A Non-Communicable Disease (NCD) is a non-infectious disease condition that can last for a long term but cannot spread from person to person. These illnesses take a long time to develop and do not present symptoms in the early stages. They require treatment for several years, and some require life-long treatment. There are several diseases which fall into this group of conditions. Cardiovascular Diseases, stroke, Diabetes, Cancer, mental health, dementia, infertility, obesity and overweight and other Chronic Respiratory Diseases are categorized as Non-Communicable Diseases. In the last few years, these diseases have become an epidemic in India, due to changes in lifestyles, increase of aging populations, unplanned urbanization, and globalization. An assessment by WHO early in the Covid pandemic found that 94% of countries reported that all or some of the staff working on NCDs in health ministries had been reassigned to COVID-19. As intermittent lockdowns and high infection rates compounded the pressure on all health-care systems, there were huge declines in the screening and treatment of NCDs. Cancer registration and screening fell rapidly where cancer registrations decreased by around 40%. The result has been a screening deficit of millions of people. Another cause of premature mortality, is the increasing occurrence of injuries. They include both unintentional and intentional injuries- due to road traffic accidents, burns, workplace related injuries, and violence. In July 2020, the UN Economic and Social Council (ECOSOC) adopted a resolution on prevention and control of NCDs, titled ‘Coordination, programme and other questions: prevention and control of non-communicable diseases’ (E/ RES/2020/22) The government in India has been implementing the National Programme for Prevention and Control of Cancer, Diabetes, Cardiovascular diseases and Stroke (NPCDCS). This is now implemented through the National Health Mission. Preventive aspect of NCDs is strengthened under Comprehensive Primary Health Care through Ayushman Bharat Health Wellness Centre scheme, by promotion of wellness activities and targeted communication at the community level. Other initiatives for increasing public awareness about NCDs and for promotion of healthy lifestyle includes observation of National & International Health Days and use of print, electronic and social media for continued community awareness. Furthermore, healthy eating is also promoted through FSSAI. Fit India movement is implemented by Ministry of Youth Affairs and Sports, and various Yoga related activities are carried out by Ministry of AYUSH. In addition, NPCDCS gives financial support under NHM for awareness generation (IEC) activities for NCDs to be undertaken by the States/UTs as per their Programme Implementation Plans (PIPs). India has more than 35,000 gynaecologists practising in rural and urban areas. They are one point contact for women’s health. They can definitely help to reduce the burden on NCDs provided each and every gynaecologist screens all patients for non-communicable diseases. The problem is that all over the world, gynaecologists are not always screening for non-communicable diseases in their patients.
Important clinical pointers are
Undertake follow-up of patients with Non-Communicable Diseases, support them to adhere to treatment and to make changes in their lifestyles.
Introduction The World Health Organization defines obstetric (maternal) sepsis as organ failure caused by infection during pregnancy, childbirth, post-abortion or postpartum period. It is the third most prevalent reason for maternal death. According to statistics, sepsis caused 11 percent of maternal fatalities worldwide.
Discussion Physiological changes related to pregnancy may imitate the start of sepsis, which makes definitive diagnosis difficult. The definition of sepsis is gradually amended over decades. Various diagnostic tools and criteria are available.
Conclusion Prevention, early diagnosis, and appropriate management can reduce sepsis related maternal mortalities and morbidities. To reduce unnecessary maternal mortality, future policy development in the area of evaluation and care of obstetric sepsis is essential.
Background
COVID-19 infection has raised multiple concerns in pregnant mothers; many questioned the risk of vertical transmission and the implication on the feto-maternal outcome. Cardiotocogrm (CTG) is the principal method to observe intrapartum fetal well-being. This paper aims to verify intrapartum CTG changes seen in seropositive COVID-19 mothers versus healthy controls and looks into their relation to subsequent delivery mode and neonatal outcome.
Methods
A case–control study recruited 90 pregnant women at the labor word of AL Yarmouk Teaching Hospital. All were term pregnancy admitted for delivery. They were grouped into 2: seropositive COVID-19 confirmed by real-time RT-PCR test (30/90) and healthy controls (60/90). We recorded their demographic criteria, laboratory results, CTG changes, delivery mode, and indication.
Results
COVID-19 cases showed significantly higher pulse rate, temperature, and leukocyte counts. Cesarian deliveries (CS) were higher in cases versus healthy controls (70 % vs. 53.3 %) and P = 0.45. Analysis of the CS indications showed that abnormal fetal heart tracing accounts for 33.3 % versus 15.6 % (P-value = 0.015) for cases versus healthy controls. 60 % of COVID-19 cases exhibited abnormal CTG changes versus 19.4 % in healthy controls. These changes were primarily fetal tachycardia and reduced variabilities.
