Indian Journal of Obstetrics and Gynecology

Background: Galactorrhea or galactorrhea is the spontaneous flow of milk from the breast, unassociated with childbirth or nursing. Hyperprolactinemia is a common problem encountered in reproductive disorders and the most effectively treatable cause of endocrine infertility. Primary infertility is a common, preventable, but neglected reproductive health problem in developing countries like India. The study was undertaken to find out the effect of galactorrhea on menstrual cycle and infertility pattern and to study the other clinical effect of galactorrhea and its various symptomatology.

Material and Methods: The study was conducted at the Department of Obstetrics and Gynaecology on 75 non-pregnant sexually active healthy females of age group 20-45 yrs presenting in outdoor during a period of one year. Females who were pregnant, post menopausal were excluded.

Results: Mean serum prolactin was 78.04ng/ml. Menstrual irregularity was present in 82.7% patients. The mean age was 29.33 years. Oligomenorrhea was the most common menstrual irregularity, amenorrhea. Serum prolactin was
mildly elevated in oligomenorrhea (76.19%) and amenorrhea (53.84%) patients. Relation of serum TSH and serum prolactin was statistically highly significant (p<0.001).

Conclusion: Routine breast examination in patients presenting with symptoms of menstrual irregularity and infertility and proper management of galactorrhea gives a significant improvement in symptoms and restoration of normal menstrual pattern and fertility.  

Keywords: Hyperprolactinaemia; Primary Infertility; Prolactin; Galactorrhea; Menstrual Irregularities.

Context: Thyroid disorders are the second most common endocrinology disorder found in pregnancy. Women with thyroid dysfunction both overt and subclinical are at increased risk of pregnancy-related complications such as threatened abortion, preeclampsia, preterm labor, placental abruption, and postpartum hemorrhage.

Materials and Methods: The present prospective analytical study was conducted among pregnant women to assess the prevalence of thyroid disorders among them and to observe the obstetric outcomes of these women suffering from thyroid disorders during the period of two years.

Results: In the present study, 62 out of 1000 pregnant women screened had thyroid disorders. The prevalence of thyroid disorders in our study was 6.2%. The prevalence of subclinical hypothyroidism, overt hypothyroidism, subclinical hyperthyroidism and hyperthyroidism was 3.6%, 1.6%, 0.8% and 0.2% respectively.

Conclusions: Thyroid dysfunction is a condition that should be treated aggressively and affects a significant number of women during pregnancy associated with adverse maternal outcome.

Keywords: Thyroid Disorders in Pregnancy; Hypothyroidism; Hyperthyroidism in Pregnancy; Pregnancy Related Complications.

Introduction: Maternal mortality amounts for the tip of iceberg but many maternal near miss cases are present which can be prevented. So, this study was conducted to find the causes of maternal near miss and maternal deaths occurred and to estimate the indicators of severe maternal outcome and overall near miss indicators during the study period at a tertiary care hospital in Nagpur.

Methodology: A thorough review of the eligible records of the patients who got admitted in the year 2015 from January to June period was done and this data was collected in the period from September 2016 to March 2017. A modified version of WHO near miss tool was used to collect the data. 

Results: A total of 105 cases were included in the analysis. The mean age of near miss cases was 24.98±4.00 years and of the maternal deaths was 26.92±4.93 years. The severe maternal outcome ratio, maternal near miss ratio, maternal near miss mortality ratio and mortality index were 55.97 per 1000 live births, 49.57 per 1000 live births, 7.75% and 11.42% respectively. The data was collected, compiled and analysed using Epi Info version 7.2 and expressed in terms of percentages and means.

Conclusions: We found that hypertensive  disorders were the most common underlying cause and anaemia being the most common secondary cause of near miss and maternal death. Majority of the near miss cases were primiparous. Among the organ dysfunction, coagulation dysfunction was most common and neurological dysfunction was the least common.

Keywords: Near Miss; Maternal Deaths; Severe Maternal Outcome; Indicators.

