Abstract

Background HPV genotypes are the most common etiological factor for genital neoplasia. It would appear that sexually transmitted infections accompanied with HPV genotypes might have synergistic interactions in cancer progression. The genetic polymorphisms are involved in metabolizing carcinogens which may contribute to the susceptibility of developing genital cancers by less efficient or overly down metabolic pathways and cell signaling. MTHFR polymorphisms are related to several metabolic disorders and human cancers. We investigated the contribution of MTHFR 1298 and MTHFR 677 polymorphisms as potential risk factors for outcomes with HPV genotypes and STIs in Iranian population.

Materials and Methods As a case–control study, MTHFR A1298C and C677T were assessed for SNPs analysis using a PCR–RFLP assay in 50 cervical intraepithelial neoplasia (CIN) cases, 98 HPV-positive subjects and 47 non-cancerous/ non-HPV patients as healthy controls. Results Finding suggested a significant association between the MTHFR 1298 CC polymorphisms (OR = 3.5, 95% CI = 1.13– 10.82, P ≤ 0.05) in women with CIN as compared to non-cancerous/non-HPV subjects. There was not a significant difference of MTHFR 677 between outcomes.

Discussion It would seem MTHFR 1298 CC is more likely to be a potential risk factor for HPV–cervical cancer progression. Consequences support further attempts to understand the clinical manifestations of neoplasia related to genital infections and gene mutations.

Abstract

Background Female genital tuberculosis often faces diagnostic challenges due to the asymptomatic nature of the disease. Our study aims at comparing the microbiological and histopathological results with PCR in diagnosing genital tuberculosis in endometrial curettage specimens.

Methods Around 139 patients with diverse gynaecological complaints were recruited for the study, and endometrial curettage specimens were collected. The specimens were subjected to microbiological culture and staining, histopathological examination and PCR to look for the presence of M. tuberculosis. Statistical analyses of the PCR results include calculating sensitivity, specificity, positive and negative prediction values and positive and negative likelihood ratios.

Results PCR yielded a detection rate of 41.7% (58/139) when compared to the microbiology (2.15%) and histopathology results (1.43%). PCR with hsp65 and cfp10, in combination, detected 20% of the cases. Statistical analyses were suggestive that PCR with hsp65 showed a higher sensitivity and specificity of 50% and 92.59% respectively.

Conclusion The results obtained in this study suggest that for a definitive diagnosis, combinations of the results from various diagnostics techniques can only be considered.

Abstract

Background Childbirth experience is unique to every woman. Negative experience is detrimental to both mother and child. This study was undertaken to understand the positive and negative experience and felt need of women undergoing labor and the factors affecting them.

Methodology This cross-sectional descriptive quantitative study was conducted among women who delivered in JIPMER and consented to participate through a questionnaire that captured four areas of childbirth experience. The study was carried out before the LaQshya guidelines were implemented.

Results Three hundred and seventy women completed the study. The mean age of women in this study was 24.5 years and 60% were primipara. Five women (1.3%) experienced physical abuse. Another 47 (12.7%) experienced disrespect in the form of scolding/insult/discrimination or nonconsented care. Three-fourths of the women wanted a relative (majority preferred their mother) with them, and 54% wanted a prayer hall in the labor room. On univariate analysis, no significant determinant was found for negative experience constituting disrespect and abuse. Complete pain relief as a need was found to be significantly higher  (X2 = 11.0783, p <   0.004) in women of lower parity. The women educated beyond scholastic level felt that informa-tion given about delivery is inadequate when compared to participants who were illiterate or had primary education only.

Conclusions In our hospital 12.7% women undergoing labor experienced disrespectful behavior and 1.3% experienced physi-cal abuse. Need for prayer hall, complete pain relief and presence of relative was felt by more than half of the participants. We did not find any specific factor influencing the negative experience.

Abstract

Background The etiology and pathophysiology of hypertensive disorders of pregnancy remains enigmatic, and till date, no test can accurately predict it. Early screening may allow vigilant antenatal surveillance, timely delivery and thus substantially reduce maternal and perinatal morbidity and mortality. Our study aims to evaluate the predictive value of uterine artery mean pulsatility index (PI) at 11–14 weeks and find a reference value for hypertensive disorders of pregnancy.