Conclusions
The higher incidence of abnormal CTG in COVID-19 cases, alongside infection signs and symptoms, underlies the exaggerated inflammatory reactions inside the pregnant mother. These inflammatory reactions are the main causes of CTG changes and higher CS rates. Therefore, obstetricians are advised to optimize the maternal condition to rectify reactive CTG changes rather than proceeding into urgent CS.
Background
HDP-gestosis score is a risk scoring system (score 1–3) for the development of pre-eclampsia. When a pregnant woman’s total score is equal to or greater than 3, she is labelled as “at risk for pre-eclampsia” and is managed accordingly. Objectives To determine the sensitivity, specificity, Positive predictive value (PPV), negative predictive value (NPV) and diagnostic accuracy of HDP-gestosis score for predicting pre-eclampsia.
Methods
This prospective study included 473 pregnant women who presented at the department of Obstetrics and Gynaecology, from June 2020 to December 2021. After 20 weeks of pregnancy, the patients were assessed for the development of pre-eclampsia. Details of age, gravida, obstetric history, menstrual cycle regularity, polycystic ovarian disease history, duration of marriage, parity, past medical and surgical intervention, previous/present medication, and family history were taken. Gestosis score was calculated and classified into mild (score of 1), moderate (score of 2) and high risk (score of≥3) for the development of Pre-eclampsia (PE). Sensitivity, Specificity, PPV, NPV and diagnostic accuracy of HDP-gestosis score for predicting the development of PE were determined.
Results
The mean age, gestational age, and BMI of the women were 28.4±6.8 years, 11.5±2.04 weeks, and 24.5±3.7 kg/ m2, respectively. The gestosis score was 2 in 43.13% of the participants, 1 in 42.28%, and≥3 in 14.59% of the women. PE developed in 15.01% (n=71) participants. The Sensitivity, Specificity, PPV, NPV, and Diagnostic accuracy of HDP-gestosis score for predicting PE were 83.1%, 97.51%, 85.51%, 97.03% and 95.35%, respectively.
Conclusion
Gestosis score is a novel early marker for prediction of the development of PE allowing for a prompt management for the patients, thereby curbing the adverse consequences
Introduction
Iron deficiency anemia (IDA) in pregnancy has a prevalence as high as 40–60% in different countries of the world. Oral iron is used to treat his commonest medical disorder in pregnancy. Ferrous sulphate is associated with considerable side effects. Ferric carboxymaltose (FCM) is a newer iron preparation which allows for single and higher dose (up to 1000 mg) of IV iron infusion. This study was conducted to compare the efficacy of FCM and FS in treating IDA during pregnancy.
Methods
A randomised control trial was done at a tertiary care centres involving 362 women (181 women each in FS and FCM group). The pregnant anemic women with IDA were enrolled between 18 and 34 weeks of pregnancy. They were given 1000 mg of FCM iv as single dose or were given FS tablets twice daily (120 mg iron daily). The data were collected for rise in the Hb and serum ferritin over a period of 6 weeks.
Results
Nine and 18 patients were lost to follow-up in the FCM and FS group, respectively. The data were analysed as per protocol analysis. FCM group women showed 2.6 gm% rise in Hb compared to 1.7 gm% of FS group. One hundred and sixty-six out of 172 women in FS group achieved anemia correction at 6 weeks. No difference was observed in the neonatal outcome. No major side effects were observed in the either group.
Conclusion
In our study, FCM was more effective than oral FS in increasing Hb in women with IDA during pregnancy. This clinical benefit with FCM was achieved without the concerns for safety and tolerability of the drug.
Background
This study aimed to investigate the serum levels of mucoprotein 3 in hypertensive diseases of pregnancy.
Methods
In total, 60 consecutive women with gestational hypertensive diseases (gestational hypertension (n = 20), severe preeclampsia (n = 20), HELLP syndrome (n = 20)) and 20 pregnant women without any gestational hypertensive diseases were included for this prospective controlled study. Serum MUC3 protein levels were measured with commercially available ELISA kits.
Results
Serum MUC3 protein level was the lowest in normal pregnant women (0.1047 ± 0.0295 ng/ml); while the severity of the disease increases, it significantly increased in severe preeclampsia (0.2700 ± 0.0199 ng/mL) and HELLP syndrome group (0.3494 ± 0.0455 ng/mL), but less in the gestational hypertension (0.2172 ± 0.0354 ng/mL) group. Mean serum MUC3 protein level differences were found the least in gestational hypertension (0.1125 ± 0.0107, p < 0.001), the most in HELLP syndrome (−0.2546 ± 0.0107, p < 0.001) compared with the pregnant control group.
Conclusion
The increase in serum MUC3 protein concentration in these women supported the argument that serum MUC3 protein may be used as a marker indicating the severity of the gestational hypertensive diseases.
