Objectives: Fetal growth restriction is defined as a patho-logic decrease in the rate of fetal growth. The most frequentetiology for late onset fetal growth restriction is uteroplacentaldysfunction which is due to inadequate supply of nutrients andoxygen to support normal aerobic growth of the fetus. How-ever, for symmetrical IUGR, fetal chromosomal anomalies,structural anomalies and fetal infections should be carefullyexcluded. Consequent to the uteroplacental vascular malad-aptation of endovascular trophoblastic invasion, there isincreased vascular resistance and decreased blood flow to theplacenta in the choriodecidual compartment.
Conclusions: This under perfusion of the placenta causesvillous damage; that is, total tertiary villous capillary bed isreduced leading to increased placental resistance. Thesechanges can be diagnosed by Doppler and characteristicchanges are seen in the uterine, umbilical, middle cerebralarteries and ductus venosus vessels. In severe cases,delivery of the fetus with optimum intrapartum surveil-lance, or caesarean section, is essential.
IUGR, Placental insufficiency, Colour doppler, Low birth weightObjectives: This study was done to compare isoxpurinehydrochloride and nifedipine as tocolytic drugs for pretermlabor.
Methods: A prospective cohort study of 832 antenatalwomen with preterm labor was conducted in the Depart-ment of Obstetrics & Gynecology. Out of 400 womenfound eligible for tocolysis, 200 were given isoxpurinehydrochloride while the other 200 were given nifedipinerandomly. The data obtained was statistically analyzed onSPSS 10.0 of Windows 2003.
Results: Incidence of preterm labor was 22% while theincidence of preterm delivery was 20.9%. Nifedipine wastwice more effective than isoxpurine hydrochloride as atocolytic agent as a tocolytic agent (Pvalue 0.006) whileside effects were comparable (Pvalue 0.133). In early-diagnosed preterm labor, nifedipine had higher efficacythan isoxpurine (Pvalue 6.45910-6) and also higherefficacy than its own in late diagnosed preterm labor(Pvalue 2.08910-5).
Conclusions: There is a high incidence of preterm labor inIndia. Nifedipine is a better tocolytic drug than isoxpurinehydrochloride, especially when started with the earliestsigns of preterm labor.
Uterine tocolytics, Preterm birth, Betamethasone, Prematurity nifedipine, Isoxpurine hydrochlorideObjectives: To compare the effectiveness, safety ofimmediate induction with PGE2gel and expectant man-agement in terms of maternal and fetal outcome in termPROM.
Methods: 100 women were randomized to group A,immediate induction and group B expectant management.ResultsSpontaneous vaginal deliveries were more ingroup B. CS and operative vaginal deliveries were more ingroup A.
Conclusion: Expectant management followed by delayedinduction with oxytocin is better than immediate inductionwith PGE2gel in term PROM. A good number of womengo into spontaneous labor and deliver vaginally with outincrease in the Cesarean section rate and infectious mor-bidity for mother and fetus.
PROM, PGE2gel, Oxytocin, Immediate induction, Expectant managementObjective: To assess maternal cardiovascular functionusing echocardiography in normal and preeclampticwomen in the third trimester of pregnancy.
Methods: 40 subjects, 20 with preeclampsia and 20 nor-motensive controls with[34 weeks gestation and singletonpregnancy were recruited. Baseline characteristics, mater-nal and fetal outcome were studied with systolic and dia-stolic parameters on echocardiography.
Results: The following parameters were higher in pre-eclamptic subjects as compared to normotensive controls–mean cardiac output (66.85±4.56 ml/min vs. 56.1±1.77 ml/min); mean LV diastolic mass (131.15±16.85 vs.104.90±23.17 g); systolic mass (88.5±7.34 vs. 83.33±23.84 g); total vascular resistance (1396.85±150.2 vs.1204.5±71.182 dyne, s cm5). Women with preeclampsiadelivered smaller babies (2410±426.16 g) as comparedto normotensive controls (2895±276.20 g). Student ‘t’test was used as a test of significance.
Conclusion: Women with preeclampsia have significantsystolic and diastolic dysfunction compared to normoten-sive controls. Blood pressure monitoring alone is insuffi-cient to identify effectively, risk of cardiovascularcomplications in these subjects.
Echocardiography, Maternal, Systolic, Diastolic, Normal, PreeclampsiaObjective: This prospective study aimed to evaluatedimensions of sacral rhomboid (quadrangular area at lowerback) as predictors of Contracted pelvis (CP).
