Indian Journal of Obstetrics and Gynecology Research

104-107

Authors: Anita Madan, Alpna Thakur, KJPS Puri.

India is one of the most thickly populated countries of the world with a varied cultural background. Sexually transmitted infections/ Reproductive tract infections (STIs/RTIs) still remain a taboo amongst majority of the population in India. Women’s health takes a back seat in most households. The National programme against STI/RTI has led to the setting up of Suraksha clinics associated with Dermatology and Obstetrics/Gynaecology departments all over India. This study is an attempt to identify the prevalence of STIs/RTIs in the patients reporting to these clinics. A total of 638 female patients were enrolled in this study. Maximum number of female patients had bacterial vaginosis i.e. 244 patients (38.2%), followed by 205 females (32.1%) having candidial vulvovaginitis. Forty-seven females (7.4%) had cervicitis/cervical erosion, while 40 females presented with non-specific discharge per vaginum. Twenty-nine females (4.5%) had herpes genitalis, 26 (4.1%) had ano-genital warts, 21 (3.3%) had molluscum contagiosum while 12 females (1.9%) were diagnosed to have pelvic inflammatory disease. Also, 12 (1.9%) reported with non-herpetic genital ulcers while 2 (0.3%) had urethral discharge. STI/RTI clinics can contribute to check the spread of STIs through early identification, education, promotion of safe sex and counselling, thus ensuring early treatment and a better quality of life.

112-115

Authors: Manasi Patnaik, Banya Das.

Objective: To study the incidence and indications of LSCS. Place and Duration: This study was carried out from January to July 2016 in Department of Obstetric and Gynaecology, KIMS, Bhubaneswar. Methodology: In this retrospective analytical study, the total number of patients delivered and the number of LSCS done in the above mentioned study period were counted to find the incidence of LSCS in our hospital. Age, parity and gestational age of the patients who underwent LSCS were tabulated. The indications of LSCS were analyzed from pre operative and intra operative findings. Result: In our study the incidence of LSCS was 67.67%. Of these patients 43.22% belonged to age group 26 -30 yrs and 2.6% patients were in 35 – 39yr age group. 1.49% patients were less than 20 yrs of age and 0.37% were more than 40 yrs. 58.73% of patients were primigravida whereas 28.06% were second gravid and 13.19% were gravida three or more. In 50.74% LSCS was done at > 38 – 42 wk gestational age (GA) followed by 40.89% in 34 – 38wk GA and 8.36% in <34wks of GA. The commonest indication of LSCS was previous caesarean section in 23% followed by cephalo pelvic disproportion(CPD) in 11.3%, preterm premature rupture of membranes and premature rupture of membranes in 9.8%. Pregnancy induced hypertension (PIH), foetal distress and oligohydramnious each accounted for 9.4%. 1.67% patients underwent LSCS after some form of treatment for primary infertility and 0.73% of patients had LSCS on request. Conclusion: LSCS rate is high compared to the WHO standard and previous LSCS is the commonest indication followed by CPD.

120-122

Authors: Aim: This study was conducted to evaluate the effects of Gestational Diabetes Mellitus on the fetus with special emphasis on perinatal complications. Method and Methodology: 50 antenatal women diagnosed as Gestational Diabetes Mellitus recruited in this study and were followed up to record their labour and delivery events with note of all fetal and neonatal outcomes. Results: From our study we observed various neonatal complications in these patients of Gestational Diabetes Mellitus namely fetal macrosomia-(14%), neonatal hyperglycemia- (24%), respiratory distress syndrome-(12%), neonatal polycythemia-(4.0%), hyperbilirubinemia -(36%), hypocalcemia- (14%), small for gestational age fetuses- (6%), IUFD/Stillbirths - (4%), neonatal deaths-(6%). Conclusion: Universal screening and regular antenatal checkups to diagnose Gestational Diabetes Mellitus early will lead to timely and proper management of the condition there were decreasing the neonatal morbidity and mortality significantly.

