Indian Journal of Obstetrics and Gynecology

Cortical blindness is loss of vision with intact pupillary reflexes and normal optic fundus, due to damage to primary visual cortex. Cortical blindness in postpartum period is an uncommon event. Possible etiologies are cerebrovascular disease complicating pregnancy, eclampsia, clinical syndrome like posterior reversible encephalopathy syndrome (PRES), etc. Common among these is PRES. The common visual disturbances seen in patientswith posterior reversible  encephalopathy syndrome (PRES ) are blurred vision, visual field deficits like quadrantanopia and hemianopia, visual hallucinations and rarely PRES produces complete loss of vision. Here we report a postpartum woman who developed complete loss of vision due to PRES. Interestingly her blood pressure was normal, though PRES is commonly associated with elevated BP. In addition to that she demonstrated uncommon site of edema in neuroimaging. To add on, her MRI brain showed high signal in DWI image which usually occurs with ischemic infarct. She was managed conservatively with excellent recovery of her vision.

Keywords: Posterior Reversible Encephalopathy Syndrome; Cortical Blindness; Post-Partum

  Introduction: The acute peurperal uterine inversion is a rare obstetric emergency and a severe complication occurring in the third stage of labour. The diagnosis of uterine inversion is made on the basis of clinical symptoms which include haemorrhage, shock and a strong pelvic pain. Case Report: A 24 year old, para 2 , living 2 , delivered vaginally at a primary health care centre three hours prior to admission was referred in view of mass per vagina and shock. On per abdominal examination there was suprapubic tenderness and the uterine fundus could not be palpated. The local examination revealed a 2nd degree perineal tear with profuse vaginal bleeding, a uterine mass was visualised in the vagina and the diagnosis of acute uterine inversion was made. Under general anaesthesia, manual correction was attempted but failed. A laprotomy was done; another attempt to correct inversion by applying traction on the round ligaments was made but was unsuccessful. An incision was taken on the posterior surface of the ring formed by the cervix and via vaginal manipulation the fundus was pulled up and uterine reposition was achieved. As persistent uterine atonicity was noted B –Lynch & square stitches were put on the uterine fundus and bilateral uterine artery ligation was done. The 2nd degree perineal tear was sutured in layers. Three units of blood were transfused intra operatively and postoperative use of  uterotonic agents, antibiotics, analgesics lead to an uneventful recovery of the patient. Conclusion: Acute uterine inversion is accompanied by high risk of postpartum haemorrhage and the best prognosis occurs where the diagnosis and manoeuvres are made at an early stage.

Keywords: Uterine; Perineal; Peurperal uterine.  

 Background: Gestational hypertension is usually defined as having a blood pressure higher than 140/90 measured on two separate occasions, more than 6 hours apart, without the presence of protein in the urine and diagnosed after 20 weeks of gestation. Aim: To determine the factors associated with pregnancy related hypertensive disorder and its outcomes. Materials and Methods: The study is a prospective study was conducted in Father Muller hospital Thumbay for a period of January 2015 to February 2016 in Department of Obstretrics and Gynaecology. During the study, 150 pregnant women with induced hypertension were selected for the study. Results: The highest percentage of pregnant women with hypertension was present in 18-23 years i.e. 36.6%, pregnancy induced hypertension was more in nulliparous women (60%), systolic blood pressure of 140-160 mm Hg was the highest blood pressure which was 90%, diastolic blood pressure of 90-100 mm Hg was the highest in 90% of the patients with PIH, medication for hypertension is taken more i.e. in 136 patients which constitute 90.6% of PIH patients, preterm foetal outcome was seen in most of the patients with PIH which constitute 46.7%, post term (3.3%), LBW (<2.5 Kg) (40%), IUGR and NICU admission constituted 4.7% and 2.7% respectively and the IUFD and neonatal death was the least outcome seen which constituted 1.3% each. Conclusion: It is noted from  our study that PIH is more prevalent in younger aged patients and patients who were nulliparous, increased adverse foetal outcome was observed. Early recognition and management can reduce morbidity and mortality among PIH patients. 

Keywords: Pregnancy Induced Hypertension; Gestational Hypertension; Preeclampsia. 

