Indian Journal of Obstetrics and Gynecology Research

220-224

Authors: SK Chawla, Atul Bucha, Archana Sethi, NS Puar, Vivek Paliwal.

Introduction: One of the commonest disorder encountered in gynecological practice is menorrhagia which accounts for about 12–23% of the outpatient department consultations and is also an indication for hysterectomy in about 21–36% of cases. Objectives: To bring out the beneficial effects of a commonly used contraceptive Centchroman (Saheli) in the medical management of menorrhagia. Materials and Method: 100 women between the ages of 25 - 50 years with complaints of menorrhagia were investigated and managed with centchroman and the results analysed in the form of decrease in amount of bleeding, pattern of bleeding, endometrial thickness. Results: Out of the 100 patients 68 patients were in pre menopausal age group. Almost all the patients registered a rise in hemoglobin levels at the end of study after treatment with centchroman. The duration of the cycles increased in 80% of the patients and the amount of bleeding reduced significantly. 17% patients did not benefit from Centchroman, out of these 10 patients underwent hysterectomy and 07 patients were reverted back to Norethisterone for better control of bleeding during the cycle. Conclusion: Centchroman (SERM), a non-steroidal, non-hormonal agent was found effective in reducing menstrual blood loss in patients with menorrhagia. It was found to be an excellent drug in controlling the systems of abnormal uterine bleeding without effecting normal endocrinal and physiological parameters.

230-234

Authors: Sunanda KM, Srinivas Krishna Jois, Sukanya Suresh.

Introduction: The maternal outcome and other pregnancy outcomes are strongly influenced by the abnormalities of liver function. This study was undertaken to look at the fetal and perinatal outcome in pregnancy with jaundice irrespective of the cause for jaundice. Materials and Method: The study was done in the department of OBG, Bangalore medical College and research institute over a period of 18 months. All pregnant women with jaundice irrespective of their gestational age were subjected to haematological tests and liver function tests and USG examination and the aetiological diagnosis was established in all the cases. The women were followed during their antenatal, intranatal and postnatal period and the fetal/perinatal outcome were documented and the likely factors influencing the outcome were studied. Results: There were 31 patients with jaundice putting the incidence to be 0.15%. 13% of the patients were in second trimester and 39% were term pregnancy patients. 35% of them had viral hepatitis, 32% had HELLP syndrome and 22% had intrahepatic cholestasis as the aetiology of jaundice. 92% delivered vaginally and 29% delivered as preterm. More than 45% of the deliveries were associated with adverse fetal outcome – intrauterine fetal demise, still birth etc., 45% had MSAF, 61% required NICU admission, 25.8% babies died. Conclusion: Jaundice continues to be a problem both for the pregnant woman and continues to have adverse effects on the perinatal outcome and the aetiology of jaundice could be the most important single determining factor for perinatal outcome.

240-243

Authors: Manju Agarwal, Apurva Garg, Uma Shankar.

Introduction: Stress Urinary Incontinence (SUI) affects the quality of life of at least one third of women globally. This problem is more common in India, where women usually do not seek treatment for their reproductive health problems and do not vocalize their symptoms. Kegel exercise and Duloxetine are said to be effective for the management of SUI. Hence it was tried to see the effects of these methods in the population of Jhalawar, Rajasthan. Materials and Method: A total of 80 females having Stress Incontinence were included in the study and 40 women were advised Kegel exercises and remaining were prescribed kegel exercises along with Duloxetine for 8 weeks. After 8 weeks they were evaluated for their symptoms. Results: Statistically significant improvement was observed after Kegel exercises alone and with combined Duloxetine and Kegel exercises but more improvement was seen when Duloxetine was added to Kegel exercises. Conclusion: It can be concluded that Duloxetine along with Kegel exercises is more effective for controlling SUI in the study population as compared to kegel exercises alone.

249-253

Authors: Preet Kamal, Ripan Bala, Madhu Nagpal, Harmanpreet Kaur.

