Three-dimensional ultrasound (3D USG) is a fast-evolving imaging technique that holds a great potential for use in gynecology. Its sensitivity and specificity is reported to be close to 100 % for diagnosing congenital uterine anomalies, comparable with those of magnetic resonance imaging (MRI) and laparoscopy. With 3D USG, a coronal view of the uterus can be obtained, clearly outlining the external contour of the uterus and providing accurate information about the shape of the cavity. Although 3D USG may not perform well in thin endometria, combining it with saline infusion sonography (SIS) overcomes this problem. Research shows that 3D USG is more sensitive and specific than two-dimensional ultrasound (2D USG) in defining and mapping uterine lesions, such as fibroids, adenomyosis, and intrauterine synechia. In cases of suspected malignancy, 3D USG is mainly used in the initial evaluation of patients. Measuring various indices and mapping vascular architecture with 3D power Doppler have been proposed for evaluating adnexal masses. Although some studies raised hope, no consensus is reached about its use, success, and limitations. In urogynecology, translabial 3D USG is proved to be a valuable tool, as it provides instant access to the axial plane, which clearly depicts the relationship of the vagina, urethra, rectum, and the muscular pelvic floor. Studies report no significant differences between translabial 3D USG and MRI measurements for evaluation of the pelvic floor. In conclusion, adding 3D USG to routine gynecological workup can be beneficial for clinicians, as it provides fast and accurate results in a relatively cost-effective setting.
Objectives: To determine the, incidence, etiology, management, maternal, and fetal outcome and to evaluate trends in our area and recommend preventable measures.
Methodology: This prospective study is done between Jan 2012 and Aug 2013 in Pt. J.N.M. Medical College Raipur. All the women who had ruptured uterus were included. Relevant history was taken, women were assessed, adequate intervention done, and were followed up till 6 months after discharge.
Results: A total number of deliveries were 11,323. Out of 11,323 deliveries, 9,844 women were without prior LSCS, 1,479 women were with prior LSCS. A total of 40 cases of rupture uterus were there 25 in women with prior LSCS and 15 in women without LSCS. Thus, incidence among women with prior LSCS was 1.69 % and for women without LSCS was 0.152 %. Overall incidence of uterine rupture was 0.35 %. Major risk factors found were unbooked status (92.5 %), injudicious use of oxytocin (52.5 %), and unjustified VBAC trial (44 %). Bladder injury was found in 20 %. Extension to cervix was found commonly in uterus with no previous section (46.66 %). Blood transfusion was required in 92.5 %. Perinatal mortality was 85%. Only one maternal death was there (2.5%).
Conclusions: Developed countries have incidence of uterine rupture 0.000 % in women without LSCS and 1 % in women with prior LSCS[1]. Thus, by directly comparing, our study of 20 month revealed that women stand 1,500 times higher risk for rupture even without previous cesarean section and 1.7 times in women with previous section in comparison to the developed countries. The overall burden of women with previous section being admitted for delivery is 12.28 %. 62.50 % women who had rupture uterus were those with previous section. Thus, careful selection of these women for trial of labor and a compulsory institutional delivery is recommended. We recommend use of oxytocin in titrated dose which clearly indicated by an obstetrician only, and it should be a prescription drug strictly.
Objectives: This study aimed to evaluate the prevalence of premalignant and malignant lesions of symptomatic and asymptomatic endometrial polyps among premenopausal women and to verify whether different clinical parameters, and polyp volume and number are associated with a more precise estimate of malignancy.
Methodology: One hundred and fifty women aged 29–52 years and with certain diagnosis of endometrial polyp were enrolled in a prospective observational study. The recruited patients underwent hysteroscopic polypectomy based on saline infusion sonohysterography and diagnostic hysteroscopy. Pathologic report was the main outcome.
Results: Among women with endometrial polyps, 62 % had asymptomatic polyps. The prevalence of premalignant and malignant polyps comprised 4.6 % of cases (3.3 % hyperplasia with atypia and 1.3 % carcinomatous polyps). The presence of abnormal uterine bleeding was not a predictor of premalignant and malignant changes in the polyp. On logistic regression analysis, the premalignant and malignant lesions were influenced by polycystic ovary syndrome (p\0.001; OR 4.61; CI 1.9–27), polyp volume [10 ml (p\0.001; OR 5.83; CI 4.31–9.17), and multiple polyps (p = 0. 01; OR 2.05; CI 1.09–3.76). Notably, the odds ratio of polyp volume[10 ml was 5.83. This additional risk confirms the importance of polyp volume in the detection of malignant transformation rather than associating bleeding in premenopausal women.
Conclusions: Polycystic ovary syndrome, polyp volume greater than 10 ml, and increased polyp number represent the markers of risk for premalignant and malignant transformation of endometrial polyps in premenopausal women. Nonetheless, the majority of polyps are asymptomatic, and the risk of malignancy is very low. Therefore, for women with polyp volume B10 ml and no risk factors, a more expectant approach may be warranted in order to reduce surgical risks and costs.
