Abstract

Abstract: Antepartum stillbirths are a major contributor to perinatal mortality. This study was undertaken to assess the role of the ReCoDe (relevant condition at birth) classification system in evaluation of stillbirths in a tertiary teaching hospital in Central Gujarat.

Aim: To determine etiology of stillbirths using the ReCoDe classification system.

Materials and Methods: This was a prospective case control study over a period of 1 year from September 1st, 2012 to August 31st, 2013. Sample size was calculated as 243 cases and 486 controls. Two controls (live births) per case were matched for gestational age and birth weight. Odd’s ratios with 95 % confidence intervals were calculated using multivariate logistic regression.

Results: Maternal age and parity that appeared to be highly significant factors on univariate analysis were not found to be independent risk factors with multivariate logistic regression. Gestational age and birth weight were not statistically significant risk factors. Other risk factors like previous stillbirth (26.13; 95 % CI 3.23–211.29), antepartum hemorrhage (11.63; 95 % CI 3.83–35.30), and hypertensive disorders (2.09; 95 % CI 1.20–3.63) were found to be highly significant independent risk factors. Major congenital anomaly (P < 0.001), birth asphyxia (P = 0.0037), cord accidents (P = 0.0037), and rupture uterus (P = 0.001) were also highly significant.

Conclusion: The stillbirth rate was 87.83 per 1000 live births. The ReCoDe primary classification system enabled 74.1 % of the cases to be assigned a relevant condition, leaving only 25.9 % as unexplained. The single largest condition associated was fetal growth restriction (25.9 %).

Abstract

Objective: To determine the influence of ‘‘structured contraception counseling’’ on Indian women’s selection of contraceptive methods.

Methods: Women (C18 and B40 years) requesting contraception were enrolled at 36 sites. ‘‘Structured contraception counseling’’ was provided by a health care professional on the available contraceptive methods. Questionnaires on the women’s pre- and post-counseling contraceptive choice, her perceptions, and the reasons behind her post-counseling decision were filled.

Results: Significant reductions were observed in the proportion of women who were indecisive (n = 260; 31.5 % pre-counseling vs. n = 30; 3.6 %, post-counseling [P\0.001]) and women opting for non-hormonal method (24.6 % pre-counseling vs. 6.8 % post-counseling, [P\0.001]). Of all the women counseled (n = 825), 89.6 % (739/825) of women chose a hormonal contraceptive method. There were significant difference (P\0.001) in the women’s choice of contraceptive in the pre- and post-counseling sessions, respectively (combined oral contraceptive: 30.8 vs. 40.7 %; vaginal ring: 1.8 vs. 14.1 %; progestogen only pills: 1.6 vs. 7.9 %; injectabledepot medroxyprogesterone acetate: 5.9 vs. 13.6 %; levonorgestrel- intrauterine system: 3.8 vs. 13.3 %).

Conclusions: Structured contraception counseling using standardized protocol and aids resulted in a significant increase in the selection of modern contraceptive methods. Post-counseling majority of women opted for hormonal methods with an increase in selection of pills and newer alternatives.

Abstract

Methods: This study for medical abortion was conducted in the Department of Obstetrics and Gynaecology, Zenana Hospital, SMS Medical College, Jaipur during 2011–2012. In total 280 cases were taken for the study and divided into two groups, among whom there were six defaulters in each group who failed to present for follow-up.

Objectives: The objectives of this study were to (1) compare the success rates of abortion at different gestational ages, (2) study the side effects of the drugs, and (3) study the acceptability in both the groups.

Results: The medical abortion with the given regimen and protocol was observed to be highly successful, and complete abortion was achieved in 98.51 and 97.76 % of the patients in Group-A and Group-B, respectively. Failure rates observed were only 1.49 % in Group-A and 2.24 % in Group-B.

Conclusions: Medical abortion can be safely performed in cases up to 63 days of gestation, but women should be counseled about the increased blood loss and duration of bleeding.

Abstract

Objectives: To study myometrial thickness (MT) sonographically as a predictor of latency interval in women with preterm premature rupture of membranes (PPROM).

