Introduction :Recurrent pregnancy losses (RPLs) are seen in up to 15–20% of all clinically recognized pregnancies, 1–2% of women in general population. Repeated losses are seen in 5–10% of women. The prevalence of chromosomal rearrangements is 6.65% in couples with repeated pregnancy losses. Two to 4% of RPL are associated with parental balanced reciprocal and Robertsonian translocations.
Materials and Methods :The study was conducted at a tertiary care hospital in New Delhi, and in total, 204 couples with RPL enrolled in the study.
ResultsIn total, 4490 couples presented to the obstetric clinic, of which 204 (4.5%) couples had repeated pregnancy losses. Cytogenetic analysis was done in 198 couples. Out of total 198 patients, 14 patients (7.1%) had cytogenetic alterations. Most common aberrations observed were structural rearrangements, of which reciprocal translocations were more common. In our study cohort, all the couples had maternal age of ≤ 35 years and all the alterations were seen either in mother or in both parents.
Discussion: Our study highlights that cytogenetic alterations not only are common in first trimester miscarriages, but are an important event in miscarriages presenting at later period of gestation and in young mothers as well.
Keywords Robertsonian translocations · Balanced translocations · Unbalanced translocations · Miscarriage
Objectives : To find out the relative prevalence of fetal neural tube defect (NTD) and its outcome in terms of survival at birth and beyond 2 years of age.
Methods : A 10-year prospective (2008–2018) observational study was performed, which included all prenatally detected fetal NTD. Two-year follow-up was done in cases of pregnancies resulting in live birth, in terms of their survival, physical morbidity and developmental delay.
Results NTD was seen in 401/648 (62%) cases among the central nervous system malformations. More than half of the cases (54.1%) presented after 20 weeks of gestation, and 42.8% of the mothers were primiparous. Spina bifida was seen in 206 cases, anencephaly in 144, encephalocele in 43, whereas iniencephaly was seen in only eight cases. Associated anomalies were present in 51.2%. Only 19.0% cases were live-born, and merely 11% were alive beyond 2 years of age. Among types of spina bifida, lumbosacral meningomyocele was the most common (41.6%), whereas thoracic was the rarest (8.7%). After 2 years, physical disability was observed in more than half of the cases who survived.
Conclusions: NTD is one of the commonest malformations with high mortality, and the physical and mental sub-normality is high among those who survive.
Keywords Fetal hydrocephalus · Central nervous system anomaly · India · Survival after birth · Spina bifida · Anencephaly · Encephalocele
Aim : To determine the role of antenatal parameters in predicting the outcome of bilateral fetal hydronephrosis.
Methodology : Total 50 antenatal women with bilateral antenatal fetal hydronephrosis (ANH) were included. On ultrasound, amount of liquor, kidney size, pelvic anteroposterior diameter, degree of caliectasis, bladder size, and thickness were observed at 28 and 32 weeks of gestation. For 3 months post-delivery, the babies were evaluated in terms of ultrasound renal parameters, serum creatinine levels, and need for surgery.
Results The mean gestational age at delivery was 37.4 ± 1.7. All babies were alive at birth, 48 were alive after 3 months. Surgery was done in 10/50 cases; cystoscopic fulguration was the most common procedure. There was a resolution of bilateral ANH in 27/50 cases, in 5/50 cases there was pylectasis with normal serum creatinine, and in 18/50 cases there was adverse outcome. Most of the parameters had better sensitivity and specificity at 32 weeks than at 28 weeks. At 32-week gestation, the renal pylectasis between 10 and 15 mm had the highest sensitivity (88.9%), and the presence of caliectasis had the highest specificity (90.6%) for adverse outcome.
Conclusions: Resolution of hydronephrosis took place in the majority of cases, and there was an adverse outcome in only one-third of them. Renal caliectasis was the best marker for the prediction of adverse outcome.
Keywords Pylectasis · Bilateral renal anomaly · India · Survival after birth · Hydronephrosis · Caliectasis · Prospective study
Background : World Health Organization proposed use of Robson Classification as a global standard for assessing, maintaining and comparing Cesarean section (CS) rates. This paper aimed to examine CS trend at a tertiary center according to Robson Ten-Group Classification System (TGCS) over three-year period (2015–2017) and to predict future Cesarean trends.
