Indian Journal of Obstetrics and Gynecology

 Endometriosis means presence of functioning endometrial tissue outside the uterine cavity. It can sometimes occur in previous surgical scar. Scar endometriosis is a rare entity and should be suspected if cyclical increasing swelling, nodularity, or pain is present following obstetrical and gynaecological surgeries in past. We are reporting a rare case of scar endometriosis, which led to sudden scar dehiscence with bleeding after seven months of caesarean section and remained unhealed despite repeated attempts of wide excision followed by resuturing along with medical treatment. Finally pituitary downregulation was done with GnRH analogue and wound was allowed to heal by secondary intention.

Keywords: Endometriosis; Scar Endometrioma; Wound Dehiscence; Non Healing Wound.

 Pancreatic pseudocyst in pregnancy is a very rare and serious condition, whose management is not standardized. Hyperlipidemia is considered as a cause of pancreatic pseudocysts in pregnancy, responsible for more cases than other causes like as alcoholic and biliary pancreatitis. Pharmacologic treatments, radiologic examinations, and especially operative interventions must be considered with greater caution. Main aim should be to save the life of mother while taking care to minimize the risk of miscarriage and preterm delivery. Multidisciplinary approach may give better outcome in this type of rare high risk pregnancies.

Key-words: Pancreatitis; Pseudocysts; Pregnancy; Management; Complication

 Evidenced based nursing is a type of evidence –based healthcare, drawing on some of the traditions of evidence- based medicine. It involves identifying solid research findings and implementing them in nursing practices, in order to increase the quality of patient care. In order to practice evidence based nursing, practitioners must understand the concept of research and know how to accurately evaluate this research these skills are taught in modern nursing education and also as part of professional training .

Keywords: Evidence; Midwifery; Practice; Maternity.

 Background: Vaginal surgery is the true hallmark of the specialty of Gynecology. Non descent vaginal hysterectomy is a more skilled procedure and has a learning curve, but nevertheless can be measured provided the correct approach and technique is adopted. Aim: Increasing surgeon’s expertise for Non descent vaginal hysterectomy. Materials and Methods: A total of 250 women admitted in PGIMSR and GMCH with benign condition indicated for hysterectomy, from July 2005 to June 2012. Non descent vaginal hysterectomy was done using two methods one is coring and other by placement of hemi uterus inside the peritoneal cavity after bisection of the uterus. Results: Placement of hemi uterus inside the peritoneal cavity after bisection of the uterus and coring definitely added to successful surgery. Out of 250 patients 246 had successful outcome. Conclusions: Vaginal hysterectomy should be the “gold standard” for the surgical removal of the uterus. Simple technique modification will definitely add extra-boon to the methodology used.

Keywords: Benign; Uterus Bisection;Vaginal Hysterectomy.

 Context: prospective study. Aims: To estimate the prevalence of leucorrhoea (vaginal discharge) among women of reproductive age group and to determine the association of demographic profile with leucorrhoea. Settings and Design: This was a prospective study conducted in the department of Obstetrics and Gynecology in tertiary care hospital in GMCH Chandigarh from December 2007 to November 2010. Materials and Methods: A total of 500 women were recruited, 250 women were included in study group who had diagnosis of leucorrhoea, and 250 women were included in control group who had some other complaints. Women in reproductive age group were included in the study i.e 20 to 50 years of age. Statistical analysis used: simple calculations , mean , percentage. Results: Maximum incidence of vaginal discharge was noted in 70% of women who belongs to low socio economic and 30% of women belongs to middle socio economic in study group Out of 250 cases of study group, Gardnerella vaginalis was found in 22% cases followed by 14% staphylococci, 4% E.coli, Diphtheroids in 3.6%, streptococci in 3.2%, Klebsiella in 2.4%, Micrococci in 1.6%, pseudomonas in 2% , no growth was observed in 2.4%. Incidence of candida was 24% and Trichomonas was 8.8%. Conclusion: Maximum incidence of vaginal discharge was seen in women who belonged to lower socioeconomic class.

Keywords: Leucorrhoea; Women; Vaginal Discharge.

