Indian Journal of Obstetrics and Gynecology Research

196-198

Authors: Sunita Mishra, Sunita Sudhir

To study the efficacy of combined diagnostic hystero-laparoscopy in evaluation of causes of female infertility. Methods: Ours was a retrospective study conducted in the Department of Obs & Gyn from January 2013 to May 2016. Patients of age-group 20-40 years were included in the study. Results: Of the 100 patients, 64% were cases of primary infertility and the rest 36% had secondary infertility. Laparoscopic abnormalities were more than hysteroscopic abnormalities in both the groups. Laparoscopy detected abnormalities in 36% of cases while hysteroscopy was helpful in diagnosing 20% of abnormalities. Combined diagnostic hysterolaparoscopy detected abnormalities in 28% of the infertile patients in both groups. Enlarged poycystic ovaries accounted for the most common laparoscopic abnormality(9%) followed by endometriosis (7%) and tubal pathology(6%). Myomas were seen in 4% cases, adenomyosis and adnexal pathology were detected in 3% of cases each. 20% cases had uterine causes of infertility. By Hysteroscopy the most common intrauterine malformation was a partial septum which was seen in six cases in the primary infertility group. Endometrial polyp, myoma and synechia were also diagnosed by hysteroscopy in both the groups of infertility. Post procedure two cases had port site infection, for which they were appropriately treated and followed up. Rest of the cases had no major surgical or anaesthetic complications. Conclusion: Combined hysterolaparoscopy can be safely employed for evaluation of infertility to diagnose & appropriately treat lesions of pelvis and uterus. This procedure can be used as a first line investigation for evaluation of female infertility.

203-208

Authors: Roy Bibhash, Prabhdeep Kaur, Amitabha Dan, Achhelal Pasi, Kunal Kanti De

Neonatal mortality is the main barrier to reduction of infant mortality in West Bengal. Home based simple newborn care by mothers in the neonatal period can reduce neonatal mortality. The practices of mothers in this aspect in Nadia are not known. A cross sectional survey of mothers of Nadia with the objectives of describing their neonatal care practices, determine factors associated with it. Methods: Nadia district has a population of 5 million and estimated pregnancies of 74000. We used PPS method cluster sampling technique. We needed 575 mothers in 23 clusters assuming 52% prevalence at 5% precision, 95% Confidence interval and design effect 1.48.Structured questionnaire was used for data collection on different socio-demographic and health system related factors and mothers’ newborn care practices. Data was analysed using Epi info 3.5 software. Results: Among 575 mothers, 518 (90.1%) kept the neonates cord stump clean. Delaying the first bath of the neonate was least practiced 292 (50.8%). Only 39 (6.8%) mothers had all safe practices. Living below poverty line (Adjusted OR 5.2, C.I. 3.4-7.8), not registering in the first trimester (Adjusted OR 2.6, C.I 1.6-4.2), maternal education not more than secondary level (Adjusted OR 2.3, C.I. 1.3-3.9) and having home delivery(Adjusted OR 3.2, C.I. 1.5-6.8) were significant factors for non-adoption of at least five safe practices. The overall neonatal morbidity rate was 57 per 1000 live births (33 /575) and neonatal mortality rate was 10 per 1000 live birth (6/575). Median contacts with the health system in the mothers having unsafe practices was 6 (range 0-11) compared to 10(range 1-11) in the other group. Out of 33 sick neonates 26(78.8%) were from mothers with unsafe practices. Conclusion: Poor and uneducated were unaware of safe newborn care practices especially for hypothermia. They had more neonatal sickness and deaths. They had less contact with the health system. There is a need to reach out to such vulnerable group and improve their coverage in existing facilities. Training of ASHA in Home based newborn care and educating mothers can be cost effective option for this section to save neonates by promoting best neonatal practices.

212-215

Authors: Deepti Verma, Manju Lata Verma

The aim of this study is to analyze indications, type and complications of hysterectomies done in the two rural tertiary level teaching institutes in Northern India. Materials and Methods: It was a retrospective study in which the detailed analysis of demographic data of the patients, surgical indications, route of surgery and complications of the patients undergoing hysterectomy in one year (January 2015-December 2015) in Mayo Institute of Medical Sciences and Hind Institute of Medical Sciences in Barabanki, Uttar Pradesh, India was done. Results: Out of the total 157 cases of hysterectomy performed in two institutes, the incidence of vaginal hysterectomy was significantly higher (69.43% vs 30.57%, p<0.05) as compared to the abdominal hysterectomy. Pelvic organ prolapse was the most common indication for hysterectomy in the study group. Fibroid uterus, dysfunctional uterine bleeding, ovarian mass, chronic pelvic inflammatory disease and cervical intraepithelial neoplasia were the other indications. Hemorrhage during abdominal hysterectomy was the most common complication encountered (n= 6, 3.82%). Conclusions: Lack of equipment’s and technical support, unawareness of the patient, and financial constraints are the major factors leading to hysterectomy rather than resorting to minimal invasive techniques for benign gynecological complains. Moreover, the incidence of pelvic organ prolapse in the rural population should be reduced by promoting institutional deliveries, awareness about the benefits of adequate post-partum rest and nutrition, and effective contraception to avoid repeated child births. This will further help in reducing the rate of hysterectomy in rural population.

220-224

Authors: Nagendra Prasad N, Sarojamma C, Nagarathanamma R, Savitha C

To evaluate efficacy and ease of use, of bidirectional barbed suture in laparoscopic myomectomy. Methods: One hundred and twelve cases of laparoscopic myomectomy were performed by a single surgeon over five years period. Most of the cases were for management of infertility. A bidirectional barbed suture was used for myoma bed closure. Assessment was made about the ease of use of barbed suture, time taken to suture hysterotomy wound and intra operative blood loss. Results: The operator found huge difference in the ease of use of bidirectional barbed suture in the closure of hysterotomy incision compared to intermittent suturing with intra corporal knotting, using conventional suture. Operative time as well as intra operative blood loss decreased with the use of barbed suture. Conclusion: Bidirectional barbed suture is a safe and effective material to close the myomectomy incision. It greatly reduces the difficulty in endosuturing and hence allows more people to practice laparoscopic myomectomy. It also reduces the time required for endosuturing.

229-233

Authors: Sarojamma Chunchaiah, Nagendra Prasad Nagothi, Roopakala BM, Nagarathnamma Rangaiah

Urinary tract infections are one of the common infections during pregnancy. Asymptomatic bacteriuria is one of the risk factor and clinical manifestation of urinary tract infections. Detection of asymptomatic bacteriuria during pregnancy is important as subsequently 25% of infected women progress to chronic urinary tract infections resistant to chemotherapy. These infections leads to various pregnancy associated maternal complications like pregnancy induced hypertension, maternal anemia, preterm labor and fetal complication like low birth weight which can be prevented by detecting and treating asymptomatic bacteriuria. Aims and Objectives: This study was carried out to detect the prevalence of asymptomatic bacteriuria in antenatal women attending outpatient department in Rajarajeswari Medical College & Hospital, to identify the common causative organisms responsible for asymptomatic bacteriuria and antimicrobial sensitivity pattern of pathogens isolated. Material and Methods: 500 asymptomatic pregnant women who attended outpatient clinic in Ob & G department Rajarajeswari Medical College & Hospital Bangalore, Karnataka, India were enrolled. Mid stream of urine was collected by clean catch technique into a sterile container and then subjected to culture& antimicrobial sensitivity test. Results: Our study showed 12% (60/500) prevalence of asymptomatic bacteriuria among antenatal women. Insignificant bacteriuria in 4% (20/500), growth of contaminants 6% (30/500) and sterile urine 78% (390/500) were seen in samples cultured. Lower socio-economic status, lower level of education, multiparity, advancing maternal age and advancing gestation period were associated with high risk for asymptomatic bacteriuria. The most common organism grown was Escherichia coli (E. coli) in 40/60 cases (66.66%), followed by Klebsiella in 8/60 cases (13.66%), Enterococcus in 7/60 (11.66%) and Staphylococcus aureus in 3/60 cases (5%). The most effective antimicrobial agent against the isolated organisms was Nitrofurantoin & the least effective were Ampicillin, Amoxicillin & Cotrimoxazole.