Methods : This prospective observational study was conducted at a tertiary teaching institute and included 81,784 females who delivered at this hospital over three-year duration (2015–2017). The data compilation was done according to Robson TGCS. The main outcome measures were overall annual CS rates, Robson group-wise CS rates, future overall and Robson group-wise CS trend. These parameters were calculated, trend analysis was done and trend over future 3 years was predicted.
Results : There were 81,784 deliveries (62,336 vaginal and 19,448 Cesarean deliveries) over the study period. The year-wise CS rate was 22.4%, 23.5% and 25.5%, respectively. The largest contribution was by group 5 followed by group 2 and group 1. Based on 3-year data, it was predicted that CS rate will increase by 0.905% annually over coming 3 years. In groups 3, 4, 6, 7 and 8, predicted trend value showed an annual increase by 0.65%, 0.05%, 0.05%, 0.05% and 0.10%, respectively; in groups 1, 2, 5, 9 and 10, it showed an annual decrease of 0.45%, 0.05%, 1.50%, 0.50% and 0.05%, respectively.
Conclusions: Increasing CS rate trend was seen over last 3 years with a predicted rise of 0.905% per year. Robson groups 5, 2 and 1 were at present major contributors; however, the trend analysis predicted a decreasing trend. Trend analysis predicted annual increment in groups 3, 4, 6, 7 and 8 over next 3 years, thereby suggesting need to focus on these groups as well.
Keywords Cesarean section audit · Cesarean trend analysis · Future Cesarean trends · Maternal health policy formulation
Key Message The new NB scope aids in better visualization of the scalp and blood collection and analysis at bed side.
Objective :Caesarean section rates and inherent complications are on the rise all over the world. One way to avoid a caesarean is to measure fetal scalp blood lactate levels. The methods available to visualize fetal scalp, obtain the blood sample and perform the blood test are separate, cumbersome and expensive, needing a certain level of expertise. We propose a device that incorporates all the steps of obtaining a fetal scalp blood lactate into one sleek, easy to use device.
Methods : The initial design, 3-D print and was tried on mannequin. After ethics committee approval, the prototype was experimented on patients in labour with singleton live fetus in cephalic presentation with no evidence of distress.
Results There were (n = 9) patients recruited. There were (n = 5) primigravida and (n = 4) multigravida all of whom were in active labour. Parity did not seem to influence ease of instrumentation. Of the (n = 9) mothers (n = 2) had meconium-stained liquor and the rest (n = 7) had clear liquor, meconium-stained liquor did not affect visualization. The mean time taken to collect the sample was 184.11(± 33.04) seconds.
Conclusions: The Neeraj-Bhaskar (NB) scope is an easy to use, affordable device that can be used time and again to decide on cases where emergency caesarean section can be avoided due to fetal distress.
Keywords NB scope · Fetal scalp blood sampling · Fetal scalp lactate · Fetal scalp visualization
Background : Differentiating malignancy from benign diseases is the key to successful management of adnexal masses. Risk of malignancy algorithm (ROMA) has been used for this purpose. We have prospectively studied the diagnostic value of ROMA in patients presented with adnexal masses.
Methods : We prospective calculated ROMA values prior to surgery for adnexal masses. The risk calculated was then correlated with the histological findings, and results were analyzed according to menopausal status. ROMA cutoff value was determined using ROC curve, and sensitivity, specificity and predictive values were calculated. Statistics were performed on SPSS software (version 20.0).
Results There were 94 patients with adnexal masses included in the study, 65 (69.1%) had epithelial ovarian cancer and 29 (30.9%) were diagnosed benign on histopathology. In both pre- and postmenopausal patients, ROMA values were significantly higher in patients with malignancy compared to those with benign disease (p < 0.05). ROMA score was of a significant diagnostic value in both premenopausal (AUC = 0.914, Z = 10.81, p < 0.001) and postmenopausal patients (AUC = 0.975, Z = 21.51, p < 0.001). In premenopausal females, ROMA > 13.3% was able to discriminate malignant from benign patients with 97.06% sensitivity and 85.00% specificity. The positive and negative predictive values were 91.7% and 94.4%. Similarly, in postmenopausal females, ROMA value of > 76% achieved 87.10% sensitivity and 100.00% specificity in discriminating malignant from benign patients with 100% positive and 69.2% negative predictive value. The overall accuracy of ROMA in pre- and postmenopausal patients was 87.0% and 85%, respectively.
