Abstract

Surgical ovarian wedge resection was the first established treatment for women with anovulatory polycystic ovary syndrome (PCOS) but was largely abandoned both due to the risk of postsurgical adhesions and the introduction of medical ovulation induction. Laparoscopic ovarian drilling (LOD) is an alternative method to induce ovulation in PCOS patients with clomiphene citrate resistance instead of gonadotropins. Surgical therapy with LOD may avoid or reduce the need for gonadotropins or may facilitate their use. However, the procedure, though effective, can be traumatic on the ovaries, which may cause postoperative adhesions and/or diminished ovarian reserve. In over-enthusiastic hands, this day-care procedure might lead to iatrogenic premature ovarian failure in young women. Some trials have compared LOD with gonadotropins, but, because of variations in study design and small sample size, the results are inconsistent and definitive conclusions about the relative efficacy of LOD and gonadotropins cannot be extracted from the individual studies. Today, evidence-based reviews conclude that there is no evidence of a significant difference in rates of clinical pregnancy, live birth or miscarriage in women with clomiphene- resistant PCOS undergoing LOD compared to other medical treatments. The reduction in multiple pregnancy rates in women undergoing LOD is the only pro- LOD argument. However, there are ongoing serious concerns about the long-term effects of LOD on ovarian function.

Abstract

Objective: To explore the importance of administering influenza vaccine during pregnancy.

Materials and Methods: An internet search for data, study and position papers was done. Medline and Pubmed were the frequently used search engines besides search for WHO and CDC position statements. The keywords used included, influenza vaccine, pregnancy, outcome, safety and trimesters.

Results: Search provided studies that had been conducted in developing nations like Bangladesh as well as developed nations like Norway and England. The WHO and CDC status reports were also accessed and studied.

Conclusion: Administration of influenza vaccine is recommended in any trimester of pregnancy, to protect the pregnant woman as well as the newborn child below the age of 6 months from the deleterious effects of influenza. The vaccine is safe and free from side effects.

Abstract

The term polycystic ovarian syndrome (PCOS) came into existence 80 years ago. Pathophysiology of PCOS remains ill understood despite extensive research in this field. It is now accepted that the manifestations of PCOS are not confined to the reproductive dysfunction, and there are endocrine–metabolic implications to PCOS with several consequences to female health. PCOS is a misnomer as ovaries do not contain epithelial cysts, but they are actually antral follicles. Moreover, the name PCOS neither reflects the hyperandrogenism which is essential for diagnosis nor the metabolic derangements. While various authors have expressed the need for change of the name, a suitable new option has not yet been established. This review aims to analyse the current understanding of pathophysiology of PCOS and addresses to the controversies associated with its diagnosis and nomenclature. The name ‘‘Hyperandrogenic Persistent Ovulatory Dysfunction Syndrome or HA-PODS’’ is proposed here to overcome diagnostic pitfalls of previous nomenclature. This new name will help formulate appropriate treatment and promote consistency in research as well. Further categorizations of HA-PODS are also discussed in the article.

Abstract

Aim: To compare obstetric and perinatal outcomes of early and late teenage pregnancies of Omani nulliparous women with singleton pregnancies cared for and delivered at a tertiary teaching hospital.

Method: In this retrospective study, we reviewed obstetric and perinatal outcomes of early teenage pregnancies (14–16 years), (n = 20) delivered at Sultan Qaboos University Hospital, Muscat, Oman, between 1 July 2006 and 30 June 2013 and compared their outcomes with outcomes of late teenage pregnancies (17–19 years), (n = 287) delivered at the same hospital during same period.

Results: When compared with late teenage pregnant women, early teenagers were found to have no significant differences in prevalence of very preterm delivery< 32 weeks (P = 0.62), preterm rupture of membranes (P =>0.99), and anemia (P = 0.34). When compared to late teenagers, early teenagers had similar cesarean sections rates (P =[0.99), instrumental delivery rates (P = 0.56) and spontaneous vaginal delivery rates (P>0.99). Both groups had similar birth weights (P = 0.87), low birth weights, (P = 0.55), and very low birth weights babies (P = 0.56 %). Perinatal mortality rate was similar in both groups.

Conclusion: We may conclude that early teenage pregnant Omani women are not at increased risk of obstetric and perinatal complication compared to older teenagers.

Abstract

Purpose of the Study: The aim of the study was to determine the prevalence and risk factor for vitamin D deficiency in our pregnant population.

Method: A total of 418 healthy primigravida with single live pregnancy and sure of dates attending the antenatal clinic between October 2011 and April 2013 were recruited. Women were excluded if they had history of current or past chronic medical disease. Women were also excluded if they had history of medication with drugs interfering with calcium and vitamin D metabolism.