 High maternal and peri- natal mortality and morbidity is cause of concern in INDIA more so in rural uneducated and economically poor women [1]. Non obstetrical surgical conditions account for approximately 1-2% of cases [2]. Detail history, thorough and repeated clinical examination, high level of suspicion, hemoglobin and blood counts, ultrasonography, Xray of chest and abdomen, CT-MRI - SCAN, peritoneal lavage, Diagnostic laparoscopy and exploratory laparotomy as and when required provides help in diagnosis. Early aggressive resuscitation followed by immediate and prompt surgery is required to achieve a favorable outcome in the management of the pregnant patient who presents with an emergency general surgical problem [3]. Present study includes all the non obstetric surgical emergencies and trauma to pregnant patients, managed in The Hospital of Pacific Institute Of Medical Sciences (PIMS), Village Umarda, Girva, Udaipur, Rajasthan from Jan 2015 to Aug 2016. Aim of present study is to highlight the importance of early diagnosis and treatment by a team comprising of general surgeon, anesthetist, obstetrician, pediatrician, and nursing staff. In the present study there had been no maternal death, two fetal losses and high morbidity in the form of prolonged hospitalization in three cases.

 Keywords: Non Obstetric General Surgical Emergency; Appendicitis in Pregnancy; Cholelithiasis in Pregnancy; Bowel Obstruction in Pregnancy; Trauma to Pregnant Women; Acute Abdominal Pain in Pregnancy; Malignancies Associated with Pregnancy

 Introduction: The infants with meconium aspiration usually have trachypnea, frequently upto 100 beats / minutes which may last for few days to weeks and sometimes persist even after complete recovery. Cyanosis is obvious in the most severely affected infants. Chest retraction is not a prominent sign, marked over distension of chest as a result of air trapping seen frequently. Methodology: The Apgar score at one minute and five minutes are noted down. The lungs were examined for aspiration syndrome and signs were noted down. The presence or absence of respiratory grunt, tachypnoea was also noted. The weight of the baby was also noted. If the baby is active just thorough oropharyngeal suction done, stomach wash was given and were placed with mother. Apgar score >7 were considered as good Results: NST pattern was nonreactive in 55.5% especially in thick meconium accounting for 66.4% than compared to thin meconium 37.34% and also accounting for increased incidence in operative interventions. Fetal heart rate- <120bpm there were 12 cases, 120- 160bpm there were 183 cases, >160 there were5 cases. Conclusion: Low Apgar scores were observed in thick meconium than in thin meconium.

Keywords: Meconium; Apgar Scores; Fetal Heart Rate.

 Background: Adolescence is a period of transition between childhood and adulthood. WHO defines adulthood as individual in the age group 9-19 yrs. Complex neuroendocrine mechanism accelerates physical and emotional development. This may be considered a physical, psychological and emotional rebirth. This age group has distinct reproductive health issues which should be diagnosed and treated promptly because reproductive health problems at this age have the potential of affecting future fertility. The present study aims to assess the magnitude and variety of gynaecological problems in adolescents. Material and Methods: Two hundred adolescent girls in age group 10-19 years, attending Gynaecology OPD in ACPM Medical College, Dhule during December 2015 to May 2016 were included in this study. Questionnaire were adopted as a quantitative research tool. Results: Among gynaecological problems experienced by adolescent girls menstrual disturbances were experienced by majority of girls 147 (73.5%) followed by pain in lower abdomen 82 (42.5%), and obesity 8 (4%) and lump in abdomen 3 (1.5%) were the least symptoms. Majority of the adolescent girls with menstrual disturbances had experienced dysmenorrhea, that is, 102 out of 147 (69.38%). Discussion: Menstrual disturbances is a common reproductive morbidity among adolescent girls. Dysmenorrhea is very common among these girls and they experience a number of physical and emotional symptoms associated with dysmenorrhea, and with the increased intensity of pain in occurrence of dysmenorrheal, the probability of experiencing these symptoms is also increased. Health education sessions regarding reproductive health and its morbidities should be conducted in schools and colleges and in communities.

