KeywordsVitamin D · Metabolic syndrome · Postmenopausal women · Insulin resistance · Obesity
Introduction :Recurrent pregnancy losses (RPLs) are seen in up to 15–20% of all clinically recognized pregnancies, 1–2% of women in general population. Repeated losses are seen in 5–10% of women. The prevalence of chromosomal rearrangements is 6.65% in couples with repeated pregnancy losses. Two to 4% of RPL are associated with parental balanced reciprocal and Robertsonian translocations.
Materials and Methods :The study was conducted at a tertiary care hospital in New Delhi, and in total, 204 couples with RPL enrolled in the study.
ResultsIn total, 4490 couples presented to the obstetric clinic, of which 204 (4.5%) couples had repeated pregnancy losses. Cytogenetic analysis was done in 198 couples. Out of total 198 patients, 14 patients (7.1%) had cytogenetic alterations. Most common aberrations observed were structural rearrangements, of which reciprocal translocations were more common. In our study cohort, all the couples had maternal age of ≤ 35 years and all the alterations were seen either in mother or in both parents.
Discussion: Our study highlights that cytogenetic alterations not only are common in first trimester miscarriages, but are an important event in miscarriages presenting at later period of gestation and in young mothers as well.
Keywords Robertsonian translocations · Balanced translocations · Unbalanced translocations · Miscarriage
Objectives : To find out the relative prevalence of fetal neural tube defect (NTD) and its outcome in terms of survival at birth and beyond 2 years of age.
Methods : A 10-year prospective (2008–2018) observational study was performed, which included all prenatally detected fetal NTD. Two-year follow-up was done in cases of pregnancies resulting in live birth, in terms of their survival, physical morbidity and developmental delay.
Results NTD was seen in 401/648 (62%) cases among the central nervous system malformations. More than half of the cases (54.1%) presented after 20 weeks of gestation, and 42.8% of the mothers were primiparous. Spina bifida was seen in 206 cases, anencephaly in 144, encephalocele in 43, whereas iniencephaly was seen in only eight cases. Associated anomalies were present in 51.2%. Only 19.0% cases were live-born, and merely 11% were alive beyond 2 years of age. Among types of spina bifida, lumbosacral meningomyocele was the most common (41.6%), whereas thoracic was the rarest (8.7%). After 2 years, physical disability was observed in more than half of the cases who survived.
Conclusions: NTD is one of the commonest malformations with high mortality, and the physical and mental sub-normality is high among those who survive.
Keywords Fetal hydrocephalus · Central nervous system anomaly · India · Survival after birth · Spina bifida · Anencephaly · Encephalocele
Aim : To determine the role of antenatal parameters in predicting the outcome of bilateral fetal hydronephrosis.
Methodology : Total 50 antenatal women with bilateral antenatal fetal hydronephrosis (ANH) were included. On ultrasound, amount of liquor, kidney size, pelvic anteroposterior diameter, degree of caliectasis, bladder size, and thickness were observed at 28 and 32 weeks of gestation. For 3 months post-delivery, the babies were evaluated in terms of ultrasound renal parameters, serum creatinine levels, and need for surgery.
Results The mean gestational age at delivery was 37.4 ± 1.7. All babies were alive at birth, 48 were alive after 3 months. Surgery was done in 10/50 cases; cystoscopic fulguration was the most common procedure. There was a resolution of bilateral ANH in 27/50 cases, in 5/50 cases there was pylectasis with normal serum creatinine, and in 18/50 cases there was adverse outcome. Most of the parameters had better sensitivity and specificity at 32 weeks than at 28 weeks. At 32-week gestation, the renal pylectasis between 10 and 15 mm had the highest sensitivity (88.9%), and the presence of caliectasis had the highest specificity (90.6%) for adverse outcome.
Conclusions: Resolution of hydronephrosis took place in the majority of cases, and there was an adverse outcome in only one-third of them. Renal caliectasis was the best marker for the prediction of adverse outcome.
Keywords Pylectasis · Bilateral renal anomaly · India · Survival after birth · Hydronephrosis · Caliectasis · Prospective study
Key Message The new NB scope aids in better visualization of the scalp and blood collection and analysis at bed side.
Objective :Caesarean section rates and inherent complications are on the rise all over the world. One way to avoid a caesarean is to measure fetal scalp blood lactate levels. The methods available to visualize fetal scalp, obtain the blood sample and perform the blood test are separate, cumbersome and expensive, needing a certain level of expertise. We propose a device that incorporates all the steps of obtaining a fetal scalp blood lactate into one sleek, easy to use device.
Methods : The initial design, 3-D print and was tried on mannequin. After ethics committee approval, the prototype was experimented on patients in labour with singleton live fetus in cephalic presentation with no evidence of distress.
