Indian Journal of Obstetrics and Gynecology Research

442-446

Authors: Anjali Pushkar Tiwari*,Anil Sharma,Jogindra Vati

Introduction: A healthy childbirth experience is absolutely vital for an antenatal woman, as it can greatly influence not only her health but also that of the newborn. Birth preparedness and complication readiness is an approach which significantly helps to increase the capacities of the woman, her partner, her family and also the health care providers to ensure appropriate care for a safe delivery. Materials and Methods: One group pre-test post-test design was used to assess the effect of self-developed informational booklet regarding BPCR on knowledge of antenatal women whereas a cross-sectional study design was used for assessment of competencies of Accredited social health activists (ASHA). Results: The mean post-test knowledge score (21.52) of antenatal women after administration of informational booklet regarding BPCR was significantly higher than their mean pre-test knowledge score (10.48) with t-calculated value of 22.307 (p value <0> Conclusion: The self-developed informational booklet regarding BPCR is significantly effective in increasing the knowledge of antenatal women. Further rounds of training of ASHAs regarding BPCR are essentially required to enhance their competencies.

454-457

Authors: Asma Nigar*

Objective: This cross sectional observational study was done to asses awareness regarding family planning methods and the practice of contraceptives among rural women in Lucknow. Materials and Methods: Five hundred women between the ages of 15-45 years, living with their husbands and coming from rural area, attending gynecology OPD of integral institute of medical sciences and research, Dasauli, Lucknow were included in this study. Women who were pregnant, had a child younger than 2 years, or had any medical disorder were excluded. Their knowledge, source of knowledge and practice of contraceptives were evaluated with the help of a predesigned questionnaire. The other variables used were the age of women, parity, religion and educational status. Results were expressed as percentages. Results: Out of 500 interviewed majority of women (49.2%) were between 22-25 years of age. 61% were illiterate belonging to low socioeconomic status, 63.3% belonged to Hindu religion. In the present study, it was observed that, 94.4% had some knowledge about family planning methods, and almost all (94.4%) of them were aware about Cu T and oral pills. The media and social circle were provided information of contraceptives in 46.6% women. Regarding the usage of contraceptive methods, 41.2% of the respondents were using some sort of contraception. Barrier method (condoms) was in practice by 26.8%, pills in 5.6%. Cu T users were 3.2% and 1.2% were using DMPA for contraception. 4.4% of women had already undergone tubal ligation. It was noted that awareness about pills and Copper was good, but their practices were very low. There were multiple reasons for non use like fear of side effects, no support from the husbands, low fertility, inhibition to ask about the contraceptives. Conclusion: There is need for strong motivation of couples through media and health personnel to achieve effective use of contraceptives, specially for Cu T and oral pills.

465-470

Authors: Hemant G. Deshpande,Chandrakant S. Madkar*,Anuja Bobe,Vaidehi Nene

Introduction: Hypertension disorders are major factors responsible for morbidity and mortality in pregnancy and preeclampsia is the leading cause. The etio-pathology of PE is not known even after significant research done on it. Only thing which we can do is try to reduce the incidence and severity by predicting its occurrence. In our study we are trying to know the effect of serum calcium and serum magnesium on pre-eclampsia. Materials and Methods: Total 256 pregnant patients attending D.Y. Patil hospital were included in our study. They were divided into two groups namely normotensive and hypertensive. The diagnosis of Pre-eclampsia was made by standard protocol, inclusion and exclusion criteria were applied for selection of case after permission from ethical committee of the institution and consent of the patients. In them we estimated serum calcium and serum magnesium levels and the correlation of these levels was studied with the pre-eclampsia related factors. Results: Both groups comparable in terms of age, gravida, parity, high risk factors, BMI. The data was analysed by application of statistical test of significance. Conclusion: Our study shows that low levels of calcium and magnesium are found in serum of pre-eclampsia patients as compared to normotensive cases of the study population. Also since calcium deficiency plays role in aetiology of pre-eclampsia antenatal administration of Ca supplements was done and its effect was studied to find out whether it is useful in reducing the severity of PE.

