Indian Journal of Obstetrics and Gynecology Research

338-342

Authors: Sunitha HB, Sonam Parikh, Manjushree R Waikar, Vinayak Panchgar, Akshaya N. Shetti.

Register Introduction: Eclampsia contributes to maternal mortality in developing, underdeveloped world. Various drugs have been tried to treat eclampsia. Magnesium sulphate has become the drug of choice due to various advantages and is associated with adverse outcome for both mother and fetus if not used correctly. This study was undertaken to know safety, efficacy of reduced doses of Magnesium sulphate as compared to standard dose. Materials and Method: After obtaining institution ethical clearance and written informed consent this study was conducted on 60 subjects for 2 years. Patients diagnosed as eclampsia and presenting with generalized tonic clonic seizure during antenatal, intrapartum, postnatal were included. Group A received single loading dose of magnesium sulphate (4gm (20%) I V over 3-5 min followed by 10gm (50%) deep i.m. (5gm in each buttock)). Group B patients received low dose magnesium sulphate (4gm (20%) i.v. over 3-5 min followed by 6gm (50%) deep i.m. (3 gm in each buttock) and maintenance dose of 3 gm i.m., every 4 hourly in alternate buttock) which was continued 24 hours after last convulsion or delivery whichever is later. Mode of delivery, recurrence of convulsion, maternal and fetal morbidity and mortality were studied. Results: Maternal and foetal outcome was comparable in both the groups. There was no significant difference with regards to recurrence of convulsions. There was no statistically significant increase in incidence of caesarian section in group B compared to group A (p>0.05). Conclusion: Single dose regime controls the eclamptic convulsions with good maternal and neonatal outcome.

350-355

Authors: Gourab Ranjan Tripathy, Anand Acharya.

Introduction: Anaemia is a major public health problems in developing world. Anaemia is a pathological condition in which the oxygen binding capacity of red cells is insufficient to meet the body’s need. Anaemia is the most common medical disorder complicating pregnancy. It may antedate pregnancy, often aggravated by pregnancy and delivery. More than 70% of pregnant women suffer from nutritional anaemia in South East Asia. Of all the anaemias diagnosed during pregnancy 75% are due to iron deficiency. The prevalence of anaemia is 55% among expectant mothers across the world and the incidence in India varies from 40 –90% according to WHO reports. Materials and Method: The prospective study was carried out in the department of obstetrics and Gynecology, in Konaseema institute of medical science Amalapuram during 2015 -16 to access the efficacy, safety and compliance of injectable iron sucrose in pregnancy with mild, moderate and severe iron deficiency anaemia for a period of 12 months from Nov 2015 to Nov 2016. Result: Among the total number of 104 patients studied, mean age of the study group was 25.4 ± 3.26 years. Teen age pregnancies with anaemia formed 5.7% of the study group. Most cases, i.e. 77.9% were between 20 – 30 years. Elderly gravidas comprised 16.4%. The mean Hb% on day of Admission was 7.670 gm% which raised to 10.388 on day 28 of completion of iron therapy. Thus the mean Hb rise on day 28 was 2.718 gm% which is statistically significant (p value being 0.000).The Hb level at 38 weeks of gestation is 9.162 which is significantly higher when compared with Hb value on the day of admission (p value being 0.000). Discussion: Haemoglobin values varied significantly with time between groups (interaction effect, p<.001). The change in haemoglobin from baseline was significantly higher on the 14th (p=.004) and 28th (p=.031) days. Ferritin values were higher in the patients receiving intravenous iron throughout pregnancy. No serious adverse drug reactions were observed. Fetal weight and hospitalization time were similar in the 2 groups. Blood transfusion was required for only one patient in the oral group. Thus, it is observed that iron deficiency anemia of pregnancy treated with the intravenous iron had restored iron stores faster and more effectively than oral iron with no serious adverse reactions.

359-363

Authors: Omkara Murthy K, Dhananjaya BS, Girish BL, Swathi P.

Objective: To study body mass index in pregnant women, to correlate body mass index in pregnancy with obstetrics outcome and to correlate body mass index in pregnancy with perinatal outcome. Materials and Method: Women attending antenatal OPD for antenatal check up at SSMC, Tumkur from January 2015 to June 2016 will be included after informed written consent. The above were placed in standard BMI categories and their obstetric outcomes and perinatal outcome variables were evaluated. Results: Increased rate of LSCS was associated with high BMI group 41.67% (n=20) when compared to normal 16.67 % (n=6) p=0.013, Significant. Increased rate of Hypothyroid was associated with high BMI group 12.5 % (n=6) when compared to normal 2.77% (n=1) p=0.109, significant. Increased rate of GDM was associated with high BMI group 20.83%(n=10) when compared to normal 8.34%(n=3)p=0.058, significant. Increased rate of GHTN was associated with high BMI group 20.83% (n=10) when compared to normal 8.34% (n=3) p=0.058, significant. Increased rate of in NICU admission was associated with underweight group 37.5% (n=6) when compared to normal 8.34% (n=3)p=0.000214, significant. Increased rate of anaemia was associated with underweight group 56.25% (n=10) when compared to normal 27.77% (n=10) p=0.04, significant. Conclusion: Body Mass Index plays a significant role in adverse pregnancy outcome. High BMI is associated with increased incidence of hypothyroid, gestational diabetes mellitus, gestational hypertension, instrumental delivery, caesarean delivery. There is significant association of underweight BMI with anaemia, low birth weight.

369-372

Authors: Vinaya G1, Rashmi Nagangouda.

Eclampsia accounts for 50,000 maternal deaths a year worldwide. The maternal case fatality rate is 1.8% and 35% of eclamptics will have one major complication. Objective: objective of study was to improve maternal and fetal outcome with single dose of magnesium sulphate therapy. Materials and Method: The present prospective study was undertaken among women aged between 18-35 years outpatient’s Department of gynecology in Karnataka Institute of Medical Sciences (KIMS) Hubli. Permission for the study was obtained from the College authorities prior to commencement. The study was undertaken during December 2009 to November 2010. Results: 100 cases of eclampsia admitted to Karnataka Institute of Health Sciences, Hubli were belong to lower socio economic status, majority of them were Hindus and illiterates. 82% had vaginal delivery and 15% had LSCS for fetal indication. In 52 cases, induction was done. LSCS was done in 11 cases in induction group, 8 cases were for fetal distress and 3 were for failed induction. Maternal mortality in our study was 1% and the cause was acute pulmonary edema. Commonest complication encountered in our study was the renal failure. In our study 70 of the them were live born out of which 49 were pre term and 21 were term. 71% of the them had birth weight of more than 1.5Kg. Among this 46 perinatal deaths, 30 were still born and 16 were neonatal death, thus giving the perinatal mortality of 46%. Conclusion: It was concluded that Magnesium sulphate is safe and effective in controlling convulsions with improved maternal and perinatal outcome.

376-380

Authors: Dhuldev S. Thengal, Preeti S. Umate, Dhundiraj Kurdukar.

Introduction: As per GLOBCAN 2012, cervical cancer is a huge wellbeing issue for women with roughly 5,28,000 cases and 2,66,000 deaths reported annually worldwide. Globally, cervical cancer includes 12% of all cancers in women and it’s leading gynaecological malignancy within the world. With this view, the present study was planned to find out risk factors of cases of carcinoma of cervix attending tertiary care hospital. Materials and Method: This was a prospective observational study of carcinoma of cervix carried out at a tertiary care hospital. Informed consent forms were obtained from each patients. Ethical committee clearance was obtained prior to start the study. The study included all diagnosed cases of carcinoma of cervix admitted in Gynaecology ward. Result: The mean age of the cervical cancer patient was 55.54 years and median age was 57.54 years. The prevalence of carcinoma cervix was 3.75 per 1000 attendees. In the present study, maximum subjects 15 (35.71%) were in the age group of 41-50 years followed by 12 (28.57%) in the age group of 61-70 years. It showed bimodal peak of incidence, 33(89.19%) were Hindus, 30 (71.42%) were illiterate, 25 (59.52%) were grand multiparous, 26 (61.90%) were married at the age less than 16 years and 37 (88.09%) were non immunocompromised. Conclusion: The risk factors like illiteracy, low socioeconomic status, rural habitat, early marriage, early sexual debut, early child birth, and high parity were prevalent in the population studied. Early detection and treatment of cervical precancerous lesions leads to reduce in cervical cancer morbidity and mortality.

384-388

Authors: Janani GD, Jaya V, Lalitha D.

