OBJECTIVE(S) : To assess the diagnostic efficacy of First Trimester Anomaly Scan (FTAS) and First Trimester Fetal Echocardiography (FTFE) as screening procedures in a medium risk population
METHOD(S) : In this retrospective study, we evaluated the diagnostic efficacy of FTAS in 6423 singleton pregnancies with a crown rump length (CRL) of 38-84 mm and First Trimester Fetal Echocardiography (FTFE) in 7702 fetuses of 45-84 mm CRL.
RESULTS : The prevalence of major abnormalities was 3.7% (235/6423) with a nuchal fold of more than 2.5 mm in 47.7% (112/235) of the fetuses. The rate of detection or suspicion of major anomalies during FTAS was 67% (245/366). The prevalence of major congenital heart disease (CHD) in 7702 fetuses including multiple pregnancies was 1.4% (105/7702) with a nuchal fold of more than 2.5 mm in 29.5% of the fetuses (31/105). The rate of detection or suspicion of major CHD during FTFE was 80% (84/105).
CONCLUSION(S) : The potential of FTAS and FTFE is far beyond providing data to determine probabilities for trisomy 13, 18 and 21.
OBJECTIVE(S) : To assess intraoperative and postoperative morbidity following single layer closure of low transverse uterine incision at cesarean section as compared to double layer closure.
METHOD(S) : In this prospective randomized controlled study, 208 women scheduled for lower segment cesarean section through Pfannenstiel or subumbilical midline incision were randomized to either single layer (n = 102) or double layer (n=106) closure of uterine incision. Primary outcome measures studied were operating time, intraoperative blood loss, febrile morbidity, and endomyometritis. Secondary outcome measures studied were number of additional hemostatic sutures needed, postoperative pain, perioperative hemoglobin fall, cystitis, wound infection, and hospitalization period. Student t test was used for comparing continuous variables. Categorical variables were compared by Chi square test or Fisher exact test.
RESULTS : The maternal demographic factors, indications for cesarean sections and high risk factors were similar between the two groups. There was significant reduction in operating time (P=0.02), intraoperative blood loss (P=0.04), febrile morbidity (P=0.025, OR 0.43, 95% CI 0.19-0.97), perioperative hemoglobin fall (P=0.04), endomyometritis (P=0.03, OR 0.38, 95% CI 0.16-0.93, and period of hospitalization (P=0.00005) in the subjects as compared to controls. There was no significant difference between the two groups regarding number of additional hemostatic sutures needed, postoperative pain, and cystitis or wound infection.
CONCLUSION(S) : Single layer closure of low transverse uterine incision at cesarean section is associated with lesser operating time, intraoperative blood loss, febrile morbidity, endomyometritis, and hospitalization period, as compared to double layer closure.
OBJECTIVE(S): To validate the Tamil version of the Edinburgh Postpartum Depression Scale (EPDS) as a screening instrument to identify depression in the postpartum period.
METHOD(S): Consecutive patients in the postpartum period, attending a primary health care center and its outreach clinics in Vellore, rural Tamil Nadu, were screened for depression using the Tamil version of the EPDS. The subjects were also interviewed using the Revised Clinical Interview Schedule (CIS-R). The International Classification of Diseases-10 (ICD-10) criteria for postnatal depression were used. Various thresholds of the EPDS were compared against the standards of the ICD-10. A receiver operator characteristic curve was drawn to obtain the best threshold value for screening.
RESULT(S): Seventeen (13.2%) of the subjects interviewed satisfied ICD-10 criteria for postnatal depression. The optimal threshold for the EPDS was 8/9. This threshold had a sensitivity of 94.1% and a specificity of 90.2%. The area under the curve was 0.921.
CONCLUSION(S): The sensitivity and specificity of the Tamil version of the EPDS is high. The instrument can be employed for screening for depression in the postnatal period.
OBJECTIVE(S) : To study the nature and outcome of pregnancy in obstetric cholestasis.
METHOD(S) : This prospective study included 32 women booked for delivery and diagnosed as having obstetric cholestasis. Medical treatment for symptomatic relief was offered to all; protocol for antenatal check-ups and induction of labor was as per obstetric indications.
RESULTS : Incidence was 1.2% (32/2668). Symptoms appeared after 30 weeks in 84.3% (27/32). 66.6% (6/9) of the multiparous women had a previously affected pregnancy. The cesarean section rate was 31.2% (10/32). Elective cesarean section was done in one woman for gestational diabetes. Intra-partum abnormal cardiotocography (CTG) was noted in 9 / 31 (29.03%) and thick meconium in 10 / 31 (32.2%). Women delivering after 38 weeks had a higher incidence of thick meconium (45% vs 11.1%), abnormal CTG (35% vs 11.1%), neonatal nursery admission (45% vs 11.1%), and perinatal mortality (105 per 1000 vs none) than women delivering between 35 and 38 weeks. The difference regarding thick meconium and neonatal nursing admission was statistically significant though that regarding abnormal CTG was not. Post partum hemorrhage was noted in 8 / 32 (25%).
CONCLUSION(S) : Obstetric cholestasis is associated with increased perinatal morbidity and mortality if delivered after 38 weeks. An attempt to deliver prior to 38 weeks may improve perinatal outcome.
OBJECTIVE(S) : To find out the correlation between clinical examination, ultrasonography (USG), and laparoscopy, the three modalities commonly used in the evaluation of chronic pelvic pain (CPP).
