Abstract

Objective: The aim of this article was to determine digital levels of the association of factors of pregnancy success after the first cycle of intrauterine insemination (IUI) with 300 infertile couples.

Methods: The IUI procedure was followed at 36 h after triggering the ovulation, if at least one follicle measured [15 mm. Endometrium thickness (ET) and serum luteinizing hormone (LH) levels were measured at day 10 for each patient. The post-wash total motile fraction (TMF) of semen of the partner of each patient was also evaluated. The principal component analysis (PCA) was done with the data to quantify the associations of related factors.

Results: The clinical pregnancy rate of first cycle IUI attempts was 17.3 %, observed in females, aged 20–39 years and men with TMF[5 million spermatozoa. The ovarian stimulation enabled the development of follicles measuring[16 mm, with LH levels\10 mIU/L and ET [5 mm for success. The PCA revealed that with the female-age parameter, three factors, NF, ET, and LH were related in the component 1; similarly, NF, LH, and RFS were related in component 2; age, NF, ET, LH, LFS, and TMF were related in component 3; and NF, ET, LH, RFS, and LFS in component 4 were related, i.e., the best correlation.

Conclusion: Associated principal determinative factors, LH, female-age, NF and LFS values were highly significant, but the factors, ET, RFS and TMF were statistically insignificant for success through IUI in pregnancy.

Abstract

Purpose: To assess how some factors may influence the failure of labor induction.

Methods: We conducted a prospective observational study from January 2009 to December 2011 with 248 patients who were admitted to the Obstetrics Unit of Ferrara University for labor induction. We selected only patients with unfavorable characteristics such as nulliparity, maternal and gestational age, and Bishop score and specific obstetric conditions such as mild preeclampsia, isolated oligohydramnios, premature rupture membrane, gestational diabetes, and hypertension for the success of labor induction. Results The induction was carried out by rapid-release gel dinoprostone. 200 patients (80.6 %) delivered vaginally (Group A), while 48 (19.4 %) underwent a cesarean section (Group B). Maternal age was one independent significant variable (p = 0.01, OR 1.08) determining the risk of cesarean delivery. Patients affected by mild preeclampsia had a three times higher risk for cesarean section. Despite the several unfavorable characteristics of the patients, the cesarean section rate was comparable to that of the normal population.

Conclusion: Several factors and clinical conditions historically considered as negative predictors of induction result should be reassessed. The success of labor induction is determined by many maternal and fetal variables, which must all be taken into account to avoid unnecessary cesarean sections.

Abstract

Objective: To analyse the impact of Janani Suraksha Yojana (JSY) on Maternal Mortality Ratio (MMR). Design Retrospective analysis of maternal mortality.

Methods: Analysis of all maternal deaths between January 2001 and December 2009.

Results and Discussion: The total number of deliveries has been steadily rising from 1,685 in 2001 to 3,957 in 2009. TheMMRdoubled from 1,500/100,000 live births in 2001 to 3,000/100,000 live births in 2006, then declined to 2,464/ 100,000 live births in 2009. Implementation of the various maternity benefit schemes has had no significant impact on the profile of dying mothers—admission-to-death interval. Deaths due to anemia and eclampsia have significantly increased (P\0.05), whereas due to sepsis (P\0.001) and hemorrhage (P\0.05), deaths have significantly decreased. Almost 96 % of dying subjects received inadequate antenatal care. However, significantly less number (P\0.001) of women are delivering at home.

Conclusions: There is a need to stress the importance of good antenatal care in reducing MMR.

Abstract

Aim: To determine the current prevalence of thyroid dysfunction in normal pregnant women and to study the impact of thyroid dysfunction on maternal and fetal outcome. Methods 400 pregnant women between 13 and 26 weeks of gestation were registered for the study. Apart from routine obstetrical investigations, TSH tests were done. Free T4 and anti-TPO antibody tests were done in patients with deranged TSH. Patients were followed up till delivery. Their obstetrical and perinatal outcomes were noted.

