Indian Journal of Obstetrics and Gynecology

Endometriosis affects women in their reproductive life and is a chronic disease. It is an important cause of dysmenorrhea, chronic pelvic pain and infertility. Diagnostic and therapeutic challenge is faced by clinicians as the disease tends to come back. Management is usually directed at relieving the symptoms and improving the chances of fertility which is either medical or surgical or a combination of the two. Some women with endometriosis might be asymptomatic, most have chronic abdominal &/or pelvic pain. Research is directed to find out ideal medication for endometriosis, with good efficacy, minimal or least side effects, cost- effective, and cantargets the basic pathology of disease to cures it. However, such cure is yet to be found. Many drugs are used to treat endometriosis- NSAIDs, combined oral contraceptive agents, Progesterones (oral, injections and local as intra uterine device. Every drug has its side effects and safety profile. Progesterones are generally preferred in very young as well as older women who cannot take long term OCP due to estrogenic side effects or contraindication Dienogest, a newer progestogen is closer to the ideal agent. Its profile is discussed below along with comparison with other progestins which are already being used. Other potential progestins are also discussed providing a whole spectrum of drugs with different efficacy and profiles.

Keywords: Endometriosis; Progesterones; DMPA; Dienogest; Levonorgestral Intrauterine System. 

Aim: The aim of the study is to study AFI <5 cm is an appropriate threshold for pregnancy intervention to prevent adverse outcome of pregnancy, and it is a determining factor in perinatal outcome in high risk pregnancies. To compare caesarean rates between patients with AFI <5 cm and AFI >5 cm in high risk pregnancies. Methodology: This study was a prospective, comparative study conducted over a period of two years total of 100 patients were selected in study group 50 high risk patients of >35 weeks pregnancy with an AFI <5cm. In the control group, 50 high risk patients of >35 weeks pregnancy with an AFI >5cm with the same complications of pregnancy. Results: The patients showed the mean age of this study population was 28.69±3.51 years and mean marriage duration was 2.89±3.12 years. In study group the highest was in IUGR (asymmetrical) and in which frequency was 18 (36%), and the highest in control group was PD in which frequency was 17 (34%). In group with AFI <5, there was high rate of non-reactive NST compared to group with AFI>5 (p<0.001). The most common indication of LSCS was acute foetal distress followed by oligohydramnios and IUGR. the characteristics of AFI<5 cm was highest for normal Apgar score at 5 mins >6 which was 22 (44%), AFI >5cm was highest for normal Apgar score at 5 mins>6 which was 46 (92%). Conclusion: From the present study, it was concluded that predictor of adverse outcome for high risk antepartum or intrapartum ladies is AFI, timely intervention is done along with antepartum and intrapartum fetal monitoring if early recognition alerts an obstetrician to prevent perinatal catastrophe and in neonatal care, there is need for improvement.

Keywords: Amniotic Fluid; Antepartum. 

Introduction: To compare 25 microgram of misoprostol with two different routes [sublingual and vaginal] for induction of labour at term in terms of efficacy, tolerability and safety. Material and Method: After getting approval from ethical committee, 180 patients those for labour induction at term were included in this study. 90 patients were administered sublingual misoprostol and remaining 90 patients were administered vaginal misoprostol after considering inclusion and exclusion criteria. Outcome measures like mode of delivery, induction-delivery interval, maternal complications, fetal outcome and complications were compared using an unpaired, two-tailed Student’s t test and chisquare test. Results: 25 g of sublingual misoprostol patients had shortened induction delivery interval and needed less number of misoprostol tablets and pelvic examination than vaginal misoprostol (p<0.05) with no significant difference in mode of delivery and fetomaternal complications. Conclusion: we conclude that 25 g of sublingual misoprostol is better in efficacy than 25 g of vaginal misoprostol for term induction with no difference in tolerability and safety.

Keywords: Induction; Labour; Misoprostol; Sublingual; Term; Vaginal.

Objective: To evaluate the preoperative and intraoperative risk factors associated with surgical site infection amongst obstetric patients and its impact on postoperative recovery. Methods: Aprospective, observational study was conducted among 332 patients Who underwent surgery in Obstetrics both elective and emergency over a period of two years. Among the 332 patients, 200 were operated on emergency basis and 132 on elective basis. Diagnosis of SSI was made as per CDC criteria. Various risk factors and impact of SSI on postoperative recovery were analysed. Results: The incidence of SSI was found to be 54 out of 332 women (16.3%). In these 54 cases, 35 (64.8%) underwent surgery on emergency basis. The most common type of SSI was superficial SSI. The risk of SSI was high in patients with exploratory laparotomies and midline incision (p <0.005). Presence of medical comorbidities like anaemia (6.29), hypertension (OR 3.07) and diabetes (OR 1.03) were identified as significant risk factors. Conclusion: SSIs are preventable by early identification and optimization of medical comorbidities and BMI. Reduction in infection rate can lead to decrease in substantial burden of the disease, both for the patients as well as healthcare services.