Keywords: Adolescent Girls; Menstrual Disturbances; Dysmenorrhoea; Health Education.

  pregnancy continue to be a major cause of maternal and perinatal morbidity and mortality worldwide. Several researchers have demonstrated the role of decreasing urinary calcium and urinary calcium to creatinine ratio in the prediction and detection of preeclampsia but no clear cutoff values have been provided, so this study was palnned to determine the role of these tests planned in the early diagnosis and their feasibility as screening tools to identify women at risk of developing preeclampsia later in rural women of western U.P. Aims: To evaluate the role of urinary calcium and calcium to creatinine ratio (CCR) for early detection of Preeclampsia in spot urine sample. Settings and Design: Cross- sectional study in tertiary health care institute Methods and Material: A crosssectional study was conducted in our department over a period of one year. Normotensive and hypertensive cases with singleton term pregnancy without other chronic medical disorder were enrolled as Group I, the controls (n=48) and Group II (n=129) respectively. After workup Midstream clean catch urine sample was collected for the estimation of calcium and creatinine. Data from all the groups were statistically analysed. Statistical analysis used: Independent T test. Results: Mean value of Urinary calcium and urinary calcium to creatinine ratio in women with hypertensive disorder of pregnancy was found to be significantly lower (p value< .001) than in normotensive women. Conclusion: Estimation of calcium and creatinine in a spot urine sample is a simple test and easily performed. It has a good diagnostic accuracy, and thus it may be adopted as a diagnostic tool for preeclampsia.

Keywords: Preeclampsia; Urinary Calcium; Urinary Calcium to Creatinine Ratio (CCR).

 Background: Cervical cancer is one of most common cancers of women worldwide with high mortality. Early detection and treatment can cure this disease at an early stage which can be achieved by regular screening using conventional Papanicolaou test, an easy, costeffective method. Objectives: To study pattern of epithelial cell abnormalities on cervical Pap smear in rural tertiary centre of Northern India over six years, to know prevalence of abnormal pap smears over that period. Material and Methods: Retrospective analysis of conventional Pap smear reports over period of six years was carried out at Obstetrics and Gynecology Department and Pathology Department of rural tertiary centre of Northern India from January 2010- December 2015 after ethical clearance. Case records of 5,725 women aged >-21 years, sexually active consulting Gynecology Out Patient Department for different complaints were collected from Pathology Department. Smears were reported as per 2001Bethesda system. Data was analyzed using SPSS-20 version. Results: Of 5725 Pap smears examined retrospectively, majority of women belonged to 41-50 years. 580 (10.13%) cases had abnormal epithelial patterns, 4448 (77.69%) had benign epithelial patterns and remaining 697 (12.17%) were unsatisfactory. Of 4448 benign cases, inflammatory lesions were most common (38.84%). Conclusion: High prevalence of epithelial cell abnormalities (10.13%) as well as squamous cell carcinoma, especially in females >70 years signifies lack of awareness about cervical cancer screening among women of this region. Also women of 41-50 years had maximum number of abnormal epithelial patterns, further indicating need for early, regular screening of women.

Keywords: Carcinoma Cervix; Cytology; Papanicolaou Smear; Screening; Squamous Cell Carcinoma.

 Anaemia is one of the major nutritional deficiency disorder affecting a large proportion of population, not only in developing but also in industrialized countries. The high prevalence of iron and other micronutrient deficiency among women before or during pregnancy in developing countries concerned. Efforts must be made to address the problem through strategies such as fortification, periodic supplementation and counseling of the women which are at risk of anaemia in pregnancy. This may help to reduce the manifestation of iron deficiency, improve public health and thus reduce material and neonatal morbidity and mortality. The study was programmed on patients coming to department of Obstetrics and Gynecology of our institution. Each patient was subjected to a preplanned Performa bearing personal details like history, examination and investigation of the patient. Detailed history, examination and investigation pertaining to diagnoses and typing of anaemia were done as discussed under material and methods are used.

Keywords: Anemia; Pregnancy; Predisposing Factors; Nutritional Anemia; Supplementation; Counseling.