Methods A prospective study of 240 antenatal women using non-probability simple random sampling was carried out in a tertiary care center. Mean uterine artery PI was obtained at 11–14 weeks of gestation. Pregnancies were followed till delivery and 7 days postpartum. The major end point was development of hypertensive disorders of pregnancy. Maternal and neonatal outcomes were also assessed.

Results The predictability of uterine artery mean pulsatility index (PI) at 11–14 weeks for hypertensive disorders of pregnancy was significantly high with an odds ratio of 174.45 (95% CI 65.31–549.13; p < 0.0001), sensitivity (89.3%), specificity (95.8%), positive predictive value(90.5%) and negative predictive value (95.1%).

Conclusion Uterine artery mean PI at 11–14 weeks of gestation is a cost-effective predictive test for hypertensive disorders of pregnancy, and the recommended reference value for Indian population of is 2.28.

Abstract

Introduction Medical students are known to have high levels of depression, anxiety and stress from the high-pressure envi-ronments that they study and train in. The coronavirus pandemic presents source of stress and anxiety to large populations in general, and to healthcare professionals in particular. This study was undertaken to assess the psychological effects of this pandemic on the mental health of medical students and trainees.

Materials and Methods An online questionnaire was designed to capture information on the participant’s anxieties related to the pandemic and included a validated tool for the assessment of anxiety and depression symptoms (GAD-7 and PHQ-9, respectively). The questionnaire was prepared on Google Forms, and the link to the questionnaire was disseminated to 113 medical students and junior doctors on 19 April 2020, and the survey closed on 22 April 2020 midnight.

Results The survey was sent to 113 students, and 83 students participated. Of the participants, 47 (56.6%) were female and 36 (43.4%) were male, and 80 (96.4%) were aged less than 30 years old. Formal anxiety and depression scores using the GAD-7 and PHQ-9 tools indicated 15/82 (18.3%) had anxiety scores of 0 (lowest possible) and 21/82 (25.6%) had the lowest possible depression score of 0. However, 6/82 (7.3%) had scores that were classified as severe depression. Females had significantly higher median anxiety (5 v 2, p <   0.002) and depression scores (5 v 3, p =   0.025) than male participants. Direct patient care and care of patients with Covid-19 did not result in significant deterioration in anxiety and depression.

Conclusion Female students/junior doctors showed higher anxiety and depression scores than males. Direct patient care and care of patients with Covid-19 did not result in a measurable deterioration in anxiety and depression in this study. In this stressful pandemic situation, it is imperative to look after the mental health of healthcare workers as well as patients.

Abstract

Objective This study aimed to examine the associations of cone margin and human papillomavirus (HPV) status after coniza-tion with cytological abnormalities and disease recurrence in patients with cervical intraepithelial neoplasia grade 3 (CIN3).

Methods This is a retrospective study of 366 women with CIN3 who underwent conization at Kagoshima University Hospital between 2004 and 2017. Conization was performed using an ultrasonic scalpel. The polymerase chain reaction for detecting HPV genotypes was performed using fresh cervical cell samples. We examined the associations of margin status and HPV status after conization with cytological abnormalities and recurrence.

Results Among 224 women with CIN3, 193 (86.2%) underwent HPV genotype testing before conization. The HPV-positive rate was 84.9%. The most common HPV genotypes before conization were HPV 16, 31, 58, 52, 18, 35, and 33. In 191 patients, the uterus was preserved after conization. Sixteen patients had pathologically positive margins, 165 had negative margins, and 10 had unclear margins. There was no significant difference in abnormal cytology and recurrence rate after conization between the three groups. Five patients with positive margins and abnormal cytology during follow-ups were HPV16- or HPV58-positive in the preoperative HPV testing. Of the 191 women, 91 (47.6%) underwent pre- and postoperative HPV genotype testing, among whom 14 (15.4%) were HPV-positive after conization. No significant difference in abnormal cytology based on HPV status after conization was found. The recurrence rate tended to be higher in HPV-positive patients than in HPV-negative patients after conization (21.4% vs. 1.3%, p <   0.05). Three patients with HPV positivity after coniza-tion and recurrence during follow-up were HPV16- or HPV58-positive.

Conclusions HPV positivity after conization for CIN3 was associated with a high recurrence rate, especially in HPV16- and HPV58-positive patients. HPV58 has not received much attention thus far, but abnormalities in cytology and recurrence may be as likely as those associated with HPV16. Thus, a careful follow-up in such patients is recommended.

