Indian Journal of Obstetrics and Gynecology Research

5-10

Authors: Hemant Deshpande,Chandrakant S Madkar*,Apurva Singh,Akanksha Allahbadia

Episiotomy is most commonly performed surgery for assisting vaginal delivery in indicated cases. Mediolateral episiotomy is most commonly performed in view of its benefits over other types. Postoperative complications and morbidity of patients is most important which should be given thought. One of the factor that plays a major role is type of suture material used. In our study we are comparing traditionally used chromic catgut with the fast acting polyglactin 910. Materials and Methods: The new prospective study and randomized control study compares long term and short term results of suturing episiotomy with Chromic Catgut 1.0 and polyglactin 910 (2.0). The parameters taken into consideration were pain and analgesia, gaping, dyspareunia etc. Total sample size was 560 consisting of 280 pts in each group. Results: The present study showed that the results of fast acting polyglactin 910 was definitely better than chromic catgut. Also morbidity in relation to pain, wound healing and other complications was found to be lesser in group of polyglactin 910. Conclusion: The present trend of suturing episiotomy with polyglactin is definitely better in terms of results and reduced morbidity.

15-19

Authors: Fasiha Tasneem*,Vijayalakshmi Shanbhag

Introduction: Invasive cervical cancer is the second most common cancer in women worldwide, but 80% of cases occur in developing countries. If detected early cervical cancer is usually curable. The papanicolaou smear is a reliable, inexpensive and effective screening test for cervical cancer. This study aimed to determine the knowledge, attitudes and practice of women in Nanded towards pap smear, barriers for their participation in the screening and also relationship between the knowledge, attitudes and practices. Materials and Methods: This study was carried out on 200 outpatient married women attending outpatient department in Dr. SCGMC, Nanded, a rural tertiary health care center in Maharashtra, India. Results and Observations: In our study done on rural population only 44% had heard about pap smear and 35% had got pap smear taken at least once, but 70% of the patients were ready to get pap smear done upon explaining about pap smear. Only 11% knew that cancer cervix could be detected before onset of symptoms and 100% were of the opinion that cancer cervix awareness program has to be conducted. Conclusion: Clearly there is a need for reformations at the grassroot level to have an appeal to the people of rural areas to help them utilize the screening tests available for early detection and treatment of the deadly disease like cancer which shows a higher prevalence in the people of rural areas with lower educational level and low socio-economic status.

24-28

Authors: Divya Pandey,Monika Gupta

Objective: To evaluate seroprevalence of Rubella infection in antenatal patients with bad obstetric history (BOH), pregnancy outcome of seropositive cases and incidence of congenital malformations in maternal Rubella infection. Materials and Methods: This was a prospective case control study done at a tertiary teaching institute over duration of one year. One hundred and seventy four antenatal women with BOH were studied against one hundred and six control cases. Their serum sample was subjected to ELISA test for Rubella IgG and IgM antibodies estimation at their first antenatal visit. Interconception interval i.e. the time interval between the previous pregnancy loss and current pregnancy was noted. All women were followed to know the pregnancy outcome. Apparent congenital anomalies in the newborns were evaluated. Chi square test was applied for statistical analysis. Result: Seropositivity for Rubella IgG antibodies, IgM antibodies and both IgG and IgM was 48.3%, 25% and 3.5% respectively in study group. Abortions, preterm delivery and stillbirths were seen in 56.8%, 18.3% and 4.5% of IgM positive cases. 2.24% with IgG positive had abortion while 4.5% with both IgG and IgM antibodies had fetal congenital malformation. Incidence of congenital anomalies in the form of Neural Tube Defects was 4.48%. Abnormal pregnancy outcome in present pregnancy was seen in 59.1% of women with interconception interval less than 3 months. Conclusions: Seropositivity of IgM Rubella antibodies was significantly higher in women with Bad Obstetric History. Incidence of Neural Tube Defects was higher with Rubella infection if exposure occurs in first few weeks of pregnancy. There is need for immunization against Rubella, of adolescent girls and seronegative prospective mothers. A proper (more than 3 months) interconception interval should be recommended after acute Rubella infection in pregnancy causing obstetric loss in that pregnancy.

