalies present with very few problems in the absence of pregnancy provided there has been no obstruction to menstrual flow. Pregnancy in a rudimentary horn is rare and that too in noncommunicating horn is extremely difficult to diagnose before it ruptures. Such cases pose a challenge for management due to diagnostic dilemma. One such interesting case is being reported here with undiagnosed rudimentary horn pregnancy whose diagnosis was confirmed only at laparotomy due to unusual presentation.