Aim: This study was conducted to evaluate the effects of Gestational Diabetes Mellitus on the fetus with special emphasis on perinatal complications. Method and Methodology: 50 antenatal women diagnosed as Gestational Diabetes Mellitus recruited in this study and were followed up to record their labour and delivery events with note of all fetal and neonatal outcomes. Results: From our study we observed various neonatal complications in these patients of Gestational Diabetes Mellitus namely fetal macrosomia-(14%), neonatal hyperglycemia- (24%), respiratory distress syndrome-(12%), neonatal polycythemia-(4.0%), hyperbilirubinemia -(36%), hypocalcemia- (14%), small for gestational age fetuses- (6%), IUFD/Stillbirths - (4%), neonatal deaths-(6%). Conclusion: Universal screening and regular antenatal checkups to diagnose Gestational Diabetes Mellitus early will lead to timely and proper management of the condition there were decreasing the neonatal morbidity and mortality significantly.

127-131

Authors: Kusum Heda, Kalpana Beniwal, Kalpana Sharma, Neena Kasliwal.

Introduction: The aim of the study was to asses clinicopathological profile of breast lesions at tertiary care center. Material and Method: The study was conducted in department of pathology, JLN medical college, Ajmer. We retrieved breast biopsies received in histopathology department over a period of 18 months from January 2015 to October 2016. A total of 602 cases of breast lesions were included in the study. Results: Out of a total of 602 cases of breast lesions, most common lesions were benign 454 (75.4%) with mean age 30.15 years, followed by malignant 99(16.4%) with mean age 48.5 years and inflammatory 49 (8.1%) with mean age 32.9 years. The overall mean age of patients was 31.8 years, with a wide age range of 11–88 years. Overall the most commonly reported lesion was fibroadenoma 322(53.4%) cases, followed by infiltrating duct carcinoma 83 (13.7%) cases, mastitis 45(7.4%) cases, gynecomastia 39(6.4%) and fibrocystic disease 37 (6.1%) cases. The maximum cases of malignancy were seen in 41- 50 years of age of life. Most common malignant lesion was infiltrating duct carcinoma. Conclusion: The breast lesions pattern revealed by the present study provides valuable information regarding clinicopathological profile of breast lesions.

137-140

Authors: Madhumathi, Jaya Vijayaraghavan.

Objective: The First trimester Pregnancy-associated plasma protein-A (PAPP-A) is one of the marker for the screening. The purpose of this study was to evaluate whether low levels of first trimester PAPP-A alone is predictive for adverse pregnancy outcomes such as intrauterine growth restriction, gestational hypertension, pre-eclampsia, low birth weight and preterm labour. Study design: This study included patients with singleton pregnancies who underwent combined first trimester screening using nuchal translucency (NT) and maternal serum free beta-human chorionic gonadotrophin (free beta-hCG) and PAPP-A at 11-13+6weeks gestation. The incidence of various adverse pregnancy outcomes such as spontaneous preterm labor, fetal growth restriction (FGR), pre-eclampsia and gestational hypertension and low birth weight were correlated in relation to Abnormal PAPP-A values(<0.4MOM). Results: In our study out of the 1100 patient were enrolled 167 women were lost to follow up and 9 were excluded.924 patients followed up for adverse pregnancy outcome. Abnormal PAPPA was found in 12.5%. IUGR was found in 10.5% (n=12;OR-5.1) preeclampsia in 8.8%(n=10;OR-2.7), Gestational hypertension 3.5% (n=4;OR-0.552), Preterm labour 15.8% (n=18;OR-2.6) and Low birth weight in 33.3% (n=38; P vlaue-0.001) women of which 25.4% delivered at term and only 7.9% delivered as preterm. Conclusion: This study demonstrated that maternal serum PAPP-A is low in pregnancies resulting in Intrauterine growth restriction, Pre-eclampsia, Preterm labour and Low birth weight. However the sensitivity of Abnormal PAPP-A to predict adverse pregnancy outcomes is poor. Thus, PAPP-A is a good predictor for adverse pregnancy outcome mainly IUGR but hence cannot be used for screening test.