239-252

Authors: Alka Pawalia, Satya Savant, Sivachidambaram Kulandaivelan, Vikram Singh Yadav

Obesity is a modifiable risk factor associated with many complications in human beings. Objective: To find and report the articles dealing with BMI on maternal (prenatal and perinatal) and child (perinatal and postnatal) complications with specific emphasis on Indian studies. Data source: Pubmed and Google Scholar were searched with key terms within the limit of studies between 2008 and 2015. Study eligibility criteria: Studies with at least 4 complications were compared with BMI classification, both cross-sectional and case-control studies; both prospective and retrospective studies were included. Participants and intervention: Pregnant women, who were classified according to BMI criteria, were compared with prenatal, perinatal and immediate postnatal complications in both mother and child. Study appraisal and synthesis methods: Since Pubmed is the primary source of selection of articles there was no separate appraisal of included studies other than eligibility criteria. 37 articles which met the eligibility included for results review and discussion. Results: Odd ratio (OR) of gestational diabetes (4.62), pregnancy induced hypertension (3.23), cesarean section (2.88), preeclampsia (2.69), microsomia (4.65), macrosomia (3.95), NICU admission (3.39), perinatal death (3.17) in obese/overweight Indian mother is either equal or higher than western counterparts. Limitation: Present study neither did meta-analysis nor did any inferential statistics. Conclusion and implications of key findings: Present study concretely supports that obesity was associated with many pre, peri and postnatal complications in both mother as well as child. So, primary and secondary prevention measure has to be taken to control the weight in reproduction age females

257-263

Authors: Shikha Joshi, Sarita Dheeraj, Sunita Fotedar

To compare efficacy and safety of induction with transcervical Foley’s catheter and low dose intravenous oxytocin for labor induction in a case of previous LSCS. Methods: One hundred women at term gestation with one previous LSCS with no contradictions for VBAC, Bishop’s score < 6, willing for VBAC (after consent) were selected and divided into two groups of 50 each. Group A was induced with transcervical Foley’s catheter and group B of another 50 was induced with intravenous oxytocin. Results: In foleys group induction-delivery interval was less 24.54±6.0 hrs compared to oxytocin group 27.88±7.08 hrs. Successful induction rate significantly higher (80% vs 66%) with foley’s as compared to oxytocin group. 76% women delivered within 24 hours of induction in foleys group whereas in the other group 64% delivered within 24 hours. Both methods are safe for labor induction. No significant systemic complications like rupture uterus noted in both groups. Neonatal outcome was similar in both the groups. Conclusions: Foleys induction and oxytocin induction are cheap, safe, easy methods with least systemic side effects like rupture or uterine hyperstimulation for labor induction in a case of previous cesarean compared to PGE2 gel though failure rates are more with only oxytocin.

267-269

Authors: Umashankar Km, Shivakumar Hc

The earliest evidence of a Vvf was found in 1923, when Derry examined the mummified body of henhenit, a lady in the court of mentuhotep of the 11th dynasty who reigned around 2050 Bc. The urinary fistulas involving female genital tract result from complications of child birth, and pelvic diseases and their treatment. In developing countries like ours, obstetrical causes are the leading causes of Vvf. Objectives: To determine the major causal factor of vesicovaginal fistula (Vvf) and the outcome of treatment. Methods: This retrospective study was conducted from 1st January, 1994 to 31st December, 2006. At Vijayanagara Institute of Medical Sciences Bellary. Total number of patients included in the study was 40. They were analyzed with regard to age, parity, causal factor, mode of treatment, and the outcome. Results: Obstetric complications were the leading causes of Vvf. Majority of the cases were treated surgically by layered method of closure vaginally. Success at primary attempt was 93.33%. Conclusions: Vesicovaginal fistula mainly results from low level of intrapartum care and improperly conducted deliveries. Primary closure is successful in 93.33%.

279-282

Authors: Maya Menon, Vinodha M

Gestational age is frequently estimated based on last menstrual period and on ultrasonography. Many people are unaware of their last menstrual period due to irregular menstruation and ultrasonography is bound to have a bias, thereby posing difficulties in the estimation of gestational age. Placenta is a fetal organ which provides the physiological link between pregnant women and her fetus. Placental growth can be estimated by measuring the thickness and estimating its volume. Placental thickness is directly related to the gestational age of the fetus till certain weeks of pregnancy. Objectives: To study the correlation between ultrasonographic placental thickness and gestational age of the fetus. Methods: This is an observational study done at ESIC Medical College & PGIMSR Chennai. 333 cases were recruited for the present study to determine the normal placental thickness for various gestational age and to study the correlation between ultrasonographic measurement of placental thickness and gestational age of the fetus. Results: Placental thickness for gestational age 11-40 weeks calculated, it gradually increased from 14.6 mm at 11weeks to 38.9mm at 40 weeks gestation. Correlation coefficient is 0.98 and p value <0.0001.There is a significant positive correlation of placental thickness with other fetal biometry parameters like BPD, FL, AC, HC and CRL.(p < 0.0001) for BPD, FL, AC and HC and (p=0.02) for CRL. Discussion: There appears to be a linear relationship between gestational age and placental thickness. Thus, placental thickness can be reliably used to estimate gestational age importantly for mothers whose clinical history is not reliable, who come for antenatal booking in second half of pregnancy and in conditions where BPD measurements becomes less reliable.

289-291

Authors: Niranjan Chavan, Pradnya Changede, Natasha D’Souza, Y.S. Nandanwar

Adnexal torsion constitutes approximately 3% of Gynaecological emergencies and is one of the causes of acute abdominal pain in a woman.1 Here we present a rare case of a gangrenous hydrosalpinx which presented with acute abdominal pain and was clinically diagnosed as a twisted ovarian cyst.

294-296

Authors: Ramesh Babu, Mahendra G, Vindhyashree S

Isolated congenital Megacystitis represents a rare variant of fetal Megacystitis without other associated anomalies. The aetiology is not clear. Various methods of management have been described in literature. We report a case of isolated congenital Megacystitis, Considerations for the evaluation and management of this rare entity are discussed.

148-152

Authors: Pradnya Rajendra Changede, Parikshit Tank.