Conclusions: ROMA is a useful and accurate test for differentiating epithelial ovarian cancer from benign ovarian masses. Further studies are needed to compare performance of ROMA with the Risk of Malignancy Index (RMI), CA 125 and HE4. Such comparative studies will be helpful to the clinician in deciding the best diagnostic tool for women with adnexal masses.
Keywords ROMA · HE4 · CA 125 · Adnexal mass
The aim of the study was to analyse risk factors, surgical findings, ovarian salvage rate and histology of ovarian mass. We reviewed 81 cases of surgically proven ovarian torsion retrospectively from June 2014 to June 2019 at a tertiary care referral centre in South India. Demographic, clinical and surgical details of all patients were noted from the medical records. Mean age of the patients was 26 years. Most of the patients were nulliparous and had a pre-existing ovarian mass of size > 5 cm. Ovarian salvage rate was 43.2%. Concomitant cystectomy with detorsion was done in 30 patients without increase in blood loss or complications. Extensive necrosis was present in 78.2% of oophorectomy specimens. Most common histology of ovarian mass in cystectomy specimens was simple ovarian cyst.
Keywords Conservative surgery · Necrosis · Cystectomy · Histology
Introduction :Gestational diabetes mellitus is one of the most common conditions complicating pregnancy. Vitamin D deficiency is closely associated with gestational diabetes mellitus.
Objectives :To study the effect of vitamin D supplementation on diabetic pregnant women with vitamin D deficiency.
MethodsThis randomized controlled study was conducted with 100 diabetic pregnant women. They were randomized into group A and group B. Group A were screened for vitamin D deficiency once diagnosed with GDM of which 40 were found to be deficient and allotted to group D (n = 40) and were supplemented with 60,000 units of vitamin D3 per month. Group B were given routine antenatal care and were screened for vitamin D deficiency when they were admitted for delivery, and 39 of them were found to have vitamin D deficiency and were studied as control group C (n = 39). Ten women in both the groups had normal levels of vitamin D, and one of them was excluded from the study as she had molar pregnancy. The vitamin D supplemented group D and the control group C were matched for age and parity at the baseline.
Results:There was a significant increase in the mean insulin and metformin requirements in both the supplemented and control groups. Vitamin D supplementation did not improve the glycaemic control in diabetic pregnant women.
Conclusions:Vitamin D supplementation did not decrease insulin resistance or improve the glycaemic control in diabetic pregnant women with vitamin D deficiency.
KeywordsVitamin D deficiency · Gestational diabetes mellitus · Glycaemic control · Vitamin D supplementation · Neonatal outcomes
Introduction : Non-healing wound causes significant morbidity and mortality of patients. One of the rare causes behind nonhealing wound infection is M. tuberculosis which often remains undiagnosed.
Aim : The aim of this study was to determine the tuberculosis as one of the causes of non-healing wound.
Methods Wounds that did not heal even after secondary suturing and tissue biopsies were sent for histopathological examination. The cases diagnosed with tuberculosis received anti-tubercular treatment. Follow-up was done after 7 and 14 days of treatment, and response was seen in terms of reduction in inflammation and discharge.
Results: Of the 36 patients, five patients had tubercular infection out of which one patient revealed tubercular granuloma, two revealed epitheloid cells, Langhans cells, whereas two revealed non-specific chronic inflammation in histopathology.
Conclusions: A high degree of suspicion and tissue biopsy is required in case of delayed or non-healing wounds to diagnose tuberculosis as a cause. Even if typical tubercular granuloma is not visible in histopathology, the presence of epitheloid cells, giant cells, Langhans cells or predominant lymphocytic infiltrate equally suggests tubercular tissue infection.
Keywords Non-healing wound · Tubercular granuloma · Epitheloid cells · Langhans cells and wound tuberculosis
Introduction : Non-progress of labour forms the largest indication caesarean section. The diagnosis of failure of descent using serial digital examination is objective, poor reproducibility, carries the risk of infection and is painful to the labouring patient. There is a need if not an alternative, adjunctive to digital vaginal examination. Measuring angle of descent (AOD) to predict vaginal birth in late labour by transperineal ultrasound provides an alternative without any of the above-mentioned drawbacks.
