Abstract

In the management of women with fibroid disease, GnRH agonists (GnRHa) are frequently used to reduce volume and vascularity before myomectomy, apparently to render the operation easier and reduce operative blood loss, and to enable a transverse supra-pubic incision instead of a midline vertical one. They induce amenorrhoea and thus aid in the correction of pre-operative anaemia. Other gynaecologists use GnRHa to shrink sub mucous fibroids greater than 5 cm in diameter to facilitate access and reduce blood loss and operating time at transcervical resection. GnRHa are also occasionally used as a temporizing measure in women with symptomatic fibroids within the climacteric. We argue against the use of GnRHa in the management of fibroid disease because they are not cost effective, render myomectomy more difficult to apply because they destroy tissue planes, the more difficult enucleation in fact increasing rather than reducing perioperative blood loss and operating time. When used before myomectomy, they increase the risk of ‘recurrence’ because they obscure smaller fibroids that ‘recur’ when the effects of the GnRHa wear off, and are associated with side effects in situations where they confer no benefits, or where alternative cheaper drugs with fewer side effects are available.

Abstract

Objective: To study the correlation of umbilical cord length with fetal parameters like Apgar score, sex, weight, and length, and its effect on labor outcome.

Design: Prospective study of 1,000 cases.

Setting: Government Hospital

Material and Method: Examination of umbilical cord was done for any loop around neck, trunk, etc; no. of loops of cord and positions; Knots of cord (True or false), any cord abnormalities. Fetal parameters recorded were sex, weight, and length of the newborn. Fetal outcome studied by Apgar score at 1 and 5 min.

Results: In our study, the cord length varied from 24 to 124 cm. The mean cord length was 63.86 cm (±15.69 cm). Maximum cases seen were in the group of cord length between 51 and 60 cm. Lower 5th percentile was considered as short cord and upper 5th percentile was considered as long cord. Short-cord group was associated with significantly higher (p\0.05) incidence of LSCS cases. Cord length did not vary according to the weight, length, and sex of the baby. The incidence of all types of cord complications increases as the cord length increases (p\0.001*). Nuchal cords had higher mean cord length than in cases without nuchal cords (p\0.001). As the number of loops in a nuchal cord increases to more than two loops, the operative interference increases. The significance was tested by using a Chi-square test, and it was found to be statistically significant (p\0.05). Nuchal cords were seen to be associated with more cases of fetal heart abnormalities (p\0.001). There is higher incidence of variability in fetal heart rate with extremes of cord length (p\0.001). The incidence of birth asphyxia was significantly more in long and short cords as compared to cords with normal cord length (p\0.001).

Conclusion: The present study showed that the length of umbilical cord is variable; however, maximum number of cases had normal cord length. Cases which had short and long cords constituted abnormal cord length. These cases had higher incidence of cord complications, increased incidence of operative interference, intrapartum complications, increased fetal heart rate abnormalities, and more chances of birth asphyxia. But cord length did not vary according to the weight, length, and sex of the baby.

Abstract

Objectives: A prospective study was conducted in the Department of microbiology (IGMC) and the Department of obstetrics & gynecology (KNH), Shimla, and Himachal Pradesh over a period of 1 year from May 2005 to April 2006 on 463 asymptomatic pregnant females with a period of gestation (POG) 28 weeks or less. The aim was to find out the prevalence of pregnancy associated bacteriuria and bacterial causes responsible for this entity.

Methods: The pregnant women were taught to collect the urine sample by aseptic technique which was then subjected to semi quantitative culture method.

Results: Significant bacteriuria was present in 7.34% cases. About 78% samples were found to be sterile. Insignificant count and growth of contaminants was positive in 1 and 13% samples, respectively. The most common etiological agent came out to be E. coli followed by other gram positive and gram negative organisms.

Conclusion: Asymptomatic bacteriuria is a common occurrence which should be diagnosed and treated in early pregnancy keeping in view its adverse effects on pregnancy.

Abstract

Aim: This study aimed to explore knowledge and acceptability of prenatal procedures both non-invasive prenatal screening tests and invasive procedures among Egyptian women in childbearing age and to assess their attitude toward such procedures. Also to examine confounding factors affecting women’s attitude toward prenatal procedures.

Study Design: A cross-sectional study on a representative sample of women in childbearing age attending Obstetrics & Gynecology outpatient clinic at Mansoura University Hospital, Egypt. An anonymous questionnaire was supplemented by voluntary interviewers for women in childbearing age.

