Indian Journal of Obstetrics and Gynecology Research

Page No. 1-5

Authors: K. Subba Rao, Sravanthi Pathapati, Cheedi Vansipriya

Background and Objectives: Meconium stained amniotic fluid has been considered a sign of fetal distress in presentations other than breech and associated with poor fetal outcome but others considered meconium passage by fetus as physiological phenomenon and produces environmental hazards to fetus before birth. Such magnitude of different opinion was the object behind taking up of this study and aim of it was to find out the maternal risk factors associated and its correlation with the fetal outcome in terms of morbidity and mortality. Methods: 100 women in labour with meconium stained amniotic fluid studied considering the inclusion criteria in the Department of Obstetrics and Gynecology, Konaseema Institute of Medical Sciences and Research Center, Amalapuram. Cases divided into two -‘thin’ and ‘thick’ meconium stained group. Maternal and Fetal monitoring, uterine contraction assessed and Apgar score, birth weight, resuscitation of baby noted. All babies of both group followed up to first week neonatal life. Results: In our study, among 100 cases, 45% of the cases had thin meconium and 55% had thick meconium. Increased incidence of meconium staining was seen in crossed dates. The other risk factors were hypertension, anemia, oligohydramnios, IUGR. 56% went in for cesarean section due to intrapartumfetal distress. Perinatal death was seen in 4 cases, one due to birth asphyxia and the other three due to MAS. Interpretation and Conclusion: Infants with meconium aspiration syndrome are to be managed in NICU for close monitoring and vigorous treatment. Co operation and coordination of the obstetrician and pediatrician is required to prevent the perinatal morbidity and mortality. Based on this study we conclude that meconium stained amniotic fluid is associated with increased incidence of caesarean section, low APGAR score, meconium aspiration syndrome and increased NICU admission.

Page No. 10-16

Authors: Anupma Kaul, Dharmendra Bhaduaria, Mandakini Pradhan, RK Sharma, Narayan Prasad

Pregnancy is challenging among females with chronic kidney disease (CKD), and requires multidisciplinary approach comprising of obstetrician, nephrologists and neonatologist. Chronic kidney disease is often clinically and biochemically silent until renal impairment is advanced. Symptoms are unusual until the glomerular filtration rate declines to <25% of normal. Some women are found to have chronic kidney disease for the first time during pregnancy. Around 20% of women who develop early pre-eclampsia (≤30 weeks’ gestation); especially those with heavy proteinuria, have previously unrecognized chronic kidney disease. (7,8,9) These diseased kidneys may be unable to adapt to the normal physiologic changes of pregnancy leading to poor maternal and fetal outcome.(4) Evidences suggest that females with mild renal impairment with normal BP and little or no proteinuria have good maternal and fetal outcomes, with little risk for accelerated progression toward ESRD or preterm delivery. However those pregnancies among CKD population have shown poor maternal and fetal outcomes. (1,2) Jones and Haslett(5) observed that CKD was associated with increased risk for adverse pregnancy outcomes especially among pregnancies with moderate or severe renal function impairment. More than one-third experience an irreversible decline in GFR and 10 percent progress to end-stage renal disease (ESRD) by 12 months postpartum. (4,6) These findings highlight the important need for early identification of CKD, pre-conception counseling, preconception review of medications and early referral of pregnant patients with CKD for specialist care

Page No. 21-25

Authors: Delphine T. Rose, Sudha VS

Background: The female gonad ‘OVARY’ is multifaceted in its histology, embryology, steroidogenesis, and thus has the potential to acquire malignancy. Therefore ovarian neoplasms exhibit a wide variation in structure and biological behaviour. The main objective of our study is to find out the occurrence and distribution of various mass lesions in ovary in our population and to know its histopathological and clinical appearance. Methods: This study was a retrospective and descriptive study done for a period of 3 years starting from the month of January 2013 to January 2016, at the Obstetrics and Gynaecology Department, Thanjavur Medical College, Tamil Nadu, India. All ovarian tumour cases diagnosed as neoplastic (benign, malignant and metastatic) were incorporated in the study. Results: Out of 5728 gynaec admissions, 234 (4%) were found to have ovarian tumours. Of these 75.64% (177/234) were neoplastic and 24.36% (57/234) were non-neoplastic lesions. Among 177 neoplasms, the commonest histological pattern observed was epithelial tumours (73.45%).Of these, mucinous tumours (53.07%) were more frequent than serous type (46.92%). Mucinous cystadenoma (62.31%) was the commonest benign ovarian tumour and serous cystadenocarcinoma was the most frequently encountered malignant tumour (60.65%). Germ cell tumours (58%) were the commonest non–epithelial ovarian tumours. Conclusion: Among the admissions, ovarian neoplasms were more in number than the non-neoplastic ones. Surface epithelial type was the predominant histological type observed and the germ cell tumours were the second commonest type. Mucinous cystadenoma and serous cystadenocarcinoma were the commonest benign and malignant ones respectively. The age of occurrence of malignant ovarian tumour has significantly come down and the predominant symptom was found to be mass abdomen

