OBJECTIVE(S) : To quantify the socioeconomic gap in relation to availing of maternal health care services during pregnancy and delivery.
METHOD(S) : The data from National Family Health Survey (NFHS) – 2 published in 2000 was used. The components of reproductive health services and socioeconomic inequalities were studied. Statistical analyses were done to test the significance of results, and ? 2 test, Odds Ratio and Confidence Interval worked out.
RESULTS : Significant differences existed in availing of delivery care services among various segments of the population. Women residing in rural areas were less likely than urban women to use the health care services (P<0.001). Both economic and educational status of women were positively associated with use of medical facilities (P<0.001). Christian and Sikh women utilized the reproductive health services far better than Hindu and Muslim women (P<0.001).
CONCLUSION(S) : There is a positive association between socioeconomic status of women and the use of maternal health
care services. Those women who were better educated, economically well off and resided in urban areas availed the
delivery care services to the maximum. Poor women cannot afford the cost of health care services.
OBJECTIVE(S): To evaluate different management practices in meconium stained amniotic fluid and their effect on perinatal outcome.
METHOD(S): This was a cross sectional study of 249 women in labor with meconium stained amniotic fluid admitted from August 1999 to July 2000. The effect of amnioinfusion on the perinatal outcome was studied and the results were analyzed by chi square test and Z test.
RESULTS: Total number of live births in the institute during this period was 3002 and the incidence of meconium stained amniotic fluid was 8.3% (249/3002). 12.9% of the babies developed meconium aspiration syndrome. Thick meconium stained liquor had higher incidence of meconium aspiration syndrome (19% vs 2%) than that in thin meconium stained group. In the amnioinfusion group the perinatal mortality was 1.2%, compared to 9.5% in the group which did not receive amnioinfusion and this was statistically significant (R R 0.13, 95% CI-0.03 – 0.59). Neonatal morbidity was 25% and mortality 31.25% in cases of meconium aspiration syndrome.
CONCLUSION(S) : Amnioinfusion plays an important role in reducing meconium aspiration syndrome and perinatal mortality.
OBJECTIVE(S): To study whether positive test for C-reactive protein in early months of pregnancy can be used as a screening test for gestational diabetes mellitus developing in later months of pregnancy.
METHOD(S): C-reactive protein was tested by latex-agglutination semi-quantitative method in early months of pregnancy in 91 women. Gestational diabetes mellitus was diagnosed by 3 hour glucose tolerance test, if recommended after performing the glucose challenge test between 24-28 weeks of pregnancy. Statistical analysis was done with Z statistic.
RESULTS: Among the 91 women 27 were C-reactive protein test positive, out of whom four developed gestational diabetes (14.8%). Among the 64 women that were C-reactive protein negative, seven developed gestational diabetes (10.9%). This was not statistically significant.
CONCLUSION(S): C-reactive protein in early months as an inflammatory marker is not a dependable screening test for
gestational diabetes developing in later months of pregnancy.
OBJECTIVE(S) : To compare the efficacy of doppler vascular technic over nonstress test (NST) in predicting fetal compromise in utero in cases of severe preeclampsia and intrauterine growth restriction (IUGR).
METHOD(S) : In this prospective study antenatal fetal surveillance was done in 55 women with severe preeclampsia or IUGR using fetal doppler and NST. The results of these tests within one week of delivery were correlated with perinatal outcome. The data were analyzed using chi square test.
RESULTS : There were 29 cases with abnormal doppler and 20 with abnormal NST. Doppler abnormalities preceded NST changes. The average time interval between abnormal doppler and abnormal NST called as the lead time was 4.14 days. There were 10 perinatal deaths, six of which occurred in the group where both tests were abnormal.
CONCLUSION(S) : Doppler identifies fetal compromise earlier than NST. The lead time helps to plan delivery in preterm
compromised pregnancies, resulting in better perinatal survival
OBJECTIVE(S): To determine the rate of culture positivity of vaginal candida species and its relation to clinical criteria used for diagnosis of vulvovaginal candidiasis (VVC).