Keywords: Obstetric Cases; Post- Operative Impact; Surgical Site Infection.

Aims & Objective: The objective of this study was to compare the knowledge, attitude and practices (KAP) among women attending ANC and those not receiving ANC with reference to recognizing the danger signals of high risk pregnancy. Material and Methods: The survey was conducted using a predesigned, structured questionnaire. 150 women who had availed antenatal care and 150 women who had never availed ANC responded to the questionnaire.  All data was entered in SPSS (Statistical package for Social Sciences) version 10.0 (SPSS, Chicago, Illinois, USA). Cross tabulations were obtained in order to compare women receiving and not receiving antenatal care. Results: The mean age of women in our study was 25±7.1 years. Mean family income per month was Rs 10.000±8,000 and 19.5% of the women were illiterate with majority (81.5%) being housewives. Antenatal care used in any of the previous pregnancy was 65.02% in the ANC group. 35.8% women had studied up to secondary school and 39.8% of their husbands had higher education. Statistically significant difference was found among women who received antenatal care as compared to those who did not in recognizing fever (OR=2.8, 95%CI 1.4-5.5), persistent vomiting (OR=2.35, 95%CI 1.19-4.64) , dizziness and fainting (OR= 1.18, 95 % CI 0.57-2.42) and antepartum haemorrhage (OR=2.1,95% CI 1.2-3.86) as danger signs in pregnancy. There was no significant difference between the two groups with regards recognizing breathlessness, persistent palpitations, generalised oedema, previously scarred uteri, multiple abortions and jaundice in pregnancy. Conclusion: Significant number of women had a basic knowledge of danger signs for anaemia, hypertension and infections in the proactive ANC group; however women are still negligent regarding unsupervised MTP Pill intake, unsafe abortions, scarred uteri, medical disorders with pregnancy. Therefore, health personals should strengthen their awareness creation activities in the community with emphasis on the predictors of high risk pregnancy.

Keywords: Antenatal Care; KAP; Oedema. 

Context: Infertility is defined as failure ofa couple to conceive for at least 1 year after regular and Unprotected intercourse. Infertility affects about 10-15% of reproductive age couples. The prevalence of infertile individuals is increasing globally. Experience has shown that routine examination and diagnostic procedures is not enough to evaluate pelvic pathology of infertile women. The present study aimed at evaluating role of diagnostic hystero-laparoscopy in primary infertility cases. Aims: To identify the incidence of various pathological condition in female reproductive tract leading to infertility and to evaluate the role of diagnostic hysterolaparoscopy in comprehensive work up of primary infertility and to help in planning appropriate management. Materials and Methods: A retrospective hospital based study was conducted among 84 cases of primary infertility that underwent diagnostic hysterolaparoscopy. Infertile women who had no significant clinical/ultrasonography findings were included in the study and incidence of various pathological conditions in the female reproductive tract leading to infertility was calculated. Results: Out of 84 study subjects, majority of infertility cases were between the age group of 21 – 30 years. We observed that 33.33% cases were reported abnormal by laparoscopy while 14.28% cases were reported abnormal by hysteroscopy. The commonest abnormalities reported in laparoscopy were tubal pathology. Conclusions: Tubal pathology accounted for the highest incidence among the laparoscopic abnormalities followed by endometriosis and ovarian pathology.

Keywords: Primary Infertility; Hysteroscopy; Laparoscopy; Tubal Pathology; Tubal Block; Endometriosis. 

Background: Caesarian section is the one of the most commonly performed operation worldwide. LSCS is the most commonly used type of caesarian section.The increase in LSCS rate has been a global phenomenon.In a developing country like India there is an increasing trend of caesarian section with increase in the institutional deliveries and growing access to obstetric care. Material & Methods: A Retrospective observational study was conducted in the department of OBG at the Raichur institute of medical sciences, Raichur from 1^st January 2015 to 30th June 2015. During this period 1352 deliveries were conducted and among these 362 who underwent LSCS were selected for the study. Results: The maximum incidences of caesarian section were in the age group of 20- 25 years (43.5%). Maximum patients belonged to primigravida (50.3%). Majority of the study group were booked patients (60.5%). Previous LSCS was the leading cause of caesarian section in 28.4% of cases followed by CPD in 13.6% of cases. Conclusion: Previous caesarean section was the leading indication for a caesarean delivery in this study group. Therefore a careful individualization of every case, meticulous clinical examination and use of intensive intrapartumfoeto maternal surveillance could probably reduce the rates of caesarean section.