Introduction Cervical cancer is the most common cancer in India. Screening of cervical cancer helps in marked reduction in invasive cervical cancers. The low sensitivity of Papanicolaou cytology (Pap smear) and high-risk human papillomavirus (HR-HPV) in excluding high-grade intraepithelial lesion (ASC-H) leads to unnecessary referrals to colposcopy-guided biopsy. The combined cervical cytology screening and HR-HPV have its own limitations and still need further standardization. Using additional biomarkers like staining with p16 and Ki-67 might help in triaging abnormal pap smear.

Materials and Methods A prospective, cross-sectional study was performed in the Department of Obstetrics and Gynaecol-ogy, in collaboration with Department of Pathology over a period of 16 months to know the efficacy of immunostaining with p16/Ki-67 in predicting the presence of significant lesion in cases of mild cytological atypia. PAP smears conventional and LBC along with P16, Ki-67 and available biopsies were correlated.

Results Liquid-based cytology (LBC) was done in 2134 cases, out of which 46 cases showed abnormal cytological find-ings such as [22 atypical squamous cells of undetermined significance (ASCUS), 3 low-grade squamous intraepithelial lesion (LSIL), 8 atypical squamous cells cannot exclude high-grade lesion (ASC-H), 6 high-grade squamous intraepithelial lesion (HSIL), 5 squamous cell carcinoma (SCC), 2 adenocarcinoma, 1 atypical glandular cells of undetermined signifi-cance (AGUS)]. Immunostaining with p16 and Ki-67 was performed on 38 cases of abnormal cytological smears. Out of 38 abnormal cytology cases, 28 cases had shown co-staining for both p16 and Ki-67, suggestive of true HPV infection of the cells. Of the 38 cases, 07/14 ASCUS, 06/06 HSIL, 07/08 ASC-H, 05/05 squamous cell carcinoma and 02/02 adeno-carcinoma also showed dual positivity for p16 and Ki-67. One AGUS was diagnosed, but the smear was unsatisfactory for immunocytochemical evaluation and excluded from the study. Three cases of LSIL were also diagnosed on cytological evaluation, and 1 of them however showed positivity for p16 and Ki-67 on immunocytochemistry (ICC). In the ASC-US group, the sensitivity and specificity of the immunostaining in diagnosing CIN2 + lesions were 87.51%, and in LSIL group, the sensitivity and specificity of the immunostaining in diagnosing CIN2 + lesions were 100%. p16/Ki-67 positivity also increased with cytological severity which in turn corresponded with histological findings: it reached from 50% in ASC-US to 100% in both HSIL and SCC categories.

Conclusion This immunostaining with p16 and Ki67 can be a useful method in the triaging of the ASC-US and the LSIL group as considering the high sensitivity and specificity values.

Abstract

Purpose of the Study To estimate and to compare the levels of cervical phIGFBP-1 among primigravida with prolonged pregnancy, with and without successful induction of labor (IOL).

Methods A diagnostic study (cross-sectional study design) was conducted in our institution from November 2016 to April 2018 on 84 primigravida at ≥   41 weeks with uncomplicated singleton pregnancy. The results were analyzed using SPSS software and receiver operating characteristics curves to determine the best cutoff using Youden Index. Sensitivity, specific-ity, positive predictive value (PPV), negative predictive value (NPV), positive (+ LR) and negative likelihood ratio (− LR) were calculated. P value <   0.05 was considered significant. Logistic regression analysis was used to determine the predictive ability of the three markers for successful IOL.

Results The cutoff level of phIGFBP-1, Bishop score (BS) and transvaginal cervical length (TVL) were 7.8 μg/l, 3 and 3.5 cm, respectively. The sensitivity, specificity, PPV, NPV, + LR and − LR of phIGFBP-1 (> 7.8 μg/l) were 0.87, 0.87, 0.89, 0.85, 6.76 and 0.15, respectively. Using logistic regression analysis, phIGFBP-1 was found to be the best predictor of successful IOL (OR 44.200; 95% CI 12.378–157.831, p < 0.001).

Conclusion phIGFBP-1 is a strong independent predictor successful IOL as compared to TVL and BS in primigravida with prolonged pregnancy.

Abstract

Background The aim of this study to determine maternal adiponectin and leptin levels as biomarkers of pre-eclampsia and compare adiponectin and leptin ratio.

