Abstract

There are significant problems to consider when we reflect on ‘‘Standards for Gynecologic Surgery.’’ Surely most professional standards are already in place, or are they? Are standards already available, locally, nationally, or internationally? Where those standards are not already available will it be possible set new standards for the multiplicity of operative interventions, performed by an array of trainees, specialists, and colleagues many of whom are outside of our remit and spread over the continents? If we do set standards how do we audit outcomes to gynecologic surgery and insure that the standards are being complied with? How do we tutor our trainees effectively and also insure that established specialists retain their skill base, are up-to-date, and compliant with continuing medical education? It is important to realize that the success or failure of a modern surgical investigation or procedure will now be judged not on the pure surgical outcome alone, but will also need to reflect patient focus through excellence in the areas of communication, patient information, informed consent and confidentiality. The accessibility to services, appropriate environment, and processes being offered by trained and competent staff members—who are supervised when required—should all be included in audits of outcomes set against agreed auditable standards.

Abstract

Aims 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.

Abstract

Objective: 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.

Abstract

Objective: The objective of this study were to (1) quantify the concentrations of inhibin A, activin A, and follistatin in maternal serum and umbilical vein (inhibin A, activin A) in IUGR due to placental dysfunction pregnancies and control group, (2) determine the concentration differences of these factors in maternal and umbilical vein serum in control and subject group, and (3) examine the relationship between fetal growth and placental function.

Method: Sandwich ELISA was used to measure the concentrations in  control  (n := 40)  and  subject  groups  (n := 30).

Results: Umbilical vein serum inhibin A, activin A con- centrations were increased in subject group compared with controls  (inhibin  A   regression   coefficient,   0.7647, P :\ 0.001, activin A P :\ 0.0005). Maternal serum inhibin A, activin A were significantly increased in subject group compared with controls (inhibin A regression coefficient, 0.7614, P :\ 0.001, activin A P :\ 0.0005). Maternal serum activin: follistatin ratio was significantly increased in sub- ject group compared with controls (P :\ 0.0005). Maternal serum inhibin A, activin A concentrations were more when compared to the umbilical vein inhibin A, activin A con- centrations in subject group.

Conclusion: The present study strengthens the evidence of using inhibin A, activin A, and follistatin as serum markers in routine screening for early detection of IUGR. But large prospective studies are needed to further define their role in clinical practice.

Abstract

Objective: To determine the clinical value of uterine artery Doppler Pulsatility index (PI) at 22–24 ? 6 weeks scan and importance of maternal history and mean arterial pressure (MAP) in the prediction of pre-eclampsia.

Materials and Methods: This was a prospective screening study of 200 women with singleton pregnancy. Maternal history and blood pressure were recorded, and MAP was calculated. Transabdominal Doppler ultrasound of uterine artery was performed. Mean PI was calculated, and the presence or the absence of bilateral early diastolic notch was noted. Women were then followed up through pregnancy and delivery for the development of pre-eclampsia, gestational hypertension, and SGA.

Result: The mean ± SD PI value for subjects who had an adverse pregnancy outcome was significantly higher (0.84 ± 0.28) than mean ± SD PI value for subjects who had normal pregnancy outcome (0.71 ± 0.16) with P value <0.000.

Conclusion: Second trimester uterine artery Doppler is a useful screening method for identification of high risk pregnancy in women who can be kept under close surveillance for better maternal and neonatal outcome. This test works better when combined with previous history of pre-eclampsia and MAP.

Abstract

Purpose: Intra uterine growth retardation (IUGR) due to fetoplacental vascular insufficiency is rampant in developing countries like India. Owing to the lack of awareness, antenatal patients often present in their third trimester for their first ultrasound examination. Alterations in the waveforms and Doppler indices of fetal middle cerebral artery (MCA), umbilical artery and bilateral uterine arteries have been extensively described in various studies in the literature. However, the role of each doppler parameter in actually predicting reduced birth weight (for gestational age) in the third trimester is often debatable and frustrating.

Method: A prospective study was done on 100 patients of clinically suspected IUGR/high-risk pregnancies of 31–41 weeks. The cases were followed till delivery; the doppler and grey scale findings were correlated with the birth weight of the baby.

Result: The highest sensitivity was found to be of HC/AC ratio, (84.4 %), the highest specificity of oligohydramnios and Cerebral/Umbilical Pulsatility ratio[C/U ratio] (100 %). The sensitivity of C/U ratio was found to be 68.8 %. Fetal MCA had the lowest sensitivity (7.7 %).

