Abstract

Infertility treatment in couples where one or both parents are infected with hepatitis raises many concerns about transmission of the infection to the baby, laboratory technicians, and medical staff, and contamination of other gametes/embryos that are from virus-free parents in the same laboratory. Exposure to the other partner is only a risk when the couple’s hepatitis status is discordant. The management of infertility, in association with HBV or HCV, has sparked debates about the potential risk of spread of infection to virus-free individuals, embryos, and/or semen. This risk can only be minimized or eliminated by the use of SOPs for safety in fertility clinics and by the use of proper initial detection and segregation of potentially hazardous materials. HBV may interfere with the development of embryos and even result in abortion and other adverse outcomes. Although sexual transmission of HCV is very low, in subfertile or infertile couples sperm washing should be used to treat HCV-positive semen before ART. Testing for HBsAg and HCV should be offered to high-risk infertile couples seeking fertility therapy to reduce the potential risk of transmission to an uninfected partner, baby, staff members, and disease-free gametes and embryos in the same laboratory. Testing for HIV, HBsAg, and HCV status should be performed on the couple prior to cryopreservation of semen or embryos.

Abstract

Aims: Gestational trophoblastic neoplasia (GTN) comprise a spectrum of interrelated conditions originating from the placenta. With sensitive assays for human chorionic gonadotropin (b-hCG) and current approaches to chemotherapy, most women with GTN can be cured with preservation of reproductive potential. The purpose of this analysis was to address the outcome of GTN in patients from a tertiary care center of India.

Materials and Methods: We undertook a retrospective and prospective review of GTN cases treated at our center over a period of 7 years from 2008 to 2014. Patients of GTN were assigned to low-risk or high-risk categories as per the FIGO scoring system. The low-risk group was treated with combination of actinomycin-D and methotrexate and the high-risk group received the Etoposide, Methotrexate, Actinomycin-D/ Cyclophosphamide, Vincristine (EMA/ CO) regimen. Salvage therapy was Etoposide, Paclitaxel / Paclitaxel, Cisplatin (EP/TP). Treatment was continued for three cycles after normalization of b-hCG level, after which the patients were followed up regularly.

Results: In total, 41 GTN patients were treated at our institution during the above period; 17 were in the low-risk and 24 were in the high-risk category. The lung was the most common site of metastasis. All low-risk patients achieved complete remission. Among high-risk patients, one patient died while receiving first cycle chemotherapy, one patient relapsed, and 22 patients achieved complete remission. The single relapsed patient also achieved remission with second-line chemotherapy.

Conclusion: Risk-stratified treatment of GTN was associated with acceptable toxicity and resulted in outcome that was comparable with international standards. The use of two-drug combination in low-risk patients is a better option especially in developing countries.

Abstract

Purpose: Hyperemesis gravidarum is the third leading cause of hospitalization during pregnancy. 5-HT3-receptor antagonists are the most effective against chemotherapyinduced nausea and vomiting and radiation. This randomized study aimed to compare and evaluate the efficacies of granisetron and promethazine for controlling nausea and vomiting of pregnancy.

Methods: The included patients were administered (oral and intravenous) granisetron and promethazine randomly. The patients were evaluated for nausea and vomiting by a senior gynecology resident blinded to designated drugs.

Results: This study revealed that granisetron significantly decreased nausea and vomiting in pregnant women (p < 0.05). Greater patient satisfaction and lesser adverse drug reactions in women receiving granisetron observed in this study suggest that it can be introduced as a more effective and safer drug in comparison with promethazine.

Conclusions: Considering the prevalence of nausea and vomiting of pregnancy and hyperemesis gravidarum, we can state that it is a health-related problem with economic, social and psychological dimensions. All efforts especially simple outpatient strategies to reduce its severity will help the pregnant woman continue her pregnancy with more satisfaction.

Abstract

Background: Congenital Adrenal Hyperplasia (CAH) is a disorder an ideal candidate to deserve newborn screening. CAH accounts for a significant mortality and morbidity in India, and its awareness among obstetricians should be treated as highly important to prevent the problem.

Purpose of the Study: It is very important for a country like India as the incidence of CAH is reasonably high justifying screening program. However, there are simple logistics that need to be followed, and the treating physicians need to be aware of, if one has to reduce the number of false positives and recalls.

Methods: This article takes one through the steps involved in the analysis, interpretation, and reasons for false positives, why the false positives, so that unnecessary calls to parents for repeat sampling are minimized along with the emphasis and the need for the routine screening for CAH.

Results/Conclusion: The results of samples can vary depending on the gestational age of the baby, weight of the baby, sampling time, and the knowledge of these data to the treating Obstetrician and Pediatrician is of paramount importance in preventing repeat samples and frustration for the family and the people involved.