146-150

Authors: Pooja Gupta Jain, Rakhi Sharma, Meenu Bhargava.

Introduction: Meconium is a dark green liquid passed normally by the newborn baby containing bile, mucus & epithelial cells. The presence of meconium in amniotic fluid is of great concern to the obstetricians. It is a potential warning of fetal asphyxia but sometimes it may be physiological with no effect on fetus. Objectives: To determine the prevalence of meconium stained liquor during labour associated risk factors and perinatal outcome in preterm, term and post term pregnancy. Materials and Method: This is a observational prospective study done on the women coming to labour room and OPD for delivery. These women were examined and records were maintained in terms of their profile, time of rupture of membrane, appearance of meconium, mode of delivery, perinatal outcome, Apgar score and compared with control group. Results: The incidence of MSL in our study is 11.01%(185 patients). There were 93 (50.2%) cases with thin staining (light green), 49 (25.9%) with moderately staining (yellow) and 44 (23.92%) with thick staining (deep green) liquor. No significant correlation was noted between maternal age and meconium staining of liquor but higher incidence of 11.6% was noted in women age group of >30 years. The incidence of staining was higher i.e. 17.1% in higher gestational age of fetus i.e. 41-42 weeks. Our study also yielded results of rising incidence of low –birth weight babies(less than 2.5kg) in meconium stained liquor cases. Instrumental vaginal deliveries (3.3%) and caesarean sections (44.6%) were found to be more prevalent in these cases. It was found that newborn with meconium stained liquor had significantly reduced APGAR scores at 1minute, 5minutes and 10 minutes(P<0.05) when compared to clear liquor cases. Meconium aspiration syndrome was more prevalent in the thickly stained group (3 patients) than in thinly stained group (zero patients). Mean Apgar Scores were significantly lower in cases complicated with thick stained liquor than in thin stained liquor or clear liquor. The incidence of admission to neonatal intensive care unit, meconium aspiration syndrome, neonatal deaths, instrumental vaginal and caesarean delivery were higher in pregnancies complicated by meconium stained liquor. Conclusion: Meconium stained liquor is associated with advance maternal age, advance gestational age, increased caesarean section rate, lower apgar scoring, increased NICU admission rate and neonata.

155-160

Authors: Neeraj Kulkarni, SM Deepti Pinto Rosario, Bijesh Yadav, Ruby Jose.

Although Cesarean delivery (CD) is the most common surgical procedure employed by the Obstetrician, vaginal delivery is the generally preferred mode of delivery by most women. But, sometimes while awaiting vaginal delivery, due to various factors mentioned below, the fetal head gets impacted during the second stage of labour. The impacted fetal head is then delivered by one of several described methods which could give rise to increased maternal and neonatal morbidity. This could lead to failed instrumental delivery with its attendant morbidity as well. The fetal head is said to be impacted when the station of the fetal head is below the Ischial spines on vaginal examination and the head cannot be easily delivered

171-174

Authors: Wills G. Sheela, Vijayalakshmi P, Mohanambal, Chellatamizh M..

Aim: 1. To estimate prevalence of thyroid dysfunction in reproductive women in rural area. 2. To correlate thyroid dysfunction with menstrual irregularity and nonresponding menorrhagia. Study Design: Cross sectional hospital based observational study. Material: 50 women in the age group of 15 to 45 years who presented with menstrual dysfunction in gynec OPD of SSSMC and RI, Ammapettai were enrolled study subjects, patients without menstrual dysfunction with similar parameters as study subjects were enrolled as control group. Method: Detailed menstrual history, height, weight, BMI, USG pelvis, thyroid profile and endometrial sample were taken and compared. Result: Commonest menstrual disorder was DUB(58%) with menorrhagia. 82% were obese, 26% had occult PCOD and 14% overt PCOD, hypothyroidism in 52% and hyperlipidemia in 12%. Proliferative endometrium was seen in 50% hypothyroid women and atrophic endometrium 2% in hyperthyroid women. 10 women had subclinical hypothyroidism. Conclusion: Prevalence on thyroid disorder with menstrual dysfunction in our study was 64%. Prevalence of hypothyroidism was 52% and subclinical hypothyroidism 10% higher than the national average. Our center is within 40km radius of nuclear reactor at kalpakkam and surrounded by mountains. Non responsive occult menorrhagia was seen in 10% women with subclinical hypothyroidism. In control group 16% women had hypothyroidism and 72% were thyroid. To conclude thyroid dysfunction is associated with menstrual disorder’s. Prevalence of hypothyroid is more than hyperthyroid.