Aim: The aim of the study was to analyse symptom relief and surgical outcomes of women with Pelvic organ prolapse (POP). Material and methods: A total of 100 women were enrolled in the study to be followed upto 6 months post surgery. After excluding 14 patients due to attrition, 86 patients were analysed. Vaginal hysterectomy and anterior colporrhaphy was done in all cases. Site specific repair was decided upon case to case basis. They were followed post operatively with regard to symptom relief and anatomical correction was analysed at 6 months using Pelvic Organ Prolapse-Quantification (POP-Q) System. Results: The incidence of POP is highest between 40-50 years of age and with parity >4. Using POP-Q staging system, 70.9% women had stage III prolapse, 17.4% had stage II, 9.3% had stage IV and 2.3% had stage I prolapse. Women with dysuria and low back ache were the least to get relieved of the symptom after surgery. The improvement of the symptoms were statistically significant with p-value <0.05. There was 86% improvement of stress urinary incontinence (SUI) when anterior colporrhaphy was combined with anti-incontinence surgery. The number of women who resumed sexual activity after surgery increased to 73% from 51.1% with significant p-value of <0.05. There was significant restoration of anatomy in point Ba (mean length from +4.05 to -2.1), point Bp (mean length from +1.8 to -2.3) and point C (mean length from +3.5 to -5.19) after surgery. Conclusion: There is significant anatomical restoration and symptom relief after surgery. The surgery had a positive effect on sexual activity.

392-394

Authors: Alpana Bansal, Meena Saxena, Mukesh Bansal.

Objective: The present study is prospective study of Misoprostol in reduced dose via vaginal route to minimise side effect in first trimester abortion. Materials and Method: 200 mg of mifepristone given orally followed by 400 mg misoprostol intra virginally after 24 hours, and after 24 hrs of vaginal misoprostol 400 mg of misoprostol was given orally. Result: The 140 women were analyzed, 134 of these women had complete abortion after completion of the treatment regimen, and success rate of 95.7% was achieved. Conclusion: Use of400 mg misoprostol vaginally after 24 hours of oral mifepristone, have less side effect and effective result for medical abortion in first trimester abortion.

399-403

Authors: Indu Verma, Sunita Goyal, Vandana Berry, Dinesh Sood.

Introduction: Aerobic vaginitis is defined as a disruption of the lactobacillary flora, accompanied by signs of inflammation and the presence of predominantly aerobic microflora, composed of enteric commensals or pathogens. The Lactobacilli are replaced by aerobic facultative pathogens like E.coli, Staphylococcus aureus, group B Streptococci, Klebsiella pneumonia, and Enterococcus species which lead to ascending vaginal infections and various complications of pregnancy. Aim and Objectives: To analyze the prevalence of aerobic vaginitis in third trimester of pregnancy and to study different aerobic bacterial vaginal pathogens and their antibiogram. Materials and Method: One hundred and sixty six pregnant women in the third trimester of pregnancy were studied for aerobic pathogens by gram staining and culture- sensitivity. High vaginal swab was taken of all the women and sent for culture and sensitivity. Diagnosis of aerobic vaginitis was made on microscopy and culture report. Results: Out of total 166 women, 88 were asymptomatic and 78 were symptomatic. Significant aerobic growth was seen in 29 women. Seventeen (21.79%) symptomatic women had positive vaginal culture and 12 (13.64%) asymptomatic women showed positive aerobic vaginal cultures. Six in the asymptomatic group had candidiasis. Commonest aerobic isolate was Enterococcus followed by E. coli and Staphylococcus aureus. We found that the overall prevalence of aerobic vaginitis was17.47%. Conclusion: High prevalence of aerobic isolates (21.79% in symptomatic and 13.64% in asymptomatic group) may have detrimental implications on the maternal and neonatal wellbeing. We recommend that all women in third trimester should be screened for the presence of vaginal pathogens.

411-415

Authors: Nisha Bhatia.

Introduction: In recent times, the caesarean section rate has increased globally. Caesarean section in a primigravida most commonly due to fetal distress may be preceded by certain risk factors present in the antenatal period; or may arise denovo at the time of labour. Hence a study of these antenatal and intrapartum factors that influence the mode of delivery in a primigravida is essential. Objective: To evaluate the antenatal and intrapartum risk factors that effect mode of delivery in a primigravida. Materials and Method: A retrospective analysis of 200 case records of primigravida at Department of Obstetrics and Gynecology, Apollo Institute of Medical Sciences, Hyderabad, was done. 100 who underwent primary caesarean section were taken as cases whereas 100 who underwent normal deliveries were taken as controls. Results: The mode of delivery in primigravida with age <25 years is normal delivery (58%). In primigravida of height <150cms, caesarean section rate of 62%. Among the caesarean section group, 55% had some antepartum risk factor. 72% of the normal delivery group, had spontaneous onset of labour. In the cases who underwent caesarean section, 51% had induction of labour as compared to 26% in the normal delivery group. 92% of primigravida who had normal delivery had clear liquor. Meconium stained liquor was found in 36% of primigravida undergoing caesarean section. Conclusions: Mode of delivery in a primigravida is influenced by various antenatal and intrapartum factors. Identification of antenatal risk factors and careful use of induction of labour can significantly reduce the primary caesarean section rate.

420-423

Authors: Surekha S. Mohan, Chamaraja Thippeveeranna, Laiphrakpam R. Singh, Naorem N. Singh.

Introduction: This study intends to analyse the primary caesarean section in multiparous women. Objectives: To study the incidence, indications, maternal and fetal outcome in primary caesarean section in multiparous women. Materials and Method: It is a prospective study of over 150 cases of primary caesarean section done in multiparous women with previous normal vaginal deliveries carried out in the department of Obstetrics and Gynecology at RIMS, Imphal, Manipur during the period from October 2010 to march 2012. Results: Maximum incidence of caesarean section in parous women with previous vaginal deliveries was seen in 30-34 years age and majority were para 2. Malpresentations (23.3%), CPD (20%), antepartumhemorrhage (19.3%) and fetal distress (12%) were the main indications for primary caesarean section. The commonest intraoperative complication was Atonic PPH (6%) followed by extension of uterine incision (3.4%). Maternal morbidity was seen in 20 cases (13.3%). Febrile morbidity was the commonest postoperative morbidity followed by UTI. Perinatal morbidity was seen in 26 cases, common causes being meconium aspiration syndrome (5.19%) followed by birth asphyxia (4.5%) and perinatal mortality was seen in 13 cases. There were no maternal deaths in the present study. Conclusion: Many unexpected complications occur in multiparous woman. Proper care during intra and postpartum period has reduced metrnal mortality and morbidity in our study. So multiparous women in labour should be managed with utmost precautions as that of primigravida.

427-431

Authors: Umbardand Shashikant M, Haseena S.

Introduction: Vaginal delivery following a previous caesarean section has proved to be safe. But the question is not whether a women can deliver vaginally following caesarean but rather the criteria that should be applied and rigidly adhered in order to follow her to progress in labour and attempt successful vaginal delivery without any maternal or fetal complication. Materials and Method: In present study, a total of 150 cases of previous caesarean section were studied during study period. In women who were booked in the antenatal clinic, routine investigations like haemoglobin percentage, uterine examination, blood grouping Rh typing, blood VDRL and ultrasound scanning were done. These women were admitted to the hospital near term or 10 days prior to the expected date of delivery. Results: Majority of cases undergoing caesarean section belonged to the age 20-30 years. Out of 150 cases 123 patients delivered vaginally there by the incidence of vaginal delivery is 82%. Thus, success rate of VBAC was 82%. Conclusion: The results from the series confirm the held belief that a history of vaginal delivery following a caesarean section ensures another vaginal delivery.

437-439

Authors: Benudhar Pande, Santosh Kumar Dora, Sharmila Pradhan.

Introduction: Uterine septum is one of the commonest congenital malformations observed in patients with poor obstetric outcome. The incidence could be as high as 80%-90%. The aim of our study is to found out the reproductive outcome among patients undergoing hysteroscopic septal resection. Materials and Method: A retrospective study was conducted over a period of 2009 to 2013 in VIMSAR and Samleswari hospital Burla. All the patients undergone septal resection, followed for a period of three years and their reproductive outcomes were noted. Results: A total of 32 women were recruited over a period of 5 years and out of this 12(37.5%) presented with infertility and 20(62.5%) had bad obstetrics history. In the primary setting septal resection was completed in 29(90.62%) and in three patients required a second setting to complete the procedure. Out of this three patients, 2(6.25%) had uterine perforation and in patient procedure was abandoned due to development of pulmonary edema. Follow up was available for 28 patients and 4 women were lost to follow up. A total of 24(85.71%) women were conceived with 17(60.71%) had deliver a live baby. Conclusion: Hysteroscopic septal resection is a simple and safe procedure with no increase in morbidity or mortality. Besides this it is associated with a better pregnancy outcome.

446-452

Authors: Rita D. Vijaychandra Doggalli, RM Desai, Sphurti Ashok Tungal.