Keywords: Caesarian Section; Foetal Distress; CPD. 

Background: Maternal death from obstetric hemorrhage is a global problem. Approximately 30 percent of direct maternal deaths worldwide are due to haemorrhage, mostly in the post – partum period. Post partum haemorrhage complicates approximately 4% of vaginal deliveries and 6% of caesarean deliveries. The purpose of this study is to determine causes of PPH, risk factors, preventable factors and to assess treatment measures adopted. Objective: To study the prevalence and risk factors of post partum haemorrhage. Methods: Antenatal patients who had risk factor for postpartum haemorrhage were followed till delivery. Study population also included puerperal women admitted with PPH. Among PPH patients, need of blood and blood component transfusion, need for conservative surgical procedures to treat PPH was studied. Results: The prevalence of PPH in the present study was found to be 5.9%. In the present study, anemia (p=0.0002), uterine malformation (p=0.02), Previous episode of PPH (p<0.0001), genital tract trauma (p=0.027) and Retained placenta (p=0.01), is found to be significant risk factor for PPH. Whereas Placenta praevia was not found to be a statistically significant risk factor for PPH (p= 0.62). Among the patients who had PPH, transfusion of blood and blood products were needed in 23 (65.7%) patients. Conclusion: In the present study, the risk factors which are observed are retained placenta, anemia, uterine malformation (bicornuate uterus), retained placenta lower genital tract trauma and previous history of PPH.

Keywords: Prevalence; Risk Factors; Retained Placenta; Obstetric Haemorrhage; Anemia. 

Aim: The study was conducted to determine the pregnancy and labour characteristics and new born outcomes in nulliparous women at age 30 and older. Methodology: It is a prospective longitudinal study conducted in the department of OBG in Yenepoya Medical College, Mangalore. Primigravidae 30 years and older (study group) in labour were compared with another group of women 25-29 years (control group) in labour. Intrapartum data collected were presentation, onset of labour spontaneous or induced, progress of labour, type of delivery vaginal or caesarean delivery and incidence of meconium staining were recorded. Chi square test was used for comparison of data. P=0.05 was considered statistically significant. Results: The rate of spontaneous vaginal delivery was 58% and casesarean section was 42% among the study group and among the control were 66% and 28%. Incidence of preterm birth among study group was 24% and in control group was 8%. Factors such as PIH, gestational diabetes, chronic hypertension, third trimester bleeding, caesarean section were higher in the study group. Conclusion: The study confirms that pregnancy and delivery at age 30 years and older poses increased risks of antepartum and intrapartum complications.

Keywords: Nulliparous Women; Pregnancy; Caesarean Birth. 

Background: Adenomyosis is a lesion of myometrium characterized by ectopic endometrium seen within the myometrium. There may or may not be hyperplasia of surrounding myometrium. A majority of cases are diagnosed following histological examination of hysterectomy specimens. Objectives: The aim of the study is to correlate adenomyosis which was diagnosed in hysterectomy specimens with clinical diagnosis and patient profile. Methods: It is a retrospective study of case records of all the patients whose hysterectomy specimens showed adenomyosis and analysed with regard to the clinical profile. Results: Of 250 patients studied the prevalence of adenomyosis was found to be highest in the age group 41-50. The chief symptom the majority presented with was menorrhagia followed by dysmenorrhea. In around 50% of cases, they were clinically diagnosed preoperatively. Conclusion: The true prevalence of adenomyosis is still unknown. The data published in other studies were found to be consistent with the results in our study.

Keywords: Adenomyosis; Menorrhagia; Histopathology. 

Introduction: Dysfunctional uterine bleeding is one of the commonest conditions met within gynaecological service of any hospital. DUB can be caused by variety of disorders. At one end it may represent an exaggerated normalphysiological process and observations alone may be warranted and to other endbleeding can be a serious underlying condition. DUB has great variations inendometrial patterns. Material & Methods: A Prospective study was conducted from April 2010 to September 2011 involving 100 patients between 14-55 years with symptoms of dysfunctionaluterine bleeding presenting to Navodaya medical college hospital, Raichur, their endometrial samples were obtained by dilatation and curettage. Results: The maximum incidences of DUB were in 21- 40 years age group (67%).Thepredominant bleeding pattern was menorrhagia (44%) and least common wascontinuous bleeding (14%). Most common endometrial profile wasproliferative (35%) and least common was irregular shedding (15%). Conclusion: DUB is more commonly seen during reproductive age group. Majority (46%) of them presented with menorrhagia.