Background
The two prongs for cervical cancer prevention are vaccination for primary prevention and effective screening for preinvasive and early invasive disease. Until human papilloma virus DNA testing can be provided in low resource settings, screening with VIA is the most feasible option. Various innovative methods have been used to improve the diagnostic accuracy of visual inspection with acetic acid (VIA). This study explores one such option.
Method
We modified VIA (VIA-Md) by using a magnifying lens mounted with battery operated light emitting devices (LEDs) to study the acetowhite areas on the cervix. The peak wavelength of the light from the LEDs was in the bluish white range. The results of VIA and VIA-Md were compared using colposcopy directed biopsy as the reference standard.
Result
The study was conducted in 273 eligible women. The sensitivity of VIA and VIA-Md for detecting CIN2 + lesions were 57.1% and 100% respectively. The specificity of VIA and VIA-Md were 99.2% and 89.5%; and p values using the colposcopy directed biopsy as the reference standard were 0.000 and 0.018 respectively. However, VIA-Md was also effective in identifying 21 out of the total 32 cases of chronic cervicitis identified by colposcopy directed biopsy.
Conclusion
VIA-Md appears to be a highly sensitive test for detection of CIN2 + lesions. However, because of concerns regarding lower specificity, VIA-Md can be used simultaneously with VIA as an effective tool for triaging women who need to be kept under close surveillance or who might benefit from local ablative therapy.
Objective
This study aimed to investigate the anatomical changes in the pelvic floor of women with breast cancer using tamoxifen by transperineal 3D ultrasonography and their effect on the urinary incontinence and sexual dysfunction.
Methods
Ninety-four patients with breast cancer using TAM in the study group and ninety-five healthy women of the same age in the control group were included in this prospective cohort study. Female Sexual Function Index and Incontinence Questionnaire-Short Form scales were applied to both groups. Ultrasonographic evaluation was performed at resting and Valsalva Maneuver with a convex (3–8 MHz) probe transperineally and the levator urethra gap and levator hiatus diameter were measured after 3-dimensional imaging. Independent t-tests were performed for statistical analysis.
Results
The mean age and body mass index of the experimental group versus control groups were 46.3 ± 6.12 years versus 46.4 ± 5.23 years and 27.6 ± 4.34 kg/m2 versus 29.2 ± 6.45 kg/m2, respectively. LUG and LH values were found significantly higher for the experimental groups compared to control groups at 17.23 ± 2.53 mm versus 14.1 ± 2.23 mm and 21 ± 2.45 cm2 versus 18 ± 4.56 cm2, respectively. (p < 0.05). The FSFI score significantly decreased (12.49 ± 3.58 versus 20.89 ± 3.69) and the ICIQ-SF score increased (4.02 ± 0.34 versus 2.34 ± 0.45) in the experimental group in comparison to control group (p < 0.05).
Conclusion
This study demonstrated that the effects of TAM usage on pelvic floor can be detected by measuring the changes in the levator ani muscle using the transperineal 3D USG. With transperineal USG screening, pelvic floor changes can be early diagnosed and clinical measures can be taken before they become symptomatic.
Objective
To evaluate pelvic floor muscle strength (PFMS) in nulliparous, parous and postmenopausal women using vaginal digital palpation and perineometer.
Material and Methods
It was a cross-sectional study, conducted in department of Obstetrics and Gynecology, VMMC & Safdarjung hospital. A total of 300 women were recruited from Gynaecology and Family welfare outpatient departments and divided into 3 equal groups—nulliparous women, premenopausal parous women and postmenopausal women. PFMS was measured by modified Oxford Scale with vaginal digital palpation and by perineometer. Linear regression analysis was performed to evaluate and compare mean PFMS and identify its associated factors.
Results
Median age was 21 years in nulliparous, 27 years in parous and 58 years in postmenopausal group. The average body mass index was 27.45, 28.01 and 34.63 kg/m2 in nulliparous, parous and postmenopausal group. The mean MOS by digital vaginal palpation was 4.66 in nulliparous, 3.9 in parous and 2.54 in postmenopausal women. The difference was statistically significant. The mean PFMS by perineometer was 40.04 cm H2O, 37.69 cm H2O and 34.93 cm H2O in nulliparous, parous and postmenopausal group, respectively. The difference was statistically significant (p < 0.001). Majority (50%) of nulliparous women had PFMs between 41 and 50 cm H2O and parous (81%) had PFMS between 21 and 30 cm H2O. There was a statistical significance between the groups.
Conclusions
The PFMS of nulliparous women was significantly higher than multiparous women, and difference was statically significant (p < 0.001). Age had an important influence on pelvic floor muscle before menopause, but after menopause, it is years of menopause which has significant negative impact on PFMS and not age.