Background: Cervical dystocia is caused by cervical spasm due to prolonged labor. Maternal complications can arise due to this such as intrapartum infection, pathological retraction ring (Bandls ring), maternal morbidity and it may also contribute to perinatal morbidity and mortality. Various spasmolytic drugs can help to relieve the cervical spasm and facilitate cervical dilatation during the first stage thereby decreasing the rate of cervical dystocia. Methods: This was a prospective study conducted in a tertiary center over a span of 1 year. 60 patients were randomly allotted in 2 groups. 1. 30 patients (15 primigravida and 15 multigravida) – control group 2. 30 patients (15 primigravida and 15 multigravida) – Injection Hyoscine butyl bromide (Buscopan) group. Injection Hyoscine butyl bromide 20 mg intramuscular was given at 3cm cervical dilatation. No further dose was given. A statistical test, ‘unpaired t test’, was used to test the results for statistical significance. A x2 (chi square) test was used to test results of side effects for statistical significance. Results: The duration of active first stage of labor was shorter in the Hyoscine butylbromide group (170.3 min) as compared to control group (216.7 min) in primigravida and multigravida (hyoscine butyl bromide group 120.9 min and control group 153.3 min). An unpaired t test showed p value of 0.011 in primigravida patients and p value of 0.003 in multigravida patients). No significant maternal and neonatal side effects were noted in the drug arm when compared to the control group (p value > 0.05). Conclusions: The rate of cervical dilatation under the influence of hyoscine butylbromide is significantly higher as compared to control group. The rate of dilatation is faster in multigravida patients as compared to primigravida. Hyoscine butylbromide is a safe drug with no fetal side effects or any significant maternal side effects. Keywords: Labor, Hyoscine butyl bromide, Cervical dilatation, Active first stage of labor, Prolonged labor

157-166

Authors: Manish R Pandya, P. Gopeenathan, P.M. Gopinath, S.K. Das, Meenakshi Sauhta, Veena Shinde.

Abstract Background Progestogens have been considered as a viable therapeutic option for the treatment of miscarriage for more than half a century. Aim: The aim of the present review is to provide a comprehensive view of the literature regarding the clinical efficacy and safety effects of progestogens for preventing recurrent miscarriages and managing threatened miscarriage during early pregnancy. Methods: A literature search was performed using electronic databases like Pubmed/ Medline to identify from 1953 to 2015. The search yielded around 27 original studies and review articles. Results: Dydrogesterone (oral) and various micronized progesterone (MCP) given orally, vaginally and intramuscularly are the most commonly used progestogens for the treatment of recurrent and threatened miscarriages. Pharmacokinetic profile of dydrogesterone exhibits better bioavailability, receptor affinity, quick onset of action and a better half-life imparting long and stable effect. Dydrogesterone exhibits 47% and 29% statistically significant reduction in odds ratio of threatened and recurrent miscarriage when compared to standard of care. While, literature supports use of MCP (vaginal), recent findings suggest no statistically significant difference in live birth rate when compared to placebo (65.8% vs. 63.3%). MCP (vaginal) is associated with vaginal discharge and irritation whereas dydrogesterone (oral) avoids vaginal discharge and no birth defects have been associated with its use. Conclusion: Treatment with dydrogesterone and other progestogens in general suggest dydrogesterone has number of advantages over other progestogens in terms of pharmacokinetic parameter clinical efficacy and safety profile. However, further studies are warranted to establish and promote the role of these progestogens in management of threatened and recurrent miscarriage. Key Words: Progestogens, Recurrent miscarriage, Threatened miscarriage Key Messages: Bioavailability · Oral bioavailability of dydrogesterone is approximately 5.6 times better than oral MCP.32,37,82 · Dydrogesterone is selective for progesterone receptor with 1.5 times better affinity than oral MCP.32 · Dydrogesterone exhibits quick onset of action reaching peak absorption levels within 30 minutes with a half-life of 5-7 hours imparting long and stable effect.37 Efficacy and safety · Based on PROMISE study data vaginal MCP therapy did not significantly improve live birth rate in women with unexplained recurrent miscarriage compared to placebo.57 · Dydrogesterone leads to a 47% statistically significant reduction in the odds of a threatened miscarriage.38 · Dydrogesterone leads to 29% statistically significant reduction in the odds of a recurrent miscarriage.39 · Clinical experience with dydrogesterone does not provide evidence of a causal link between maternal dydrogesterone use during pregnancy and birth defects.41 · Use of medroxyprogesterone and hydroxyprogesterone in the management of miscarriages has not been supported in literature. They are indicated as contraceptive and for preventing preterm labor; respectively.61,62,73 Recommendations · Dydrogesterone has been approved for pregnancy indication including threatened miscarriage, habitual miscarriage, and infertility.81 · Dydrogesterone has been recommended for the treatment of threatened and recurrent miscarriage by FOGSI and EPC guideline.79,80 Oral MCP is not indicated for threatened and/or recurrent miscarriages.81

172-176

Authors: Ramadoss Kabilan Vidhyalakshmi, Sareena Gilvaz, Annie V Thadicaren.

Background & Objectives: Asymptomatic bacteriuria during pregnancy is one of the risk factor for preterm delivery if untreated. The aim of this study is to find out the prevalence of ASB in pregnant women presenting with preterm labour pain and also to determine the common pathogenic micro-organisms associated and their antibiotic sensitivity. Methods: This is a prospective case- control study carried out in the Jubilee Mission Hospital, Thrissur, Kerala from Oct 2013 to March 2015. Cases (50) are those who came with preterm labour and patients in the control (50) group are those who do not present with preterm labour pain between 24-37 weeks. Patients were selected with specific inclusion and exclusion criteria. They were followed till delivery and treatment was given accordingly. Both maternal and fetal outcomes were noted. Results: Asymptomatic bacteriuria was present in 11 patients whoc presented with preterm labour pain and hence the prevalence of asymptomatic bacteriuria in preterm labour in the study population was 22%. Most common pathogenic organism found was E.coli (20%) followed by Klebsiella (2%). Mixed growth suggestive of contamination was found in both case (14%) and control (12%) group. Sensitivity to nitrofurantoin was seen in 4 cultured samples (36.36%) of the patients with ASB. Conclusion: Asymptomatic bacteriuria is a common infection in pregnancy and they are at an increased risk for adverse maternal and fetal outcomes which could be prevented by antimicrobial therapy. Hence pregnant women should be screened for bacteriuria and treated with appropriate antibiotics according to the sensitivity. Keywords: Asymptomatic bacteriuria, UTI, Pregnant women, Preterm labour, E. Coli

181-184

Authors: Anshika Lekhi, Navin Bhatia, Manju Lal.

Conjoined twin is an unusual congenital anomaly having severe mortality and morbidity. We are reporting a rare case of conjoined cephalothoracopagus janiceps twins diagnosed by ultrasonography at 30 weeks when they presented to our department for the first time. Two live male conjoint babies were delivered by caesarean section. They died in half an hour after birth. Mother was discharged from hospital at 7th post natal day. This case is extremely rare because of following features: (a) presence of separate hearts (b) male sex (c) bony fusion at the level of the base of skull. Literature suggests that early diagnosis by a combination of ultrasound is essential for management. It gives an opportunity for viability and process of surgical separation. With this early counseling of parents and termination can be done if indicated. Key words: Conjoined Twins, Cephalothoracopagus, Janiceps

187-189

Authors: Rachna Chaudhary, Haripriya Bajwa.

