Abstract

Preterm birth is a global concern resulting in prematurity which is the leading cause of newborn death and long-term squeal in the survivors. In this review, we will summarize the data available to this date in regard to the causes, available interventions, and contemporary research for future applications.

Abstract

Objectives: A variety of biological, biochemical, and biophysical markers implicated in the pathophysiology of preeclampsia during the last two decades have instigated the growing interest in this study to include both bhCG and lipid profile studies in the early second trimester as early predictors of pregnancy-induced hypertension. Early identification of at-risk women may help in taking timely preventive and curative management to prevent or delay complications associated with pregnancy-induced hypertension.

Method: A prospective study was performed on 120 patients attending the outpatient department of the Obstetrics and Gynaecology of the Maharaja Agrasen Hospital. All the patients were screened for serum bhCG and serum lipid profile in their early second trimester (14–20 weeks) and followed up till their delivery. Comparative studies of serum bhCG and serum lipid profile were performed between those who remain normotensive (group I) and those who developed pregnancy-induced hypertension (group II).

Results: TG, total cholesterol, VLDL, and LDL values for those women who developed PIH (group II) were significantly higher than those who remain normotensive (group I), with p value of\0.05 which is statistically significant. HDL and bhCG values for group II were not higher than those in group I with p value[0.05 which is statistically insignificant.

Conclusion: Maternal lipid profile in second trimester is very good noninvasive test which can be used for prediction of pregnancy-induced hypertension before its clinical onset. However, there is no correlation between maternal serum bhCG and pregnancy-induced hypertension.

Abstract

Objectives: To find the incidence of human papillomavirus (HPV) infection and cervical intraepithelial neoplasia (CIN) in pregnant women and compare Pap smear with the HPV DNA test in detecting HPV infection.

Materials and Methods: Hundred antenatal women, irrespective of gestational age, were enrolled as subjects in this prospective pilot study for blood investigations, wet mount examination of cervical discharge, Pap smear, and highrisk HPV DNA detection of cervical scrape by PCR. Women showing abnormality in Pap smear and/or those who were high-risk HPV DNA positive were subjected to colposcopy.

Results: The incidence of HPV-positive pregnant women was 18 %. Koilocytosis on Pap smear was observed in six women. Three high-risk HPV DNA-positive women showed changes consistent with CIN 1 on colposcopy.

Conclusion: The HPV DNA test is the most sensitive and reliable in detecting HPV infection as compared to Pap smear, but considering the cost of PCR, Pap smear screening of all antenatal women was recommended.

Abstract

Aim: To study management and maternal and fetal outcome in single fetal death in twin pregnancies.

Materials and Methods: We studied 64 (1.37 %) twin deliveries out of a total of 4,655 deliveries in GMC, Haldwani (Uttrakhand). Out of them, 5 (7.81 %) were complicated with single fetal death in the second or third trimester. These cases were managed conservatively with regular monitoring of maternal coagulation profile along with intensive fetal surveillance for the surviving twin. The cases were studied for antenatal complications and placental chorionicity with placental histopathology and postmortem of the dead fetus. Neonatal and maternal outcome in the postpartum period was also studied.

Results: No antenatal complications were present in four out of five cases with one having PIH. Three out of five pregnancies could be extended to term and had no maternal complications. The other fetus could be salvaged in three and all of them had a normal neonatal period. One pregnancy ended in preterm labor with delivery of a preterm baby which could not be saved. One resulted in death of the other fetus also where pregnancy was remote from term.

Conclusions: Although our study was small, it indicates that in case of twin pregnancy with single fetal death with good surveillance, the live fetus can be salvaged.

Abstract

Objective: To evaluate the accuracy of transvaginal sonography (TVS) and saline infusion sonohysterography (SIS) for detection of uterine cavity abnormalities in patients with abnormal uterine bleeding (AUB) taking hysteroscopy as the gold standard.

Methods: This was a prospective study done in the department of Obstetrics and Gynecology of a tertiary care academic hospital. Sixty premenopausal and postmenopausal women who presented with AUB underwent TVS, SIS, and hysteroscopy. The presence of focal abnormality and the type of abnormality, i.e., polyp, submucous myoma, and endometrial hyperplasia, were noted. The results of TVS and SIS were compared with hysteroscopy.