 Background and Aim: The aim of antepartum fetal surveillance is to identify fetus at increased risk of harm. Amniotic fluid volume has been proved an indirect measure of fetoplacental function and hence the  estimation of amniotic fluid volume assists in risk assessment by  application of dynamic ultrasonographic methods. Of the various semiquantitative methods the four quadrant technique provides a fetal convenient method for evaluating amniotic fluid volume. Materials and Methods: This was a comparative, nonrandomized study done over a period of 18 monthson 100 women with the gestational age of 34 to 42 weeks. They are divided on amniotic fluid index done with study of umbilical artery Doppler. Results: 100 cases of complicated and uncomplicated pregnancy of term gestation are included in the study. 70 cases are booked and 30 cases are unbooked. 37cases are primigravidae, 63 cases are multigravidae. Low AFI values are most commonly associated with primigravidae and high AFI volume are associated with multigravidae. Out of 14 cases with vey low AFI 35.71% had PIH, 35.71% of post dates, 28.57% cases are IUGR. This indicates low AFI values are more commonly associated with complications like post dates, PIH, IUGR. 64.28% of cases are associated with meconium staining of liquor in low AFI values. Cesarean section rate and forceps delivery is  significantly higher in patients with low AFI values. Out of 14 cases with low AFI 71.42% of cases underwent cesarean section and fetal distress is commonly associated with low AFI and is the leading indication of LSCS. Conclusion: The risks of meconium staining  of liquor, intrapartum fetal distress, operative delivery and perinatal mortality significantly higher in patients with amniotic fluid values of less that 5 compared to those with amniotic fluid index ranging between 8 and 18. 

Keywords: Amniotic Fluid Index; Intrapartum Fetal Distress; Perinatal Mortality

 Introduction: Intrauterine demise of one twin is a relatively frequent complication in multi fetal gestation. The incidence is higher in monochorionic twins compared to dichorionic twins. Mortality and morbidity of surviving twin is significantly increased in such cases. Aims: 1. To evaluate the effect of single fetal demise on surviving twin. 2. Perinatal and maternal outcome in such cases. 3. To review management of twin pregnancies with single intrauterine fetal demise. Materials and Methods: This  retrospective study was conducted at RL Jalappa hospital and research centre, Sri Devaraj Urs Medical College, kolar. Twin pregnancies  with single fetal demise were identified from parturition register and perinatal case records. Antenatal records, USG reports and neonatal summaries were analyzed. Data on maternal characteristics like age, parity, gestational age at diagnosis, antenatal, intrapartum and post natal complications were analyzed. Fetal parameters such as gestational age at single fetal demise, chorionicity, fetal biometry, biophysical profile, doppler study  and other USG details were noted. The time interval between single fetal demise and the delivery of the surviving twin and its perinatal outcome were analyzed. Results: We studied 145 twin pregnancies over a period of two years retrospectively. 17 cases were complicated with single fetal demise in 2nd/3rd trimester with incidence of 11.7%.  Mean gestational age of single fetal demise in twins was 33 weeks and maximam duration of prolongation of pregnancy was 10 weeks. 14 cases delivered between 32-36 weeks contributing to preterm birth rate of 85% and 3 cases delivered at term.12 out of 17 had same sex. 12 fetuses (76.47%) had live birth with good neonatal outcome and 5 out of 17 surviving were died in neonatal period. Cause of death being prematurity, severe growth discordancy with TTTS in 2 cases, severe growth discordancy in 3 cases and birth asphyxia, sepsis with pulmonary hemorrhage in one neonate. Prematurity was the common factor in all cases. We found that 5 mothers had preeclamsia,7 had anemia of moderate to severe degree and one case was Complicated with deranged coagulatation profile. Conclusion: Single fetal demise is more common in monochorionic twin gestations. Perinatal outcome of the surviving twin depends on the gestational age at delivery and chorionicity. Intensive fetal survaillence is needed for optimal management of such cases.The risk of conservative management should be weighed against the risk of preterm birth and its sequelae.  

