Indian Journal of Obstetrics and Gynecology

Introduction: Paraovarian cysts occur in the broad ligament between the ovary and the tube, predominantly arising from mesothelium covering the peritoneum (68%) but also arise from the paramesonephric tissue (30%) and rarely from mesonephric remnants (2%). In this report, the authors present successful laparoscopic management of a large paraovarian cyst of mesonephric origin. Case Report: A 30yearold P2L2 presented with oligomenorrhoea. On examination, BMI was 30Kg/m2, hirsutism was present. Per abdomen examination revealed a mobile, cystic mass corresponding to 20 weeks’ size.Ultrasonography of lower abdomen revealed a normal uterus and left adnexa and a mass of 11.6 x10 cm in the right adnexa. With a preoperative diagnosis of ovarian cyst in PCOS, she was taken up for laparoscopy, which showed a bulky left ovary and right ovarian cyst of 15x12cm with smooth wall and clear fluid. Histopathology revealed a mesonephric cyst. Conclusion: Physicians should maintain a high index of suspicion for this uncommon cyst which is often difficult to diagnose both clinically, radiologically and even intraoperatively. Large size should not deterr the physician in taking recourse to the laparoscopic approach,provided the benign nature has been determined preoperatively.

Keywords: Paraovarian; Mesonephric; Cyst; Laparoscopic; Rare.

Posterior reversible encephalopathy syndrome (PRES) is a reversible syndrome characterized by headache, seizures, altered sensorium, and loss of vision associated with white matter changes on imaging. We report here a 23 yearold lady third postpartum day, presenting with high blood pressure, seizures and loss of vision and diagnosed as posterior reversible encephalopathy syndrome. She was treated successfully with antihypertensives and showed dramatic improvement. This condition is important to recognize and needs to be treated promptly to prevent morbidity and mortality in pregnancy and postpartum.

Keywords: Posterior Reversible Encephalopathy Syndrome; Postpartum; Eclampsia; Oligohydramnios.

Pseudomyxomatous peritonei is a clinical condition caused by cancerous cells (mucinous adenocarcinoma) that produce abundant mucin or gelatinous ascites. The tumors cause fibrosis of tissues and impede digestion or organ function, if left untreated, the tumors and mucin they produce will fill the abdominal cavity. The standard treatment for these patients is watchful monitoring and debulking followed by chemotherapy. I report a case of a 54 year old female and review the clinical features and treatment of this disease.

Keywords: Ovary; Pseudomyxomatous Peritonei; cyst. 

Intrauterine retention of fetal bone is a rare complication of abortion, causing menorrhagia, irregular menstrual cycle, secondary infertility, chronic pelvic pain, dysmenorrhea, and vaginal discharge. A 25year old female P1L1MTP1 came with complaints of menorrhagia, irregular menstrual cycle, and secondary infertility with previous history of MTP done for lactational amenorrhea. USG was suggestive of hyper echogenic linear shadow in uterine cavity? Foreign body? IUCD ?endometrium with bone tissue. On hysteroscopy multiple bones were seen, one long bone was occupying both Ostia. Removal of fetal bones was done using hysteroscopic grasper in the same sitting. Patient resumed her normal menstrual cycle and later conceived spontaneously. Hysteroscopy is a gold standard for diagnosis and treatment of fetal bones in the uterine cavity.

Keywords: Intrauterine Fetal Bone; Abortion; Menorrhagia; Infertility; Hysteroscopy. 

Background: Eisenmengers syndrome consists of pulmonary hypertension with a reversed or bidirectional shunt at the atrioventricular or aortopulmonary level.Maternal mortality in the presence of Eisenmengers syndrome is reported to be up to 50% and increases more if there is comorbidity. Case Report: We report successful outcome in a primi with Eisenmengers syndrome with severe preeclampsia that underwent emergency lower segment caesarean section for foetal bradycardia. Conclusion: Pregnancy should be avoided in case of Eisenmengers syndrome, but one can expect good outcome even with other co morbidity with coordinated multidisciplinary approach with cardiologist, cardiothoracic surgeon, anesthesiologist and obstetrician with intense monitoring to detect adverse maternal and fetal outcome.

Keywords: Eisenmengers Syndrome; Severe Preeclampsia; Pregnancy; Outcome. 

A 22 year old female with severe calcified mitral stenosis with moderate PAH (grade 4 NYHA) presented at 28 weeks of gestation. Patient was referred from a cardiologist for immediate caesarean and cardiac surgery for severe pulmonary hypertension. A multidisciplinary team including cardiologist, cardiac surgeon and obstetrician decided to assist the parturient in continuing her pregnancy under close monitoring till 3536 weeks of gestation. At term, the patient underwent a successful elective cesarean section followed by concomitant mitral valve replacement under cardiopulmonary bypass. A live healthy female child weighting 1.67 kg was delivered and shifted to NICU. It was a real challenge to continue pregnancy with critical mitral stenosis (size = 0.6 cm2), fortunately both fetal and maternal outcome were excellent. Both mother and child were discharged from the hospital after an uneventful postoperative recovery.