Results: On hysteroscopy, 76.67 % (n = 46) patients were diagnosed with intra cavity abnormalities. SIS showed sensitivity, specificity, PPV, and NPV of 89.1, 100, 100, and 73.7 %, respectively. In comparison, TVS showed sensitivity, specificity, PPV, and NPV of 43.48, 78.57, 86.96, and 29.73 %, respectively.

Conclusions: SIS was found to be more sensitive and specific than TVS in detection of intra cavity abnormalities.

Abstract

Objective: To analyze the social factors influencing unmarried pregnancies in urban population.

Methodology: Observational study was conducted at the Institute of Obstetrics and Gynaecology, Chennai, from January 2006 to December 2010. Convenience sampling technique was used, and 115 subjects were interviewed using structured questionnaire.

Results: 15.6 % of the subjects were\16 years of age, and 40.8 % were between 17 and 19 years. 21.7 % of the subjects were illiterate. In 60 % of cases, the average daily income was less than Rs. 100. There was history of alcoholism in 60 % of family members. 80 % of girls were involved in sexual activity willingly, and in 20 %, the subjects were assaulted by force. Five subjects were mentally retarded. 52 % were involved in sexual activity with married men. 72 % reported for termination in the second trimester.

Conclusions: There is a need for educating girls in the area of gender relationship. Contraceptive awareness should be created.

Abstract

Objective: To study oxytocin, misoprostol, and methylergometrine in active management of the third stage of labor and determine duration of the third stage of labor, blood loss, adverse effects, and need for additional uterotonics in each group.

Methods: Clinical trial of 300 women with healthy singleton pregnancy allocated into three groups to receive either: 10 IU intravenous oxytocin infusion, 600 lg sublingual misoprostol, or 200 lg intravenous methylergometrine. Primary outcome measure was blood loss in the third stage of labor; secondary measures were duration of the third stage, side effects, and complications.

Results: Subjects who received 600 lg of misoprostol had the least blood loss, followed by oxytocin, and methylergometrine. The shortest mean duration of the third stage was with misoprostol. Shivering and pyrexia were observed in misoprostol group, and raised blood pressure in methylergometrine group.

Conclusions: Misoprostol is as effective as oxytocin and both are more effective than methylergometrine in active management of the third stage of labor.

Abstract

Objective: To study the antepartum fetal growth between customized ‘‘GROW’’ curves and noncustomized growth curves with neonatal growth pattern.

Methods: Fetal growth scans are performed between 30 and 35 weeks to singleton mother. Estimated fetal weights (EFWs) were determined using ultrasound variables (biparietal diameter, head circumference, abdominal circumference, and femur length). This EFW is plotted on SONOCARE software [noncustomized growth curves developed by Medialogic solutions (P) Ltd., Chennai, India] and customized ‘‘GROW’’ curves to determine the type of antenatal fetal growth as AGA, small for gestational age (SGA), or large for gestational age (LGA). The fetuses were followed longitudinally till birth, and the newborns’ growth patterns were determined according to birth weight at the gestational age of delivery (\10th percentile for gestational age as SGA and[90th percentile as LGA) and compared to antenatal prediction of fetal growth patterns determined by noncustomized growth curves and customized ‘‘GROW’’ curves.

Results: According to noncustomized growth curve at antenatal period, 93 % fetuses are AGA; 5.6 % are LGA, and 1 % are SGA. According to customized GROW curves, when the same EFW is plotted on GROW curves, 83 % are found to be AGA, 6.8 % LGA, and 10 % SGA. At postnatal period, according to newborn growth curve, 87.8 % are AGA, 8.8 % LGA, 3.4 % SGA. Sensitivity of customized ‘‘GROW’’ curves is more than that of noncustomized growth curves (45.45 vs. 18.18 %) for detection of SGA fetus.

Conclusions: Antenatal predictions of SGA baby by ultrasonography can be almost doubled with customized ‘‘GROW’’ curves than noncustomized growth curves. Customized GROW curves also better predict perinatal morbidities like neonatal jaundice and NICU admission. Antenatal serial fetal growth monitoring should be done with customized GROW curves.

