OBJECTIVE(S): To determine the value of middle cerebral artery to umbilical artery (CU) ratio by doppler velocimetry in pregnancies at or beyond 40 weeks of gestation and correlate it with perinatal outcome with the aim of ascertaining a cutoff value of CU ratio for predicting adverse perinatal outcome in these pregnancies.
METHOD(S): Thirty-one pregnant women at 40 weeks or more of gestation with singleton fetus in vertex presentation were enroled in the study. They underwent biweekly doppler velocimetry studies of the middle cerebral artery and the umbilical artery of the fetus and from this, the CU ratio was calculated. Routine antepartum tests of fetal surveillance like nonstress test, amniotic fluid index and biophysical score were done. Pregnancies were terminated if any of the routine tests of fetal surveillance were abnormal or when the period of gestation extended beyond 42 weeks. Adverse perinatal outcome was defined as fetal bradycardia or tachycardia requiring cesarean section, presence of meconium stained liquor, apgar score at 5 minutes < 7, fetal acidosis, meconium aspiration syndrome, admission to neonatal intensive care unit, and perinatal morbidity and mortality.
RESULTS: Of the 31 women included in the study, 5 (16.1%) had an adverse perinatal outcome. The middle cerebral artery pulsatility index or umbilical artery S/D ratio when used alone had poor predictive value for adverse perinatal outcome. However when the predictive efficacy of CU ratio was calculated, a cutoff value of 1.3 had a sensitivity of 80% and negative predictive value of 93.3% for predicting adverse perinatal outcome in postdate pregnancies. This assured the obstetricians of the fetal well being. The specificity and positive predictive value of CU ratio however were low, being 53.8% and 25% respectively. Its false positive rate was also high (46%).
CONCLUSION(S): Although CU ratio of 1.3 assures the obstetrician of fetal well being, its low specificity and high false
positive value can lead to unnecessary tests and intervention. Hence it is not an ideal test for routine antepartum fetal
surveillance in low risk postdate pregnancies.
OBJECTIVE(S): To evaluate the incidence of TORCH infections in pregnancy wastage in women with bad obstetric history (BOH).
METHOD(S) : The study included 150 women with bad obstetric history and 75 clinically normal women with previous normal full term deliveries. Serological evaluation for TORCH infections was carried out by IgM ELISA method.
RESULT: Seropositivity for toxoplasma was 14.66%, rubella 4.66%, cytomegalovirus 5.33% and herpes simplex virus 8.66%. Maximum number of cases of abortion (27.27%), intrauterine growth retardation (9.37%), intrauterine death (17.64%) and preterm labor (18.18%) was associated with toxoplasma infection. Early neonatal deaths (8%) were maximally associated with rubella virus and herpes simplex virus infections while congenital malformations (9.52%) were evident maximally with herpes simplex virus infection.
CONCLUSION(S) : Seropositivity in women BOH is significantly higher (P=0.0006) in women with BOH than that in
control. A previous history of pregnancy wastage and the serological reaction for TORCH infections during current
pregnancy must be considered while managing BOH cases so as to reduce the adverse fetal outcome.
OBJECTIVE(S) : To study prevalence and method of diagnosis of acute rubella infection during early pregnancy.
METHOD(S) : Clinical signs and symptoms of acute rubella infection were looked for in 100 pregnant women booked before 12 weeks of gestation. Serial rubella specific IgG and IgM serologic testing was done in these 100 women before 12 weeks of pregnancy, after 3 weeks, and again at 18-20 weeks of gestation. Ultrasound was done at 12-14 weeks and at 18-20 weeks of gestation for detecting malformations.
RESULTS : No woman had clinical signs and symptoms of rubella infection. One woman was IgM positive at 9 weeks of pregnancy; 79 were IgG +ve but IgM -ve initially and also on repeat sampling after 3 weeks; while 20 women were nonimmune (IgG and IgM negative) in the first trimester, after 3 weeks, and again at 18-20 weeks.
CONCLUSION(S) : Acute rubella infection was diagnosed by serial serologic screening in 1% women in early pregnancy.
OBJECTIVE(S): To analyze the possible factors contributing to women obtaining antenatal care services and to determine whether these services influence their decision regarding the place of delivery.
METHOD(S): A cross-sectional survey of 7005 pregnant women was carried out in the sampled areas of 28 districts in 14 states.
RESULTS : Since early reporting of pregnancy in rural areas is rare, a detailed ananlysis was carried out on 5344 pregnant women with a gestation of more than 4 months. Of these, 73.9% had at least one antenatal contact with a auxiliary nurse midwife (ANM) or had visited a Government Health Facility for antenatal services or problems. There was a statistically significant reduction in the proportion of women obtaining antenatal care services with increasing age, parity, and number of living children. No association was observed with outcome of previous pregnancy and presence of health facility in the village. Awareness of care during pregnancy and knowledge of pregnancy related complications were associated with increased utilization of antenatal care services. However, knowledge of serious complications was found to be lacking even in women who availed of the care. In both the groups – those who availed of antenatal care services and those who did not – about 14% had not decided about the place of delivery. 51.7% of the women with antenatal care preferred institutional delivery as compared to 27.6% of those who had not availed antenatal care services.
CONCLUSION(S) : There is a need for improving community awareness on maternal health and for motivating women to
utilize maternal care services.
OBJECTIVE(S): To evaluate the various effects of programed labor protocol on normal nulliparas and their neonates.
METHOD(S): Two hundred women with 37 to 41 weeks pregnancy with vertex presentation in active phase of labor without any fetal or maternal complication were alternately allocated to two groups. Hundred women received programed labor protocol while 100 were managed expectantly and taken as controls.
