Indian Journal of Obstetrics and Gynecology Research

59-61

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

Objectives: This study was carried out to study the incidence of DIC in various obstetric conditions and to study the role of component therapy and its effects on the deranged coagulation profile and maternal outcome in patients with deranged coagulation profile. Materials and Methods: An observational retrospective study design was selected for this study. A total of 100 cases that had presented to labour room of our hospital between January 2013 and January 2014 with deranged coagulation profile were studied for improvement in maternal outcome after giving component therapy. All the antenatal women admitted and having alteration in any of the following laboratory parameters were included in the study (Hb, Platelet, PT, INR, aPTT, Sr. fibrinogen). Patients having jaundice due to obstetric condition (excluding any infective etiology like hepatitis or other hepatic conditions) were included. Any patient having just altered hemoglobin suggestive of anemia and transfused with red cell concentrate for the same were excluded. Any patients with medical condition like ITP, SLE, and Dengue etc. that can alter coagulation profile were excluded. Results: 21 patients tested positive for D- dimer i.e. 21 patients had DIC among 100 patients with deranged coagulation profile during study period. Incidence of DIC in our study was 0.002%. Out of patients with DIC, 42.85% had IUFD, 42.85% severe pre-eclampsia, 30.49% abruptio placenta, 19.04% eclampsia and 14.28% had PPH. Incidence of DIC in PPH- 60%, abruptio placenta 23.07%, severe pre-eclampsia 23.07%, eclampsia 22.22% and 20.8% in IUFD.

65-68

Authors: Reema Sircar, Geetanjali Pawar

Objective: To determine the frequency, causes and outcome of liver disease in pregnant women. Setting: Tertiary care teaching hospital. Method(s): All pregnant women with liver disease attending the inpatient or outpatient services of the Department of Obstetrics and Gynecology over a period of 3 years were evaluated and followed up till delivery or death. Results: The study included 40 patients of Cholestatic jaundice, 38 patients of viral hepatitis, 15 patients of sepsis, 5 patients of HELLP syndrome and 1 patient each of hyperemesis gravidarum, amoebic abscess, enteric hepatitis & acute cholecystitis with pancreatitis. Intra hepatic cholestasis of pregnancy was the most common and least detrimental cause of liver disease in pregnancy. Number of preterm deliveries and incidence of LSCS was highest with HELLP Syndrome. ICU admissions were maximum with diagnosis of Hepatitis E and NICU admissions highest with HELLP Syndrome. Both HELLP Syndrome and Hepatitis E were responsible for maximum maternal and perinatal deaths. Conclusions: Liver disease in a pregnant woman needs to be treated with caution.

73-91

Authors: Manish R. Pandya, Dharmesh K. Golwala, Kalpana Khandheria

Background: To evaluate the clinical efficacy and safety effect of Ovaryl tablet a marketed herbal formulation of Mercury Laboratories Ltd., in Poly cystic Ovarian Syndrome. Methods: 58 women patients’ age range between 20 to 40 years, suffering from Poly cystic Ovarian Syndrome symptoms like hirsutism, irregular periods, ovulation, volume of ovary, weight and serum insulin levels. Results: A significant improvement was observed in clinical symptoms like hirsutism, irregular periods and ovulation after MOT medication.Laboratory investigation showed decrease in Serum Insulin levels. A minimum decrease of 2.87% and 36.73% maximum decrease of serum insulin levels were observed on 90th day of MOT treatment. 22.06% maximum and 1.55% minimum decrease of ovary volume in Right Ovary. 24.39% maximum and 1.37% minimum decrease of ovary volume in Left Ovary was observed. Upper Abdomen USG was normal in all the 58 patients, no cyst was reported. Conclusion: Poly cystic Ovarian Syndrome symptoms like hirsutism, irregular periods, ovulation, and volume of ovary, weight and serum insulin levels were taken care off.

