OBJECTIVE(S) : To examine the role of intrapartum cervicogram in vaginal birth after cesarean section (VBAC).
METHOD(S) : Prospective partographic analysis of 81 women who had one previous cesarean section was done. Duration of labor, initial dilatation rate (IDR) and average dilatation rate (ADR) were calculated. Statistical analysis was done with ‘Z’ test.
RESULTS : Vaginal birth was successfully achieved in 74%. The mean duration of first stage and of second stage of labor were 10.93 + 5.86 hours and 23.44 + 16.23 minutes respectively. The mean duration of first and of second stage were shorter in women with previous vaginal birth compared to those who had no previous vaginal birth. The mean IDR and ADR of vaginally delivered women were 0.74 cm/hour and 1.14 cm/hour respectively. The women requiring repeat cesarean section had significantly slower dilatation rate (mean IDR 0.4 cm/hour, mean ADR 0.29 cm/hour). Ninety-five percent of the women with IDR > 1 cm/hour and 97% women with ADR > 0.5 cm/hour delivered vaginally while 67% women with IDR < 0.5 cm/hour and 87% women with ADR < 0.5 cm/hour required repeat cesarean section. Alert line was crossed in 25 women and 21 of them required repeat cesarean section.
CONCLUSION(S) : IDR > 1 cm/hour and ADR > 0.5 cm/hour have 95% and 97% positive predictive value respectively for VBAC. Alert line is helpful in identifying cases requiring intervention.
OBJECTIVE(S) : To compare efficacy, safety and tolerance of oral misoprostol with intracervical dinoprostone for cervical ripening and labor induction.
METHOD(S) : One hundred and ninety women with single live fetus, term gestation, cephalic presentation and reactive fetal heart pattern admitted for induction of labor were included in the study. They were randomized to receive either a single dose of 200 mg of oral misoprostol (study group) or 0.5 mg of intracervical dinoprostone for a maximum 3 doses at 8 hourly intervals (control group).
RESULTS : Induction-delivery interval was significantly shorter in the study group (11.68 hours vs 14.83 hours; P<0.01). Failure of induction was higher in the control group (14.83 vs 1.05%). Cesarean section rate in the study group was comparable with that in the control group (17.89% vs 20%). In the study group most of the cesarean sections were done for fetal distress (35.2%). Neonatal outcome was comparable in the two groups. Incidence of abnormal uterine activity was significantly higher in the study group.
CONCLUSION(S) : Single dose of 200 < g oral misoprostol was more effective for cervical ripening and labor induction than 0.5 mg of intracervical dinoprostone given 8 hourly.
OBJECTIVE(S) : To study indications and maternal outcome of emergency obstetric hysterectomy.
METHOD(S) : A retrospective study of the cases of emergency obstetric hysterectomy performed over a period of 7 years from 1997 to 2003 was done. Maternal characteristics, indications, and maternal morbidity and mortality were analyzed.
RESULTS : During the study period there were 41 emergency obstetric hysterectomies and 15,461 deliveries, giving an incidence of 0.26%. Majority of the cases were unbooked (75.6%). It was more common in para three and four (60.9%). Atonic post-portum hemorrhage and ruptured uterus were the common indications (78.04%). The maternal mortality was 9.7%.
CONCLUSION(S) : Emergency obstetric hysterectomy is a life saving procedure. The maternal outcome greatly depends on timely decision and good clinical judgment because unnecessary delay can cost life and undue haste can cause morbidity.
OBJECTIVE(S) : To evaluate O’ Sullivan’s screening test to identify women at risk for gestational diabetes, evaluate intrapartum and neonatal outcomes, and analyze the risk factors.
METHODS(S) : Three hundred and seventy eight pregnant women attending the antenatal clinic with gestation of 24 to 28 weeks were recruited for the study. They were given 50g glucose orally, regardless of the time of previous meal, and one hour later blood was collected for glucose estimation. Women with a plasma glucose level > 140 mg/dL were subjected to a 75 g 2-hour oral glucose tolerance test.
RESULTS : The detection rate of mild gestational hyperglycemia (MGH) was 6.8% and that of gestational diabetes mellitus (GDM) was 2.6%. Pregnancy induced hypertention and placental abruption were significantly associated with MGH/ GDM. No statistical association was found with mode of delivery and other intrapartum complications. Babies born to women with MGH or GDM were eight times more likely to have hypoglycemia and three times more likely to have jaundice requiring phototherapy , as compared to babies born to women without MGH or GDM.
CONCLUSION(S) : Antepartum, intrapartum and perinatal morbidity is increased in women with both MGH and GDM. These results need to be validated against a larger cohort.