RESULTS : Fifty-four percent of subjects achieved good pain relief. Onset of the analgesic effect started in 17 minutes. No fetal and maternal complications or adverse effects were observed. Duration of all stages of labor were reduced.
CONCLUSION(S): Programed labor protocol provides effective labor analgesia, augments the process of labor and significantly
reduces third stage blood loss without adversely affecting the fetus.
OBJECTIVE(S): To analyze the acceptance and response to antenatal HIV testing in a teaching hospital, using an opt-in strategy.
METHOD(S) : Data of 8309 women attending the antenatal clinic for the first (booking) visit who received antenatal HIV testing was entered and analyzed by EPI 6 software.
RESULTS : Seroprevalence of HIV was 1.09%. Only 30.3% returned for post-test counseling. Thirty-three of the 41 spouses accepted HIV testing. Awareness about HIV and mode of transmission was poor.
CONCLUSION(S): There is a need to spread more information and awareness about HIV testing in the antenatal clinic
setting. Mechanisms to improve the post-test counseling coverage rates need to be considered.
OBJECTIVE(S): To analyze the indications, factors influencing the choice of technic, complications, and health care utilization of different approaches to hysterectomy.
METHOD(S) : A retrospective analysis of all women who underwent hysterectomy over a period of 2 years from August 2002 to July 2004 was carried out.
RESULTS : Of the 373 hysterectomies 54.4% were abdominal, 38.9% vaginal and 6.7% laparoscopic. Sixty-eight percent (17/25) of women in the laparoscopic group were less than 50 years of age. Uterine leiomyoma was the commonest indication for abdominal and laparoscopic hysterectomies while uterovaginal prolapse was the commonest indication for vaginal hysterectomy. Adnexectomy was performed in 42.1% of women in the vaginal hysterectomy group. The mean operative time was 78.6 ± 6.4 minutes for vaginal hysterectomy, 102.7 ± 7.7 minutes for abdominal hysterectomy, and 133.4 ± 7.9 minutes for laparoscopic hysterectomy.
CONCLUSION(S) : Every technic for hysterectomy has its own set of indications, contraindications, advantages and
disadvantages. The choice of an optimal surgical procedure depends on a complex assessment of preoperative findings,
expertise and experience of the operating surgeon, and the technical possibilities of the setting.
OBJECTIVE(S): To know the status of free radicals and their scavengers in the blood and endometrial tissue in infertile women and to develop the base line data in different types of female infertility.
METHOD(S): A prospective study was conducted on 75 women with primary infertility, 20 with secondary infertility and 30 fertile controls. Markers of oxidative stress viz., level of malonyldialdehyde (MDA) for free radicals and antioxidants catalase (CAT) and superoxide dismutase (SOD) as scavenging enzymes were measured in blood and endometrial tissue.
RESULTS : Infertile women had significantly (P<0.001) high MDA levels and significantly (P<0.001) low CAT and SOD levels in both blood and endometrium as compared to those in controls. Unexplained infertility group of patients had significantly (P<0.001) high levels of oxidant (MDA) while antioxidant (CAT and SOD) levels were significantly low (P<0.001).
CONCLUSION(S) : The study favors the significant role of free radicals injury in cases of female infertility, and damage is
more at endometrial tissue level in cases of unexplained infertility.
OBJECTIVE(S) : To find out the incidence of hyperprolactinemia in female infertility after excluding tubal factor and male factor, and to find its correlation with hypothyroidism.
MATERIAL(S) : One hundred and eleven women attending the out patient department of Obstetrics and Gynecology were included in the study. The exclusion criteria were male factor infertility, and amongst the female factors tubal factor, congenital anomaly of the urogenital tract and any obvious organic lesion.
RESULT(S) : Sixty percent women had primary infertility and 40% had secondary infertility. Anovulatory/oligo-ovulatory cycles were detected in 49.5% (49% and 50% in primary and secondary infertility respectively). Galactorrhea was present in 9% of the women. The incidence of hyperprolactinemia i.e. serum prolactin levels > 25 ng/mL was 46%. The mean serum prolactin level in hyperprolactinemic women was 76.53 ± 55.97 ng/mL (range 48.3 to 200 ng/mL). The incidence of hypothyroidism in hyperprolactinemia was 25.5%.
CONCLUSION : There is a high incidence of hyperprolactinemia in infertile women. A positive correlation of 1:4 was found
between hypothyroidism and hyperprolactinemia.
OBJECTIVE(S): To determine the prevalence of extramarital sexual relationships among infertile women and factors that make them vulnerable to extramarital sex.
METHOD(S): A questionnaire survey was made of 558 consecutive infertile women seen in three health care centers in southeast Nigeria within a 18 month period.
RESULTS: Two hundred and seventeen (38.9%) of the 558 respondents engaged in extramarital sexual relationships. Factors that predispose to this practice include increasing maternal age, higher educational status and social class, polygamy, primary infertility, and inability to achieve pregnancy in the first 3 years of marriage. Also women who have had a previous out of wedlock child were more likely to engage in further extramarital sex. Procreation (55.3%) was the commonest reason for involvement in extramarital sex. Other reasons include pressure to prove fertility (20.3%), sexual satisfaction (12.9%), economic support (9.2%), and frustration in marriage (2.3%). 81.6% of the sexual partners of these women were those they encountered in the course of seeking solution to their childlessness viz.,spiritualists (36.9%), traditional healers (30%), and medical personnel (14.7%). They capitalized on the vulnerability of these women that desperately needed a child to save their marriage from total collapse and subsequent mistreatment by husbands and their relatives. This is because the African society places high premium on having children who will propagate their father’s name.
CONCLUSION: To save the infertile African women from this culturally rooted gender discrimination, it is important to
achieve sociocultural changes and economic empowerment of women.