Objectives: To study the efficacy and safety profile of isosorbide mononitrate (IMN) as an agent for cervical ripening.
Methodology: This study was conducted in the Department of Obstetrics and Gynecology, M Y Hospital & M G M Medical College Indore from September 2011 to February 2013. Pregnant women attending the antenatal clinics were screened for possible participation in the study after explaining the nature of the study. This study was conducted on 150 patients. An initial dose of 40 mg IMN was applied in the posterior vaginal fornix, and the same dose was repeated after 6 h. Cervical ripening was assessed by the change in Bishop Score 12 h after the initial application.
Results: In a study of 150 cases, mean maternal age was 22.2 ± 2.6 years (range 19–35 years) and mean gestational age was 40.5 ± 1.07 (range 40–42 weeks). 52 women were primigravidas, while 98 were multigravidas. The mean Bishop Score—before drug administration was 1.94 ± 1.3 (range 0–5), and mean fetal heart rate was 137 ± 6.2 bpm. The mean of Bishop scores before IMN administration was 1.94 ± 1.3, while mean of Bishop score after drug administration was 6.7 ± 2.2; mean difference was equal to 4.76. P value was equal to 0.0001. By conventional criteria, this difference is considered to be statistically significant. The mode of delivery 96 (64 %) delivered vaginally, while 54 (36 %) were delivered by Cesarean section. Mean Apgar score at 1 min was 8.2 ± 0.9 SD (range 7–10), while mean Apgar score at 5 min was 9.4 ± 0.6 (range 8–10). The only side effect noted was headache, and 30 cases (20 %) complained of headache.
Conclusions: IMN seems to be effective, safe, inexpensive, and well-tolerated agent for cervical ripening. It is cost effective and safe with minimal side effects.
The incidence of pre-term low birth weight still prevails in developed as well as developing countries though the numbersmay vary. Periodontitis is a chronic inflammatory process with multifactorial etiology and adversely affects the outcome of pregnancy which becomes a major public health problem. The association of periodontitis as risk factor for preterm birth has been in extensive research in the past two decades when a number of studies investigated this relationship. However, definite connection has not been proved yet and research is still ongoing. This article describes about the possible relationship that can exist between pre-term lowbirth weight infants and periodontal disease.
Objectives: To ascertain the prevalence, presentation, diagnosis, severity, and complications of HELLP syndrome. Materials and Methods This is a prospective observational study analyzing the conditions and the data of 24 cases of HELLP syndrome in a tertiary care hospital. The analysis was done for the demographic characteristics, presentation of these patients, complications associated, and the perinatal outcome.
Results: 0.45 % of the patients admitted for delivery developed HELLP syndrome. Majority of the patients developed the condition in 30–36 weeks period of gestation, while five patients developed it in the postpartum period. The condition led to 12.5 % of maternal and 45.8 % of perinatal mortality.
Conclusion: HELLP syndrome is an important cause for maternal and perinatal morbidity and mortality.
Objectives: To study the diagnostic potential of optical imaging and its comparison with colposcopy, in detecting early cervical dysplasia
Methods: The study was conducted on 200 patients attending the outdoor of UISE maternity hospital with symptoms suspicious of cervical lesions. All patients were subjected to colposcopy, followed by histo-pathological examination. Out of all HPE, 18 samples each from normal and dysplastic histology were sent to IIT Physics lab, Kanpur for optical imaging. Statistical analysis was done using sensitivity, specificity, PPV, and NPV. Chi square test was applied to calculate p value
Results: In optical imaging, depolarization images had shown significant changes in the epithelium region of the dysplastic tissue as compared to normal one. It is found that the mean value of depolarization power for normal cervix tissues is less than 0.32, while for dysplastic tissues it is greater than 0.32
Conclusions: Optical imaging is fast, non-invasive tool with high sensitivity and specificity, comparable to colposcopy (sensitivity 88.9 vs 100 %, specificity 83.3 vs 86.6 %) and thus is useful in both for screening and diagnosis of cervical dysplasia
Objectives: Evaluation of double cross plasty for management of obstructive or non obstructive transverse vaginal septum.
Methods: 13 patients presented either as cryptomenorrhoea or as infertility/dyspareunia were diagnosed to have transverse vaginal septum. They were subjected to double cross plasty and were subsequently followed up for period of two years.
Results: 13 patients presented either as cryptomenorrhoea or infertility/dyspareunia. Nine patients had transverse vaginal septum at low level, three at midlevel, and one had high-level septum. The thickness of septum was 1–3 cms in 12 patients. Double cross plasty was performed in all patients. One patient with high vaginal septum which was thick needed bilateral labial flaps. All patients were followed up to period of 2 years and none had restenosis. Three patients had pregnancies with vaginal delivery in two of them.
Conclusions: Double cross plasty for management of transverse vaginal septum is a better technique compared with currently used surgical methods. In our series, it did not cause restenosis and some of our patients were able to deliver vaginally.