 Background: Vibroacoustic stimulator provokes a physiological sympathetic range response characterized by fetal heart rate acceleration suggesting an intact non-hypoxic CNS. Objectives: To assess the adjunctive use of vibroacoustic stimulation to alter fetal behavioral states, reduce the false positive non-reactive tests. Materials and Methods: A prospective study was conducted at Sri Adichunchanagiri institute of Health and Research Centre. 100 women performing VAST test and control group (n=100) without VAST test. It was done by placing vibroacoustic stimulator, with 75Db sound intensity at one meter, frequency of 75Hz on abdominal wall over fetal head for 3 seconds. Fetal startle response was observed along with fetal heart rate acceleration. If the test comes nonreactive, it is considered as positive test and if the test comes reactive it is considered as negative. Statistical Analysis: Chi-square test with descriptive and inferential statistical analysis was done. Summary and Results: With VAST, startle response was observed in 85% of patients in study group, 42 (89.4%) had normal perinatal outcome and 43(81.1%) had abnormal perinatal outcome. Association between BPP scoring before and after VAST was statistically significant(p<0.001). 85% of patients had reactive NST, 51(77.3%) had normal perinatal outcome and 34(100%) had abnormal perinatal outcome. Association between them were found to be statistically significant. Conclusion: It is simple, rapid and non- invasive tool for detection of fetal well being. VAST appears to be a safe and reliable method of antenatal fetal evaluation.

Keywords: VAST; NST; BPP.

 Introduction: Amniotic fluid volume helps in assessing perinatal outcome. It’s appearance and composition can be a beacon in forecasting fetal well-being. This article substantiate the above claim, the discussed study and it’s discussions speaks for itself. Method: The study was carried out on two hundred women who attended the Institute of Obstetrics and Gynaecology, Government Victoria Hospital, Visakhapatnam from March 2002 to March 2004. It is comparitive prospective study comparing 100 cases of oligohydramnios (Amniotic Fluid Index <5 cm) as study group with 100 cases of Normal (Amniotic Fluid Index >5 cm) as control group. Result: In the oligohydramnios group, The risk of meconium staining of liquor resulting intrapartum fetal distress and consequent increase in cesarean section rate is higher. Increased rate of still births and low apgar scores and consequent increase in the rate of admission into neonatal intensive care unit. Discussion: Incidence of meconium aspiration syndrome, meconium stained liquor is statistically higher in the study group. Incidence of emergency caesarean section, incidence of caesarean section for fetal distress is statistically higher in the study group. Incidence of still births, low apgar score, low birth weight babies, new borns requiring admission into neonatal intensive care unit is statistically higher in the study group. Conclusion: Antenatal amniotic fluid index estimation is a reliable indicator for predicting adverse perinatal outcome.

Keywords: Amniotic Fluid Index; Perinatal Outcome; Meconium Stained Liquor (MSL); Meconium Aspiration Syndrome (MAS); Caesarean Section; Oligohydrominos.

 Introduction: Accurate estimation of foetal weight is of paramount importance in the management of labour and delivery. During the last decade, estimated foetal weight has been incorporated into the standard routine antepartum evaluation of high-risk pregnancies and deliveries. Aims and Objectives: To Study fetal weight in term pregnancy by Hadlocks formula using Ultrasound and comparison with actual birth weight of baby. Methodology: This was a Study carried out at medical college and hospital from January 2009 to October 2010 in the department of obstetrics and gynecology. Two hundred women at term were studied. The fetal weight was estimated at the time of admission. Fetal birth weight was measured by Hadlock method. The Statistical analysis done by SPSS 17. Result: Mean age of mothers was found to be 22.67 years of them 18 years minimum age was seen. Of 52.4 kg as mean weight of study population maximum weight found was 77 kgs. 142 cms was the minimum height found and 154.61 cms mean height of mothers.59% babies were normally delivered and 24.5% babies were delivered by LSCS. Instrumental vaginal delivery was performed in 16.5% mothers.The Mean ±SD for Actual birth weight (Grams) was 2643.00 ± 331.14 (Range-2000 to 3615)And Hadlock USG (Grams) Mean ±SD 2608.45 ± 285.94 (Range- 2010 to 3478). Hadlock had mean error of -34.5 gms. There was Significant difference in Birth weight predicted by Hadlock’s (USG ) and Actual birth weight (P<0.03) Hadlock had error of 100gms in 30.5% babies and only in 10.5% it was more than 200gms. Hadlock determines 95 % accurately birth weight with just 10% error and with 15% error birth weight is accurately determined in 100% babies. Hadlocks (USG) overestimated the birth weight in 41.5% babies, of them 12 and 14% had more weight upto 100 gms. 58.5% babies had their weight underestimated which was 51 to 100 gms and 101 to 150 gms less in 16.5% and 15% babies respectively. Conclusion: In our study, Hadlock’s formula showed the greatest accuracy in prediction of birth weight but it having some errors so it should be considered combining with the clinical assessment.