Abstract

Abstract: Antepartum stillbirths are a major contributor to perinatal mortality. This study was undertaken to assess the role of the ReCoDe (relevant condition at birth) classification system in evaluation of stillbirths in a tertiary teaching hospital in Central Gujarat.

Aim: To determine etiology of stillbirths using the ReCoDe classification system.

Materials and Methods: This was a prospective case control study over a period of 1 year from September 1st, 2012 to August 31st, 2013. Sample size was calculated as 243 cases and 486 controls. Two controls (live births) per case were matched for gestational age and birth weight. Odd’s ratios with 95 % confidence intervals were calculated using multivariate logistic regression.

Results: Maternal age and parity that appeared to be highly significant factors on univariate analysis were not found to be independent risk factors with multivariate logistic regression. Gestational age and birth weight were not statistically significant risk factors. Other risk factors like previous stillbirth (26.13; 95 % CI 3.23–211.29), antepartum hemorrhage (11.63; 95 % CI 3.83–35.30), and hypertensive disorders (2.09; 95 % CI 1.20–3.63) were found to be highly significant independent risk factors. Major congenital anomaly (P < 0.001), birth asphyxia (P = 0.0037), cord accidents (P = 0.0037), and rupture uterus (P = 0.001) were also highly significant.

Conclusion: The stillbirth rate was 87.83 per 1000 live births. The ReCoDe primary classification system enabled 74.1 % of the cases to be assigned a relevant condition, leaving only 25.9 % as unexplained. The single largest condition associated was fetal growth restriction (25.9 %).

Abstract

Methods: This study for medical abortion was conducted in the Department of Obstetrics and Gynaecology, Zenana Hospital, SMS Medical College, Jaipur during 2011–2012. In total 280 cases were taken for the study and divided into two groups, among whom there were six defaulters in each group who failed to present for follow-up.

Objectives: The objectives of this study were to (1) compare the success rates of abortion at different gestational ages, (2) study the side effects of the drugs, and (3) study the acceptability in both the groups.

Results: The medical abortion with the given regimen and protocol was observed to be highly successful, and complete abortion was achieved in 98.51 and 97.76 % of the patients in Group-A and Group-B, respectively. Failure rates observed were only 1.49 % in Group-A and 2.24 % in Group-B.

Conclusions: Medical abortion can be safely performed in cases up to 63 days of gestation, but women should be counseled about the increased blood loss and duration of bleeding.

Abstract

Objectives: To study myometrial thickness (MT) sonographically as a predictor of latency interval in women with preterm premature rupture of membranes (PPROM).

Study design: The data were collected in a prospective manner from the antenatal patients between November 2011 and June 2013 during the follow-up of patients in the Department of Obstetrics and Gynecology, Goa Medical College. 100 patients with the periods of gestation of 28–36 weeks were studied, out of which 50 were PPROM cases and 50 were controls, both not in labor. The demographic factors and MT of uterine wall are measured at four different levels: midanterior, posterior, lower uterine segment (LUS), and fundus, which are then compared with the latency interval which is defined as the time from the rupture of membranes to the time of delivery.

Results: There was a significant inverse relation between the periods of gestation and latency interval, and positive correlation between anterior MT (p value 0.047), LUS thickness (p value 0.000), and latency interval implicating that the thicker the myometrium at admission in cases of PPROM the longer the latency period.

Conclusion: MT appears a promising tool for obstetricians for predicting latency in cases of PPROM and guiding the management.

Abstract

Objective: To study the role of low molecular weight heparin (LMWH) in perinatal outcome.

Methods: A randomized, case control study was conducted at Safdarjang hospital, New Delhi. Patients were recruited from Sept. 2011 to May 2013 and were followed up till delivery. Thirty cases and controls were enrolled which comprised non-thrombophilic patients with previous history of preeclampsia, fetal growth restriction, abruption, and stillbirth ( > 20 weeks). Study group received daily single dose of LMWH depending upon the weight, subcutaneously; it was started before 15 weeks of gestation and continued up to 36 weeks. Nursery/NICU admission, APGAR score at 0 and 5 min, birth weight, gestational age at delivery, mode of delivery were observed among the interventional and control groups.

Result: There was substantial reduction (80 %) in nursery/ NICU admission. The mean gestational age and birth weight of the cases were observed to be higher as compared to those of control (38.05 ± 2.02 vs. 37.58 ± 2.06 weeks and 2770 ± 400 vs. 2530 ± 0.533 g).

Conclusion: Prophylactic LMWH before 15 weeks of gestation improved the perinatal outcome in non-thrombophilic pregnant women.

