Abstract

Aim: Aim of the study is to evaluate the myocardial performance index in intrauterine growth restricted fetuses and compare this index with appropriate for gestational age fetuses.

Materials & Methods: A prospective study was conducted in S.M.S Medical College Jaipur, involving 72 singleton fetuses C 28 weeks of gestation divided into two groups: 36 intrauterine growth restricted fetuses (IUGR) and 36 appropriate for gestational age fetuses (AGA). Myocardial performance index was obtained by fetal echocardiography.

Results: The mean myocardial performance index in the IUGR fetuses and AGA fetuses was statistically significant and that was 0.62 ± 0.02 and 0.45 ± 0.01, respectively; (p value:\0.0001). These findings suggest that IUGR induces primary cardiac changes, which could explain the increased predisposition to cardiovascular disease in adult life. This study concluded that Fetal echocardiographic parameters (MPI) identify a high risk group within the IUGR fetuses, which could be targeted for early screening of blood pressure and other cardiovascular risk factors, as well as for promoting a healthy diet and physical exercise.

Abstract

Background: Higher-order multiple (HOM) pregnancies are associated with increased incidences of pregnancy complications mainly abortions, pre-eclampsia, preterm delivery and fetal death. Multifetal reduction (MFR) during first trimester and subsequent delivery of twins can reduce pregnancy associated morbidities. This study was conducted to evaluate the maternal and fetal outcomes of MFR procedure in patients with HOMs those managed in a tertiary care hospital.

Methods and Material: It was a prospective observational study carried out in a tertiary care military hospital, India, and all women with higher-order multiples (triplets or more) conceived spontaneously or after infertility treatment (ovulation induction, intra-uterine insemination, or in vitro fertilization) during the 3-year period from Jan 2014 to Dec 2016 were included for MFR. Demographic and clinical data, and obstetric and neonatal outcomes were tabulated.

Results: The study included 32 HOM pregnancies which underwent MFR. 16% patients had pre-eclampsia and 12% patients had gestational diabetes. The study had 2 pregnancy losses before 24 weeks period of gestation (POG). 70% patients underwent cesarean delivery with mean gestational age of 35.5 weeks. Average birth weight of newborn was 1820 gm and 80% of them required NICU admission. Conclusion Favorable pregnancy outcomes can be achieved after multifetal reductions during first trimester in higher-order multiples, but the procedure is not totally safe.

Abstract

Background: Attempting vaginal birth after cesarean section (VBAC) places women at an increased risk of complications. Trial of labor after cesarean (TOLAC) calculators aim to predict the chance of successful vaginal birth after cesarean (VBAC) based on the patient’s preexisting demographic and clinical factors.

Objective: To assess the rate of successful TOLAC using two calculators: FLAMM and the Grobman calculator, and to compare the performance of the two calculators in the successful prediction of VBAC.

Methods: Prospective cohort study in subjects with previous one caesarean section using well-defined inclusion and exclusion criteria.

Results: A total of 280 subjects with previous one cesarean section were enrolled. One hundred thirty-nine subjects consented for TOLAC, 90 (67%) underwent successful trial of vaginal birth, and 49 (32.8) required cesarean section. Cervical dilatation (p \0.0001) and effacement (p\0.0001), and any prior vaginal delivery (p\0.02) were significantly associated with a successful outcome. At a cutoff score of 5, the sensitivity of the FLAMM score was 72% and specificity was 76%. For the Grobman calculator, the best sensitivity (69%) and specificity (67%) were seen at a cutoff score of 85%.

Conclusion: Both prediction models, the FLAMM and the ‘‘close to delivery’’ nomogram, recommended by Grobman et al. are easy to use and could successfully estimate the chances of vaginal birth in previous caesarean, in this small cohort. The decision for women opting for TOLAC can be individualized, and patient-specific chances of success can be predicted by the use of these prediction models.

Abstract

Objectives: To compare the incidence of visible strings after postplacental intracesarean insertion of Cu375 and CuT380A intrauterine contraceptive devices (IUD).

