OBJECTIVE(S) : To evaluate the cervical canal in the second trimester by transvaginal and transabdominal ultrasonography and to find the one which is more accurate of the two.
METHOD(S) : One hundred and twenty pregnant women were enroled in this prospective study. Women with cervical imcompetence, multiple gestation, maternal medical diseases, previous cervical surgery and history of preterm delivery were excluded. Maternal and fetal data were collected. Each woman underwent a transabdominal and endovaginal ultrasonographic cervical length measurement. Statistical comparisions were made between the two ultrasonographic methods for gestational age at birth and parity. Significance was set at P < 0.05.
RESULTS : Preterm delivery occurred in 14.2% of the women. Transvaginal ultrasonographic cervical length measurements of term and preterm deliveries showed a statistically significant difference (P < 0.05) but no significant difference was found in transabdominal measurements (P > 0.05). Although transvaginal cervical length measurements showed a statistically significant difference between primiparous and multiparous women (P < 0.05), the difference was at significance limit by transabdominal route (P=0.05).
CONCLUSION(S) : Transvaginal ultrasonography seems to be the optimal method for the assessment of cervical length in the second trimester and for screening for spontaneous preterm delivery.
OBJECTIVE(S) : To study the control of postpartum hemorrhage in cases of placenta previa by isthmic-cervical apposition suture.
METHOD(S) : Isthmic-cervical apposition suture was applied in eight cases. A No.2. Chromic catgut on straight needle was passed through the uterus above the bladder reflection, 3 cm below the lower edge of uterine incision and 2 cm medial to the lateral edge of lower segment. The needle was passed from the anterior to the posterior aspect of the uterus and then brought back from the posterior through the anterior wall 1 cm medial to the entry point and tied anteriorly. The same procedure was repeated on the other side.
RESULTS : Isthmic-cervical apposition suture was effective in all cases.
CONCLUSION(S) : Isthmic-cervical appostion suture is a simple, effective, quick and safe method for controlling postpartum hemorrhage in placenta previa during cesarean section.
OBJECTIVE(S) : To compare methylergometrine (250 < g) and carboprost tromethamine i.e. 15-methyl analogue of PGF a (125 mg) as prophylaxis for postpartum hemorrhage (PPH).
METHOD(S) : A cross-sectional randomized comparative study was carried out at our tertiary care teaching hospital on 130 women in labor. They were randomly allotted to one of the two groups. Group A included 65 women who were given methylergometrine (250 < g) intravenously and Group B included 65 women who were given injection carboprost (125 < g) intramuscularly at the time of delivery of anterior shoulder. Main outcome measures were duration of third stage, incidence of PPH and side effects of the drug. Statistical analysis was done with students t test and chi square test.
RESULTS : The two groups were comparable with regard to age and parity. 78.4% of Group A and 46.1% of Group B had one or more high risk factors for PPH (P=0.001). Mean duration of third stage of labor in the two groups was comparable and there was no case of retained placenta. Placental separation occurred within 5 minutes in 87% in Group A and in 83% in Group B (p=0.456). PPH occurred in 4.6% in Group A and 6.1% in Group B (P=1.0). Among the high- risk women, PPH occurred in 7.8% in Group A and 13.3% in Group B (P=0.55). Side effects were noted in 3% in Group A and in 12.4% in Group B (P=0.04).
CONCLUSION(S) : Methylergometrine (250< g) and carboprost (125< g) are comparable in efficacy for prevention of PPH but since side effects and the cost are significantly more with carboprost, methylergometrine should be preferred for routine use, reserving carboprost for women in whom methyleyometrine is contraindicated.
OBJECTIVE(S): To evaluate the prevalence of postpartum psychiatric morbidity and to identify the risk factors associated with this problem.
METHOD(S): An epidemiological study was conducted on 478 new mothers between July and September 2002. General Health Questionnaire and Edinburgh Depression scale were used on day 3 and 3 weeks postpartum to identify women with psychiatric morbidity. Demographic, obstetric, and psycho-social risk factors were analyzed. Chi-square test was used for statistical analysis.
RESULTS: The prevalence of postpartum psychiatric morbidity was 33.4% and 6.5% of cases had major illness with postnatal depression and psychosis. Parity, marital status, habits of spouse, previous obstetric complications, current perinatal events, mode of delivery, and sex of the baby did not have major impact on the occurrence of postpartum depressive disorder. Women whose husbands were unskilled workers suffered more (8.2%) compared to those with skilled worker husbands (2.2%). The prevalence was high in women in nuclear families (9.4%) as compared to that in those in joint families (1.2%). The incidence was very high among women who had non-arranged marriages (17.7%).
CONCLUSION(S): Pregnant women should be screened to identify those at risk for psychriatric illness. Necessary prevention and treatment should be offered.
OBJECTIVE(S) : To assess seroprevalence of HIV infection in antenatal women.
METHOD(S) : This study was conducted on 1000 antenatal women over a period of 12 months from 1st December 2003 to 30th November, 2004. After taking informed consent and a detailed history, proper general and obstetrical examination was done. All women underwent serological testing for detection of HIV antibodies by 2 rapid tests Pareekshak and Immunocomb test, and ELISA test. ELISA positive samples were further confirmed by Western Blot test. Post-test counseling was done in all seropositive subjects.
RESULTS : Seroprevalence rate of HIV infection was 0.4% .
CONCLUSION(S) : The seroprevalence of HIV infection according to the seroprevalence rate in antenatal women is low.