Endometriosis is a chronic debilitating disease that occurs in 6- 10% of the female population and about 35-50% of women with pain, infertility or both and characterized by endometrial tissue outside the divided into pelvic and extrapelvic sites. The most common sites affected are ovaries, however it can occur in rare sites like gastrointestinal tract, pulmonary structures, diaphragm, umbilicus, urinary system, laparotomy and episiotomy scars, breasts, perineum, extremities and even in central nervous system. The clinicopathological spectrum of endometriosis with emphasis on occurrence at unusual sites were studied with total of 30 cases from different sites diagnosed as endometriosis by FNAC (4 cases) and histopathology in all cases over a period of 17 years in a tertiary care hospital. The most common site located is ovary in 23 cases (76.6%) followed by abdominal wall in four cases (13.3%). The uncommon extrapelvic locations , include each in vulva (3.33%), perianal (3.33%), and bladder (3.33%). Clinical presentation in different location of endometriosis varies. Malignant transformation is very rare and may
occur in less than 1% of women, the most common site being ovary. Regarding pathogenesis, several theories are suggested. Follow up varied from 1-2 years. The typical presentation and local findings allows to make a correct diagnosis in
clinically suspicious endometriosis. Proper caution must be taken during lower abdomen surgical procedures. Complication like bleeding from cyst, bowel obstruction in intestinal, reduced fertility etc, may be circumvented, if early diagnosis and treatment is instituted.

Keywords: Endometriosis; Chocolate Cyst; Scar Endometriosis; Extra Pelvic Endometriosis.

Background: Cesarean section and hysterectomy are most commonly performed operations in obstetrics and gynecology. The most common complication associated with hysterectomy is infection. Single dose preoperative antibiotic prophylactic therapy also reduces cost, potential toxicity, post operative infection and risk of duration of hospitalization, colonization with resistant organisms hence, the  current study is undertaken to evaluate a efficacy of single dose of preoperative antibiotic prophylaxis versus routine postoperative antibiotic therapy in gynecological surgeries.

Method: 100 patients admitted and undergoing elective Gynecological surgeries like vaginal hysterectomy, abdominal hysterectomy and laparotomies in the department of Obstetric and Gynecology were enrolled in the study as per selection criteria. They were randomly assigned as group I and group II after obtaining informed consent.

Result: The incidence of febrile morbidity in group I was 5% and 8.33% in group
II and was statistically insignificant. Incidence of infectious febrile morbidity in group I is 1.66 and 3.33% in group II. 3.33% patients in group I and 5% patients in group II had non-specific pyrexia. The incidence of postoperative infectious morbidity in group I was 5% and in group II was 10%. Prolonged postoperative stay (>10 days) observed in 10% of patients in group I and 21.66% patients in group II.

Conclusion: Single dose antibiotic prophylaxis is equally effective in preventing post operative (respiratory/ urinary/ pelvic) infections and surgical site infection. As far as safety is concerned, single dose antibiotic is safer than routine antibiotic for prolonged period. Single dose antibiotic prophylaxis is more cost effective than routine antibiotic for prolonged period. 

Keywords: Febrile Morbidity; Postoperative Stay; Antibiotic Prophylaxis; Adverse Effect of Drug.

 

Background: It has been well known that foetal size at birth influences the maternal and perinatal outcome. Birth of small for gestational age (SGA) is associated with high rates of admission to neonatal intensive unit (NICU) for problems such as hypoxia, respiratory distress, whereas birth of large for gestational age (LGA) may cause more obstetric trauma during vaginal births and both conditions lead to high rates of operative abdominal delivery. Recent investigations have shown that single estimation of Umbilical Cord Cross Sectional Area (UCCSA) can reasonably predict foetal weight ranges.

Objective: To correlate fetal UCCSAobtained at the time of third trimester scan with neonatal birth weight.

Design: Prospective observational study over a period of two years.

Setting: Department of Obstetrics and Gynaecology, Kasturba Medical College, Manipal, Karnataka, India

Population: Two hundred and fifty women from 34 weeks gestational age who have delivered within 2 weeks of UCCSA.

Methods: Women from 34 weeks’ gestation, who presented for sonographic examination and who delivered within 2 weeks of the examination, were included in the study. The UCCSA was measured in a free loop of the umbilical cord. Linear regression analysis was used to correlate umbilical cord cross sectional area with neonatal birth weight.

Results: It was observed that proportion of cases with a lean umbilical cord was significantly higher in the group of small for gestational age group (60.7%) compared with other group (4.5%). A large umbilical cord was found in 65.2% of macrosomic babies compared with 4.4% in nonmacrosomic infants. All these association were found to be statistically significant (p<0.005).

Conclusion: There is a positive correlation between UCCSA and birth weight. As UCCSA increases, there is an increase in mean birth weight. 