Methods: This was a prospective, randomized comparative study. A total of 100 women fulfilling the inclusion and exclusion criteria underwent postplacental intracesarean insertion of either Cu375 IUD or CuT380A IUD. Women were followed up at 1, 6 weeks and 3 months after IUD insertion and were questioned about IUD expulsion or removal at each visit. The cervix was inspected to visualize the IUD strings. Data were analyzed by Chi-square test.

Results: At 6-week follow-up, 97.9% women in group A versus 41.7% women in group B had strings visible at the cervical os and at 3 months 100% women in group A versus only 47.9% women in group B (p < 0.001) had visible strings of IUD.

Conclusion: Both Cu375 and CuT380A IUD are safe postpartum method of contraception but Cu375 if used for intracesarean IUD insertion increases the incidence of visible IUD strings. Hence, it avoids radiological investigations and invasive procedures at follow-up visits required to locate the IUD when strings are not visible. CTRI No. CTRI/2015/09/006221.

Abstract

Background: The aim of this study is to examine rates of magnesium sulfate utilization by emergency obstetric care trainees to treat preeclampsia–eclampsia in India. Secondarily, structural barriers are identified which limit the use of magnesium sulfate, highlighting limitations of emer-gency obstetric care training, which is a commonly implemented intervention in resource-poor settings.

Methods: Trainees’ curriculum specified magnesium sulfate treatment for eclampsia and severe preeclampsia. Case records were analyzed for preeclampsia–eclampsia diagnosis, magnesium sulfate utilization, delivery route, and maternal and neonatal outcomes from 13,238 reported deliveries between 2006 and 2012 across 75 district hospitals in 12 Indian states.

Results: Of 1320 cases of preeclampsia–eclampsia, 322 (24.4%) had eclampsia. Magnesium sulfate was given to 12.9% of preeclamptic and 54.3% of eclamptic women, with lower usage rates in rural communities. Among the 1308 women with preeclampsia–eclampsia, only 24 deaths occurred (1.8%). In contrast, among the 17,179 women without preeclampsia–eclampsia, there were 95 reported deaths (0.6%). Both maternal mortality ratios were found to be much higher than the Millennium Development Goal target of 0.15%. Magnesium sulfate administration was associated with a higher death rate in preeclamptic but not eclamptic women, representing possible confounding by severity. 

Conclusion: To optimize resources spent on emergency obstetric care training, the consistent availability of magnesium sulfate should be improved in India. Increasing drug availability, implementing clinical guidelines around its administration, and training health-care providers on the identification and treatment of preeclampsia–eclampsia could lead to notable improvements in maternal and infant mortality. 

Abstract

Background: Burns in pregnancy can be a potentially lifethreatening condition for both mother and baby. Human physiology is altered during pregnancy and burns add further stress leading to diminished maternal reserves. Very few studies have been reported for management of such patients.

Materials and Methods: This was a prospective based study carried out in Department of Burns and Plastic Surgery in collaboration with Department of Obstetrics and Gynaecology and Department of Pediatrics for a period of 20 months from December 2011 to July 2013. Pregnant women with thermal injuries more than 15% TBSA were included in the study. Patients with coexisting obstetrics complications and burns other than thermal were excluded.

Results: Out of 3397 female patients of burns admitted, 1382 patients were in reproductive groups, 1116 were married and 67 were pregnant; these were enrolled. Maternal and fetal outcome is inversely linked with the TBSA of the mother (p\0.001). In TBSA group 15–30%, there was no maternal and fetal mortality, but in TBSA [30–50% maternal mortality was 44%, and in 50–70% maternal mortality was 83% and no mother survived in [70%. In TBSA 30–50%, fetal mortality was 72%. Only one baby survived in 50–70% TBSA group and one in [70% TBSA group after intensive care in NICU for prematurity. Fetal survival was also dependent on gestational age, and there are better outcomes in late trimesters.

Conclusion: Maternal and fetal outcome are directly related to TBSA of mother, and best care can be offered to such patients with a multidisciplinary team-based approach.