Materials and Method: Data was recorded on management practices, associated complications and mortality for a period of 1 year in 2015-2016 at teaching hospital for vaginal delivery after caesarean section(VBAC). Results: A total of 4996 deliveries occurred during the study duration, there were 2248(45%) total cesarean section and 767(33%) were the number of previous cesarean section. In 767 previous LSCS cases 644(28%) had repeat cesarean delivery and 123(5%) delivered vaginally. A trial of labor was planned in 206 women. The success rate of VBAC was 60% with 123 women had successful vaginal delivery and 83 delivered by emergency repeat cesarean section. Major indication of emergency cesarean section was CPD (27%), fetal distress(5%), medical disorder associated (12%), PROM (24%). In majority, surgical technique was conventional. Scar dehiscence and surgical complications were observed in 5.4% and 4.0% of cases respectively. Blood transfusion was given in 1 and post-operative complications were seen in 12.One patient had broad ligament hematoma compressing ureter, who underwent DJ stenting, managed conservatively. Other patient had atonic bladder who had prolonger per urethral catheter, others had complications like fever in postoperative period, UTI, wound infection.

455-457

Authors: Nishant H. Patel, Bhavesh B. Aiarao, Bipin Shah.

A 25 year old female was referred to C. U. Shah Medical College and Hospital on her 1st post-partum day for post partum hemorrhage and associated widening of pubic symphysis 1 hour after delivering a healthy male child weighing 2.7 with complaints of bleeding per vaginum. Uterus was well contracted & widening of pubic symphysis was noted on local examination. Exploration followed by paraurethral and vaginal wall tear repair was done under short GA. X-Ray pelvis revealed fracture of pubic symphysis and hence post procedure patient was given complete bed rest along with pelvic binder under adequate antibiotic coverage. Patient took discharge against medical advice on post-partum day 10. Patient was discharged on hematinics and advised to take complete bed rest and use pelvic binder for 30 days.

460-462

Authors: Mo Anish Hingora, Manish Pandya.

Introduction: Uterine rupture in pregnancy is a rare and often complicate with a high incidence of fetal and maternal morbidity. Bicornuate uterus is a rare uterine anomaly result from incomplete fusion of the two Mullerian ducts during embryogenesis. Bicornuate uterus very rarely can lead to rupture of the uterus with high mortality and morbidity rates

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.

108-111

Authors: Esha Michael, Rekha Wadhwani.

Background: Urinary tract infection in pregnancy has been found to be a very common health problem, specially in country like India. The total incidence is 5-10% in pregnancy. This study aims to determine the incidence of UTI in pregnancy, most common micro-organism responsible for UTI, most sensitive antibiotics and maternal and fetal outcome. Methods: We randomly select 600 pregnant women, 200 in each trimester, attending outpatient department of Sultania Zanana Hospital, Bhopal, India from the period of October 2013 to September 2014. All pregnant women between 18-35 yrs of age without any medical disorders or previous adverse pregnancy outcomes were in inclusion criteria. Urine culture sensitivity was done as a screening test for UTI. They were followed up till delivery in relation to any pregnancy complication and perinatal outcome. Results: It was found that incidence of UTI was highest in second trimester(15%) and total incidence was 9.8%. The most common maternal morbidity was preterm labour (6.6%) and fetal morbidity was LBW (3.6%). Pregnant women with UTI are susceptible for adverse maternal and fetal outcomes like recurrent infection, chorioamnionitis, PROM, preterm labour, cystitis, pyelonephritis, prematurity, IUGR, LBW, GBS which could be prevented by antimicrobial treatment. Conclusions: From this study, we concluded that every pregnant women should be screened for UTI and urine culture sensitvity should be a part of routine antenatal care. Public educational programmmes on the importance of personal hygiene and good environmental sanitation habits should be carried out frequently.

116-119

Authors: Nazima Allaudin.

Background: The amniotic fluid which sheathes the fetus acts to be a protective shroud. Fetal well-being is embodied by the amniotic fluid index. If the amniotic fluid index exceeds 25cms, it leads to polyhydramnios resulting in high rate of perinatal mortality and congenital malformations. Objectives: To evaluate the occurrence of congenital malformations and report perinatal outcome in polyhydramnios. Study Design: A Prospective study was conducted in Neonatal intensive care unit and gynecology wards of Owaisi Hospital and Research Centre for a period of 2 years. Methods: 50 cases of polyhydramnios were evaluated and followed up based on amniotic fluid index which was measured by conducting ultrasound scans; congenital malformations were observed both by ante natal and post natal ultrasound scans. The perinatal outcome such as congenital anomalies, fetal distress, mortality etc was recorded. Results: 50 cases of Polyhdramnios formed the study population. Congenital malformations were found in 12% neonates of which Diaphragmatic hernia and hydrops fetalis were most commonly noted. 8% neonatal deaths were recognized. 2% cases with fetal distress were observed. If amniotic fluid index exceeded 30cms there was increased mortality rate and congenital malformations. Conclusion: Attributable to Polyhydromnios, risk of congenital malformations, neonatal mortality and fetal distress was often observed and risks were greater with amniotic fluid index over 30cms.

123-126

Authors: Kalpana, Maya Singh, Priyanka Rai, Arun Nagrath, Sonia Vishvakarma.

Objectives: To find out the comparative evaluation of Sonosalpingography, Hysterosalpingography and Laparoscopy for determination of tubal factors in cases of primary and secondary infertility. Method: A total of 71 patients 45 with primary infertility and 26 with secondary infertility attending our obstetrics and gynaecology department were studied from June 2015 to July 2016. All underwent Sonosalpingography, Hysterosalpingography and Laparoscopic chromopertubation. Chi square tests were used for statistical analysis to find out the sensitivity and specificity of the test. Result: Sonosalpingography has 100% sensitivity and 80.5% specificity in comparision to laparoscopy chromopertubation whereas hysterosalpingography has sensitivity of 94.6% and specificity of 73.1%. Conclusion: As Sonosalpingography has high sensitivity and specificity and is less invasive. It should be used initially to assess tubal patency in case of infertility. Laparoscopy is the best technique for diagnosing tubal and peritoneal disease as it allows direct visualization of all the pelvic organs.

132-136

Authors: Krishnapriya Radhakrishnan, Rathi Devi, Nikil Shetty, Pundalik Balliga.

In the background of increasing rates of caesarean sections, this study was done to find the current trends of the surgery. Aim: To study 500 consecutive caesarean sections in a tertiary referral maternity hospital in South India to understand the current trends in caesarean. Objective: 1. To find out the incidence of caesarean sections and the pattern of the indications 2. To find the pattern of age distribution, parity, period of gestation, intra operative & post operative complications, fetal & maternal outcome in caesarean sections & 3. To compare elective and emergency caesarean sections Method: This was a prospective study carried out in a District Maternity hospital in South India. We included 500 consecutive caesarean sections from the time of commencement of the study. The various characteristics of the patient & newborn profile, the surgical indications & complications were noted and compared in elective & emergency caesarean sections & the statistical significance was noted by applying Chi square test. Results: The incidence of caesarean section was found to be 30.1% in our study. Of the total 500 cases studies, 68.2% were emergency sections. Most elective cases were in parous women (69.1%); whereas most emergency cases were in nulliparous women (68.03%). Commonest indication for caesarean section was previous caesarean section in the elective group; while in the emergency group, it was meconium and fetal distress. Intra operative complications and perinatal mortality were significantly more in emergency cases. Post operative morbidity was seen in 16.2% cases. Conclusion: There is a need to avoid unwarranted surgeries, mainly primary caesarean section and also the need to give trial of scar in carefully selected cases so that the caesarean rate stabilizes with good maternal and fetal outcome.

141-145

Authors: Rachna Chaudhary, Shakun Singh, Vandana Dhama, Madhumita Singh.

Background: Amniotic fluid volume estimation is an important part of fetal assessment as variation in its amount has been related to a variety of pregnancy complications. Our aim was to determine whether low amniotic fluid index (AFI) affects maternal and fetal outcome. Methods: This prospective observational study included 200 antenatal patients of term gestation of which 100 cases with AFI<8 and 100 controls with AFI ≥8 but ≤ 15 were included in study. Ultrasonography and NST were done and results of both groups compared for the presence of meconium passage, non reactive NST, abnormal fetal heart rate, induction of labour, mode of delivery. Results: There was increased incidence of non-reactive NST (40% vs 12%), meconium stained (33% vs 10%) in oligohydramnios group. 49 out of 100 patients (49%) had vaginal delivery out of which 32 (64.6%) were spontaneous in onset and 17 (35.4%) were induced. While in controls 78% had vaginal delivery out of which 91% were spontaneous while 9% were induced. 51% underwent LSCS out of which 18% underwent elective and 33% had emergency LSCS in cases while in controls 22% underwent LSCS all of them were emergency cesarean. Conclusion: Oligohydramnios affect the maternal outcome in terms of obstetrical interventions like LSCS for fetal distress, meconium stained liquor and non reassuring fetal heart rate. Vaginal delivery and caesarean section should be well balanced so that unnecessary maternal morbidities are prevented and labour outcome improved.