Results: 465 women were included in the study. The mean age ± SD was 27 ± 6 years. About 44 % of women were knowledgeable about non-invasive prenatal screening procedure, and only 25.5 % had heard about invasive prenatal procedures. 88.8 % express positive attitude regarding performance of the screening tests. Forty-one percent of the group agreed to perform invasive prenatal procedures during their pregnancy. Educational level and family history of congenital anomalies significantly affected attitudes toward testing during future pregnancy. The cost of procedure affected the decision to perform in 56.7 % of women.

Conclusion: Egyptian women express positive attitude toward non-invasive prenatal screening but showed poor knowledge. Their attitude toward invasive procedure is guarded by the risk of abortion. Education and family history of fetal anomalies are the factors that affect attitudes. The cost of the prenatal test affects the decision made by the women to participate in testing.

Abstract

Need: Despite availability of intensive care units and improved antenatal care, some women still die from Eclampsia. Eclampsia is associated with increased risk of maternal death varying from 1.8 % in developed countries to 14 % in developing countries. Cerebral complications are the major cause of death in eclampsia patients. Eclampsia along with hypercoagulopathy of pregnancy is a high risk fact for patient in respect of development of cerebrovascular thrombosis/ischemic strokes. Eclampsia patients who are refractory to the routine treatment have been found to have various CNS pathological conditions amenable to the medical treatment.

Aims and Objectives: (1) To study the neuropathophysiology behind an eclamptic seizure to reduce the morbidity associated with it. (2) To study the role of neuroimaging in patients with atypical eclampsia.

Methodology: Prospective study design included 30 patients for the study. All patients were admitted in the eclampsia room with h/o convulsions. All patients were put on MgSO4 therapy and antihypertensives. The patients who are refractory to the treatment such as having recurrent convulsions despite therapy MgSO4 were selected for neuroimaging with CT scan. Neuroimaging is done using Phillips Tomoscan CT scanner where slices of 10-mm thickness were taken through the entire brain in the transaxial plane. Abdomen shielding is done with lead shield to prevent radiation hazard.

Result:

Conclusion: Eclampsia patients who were refractory to the treatment with MgSO4 and antihypertensives have been found to have very significant and morbid CNS pathological conditions. Neuroimaging in these patients have done a pivotal role in identifying the abnormality and rectifying it with medical means which had definitely improved patient’s condition and have reduced morbidity.

Abstract

Objective: To evaluate nulliparous breech delivery so as to determine prognostic factors for an unsafe vaginal delivery (VD).

Methods: This retrospective and descriptive study was carried out in the University Teaching Hospital Yaounde´– Cameroon, from January 1, 2005 to December 31, 2009. Files of 126 women with singletons in breech presentation and normal fetal heart beats at a gestational age C32 weeks were reviewed with a trial of VD ordered in 104. The parameters recorded were mother’s age, gestational age, mode of delivery, birth weight, 5th minute Apgar scores, neonatal outcome, and use of episiotomy.

Results: The results showed that 84 (66.7 %) had a successful VD. Failure of VD or poor Apgar score after VD were observed if fetal weight C3,500 or\1,800 g, footling breech, maternal age [28 or \19 years, post term, and rigid cervix.

Conclusions: Elective cesarean section should be systematic if the unsafe circumstances above mentioned are present.

Abstract

Objectives: Recently, it has been found that women who have thrombophilia have increased risk of fetal loss. This study was designed to corroborate the association of elevated factor VIII level, protein C and protein S deficiencies, and the presence of LAC in women with recurrent pregnancy loss.

Materials and Methods: 53 patients with history of two or more pregnancy losses and 47 healthy age-matched subjects with no history of pregnancy loss and who have delivered at least one term infant without any complication were enrolled into the study.

Results: Thrombophilic defect was present in 64.15 % of patients of study group. Protein S deficiency (50.94 %) was the most common thrombophilic defect observed. Spontaneous abortion (SA), preterm birth (PTB), and intrauterine growth retardation (IUGR) were the most important pregnancy complications observed. The strongest associations of pregnancy complications were observed with protein S deficiency (87.5 %) and with elevated factor VIII (66.66 %) level.

Conclusion: This study observed strong association of thrombophilia with unexplained recurrent pregnancy loss.