Ovaries are rare sites of ectopic gestation; here we present a case of ovarian ectopic pregnancy and stress the importance of histopathological examination for definitive diagnosis.

Keywords: Ectopic Pregnancy; Ovary. 

Thanatophoric dysplasia (TD) is a type of lethal skeletal dysplasia having very rare description about its clinical profile in medical literature. Here we discuss the anatomical features, abnormalities and clinical profile of Thanatophoric dysplasia in the present study. A search of PubMed, Web of Science, and EMBASE and google search was made to identify previous citations in the English literature reporting sonographic findings in fetuses with Thanatophoric dysplasia. We used key words related to Thanatophoric dysplasia and prenatal ultrasound, including ‘thanatophoric dysplasia’, ‘ultrasound’, ‘prenatal’, ‘sonography’, ‘skeletal dysplasia’, ‘limb shortening’, ‘macrocephaly’, ‘telephone receiver femur’ and ‘cloverleaf skull’ etc. Studies where the diagnosis of thanatophoric dysplasia was confirmed by radiological findings or molecular diagnosis were included in our study. We have found 34 cases of thanatophoric dysplasia from 1971 to 2016. Out of these 34 cases 17 were type 1 and two cases were type 2. Out of 34 cases 5 cases are diagnosed before 20 weeks, 5 cases were diagnosed between 2026 weeks and 22 cases were diagnosed after 26 weeks. The most common anomalies found are narrow thorax (100%), Platyspondily (41.1%), Hypoplastic pelvic bones (50%), Telephone receiver femur (55.8%), Short ribs (38.2%), Clover leaf skull (26.4%), Frontal bossing (35.2%), brachydactily (26.4%) and Depressed Nasal Bridge (26.4%). Out of nine cases where the the difference between gestational age measured by biparietaldimeter (BPD) and femur length (FL) were reported only one case had been reported to be diagnosed before 20weeks where the difference is 5 weeks. Three cases were diagnosed between 20 and 26 weeks where the difference is 78 week, 7+2 week and 8+6 week respectively. In the rest five cases the difference of gestational age ranges from 1016 weeks to 24 weeks. Any discordance between femur length measurement and abdominal circumference or head circumference in first or early second trimester ultrasound should be suspected for this dysplasia. Counseling of the affected A parent about the low recurrence rate is also an important part of management.

Keywords: Thanatophoric Dysplasia; Telephone Receiver Femur; Clover Leaf Skull; Limb Shortening. 

Background & Objective: To improve the obstetric result in high risk pregnancy by ante partum fetal assessment by biophysical profile scoring. Methods: 50 patients of high risk pregnancy were selected after 32 weeks of gestation and five variables of biophysical profile were scored. Results: BPP score 10/10 in 40% cases 8/10 in 32% cases & 6/10 or less in 28% cases. NST was reactive in 60% cases and non reactive in 40 % cases. AFI was less than 5 in 12% cases. Delivery was by LSCS in 32% cases. NICU admission was 68% of which maximum had BPP score was 6 or less. Interpretation & Conclusion: Fetal biophysical profile is a very effective method for ante partum fetal surveillance. It has been seen low biophysical profile score of fetus results in increase operative delivery, birth asphyxia, low  APGAR, increased NICU admission.

Keywords: Biophysical Profile; NST; Fetal Breathing Movement; Fetal Movement; Fetal Tone; Amniotic Fluid; APGAR. 

Background: Transvaginal ultrasound is a noninvasive diagnostic tool commonly used to evaluate women with postmenopausal uterine bleeding. The ultrasound examination for endometrial pathology includes a measurement of endometrial thickness. In clinical studies, endometrial malignancy is uncommon in women with an endometrial thickness measurement <5 mm. Aim: To evaluate transvaginalultrasonographic measurement of endometrial thickness as a valid biomarker of oestrogen exposure by correlating with serum oestrogen levels and to validate its assessment in diagnosing endometrial cancer in comparison with biopsy. Materials and Methods: A crosssectional study was conducted for a period of one year among women in age group of 40 – 70 years attending the gynaecology OPD in our hospital with the complaints of postmenopausal bleeding. Total of 250 women were included in the study. Basic blood and biochemical tests were performed and serum estradiol levels were measured for all women in the study population. Transvaginal ultrasound was performed on all patients by using a 7.5 MHz transvaginal sector probe with phased array and end firing potential. Results: A perfect positive correlation exists between the endometrial thickness and the serum oestrogen levels (r = 0.62). The sensitivity (100%), specificity (98.6%) positive predictive value (94.1%) and negative predictive value (100%) for endometrial thickness in detecting cancer endometrium was found to be very high which would suggest that assessment of endometrial thickness through transvaginal ultrasound is an effective screening test in the detection of endometrial carcinoma. Conclusion: Though endometrial thickness can be used as an initial screening test in detection of endometrial malignancies but the high rates of false negatives might warn us in using it alone without a endometrial biopsy. Still many multicentric studies are warranted to substantiate our findings and to set a cutoff level of endometrial thickness in diagnosing carcinoma.