Results: The prevalence of hypothyroidism and hyperthyroidism was 12 and 1.25 %, respectively. Adverse maternal effects in overt hypothyroidism included preeclampsia (16.6 vs. 7.8 %) and placental abruption (16.6 vs. 0.8 %). Subclinical hypothyroidism was associated with preeclampsia (22.3 vs. 7.8 %) as compared to the euthyroid patients. Adverse fetal outcomes in overt hypothyroidism included spontaneous abortion (16.6 vs. 2.39 %), preterm birth (33.3 vs. 5.8 %), low birth weight (50 vs. 12.11 %), intrauterine growth retardation (25 vs. 4.9 %), and fetal death (16.6 vs. 1.7 %) as compared to the euthyroid women. Adverse fetal outcomes in subclinical hypothyroidism included spontaneous abortion (5.5 vs. 2.39 %), preterm delivery (11.2 vs. 5.8 %), low birth weight (25 vs. 12.11 %), and intrauterine growth retardation (8.4 vs. 4.9 %) as compared to the euthyroid women.

Conclusion: The prevalence of thyroid disorders was high in our study with associated adverse maternal and fetal outcomes. Routine screening of thyroid dysfunction is recommended to prevent adverse fetal and maternal outcome.

Abstract

Objectives: The aim of this study was to analyze the incidence, possible etiological factors, pathology, clinical manifestations, brain CT scan features, treatment, and prognosis of cerebrovascular complications occurring in pregnancy and puerperium.

Methodology: This is a prospective analytical study con- ducted at the Govt. Hospital for women and children, Chennai, from January 2006 to February 2008. During the above period, 26 women were diagnosed with various cerebrovascular complications. In these patients, the clin- ical data, risk factors, neurological features, investigations, results, and neuroimaging reports were analyzed.

Results : The incidence of cerebrovascular complications   in this study was 66 per 100,000 deliveries. None had prior history of diabetes, hypertension, renal disease, or seizure disorder. Two women were suffering from cardiac disease. PET and eclampsia were seen in 19/26 (73 %) cases. Seven women were suffering from anemia and one with severe sepsis. The neurological complications manifested pre- dominantly in the postpartum period. Cases presented with hemiplegia/facial palsy and aphasia. CT scan imaging showed intracerebral hemorrhage in four cases, cerebral infarcts in five cases, and cortical vein thrombosis in 16 cases. There were five maternal deaths in this study.

Conclusion : Stroke occurring in pregnancy,  though rare,   is a serious complication which can lead to maternal death. In this study, hypertension has emerged as an important risk factor; therefore, attention should be focussed on maintaining normotension in the peripartum period.

Abstract

Objectives: To assess the efficacy of calciuria as a diagnostic test for the prediction of preeclampsia, and also to determine the changes in urinary excretion of calcium in preeclampsia and normotensive women.

Methods: A prospective study was conducted on 60 primi mothers in the age group of 20–30 years, and all were enrolled at 16 weeks of gestation with clinical follow up by 4 weeks and 24 h urinary calcium and creatinine estimation. Ten mothers developed preeclampsia (study groups) and fifty remained normotensive (control groups). By means of Receiver-operator curve, a cut-off level of urinary calcium in 24 h was chosen for predicting preeclampsia.

Results: Preeclamptic women excreted significantly less total urine calcium (87.0 ± 3.59 mg/24 h) than normotensive women (303.68 ± 17.699 mg/24 h) (p\0.0001) at 40 weeks of gestation. Urinary calcium and calcium/ creatinine (Ca:Cr) ratio decreases progressively from 28 weeks to 40 weeks in the study group when compared to normotensive group.

Conclusions: Preeclamptic women excrete less calcium than normotensive women. This parameter would predict preeclampsia earlier in pregnancy.

Abstract

Aim: To determine whether an antepartum low amniotic fluid index (AFI) is a predictor of adverse perinatal outcome in normal pregnancy and to determine a threshold level of AFI that could predict an adverse outcome.