151-154

Authors: Pranabika Mahanta, Phatik Chandra Kalita, Anuradha Hazarika Medhi.

Aim: To evaluate the effectiveness of oral Ru-486 (mifepristone) and Prostanglandin analogue (misoprostol) in facilating spontaneous abortions in pregnant women with missed abortion and also to study its safety and side-effects associated with these drugs. Materials and Methods: This study was undertaken in the Department of Obstetrics & Gynaecology, Jorhat Medical College & Hospital, Jorhat Assam from August 2012 to June 2013. It was a prospective study. In this study 60 patients attending gynaecology OPD with a diagnosis of missed abortion were included. The diagnosis is confirmed with ultrasonography. Patient with diagnosis of missed abortions were first counselled for medical abortion. They were also counselled for the need of surgical intervention if this fails. Written consent is taken. Heamoglobin estimation, ABO grouping and Rh typing, platelet count Bleeding time clotting time, s.creatinine, liver function test were the minimum investigations done before prescribing the drugs. Tab mifepristone 200mg is advised to take on day 1, followed by tab Prostanglandin analogue 800microgam on day 3 after 48 hrs. Patient’s data were entered in a pretested questionnaire. Patients are asked to attend OPD after one week. Again they are interviewed with the same questionnaire to find of any side effect or complications. On day 10 ultrasonography was done to confirm complete abortion of the product of conceptus. Data were analysed with statistical tests. Results: Data were analysed using the SPSS for Windows Statistical Package. Conclusion: The results of the present study suggest that the use of mifegest and misoprost orally is safe and effective to induce expulsion of the products of conception in cases with diagnosis of missed abortion.

161-165

Authors: Sunil Kumar Samal, Setu Rathod, Seetesh Ghose, P. Pallavee.

Background: Although, sterilization during postpartum period has many advantages including technical simplicity and completion of two events delivery and sterilization simultaneously thus by saving time and resources, it has not achieved full acceptance. Aims & Objective: The aim of the study to estimate the numbers of eligible couples who do not accept a permanent method of family planning during postpartum period [Female- Puerperal sterilization and Male- NSV/Vasectomy] and to identify the factors for non-acceptance of a permanent method of family planning Materials & Methods: This was a cross sectional study conducted from November 2015 to October 2016[one year]. The study was conducted in postnatal ward, department of Obstetrics & Gynaecology. The study subjects include postpartum mothers with their spouse who have completed their families but declined to adopt any method of permanent sterilization (Non-acceptors). Results: Among the non-acceptors, most common reasons in case of wife were feeling of lack of strength for surgery (59%), fear of not able to do hard work after surgery(51.5%) and fear of lack of people in the home to look after surgery(33.3%). For males, loss of masculinity or libido (66.6%), belief of not able to do hard work after surgery (61.3%) and fear of not having enough strength for surgery (33.3%) were the major barriers for acceptance. In case of Muslim couples (21.2%) religious reason is one of the important causes for non-acceptance. The factor of having at least on male child was a major deciding factor for acceptance of any method of permanent sterilization. Conclusion: Lower socioeconomic status, ignorance about the procedure due to lack of knowledge, deep-rooted belief of weakness caused due to operation and preference for at least one male child are some of important barriers for acceptance of any permanent family planning method among eligible couples. Awareness, counseling and motivation about family planning methods and clearing the myths about family planning procedures and promotion of small family norm should be followed to help the eligible couples to select any method of permanent family planning.

175-178

Authors: Vasundhara Padmanabhan, D. Susmitha, Satya Sowjanya.

Abnormal uterine bleeding (AUB) is one of the most common disorder for which a woman needs immediate attention. Transvaginal ultra sonography (TVS) being simple and non invasive modality and Hysteroscopy is a new endoscopic approach that can visualise the entire uterine cavity to detect the pathology. This study was designed to compare the accuracy of hysteroscopy and transvaginal ultrasonography in the diagnosis of intracavitary disorders in patients with abnormal uterine bleeding.

184-188

Authors: Santosh Kumar Dora, Shilpa M. Patel, Niyati Jain, Ava Desai, Meeta Mankad.

Objective: Cervical cancer though common among the developing world, still very few data is available for young patients with cervical cancer. This paper attempts to evaluate the epidemiology with special focus on disease free survival and the prognostic significance of the young age in cervical cancer. Material & Methods: For this retrospective study young patient with age less than 30 years & cervical cancer, over duration of 2009 to 2014 were included. Pertinent data were collected retrogradely from the case records & whenever required patients were contacted over phone. Results: Between 2009 to 2014, a total of 8363 cervical cancer patients were referred to us, out of which 169 patients with carcinoma cervix in the age group of < 30 years were treated at our hospital. From the 169 patients, 52 patients were lost to follow up. Among 117 patients who were treated, 65(55.55%) had Disease Free survival of less than 6 months. According to the histopathology squamous cell carcinoma had a disease free survival (DFS) of 8.5 months, followed by adenocarcinoma 10.62 months. Conclusion: We have found the poor prognosis of cervical cancer in young patients compared to older patients. More studies are required to study the pathophysiology and factors implicating the prognosis in young patients with cervical cancer to know this basic difference in survival among old and young patients with cervical cancer.

193-197

Authors: D. Kavitha Yogini, B. Devi, C. Palanivelu, P. Kodeeswari.

The aim of this study was to analyze retrospectively and present our experience in the feasibility of total laparoscopic hysterectomy for large uteri with benign pathology. 111 patients who had symptoms with myoma uterus, Abnormal uterine bleeding who underwent Total laparoscopic hysterectomy(TLH) in our hospital. All cases of myoma uterus irrespective of size, number & location of myoma were included in the study. Standard techniques of TLH and it modifications, like prior uterine artery ligation, morcellation after uterine artery ligation. 72% of patients had previous vaginal deliveries and 25.2% had previous cesarean section. 32% of patients had family history of fibroid. Average duration of surgery was 136min (40-300). Average weight of specimen was 457grams (300- 1500). Average blood loss was 46ml (10-500). We conclude that TLH is technically feasible irrespective of the size of the uterus in the hands of an experienced gynecologic laparoscopic surgeon.

203-207

Authors: Augustine Umoh, Emmanuel Inyang-Etoh.

Background: Spousal physical abuse among pregnant women continues to occur in our environment due to dysfunctional marital social relationships, against the backdrop of violation of the rights of affected women with possible untoward consequences on their pregnancy. Methods: Relevant information were obtained through structured self-administered questionnaire administered through simple random sampling technique to consenting women attending antenatal clinic in the centre studied. Results: The prevalence of spousal physical abuse among respondents was 10.2%, and 8.6% of the respondents reported spousal abuse in the index pregnancy. The mean age of respondents was 29.1years + 5.2 and most (88.9%) of the respondents who reported spousal abuse were married. Over half (51.1%) of the respondents who reported spousal abuse had attained tertiary level of education. Husbands of respondents with higher levels of education were more likely to abuse their spouses than those with lower levels of education; p< 0.001. The majority (31.2%) of the husbands who abuse their spouses were civil servants. Respondents’ husbands who performed unskilled/low-skilled jobs were significantly more likely to abuse their spouses than husbands who engaged in high-skilled jobs; p< 0.001 More than a quarter (26.7%) of the respondents who reported abuse were slapped by their husbands and spousal abuse was an occasional occurrence in more than half (53.4%) of the respondents. Conclusion: Spousal physical abuse is a continuing social problem in Uyo and men with higher levels of education and those with un-skilled/low-skilled jobs were significantly more likely to physically abuse their wives in the study population.

212-213

Authors: Salve Archana R, Alka Vijay.

Introduction: To report pregnancy in women with partial hypopituitarism as a result of surgery for a non-functioning pituitary macroadenoma using recombinant Follicle Stimulation Hormone (rFSH) and Recombinant Luteinizing Hormone (rLH). Case Description: A 29-year-old woman with partial hypopituitarism underwent Controlled Ovarian Hyperstimulation (COH) with rFSH, rLH achieving a pregnancy. Co-treatment with rLH enhanced FSH action, promoted follicle development and shortened COH duration and reduced FSH doses. Conclusion: Ovulation induction in women with partial hypopituitarism requires both Follicle Stimulation Hormone (FSH) and Luteinizing Hormone (LH) to achieve optimal follicular growth. Adding LH from start of stimulation optimizes controlled ovarian stimulation in hypogonadotropic hypogonadism supporting the concept that LH is required in the early follicular phase as well.