Abstract

Purpose: This cross-sectional observational study was undertaken to assess perinatal outcome of the second twin in respect to gestational age, presentation, mode of delivery, and birth weight.

Methods: Seventy women with confirmed twin pregnancy were admitted and managed in a tertiary care teaching hospital in Kolkata, India from May 2008 to April 2009. All relevant data were recorded and analyzed statistically by simple proportions and v2 test.

Results: Women with frequent antenatal visits had highly favorable perinatal outcome than those with fewer or no visits in this hospital (p < 0.001). Higher perinatal mortality was observed among preterm than term (p < 0.01) cases, and among low birth weight than normal babies (p < 0.05). Second twins in vertex–vertex presentation encountered higher perinatal mortality compared to those in vertex–nonvertex and nonvertex–other presentations (p < 0.05). Perinatal outcome was unfavorable when both delivered vaginally than for both cesarean deliveries and cesarean after first vaginal delivery (p < 0.01). Preterm labor was the most frequently observed maternal complication. Birth asphyxia and perinatal mortality were common among second than first twins.

Conclusions: Gestational age, presentation, mode of delivery, and birth weight are the significant determinants of perinatal outcome of the second twin. Women with frequent antenatal care show favorable outcome. The second twin is at higher risk of perinatal morbidity and mortality than the first twin.

Abstract

Objective: This study was conducted to compare underweight and obese women and their weight gain during pregnancy on fetomaternal outcome.

Method: This is a prospective, non-interventional, observational study on 1000 women (BMI between 20 and 30 were excluded). Women attending ANC OPD with singleton pregnancy at or before 16 weeks were included and BMI calculated in early pregnancy. Their weight gain during pregnancy was noted. Any complications in the mother or perinate were noted.

Results: Incidence of obesity in our institute was 17 % and that of underweight was 18 %. Pre-eclampsia, gestational hypertensions, gestational DM, antepartum hemorrhage, all were more common among obese women, while anemia was more common in the underweight. Post-dated pregnancy, induction of labor, cesarean delivery, and postpartum complications were more common in obese women. Fetal complications were also higher in obese patients.

Conclusion: Lower as well as higher prepregnancy BMI is an independent risk factor that is associated with increased morbidity and mortality in both the mother and the fetus.

Abstract

Background: HIV-positive females are more likely to have abnormal Pap smears than HIV-negative women. These abnormal Pap smears are usually associated with low CD4 cell counts and human papilloma virus infection.

Materials and Methods: This was a prospective hospitalbased study from April 2013 till March 2014. A total of 250 (both symptomatic and asymptomatic) HIV-positive females were examined in Gynaecology OPD at R.C.S.M. G.M.C and C.P.R. Hospital, Kolhapur, and their cervical smears were taken. They were categorized as per modified Bethesda system 2001. The findings in HIV-positive women were correlated with risk factors (age, disease duration, CD4 count and ART use).

Aims: To study the spectrum of cytological abnormalities on Pap smear in HIV-positive females and classify precancerous and cancerous lesions in HIV-positive females according to Bethesda system 2001 and to be familiar with terminology and morphological criteria of Bethesda system 2001. To study the association of Pap smears abnormalities among HIV-positive women with their immune status (CD4 count).

Results: NILM is the commonest finding (83.2 %) which is subdivided into non-inflammatory, non-specific and specific inflammatory and atrophic smears. Candida vaginitis was the commonest cause of specific inflammatory condition accounted for (2.52 %) of all inflammatory smears. The percentage of squamous cell abnormalities was 12 %: ASCUS ? ASC-H—6.22 %, LSIL—2.10 %, HSIL—3.4 % and SCC—0.8 %. The highest incidence of intraepithelial lesions in HIV-positive females was in the age group 31–40 years. There is no association of Pap smear abnormalities among HIV-positive women with their immune status (CD4 count) and duration of ART.

Conclusion: Periodic, regular gynaecologic and Pap smear examination would help in early detection of intraepithelial lesions and their treatment so as to prevent invasive malignancy and mortality.

Abstract

Purpose: The purpose of this study was to correlate the clinical findings, RMI-4 index and frozen section, in cases of ovarian fibroma with the final histopathology.

Methods: This is a retrospective study of clinical and pathological features of 23 patients of ovarian fibroma. The patient’s age ranged from 34 to 66 years (mean— 49 years). The most common presenting symptom was abdominal pain. On clinical examination, the mean size of ovarian tumor was 9.5 cm, CA-125 levels were found to be raised in 14 patients, and it was associated with ascites in 10 patients. USG showed a well-circumscribed mass (with a mean size of 14 cm), on the left side in 14 cases and on the right side in 9 patients. RMI-4 was calculated in all the patients, and it revealed the possibility of a benign histology in 17 patients. All patients underwent exploratory laparotomy with the removal of ovarian tumor followed by frozen section examination. All but one (22/23) patient had positive correlation among frozen section and final histopathological findings.