Keywords: Umbilical Cord Cross Sectional Area (UCCSA); Small for Gestational Age (SGA); Macrosomia; Neonatal Birth Weight.

Background: Programmed labour technique provides double advantage of pain relief during labour and also improving the obstetric outcome and hence reaching safe motherhood. The aim of the present study is to evaluate the efficacy of programmed labour protocol in providing shorter, safer and relatively pain free deliveries.

Materials and Methods: The present prospective clinical study was conducted in the department of OBG, RIMS, Raichur during a period of 6 months (2017). The study included 100 uncomplicated Primigravida in active phase of labour. Detailed history, general physical examination and obstestric examination including vaginal examination were performed for all the patients. On entering of the patient into active phase, artificial rupturing of the membranes was done. Medications were given as per the programme. The results were arranged in a tabulated form and analysed using SPSS software.
Results: In this study a total of 100 subjects were enrolled, 50 belonged to cases and 50 belonged to control. The mean age of females was 35.43±23 years. In case group the rate of cervical dilatation was 1.70 cm/hr and that amongst control group was 1.21 cm hr.There were 4% (n=2) cases with score 3 in case group. Score 2 was seen in 40% (n=20) cases and 4% (n=2) controls. There were 44% (n=22) cases and 26% (n=13) control with score of 1. 

Conclusion: Programmed labor can be considered as an effective method of providing safe and prolonged analgesia to patients such that their delivery becomes considerably painfree. In our study, majority of the females were between 26-30 years of age and cervical dilatation and duration of labor were considerably better in case group.

Keywords: Labour; Obstetric; Prospective.

 

Cardiac disease is an important cause of maternal mortality and morbidity both in antepartum and postpartum period. Objective of the present study was to determine the incidence, etiology and the type of the heart disease and maternal and fetal complication in pregnant women with heart disease.

Methods: This study was conducted in the department of obstetrics and gynecology at Geetanjali medical college a tertiary care center Udaipur, 35 women with heart disease which were previously established or diagnosed during pregnancy were enrolled in the study over the period of 1 year. 

Results: In 35 women pregnancies were complicated by the heart disease in the study.The incidence of the heart disease were less than 1%. The principle cause of of the cardiac lesion was Rheumatic Heart Disease (RHD) (62.86%). While congenital heart disease was seen in 8.57%. Among the women who had RHD, mitral stenosis seen in 27.7% was most common lesion followed by MR in 18.18% and 4.55% patients of aortic lesions and combined valvular heart lesion in 13.66%. 1 (2.86%) patient had maternal mortality due to pulmonary edema with severe MS. Majority of the patients belonged to NYHA class 1.  57.14% underwent caesarean section and 42.86% underwent vaginal delivery. In Maternal complications 45.71% had preterm deliveries and 40% had IUGR component. Various neonatal complications like low birth weight in 40% and prematurity in 34.29% and 14.29% required NICU admission , 11.43% were still births and one congenital heart lesion in 2.86%. 

Keywords: Pregnancy with Heart Disease; Rheumatic Heart Disease; Maternal Complications; Fetal Complications.

Background: Polycystic ovarian syndrome (PCOS) patients are prone to develop insulin resistance with compensatory hyperinsulinemia, dyslipidemia, hypertension, and obesity. There is evidence that plasma levels of several hemostatic factors are modulated by hyperglycemia, insulin resistance with compensatory hyperinsulinemia, proinflammatory agents, and dyslipidemia, all of which are typical in PCOS. Hence; we planned study to evaluate the coagulation disturbances in PCOS patients. 

Materials & Methods: The present prospective study included assessment of 50 women with PCOS and 50 controls. Parameters like platelet count, bleeding & clotting time, prothrombin time, APTT, fibrinogen levels are tested. All the results will be analyzed by SPSS software 16.0. 

Results: A total of 100 subjects were included in the present study; 50 with PCOS, and 50 healthy controls. Fibrogen activity was found to be significantly higher in subjects of PCOS group. 

Conclusion: Prothrombotic state might occur with greater frequency in PCOS women.

Keywords: Coagulation; Disturbances; Polycystic Ovary Syndrome.

Objective: The main objective of the present study to investigate that the histopatological differences in normotensive and hypertensive pregnancies. Research Design: A prospective case-control observational study designed was used in current study.