97-100

Authors: Seema Sharma, Manju Maheshwari, Shubhra Gupta

Objective: To study the role of uterine artery notch on color Doppler ultrasound in prediction of PIH. Methods: This observational prospective longitudinal study was conducted in Department of Obstetrics and Gynaecology Mahatma Gandhi Medical College and Hospital, Jaipur. Study sample comprised of 100 antenatal patients with 20-28 weeks of gestation attending OPD of Department of Obstetrics and Gynaecology Mahatma Gandhi Medical College and Hospital, Jaipur from august 2013-14 and studied for the presence of Doppler changes during antenatal period. Results: The primary outcome was that uterine diastolic notch shows sensitivity 60%, specificity 100%, PPV 100 % and NPV 85.37% in predicting PIH. Conclusion: After analysing all the results, it has been concluded that uterine artery Doppler notching is good predictor for PIH.

103-107

Authors: Anushree. D. Patil, Sushil K Shinde, Geetanjali M. Sachdeva, Achhelal R. Pasi, Shanta M. Chitlange,

Introduction: Diagnosis of endometrial tuberculosis is often carried out by using commercially available molecular diagnostic tests on endometrial biopsy samples and menstrual blood samples of infertile women in many infertility clinics. Aim: To determine whether menstrual blood is a good alternative sample for diagnosis of endometrial tuberculosis. Methods: Women (n=123) presenting with infertility were investigated for endometrial tuberculosis by testing menstrual blood samples as well as endometrial aspirates with GEN-PROBE AMPLIFIED Mycobacterium Tuberculosis Direct (MTD) test which is a Nucleic Acid Amplification Test (NAAT) and VersaTREK culture. Results of the two tests for detection of M. Tuberculosis were compared in menstrual blood and endometrial aspirate samples. Results: Out of 123 menstrual blood samples tested M. tuberculosis was detected by culture in only 0.8 per cent of women. Mycobacterium other than Tuberculosis (MOTT) was detected in 2.43 per cent samples of menstrual blood on culture reports and was identified to be Mycobacterium inter medium. Conclusion: Menstrual blood was not found as a good alternative sample for diagnosis of endometrial tuberculosis. Results of MTD tests on menstrual blood sample for diagnosis and management of endometrial tuberculosis (as is widely used in infertility clinics) should be interpreted with caution. Pathological significance of Mycobacterium inter medium in female infertility, though a possible contaminant, needs further research.

117-119

Authors: Prashant Joshi, Linthoi Rajakumari

Intrauterine contraceptive device has been widely used and is commonly used as contraception in developing countries due to lower failure rate and the cheap cost with millions of women using it worldwide. The case report shows a missing Cu-T found in the abdominal cavity with its vertical stem penetrating into the rectum in a 20year old woman. Laparotomy with closure of rectal injury and uterine perforation with retrieval of the Cu-T was successfully done.

123-126

Authors: Mehul A Sangani, Manish R Pandya

The death of a formed fetus is one of the most emotionally devastating events for parents and clinicians. It is psychological and emotional shock to parents when they know that their baby has suddenly died in utero. Aims and Objectives: To know the causes of IUD and determine the risk factors and minimize the complications of IUD and maternal morbidity and mortality. Method: A prospective study was done to study 110 cases of IUD. On admission, patient's detailed history was taken, examination, investigations and ultrasonography was done and the case was managed accordingly. Results: A total 110 cases of IUD were studied over one year in our institute. Out of them 70 had not taken any antenatal visits, 96 patients were aged below 30 years, 11 patients were aged between 31 to 35 years and 3 patients above 35 years. 56 were primigravida, 40 were second gravida and 14 were multigravida. Of 28 cases causes were unknown, 18 cases had abruptions, 8 cases had PIH, 15 cases had preeclampsia, 11 cases had eclampsia, 12 had cord accidents, 3 had oligohydraminos, 2 had jaundice, 1 had rupture uterus and 8 patients had congenital anomaly. 28 patients delivered spontaneously, 75 delivered by induction of labor and 7 patients required caesarean section. 5 patients developed PPH and 7 patients developed DIC.

