Indian Journal of Obstetrics and Gynecology Research

318-321

Authors: A. Mangala Geetha

Infertility accounts to nearly one-third of the patients who seek the medical advice of a gynecologist. Infertility or otherwise sub fertility is the failure of a couple to conceive after 1 year of regular, unprotected intercourse. Amongst the various causes for female infertility ovulatory dysfunction is the most common and accounts to 30-40% of all cases.1 The capacity of an ovary to produce egg cells that are capable for fertilization is known as ovarian reserve. Tests done to asses quantitative ovarian reserve of a woman desirous of pregnancy includes Day 3 FSH, AMH, Antral follicular count and ovarian volume measurement. Antral follicular count is referred as a number of oocytes and follicles in ovaries which is morphologically healthy. Anti mullerian hormone is produced by healthy ovarian follicles and serves as a marker of quantity of healthy follicles and oocytes in ovaries. Ovarian volume assessed by ultrasound can be used as a marker of functional ovarian potential. The aim of this study is to compare the ovarian reserve of fertility proven women with women presenting with sub-fertility using the sonographic tests like antral follicular count and ovarian volume measurement in a tertiary care teaching hospital in Thoothukudi, Tamil Nadu, South India and thence to asses if they are corresponding to standard cut-off values of other parts of the globe.

327-330

Authors: Sujithra. D., Sukanya Mukherjee, Sudha S

Introduction: The prevalence of Gestational diabetes mellitus (GDM) is high in Asian subcontinent. As per current guidelines, the routine screening for GDM is at 24 to 28 weeks of gestation.30 to 50% of GDM cases may remain undiagnosed until such period of screening. This study aims to investigate HbA1C levels at as early as 12 weeks of pregnancy as a predictor of GDM. Materials and Methods: This prospective study included 100 patients enrolled at their first antenatal visit, or before 12 weeks of gestational age, who attended OPD. At the time of enrolment for HbA1c and routine antenatal investigations were done. A 75 gm GTT was done at 22 to 26 weeks of gestation. HbA1c cutoff was taken as ?5.7 & ?6.4 and patients having value ?5.7 were taken as abnormal. Subjects with HbA1c ?6.5, overt diabetes, hemoglobinopathies, anaemia, chronic renal diseases and multiple pregnancies were excluded from the study. Results: It is found that women >28 years had higher levels of hbA1C in comparison to patients <28> Conclusion: The study concludes that women with higher HbA1c (?5.7) were more likely to develop GDM than those women with lower HbA1C (?5.7). HbA1c can be done routinely in early pregnancy (1st trimester). Women with higher HbA1c (?5.7) can benefit from early interventions early in pregnancy thereby prevent GDM and adverse perinatal and pregnancy outcomes.

335-338

Authors: Shaifali Patil, Anup Kapse

Introduction: Abruptio placenta is a serious obstetric complication which is characterised by the premature separation of the placenta. It is also associated with premature deliveries, maternal and fetal morbidities. Multiple factors are known to be associated with increased risk of placental abruption as alcohol and cocaine use and cigarette smoking, and nutritional deficiencies etc. Materials and Methods: It was a retrospective study conducted among 47 cases of abruptio placentae admitted under the department of obstetrics and gynecology, in MGM Hospital, Kalamboli, Navi Mumbai, for a period of 2 years (December 2015 to December 2017). Results: The mean age of presentation was reported to be 26.59 years. The incidence of abruptio placentae was found to be least after the age of 35 years (Table 1). Majority of cases were multigravida, while 32% cases presented with AP were primigravida. Among the multigravida cases, the majority of cases were of gravida 2 and 3 and the mean gravida order was 2.4. Conclusions: From the current study, we can conclude that multiparty, cesarean section, previous abortion, and placental abruption can be considered at high risk of placental abruption.

344-348

Authors: Shaifali Patil, Shivali Tripathi, Siddharth Shah

Introduction: Vitamin D is a fat-soluble vitamin which comes primarily from exposure to sunlight, and only few foods acts as a source of it. Vitamin D deficiency is a preventable health problem. Research shows that during pregnancy, adequate vitamin D intake is necessary for maternal, fetal and child health. This study was conducted to determine prevalence of vitamin D deficiency in pregnant women and neonates and will also help us to determine if 400IU daily recommended dose is sufficient to treat hypovitaminosis D. Materials and Methods: The study was carried out for 1 ½ years on 100 pregnant, divided in two groups in which one group was given supplementation and 2nd group was of unregistered patients. Results: The prevalence of Vitamin D deficiency was observed as 82% in present study. On supplementing the subjects with 400IU vitamin D with calcium 1000 mg daily, the prevalence reduced to 14% while normal levels were achieved in 58% as compared to 8% during the first trim which was significant with p value of <0> Conclusion: We recommend evaluation of the status of vitamin D in all pregnant women along with D3 supplementation. Routine supplementation of pregnant mothers with 400IU vitamin D with calcium 1000 mg daily resulted in significant improvement of vitamin D levels in study group, but sufficient levels were reached in just over half of the females. We thus propose further research on the daily dosage recommendations along with other factors affecting vitamin D levels in pregnant females like eating pattern, compliance to prescribed drugs and sun light exposure.