Study design: The data were collected in a prospective manner from the antenatal patients between November 2011 and June 2013 during the follow-up of patients in the Department of Obstetrics and Gynecology, Goa Medical College. 100 patients with the periods of gestation of 28–36 weeks were studied, out of which 50 were PPROM cases and 50 were controls, both not in labor. The demographic factors and MT of uterine wall are measured at four different levels: midanterior, posterior, lower uterine segment (LUS), and fundus, which are then compared with the latency interval which is defined as the time from the rupture of membranes to the time of delivery.

Results: There was a significant inverse relation between the periods of gestation and latency interval, and positive correlation between anterior MT (p value 0.047), LUS thickness (p value 0.000), and latency interval implicating that the thicker the myometrium at admission in cases of PPROM the longer the latency period.

Conclusion: MT appears a promising tool for obstetricians for predicting latency in cases of PPROM and guiding the management.

Abstract

Objective: To study the role of low molecular weight heparin (LMWH) in perinatal outcome.

Methods: A randomized, case control study was conducted at Safdarjang hospital, New Delhi. Patients were recruited from Sept. 2011 to May 2013 and were followed up till delivery. Thirty cases and controls were enrolled which comprised non-thrombophilic patients with previous history of preeclampsia, fetal growth restriction, abruption, and stillbirth ( > 20 weeks). Study group received daily single dose of LMWH depending upon the weight, subcutaneously; it was started before 15 weeks of gestation and continued up to 36 weeks. Nursery/NICU admission, APGAR score at 0 and 5 min, birth weight, gestational age at delivery, mode of delivery were observed among the interventional and control groups.

Result: There was substantial reduction (80 %) in nursery/ NICU admission. The mean gestational age and birth weight of the cases were observed to be higher as compared to those of control (38.05 ± 2.02 vs. 37.58 ± 2.06 weeks and 2770 ± 400 vs. 2530 ± 0.533 g).

Conclusion: Prophylactic LMWH before 15 weeks of gestation improved the perinatal outcome in non-thrombophilic pregnant women.

Abstract

Purpose: This cross-sectional observational study was undertaken to assess perinatal outcome of the second twin in respect to gestational age, presentation, mode of delivery, and birth weight.

Methods: Seventy women with confirmed twin pregnancy were admitted and managed in a tertiary care teaching hospital in Kolkata, India from May 2008 to April 2009. All relevant data were recorded and analyzed statistically by simple proportions and v2 test.

Results: Women with frequent antenatal visits had highly favorable perinatal outcome than those with fewer or no visits in this hospital (p < 0.001). Higher perinatal mortality was observed among preterm than term (p < 0.01) cases, and among low birth weight than normal babies (p < 0.05). Second twins in vertex–vertex presentation encountered higher perinatal mortality compared to those in vertex–nonvertex and nonvertex–other presentations (p < 0.05). Perinatal outcome was unfavorable when both delivered vaginally than for both cesarean deliveries and cesarean after first vaginal delivery (p < 0.01). Preterm labor was the most frequently observed maternal complication. Birth asphyxia and perinatal mortality were common among second than first twins.

Conclusions: Gestational age, presentation, mode of delivery, and birth weight are the significant determinants of perinatal outcome of the second twin. Women with frequent antenatal care show favorable outcome. The second twin is at higher risk of perinatal morbidity and mortality than the first twin.

Abstract

Purpose To compare the effect of combined oxytocin– misoprostol versus oxytocin and misoprostol alone in reducing blood loss at cesarean delivery.

Methods: One hundred fifty patients of 18–40 years with singleton term pregnancies scheduled for cesarean section under spinal anesthesia were recruited in a prospective double-blind randomized clinical trial to one of the three following groups to receive 20 IU infusion of oxytocin (group O), 400-lg sublingual misoprostol tablets (group M) or 200-lg misoprostol plus 5 IU bolus intravenous oxytocin (group MO) after delivery. The hemoglobin level before surgery and 24 h after surgery, the need for additional oxytocic therapy, and the incidence of adverse effects were recorded.

Results: The mean blood loss during surgery was significantly lower in group MO compared to other groups (P = 0.04). Comparison of mean arterial pressure (P = 0.38) and heart rate (P = 0.23) changes during spinal anesthesia and surgery failed to reveal any statistically significant differences between all groups through repeated measure analysis.