Abstract

Background: Deficiencies of enzymes in the folate cycle may lead to the generation of homocysteine, a toxic metabolic intermediate with pro-oxidant effect and ability to induce oxidant stress and lipid peroxidation as part of the pathophysiological process in gestational hypertension (GH) and pre-eclampsia (PE).

Aim: The aim of this study is to assess the reliability of plasma homocysteine (hcy) 5, 10 methylenetetrahydrofolate reductase (MTHFR) enzyme and oxidative stress parameters as indicators of aetio-pathogenesis and severity of gestational hypertension and pre-eclampsia.

Subjects and Methods: This was a comparative cross-sectional study conducted over 6 months. Two hundred pregnant women were recruited from two sites. They were divided into gestation hypertension (n = 40), pre-eclampsia (n = 60) and control groups (n = 100). Parameters evaluated for statistical analysis were MTHFR enzyme level, plasma homocysteine and malondialdehyde (MDA) levels, with glutathione (GSH), superoxide dismutase (SOD) and catalase (CAT) activities.

Results: Mean plasma hcy level and MDA were significantly higher in pre-eclampsia and gestational hypertension when compared to control group (p < 0.05). However, MTHFR enzyme level, GSH, SOD and CAT were significantly higher in normotensive females when compared to PE and GH subgroups (p < 0.05). Pre-eclampsia was significantly associated with an increased risk of lipid peroxidation (OR = 4.923; p = 0.007).

Conclusion: Pre-eclampsia and gestational hypertension are associated with marked homocysteine metabolic derangement and increased lipid peroxidation induced by oxidative stress and reduced MTHFR enzyme activity which may be the significant risk factors in the aetio-pathogenesis of GH and PE.

Abstract

Objective: To assess the safety and efficacy of postpartum IUCD in caesarean section patients.

Methods: This prospective observational study included 200 women, who gave informed consent for postpartum intrauterine contraceptive device (PPIUCD) insertion during caesarean section from January 2013 to May 2014. These patients were followed up at 6 weeks and 6 months.

Results: There were no major complaints in either group in post-operative period. At 6-month follow-up in PPIUCD users, 89.5% of patients continued to use this method. 5.5% were lost to follow-up, 2.5% had spontaneous expulsion, and 2.5% removed the IUCD due to various reasons. Eight per cent of patients who wanted removal of IUCD in the second follow-up were counselled to continue, and they did so.

Conclusion: The results of our study suggest that immediate intra-caesarean IUCD insertion appears to be a safe and effective method of contraception. The acceptability of intra-caesarean IUCD was high, and its continuation rate has demonstrated its safety.

Abstract

Background: Transversus abdominis plane (TAP) block is a fascial plane block providing postoperative analgesia after lower abdominal surgeries including Cesarean section. Conventionally, it is administered under ultrasound guidance or by blind technique. We studied a novel transperitoneal surgical TAP block for providing safe and effective analgesia after Cesarean section through transverse incision.

Methods: A hundred patients who fulfilled the inclusion criteria were included in the study after obtaining informed written consent. They were randomized in two groups: Group A with surgical TAP block and Group B without TAP block as control. Surgical TAP block was administered by transperitoneal route before the closure of peritoneum with 0.25% bupivacaine (dose adjusted with weight of the patient), and visual analogue score was assessed by a blind assessor. Time for rescue analgesia was noted and analyzed with the ‘two independent sample t test.’

Results: The duration of postoperative analgesia in hours was significantly longer in the TAP block group compared with the control group (5.14 ± 1.63 vs 2.61 ± 0.89, p < 0.001). There was no reported complication of the surgical technique or any adverse effect of the used drug.

Conclusion: Surgical TAP block via the transperitoneal route is a safe, easy and effective mode of providing postoperative analgesia after Cesarean section. This technique does not need any costly specialist equipment, overcomes the technical limitations of ultrasound-guided TAP block and can be used in obese patients also. It has almost no side effects, and the technique can be easily mastered.

Abstract

Background: To compare diagnostic accuracy of non-fasting DIPSI and HbA1c with fasting WHO 1999 as gold standard for diagnosis of gestational diabetes mellitus (GDM). 

