Plagiarism is a serious form of scientific misconduct.
Literal meaning of the Latin word ‘‘to Plagiare’’is ‘‘to steal or to kidnap’’. The act of taking the writings of
another person and passing them off as one’s own is plagiarism.
It implies intellectual theft in the world of medical
writing. The ‘‘copy and paste’’ culture is becoming rampant
all over the world after the advent of electronic publications,
and Indian medical literature is no exception. This
editorial will enlighten aspiring authors and readers about
various forms of plagiarism and reasons for engaging in
plagiarism. More so, it will also elaborate on how to prevent
and cure this plague. Possible consequences that
authors may face on detection of the plagiarism are also
discussed. I am concluding my editorial series on medical
writing with this last editorial of the year. I sincerely hope
that these editorials helped authors and readers and this journal continues to receive high-quality papers written
with the greatest honesty and integrity.
Keywords : Plagiarism Scientific misconduct Ethics
Scientific research
Fibroids in pregnancy are increasingly common,due to advanced maternal age, better diagnostic tools anduse of assisted reproductive techniques. Cesarean section(CS) is the commonest mode of delivery in these patients.Cesarean myomectomy (CM) is the term used to describethe removal of fibroids at CS; it has always been a con-troversial topic, with two schools of thought. Someobstetricians advise against it due to the traditional fear ofmassive obstetric hemorrhage and its attendant complica-tions. However, recent literature advocates elective oropportunistic myomectomy in well-selected cases duringCS. This is especially valuable in low-resource settingswhere the patient may be spared a repeat surgery andproblems of anesthesia and cost associated with it. Thisreview examines the recent published data on CM, itsindications, technique, safety and applicability in modernobstetrics.
Keywords: Fibroids, Pregnancy, Cesarean myomectomy
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
Background: Various medical methods for second-trimester medical termination of pregnancy (MTP) exist. Misoprostol alone has been used with myriad variations in route and dosage. Comparison between oral and vaginal routes of misoprostol forms the basis of this study.
Methods This was a prospective comparative study of misoprostol for second-trimester (14–20 weeks) MTP, comparing oral versus vaginal routes. Sixty patients were randomly allotted to two groups; 30 received oral misoprostol 400 lg 4 h up to a maximum of five doses (2000 lg), and 30 received vaginal misoprostol in the same dose and duration. In both groups, oxytocin infusion was started if abortion did not occur. Efficacy of oral versus vaginal misoprostol, induction–abortion interval (AI) and need for surgical intervention were analyzed.
Results: Both groups were well matched in terms of age, parity, previous LSCS, mean gestational age and indication for MTP. Overall mean induction–abortion interval was 19.59 h (21.66 vs. 18.57 h, oral vs. vaginal, respectively), with vaginal group taking lesser time (p 0.09). Sixty percentage in oral group required five doses, while 70% in vaginal group required 3–4 doses of misoprostol (p 0.010). 23.7 versus 6.7% in oral versus vaginal group required check curettage (p 0.038). There were no major complications, and there was only one failure in oral group. Conclusions Though both oral and vaginal misoprostol are safe, vaginal route appears to be more efficacious for second-trimester MTP.
Misoprostol Abortion interval Second-trimester MTP Curettage
Materials and Methods: The PanoramaTM NIPT was performed
in 516 pregnancies, which had tested intermediateto-
high risk on conventional first and second trimester
screening. Results were confirmed either by invasive
diagnostic testing or by clinical evaluation after birth.
Results Of 511 samples analyzed, results were obtained in
499 (97.7%). Of these, 480 (98.2%) were low risk and 19
were high risk. A sensitivity of 100% was obtained for
detection of trisomies 21, 18, 13 and sex chromosomal
abnormalities. The specificity ranged from 99.3 to 100%
for abnormalities tested. Taken together, the positive predictive
value for trisomies 21, 18, 13 and monosomy X was
85.7%. The average fetal fraction was 8.2%, which is lower
than the average observed elsewhere.
Conclusion: This is the first report of detailed experience
with NIPT in India and demonstrates comparable performance
in all aspects of testing to the results elsewhere.
Keywords: Prenatal screening India NIPT SNP
Trisomy 21 Trisomy 18 Trisomy 13
Chromosomal aneuploidies
Methods:
Three cases of interstitial pregnancy were retrospectively
analyzed.
Result Successful laparoscopic cornuostomy and removal
of products of conception were performed in two cases,
while one case was successfully managed by local injection
with KCL and methotrexate followed by systemic
methotrexate.
Conclusion: Early diagnosis and timely management are
key to the management of interstitial and cornual ectopic
pregnancy. With expertise in ultrasound imaging and
advances in laparoscopic skills progressively, conservative medical and surgical measures are being used to treat
interstitial and cornual ectopic pregnancy successfully.
Keywords: Interstitial pregnancy Cornual pregnancy
Laparoscopic cornuostomy Methotrexate
Background: The critically ill obstetric patient represents a
challenge that usually requires a multidisciplinary
approach. Lack of awareness and the absence of regular
antenatal care make the critically ill patients to be referred
late and sometimes in moribund conditions. The objective
of the present study is to determine the incidence, predictors
and outcome of obstetric ICU admissions.
Methods: This retrospective study was conducted over a
period of 2 year from July 2015 to June 2017 in Department of Obstetrics and Gynecology at Institute of
Medical Sciences, BHU, Varanasi, India.
Results: Out of a total of 4986 deliveries, 756 patients
underwent HDU admission, while 92 obstetric patients
were admitted to ICU during this study period. Maximum
number of patients (73.91%) were in the age-group of
20–35 years, 64.13% of patients constitute lower socioeconomic
status group, 68.47% of patients reside in rural
area and there was inadequacy in receiving antenatal care
in case of 60.86% of patients. Maximum number of
patients were admitted for a period of 4–7 days. Blood
transfusion (64.1%), the use of inotropic drugs (45.6%),
central line placement (44.5%) and mechanical ventilation
(26.08%) were the major interventions performed in ICU.