33-37

Authors: Vibha Rani Pipal,Narendra Mahavar*,Seema Yadav,Dharmendra Kumar Pipal

Introduction: In the present study, we assessed the safety and efficacy of PGE? gel for labour induction and augmentation by Oxytocin injection in women attempting VBAC after caesarean section and thus reducing the rate of c-section in patients having previus c-section for non-recurring cause. Aims and Objectives: We aimed at to evaluating the safety and efficacy of prostaglandin (PGE?) gel for induction of labour in previous c-section delivery and correlate Bishop’s Score with pregnancy outcome in women attempting VBAC. Materials and Methods: This is a prospective study of women admitted in Rajkiya Mahila Chikitsalya, Ajmer over a period of one year from July 2011 to June 2012 with singleton live pregnancy of >34 weeks of gestational age with previous one caesarean delivery and willing for VBAC. Result: Success rate of VBAC was more in induced than spontaneous group (57.33% to 50.0%), and in patients with previous vaginal delivery after caesarean sectioned patients who were having Bishop’s score >6. Rate of uterine rupture in induced group was more than spontaneous group but it was statistically insignificant. Admission in NICU was more in spontaneous group while APGAR score <5> Conclusions: In spontaneous and induced group there was no significant difference in distribution of group according to ANC visit, age, parity, gestational age, rate of uterine rupture, rate of uterine dehiscence, still birth, APGAR score <5>

41-45

Authors: Sujata Dhaded,Roopa C*,Siddesh B.S

Introduction: Vaginal discharge is a normal physiological discharge which is usually white or clear, non-offensive and varies with menstrual cycle. Abnormal vaginal discharge if untreated can lead to cervicitis, pelvic inflammatory disease, urinary tract infection and also infertility. As abnormal vaginal discharge presents vaguely in a clinical set up, diagnosis is made by laboratory confirmation for rapid identification of causative pathogens and appropriate treatment. Materials and Methods: This is a retrospective study where records of clinically suspected vaginitis/cervicitis cases from Jan 2016 till June 2018 were studied. History, general examination findings, per speculum and pelvic examination findings, investigations performed and treatment given were collected for these cases and the data was analyzed. The amount, odor, color, pH and consistency of vaginal discharge were noted. Three high vaginal swabs were taken from every patient using sterile swab sticks and labeled. The tests include: saline wet mount, KOH mount and Grams stain. Bacterial vaginosis was diagnosed using the Amsel's clinical criteria and standard microbiological techniques. The collected samples were also cultured on MacConkey’s agar, Blood agar and Sabouraud’s Dextrose agar for aerobic bacterial and fungal cultures respectively. The antibiotic sensitivity testing of all isolates was performed by Kirby Bauer’s disc diffusion method on Muller Hinton agar and interpreted as per CLSI guidelines. Results: This is a retrospective study where records of clinically suspected vaginitis/cervicitis cases were studied. A total of 1680 clinically suspected vaginitis/cervicitis case records were collected in this study. Out of 1680 cases, only 475 (28.27%) cases were positive for growth of a pathogen and the remaining 1205 (71.72%) cases either showed no growth or no pathogens were isolated. Bacterial vaginosis was diagnosed in 120 (7.14%) cases and trichomoniasis was diagnosed in 51 (3.03%) cases. Out of the 475 samples positive for growth, most common isolate was Escherichia coli (195, 41.05%), followed by Coagulase negative staphylococcus (130, 27.36%). Conclusion: Escherichia coli was the most common organism causing infection in our study population followed by Coagulase negative staphylococcus. Clinical diagnosis along with complete microbiological evaluation is necessary to determine the causative agents of vaginal infections for appropriate management.

