Abstract

Preeclampsia and eclampsia are grave complications of pregnancy responsible for morbidity and mortality. National Eclampsia Registry of the FOGSI has helped in
quantifying the magnanimity and also the clinical relevant pointers which can help in improving the health care delivery. Many complex pathogenic mechanisms are now
implicated to be responsible for this disease rightfully called the GESTOSIS which means pregnancy going abnormal. Many preventive strategies have been suggested but only a few are scientifically proved to be useful. Early antenatal care, clinical risk assessment, biomarkers, close vigilance, calcium and nutritional supplementation are useful.

Abstract

Objectives: To compare the efficacy of three suture materials, i.e., poliglecaprone 25, polyglactin 910, and polyamide, as subcuticular skin stitches in post-cesarean
women.

Study Design: This was a randomized clinical trial. Population The study was conducted in the department of obstetrics and gynecology of a tertiary institute,
LTMMC, Sion, Mumbai, India. Only those women undergoing emergency cesarean section were included. Methods The study was conducted in the department of
obstetrics and gynecology of a tertiary institute, LTMMC, Sion, Mumbai, India. 90 women undergoing emergency cesarean section were included and divided into three
groups. In group 1, poliglecaprone 25 was used as subcuticular skin stitches; in group 2, polyglactin 910 was used as subcuticular skin stitches; and in group 3, polyamide was used as subcuticular skin stitches.

Results: Thirty percentage of the patients in group 3 had discomfort on day 10, while it was only 3.3 % in group 1. In group 1, 6.6 % patients had swelling and indurations,
while it was 33.3 % in group 2 on day 4. Wound dehiscence was present in 3.3 % patients in group 1, 26.6 % in group 2, and 6.6 % in group 3. Regarding wound healing,
93.3 % patients had excellent wound healing in group 1, 66.6 % in group 2, and 86.6 % in group 3. Conclusions The results were almost similar with poliglecaprone
and polyamide, except for discomfort which was present more in patients in group 3.

Abstract

Introduction: Twin pregnancy is a high-risk pregnancy with different prevalences in different regions of the world which is on the rise due to growing use of assisted reproductive technology. The objective of this study is to determine the frequency of twin pregnancy and the neonatal outcome of these pregnancies.

Materials and Methods: This is a descriptive-analytic study conducted in 2004–2007 in Mo’tazedi Hospital, Kermanshah on 142 twin deliveries as well as the singleton
deliveries before and after twin pregnancy as the control group. The required information, including maternal age, gestational age, newborn’s gender, presentation of twins, birth weight, Apgar score, fetal anomalies, and neonatal mortality were extracted from medical files and analyzed statistically.

Findings: After assessment of 29,438 deliveries performed from 2004 to 2007, the frequency of twin pregnancy was found out to be 1 in 208 cases (48 %). The mean age of mothers was higher in twin pregnancies. The mean gestational age of twin pregnancy was 34.3 weeks. Apgar score and neonatal weight were significantly lower in twin pregnancy compared to singleton pregnancy (p\0.001). Furthermore, visible anomalies and mortality were significantly higher in neonates born to twin pregnancies compared to singleton pregnancies (p\0.0001 and p = 0.009, respectively). The ratio of male to female neonates was 1.

Conclusion: This study indicated that twin pregnancy is a high-risk condition and entails greater neonatal complications compared to singleton pregnancy. Therefore, it is
recommendable to have greater perinatal care and perform deliveries in well-equipped centers under supervision of an obstetrician.

Abstract

Objectives (1) To study the status of sex ratio at birth with increasing birth order, (2) To ascertain the relationship of declining sex ratio with respect to socio demographic factors. (3) To study outlook of patient towards sex preference, willingness to determine sex of the fetus, wish to terminate the pregnancy in case of unwanted sex of the baby.

Methods: This is the retrospective study done in the Department of Obstetrics and Gynaecology, Nowrosjee Wadia Maternity Hospital, Parel, Mumbai. The data was collected from the records maintained in Medical Record Department from January 2007 to December 2012 and were studied to determine the sex ratio as well as its relationship with the increasing parity. 95 % confidence interval for the sex ratios was calculated.

Results: Average sex ratio of 6 years was 908 females per 1,000 males. Sex ratio was 972 females per 1,000 males in primi para, which decreased to 879 females per 1,000 males in second para, further reduced to 784 females per 1,000 males in third para and 864 females per 1,000 males in fourth para.