Page No. 6-9

Authors: Aneeta Jassar, Deepak Patil

Background: Conventionally, carcinomas of the ovary have been thought to arise de novo from the ovarian surface. However recent studies have indicated that putative ‘precursor’ changes are present in the fimbrial ends of fallopian tubes. Aims: The study was aimed to identify histological changes in the fimbrial ends of fallopian tubes across three sets of patients. Settings and design: Histological sections from fimbrial ends of fallopian tubes from a total of 14 women who underwent prophylactic salpingo-oopherectomy for non-neoplastic diseases, twelve who were treated for non-serous ovarian carcinoma and nine consecutive cases of ovarian serous carcinoma cases over a three year period from a tertiary care hospital were studied. Methods and Materials: Sections were stained with hematoxylin-eosin and p53 immunohistochemical staining. Statistical analysis used: One-way ANOVA (Analysis of Variance). Results: Histological changes in the fimbriae ranging from SCOUT to STIL and STIC and p53 signatures were found across all three populations but were multifocal and significantly higher in cases of ovarian serous carcinoma. Conclusions: Our study identified statistically significant differences in histological changes and p53 immunostaining in the fimbrial end of fallopian tubes across three populations of patients.

Page No. 17-20

Authors: Dharmavijaya MN, Chandra Mouli A, Jyoti Kamda

Background: Gestational diabetes mellitus (GDM) poses problems for both mother and fetus. The objective of this study was to compare the maternal and perinatal outcome between women with gestational diabetes mellitus and non-diabetic women. Study Design: A case–control study with 140 cases and 140 age-matched controls was conducted for a period of 22 months (August 2013–June 2015) in Dept of Obg mvj medical college. Hoskote, Bangalore. Materials and Methods: Universal screening was applied by means of glucose challenge test (GCT) using 50 g of glucose. If GCT >130 mg%, the patients were subjected to oral glucose tolerance test with 100 g of glucose. National Diabetes Data Group criteria was taken to assign patients to study group. These women were further followed up and the maternal and perinatal outcomes were assessed. Statistical Analysis: Univariate analysis was done by means of t test, Odd’s ratio, Chi-square test, and Fisher Exact test. P < 0.05 was taken as significant. Results: The frequency of induction of labor was significantly higher than spontaneous labor. 40.1% GDM mothers and 35.8% of non-diabetic mothers were delivered by Cesarean section. Premature rupture of membranes (PROM) was the most common complication of labor Babies of diabetic mothers had a positive trend toward prematurity Hypoglycemia was the most common neonatal complication and nine babies of diabetic mothers were macrocosmic. Conclusions: Maternal morbidities and neonatal complications such as neonatal hypoglycemia, macrosomia, and prematurity were significantly higher in GDM.

Page No. 26-29

Authors: Lavanya SG, Ganitha G

Background: Eclampsia remains one of the major causes of maternal morbidity and mortality especially in developing countries. Objective: The purpose of this study is to determine the frequency of eclampsia, some epidemiological factors associated with it, its complications and the maternal and perinatal outcome in eclamptic patients. Material and Method: A prospective observational study was performed on all women with eclampsia admitted to a tertiary care teaching hospital for a period of one year. Results: There were 12,949 deliveries during the study period, out of which 84 had eclampsia, giving an incidence of 0.64%. Majority of the patients (90.47%) were unbooked. The incidence of antepartum eclampsia (89.28%) was more than intrapartum (1.19%) and postpartum (9.52%) eclampsia. Eclampsia was commonest amongst the age group of 21-25 years (57.14%). 73.8% of the cases were primigravida. 45.23% of patients had gestational age at delivery between 36-40 weeks. 57 patients (67.85%) had severe hypertension on admission (diastolic BP>110 mmHg). 39 patients (46.42%) were delivered through caesarean section. Maternal complications include sepsis and hematoma (7.14%), pulmonary edema (4.76%), renal failure (4.76%), HELLP syndrome (4.76%). There were 3 maternal deaths giving a maternal mortality of 3.57%. Out of the 87 babies delivered, 46 babies (52.87%) had birth weight less than 2000 grams. There was one intrauterine death (1.14%), 14 stillbirths (16.09%) and 12 neonatal deaths (13.79%) giving a perinatal mortality rate of 31.03%. Conclusion: Improvement in hygiene, socioeconomic factors, prenatal care and medical care appear to play an important role in the prevention of eclampsia.

Page No. 35-38

Authors: Girish BL, Indira N, Nandagopal KM, Omkarmurthy K

Background: Maternal mortality has been burden to the health care system and the society. It is rightly considered as a measure for efficiency of health care system of a given community and it is considered as one of the indicators of reproductive health care. The African and south Asian countries have failed considerably, as seen in historical data of these regions. Objective of this study: India committed to work towards Millennium Development Goal by being a signatory of United Nation Millennium Declaration in the year 2000. MDG5A calls for 75% reduction in MMR between 19990 and 2015. National targets were set and monitored byinternational and national agencies. This study is taken out of interest to know the performance at the district level and relate the results with the performance at state, national and international level. Material and Methods: The pooled data for maternal death is maintained atthe district level by the Reproductive Health Office, which works under the purview of District Health Officer. Data for the year April 2015-March 2016 is taken for analysis. Results: Total number of live births was 34432 among them 34321 were Institutional deliveriesand 111 were home deliveries. Total number of maternal deaths were 20 and Maternal mortality ratio was 58.086 per 1,00,000 live births: Among maternal deaths 19(95%) delivered in hospital as compared to home delivery 1(5%); .4 (20%) died anteparrtum, 9(45%) died intrapartum, 7 (35%) died postpartum. 11(55%) had less than 3 antenatal care visits, 9(45%) had more than 3 visits; 2(10%) were aged less than 20 years, 15 (75%) were aged between 20 and 30 years and 3(15%) were aged above 30 years; 7(35%)were nulliparous, 12(60%) were between p2 and p5, 1(5%) was more than p5.18(90%) were from rural background 2(10%) were from urban. Conclusion: There has been a mixed trends in achievement in reduction of MMR (Maternal Mortality Ratio). The area where study was conducted had satisfactory achievements, mainly because of it being a developed district, socially and economically. However, the achievements towards MMR reductions have wide disparities between districts in the state and states within the country. South Indian states have a better performance as compared to north Indian states. None of the states achieved the targets set for 2015 under MDG5a. More efforts are required for achieving new target set under SDG by 2030.

Page No. 45-49

Authors: Fatima Zahra Shaik Mohammed, Juveria Jahangir

Objective: To study and analyse the vaginal birth with previous caesarean section and its out come Methods: A study of 100 cases of post caesarean pregnancies with induction of labour carried out. Trial is given with one previous lower segment caesarean section with no obstetric contraindication and scoring system to predict the success in trail of labour with the inclusion criteria including singleton pregnancy presenting with vertex, with adequate pelvis without any antenatal complications. The exclusion criteria included classical or unknown uterine scar type, past history of uterine rupture, past history of corporeal surgery, severe myopia complicated by retinal detachment, incompatible with safe vaginal delivery and multiple pregnancy. Results: In our study we found that out of 100 cases, 61% had viganial delivery and 39% underwent caesarean section. Out of 61 cases delivered vaginally, 45 cases had FTND with episiotomy, 07 FTND without episiotomy, 04 FTND with first degree perianal tear, 11 cases were by outlet forceps with episiotomy and 5 cases were delivered by low forceps. Conclusion: conclude that predicting the score for VBAC and giving trial of labour helps in decreasing the number of repeat caesarean sections in selected cases where there is no contraindication for vaginal delivery. The high probability of success and minimum risk of uterine rupture, favours the use of trial for vaginal delivery in women with previous caesarean section.

Page No. 54-58

Authors: Nitin N. Kulkarni, Harshil P. Shah, Laxmikanth R. Kanade

Background: Oligohydramnios (reduced amniotic fluid) found to be responsible for many complications like Mal-presentations, Umbilical cord compression, Meconium aspiration syndrome and hence increased operative delivery. Maintenance of maternal hydration, supplementation of antioxidants and essential amino-acids is mainstay of treatment. Various modalities are available to treat oligohydramnios & reducing complications of oligohydramnios. Objective: To compare efficacy of L- Arginine sachets versus All Essential Amino-Acids(EAA) infusions for treatment of oligohydramnios cases. Study Design: Prospective comparative study. Materials and Methods: A total of 100 women attending antenatal clinic diagnosed with oligohydramnios were included in our study. 50 patients received only L-Arginine sachets(5 gm twice a day). Another 50 received all EAA infusion(200 ml on alternate day preceded by 500 ml of 10% fructodex). Results of both the groups were obtained in view of -Mean increase in liquor, intervention delivery interval, and neonatal outcome. Results: The Mean Gestational age at the time of recruitment was 32.3 and 31.6 weeks in study and control group respectively. The mean AFI at the time of enrollment was 6.13 ±0.53, 6.10 ±0.31 in both groups respectively. Patients were delivered at ≥ 37 weeks (in study group 80% in control group 78%). The Mean AFI at the end of therapeutic intervention was (8.63 ± 0.71 and 8.53 ± 0.70, in study group and control group respectively), so we got improvement in mean AFI by 2.50 ± 0.18 in study group and 2.43 ± 0.39 in control group. There was no significant neonatal morbidity in these patients. Significant improvement in liquor volume was obtained in both the groups. Conclusion: Treatment with L-Arginine and All EAA infusion resulted in significant improvement in liquor and prolongation of duration of pregnancy. But L-Arginine sachets are more cost effective and without hospitalization. Also there is no significant difference between results of study and control groups.