51-57

Authors: Priyanka Roy,Indranil Dutta*,Arati Biswas

Introduction: Over the past several years it has been proved that maternal thyroid disorders influence the outcome of mother and fetus, during and also after pregnancy. The most frequent thyroid disorder in pregnancy is maternal hypothyroidism. Overt hypothyroidism (low serum free T4 & high TSH level) complicates from 2 to 3 pregnancies per 1000 whereas subclinical hypothyroidism (high serum TSH but normal free T4 level) is seen in 2.3% cases.2 Endemic iodine deficiency accounts for most hypothyroidism in pregnant women worldwide whereas chronic autoimmune thyroiditis is the most common cause of hypothyroidism in iodine sufficient parts of the world. Objectives: (1) To detect cases of overt or subclinical hypothyroidism in antenatal mothers in early weeks of gestation by screening methods, (2) To start early treatment in positive cases for reduction of deleterious effects on maternal and fetal outcome, (3) To study the maternal complications during antenatal, intranatal and postnatal period in hypothyroid mothers in comparison to euthyroid pregnancy. (4) To note any difference in incidence of low birth weight babies and early neonatal complications in hypothyroid women. Material and Methods: A prospective clinical study was conducted department of Obstetrics and Gynaecology, Calcutta National Medical College and Hospital, Kolkata, Study population included all pregnant mothers attending antenatal clinic in Calcutta National Medical College and Hospital, Study period was one year (June 2012-May 2013), Sample size is 500 in number. Results: Cases (hypothyroid, TSH>2.3 µU/ml) constituted 4.4% of the screening population, in which the incidence of overt hypothyroid (free T4<0>4 within normal range) was 4.4%. Controls (euthyroid, TSH<2>

63-67

Authors: Piyusha Chandrayan,Varsha Shah,Niraj Pandit*,Ruhi Varghese

Aim: Study aimed to identify prevalence of risk of anemia in pregnancies in institutional antenatal coverage. Materials and Methods: study performed hospital based cross sectional analysis of 8065 antenatal women, who had attended antenatal care programme from Jan 2016-Dec 2016. High Risk factors were identified based on age, multiparity, High blood pressure (SBP>120 mmHg, DBP>80 mmHg), weight of mother at first antenatal visit, lower Hb level (<11> Results: Out of total 8065 pregnant women attending antenatal care clinic, 2525 women (31.31%, 95% CI 30.3% - 32.34%) were identified to be anemic- a major risk factor in the study. The study population’s mean age was 23.5+-3.5 years with majority of adolescent age group. Significant associations were observed between anaemia, literacy level of mother, economic status and location. The prevalence for sickle cell population was 2.43% (95% CI 2.11%-2.8%). Conclusion: This study presented anemia as major risk factor in antenatal women, imposing greater need of targeted clinical attention. It is recommended to promote awareness on iron deficiency and its implications to avert cases of anemia.

71-77

Authors: R K Saxena*,Noor Fathima Tameem Ansari,Anju Balan

Introduction: World medical community has raised concerns over the rising caesarian rates. Materials and Methods: This was a prospective, cross-sectional, hospital-based study to determine factors responsible for a woman’s choice of delivery, that is, caesarian delivery (CD) or vaginal delivery (VD). Pregnant women attending antenatal clinics, were interviewed with a structured questionnaire, and data was analyzed. Results and Discussion: 266 responses were analyzed, wherein, 186 women preferred VD and 80 women preferred CD. The characteristics of women who chose CD as their preferred mode of delivery, were compared with the women who chose VD as their preferred mode of delivery. Age, religion, occupation, and economic status did not influence a women’s choice of delivery. Factors strongly related included educational status, wherein, more educated women were likely to prefer CD. Contrary to popular perception gravida, para, number of miscarriages or living children did not influence the choice of delivery. 90% of women who had previous CD, preferred CD for this delivery, they were not aware of the option for trial of labour after caesarian. 49% (n = 45) of the 91 patients delivering in private hospitals underwent CD, as compared to only 13% (n = 11) of the 85 patients delivering in government hospitals. The high caesarian rates in private hospitals is partly driven by caesarian delivery on maternal request. Conclusion: Counsel the pregnant women regarding the process and benefits of normal VD, as well as the risks of unnecessary CD can influence patient decision-making and decrease CD rates.