Vulval growths though rare, may be cause of discomfort as well as social withdrawal. The patient usually complains only of swelling or of bleeding and discharges from it. The treatment is excision and removal, recurrence is rare. We present a rare case of a fibroma of the labia majora with coexistent uterine fibroid in a postmenopausal woman. Keywords: vulvar fibroma, uterine fibroma, postmenopausal

194-195

Authors: Kamala Verma, Girish Chandra Baniya.

Diagnosis of ectopic pregnancy in a sterilized female may be missed many times and it is associated with greater risk of maternal morbidity and mortality. Risk of ectopic pregnancy after failure of tubal ligation is not only limited to initial years but also seen many years after the procedure. So due consideration should be given to ectopic gestation as a part of the differential diagnosis in acute abdomen of reproductive age group female even in the presence of tubal ligation history. Keywords: Tubal ligation; Ectopic pregnancy; Sterilization failure

1-6

Authors: Amitabha Dan, Bhatnagar Tarun, Achhelal Pasi, M Jalaluddin

Background: National Rural Health Mission introduced ‘Nischay Yan’, a free assured referral transport, since 1st April 2011 in Nadia district, West Bengal, India to reduce neonatal mortality rate (NMR). We conducted a cross sectional study to estimate the prevalence of awareness and utilization of the scheme along with factors associated with its use in mothers and to describe the strengths and gaps in the scheme. Method: A total of 575 mothers of children born between 1st July and 31st December 2011 in 23 clusters were surveyed. Univariate and multivariate logistic regression was done to study the determinants of awareness and utilization of Nischay Yan services. Result: Out of 575 mothers, 77.9% were aware of Nischay Yan and knew the number 102.Majority of the mothers (96.9%) got the information from ANM and ASHA. Only 187 of 575 (32.5%) mothers had availed the services of Nischay Yan. Of the187 mothers who availed Nischay Yan, 164 (87.7%) utilized it for delivery and 23(12.2%) for the purpose of neonatal care. ASHA escorted only 42 (22.4%) of 187 mothers. Of the187 mothers who utilized Nischay Yan, 77% availed the ambulance from doorstep and (82.4%) had to wait up to one hour to get the Nischay Yan. Half of 187 mothers reached a facility in two hours. One hundred seventy one (44%) of 388 mothers did not utilize Nischay Yan because of non availability of the ambulance. On Univariate analysis mothers characteristics such as age (OR=2.9, 95% C.I=1.8 -5.1), living in nuclear family (OR=1.7, 95% C.I=1.03-2.8), Knowing the telephone number102 (OR=43.9,95% C.I=4.7-410.3), Knowing the danger sign for referral of pregnant woman(OR=6.5, 95% C.I=3.01-14.07), having three antenatal check-ups (OR=21.9, 95% C.I=2.2-219.5) and Possessing functioning mobile or landline phone (OR=12.44, 95% C.I=1.3-112.4) were significantly associated with use of Nischay Yan. Conclusion: Majority of the mothers were aware of Nischay Yan scheme while only one third utilized it. Mothers who knew the number 102 and had functioning telephones were more likely to use Nischay Yan ambulance. Major cause of non use of Nischay Yan was non-availability of ambulance. The ambulance density was adequate as per programme but less as per requirement.

13-17

Authors: Ravindra.S.Pukale, Prashant S. Joshi, Arathi M.S.

Introduction: The incidence of caesarean section is increasing with each passing decade without remarkable decrease in maternal and perinatal mortality. This study is an attempt to reduce the rates of caesarean sections by adopting various measures and also to know the prevalence and incidence of caesarean section in SAH&RC. Materials and methods: This is a Descriptive study conducted in Sri Adichunchanagiri Hospital & Research Centre, BG Nagara, A Rural Medical College in Mandya District, Karnataka. The study was done for a period of 18 months including all cases admitted in Labour Room in the hospital. Results: Total 2000 cases of deliveries were included out of which 939 cases underwent caesarean section for various indications. Prevalence rate of caesarean section was 46.95%.Previous caesarean was the most common indication for caesarean delivery.

23-27

Authors: Garg Seeru, Soni Anita

Objective: To study effectiveness of LNG IUS (levonorgestrel releasing intrauterine system) insertion for patients with Abnormal uterine bleeding and to assess whether the LNG IUS can provide a conservative alternative to hysterectomy in the treatment of AUB. To correlate the cost effectiveness, symptomatic relief and psychological relief achieved with LNG IUS insertion. Materials and methods: It was a prospective non-comparative study with patients who had heavy menstrual bleeding and/or dysmenorrhea and diagnosed as adenomyosis or Idiopathic AUB (According to the FIGO PALM-COEIN Classification of AUB1). Thirty patients had LNG IUS insertion whereas another thirty patients opted for hysterectomy. We analyzed them in terms of symptomatic relief, cost effectiveness and psychological relief. Results: After LNG IUS insertion 93.33% of patients had significant decrease in blood loss and 76.6% had significant decrease in pain analyzed on visual analog score (VAS). Forty % of patients complained of inter-menstrual spotting but only 6.6 % had irregular heavy bleeding and only 2 patients out of 30 requested hysterectomy post LNG IUS insertion. 90% patients developed amenorrhea after 1year and only 1 woman required removal of LNG IUS as she was dissatisfied due to vaginal discharge. Hospital stay for LNG IUS was only 6-8 hours while it was 48-72 hours for patients who underwent hysterectomy. Conclusion: There is a significant relief in symptoms along with significant decrease in cost with LNG IUS insertion with a psychological satisfaction of conserving the uterus. Thus the LNG IUS is an excellent and cost effective alternative to surgical management in AUB

32-37

Authors: Rajeswari, Shobha

Objectives: The aim of the study was to help generate information and knowledge regarding the causes and complications leading to maternal deaths in an Urban tertiary care hospital, to find if any of them are potentially preventable and to use information thus generated to save lives. Method: The Medical records of all maternal deaths over a period of 5 years between June 2009 to May 2014 were reviewed and analysed for maternal age, antenatal registration, mode of delivery, parity, admission date interval and causes of death. Results: The maternal mortality rate ranged between 448 to 750 / 100000 births in the study period. The causes of death were eclampsia - pregnancy induced hypertension (39.4%) haemorrhage (35%), Sepsis(6%), Hepatitis (6.5%), Anaemia (13%), Heart Disease (2.6%). Maximum deaths occurred between 21-30 years of age is 84.6%. Mortality highest in post natal mothers 158 (69.2%). Unbooked cases constituted 204(89.4%) of Maternal deaths and included 157(68.8%) of referred cases. Overall mortality was 544/100000 of maternal deaths due to direct obstetric deaths 181 (79.3%) and indirect obstetric deaths 47 (20.6%). Conclusion: The classical triad of causes of maternal mortality in our study remained eclampsia, haemorrhage, sepsis in that order. Haemorrhage and sepsis are considered potentially preventable causes of maternal deaths.

