Objectives: A variety of biological, biochemical, and biophysical markers implicated in the pathophysiology of preeclampsia during the last two decades have instigated the growing interest in this study to include both bhCG and lipid profile studies in the early second trimester as early predictors of pregnancy-induced hypertension. Early identification of at-risk women may help in taking timely preventive and curative management to prevent or delay complications associated with pregnancy-induced hypertension.
Method: A prospective study was performed on 120 patients attending the outpatient department of the Obstetrics and Gynaecology of the Maharaja Agrasen Hospital. All the patients were screened for serum bhCG and serum lipid profile in their early second trimester (14–20 weeks) and followed up till their delivery. Comparative studies of serum bhCG and serum lipid profile were performed between those who remain normotensive (group I) and those who developed pregnancy-induced hypertension (group II).
Results: TG, total cholesterol, VLDL, and LDL values for those women who developed PIH (group II) were significantly higher than those who remain normotensive (group I), with p value of\0.05 which is statistically significant. HDL and bhCG values for group II were not higher than those in group I with p value[0.05 which is statistically insignificant.
Conclusion: Maternal lipid profile in second trimester is very good noninvasive test which can be used for prediction of pregnancy-induced hypertension before its clinical onset. However, there is no correlation between maternal serum bhCG and pregnancy-induced hypertension.
Pregnancy-induced hypertension, bHCG, TG, Total cholesterol, VLDL, LDLObjectives: To find the incidence of human papillomavirus (HPV) infection and cervical intraepithelial neoplasia (CIN) in pregnant women and compare Pap smear with the HPV DNA test in detecting HPV infection.
Materials and Methods: Hundred antenatal women, irrespective of gestational age, were enrolled as subjects in this prospective pilot study for blood investigations, wet mount examination of cervical discharge, Pap smear, and highrisk HPV DNA detection of cervical scrape by PCR. Women showing abnormality in Pap smear and/or those who were high-risk HPV DNA positive were subjected to colposcopy.
Results: The incidence of HPV-positive pregnant women was 18 %. Koilocytosis on Pap smear was observed in six women. Three high-risk HPV DNA-positive women showed changes consistent with CIN 1 on colposcopy.
Conclusion: The HPV DNA test is the most sensitive and reliable in detecting HPV infection as compared to Pap smear, but considering the cost of PCR, Pap smear screening of all antenatal women was recommended.
Cervical intraepithelial neoplasia, Human papillomavirus, HPV DNA, Pap smear, ColposcopyAim: To study management and maternal and fetal outcome in single fetal death in twin pregnancies.
Materials and Methods: We studied 64 (1.37 %) twin deliveries out of a total of 4,655 deliveries in GMC, Haldwani (Uttrakhand). Out of them, 5 (7.81 %) were complicated with single fetal death in the second or third trimester. These cases were managed conservatively with regular monitoring of maternal coagulation profile along with intensive fetal surveillance for the surviving twin. The cases were studied for antenatal complications and placental chorionicity with placental histopathology and postmortem of the dead fetus. Neonatal and maternal outcome in the postpartum period was also studied.
Results: No antenatal complications were present in four out of five cases with one having PIH. Three out of five pregnancies could be extended to term and had no maternal complications. The other fetus could be salvaged in three and all of them had a normal neonatal period. One pregnancy ended in preterm labor with delivery of a preterm baby which could not be saved. One resulted in death of the other fetus also where pregnancy was remote from term.
Conclusions: Although our study was small, it indicates that in case of twin pregnancy with single fetal death with good surveillance, the live fetus can be salvaged.
Twin pregnancy (TP), Single fetal death, Monoamniotic, MonozygoticObjective: To evaluate the accuracy of transvaginal sonography (TVS) and saline infusion sonohysterography (SIS) for detection of uterine cavity abnormalities in patients with abnormal uterine bleeding (AUB) taking hysteroscopy as the gold standard.