Page No. 66-70

Authors: Reshma Shri Aravind, Latha Maheshwari, Aravind Chander

Background: Our goal was to find association between first trimester fasting blood sugar value compared with the second trimester oral glucose tolerance test value (75gm DIPSI criteria) for diagnosis of GDM. To find the efficiency of FBS and BMI as a screening test for GDM. Material and Method: 270 antenatal patients having antenatal follow up from 1st trimester of pregnancy between June 2014 – May 2015. The study period was 12 months. Their fasting blood glucose levels was measured in first trimester. The patients were followed up during second trimester and 75 grams OGTT was done. Correlation between first trimester FBS, BMI versus second trimester OGTT were done. Screening property of both fasting blood sugar and BMI were calculated and compared using receiver operating characteristic (ROC) curves. Result: Out of 270 patients, 14 patients developed GDM, 1 patient developed overt diabetes. With threshold of FBS>90 yielded sensitivity of 86%, specificity of 52%. FBS >90mg/dl can be considered as a threshold value for predicting GDM. With a threshold of BMI>24 yielded sensitivity of 60%, specificity of 67.5%, hence BMI >24 is a good predictor of GDM. Receiver operating characteristic curve shows FBS(AUC-0.69) has little more discriminatory power in identifying GDM than BMI(AUC=0.63). P value <0.05 was considered statistically significant. Conclusion: In conclusion, FBS measurement at first prenatal visit or at first booking will be useful to screen for previously undiagnosed pre-existing diabetes mellites and also help to predict the development of GDM earlier.

Page No. 77-82

Authors: Sonali Deshpande, Shrinivas Gadappa, Kanan Yelikar, Nutan Wanjare, Sumit Andurkar

Objective: Despite contraception becoming widely available, there is poor acceptance of contraceptive methods either because of ignorance or fear of associated complications. The Marathwada region is an economically backward area of the Maharashtra state in India with a large number of floating populations. Consistent use of family planning methods is difficult in such populations. Post-placental insertion of intrauterine contraceptive device (PPIUCD) has huge potentiality and scope in the Marathwada region. Therefore, our study aimed to assess the awareness, acceptability and clinical outcomes of PPIUCD in a tertiary care hospital. Study design: This was an observational study conducted in the department of Obstetrics and Gynaecology, Government Medical College and Hospital, Aurangabad between January 2015 and December 2015. Subjects were 1944 women visiting the antenatal clinic. A preformed and predesigned questionnaire was applied to determine if these women were aware of the PPIUCD. Acceptability was defined as the number of antenatal women who agreed to undergo insertion of PPIUCD. The primary outcome was safety assessed by pain, bleeding, infection, perforation, expulsion rate, and removal rate. Results: Of 1944 women, only 78(4%) were aware of the PPIUCD. The overall acceptability was found to be 25%. Approximately 37% of women had complications. Not a single woman suffered from uterine perforation. The expulsion and removal rates were 9.2% and 10.2%, respectively. Conclusion: The PPIUCD seems to be a safe, effective option for spacing pregnancies as well as limiting the family size; it can be a useful contraceptive tool for migrant populations. Implications: The Marathwada region in India is an economically backward area with a large number of floating populations. Consistent use of family planning methods is difficult in such populations. The PPIUCD has huge potentiality and scope in the Marathwada region and seems to be a useful contraceptive tool for migrant populations.

Page No. 86-88

Authors: Swathi Bhat, Ambika HE, Savitha CS, Lepakshi BG

Introduction: To evaluate safe mode of delivery for patients with previous lower segment Cesarean Section. Methods: A prospective study conducted on 100 women with previous lower segment Cesarean section during the period from June 2015 to Dec 2015.Women enrolled for trial of scar were closely monitored for evidence of either maternal or fetal distress. Results: In the present study of the 100 patients, 24 (24%) delivered vaginally. Commonest indication for repeat Cesarean was previous Cesarean followed by CPD & Fetal distress. Conclusion: Spontaneous onset of labour, prior vaginal delivery, non-recurrent indication for previous Cesarean, weight of the baby less than3.5Kg are predictors of successful vaginal birth in women with one previous Cesarean Section.

Page No. 92-95

Authors: Manish Pandya, Pankaj Patil, Swati Naik, Shahu Ingole, Rishi Jain

Introduction: Ferric Carboxymaltose (FCM), a dextran free iron formulation can be administered in large doses without the risk of severe anaphylactic reactions in postpartum anemia (PPA). Evidence suggest that FCM is highly effective in correcting anemia and restoring iron stores faster. Aims & Objective: To gather real-world clinical practice events on safety and efficacy of FCM injection in Indian patients with PPA. Materials and Methods: This was a prospective, observational, non-comparative, non-interventional, prescription event monitoring study. Data were collected from 535 postpartum iron deficiency anemia patients treated with FCM injection. Safety was assessed from adverse events reported within 1 week post FCM administration. Treatment efficacy was assessed by change in Hb from baseline, at 1 week after treatment. Results: There were no serious adverse events (AE) reported. Only 4 patients (<1%) reported AE (mild nausea, n=1; shivering, n=1; palpitation, n=1; pruritus and breathlessness, n=1). Mean change in Hb evaluated in 498 patients showed significant increase from baseline of 8.5 ± 1.2 gm/dl to 10.5 ± 1.0 gm/dl (difference = 2 ± 1.03 gm/dl; p < 0.001) at 1 week post-treatment. Increase in Hb was maximum (2.95 ± 1.08 gm/dl) in severely anemic patients with baseline Hb ≤7 gm/dl (n = 87). Safety and efficacy of FCM was rated by physicians as ‘very good and good’ in 99% patients. Conclusion: Intravenous FCM was safe with AE profile similar to earlier reports. Clinical utility of FCM in the treatment of PPA was demonstrated with significant improvement in Hb in 1 week.

Page No. 101-103

Authors: Bharathi KR, Vijayalakshmi S, Divya K

Meigs disorder an uncommon, particularly fascinating disorder of the old, which is portrayed by a triad of a benign ovarian tumor (fibroma, fibrothecoma, Brenner tumour, and occasionally granulosa cell tumour), hydrothorax, ascites. The possible conclusion of this pathology is fundamentally clinical regardless of the precious esteem that imaging strategies have. It also creates a condition of perplexity in the determination by impersonating ovarian tumours and in this manner turns into a diagnosis of exclusion. Hence, precise diagnosis gets to be distinctly important to differentiate it from ovarian malignancy considering the reality of it having a good prognosis. The case herein concerns a 65-year-old postmenopausal woman coming with history of mass per abdomen with acute pain abdomen, with clinical and radiological examination revealing a large pelvic tumour of size 15*12 cm with cystic and solid components associated with bilateral pleural effusion with moderate ascites.

307-313

Authors: Rakhee R. Sahu, Anjali Sonawane

Prostaglandins E1 and E2 have been extensively used for cervical ripening and induction of labour. The objective of our study is to compare the efficacy of sublingual route of misoprostol along with intracervical Dinoprostone gel as induction method. Methods: This is a randomized prospective interventional study conducted in 100 full term pregnant women. Group1- 50 cases- Tablet Misoprostol 50 mcg sublingual followed by tablet Misoprostol 25 mcg sublingually 4 hourly, to maximum of 200 mcg. Group 2 – 50 cases - PGE2 gel (0.5mg, 6 hourly two gels) intracervical application followed by tablet Misoprostol 50 mcg sublingual followed by Tab. Misoprostol 25mcg sublingually 4 hourly, to maximum of 200 mcg. Results: There was no significant difference between group 1 and 2 for demographic characteristics, gravidarum, Bishop’s score. The mean duration of latent phase for Group 1 was significantly shorter (11hrs 40 min) than that in Group 2 (21hrs 36 min). There was no significant difference in mean duration of active phase of labour between the 2 groups. In our study the mean induction to delivery interval (IDI) for Group 1 was 15 hrs 16 min (6.33), whereas the mean induction to delivery interval for Group 2 was 25 hrs 3 min (7.43) which was statistically significant (P value <0.0001). There was no significant difference in mode of delivery and fetal Apgar score between the 2 groups. Conclusion: Misoprostol alone was more efficient than Dinoprostone followed by Misoprostol in terms of short Induction to Delivery interval.