Materials and Methods : A prospective observational study in 64 patients in the late first stage and second stage of labour with cephalic presentation was carried out, from September 2017 to December 2018, in PGIMER and DR. RML Hospital. Angle of descent was measured by transperineal ultrasound. Angle of descent is the angle between the longitudinal axis of pubic bone and a line joining the lowest edge of the pubis to the lowest convexity of the foetal skull. Time of assessment of AOD1 was noted, and if patient did not deliver within 2 h, another AOD2 was recorded. Eighty-five readings were obtained, and AOD predicting successful vaginal delivery was calculated.
Results and Discussion : AOD of 116° and more resulted in vaginal delivery, spontaneous or instrumental. As the angle of descent increased, there was a decrease in time interval to vaginal delivery with correlation coefficient of − 0.939.
Conclusions : The use of intrapartum transperineal ultrasound and measurement of angle of descent can prove to be a valuable adjunct in management of labour, especially in cases of prolonged first and second stages of labour in predicting successful vaginal delivery. AOD of 116° or more can predict successful vaginal delivery within 2 h. AOD can be used in centres having facilities of intrapartum ultrasound. The authors recommend the use of ultrasound in labour room as it is non-invasive and can provide a lot of information. This method is currently useful for tertiary centres or medical colleges.
Keywords : Transperineal ultrasound · Angle of descent · Progress of labour
Objectives To evaluate β-hCG concentration in vaginal fluid as a biochemical marker for PPROM in suspected cases and its correlation with onset of labour.
Materials and Methods This is a prospective case–control study carried out in tertiary care centre in 1 year. Total 150 pregnant women of gestational age 28–36 week + 6 days were included and were divided into two groups: control (Group 1) (n = 50) normal antenatal patients. Group 2 cases with history of leaking per vaginum subdivided into two groups—Group 2A—(n = 50) with no detectable leakage of amniotic fluid present on per speculum examination and Group 2B—(n = 50) with minimal leaking per vaginum present upon per speculum examination (frank leaking were excluded). β-hCG level was measured by chemiluminescent microparticle assay, and all women were followed till onset of labour.
Results Mean β-hCG level in vaginal fluid was measured as 6.10 ± 8.52 mIU/mL, 57.10 ± 30.86 mIU/mL and 111.35 ± 36.01 mIU/mL in Group 1, Group 2A and Group 2B, respectively. By taking 21.5 mIU/ml as cut-off, receiver operating characteristic curve shows sensitivity 100%, specificity 92.0%, positive predictive value 92.6%, negative predictive value 100% and diagnostic accuracy 96%. Regarding the correlation of β-hCG level with onset of labour if the β-hCG level is < 21.5 mIU/ml, 100% pregnancy continued beyond 4 weeks and 56% women delivered within 4 weeks when β-hCG level is > 75 mIU/ml.
Conclusion β-hCG in vaginal fluid is a reliable biochemical marker for diagnosing suspected cases of PPROM and is well correlated with onset of labour.
Keywords β-hCG • Vaginal fluid • PPROM
Objective : To assess the intra- and postoperative results of cesarean myomectomy.
Methods : A retrospective study was conducted to collect the results of cesarean myomectomy procedures performed in our tertiary center between June 2013 and December 2018. The subjects were 2219 pregnant women undergoing cesarean section at these units.
Results A total of 2219 scheduled patients undergoing CS were included in the present study. Sixty-five patients have undergone intramural myomectomy during CS; 82 patients have had subserosal myomectomy during CS. No statistically significant differences were found between the three groups in changes of preoperative Hb, postoperative Hb, mean Hb and length of hospital stay. Operation times were significantly longer in both intramural and subserosal myomectomy groups (45.23 ± 8.498 vs. 39.02 ± 6.824 vs. 32.14 ± 5.423 min, p 0.01). Only in the intramural myomectomy group, two patients were subjected to blood transfusion (3%). Assessment of intramural myomectomy patients was carried out by taking 5 cm as the cutoff value. No statistical differences were found between the two groups in terms of mean Hb change, operation time, length of hospital stay. In the group with intramural myomectomy larger than 5 cm, two (15.38%) patients needed a blood transfusion.
Conclusions : Cesarean myomectomy operation performed by experienced surgeons has no adverse effects other than lengthening the duration of operation and can be safely implemented.
Keywords Myoma uteri · Cesarean section · Myomectomy
Background Women with response to primary treatment for advanced ovarian cancer are said to have progression if CA125 increases more than double the upper normal limit (70 IU/L) on follow-up. It was, however, noted that large section of women with CA125 > 35 IU/L had disease on imaging.