Conclusion: HC/AC ratio is quite sensitive, and oligohydramnios is a highly specific parameter to diagnose IUGR. However, the former has lower specificity, and the latter has very poor sensitivity. The MCA PI alone is not sensitive at all, and should not be used for screening purposes in IUGR patients. Also, C/U ratio is more sensitive than oligohydramnios and more specific than HC/AC ratio and stands out as the best parameter of all to diagnose IUGR in the third trimester.

Abstract

Objective: To compare effectiveness of intravenous iron– sucrose versus oral ferrous fumarate in postpartum anemia.

Methods: In this study, 40 women with postpartum anemia with hemoglobin (Hb) less than 8 g/dl within 48 h postpartum were randomised into two groups. Group I consisted of 20 women who received 300–600 mg of intravenous iron–sucrose every alternate day for 3 days. Group II consisted of 20 women who were given 300 mg ferrous fumarate orally daily for 14 days.

Result: On day 14, the increase in mean Hb level in group I was 2.4 g/dl in comparison to 1.2 g/dl in group II. Women in group I had significantly higher mean Hb values on days 7 and 14 (p\0.001) than women in group II.

Conclusion: These results suggest that intravenous iron– sucrose increases the Hb level more rapidly than oral ferrous fumarate in postpartum anemia without any serious side effects.

Abstract

Objective(s): To determine the risk factors for pregnancy among unmarried adolescents and young adults.

Method(s): Case–control study was done over a period of 2 years. Data collected from 181 unmarried abortion seekers and 181 unmarried non-pregnant controls (B24 years) attending three Medical Colleges of Kerala.

Results: Logistic regression analysis showed a strong association between unmarried adolescent pregnancy and lack of parental supervision and control (OR 8.74, P = 0.000), poor intra-family relationship (OR 7.01, P = 0.000), family problem (OR 4.41, P = 0.000), lack of knowledge on sexual and reproductive health (OR 4.95, P = 0.0003), and nonengagement of adolescent in any productive activity (OR 4.41, P = 0.0373).

Conclusion(s): Lack of parental control, family problem, poor intra-family relationship, lack of knowledge on sexual and reproductive health, and lack of engaging in any productive activity were found to be significant predictors for unmarried adolescent pregnancy.

Abstract

Objectives: To assess the prevalence of Pap smear abnormalities and to characterize the associated risk factors in HIV seropositive women.

Material and methods: We conducted a cross-sectional study on 252 HIV seropositive women in and around Krishna district, Andhra Pradesh, India by screening them for cervical cytological abnormalities by means of con- ventional Pap smear screening and the abnormalities reported as per modified Bethesda system.

Results: The prevalence of Pap smear  abnormalities  in HIV seropositive women was found to be 7.17 % which was a twofold increased risk as compared to the general population. On analysis of the risk factors like younger age for abnormal pap smears, mean CD4 count, duration of disease, and ART/HAART therapy the difference between the two groups of HIV seropositive women with normal pap smears and seropositive women with abnormal pap smears was found to be not statistically significant.

Conclusion: HIV/AIDS is associated with a twofold increased risk for cervical cytological abnormalities, and hence the need for periodic pap smear screening in this high risk group to reduce the global burden of cervical cancer.

Abstract

Objectives: The study was undertaken to evaluate maternal, perinatal outcomes following transcervical intrapartum amnioinfusion in women with meconium-stained amniotic fluid.

Methods: A prospective comparative study was conducted on 100women with meconium-stainedamniotic fluid in labor. Group A: study group (50 cases) received amnioin fusion. Group B: control group (50 cases) did not receive amnioin fusion. FHR monitoring was done using cardiotocography.

Results: Significant relief from variable decelerations was seen in 68.18 % cases in the amnioinfusion group as compared to 7.1 % cases in the control group. 78 % cases who were given amnioin fusion had vaginal delivery as compared to 18 % cases in the control group. Fourteen percent cases in the study group had cesarean delivery as compared to 68 % cases in the control group. Meconium aspiration syndrome was seen in six percent neonates in the study group as compared to 20 % in the control group. Two neonates died in the control group due to meconium aspiration syndrome. There was no maternal mortality or major maternal complication.

Conclusions: Intrapartum transcervical amnioinfusion is valuable in patients with meconiumstained amniotic fluid.