43-50

Authors: Rajalekshmi M, Chithra Jayakrishnan, Nithya R, Vijay Narayanan S

Background: A screening test is ideally needed at the time of onset of labour which can detect the already existing compromise on the foetus and which can also predict its well-being for following hours in labour, which will pave way for timely intervention that will curtail the neurological damage and death. Assessment of foetal wellbeing in labour ward through admission cardiotocography (CTG) helps us to look for already prevailing high risk factors vigilantly and also new factors that have recently appeared. Aim: To ascertain admission CTG as an effective tool in predicting the foetal outcome and mode of delivery. Materials and Methods: In this study 400 women’s Admission CTG’s will be compared for pregnancy and neonatal outcomes such as mode of delivery, APGAR score, admission into neonatal intensive care unit (NICU) and duration of stay in NICU. Statistical analysis is done using Chi square test and p<0.05 is considered as statistically significant. Sensitivity, specificity, positive and negative predictive values, diagnostic accuracy of the admission CTG is also measured. Results: There is a statistically significant co-relation between the admission CTG and the mode of delivery, APGAR score and NICU stay of the neonates. Conclusion: We conclude that the admission test can be used as a useful tool to analyse CTG tracings of women in early labour to give quality care and to predict the mode of delivery and foetal outcome.

55-58

Authors: Hemant G. Deshpande, Chandrakant S Madkar, Kavya K. Patel.

Introduction: Obstetric hemorrhage is a much dreaded and dangerous complication. Prevention of postpartum hemorrhage depends on proper management of second stage and third stage of labor. This study attempts to evaluate the effect of oxytocin instillation through umbilical vein in reducing the blood loss and time taken for placental separation in caesarean section. Methods: The study was an interventional study. Two hundred cases of caesarean section conducted at DR D. Y. PATIL HOSPITAL, PUNE were taken for the study. Patients undergoing caesarean section were divided into two groups randomly and allocation done on the basis of lottery system. Based on allocation one group was subjected to 20 units of intraumbilical oxytocin and other group received 20 units intra venous oxytocin drip in500ml normal saline. Observer was blind (blood loss in ml and time for expulsion of placenta was measured by other). 100 cases of elective and 100 cases of emergency caesarean section were included in the study. Amount of blood loss and time taken for placental separation were observed. Results: amount of blood loss and the time of placental separation was significantly less in the intraumbilical group compared to intravenous group. Conclusion: oxytocin is a gold standard oxytocic drug and newer route of administration of 20 units in 20 ml normal saline intraumbilically, immediately after the delivery of the baby in both elective and emergency caesarean section, reduce the duration of third stage of labor and reduces blood loss significantly.

65-67

Authors: Prameela, Kavya D Sharma

Pelvic inflammatory disease (PID) is one of the most frequent infections seen in reproductive age group and is associated with major clinical and pelvic health problem. It is Infection & inflammation of upper genital tract organs typically involving fallopian tubes, ovaries & surrounding structures. PID is polymicrobial in nature and is associated with different etiological agents. Clinical presentations may vary from mild to severe. No specific signs and symptoms are pathognomic of PID. Laboratory tests are also poor predictors of PID. There may be subclinical symptoms and patient later may present with infertility. CDC recommends treatment for even mild cases of PID. Therapeutic goal in management of PID is to prevent chronic residual disease. Failure of antibiotic therapy to prevent sequelae of salpingitis reflects the emphasis of additional therapy along with antibiotics. Placentrex is a drug containing Peptides (FNP-III, CRF), Nucleotides (PDRN) & Glutamate and is derived from an extract of fresh term, healthy, human placenta. It has significant anti inflammatory effect involving chemical mediators of immunological response. Effect of placentrex is well documented in wound healing1 and in treatment of burns and radiation effects 2. It has been recommended for prescription for PID but there is not much data in literature regarding the efficacy in PID. So we conducted a trial to find efficacy of placentrex in comparision with azithromycin for the treatment of PID.

73-75

Authors: Anusha Kamath

We report 2 cases of carcinoma cervix treated at our institution where a window to detect malignancy at an early stage was available, yet missed. Case 1: A 38 year old nulligravida, post-renal transplant patient, reported with abnormal discharge per vaginum and inter-menstrual bleeding. She was found to have Squamous Cell Carcinoma of Cervix Stage Ib2 on evaluation. A decision to start IMRT was taken. The patient didn’t continue further treatment at our institute and was lost to follow up. Case 2: A 47 year old lady presented with 4 months postpartum bleeding. She had undergone caesarean delivery post-IVF 6 months ago. She was found to have Squamous cell carcinoma Stage IIa on evaluation, for which she underwent Radical Hysterectomy with bilateral pelvic lymph node dissection. She received Postoperative radiotherapy along with Intracavitary Radiotherapy.

78-79

Authors: Ambarisha Bhandiwad, Surakshith L Gowda, Anupama N K

Fallopian tube prolapse is a rare complication of hysterectomy and can be easily mistaken as vaginal granulation tissue or vaginal adenocarcinoma. We are presenting a case of post vaginal hysterectomy fallopian tube prolapse in a 63 year old lady which was managed effectively by vaginal route. By combining routine salpingectomies with hysterectomy can prevent this condition and also provide an additional protection against tubal and ovarian cancers.

83-85

Authors: Nayana H. Patel, Jayprakash Shah, Niket H. Patel, Nilofar R. Sodagar

Uterine fibroids are very common non-cancerous (benign) growths, occurring in 20% - 30% of women of reproductive age that develop in the muscular wall of the uterus. The sonographic diagnosis of uterine fibroids generally is accepted as accurate with transvaginal sonography. In women who have pelvic masses of unknown cause, unusual manifestations of fibroids such as necrosis or degeneration may simulate a carcinoma or hydrometra resulting in problems with image interpretation. We report a case of an unsuspected large degenerated uterine fibroid in a lady mistakenly diagnosed as didelphysbicolis uterus on ultra sonography.

206-212

Authors: Meena Armo, Kavita Babbar

Objective: To determine the factors responsible for maternal morbidity and mortality in women who underwent an unsafe second-trimester medical abortion so that it would help health professionals to revise abortion policies and practices to reduce it. Method: A retrospective record based data analysis was performed on patients with history of unsafe second-trimester medical abortion carried out at location other than our college hospital, during the period of June 2009 to May 2014. Results: Out of 758 cases of abortion observed, 123 (16.22%) women had undergone an unsafe second-trimester medical abortion and admitted in obstetrics & gynaecology department with complications. Majority of patients were rural, illiterate, from very low socioeconomic background. Most frequent complain for admission was severe bleeding. The most common reason for the termination was unintended pregnancy. Of total 123, 19(15.44%) women sought abortion due to sex preference. Majority of provider were either paramedics or quacks. Complications observed in 86(69.91%) cases. Majority of 101(82.11%) patients required surgical interventions. Of total, 4 (3.25%) patients couldn’t survive despite of all resuscitative measures. Conclusion: Abortion right as well as safe abortion service is still a distant dream in rural areas of our state. Declining sex ratio could be an alarming sign which needs immediate attention and action.