318-321

Authors: Kamala Verma, Girish Chandra Baniya, Sudesh Agrawal, Shailendra Lomrod

eclampsia continues to be a major obstetric emergency particularly in developing countries such as India and is a major contributor to maternal and perinatal mortality hence the importance of continued effort in monitoring and reviewing each eclamptic patient and to analyse factors affecting the maternal and fetal outcome. Aim & Objective: To study the Maternal and perinatal outcome in eclampsia patients and the various factors associated with occurrence and complication of eclampsia. Material and Method: The present study was a prospective study. A total number of 130 patients of tonic-clonic convulsion with pregnancy diagnosed as eclampsia were included in the study. All eclamptic patients either antepartum, intrapartum or postpartum were included in the study irrespective of their age, gestational age, parity and status of booking on admission. Results: During the study period incidence of eclampsia at our Centre was .82%. Total maternal death due to eclampsia was 8 and perinatal death was 49. It is concluded that good antenatal care, timely identification of signs and symptoms of pre-eclampsia intensive monitoring, earlier and meticulous termination of pregnancy can help in improving maternal and fetal outcome in eclampsia patients.

326-329

Authors: Jitendra P. Ghumare, AP Morey

Stillbirth rates are unacceptably high in developing countries. India accounts for the highest stillbirth rate in the world. Occurrence of stillbirths poses difficult situation and remains big challenge to health care system. Present study was conducted to understand the incidence, maternal & foetal characteristics and etiological factors for stillbirth. Material and Methods: The present retrospective record based study conducted at a tertiary care hospital of a Government Medical College, Maharashtra, India. The study includes stillbirths during the period of April 2014-March16. Variables like age, gravida, parity, etiology, birth weight etc. recorded from the indoor papers of stillbirths. All data entered, cleaned and analyzed using Microsoft Excel. Results: During the study period there were 19085 deliveries out of 978 were still births. The incidence of still births was 51 per thousand births. Maternal characteristics shows 442(45.9%) from the age group of 21-25 yrs, pre term(66.1%), prime gravid 51.39%, while macerated 634(64.8%), &65.5% low birth weight babies observed. Pregnancy induced hypertension [259(26.48%)], Prematurity [184(18.81%)], Medical disorder including Severe anemia [135(13.8%)] & IUGR [89(9.1%)] were most common etiology found among stillbirth. Conclusion: Progress in reducing Still birth remains at slow rate. Adequate antenatal care including nutrition, identification of risk pregnancies, timely referral of high risk cases will help to reduce the still birth rate. High quality intrapartum care at tertiary care centre located at rural area will certainly reduce the substantive number of still births.

334-338

Authors: Meenakshi Kanwar Bharadwaj, Ganga Sagar Tiwary

It has been reported that worldwide, one in 10 pregnancies is associated with diabetes, 90% of which are GDM. In India rates of GDM are estimated to be 10-15% with it expected to increase to 20%. There is a significant positive association between maternal hyperglycemia and adverse maternal outcome with the strongest association been found for hypertension in pregnancy. The present study is an effort to bring out the association between GDM and hypertension in pregnancy. Method: A prospective observational study was carried out on 1059 pregnant women. Amongst them, 129 who met the revised IADPSG criteria were diagnosed with GDM and rest included in normoglycemic group. Women with preeclampsia and gestational hypertension were included in the pregnancy associated hypertension (PAH) group. The risk of PAH in women with normoglycemia and GDM was calculated and maternal demographic factors associated with it identified. Result: There were 60 (3.8%) women with PAH. Normoglycemic women had lower rate of PAH, as compared to women with GDM (5.4% vs 7.8%, p>0.05). The risk of GDM patients developing pre-eclampsia was significantly more than normoglycemic women developing it (p<.05). Also, women with GDM and PAH had the highest rates of pregnancy after 35years, obesity, primiparity, and cesarean sections. Conclusion: This study demonstrates that GDM is associated with a higher incidence of PAH. There is a pre-pregnancy predisposition to dysfunction of beta cells which may be unmasked by the progressive insulin resistance of pregnancy and this is the common pathophysiology postulated with both GDM and hypertension in pregnancy. There is a necessity for early diagnosis and intensive monitoring of women with GDM for the development of PAH.

343-347

Authors: Naina Kumar, Prem Singh, Samar Rudra

The Papanicolaou test (Pap test) is most sensitive and widely used screening test for early diagnosis of various cervical lesions including infections. Objectives: To know the utility of Pap smears in diagnosing cervical infections and to study the pattern of infections on Pap smears occurring in this region of India. Material and Methods: Retrospective analysis of Pap smear reports of 5725 women who attended the Out Patient Department of Obstetrics and Gynecology with various complaints and for routine Pap smear screening during the period of January 2010 to December 2015 were collected from the Pathology Department of a rural tertiary care centre of Northern India after proper Institutional Ethical approval. The reporting of Pap smears was done by Bethesda 2001 system and by wet mount preparation of slides for diagnosis of various infections. Final analysis of data was done by using SPSS-20 version software. Results: Of 5725 Pap smears examined retrospectively, 4448 (77.69%) cases were benign epithelial patterns, 580 (10.13%) abnormal epithelial patterns and remaining 697 (12.17%) were unsatisfactory. Of 4448 benign cases, 1292 had infectious patterns on Pap smear with bacterial vaginosis (68.73%) being most common followed by Trichomoniasis (20.05%) and candidiasis (11.07%). HPV infection was noted in only 2 cases (0.15%). Majority of women belonged to 41-50 years of age group. Conclusion: Pap smear is one of the most simple and quick test for diagnosing cervical infections. However, for confirmation of Pap smear reports for infections, other tests like vaginal culture are required.

352-355

Authors: Omkara Murthy K, Dhananjaya BS, Jamuna R, Chaitra R

To study the effect of IV labetalol in hypertensive emergencies in pregnancy and their effects on maternal and Perinatal outcome. Pregnant women with blood pressure >160/110 mmHg were subjected to the trial. Patients were randomized to receive intravenous labetalol injection (in an escalating dose regimen of 20, 40, 80, 80 and 80 mg) every 15 minutes until the target blood pressure of <150/100 mmHg was achieved. Addition of nifedipine treatment was done if the initial treatment regimen was unsuccessful. Primary and secondary outcomes like the time interval and number of doses required to achieve a blood pressure of ≤150/100 mmHg and adverse effects of the antihypertensive agents were reported. IV Labetalol is effective in sustaining therapeutic level. Objective: To study the efficacy of IV Labetalol in management of hypertensive emergencies in pregnancy and adverse effects of labetalol. Materials and methods: A prospective observational study of 60 cases with hypertension in pregnancy, treated with Labetalol, was conducted over a period of one and half years. Results: The effective control of blood pressure with the use of Labetalol in the dosage used, was observed in cases of moderate to severe pregnancy induced hypertension. Conclusion: Intravenous labetalol is an effective and safe drug in the management of hypertension in pregnancy.

361-365

Authors: Bharti Sahu, Poorva Badkur

Aims and Objectives 1. To study five years maternal mortality in the tertiary referral hospital of MP. 2. To find out various causes of these maternal deaths. Method: A retrospective analysis of maternal deaths from hospital records and death summaries of five years between Jan 2010 to Dec 2014 at NSCB Medical College and Hospital, Jabalpur in Madhya Pradesh. Results: During the review period, there were 349 maternal deaths and 22,260 live births direct causes were 69% (n = 243), of which 49.2% (n = 174) from pregnancy induced hypertension and 8.8% (n = 30) from hemorrhage, were the leading causes of mortality. Out of total, indirect causes were 30.37% (n=106) of which severe anemia 20.06% (n=70) had topped. Of all, 94% (n=340) women were unbooked, 83% (n=290) were resident of rural areas, 82% (n=286) belong to age group 20-30 years and 56% (n=197) were primigravidas, 80% (n=281) were referred, and 62% experienced delay in care. Conclusion: The load of maternal mortality was found to be intolerably huge. Most women died of direct causes and experienced delay in care. Improvement in the quality of skilled maternity care, need to avail good, proper and effective antenatal care, timely referral, prompt transportation, provision of family planning services, among other factors, can drastically curtail the maternal deaths.