Objective: To determine the feasibility, safety and outcome of cesarean myomectomy. Methods: It was a prospective study carried out in 25 pregnant women who had uterine myomas and underwent myomectomy during elective or emergency cesarean section. Analysis was done with reference to age, parity, characteristics of uterine myomas, operative morbidity, haematological changes occurring between preoperative and postoperative periods. Duration of surgery and post-operative duration of stay in hospital was also analysed. All cesarean myomectomies were performed by senior obstetrician. Followup of all the patients was done after six weeks. Results: Cesarean myomectomy helps in preventing repeat surgery for myomas and thereby prevents the risk of repeat anesthesia and relaparotomy. In our study forty fibroids of various sizes (2-12 cm) were removed in 25 women during cesarean section. Majority of fibroids were located on anterior wall of uterus except one which was located on the posterior wall of the body of uterus and was submucosal. Majority of the fibroids were detected in the body of uterus and were of subserous and intramural type. Insignificant difference was found in mean preoperative (11.5±0.9 gm/dl) and postoperative haemoglobin(10.7± 0.7gm/dl).Post-operatively only two patients required blood transfusion and one patient had fever. Mean time taken for operation was 63.9± 6.34 minutes and mean post-operative duration of hospital stay was 7.2 ± 1.7 days only. No patient had postpartum haemorrhage requiring cesarean hysterectomy in our study. Conclusion: Cesarean myomectomy is safe surgical procedure without any significant complications if performed in selected patients by experienced Obstetrician in tertiary care centre.

262-264

Authors: Bandamma Narendra S, Radhika Deshpande, Kavita Umapathy Gowda.

Introduction: Each year approximately 1.3 lakh women are diagnosed with cervical cancer and 74000 die of it in India as per WHO observations. The importance of Pap smear in pregnancy is to screen more number of cases in reproductive age group. This prospective study is conducted with the aim to popularise the test and to screen many patients and to create awareness of carcinoma cervix in the society. Methods: The study was conducted in the department of Obstetrics and Gynaecology at SSIMS and RC from September 2015 to September 2016. Pap smear was taken and the cytology was reported as per the modified Bethesda classification and report was given. Results: The total numbers of cases studied were 100. 92 of the cases had satisfactory smear. 8% had infections, so report was given unsatisfactory in all those cases. In our study we found no abnormal PAP smear. 20% of the cases had candida and trichomonas infections.

270-273

Authors: Rekha Choudhary, Saroj Choudhary, Priyanka, Divya.

Objectives: To find out the various risk factors responsible for the high maternal morbidity and mortality and poor perinatal outcome in rural obstetrics cases and to compare them with urban counterparts and also plan to suggest preventive and social measures to reduces maternal and perinatal morbidity and mortality by improving health services, infrastructure and referral system. Materials and Method: In this prospective comparative study 200 patients admitted in Obst & Gynae department of umaid hospital after 28 weeks of gestations from rural and urban populations & studied till child birth and early puerperium from Jan 2016 to Dec 2016. Results: In our study maximum number of patients in both rural and urban groups were in age group of 20-30 years. Among postpartum complications in rural group, PPH accounts for 06%, post-partum eclampsia 01%, pyrexia 03%, pelvic hematoma in 01%, episiotomy gaping in 01% & in LSCS delayed wound healing was 07% while in urban group PPH 1%, pyrexia 01%, post LSCS delayed wound healing was 04%. Blood was transfused in 13 patients in rural group and in 04 patients in urban group. Incidence of birth asphyxia was 10.78% in rural as compared to 04% in urban group. Conclusions: we concluded that rural women had an elevated risk of complications during & after pregnancy and that better utilization of maternal health care, especially for delivery, reduces adverse maternal and perinatal outcome.

278-282

Authors: Sangeeta Shah, Preethi Reddy B.

The second stage of labor is the most critical period for the mother and fetus and requires expertise and vigilence. A prolonged second stage is generally responsible for maternal and neonatal morbidities. Maternal morbidities can be in the form of postpartum hemorrhage, third or fourth degree perineal tears and a higher incidence of instrumental or operative modes of deliveries. Regarding neonatal risks with a prolonged second stage there is increased risk of Apgar score less than 7, neonatal intensive care unit(NICU) admission, birth depression and minor trauma. The purpose of this study is to assess maternal and neonatal morbidities associated with a prolonged second stage of labor.

288-291

Authors: Shachi Joshi, Mittal Parmar.