Obstetric hemorrhage was found to be the most frequent
clinical diagnosis leading to ICU admission (31.5%) followed
by hypertensive disorders (25%).
Conclusion: In addition to timely referral, health education
and training of health professionals may improve clinical
outcome and better obstetric practice, especially in countries like India. Obstetric ICU dedicated for the
management of only obstetric patients should be constructed
in order to compensate for heavy burden critically
ill women.
Keywords: Obstetric ICU HDU Maternal mortality
Objectives: In this study, we tried to make the customized labor curve by studying the labor pattern among the primigravidas and we compared the cervicograph with Zhang’s and Suzuki’s curves. This study may be a motivator for future research to create own labor norms for our Indian population which may help in reducing the cesarean section rates, principally in primigravidas.
Materials and Methods: It was a prospective observational study, which included 156 primigravidas with uncomplicated term singleton pregnancy with spontaneous onset and progression of labor, who had normal vaginal delivery with good maternal and neonatal outcome.
Results: The shape of the labor curve of this study was similar to Zhang’ and Suzuki–Horiuchi’s curves which had slower progression. The active phase started from 5 to 6 cm of cervical dilatation onwards which was similar to Suzuki–Horiuchi’s curve. In the present study, the mean rate of cervical dilatation in the active phase was 1.5 cm/ hour in contrast to Friedman’s study which had a mean rate of cervical dilatation of 3 cm/hour with lower limit of 1.2 cm/hour as 5th centile.
Conclusion: In the present study the mean rate of cervical dilatation in active phase in Indian women was approximately equivalent to the lowest acceptable rate of cervical dilatation in Friedman’s study. If we continued to follow Friedman’s labor norms, it could result in increasing c-sections. Hence, it would be prudent to create a customized labor curve for the local population served based on their individual characteristics features.
Labor pattern in primigravidas Customized labor curve Cervicograph Labor pattern Indian study Spontaneous laborBackground: Ectopic pregnancy is increasing in incidence. Nevertheless, there is wide availability of tools for early diagnosis and advances in management. Though it is not a leading cause of maternal mortality, it significantly causes morbidity and jeopardizes reproductive outcome in women desirous of fertility.
Aims: To determine incidence, risk factors, symptoms, signs, type of ectopic pregnancy and management. Settings and Design This is a one-year prospective, descriptive study conducted in Department of Obstetrics and Gynaecology, Sri Ramachandra Medical College and Research Institute, Porur, Chennai.
Results: There were 119 ectopic pregnancies during the study period. The incidence of ectopic pregnancy is 2.81/ 100 deliveries. Ectopic pregnancy was common in 26–30 years, the minimum age at diagnosis was 18 years and maximum age was 40 years. Fourteen women had previous one ectopic pregnancy. Four had previous two ectopic pregnancies. Previous cesarean and treatment for infertility were the commonest risk factors. The classic triad was present in only 27.7% of patients. Fourteen patients presented with shock. Five women were diagnosed even before they missed their periods. Success rate of medical treatment with methotrexate is 83.33%. Tubal pregnancy was the commonest type, and ampulla was the commonest site. Right side was affected more than left side. Thirty-three patients (27.7%) required blood transfusion. Seven developed morbidity. After 1-year follow-up of 68 women who were desirous of fertility, five women have become pregnant subsequently with intrauterine gestation.
Ectopic pregnancy, hCG, Methotrexate, Tubectomy, LaparoscopyBackground: Purpose Breech presentation is the most common abnormal presentation occurring in 3–4% of all deliveries. Incidence of caesarean section for breech presentation has increased markedly in the last few decades. Attempting external cephalic version (ECV) reduces the chance of noncephalic presentation at term, thus reducing the rate of caesarean sections.
Methods: Prospective study was conducted in secondary healthcare centre, in rural set-up from August 2013 to August 2015. A total of 52 patients were enrolled into the study.
Results: ECV was successful in 32 out of 52 patients with overall success of 61.5%. Out of the 32 successful ECVs, 24 patients delivered vaginally (75%) (p value 0.00), 6 patients delivered by caesarean section, and 2 patients were lost to follow-up. Transverse lie had 100% success rate for ECV (p value 0.005). Gravidity, placental position, gestational age and use of tocolytics did not influence the success rate of ECV. Most common problem observed during the procedure was abdominal discomfort.
Conclusion: ECV is a safe procedure with high percentage of patients delivering vaginally after successful version. Hence, acquiring skills in ECV should be considered mandatory in the postgraduate training of future obstetricians.
Keyword: Breech presentation, Transverse lie, External cephalic version (ECV).Background: Heterotopic pregnancy (HP) is a condition characterized by the coexistence of multiple fetuses at two or more implantation sites. It occurs in 1% of pregnancies after assisted reproductive techniques (ART). Presence of triplet intrauterine pregnancy with ectopic gestational sac is one of the rarest forms of HP. Ectopic pregnancy is implanted in the ampullary segment of the fallopian tube in 80% of cases. Most of the patients present with acute abdominal symptoms due to rupture of the tube. Case Presentation This article reports a case of quadruplet heterotopic pregnancy after intracytoplasmic sperm injection (ICSI) with an ampullary ectopic pregnancy and intrauterine triplet pregnancies. The ruptured ampullary pregnancy was emergently managed by right salpingectomy. This was followed by embryo reduction at 12 ? 6 weeks and successful outcome of intrauterine twin pregnancy.
Heterotopic pregnancy, Quadruplet, Embryo reduction, ICSI conception, Ectopic pregnancy