Keywords: Hadlock’s USG; Birth Weight; Foetal Weight

 Introduction: With the advancement of technology, plethora of tests, techniques have evolved to assess fetal well-being, but there is no single indicator which gives complete picture with certainty. Among all amniotic fluid is a key indicator, which is substantiated in this article. Method: The study was carried out on two hundred women who attended the Institute of Obstetrics and Gynaecology, Government Victoria Hospital, Visakhapatnam from March 2002 to March 2004. It is comparitive prospective study comparing 100 cases of oligohydramnios (Amniotic Fluid Index <5 cm) as study group with 100 cases of Normal (Amniotic Fluid Index >5 cm) as control group. Result: As gestational age increases beyond 40 weeks, amniotic fluid index decreases in the study group (32%) when compared to control group (8%). Incidence of oligohydramnios in high risk pregnancies is statistically higher when compared to control group as p< 0.05. Incidence of induction rate is statistically higher in the study group (43%). Discussion: In the oligohydramnios group, mean AFI was 3.75 cm with range 2.1 – 4.85 cm where as in the control group mean AFI was 12.85 cm with range 7.5 – 18.5 cm. The age groups are comparable. In the present study there is no statistical difference in parity between study and control groups. High risk pregnancy associated with oligohydrominos. As gestational age increases beyond 40 weeks, amniotic fluid index decreases.Patients with complications (like Pregnancy Induced Hypertension, Intra Uterine Growth Retardation and Post dates) were found to have oligohydramnios and there by increasing incidence of fetal distress and intervention for fetal distress. Conclusion: Of the various semiquantitaive methods described, the four quadrant technique or amniotic fluid index provides a most convenient and reproducible method of evaluating amniotic fluid volume. As gestational age increases amniotic fluid decreases so we should do timely intervention and induction of labour.

Keywords: Ultrasonography; Oligohydrominos; Hydrominos; FetoPlacental Circulation; Amniotic Fluid Volume; Primi-Para.

 Introduction: The advent of ultrasonography has revolutionized the screening and diagnostic realm., Specially in the field of gynecology for early reporting. Gynecological ultrasound is one of the most accurate imaging techniques in clinical practice. Aims and Objectives: To Study co-relation of USG diagnosis with clinical diagnosis of ovarian masses at tertiary health care center. Methodology: After approval from Institutional ethical committee, this prospective study was conducted at department of Obstetrics and Gynecology during the period of September 2013 to September 2015 on 100 women who were randomly selected among the women attending the hospital’s Obstetrics & Gynecology OPD. .A detailed history of presenting complaints & associated symptoms was noted along with menstrual history. Patients were diagnosed clinically then by Ultrasonographically. Result: In the present study, out of the 100 women; maximum (36%) were within the age group of up to 25 years, 27% in 36 to45 years, 25% in 26 to 35 years, 6.0% in 46 to 55 years & 5% >55 years each Out of 100 women, 38% were para two, 30% were primipara 23% were nulliparous & 9% were para three. All benign ovarian cysts, benign ovarian tumors, dermoid cysst, malignant ovarian tumors on USG were diagnosed as adnexal mass clinically. Of 9 patients with functional cyst 6 were diagnosed as adnexal mass and 3 as no mass palpable, all with haemorrhagic cyst had no palpable mass, of 30 PCOS patients 11 were diagnosed clinically while 19 had no mass palpable diagnosis on clinical examination. Of 3 patients with chocolate cyst 2 had adnexal mass and 1 as no mass palpable on clinical diagnosis. Conclusion: The adnexal masses are detected clinically but the details of it only visible by sonography so all clinically suspected adnexal masses should be examined by ultrasonography.

Keywords: Benign Ovarian Cyst; Benign Ovarian Tumor; Dermoid Cyst; Malignant Ovarian Tumor; PCOS.