Keywords: Single Intrauterine death; Twins; Monochorionicity; TTTS
 

Introduction: Teenage pregnancy is a serious problem all over the world and more so in developing countries like India, as early marriages and early pregnancy are the accepted cultural norms of our society. The present study aims to look at the incidence and maternal and foetal outcomes in teenage pregnant women in hospital visiting patients in Sion, Mumbai. Aim of the Study: To study incidence of teenage pregnancy and to study maternal and foetal outcome in this age group. Materials and Methods: This was a prospective study done over a period of two years. For all the antenatal cases complete history was taken. Antenatal course and labour management was observed and findings were noted. Intrapartum and post-partum course in the wards was studied. Various parameters were noted and analysed like incidence of pregnancy in teenagers, the marital status, age, parity, medical disorders, pregnancy related complications, incidence of malpresentations, mode of delivery, birth weight of babies and duration of hospital stay. Results: The incidence of teenage pregnancy was 6.45%. Most of the teenagers (85.1%) in the study were primigravida. The incidenceof preterm delivery among teenagers was higher (37.76%) than in the nonteenage patients (22.07%).The incidence of malpresentations was found to be higher in the teenage patients (4.3%) as compared to nonteenage patients (6.9%). Lower birth  weight babies and still births were more common in teenage pregnancies than in nonteenage pregnancies. Conclusion: The overall incidence of teenage pregnancy in the study was 6.45%. Most of teenagers were married and desirous of child bearing.Teenagers were predisposed to PIH, preterm labour and anaemia. Teenage mothers tolerated pregnancies well and there was no increase in operational intervention when compared to adult group.

Keywords: Teenage Pregnancies; Maternal and Foetal Outcome; PIH
 

Risk Malignancy index is widely used to predict malignant ovariantumour. The aim of our study is to determine how accurately the RMI can predict malignant ovarian tumours in a high density tertiary care centre. This study is a retrospective review of 35 patients who have attended Gynaecological clinicals in Govt Rajaji Hospital Madurai between February to July 2017. Information on menopausal status, ultrasound findings, CA-l25  and histopathological examination report was collected and RMI Score was calculated for all patients. 

Keywords: Malignant ovarian masses; RMI; CA-125

Prevalence of preterm birth is 5- 10% of all the pregnancies. Preterm labour is a significant obstetric problem, has a major impact on neonatal mortality and morbidity. It turns a pregnancy into high risk situation which can be detrimental for both mother and the baby. Hence the current study intends to identify the risk factors and the outcome of preterm birth. Objective: 1. To identify the risk factors associated with preterm deliveries. 2. To assess the neonatal morbidity and mortality associated with preterm birth. Materials and Methods: A descriptive study was  undertaken at JSS Hospital, Mysore for one year. The data was collected from the subjects satisfying the inclusion criteria. Data regarding general information, associated risk factors, delivery outcome of antenatal women and also morbidities & mortality of all preterm babies were collected. Results: A total of 1748 deliveries in our hospital 148 were preterm deliveries. Incidence of preterm deliveries is 8.5%. The factors significantly associated are preeclampsia (odds ratio [OR] 5.25) uterine anomalies (OR 5.50), cervical incompetence (OR 4.97), preterm premature rupture of membranes (OR 3.73), antepartum haemorrhage (OR 3.54), multiple gestation (3.12), multigravida (OR 1.67), low socioeconomic status (OR 1.73), education status upto high school (OR 0.34). Perinata  morbidity noted is 69% with 80% babies seeking NICU Care. Significantly associated morbidities seen in preterm babies are hyperbilirubinemia (OR 8.14), septicaemia (OR 6.19), respiratory distress syndrome (OR 4.49), intra uterine fetal demise (OR 5.06), intra uterine growth restriction (OR 2.06). It is mostly seen in babies of gestational age 31-34 weeks (35.14%). Perinatal mortality is 11.4%. Discussion & Conclusion: Early identification of risk factors, diagnosis of preterm labour, use of prophylactic pharmacologic therapy to prolong gestation like tocolytic therapy when indicated, and systematic maternal and fetal surveillance and patient education will go a long way in improving outcome of preterm infants.

Keywords: Preterm Birth; NICU; Low Birth Weight; Tocolytic Therapy.