Sample: The present study was conducted in total 200 inpatients in the Department of Gynaecology and Obstetrics, Institute of postgraduate medical education and research with associated S.S.K.M. Hospital Kolkata city in West Bengal, India.

Statistical Analysis: Descriptive, chi-square test and Fisher exact test applied on data analyses.

Result: Finding of the result in current study indicated that the shape of placenta was not found to be statistically significant, commonest mode of cord-insertion was central but it was statistically not significant. The incidence of retro-placental hematoma was increased in the hypertensive group with p-value<0.003, it is highly significant. The incidence ofinfraction was increased in the hypertensive group with pvalue<0.001, it is highly significant. he incidence of calcification was increased in the hypertensive group with p-value<1.000, it is statistically not significant.

Conclusion: The present study concluded that the hypertensive disorders of pregnancy adversely influence the morphology of the placenta. The study reveals that the placental weight and fetal weight are significantly less in hypertensive group than the normotensive group.

Keyword: Histopatological; Normotensive; Hypertensive; Pregnancies.

Introduction: Maternal obesity has been associated with adverse pregnancy outcomes, such as preeclampsia, eclampsia, pre and post term delivery, increased rate of caesarean section.

Objectives: To find out the effect of increasing body mass index (BMI) on pregnancy outcomes in nulliparous women delivering singleton babies. Method: This was a hospital based observational study, based on 300 nulliparous women delivering singleton babies in june(2017) to dec (2018). Women were categorized into four groups. Underweight (BMI< 20kg/m2) , normal (BMI 20-25 kg/ m2), overweight (BMI 25-30 kg/ m2), and obese BMI >30 kg/m2. Obstetric Outcome compared by univariate and multivariate analysis.

Results: Maximum no. of patients who underwent L.S.C.S (40%) were having B.M.I > 30 kg/ m2. L.S.C.S. with C.P.D, Postdatism and post – L.S.C.S wound infection was maximum (44%),(32%) and (22%) for B.M.I > 30 kg/m2. Maximum no. of patients with Pre- eclampsia (38%)were having BM.I. between 25- 29.9 kg/m2.

Conclusions: Increasing BMI is associated with increased incidence of cesarean delivery, Pre-eclampsia and preterm delivery and post datism.

Keywords: BMI; Innulliparous Women; Singleton pregnancy.

 

Background: Misoprostol is being in use as an agent for preinduction cervical ripening. But still the ideal dosage, route of administration of this agent is not exactly known.

Aim: To evaluate the efficacy and safety of 25 mcg and 50 mcg intravaginal misoprostol for labor induction.

Materials and Methods: We carried our study on 120 low-risk singleton pregnancies reported to the antenatal ward of Chalmeda Anand Rao Institute of Medical Sciences, Karimnagar, Telangana, India. The sample was categorized in to two groups, group A women were given 25 mcg (n = 60) and group B women received 50 mcg (n = 60) of intravaginal misoprostol. The dosage was repeated every four hours (limiting maximum number of doses to 3 doses). Induction vaginal delivery interval was the main outcome measure. Results: Most of the patients of both groups were 20 to 25 years. We found primigravidae cases in Group A and B to be 75 and 55% respectively. The percentage of cases of term pregnancies was 53.33% and 40% cases in group A and B respectively. Oxytocin augmentation was need in 41.66% cases (Group A) and 33.33% cases(Group B). After six hours, Modified Bishop’s score was 7-10 in 70% (Group A) and 71.67% (Group B) cases. Vaginal deliveries were more in Group A (66.66%) than Group B (50%). Cesarean section rate was more in group B (36.66%) when compared with group A (16.67%).

Conclusion: 25 mcg misoprostol is safe and successful for labor induction.

Keywords: Cervical Ripening; Labor Induction; Prostaglandin; Vaginal Misoprostol.

 

India is still a country with high  maternal mortality rate of 178 per 100000 live births. Since severe obstetric morbidities and complications are directly linked to ICU admission, we conducted a study in a tertiary care hospital to determine the rate of ICU admission of obstetric patients and their underlying causes. The results show primigravida to be most vulnerable and haemorrhage due to a variety of underlying etiologies to be the most  common cause of ICU admission. Eclampsia, respiratory distress, electrolyte imbalance, anaphylactic reaction, hypotension, ectopic  pregnancy are some of the most common causes.

Keywords: Obstetric Cases in Intensive Care.

Objectives: To study sociodemographic factors related to Fetomaternal outcome in pregnancies with infective hepatitis.