179-183

Authors: Punya BS, Sailakshmi MPA.

Aim: To compare the maternal and fetal outcome between term and post dated pregnancies. Methodology: Keeping in mind that the post dated pregnancy causes lot of threats to the mother and the fetus, in our hospital, labor is induced at 40 completed weeks i.e. at 40+0 weeks. In this study we tried to find out the prevalence of Post dated pregnancy (pregnancies beyond 40 weeks), it’s maternal and fetal outcome and compare the same with term pregnancy (37-40 weeks). Results: In the present study, total of 2174 cases were studied out of which 486 cases were post dated pregnancies. The incidence of post dated pregnancy was 17.36%. PRIMIs were more prone for post dated pregnancies according to our study. The ‘P’ value was statistically significant (p<0.001) in the following outcomes- Intra uterine fetal deaths, forceps and vaccum assisted vaginal deliveries, emergency LSCS, meconium stained liquor causing fetal distress, lower APGAR scores, admission to NICU ,all were more in post dated pregnancies compared to term pregnancies with statistic significance proving the same. Conclusion: Maternal morbidity increased in the form of emergency LSCS, postpartum hemorrhage, instrumental deliveries, as the gestational age increased beyond 40 weeks. The study also showed that there was significant increase in perinatal morbidity and perinatal mortality in the form of birth asphyxia, meconium aspiration syndrome and perinatal death as the gestational age went beyond 40 weeks. Maternal and fetal morbidity and mortality can be reduced by electively inducing pregnant women at 40+0 weeks as allowing them to continue beyond this gestational age has shown adverse feto-maternal outcomes.

189-192

Authors: R. Sujatha, Archana, N. Saravana Kumar, PM Subramaniam.

Background: Cervical carcinoma was once the most frequent form of cancer in women around the world. Since the introduction of the papanicolaou(pap) smear 50yrs ago, the incidence of cancer cervix has plummeted. It remains the most successful cancer screening test ever developed. In populations that are screened regularly, cancer cervix mortality is reduced by as much as 99%. Objectives: This is a prospective study aimed to screen all OP patients with cervical smears from January 2015 to December 2016 at Annapoorana Medical College and Hospital, situated in a rural area at Salem. The main purpose was to study the incidence of pre-malignant and malignant lesions in small section of rural population in and around Annapoorana Medical College and Hospital. Those cases diagnosed clinically as carcinoma cervix were not included in this study. Methods: Pap smear cytology reports and relevant clinical data noted in a structured proforma. Smears were reported as per the 2001 Bethesda system. Results: A total of 500 pap smears were examined. There were 7 unsatisfactory or inadequate samples. NILM, Negative for intraepithelial lesion or malignancy, 458 of which 231 showed normal cytological findings and 227 showed non-neoplastic changes. Out of the total 42 abnormal pap smears, only 24 cases reported to have epithelial cell abnormality. The 24 abnormal cases consist of 9 with ASCUS, 11 LSIL, 3 HSIL, 1 invasive squamous cell carcinoma. Conclusion: Useful in diagnosing malignant and pre-malignant lesions of Cervix. The epithelial cell abnormality rate is 4.8% in our study, comparable to other studies. In developing nations like India with poor per capita incomes, it is a major challenge to devise screening programme which is cheap and widely applicable. Medical and paramedical staff can easily be trained to perform this simple test which reduces the incidence and mortality of cancer cervix.

