OBJECTIVE(S) :To find out the correlation between persistence of uterine artery notch and development of intrauterine growth retardation (IUGR) and pregnancy induced hypertention (PIH), and to see if doppler assessment can help identify high risk pregnancies.
METHOD(S) : Fifty-three women, 38 primiparas forming Group I and 15 high risk pregnancies forming Group II underwent doppler evaluation around 24 weeks of gestation. They were followed up and the outcome noted.
RESULTS : Eight of the 38 in Group I and nine of the 15 in Group II showed persistence of bilateral notch. Of these 17, nine (52.9%) developed IUGR with PIH, and eight (47.1%) had IUGR alone. Persistence of bilateral notch was more significant and majority of women with persistence of unilateral notch had a normal outcome.
CONCLUSION(S) : Uterine artery should be evaluated along with routine scan in all patients whenever possible but in high risk patients uterine artery evaluation should specifically be done at 24 weeks.
uterine artery notch, intrauterine growth retardation, pregnancy induced hypertentionOBJECTIVE(S) : To know the outcome of trial of vaginal birth after previous cesarean section (PCS) with special reference to induction of labor at a rural institute with resource constraint.
METHOD(S) : The present prospective observational study was carried out over a period of 2 years by recording the events of labor in cases of PCS at a rural referral health care educational institute in Central India. During the study period 945 cases of PCS were admitted, however 232 were excluded from the study because either they had exclusion criteria or they did not deliver at the place of study, leaving a total of 713 study subjects.
RESULTS : In 324 women (45.5%) vaginal delivery was contemplated and in 389 (54.5%) repeat cesarean section (CS) was planned. Out of the 324 planned for vaginal delivery, 231(71.2%) finally delivered vaginally making it over all 32.4% (231/713) vaginal births and 67.6% (231/713) repeat CS in cases of PCS. Induction of labor could be safely done in 19 (5.8%) cases without any mortality or induction related complications. Major morbidity did occur in 0.68%.cases but it had nothing to do with trial or induction of labor. Perinatal loss was 0.61%.
CONCLUSION(S): A trial of labor and induction of labor are safe modalities in women with PCS even in poor resource settings. The key is the discerning selection of women who should have elective repeat CS or induction of labor or a trial of spontaneous onset of labor with vaginal delivery.
previous cesarean section, induction of labor, vaginal birth after cesarean sectionOBJECTIVE(S): To study the clinical profile, management and outcome of the patients with pregnancy related acute renal failure (PRARF).
METHOD(S): All patients with PRARF admitted between July 1999 and December 2004 were analyzed.
RESULTS: Total number of women with PRARF was 41, whereas the total number of patients with acute renal failure (ARF) was 966. Age range of women with PRARF was 15 to 45 years. 75.61% of the cases of PRARF were seen in the postpartum period. It was caused by sepsis in 39.02% (16/41), toxemias of pregnancy in 24.39% (10/41), and hemorrhages of pregnancy in 17.07% (7/41). Puerperal sepsis was the cause in 29.27%, and septic abortion in 9.76%. Dialysis was needed in 53.66%. Twenty-five patients (60.98%) recovered, six (14.63%) left against medical advice and 10 (24.39%) expired. CONCLUSION(S): PRARF constitutes 4.24% of ARF. The majority of PRARF cases were seen in the postpartum period. Postpartum sepsis was the most common cause of PRARF. The overall mortality was 24.39%.
acute renal failure in pregnancy, acute renal failureOBJECTIVE(S) : To determine changes in selenium levels and the glutathione peroxidase activity in the red cells and plasma in women having miscarriage as compared to those in women with normal pregnancy and in nonpregnant women.
METHOD(S) : Blood selenium levels and glutathione peroxidase activity were measured in 30 women presenting consecutively with a miscarriage, in 30 women having a normal pregnancy and in 30 nonpregnant women. In women presenting with miscarriage, the values were repeated after 48 hours of miscarriage. The mean values of each group were compared statistically.