Methods: This was a prospective study done in the department of Obstetrics and Gynecology of a tertiary care academic hospital. Sixty premenopausal and postmenopausal women who presented with AUB underwent TVS, SIS, and hysteroscopy. The presence of focal abnormality and the type of abnormality, i.e., polyp, submucous myoma, and endometrial hyperplasia, were noted. The results of TVS and SIS were compared with hysteroscopy.
Results: On hysteroscopy, 76.67 % (n = 46) patients were diagnosed with intra cavity abnormalities. SIS showed sensitivity, specificity, PPV, and NPV of 89.1, 100, 100, and 73.7 %, respectively. In comparison, TVS showed sensitivity, specificity, PPV, and NPV of 43.48, 78.57, 86.96, and 29.73 %, respectively.
Conclusions: SIS was found to be more sensitive and specific than TVS in detection of intra cavity abnormalities.
SIS, Hysteroscopy, AUB, TVS, Endometrial polypsObjective: To analyze the social factors influencing unmarried pregnancies in urban population.
Methodology: Observational study was conducted at the Institute of Obstetrics and Gynaecology, Chennai, from January 2006 to December 2010. Convenience sampling technique was used, and 115 subjects were interviewed using structured questionnaire.
Results: 15.6 % of the subjects were\16 years of age, and 40.8 % were between 17 and 19 years. 21.7 % of the subjects were illiterate. In 60 % of cases, the average daily income was less than Rs. 100. There was history of alcoholism in 60 % of family members. 80 % of girls were involved in sexual activity willingly, and in 20 %, the subjects were assaulted by force. Five subjects were mentally retarded. 52 % were involved in sexual activity with married men. 72 % reported for termination in the second trimester.
Conclusions: There is a need for educating girls in the area of gender relationship. Contraceptive awareness should be created.
Legal abortions, Unmarried pregnancy, Social factors, Sexual abuseObjective: To study oxytocin, misoprostol, and methylergometrine in active management of the third stage of labor and determine duration of the third stage of labor, blood loss, adverse effects, and need for additional uterotonics in each group.
Methods: Clinical trial of 300 women with healthy singleton pregnancy allocated into three groups to receive either: 10 IU intravenous oxytocin infusion, 600 lg sublingual misoprostol, or 200 lg intravenous methylergometrine. Primary outcome measure was blood loss in the third stage of labor; secondary measures were duration of the third stage, side effects, and complications.
Results: Subjects who received 600 lg of misoprostol had the least blood loss, followed by oxytocin, and methylergometrine. The shortest mean duration of the third stage was with misoprostol. Shivering and pyrexia were observed in misoprostol group, and raised blood pressure in methylergometrine group.
Conclusions: Misoprostol is as effective as oxytocin and both are more effective than methylergometrine in active management of the third stage of labor.
Third stage, Active management PPHObjective: To study the antepartum fetal growth between customized ‘‘GROW’’ curves and noncustomized growth curves with neonatal growth pattern.
Methods: Fetal growth scans are performed between 30 and 35 weeks to singleton mother. Estimated fetal weights (EFWs) were determined using ultrasound variables (biparietal diameter, head circumference, abdominal circumference, and femur length). This EFW is plotted on SONOCARE software [noncustomized growth curves developed by Medialogic solutions (P) Ltd., Chennai, India] and customized ‘‘GROW’’ curves to determine the type of antenatal fetal growth as AGA, small for gestational age (SGA), or large for gestational age (LGA). The fetuses were followed longitudinally till birth, and the newborns’ growth patterns were determined according to birth weight at the gestational age of delivery (\10th percentile for gestational age as SGA and[90th percentile as LGA) and compared to antenatal prediction of fetal growth patterns determined by noncustomized growth curves and customized ‘‘GROW’’ curves.
Results: According to noncustomized growth curve at antenatal period, 93 % fetuses are AGA; 5.6 % are LGA, and 1 % are SGA. According to customized GROW curves, when the same EFW is plotted on GROW curves, 83 % are found to be AGA, 6.8 % LGA, and 10 % SGA. At postnatal period, according to newborn growth curve, 87.8 % are AGA, 8.8 % LGA, 3.4 % SGA. Sensitivity of customized ‘‘GROW’’ curves is more than that of noncustomized growth curves (45.45 vs. 18.18 %) for detection of SGA fetus.