370-374

Authors: Ranjana Desai, Parihar Priyanka, Jodha Bhanwar Singh, Kiran Mirdha, Rakesh Karnawat

Objective: To evaluate the post-surgical maternal deaths and to make recommendation & design a protocol for decreasing future mortality. Design Retrospective analysis of post-surgical maternal mortality. Methods Analysis of all post-surgical maternal deaths between January 2006 and December 2010. Results and Discussion: During the study period there were 95413 deliveries in the institute. The total number of maternal deaths from January 2006 to December 2010 were 285. Out of this, 88(30.88%) were post-surgical deaths. Amongst the victims majority were unbooked (75%), multiparous (43.18%), Hindu (79.55%), coming from rural (68.18%) area. (67.05%) belongs to age group between 21 to 30 years. (72.73%) were serious at the time of admission and (42.04%) patients had haemoglobin level below 7 gm%. More than half (60.22%) died within 24 hours of hospital admission. (48.86%) patients were taken for surgery within 4 hrs. (21.59%) deaths occurred within 4hrs after surgery, (38.64%) deaths within 4-12 hrs, (21.59%). Cesarean was done in (56.83%) cases. In (28.41%) cases hysterectomy was done for postpartum hemorrhage. Out of this (10.23%) were normal vaginal delivered, (9.09%) were rupture uterus, (5.68%) were cesarean hysterectomy, (1.14%) after forcep delivery and (2.27%) after evacuation & curettage. The most common indication for caesarean was antepartum eclampsia (20%) followed by obstructed labour (12.73%). Direct causes were responsible for 84.09% and indirect causes for 15.91% deaths. Majority (38.64%) were attributable to hemorrhage, hypertensive disorders (20.45%), pregnancy related sepsis (11.36%), pulmonary embolism (9.09%) and (2.27%) were anesthesia related. Other causes were anemia, jaundice, acute respiratory distress syndrome, heart disease, chronic hypertension, aspiration pneumonitis and HELLP syndrome.(25%) patients were given whole blood and in (38.64%) patient’s blood with platelets and fresh frozen plasma given. All the patients were associated with risk factors and lack of proper antenatal care, lack of knowledge, illiteracy, poor transport and late referral further increases the surgical risk. Conclusions: Good antenatal care, high risk screening, comprehensive emergency obstetric services, hospital delivery and incorporation of obstetric drills decreases the post-surgical deaths.

379-382

Authors: Shachi Ashit Joshi

Hysterectomy–abdominal or vaginal or laparoscopic assisted vaginal hysterectomy is the most commonly performed elective major gynaecological surgery. The present study was conducted in our institute in 120 hysterectomy patients admitted for hysterectomy from February 2015 to July 2015. Objective: The objective of this study was to compare the intra operative and post-operative complications following vaginal hysterectomy for non descent uterus and abdominal hysterectomy for similar indications. Methods: A prospective comparative randomized study was carried out on 120 cases out of which 60 undergoing vaginal hysterectomy for non-descent uterus and 60 undergoing abdominal hysterectomy for similar indications. Results: The most common indication was fibroid uterus; there was a statistical highly significant difference in blood loss. Postoperatively, complications were more common in those who underwent abdominal hysterectomy. Postoperatively, patients who underwent vaginal hysterectomy ambulated earlier and were discharged earlier. Conclusion: Vaginal hysterectomy is a safe, least invasive route and is associated with lesser complications.

388-392

Authors: Shikha Saxena, Ranjana Gupta, Lata Agarwal, Prem Chandra Srivastava, Ayaz Khurram Mallick

Thyroid dysfunction and high prolactin levels can affect fertility due to anovulatory cycles, luteal phase defects and sex hormone imbalance. The study was designed to evaluate the status of Thyroid stimulating hormone (TSH) and prolactin in female infertility after exclusion of tubal factor and male factor infertility, and to determine the degree of association of TSH with prolactin in cases of infertility. Material & Methods: The study design was a randomized case control study conducted at Rohilkhand Medical College & Hospital, Bareilly, U.P. The study subjects included 50 infertile and 50 normal fertile women in the age group of 20- 40 years attending Gynaecology OPD during one year study period. The TSH and prolactin hormones were assayed using Enhanced Chemiluminescence Immunoassay and Enzyme Linked Immunosorbent Assay. Student’s t-test, Analysis of variance and Pearson’s correlation were used to analyze the data, with the significant p-level set at <0.05. Results: We found significantly higher mean TSH and prolactin levels in infertile females when compared with the normal fertile females. The mean TSH values were significantly higher in both primary and secondary infertility cases whereas mean prolactin level was significantly increased in primary infertility cases only. TSH and prolactin levels showed significant positive correlation in both primary and secondary infertility cases. Conclusion: There is a greater propensity for thyroid dysfunction and a higher prevalence of hyperprolactinemia in infertile women than the fertile ones and therefore, estimation of thyroid profile and prolactin should be included in the workup for infertile women.

397-399

Authors: Khushpreet Kaur, Parneet Kaur, Surya Malik

To study relative preponderance of critical obstetrical emergencies with various maternal factor like quality of antenatal care during pregnancy, regular antenatal checkup during pregnancy, socioeconomic status, education and area wise distribution and to study the contribution of each emergency to maternal mortality and morbidity and fetal outcome. Methods: The present study was conducted on a prospective basis for one year, from 1st Feb 2011 to 31st Jan 2012 in the department of Obstetrics and Gynecology Govt. Medical College and Rajindra Hospital, Patiala. All the cases referred as critical emergency from nearby areas during their antenatal period or within 42 days of delivery were included in the study. A detailed history including age, parity, gestational age, antenatal care during pregnancy, socioeconomic status, obstetrical history, medical or surgical disorders was taken into account. Attention was paid on the management received by each case including blood transfusion, surgical interventions, ICU admission etc. Results: Total deliveries during this period were 2223. Total obstetric emergencies came out to be 252. Thus the incidence of obstetric emergencies came out to be 11.3%. Various obstetric emergencies that were encountered – Hemorrhage (47.97%), Hypertensive disorders of pregnancy (35.32%), obstructed labor (12.3%), P. sepsis (3.18%), Rupture uterus (2.78%). Maternal mortality came out to be 8.8% Hemorrhage was leading cause of death in 36.36% cases followed by P. sepsis (13.64%), Hypertensive disorders of pregnancy (13.64%), Rupture uterus (9.09%). There were 70.2% Live births and 29.8% still births. Conclusions: It was concluded that obstetric emergencies are more common in unbooked cases and women with low socioeconomic status with poor access to antenatal care

407-409

Authors: Vasavi Kolluru, Anantha Reddy

High risk pregnancy refers to pregnancy with an increased risk of adverse outcome in mother or the baby. Scoring the risk, will identify mothers at risk earlier, so that proper resource allocation, planned management or timely referral to higher centers is facilitated and thereby perinatal mortality or morbidity can be reduced. Methods: 200 pregnant women with term gestation, admitted to labour room were evaluated. The risk factors in each case were assessed and their individual risk scores were determined using a simple scoring system. Subsequently their perinatal outcomes were compared to their respective risk scores. Results: It was found that there was a significant association between poor perinatal outcome and high risk pregnancies predicted by this scoring schedule. 20% of the cases belonged to high risk group, out of which 32.5% cases had maternal complications. Significant association between high risk score and perinatal mortality and birth asphyxia was found. Conclusions: There was a significant correlation between high risk and poor perinatal outcome. So a simple scoring system, such as the one used in our study, can be adopted at primary and rural health centers as a screening tool to predict pregnancies at high risk for poor perinatal outcome. Thereby facilitating early referral of these women to tertiary care centres.

414-417

Authors: Vasundhara P, Satya Sowjamya K

Globally the incidence of infertility is increasing. Infertility affects 10-15% of couple of reproductive age group. 12% of the female population of reproductive age were reported infertile in 2002 national survey of family growth. Infertility is a social stigma and psychological trauma to the couple. The couple should undergo battery of investigations to diagnose their cause for infertility. Most of the time, the work up is cumbersome and time consuming. Once diagnosis is achieved treating that cause takes some more time. To avoid this problem we need a proper test to diagnose and treat the problem early. Diagnostic hystero-laparoscopy is such a type of test to diagnose accurately and to treat properly at the same time. Aim of the study: The Primary aim of the study is to detect the anatomical abnormalities in the reproductive organs in infertile women by doing diagnostic hystero- laparoscopy, and also to compare the results with other modalities of diagnostic procedures like hysterosalpingography, transvaginal ultrasonography, Secondary aim is to treat the anomalies while doing hystero-laparoscopy.

422-425

Authors: Batiston Decruse Waanbah, Swati Rathore, Santosh Joseph Benjamin, Beena Kingsbury

Takayasu’s Arteritis is more common in women than men (8:1) with the peak incidence in the second and third decades, although a minority may present in their teens. The exact etiology remains unknown but it may have an autoimmune basis. It affects the aorta and its branches, leading to stenosis, thrombosis and the formation of aneurysms. During pregnancy it is associated with a number of fetal and maternal complications. The mode of delivery in patients with TA is determined by the haemodynamic status of the mother. A multidisciplinary collaboration of rheumatologists, cardiologist along with obstetricians is necessary to improve maternal and fetal outcome.

430-432

Authors: Monika Gupta, Swaraj Batra

The prevalence of congenital uterine anomalies among females of reproductive age group has been reported as 1:200 to 1:600. One such rare congenital uterine anomaly is rudimentary horn. The prevalence of unicornuate uterus with rudimentary horn is even rarer i.e.1:100,000. (1) These uterine anomalies present with very few problems in the absence of pregnancy provided there has been no obstruction to menstrual flow. Pregnancy in a rudimentary horn is rare and that too in noncommunicating horn is extremely difficult to diagnose before it ruptures. Such cases pose a challenge for management due to diagnostic dilemma. One such interesting case is being reported here with undiagnosed rudimentary horn pregnancy whose diagnosis was confirmed only at laparotomy due to unusual presentation.