83-86

Authors: Dhanasekar Karukkupalayam Ramasamy,Gomathy Nachimuthu,Trayambak Dutta*

Menopausal syndrome is marked by an array of psychosomatic as well as vasomotor symptoms such as hot flushes and night sweats. Amongst vasomotor symptoms of menopause, hot flushes are the most common. It consists of sudden sweating and periodic flushing with palpitations, chills, anxiety, choking and nausea. Depletion of estrogen is in part a cause for these symptoms, but not entirely. Neuronal origin of menopausal symptoms is gaining significance for better understanding the pathophysiology of vasomotor symptoms. There is significant change that occurs in the thermoregulation due to menopause. An important neuronal theory is narrowing of thermoneutral zone due to elevated central sympathetic activation. The first line therapy such as lifestyle changes, either alone or combination with dietary isoflavones, do not effectively control the vasomotor symptoms in severe cases. In such individual hormone therapy is inevitable, albeit it’s higher risk for coronary artery disease, breast carcinoma and pulmonary embolism. Therefore, it is imperative that the therapeutic target should be directed towards the central origin of symptoms and it should be devoid of these adverse effects. Medicinal plants and complimentary therapies have proved to be of great therapeutic advantage for patients with menopausal syndrome. Amongst medicinal plants studied extensively so far for reduction of menopausal symptoms, Valeriana Officinalis, Passiflora incarnata and Humulus lupulus are particularly important. Valeriana Officinalis binds to the beta subunit of the GABA-A receptor which leads to chloride channel mediated anxiolysis. It also decreases the metabolism of GABA thereby potentiating its effect. Passiflora incarnata acts by increasing the level of serotonin via modulating the content of mono-amine oxidases. Humulus lupulus increases the level of GABA thereby exerting its sedative and anxiolytic effect in menopause. The GABA mimetic action of these three ingredients controls the psychosomatic and vasomotor symptoms of menopause mediated by central sympathetic action. Clinical trials with these three herbs in European post menopausal women have led to active control and reduction in menopausal symptoms. This review delineates their role in the management of menopausal syndrome.

91-93

Authors: Durga K,S Yuvarajan*

Introduction: Community acquired pneumonia (CAP) is recognized as a common problem that carries a substantial morbidity and mortality in preantibiotic era. With the advent of newer diagnositics and advanced antimicrobials there is reduction in morbidity and mortality, but in era of MDR pathogens its often difficult and challenging to manage CAP. However, pneumonia in younger individuals can be severe and fatal. Pneumonia in the pregnant patient is the most frequent cause of life threatening non-obstetric infection. Aims and Objective: The aim of this study was to assess the pattern of community acquired pneumonia among pregnant women in tertiary care hospital. Materials and Method: 32 pregnant ladies presented with signs, symptoms & radiological findings consistent with community acquired pneumonia were selected from out patient’s clinics of obstetrics and gynecology department. Results: The present study included 32 pregnant ladies with community acquired pneumonia, who were selected from out patient’s clinics of obstetrics and gynecology department. Their ages ranged from 20–40 years old with mean age of 25.32 years old (±4.20 SD). Cough (90%) was the most common symptom followed by fever (70%) among the patients. Chest x ray done with abdominal shield showed pulmonary infiltrates in (65%). The most common radiological findings are consolidation (75%) nodular infiltrates (20%), cavity (3%), pleural effusion (2%). The most common organisms isolated were streptococcus pneumonia, hemophilus influenza, staphylococcus aureus mycobacterium tuberculosis. Conclusion: Morbidity and mortality in pregnant patients with pneumonia continue to pose a significant challenge. Early recognition of the diseases process and appropriate antibiotic treatment are required to ascertain an optimal outcome. The treatments in the gravid patients generally follow standard guide lines for the treatment of pneumonia in adults. Concern for fetal outcome should not delay any treatment strategies as improvement in maternal oxygenation and status is the best way to ensure fetal protection.