353-356

Authors: Vasudha Sawant, Sreesti Jaiswal, Manjiri Desai

Introduction: The Aims of this study were to identify the prevalence of reproductive tract infection in married women of reproductive age group (18-45 years), to analyse the impact of socioeconomic and demographic factors on reproductive tract infections, to treat the underlying cause. Materials and Methods: Total of 500 women were examined, out of those 300 women was found to have reproductive tract infections and were enrolled for further study and evaluation. Appropriate antibiotics were given to them and then followed. Results: The study results showed a high prevalence of RTI (60%). The highest prevalence was found among the age group between 26-29years followed by 30-33years and 34-37 years. The most affected women were from rural population (80%), low socioeconomic group (63.4%) and illiterate (59%). Conclusion: The present study showed high prevalence of RTI. It needs further depth study on their literacy and economic factors to evaluate and analyse the impact of these factors on reproductive tract infections.

361-364

Authors: Vipul S. Patel

Objectives: To compare empirical treatment with fosfomycin and nitrofurantoin in uncomplicated lower urinary tract infection during pregnancy. Materials and Methods: Patients were recruited from OPD of obstetrics and gynecology presenting with symptoms of lower (UTIs) urinary tract infection. Patients were divided randomly alternately in two groups. Fosfomycin therapy was given in group 1 (n=60) and seven days nitrofurantoin therapy was given in group 2(n=60). Patients were evaluated for symptoms improvement, compliance, side effects and cost of treatment. Results: Efficacy of fosfomycin on day 7 post treatment is 98% compare to nitrofrantoin I s83.3%. Side effect is 15% in fosfomycin group as compare to 28.3% in nitrofurantoin group. Compliance is 100% in fosfomycin group as compare to 96.6% in nitrofrantoin group. Cost of therapy in fosfomycin group is 300 Rs average while 170 Rs in nitrofurantoin group. Conclusion: Fosfomycin is first line empirical treatment of uncomplicated UTIs during pregnancy because it is safe, effective, less resistance, higher patient’s compliance with fewer side effect and equal cost of therapy.

372-376

Authors: Varun Gaitonde, Supriya Patil, Sanjaykumar Patil, Yamini Patil

Introduction: Pathophysiology of PCOS reveals excessive ovarian and/or adrenal androgen secretion results in hyperandrogenism and is associated clinical manifestations ranging from hirsutism, acne, male-pattern baldness to irregular menses, infertility. This study aims at assessing the prevalence and clinical presentations of PCOS among women of the reproductive age group attending the OPD of a tertiary care centre. Materials and Methods: The study was carried women of reproductive age group (15-45yrs) attending Obstetrics and Gynaecology OPD of a tertiary care hospital presenting with relevant symptoms from July 2015 to July 2017. Results: In the present study, the average age of participant was 22.47 + 3.44 years, we also found that menstrual abnormalities were observed among all the study participants followed by skin discolouration (32.4%). Average BMI in kg/m2 was 22.22 + 2.22. Conclusions: PCOS in a common disorder among young women. Menstrual problems are the commonest reason for gynecological OPD consultation among adolescent girls. Evaluation of bleeding problems in adolescents is justified, before considering them as normal physiological transitio