Result: Ovarian fibroma generally tends to occur in postmenopausal women. All the patients in our study of ovarian fibroma were symptomatic, with the presence of palpable mass in majority of patients. RMI-4 Index correlated very well with benign nature of disease. Frozen section has an invaluable role at surgery; fertility-conserving surgery is the choice in young women.

Conclusion: Clinical findings, RMI-4 Index and frozen section, play vital roles before and during surgery in cases of benign ovarian tumors.

Abstract

Background: Metabolic syndrome (MetS) is on the rise due to the epidemic increase of obesity. It increases the risk of atherosclerotic cardiovascular diseases and type II diabetes mellitus.

Aims: To study the prevalence of MetS and its components in premenopausal and postmenopausal women.

Design: Cross-sectional comparative study.

Material and Method: Five hundred premenopausal women and 500 postmenopausal women in the age group 40–65 years, attending OPD of Obstetrics and Gynecology Department of Pt. J.N.M. Medical College, Raipur from September 2012 to August 2014 were analyzed and assessed for the MetS risk factors and evaluated according to the NCEP ATP III criteria.

Results: The prevalence of MetS in postmenopausal women was 48.6 %, nearly 1.7 times the prevalence in premenopausal women (27.4 %). Except for central obesity and low HDL cholesterol, the frequency of hyperglycemia, high blood pressure, and hypertriglyceridemia were significantly higher in postmenopausal than in premenopausal women. All the five factors of NCEP ATP III criteria were present in 5 % of postmenopausal women in contrast to 0.4 % in premenopausal women.

Conclusion: Prevention is better than cure. The need of the hour is to target premenopausal women who are at risk of developing MetS in their postmenopausal age. It will delay and prevent them from future morbidities.

Abstract

Background: of the Study In India, although a number of contraceptive choices are available, the usage of contraceptive methods among postpartum women is rather low. The current study intended to determine the impact of ‘‘structured contraception counseling’’ on women’s decision making on selection of contraceptive methods and the reasons behind the selection of a contraceptive method.

Methods: One-hundred-and-seventeen postpartum women in the age group of 18–35 years, requesting contraception, were enrolled in the study. ‘‘Structured contraception counseling’’ was provided using a standardized protocol with balanced and comprehensive education material on the available hormonal and nonhormonal contraceptive methods. Questionnaires with information on the women’s pre- and post-counseling contraceptive choice, her perceptions, and the reasons behind her postcounseling decisionwere filled by the participatingwomen.

Results: Maximumwomen enrolled for the study were in the age group of 21–25 years. In pre-counseling, 36 % postpartum women selected a contraceptive method, 23.1 % a nonhormonal method, and 12.8 % a hormonal method. After ‘‘structured contraception counseling,’’ 92.25 % of women chose a contraceptive method. There were significant differences between the women’s choices of contraceptive methods in the pre- and post-counseling sessions, respectively [progesterone-only pills (POP): 5.1 vs. 38.46 %, (p < 0.001); injectable-depotmedroxy progesterone acetate (DMPA): 2.56 vs. 21.356 %, (p < 0.01); and intra uterine device (IUD): 10.28 vs. 23.92 %, (p < 0.001). 38.46 % chose a POP, 21.36 % injectable-DMPA, and 23.9 % the IUD].

Conclusion: ‘‘Structured contraception counseling’’ using standardized protocol resulted in significant improvements in the selection of contraceptive methods by postpartum women.

Abstract

Objective: This study has been designed with the intention to bring a substantial change in the mindsets or life skills of adolescent girls at secondary school level regarding their concept of child survival and safe motherhood practices in order to deal effectively with real-life situations.

Methodology: A cross-sectional analytical study was carried out with 538 adolescent girls regarding assessment of their knowledge on variables like correct nutrition, irondeficiency anemia and its prevention, care during pregnancy, safe birth, skilled birth attendance, breast feeding and complementary feeding practices, child’s growth and development issues, immunization, management of common childhood illnesses. etc.

Conclusion: Analysis was done using Mc Nemar’s Chisquare test for paired data. Values obtained were highly significant for nutrition, iron-deficiency anemia and its prevention, care during pregnancy, and management of childhood illnesses variables, whereas study findings were found to be insignificant for rest of the variables. This study based on life skills approach and counseling worked well to promote and motivate adolescent girls for positive decision making. In this context, every adolescent girl should be encouraged to raise her unsolved issues in order to achieve safe motherhood plus growth and development of their children.