OBJECTIVE(S) : To study pregnancy outcomes in growth restricted fetuses with normal umbilical artery velocimetry, low-end diastolic umbilical flow, and absent or reversed diastolic flow.
METHOD(S) : One hundred and thirty-four pregnant women with growth-restricted fetuses were evaluated by umbilical artery velocimetry between 28 and 41 weeks of pregnancy. Outcome of pregnancy was recorded for the normal doppler group (n=90; 69.5%), the low-end diastolic flow group (n=30; 20.5%) and the group with absent / reversed diastolic flow (n=14; 10%).
RESULTS : Fetuses with abnormal umbilical flow velocimetry had higher incidence of oligolydramnios and abnormal NST compared to fetuses with normal umbilical flow. The average birth weight, diagnosis to delivery interval, and gestational age at delivery were comparatively lower with higher incidence of admission to neonatal intensive care unit in fetuses with abnormal umbilical doppler velocimetry. There was no perinatal death in the study.
CONCLUSION(S) : Growth restricted fetuses with normal umbilical flow velocimetry are at a lower risk than those with abnormal velocimetry in terms of poor apgar score, and neonatal intensive care admission and its duration. The need for positive pressure ventilation at birth was more in babies with absent diastole / reversed diastolic flow of umbilical artery velocimetry. The average birth weight of the neonates with abnormal umbilical artery doppler was lower of compared to that of neonates with normal umbilical artery velocimetry. The poor neurological sequelae were noticed in neonates with absent diastole / reversed diastolic flow after 6 months follow up.
OBJECTIVE(S) : To find out the utility of emergency internal iliac artery ligation (EIIAL) in a busy gynecological and obstetric setup.
MATERIAL AND METHOD(S) : Between Jan 2002 and Dec 2003, a total of eight EIIAL were performed as life saving procedures along with either ovarian artery ligation or subtotal hysterectomy as and when required.
RESULTS: Except one patient, who died of renal failure, all could be successfully treated.
CONCLUSION(S): EIIAL still remains an important life saving procedure and should be taught to the postgraduates.
OBJECTIVE(S) : To analyze the performance of four different embryo transfer catheters viz. Wallace, Frydman, Labotect and TDT in an IVF-ET Program.
METHOD(S) : The embryo transfer cycles were grouped into four according to the catheter used and the pregnancy rates were compared in each group. Woman’s age, diagnosis, ovulation induction method and number of embryos transfered were similar in all the four groups. The ease or difficulty in transfer was also noted and pregnancy rates compared.
RESULTS : The pregnancy rates were better (P<0.001) with soft catheters (Labotect 39.4%, Wallace 41.4%) as compared to stiff ones (Frydman 24.2%, TDT 31.4%) but when the number of embryos transferred in each group was taken into account and relationship between type of catheter and success rate was analyzed keeping the number of embryos fixed in each group, there was no statistically significant difference in pregnancy rates between the four groups. The ease or difficulty in transfer does not appears to influence the implantation rate.
CONCLUSION(S) : Catheter choice in an IVF-ET program does not influence success rate. Most important variable affecting success rate is the number of embryos transferred.
OBJECTIVE(S) : To compare the quality of smear and the rate of pick up of positive pathology from smears obtained from cytobrush spatula and from cotton swab spatula.
METHOD(S) : Five hundred and fourteen women were randomized into cytobrush with cotton swab group with 257 women in each group. Wooden Ayres spatula was used in both the groups for ectocervical sampling. Cytobrush or cotton swab was used for endocervical sampling. All the slides were reported following the Bethesda system (1991) of reporting.
RESULTS : Both the groups were matched with respect to age, parity, age at menarche, years of married life and years after last delivery. Significantly more number of satisfactory smears were seen in cytobrush group. Inadequate smears in the form of absent endocervical cells occurred in 3.12% patients of the cytobrush group as compared to 8.56% in the cotton swab group, the difference was statistically significant (P = 0.0082). Positive pathology was seen in 11.11% of patients in the cytobrush group as compared to 6.45% in the cotton swab group. Although this difference is not statistically significant, there is almost a 5% increase in pick up rate with the cytobrush.
CONCLUSION(S) : With cytobrush spatula there is an increase in the percentage of satisfactory smears. Inadequate smears in the form of absent endocervical cells occurred less frequently with cytobrush. The pick up rate of positive pathology was more with cytobrush.
OBJECTIVE(S) : To compare the quality of smear and the rate of pick up of positive pathology from smears obtained from cytobrush spatula and from cotton swab spatula.
METHOD(S) : Five hundred and fourteen women were randomized into cytobrush with cotton swab group with 257 women in each group. Wooden Ayres spatula was used in both the groups for ectocervical sampling. Cytobrush or cotton swab was used for endocervical sampling. All the slides were reported following the Bethesda system (1991) of reporting.
