OBJECTIVE(S) : To review the presentation, management and outcome of obstructed labor during the period from January 1993 to December 1998.
METHOD(S) : Out of 43,906 deliveries reviewed, 245 or 0.56% had obstructed labor. Of these, 155 (63.27%) were delivered by lower segment cesarean section (LSCS) and 90 (36.73%) by destructive operations. These two groups have been compared.
RESULTS : 38.37% (94/245) women presented with dead babies in whom destructive operations [most commonly craniotomy (74.44%)] were performed in 91.49% and LSCS in 8.51%. Complications following LSCS and destructive operations were 7.09 % and 21.11% respectively. Perinatal mortality was 12.90%. At birth, 28.57% babies were severely depressed. 8.57% of the live born babies continued with poor apgar scores at 5 minutes. Maternal mortality was 2.04%.
CONCLUSION(S) : The individualized approach to the management of obstructed labor by either LSCS or a destructive operation according to the situation has a favorable outcome in our set-up.
obstructed labor ● destructive operations ● cesarean sectionOBJECTIVE(S) : To assess the facilities and manpower available in the first referral units (FRUs) for mothers and childcare, and the functioning of the existing manpower.
METHOD(S) : The study was conducted in seven FRUs of three districts of West Bengal bordering Bihar and Orissa. Data was collected by interviewing the district officials, analysing information available in the districts, direct observation of the FRUs and review of maternal morbidities.
RESULTS : Only two thirds of the FRUs had adequate manpower but the rural hospitals were declared as FRUs without facilities and manpower support. FRU kit N was available but not used. Specialists lack training in child survival safe motherhood (CSSM), reproductive and child health (RCH) and baby friendly hospital initiative (BFHI). Blood banks ceased to function beyond afternoon. Type I and II delay were found to be predominant in obstetric emergencies.
CONCLUSION(S) : FRU, need to be made functional for the clients with face lifting and ensuring 24 hours services, especially of the blood bank.
OBJECTIVE(S) : To assess the effect of amnioinfusion in labors complicated by meconium stained amniotic fluid and to observe any difference in the fetomaternal outcomes in the two groups receiving amnioinfusion and monitored with and without carditocography.
METHOD(S) : Two hundred women in labor complicated by meconium stained amniotic fluid were included in the study from April 2002 to November 2003. They were divided into two groups while receiving amnioinfusion viz; Group A not monitored with cardiotocography (CTG) and Group B monitored with CTG. They were evaluated for fetomaternal outcome and other aspects of the study. For statistical analysis chi-square test was employed.
RESULTS : There was no significant difference between the mean duration of amnionfusion in the two groups. Most common CTG abnormality was variable deceleration. The rate of cesarean section was higher in Group B, the most common indication being fetal distress. Two perinatal deaths occurred in the study, both belonging to Group B.
CONCLUSION(S) : Aminoinfusion is a simple, inexpensive and feasible technique to improve fetomaternal outcome. No significant difference in the two groups, except for higher cesarean section rate in Group B, could be demonstrated. No maternal complication was noticed.
OBJECTIVE(S) : To study the various types of ovarian germ cell tumors (OGCT), their clinical presentation and management.
METHOD(S) : Eleven patients of ovarian germ cell tumors admitted during the period of 1st October 2000 to 30th September 2003 were clinically studied along with their sonography, laparotomy findings and histopathology.
RESULTS : Teratomas were observed in 63.63% (n=7) of cases, followed by malignant germ cell tumors in 27% (n=3) and special tumor i.e. struma ovarii in 9.0% of cases. These tumors occurred in patients aged 13 to 50 years, the peak incidence being at 18-30 years.
CONCLUSION(S) : Ovarian germ cell tumors are rare and mostly seen in young women.Timely surgery and chemotherapy in malignant tumors save the life of the women.
OBJECTIVE(S) : To know the status of antioxidant enzymes in postmenopausal women and to find their correlation with metals.
METHOD(S) : Plasma malondialdehyde (PMDA) which is a marker of lipid peroxidatin, estradiol, status of antioxidant enzymes, trace metals and lipid profile level were estimated in the blood of postmenopausal women (n=50) and compared with those in age matched premenopausal women treated as control (n=50).
RESULTS : In post menopausal women, there was a significant decrease in estradiol, reduced glutathione, glutathione peroxidase, superoxide dismutase and high density lipoprotein cholesterol (HDL-C) and a significant increase in PMDA, catalase, zinc (Zn) total cholesterol (Tc), triglyceride (Tg), very low density lipoprotein (VLDL), and low density lipoprotein (LDL) when compared to these in the control group. The changes in copper (Cu) and iron (Fe) between the groups were nonsignificant. Superoxide dismutase showed an inverse correlation with Zn
CONCLUSION(S) : Menopause is associated with oxidative stress as indicated by increase in lipid peroxidation and lipid parameters except HDL. Antioxidant enzymes like superoxide dismutase (SOD) and glutathione peroxidase (GPX) decrease while catalase (CAT) increases in postmenopausal women showing oxidative stress in the cells.
OBJECTIVE(S) : To correlate hormonal and anthropometrical data of patients with polycystic ovarian syndrome (PCOS).
METHOD(S) : Seventy women (12-35 years of age ) with PCOS based on clinical suspicions were compared with 10 normal women.
RESULTS : Mean body mass index (BMI) was 21.6 kg/m2 in normal women, 27.44 kg/m2 in overweight subjects(n=44) and 31.86 kg/m2 in obese subjects (n=21). Mean waist : hip ratio (WHR) was 0.82 in normal women and 0.83 in subjects. Seventy percent subjects were overweight, among whom 46.93% had high LH: FSH ratio, 59.18% had hyperandrogenism and 44.2% were hirsute, having significantly high BMI and total testosterone (TT). Sixty percent subjects were hyperandrogenic with high basal insulin BI in 35.7%. 62.8% fulfilled sonographic criteria for diagnosing PCOS - 70.45% of them bilateral , 22.72% only left-sided and 6.81% only right sided. 59.3% were hirsute and 38.6% hyperinsulinemic (BMI and TT were significantly high). A positive predictive value for TT was 64.44% and for LH: FSH 55.55%.
CONCLUSION(S) : High TT level is the single most diagnostic criterion. Hyperinsulinemia is related to hyperandrogenism. Bodyweight was related to ovarian stroma and hirsutism. Bengali women have lower bodyweight, but have more abdominal obesity. Ultrasonography is sensitive, but not specific for diagnosis of PCOS. Left ovary is affected more often in unilateral involvement.
OBJECTIVE(S) : To obtain unbiased normal control subjects from eumenorrheic non-PCOS healthy women based on their fertility potential.
METHOD(S) : Two hundred forty-nine eumenorrheic non-PCOS healthy subjects out of 1792 infertile women were looked into. They were classified on the basis of their male factor association as Group A (with male factor, n = 117) and Group B (without male factor, n = 132). IUI cycles with donor sperm in Group A and husband’s sperm in Group B using clomiphen citrate and hCG protocol were studied.
RESULTS : Group A subjects showed a better pregnancy rate than group B (25.6% vs 13.27%). Serum insulin, serum hormone binding globulin, leptin and bioavailable estradiol in Group B showed significant rise as compared to those in Group A. 25.6% pregnancies in Group A being at par with accepted normal pregnancy rate, Group A can be considered as normal for endocrine evaluation.
CONCLUSION(S) : Eumenorrheic non-PCOS healthy infertile women with male factor (Group A) may be selected as ideal control subjects to obtain precise cut-off values of various endocrine and biochemical parameters in infertility.