Keywords: Endometrial Thickness; Transvaginal Ultrasound; Serum Oestrogen; Biopsy; Endometrial Carcinoma. 

Introduction: The amniotic fluid, commonly called a pregnant woman’s water or waters (latin liquor amnii), is the protective liquid contained by the amniotic sac of a pregnant female. Aims and Objectives: To study fetomaternal outcome in pregnancies with Abnormal Liquor. Material and Methods: This was crosssectional study carried out at the OBGY Dept. of the tertiary health care center during the one year duration i.e. Jan 2015 to Jan 2016 in all ANC patients attending the ANC clinic for routine checkup were advised Gestational; USG those who showing Abnormal (AFI) i.e. Low Oligohydramnios or High Polyhydramnios were by their written consent were included study. The detailed history like age and ANC complications (Maternal outcome) and Fetal Outcome were retrieved with the help of record paper available in the record section. Result: majority of the patients with Oligohydramnios were in the age group of 2125 were 55.56% where for Polyhydramnios were >30 i.e. 41.82%.In maternal outcome PIH was 31.11 and 30.91; APH was 22.22 and 23.64; PPH20.00 and 16.36; Preterm labour 15.56 and 9.09; Abortion 4.44 and 18.18 in Oligohydramnios and Polyhydramnios Group respectively. The congenital anomalies were more common in Polyhydramnios group as compared to Oligohydramnios group i.e. 26.67 % and 35.19% respectively. Hydrocephalus was 6.67 and 7.41; Anencephaly4.44 and 5.56; Meningocele2.22 and 3.70; Spina bifida 2.22 and 3.70; Oesophageal atresia 2.22 and 3.70; Duodenal atresia 2.22 and 3.70; Omphalocele2.22 and 1.85; Polycystic kidney 2.22 and 1.85; Hydronephrosis with hydroureter 2.22 and 1.85 respectively in Oligohydramnios Polyhydramnios group rescpectively. Conclusion: It can be concluded from our study that majority of the patients with Oligohydramnios were in the age group of 2125 were 55.56% where for Polyhydramnios were >30. Majority of the patients with Oligohydramnios were in the age group of 2125 were 55.56% where for Polyhydramnios were >30 i.e. 41.82%.In maternal outcome PIH was most common followed by, APH in Oligohydramnios and Polyhydramnios Group respectively. The congenital anomalies were more common in Polyhydramnios group as compared to Oligohydramnios group these were Hydrocephalus, Anencephaly, Meningocele.

Keywords: FetoMaternal Outcome; Abnormal Liquor; Congenital Anomalies. 

Objective: This study was carried out to determine the menstrual abnormalities experienced by adolescents to know their awareness and health seeking behavior regarding the same. Methods: All the adolescents attending or accompanying the patients in the OPD of the institute were enrolled after an informed written consent. Data was collected on predesigned questionnaire to assess their level of awareness on menstrual abnormalities. Results: A total of 200 adolescents were included in the study. There was a complete lack of knowledge about menstrual problems in 160(80%) respondents. Knowledge of irregular cycle, prolonged and short cycle was more in participants who were of between 1519 year of age. There was a statistically significant relationship between the age and knowledge of irregular, prolonged and short cycle (p=.001). There was statistically significant association found between age and dysmenorrheal (p=0.004). Conclusion: The results reveal that the majority of respondents were unaware of menstrual problems and suffered from reproductive health morbidities, which include dysmenorrhea, menorrhagia and irregular menstruation. Reproductive information programs that currently refer to menstruation in explanations of reproductive functions could easily incorporate more information about menstrual disorders and help break factors that prevent women from obtaining timely and appropriate care for menstrual dysfunction.

Keywords: Menstrual Abnormalities; Adolescents; Awareness. 

Introduction: Universal precautions as applied to blood and body fluids that has been known in the transmission of blood borne infections such as semen, breast milk, vaginal secretions, synovial fluid, cerebrospinal fluid, amniotic fluid, and any body fluid contaminated with blood. Aims and Objective: 1. To find out the knowledge and attitude of medical personnel on HIV/AIDS transmission. 2. To find out the practice of universal basic precautionary measures among medical personnel in the department of obg mvj medical college, with respect to HIV prevention . Materials and Methods: Structured questionnaires were administered to 500 health professionals ranging from medical students to consultants .The questionnaires were self administered by respondents after they were introduced by the authors at a group meeting. All the medical students included in the study were final year students who had been exposed widely to clinical practice. All the respondents handed in their filled questionnaires by the end of the session. Results: Four hundred and eighty one (92%) respondents claimed knowledge about universal precautions, 20 (4%) had no knowledge and 20 (4%) others gave no response. All respondents except one person said UBP reduce the risk of HIV transmission. 481 (96%) of the respondents agreed that UBP should be practiced for all patients. 9 respondants (2%) said it should be so for only HIV positive patients and 11respondants (2%) was silent on the issue.

