Abstract

The obstetric forceps was designed to assist extraction of the foetal head and thereby accomplish delivery of the foetus in the second stage of labour. More than 700 types of obstetric forceps have been described. An understanding of the anatomy of the birth canal and the foetal head is a prerequisite to becoming a skilled and safe user of forceps. Operative vaginal delivery rates have remained stable at between 10 and 13 %. The last few decades has seen a rise in caesarean section, along with the introduction and safe use of the vacuum extractor. This has resulted in a decline both in the use of the obstetric forceps as well as in the training for the same. The forceps is less likely to fail when used as the primary instrument thereby reducing the need for the sequential use of two instruments which increase the morbidity of the neonate. Perineal trauma is more likely to occur with the use of the forceps but the evidence is that the maternal concern is less when compared to the ventouse. Simulation training is an important part of obstetric training. Application of forceps blades in the simulation setting can improve the skill level of obstetricians. The use of the forceps should not be decreasing and more senior involvement in training is necessary so that juniors develop the proper skills to perform forceps delivery in a competent and safe manner. It is vital that the art of the forceps is not lost to future generations of obstetricians and the women they care for.

Abstract

Objective: The aim was to study the correlation of placental thickness, measured at the level of the umbilical cord insertion, with the ultrasonographic gestational age in normal and IUGR pregnancies in the late second and third trimester.

Materials and Methods: A total of 498 patients were observed for correlation of the placental thickness with ultrasonographic gestational age and their outcomes by dividing them into Group A (outcome fetal weight\2,500 g, n = 122) and Group B (fetal weight[2,500 g, n = 376). The mean placental thickness was calculated at the umbilical cord insertion in both groups along with ultrasonographic fetal age and estimated fetal weight. The mean values of placental thickness along with respective standard deviation were calculated from the 24th to 39th week of gestational age.

Results: A positive correlation was observed between placental thickness and ultrasonographic gestational age in both groups (p value of 0.01), with Pearson’s correlation coefficient (‘‘r’’) values of 0.325 in GroupA and 0.135 in Group B. Regression analysis yielded linear equations of relationship with placental thickness and gestational age in both groups. The placental thickness was also found to be lower in Group A between 26 and 27 weeks and 30 and 31 weeks, having mean values of 2.48 ± 0.063 cm (p value of 0.042) and 2.76 ± 0.552 (p value of 0.05) in Group A as compared to 3.04 ± 0.25 and 3.13 ± 0.183 cm in Group B.

Conclusions: Placental thickness measured at the level of umbilical cord insertion can be used as an accurate sonographic indicator in assessment of gestational age in singleton pregnancies because of its linear correlation.

Abstract

Aim/Objective: Peripartum cardiomyopathy (PPCM) is a disorder of unknown etiology in which symptoms of heart failure occur between the last month of pregnancy and 5 months post-partum. These findings prompted us to carry out a more detailed study aimed at correlating plasma levels of C-reactive protein TNF-a and IL-6 as prognostic value for major clinical in-hospital events and 6-month follow-up in patients with PPCM.

Materials and Methods: After ethical clearance, in the present prospective case–control study, a total of 86 subjects were enrolled [patients (n = 46) and controls (n = 40)]. After checking for the inclusion and exclusion criteria, informed consent was obtained and patients were enrolled. The details of history of pre-eclampsia and mode of delivery were obtained from the patients. The history of onset of symptoms and signs was recorded at the first presentation and at 6 months. Clinical assessment, echocardiography, and blood analysis were done at baseline and after 6 months of standard therapy. All patients received treatment with diuretics and the ACE inhibitor (ramipril), Carvedilol if not contraindicated, and inotropic support inj-Dobutamine. Inflammatory markers (C-reactive protein, TNF-a, and IL-6) were measured at baseline and at 6 months. Data were analyzed using the SAS version 9.1 statistical program.

Results: The characteristics of the study population at first presentation to the cardiac clinic are similar (compared with controls): 0.91 % of the study patients were diagnosed as PPCM patients for the first time and 49 % patients presented within one month after delivery. C-reactive protein (22 vs 08 mg/dl, p\0.05), TNF-a (9.6 vs 3.2 pg/dl, p\001), and IL-6 (73.19 ± 34.4 vs 31.52 ± 8.83 pg/dl, p\0.005) were significantly abnormal, and these patients showed significantly higher LV dimensions, LV EDD (61.6 ± 7.1 vs 46 ± 9 mm p\0.004) LV ESD (53.1 ± 7 vs 32 ± 8, p\0.005), and significantly lower echocardiographic left ventricular ejection fraction (LVEF) (25.9 ± 8.2 vs 55 ± 12 p\0.001) and correlate well with NYHA FC and death. LVEF improved from 25.9 ± 8.2 to 42.9 ? 13.6 % at 6 months (p\0.0001). Patients who completed 6 months of standard care showed a significant reduction of heart rate, LV dimensions, and NYHA FC (p\0.001). However, normalization of LVEF ([50 %) was only observed in 11 (35 %) patients. Seven patients died within 6 months of diagnoses and eight patients were lost to follow-up.