Materials and Methods This is a prospective study. The enrolled women were divided into two groups: first, study group (n = 60) comprised of women diagnosed with pre-eclampsia and second, control group (n = 60) comprised of age- and gestation-matched normotensive and nonproteinuric women.

Main Outcome Measures Maternal serum adiponectin and leptin levels and their ratio were compared in pre-eclamptic (study group) and normotensive (control group) women.

Results Adiponectin levels were insignificantly higher in study group than control group. Leptin levels in study group were significantly higher than control group (p < 0.001). Adiponectin/leptin ratio was significantly lower in study group than con-trols (p < 0.0001). Sensitivity, specificity, positive predictive value and negative predictive value of serum leptin and serum adiponectin/leptin ratio as a biomarker of pre-eclampsia were 90%, 88.3%, 88.5%, 89.8% and 68.3%, 90%, 87.2%, 74%, respectively. Serum leptin levels and serum adiponectin/leptin ratio had cut-off point as 23.3 ng/ml and < 0.153, respectively. Accuracy of both serum leptin and adiponectin/leptin ratio was significant (p < 0.0001).

Conclusion Maternal leptin-level estimation should be integrated into the investigations for pre-eclampsia, and a cut-off level of > 23.3 ng/ml should be used as a biomarker for diagnosis. Adiponectin–leptin ratio should be considered as a biomarker for PE and should be determined in all cases of pre-eclampsia, and a cut-off of < 0.153 should be used for diagnosis.

Abstract

Background Genetic and epigenetic factors play significant roles in the aetio-pathogenesis of pre-eclampsia (PE). The effects may vary across racial and geographical boundaries. The role of epigenetic modification in pre-eclampsia was studied among African populations in Lagos, Nigeria.

Aim and Objectives This study aimed to determine the pattern of Methylene tetrahydrofolate reductase gene (MTHFR) CpG island methylation in pre-eclampsia, and evaluate associated covariates.

Methodology This study was an observational, cross-sectional, study conducted at the Lagos University Teaching Hospital and the Lagos State Island Maternity Hospital. A total of 400 pregnant women consisting of 200 pregnant women diagnosed with pre-eclampsia (study group) and 200 pregnant normotensive and apparently healthy women (control group) were recruited for the study. Demographic and clinical histories were obtained through questionnaires. The DNA Methylation status of the CpG Island in promoter region of the MTHFR gene was assessed using bisulphite conversion and methylation specific PCR method. The biochemical parameters measured in the study were: red cell folate, vitamin B12, plasma homo-cysteine (Hcy) and methylene tetrahydrofolate reductase enzyme level.

Results Homozygous  MTHFR  CpG  island  hypomethylation  pattern  was  significantly  associated  with  pre-eclamp-sia  (χ2 = 22.96; p  =    0.000),  Mean  values  of  plasma  homocysteine  in  PE  women  with  homozygous  hypomethylation  (26.1 ±   9.1 umol/L) were significantly higher than (20.1 ±   4.2 umol/L) observed in PE subjects with homozygous hyper-methylation (p =   0.008). Homozygous CpG island hypomethylated pattern of the MTHFR promoter region, was associ-ated with the lowest median MTHFR enzyme level (72.8 ±   39.8 pmol/L) compared with heterozygous methylated pattern (91.3 ± 60.9 pmol/L; p =   0.047) and homozygous methylated pattern (82.3 ±   31.0 pmol/L; 0.047). Red cell folate and Vitamin B12 levels were not significantly associated with CpG island methylation status.

Conclusion Epigenetic modification plays significant role in the pathogenesis of pre-eclampsia.

Abstract

Objective We aimed to determine performance of sequential organ failure assessment (SOFA) and Sepsis in Obstetrics Score (SOS), in women with pregnancy-associated sepsis (PAS) with respect to critical care admission and mortality.

Methods Obstetric patients with PAS fulfilling any 2 of the quick SOFA (qSOFA) criteria were enrolled as cases. The vari-ous parameters of SOFA and SOS were recorded at admission and compared for outcomes.

Results Critical care was required in 32 (50.7%) patients and associated mortality was high (31.7%). For our study population, a threshold of SOFA ≥ 6 had the best combination of sensitivity (84.4%) and specificity (61.3%) for critical care admission. For SOS, a cut-off value of ≥ 6 gave best sensitivity (64%) and specificity (40%) for the same.

Conclusions SOFA was far more predictive of patient’s critical condition as well as mortality compared to SOS. SOFA was superior to SOS in determining critical care admission and mortality for PAS.