Key words : Universal Basic Precautions; HIV; Tertiary Care Hospital.

Background: Polyhydramnios carries a high rate of complications during pregnancy and adverse perinatal outcomes. The aim of this investigation was to evaluate the Pregnancy oucome in polyhydramnios. Methods: The prospective study carried out in Mangalore Fetal Medicine Centre, which is specialized centre for obstetric ultrasonography from Jan 2014 to June 2016. Possible confounding factors that could affect the occurrence of polyhydramnios were analyzed. We then investigated the relative risks of these events to adverse perinatal outcome by adjusting the variants. Results: Significantly higher incidences of preeclampsia, placental abruption, placenta accreta, past history of fetal death or preterm delivery, multiple pregnancies, bodyweight gain 20kg during pregnancy and primiparity were noted in patients with polyhydramnios than in patients without this condition. The presence of polyhydramnios significantly increased the rate of preterm delivery,low birth weight or very low birth weight, low oneand fiveminute Apgar scores, fetal death, large for gestational age babies, meconiumstained amniotic fluid, Cesarean section, fetal distress in labor, NICU transfer and neonatal death. Conclusions: Polyhydramnios carried a higher incidence of adverse perinatal outcomes,such as low Apgar scores, fetal death, fetal distress in labor, NICU transfer and neonatal death, despite exclusion of congenital anomalies from the study population. Detailed antepartum fetal wellbeing surveillance, intensive intrapartum monitoring and further attention to postpartum is warranted in patients with this condition.

Keywords: Polyhydramnios; Perinatal Outcome; NICU.

Introduction: Various maternal complications such as pre – eclampsia, eclampsia, anemia, oligohydramnios etc. are the major causes for perinatal loss. Such high risk pregnancies need to be identified so that appropriate surveillance and timely interventions can be employed. Methodology: Pregnant women with high risk factors attending the antenatal out patient clinic or admitted to the wards in the Obstetrics and Gynaecology department, for their high risk factors were recruited into the study. Results: In the present study, majority of the cases (74%) were booked and 26% were unbooked. Majority of the cases (47%) belonged to an age group of 2125years. 18 patients (26%) belonged to age group of 2630 years of age. Conclusion: The risk factors with which the patients presented were; hypertensive disorders in pregnancy which included mild and severe preeclampsia and gestational hypertension (37.14%), which formed the majority of cases.

Keywords: Pregnancy; Risk Factors; Profile.

Background and Objectives: Abnormal uterine bleeding (AUB) is any bleeding from the genital tract which is a deviation from the normal in frequency, cyclicity, or quantity . Thyroid dysfunction is associated with marked number of menstrual disabilities. This study aimed at detecting thyroid dysfunction in patients with a provisional diagnosis of AUB and early referral of positive cases to physician for further evaluation for prevention of overzealous surgical intervention. Methods: In this study, 151 cases of clinically diagnosed AUB were enrolled from Gynaecology OPD and in Patients of R.L Jalappa Hospital and Research centre, constituent of Sri Devaraj Urs Medical College, Tamaka, Kolar. All patients from puberty to premenopausal age groups manifesting as menorrhagia, acyclical metropathia, polymenorrhagia, metrorrhagia, oligomenorrhoea, polymenorrhoea and hypomenorrhoea were evaluated for their thyroid function by T3, T4, TSH screening. A patient who had clinical symptoms and signs of thyroid disease, was on hormonal treatment, IUCD users, or had bleeding disorders were excluded from the study. Results: Among 151 patients studied, 23.17% of patients had thyroid dysfunction of which 13.25% had subclinical hypothyroidism, 7.28% had hypothyroidism and only 2.64% had hyperthyroidism. The most common bleeding abnormality in subclinical hypothyroid patients were found to be polymenorrhoea and menorrhagia. All hyperthyroid women were identified as oligomenorrhoeic. Interpretation and Conclusion: In our study, thyroid dysfunction was observed in 23.17% of women with abnormal uterine bleeding, of which most common was subclinical hypothyroidism(13.25%), followed by hypothyroidism (7.28%) and hyperthyroidism( 2.64%). Oligomenorrhoea (34.48%), followed by polymenorrhoea (33.3%) and acyclical bleeding (27.2%) were commonest menstrual abnormalities seen in thyroid dysfunction. Hence, T3, T4 and TSH screening should be made mandatory in abnormal uterine bleeding cases, to detect thyroid dysfunction. Treatment of thyroid dysfunction in women with abnormal uterine bleeding will avoid overzealous surgical intervention and injudicious hormonal treatment.