METHOD(S): A prospective study of laboratory diagnosis of VVC by estimation of vaginal pH, direct microscopic examination of vaginal discharge/secretions, and vaginal culture for candida species, was carried out in 400 women with vulvovaginal symptoms.
RESULTS: Culture for candida species was positive in 92 (23%). Of the 92 women, 76(82.6%) showed pH in normal range and 78 (84.8%) were positive for yeast cells and mycelia on direct microscopic examination. C. albicans accounted for 69.57% and other candida species for 30.43% of the isolated candida species. Culture positivity was significantly related to pregnancy, increase in parity, use of oral contraceptives, and use of antibiotics. Pruritus with or without vaginal discharge and vaginal erythema were the most common symptoms and signs in women with positive candida culture.
CONCLUSION(S): Culture positivity rate of 23% in the present study suggests that VVC cannot be accurately diagnosed
by clinical criteria alone. It requires correlation of vulvovaginal symptoms with candida culture.
OBJECTIVE(S) : To study the reasons for postpartum admissions to our tertiary care rural hospital.
METHOD(S) : Records of 200 women hospitalized for various postpartum disorders were analyzed.
RESULTS: The common disorders for which postpartum women sought tertiary health care were puerperal sepsis (51%), secondary postpartum hemorrhage (28%), and postpartum eclampsia (8.5%). Most common causes of sepsis were infected episiotomies at health care facilities where deliveries took place or infected vaginal / perineal tears in home deliveries. Secondary postpartum hemorrhage in some cases was from perineal and/or vaginal tears and in others from retained placental pieces. Some women were admitted for postpartum eclampsia after having delivered at hospitals with prenatal care, others at home with no prenatal care. Blood pressure of women who had delivered at primary health center had never been recorded.
CONCLUSION(S): Most of the problems were due to lacunas in the health care provided in postpartum period. Some
women are deprived of care while others suffer due to poor care or interventions. Appropriate care at primary, secondary,
and tertiary level is imperative.
OBJECTIVE(S): To determine the prevalence of hepatitis E virus (HEV) infection in pregnancy and to study the clinical outcome of this infection.
METHOD(S): During this one year prospective study there were 40 women with viral hepatitis during pregnancy of whom 25 were HEV positive. Prevalence of HEV infection, and maternal and fetal outcomes were studied.
RESULTS: Majority of the women were primigravidas in the age group of 20-25 years. Prevalence of HEV infection was found to be 62.5% (25/40) and maternal mortality 12% (3/25). Preterm delivery was the most common outcome leading to prematurity as the most common fetal problem with the birth weight ranging from 1.6 to 2 kg.
CONCLUSION(S): Hepatitis E was the commonest etiological agent in those who had viral hepatitis during pregnancy, with
preterm delivery as the commonest complication. Maternal mortality was 12%.
OBJECTIVE(S) : To compare the efficacy and safety of vaginal dinoprostone with misoprostol for induction of labor in women with unfavourable cervix.
METHOD(S) : A progressive randomized comparative study was carried out. Two hundred pregnant women with unfavourable cervix were alternately assigned to two groups of 100 each for dinoprostone (Group A) and misoprostol (Group B) administration. Success of induction, mean induction delivery internal, uterine contractions, and apgar score were analyzed. Statistical evaluation was done by student t test and chi square test.
RESULTS : The mean induction delivery interval was 12.34 hours in Group A and 9.8 hours in Group B, spontaneous vaginal deliveries were 86% in Group B in contrast to 68% in Group A (P<0.01). Uterine contraction abnormalities were more in Group B than in Group A (12% vs 4%; P>0.10). Failure of induction was 8% and 2% in Group A and B respectively (P>0.10). Apgar scores at 1 and 5 minutes in Group A and B were 7.2 and 7.74 vs 7.15 and 7.59 respectively.