Methods: This was a prospective study conducted among 180 pregnant women at 37–40 weeks of gestation with no known obstetric or medical complications with an AFI B 5th percentile. The results were statistically analyzed and compared.

Results: In the control group, the mean AFI was 10.14 cm and in the study group, it was 4.14 cm. 65 % patients in the study group and 24 % in the control group had a nonreactive non-stress Test. In the control group, 53 % of patients were induced for reasons other than oligohydramnios, while in the study group, 86 % of patients were induced for oligohydramnios. Among the control group, 33 % had a LSCS, while 67 % delivered vaginally; and in the study group, 34 % delivered vaginally and 66 % had a LSCS. In our study, a 5-min APGAR\7 was seen in 34 % in the study group and 11 % in the control group. 33 % neonates in the control group and 64 % in the study group had birth weights\2.5 kg.

Conclusions: In the presence of oligohydramnios, perinatal morbidity and mortality are high. Determination of AFI is a valuable screening test for predicting fetal distress.

Abstract

Objectives: Hypertension disorders are associated with higher rates of maternal, fetal, and infant mortality, and severe morbidity, especially in cases of severe preeclampsia, eclampsia, and HELLP syndrome. The aim of the study was to determine maternal outcomes in pregnant women with severe preeclampsia.

Data Source: The data source consisted of 349 cases with severe preeclampsia.

Design: A cross-sectional study was undertaken on 349 cases of severe preeclampsia in pregnancy.

Setting/Period: The patients selected for this study were from those who presented at Kermanshah University of Medical Sciences, Department of Obstetrics and Gynecology during 2007–2009.

Materials and Methods: Statistical analysis was performed using SPSS 16 software and conducting Chi square and independent sample t tests. Demographic data involving age, parity, gestational age, clinical, and laboratory findings were recorded from the medical files. In addition, delivery route, indications of cesarean delivery, and maternal complications were determined.

Results: Of the 349 severely preeclampsia cases, among the 22 cases (6.3 %) who had suffered fromeclamptic seizers, 17 cases (77.3 %) were in the age group of 18–35 years (P = 0.351) and 13 cases (59.1 %) in the gestational age group of 28–37 weeks (P = 0.112). One case (0.3 %) was demonstrated to have HELLP syndrome. Placental abruption was obstetric complication in 7.7 %(27 cases). Delivery route was vaginal in 120 cases (34.4 %), while 229 cases (65.6 %) underwent cesarean delivery. The most frequent maternal complication (37 cases) reported was coagulopathy (10.6 %).

Conclusions: We concluded that severe preeclampsia and eclampsia are associated with higher rates of maternal severe morbidity and that these two factors still remain the major contributors to maternal morbidity in Iran.

Abstract

Objectives: To compare maternal and neonatal effects of assisted vaginal delivery by forceps and vacuum extraction.

Methods: A prospective randomized study. One hundred eligible women requiring assisted vaginal delivery in the second stage of labor were randomized to deliver by forceps or vacuum extraction.

Results: All of those allocated to forceps delivery actually delivered with the allocated instrument (100 % delivery rate in forceps vs. 90 % in VE); however, maternal trauma (40 % in forceps vs. 10 % in VE, p\0.001), use of analgesia (p\0.001), and blood loss at delivery (234 ml in VE vs. 337 ml in forceps group, p\0.05) were significantly less in the group allocated to deliver by vacuum extraction. Vacuum extraction, however, appears to predispose to an increase in neonatal jaundice and incidence of cephalhematoma. More serious neonatal morbidity was rare in both groups.

Conclusion: Extrapolation of the data from the study reveals that there is a significant reduction in maternal injuries. However, vacuum extraction has the potential to injure babies more.

Abstract

Objectives: The aim of this was to evaluate the accuracy of two-dimensional (2D) ultrasonography in the diagnosis of nuchal cord to enable us determine if it can be recommended for its antenatal diagnosis.