Keywords: Abnormal Uterine Bleeding (AUB) Hypothyroidism Subclinical Hypothyroidism Hyperthyroidism. 

Introduction: Anemia is one of the most commonly encountered medical disorders during pregnancy. The fact that some of the pregnant women do not respond to iron therapies, implies deficiency or abnormalities of other factors involved in the hemoglobin/RBC generation and its function. One of the important factors is Vitamin B12 Aims and Objectives: 1.To find out the prevalence of vitamin B12 deficiency in primigravid pregnant women in first and early second trimester. 2. To study the effect of B12 deficiency on pregnancy outcome. Results: The prevalence of anemia is 57% with 29.5% mild, 25.5% moderate and 2.1% severe anemia (Hb%: mild 1011, moderate 710 and severe <7gm%). Serum folate was normal (>/= 3ng/dl) in 93.3% and low(<3ng/dl) in 5.7%. Vitamin B12 was normal in 70% (>200pg/dl) and low(<200pg/dl) in 30% of the study group. Conclusion: Anemia is still a major complication of pregnancy with a very high prevalence of 57%. This study revealed that there is significant B12 deficiency in pregnancy of 30%.B12 deficiency is associated with preeclampsia but not with low birth weight. There was folic acid deficiency with a prevalence of 5.7% Folate deficiency is associated with early abortions and low birth weight. The study suggests that apart from iron and folate, vitamin B12 also is a major factor affecting maternal and perinatal outcome and needs further evaluation.

Keywords: Folic Acid; Haemoglobin; B12 and Fetal Outcome. 

Background: The development and perfection of specific and accurate diagnostic tests for identification of fetus at risk of damage or death in utero has long been a major challenge for obstetrician and perinatologists. The primary objective of antenatal fetal assessment is to avoid fetal damage or death. Aims and Objectives: To evaluate efficacy of Modified Biophysical Profile as a practical method for antenatal fetal surveillance and to correlate it with perinatal outcome. Materials and Method: In the present study hundred high risk pregnant women were enrolled. Modified Biophysical Profile Score(MBPP) was performed in these high risk women and the outcome was judged by fetal distress in labor, presence of meconium stained amniotic fluid, 5 minute Apgar score, NICU admission and perinatal mortality. Results: Non stress test (NST) was found reactive in 75% women and nonreactive in 25% women. 65% women had an amniotic fluid volume (AFI) of >5 while 35% had an AFI of  5 cm. Abnormal MBPP score was found in 54% high risk women. In these, pregnancy was terminated either by induction (63.8%) or by performing elective cesarean (35.2%). 46% women had normal MBPP score. In this group 47.8% were left for spontaneous labor, 30.43% were induced and 21.7% were taken for elective cesarean due to various reasons. Incidence of emergency cesarean was found more in group with abnormal MBPP (22.2%) as compared to group with normal MBPP (17.3%). Women with abnormal MBPP score had more chances of fetal distress (14.81%) as compared to those with normal MBPP (4.34%) (p value .0379 i.e significant). More babies with low Apgar score were delivered in group with abnormal MBPP score (22.22%) as compared to only 10.8% in group with normal MBPP score (p 0.285). One early neonatal death was observed in group with abnormal MBPP score. Coclusion: With the help of MBPP score we can identify those fetuses that are in a compromised state in utero and thus by timely intervention we can avoid fetal damage or death. It is relatively easy to perform, less time consuming, none Provocative and thus can be safely used as a screening test for high risk pregnancies at tertiary as well as peripheral level.

Keywords: MBPP; NST; AFI; High Risk Pregnancies. 

This Study evaluates the factors affecting the expulsion, removal and continuation of post placental insertion of Cu 375 and CuT380A in women according to their socioeconomic profile, literacy status parity and the complications viz. uterine perforation, expulsion, pelvic infection, menstrual abnormality, lost strings and displacement following PPIUCD insertion among the acceptors. Study involved 300 women, divided into two groups: Group A and Group B. Mean age was 24.99 years, 63.8% women were literate and Mean parity in group A & B was 1.97 and 2.06 respectively. Mean pain score during intrauterine contraceptive device insertion on visual analogue scale was 2.93 in group A and 3 in group B. 84% women completed 12 month follow up in group A and 83.33% women in group B. Visibility of strings increased in successive follow up visits and was visible in >80% of women at the end of one year in the both groups. Fifty one percent subjects in group A and 54% in group B experienced amenorrhea up to six month. Menorrhagia was reported in 7.33% in group A and women 8.66% in group B at the end of 1 year of follow up. Pain was complained by 26 out of 150 women in group A as compared to 36 out of 150 women in group B after 1 month of insertion. Psychosocial (nonmedical/ personal) was most common cause accounted for 33.3% removals in our study. There was no case of PID in group A whereas there were 3 case of PID in group B. There was no perforation/ trauma and pregnancy in either group.