Page No. 30-34

Authors: Girish BL, Indira N, Dhananjaya BS, Omkarmurthy K

Background: Preterm birth is well known condition causing morbidity and mortality, leading to curtailing life and also potential of life in long term. The burden not only affects the individual but also the family, community and nation. The issues concerned vary from social to financial issues. The requirement for reduction in IMR calls for prevention and management of Preterm births. Objectives: Infant mortality rate is one of the prime indicators of health services of health delivery systems and commitment of a country towards child health. The preterm births have been considered as prime contributor to infant mortality and under 5 mortality. Global efforts have been made to reduce Preterm births and thereby IMR, by World Health Organisation. Aggressive health policy and dedicated programmes were launched in India since past few years. This study is undertaken to study the performance at local region and to analyse trends at national levels. Material and Method: The data available at the reproductive and child health officer, RCHO is taken up for analyses. Results: Total live births for the year 2015-16 were 34,340. The total number of preterm delivery for the same period was 2507 accounting for 7.3% of all live births. The infant deaths were 436 contributing to a Infant Mortality Rate of 12.69 per 1000live births. Total neonatal deaths were 272, which contributed to 62.38% of infant deaths. The proportion of preterm deaths in neonatal death was 44.11%. Conclusion: Preterm birth continues to contribute significantly towards neonatal and infant deaths. Preterm births estimates have shown wide disparities in estimates and survival. At global level, India has highest contribution in terms of total preterm births annually, ranking number one in the world. To achieve the targets extra efforts has to be made to decrease preterm births and mortality related to the same disorder. Newer strategies with more commitment can help achieve the new targets.

Page No. 39-44

Authors: Kamala Verma, Girish Chandra Baniya

Background: Teenage pregnancy is widely recognized as one of the most complex and serious social, economic and health problems throughout the world. Teenage pregnancy is a high risk pregnancy. Outcome is less satisfactory than that of a pregnancy in general population. Aim & Objective: To find out the incidence of teenage pregnancy, to study the maternal and fetal outcome in teenage pregnancy and to compare the outcome of teenage pregnancy with that of 20-26 years of an adult mother. Material and Method: It is a prospective case-control study. 150 cases of teenage pregnancy (13-19 years) were compared with 150 cases of controls (20-26 years) for fetal outcome. After randomization, assessment of Sociodemographic details was done with the help of semi-structured performa. Statistics: The proposed study was conducted in phased manner observing ethics of voluntary participation and informed consent of the participants were taken. Results: the mean age of teenage mother and adult mother was 18.25 and 22.78 years respectively. Our study showed that preterm delivery was higher in teenage mothers (20%) as compared to adult mothers (6%). The incidence of LSCS was significantly more in teenage mothers (28.67%) as compared to the adult mothers (15.3%). There was a higher proportion of low birth weight in teenage mothers (31.33%) as compared to adult mothers (14.67%). Birth asphyxia is a most common complication and seen in 11.3% of cases.

Page No. 50-53

Authors: Muralikrishnan Nambiar, Anupama Suresh, Kauma Kurian

Introduction: This study aims at comparing the effectiveness of two drugs available in the market in the prophylaxis of postpartum haemorrhage, i.e., carboprost and methylergometrine. Aim: To compare the efficacy of Carboprost and methylergometrine as prophylaxis of postpartum haemorrhage. Methodology: This was an observational study involving 150 pregnant women who received either methylergometrine (250 mcg) or carboprost (125 mcg) following the delivery of anterior shoulder of the baby. Incidence of postpartum haemorrhage, median duration of third stage of labour, median post-partum blood loss, fall in haemoglobin and fall in hematocrit along with side effect profile of the drug were studied. χ 2 test and students unpaired t test were the test of statistical significance employed. Results: Median duration of third stage of labour was 6.3 minutes in women who received Methylergometrine and 5.5 minutes in those who received carboprost.(p value <0.001). Median postpartum blood loss was 300 ml in patients who received methylergometrine and 150 ml in those who received carboprost.(p value <0.001). Change in haemoglobin and PCV were 0.6 and 2.4 respectively in patients who received methylergometrine and 0.3 and 1.2 respectively in women who received carboprost (p value <0.001). Conclusion: Carboprost was superior to methylergometrine with respect to the above mentioned outcome measures with no significant difference in side effects; thus should be preferred to methylergometrine in active management of third stage of labour.