Materials and Methods: Between 01 January and 30 April 2012, 93 singletons pregnancies in cephalic presentation with 2D ultrasound scan done at term but within 24 h before onset of labor for exploration of the presence or absence of nuchal cord were reviewed. The procedure was carried out using the same equipment (Voluson 730 Expert) and by the same radiologist who had good training in the ultrasonographic diagnosis of nuchal cord.

Results: Among the 38 cases of nuchal cord present at delivery, the diagnosis by means of 2D ultrasonography was done in 32 cases (sensitivity: 84.2 %). The diagnosis was also correct among 47 of the 55 absent nuchal cords at delivery (specificity: 85.4 %). In eight cases, nuchal cord diagnosed by 2D ultrasonography was not observed at delivery (positive predictive value: 80 %). Furthermore, six cases of nuchal cord were undiagnosed by 2D ultrasonography (negative predictive value: 88.7 %).

Conclusion: Two-dimensional ultrasonography for the antenatal diagnosis of nuchal cord by a skilled radiologist can reach sensitivity and specificity of more than 84 %. Therefore, in settings where only 2D ultrasonography is available, efforts should be made by operators for antenatal diagnosis of nuchal cord.

Abstract

Objectives: The aim of this study was to compare the efficacy and safety of intravenous iron with oral iron in the treatment of iron deficiency anemia of pregnancy.

Methods: A randomized experimental study was conducted at K. J. Somaiya Hospital involving 200 pregnant women with iron deficiency anemia. In the intravenous group iron dose was calculated from: Total iron dose required (mg) = 2.4 9 weight kg 9 target hemoglobin - actual hemoglobin) g/dl ? 500. Target hemoglobin was set at 12 g/dl. In the oral group patients received 200 mg oral ferrous ascorbate daily. Hemoglobin and serum ferritin were reviewed at 2, 4, and 6 weeks. Paired and independent t test was applied.

Results: The change in hemoglobin and ferritin levels from baseline was significantly higher in the intravenous group than the oral group at each measurement (P = 0.000).

Conclusion: Intravenous iron elevates hemoglobin and restores iron stores faster than oral iron, with no severe adverse reactions.

Abstract

Purpose: Our aim was to identify couples at risk of having a homozygous or compound heterozygous child with a severe hemoglobinopathy by antenatal screening and prenatal diagnosis in Surat, South Gujarat.

Method: Pregnant women were screened for hemoglobinopathies by means of red cell indices, the solubility test, cellulose acetate electrophoresis tests, and confirmation by HPLC. Husbands of the pregnant women having hemoglobinopathies were counseled and screened for hemoglobinopathies. The couples at risk were again counseled and referred to the National Institute of Immunohematology, where mutations in parents and fetuses were identified by molecular analysis. After prenatal diagnosis, the continuing pregnancies were followed up and infants were tested at birth.

Results: Out of 3,009 women, 37.04, 52.6, and 10.3 % were in the first, second, and third trimester of pregnancy, respectively. Among those having hemoglobinopathies, 102 (3.38 %) had the b-thalassemia trait, 46 (1.5 %) the Sickle cell trait, and 26 (0.86) had hemoglobin variants like Hb DPunjab, Hb E, Hb DIran, Hb QIndia, Hb JParis-I, and Hb OIndonesia. Out of the 14 couples at risk of having an affected child, 11 (78.5 %) couples opted for prenatal diagnosis. Three fetuses had homozygous b-thalassemia and hence the pregnancies were terminated. Follow up of normal or heterozygous fetuses confirmed the diagnosis.

Conclusion: During antenatal screening, we found many Hb variants of β and α globin chains. Late antenatal registration, non-cooperation of the husband for investigation, and refusal for prenatal diagnosis are the main hurdles in the hemoglobinopathy prevention program and awareness is necessary.

Abstract

Background: Cervical and endometrial carcinoma incidentally found in the surgical specimen with high risk pathological finding or with gross residual disease.

Material and Methods: Between 2004 and 2010, 320 cervical and endometrial cancer patients were treated with EBRT and brachytherapy after having undergone total/ subtotal hysterectomy. Sixty patients were lost to followup.