Materials and Methods: This observational study was carried out in department of Obstetrics and Gynaecology, in our institute, enrolling 50 subjects from January 2017 to June 2017 who attended the emergency labour room and Antenatal OPD with history suggestive of Infective Hepatitis and admitted in Antenatal ward, and some were later transferred to Medical ward . All pregnant women with Infective Hepatitis were selected, all their details entered in preformed, effective interventions were recorded.

Conclusion: Maximum cases of Infective Hepatitis were found in registered subjects with age group of 21-25 years, who were urban area, poor socio-economic class.

Results: Out of 50 subjects of infective hepatitis subjects from referred subjects from rural area and low socioeconomic area between age group of 21-25 years have higher rate of mortality.  

Keywords: Pregnancies; Infective Hepatitis.

Hypertensive disorder in pregnancy is a common disease. The incidence of pregnancy induced hypertension (PIH) in India range from 5 -15%. Though the exact cause of PE is still undecided, endothelial dysfunction with associated intense vasospasm has been implicated in its causation. Recently homocysteine, a metabolite of essential aminoacid methionine, has been postulated to produce oxidative stress and endothelial cell dysfunction. The present study is aimed at the estimation of homocysteine concentration in both pre-eclamptic and normotensive pregnant women, thereby deducing its relation in causation of preeclampsia. The present study was carried out in 90 pregnant women of whom 45 were Preeclampsia (cases) and 45 were normotensive pregnant women(controls) admitted to R.L.Jalappa Medical College, Kolar, Maternal serum homocysteine levels were measured by ELISA method.

Results: In the present study  of 45 preeclamptic women and 45 normotensive pregnant women in whom the serum homocysteine levels were compared. Majority of the subjects were in the age group of 21 -25years in both the groups. All the ninety subjects were primigravida. We have found that there is a statistically significant correlation between serum homocysteine levels and severity of PE i.e. the mean serum Hcy levels in controls (7.9±1.3 mol/l), mild preeclampsia (14.5±3.2 mol/ l) and severe preeclampsia (19.6±3.9 mol/ l). Serum homocysteine levels increased with increasing severity of PE with p - value being highly significant (p<0.001). Significant positive correlation was found between serum homocysteine levels and SBP and DBP i.e. with increase in SBP and DBP there was significant increase in serum homocysteine in preeclampsia. In our study, hyperhomocysteinemia was associated with poor pregnancy outcome in preeclampsia; IUGR (48.9%), Preterm (28.9%) and SGA (15.6%).

Interpretation and Conclusion: Homocysteine concentration decreases during normal pregnancy, but this does not occur in preeclampsia. In preeclampsia there is increase in levels of homocysteine compared to normotensive women. In PET, homocysteine levels further increase with increasing severity of preeclampsia. Hyperhomocysteinemia is associated with poor pregnancy outcome.

Keywords: Homocysteine; Normotensive; Preeclampsia.

Introduction: cardiovascular  diseases (CVD) are the leading cause of morbidity and mortality across the world. Postmenopausal women may have an increased risk of CVD. Vitamin-D (Vit-D) is believed to have an important role in the progression of CVD. Hence the study was undertaken to assess the link between Vit-D and CVD among postmenopausal Kerala population.

Materials and Methods: A crosssectional study was undertaken in 149 postmenopausal women. Demographic parameters were collected by using a questionnaire. Blood samples were collected and Vit-D status of all volunteers was estimated. The sample population was further grouped into three based on the Vit-D status as Vit-D deficient, insufficient and normal groups. Other parameters such as blood glucose, blood pressure, TC, TG, HDL, and LDL were measured and recorded. The result was analyzed by using appropriate statistics.

Result: There was a significant difference in the biomarkers of CVD between the test groups. The one way ANOVA between the groups showed a significant difference (p 0.05) in body weight, FBS, HDL, and TG. The Person correlation test indicated a negative correlation between Vit-D with SBP, LDL, ApoB, hsCRP and Lp-PLA2. Whereas a positive correlation was noted with Apo-A1 levels.

Conclusion: The result of the present study revealed that there is a significant association between Vit-D status and risk for CVD in the postmenopausal women of Kerala population. The study could reveal the elevated levels of conventional and specific biomarkers for cardiovascular risk. 

Keywords: Postmenopausal Women; Vitamin D Status; Cardiovascular Risk;
Kerala Population.