Keywords: Intrauterine Contraceptive Devices; PostPlacental; Psychosocial; Menorrhagia; Expulsion. 

Background and Aim: Abnormal uterine bleeding in premenopausal and postmenopausal women is the single most common reason for gynaecological referrals. Present study was done with an aim of Hysteroscopic Evaluation in Patients with Abnormal Uterine Bleeding. Methods: The study includes the patients attending gynaecology OPD at Gujarat Adani institute of medical science, Bhuj, Kutch, over a period of 18 months. Under anaesthesia, patient is placed in dorsal lithotomy position the sample size of the study includes 70 patients. The hysteroscope is inserted into the cervical canal and advanced into the uterine cavity through internal os under direct vision by manipulating along the axis of the canal. Endometrial cavity were visualised systematically. Any intrauterine pathology is looked for and endometrial samplings were taken from the abnormal sites for Histopathological examination. Results: Of the 70 patients majority, 11 (42%) had symptoms for more than 1 year, 45 patients (30%) had symptoms for 6 months to 1 year and 14 patients (28%) had symptoms for less than 6 months. Majority of the patients presented with menorrhagia. One of the most consistent findings in this study has been the detection of intra uterine Pathology like endometrial hyperplasia (17 cases, 18%), endometrial polyp (13 cases, 18%) and submucous myoma (3 cases, 5%) with 100% accuracy with hysteroscopy. Conclusion: Hysteroscopy was more sensitive in detecting endometrial polyp, submucous fibroid and endometrial hyperplasia but it was found less sensitive than curettage in detecting cancer and normal endometrium.

Keywords: Endometrial Hyperplasia; Hysteroscopic; Menorrhagia; Submucous Myoma; Uterine Bleeding.

Aim: 1. to determine the proportion of women accepting immediate PPIUCD. 2. To assess the safety, efficacy, continuation and expulsion of IUCD insertion in immediate post partum period and also compare the risk and complication of postpartum IUCD. Setting and Design: The study was a prospective hospital based analytical study to assess the acceptability and safety of PPIUCD use in women after delivery. The data were recorded in enclosed proforma and data analysis was done using EPIinfo software applying chi square test. The study was conducted at the SMIMER Hospital, a tertiary care teaching hospital attached to SMIMER Medical College, Surat, Gujarat, India. Materials and Methods: A prospective analytical study was conducted during the period from August 2014 to August 2015, among the eligible postpartum women, at a tertiary care hospital, SMIMER Hospital, Surat. Counseling was done about IUCD. After obtaining consent, CuT 380 was inserted in 179 women and was followed up to 6 weeks. Statistical Analysis Used: Data analyzed using EPIinfo software applying Chi square test. Results: Acceptance of PPIUCD was around 18.8%. Majority of our subjects were in 2125 years of age group. Women undergoing normal vaginal delivery accepted PPIUCD more frequently than those who underwent Caesarean section. Main reported complications were pain abdomen (10.21%) and bleeding (9.48%). Expulsion rate was 5.83%. 81.75% clients continued to use PPIUCD at 46 weeks. Conclusion: Even though expulsion rate was high, acceptance and continuation were high for IUCD when it was inserted in postpartum period.

Keywords: Contraception; Complications; Expulsion Rate.

Background and Aim: The ovaries are part of the female reproductive system. There are various types of ovarian cysts such as dermoid cysts and endometrioma cysts. However, functional cysts are the most common type. Aim of the study is to evaluate the patient’s perception regarding ovarian cysts and the awareness of the patients about the symptoms and health management in ovarian cysts. Methods: Females from the different areas of Bhuj district were included in the study. A total of 150 females were approached for the study. The questioner was randomly distributed among the females attending the ward for any of the reason. Out of 150 females, 115 were ready to fill the questioner. rest some females denied for one or the other reason so were excluded from the study. Women were eligible had no previous lung, colon or ovarian cancer diagnosis. Results: The majority of the respondents suffer pain during menstrual period. The value was significant (p = 0.030 and p = 0.005) with regard to worsening symptoms and severity of pain, respectively. Educational level influenced knowledge about cyst with patients with a higher educational level more likely to visit the physician. Conclusion: The findings of this study indicate that overall awareness level was high among inpatients but this was due to the fact that physicians informed about their diagnosis. Lack of prior knowledge of the disease can be attributed to lack of education, poor understanding of the patients regarding their disease and noncompliance with the medication that were prescribed to them.

Keywords: Educational Level; Menstrual Period; Ovarian Cysts; Reproductive System. 