Conclusions: Plasma markers of inflammation were significantly elevated in PPCM patients and correlated with increased LV dimensions and lower EF at presentation. Baseline CRP, IL-6, TNF-a, and higher NYHA FC were the only predictors of mortality. These results contribute to inflammation which may contribute to the pathogenesis of PPCM and its complications and predictors of mortality.

Abstract

Purpose: The purpose of this study was to investigate the influence of the depth of myometrial invasion and tumor grade on lymph node involvement in endometrial carcinoma.

Methods: Patients with endometrioid carcinoma of endometrium who underwent surgical staging between January 1999 and September 2010 under the division of gynecologic oncology were studied retrospectively. Patients treated by radiotherapy or chemotherapy before surgeries were excluded.

Results: The study group included 61 patients. Six patients had lymph node metastasis, of which 83.3 % had[50 % myometrial invasion (P = 0.052). Grades 1, 2, and 3 were each seen in 33.3 % of them (P = 0.061). When the study group was divided into two sets, namely, those with\50 and [50 %myometrial invasion, the odds ratio was 10.3, which means that the chance of the prevalence of lymph node metastasis in the latter group is 10 times more.

Conclusions: Although the P value was not significant, the odds ratio reveals that there is an increased risk of lymph node positivity with deeper myometrial invasion. Surgical staging needs to be done for all operable cases of carcinoma endometriumto determine the prognosis and further management.

Abstract

Objective: The aim of this study was to determine the effects of period of gestation and position of fetal neck on nuchal translucency measurement.

Materials and Methods: Nuchal translucency was measured in the mid-sagittal plane, with the fetal neck in the flexed, neutral, and extended positions in 100 pregnant women between 11 and 13?6 weeks. Mean nuchal translucency measurements at different periods of gestation were compared. Differences between the extended and neutral positions (D extended nuchal translucency) and those between the flexed and neutral positions (D flexed nuchal translucency) were calculated. The repeatability coefficients for the measurements in all the three positions were computed. Statistical analysis was also done.

Results: Nuchal translucency values were 1.050 ± 0.282 mm in the 11th week, 1.243 ± 0.348 mm in the 12th week, and 1.823 ± 0.357 mmin the 13th week (r = 0.747, p\0.0001). The mean D flexed value was 0.233 ± 0.133 mm lesser than the neutral value (p\0.0001). The mean D extended nuchal translucency was 0.305 ± 0.155 mm greater than the neutral value (p\0.0001). The repeatability coefficientwas the lowest in the neutral position (0.17 mm in the neutral position, 0.28 in the flexed position and 0.41 mm in the extended position).

Conclusion: We concluded that the period of gestation and fetal neck position can make a significant difference to nuchal translucency measurement. Repeatability of measurement is more accurate with the fetal neck in the neutral position. These findings have important implications for clinicians using nuchal translucency to screen the obstetric population for Down’s syndrome.

Abstract

Background and Objectives: Intrauterine growth restriction is associated with increased perinatal mortality and morbidity, possibly extending also in adult life, as compared to fetuses and newborns presenting characteristics of normal growth. The present study had been planned to measure the pulsatility index (PI) and resistive index of the middle cerebral artery with pulsatility and resistive index of the umbilical artery in predicting fetal growth restriction.

Materials and Methods: Atotal of 60 pregnant women with a clinical history and grayscale-screened patients were taken for Doppler analysis, and a final comparison of accuracy of Doppler indices was done with perinatal outcome.

Statistical Analysis: The statistical analysis was done using the Statistical Package for Social Sciences version 15.0 statistical analysis software. The values were represented in number (%) and mean ± SD.

Observation and Results: The umbilical artery PI had maximum sensitivity at the third visit (32–37 weeks) and maximum specificity also at the third visit (32–37 weeks). The umbilical artery resistive index had maximum sensitivity at the second visit (28–32 weeks) and maximum specificity at the third visit (32–37 weeks). The MCA PI had an overall diagnostic accuracy of 52.8 %.

Conclusion: The PI of the umbilical artery was more sensitive than the PI of the middle cerebral artery. Umbilical artery PI has the maximum overall diagnostic accuracy of 75 %.

Abstract

Objective: The purpose of this study was to establish an Indian reference for normal fetal nasal bone length at 16–26 weeks of gestation.