Conclusion: The use of combined lower dose of misoprostol– oxytocin significantly reduced the amount of blood loss during and after the lower segment cesarean section compared to higher dose of oxytocin and misoprostol alone, and its use was not associated with any serious side effects.

Abstract

Introduction Better diagnosis and early referral due to increased health care coverage have increased the cesarean deliveries at tertiary-care hospitals of India. Improvements in the health care system raise many concerns and need of cross-checking system in place to counter the problems pertaining to patient education and participation of patient. While most of the cesarean sections are done in good faith for the patient, it does not escape the purview of consumer awareness and protection.

Materials and methods This cross-sectional study was undertaken at a tertiary level government institution to understand the level of awareness of 220 patients regarding the various aspects of cesarean delivery which are essential for women to know before giving an informed consent.

Results 71 % of the women had knowledge about the indication and need to do cesarean delivery. Of these, only one-third (25 % of total women) were properly explained about procedure and complications. Other demographic and social characteristics were also evaluated.

Discussion While the health care schemes have had their improved results, the onus lies upon the caregivers to improve and maintain the quality of health care in these tertiary-care government hospitals in proportion to the increase in patient load. The results of this study highlight the need for proper counseling of patients regarding complications of cesarean section. The fact that only 25 % of total cases were explained proper procedure and complication as opposed to 71 % of patients having proper knowledge about the indication of cesarean section points out the lack of information in seemingly ‘‘informed’’ consent.

The way forward To bring about awareness about the risks and complications of cesarean section, there is a need that patients be counseled during the antenatal visits, specifically when patients visit near term for antenatal check up.

Abstract

Objective: This study was conducted to compare underweight and obese women and their weight gain during pregnancy on fetomaternal outcome.

Method: This is a prospective, non-interventional, observational study on 1000 women (BMI between 20 and 30 were excluded). Women attending ANC OPD with singleton pregnancy at or before 16 weeks were included and BMI calculated in early pregnancy. Their weight gain during pregnancy was noted. Any complications in the mother or perinate were noted.

Results: Incidence of obesity in our institute was 17 % and that of underweight was 18 %. Pre-eclampsia, gestational hypertensions, gestational DM, antepartum hemorrhage, all were more common among obese women, while anemia was more common in the underweight. Post-dated pregnancy, induction of labor, cesarean delivery, and postpartum complications were more common in obese women. Fetal complications were also higher in obese patients.

Conclusion: Lower as well as higher prepregnancy BMI is an independent risk factor that is associated with increased morbidity and mortality in both the mother and the fetus.

Abstract

Objectives: To study the efficacy safety effect on menstrual cycles, expulsion, continuation, and failure rate of post placental Copper-T-380A after vaginal and cesarean birth in a tertiary center, over the period of 1 year.

Methods: A total of 150 women who opted for insertion of Copper-T-380A within 10 min of expulsion of placenta whether delivered vaginally or by cesarean section were enrolled into study. Women having past history of ectopic pregnancy or any genital tract infection or hemorrhagic disorders, uterine anomaly, chorioamnionitis, LPV[18 h, unresolved PPH, Hb\8 g% were excluded from the study.

Results: No incidence of perforation, PID, and failure of contraception was detected. Percentage satisfaction among users after 6 weeks—91.7 %, 3 months—92.9 %, and 6 months—95.6 %.

Conclusion: Although there was high incidence of missing IUCD threads (probably owing to coiling of long threads), the actual expulsion rate was far lesser. Removal rate due to menorrhagia, pain in abdomen, and vaginal discharge was low, and 6 months continuation rate was considerably good.

Abstract

Background: HIV-positive females are more likely to have abnormal Pap smears than HIV-negative women. These abnormal Pap smears are usually associated with low CD4 cell counts and human papilloma virus infection.

Materials and Methods: This was a prospective hospitalbased study from April 2013 till March 2014. A total of 250 (both symptomatic and asymptomatic) HIV-positive females were examined in Gynaecology OPD at R.C.S.M. G.M.C and C.P.R. Hospital, Kolhapur, and their cervical smears were taken. They were categorized as per modified Bethesda system 2001. The findings in HIV-positive women were correlated with risk factors (age, disease duration, CD4 count and ART use).