 Background: Intensive care unit admission of a mother is a critical marker of the sever maternal morbidity. In our study we assessed the prevalence of the pregnant and puerperal women’s admission to the ICU, the reason for the need of the multidisciplinary care in a tertiary care center. Material and Methods: A retrospective 4year records were analyzed from the ICU of all the pregnant women, who were admitted to the ICU in the ESIC hospital from2013 to 2016. Results: Over the past 4year period, a total of 13,182 women were delivered in our institute, of whom 92 (4.34%) women needed ICU care. Maternal mortality rate was found to be 0.03% (4 deaths) of the patients who were admitted in the ICU. 36 (39.1%) were in the age group between 20–24 years. 31 (33.6 %) were the primigravidas. The commonest period of gestation was found to be at 37–40 weeks, with 36 cases (39.1%). Post delivery admission was 31 (33.6%). Severe anemia in 45 (48%) being the most common followed by, hypertensive disorders of pregnancy in 36(39.1%) and, PPH topped the list being 31 (33.6%), heart disease in 4 (4.3%), and sepsis in 9(9.7 %). The cause of the maternal mortality was sever preeclampsia and HELLP in one patient, amniotic fluid embolism in another, uterine rupture in a previous 3 cesarean section in an elderly patient and one was of a referred patient in view of intrauterine fetal demise and H1N1. Conclusions: Highermorbidity and mortality was noted in women with hemorrhage, which was found to be much higher than hypertensive disease of pregnancy and sepsis.

Keywords: Intensive Care Unit; Sepsis; Obstetric Hemorrhage; Preeclampsia; Maternal Mortality.

Background: The hypertensive diseases complicating pregnancy still remains the major problem in developing countries that threatens the maternal health and foetal viability adding to maternal and neonatal mortality and morbidity. There are many screening tests available but none of them proved to be effective in predicting PIH and preeclampsia. Present study designed to assess maternal serum IL6 levels in patients with pregnancy induced hypertension, preeclampsia and eclampsia and their correlation to fetomaternal outcome. Method: A casecontrol study on 50 normal pregnant women >20 weeks gestation as control and 50 women with SBP  140 mm of Hg and/or diastolic pressure   90 mm of Hg of pregnancy with >20 weeks gestation were recruited as study groups. All medical history, physical examination along with IL6 levels were analysed. Outcome measures of newborns were assessed for maturity, APGAR scores, birth weight, and neonatal complications. Results: Mean SBP was 161.4 mm of Hg and mean DBP was 106.5 mm of Hg in study group. Mean IL6 levels observed as 92.8 pg/ml in study group and 26.50 pg/ml in control group with p value of < 0.00001. In the present study, 21 (42%) babies were of APGAR < 7 in study group and 12 (24%) of babies were of APGAR < 7 in control group. The overall perinatal mortality was 36% in the study group, with 12 (24%) early neonatal deaths and it was only 2% in control group. Conclusion: The study results indicate that IL6 concentrations were increased in the circulation of preeclamptic patients compared with control women. It supports the hypothesis of immune activation involved in preeclampsia and that IL6 may participate in the abnormal immune response. Hence, it can be used as an indicator for assessing the severity of the disease and fetomaternal outcome.

Keywords: Preeclampsia; Interleukin6; Pregnancy Induced Hypertension; Fetomaternal Outcome.

Objectivewe aim to evaluate another safe method for second trimester abortions upto 20wk of gestation. Methods: this is a prospective study of 40 patients undergoing termination of pregnancy upto 20 wk in Geetanjali medical college & Hospital. Detail history of patient was obtained and study carried out after consent of the patient. Result: To induce termination of pregnancy, during 1120 weeks of gestation, extra amniotic 20% mannitol solution (100ml) + carbeprost (250) was used in 20 patients. The amount of mannitol was 100 cc through foleys catheter. Where as other 20 patients were induced with vaginal misoprostol 200 mg repeated 46 hrly. Mean abortion time with mannitol was 31.55 hour, with no side effects were noted. The longest induction abortion interval was 45 hours and 80% with in 30 hours and 100 % delivered with in 36 hours.

Kerywords: Intracervical Misoprostol; Mannitol; Amniotic 

Aim: To see eficasy of Step Glucose Tolerance Test after 75 gram glucose intake as a screening method for gestational diabetes mellitus of pregnant women on their first antenatal visit. Method: This study includes a total 150 pregnant women attending antenatal clinic for routine checkups were given a 75 gram glucose powder dissolved in a glass of water, to be consumed within 510 minutes irrespective to the time of the last meal and she was asked not to eat or drink anything other than water for next 2 hours. A venous blood sample was collected after 2 hours for estimating plasma glucose. Gestational diabetes mellitus was diagnosed if 2 hours plasma glucose was>140mg/dl these data’s were tabulated and results were calculated. Results: Out of 150 womens enrolled in, 50 antenatal women were diagnosed as having GDM by single step test, which would have been missed if random blood sugar was taken as criteria. Conclusion: G75 glucose tolerance test is a simple, convenient and very sensitive method to detect gestational diabetes mellitus. We recommend universal screening of all pregnant women to improve maternal and perinatal outcome.