97-100

Authors: Henry Owuor*

Introduction: Uterine papillary serous carcinoma (UPSC) is a clinically aggressive type of endometrial carcinoma. They represent about 10% of endometrial carcinomas and are responsible for 40% of deaths and recurrences associated with endometrial cancer. Patient Presentation: JM is a 75 year old woman who presented with eight months’ postmenopausal vaginal bleeding, loss of weight and low abdominal pain. Except for obesity and bilateral pitting edema, she had normal findings on physical examination. Management and Outcome: Pelvic ultrasound showed an intra-uterine mass of increased echo (4×4 cm) and a pelvic CT scan showed a bulky uterus bulky with prominent endometrium. Visual inspection with acetic acid and Lugol’s iodine was negative for cervical cancer whereas Pipelle biopsy indicated endometrial cancer. She had total hysterectomy with bilateral salpingo-oophorectomy. She is due to start chemotherapy. Conclusion: Even though endometrial biopsy using a Pipelle is highly sensitive for detection of high-grade endometrial carcinomas, it is less accurate at predicting UPSC. Patients undergoing surgery for endometrial cancer should therefore have a comprehensive surgical staging as the patient may have UPSC. Due to the risk of recurrence, adjuvant chemo-radiation should be administered after surgery.

105-107

Authors: Naina Kumar*,Himani Agarwal

Malignant mixed mullerian tumour of uterus also called carcinosarcoma is a very rare and also very aggressive type of tumour involving both epithelial and mesenchymal component thus is considered as a metaplastic carcinoma. Common presentation of these patients is post-menopausal bleeding with uterine enlargement. Here we present the case of 55 year old women with post-menopausal bleeding. Total abdominal hysterectomy with good vaginal cuff with bilateral salpingo-oophrectomy with bilateral pelvic lymphadenectomy was done and a diagnosis of malignant mixed mullerian tumour with Genital Tuberculosis was made

110-112

Authors: K J Swathy*,Usha V

Clear cell carcinoma in pregnancy is a rare event, accounts for less than 1%. Here we present a 29year old women who was incidentally diagnosed to have an abdominal mass corresponding to 24 week size on her first trimester visit, Ca 125 was 49, MRI pelvis showed large complex ovarian cyst probably cystic ovarian neoplasm. Patient underwent fertility preserving staging laparotomy. Intraoperative right salphingo-ovariotomy was performed. Histopathology reported as Clear cell carcinoma of ovary. The couple decided to undergo Medical termination of pregnancy after multidisciplinary team counselling provided by Medical oncologist and obstetrician. After six months of adjuvant chemotherapy with paclitaxel and carboplatin patient improved symptomatically better and is on regular follow up.

116-118

Authors: Dhwani Mehta*,Charmi Pawani,Nimish Pandya

Witnessing Multigravida, Grand Multigravida and Great Grand multigravida pregnancy is very usual and common in the Kacchch district of Gujarat, India. Kachchh happens to be the largest District of India with majority of population living in the rural area who are illiterate and believe in the norm of “Home delivery: Safe delivery”. In the era of 20th century where a majority of us are happy with normal labour conducted by a skilful obstetrician at the hospital with the simultaneous assessment by the paediatrician there occurs a significant population nesting in rural corners who still abide by the traditional birth practices with “The Normal Dia Labour” unaware of its aftermath. A 59 year old, Widow, Female Patient P5L2D3 with all full term normal vaginal delivery conducted at Home presented to G.K. General Hospital (the only tertiary referral centre in the entire district) with inability to pass urine and with something coming out per vaginum. On examination it was a case if long standing procidentia with decubitus ulcer with purulent exudation and simultaneous contamination of it with pus and faecal matter from the surrounding rectal prolapse. Surgical correction by vaginal hysterectomy and repair of rectal prolapse was done with building up of perineum - a surgery which was a difficult nut to crack for the Gynaecologists and Surgeons. With increased parity and poor interval spacing with improper perineal support during the labour, the perineum becomes lax and the ligament and supports of the uterus become asthenic, flaccid. This shall present with pelvic organ prolapse in the peri-menopausal age, menopausal and post-menopausal age group. The ladies in the rural Indian setting believe it to be a social stigmata and thus rarely these cases reach the hospital for intervention.