Keywords: Dysfunctional Uterine Bleeding; Menorrhagia; Proliferative Endometrium. 

Introduction: Nearly 40% of the infertile women present with ovulation-related causes and 70% of these patients can be diagnosed and treated effectively. Thus, knowing the time of ovulation is crucial in management of infertility. Transvaginal sonography (TVS) and endometrial biopsy are being used to detect ovulation in infertile women. Aim: To assess qualitatively the usefulness of serial TVS in detecting ovulation and compare the findings with endometrial biopsy (EB) findings. Methods: In thisprospective observational study on 100 infertile women, after obtaining the informed consent, detailed history and clinical examination of the patients was performed. TVS was performed on every alternate day after 11th day of menstrual cycle till the evidence of ovulation or up to 17th day of cycle and EB was done on day 1 of next menstrual cycle for histopathological evaluation of endometrium. The results of TVS and EB for detecting ovulation were compared with Chi square test. Results: In this study, the same 100 patients after serial TVS were subjected to EB. Ovulatory cycle was observed in 73 cases with TVS while secretory phase was detected in 63 cases in EB and proliferative phase was seen in 29 cases. Non dominant follicle was seen in 11 cases in TVS out of which only 9 cases in EB showed proliferative endometrium. Failure to rupture of follicle was seen in 10 cases in TVS. Signs of Polycystic ovarian syndrome (PCOS) were detected in 6 cases by TVS. Thus, there is better detection rate of ovulation by TVS (sensitivity = 100%) compared to EB (P < 0.00354; Chi-square test), while specificity was greater (96%) with EB. Conclusion: Our observations indicate that serial TVS along with EB together can be a useful to detect ovulation in the management of infertility. In addition, TVS can also provide details of any uterine, endometrial, cervical or adnexal pathology.

Keywords: Transvaginal Sonography; Infertility; Ovulation; Secretory phase; Proliferatory phase; Endometrial Biopsy. 

It is recognized universally that menstrual disturbances may accompany and even may precede thyroid dysfunction. The objective of the study was to evaluate the prevalence of thyroid dysfunction in abnormal uterine bleeding and correlation with menstrual disorders. The present study was conducted on 100 patients who presented with abnormal uterine bleeding in gynecology OPD VIMS bellary. Among the 100 women 17 (%) had hypothyroidism, 2 (%) had hyperthyroidism and 81 (%) were euthyroid. Menorrhagia was the most common menstrual disorder in hypothyroidism and oligomenorrhoea in hyperthyroidism. In the present study 14(%) patients had proliferative endometrium, 3(%) secretory endometrium of hypothyroid patients and secretory endometrium in 2 (%) hyperthyroid patients. The menstrual irregularities are significantly more frequent in patients with thyroid dysfunction and menorrhagia was the commonest menstrual abnormality.

Keywords: Abnormal Uterine Bleeding; Dysfunctional Uterine Bleeding; Menorrhagia; Oligomenorrhoea; Thyroid Dysfunction. 

Background: Hysterectomy is one of the most commonly performed definitive treatment for various gynecological diseases worldwide. In this study we aim to analyze the hysterectomies done in our hospital with respect to age, indications, routes of hysterectomies, complications and histopathological correlation with clinical findings. Material and Methods: This prospective, observational study was conducted on total of 579 patients in the Department of Obstetrics & Gynecology, Pacific Medical College & Hospital, Rajasthan. Clinical diagnosis was established on the basis of history, clinical examination and investigations which included ultrasound, Pap’s smear and endometrial biopsy if done. All hysterectomy specimens were subjected to histopathological examination. Sensitivity, specificity, positive predictive value, negative predictive value and p-value of clinical diagnosis with histopathological diagnosis was calculated. Results: The commonest indication of hysterectomies in our hospital was abnormal uterine bleeding (26.94%). Total abdominal hysterectomy with bilateral salpingoophorectomy was the most common procedure with an incidence 74.27%. The overall sensitivity was 90.36%, specificity was 98.6% and positive predictive value was 85.9% in our study. The accuracy of the diagnosis ranged from 89.6 % to 100% and p - value was significant at 0.001 for adenomyosis and proliferative endometrium. In all cases of malignancies and cervical dysplasia p value was insignificant because all malignancies can be diagnosed clinically and histopathology is for confirmation and further management. Conclusion: Every hysterectomy specimen should be subjected to histopathological examination to ensure diagnosis and further management in particular of malignant diseases. Histopathological analysis correlates well with the pre-operative clinical diagnosis for hysterectomy.

Keywords: Clinicopathological; Histopathological Diagnosis; Hysterectomy; Adenomyosis; Total Abdominal Hysterectomy.