Page No. 59-65

Authors: Pooja Gupta Jain, Smriti Singhal, Priyanka Pandey, Meena Bhargava

Introduction: Hysterectomy is the commonest major operation performed by gynaecologist through various approaches and techniques including vaginal, abdominal, laparoscopic and robotic hysterectomy. Vaginal hysterectomy offers lesser complications during intra and post-operative period in comparison to abdominal hysterectomy. The past years have seen growing indications for vaginal hysterectomy and with the help of debulking techniques hysterectomy through vaginal approach become easier in large size uterus and now has been preferred over abdominal hysterectomy. Objectives: The objectives of the study are to compare intra and post-operative complications, efficacy of abdominal hysterectomy with vaginal hysterectomy. Methodology: A total of 170 cases with an indication of hysterectomy were selected of which 85 underwent Non descent vaginal hysterectomy and rest 85 underwent abdominal hysterectomy. These patients were further evaluated and statically analysed for various factors including age, parity, operative time, blood loss and intra and post-operative complications. Collected data were analysed. Results: No significant association was found between age, parity and selection of procedure. Fibroid was the most common indication for hysterectomy in both the groups. Patients of NDVH group were operated with minimal blood loss, in lesser duration in comparison to patients operated by abdominal hysterectomy. Significant association was found for above two factors which highly influence the selection of procedure. 7.1% cases of NDVH required debulking procedure. Blood transfusion (17.6%), difficulty in opening the anterior pouch (24.7%), difficulty in delivery of the uterus (15.3%) was more in control group as compared to study group. post-operative complications were more in control group as compared to the study group like resuturing (4.7%), wound infection (9.4%), gastro-intestinal discomfort (15.3%), fever (17.6%) and abdominal distension (14.1%) which was significant. Faster recovery was observed in group of NDVH. Follow-up complications like vaginal discharge/UTI were almost equal in both the groups. Conclusion: Non descend vaginal hysterectomy offers several benefits over abdominal surgery in terms of Less intra-operative blood loss, less febrile morbidity, low postoperative complications, faster recovery, less hospital stay, thus demonstrating that the vaginal route should be the choice of operation for non-descent cases.

Page No. 71-76

Authors: Jaya Vijaya Raghavan, Sheila K. Pillai, Dilshath Meera

Objective: To compare the efficacy of intracervical dinoprostone and sublingual misoprostol in preinduction cervical ripening. Study design: This prospective observational study was performed on 410 women with medical or obstetrical indications for labour induction. On an alternative basis, women were selected for intracervical dinoprostone and sublingual misoprostol for preinduction cervical ripening. 0.5 milligram of dinoprostone was placed intracervically every 6-12 hours for a maximum of three doses in one group and 25 microgram of misoprostol was given sublingually, every 4 hours for a maximum of five doses in the other group. Mean number of doses required, induction to active phase interval, induction to delivery interval, need for oxytocin augmentation, mean cost and neonatal outcomes were analyzed. Statistical analysis was done using SPSS 17 version software. Statistical significance was considered as 0.05 level (P value). Results: There was no significant difference in the mean number of doses required with regard to Bishop’s score when misoprostol was used, but significant difference was there when dinoprostone was used. There was no statistically significant difference in induction to active phase interval, induction to delivery interval and neonatal outcomes between the two groups. There was significantly higher failed induction in dinoprostone group. There was significantly lesser oxytocin requirement in misoprostol group. Mean cost was 37.75 times greater in dinoprostone group. Conclusion: 25 microgram of sublingual misoprostol provides a cheaper alternative method to intracervical dinoprostone for induction of labour.