Conclusions: Antenatal predictions of SGA baby by ultrasonography can be almost doubled with customized ‘‘GROW’’ curves than noncustomized growth curves. Customized GROW curves also better predict perinatal morbidities like neonatal jaundice and NICU admission. Antenatal serial fetal growth monitoring should be done with customized GROW curves.
Customized growth curves, Fetal growthObjectives: Critical evaluation of iron sucrose (Malhotra, FOGSI Focus 9–11, 2009) in terms of efficacy, safety, and feasibility at rural setup for the treatment of anemia of pregnancy (Raja et al., Rawal Med J 28: 40–3, 2003) along with any reduction in blood transfusion rate at peripartum period of 37 weeks to 48 h within delivery.
Methods: In a prospective cohort study conducted in Department of Obstetrics and Gynaecology, during the year 2008 AVBRH-Wardha, 256 consecutive women of irondeficient anemia (IDA) treated with intravenous iron sucrose were studied for feasibility, safety, and efficacy of drug. Blood transfusion rates were compared for the years 2007 and 2008 in cases of antenatal women from37 weeks onward up to 48 h post delivery.Results were analyzed by Z-test.
Results: Mean rises in Hb g% were 1.1 ± 0.2, 2.3 ± 0.8, and 3.0 ± 0.4 after 1, 2, and 3 weeks, respectively. Decline in rate of blood transfusion among total anemic women at peripartum period was 9.36 %.
Conclusion: Iron sucrose therapy is very much relevant in rural scenario.
Anemia, Iron sucrose, Rural hospital, PregnancyObjectives: To determine the current prevalence of four major sexually transmitted infections (STIs: HIV, Hepatitis B, Herpes simplex virus 2, and Syphilis) in asymptomatic pregnant women.
Methods: This is a prospective study of 500 consecutive, apparently healthy asymptomatic pregnant women who were attending the antenatal clinic. The information regarding their socio-demographic and behavioral characteristics and obstetric performance was recorded. The blood samples was collected after obtaining their informed written consent from those who were tested for the HIV antibodies (NACO guidelines), HBsAg (ELISA test), HSV2-IgM (ELISA test), and Syphilis (VDRL and TPHA tests).
Results: The overall prevalence of one or the other four STIs studied was 4.8 % with the highest prevalence of HBV (2.4 %), followed by HSV-2 (2 %), and HIV (0.4 %). No woman tested positive for syphilis and multiple infections. All the infections were more common in illiterate, multigravida, monogamous women of low socio-economic status. High-risk sexual behavior of the husbands, history of STIs in husbands, and blood transfusions were the other factors associated with the prevalence of these infections.
Conclusions: The relatively high prevalence of HBV and HSV-2 infections in asymptomatic pregnant women suggests that there is need of screening for HBV and HSV-2 infections along with the pre-existing screening for HIV and Syphilis and universal immunization of HBV high-risk infants.
Asymptomatic pregnant women, HSV-2, HBV, HIV, SyphilisObjective: To evaluate role of serum estradiol levels in predicting likelihood of pregnancy in women undergoing GnRH-a protocol in IVF-ET cycles.
Design: A 3-year retrospective analysis of estradiol levels on down-regulated day 2, day 6, and day of hCG trigger and subsequent clinical pregnancy rates.
Setting: A university hospital tertiary referral centre.
Population or Sample: Women undergoing IVF treatment. Methods Hormonal assessment on the down-regulated day 2, day 6, and day of hCG trigger.
Main Outcome Measure(s): Comparison of hormonal profile, antral follicular count on day 2, endometrial thickness on day of trigger, and number of oocytes retrieved between pregnant and the non-pregnant group. The prediction of IVF success was based on the quantitative levels of estradiol on a specific day in down-regulated cycle.
Result(s): The overall pregnancy rate was 32.25 % (50/ 160). Estradiol level on down-regulated day 2 was 31.9 ± 12.6 and on the day of trigger was 1,996.46 ± 1,252.36 in pregnant women, which was significantly higher as compared to estradiol levels in nonpregnant women (27.6 ± 12.3 and 1,525.1 ± 1,116.42, respectively). It was found to be a significant prognostic marker for successful IVF treatment. Estradiol levels on down-regulated day 6 were found to be non-significant between the two groups.