Results: The prevalence of vitamin D deficiency during pregnancy has been found to be 391 (93.5 %). Severe vitamin D deficiency among pregnant patients was 34.44 % (144/418). The levels of serum 25(OH)D and serum calcium were significantly lower in severe deficient group than the adequate group [7.10 ± 1.49 vs. 38.90 ± 4.22 ng/ml (p = 0.001) and 7.13 ± 1.41 vs. 9.39 ± 0.88 ng/ml (p = 0.001)], respectively. Maternal education, husband education, socioeconomic status, serum calcium, serum phosphorous, and season were significant factors associated with vitamin D deficiency. Significant independent variables for severe vitamin D deficiency were low serum calcium, serum alkaline phosphatase, and serum phosphorus (OR 39.41, 95 % CI 10.30–150.85, p < 0.01), (OR 18.03, 95 % CI 3.95–82.44, p < 0.01), and (OR 8.40, 95 % CI 2.47–28.61, p < 0.01).

Conclusion: Vitamin D deficiency is highly prevalent among pregnant women in Northern India, and these raises concern about the health consequences for the mother and the offspring.

Abstract

Background: Antenatal diagnosis of the invasiveness of a placenta percreta helps in planning the surgical approach, reducing blood loss and morbidity. Doppler sonography is the mainstay diagnostic modality with a sensitivity of 80–95 %. With the advent of high magnetic field MRI techniques, there has been recent interest in evaluation of placenta by MRI. On an extensive PUBMED search, we could not find any citations describing imaging, ultrasound, or MRI features to evaluate vesical wall invasion by placenta percreta.

Purpose: We attempt to evaluate transmyometrial vesical wall invasion by placenta percreta using chemical shift artifact as a marker of intact bladder-myometrial interface on steady-state MRI sequences.

Materials and Methods: This is a prospective observational study, conducted at a university hospital. We have compiled clinico-radiological criteria for diagnosis of invasive placentae based on the existing body of evidences, in four patients. We further go on to analyze a specific proposed sign on a newly introduced MR imaging sequence i.e., loss of chemical shift artifact (India ink line) on steady-state GRE sequence (TrueFISP), to diagnose transmyometrial vesical invasion in placenta percreta.

Results: Though the sample size is small, the sensitivity, specificity, positive, and negative predictive value of the proposed sign for the purpose was 100 %.

Conclusions(s): Loss of chemical shift artifact (India ink line) on steady-state GRE sequences at the vesico- myometrial junction in case of invasive placentae confirms vesical wall invasion, a prospective diagnoses of which can help in planning the surgical protocol and preventing potentially fatal blood loss.

Abstract

Objectives: To assess the preoperative serum levels of CA 125 with its diagnostic role and to evaluate the p53 expression in patients of primary ovarian neoplasms. We also wished to judge their relationship with other parameters like clinical staging and histopathologic tumor type.

Materials and Methods: The present study was conducted on 86 patients during the study period of 2.5 years. Preoperative CA 125 levels were evaluated by an automated immunoassay analyzer. p53 expression was judged immunohistochemically with pre-diluted monoclonal antibody. An objective scoring was done depending on distinct nuclear immunopositivity.

Results: Median value of preoperative CA 125 levels was 32 U/mL in benign surface epithelial-stromal tumors (BSEST), 53 U/mL in borderline surface epithelial-stromal tumors (BOT), 346 U/mL in malignant surface epithelial-stromal tumors (MSEST) and 560 U/mL in serous adenocarcinomas (SAC). Most of ovarian tumors were in the FIGO stage I (64 cases, 74.4%), but higher stages (II, III, IV) were observed mostly in MSESTs. SACs displayed the maximum p53 expression. Considering the cut-off value of more than 35 U/mL in CA 125 levels, the sensitivity to diagnose MSESTs was 94.7%. Preoperative CA 125 levels strongly and positively correlated with FIGO staging and p53 expression. Similarly p53 expression strongly and positively correlated with FIGO staging and histopathological categories.

Conclusion: Higher values of preoperative CA 125 levels and higher expression p53 are associated with MSESTs and BOTs especially of serous type. They strongly correlate with each other and with tumor stage. But there is no serum CA 125 concentration that can clearly differentiate benign and malignant ovarian masses.

Abstract

Objective: To study the prevalence of thyroid disorders and its correlation with menstrual disorders.

Methods: 100 women aged between 15 and 45 years who attended gyne OPD in Kasturba Hospital, Delhi, were included for this cross-sectional study. The study group comprised 50 patients presented with menstrual complaints. The control group consisted of 50 women of same age group with complaints other than menstrual disorders. Thyroid function tests, anti-TPO antibody estimation, and endometrial sampling were done in all patients.

Results: In patients with menstrual disorders, 44 % had thyroid disorders in which subclinical hypothyroidism was prevalent in 20 %, overt hypothyroidism in 14 %, and overt hyperthyroidism in 8 %of the women. Autoimmune thyroid antibodies were present in 30 % patients of women with menstrual disorders. On endometrial sampling, hypothyroid patients mainly had proliferative endometrium (42.85 %) whereas hyperthyroid had atrophic endometrium (60 %).

Conclusions: Thyroid dysfunction is an important causative etiology of menstrual abnormalities. Assessment of thyroid function should be done in all patientswithmenstrual disorders to avoid unnecessary interventions like curettage and hysterectomy.