381-383

Authors: Sowmya Gopinath, Dhananjaya B S, Chandhana Krishna

Introduction: Pregnancy and child birth though considered as physiological process can become lethal for any woman. Childbirth was considered as rebirth to a woman in olden era. The atmost duty of an Obstetrician is to identify the abnormal events at the earliest, intervene appropriately and avoid the catastrophe. The importance of partogram is to prevent the maternal and perinatal complications. The World Health Organisation has simplified the partogram for its use by skilled birth attendants. Aims and Objectives: To study the progress and outcome of labour using modified WHO partogram in pontaneous labour in primigravidas. Materials and Methods: A cross sectional study of 200 women primigravidas admitted to Sree Siddhartha Medical College from December 2016 to November 2017 with spontaneous onset of labour at term with no high risk factors were recruited for the study using modified WHO Partogram. Augmentation of labour requirement, duration of active labour, mode of delivery, maternal and perinatal outcome were studied. Patients were divided into 2 groups – Group 1 and Group 2. Group 1- cervical dilatation and descent curve falling to the left of the alert line. Group 2- cervical dilatation and descent curve falling to the right of the alert line. Though Group 3 with women to right of action line was planned, there were no patients in group 3.Results: Most women belonged to age group of 21-25 years. The mean gestational age was 38.2 weeks. In Group 1, the mean duration of active phase of first stage of labour was 4.52±0.10 hours, where as it was 5.94±1.46 hours in Group 2. In Group 2, the mean duration of second stage of labour was 45.44±1.94 mins but it was 34.42±16.41mins in Group 1study subjects. Mean rate of cervical dilatation is 1.2 cm/hr. Seventy seven percent had normal delivery, 11% had caesarean delivery and 12% had instrumental delivery. Patient crossing the alert line had longer duration of labour. Augmentation was significantly higher in Group 2 (92.3%) than in Group 1 (67.8%). In the study group, there were no maternal and perinatal deaths. Conclusion: The partograph is an inexpensive and easily accessible tool that can effectively monitor the progress of labour. The WHO simplified partograph is highly useful in identifying when to intervene and also reduces perinatal and maternal mishaps.

389-391

Authors: Sudha .R, Umashankar, Dharmavijay

Introduction: Hysterectomy is one of the commonly performed gynaecological surgery. Vaginal hysterectomy is a natural orifice surgery where as laparoscopic hysterectomy is a minimally invasive procedure. Vaginal hysterectomy is associated with less morbidity, less operative time, short duration of hospital stay and reduced cost compared to laparoscopy. With increasing containment of health care costs and epidemic increase of non communicable medical disorders there is a need for performing vaginal hysterectomy in benign non prolapsed uteri especially in rural settings. Aims and Objectives: The objective of this study is to know the intra operative factors and to study the short term outcomes associated with non descent vaginal hysterectomy {Heaney,s hysterectomy}. Materials and Methods: This is prospective observational study conducted at MVJ Medical College and Research Hospital located in rural setting from January 2012 to December 2012. All the patients requiring hysterectomy for benign conditions not associated with uterine descent underwent non descent vaginal hysterectomy. Intra operative factors like blood loss, difficulty in delivery of uterus, bowel and bladder injuries, and conversion rates to laparotomy were noted. Post operative complications were noted. Results: Seventy two patients were planned to undergo non descent vaginal hysterectomy for various benign conditions. Vaginal hysterectomy was done successfully in 70 patients. The mean age was 45.6±3.4 and mean parity was 2.2±0.45. Dysfunctional uterine bleeding (55%) was the most common indication. Average duration of surgery was 45- 80 min. The requirement of post operative analgesia was minimal by the patient as there was no abdominal incision. Post operative complications were less. The duration of hospital stay was 3-5 days. Conclusions: Non descent vaginal hysterectomy is less invasive surgery. Less morbidity, lesser duration of hospital stay, cost effectiveness makes vaginal route as the choice for women in rural settings

395-398

Authors: V.S. Prasanna Kumar Reddy, V. Manasvi, Aradhana Giri

Introduction: Pre-eclampsia and intrauterine growth restriction are important causes of maternal and perinatal morbidity and mortality. Gestational age at the onset of pre-eclampsia will determine the degree of fetal compromise. Hence, early detection of preeclampsia is important to improve maternal and perinatal outcome. Utero placental circulation can be non-invasively assessed by Doppler analysis of uterine arteries. Aims and Objectives: The aim of our study is early prediction of pre-eclampsia and Intra uterine growth restriction by Doppler assessment of uterine artery. Materials and Methods: 100 antenatal women of singleton pregnancy at 16-24 weeks of gestation were selected for study in the department of Obstetrics and Gynecology at MNR Medical College, Sangareddy from May 2015 to April 2016. Doppler evaluation of uterine artery along with routine biometry was done. Results: Out of 100 cases studied, 19 patients showed abnormal uterine artery Doppler results and among these 16(84.2%) developed preeclampsia, 8(42%) had intrauterine growth restriction, 6(31.5%) babies required NICU admission and 2(10.5%) intrauterine fetal deaths were noted. Sensitivity and specificity to detect pre-eclampsia was 84.2% and 83% respectively and that of intrauterine growth restriction was 42% and 96% respectively. Conclusion: Uterine artery notching, high PI, RI in uterine artery Doppler analysis can be a good screening tool for early prediction of pre-eclampsia and intrauterine growth restriction.