Results: Median follow-up was 21 months. Endometrial and cervical cancer with a high risk for local recurrence achieved CR 93.8 and 89 %, respectively. 56 % patients experienced CR with residual disease with cervical cancer. Median OS for endometrial and cervical cancer with residual disease was 8.5 and 24 months, respectively. Grade 3 adverse events were 5 and 3.5 % for rectum and bladder, respectively.

Conclusion: The incorporation of chemotherapy during pelvic radiotherapy followed by HDR interstitial brachytherapy for residual disease is inadequate and improves survival. We are still in learning phase of brachytherapy in post-operative gynaecological malignancy cases; expertise will be developed by practice.

Abstract

Objectives: To evaluate the clinico-pathological features, surgical procedures and postoperative treatment and their relation to survival in women with granulosa cell tumours.

Methods: Data of 37 women with granulosa cell tumours were collected and reviewed retrospectively. Mann–Whitney test, log rank test and Kaplan–Meier survival analysis were applied appropriately.

Results: Thirty-seven women of median age 48.6 years were diagnosed in stage Ia (45.9 %), stage Ic (27 %), stage III (16.2 %) and unstaged (10.8 %). The median follow up was 5 years. Overall survival was 93 % at 5 years. Disease- free survival at 5 years was 63 %. Tumour stage and residual disease were associated with poor prognosis (p\0.001). Mitotic rate and tumour grade were not of prognostic significance.

Conclusions: Stage of disease and residual disease are valuable prognostic factors. Prospective studies with large sample sizes and long-term follow up are needed to confirm our findings.

Abstract

Objective: Vulvovaginal candidiasis (VVC) is a common gynecological finding among the women worldwide. Candida species are often less susceptible to antifungal agents. Owing to this fact, in this study, we aimed at assessing the prevalence rate and antimicrobial susceptibility pattern of various azoles against Candida species causing VVC in symptomatic women.

Methods: The prospective study included 217 female patients with symptoms of vaginal discharges. Specimens were characterized microscopically and were subjected to antimicrobial susceptibility testing against various azoles according to NCCLSM44 disk-diffusion method.

Results: VVC was detected in 18.4 % of the cases. Based on age distribution, the highest rate of Candida infection was observed in the age group of 20–29 years (42.5 %). Antifungal susceptibility revealed that fluconazole was highly effective against Candida Species (97.2 %); on the contrary, the highest resistance was observed in the case of miconazole (63 %).

Conclusion: In the current study, prevalence rate of VVC was found to be 18.4 %, and among the various azoles tested, fluconazole has the highest antimicrobial activity.

Abstract

Objective: Placental growth factor (PlGF) is an angiogenetic factor and inducts the development of preeclampsia in a hypoxic environment. In this study, we examined maternal blood PlGF levels in a pregnant population between 16 and 19 weeks of gestation for determining the prospective value for early diagnosis of preeclampsia as a screening test.

Materials and Method: In this prospective cross-sectional study, 114 nulliparous normotensive pregnant women were selected for the control group and 34 patients who have chronic hypertension or had a medical history of hypertensive disorders in previous pregnancies were selected for the study group.

Result: In the study group, the risk of preeclampsia increased 3.2 times when compared with the control with a confidence interval of 95 %. The cut-off value for PlGF for discriminating preeclamptic and non-preeclamptic patients was found to be 62.5 pg/ml.

Conclusion: Patients with a medical history of hypertensive disorders and low PIGF levels in early second trimester have an increased risk for preeclampsia.

Abstract

Objective: The aim of this study was to investigate perinatal outcome and the rate of cesarean section (CS) following intrapartum amnioinfusion in women with meconium-stained amniotic fluid (MSAF).

Method: A total of 100 women at term in labor with meconium were randomized to infuse transcervical intrapartum amnioinfusion with saline (50) and routine obstetrical care (50). Perinatal outcome and obstetric outcome were recorded and analyzed in both groups by means of Chi-square test.