OBJECTIVE(S) : To ascertain the occurrence of group B streptococcal (GBS) carriage among pregnant women and occurrence of neonatal GBS infections in our hospital where a risk factor based screening protocol is followed and to determine the efficacy of such a protocol in preventing neonatal infections and death due to group B streptococci.
METHOD(S) : A retrospective analysis was done of the occurrence of group B streptococcal colonization among 741 pregnant women who were at risk i.e. they had at least one of the following risk factors namely-prolonged rupture of membranes (>18 hours), preterm labor (<37 weeks), intrapartum fever, vaginal discharge, and previous baby with GBS infection, Vaginal swab and urine cultures indicated GBS. The occurrence of neonatal GBS infection was also studied.
RESULTS : The occurrence of GBS colonization was 1.62% and neonatal GBS infection was 0.53 per 1000 live births. There were no cases of invasive neonatal disease or deaths due to GBS.
Conclusion(S) : The low occurrence of GBS colonization (1.62%) and GBS disease (0.53 per 1000), and the lack of invasive neonatal GBS disease and neonatal deaths shows that selective risk factor based screening and antibiotic prophylaxis is an effective protocol for preventing neonatal morbidity and mortality due to group B streptococci.
OBJECTIVE(S) : To appraise the association between unicornuate uterus and ectopic (undescended) ovaries with emphasis on diagnostic procedures and therapeutic implications.
METHOD(S) : A magnetic resonance image (MRI) after mild clomiphene citrate (CC) stimulation was used to visualize the presence of an undescended ovary in the upper abdomen in 12 cases of unicornuate uterus.
RESULTS : Six out of 12 patients with a unicornuate uterus had a concomitant ectopic ovary.
CONCLUSION(S): Undescended ovaries are commonly found in women with a unicornuate uterus. The lack of reports on undescended ovaries is fascinating, suggesting the possibility that many cases remain unrecognized. Consequently, important clinical information is missed in many patients. MRI after CC stimulation is an elegant method to diagnose ectopic ovaries.
OBJECTIVE(S) : To establish the validity and reliability of imprint cytology in intraoperative diagnosis of ovarian tumors and to compare it with histopathology.
METHOD(S) : Multiple imprint smears were taken from the resected tumor masses during surgery in 67 patients. After staining, the findings were noted and compared with subsequent histopathology report.
RESULTS : There were 53 celomic epithelial ovarian tumors and 14 non-celomic ovarian tumors.There were 41(61.19%) benign and borderline tumors, and 26 (38.81%) malignant ones. Overall diagnostic accuracy was 89.55% .
CONCLUSION(S) : Imprint cytology is a less expensive, simple, fast and reliable method for diagnosis of ovarian tumors during surgery.
OBJECTIVE(S) : To study the mean progesterone levels in mid-luteal phase in conception cycles, both spontaneous and clomiphene citrate induced.
METHOD(S) : A record of 210 cases of primary infertility were analysed. Sixty of them had regular menstrual cycles (cycle length 26-35 days) and 150 had oligomenorrhea (cycle length >35 days). To detect the ovulatory status, these 60 cases were advised to test for mid-luteal phase plasma progesterone levels (day 21-day 23). Nineteen of these women were found to have conceptive menstrual cycles on follow up with the blood reports (Group A). Out of 150 cases with oligomenorrhoea, 23 cases of polycystic ovarian syndrome (PCOS) conceived in the first cycle of treatment with clomiphene citrate for induction of ovulation (Group B). Serum progesterone levels were measured 7-9 days after documented ovulation by follicular study with ultrasonography.
RESULTS : Mean progesterone levels in Group A and Group B were 17.11 ± 5.30 ng/mL and 23.94 ± 17.07 ng/mL respectively. Statistical analysis showed that the difference in these values were significant.
CONCLUSION(S) : Mean mid-luteal phase progesterone level in spontaneous conception cycle is significantly lower than that in clomiphene citrate induced conception cycle.
OBJECTIVE(S) : To study the gynecological problems of adolescents.
METHOD(S) : A total of 124 adolescent girls attending the gynecological outpatient department were included in the study. After history taking and examinations, investigations like hemogram, coagulograms, hormonal assays, and sonography were done wherever applicable.
RESULTS : Menstrual disorders were found to be the commonest gynecological problem (58.06%). They varied from amenorrhea (29.16%) to menorrhagia. Dysfunctional uterine bleeding was the commonest etiology of menstrual dysfunction (32/46) in the group under study.
CONCLUSION(S) : Menstrual abnormalities are the most common problems of adolescents. Setting up of adolescent clinics is desirable
OBJECTIVE(S) : To evaluate the efficacy of a minimal stimulation protocol in IVF.
METHOD(S) : The study included 31 couples who attended our hospital from 1st January 2003 to 31st December 2003. They were unable to afford full-fledged IVF programme. Basal scan was performed on day 2 to exclude any cyst. Clomiphene citrate 100 mg from day 2 to day 6 was given. Follicular monitoring was done from the 7th day. Inj. HMG 75- 150 IU was given daily intramuscularly. Subsequent visits were determined according to each patient’s response. Cetrorelix 0.25 mg was started when the lead follicle was >13 mm and continued until ovulation induction. For comparison, a group of women (n=49) undergoing 1st IVF cycle with standard long protocol was used as control.
RESULTS : There was no cancellation of any cycle due to premature luteinisation. Fertilization rate and pregnancy rate / transfer in the study and the control group were 71.2% vs 70.1% and 28.6% vs 30.6% respectively.
CONCLUSION(S) : Minimal ovarian stimulation protocol is a good alternative approach.