Objective To compare values of CA125 rise at which radiological recurrence can be detected.
Methods This is a retrospective observational study where women with advanced epithelial ovarian cancer who underwent interval debulking surgery and completed treatment at Tata Medical Center, Kolkata, India, from 2012 to 2016, and were followed up with Ca125. If CA125 doubled or exceeded 35 IU/L or increased to ≥ 70 IU/L, women were subjected to imaging.
Results Among 142 women who underwent treatment, 64 women with response to primary treatment had recurrence. Recurrence was noted in two (3%) patients with doubling of Ca125 but ≤ 35 IU/, 18 (24%) patients with CA125 > 35 IU/L and 41 (64%) patients when CA125 was ≥ 70 IU/L. Three patients (5%) with normal CA125 had recurrence. Among the recurrence group, 45 women had R0 during surgery of which 27 (60%) had CA125 ≥ 70 IU/L and 14 (31%) had CA125 > 35 IU/L during recurrence. Sensitivity and specificity of value > 35 IU/L were 30.51% and 33.33%, respectively, with accuracy of 32.03%, while sensitivity and specificity at > 70 IU/L were 69.49% and 66.67%, respectively, with accuracy of 67.97%.
Conclusion CA125 value of ≥ 70 IU/L is a better predictor of recurrence; however, imaging done when value rises > 35 IU/L would be able to detect significant recurrences early thus allowing early treatment.
Keywords Ovarian cancer • Recurrence • CA125 • Imaging
Background :Prevalence of obesity among women of reproductive age is increasing worldwide. As the prevalence increases among the women of reproductive age group, so it does among pregnant females. This study was conducted with the aim to assess obesity-related adverse maternal, neonatal and perinatal outcomes using new Asian Indian guidelines.
Methodology :Pregnant women up to 16-week gestation on first visit were enrolled. There were two exposure groups: one with BMI < 25 kg/m2 and second with BMI ≥ 25 kg/m2 matched for maternal age and parity, 100 in each group. The study focused on development of various adverse maternal and foetal/perinatal complications. Comparative analysis of data was done to estimate the odds of each outcome taking non-obese group as reference.
ResultsThere was a significant increase in risk among obese mothers compared to non-obese mothers for maternal complications like hypertensive disorders of pregnancy{OR 3.83}, preeclampsia{OR 9.2}, gestational diabetes mellitus{OR 4.85} and insulin requirement{OR 12.46}, induction of labour{OR 2.71}, caesarean section post induction{OR 8.50}, prolonged labour{OR 4.69}, caesarean sections{OR 5.18} and postpartum haemorrhage{OR 2.21}. Also, there was a significant increase in risk among obese mothers compared to non-obese mothers for foetal and perinatal complications like miscarriages{OR 4.85}, preterm newborns{OR 4.63}, medically indicated preterm{OR 6.59}, shoulder dystocia{OR could not be calculated}, large for gestational age{OR 5.91}, hyperbilirubinaemia {OR 4.26} and neonatal intensive care unit admissions{OR 3.26}.
Conclusions:It was concluded that obesity defined by Asian Indian guidelines (BMI ≥ 25 kg/m2) is associated with adverse pregnancy outcomes at odds comparable to western studies with obesity taken as BMI ≥ 30 kg/m2.
KeywordsMaternal obesity · Asian guidelines · Pregnancy outcome · Perinatal outcome
Aim This study analyses the socio-demographic characteristics associated with post-sterilization regret.
Study Design The study uses cross-sectional data from the fourth round of National Family Health Surveys (2015–2016).
Methods Simple bivariate and binary logistic regressions analyses were used.
Results Research shows that 7% of women aged 15–49 reported sterilization regret, which increased by 2% from 2005 to 2016. It was found that factors significantly associated with sterilization regret were years since sterilization, child loss experience, regions of residence, and quality of services. Women who got sterilized at the age of 30 or more were more likely to express regret, than women who were sterilised before 25 years of age, when adjusted for confounding variables (aO.R= 1.006). Women having sons were less likely to report sterilization regret than women who had only daughters (aO.R.=1.3 for each) but on the contrary women having both son and daughter were significantly less likely to express regret in comparison with women having only sons (aO.R. = 0.8 for each. Women who had experienced child loss had higher odds of reporting sterilization regret in rural (aO.R =1.2) as well as in urban (aO.R = 1.3) areas respectively, compared to those who did not experience any child loss.