218-226

Authors: Lakshmi Garuda, Suhasini Kambham, Neelohita B

Background: This study examines the factors responsible for acceptability of the post placental intracaesarean insertion of IUCD among the clients in the study and evaluates the safety and efficacy and occurrence of complications like bleeding, missing strings, infection, pregnancy and expulsion and their incidence of occurrence after a follow up of 6 months post insertion. Aim: To assess the acceptability, efficacy, feasibility and safety of IUCD insertion immediately after expulsion of the placenta in a caesarean section. Materials and Methods: We have conducted a study on 220 patients delivering by caesarean section at our hospital, Kakatiya Medical College, Warangal, INDIA. After taking informed consent and explaining the patients about the advantages and limitations, we have succeeded in inserting intrauterine device cu-t380A immediately after expulsion of placenta in patients delivering by caesarean section in 220 patients and followed up the patients at 2-6 weeks and 6weeks-6months period to evaluate the safety, efficacy and complications occurring and their incidence of occurrence. Results: Total women counseled were 480, Accepted in 231, Declined in 249. Intrauterine cesarean insertion was done in 220 patients and deferred in 11 patients due to post partum hemorrhage. Out of 220 patients, 28 patients lost to follow up, Removal rate was 20 and continued in 160. The total complications are 68 (Expulsion 12,Bleeding 20, Strings not visible 32,Infections 4,Pregnancy 0),These results were comparable to other national and international studies. We compared complications between elective and emergency intracesarean insertions and their statistical significance were evaluated. Conclusion: Advantages of immediate post-partum insertion include high motivation, assurance that the woman is not pregnant, and convenience. However, expulsion rates appear to be higher than with interval insertion. The popularity of immediate post-partum IUCD insertion in countries as diverse as China, Mexico, and Egypt support the feasibility of this approach. Early follow-up may be important in identifying spontaneous IUD expulsions.

232-237

Authors: Hema Gayathri Arunachalam, Savitri Subramanyam, Mala Vijayakrishnan

Background: Throughout developing world there is a large gap between people desire to space and their use of contraception (UNMET NEED) and this end up in unwanted pregnancy. In India 20 % of pregnancies are unwanted and more than half undergo unsafe abortion contributing to 8% of maternal death. ‘You cannot die from a pregnancy you don’t have’. India being the second populous, to combat unmet need is a national emergency, and post abortal counselling is an effective tool. Aim: This prospective observational study was conducted to assess the impact of post abortal contraception counselling and to determine the acceptability of concurrent contraception. Material and Method: All258 women who had abortion and who had been provided post abortion counselling between October 2007 and September 2009 were the main source of study. The women were enquired about any contraception use and compliance, before abortion. Following post abortion counselling, the number of women who accepted to use contraception in the immediate post abortal period were determined. Women who accepted concurrent contraception were followed up by phone call 5months later, with emphasis on practices towards contraception and perseverance. Statistical data: Calculated by simple percentage, p value, odds ratio. Result: Following post abortal counselling the contraceptive acceptance increased remarkably by 74.2% and use of modern method increased by 2 fold (79.5% compared to 29.2 % prior counselling). Extended follow up after 5 months showed that women persevered with contraceptive usage when it was initiated in the immediate in the post abortal period (p 0.0). 10.3 % discontinued in the interval period. Besides increase awareness in multiparous (76%), unplanned pregnancy was high (76.48%) due to poor compliance (41.76%) and the rest of patients discontinued due to fear of side effects and myth about contraception. In my study education and socio-economic class did not significantly affect the acceptability of contraception (p 0.239, p 0.730). Conclusion: Women having had an unplanned pregnancy and abortion is anxious to avoid repeating it again and also more receptive. Hence post abortion period is an opportune time for health professionals to have a major impact on reproductive health outcomes.

242-245

Authors: Swati Agrawal, Veena Agrawal, Sunita Yadav

Background: Amniotic fluid is an indicator of placental function on the fetal development. The amniotic fluid index is the most commonly used method of measuring amniotic fluid. Objective: The purpose of this study was to study amniotic fluid index in normal and high risk pregnancy (PIH) at term (37-40 weeks) and to correlate amniotic fluid index with foetal outcome. Materials and Methods: The present study of assessment of Amniotic Fluid Index in high risk cases of pregnancy was carried out in the Department of Obstetrics and Gynaecology, Gajra Raja Medical College, Gwalior. The ultrasonic examination was performed in the radio diagnosis department of Gajra Raja Medical College, Gwalior. This comparative study was carried out on total 200 patients admitted to Kamla Raja Hospital from July 2006 to March 2007. Scans were performed from 37 weeks to 40 weeks earlier if indicated. Results: This study showed that maximum numbers of cases admitted in both the groups were ranged between 37-39 weeks of gestational age. It was also seen that maximum patients in high risk (100) and control (100) groups were in 21-30 years age and minimum patients belong to age group > 37 years. Most of the patients were from antenatal clinic, 60 patients in control group and all 100 patients in PIH group attended antenatal clinic regularly. It was also seen in both groups that maximum patients were primigravida (40.5%). The amniotic fluid volume as measured by amniotic fluid index was within normal limits (86%) in low risk group patients. Incidence of congenital anomaly in high risk group was 20% and with oligohydramnios was 7.41%. We found one case of renal agenesis and one of multiple anomalies with oligohydramnios, also incidence of IUGR was very high in both groups. Conclusion: This study showed that, amniotic fluid volume estimation by ultrasonography is a good method of estimation of foetal wellbeing. Amniotic fluid volume is altered in high risk (PIH) pregnancies; it reflects intrauterine growth retardation and congenital malformations in few cases.

250-254

Authors: Kavita Sambharam, Anand Bhalerao

Objective: To study the associated factors for the development of urinary problems in post-menopausal women and the appropriate investigations, management and regular follow up of such cases. Methods: A total 121 post-menopausal women with urinary symptoms attending the gynaecology OPD as well as in patients were enrolled in the study. These patients were studied and evaluated based on history, clinical examination, investigation and follow up. The data was then subjected to statistical analysis and conclusions were drawn. Results: Burning micturition was the most common urinary symptom in the present study, seen in 85.12% post-menopausal women followed by urinary frequency (59.50%), urinary incontinence (28.92%), urinary urgency (27.27%) and mass per vaginum (25.61%). Escherichia Coli was the most common organism found in 45 post-menopausal women on urine culture and sensitivity. Local estrogen therapy provided relief of symptoms more than those who did not receive any local estrogen therapy. Conclusion: In modern era, a woman spends almost 1/3rd of her life is the in post-menopausal age group. Hence we need to concentrate on the various health aspects of menopause including urinary problems. As shown in this study, most of these problems can be treated medically, though few may require surgical treatment.

261-263

Authors: T.Vijaya Krishna, Archana Singh, M.Sumina, H.Anupama

Objectives: To compare the changes in lipid profile in women with pre-eclampsia to normotensive pregnant women. Method: This prospective observational study conducted in 300 patients, 150 being normotensive pregnant women and 150 hypertensive pregnant women. Lipid profile was estimated and compared. Results: There is a significant increase in triglycerides, total cholesterol, LDL & VLDL in the cases group but no significant difference in HDL between both groups. Conclusion: Pregnancy is associated with physiological hyperlipidemia. But abnormal increase in triglycerides, total cholesterol, LDL & VLDL could contribute to promotion of oxidative stress and vascular injury leading to pre-eclampsia.