Conclusion(s): Estradiol level on down-regulated day 2 of menstrual cycle and on the day of trigger was found to have a significant impact on the success of IVF-ET.
Estradiol, Day 2, Day 6, Day of hCG trigger, IVF outcomeObjective: To determine intrauterine contraceptive device (IUCD) discontinuation rate and its causes and related factors among women attending the OPD/family planning clinic in Mahila Chikitasalaya, SMS Medical College, Jaipur from January 2012 to December 2012.
Methods: 387 women who had an intrauterine device (IUD) inserted during the last 1–5 years were interviewed during their visits to the OPD/family planning clinic. Sociodemographic characteristics for all women were described using frequency distribution. Life tables were used to describe the proportion of women who discontinued IUD at various time intervals. The main outcome measure was IUD discontinuation.
Result(s): The incidence of IUD discontinuation in the first year following insertion was 16.79 %. Approximately 31 % of the study sample continued using their devices after 5 years. The average duration of IUD use was 36 months. Of the 387 women, 56 % discontinued IUD use because of a desire to conceive, 27.7 % because of side effects, 15.36 % because of opposition from the woman’s family, and 1.5 % because they were sexually inactive. The most common side effects reported as the reasons for discontinuation were bleeding, infection, and pain. Discontinuation was inversely related to the age at insertion, the number of living children, and the sex of children. Previous contraceptive users were significantly less likely to discontinue IUD use.
Conclusion(s): The crude cumulative rate of IUD discontinuation was 16.79 % during the first year, suggesting a need to tackle the problem of discontinuation through effective educational strategies and counseling techniques. Desire to have a male child still predominates among Indian families. The average duration of IUD use in majority of the females was about 36 months (45 %), thereby fulfilling its objective of spacing between children as laid down by the WHO (2 years spacing between pregnancies). About 31 % of the women continued using IUCD even after 5 years. It is crucial to correct misconceptions and identify the lack of correct and complete information both among the providers and the acceptors, to improve the effectiveness of family planning programs.
IUCD, Discontinuation, Sociodemographic characteristics, Family planningObjective: This prospective randomized controlled study was carried out with the purpose of assessing the efficacy of sublingual misoprostol in decreasing intraoperative blood loss and the need for additional uterotonic agents at cesarean delivery.
Methods: One hundred seventy-four women undergoing elective or emergency cesarean delivery were assigned randomly to receive either 400 lg misoprostol or placebo sublingually at the time of cord clamping. An intravenous infusion of 20 units of oxytocin was started in all women at the same time. The primary outcome measures were intraoperative blood loss, need for additional uterotonic agents, and perioperative hemoglobin (Hb) fall.
Results: The maternal demographic factors, indications for cesarean delivery, and high-risk factors were similar between the two groups. Mean intraoperative blood loss was significantly less in misoprostol group as compared with placebo group (595 ± 108 vs. 651 ± 118 ml, P = 0.025). Fewer women needed additional uterotonic agents in misoprostol group (22.2 vs. 42.8 %; P = 0.0035; RR 0.52, 95 % CI 0.33–0.82). Perioperative Hb fall was significantly less in misoprostol group (0.87 ± 0.29 vs. 1.01 ± 0.26 g, P = 0.0018).
Conclusion: Sublingual misoprostol decreases intraoperative blood loss and the need for additional uterotonic agents at cesarean delivery.
Sublingual misoprostol, Blood loss, Cesarean deliveryObjectives: To study the maternal mortality and the complications leading to maternal death.
Methods: A retrospective study of hospital records and death summaries of all maternal deaths over the period from January 2000 to August 2009 was carried out.
Results: There were a total of 80 maternal deaths out of 88,443 live births giving maternal mortality rate (MMR) of 90.45 per 100,000 live births. Unbooked and late referral accounted for 77.5 % of maternal deaths. The majority of the deaths was in 30–40-year age group and around term. Hemorrhage was the commonest cause of death (52.5 %), followed by sepsis (13.75 %) and pregnancy-induced hypertension including eclampsia (10 %).