Background Hypertensive disorders of pregnancy lead to pathological changes in various organ systems of mother and fetus which contributes to maternal and fetal morbidity and mortality. It is a multisystem disorder which can involve end organs like kidneys, liver, eyes, hemopoietic system and placenta. Retinal involvement, though quite common, is rarely investigated. It is a unique site where the blood vessels can be directly observed. Observing retinal vasculature may provide clue to status of similar vessels in other parts of body including placental circulation.

Methods Hospital-based descriptive study which included 150 patients diagnosed as preeclampsia/eclampsia, who were admitted in the intensive care unit. Written consent was obtained from study subjects. Data were collected by history taking and examination of the subjects using pre-structured questionnaire. Ocular examination was carried out by ophthalmolo-gist, which included anterior segment examination, visual acuity and dilated fundus examination. Multiple qualitative and quantitative parameters were studied. Data were analyzed by SPSS 14.0 software.

Results Ocular symptoms were seen in 22% of severe preeclampsia and in 100% of eclampsia patients. Blurred vision was the most common ocular complaint. Fundus changes were seen in 48.7% total study subjects. Arteriolar narrowing was the most common finding on fundus examination. Systolic blood pressure and serum creatinine were found predictive of changes in fundus (p =   .000). Incidence of fetal growth restriction was found to be significantly associated with fundus involvement (p value .000).

Conclusion Ophthalmic examination including fundus examination should be a routine in the investigational armamentarium of hypertensive disorders of pregnancy.

Abstract

Introduction Immune thrombocytopenia (ITP) complicates 1–2 cases/10,000 pregnancies in India. Management of these patients is a challenge as it is associated with potential risks of maternal bleeding episodes and neonatal alloimmune throm-bocytopenia (NAITP).

Objective To study the maternal and fetal/neonatal outcome of pregnancy in Indian patients with ITP and identify the risk factors for NAITP.

Materials and Methods In this retrospective study, all ITP patients with pregnancy who were diagnosed and treated at our center over 8 years (August 2010– August 2018) were evaluated for their hematological, obstetrical, and fetal outcomes.

Results Twenty-nine pregnancies in 27 ITP patients were studied. The mean interval between the diagnosis of ITP and each pregnancy was 29 ±   14.9 months. The mean baseline platelet count was 0.18 ±   0.05 X  109/L. Twenty-seven (93.1%) cases were treated with oral prednisolone. Twenty deliveries (69.0%) were vaginal and 9 (31.0%) deliveries were by cesarean sec-tion. There were no major bleeding episodes during pregnancy or delivery.The mean neonatal platelet count was 1.23 ±   0.58 ×   109/L at birth. NAITP was seen in 3 (3.5%) neonates. No bleeds or intrac-ranial hemorrhages were observed. Only maternal platelet count < 50 X  109/L at delivery showed a statistical correlation with NAITP (p =   0.022). There was no positive correlation between NAITP and the duration of maternal ITP, the timing of ITP onset, or type of treatment.

Conclusion Successful outcome of pregnancies in ITP patients is possible, and the risk of maternal bleeding and NAITP is low.

Abstract

Introduction Ensuring safety of the mother along with the delivery of a healthy baby is the ultimate objective of all obste-tricians. Labour induction is increasingly becoming one of the most common obstetric interventions in India. The aim of the study is to compare the feto-maternal outcome of induction of labour versus spontaneous labour in postdated women.

Method This was a prospective observational comparative study. A total of 100 patients were selected, 50 who had induc-tion of labour (study group) and 50 who had spontaneous labour (control). A structured proforma and partographs were used to obtain data.

Result 42% nulliparous women had induction of labour as compared to 29% multiparous women. The rate of cesarean sec-tion (58%) was substantially higher in those who had been induced. Non-progression of labour or failure of induction was the commonest indication for cesarean section. Post-partum haemorrhage was a complication found more commonly in the study group. Perineal tears were found more commonly in the control group.

The mean birth weight of babies born to mothers who had been induced was significantly higher than that of those born to women who went into spontaneous labour. The APGAR scores were comparable in both groups. There was a higher incidence of hyperbilirubinemia in the study group.

Conclusion Although induction of labour is a relatively safe procedure, some foetal and maternal risks were found to be higher in induced group than in those with spontaneous labour. Induction must be carried out only when necessary and not as a routine elective procedure.