RESULTS : The selenium concentrations in red cells and plasma in women with miscarriage were significantly lower as compared to those in women with normal pregnancy and in nonpregnant women. The glutathione peroxidase activity was also reduced significantly in women with miscarriage. Student t test was employed for statistical evaluation.
CONCLUSION(S) : The reduced selenium concentration and the decreased blood glutathione peroxidase activity may play an important role in the occurrence of spontaneous abortion.
selenium, glutathione peroxidase, miscarriageOBJECTIVE(S) : To find out whether abnormal umbilical coiling index (UCI) is related to adverse antenatal and perinatal outcomes.
METHOD(S) : One hundred of seven umbilical cords were examined. A coil was defined as a complete 360 degree spiral course of umbilical vessels around the Wharton’s jelly. UCI was calculated by dividing the total number of coils by the umbilical cord length in centimeters. The outcomes measured were gestational age, intrauterine growth retardation, meconium staining, birth weight, apgar score, ponderal index, and pregnancy induced hypertension. Hypocoiled cords were those having UCI less than 10th centile, and hypercoiled cords those having UCI more than 90th centile. Statistical analysis was done by chi square test, Fishers exact test and the t test where applicable.
RESULTS : The mean UCI was 0.13±0.08. No coiling was seen in 6 (5.6%) cases. Anticlockwise coiling was significantly more frequent ( t 3.02, P < 0.01) than clockwise coiling. In hypocoiled group low apgar score, meconium staining, and pregnancy induced hypertension were all significantly higher than in those with normal coiled group. Babies with apgar < 7 had significantly lower UCI than babies with apgar ≥ 7 (t 2.13, P < 0.05). No statistical significance was seen between the hypercoiled and normal coiled group.
CONCLUSION(S) : Low UCI was associated with adverse antenatal and perinatal complications.
hypocoiling umbilical cord, hypercoiling umbilical cord, sonography, umbilical coiling indexOBJECTIVE(S) : To study the efficacy and safety of attempted vaginal birth after a cesarean delivery (VBAC).
METHOD(S) : A prospective study was carried out from 1st January 2001 to 31st December, 2003 on 263 women with one prior lower segment cesarean section (LSCS) for a nonrecurrent cause. All unbooked women and those with estimated fetal weight more than 3.5 kg, breech presentation, history of postoperative wound infection after previous LSCS, anemia (Hb < 10 gm%), pregnancy induced hypertention, diabetes, heart disease, renal disease, cephalopevic disproportion abnormal presentation and placenta previa were excluded from the study. An informed consent was taken for allowing a trial of vaginal delivery. Spontaneous onset of labor was awaited up to 41 weeks. Induction of labor was considered only in highly selected cases. Labor was constantly supervised by competent staff and meticulously monitored by cardiotocography (CTG).
RESULTS : Out of the 263 women enrolled for the study, 15 had to leave the station and 11 aborted leaving a total of 237 patients; 171 (72.1%) of these delivered vaginally while 66 (27.9%) required emergency cesarean section. There was one case of scar dehiscence (0.5%), three cases of cervical tear (1.5%) and one case of second degree perineal tear (0.5%). The perinatal morbidity was comparable to that for other normal vaginal deliveries.
CONCLUSION(S) : VBAC should be considered in cases of previous one cesarean delivery for nonrecurrent indication
vaginal birth after cesarean delivery, previous cesarean deliveryOBJECTIVE(S) : To study the influence of socioeconomic factor on source of information and level of awareness of facts of menarche and reproduction among school going adolescent girls.
METHOD(S) : A cross sectional, community based study was done among 1700 school going adolescent girls. Responses about source of information and level of awareness of adolescent physical changes and menarche and reproduction were analyzed statistically in high and upper middle socioeconomic group (Group A; n=450) and low middle socioeconomic group (Group B; n=1250).
RESULTS : Source of information on adolescent physical changes and menarche varied significantly in the two groups (P = 0.02). Majority of girls have only incomplete knowledge on these topics (P = 0.10). Major source of information was television in both the groups without any significant difference (P = 0.50) but significantly more girls had clear concept of reproduction (P < 0.05) and AIDS,hepatitis B and sexually transmitted diseases (P=0.02) in Group A.