Methods: In 300 uncomplicated primigravidae after37 weeks gestation, transverse and vertical diagonal (TDand VD) of sacral rhomboid were recorded. Post- delivery,patients fell into two groups: Normal Deliveries (group 1)and CP (group 2, i.e., LSCS for contracted pelvis, instru-mental delivery for Non Progress of Labor (NPOL) or birthmishaps). Analysis was done with SPSS version 10.5 andcross tabulation.
Results: Rhomboid dimensions were smaller in CP group(Pvalue 0.003 and 0.012. On univariate analysis, 10thpercentile cutoff of TD was the most significant risk factorwith Odds ratio of 7.5 (95% CI 3.5–16.2). VD and heightbelow 10th percentile had Odds ratio of 2.7 (95% CI1.2–6.1) and 2.99 (95% CI 1.2–7.3), respectively. Bothdimensions of sacral rhomboid below 10th percentileincreased risk of CP by 13 times (OR 13, 95% CI 3.5–48.6)and detected 2 out of 3 at risk women.
Conclusion: Smaller dimensions of sacral rhomboid arepromising screening parameter for contracted pelvis whichcan be used in community to pick up high risk primigravidae.
Sacral rhomboid, Contracted pelvis, Primigravidae, Indian, PredictObjective: To evaluate the association of different factorswith postpartum depression.
Methods: A prospective study conducted in the Depart-ment of Obstetrics and Gynecology, Medical College,Kolkata. Six thousand patients, 4–7 days postpartum, wereinterrogated using Edinburgh Postnatal Depression Scale(EPDS). Sociodemographic factors (age, parity, literacy,socioeconomic status, marital status and family structure),history of psychiatric disorder and abuse, mode of deliveryand obstetric outcome were recorded. The results wereanalyzed statistically using Chi-square test.
Results: Incidence of PPD was 25%. Significant associationof PPD was seen with poor socioeconomic group (P\0.05),literacy (P\0.001), nuclear family structure (P\0.05),single mother (P\0.001), past history of psychiatric illness(P\0.001), history of abuse (P\0.05), and poor obstetricoutcome (P\0.001). Age, parity and method of deliveryshowed no association.
Conclusion: EPDS should be used routinely to screen forPPD among high risk cases.
Postnatal depression, Edinburgh postnatal depression scaleObjectives: To determine the efficacy of 400 mcg sub-lingual misoprost as an adjunct to suction evacuation infirst trimester pregnancy termination.
Method(s): During the study period of January2006–June2007, two hundred twenty-one pregnant women wantingfirst trimester pregnancy termination were randomised intotwo groups. In the study group of one hundred twenty-onewomen, sublingual misoprostol was used 3 h prior tosuction evacuation. In the control group of hundredwomen, direct suction evacuation was used. In cervicaldilatation achieved by misoprostol, time required for suc-tion evacuation, blood loss, pain perceived by patient andcomplications that occurred in the two groups were com-pared by STATA 9 stastistical software.
Result(s): In the study group, mean cervical dilatation wasup to 5.61 with Hegar dilator and in control group, it was5.03. (P=0.004). Average time required for suctionevacuation was 7.28 min in study group and 8.73 min incontrol group (P\0.0001). Blood loss was less in studygroup as compared to those in the controls. In study group,only 10.74% women perceived pain compared to twentypercent women in control group.
Conclusion(s): Use of sublingual misoprost prior to firsttrimester pregnancy termination by suction evacuationripens the cervix so there is less need for cervical dilata-tion, pain perceived by patient is less, the time required forsuction evacuation is less and there is reduction in bloodloss. Sublingual misoprostol is effective and safe for cer-vical ripening and dilatation before suction evacuation.
Misoprostol, First trimesterpregnancy termination, Suction evacuationObjectives: To compare the tocolytic efficacy of Nifedipineand Ritodrine, their adverse effects and neonatal outcome.DesignProspective randomized trial.
Methods: One hundred twenty women with clinical fea-tures of preterm labor fulfilling designated inclusion andexclusion criteria were enrolled in the study. They wereallocated to either nifedipine group or Ritodrine group byusing simple randomization technique. Tocolytic efficacy,maternal side effects and neonatal outcomes were evalu-ated. Tools of statistical analysis used were Epi Info soft-ware and Chi square test.