1-6

Authors: Chandrakant Madkar, Jayalakshmi Musale, Hemant Deshpande, Rajendra Shitole

Objective: The placenta weight/birth weight (PW/BW) ratio has been shown to be associated with certain long-term fetal outcomes; however, its association with short-term outcomes has not been evaluated. Our aim was to assess the correlation between the PW/BW ratio and short-term adverse obstetrics outcomes in full-term, appropriate-for-gestational-age (AGA) newborns. Design: Prospective, randomized. Setting: Dr. D.Y. Patil Medical College & Hospital, Pimpri, Pune Methods: In our study, three groups of full-term neonates have been taken, according to their PW/BW ratio (high, normal and low) and are compared. Our primary outcome includes the admission rate to the neonatal intensive care unit (NICU) and secondary outcomes included an Apgar score < 7 at 5 minutes. Results: Our study showed that the high PW/BW ratio group was associated with increased rates of admission to the NICU and Apgar scores < 7 at 5 minutes as compared to normal PW/BW ratio. The low PW/BW ratio group showed decreased rates of NICU admission. A high PW/BW ratio is significantly correlated with short-term adverse perinatal outcomes. Conclusion: The possibility of short term health risks for newborns can be predicted by the PW/BW ratio.

11-15

Authors: Khan Arshiya, Saxena Shivi

Introduction: Gestational Diabetes Mellitus (GDM) has public health importance far beyond its immediate effect on the mother and child. Pregnancy is a diabetogenic state and GDM is a major driver of the Type 2 diabetes epidemic. About 1% - 3% of all pregnant women will show glucose intolerance. GDM is the most common metabolic complication that affects pregnant women. The frequency of GDM and its associated maternal, prenatal and long term morbidity emphasizes the importance of screening method. Aim: To study the role of 50 gm glucose challenge test for screening of gestational diabetes Method: Two hundred and fifty antenatal patients between 24-28 weeks of gestation were screened for gestational diabetes by 50 gm oral glucose challenge test. Those in whom plasma glucose was 130 gm /dl or higher were considered positive and then subjected to Glucose tolerance test (GTT 100 gm: 3 hour). Those with risk factors but negative GCT at 24-28 weeks were again screened at 32 –34 weeks. Comparison was made among normal patients and patients diagnosed with gestational diabetes regarding risk factors, clinical examination, routine and special investigations and pregnancy outcome Results: Out of 250 patients 150 had no risk factors while 100 had one or more risk factors. 10 patients (4%) were diagnosed as having gestational diabetes. 8 patients were detected at 24-28 weeks and 2 were detected from the risk factor group at 32-34 weeks. Conclusion: Universal screening of all pregnant patients during 24-28 weeks with glucose challenge test is simple, convenient, cheap and easy to organize instrument to identify women with GDM. In India we recommend universal screening of all pregnant women, as they have 11 fold increased risk of developing glucose intolerance during pregnancy compared to Caucasian women.

28-35

Authors: Neha Palo Chandel, Vidya V Bhat, R S Bhat, Sidharth S Chandel

Introduction: Heavy Menstrual Bleeding is a major factor affecting the quality of life and work performance in the perimenopausal women. In a country like India, especially in the rural settings, females hesitate to report to clinicians for gynecological problems like HMB, which affect their life significantly. And even if they do report, they are made to undergo unnecessary hysterectomies, despite there being alternative methods to manage such conditions. Methods: We initiated a prospective therapeutic study from July 2012 to July 2014, where we screened 2106 patients with menorrhagia to study the role of TCRE in these patients, 179 patients fulfilled the inclusion criteria, gave consent and were operated with TCRE to study its outcomes. These patients were cases of Mirena failure or those not willing for Mirena, histopathological diagnosis of simple hyperplasia as well as cystoglandular hyperplasia and especially the poor-follow up cases and rural patients with HMB. Results: TCRE has success rate of 85.5% as assessed by the patients’ satisfaction after the procedure and improvement in their bleeding pattern.11.2% reported with recurrence of menorrhagia, out of which 7.3% received exogenous progesterone therapy later, and were relieved with it, while 3.9% underwent a hysterectomy as the last resort. Haematometra was observed post–operatively in 3 cases(1.7%), Fluid overload was observed in 2 cases(1.1%) and ‘False- passage’ was encountered in 1 case (0.5%), where the procedure was abandoned and was performed after a month. Conclusion: Hysteroscopic TCRE is an effective modality, avoids unnecessary hysterectomy in the perimenopausal women and allows early return to work. The cost-effectiveness, improved quality of life and work performance provides TCRE an edge over the ‘conventional’ hysterectomy.

