OBJECTIVE(S): To evaluate the diagnostic efficacy of hysteroscopy, transvaginal ultrasonography (TVS) and histopathological examination in cases of abnormal uterine bleeding.
METHOD(S) : A total of 70 patients were included in this study done during the period of one year out of whom 50 with complaints of abnormal uterine bleeding were included in the study group and 20 with no menstrual irregularity and normal pelvic examination formed the controls.All women underwent TVS and hysteroscopy, and dilatation and curettage was done only in cases with abnormal findings. Endometrium was sent for histopathology. Findings were compared and chi square test used for statistical analysis.
RESULTS : Most common symptoms in patients with abnormal uterine bleeding were menorrhagia (40%), metrorrhagia (18%), menometrorrhagia (14%), and polymenorrhea (14%). Compared to hysteroscopy TVS has sensitivity of 78.15% and specificity of 44.4% while D and C has a sensitivity of 89% and specificity of 45%.
CONCLUSION(S) : Hysteroscopy and guided biopsy is more sensitive than TVS or D and C in diagnosing causes of
abnormal uterine bleeding.
OBJECTIVE(S) : To study AgNOR counts in cervical intracepithelial neoplasia CIN I, CIN II and CIN III lesions.
METHOD(S) : AgNOR counts were done in histology specimens in 43 histologically proven cases of CIN.
RESULTS : AgNOR count in CIN I was 1.64, in CIN II 2.68 and in CIN III 4.3. The differences in AgNOR counts between CIN I and CIN II, between CIN II and III, and between CIN I and CIN III were statistically significant.
CONCLUSION(S) : AgNOR count is a simple and inexpensive technic which can be used as an adjunct to histology
for diagnosing CIN especially in doubtful cases.
OBJECTIVE(S) : To study the effectiveness of sacrospinous fixation for vault suspension.
METHOD(S) : Thirty-five women with genital prolapse were subjected to sacrospinous colpopexy during vaginal hysterectomy and repair.
RESULTS : The intraoperative complication encountered was rectal injury in one case (2.8%). The postoperative complications were fever in five cases (14.2%), urinary tract infection in four (11.4%), and urinary retention in one (2.8%). Complications were dysparunia in three cases (8.5%) noted at 3 months follow-up and recurrence of prolapse in one (2.8%) case noted at the time of discharge. This patient had developed ischiorectal abscess which was drained on 10th postoperative day.
CONCLUSION(S) : Sacrospinous colpopexy is a safe, efficacious, and simple procedure which is indicated in severe
degrees of prolapse with significant loss of vaginal supports.
OBJECTIVE(S): To determine whether any specific dermatoglyphic (DG) features would emerge as markers in amenorrheic subjects.
METHOD(S): The study was done on 100 amenorrheic patients and 100 eumenorrheic controls with normal karyotype. Their finger tip patterns, hypothenar patterns, simian crease, Sydney line, interdigital area patterns (qualitative parameters of DGs) were analyzed. Printing method was used. The observations were correlated not only between subjects and controls but also between subjects with normal karyotype and subjects with abnormal karyotype. For statistical analysis percent frequency and chi square test were used.
RESULTS: Subjects and controls have shown predominantly loop pattern. It was arch pattern which predominated for the 2nd finger, loop for the 5th finger and whorl for the 4th finger. An increase in the loop pattern in the hypothenar area was observed in subjects, the highest being in patients with abnormal karyotype. Near significant association was seen for the simian crease and Sydney line in subjects. There was significant difference between the patterns in the left 1st interdigital area between controls and subjects with normal karyotype (P=0.05) and in the left 2nd (P=0.009) and 3rd (P=0.04) interdigital areas between controls and subjects with abnormal karyotype.
CONCLUSION(S): The qualitative DG parameters could be used in amenorrheic subjects for further referral for karyotyping
and counseling.
OBJECTIVE(S) : To study the health, educational status, and age of marriage in urban slums.
METHOD(S) : Married female population aged 15-49 years was questioned on reproductive health issues. The data were analyzed.
RESULTS : Of the 200 couples interviewed, 53% males were in the 26-30 years age group and 34% females in the 21-25 years age group. At the time of marriage 41% of males were below 21 years of age and 56% of females below 18 years. Forty-eight percent males and 40% females were educated, and 26% couples had four children. Ninety-four percent females delivered at home with the help of traditional dai. Ninety-three percent had received tetanus toxoid injection during antenatal period. Thirty-two percent of couples didn’t have any knowledge about contraceptives and though 21% had the knowledge they did not use any contraceptive.