Results: Tocolysis was successful i.e., prolongation ofpregnancy for 48 h in 54 (90%) women in Nifedipinegroup as compared to 41 (68.3%) women in Ritodrinegroup (Pvalue=0.003 andv2=8.54). The prolongationof pregnancy up to 37 weeks was observed in 28 women(46.6%) in Nifedipine group compared to 16 women(26.6%) in Ritodrine group (Pvalue=0.033). 18 women(30%) in Nifedipine group had side effects compared to 48women (80%) in Ritodrine group (Pvalue\0.001).Neonatal outcome was similar in both the groups.
Conclusion: Oral Nifedipine is cheaper and effectivealternative which has fewer and less serious side effects ascompared to I.V. Ritodrine for suppression of the pretermlabor.
Preterm labor, Nifedipine, Ritodrine, TocolysisObjectives: To determine the efficacy of 400 mcg sub-lingual misoprost as an adjunct to suction evacuation infirst trimester pregnancy termination.
Method(s): During the study period of January2006–June2007, two hundred twenty-one pregnant women wantingfirst trimester pregnancy termination were randomised intotwo groups. In the study group of one hundred twenty-onewomen, sublingual misoprostol was used 3 h prior tosuction evacuation. In the control group of hundredwomen, direct suction evacuation was used. In cervicaldilatation achieved by misoprostol, time required for suc-tion evacuation, blood loss, pain perceived by patient andcomplications that occurred in the two groups were com-pared by STATA 9 stastistical software.
Result(s): In the study group, mean cervical dilatation wasup to 5.61 with Hegar dilator and in control group, it was5.03. (P=0.004). Average time required for suctionevacuation was 7.28 min in study group and 8.73 min incontrol group (P\0.0001). Blood loss was less in studygroup as compared to those in the controls. In study group,only 10.74% women perceived pain compared to twentypercent women in control group.
Conclusion(s): Use of sublingual misoprost prior to firsttrimester pregnancy termination by suction evacuationripens the cervix so there is less need for cervical dilata-tion, pain perceived by patient is less, the time required forsuction evacuation is less and there is reduction in bloodloss. Sublingual misoprostol is effective and safe for cer-vical ripening and dilatation before suction evacuation.
Misoprostol, First trimesterpregnancy termination, Suction evacuationObjectives: To compare the tocolytic efficacy of Nifedipineand Ritodrine, their adverse effects and neonatal outcome.
Design: Prospective randomized trial.
Methods: One hundred twenty women with clinical fea-tures of preterm labor fulfilling designated inclusion andexclusion criteria were enrolled in the study. They wereallocated to either nifedipine group or Ritodrine group byusing simple randomization technique. Tocolytic efficacy,maternal side effects and neonatal outcomes were evalu-ated. Tools of statistical analysis used were Epi Info soft-ware and Chi square test.
Results: Tocolysis was successful i.e., prolongation ofpregnancy for 48 h in 54 (90%) women in Nifedipinegroup as compared to 41 (68.3%) women in Ritodrinegroup (Pvalue=0.003 andv2=8.54). The prolongationof pregnancy up to 37 weeks was observed in 28 women(46.6%) in Nifedipine group compared to 16 women(26.6%) in Ritodrine group (Pvalue=0.033). 18 women(30%) in Nifedipine group had side effects compared to 48women (80%) in Ritodrine group (Pvalue\0.001).Neonatal outcome was similar in both the groups.
Conclusion: Oral Nifedipine is cheaper and effectivealternative which has fewer and less serious side effects ascompared to I.V. Ritodrine for suppression of the pretermlabor.
Preterm labor, Nifedipine, Ritodrine, TocolysisObjective: To compare efficacy and safety of 50lgmmisoprostol vaginal with oral for labor induction.
Methods: 110 women at term gestation, Bishop scoreB4,with various indications for labor induction were random-ized and double blinded. After decoding 51 women hadreceived misoprostol orally and 52 vaginally, four hourly(maximum six doses) or till woman went into active labor.
Results: Statistical analysis was done with SPSS 11.0. Invaginal misoprostol group induction delivery interval wassignificantly less (9.79 vs. 16.47 h) and successful induc-tion was significantly higher (90.38 vs. 74.51%) than oralgroup, with in 24 h of induction. As for as dose required isconcerned in vaginal group 40.38% women needed twodoses for delivery, in contrast 35.29% in oral group max-imum six doses were required.
Conclusion: Vaginal route of misoprostol is more effec-tive labor inducing agent than oral.
Vaginal misoprostol, Oral misoprostol, Induction of laborObjectives: The sex cord stromal tumors (SCST) accountfor approximately 7% of all malignant ovarian tumors.They are endocrinologically active tumors of which gran-ulosa cell tumors are the commonest. We describe ananalysis of all cases of SCST managed, in our departmentover the last five years and discuss two cases of unusualpresentation of these tumors.