Conclusion Women need to be counselled about the permanent nature of sterilization in order to avoid future regret as sterilization is largely dominated by socio-economic conditions. Thus, couples' decision-making towards using the contraceptive from the basket of choice would help in uplifting the social and cultural status of women in conservative societies and will have a positive effect on contraceptive use. In addition, efforts should be made to educate both the partners equally about contraceptive methods that have higher efficiency. Further, there is also a need to improve the quality of services, both in terms of counselling and service provision. Lastly, health-related policies should tackle disparities in the empowerment, and economic status of women that would result in decreased post-sterilization regret, and will improve sexual relationships following sterilization.
Keywords Sterilization • Regret • National Family Health Survey • Regressions analysis
Aims The objective of this study was to describe the clinicopathological details in patients referred to the Gynaecologic Oncology Department with possible ovarian or primary peritoneal cancer where the final diagnosis turned out to be abdominal tuberculosis.
Methodology Retrospective chart analysis of 23 cases diagnosed with abdominal tuberculosis who were admitted under the Division of Gynaecologic Oncology suspected to have disseminated peritoneal malignancy, during 2014–2017.
Results There were 23 patients who were referred to the Gynaecologic Oncology outpatient for evaluation of ascites, to rule out malignancy. The mean age of this patient group was 35 years (SD 14.5, range 14–65). The mean CA 125 was 333.5 [400.7 (9.09–1568)]. Ascitic fluid analysis confirmed TB in 26%; omental biopsy revealed TB in 69%, and operative diagnostic procedures (laparoscopy and laparotomy) were done in 15 of the 23 patients which had a positive pick up rate of 100% to confirm the diagnosis of TB. Culture of ascitic fluid/omental tissue and PCR yields were poor with a pick up rate of 33% and 6%.
Conclusions Abdominal TB is common in India and can mimic ovarian malignancy, and hence, high degree of suspicion needed. The isolation of AFB is the gold standard for diagnosis of pulmonary tuberculosis but has a low yield in abdominal TB. Ultrasound-guided procedure is reasonable as an initial procedure. As much time can be lost in working up these patients through multiple diagnostic algorithms using ascitic tap, USG biopsy and then an operative procedure, diagnostic laparoscopy could be considered early in the work up. It is a simple, time-saving and cost-effective way of establishing a diagnosis sooner with least complications.
Keywords Abdominal/peritoneal tuberculosis • Ascites differentials • Mimics of ovarian cancer
Immediate post-placental IUD insertion is defined as IUD insertion within 10 min of the expulsion of the placenta. Although the expulsion rate in post-placental insertion is higher than interval insertion, the benefits of highly effective contraception immediately after delivery may outweigh the risks of expulsion.
Aims : To compare post-placental IUD (PPIUD) insertion with interval IUD insertion (IIUD) in terms of safety, effect on menstrual cycle, efficacy and satisfaction
Materials and Methods : After meeting all eligibility criteria, the patients were asked to choose between post-placental IUD insertion and interval/delayed IUD insertion. In PPIUD group, insertion was done within 10 min of expulsion of placenta by hand technique. Individuals in IIUD group were asked to return after 6 weeks for IUD insertion by withdrawal technique. Both the groups were followed at 6 weeks, 6 months, 12 months by history, physical examination, per speculum examination and ultrasonography.
Observations 238 patients were allocated to PPIUD group and 273 to IIUD group. In the PPIUD group, there was no bleeding/ spotting demonstrable as it was masked by the lochia. Mild pain at insertion was seen in only 11 patients in the PPIUD group. Slight bleeding/spotting was seen in 7.8% patients in the IIUD group, while mild to moderate pain was seen in 39.9% patients. At 6 weeks, 6 months and 1 year follow up with regard to patients complaining of pelvic pain/dysmenorrhea, the difference between the two groups was not statistically significant. Our study found that irregular bleeding or spotting was more in interval insertion than in the post-placental group. The difference in the two groups was statistically significant at 6 weeks and 6 months, but was not significant at 1 year. There was no case of perforation in either group. Our study found a statistically significant difference in expulsion after post-placental compared to delayed insertion. The difference between the two groups was statistically significant (p = 0.006) for cumulative expulsion. However, for interval expulsion rate, the difference was not statistically significant (p = 0.6). In our study, continuation rates appear to be higher in the PPIUD group, but the difference is not statistically significant.