Conclusion: The ‘sex ratio at birth’, defined as the number of girls born for every 1,000 boys born, is a more accurate and refined indicator of the extent of prenatal sex selection.

Abstract

Phenotypic variability and the lack of a diagnostic marker have complicated the rapid diagnosis and genetic counseling for Cornelia de Lange syndrome (CdLS). The clinical features of CdLS are striking and easily recognizable by characteristic facial dysmorphism, upper-extremity malformations, hirsutism, cardiac defects, growth and cognitive retardation, and gastrointestinal abnormalities with severe mental retardation. The molecular diagnosis is essential for predicting prognosis and genetic counseling in the affected family, especially while planning the next pregnancy. We report here from India six cases of CdLS and how precise mutational screening in two cases helped in prenatal diagnosis and proved significant in prevention of recurrence in the affected family.

Abstract

Objective(s): We aimed to evaluate the predictive value of amniotic fluid index (AFI) (\5) for adverse perinatal outcome in terms of cesarean section for fetal distress, birth weight, meconium staining, Apgar scores, and cord pH at birth.

Method(s): This was a prospective study of 200 antenatal women booked at Ram Manohar Lohia (RML) Hospital during the years 2009–2011 with gestational age between 34 and 41 weeks. The women’s history, clinical examination recorded, and AFI were measured and the perinatal outcome was compared between two groups, i.e., AFI\5 and[5.

Result(s): The cesarean section rate for fetal distress and low birth weight babies, \2.5 kg, was higher in patients with oligohydramnios (p = 0.048, 0.001, respectively). There was no significant difference in meconium staining, Apgar score at 5 min\7, and cord pH at birth between the two groups (p = 0.881, 0.884, 0.764, respectively).

Conclusions: Oligohydramnios has a significant correlation with cesarean section for fetal distress and low birth weight babies.

Abstract

Study Objective: To retrospectively evaluate the complications of the laparoscopic pelvic surgeries and to formulate the guidelines to avoid them.

Design: Retrospective study (Canadian Classification) Setting Advanced Laparoscopic Institute. Patients Nine hundred and seven operated for gynecological
malignancies.

Intervention Laparoscopic surgeries: Measurements and Main Results 567 women suffering from different pelvic conditions were studied in a period of 60 months. The median age of the patient was 35 (11–80). Complications occurred in 32 patients (32/567, 5.5 %). The overall incidence of urinary tract injury in all the advanced cases at our institute was 2.1 % (12/567). The incidence of bowel injury at our center was 1.76 %. The incidence of vascular injury at our institute was 1.76 % (10/567). Conclusion Laparoscopic complications are different than those seen following open surgeries. Anticipation, early recognition, and timely intervention help to reduce morbidity. Laparoscopic management of complications is possible. Formulating standard guidelines can help to avoid many such complications.

Abstract

Objective: To construct a simple clinical scoring system for evaluation of vulval lesions that will be helpful in clinically detecting the premalignant or malignant lesions of vulva.

Methods: Seventy women referred for vulval examination at a tertiary care centre in north India were examined over a period of 2 years. Biopsy was performed in 66 consenting women. Association of high-grade vulval lesion with various clinical parameters such as age, duration of symptoms, presenting complaints, the presence of depigmentation, ulceration, hyperkeratosis, acetowhite changes on acetic acid application, asymmetrical distribution of the lesion, surface elevation on naked eye or colposcopy, induration on palpation and toluidine blue stain retention was studied. The significantly associated factors were assigned a value of 0 or 1 depending on whether they were present or absent. Score was then formulated for detection of high-grade lesion defined as moderate to severe dysplasia and early malignancy.

Main outcome measures: Histopathology.

Result: Out of the various parameters that were studied, duration of symptoms more than 6 months, hyperkeratosis,asymmetrical distribution of the lesion, surface elevation on naked eye or colposcopy, induration on palpation and positive toluidine blue stain retention of the lesion were found to be significantly associated with a malignant or premalignant lesion. It was found that a score of equal to or greater than 3/6 was significantly associated with a malignant or premalignant lesion.

Conclusion: This simple scoring system has a potential to identify the high-grade lesions and can be used to identify the vulval lesion requiring a biopsy or further referral to higher centre.

Abstract

Objectives: To determine the serum levels of anti-dsDNA, anti-histone, and anti-nucleosome antibodies after laparoscopic ovarian electrocauterization in patients with polycystic ovarian syndrome (PCOS).