Page No. 83-85

Authors: Surya Malik, Khushpreet Kaur, Parneet Kaur

Objective(s): To study the incidence, indications, maternal and fetal outcomes in cases of emergency obstetric hysterectomy. Material and Methods: A retrospective study of all the cases who underwent obstetric hysterectomy was conducted for one year in the Department of obstetrics and gynecology, Govt. Medical College, Patiala, Punjab. A detailed history including demographic profile, gestational age, antenatal care during pregnancy, obstetrical history, high risk factors were taken into account. Results: Total deliveries during this period were 2223 and out of them 11 patients underwent obstetric hysterectomy, including one case of septic abortion, giving an incidence of 0.494%. Majority of the patients who underwent obstetric hysterectomy were of rural background, uneducated and unbooked. Postpartum hemorrhage (PPH) 45.45%, and Rupture uterus 36.4% were the two most common indications for obstetric hysterectomy. Maternal Mortality was 27.27% .Fetal mortality was 60%. Conclusions: Obstetric hysterectomy is a necessary evil in obstetrics. Although, it curtails the future child bearing potential of woman, yet in many cases, it saves the life of mother. It can be called as “Ray of Hope for a dying Mother.”

Page No. 89-91

Authors: Payel Ray, Chandra Mouli A., Ratna Bulusu, Chandrachur Konar

Background: to evaluate the fetomaternal risks and outcome associated with borderline AFI at term. To study the mode of delivery among these patients. Methods: 107 pregnant subjects who were at 37-42 weeks period of gestation and ultrasonically diagnosed to have AFI between 5- 8cms were included in the study. They were monitored throughout labour and fetomaternal outcome was studied. Results: out of the 107 subjects maternal morbidity observed in 7.4% pregnant women. Neonatal morbidity was significantly higher at the rate of 66.3%. IUGR (21.4%), non-reassuring NST(31.7%), apgar score less than 7 at 5 minutes(3.7%), respiratory distress(6.5%), meconium aspiration(0.9%) were observed. 50% pregnant women underwent caesarean section for fetal distress which was observed as the most common indication accounting for 41% of cases. Incidence of meconium stained liquor was found in 75% of cases which is significantly high. Conclusion: That there is a high risk of adverse perinatal outcome and higher rate of operative delivery in cases of borderline AFI at term. Providing intensive intrapartum monitoring and good NICU facilities for such cases is necessary to optimise the fetomaternal outcome.

Page No. 96-100

Authors: Bharti Maheshwari, Varisha Mahtab, Smita Tyagi, Prachi Tyagi

Objective: To compare the efficacy safety and cost effective of oral iron and injectable iron sucrose and FCM in pregnancy in 2nd and 3rd trimester. Methods: A prospective randomised control trial study in 300 women with HB 7-9gm% done in department of obstetrics on Gynae in Muzaffarnagar Medical College, Muzaffarnagar. Result: Mean changes in Hb: oral iron 9.14gm%, inj.iron sucrose 10.54gm%, inj FCM 11.66gm%. The value of p is < 0.00001. The result is significant at p ≤0.05. Mean changes in PCV: oral iron 25.1%, inj iron sucrose 36.7%, inj FCM 37.46%. The value of p is <0.00001. The result is significant at p ≤ 0.05.Mean changes in MCV: oral iron 74.5Fl. The value of p is 0.172115. The result is not significant at p ≤ 0.05., inj iron sucrose 72.52.4Fl, inj FCM 80.4Fl. The value of p is < 0.00001. The result is significant at p ≤ 0.05.Mean changes in MCHC: oral iron 32.9%, inj iron sucrose 37.6%, inj FCM39.31%. The value of p is < 0.00001. The result is significant at p ≤ 0.05 Mean changes in serum feritin oral iron 28.95 µg/l, inj iron sucrose 29.25 µg/l, inj FCM 47.3µg/l. The value of p is < 0.00001. The result is significant at p ≤ 0.05.Mean changes in serum iron oral iron 36.27µg/dL, inj iron sucrose 38.1 µg/dL, inj FCM 73.8 µg/dL. The value of p is < 0.00001. The result is significant at p ≤ 0.05. Mean decrease in TIBC: oral iron 369µg/dL, inj iron sucrose 330µg/dL, inj FCM 324 µg/dL. The value of p is < 0.00001. The result is significant at p ≤ 0.05. Regarding efficacy both oral iron and injectable group was statistically significant. The value of p is < 0.00001. The result is significant at p ≤ 0.05. Conclusion: We can conclude from this study that injection FCM is a promising alternative for IDA as its compliance is better than others, it can be safely used for correction of anaemia without any side effects over the mother and fetus.