CONCLUSION(S) : There was poor utilization of the reproductive child health (RCH) services provided by the government,
lack of awareness regarding birth spacing, and very low use of contraceptives. Literacy and age at marriage are not raised
inspite of laws made by the government.
OBJECTIVE(S): To assess obstetric conjugate ultrasonically at term in the labor room setting, and to study its relationship with mode of delivery, maternal height and neonatal weight.
METHOD(S): Fifty-five women at term, in early labor or admitted for induction of labor, entered the study. Longitudinal ultrasonic scanning by transabdominal 3.5 MHz curvilinear probe was performed for measurement of obstetric conjugate from a site most adjacent to pubic symphysis to the sacral promontory. Based on this obstetric conjugate measurement, women were divided into three groups namely those with obstetric conjugate < 10 cm, 10.1-12 cm, and > 12 cm. Mode of delivery was noted and maternal height and neonatal weight were correlated with ultrasonic obstetric conjugate. Ordinary least square method and logistic regression analysis were used for statistical analysis.
RESULTS: The mean age of the women was 22.65 ± 3.14 years and mean height 149.11 ± 6.72 cm. The cesarean delivery rate was 50%, 3.12%, and 11.7% when ultrasonic conjugate was < 10 cm, 10.1-12 cm, and >12 cm respectively. A positive relationship was found between maternal height and obstetric conjugate. Results from regression analysis show that maternal height determines ultrasonic obstetric conjugate significantly (P <0.001). A good relationship between neonatal weight and ultrasonic obstetric conjugate was also obtained (P < 0.001), with an elasticity of 0.47.
CONCLUSION(S) : Ultrasonic obstetric conjugate measurement is a simple, noninvasive and safe method of assessing the
anteroposterior diameter of the pelvic inlet. An ultrasonic obstetric conjugate of less than 10 cm should alert the obstetrician
for a possibility of cesarean delivery
OBJECTIVE(S) : To know the variations in drug prescriptions given to pregnant women by varied types of medical practitioners.
METHOD(S) : Prescriptions possessed by women admitted for labor were collected in 160 consecutive unbooked labor admissions. These prescriptions were analyzed to study the prevailing practices of prescribing medications to pregnant women.
RESULTS : One hundred and sixty women generated 300 prescriptions. There were practitioners of four different acquainted systems and three incomprehensible systems of medicine who prescribed drugs to pregnant women. Persons with 16 different qualifications were engaged in providing care to pregnant women. Number of drugs prescribed per prescription ranged from one to ten. Repetition of the same drug in the same prescription but by different trade name was seen in 41 prescriptions. In 65 prescriptions one or many drugs were written in illegible handwriting. Teleprescription and quackery were other observations.
CONCLUSION(S) : There is anarchy in prescription practices. Continuation of medical education programs on prescribing
in pregnancy would benefit both the care providers and the pregnant women.
OBJECTIVE(S): To evaluate the fetomaternal outcome of women with renal disease and the effect of pregnancy on renal disease.
METHOD(S): Fourteen cases of renal disease were followed prospectively throughout pregnancy studying the course of pregnancy and renal disease.
RESULTS : One woman needed termination of pregnancy at 18 weeks. Hypertension and intrauterine growth retardation (IUGR) occurred in 8 out of the remaining 13 cases (61.5%), anemia in 7 (53.8%), urinary tract infection in 3 (23%), premature rupture of membranes in 2 (15.3%), prematurity in 7 (53.8%), fetal distress in 4 (30.8%), still birth in 1 (7.6%), and neonatal death in 2 (15.3%). Renal function worsened in 2 cases (15.3%). Fetomaternal complications were more in severe renal disease. Of the six women of hydronephrosis five presented with abdominal pain, which was relieved in four by positional change and in one by a ureteric stent.
CONCLUSION(S): The level of renal insufficiency is more important in predicting pregnancy outcome. Complications
like hypertension, anemia, IUGR, and prematurity were seen more frequently in severe renal disease than in mild
disease. Acute hydronephrosis presenting with abdominal pain is easily treatable by positional change.