Conclusions: PPIUD is a safe, easy and effective alternative to interval IUD insertion and qualifies to be popularized as a first-line contraceptive agent in eligible patients owing to its immediate and sustained contraceptive benefit, patient comfort, convenience and lower incidence of side effects.
Keywords Post-placental · Interval IUCD · Contraception · Intrauterine contraceptive device · Delayed IUCD · IUCD expulsion
Background: Evidences suggest that females with CKD are
associated with high risk of maternal and fetal complications.
Early referral in CKD with pregnancy for specialist
care may prove useful for maternal and fetal outcome.
Methods Study looked for assessment of impact of CKD
detection at the time of pregnancy and its impact on fetal
and maternal outcome.
Results: A total of 465 females were retrospectively evaluated
for renal status during their pregnancies, 172 females
were unaware about their renal illness at the time of
pregnancy, while 208 females were under regular obstetrical
and nephrological follow-up during their pregnancy.
44.1% of these females in both groups had GFR\60 ml/
min. Preeclampsia was observed in 17.6% of planned
pregnancies, while it was observed in 47.5% of unplanned
pregnancies. Worsening of renal failure during and following
pregnancy was observed among all stages of CKD,and there was greater decline in GRF with progression to
ESRD earlier during or after pregnancy among unplanned
pregnancies. Planned pregnancy group had better fetal
outcome. Low birth babies weighing\2500 g in unplanned
group were much higher than in planned pregnancies.
Conclusions Chronic kidney disease is often clinically
silent until renal impairment is advanced. Pregnancy can be
a check point for detection of renal disease and managed
appropriately for better maternal and fetal outcome.
Keywords: Pregnancy Chronic kidney disease Maternal outcome Foetal outcome Dialysis dependancy
Purpose The objective of this study is to report the incidence
of single umbilical artery (SUA) on prenatal diagnosis
and formulate protocol for counselling and its
management in Indian scenario.
Method A total of 1024 cases were screened for Single
umbilical artery (SUA) between 12 and 20 weeks gestation
during the 1 year period from May 2016 to April 2017.
Targeted anomaly scan was performed for all cases at
18–20 weeks. Those with additional structural anomalies were subjected to invasive genetic testing. Serial growth
monitoring starting from 28 weeks was done.
Results Out of ten cases diagnosed with SUA, five had
isolated SUA. Two out of five cases of isolated SUA
developed FGR in third trimester. Out of the remaining,
three cases with additional structural anomalies had normal
foetal karyotype, whereas other two cases showed chromosomal
abnormalities (12pder and trisomy 18).
Conclusion Targeted anomaly scan is must in all cases of
SUA. Invasive genetic testing must be offered in case of
associated anomalies. Serial growth monitoring in third
trimester is an important part of protocol.
KeywordsPrenatal Single umbilical artery
Counselling Management India
Background: The course of pregnancy in a woman with
portal hypertension is a difficult one as it is associated with
complications like variceal bleeding, splenic artery rupture
and coagulopathy. All these pose a threat to a woman’s life.
Although this condition is rare, every obstetrician should
have a high index of suspicion when an antenatal mother
presents with splenomegaly, thrombocytopenia or
hematemesis. Hence, we aimed to review maternal and fetal
outcomes in pregnant women with portal hypertension.
Methods: In a retrospective observational study, 41 women
and 47 pregnancies were evaluated, from January 2000–
December 2015 at Fernandez Hospital, a tertiary referral
perinatal center. Maternal outcomes studied were variceal
bleed during pregnancy, surgical procedures, morbidity and mortality. Neonatal variables were gestational age at
delivery, birth weight and morbidities.
Results: Mean maternal age was 26.4 years. Average gestational
age at delivery was 36.5 weeks. Mean birth weight
was 2507.5 g. There were three maternal deaths out of 47
deliveries, the cause of death was massive variceal bleed in
one, the second one was due to cardiac arrest on MRI table,
and the third death was due to splenic hilar vessel bleed.
There was one stillbirth, and no neonatal deaths.
Conclusion A multidisciplinary approach is essential to
improve perinatal outcomes in pregnancy complicated by
portal hypertension. Surgical measures to reduce portal
venous pressure done before pregnancy or beta blockers
during pregnancy might help reduce sudden variceal
bleeds.
Keywords: Portal hypertension Variceal bleed
Pregnancy Outcomes