476-480

Authors: M V. Ramana Rao,Naima Fathima*,Swathi J

Introduction: PPIUCD is a very safe, reversible, long term contraceptive. The recommended interval between pregnancies is at least 24 months in order to reduce the risk of adverse maternal, perinatal and infant outcomes. In our district the usage of PPIUCD is 0.1% and 60% of deliveries take place in private health facilities. This preliminary study is conducted in a private teaching hospital with the aim to determine proportion of women accepting PPIUCD and to develop our own data regarding immediate complications to guide us in counselling the women and to implement PPIUCD services. Materials and Methods: This prospective feasibility study was done from July 2017 to January 2018. 100 women attending the for antenatal checkups were counselled for PPIUCD. The women who consented were inserted with PPIUCD. Results: Acceptance rate was 30% and most of the women who accepted PPIUCD were primiparae (58.3%). An analysis of the reasons for acceptance of PPIUCD showed that long term efficacy (33.3%), safety (20%), fewer clinic visits (16.6%) and non hormonal (13.3%) were the most common reasons for acceptance. Conclusion: The PPIUCD is safe having no reported incidence of perforation with low rate of expulsion, pelvic infection and few lost strings and these complications can be reduced further with training and practice. The acceptance and continuation rates can be improved with counselling and strategic follow up protocols in our district with very low rate of PPIUCD usage.

485-488

Authors: Vipul Patel*

Introduction: To create pneumoperitoneum is the first step to any successful laparoscopic procedure. Various techniques for creation of pneumoperitoneum are traditional veress needle, open method, visual entry system and direct trocar insertion (DTI). Despite of rapid increase in the number of laparoscopic surgeries every year there is no clear guideline on the safe method of entry into the abdomen. Objective: The aim of this study is to evaluate safety and complications of direct trocar insertion. Materials and Methods: Retrospective multicenters study of patients who were undergoing various gynecological laparoscopic surgeries. All patients were undergoing DTI access method for primary port insertion. The study focuses on effectiveness of BMI, parity, previous surgery for DTI and evaluates complications. Conclusion: DTI is safe, fast and reliable alternative to primary peritoneal access and creation of pneumoperitoneum.

496-499

Authors: Ramdas G. Narwade*,Uttam B. More

Introduction: Birth weight is an important health indicator. The health indicator helps us to know the trend of population structure and social setup of the tribal people. The present study was conducted to study the birth weight among two population categories - tribal population of Kinwat, District Nanded and non-tribal population of Badnapur, Jalna, Maharashtra. Materials and Methods: The birth weight of 2000 neonates born from 1st April 2012 to 31st March 2014 were obtained from the registers of the maternity wards of two Hospitals; More Nursing Home, Kinwat District Nanded for tribal population and IIMSR Medical College & Noor Hospital, Badnapur, Jalna, Maharashtra, India. Results: Mean birth weight among the tribal neonates (2.74 kg) was significantly lower (p-value=0.001) than among non-tribal neonates (2.88 kg). Also, the proportion of low birth weight neonates was significantly higher among the tribal population. Similarly, for maternal age (age group 20-25 years) and parity (Para 2-4), the mean birth weight is significantly lower in tribal population as compared to the non-tribal population. Conclusion: The mean birth weight is lower in tribal population and also the proportion of low birth weight in neonates is high in this population. This signifies that the tribal population deserves attention and focused health interventions.