Abstract

Background/Purpose There is an increasing trend in the utilization of long-acting reversible contraceptive (LARC) meth-ods globally. The study assessed the utilization of LARC methods and its determinants in a tertiary hospital, southwestern Nigeria using a mixed method study.

Methods A cross-sectional study of women attending the Family Planning Clinic of the tertiary hospital was conducted between November 1, 2018 and October 31, 2019 using both quantitative and qualitative methods. Quantitative data was collected using structured questionnaire while in-depth interviewer topic guide was used to obtain qualitative data from the respondents. The quantitative and qualitative data obtained from the respondents were analyzed using SPSS version 22 and open code version 3.6.2, respectively, and the determinants of utilization of LARC methods were identified using multivariate regression model.

Results The current utilization rate of LARC methods was 65.6% and implants accounted for 75% of LARC used. Higher education (p =   0.035), more than 3 living children (p =   0.030), previous use of LARC (p =   0.028), good knowledge (p = 0.025) and positive attitude of the women about LARC (p =   0.026) were significant determinants of utilization among the women. Limiting size of family was the commonest reason among LARC users, while partner disapproval, fear of procedure and side effects were reasons given by non-users.

Conclusions The utilization rate of LARC methods are high, and this should be sustained through improved information dis-semination, education of women and involvement of male partners in reproductive health matters including family planning.

Abstract

Aim  Application of Flash glucose monitoring (FGM) system to evaluate glycaemic variability (GV), patient satisfaction and clinical utility in pregnant women with diabetes

Methods This prospective study was conducted in a tertiary care teaching hospital on 70 pregnant women with diabetes where blood sugar levels were monitored by FGM and self-monitoring of blood glucose (SMBG)

Results FGM generated 19,950 readings versus 1470 readings by SMBG over 3 days. Glucose values measured by FGM and SMBG had significant positive correlation (r > 0.89; p <   0.001). Significant difference (p < 0.001) was present between minimum glucose values by FGM (52.49 ±   15.42 mg/dl) and SMBG (72.74 ±   18.30 mg/dl). FGM (20.9%) was able to pick exact duration of hypoglycaemia, while one-third of this duration was missed by conventional SMBG (14.7%; p < 0.05). Hypoglycaemic episodes were observed in 92.9% women by FGM as compared to 45.7% by SMBG (p < 0.001).  No  signifi-cant difference was observed in maximum glucose level or duration of hyperglycaemia by both methods. FGM identified hyperglycaemia in 74% women vs. 52% by SMBG (p < 0.001). GV calculated by using MODD by FGM was 118.4 ±   52.4 mg/dl and by SMBG was 83.2 ±   53.2 mg/dl (p < 0.001). 100% women preferred AGP vs. SMBG.

Conclusion This is the first study to evaluate FGM for GV and patient satisfaction in women with GDM. Significant cor-relation was observed in glucose values by FGM and SMBG. FGM was more sensitive in detecting GV and hypoglycaemic excursions as compared to SMBG. All women preferred FGM over SMBG. Use of FGM gave new insights in clinical man-agement of challenging cases.

Abstract

Background The risk of mortality for the mother and the newborn is aggravated during birth in low- and middle-income countries due to preventable causes, which can be addressed with increased quality of care practices. One such practice is intrapartum fetal heart rate (FHR) monitoring, which is crucial for the early detection of fetal ischemia, but is inadequately monitored in low- and middle-income countries. In India, there is currently a lack of sufficient data on FHR monitoring.

Methods An assessment using facility records, interviews and observation was conducted in seven facilities providing ter-tiary, secondary or primary level care in aspirational districts of three states. The study sought to investigate the frequency of monitoring, devices used for monitoring and challenges in usage.

Results FHR was not monitored as per standard protocol. Case sheets revealed 70% of labor was monitored at least once. Only 33% of observed cases were monitored every half hour during active labor, and none were monitored every 5 min during the second stage of labor. More time was observed for monitoring with a Doppler compared with a stethoscope, as providers reported fluctuation in readings. Reportedly, low audibility and a perceived need of expertise were associated with using a stethoscope. High case load and the time required for monitoring were reported as challenges in adhering to standard monitoring protocols.

Conclusion The introduction of a standardized device and a short refresher training on the World Health Organization and skilled birth attendant protocols for FHR monitoring will improve usage and compliance.

Abstract

Purpose of the Study  The aim of this study was to show the clinical results of postoperative evaluation of cases of imperforate hymen that presented at our center during a 21-year period.