  Introduction: Contraception has been a single most important intervention to reduce the burden of unwanted pregnancy. Understanding the attitude and knowledge of the women towards contraception, helps in improving their acceptance. Materials and Methods: This questionnaire based cross sectional study was conducted over a period of 6 months to assess the contraceptive knowledge and practice in the rural women of Uttar Pradesh. A total of 500 currently married rural women of 15-45 years of age were interviewed. Results: 98% of women knew about condoms but it was found to be the method of choice in only 10.4% of women. 82% were aware about Copper -T but only 8% were practicing it. 61% had knowledge about OCP’s and 8.6% were practicing it. 62% of women knew about injectable contraceptives but only 8.6% were using it. The most common source of information was television and media (65%). Wish for having more children, fear of side effects, lack of awareness about benefits of spacing and limiting the births, lack of support from husband and family, lack of awareness about contraceptive methods were the various reasons for not using contraception. Conclusions: While there is good contraceptive awareness in rural Uttar Pradesh, but this is not matched with contraceptive prevalence and prospects for improvement exist. Imparting knowledge to couples as well as to their parents and society  about the health benefits of spacing and limiting number of children can play an important role in reducing maternal and perinatal mortality and morbidity. 

Keywords: Acceptance, Awareness, Contraceptive method, Practices, Knowledge  

  Background: 8-10% pregnancies end in preterm labour or threatened preterm labour which has maternal and foetal complications just due to infections such as bacterial vaginosis, which can be identified by simple tests like Amsel Criteria and treated at the earliest with appropriate antibiotics. Aim: The prevalence of bacterial vaginosis in preterm & threatened preterm labor based on amsel’s criteria and treatment of bacterial vaginosis in managing preterm & threatened preterm deliveries. Materials and Methods:  The study was carried out in department of obstetrics & gynaecology, Government Rajaji hospital, Madurai medical college,  Madurai. 200 women with symptoms of preterm & threatened preterm labour. Examination of vaginal discharge,vaginal pH, microscopy for clue cells and Whiff test, which are Amsel’s criteria,  were done. Chi-square test was used to find outthe association of variables and p value less than 0.05 was taken as statistically significant. Results: There was  significant association between bacterial vaginosis and preterm labour.There was significant association between bacterial vaginosis and delivery of low birthweight babies.There was strong evidence that treatment of bacterial vaginosis in preterm & threatened preterm reduces the  neonatal complications. Conclusion: The prevalence of bacterial vaginosis was 30% in preterm & threatened preterm deliveries. There was a significant association between bacterial vaginosis and preterm labour. There was also significant association of various factors like low socio economic status, low BMI and history of previous preterm deliveries to the study group. There was storng evidence that treatment of bacterial vaginosis in preterm & threatened preterm deliveries reduce the neonatal complications.

Keywords: Bacterial Vaginosis; Gardnerella Vaginalis; Amsel’s Criteria.  

Aim: This prospective, randomized, double blinded studywas conducted to evaluate the effectof prophylactic intravenous 8 mgondansetron for attenuation ofhypotension and bradycardia incaesarean section under spinalanaesthesia. Materials & Methods:After obtaining the approval fromthe ethical committee of IGMCShimla 60 patients of ASA I and IIaged 20-40 years undergoing electivecaesarean section were included inthe study. Group 1 receivedpreloading with ringer lactate(500ml) thirty minutes beforesurgery and Ondansetron 8 mg in 5ml NS, 5 minutes before spinalanaesthesia.Group 2 receivedpreloading with ringer lactate (500ml) thirty minutes beforesurgery and 5 ml NS, 5 minutes before spinal anaesthesia. Results: Both the groups were comparable in demographic variables like age, ASAstatus and duration of surgery (p>0.05). The baselinehaemodynamic parameters were comparable in both the groups(p>0.05). The oxyhaemoglobin saturation was comparable andthere was no significant difference in both the study groups (p>0.05).The time for fixation of sensory and motor block was similar in both thegroups. The heart rate at all the time intervals was comparable in both the  groups with higher mean heart rate in Group 1 at 14 minutes and 16 minutes of time interval. The fall in MAP was significantly more (p=0.018) in Group 2 than in Group 1 and was seen at 2 minutes onwards whereas it was observed at 10 minutes to 25 minutes in Group 1. The mean phenylephrine consumption was more in Group 2 than in Group 1, 50µgms vs. 23±50µgms respectively, although the p value remained insignificant. (p=0.091). In our study we had significant fall in blood pressure at 2 minutes in Group 2 and the vasopressors were used more during the first 10 minutes after subarachnoid block in Group 2 as compared to Group 1. After 10 minutes, 3 patients required them to maintain BP in both the groups. In intra group comparison of blood pressure significant fall in BP from base line was observed at 10 min interval in group 1 (p=0.002). Whereas this fall was seen at 2 minutes of subarachnoid block in Group 2 (p=0.04). There were no statistically significant untoward effects observed in any of the study groups. Conclusion:- Ondansetron seems to prevent the initial fall in BP during first 10 minutes after  subarachnoid block. Though Ondansetron had attenuated hypotension in the first 10 minutes with lower vasopressor usage (13% in Group 1 vs. 40% in Group 2) after spinal anaesthesia in elective caesarean section in our study but since we did not get statistically significant results in vasopressors use after 10 minutes we recommend further studies with bigger sample size to prove the hypothesis that Ondansetron use obtunds the fall in blood pressure in spinal anaesthesia in cesarean section. 