39-42

Authors: Prashant Joshi, Raksha Madhu

A 40 year old lady P3L3 tubectomised, presented to us in routine gynaec OPD with complaints of mass per vagina since 2 years. Patient is a known case of HTN & DM on treatment. On examination, moderately built and nourished lady, on per speculum examination second degree uterine descent with cystocele, on bimanual examination uterus retroverted, mobile, atrophic, bilateral fornices free, cervical mobility non tender. On ultrasound uterus is retroverted, postmenopausal status, ovaries normal. Impression – prolapsed uterus. Patient underwent Vaginal Hysterectomy with cystocele repair. Intraoperatively, we found a cyst 7Χ7 cm arising from the uterine fundus, cyst containing serous fluid, no continuity with endometrial cavity with congested blood vessels seen on the inner surface. Uterus, tubes and ovaries was normal. Histological examination showed cyst arising from serosal surface of uterine fundus, uniloculated. One of the cut sections of the cyst showed fallopian tubal epithelium embedded in the cyst wall. Uterine endometrium shows senile cystic atrophy and cervix shows chronic polypoidal endocervicitis. A diagnosis of “Cystic Endosalpingosis of the uterus” was made. The case is reported because of its great rarity and difficult diagnosis.

46-49

Authors: Kamal Singh, Sita Thakur, Monika Sharma

Ovarian torsion is an infrequent diagnosis in the paediatric age group but can be catastrophe especially if ovarian salvage is not possible. The clinical picture is nonspecific, and children cannot always articulate their symptoms, which often make the diagnosis a challenge. Because of its nonspecific manifestations, torsion has been confused with other conditions, such as appendicitis. Due to this cases often reported late, as in our case. A 7 yr old Fch presented with acute abdomen after two days. Imaging shows left adnexal mass with doubtful vascularity. So exploratory laparotomy followed by left salpingoopherectomy performed. We are reporting this case, as left sided ovarian torsion is a rare presentation of adnexal torsion in this age group.

56-58

Authors: Savita Rani Singhal, Deepmala Mittal

Nuchal cords at term are present in 15 to 34% of births for single loop and 5-6% for multiple nuchal cords. Despite the good prognosis in most of the cases, nuchal cord is associated with variable fetal heart rate deceleration, decreased fetal movements, fetal distress, and intrauterine fetal demise in few cases. Diagnosis of nuchal cord is by colour doppler which has senstivity of 60%- 95%. Multiple nuchal cord, especially four or more loops, demands special care due to the risk of intermittent cord compression. We present a rare case of gravid four para three woman, in which intra uterine death (IUD) occurred due to the six tight loops of cord around neck, which was not detected in the antenatal period.

1-11

Authors: Manish R. Pandya, Dharmesh K. Golwala.