198-202

Authors: Rita D. Vijaychandra Doggalli, Dhanalaxmi Vishwanath Lotlikar.

Background: A 5 year retrospective study is carried out in the SDM College of Medical Science and Hospital from 2011 to 2015 to determine the factors influencing the fetal and maternal outcome. The purpose of the study is to analyses the role of eclampsia on maternal and neonatal health and the complications associated with eclampsia. Method: The present study is a 5 year retrospective study from 2011 to 2015 in a 104 eclamptic patients above 28 week of gestational age. The data was collected from the medical records of the patients with eclampsia and the incidence of antepartum, intrapartum and postpartum eclampsia and its influence on maternal complications like anaemia, renal complications, CNS complications, ocular complications, disseminated intravascular coagulation, abruption, HELLP syndrome, pulmonary oedema, SICU admission, maternal deaths and perinatal morbidity and mortality were analysed. The benefits of medical management with Magnesium sulphate also studied. Results: The study showed that the incidence of eclampsia in 5 year is 0.45%, out of which the percentage of antepartum eclampsia being maximum 71.15%. These mothers with eclampsia had life threatening complications like anaemia (32.6%), renal complications like renal failure (7.6%), CNS complications in the form of cerebral hemorrhage (6.7%), ocular complications (3.8%) which included retinal detachments, macular oedema, disseminated intravascular coagulation (4.8%), abruption (4.8%), HELLP syndrome (9.6%), pulmonary oedema (2.8%), SICU admission (14.4), maternal deaths (3.8%). The perinatal outcomes studied with the maximum preterm labours(45.1%), intrauterine deaths (17.6%) early neonatal deaths (12.3%) whereas the overall full term vaginal deliveries and LSCS were 20.1% and 33.65% respectively. Conclusion: Eclampsia has a greater threat of the maternal and perinatal heath. The early referral to tertiary centre, transport facility, use of Magnesium sulphate has decreased the severity. . Early detection and intensive management is essential for improving the maternal and fetal outcome.

208-211

Authors: Avichala Taxak, Aparna Vijaysinh Dodia, Palak Bhikhabhai Patel, Harshad Shah, Asutosh Davee.

Aims and Objectives: · The purpose of this study is to assess the ability of MRI in diagnosis of Sonographically indeterminate adnexal lesions. · To further characterize them in terms of content (solid, cystic, both solid-cystic), origin, tissue characterization (fat, blood, fibrous) and benign vs malignant potential. · To elucidate the sonographic imaging features leading to indeterminate diagnoses. Conclusion: Adnexa is a complex structure, a significant proportion of adnexal masses detected by sonography are indeterminate. Sonography remains the initial imaging modality of choice in the assessment of the female pelvis, because it is readily available, inexpensive, safe and quick. Despite the high sensitivity of US, it is rarely specific. This study revealed that sonography performed poorly for determining the origin of the mass, which is the essential first step in characterizing an adnexal mass. MRI with its high contrast resolution & tissue characterization capabilities, helps in accurately resolving these uncertainties.

214-216

Authors: Nishant Patel, Bhavesh B. Airao, Bipin R. Shah, Manish R. Pandya.

A 30 year old female, gravida 3, para 2 with two previous full term normal vaginal deliveries and a history of 9 months of amenorrhea was referred to C. U. Shah Medical college and Hospital for severe anemia with complaints of lower abdominal pain and breathlessness. Abdomen was soft, non-tender and unduly enlarged. Fetal heard sounds were absent. Laparotomy was performed under diagnosis of uterine rupture. Uterus was found to have ruptured from the posterior wall and was beyond repair. Hence Obs hysterectomy was performed. Patient recovered completely on post op day 11 and was discharged the same day. Gravid non scarred uterus can rarely rupture spontaneously during labour and can present with vague complaints which can be difficult to diagnose merely on the basis of clinical signs and symptoms.