Aims: To study the spectrum of cytological abnormalities on Pap smear in HIV-positive females and classify precancerous and cancerous lesions in HIV-positive females according to Bethesda system 2001 and to be familiar with terminology and morphological criteria of Bethesda system 2001. To study the association of Pap smears abnormalities among HIV-positive women with their immune status (CD4 count).

Results: NILM is the commonest finding (83.2 %) which is subdivided into non-inflammatory, non-specific and specific inflammatory and atrophic smears. Candida vaginitis was the commonest cause of specific inflammatory condition accounted for (2.52 %) of all inflammatory smears. The percentage of squamous cell abnormalities was 12 %: ASCUS ? ASC-H—6.22 %, LSIL—2.10 %, HSIL—3.4 % and SCC—0.8 %. The highest incidence of intraepithelial lesions in HIV-positive females was in the age group 31–40 years. There is no association of Pap smear abnormalities among HIV-positive women with their immune status (CD4 count) and duration of ART.

Conclusion: Periodic, regular gynaecologic and Pap smear examination would help in early detection of intraepithelial lesions and their treatment so as to prevent invasive malignancy and mortality.

Abstract

Objective: The objective of this study was to identify clinical practices worldwide, which would help in recognizing women at risk of excessive bleeding or of developing pelvic infection following trans-vaginal ovum pick-up (TV-OPU), measures taken to minimize risks and their management.

Method: A prospective, web-based questionnaire with distinct questions related to the practice of TV-OPU. Results A total of 155 units from 55 countries performing 97,200 IVF cycles annually responded to this web-based survey. A majority (65 %) responded that they would routinely carry out full blood count, while 35 % performed coagulation profile. Less than a third agreed screening women for vaginal infections. About a third used both sterile water and antiseptic to minimize ascending infection, and 52 % used antibiotics for prophylaxis. Doppler ultrasound was routinely used by 20 % of clinicians. 73 % of the clinicians preferred conservative management as their first line management for patients diagnosed with intra-abdominal bleeding.

Abstract

Objectives: Uterine morcellation of presumed leiomyomas inadvertently results in an increase in morcellated uterine leiomyosarcoma (ULMS). Morcellation alters the natural course of ULMS, leading to an increased incidence and earlier recurrences. Recurrences following tumor morcellation are significantly more likely to occur in the peritoneum. Since there is no reliable method for predicting whether a woman with fibroids may have a uterine sarcoma, the US FDA (Food and Drug Administration) discourages the use of laparoscopic power morcellation during hysterectomy or myomectomy (US Food and Drug Administration, http://www.fda.gov/MedicalDevices/Safe ty/AlertsandNotices/ucm393576.htm in 2014). In the wake of recent ban on usage of power morcellation by US FDA, we introduce a technique of in-bag morcellation, thus avoiding spillage of tissues in the peritoneal cavity and spread of an undiagnosed disease or cancer or sarcoma.

Methods: We present a study of twenty-one cases of laparoscopic in-bag morcellation of fibroid and uteri done by Total Health Care method.

Results: The in-bag morcellation technique handles the issue of ULMS and makes laparoscopic myomectomy and hysterectomy possible with fair safety.

Conclusions: Further studies should be directed toward identifying patients at high risk of ULMS prior to presumed leiomyoma resection in order to reduce the risk of inadvertent tumor morcellation.

Abstract

Purpose: The purpose of this study was to correlate the clinical findings, RMI-4 index and frozen section, in cases of ovarian fibroma with the final histopathology.

Methods: This is a retrospective study of clinical and pathological features of 23 patients of ovarian fibroma. The patient’s age ranged from 34 to 66 years (mean— 49 years). The most common presenting symptom was abdominal pain. On clinical examination, the mean size of ovarian tumor was 9.5 cm, CA-125 levels were found to be raised in 14 patients, and it was associated with ascites in 10 patients. USG showed a well-circumscribed mass (with a mean size of 14 cm), on the left side in 14 cases and on the right side in 9 patients. RMI-4 was calculated in all the patients, and it revealed the possibility of a benign histology in 17 patients. All patients underwent exploratory laparotomy with the removal of ovarian tumor followed by frozen section examination. All but one (22/23) patient had positive correlation among frozen section and final histopathological findings.