Abstract

Objectives: To study the role of neoadjuvant chemotherapy (NACT) followed by surgical cytoreduction in the management of advanced epithelial ovarian cancers.

Methods: A prospective hospital based study of patients with advanced epithelial ovarian cancers (stage III and IV) was conducted at Gujarat Cancer & Research Institute, Ahmedabad during August 2008 to August 2010. Total 50 patients were treated with NACT followed by surgical cytoreduction and followed up till August 2010. Response to NACT, optimal cytoreduction rate and overall response rate were analyzed.

Results: There were 43 patients (86%) with stage III disease and 7 (14%) with stage IV disease. All patients were given NACT and after NACT, complete response occurred in 17 patients (34%), 27 (54%) had partial response. Optimal surgical cytoreduction could be achieved in 36(72%) of the patients. The median follow up was 19 months.

Conclusions: NACT followed by surgical cytoreduction is a promising treatment strategy for the management of advanced epithelial ovarian cancers.

Abstract

Objectives: To evaluate the effect of metformin and pioglitazone on insulin resistance, ovulation and hyperandrogenism in women with PCOS.

Methods: 100 patients of age 18–30 years were included in this randomised double blind trial for treatment with either metformin or pioglitazone for a period of 6 months.

Results: Administration of metformin and pioglitazone for 6 months revealed that 50 % of the patients achieved menstrual cyclicity. A decline in F–G grading for hirsutism within the both the groups was observed. The lipid profile also showed a decrease in total cholesterol, an increase in HDL-C, a decrease in VLDL-C levels but more so in the pioglitazone group. HOMA-IR declined more than 50–55 % with pioglitazone and 15 % with metformin. Thus, pioglitazone may be a better treatment option as far as protection from tendency to development of diabetes is conscerned. The rise in serum SHBG levels and decline in free androgen index and L/H ratio are more remarkable with pioglitazone (P\0.05). Ovulation was restored in 44.2 and 56 % of patients on metformin and pioglitazone, respectively.

Conclusion: Pioglitazone may be a new alternative for use in women with PCOS, providing more metabolic and reproductive benefits and possibly protection from developing diabetes and cardiovascular problem.

Abstract

Objective: This study was designed to evaluate the immunohistochemical expression of proliferating cell nuclear antigen (PCNA) and p53 protein expression in preneoplastic and neoplastic lesions in uterine cervix.

Study Design: A total of 36 cervical biopsies were subjected for immunostaining and the results were correlated with different prognostic parameters. Bivariate and multivariate statistical analyses were done using ‘‘STATA’’ software.

Results: PCNA labeling index and p53 expression increased with increasing severity of CIN lesions. PCNA labeling index was maximum (46.0) carcinoma cervix with intense positive staining. In bivariate statistical analysis, p53 and PCNALI were found to be insignificant (0.4184 and 0.4328, respectively). Menopausal stage was significantly associated with CA and CIN groups (P\0.166 and P\0.049), respectively.

Conclusion: These markers may be of greater importance in low-grade CIN lesions showing high proliferative index. This will place the low-grade lesions in higher grade indicating the utility of proliferative markers in decision making for intervention. This method is simple and cost effective and may be useful in developing countries where HPVDNA testing is still out of reach because of high cost.

Abstract

Objectives: To evaluate local disease control and early complications of concomitant brachytherapy with external beam-radiotherapy in early stage carcinoma cervix.

Methods: Fifty patients of early stage carcinoma cervix (FIGO-IB/IIA) were randomly divided into study group concomitant external beam irradiation (EBRT) and HDRICBT (intra-cavitary brachytherapy, xrt = 50 Gy/25 Fr, HDR 5.2 Gy*5 Fr) and the control group EBRT followed by HDR-ICBT (xrt = 50 Gy/25 Fr, HDR 7.5 Gy*3 Fr). Acute reactions and local disease response were compared between treatment and at 6-month follow up.

Results: Median overall treatment times were 38 and 61 days in the study and the control groups, respectively. Acute skin reactions and diarrhea were more in the study but manageable. At the completion of the study, there were 80 and 68 % complete responses, 16 and 20 % partial responses, 0 and 8 % stable diseases in the study group and the control group, respectively.

Conclusions: Response was better in the study group but statistically insignificant. Larger number of patients and longer follow up are required to arrive at concrete conclusion.