Background: Breech presentation is the commonest abnormal fetal    presentation met with in practice. It has been attended by a high perinatal morbidity and mortality. The clinical art of conducting vaginal breech delivery and obtaining mastery over the same requires many years of skillful training and supervision. The aim of this study is to assess maternal and fetal outcome in breech presentation.

Methods: The study is conducted in WEST INDIA in a tertiary care centre for a period of 3 years (January 2015 to December 2017). A total of approx 500 antenatal cases with breech presentation with  attending antenatal OPD in our hospital were studied. Patients were subjected to detailed history with respect to age, parity, mode of delivery. Antenatal USG scan was done to confirm breech presentation, type of breech presentation, placental location and uterine anomaly. Maternal parameters (genital tract trauma, wound infection, mortality etc) and fetal parameters (birth weight, APGAR, trauma, NICU admission, mortality etc) documented and analysed using statistical methods. A thorough obstetric and systemic examination was done.

Results: In our study incidence of breech presentation was more common in multigravida patients (55%) as compared to primigravida patients  (45%).Incidence of breech presentation is more  common in age group between 21 to 25 years of age accounting for 48%. In primigravida patients, incidence of cesarean section was more common than multigravida  patients, accounting for 62.50% of total LSCS. In multigravida patient vaginal delivery was more common (56.36%), whereas in primiparous women incidence of cesarean section is higher than vaginal delivery (88.88% v/s 11.11%). Overall maternal morbidity was higher in LSCS than vaginal delivery. Anterior was most common location of placenta, followed by fundal. Incidence of oligohydramnios in breech presentation in our study was 4 % & 1 % in case of polyhydramnios. Incidence of placenta previa was 3%. Distribution of parity according to type of breech was complete breech: 7.80% in primigravida and 92.10% in multigravida. In frank breech 71.92% primigravida and 28.07% in  multigravida. Distribution of type breech among mode of delivery was as follow: Most babies delivered vaginally were of frank variety, about 69.44%. Complete breech accounted for 45% of emergency LSCS, 37.5% of elective LSCS, 30.55% of vaginal deliveries. Most of the babies (47%) were having baby weight in between 2 to 2.5 kg, 37% having birth weight  between 2.5 to 3 kg.The perinatal outcome was good in EL LSCS & EM LSCS with an incidence of 100% & 92.5%. The incidence of low APGAR is 2 times higher in vaginal delivery in comparison with cesarean delivery. The incidence of NICU admission is 7.5% with cesarean delivery and 16.66% with vaginal delivery. The multigravida patients have good perinatal outcome than primigravida (92.72% vs 82.22%). Perinatal mortality is commonly associated with vaginal breech delivery 8.33%. In our study perinatal mortality was more common in frank breech as compared to complete breech.

Conclusion: The perinatal morbidity and mortality rate have played a
huge role in changing the plan -how to deliver a breech baby. But an important fact is presence of experienced obstetrician. Vigorous  intrapartum monitoring and proper technique of breech delivery have been established as the most important determinant for successful outcome in vaginal breech delivery without compromising feto-maternal well-being and curtailing the caesarean section rate. Parents must be informed about potential risks and benefits to the mother and neonate for both vaginal breech delivery and cesarean delivery. Discussion of risks should not be limited only to the current pregnancy. The risks of a cesarean on subsequent pregnancies, including uterine rupture and placental attachment abnormalities (placenta previa, abruption, accreta), as well as maternal and perinatal sequelae from these complications, should be reviewed as well. Delivery of breech fetus where labor is supervised by experienced obstetrician and delivery is performed by or under guidance of experienced obstetrician definitely lowers maternal morbidity, perinatal morbidity and perinatal mortality. External cephalic version (ECV) is a safe alternative to vaginal breech delivery or cesarean delivery, reducing the cesarean delivery rate for breech by 50%. ACOG (2016) recommends offering ECV to all women with a breech fetus near term. Adjuncts such as tocolysis, regional anesthesia, and acoustic stimulation when appropriate may improve ECV success rates. In our study it has been observed that abdominal route of breech delivery is safer though it has its own disadvantages. Cesarean section reduces overall perinatal mortality. But it has also been observed that cesarean section has problems of more hospital stay, and chances of maternal morbidity like in our study wound gap & need of blood transfusion. There is still a place for vaginal breech delivery in selected cases of breech presentations more so in mutiparous women.

