OBJECTIVE(S) : To evaluate the feasibility and outcome of myomectomy during cesarean section.
METHOD(S) : The study was conducted from January 1998 to December 2004. A total of 14 cases of cesarean myomectomy done during this period were included. Both single as well as multiple myomas were enucleated during lower segment cesarean section (LSCS). Analysis was done with reference to age and parity, number, size and location of the fibroids, time required for surgery, blood loss, postoperative period, and findings at follow up after 6 weeks.
RESULTS : Mean surgical time was 54.14 ± 3.84 minutes which was more than the mean surgical time of 35±3.26 minutes for LSCS alone in our institution but the difference was not statistically significant (P>0.05). Mean blood loss in cesarean myomectomy was 472 mL which is not very alarming. Postoperative period was uneventfull in all the cases under study.
CONCLUSION(S) : Cesarean myomectomy is a feasible undertaking in experienced hands.
cesarean delivery, myomectomy, cesarean myomectomyOBJECTIVE(S) : To determine the prevalence of vitamin A deficiency in mothers of intrauterine growth restriction (IUGR) neonates and to evaluate the relationship of vitamin A levels with birth weight.
METHOD(S) : In a case control-cross sectional study, 50 mothers at term with small for gestional age neonates and 50 mothers at term with appropriate for gestational age neonates were studied to determine the prevalence of clinical and biochemical status of vitamin A deficiency. Serum vitamin A level was then correlated with birth weight in each of the two groups separatelty, and also jointly only in all the mothers in the two groups who had body mass index (BMI) of more than 18 kg/m2 and hemoglobin level of more than 10 g /dL. Student t test and chi square test were used as applicable to find out the significance between two observed values, and regression analysis was used to determine the correlation between two continuous variables.
RESULTS: Clinical signs and symptoms of vitamin A deficiency (night blindness, conjunctival xerosis, Bitot’s spots, corneal xerosis) and low levels of serum vitamin A were commonly seen almost twice often in mothers who delivered IUGR newborns. At least 24% mothers delivering IUGR babies and 10% mothers delivering appropriate for gestational age babies had one or the other clinical sign of hypovitaminosis A. Clinical signs of vitamin A deficiency correlated well with serum vitamin A levels. Severe deficiency of vitamin A (serum vitamin A < 10 mg/dL) was observed in 4% mothers who delivered IUGR babies, while it was not observed in mothers of appropriate for gestational age babies. There was no correlation between serum vitamin A levels and birth weight when other factors such as malnutrition and anemia were associated, but increasing serum vitamin A levels were associated with higher birth weight when mothers had BMI of more than 18 kg/m2 and hemoglobin level of more than 10 g/dL.
CONCLUSION(S): Vitamin A deficiency during pregnancy may be a very important factor for growth hindrance of the fetus. In malnourished mothers, besides vitamin A many other factors also have an influence on intrauterine growth restriction but vitamin A deficiency appears to be a key factor in mothers who are otherwise not severely malnourished.
vitamin A, intrauterine growth restrictionOBJECTIVE(S) : To evaluate the usefulness of glucometer screening during pregnancy and to determine a suitable cut off value for glucometer screening.
METHOD(S) : Two hundred women between 24 and 28 weeks of gestation attending our antenatal clinic were screened for blood sugar level by laboratory and glucometer methods 1 hour after 50g glucose load.
RESULTS : Forty-three (21.5%) had abnormal screening on laboratory testing. On glucometer screening only 22 (51.1%) of these women were detected to be abnormal taking plasma sugar value of 140 mg/dL as cut off value for positivity by both the methods.
CONCLUSION(S) : Laboratory testing of venous plasma glucose is superior to capillary glucometer screening. Optimal screening cut off value on glucometer screening on drawing a receiver operater characteristic (ROC) curve is also140 mg/dL with sensitivity of 66.6% and specificity of 79.3%.
gestational diabetes screening, glucometerOBJECTIVE(S) : To evaluate risk factors, type and site of rupture, management, and maternal and perinatal outcome of uterine rupture at a teaching institution.
METHOD(S) : The details of 253 cases of uterine rupture managed between January 1995 and December 2004 were reviewed.