Abstract

Objective: To evaluate role of serum estradiol levels in predicting likelihood of pregnancy in women undergoing GnRH-a protocol in IVF-ET cycles.

Design: A 3-year retrospective analysis of estradiol levels on down-regulated day 2, day 6, and day of hCG trigger and subsequent clinical pregnancy rates.

Setting: A university hospital tertiary referral centre.

Population or Sample: Women undergoing IVF treatment. Methods Hormonal assessment on the down-regulated day 2, day 6, and day of hCG trigger.

Main Outcome Measure(s): Comparison of hormonal profile, antral follicular count on day 2, endometrial thickness on day of trigger, and number of oocytes retrieved between pregnant and the non-pregnant group. The prediction of IVF success was based on the quantitative levels of estradiol on a specific day in down-regulated cycle.

Result(s): The overall pregnancy rate was 32.25 % (50/ 160). Estradiol level on down-regulated day 2 was 31.9 ± 12.6 and on the day of trigger was 1,996.46 ± 1,252.36 in pregnant women, which was significantly higher as compared to estradiol levels in nonpregnant women (27.6 ± 12.3 and 1,525.1 ± 1,116.42, respectively). It was found to be a significant prognostic marker for successful IVF treatment. Estradiol levels on down-regulated day 6 were found to be non-significant between the two groups.

Conclusion(s): Estradiol level on down-regulated day 2 of menstrual cycle and on the day of trigger was found to have a significant impact on the success of IVF-ET.

Abstract

Objective: To determine intrauterine contraceptive device (IUCD) discontinuation rate and its causes and related factors among women attending the OPD/family planning clinic in Mahila Chikitasalaya, SMS Medical College, Jaipur from January 2012 to December 2012.

Methods: 387 women who had an intrauterine device (IUD) inserted during the last 1–5 years were interviewed during their visits to the OPD/family planning clinic. Sociodemographic characteristics for all women were described using frequency distribution. Life tables were used to describe the proportion of women who discontinued IUD at various time intervals. The main outcome measure was IUD discontinuation.

Result(s): The incidence of IUD discontinuation in the first year following insertion was 16.79 %. Approximately 31 % of the study sample continued using their devices after 5 years. The average duration of IUD use was 36 months. Of the 387 women, 56 % discontinued IUD use because of a desire to conceive, 27.7 % because of side effects, 15.36 % because of opposition from the woman’s family, and 1.5 % because they were sexually inactive. The most common side effects reported as the reasons for discontinuation were bleeding, infection, and pain. Discontinuation was inversely related to the age at insertion, the number of living children, and the sex of children. Previous contraceptive users were significantly less likely to discontinue IUD use.

Conclusion(s): The crude cumulative rate of IUD discontinuation was 16.79 % during the first year, suggesting a need to tackle the problem of discontinuation through effective educational strategies and counseling techniques. Desire to have a male child still predominates among Indian families. The average duration of IUD use in majority of the females was about 36 months (45 %), thereby fulfilling its objective of spacing between children as laid down by the WHO (2 years spacing between pregnancies). About 31 % of the women continued using IUCD even after 5 years. It is crucial to correct misconceptions and identify the lack of correct and complete information both among the providers and the acceptors, to improve the effectiveness of family planning programs.

Abstract

There are many etiological factors responsible for recurrent abortions. However, no explanation can be identified in approximately 40–50 % of women with recurrent miscarriage (RM). Several studies demonstrated that successful pregnancy is dependant on shifting of maternal immune response from (proinflammatory) Th1 toward (anti-inflammatory) Th2 phenotypes. It was suggested that unexplained RM might be due to immunologic factors. Recently, there is improved understanding regarding the role of the different immune cells and proteins that are important at each stage of a normal pregnancy. Various immune-based therapies with variable clinical evidences have been reported in women with RM with variable efficacy. Still there is lack of information about the mode of action and possible adverse effects of the treatment and a reliable marker for patient selection for immunopotentiation. Adequately powered placebo-controlled studies are required to study and treat couples with the so-called idiopathic recurrent miscarriage.