504-510

Authors: Anitha Padmanabhan,Shruti Chandrakar*

Aims: The main objective is to study the gross pathology and microscopy of all organs in cases of maternal death, establish clinico-pathological correlation, to ascertain the exact cause of death and classify them into direct or indirect causes. Settings and Design: Cross sectional study of all medical autopsies. Materials and Methods: A cross sectional study of all medical autopsies performed on deaths related to pregnancy at our tertiary care hospital over a period of four years. A total of 100 cases were studied. Maternal mortality autopsies where medico legal implications were involved or unnatural deaths not related to pregnancy were excluded from the study. Statistical Analysis used: Nil Results: The maximum no. of maternal deaths occurred in the age group 20-24 years (45%) followed by 30-34 years (19%). 62% of patients in our study were multigravidae. Majority of maternal deaths were seen in the postpartum period (75%). In the antepartum period maximum number of maternal deaths occurred in 3rd trimester (14%) Our study revealed majority of maternal deaths were due to indirect causes (76%), Pregnancy induced hypertension was the most common direct cause of death (9%). The majority of cases were due to infectious aetiology (45%), while the other indirect causes were sepsis (14%), coagulopathy (8%) and hemodynamic (8%). Conclusion: The higher MMR in our study could be attributed to the fact that ours being a tertiary and referral care hospital, where patients are referred late and most of them are complicated cases and in serious condition at the time of admission. The low socioeconomic status of the patients, delay in referral and non-utilisation of the available antenatal care could be the major contributing factors. Our study revealed majority of maternal deaths were due to indirect causes especially respiratory infections and hepatitis Increased incidence of indirect causes reflect the present health care system. So adequate prenatal testing for these causes (infections), improving the nutritional status, sanitation can help in lowering the maternal mortality rate.

516-519

Authors: Premalatha T S,Sumangala G*,Geeta Acharya,Kiran Kulkarni,Vishakha Bidkar

Optimal cyto-reduction of advanced EOC has profound impact on the survival and prognosis of patients3. Suboptimal cyto-reduction of advanced ovarian cancer is related to initial tumor bulk which indirectly correlates with serum CA125 levels. Can assessment of level of CA 125 in pre-opererative period predict optimal cyto-reduction is the aim of the study. The mean age of the 70 patients in this study was 49.9 years (SD- 11.75, Range: 21-69 years). Fourty four (63%) had stage III-?V disease. Sixty five (93%) patients had papillary serous ovarian cancer. The serum CA125 levels ranged from 6- 5300 U/ml with median pre-operative serum CA-125 level for all the patients being 259 U/ml (IQR- 682.98U/ml). The level was elevated (>35 U/ml) in 49% of patients with stage ?-? compared with 93% of patients with stage ? or ?V disease. Optimal tumor cyto-reduction was obtained in 61/70 cases (87%) of total patients and in 35/44 (80%) of patients with stage III-?V disease. Diaphragmatic stripping, appendecetomy, recto-sigmoid resection and anastomosis, pelvic peritonectomy, peritoneal stripping/ debulking of peritoneal disease, hemi-colectomy, ileo colic anastomosis and partial nephrectomy. Most of our patients were in intermediate surgical complexity category with a score between 4-7. In 9 patients all belonging to advanced stage, sub-optimal cyto-reduction was done due to multiple co-morbidities, multiple mesenteric lymphnode involvement, multiple small bowel and liver parenchymal deposits and patient not willing for colostomy. An ROC curve analysis showed threshold value of CA125 of 411U/ml. With a cut-off of 411U/ml, 97% of total patients with CA125 levels lower than 411U/ml were able to undergo optimal cyto-reduction. Also, in 76% of patients with CA125 level more than 411U/ml optimal cyto-reduction could be achieved. When only advanced stages (stage III-IV) were considered, with a cut-off of 411U/ml, 88% of patients with CA125 levels lower than 411U/ml were able to undergo optimal cyto-reduction. Also, in 73% of patients with CA125 level more than 411U/ml optimal cyto-reduction could be achieved. With a pre-operative cut-off value of CA125 more than 411U/ml, the sensitivity, that is, probability to predict sub-optimal cyto-reduction was 65% and specificity, that is, probability to predict optimal cyto-reduction was only 67%. Which showed poor predictability for resectability which was in concordance with other studies. Though it is difficult to draw definite conclus

525-529

Authors: J Sowjanya Kumari*,V Revathi,K Sharmista Reddy

Introduction: Maternal mortality is a key indicator of health services provided to population and reflects the health status of community. Aim: To study the factors responsible for maternal mortality. Materials and Methods: Maternal deaths that occurred in one year in Government Maternity Hospital, Tirupati were studied. Present study was conducted from January 2017 to December 2017 in Department of Obstetrics & Gynaecology, Government Maternity Hospital, S.V. Medical College, Tirupati. Results: 21 maternal deaths had occurred during the study period. 57.1% were unbooked cases, 61.9% were primiparous women and 61.9% were belonging to the age group of 21-25 years. Leading cause of death was hypertensive disorders of pregnancy (47.6%) followed by postpartum haemorrhage (28.4%). Maternal deaths due to direct causes were 85.7% and indirect causes were 14.3%. type 2 and 3 delays contributed to 57.1% and 38.1% maternal deaths respectively. Most of the cases were referred to the institute in late stages. Conclusion: Health education, regular antenatal check ups, early identification of high risk pregnancies and timely intervention are needed to reduce maternal mortality.