Rates of primary caesarean sections has increased dramatically since the 1980’s. Consequently, an increasing proportion of pregnant women attending for care have had a previous caesarean and face the question of mode of delivery. These women are at increased risk of complication compared with other women. The primary choice for women in this situation is whether to have a repeat caesarean section or to attempt vaginal birth. Both repeat CS (ERCS) and VBAC have inherent risks for the mother and the baby. Antenatal counselling and informed consent is crucial. Counselling should incorporate an individualized assessment of the risks and benefits of ERCS and planned VBAC modes of delivery. Women considering their options for birth after a single previous cesarean should be informed that, overall, the chances of successful planned VBAC are 72-76%. VBAC should not be undertaken without thorough discussion of the risks during labour with the pregnant women. It should not be undertaken in units where full obstetric facilities such as emergency transfer to theatre, blood transfusion and continuous fetal monitoring are not available. Planned VBAC is associated with slightly increased perinatal risk than planned ERCS, although absolute risks are low for both modes of delivery. Planned VBAC exposes the woman to a very low (0.25%) additional risk for experiencing perinatal mortality or serious neonatal morbidity and an additional 1.5% risk of any significant morbidity compared with opting for ERCS from 39 weeks of gestation. Absolute risk of delivery-related perinatal death associated with VBAC is extremely low (4 per 10 000 (0.04%)) and comparable to the risk for nulliparous women in labour. Planned VBAC is therefore appropriate and may be offered to the vast majority of multiparous women with a singleton pregnancy of cephalic presentation at term with a single previous single lower segment caesarean delivery. From a maternal point of view, the safest outcome is spontaneous labour and spontaneous vaginal delivery while the outcome associated with the greatest morbidity is a failed VBAC resulting in caesarean section. In women with single previous lower segment caesarean section, who opted for ERCS, the major obstetric drawback is the risk of rare, but severe, adverse outcomes in future pregnancies. The two major clinical factors determining the choice for VBAC are, therefore, the likelihood of a successful attempt and the mother’s plan for future pregnancies.

297-300

Authors: Monica Saraswat, Tony Jose, Meenakshi Rajput, Nilopher Siddique.

Introduction: Patients with PCOS not only have raised androgen levels which leads to anovulation but may also have high AMH levels. When ovulation induction fails, androgen levels are reduced by laparoscopic ovarian drilling (LOD) thereby effecting ovulation and thus improving fertility. Studies have suggested that LOD also reduces AMH levels and the degree of its fall may forecast the success of LOD. Materials and Method: The study objective was to evaluate baseline AMH levels and its change post LOD in patients with clomiphene resistant infertility, and correlate with spontaneous rates of ovulation and pregnancy. Results: AMH levels were found to be high in clomiphene resistant PCOS. LOD was found to be safe and effective in the management of these patients and it caused statistically significant drop in AMH levels effecting spontaneous ovulations and pregnancies. Though the degree of fall did not correlate statistically with the success of the procedure, the chances of pregnancy were found to better in patients whose pre-LOD AMH levels were higher. Conclusion: AMH levels could be a useful marker in PCOS related infertility with clomiphene resistance and LOD could be a safe and effective option for management of patients with high AMH levels and fall in AMH levels may emerge as a prognostic indicator. Randomized studies with adequate sample size would bring out the utility AMH as a prognostic marker in PCOS related infertility.

306-308

Authors: Annapoorna Yalla, Sarojini Vaddadi.

Uterine rupture is a rare but a life threatening condition in pregnancy. This is usually reported in scarred uterus, multigravid women and in laboring women. We are reporting a unique case of rupture of an unscarred uterus in a primigravid woman with review of literature.

312-313

Authors: Gayathri KB, Sajana G, Sudha P, Vimala Devi N, Bhargav PRK.

Vaginal fibroids with coincidental uterine fibroids are very occurrences in gynaceological practice. They tend to pose management difficulties with regards to radiological, clinical and operative aspects. Here, we attempted to address those aspects in two case scenarios with mini review.

317-318

Authors: Ranjeet V Chaudhary, Bhavesh B. Airao, Bipin R. Shah, Manish R. Pandya.

A 55 year old postmenopausal woman was brought to casualty department of C. U. Shah Medical College and Hospital with history of fall down with lower abdominal pain and vomiting. Patient having history of lower abdominal pain, non foul smelling whitish discharge, low grade on and off fever since 1 year associated with gradual weight loss since 2 years. Per abdominal examination reveals tender, distended with muscle rigidity. Exploratory laparotomy was performed under the diagnosis of perforation of GI tract with x-ray showing free gas under diaphragm. On exploration, the uterus was found to have fundal perforation of size 2x2 cm in dimension. With purulent material extruding from uterine cavity and abdominal cavity filled with purulrnt discharge around 1.5 litre. A Total abdominal hysterectomy with bilateral Salpingoophrectomy was performed uneventful and peritoneal cavity wash given with normal saline multiple times. Patient recovered completely without any complications and was discharged. Perforation due to pyometra can cause peritonitis in post menopausal females with signs of acute abdomen as an unusual but serious condition.

327-331

Authors: Manish Pandya, Mo. Anish Hingora.

Introduction: Hirschsprung disease is a developmental disorder characterized by absence of ganglia in the distal colon, resulting in a functional obstruction. Case Report: Here we are presenting a case report of Hirschsprung Disease in a viable age of fetus and sharing our experience in diagnosis and treatment of this rare entity. Conclusion: Hirschsprung disease is diagnosed in the newborn period, but this rare entity is detectable at early stage with routine ultrasound investigations.