Keywords: Breech: Etiology; Risk Factors.

Objectives: Evaluation of foetal outcome in pregnancy with heart disease in tertiary center in south Gujarat.

Material & Method: This is a prospective analytic study of 30 pregnant women with heart disease attending antenatal outpatient department or coming as emergency patient in labour room of New Civil Hospital, from july 2016 till August 2017.

Inclusion Criteria: All the pregnant women with heart disease attending antenatal outpatient department or coming as emergency patient in labour room of New Civil Hospital, from july 2016 till August 2017.

Exclusion Criteria: Patients not giving consent, pregnant patient with some other systemic disease.

Reult: Mean age of the patients enrolled was belonged to 20-25 years (73%). 57%  of the subjects had Rheumatic heart disease. Mitral valve is the most common valve affected in RHD. In our study 75% of subjects were in NYHA grade 1 and 2. 60% of the babies were full term with gestational age more than 37 weeks & birth weight >2.5kg. In our study most common complication was Prematurity (37%) and second most common was IUGR (17%).

Conclusion: a pregnant cardiac patient has to be in constant supervision of obstetrician, physician, cardiologist and neonatologist to improve the fetal outcome. Early diagnosis, preferably pre conceptional is crucial to reduce complications and morbidity. Careful history taking and physical examination are key to diagnose heart disease early and to prevent fetal complications.
Keywords: Foetal Outcome; Heart Disease; Pregnancy; Complications.

Background and Aims: Teenage pregnancy is often attributed for poor maternal and neonatal outcome. The incidence is found to be more in certain communities and those with poor socioeconomic and educational status. Preterm delivery and low birthweight are also more common in teenage pregnancy. This study was aimed at the demographic profile, mode of delivery and the incidence of preterm deliveries in teenage pregnant girls.

Methods: In this prospective comparative study, two equal groupsof 250 teenage pregnant girls between 17-19 years (Group T) and pregnant women between 20-30 years of age (Group W) were evaluated regarding their demographic profile with respect to age, referral status, religion, socioeconomic and educational status. Their gestational age at delivery, mode of delivery and birthweight of the neonates were also recorded. Statistical analysis was done using SPSS version 16.0 and the data analyzed using Chisquare test and Fisher’s exact test.

Results: Mean age in Group T was 18.5 years with SD 0.57 and in Group W it was 23.6 years with SD 2.30. Among Group T, 25.2% were referred from peripheral centers, while it was 4.0% in Group W. Statistically significant higher incidence of teenage pregnancy was noted among the Muslims compared to other communities (p< 0.00001). There was no statistically significant difference in teenage pregnancies with respect to their socioeconomic and educational status. Statistically significant increase in preterm delivery before 37 weeks of gestation was found in Group T as compared to Group W (p = 0.0004). There was no statistically significant difference regarding the mode of delivery and birthweight of the neonates.

Conclusions: Increased incidence of teenage pregnancies was found among Muslims, compared to other communities, but there was no significant influence with respect to their educational and socioeconomic status. There was higher incidence of preterm delivery in teenage pregnancies, but there were no significant differences in the mode of delivery and birthweight of the neonates in this group.

Keywords: Teenage Pregnancy; Demographic Profile; Mode of Delivery; Birthweight.


 

It has been described in the late 1960s that there is a drop in blood pressure, especially Diastolic blood pressure in the second trimester at around 18 weeks. The blood pressure then subsequently rises to the pre pregnancy levels during the third trimester. The so called secondary wave of trophoblastic invasion, which produces deep modifications of the spiral arteries, and makes them insensitive to vasoconstrictors. However, recent studies by various authors show that there is no mid trimester drop; but rather, an increase as compared to the first trimester blood pressure.

Materials and Methods: We conducted a prospective study in the antenatal department of JSS Medical College & Hospital, Mysuru; over a period of one year, from July 2016 to June 2017. The blood pressures of 120 women were recorded at four different periods of gestation and compared.

Results: The systolic pressures showed a non significant but steady increase up to 32 weeks and then a significant rise when compared to the first trimester. The diastolic blood pressure and mean arterial pressure showed a non significant decrease from baseline at 16 – 20 weeks. This was  followed by a rise in both diastolic pressures and mean arterial pressure as gestation advanced.

Conclusion: Our study disproves the age old concept that there is a mid trimester fall in blood pressure. It is the first of its kind in the Indian population. 