Keyword: GDM. 

Introduction: Uterine leiomyomas (fibroids) are the commonest benign tumors in women. Leiomyomas are the most common tumors in women of reproductive age. They are symptomatic in 50% of cases, with the peak incidence of symptoms occurring among women in their 30s and 40s. The presentation of uterine fibroids is quite variable. The majorities of women with uterine fibroids are generally asymptomatic at the early stage and consequently get less clinical attention due to undiagnosed disease, while symptomatic women typically complain of abdominopelvic mass with or without abnormal uterine bleedingmainly menorrhagia. Objectives: To study clinical manifestations of fibroid uterus presenting as abdominopelvic lump. Materials and Method: In the present study total 100 cases of abdominopelvic lump attending the Obstetrics & Gynaecology OPD during the period of June 2013 to October 2014 were enrolled. A detailed history of presenting complaints & associated symptoms were noted along with menstrual history. A thorough general & systemic examination was performed. Examination assessed the presence or absence of mass (upon P/A, P/Sp or P/V). During bimanual examination the position, size, shape, mobility & tenderness of uterus & uterine appendages was noted. A clinical diagnosis was put forth based on the symptomatology, per abdomen, per speculum & per vaginum findings for the presenting condition. Results: Fibroid was the most common abdominopelvic mass (53%). Majority of the women were in the age group of 36 to 45 years. Majority of the women were parous (98%). The most common presenting symptom among the fibroid cases was menstrual irregularity (81.13%) followed by lump in abdomen (60.38%). Pain was reported by 33.96% patients. Among the patients of menstrual disturbances Menorrhagia, dysmenorrhea and polymenorrhea were the most common type observed. 32 cases of fibroid had palpable mass. Most of the fibroid masses were firm in consistency (52.83%). Maximum fibroid masses had smooth contour (52.83%). All the palpable masses were mobile. The findings of clinical diagnosis were compared with the gold standard histopathological examination and it was observed that clinical examination had sensitivity of 73.58% with specificity of 80.85%. Conclusion: Thus we conclude that fibroid uterus was the most common (53%) presenting as abdominopelvic lump. Menstrual irregularity was the most common presenting symptom followed by lump in abdomen and pain was observed. Menorrhagia, dysmenorrhea and polymenorrhea were the most common type of menstrual abnormality. Clinical examination had sensitivity of 73.58% with specificity of 80.85%.

Keywords: Fibroid Uterus; Abdominopelvic Lump; Menstrual Disturbances; Pain. 

Aim: To evaluate the impact of intrapartum Cardiotocographic (CTG) monitoring on neonataloutcome in high risk pregnancies in our setup. The basic principle of intrapartum fetal monitoring is to identify the developing fetal hypoxia and to intervene appropriately, thereby decreasing the perinatal morbidity and mortality. Methods: It was a hospital based prospective study over a period of one year. Admission CTG was done for the study population, trace was interpreted. The following parameters like color of the liquor, Mode of delivery, Appearance, Pulse, Grimace, Activity and Respiration (APGAR) and Neonatal Intensive Care Unit (NICU) admission were noted and recorded. The results were analysed using SPSS Software version 20. Results: Among the study population 80% had normal trace, 8.7% had suspicious trace and 11.3% had pathological trace. Meconium stained liquor was present in 24.2%, 30.8%, 70.6% of normal, suspicious and pathological traces respectively. 15% of normal trace, 61.5% of suspicious and 88.2% of pathological trace groups were delivered by Lower Segment Caesarean Section (LSCS). APGAR score at 5 minutes of birth was <7 in 3.3%, 38.5% and 82.4% of normal, suspicious and pathological trace groups respectively. When NICU admission was analysed 0.8%, 23.1% and 76.5% of normal, suspicious and pathological trace groups were admitted in NICU respectively. Sensitivity, specificity, positive predictive value and negative predictive value of CTG towards 5min APGAR and NICU admission were calculated based on the results of the normal and pathological trace groups. Conclusion: Our study concluded that the admission CTG can be used as an important non invasive tool to diagnose fetal compromise at the time of admission and during the course of labour in high risk cases especially in the era of potential litigations in Obstetrics.

Keywords: Cardiotocogram; High Risk Pregnancy; Neonatal Outcome. 

Cell Fee DNA (cf DNA) in maternal circulation is derived from both mother and fetus.Prenatal screening for aneuploidies can be performed using these cfDNA in maternal blood. It is new noninvasive technique which provides highly accurate results but it is still screening test due to very infrequent false positive& false negative results. CfDNA is highly fragmented hemopoitic cells. Each fragment is between 50 to 200 base pairs. There is clear pattern to fragmentation size and patterns differ between maternal &fetalcfDNA. Maternal clearance of fetalcfDNA occurs in 2 days after delivery. Half life of cfDNA is approximately one hour.