Conclusions: Hemorrhage, sepsis, and pregnancy-induced hypertension including eclampsia were found to be the direct major causes of death. Anemia and cardiac disease were other indirect causes of deaths.
Maternal mortality, Postpartum hemorrhage, Sepsis, Eclampsia, AnemiaIntroduction: Premature rupture of membrane is managed either expectantly or actively. The purpose of the study was to assess the effectiveness of early labor induction with cervical prostaglandin E2 versus expectant management in women with term premature rupture of membrane.
Material and Methods: Singleton pregnancy cases with cephalic presentation reported between 37 and 41 weeks of pregnancy with PROM of \6 h and cervical dilatation \3 cm were studied over a period of 2 years. Out of 100 patients studied, half of them were managed by expectant protocol and the other half by early induction within 6 h of PROM with intracervical gel. Main outcomes measured were PROM–delivery interval, mode of delivery, neonatal and maternal morbidity, and period of maternal and/or neonatal hospitalization. Chi-square test was used to compare frequencies between two groups. Differences between means of other measurement were compared by independent t test.
Results: PROM–delivery interval was 22 h in expectant group, while in early induction group, it was 13 h (p value\0.001). Rate of cesarean section remained almost same in both groups. Increases in maternal–neonatal infection rate and hospital stay were noted in expectant group; however, this was not statistically significant.
Conclusion: Immediate labor induction with prostaglandin in cases of term PROM shortens delivery interval and maternal hospital stay with reduction in maternal–neonatal sepsis.
Premature rupture of membrane, Term PROM, Induction, Expectant managementObjective: To evaluate the clinical, laboratory, and diagnostic features in women with abdominal tuberculosis that resembled advanced ovarian malignancy.
Methods: A retrospective review of women with abdominal tuberculosis who were managed at GCRI Ahmedabad from 1996 to 2001 was undertaken.
Results: Fifteen patients (3.06 %) with suspected ovarian cancer cases, finally diagnosed as abdominal tuberculosis over a 6-year period (1996–2001), are analyzed. During this period, 492 patients were operated for suspected ovarian malignancy. Pre-operatively, ultrasound-guided biopsies were inconclusive in 14 cases and hence, exploratory laparotomy was planned. They underwent laparotomy and biopsy for final diagnosis. Frozen sections—of peritoneal/ omental biopsies in 11 cases and ovarian tumour in three cases—were indicative of tuberculosis in all the 14 cases.
Conclusion: The data of this study indicate that the majority of the cases with peritoneal tuberculosis can be diagnosed intra-operatively through the use of frozen section in conjunction with clinical features. Ascites and high levels of Ca125 do not necessarily indicate that the clinical picture is malignant in reproductive women. Laparoscopic tissue biopsy may be a fundamental tool in the management of such cases to avoid extended surgery.
Abdominal tuberculosis, CA-125, Adenosine deaminase, GranulomasObjectives: To study the various factors affecting the success rate of tubal recanalization and the reasons for failure of the procedure.
Methods: A retrospective study was conducted during 2000–2007 @ KIMS, Hubli.
Results: Of the 25 subjects who underwent tubal recanalization, 44 % of women conceived and they were [35 years of age. Laparoscopically sterilized patients had better chances of conception (50 %) following reversal than those who were sterilized by Pomeroy’s method (30 %). With post-reversal tubal length of [4 cm, pregnancy rate was 50 %. Isthumus–Isthumus and Isthumus– Ampullary anastomosis have 50 % success rates.
Conclusion: Tubal recanalization by microsurgical technique is one of the methods to solve infertility after sterilization.
Sterilization, Tubal recanalization, Microsurgical techniqueObjectives: The study of health status of grass-root level health care providers may help us understand the delivery gaps from the programmatic point of view.