535-538

Authors: Naheed Zia Khan*,Akhilesh Dutta Dwivedi,Mukesh Shukla

Introduction: Intravenous iron sucrose and oral iron therapy are the primary therapeutic modalities for management of iron deficiency anaemia during pregnancy, but its efficacy during pregnancy is still a matter of argument among healthcare personnel. Therefore the objective of this study is to compare the effect of oral iron and intravenous iron sucrose on pregnancy related outcome among pregnant females with iron deficiency anemia. Materials and Methods: Randomized clinical trial was conducted among females between 14 to 36 weeks gestation with iron deficiency anemia who were managed either with oral ferrous sulphate or intravenous iron sucrose therapy. Chi-square test was used for statistical analysis with p <0> Results: About 11.25% of the study subjects had the complication of abruption/ Post-Partum hemorrhage or had the need of blood transfusion in oral group. No significant difference in respect to maternal complications as well as mode of delivery was observed in between the two groups. In intravenous group proportion of appropriate for gestational age newborns (AGA) were significantly higher than the oral group (p<0> Conclusions: Intravenous iron sucrose use for treatment of iron deficiency anaemia could reduce morbidities from iron deficiency and have better foetal outcome in terms of appropriate for gestational age in newborns.

544-548

Authors: Prashanta Krishna Gupta,Sangeeta Rai*

Objective: To assess ovarian reserve in infertile women with genital tuberculosis and compare with women with proven fertility by hormonal and ultrasound markers of ovarian reserve. Materials and Methods: A cross-sectional study was conducted at an outpatient S S Hospital BHU, Varanasi, India with 50 women with Gestational Tuberculosis (GTB) and 50 healthy controls. Ovarian reserve tests were done by estimating serum levels of follicle-stimulating hormone (FSH), luteinizing hormone (LH), estradiol (E2), on day 3 of a natural menstrual cycle and anti-Mullerian hormone (AMH) in any day of cycle. On D3 Antral Follicles Count (AFC) were also estimated on Ultrasound. Result: The median FSH was 8.91 (5.60-11.07) mIU/ml, LH 6 (4.65-8.55) mIU/ml and the mean E2 61.30±15.23 pg/ml which were significantly higher than controls (FSH-5.50, LH-3.80, and E2-41.53). The median AMH levels 1.23 ng/ml was significantly lower in GTB than controls (AMH-2.50). And, the median AFC 6.0(4.0-8.0) was significantly lower in GTB than control 11.0 (8.25-12.0). Conclusion: The median FSH, LH and the mean E2 on day-3 of cycle and AMH on any day of cycle along with AFC are good predictors of Ovarian reserve and found to be low in GTB.

553-558

Authors: Rakhee R. Sahu*,Shraddha M. Shivgan

Epidural analgesia is regional anaesthesia that blocks pain in a particular region of the body. The use of epidural analgesia (EA) in labor is widespread in modern labor ward practice, and its benefits in terms of pain relief are well-recognized. Aims: To study the effect of epidural analgesia on second stage of labor, maternal and neonatal outcomes and its efficacy in labor. Study Design: This is Prospective Cohort Study was carried at Dr. L. H. Hiranandani Hospital. All the women admitted in labour room for delivery were divided into 2 groups. Case Group: Included 84 women who opted for epidural analgesia. Control Group: Included 90 women who did not take epidural analgesia. Results: The 2nd stage of labor in epidural group was 54.61 (± 37.24) mins and 37.36 (± 26.79) mins in the non epidural analgesia group. By using unpaired t-test, it was found that the data was significant (p=0.032). The incidence of caesarean section in the epidural group was 16.66% and the in non-epidural group was 12.22%. It was observed that epidural analgesia did not increase the rate of instrumental delivery or caesarean section. The mean VAS Score before epidural analgesia was 6.2 (± 1.07) whereas it was 3.95 (± 1.46) after epidural analgesia. On applying Wilcoxon Matched Pair test, it was found that the pain was reduced significantly in the mothers after receiving the epidural analgesia. Conclusion: Epidural analgesia can be safely recommended as a method of labor analgesia. Epidural analgesia has no significant adverse effects on maternal and neonatal outcomes