Result: The CS rate due to fetal distress was 40.0 % in the control group and 20.0 % in the study group. The difference was statistically significant (P\0.01). Respiratory distress of the neonate was significantly less common in the study group than in the control group (4.0 % vs. 12 %; P = 0.0349).

Conclusion: Amnioinfusion in cases of meconium-stained liquor significantly improved neonatal outcome and CS rate without increasing any maternal and fetal complications.

Abstract

Objectives: To study the efficacy of fetal Doppler and non-stress test (NST) in predicting fetal compromise in preeclampsia and growth-restricted fetuses.

Method: ln a prospective study, 189 pregnant women beyond 32 weeks of gestation with preeclampsia or growth-restricted fetuses confirmed by ultrasound were evaluated by Doppler velocimetry (umbilical and middle cerebral artery) and non-stress testing. The outcome of pregnancy was recorded according to Group I (n = 109, Doppler and NST normal), Group II (n = 48, Doppler abnormal and NST normal), Group III (n = 14, Doppler normal and NST abnormal), and Group IV (n = 18, Doppler and NST both abnormal). The evaluation was done by Chi square testing.

Results: Both Doppler and NST had a better specificity and negative predictive value, indicating that these tests were more predictive of a healthy fetus. The fetal compromise in terms of APGAR scores, NICU admissions, birth weight, etc., was greater when both Doppler and NST were abnormal. Doppler detected changes earlier in the disease cascade than NST as evidenced by the lead time of 5.86 days.

Conclusion: The use of both the tests is necessary as it helps in detecting a spectrum of fetuses compromised at various stages of disease affection.

Abstract

Purpose: To evaluate various laparoscopic methods for management of tubal ectopic pregnancy and study the incidence of ectopic pregnancy including the incidence of cornual ectopic pregnancy and conversion to laparotomy during laparoscopic procedure.

Methods: A retrospective study was conducted in North Point Hospital, Delhi, on all laparoscopies conducted in 4 years, i.e., from January 2008 to December 2011.

Results: Incidence of ectopic pregnancy was 4.62 % (out of all laparoscopic surgeries over 4 years) and that for cornual pregnancy was 4.65 % (out of all ectopic pregnancies); no laparotomy was done for the management of ectopic pregnancy. The site of ectopic pregnancy in the tubal pregnancy varied, with 76.75 % in the ampullary region, 16.27 % isthumic, 2.33 % fimbrial, and 4.65 % in the cornual region. Salpingectomy was done in 53.5 % cases and 46.5 % of patients underwent a conservative approach in the form of salpingostomy.

Conclusion: The laparoscopic management of ectopic pregnancy is a safe and effective option with greatly reduced morbidity.

Abstract

Objectives: The objective of the current study is to compare outcomes of twin pregnancies with attempted labor and active second-stage management with twin pregnancies delivered by planned cesarean delivery.

Material and Method: Two hundred and eighty-three patients with twin pregnancy meeting the inclusion criteria were reviewed. They were followed for success of ECV and/or IPV in planned vaginal group and abdominal mode of delivery. Fetal outcome was assessed by APGAR score of both twins as well as NICU admission, if needed.

Results: Out of 283 patients, 116 patients (40.9 %) had planned cesarean section, and 167 patients (59.01 %) had planned vaginal delivery. Out of 167 patients, 148 patients (88.6 %) had a vaginal delivery of both twins. ECV was successful in 36 patients (25.3 %), and IPV was successful in 102 (95.3 %). IPV failed in five patients (4.6 %), and hence resorted to emergency cesarean section. There was no significant difference in the rates of twin B having a 5-min Apgar score lower than 7 or an arterial cord pH below 7.20 in both the groups. Among the patients in the planned vaginal delivery group, the cesarean delivery rate was 8.3 %, out of which combined vaginal—cesarean delivery rate was 4.6 %.

Conclusion: Active second-stage management is associated with neonatal outcomes similar to those with planned cesarean delivery and a low risk of combined vaginal cesarean delivery.