Result: Ovarian fibroma generally tends to occur in postmenopausal women. All the patients in our study of ovarian fibroma were symptomatic, with the presence of palpable mass in majority of patients. RMI-4 Index correlated very well with benign nature of disease. Frozen section has an invaluable role at surgery; fertility-conserving surgery is the choice in young women.

Conclusion: Clinical findings, RMI-4 Index and frozen section, play vital roles before and during surgery in cases of benign ovarian tumors.

Abstract

Objectives Our objective was to determine the utility of urine dipstick test for the screening of urinary tract infection in catheterized women following gynecological surgeries.

Methods: This was a descriptive study carried out in a tertiary care centre. Five hundred post-operative women were enrolled in the study whose urine samples were collected under sterile precautions from their catheters and simultaneously subjected to the dipstick test at the bed side of the patient and submitted to the laboratory for semi-quantitative culture and microscopy. Data were expressed as proportion. The results of the culture, microscopic examination, and the dipstick test were analyzed using Chi-square test.

Results: When culture results were compared with the leukocyte esterase (LE) test and the nitrite reduction (NR) test, the P value obtained was \0.0001, respectively. Sensitivity was 88.24, 85.29, and 87.88 %, respectively, for the LE test, NR test, and when both these tests were combined. The specificity for the LE test and the combination were, respectively, 98.46 % while for the NR test was 96.71 %. The positive predictive value decreased from 81.08 to 80.56 % on combining the tests while the negative value remained unchanged at 99.11 %.

Conclusions: These bedside tests could considerably reduce the laboratory workload and allow important clinical decisions to be made early.

Abstract

Background: Metabolic syndrome (MetS) is on the rise due to the epidemic increase of obesity. It increases the risk of atherosclerotic cardiovascular diseases and type II diabetes mellitus.

Aims: To study the prevalence of MetS and its components in premenopausal and postmenopausal women.

Design: Cross-sectional comparative study.

Material and Method: Five hundred premenopausal women and 500 postmenopausal women in the age group 40–65 years, attending OPD of Obstetrics and Gynecology Department of Pt. J.N.M. Medical College, Raipur from September 2012 to August 2014 were analyzed and assessed for the MetS risk factors and evaluated according to the NCEP ATP III criteria.

Results: The prevalence of MetS in postmenopausal women was 48.6 %, nearly 1.7 times the prevalence in premenopausal women (27.4 %). Except for central obesity and low HDL cholesterol, the frequency of hyperglycemia, high blood pressure, and hypertriglyceridemia were significantly higher in postmenopausal than in premenopausal women. All the five factors of NCEP ATP III criteria were present in 5 % of postmenopausal women in contrast to 0.4 % in premenopausal women.

Conclusion: Prevention is better than cure. The need of the hour is to target premenopausal women who are at risk of developing MetS in their postmenopausal age. It will delay and prevent them from future morbidities.

Abstract

Background: The discrimination between benign and malignant ovarian tumors is important considering to optimally plan for an appropriate surgical treatment.

Aims: To determine the applicability of risk of malignancy index (RMI 2) for triaging patients with adnexal masses seen at tertiary care hospital in India.

Subjects and Methods: A retrospective case note review of patients with adnexal masses admitted in Gynecology department was done. RMI 2 was calculated for each patient using ultrasound score, menopausal status, and CA- 125 levels (U/ml), and the value of RMI was compared to the histological diagnosis. Statistical analyses were performed using SPSS version 17.0 by descriptive and inferential statistics. The p value B0.05 was considered significant.

Results: The Mean age and SD of hundred patients was 52.8 (10) years. Most of the patients were postmenopausal (68/100). A significant relationship of ovarian malignancy was found with increasing age, high ultrasound score, and high serum CA-125. The average value of CA-125 in benign and malignant ovarian tumor was 7.4 and 625, respectively. The RMI 2 at a cut-off value of 200 had a sensitivity of 96.7 %, specificity of 84 %, positive predictive value of 85.5 %, and negative predictive value of 67.7 %.

Conclusion: Our study confirms the applicability of RMI 2 [200 in diagnosing adnexal masses with high risk of malignancy. It can be easily introduced into clinical practice to facilitate the selection of the patients for surgery and also helpful in triaging patients to different treatment groups.