METHOD(S) : One hundred women with pelvic pain of more than 6 months duration attending gynecological outpatient department were included. They were examined clinically and then subjected to transabdominal sonography and laparoscopy. Kappa statistics was used to estimate the extent of agreement between the three modalities.
RESULTS : Among the 74 patients with abnormal findings on laparoscopic examination, 53 had abnormal clinical findings and 61 had positive USG findings. Though USG had a higher sensitivity for ovarian cyst, laparoscopy was more predictive for other positive findings. Excluding functional cyst and myomas, no attributable causes could be found in 26 of the 100 cases.
CONCLUSION(S) : Diagnostic laparoscopy is a more sensitive method for evaluation of chronic pelvic pain. Combined clinical and USG findings had a negative predictive value of 66.7%.
OBJECTIVE(S) : To study the correlations between fasting glucose : insulin (G:I) ratio, serum triglyceride (TGL) level, and triglyceride: high density lipoprotein cholesterol (HDL) ratio in adolescent girls with polycystic ovarian syndrome (PCOS)
METHOD(S) : Fifteen adolescent girls diagnosed as having PCOS were studied. Body mass index (BMI) was calculated in each case and fasting glucose insulin, triglyceride (TGL) and HDL levels were measured. From these values, G:I ratio and TGL:HDL ratio were calculated in each case.
RESULTS : No correlation was found between the G:I ratio and TGL level or between G:I ratio and TGL:HDL ratio in normal BMI adolescent girls and overweight girls with PCOS. Moderate negative correlation was found between G:I ratio and TGL:HDL ratio in girls at risk of overweight.
CONCLUSION(S) : Absence of significant correlations between the different markers of insulin resistance in adolescent PCOS girls stresses the fact that these girls in contrast to adults need to be monitored with other markers of insulin resistance.
OBJECTIVE(S) : To evaluate the impact of national health policies on septic abortion trends in a tertiary hospital.
METHOD(S) : A prospective study was carried out in pre-RCH (phase I), post-RCH (phase II) and post revised Medical Termination of Pregnancy (MTP) act (phase III), to evaluate the epidemiological data of the patients of septic abortion admitted in the department of Obstetrics and Gynecology. An attempt was made to analyze the changing trends, study the impact of various government policies, and to suggest means to reduce morbidity and mortality from septic abortions.
RESULTS : There was a significant increase in the incidence of septic abortion in phase III over phase I (Z I/III = 6.214; P < 0.0001, highly significant). We also observed a linear trend of increasing incidence of septic abortion (x2 for linear trend = 44.637; P < 0.0001). There was no significant difference in the mean age and parity of the cases in the three phases, (P > 0.05). While considering the nulliparous group only, there was a significant increase in the incidence in phase III as compared to phase I (Z I/III=2.133; P < 0.05). Taking unmarried and widows together, most of the married women reported in the 1st trimester and this trend was found to be statistically significant (x2 for linear trend = 3.997; p=0.04558). There was an increasing severity of peritonitis with criminal abortion and lower degree of sepsis with spontaneous abortion, and this was found to be statistically significant (x2 = 12.164; P=0.0162 at 4 d.f.).Even though the increase in the cases of septic abortion over the three phases is statistically significant, increase in maternal mortality is insignificant (Z I/III = 0.586; P > 0.05), showing better health care services being provided by the concerned health agencies.
CONCLUSION(S) : The changing trend over the three phases shows an increase in the incidence of septic abortion in women beyond 30 years of age, in nulliparas and in primiparas. Therefore, there is an urgent need to address the unmet needs of contraception amongst these women. There is a need to popularize the Government Health Care setups as providers of free, quick and quality abortion services.
OBJECTIVE(S): To evaluate and compare the effects of raloxifene and HRT on serum lipids, plasma fibrinogen, and drug tolerability in healthy postmenopausal women.
METHOD(S) : Effects of raloxifene (60mg/day) and HRT (conjugated equine estrogen 0.625mg and medroxy progesterone acetate 2.5mg daily) on serum lipids, plasma fibrinogen levels and drug tolerability were studied in 81 healthy postmenopausal women in prospective, randomized parallel designed study. Results obtained were analyzed by applying paired t test and unpaired t test. P value less than 0.01 was taken as significant..
RESULTS : At the end of 6 months, raloxifene and HRT lowered total cholesterol by 6% and 4.74% respectively. Levels of low density lipoproteins were reduced more with HRT (14.18%) than with raloxifene (8.18%). Triglyceride, very low density lipoprotein and high density lipoprotein levels were raised by HRT (11.05%, 11.02% and 24.37% respectively) but were not significantly altered by raloxifene. Raloxifene significantly lowered fibrinogen levels by 7% while HRT had no effect. The only significant adverse effect observed with raloxifene therapy was hot flashes (26%).
CONCLUSION(S) : Raloxifene favourably affected the biochemical markers of the cardiovascular risk and has a good tolerability profile.
OBECTIVE(S) : To find the incidences of osteopenia and osteoporosis and their relation with age, diet and mensturation in women above the age of 40 years.
METHOD(S) : Successive 200 women attending our well women clinic from January 2002 to December 2003 had their BMD estimated by DEXA. The results were analyzed.
RESULTS : After the age of 60 years there was an almost 100% incidence of either osteopenia or osteoporosis. In the age group between 40 and 65 years, the incidence of osteopenia was 34% and osteoporosis 8%.
CONCLUSION(S) : A substantial female population has osteopenia and osteoporosis after the age of 40 years.