Results There were (n = 9) patients recruited. There were (n = 5) primigravida and (n = 4) multigravida all of whom were in active labour. Parity did not seem to influence ease of instrumentation. Of the (n = 9) mothers (n = 2) had meconium-stained liquor and the rest (n = 7) had clear liquor, meconium-stained liquor did not affect visualization. The mean time taken to collect the sample was 184.11(± 33.04) seconds.
Conclusions: The Neeraj-Bhaskar (NB) scope is an easy to use, affordable device that can be used time and again to decide on cases where emergency caesarean section can be avoided due to fetal distress.
Keywords NB scope · Fetal scalp blood sampling · Fetal scalp lactate · Fetal scalp visualization
Background : Differentiating malignancy from benign diseases is the key to successful management of adnexal masses. Risk of malignancy algorithm (ROMA) has been used for this purpose. We have prospectively studied the diagnostic value of ROMA in patients presented with adnexal masses.
Methods : We prospective calculated ROMA values prior to surgery for adnexal masses. The risk calculated was then correlated with the histological findings, and results were analyzed according to menopausal status. ROMA cutoff value was determined using ROC curve, and sensitivity, specificity and predictive values were calculated. Statistics were performed on SPSS software (version 20.0).
Results There were 94 patients with adnexal masses included in the study, 65 (69.1%) had epithelial ovarian cancer and 29 (30.9%) were diagnosed benign on histopathology. In both pre- and postmenopausal patients, ROMA values were significantly higher in patients with malignancy compared to those with benign disease (p < 0.05). ROMA score was of a significant diagnostic value in both premenopausal (AUC = 0.914, Z = 10.81, p < 0.001) and postmenopausal patients (AUC = 0.975, Z = 21.51, p < 0.001). In premenopausal females, ROMA > 13.3% was able to discriminate malignant from benign patients with 97.06% sensitivity and 85.00% specificity. The positive and negative predictive values were 91.7% and 94.4%. Similarly, in postmenopausal females, ROMA value of > 76% achieved 87.10% sensitivity and 100.00% specificity in discriminating malignant from benign patients with 100% positive and 69.2% negative predictive value. The overall accuracy of ROMA in pre- and postmenopausal patients was 87.0% and 85%, respectively.
Conclusions: ROMA is a useful and accurate test for differentiating epithelial ovarian cancer from benign ovarian masses. Further studies are needed to compare performance of ROMA with the Risk of Malignancy Index (RMI), CA 125 and HE4. Such comparative studies will be helpful to the clinician in deciding the best diagnostic tool for women with adnexal masses.
Keywords ROMA · HE4 · CA 125 · Adnexal mass
The aim of the study was to analyse risk factors, surgical findings, ovarian salvage rate and histology of ovarian mass. We reviewed 81 cases of surgically proven ovarian torsion retrospectively from June 2014 to June 2019 at a tertiary care referral centre in South India. Demographic, clinical and surgical details of all patients were noted from the medical records. Mean age of the patients was 26 years. Most of the patients were nulliparous and had a pre-existing ovarian mass of size > 5 cm. Ovarian salvage rate was 43.2%. Concomitant cystectomy with detorsion was done in 30 patients without increase in blood loss or complications. Extensive necrosis was present in 78.2% of oophorectomy specimens. Most common histology of ovarian mass in cystectomy specimens was simple ovarian cyst.
Keywords Conservative surgery · Necrosis · Cystectomy · Histology
Introduction : Non-healing wound causes significant morbidity and mortality of patients. One of the rare causes behind nonhealing wound infection is M. tuberculosis which often remains undiagnosed.
Aim : The aim of this study was to determine the tuberculosis as one of the causes of non-healing wound.
Methods Wounds that did not heal even after secondary suturing and tissue biopsies were sent for histopathological examination. The cases diagnosed with tuberculosis received anti-tubercular treatment. Follow-up was done after 7 and 14 days of treatment, and response was seen in terms of reduction in inflammation and discharge.
Results: Of the 36 patients, five patients had tubercular infection out of which one patient revealed tubercular granuloma, two revealed epitheloid cells, Langhans cells, whereas two revealed non-specific chronic inflammation in histopathology.
Conclusions: A high degree of suspicion and tissue biopsy is required in case of delayed or non-healing wounds to diagnose tuberculosis as a cause. Even if typical tubercular granuloma is not visible in histopathology, the presence of epitheloid cells, giant cells, Langhans cells or predominant lymphocytic infiltrate equally suggests tubercular tissue infection.
Keywords Non-healing wound · Tubercular granuloma · Epitheloid cells · Langhans cells and wound tuberculosis