Abstract

Background: of the Study In India, although a number of contraceptive choices are available, the usage of contraceptive methods among postpartum women is rather low. The current study intended to determine the impact of ‘‘structured contraception counseling’’ on women’s decision making on selection of contraceptive methods and the reasons behind the selection of a contraceptive method.

Methods: One-hundred-and-seventeen postpartum women in the age group of 18–35 years, requesting contraception, were enrolled in the study. ‘‘Structured contraception counseling’’ was provided using a standardized protocol with balanced and comprehensive education material on the available hormonal and nonhormonal contraceptive methods. Questionnaires with information on the women’s pre- and post-counseling contraceptive choice, her perceptions, and the reasons behind her postcounseling decisionwere filled by the participatingwomen.

Results: Maximumwomen enrolled for the study were in the age group of 21–25 years. In pre-counseling, 36 % postpartum women selected a contraceptive method, 23.1 % a nonhormonal method, and 12.8 % a hormonal method. After ‘‘structured contraception counseling,’’ 92.25 % of women chose a contraceptive method. There were significant differences between the women’s choices of contraceptive methods in the pre- and post-counseling sessions, respectively [progesterone-only pills (POP): 5.1 vs. 38.46 %, (p < 0.001); injectable-depotmedroxy progesterone acetate (DMPA): 2.56 vs. 21.356 %, (p < 0.01); and intra uterine device (IUD): 10.28 vs. 23.92 %, (p < 0.001). 38.46 % chose a POP, 21.36 % injectable-DMPA, and 23.9 % the IUD].

Conclusion: ‘‘Structured contraception counseling’’ using standardized protocol resulted in significant improvements in the selection of contraceptive methods by postpartum women.

Abstract

Objective: This study has been designed with the intention to bring a substantial change in the mindsets or life skills of adolescent girls at secondary school level regarding their concept of child survival and safe motherhood practices in order to deal effectively with real-life situations.

Methodology: A cross-sectional analytical study was carried out with 538 adolescent girls regarding assessment of their knowledge on variables like correct nutrition, irondeficiency anemia and its prevention, care during pregnancy, safe birth, skilled birth attendance, breast feeding and complementary feeding practices, child’s growth and development issues, immunization, management of common childhood illnesses. etc.

Conclusion: Analysis was done using Mc Nemar’s Chisquare test for paired data. Values obtained were highly significant for nutrition, iron-deficiency anemia and its prevention, care during pregnancy, and management of childhood illnesses variables, whereas study findings were found to be insignificant for rest of the variables. This study based on life skills approach and counseling worked well to promote and motivate adolescent girls for positive decision making. In this context, every adolescent girl should be encouraged to raise her unsolved issues in order to achieve safe motherhood plus growth and development of their children.

Abstract

Objectives: To study correlation between ovarian reserve with biophysical markers (antral follicle count and ovarian volume) and biochemical markers (S. FSH, S. Inhibin B, and S. AMH) and use these markers to predict poor ovarian response to ovarian induction.

Methods: This is a prospective observational study. One hundred infertile women attending the Obst & Gynae Dept, KGMU were recruited. Blood samples were collected on day 2/day 3 for assessment of S. FSH, S. Inhibin B, and S. AMH and TVS were done for antral follicle count and ovarian volume. Clomephene citrate 100 mg 1OD was given from day 2 to 6, and patients were followed up with serial USG measurements. The numbers of dominant follicles ([or = 14 mm) at the time of hCG administration were counted. Patients with \3 follicles in the 1st cycle were subjected to the 2nd cycle of clomephene 100 mg 1OD from day 2 to day 6 with Inj HMG 150 IU given i.m. starting from day 8 and every alternate day until at least one leading follicle attained C18 mm. Development of\3 follicles at end of the 2nd cycle was considered as poor response.

Results: Univariate analyses showed that s. inhibin B presented the highest (ROCAUC = 0.862) discriminating potential for predicting poor ovarian response, In multivariate logistic regression model, the variables age, FSH, AMH, INHIBIN B, and AFC remained significant, and the resulting model showed a predicted accuracy of 84.4 %.

Conclusion: A derived multimarker computation by a logistic regression model for predicting poor ovarian response was obtained through this study. Thus, potential poor responders could be identified easily, and appropriate ovarian stimulation protocol could be devised for such pts.