Methods: Pregnant women attending antenatal clinic underwent a 2-h 75-gm GCT in non-fasting state (DIPSI). HbA1c was also determined at the same sitting. A 2-h 75-gm GCT was repeated for all women after 72 h in a fasting state (WHO criteria). GDM was diagnosed if plasma glucose was >=140 mg/dl by either test or if HbA1C >=6%. 

Results: Of the 800 women evaluated, 51 were diagnosed as GDM by WHO criteria, 63 by DIPSI, and 40 by HbA1c. The sensitivity of DIPSI test with respect to WHO 1999 was 98.04% and specificity 98.26%. The diagnostic accuracy was 98.25%. The area under the ROC curve for DIPSI was 0.988 (p < 0.001) (95% confidence interval: 0.960–1.000). The sensitivity of HbA1c with respect to WHO GTT was 47.06%, specificity 97.86%, and diagnostic accuracy 94.63%. The ROC curve between WHO GTT and HbA1c covered an area of 0.805 (p < 0.01) (95% confidence interval: 0.731–0.879). 

Conclusions: Non-fasting DIPSI criteria had high diagnostic accuracy compared to gold-standard WHO GTT and can be an effective and practical alternative to the latter. HbA1c had a low sensitivity although the specificity was good and therefore is not a suitable test for screening GDM. 

Abstract

Introduction: Complete loss of vision is an uncommon ocular complication of pre-eclampsia/eclampsia. The conditions which lead to visual loss in pre-eclampsia include cortical blindness, retinal detachment, retinal vascular thrombosis and optic nerve atrophy. 

Objectives: The objective was to describe the cause, clinical course and prognosis in blindness complicating preeclampsia. 

Methodology: This is a prospective observational study conducted at the Govt. Hospital for Women and Children, Chennai, from January 2006 to December 2010. Sixteen women who were diagnosed with blindness complicating pre-eclampsia were analysed for the cause of blindness, clinical details and prognosis. 

Results: The incidence of blindness among women with pre-eclampsia and eclampsia was 0.17%. The cause of visual loss was cortical blindness in 14 patients and retinal detachment in two patients. Blindness manifested predominantly in the intrapartum and postpartum period in 13/16 cases (81.25%). Seven patients (43.75%) suffered from severe pre-eclampsia, and nine patients (56.25%) suffered from eclampsia. HELLP syndrome, gestational diabetes mellitus (GDM) and anaemia were seen in two patients each. Seven patients also presented with motor deficits. CT scan imaging showed cortical vein thrombosis in five cases, arterial infarcts in two cases, widespread hypodense areas in the occipito-parietal region in six cases. In patients with cortical blindness, recovery of vision occurred within 10 days. 

Conclusion: Cortical blindness and retinal detachment are rare complications of pre-eclampsia and eclampsia. The prognosis is usually good especially with cortical blindness where the loss of vision is transient. The mainstay of management is effective treatment of pre-eclampsia/ eclampsia along with termination of pregnancy. 

Abstract

Introduction: Insulin resistance is one of the most common features of polycystic ovary syndrome, and some studies suggest that vitamin D deficiency may have role in insulin resistance. 

Objective: To study the effect of vitamin D supplementation on the clinical, hormonal and metabolic profile of the PCOS women. 

Study Design: Randomized, placebo-controlled, interventional, double-blind study. 

Materials and Methods: PCOS women were evaluated and enrolled after considering inclusion and exclusion criteria. They were randomized by block randomization with sealed envelope system done in two groups. In the study group (n = 25), patients were supplemented with vitamin D 60,000 IU weekly for 12 weeks, whereas control group (n = 25) was given placebo weekly for the same period. Both the groups were compared pre- and post-supplementation for variables like clinical profile, biochemical profile and metabolic profile. Statistical analysis was performed by the SPSS program for Windows, version 10.1 (SPSS, Chicago, IL). 