Methods: A detailed interview of 313 Anganwadi workers (AWW) was taken in a predesigned, pretested questionnaire, and their clinical examination and Pap smear study were arranged at New Civil Hospital, Surat during November 2007–April 2008. All AWWs were accompanied for follow up and examination. Data were analyzed using Epi-Info Software.
Results: Mean age of menarche and menopause was 14.3 and 44 years, respectively. Among 73 women having menopause, 53 (72. 6%) had natural menopause. On taking history, only 9.5 % gave positive findings, while 42.3 % had positive clinical signs on examination. Inflammation was reported in 43.4 % Pap smear, while 2.8 % had cervical dysplasia of varying grades.
Conclusions: All women should be advised to undergo complete pelvic examination including Pap Smear for the detection of gynecological morbidity.
Anganwadiworkers, Reproductive morbidity, Pap smearAims and Objectives : To compare the efficacy, safety, and rate of response of intravenous iron sucrose and intramus- cular iron sorbitol therapy for anemia during pregnancy.
Material and Methods : 100 antenatal cases of gestational age 14–32 weeks were included in this prospective study. Cases were randomly divided into two groups. Group A, having 50 cases received intravenous iron sucrose, and 50 cases in Group B received intramuscular iron sorbitol. Response to therapy in both groups was studied and compared.
Results : The mean pretherapy hemoglobin in group A was 6.49 gm/dl and in group B was 6.48 gm/dl. The rise in hemoglobin after 4 weeks of starting therapy was 3.52 gm/dl in group A and 2.33 gm/dl in group B. The difference was statistically significant (P :\ 0.01). The mean time taken to achieve target hemoglobin (C11 gm/dl) was 6.37 weeks in group A and 9.04 weeks in group B. In group A, 8 % (four) cases had grade I adverse effects. In group B, 24 % (12) cases had grade I adverse effects. The difference was statistically significant (P := 0.027). In both the groups, no case dis- continued the therapy.
Conclusion : Intravenous iron sucrose is safe, convenient, more effective, and faster acting therapy than intramuscu- lar iron sorbitol therapy for treating moderate to severe anemia during pregnancy.
Pregnancy, Iron deficiency anemia, Iron sorbitolObjectives: (1) To compare the efficacy of Pap smear and HPV PCR for detection of CIN; and (2) To study the distribution of HPV genotypes.
Methods: One hundred women presenting at the female Outpatient Department with unhealthy cervices were subjected to a detailed history, clinical examination, Pap smear, HPV DNA PCR test, and colposcopic-directed biopsy (where indicated).
Results: This study has shown that there is a strong association of HPV infection with higher grades of CIN (100 % in patients with CIN 2, CIN 3, and CIS). The detection of CIN by HPV PCR was more accurate than by Pap smear. The most prevalent HPV genotype found in our study was HPV 16.
Conclusion: The advent ofHPVtesting has opened the doors for more accurate cervical cancer surveillance strategies than Pap smear. Early detection and treatment of CIN will considerably reduce the incidence of cervical cancer.
Cervical intraepithelial neoplasia, Cancer cervix, Human Papillomavirus, Polymerase chain reactionObjective: To find whether placental laterality as determined by ultrasound can be used as predictor for the development of preeclampsia.
Methods: This prospective study was conducted in the Department of Obstetrics and Gynecology, Govt. Medical College, Jammu from 2006 to 2007. 150 pregnant women attending antenatal clinic both OPD and IPD at 18–24 weeks of gestation without any high risk factor were subjected to ultrasound examination, and placental location was determined. These cases were followed for the development of signs and symptoms of preeclampsia.
Results: Out of the total 150 women, 84 (56 %) had laterally located placenta and of them, 56 (66.6 %) developed preeclampsia, while the remaining 66 (44 %) had centrally located placenta and of them, 24 (36.3 %) developed preeclampsia. So, the overall risk of developing preeclampsia with laterally located placenta was 5.09 (odds ratio) and 95 % confidence interval (2.40–10.88). The difference was found to be statistically significant, p value (0.00002) by v2 test.
Conclusion: From the above study, we concluded that females with laterally located placenta determined by USG at 18–24 weeks of gestation have five times greater risk of developing preeclampsia.