Methods: Ten cases of SCST which were managed in theDepartment of Gynecology and Obstetrics at UniversityCollege of Medical Sciences (UCMS) & associated Guru TegBahadur hospital, Delhi from Jan. 01 to Dec. 05 were analyzed.
Results: Of the total 312 ovarian tumors which were oper-ated in these 5 years, 73 (23.3%) were malignant, 10 cases(13.6%) out of the malignant ovarian tumors were SCST.The age of presentation varied from 4 to 70 years. Fourwomen presented with lump abdomen as their chief com-plaint, 2 had postmenopausal bleeding, 2 presented withirregular bleeding per-vaginum, 1 woman had secondaryamenorrhea and one young girl who was only 4years olddeveloped precocious puberty. The majority of cases (70%)were granulosa cell tumors, 10% were fibromas and 20%thecomas. Maximum patients 9 (90%) were stage I at thetime of surgery and only 1 case was stage IV with tumorinfiltrating into omentum and gut.
Conclusion: SCST tumors are rare endocrine activetumors that are essentially unilateral, benign or with a lowmalignant potential. Though most patients present with oneor a combination of symptoms ranging from abnormalvaginal bleeding, abdominal distention and abdominalpain, the signs of Paraneoplastic syndrome (PNS) may bethe first indication of the presence of an ovarian malig-nancy and can even facilitate its diagnosis.
Sex cord, Ovarian, Paraneoplastic, Precocious, Granulosa cell, Endometrial hyperplasiaOne-third of all gynaecological consultationsare because of abnormal uterine bleeding (AUB). Thisproportion rises to more than 2/3rd when peri & postmenopausal women are considered. In normal to 12 weeksize uteri, the cause of abnormal bleeding often remainsobscure.
Objectives (S): Clinical and hysteroscopic evaluation ofthe cervical canal & uterine cavity of 100 women withAUB to evaluate various causes of AUB in the studypopulation.
Method (S): 100 women with AUB and uterine size nor-mal to 12 weeks pregnancy were subjected to clinical &hysteroscopic examination. The cause of bleeding wasevaluated.
Results: Menorrhagia (30%), menometrorrhagia (16%),oligomenorrhea (16%) and postmenopausal bleeding (2%)were some of the indications for hysteroscopy. Intrauterinepathology was diagnosed in 74% of cases. Hyperplasticendometrium (30%) and mucus polypi (28%) were themost frequent findings. 13% of the cases had multiplefinding. A surprising 7% had IUCD in their uteri withouttheir knowledge, while bony spicules was found in 1patient. Both patients with post menopausal bleeding hadatrophic endometrium.
Conclusion (S): Hysteroscopy can be easily learnt. It givesa clue to diagnosis in AUB and can reduce the burden ofhysterectomy in many cases which can be treated by simpleprocedures.
Abnormal uterine bleeding, Hysteroscopy, Menorrhagia, Oligomenorrhea, AmenorrhoeaObjective: To study serum gonadotropin (FSH, LH) levelsin cases of subclinical and overt hypothyroid women inreproductive age group.
Material and Method: Female patients of reproductiveage group attending thyroid clinic of Acharya VinobaBhave Hospital were included in the study. Detail men-strual history was taken, and serum FSH and LH levelswere estimated by radio immuno assay method.
Result: Eighty patients were included in the study,out of whom 46 (57.5%) had subclinical hypothyroidismand 34 (42.5%) had overt hypothyroidism. In subclinicalhypothyroidism group the menstrual dysfunction whichdominated in our study was oligomenorrhea (28.2%) fol-lowed by menorrhagia (17.39%). 39.13% had normalmenstruation. In overt hypothyroidism group again it wasoligomenorrhoea (23.5%) which was the principal men-strual abnormality followed by menorrhagia (17.64%). Thepercentage of females with normal menstruation was47.05%. The levels of serum FSH and LH were signifi-cantly low in cases of both subclinical and overt hypo-thyroid women. They were significantly low when donebetween day 2 and 5 of the cycle.
Conclusion: Hypothyroidism decreases levels of serumFSH and serum LH. Subclinical hypothyroidism is one ofthe major etiological factors of infertility. Autoantibodiesagainst thyroid should be searched for in cases of femalepatients with infertility.
Serum gonadotropins, Follicular stimulating hormone (FSH), Luteinizing hormone (LH), Hypothyroidism