CONCLUSION(S) : Misoprostol is more efficacious for cervical ripening and labor induction than dinoprostone as seen by
shorter induction delivery interval, greater number of vaginal deliveries, and good perinatal outcome.
OBJECTIVE(S): To compare the efficacy of vaginal hysterectomy with that of abdominal hysterectomy in nonprolapsed uteri.
METHOD(S) : A prospective comparative study was carried out on 100 women with nonprolapsed uteri. Group A consisted of 50 women operated by the vaginal route and Group B of 50 women operated by the abdominal route. A preoperative sonographic estimation of uterine volume was done in both the groups.
RESULTS : The most common indication was fibroid uterus in both the groups. There was a statistically highly significant difference in the mean time taken (P < 0.001), mean blood loss (P < 0.001) and mean hospital stay (P< 0.01) favoring vaginal hysterectomy. There was an apparent linear relationship between uterine volume and operating time.
CONCLUSION(S): Vaginal hysterectomy whenever feasible should be prefered over abdominal hysterectomy even when
the uterine size is > 12 weeks, cervix is flushed with vagina, subpubic angle is narrow and there is history of previous
pelvic surgery.
OBJECTIVE(S): To study the effect of premenstrual stress on cardiovascular and central nervous system.
METHOD(S): Effect of premenstrual stress on cardiovascular system i.e. pulse rate, blood pressure and weight, and on central nervous system i.e. visual and auditory reaction time, was studied on 60 healthy female students between the age of 17 and 20 years during premenstrual and postmenstrual phase.
RESULTS: There was significant increase in pulse rate, blood pressure, weight, auditory reaction time (ART), and visual reaction time (VRT) during premenstrual period as compared to postmenstrual period.
CONCLUSION(S): These changes could be attributed to fluid and salt retention due to ovarian steroids and to exaggerated
response to hormonal changes leading to decrease in the processing capability of central nervous system
OBJECTIVE(S) : To evaluate the effectiveness of 2 months oral contraceptive pill (OCP) pretreatment for clomiphene citrate (CC) resistant cases followed by repeat clomiphene citrate treatment.
METHOD(S) : In a prospective nonrandomized study at a private tertiary infertility center, 46 anovulatory women under the age of 36 years with CC resistance, were evaluated. Two months hypothalamic-pituitary-ovarian (HPO) axis suppression with OCP was followed by CC 100 mg from day 3 for 5 days.
RESULTS : Thirty-one (67.39%) patients showed dominant follicle ( > 20 mm) with 100 mg CC given for 5 days from day 3 of the cycle following two cycles of OCP.
CONCLUSION(S) : Suppression of the HPO axis for 2 months with OCP followed by 100 mg CC for 5 days results in good
rates of folliculogenesis in women who had previously failed to develop a dominant follicle with similar dose of CC.
OBJECTIVE(S) : To study the role of color doppler in differentiation of benign from malignant adnexal mass and to evaluate usefulness of this new scoring system evolved by Alcazar for the same.
METHOD(S) : A prospective cohort study, was done from August 2003 to July 2004 on 38 patients admitted with adnexal mass. All of them were subjected to preoperative ultrasonography and color doppler study. The data were used for calculation of score for probability of malignancy using new scoring system developed by Alcazar. The efficacy of scoring system was evaluated by histopathological examination of the mass or by fine needle aspiration cytology of the mass or by ascitic fluid cytology as a gold standard.
RESULTS : Alcazar’s scoring system was able to identify 17 out of 18 malignant adnexal masses and 19 out 20 benign adnexal masses as diagnosed by histopathology. The sensitivity and specificity of Alcazar’s scoring system was 94.44% and 95% respectively.
CONCLUSION(S) :The new scoring system of Alcazar using both ultrasonographic and colour doppler studies is useful in
differentiating a benign from a malignant adnexal mass and gives better results than DePriest’s and Sassone’s scoring
systems.