563-566

Authors: Archana S*,O Syamala

Objectives: To study the etiological factors, maternal morbidity and mortality in patients who underwent obstetric hysterectomy at our tertiary care centre during the period from April 2014 – September 2016. Study Design: It is a hospital based study during the period of April 2014 – September 2016. Materials and Methods: Critical review of 14 patients who underwent obstetric hysterectomy during the period of April 2014 – September 2016. The indications for the hysterectomy, maternal morbidity and mortality, neonatal outcome were studied. Results: During the study period, in our tertiary care centre there were11609 deliveries of which 14 emergency obstetric hysterectomies were done. The majority of cases were unbooked – N=9 (64%). There was one maternal death. The commonest indications for obstetric hysterectomy were – placenta accreta followed by postpartum haemorrhage. Conclusion: Skill in emergency obstetric hysterectomy remains a necessary tool for consultant obstetricians. In spite of intra operative risks and post-operative complications, it remains a potentially life saving procedure. The maternal outcome greatly depends on timely decision and good clinical judgment because unnecessary delay can cost life and undue haste can cause morbidity.

570-572

Authors: Veena Vidyasagar*,Preethi E

A 34 year old lady reported to casualty OPD with complaints of pain abdomen of one day’s duration. She gave H/O irregular menstrual periods and had her last menstrual period one month back. Obstetric history – P2L2A2. MTP and abdominal tubectomy done 7 years back. On per abdominal examination, there was tenderness all over abdomen. Patient was admitted with provisional diagnosis of UTI with APD. Antibiotics and other supportive measures were started. Relevant investigations were ordered for. Patient was referred to Gynaecologist for C/O pain lower abdomen and irregular menstrual periods. On per abdominal examination done by Gynaecologist, there was mild rigidity over right side of umbilical region. Urine pregnancy test was weakly positive. Ultrasound revealed mobile internal echoes in urinary bladder, minimal fluid in endometrial cavity and Pouch of Douglas. Serum Beta HCG was sent. Patient’s general condition remained stable. Review scan done on next day revealed features suggestive of right adnexal ectopic gestation with minimal fluid in pelvis. It was decided to take her up for laparotomy. Abdomen was opened by Pfannesteil incision. Omentum was partially adherent to parietal peritoneum. Blood clot with some tissue (? Products of conception) was seen adjacent to fimbria of right fallopian tube. Same removed along with right sided salpingooopherectomy and left sided tubectomy. Beta hCG levels after surgery showed decreasing trend and remained normal when done 70 days after surgery. Histopathology report of right fallopian tube along with some tissue fragments was suggestive of Partial hydatidiform mole

576-578

Authors: Pooja Chandak*,Shobha Toshniwal,Sameer Deshmukh

Superior mesenteric venous thrombosis is a rare entity in itself with pregnancy being the cause is a rare possibility. Here presented a rare case of 25 years primigravida with term gestation with acute abdomen underwent LSCS for suspicion of ruptured uterus suggested ischemic bowel segment due to SMV thrombosis who underwent resection and anastomosis with uneventful post op period.

582-584

Authors: Manish Pandya*,Jignashu Kanziya,Jiten Senta,Shrina Shah,Imran Badi

Craniosynostosis is a condition of one or more of the fibrous sutures in an infant skull prematurely fuses by turning into bone (ossification).1 Premature fusion of cranial sutures may have an effect on cranial shape an less frequently on brain growth.2 There is a changing in the growth pattern of the skull and the skull can’t expand perpendicular to the fused suture, craniosynostosis can lead to abnormal head shape and abnormal facial features and results in increased intracranial pressure leading possibly to visual difficulty, sleeping impairment, eating problem, or impaired mental status with a significant reduction in IQ.