270-275

Authors: Pavithra.I, Sheila.K.Pillai, Jaya Vijayaraghavan

Background and objectives: Gestational Diabetes Mellitus is an important medical disorder in pregnancy which is amenable to treatment thereby improving the maternal and neonatal morbidities to a great extent. Insulin has been the gold standard for management of GDM but has many demerits as far as patient acceptance and compliance are concerned. Oral hypoglycemic agents if proven safe can revolutionise the treatment of GDM. The present study aims to compare the efficacy of insulin and glibenclamide in the treatment of GDM and also to analyse the maternal and neonatal outcomes. Methods: It is a prospective observational study carried out in our institution. 100 antenatal patients diagnosed as GDM by standard criteria were recruited and randomized to two study arms of 50 each. Group A was started on insulin and Group B was started on glibenclamide upto a maximum dose of 20 mg per day. Capillary blood glucose levels were monitored and patients were followed up till delivery and neonatal outcomes also were analysed. Results: One week after starting treatment 72% of Group A and 68% of Group B achieved target levels of blood glucose and the difference was not statistically different. Before delivery 88% in Group A and 86% in Group B had values within normal range. The reduction in fasting blood glucose levels in glibenclamide group before delivery was statistically significant. The incidence of maternal and neonatal morbidities was comparable in both the groups.8% of patients had treatment failure with glibenclamide and were switched over to insulin. Conclusion: Glibenclamide appears to be an effective treatment agent in GDM with maternal and neonatal outcomes comparable with insulin. Studies involving more number of patients are still needed before glibenclamide can be considered as an effective alternative to insulin.

283-288

Authors: Manish R Pandya, Zeel V Gajera, Ravi R Vachhani

Obstetrics & Gynaecology is the medical and surgical specialty that focuses on the research prospectus of reproductive system in females.Indian Journal of Obstetrics and Gynaecology Research is a peer-reviewed journal that publishes articles on all aspects of basic and clinical research in the fields of obstetrics and gynaecology and related subjects, with emphasis on matters of worldwide interest. The journal publishes invited and submitted reviews and original articles about clinical topics and basic research; case reports; and preliminary communications from all sub-specialties in gynaecology and obstetrics.

294-296

Authors: Maya Menon, T. A. Sridevi

Moyamoya disease is a rare cerebrovascular occlusive disorder characterised by bilateral stenosis of terminal portion of the internal carotid artery near circle of Willis.This is a case of 28 yrs primigravida diagnosed as childhood stroke secondary to Moyamoya disease with left hemiparesis on antiepileptic drugs booked under combined care of obstetrician and neurologist was started on anticoagulant along with iron, calcium and folic acid. Antenatal period was uneventful. Patient had spontaneous on set of labour and had a assisted vaginal (vacuum) delivery, alive female baby was delivered with Apgar score of 8/10. Care was taken to avoid dehydration and hypotension during the peripartum period. There are no prospective trials that address the safest mode of delivery for women with MMD. Pregnant patient should be counselled about the risk and potential benefit of medical and surgical treatment and managed by multidisciplinary team of obstetrician, neurologist, neurosurgeon and anesthesiologist.

127-131

Authors: Ravinder Pal Singh, Megha Pravin Khobragade, Anil Kumar, Achhelal Ramashankar Pasi

Background: decreasing sex ratio is an issue of major concern in India and has long-term social and demographic consequences. A community based cross-sectional study was conducted to explore the reasons and perceptions of people regarding decreasing sex ratio and gender inequalities. Objectives: to assess the knowledge, attitude and practices regarding gender preference, gender inequality and female infanticide. Material and Methods: study was conducted in 30 villages of Kathua district of Jammu & Kashmir. Study participants were eligible couples of the selected villages. Villages and study participants were selected by systematic random sampling. Data on knowledge, attitude and practice was collected using a standard questionnaire. Results: out of 300 couples 30% were illiterate. Overall 70% & 66% of the couples were aware of the decreasing sex ratio & its social consequences respectively. Though 75% of the respondents knew that sex determination is a crime, 17% reported that they would go for prenatal determination of sex and 11% of women were in favor of doing female feticide. A total of 79% couples reported preference for son. Antenatal USG was conducted in 60% of pregnancies, 61% of women reported to have experienced family pressure for son and 31% sought divine intervention to have son. Conclusion: over all study population had good knowledge of declining sex ratio, its social consequences and illegality of prenatal sex determination including female infanticide. Prenatal sex determination and female feticide was not preferred by majority of the study population. Most of the couples had perceived preference for son and majority had faced family pressure for the same. Recommendations: strengthening the ongoing IEC and BCC activities to promote gender equalities in the rural part of northern India. Implementation of policies & programs for overall development of girls. Keywords: sex determination, gender preference, gender inequalities, female infanticide, Jammu & Kashmir

137-148

Authors: K.Ramalingam, Devisrimurari, Mounica. Bollu, Shaik. Faizan Ali

Background: Gestational diabetes is associated with significant metabolic alterations, increased maternal and perinatal morbidity and mortality. Indians fall into high risk ethnic group for diabetes mellitus. Objectives: The objective of this study is early detection and treatment of gestational diabetes mellitus(GDM) in pregnant women and to assess perinatal outcome in a well controlled and poorly controlled gestational diabetes mellitus patients. Materials and Methods: Sample: All pregnant women attending to outpatient department in obstetrics and gynaecology department at NRI medical college hospital in Chinakakani Guntur(Dt) universally screened for GDM in all three trimesters. Methods: single step oral glucose tolerance test(OGTT) with 75 grams glucose. This test is performed by asking the patient to come with overnight fasting. after collecting fasting venous sample from patient, solution made of 75 grams glucose mixed with 150 ml water is given. patients with fasting plasma glucose value ≥90 mg/dl and 2nd hour plasma glucose value≥140mg/dl are diagnosed to have gestational diabetes. Results: Out of 71 pregnant women diagnosed as GDM, the commonest risk factors are age≥25 years(61.9%),followed by past history of abortion(33.8%), obesity(32.39%), overweight(32.39%), past history of GDM(16.9%), family history of diabetes to mother(22.5%),father(19.7%),both parents(4.2%). 9.8% of GDM patients were diagnosed ≤ 12 weeks, 61.9% between 13-28 weeks,22.5% between 29-34 weeks and 5.6%≥35 weeks. OGTT was carried out in all three trimesters for all antenatal women, so that GDM cases diagnosed in late weeks of gestation are not missed.GDM patients were followed up with 75 grams OGTT after 6 weeks, and 16.9% of women were positive for the test. Conclusion: Single step OGTT with 75 grams glucose with cut-off values of fasting plasma sugar≥90mg/dl and 2nd hour plasma sugar≥140 mg/dl is very useful in diagnosing GDM. Universal screening for GDM is superior to selective screening(based on risk factors) for detecting more cases, facilitating early diagnosis and treatment of a disorder that carries an adverse prognosis in antenatal women with no symptoms of GDM. The criteria recommended by WHO are simple and cost effective and it is practised in many centres. Further assuming that effective treatment is available, WHO criteria of 2nd hour plasma sugar levels≥140mg is useful in identifying a large number of cases and may have greater potential for prevention.one step procedure of WHO serves dual purpose for screening and diagnosis