RESULTS : Both the groups were matched with respect to age, parity, age at menarche, years of married life and years after last delivery. Significantly more number of satisfactory smears were seen in cytobrush group. Inadequate smears in the form of absent endocervical cells occurred in 3.12% patients of the cytobrush group as compared to 8.56% in the cotton swab group, the difference was statistically significant (P = 0.0082). Positive pathology was seen in 11.11% of patients in the cytobrush group as compared to 6.45% in the cotton swab group. Although this difference is not statistically significant, there is almost a 5% increase in pick up rate with the cytobrush.
CONCLUSION(S) : With cytobrush spatula there is an increase in the percentage of satisfactory smears. Inadequate smears in the form of absent endocervical cells occurred less frequently with cytobrush. The pick up rate of positive pathology was more with cytobrush.
OBJECTIVE(S) : To analyse gynecological and reproductive morbidities associated with unicornuate uterus with non- communicating rudimentary horn.
METHOD(S) : The clinical details of 18 cases of unicornuate uterus with non-communicating rudimentary horn found on laparotomy in a duration of 7 years (April 1997 - March 2004) were reviewed.
RESULTS : Out of 18 patients three teenagers presented with dysmenorrhea and pain in abdomen and had hematometra in the non-communicating rudimentary horn. Seven had ectopic pregnancy, which occurred in non-communicating rudimentary horn of which five presented in a state of shock. Out of these seven ectopic pregnancies, five were seen in 1st trimester and two in 2nd trimester. Preoperative diagnosis of non-communicating rudimentary horn pregnancy was possible in two cases. Eight patients had intrauterine pregnancy and at cesarean delivery, they were diagnosed to be having unicornuate uterus with non-communicating rudimentary horn. Pregnancies associated with this condition had high incidence of abortion, preterm labor, malpresentations and cesarean delivery.
CONCLUSION(S) : Unicornuate uterus with non-communicating rudimentary horn is a rare condition but is associated with many gynecological and reproductive morbidities. It should be diagnosed before pregnancy occurs or at the latest before rupture occurs and should be treated by immediate surgery.To analyse gynecological and reproductive morbidities associated with unicornuate uterus with non- communicating rudimentary horn.
METHOD(S) : The clinical details of 18 cases of unicornuate uterus with non-communicating rudimentary horn found on laparotomy in a duration of 7 years (April 1997 - March 2004) were reviewed.
RESULTS : Out of 18 patients three teenagers presented with dysmenorrhea and pain in abdomen and had hematometra in the non-communicating rudimentary horn. Seven had ectopic pregnancy, which occurred in non-communicating rudimentary horn of which five presented in a state of shock. Out of these seven ectopic pregnancies, five were seen in 1st trimester and two in 2nd trimester. Preoperative diagnosis of non-communicating rudimentary horn pregnancy was possible in two cases. Eight patients had intrauterine pregnancy and at cesarean delivery, they were diagnosed to be having unicornuate uterus with non-communicating rudimentary horn. Pregnancies associated with this condition had high incidence of abortion, preterm labor, malpresentations and cesarean delivery.
CONCLUSION(S) : Unicornuate uterus with non-communicating rudimentary horn is a rare condition but is associated with many gynecological and reproductive morbidities. It should be diagnosed before pregnancy occurs or at the latest before rupture occurs and should be treated by immediate surgery.
OBJECTIVE(S) : To find out the correlation between the mathematical indices of insulin resistance (IR) and body mass index (BMI) in polycystic ovarian syndrome (PCOS).
METHOD(S) : Sixty-six PCOS women were studied. BMI was calculated in each case and the mathematical indices of insulin resistance namely, fasting glucose: fasting insulin ratio (G:I), homeostatic model assessment (HOMA), and quantitative insulin sensitivity check index (QUICKI) were calculated from the values of fasting sugar and fasting insulin level. Patients were classified into three groups depending on BMI – Group A (< 24 kg/m2, n=22), Group B (25-29 kg/m2, n=22), and Group C (> 30 kg/m2 ; n=22). Intra-group and inter-group correlation coefficients were calculated between these parameters.
RESULTS : Strong negative correlations between G:I and HOMA and strong positive correlations between G:I and QUICKI were found in each of the three groups. HOMA and QUICKI showed strong negative correlations in each of the three groups. There were moderate positive correlations between the respective indices among Group A and B. None of the indices showed any significant correlations with BMI, both intra-group and inter-group.
CONCLUSION(S) : Mathematical indices of insulin resistance have mild correlations with BMI in PCOS, in contrast to many other insulin resistant states and should be utilised cautiously in routine clinical practice in the management of PCOS.