Result: In the study (n = 50), PCOS patients were enrolled; 34 patients (68%) were vitamin D deficient (<=20 ng/ml) out of which 10 patients (29%) were severely deficient ( < 10 ng/ ml). Twelve patients (24%) were vitamin D insufficient showing high prevalence of vitamin D deficiency in the PCOS women. The difference in mean serum fasting glucose pre- and post-supplementation of vitamin D in study group was found to be statistically significant with p value of 0.041. There was significant difference seen in insulin resistance (IR) (2.38 ± 4.88–1.00 ± 0.58, p = 0.003), serum fasting insulin (10.34 ± 20.00–5.00 ± 3.25, p = 0.021), and increase in insulin sensitivity determined by QUICKI (0.37 ± 0.04–0.394 ± 0.009, p = 0.001) after supplementation with vitamin D. 

Conclusion: The study concluded that there was a beneficial effect of vitamin D supplementation on ovulatory dysfunctions and blood pressure. Post-supplementation, there were decrease in insulin resistance and increase in insulin sensitivity. In the study decreased serum fasting insulin level and fasting blood sugar after vitamin D supplementation suggest underlying role of vitamin D in glucose homeostasis. 

Abstract

Objective: This study aimed to evaluate the efficacy of unilateral laparoscopic ovarian drilling versus bilateral laparoscopic ovarian drilling with thermal dose adjusted according to ovarian volume in clomiphene citrate (CC)- resistant PCOS patients in terms of endocrine changes, menstrual cycle resumption, ovulation and pregnancy rates. 

Patients and Methods: This study was conducted in the Department of Obstetrics and Gynecology, Zagazig university hospitals. One hundred CC-resistant PCOS patients were divided into two groups. Group (I) (50 patients) underwent unilateral laparoscopic ovarian drilling with thermal dose adjusted according to ovarian volume (60 J/ cm3 of ovarian tissue), and group (II) (50 patients) underwent bilateral laparoscopic ovarian drilling using the same previously mentioned thermal dose. Endocrinal changes and menstrual cycle resumption were assessed within 8 weeks postoperatively, but the ovulation and pregnancy rates were estimated after 6-month follow-up period. 

Results: There was no statistically significant difference between the two groups as regards demographic data (p > 0.05). As regards menstruation cycle resumption (62.5 vs. 81%) (p = 0.047), total ovulation rate (54.2 vs. 78.7%) (p = 0.011) and cumulative pregnancy rate (33.3 vs. 55.3%) (p = 0.031), there was statistically significant difference between both groups. After drilling, there were highly statistically significant decrease in the mean serum levels of luteinizing hormone (LH) and significant decrease in the mean serum levels of testosterone in both groups. Mean serum level of follicle stimulating hormone (FSH) did not change significantly in both groups after drilling.

Conclusion: Bilateral laparoscopic ovarian drilling with thermal dose adjusted according to ovarian volume is more effective than the right-sided unilateral technique with thermal dose adjusted according to ovarian volume in terms of menstrual cycle resumption, ovulation and cumulative pregnancy rates in CC-resistant PCOS patients. 

Abstract

Purpose: This study was undertaken to find out the proportion of women with thyroid dysfunction in pregnancy complicated by diabetes mellitus; to find out the association, if any, of thyroid dysfunction and of antithyroid peroxidase (anti-TPO) antibodies during pregnancy in women with pregestational (PGDM) and gestational diabetes mellitus (GDM); and to find out the maternal and perinatal outcomes of pregnancies complicated by both diabetes mellitus and thyroid dysfunction.

Methods: A cross-sectional observational study was conducted in a tertiary care teaching hospital in Kolkata, India, for a period of 1 year. Sixty-four pregnant women with diabetes, both PGDM and GDM, were recruited from the antenatal clinic. They were managed and followed up till 6 weeks postpartum. Their plasma glucose levels were estimated, and thyroid function was evaluated periodically. All relevant data were recorded and analyzed statistically.