405-408

Authors: Uma Pandey, Stephen Lindow

Introduction: Oligohydramnios is associated with intrauterine growth restriction, congenital anomaly, neonatal and maternal morbidities. The outcome in cases of borderline oligohydramnios is less clear. This study was performed to document fetal, neonatal and maternal outcome in cases of borderline oligohydramnios among those women who delivered in our unit. Materials and Methods: The duration of the study was July 2013-June 2016 and a total of 66 women who were more than 37 weeks gestation were included. The data was compared with 66 control women from the same institution. Results: Overall 45.4%% cases were delivered normally while 62.5% of the control group had a vaginal delivery (p=0.02). Emergency caesarean section cases were due to fetal distress in 35.29% of cases compared to 8.6%in the control group (p=0.02).The fetal and neonatal outcome was far better in the control group as there was 45 versus 8 cases where there was a neonatal problem (p< 0> Conclusions: Cases of borderline oligohydramnios at term have a higher risk of perinatal complications and operative delivery and should be monitored during labour. Delivery should preferably be in a unit where excellent neonatal facilities are available.

413-418

Authors: Kusum Lata Mathur, Manu Sharma, Devanshi Sharma, Shikha Talati

Introduction: Premenstrual dysphoric disorder (PMDD) is a severe and debilitating form of Premenstrual syndrome (PMS) affecting women in their reproductive age. There is paucity of Indian research in this area among adolescents. Aims: To determine the prevalence of PMDD in adolescent school students, and to study relationship between PMDD and anxiety, depression, self-esteem and quality of life (QOL). Materials and Methods: A cross-sectional survey was conducted on 100 adolescent students of an urban school. The Premenstrual symptom screening tool for adolescents (PSST-A), Hamilton anxiety (HAM-A) and Depression (HAM-D) Scale, Rosenberg self esteem scale (RSES) and The women’s quality of life questionnaire were employed. Results: All participants reported at least one PMS symptom of minimal severity and 68% had at least one PMS symptom of moderate-severe intensity. Twenty five percent of the participants had ‘moderate-to severe’ PMS. None of the participants qualified for PMDD. Disruption of daily activities was reported by 35% while 22% missed school due to PMS. A statistically significant relationship was found between PSST scores and HAM-D score (p<0> Conclusion: Although PMS and PMDD pose a difficulty, majority of adolescents do not have significant anxiety, experience positive self-esteem and good quality of life. There is a need for multi-centric and multi-disciplinary research to further elucidate the factors associated with PMS and PMDD in this population.

424-428

Authors: Jiten Senta, Imran Badi, Mo Anish Hingora, Jignashu Kanziya, Manish Pandya

Fetal hydrothorax were diagnosed during ultrasound examination in asymptomatic women in the second trimester of pregnanancy.1 Fetal hydrothorax is a condition in which fluid accumulates in the fetal chest, in the space between the lungs and the chest wall (known as the pleural space). This fluid may also be referred to as “pleural effusion.” Fetal hydrothorax usually develops when there are leaky or obstructed veins or lymphatic channels. occasionally, the fluid leakage may result from a mass (such as a lung mass), infection or chromosome problem, but in many instances no specific cause for the leaky fluid may be found.

433-435

Authors: Mily Pandey, Monu Singh, Achla Batra, B. Preethi, Inlo Miuli

Pregnancy in a caesarean scar is a rare entity where the pregnancy is implanted into a prior caesarean delivery uterine scar and located outside the normal uterine cavity. We report a case of caesarean scar ectopic pregnancy occurring in the scar of a previous caesarean section, diagnosed by ultrasonography and Doppler and the surgical management of such a case following failure of medical therapy. We present history, clinical findings and imaging of our case followed by discussion about, diagnosing and management of such a case and the options available.

438-441

Authors: Trisha Arora, Naina Kumar

Endometrial carcinoma is one of the commonest gynecological cancers of female genital tract, usually occurring after menopause. Supraclavicular lymph node is one of the rare sites of metastasis in the endometrial carcinoma. The present article illustrates the typical and atypical metastasis, surgical staging and role of lymph node dissection in patients with endometrial carcinoma. Typical sites are pelvic, the para-aortic nodes, the peritoneum, and lungs. Atypical sites are extra-abdominal lymph nodes, brain, bones, liver, soft tissue and adrenals. It is therefore important for the radiologists to recognize typical & atypical sites of metastases seen in patients of endometrial carcinoma so as to facilitate early diagnosis and treatment.