CONCLUSION(S): Socioeconomic factor significantly influences source of information and level of awareness on menarche
and reproduction among adolescent girls. Hence, adolescent health counseling should be tailored accordingly.
OBJECTIVE(S) : To compare the health profile of the adolescent urban schoolgirls and the underprivileged tea garden girls residing in the sub-Himalayan region.
METHOD(S) : Seven hundred tea garden girls and 650 urban schoolgirls aged 12-20 years in the Siliguri area were surveyed by means of a preset questionnaire. Comparative analysis of the basic health profiles of these two different groups of girls living in the same ecozone was done.
RESULTS :Forty-three percent of the tea garden girls attained their menarche at 12 years while 38.5% schoolgirls did so at 13 years. Nutritional deficiencies were widely prevalent among the tea garden girls and so were school drop-outs. Mild to moderate anemia was especially rampant. However most school girls were overweight or obese and 14.6% had their BMI >29. Awareness regarding sexually transmitted diseases, unwanted pregnancies, and contraception was also substantially poor among the tea garden girls.
CONCLUSION(S) : Poor adolescent girls’ health needs to be improved with a goal to promote the future reproductive health
of the society.
OBJECTIVE(S) : To study the various gynecological pathologies of women who were under tamoxifen therapy for the management of carcinoma breast.
METHODS : Six women who were under tamoxifen therapy for a period of 2 to 4 ½ years were reviewed. One of them had prior hysterectomy. Five of them presented with abnormal vaginal bleeding.
RESULTS : Wide spectrum of gynecological pathologies like endometrial hyperplasia, atypia, endometrial carcinoma, myohyperplasia, uterine fibroids, and cervical cell abnormalities were observed.
CONCLUSION(S) : Tamoxifen therapy is beneficial but its adverse effects on long term use require effective surveillance
jointly by the surgeon and the gynecologists.
OBJECTIVE(S) : To determine the incidence of postpartum stress urinary incontinence (SUI), its correlation with vaginal delivery, forceps delivery and cesarean section, and to asses the incidence of genuine stress incontinence with urodynamics.
METHOD(S) : Out of 250 initially selected primiparas 222 responded to the questionnaire for the SUI at 8 weeks postpartum. Urodynamic study was advocated to those, who said that they had SUI. The incidences of SUI after different modes of delivery were compared with each other. Statistical analysis was done by odds ratio and 95% confidence limit estimation and chi square test.
RESULTS : The incidence of SUI was 23.42%. SUI was significantly higher after vaginal delivery and more so after forceps delivery in comparison with that after cesarean section. No significant difference was observed between forceps delivery and vaginal delivery. Incidence of genuine stress incontinence was 6.06%.
CONCLUSION(S) : Incidence of SUI was lower after cesarean section. Urodynamics show lower incidence of genuine stress incontinence than that revealed by women’s perception.
postpartum stress urinary incontinence, mode of delivery, urodynamicsOBJECTIVE(S) : To assess the knowledge, attitudes, and practices related to mifepristone-misoprostol medical abortion among Indian obstetrician-gynecologists.
METHOD(S) : A self-administered questionnaire documenting provider and facility characteristics, familiarity with mifepristonemisoprostol abortion, and opinions about medical abortion practice patterns was mailed to a nationally representative sample of 1000 members of the Federation of Obstetric and Gynecological Societies of India (FOGSI). When possible, nonresponders were followed up and interviewed by phone. A total of 440 completed questionnaires were received.
RESULTS : Nearly all (90%) respondents, including 79% of those not providing the method, reported at least some familiarity with mifepristone-misoprostol. Use of medical abortion was significant (69%) and generally entailed 200 mg mifepristone (50%) and 400 µg misoprostol (73%) administered orally (75%). Thirty percent of current providers prescribed both mifepristone and misoprostol for home use. Medical abortion nonproviders had concerns about compliance (77%), and safety and efficacy (70%).
CONCLUSION(S) : Medical abortion is beginning to enter mainstream abortion practice of FOGSI members.