RESULT(S) : The incidence of uterine rupture was 1 in 346 deliveries; 70 % were unbooked cases. One hundred twenty eight (50.60%) cases of uterine rupture occurred in a scarred uterus (127 had previous cesarean section scar and one had a scar of previous uterine perforation repair) while 125 (49.40%) occurred in unscarred uterus, with cephalopelvic disproportion as predisposing factor in 69 (27.25%), malpresentation in 20 (7.90%), labor induction in 14 (11.46%), instrumental delivery in two, and multiparity in 20 (7.90%). Repair of uterus was done in 147 (58.33%) cases and hysterectomy in 105 (41.51%). Bladder injury was present in 11 (4.34%) cases. Sixtysix percent had postpartum hemorrhage. Blood transfusion was required in 210 ( 83%) cases .There were seven (2.76%) maternal deaths and perinatal mortality was 94.07 %.
CONCLUSION(S) : Uterine rupture, is a major risk factor for maternal and perinatal morbidity and mortality. Proper antenatal care, early referral of women at risk, and repeat cesarean section in parturients with a previous uterine scar, especially when labor fails to progress, would improve maternal and perinatal outcome.
uterine rupture, cesarean section, maternal mortality, perinatal mortalityOBJECTIVE(S) : To detect and evaluate vault hematoma following abdominal and vaginal hysterectomies and correlate it with postoperative morbidity.
METHOD(S) : A prospective observational study was performed during a 1 year period from January 2004 to December 2004. During the year 820 women underwent hysterectomy and 380 of them who were willing to undergo postoperative sonography were included in the study. All the patients were scanned on the 3 rd or 4th postoperative day. A transvaginal sonographic scan was done for patients who had undergone abdominal hysterectomy and a transabdominal scan was done for those who had undergone a vaginal hysterectomy. The findings were correlated with postoperative morbidity.
RESULTS : Of the 380 women scanned, 40 or 10.53% had vault hematoma, 4.47% (17/38) developed febrile morbidity, 1.3% (5/380) required colpotomy, 0.26% (1/380) developed subacute intestinal obstruction, and 0.53% (2/380) had fever due to urinary tract infection. Patients who needed intervention had prolonged hospital stay (10-13 days). The incidence of vault hematoma was significantly higher after vaginal hysterectomy than after abdominal hysterectomy (small hematoma - P=0.009; medium hematoma - P=0.003).
CONCLUSION(S) : Ultrasound detection of significant vault hematoma on 3rd or 4th day following hysterectomy identifies a high risk population of patients who need further management or follow up before discharge.
vault hematoma, postoperative morbidityOBJECTIVE(S) : To study the prevalence of genital Chlamydia trachomatis by first void urine polymer chain reaction (PCR) test.
METHOD(S) : This case-control study was performed on 100 (50 symptomatic, 50 asymptomatic) randomly selected women attending Gynecological and Family Planning outpatient departments. PCR for Chlamydia trachomatis was done on first void urine by in house PCR test by KL-1 and KL-2 plasmid primers. Wet mount and gram stained vaginal smear were studied for presence of Trichomonas vaginalis, Candida spp and bacterial vaginosis by Nugent’s criteria. Statistical analysis was done by chi square test.
RESULTS: Genital Chlamydia trachomatis infection was present in 14% of symptomatic and 4% of asymptomatic women (P=0.081). Lower abdominal pain and cervical erosion were found to be significantly associated with presence of Chlamydia trachomatis.
CONCLUSION(S): Universal screening for genital Chlamydia trachomatis should be done in reproductive age group.
Chlamydia trachomatis, first void urine, polymerase chain reactionOBJECTIVE(S) : To identify risk factors for meconium stained amniotic fluid (MSAF).
METHOD(S) : Maternal and neonatal data was prospectively collected for consecutive singleton deliveries at term with cephalic presentation. Detection of MSAF during delivery was the primary outcome. Using univariate and logistic regression analysis, predictors of MSAF were uncovered.
RESULTS : MSAF was present in 159 (15.76%) of the 1009 deliveries studied. Thin and thick MSAF constituted 39% and 61% cases respectively. Univariate analysis identified eight risk factors (P<0.05) – primigravidity, postdated pregnancy, anemia, chorioamnionitis, prolonged labor, fetal distress, cord problems, and fetal growth retardation. Six risk factors were identified when thick MSAF was analyzed separately – maternal age >30, primigravidity, postdated pregnancy, prolonged labor, fetal distress, and cord problems. Logistic regression analysis identified four independent risk factors for MSAF – postdated pregnancy, fetal distress, cord problems, and fetal growth retardation (positive predictive value – 25.3%, negative predictive value - 89.7%), and three for thick MSAF – maternal age >30, postdated pregnancy, and fetal distress (positive predictive value - 19.5%, negative predictive value - 94.5%).