Methods: Our study was performed on 35 patients with PCOS resistant to medical therapy, 35 patients with unexplained infertility, and 35 healthy fertile individuals. Patients with PCOS underwent laparoscopic electrocauterization while those with unexplained infertility underwent diagnostic laparoscopy. Serum levels of anti-dsDNA, anti-histone, and anti-nucleosome antibodies were measured at baseline and 1 month after operation and were compared between groups.

Result: Baseline characteristics were similar between groups. Patients with PCOS had significantly higher levels of anti-dsDNA compared to unexplained infertility (p\0.001) and control groups (p = 0.001). Anti-histone antibodies were higher in PCOS group compared to control group (p = 0.001). In those patients suffering from PCOS, anti-histone antibody increased significantly 1 month after ovarian electrocauterization (p = 0.017). Similarly, serum levels of anti-nucleosome antibodies increased significantly 1 month after operation (p\0.001).

Conclusion: Laparoscopic ovarian electrocauterization in patients with PCOS results in increased levels of anti-histone and anti-nucleosome antibodies. Anti-dsDNA, antihistone, and anti-nucleosome antibodies also increase after diagnostic laparoscopy in those with unexplained infertility. Patients with PCOS have higher levels of anti-dsDNA and anti-histone antibodies compared to those with unexplained infertility and healthy fertile subjects.

Abstract

Research Questions: (1) What is the prevalence of common gynecological morbidities and gynecological symptoms among postmenopausal women in rural Pondicherry? (2) What are the determinants of postmenopausal gynecological morbidities?

Methods: Study Design: Community-based cross-sectional study. Setting: Two villages in Pondicherry, India. Participants: All postmenopausal women aged 50 years and above in the two villages. The participants were interviewed in their households and motivated for examination. By adopting social mobilization strategies coupled with a ‘‘Geriatricfriendly’’ camp approach, 239 eligible women completed gynecological examination. Bivariate analysis of association between gynecological morbidities and its determinants was done using Chi square test.

Results: Among the study population, the prevalence of at least one gynecological morbidity was 44.4 % (CI 38.0–50.8), whereas the prevalence of at least one gynecological symptom was only 25.9 % (CI 20.3–31.5).

Genital prolapse was the most common morbidity which was present in 18.8 % of women. On bivariate analysis, the prevalence of gynecological morbidity was significantly associated with a lower socio-economic status and associated chronic co-morbidities.

Conclusions: Postmenopausal women harbor a considerable magnitude of gynecological morbidities, and approaches such as geriatric-friendly camps can help in uncovering the full spectrum of gynecological morbidities.

Abstract

Purpose: Post-operative nausea and vomiting (PONV) is considered as one of the most disturbing sequels of surgeries under general anesthesia, which if not controlled
appropriately increases post-operative morbidity, nursing burden, and general healthcare costs. In this study, we compared granisetron with its brand Kytril and also with metoclopramide regarding PONV management.

Methods: A total of 180 obstetrics and gynecology patients who underwent surgeries under general anesthesia participated in this prospective study at the Dr. Shariati Teaching Hospital, Tehran, Iran. The patients were randomly assigned to single-dose generic granisetron (40 mcg/kg), Kytril (40 mcg/kg), or metoclopramide (0.2 mg/kg) at the end of the surgery. Two episodes of emetic symptoms (nausea and vomiting) were recorded by a gynecologist who had no knowledge of which treatment each patient had received. This gynecologist observed the patients at three different intervals: 0–6, 6–12, and 12–18 h post-surgery.

Results One hundred and thirty-seven patients (76.1 %) underwent hysterectomy and 40 patients (22.2 %) underwent myomectomy. Each group consisted of 60 patients (33 %). The incidence of vomiting in the first 6, 12, and 18 h post-surgery was 22, 15.2, and 13.3 % for granisetron; 18.6, 10, and 8.3 % for Kytril; and 22, 11.9, and 5 % for generic metoclopramide, respectively. There was no significant difference in the incidence of PONV with any of these agents.

Conclusions: All three anti-nausea and vomiting agents, granisetron, its brand (Kytril), and generic metoclopramide, have a similar effect to manage PONV in obstetrics and gynecological surgeries. Trial registration This trial is registered with www.irct.ir, number IRCT201010134927N1.