Background: To evaluate the clinical efficacy and safety effect of Zanopause tablet a marketed herbal formulation of Emami Ltd., in pre-menopausal and menopausal women Methods: 50 women patients age range between 40 to 70 years old suffering from pre-menopausal and menopausal symptoms like hot flashes, night sweats, irregular periods, loss of libido, vaginal dryness and mood swings. Zanopause tablet was given twice a day for 60 days. Results: A significant improvement was observed in clinical symptoms like hot flashes, night sweats, irregularity of periods, loss of libido, vaginal dryness and mood swings after ZZT medication. Laboratory investigation showed improved Haemotological levels in all the patients. Other parameters were observed in normal range. On ‘0th’ day 7.6 - 14.1 (G %), 8.1 – 14.7 (G %) on 45th day and 8.7 – 15.2 (G %) on 60th day. ZZT medication showed a significant increase in Haemoglobin level of patients. 5200 - 9900 (/cu.mm.) on ‘0th’ day, 5600 - 1100 (/ cu.mm.) on 45th day and 4.01-5800 - 9700 (/ cu.mm.) on 60th day, WBC count was observed in normal range, from the data obtained from blood samples of 50 patients. Upper Abdomen USG was normal in all the 50 patients. Conclusion: Menopause symptoms like hot flashes, night sweats, irregularity of periods, loss of libido, vaginal dryness were taken care off. Increase in Haemoglobin levels and status of wellbeing. Reduce pain in knee joints were observed.

16-24

Authors: Gupta Monika, Srivastava Shilpi, Khan Sohrab A.

Introduction: There is very little information about the pregnancy related lumbo-pelvic pain and pregnancy related pelvic girdle pain (PPGP) in Asian countries, particularly in India. Most of the information about these pains has been obtained European countries. Objective: To find out the prevalence of lumbopelvic pain and pregnancy related pelvic girdle pain (PPGP) in Indian primigravida. Methods: A hospital based observational cross-section study including 227 primigravida who were interviewed for demographic data. Those who complained of lumbopelvic pain were assessed for the diagnostic criteria for PPGP. Results: A total of 137 primigravida (60.3%) reported lumbopelvic pain. Based on the diagnostic criteria, 68 women (29.9%) had PPGP and 69 had combined pain (PPGP + PLBP and PLBP). The mean intensity of pain in women with lumbopelvic pain using the visual analogue scale was 5.2 ±1.0 and PPGP was 5.5± 0.7. Conclusions: More than half of the pregnant women studied experienced lumbopelvic pain at the time of examination which shows that about 1 in every 2 primigravida had lumbopelvic pain. PPGP and combined pain (PPGP+PLBP) both are almost equally prevalent and need clinical attention.

31-42

Authors: Dr. Vinita Singh.

Chromosomal abnormalities occur in 0.1% to 0.2% of live births; Trisomy 21 (Down syndrome) is the most common karyotype abnormality in live-born infants (1 per 800 live births. Trisomy 21 is the most common genetic cause of mental retardation and one of the few aneuploidies compatible with post-natal survival. The vast majority of meiotic errors leading to the trisomic condition occur in the egg, as nearly 90% of cases involve an additional maternal chromosome. The severity of each of the phenotypic features is highly variable among the patients. Besides mental retardation, present in every individual with Down syndrome (DS), Trisomy 21 is associated with more than 80 clinical traits including congenital heart disease, duodenal stenosis or atresia, imperforate anus, Hirschprung disease, muscle hypotonia, immune system deficiencies, increased risk of childhood leukemia and early onset Alzheimer's disease. The rapid changes in prenatal screening and diagnostic techniques bring new challenges Developments in Trisomy 21 (Down syndrome) screening have sought to increase sensitivity and specificity of screening tests.Various methods have been used to identify women at risk of carrying a fetus with Trisomy 21, including consideration of maternal age, biochemical markers, amniocentesis and prenatal ultrasound. This article reviews the literature on prenatal screening for Down’s syndrome which is evidence based and this extensive literature examines how appropriate widely-held understandings of Down’s syndrome are, and asks whether or not practitioners and prospective parents have access to the full range screening and diagnostic test and keeping in account moral, ethical, social &financial milieu of the region and from the point of view of a regional foetal medicine unit. From the point of view of the individual woman, this means that if she chooses to participate in screening, she will have a high chance of detection of Down syndrome, and a low chance that a subsequent invasive diagnostic test will be recommended when her baby is unaffected, since invasive testing carries a low but measurable risk of foetal death.