Methods A Foley’s catheter was inserted in 74 patients of imperforate hymen who reported to the Department of Obstetrics and Gynecology, Meram Faculty of Medicine, Necmettin Erbakan University, between January 1, 1996, and December 31, 2016 with history of pelvic pain. In each case, the hymen was opened via a circular incision from the central of the distended. A Foley’s catheter was inserted, and estrogen cream was prescribed for application on the hymenal structure for 14 days. The catheter was removed after 14 days.

Results  The mean age of the patients at the time of this study was 28.3 ±   2.6 years, and the mean age at diagnosis was 13.2 ±   2.5 years. Twenty-nine (96.6%) patients had experienced vaginal bleeding during their first sexual intercourse expe-rience, and one patient (3.4%) had not. Fourteen out of the 30 married women had become pregnant, of whom nine had delivered vaginally and five had delivered via a cesarean section. After undergoing renal ultrasound, none of the patients had any apparent anomalies. Only one patient had a uterine anomaly, which was a bicornuate uterus.

Conclusion A circular incision with insertion of Foley’s catheter prevents many social problems by preserving the hymen’s architecture and allowing vaginal bleeding to occur during the first sexual intercourse experience.

Background Karyotyping has been the gold standard for prenatal chromosome analysis. The resolution should be higher by chromosome microarray analysis (CMA). The challenge lies in recognizing benign and pathogenic or clinically significant copy number variations (pCNV) and variations of unknown significance (VOUS). The aim was to evaluate the diagnostic yield and clinical utility of CMA, to stratify the CMA results in various prenatal referral groups and to accumulate Indian data of pCNVs and VOUS for further interpretation to assist defined genetic counseling.

Methods Karyotyping and CMA were performed on consecutive referrals of 370 prenatal samples of amniotic fluid (n = 274) and chorionic villi (n = 96) from Indian pregnant women with high maternal age (n = 23), biochemical screen positive (n = 61), previous child abnormal (n = 59), abnormal fetal ultrasound (n = 205) and heterozygous parents (n = 22).

Results and Conclusion The overall diagnostic yield of abnormal results was 5.40% by karyotyping and 9.18% by CMA. The highest percentage of pCNVs were found in the group with abnormal fetal ultrasound (5.40%) as compared to other groups, such as women with high maternal age (0.81%), biochemical screen positive (0.54%), previous abnormal offspring (0.81%) or heterozygous parents group (1.62%). Therefore, all women with abnormal fetal ultrasound must undergo CMA test for genotype– phenotype correlation. CMA detects known and rare deletion/duplication syndromes and characterizes marker chromosomes. Accumulation of CNV data will form an Indian Repository and also help to resolve the uncertainty of VOUS. Pretest and posttest genetic counseling is essential to convey benefits and limitations of CMA and help the patients to take informed decisions.

Purpose To compare between postplacental insertion of levonorgestrel intrauterine system versus copper intrauterine device regarding expulsion rates, patient satisfaction, complications, and continuation rates.

Methods This prospective observational study was conducted on 1100 participants divided in to two groups: group (1) CU-IUD group and group (2) LNG-IUS group where women were assigned for postplacental insertion of either CU-IUD or LNG-IUS, respectively. Follow-up at 6 weeks, 3 and 6 months postpartum and data were collected and analyzed to evaluate outcomes.

Results No statistical difference between both groups regarding patients’ characteristics, the overall expulsion rate was higher in LNS-IUS group than CU-IUD group; 77 patients (14%) and 50 patients (9%), respectively, (P value < 0.05), odds ratio: 1.63 at CI: (1.12–2.37). No significant difference between the two groups regarding pain intensity, perforation, abnormal uterine bleeding, and clinical endometritis (P > 0.05). Overall satisfaction rate at six months was 478(87%) in the CU-IUD group and 472(85.8%) in the LNS-IUS group (P value > 0.05), odds ratio: 1.1 at CI: (0.78–1.55). Continuation rate at s6 months was comparable between the two groups 485 (88.2%) and 480 (87.3%) in CU-IUD group and LNS-IUS group respectively, (P value < 0.05), odds ratio: 1.09 at CI: (0.76–1.56).

Conclusion The rate of expulsion of LNG-IUS is higher than copper IUD when inserted postplacental, yet the continuation and acceptability rates were comparable between the two groups.