Results: Most (81.25%) women had GDM. Forty percent women suffered from some form of thyroid disorder, mostly (37.5%) hypothyroidism. Thyroid dysfunction was not associated with the type of diabetes mellitus (GDM or PGDM) (p[0.05). The higher rate of anti-TPO titers was observed in pregnancies with PGDM compared to pregnancies with GDM; however, this difference was not statistically associated (p[0.05). All pregnant women with combined endocrinopathy delivered by cesarean section, and the most common neonatal complication observed was jaundice.

Conclusions: Thyroid disorders are quite common during pregnancy complicated by diabetes mellitus. The study findings warrant routine screening for thyroid abnormalities in diabetic pregnant women. These women have increased rate of maternal and neonatal complications.

Abstract

Purpose: Polycystic ovarian syndrome (PCOS) is a common reproductive disorder. Increasing serum prolactin in these patients could be detected in both follicular and luteal phase of the normal and stimulated cycles. Hyperprolactinemia affects the hypothalamic–pituitary–ovarian axis causing anovulation and abnormal uterine bleeding. In this study, the efficacy of combined cabergoline and metformin therapy was compared to metformin therapy alone in patients with PCOS on the body mass index, androgen profile and menstrual cycle regulation. 

Methods: Two hundred and fifty patients with polycystic ovarian syndrome (PCOS) with increased serum prolactin were randomly allocated into two groups: group (1) received oral metformin tablet 1000 mg per day and cabergoline 0.5 g tablet weekly for 3 months as a case group, and group (2) received oral metformin tablet 1000 mg per day and a placebo tablet weekly for 3 months as the control group (n = 123). Body mass index (BMI), menstrual cycle regularity, serum testosterone, serum prolactin and dehydroepiandrosterone sulfate (DHEAS) level were compared before and after treatment in both groups. 

Results: There was significant decrease in body mass index and improvement of androgenic profile in both groups after treatment. In group (1), there was significant improvement in cycle regularity and significant decrease in serum prolactin level post-treatment. 

Conclusions: The use of cabergoline in addition to metformin had more favorable effect on cycle regularity and prolactin level in patients with polycystic ovarian syndrome with hyperprolactinemia than the use of metformin alone. 

Abstract

Background: With the availability of neuroimaging, it is possible to know the exact underlying CNS pathology in eclampsia, and thus, the therapy can be targeted at the same. The present study was undertaken to find out the neurological changes in cases of eclampsia and to find the incidence of PRES in association with eclampsia and to study the role of Inj. Mannitol in cases of eclampsia with PRES who do not respond to Inj. MgSO4 alone.

Methods: This is a referral hospital-based prospective study of 110 consecutive cases of eclampsia who were subjected to MRI/CT scan brain without contrast. All 110 women with eclampsia were treated with routine principles of management of eclampsia. Inj. MgSO4 was the drug of choice as anticonvulsant. Inj. Mannitol was added as antiedema agent in patients who did not respond to MgSO4 alone.

Results: All patients of eclampsia showed PRES on neuroimaging. 40 (36.36%) patients received inj. Mannitol as they had either recurrent convulsions or extreme irritability or deep coma after multiple convulsions and did not recover consciousness after convulsions were controlled.

Conclusion: PRES is the core component of the pathogenesis of eclampsia, and the incidence is 100% in our study. Inj. MgSO4 is the drug of choice, and addition of Inj. Mannitol in cases with recurrent convulsions, extreme irritability, visual symptoms and severe headache plays a dramatic role in control of convulsions and recovery of the patients.

Abstract

Objective: To evaluate the role of platelet indices in preeclampsia and eclampsia.

Methods: An observational analytical study was conducted in Department of Obstetrics and Gynaecology, Ambedkar Hospital, Pandit Jawaharlal Nehru Memorial Medical College, Raipur. It was performed on 150 women between March 2015 and February 2016; among them, 42 were taken as controls, 36 were preeclampsia and 72 were eclampsia. Their platelet count and platelet indices were done, analyzed and compared..