Keywords: Systolic Blood Pressure; Diastolic Blood Pressure; Mean Arterial Pressure; Pregnancy.

Introduction: Anemia is a very common problem in both non pregnant and pregnant women and its association with adverse pregnancy outcomes is an important issue. Adverse perinatal outcomes include intrauterine growth  retardation, prematurity, birth weight and significant mortality risks associated with anemia particularly in the developing countries. 

Aim: To know the effect of anemia in pregnancy on neonatal outcome.

Materials and Methods: This was a retrospective study conducted at Jhalawar medical college,  Jhalawar, for a period of one year. A total of 9430 pregnant women were delivered during study period. Out of those 336 were excluded (pregnancy induced hypertension, medical disease etc) and 9004 patient’s (5404 were anemic and 3600 were non anemic) data were recorded and perinatal outcome (live birth, still birth, intrauterine death (IUD), low birth weight and preterm delivery) were analyzed.

Results: Most common age group of pregnant patient was 20-25 year in both anemic and non anemic patients. Number of cesarean section were higher in anemic group (27.9% v/s 27%) Out of 3600 patients in non anemic group 972 (27%) but this difference was statistically not significant (p >0.05). There was significant high chances of preterm delivery, low birth weight and Perinatal death in anemic  mother as compare to non anemic mother (14.2 %v/s 11.4%, 23.7% v/s 16.3% and 4.4% v/s 2.3% respectively) (P<0.05).

Conclusion: Anemia during pregnancy significantly associated with adverse perinatal outcome. Efforts must be made through strategies such as fortification and periodic supplementation and counseling of women of the risks of anemia during pregnancy.

Keywords: Maternal Anemia; Perinatal; Fetal; Low Birth Weight; Preterm.

Aim: To compare combined perinatal outcome and maternal characteristics between detected and undetected small for gestational age foetus.

Materials and Methods: It is a prospective, observational cohort study done atmaternity referral perinatal centre with about 8000 deliveries per year. The sample comprised of mothers who delivered SGA neonates. Data was collected as maternal characteristics including age, body mass index, parity, risk factors for SGA, type of labour, mode of delivery, induction of labour rate, gestational age at delivery, rate of presumed fetal zcompromise leading to caesarean section assisted vaginal deliveries, low Apgar’s, cord pH and composite neonatal morbidity between detected and undetected SGA. Composite neonatal morbidity includes respiratory distress, sepsis, neonatal hypoglycaemia requiring IV fluid, severe birth asphyxia and NICU admission for greater than 48 hours and neonatal seizure.

Results: Prevalence of SGA was 6.4% with detection rate of 50%, significant risk factor for SGA was present in 37% cases so recognition of risk factor improves detection rate of SGA. Higher rate of induction and caesarean section rate were seen in detected SGA. Instrumental delivery rate was more in undetected SGA. Un detected SGA had more signs of fetal distress during labour, low cord pH and low Apgar, but NICU admissions were more in detected SGA. There was no significant perinatal mortality in term SGA babies.

Conclusions: Every unit should have protocol to identify and manage SGA fetus for better outcome.

Keywords: Small for Gestational Age; Perinatal Outcome; Maternal Characteristics.

Background: The study was conducted to determine the incidence, indication andfetomaternal outcome associated with emergency obstetric  hysterectomy in a tertiary care centre.

Methods: Forty-two cases of emergency obstetric hysterectomy performed during the three-year period from July 2014 to July 2017 were analysed in the Department of Gynaecology and Obstetrics at Surat Municipal Institute of Medical Education and Research, Surat.

Results: During the study period there were 42 cases of obstetric hysterectomy out of 16221 deliveries giving an incidence of 0.25%. Majority of the patients 34 (80%) were unbooked and were in the age group of 26-30 (38%).Majority were second parapatients.  Atonicpostpartum haemorrhage was the most common indication contributing to 45.2% of the cases. There were six maternal deaths in the study. All were unbooked and three of them died of disseminated intravascular coagulation, two died of hypovolemic shock with  cardiopulmonary arrest and one died of septicemia. Whereas there were 21.4% perinatal mortality and 19.1% NICU admissions.

Conclusions: Emergency obstetric hysterectomy is a potentially lifesaving procedure which often puts obstetrician in dilemma at the time of decision making. 

Keywords: Emergency Obstetric Hysterectomy (EOH); Morbid