CONCLUSION(S) : Mothers with postdated pregnancies, cord problems in labor, and fetal distress are at increased risk of developing MSAF. Thick MSAF is likely with maternal age >30, postdated pregnancy, and fetal distress. In the absence of these factors the risk of meconium in liquor is low.
meconium stained amniotic fluid, predictors of meconium stained amniotic fluidOBJECTIVE(S) : To compare safety, efficacy, complications, and cost effectiveness of extraamniotic instillation of ethacridine lactate with vaginal misoprostol for voluntary termination of second trimester pregnancy.
METHOD(S) : A prospective comparative study on 120 pregnant women between 13 and 20 weeks was conducted from July 2004 to June 2005. Women were randomized in two groups. In one group extraamniotic ethacridine lactate (10mL/ week of gestation) instillation was done and in the other, 400 ? g tablet of misoprostol was inserted in the vagina every 12 hours for a maximum of 4 doses.
RESULTS : The rate of successful abortions within 48 hours was 95% (57/60 women) in each group. Among those who had aborted within 48 hours, the mean interval from induction to abortion was shorter in misoprostol group (15.5 hours vs 31.3 hours, P<0.0001). The rate of complete abortion, defined as expulsion of both fetus and placenta without operative assistance, was 66.6% for misoprostol and 70% for ethacridine lactate (P=0.344). The average cost per treatment was Rs. 57.95 for misoprostol as compared to Rs.86.10 for ethacridine lactate. Side effects were uncommon and did not differ between the two groups.
CONCLUSION(S) : Success rates of misoprostol and ethacridine lactate were comparable but the induction abortion interval was almost half in misoprostol group when compared with that in ethacridine lactate group.
voluntary termination of midtrimester pregnancy, ethacridine lactate, vaginal misoprostolOBJECTIVE(S) : To analyze demographic trends in voluntary termination of pregnancy (MTP) over a 17 year period and to study contraceptive acceptance in patients undergoing MTP.
METHOD(S) : Retrospective analysis of 28236 MTP cases from hospital records over a span of 17 years was carried out. Various parameters like age, residence, religion, marital status, educational status, parity, number of male children, weeks of gestation, and contraceptive acceptance were studied.
RESULTS : There was no decline in the rate of induced abortion over the 17 year period. Only 1.1% women were in the teenage group. Most (99.4%) of the women were married. 72.5% women were having two or more living children. 73.7% had one or two male children irrespective of the number of female children. 89.3% had less than 12 weeks pregnancy at the time of termination. 52.7% accepted intrauterine contraceptive device (IUCD). 38.4% underwent sterilization. 1.7% accepted barrier or hormonal methods, while 7.2% did not accept any contraception. In 1988, 82.8% women accepted one of the contraceptive methods, while in 2004, 98% accepted it.
CONCLUSION(S) : Although significant number of women practice contraception, induced abortion is unfortunately used to control family size and for birth spacing. The rate of termination in multiparas has increased over the years. The rate of termination of pregnancy after 12 weeks has declined over the last 3 years.
induced abortion, sterilization, voluntary termination of pregnancyOBJECTIVE(S) : To compare oral with vaginal administration of misoprostol for induced abortion in women treated initially with mifepristone.
METHOD(S) : We administered 200mg of mifepristone to 128 women seeking termination of pregnancy within 9 weeks of amenorrhea. Forty eight hours later, they were assigned to receive 800 ? g misoprostol either orally or vaginally.
RESULTS : The complete abortion rates in vaginal group and oral group were 96.7% and 86.2% respectively. Median induction to abortion interval was significantly longer in women in the oral group compared to that in the vaginal group (P=0.04).
CONCLUSION(S) : Mifepristone followed by vaginal misoprostol was more effective at inducing an abortion up to 9 weeks of pregnancy than followed by oral form.
medical abortion, mifepristone, misoprostol