Result: In our study, we found that mean platelet count and mean plateletcrit showed a significant decrease while mean MPV and mean PDW showed a significant increase with increasing severity of disease. Also, we observed that 66.7% preeclampsia and 51.4% eclampsia were nonthrombocytopenic. Among these women, a decrease in the values of plateletcrit and an increase in PDW were seen in a significantly higher number of eclampsia patients. So these two platelet indices can become the new marker for an adverse outcome in preeclampsia and eclampsia even in women presenting with normal platelet counts..

Conclusion: Platelet indices showed a significant variation along with the severity of the disease. Platelet indices, especially PDW and plateletcrit, can be used along with platelet count to evaluate the severity of preeclampsia and eclampsia instead of relying on platelet count alone.

Abstract

Objective: Construction of reference centile chart of middle cerebral (MCA) and umbilical artery (UA) Doppler along with cerebroplacental ratio from 24 to 40 weeks gestation in Indian population.

Method: It was a cross-sectional observational study; antenatal women between 24 and 40 weeks gestation underwent the MCA and UA Doppler. The centile charts for MCA, UA and cerebroplacental ratio (CPR) were derived.

Results: Total 300 antenatal women were included; the MCA PI, RI, S/D ratio values showed a parabolic curve with the peak at 33–35 weeks; the umbilical artery Doppler and cerebroplacental ratio showed a linear decrease with increasing gestational age. The regression analysis showed a weak correlation between the Doppler parameters and the gestational age. The MOM values of all Doppler parameters, across the gestational age, were also derived.

Conclusion: The constructed MCA, UA and CPR charts along with their MOM values could be used as reference for the regional population.

Abstract

Objective: To determine critical factors and barriers to postpartum intrauterine contraceptive device (PPIUCD) use in India in order to guide programs aimed at reducing maternal and child mortality.

Methods: All pregnant women were enrolled for contraception counseling during their visit to the antenatal outpatient clinic. Women who opted for PPIUCDs were enrolled in the study and offered PPIUCD insertion, irrespective of mode of delivery. Those who withdrew consent when in labor or soon after delivery, experienced severe bleeding, or exhibited unstable vital signs were excluded, as were febrile women and those diagnosed with chorioamnionitis.

Result: A total of 66,508 women were enrolled in the study. 86.1% indicated they discussed family planning options with their partners/husbands before making a decision. 178 respondents (0.3%) could not mention one advantage of PPIUCDs, while 23.1% could not mention one disadvantage. 13.9% of the women withdrew consent. Family member objections (43.44%), husband/partner objection (27.94%), and deciding on another method (15.59%) were the main reasons for consent withdrawal.

Conclusion: Awareness of PPIUCDs is not a limiting factor in women’s consent to PPIUCD insertion. As a woman’s decision to use a PPIUCD is significantly influenced by family members and her partner/husband, awareness initiatives that target these populations should be considered.

Abstract

Background: Herlyn–Werner–Wunderlich syndrome is an uncommon entity characterized by uterus didelphys, obstructed hemivagina and ipsilateral renal agenesis (also called OHVIRA syndrome). Due to rarity and varied presentations, often correct diagnosis is missed out during work up, leading to management problems. We describe our dependence on detailed preoperative work up and minimally invasive endoscopic approach in management of the eight patients of OHVIRA syndrome.

Methods: In this retrospective case series study, eight patients of OHVIRA syndrome were managed from January 2012 to March 2018 with the help of improved imaging facility and diagnostic work up. Precise diagnosis helped in adopting minimally invasive approach in management. Patients were reviewed, focusing on presentation, radiologic findings and surgical management.

Results: Median age at diagnosis was 19 years (range 13–41 years). Abdominal pain and dysmenorrhea were the main presenting complaint. All patients except one had associated ipsilateral renal agenesis. Surgical excision of the obstructed hemivaginal septum and hematometra drainage was the main treatment. In seven patients, vaginoscopic resection of vaginal septum was done with resectoscope except one 41-year-old patient, where resection of vaginal septum was performed laparoscopically along with hysterectomy.

Conclusion: Vaginoscopic resection of obstructed hemivaginal septum is an effective method. Management has shifted to minimally invasive approach due to improved imaging, precise preoperative diagnosis and proper understanding of the disease.