Methods: The fetal nasal bone was measured by ultrasound in 2,962 pregnant women at 16–26 weeks of gestation from 2004 to 2009 by a single operator, who performed three measurements for each woman when the fetus was in the midsagittal plane and the nasal bone was between a 45 and 135 angle to the ultrasound beam. All neonates were examined after delivery to confirm the absence of congenital abnormalities.

Results: The median nasal bone length increased with gestational age from 3.3 mm at 16 weeks to 6.65 mm at 26 weeks in a linear relationship. The fifth percentile nasal bone lengths were 2.37, 2.4, 2.8, 3.5, 3.6, 3.9, 4.3, 4.6, 4.68, 4.54, and 4.91 mm at 16, 17, 18, 19, 20, 21, 22, 23, 24, 25, and 26 weeks, respectively.

Conclusions: We have established the nasal bone length in South Indian fetuses at 16–26 weeks of gestation and there is progressive increase in the fifth percentile of nasal bone length with advancing gestational age. Hence, gestational age should be considered while defining hypoplasia of the nasal bone.

Abstract

Purpose: In modern days, grand multiparity is confined to communities where contraception is not practiced because of social and religious beliefs. For this reason, it is quite prevalent in all GCC countries. Few studies have compared the outcomes between the three groups: low parity (2–4), grand multiparity (5–9), and great grand multiparity (10 and more) . This study intended to analyze the trends in the occurrence of various perinatal complications across these three groups.

Methods: This historical cohort study was conducted in Mafraq Hospital, Abu Dhabi between January 1, 2009 and December 31, 2011. There were 1,658 multipara, 1,198 grand multipara, and 160 great grand multipara.

Results: Different complications revealed different trends with increasing parity. Many antenatal and intrapartum complications like diabetes (overt and gestational), anemia, preterm delivery, malpresentation at term, postpartum hemorrhage, and macrosomia showed a linear increase with increasing parity, while some, like the need for labor augmentation and soft tissue injuries showed a declining trend with increasing parity. Interestingly, some complications like placenta praevia, need for induction of labor, cesarean delivery, and post-term delivery followed an inverted V curve, showing an increase in their occurrence up to parity nine but a decline thereafter with further increasing parity of ten or beyond.

Conclusion: Women in different parity groups were at risk of different complications. There are some complications which decrease with increasing parity, and perinatal mortality remains very low suggesting that in modern settings, with favorable socioeconomic conditions and access to high-quality healthcare, a satisfactory perinatal outcome can be expected with low morbidity and mortality.

Abstract

Objective: To measure the levels of early follicular phase Anti-Mullerian hormone (AMH) in Indian patients of IVF and to evaluate the AMH as a predictive marker of ovarian response in assisted reproductive technology outcome.

Methods: Sixty women (age 25–40 years) selected for in vitro fertilization treatment were included in this study. Analysis of day-2 serum samples was done for the AMH, FSH, Inhibin B, and LH by ELISA kit methods. USG was done for the antral follicle count (AFC) and oocytes’ retrieval. Hormone parameters were compared and correlated with the oocytes’ retrieval count and the AFC. The discriminant analysis was done to compare relevance of different parameters for predicting ovarian response.

Result(s): The Anti-Mullerian hormone showed a significant correlation with the oocytes’ retrieval after ovulation induction for IVF (r = 0.648, p\0.0001) and no correlation was seen with serum FSH, LH, and Inhibin. Serum AMH levels show 80 % sensitivity and 80 % specificity in predicting poor ovarian response.

Conclusion(s): There is a significant correlation between day-2 serum AMH levels and the oocytes’ retrieval count in women undergoing ovulation induction for IVF, and the AMH is a good marker as the negative predictive values for the success of ART. There is no correlation found between other hormonal ovarian reserve markers and the oocytes’ retrieval count.

Abstract

Objective: A prospective cohort study in a teaching hospital to assess the efficacy and safety of neoadjuvant chemotherapy in the treatment of locally advanced carcinoma cervix.

Method: Neoadjuvant chemotherapy in the form of cisplatin 75 mg/m2 and paclitaxel 135 mg/m2 on day 1 and repeated at 14 days’ interval for up to a maximum of three courses.

Results: Neoadjuvant chemotherapy in cervical cancer was effective in the downstaging of the disease. Downstaging was observed in 19.23 % of patients after two cycles and in 50 % of patients after three cycle of NACT. Operability increases to 33.3 and 38.4 % after two and three cycles of NACT, respectively. Complete pathological response was observed in 37.5 % of patients after NACT. No significant adverse effect in the feasibility of surgery was observed.

Conclusion: The present study showed that neoadjuvant chemotherapy was an effective and well-tolerated mode of therapy with significantly less morbidity and mortality.