Objectives
DNA methylation of paired box-1 (PAX-1) gene has been shown to be a potential biomarker for the detection of high-grade cervical intra-epithelial neoplasia (CIN) and invasive cervical cancer. The objective of this pilot study was to quantify and compare methylation percentage of PAX1 gene in benign cervical lesion, pre-invasive and invasive cervical cancer.
Methods
A total of 200 screen positive women (VIA, VILI and Pap test) underwent colposcopy. Cervical scrapes taken were taken and stored for DNA analysis and PAX 1 methylation status. Women with Swede score of 5 or more (n = 98) were biopsied. Cervical scrapes and biopsy were taken from women with obvious cervical growth (n = 14), without prior colposcopy. Sixty women were recruited to the study and allocated into three groups on the basis of histopathology, i.e., benign cervix (Group 1; n = 20), CIN 2/3 (Group 2; n = 20) and invasive cervical carcinoma (Group; n = 20). PAX 1 methylation percentage was calculated from the DNA extracted from the cervical scrapes of the women recruited.
Results
The mean PAX1 methylation percentage in benign lesions, CIN 2/3 and invasive cancer was 9.58% (SD ± 2.37%), 18.21% (SD ± 2.67%) and 24.34% (SD ± 4.09%), respectively, with p-value of < 0.001.
Conclusions
PAX 1 gene methylation has a promising role in identifying high-grade lesions and invasive cancer.
Background
Ergot derivatives are commonly used for the treatment of postpartum as well as postabortal hemorrhage. Peripheral Gangrene is a rare acute complication of administration of ergometrine and its analogue in patients with postpartum or postabortal hemorrahge
Case report
We report a case of 25 years multipara with undiagnosed primary antiphospholipid antibody syndrome, develops fingertip gangrene after the use of Inj Methergine to manage postabortal hemorrage.
Conclusion
Methergine use always needs a word of caution, before its use we have to rule out all the contraindications and assess high risk patients who have high chances of complications.
Labetalol is a commonly used first-line drug for the treatment of gestational hypertension (GHT). It has rarely been associated with Raynaud’s phenomenon of the nipple (RPN). Herein, we report a case of labetalol-associated RPN, the first from India. A 30-year-old woman, gravida 1, para 0, with no significant medical history and regular antenatal check-up was diagnosed with GHT at 34 weeks of gestation. She was initiated on tablet Labetalol 100 mg twice daily. Around 1-hour after the first dose, she complained of severe burning sensation with severe tenderness at nipple-areola area, lasting 2-3 hours. She experienced similar symptoms, within 45 minutes of second dose and immediately contacted her Obstetrician. Subsequently, tablet Labetalol was withdrawn and tablet Nifedipine 20 mg twice daily was initiated, following which she did not experience any adverse events and pregnancy remained uneventfully till delivery at full-term. Spontaneous resolution of nipple-related adverse event, absence of similar event following initiation and continuation of Nifedipine, and review of literature allowed us to reach the diagnosis of labetalol-associated RPN. Through this case, we intend to report a rarely documented adverse event associated with Labetalol use in pregnancy. Moreover, Obstetricians should be made aware of Labetalol-associated RPN. When prescribing Labetalol in pregnancy, patient should be counselled regarding any nipple-related discomfort and encouraged to report on an urgent basis.
Case report of a 50 year old lady presenting with leiomyosarcoma after hysterectomy. This is a case of leiomyosarcoma occurring after a hysterectomy done for benign fibroids occurring after 3 years of the surgery. The rarity of this case is due to rare diagnosis of uterine smooth muscle tumour of uncertain malignant potential (STUMP) in patients and incidence of leiomyosarcoma in these cases.
Objective
To study the incidence and risk factors for obstetric brachial plexus palsy and assess the functional outcome.
Material and Methods
Five-year data of infants with OBPP were reviewed. Case–control study was performed using matched controls to identify the risk factors. Infants with OBPP were followed up to assess functional outcome.
Results
Of the 14,184 live births over a period of 5 years from 2013 to 2017, 23 (11 males, 12 females) had OBPP. Incidence of OBPP was 1.6 per 1000 live births. Higher birth weight (p-value 0.002) and instrumental delivery (p-value 0.02) were independent risk factors for obstetric brachial plexus palsy by multivariate logistic regression analysis. No cases of obstetric brachial plexus palsy were seen in babies born by cesarean section. 95% of the infants with obstetric brachial plexus palsy had complete recovery by 4 months of age.
Conclusion
Higher birth weight and instrumental vaginal delivery are independent risk factors for obstetric brachial plexus palsy. Cesarean section may have a protective effect against OBPP. Most infants with obstetric brachial plexus palsy have complete recovery.
Obstetric brachial plexus palsy · Instrumental delivery · Birth weight · Residual deficit