OBJECTIVE(S) : To assess the significance of argyrophilic nuclear organizer region (AgNOR) counts in diagnosis and prognosis of squamous cell carcinoma of the cervix treated by radiotherapy.
METHOD(S) : The study was conducted on 50 histologically proven, previously untreated cases of various grades of squamous cell carcinoma of the cervix and 25 age matched healthy controls. AgNOR staining was performed on cervical and vaginal smears. The patients were subjected to Cobalt-60 radiotherapy and smears obtained 4 and 8 weeks after therapy were assessed for AgNOR score.
RESULTS : In squamous cells of the control group, the AgNORs were fine, tightly packed and centrally placed in the nucleoli . AgNORs in carcinoma of the cervix prior to radiotherapy were large and variable in size and shape. The cases studied for AgNOR count 4 weeks after radiotherapy showed multiple AgNOR dots which were fewer in number and less coarse as compared to the pre-radiation group. After 8 weeks of radiation therapy, the AgNOR count further declined in number, and the dots were usually single and fine. In patients who showed persistence of malignancy, the AgNOR dots were found to be coarse and present in large clumps.
CONCLUSION(S) : AgNOR is an effective tool reflecting the proliferation rate of the tumor and has a significant diagnostic and prognostic value in tumor pathology.
OBJECTIVE(S) : To evaluate the rubella immune status amongst adolescent girls (15-18 years), and correlate it with socio- economic status.
METHOD(S) : This community based, cross sectional study comprised of 230 adolescent unmarried girls (115 girls of high socioeconomic status and 115 girls of low socioeconomic status). ELISA method was used to estimate the immunity status of rubella IgG in their serum samples.
RESULTS : Overall seronegativity was 17.83%, indicating vulnerability to acquire rubella. It was 9.56% in the lower socioeconomic status group and 26.09% in the higher socioeconomic stauts group, and the difference was statistically significant (P<0.001). None of the girls gave history of MMR or rubella vaccination.
CONCLUSION(S) : High seronegativity and susceptibility to rubella, especially in high socio-economic group of adolescent girls was prevailant in the study. A policy of immunization with MMR or rubella vaccine of susceptible, non-immune adolescent girls is highly desirable in order to prevent rubella and congenital rubella syndrome.
OBJECTIVE(S) : To classify ovarian dermoids on the basis of their sonograpohic appearance.
MATERIAL AND METHOD(S) : Twenty-five ovarian dermoids in 22 patients ranging in age from 18 to 58 years were evaluated with a 3 MHz mechanical and 3.5 MHz convex electronic tansducer.
RESULTS : A varied spectrum of sonographic appearances was found which depended on the internal composition of the cyst. According to the composition and sonographic morphology, the scans were classified into four broad groups – Group I – Cystic, Group II – Complex, predominantly cystic mass, Group III – Lesions with hair/fluid level, and Group IV – Solid or predominantly solid appearance.
CONCLUSION(S) : Ovarian dermoids show variegated appearances on sonography.
OBJECTIVE(S) : To establish the benefits of office hysteroscopy in women suffering from various gynecological disorders and to prove that a conventional hysteroscope rather than an office hysteroscope can be used for this purpose.
METHOD(S) : Between January 2003 and October 2003, 207 patients attending the gynecological outpatient department at a government hospital for various problems were selected for the procedure of office hysteroscopy. The procedure was carried out using a conventional 30 degree 4 mm fore oblique hysteroscope.
RESULTS : The indications for the procedure were abnormal uterine bleeding in 33.33%, infertility in 52.1%, postmenopausal bleeding in 4.34%, tamoxifen therapy for breast cancer in 8.21% and post-abortal amenorrhoea in 0.96%, and abnormal findings were seen in 43.47%, 50.92%, 44.44%, 35.29% and 100% respectively. The procedure was well tolerated by most patients and there was no significant complication.
CONCLUSION(S) : Ninety-eight out of 207 patients (47.34%) had positive findings making this investigation a necessary tool in the armamentarium of a modern gynecologist.
OBJECTIVE(S) : To evaluate a medical method of managing missed abortions.
METHOD(S) : Eighty-four women of missed abortion confirmed by ultrasonography were counselled and informed about the medical method. A tablet of 200 mg misoprostol was inserted deep in the vagina every 4 hours for a maximium of 4 doses. Women were observed for side effects, and symptoms and signs of abortion.
RESULTS : Success rate was 95.23%. Complete abortion rate was 88.09%. Incidence of side effects was very low. The method has many advantages over surgical methods.
CONCLUSION(S) : Misoprostol is an effective medical method of evacuating the uterus with missed abortion.