155-158

Authors: Savita Rani Singhal, Veenu Kadian2, Sunita Singh, Veena Singh Ghalaut

Background: To compare the efficacy and side effects of ferrous sulphate, fumarate, ascorbate, sodium feredetate and ferrous bisglycinate in the treatment of iron deficiency anemia in pregnancy. Material and methods: The study is a prospective, randomized, comparative clinical study comprising of 250 antenatal women with hemoglobin between 7-10 gm %. The patients divided into five groups I, II,III,IV and IV of fifty each, by systematic randomization and were treated with ferrous sulphate (100mg), ferrous fumarate (100mg), ferrous ascorbate (100mg), ferrous bisglycinate (30 mg), sodium feredetate (33 mg) respectively. Hemoglobin estimation was done at day 0, 30 and 60 and serum ferritin levels were done on day 0 and 60. Results: There was significant and comparable rise in hemoglobin on day 30 and day 60 in all the five groups (p<0.001). Ferrous ascorbate and ferrous bisglycinate showed significantly (p<0.05) more rise as compared to ferrous sulphate. Maximum side effects were with ferrous fumarate (51) followed by ferrous sulphate (40), ferrous bisgylycinate (26), ascorbate (18) and sodium feredetate (10). Conclusion: Ferrous ascorbate and bisglycinate are more effective than ferrous sulphate in treatment of iron deficiency anemia in pregnancy. Sodium feredetate had minimum side effects. Keywords: Ferrous ascorbate, Ferrous bisglycinate, Ferrous fumarate, Ferrous sulphate, Sodium feredetate, Anemia, Pregnancy

163-168

Authors: Mital Joshi, Sirimavo Nair

Objective: The study was designed to determine the prevalence of menopausal symptoms during menopausal transition in middle age (30-60 years) women in Vadodara (N=1000). Method: They were interviewed by means of standard Menopause Rating Scale questionnaire (MRS) to report on the menopausal symptoms which were divided into somatic, psychological and urog. A predesigned questionnaire was used to assess their knowledge associated with menopause along with self-reported health profile. Results: The mean age of the study population was 42 + 5.1; where mean age of premenopausal group was 40.07 + 3.79, peri menopausal group was 41.72 + 4.28 and post-menopausal group was 46.4 + 5.32. The women reported pain in hands or legs as the most prevalent symptom (73.6%), followed by anxiety (67.4%), physical and mental exhaustion (66.8%). Other symptoms like dryness of vagina (48.5%), heart discomfort (45%), mood swings (35.5%) and irritability (32.8%) were reported by nearly half of the population. Severity of symptoms were observed for anxiety (2.7%), heart discomfort (2.3%), sleep disturbances (2.3%), bladder problems (2.1%). The mean total MRS was found to be rising up during transition from premenopause (4.60 + 3.07) to perimenopause (6.53 + 3.93) and showed a decline during transition from perimenopause to postmenopause (5.78 + 3.03). Amongst the three subscales of MRS, the mean of the Psychological domain (2.59 + 1.91) was higher followed by somatic symptoms (2.03 + 1.54) and least by the urogenital symptoms (0.92 + 0.99). A similar trend was observed during all stages of reproductive life, i.e. premenopausal, perimenopausal or postmenopausal (p<0.001) in these subjects. Knowledge of participants regarding the menopause and related health issues was very poor. Conclusion: The study concluded that, the time span between different menopausal transitions are very short and clashes with the time when a woman is already barring the highest degree of family responsibilities in her life. Therefore this raises a call for measuring and improving health- related quality of life of women during transition stages

174-175

Authors: Kartikey R. Shastri, Nalini I. Anand, Bhakti M. Ganatra

Obstetrics & Gynaecology is the medical and surgical specialty that focuses on the research prospectus of reproductive system in females.Indian Journal of Obstetrics and Gynaecology Research is a peer-reviewed journal that publishes articles on all aspects of basic and clinical research in the fields of obstetrics and gynaecology and related subjects, with emphasis on matters of worldwide interest. The journal publishes invited and submitted reviews and original articles about clinical topics and basic research; case reports; and preliminary communications from all sub-specialties in gynaecology and obstetrics. IJOGR publishes original research work in all relevant areas of reproduction, contraception, obstetrics and gynaecology that include reproductive endocrinology, reproductive physiology, assisted reproductive technologies, cloning, environmental effects on reproductive health, infertility, family planning, sexual health, obstetrics, prenatal diagnosis, maternal-fetal medicine, midwifery, perinatology, gynecological urology, gynecological oncology, gynecological endocrinology, general gynaecology and menopause.

179-184

Authors: Rakhee R Sahu, Anjali Sonawane

Obstetrics & Gynaecology is the medical and surgical specialty that focuses on the research prospectus of reproductive system in females.Indian Journal of Obstetrics and Gynaecology Research is a peer-reviewed journal that publishes articles on all aspects of basic and clinical research in the fields of obstetrics and gynaecology and related subjects, with emphasis on matters of worldwide interest. The journal publishes invited and submitted reviews and original articles about clinical topics and basic research; case reports; and preliminary communications from all sub-specialties in gynaecology and obstetrics. IJOGR publishes original research work in all relevant areas of reproduction, contraception, obstetrics and gynaecology that include reproductive endocrinology, reproductive physiology, assisted reproductive technologies, cloning, environmental effects on reproductive health, infertility, family planning, sexual health, obstetrics, prenatal diagnosis, maternal-fetal medicine, midwifery, perinatology, gynecological urology, gynecological oncology, gynecological endocrinology, general gynaecology and menopause.

188-190

Authors: Gangadhara Rao Koneru, Rekha Prabhu, Hema Gayatrhi A, Haritha P, Prabha Devi Kodey

Psoas Abscess is a rare association with pregnancy. A 24 years old primi gravida with term pregnancy presented with PROM, oligo hydramnios, fever, tachycardia and inability to move both lower limbs. On examination, membranes were intact, there was bleeding PV with excess vaginal discharge. There was foetal tachycardia (180/min). To exclude abruptio ultrasound was done. Intra Uterine Death was diagnosed. That time patient was in early labour which was accelerated with syntocinon. Suddenly she became hypoxic and was ventilated. She delivered a stillborn baby. In the puerperial period patient suffered fever for more than a month. As fever was not controlled for long period (one month) CT was done which showed hypodense areas in right psoas muscle. CT guided Percutenous drainage was failed. By MRI investigation, it was diagnosed as multiple abscesses with sacro illitis and was drained extra peritoneally. As fever is not controlled with broad spectrum antibiotics, montox skin was done which was strongly positive. Hence treatment with anti tuberculosis drugs was planned. Finally fever was controlled by antituberculosis drugs ISONIAZID 300 mg/day, REFAMYCIN 600 mg/day, ETHAMBUTOL 800mg/day, Inj. STREPTOMYCIN 1 gm/day as a thereuptic trail.

198-201

Authors: Joylene D’Almeida, Prashanth Hegde, Sujaya V Rao

Cervical ectopic pregnancy is defined as the implantation of an ectopic pregnancy in the cervix. The actual incidence is < 1%. Though rare, it requires a strong degree of clinical suspicion combined with ultrasound evidence to arrive at the diagnosis. The management of a cervical ectopic includes medical and surgical options. Medical options include using durgs like methotrexate and etoposide. Surgical options primarily include curettage and tamponade. Hemorrhage is a dreaded complication of a cervical ectopic and a torrential haemorrhage warrants an emergency hysterectomy.