OBJECTIVE(S): To compare immediate induction with PGE2 gel and delayed induction with intravenous oxytocin drip in women with premature rupture of membranes(PROM) at term.
METHOD(S): In this prospective study 223 women were randomly assigned to either immediate induction with PGE2 gel instilled in posterior fornix or expectant management for 12-24 hours followed by induction of labor with intravenous oxytocin drip. The two groups were compared with respect to mode of delivery, labor characteristics, and neonatal and maternal infectious morbidity.
RESULTS : Ninety-one percent of women required single application of PGE2 gel for labor induction in immediate induction group. Thirty-two percent women had onset of spontaneous labor during observation in delayed induction group. Immediate induction with PGE2 resulted in significantly lower rate of cesarean section (17.8% vs 28.5%, P = 0.049) and of lower rate of operative vaginal delivery (3.5% vs 14.2%, P=0.007) among nulliparous women. There was no significant difference in the mode of delivery among multiparas. Interval from induction to active labor, duration of active labor, and length of hospital stay before delivery were not significantly different between the two groups. The maternal morbidity was almost negligible. Only a few neonatal infections occurred and no significant difference was noted between the two groups (2.7% vs 3.5%, P= 0.71).
CONCLUSION(S): In women with PROM at term, immediate induction of labor with PGE2
gel and expectant
management followed by oxytocin result in similar low rates of neonatal infection. Immediate induction of labor
with PGE2
gel results in significanlty lower rate of cesarean section and of operative vaginal delivery in nulliparas.
OBJECTIVE(S): To study the effect of intraamniotic infusion (IAI) of normal saline in meconium stained amniotic fluid.
METHOD(S): Between January 2003 and June 2004, 200 women at term with vertex presentation having moderate to thick meconium stained liquor were alternately allocated to the study group where IAI was given and to control group where IAI was not given. Chi square test was used for statistical analysis.
RESULT(S): Cesarean section rate for fetal distress, apgar score <5 at one minute and meconium aspiration syndrome (MAS) were significantly less frequent in the study group compared to those in the control group (P < 0.01, <0.05 and <0.01 respectively), without increasing the febrile morbidity of the mother.
CONCLUSION(S): IAI using simple equipment is safe and beneficial for management of women with moderate to thick
meconium stained liquor.
OBJECTIVE(S) : To survey the knowledge, attitude, awareness and perception of emergency contraception (EC) among women coming for induced abortion.
METHOD(S) : A survey was carried out over a period of 6 months with the help of predesigned questionnaire, in 100 consecutive women attending our voluntary abortion (MTP) clinic for an induced abortion.
RESULTS : Only 27% of women were using regular contraception. Condoms were the most popular choice in 75% of all users. Only one woman out of 100, was aware of EC even though it was a predominantly urban and educated population.
CONCLUSION(S) : Public information strategy needs to be devised so that EC is widely publicized and used as a
back up to prevent unwanted pregnancies.
OBJECTIVE(S) : To study the incidence, socioeconomic and demographic precedent factors, clinical features, management, complications, and maternal morbidity and mortality of septic abortion with special emphasis on unmet needs of safe abortion.
METHOD(S) : One hundred and twenty two cases of septic abortion following voluntary abortion were admitted and analyzed in a retrospective study conducted from 1st May, 2003 to 30th April, 2004 at our tertiary health care center.
RESULTS : There was a total of 5003 obstetrical admissions for pregnancy and its related problems, out of which 352 (7.04%) were for abortions – threatened, incomplete, inevitable, missed, and septic ones resulting from induced abortions carried out outside. One hundred and twenty two women had septic abortion giving an incidence of 34.66% (122/352). Their mean age was 30.03 years. There were 7 (5.74%) primigravidas and 115 (94.26%) multigravidas, out of whom 36.62% (42/115) were grand multiparas. One hundred and thirteen of the 122 were from rural areas. 47.54% (58/122) were admitted in a state of septic shock. 17.21% (21/122) required exploratory laparotomy and 80.95% (17/21) of them required hysterectomy. Total maternal mortality during this period was 112 out of which 26 (23.21%) were due to septic abortion.
CONCLUSION(S) : Increasing awareness, making legal abortion services easily available to the masses at cheaper cost,
and stringent laws to contain quackery are required to decrease the incidences of illegal and septic abortions, and related
maternal morbidity and mortality.