Keywords: Ondansetron; Spinal Anaesthesia; Cesarean Section.  

Introduction: In certain conditions when normal delivery cannot be allowed for various reasons, assisted vaginal delivery is the method of choice. Vaginal delivery being assisted by instruments can either be of vacuum extraction or forceps, a choice based on pelvic findings. The aim of the study was to observe the immediate maternal & neonatal effects of vacuum and forceps deliveries and to compare the effects of the same. aterials & Methods: This prospective study was done in a tertiary care centre from January to Aug 2017. 63 ventouse and 11 forceps deliveries were done. The indications,  maternal and neonatal outcomes were observed. Result: 72.72% of forceps and 66.7% of ventouse deliveries were carried out in primigravida. Failure of secondary forces (Poor maternal bearing down efforts) was the indication in 60.31% of ventouse and 36.26% of forceps deliveries. Prolonged 2nd stage of labour was an indication in 20.63% of forceps and 27.27% of ventouse. Failure rate of ventouse was 9.52%, while forceps was 8.33% . Extension of an episiotomy (30.15%) was more in ventouse than forceps, while 3rd degree perineal tear were seen in (36.36%) cases, vaginal wall lacerations (72.7%) and traumatic PPH (27.27%) occurred more with forceps deliveries. Babies who had ventouse deliveries had higher Apgar score at one minute than those in whom forceps deliveries were done. Conclusion: Ventouse is the preferred instrument whenever the need arises for instrumental delivery. It causes much less maternal morbidity. However neonatal morbidity was insignificant in both the study groups. 

Keywords: Instrument Delivery; Ventouse; Vaginal Delivery.  

Objective: To evaluate maternal vitamin D levels in term normotensive and pre-eclamptic/ eclamptic patients and to assess associated factors such as BMI, birth weight, and mode of delivery and fetomaternal outcome. Method: This was a prospective case control study  arried out in Department of Obstetrics and Gynaecology, R.N.T. Medical College Udaipur from July 2017 to December 2017. 100 patients were divided into control and study groups of 50 each. Control group had normotensive term pregnant women while the study group had  pre-eclamptic and eclamptic women. Results: We found more incidence of vitamin D deficiency (96%) in study group as compared to controls (82%). Vitamin D levels were lower in the study group  (7.81±4.88ng/ml) compared to control group (12.94±6.72ng/ml) (P<0.001). Group with BMI >24.9 had the lowest vitamin D level (5.50±2.91ng/ml) (p<0.01). Mean Thyroid Stimulating Hormone (TSH) in study group was 4.71±1.51µIU/ml and in control was  3.0±1.11µIU/ml (p value<0.001). Incidence of hypothyroidism was 36% in study group and 12% in controls (p<0.05). The mean Vitamin D Levels in the two groups (TSH ï‚³4.5mIU/ml and TSH <4.5mIU/ml) were 5.60±3.08 ng/ml and 11.88±7.84ng/ml respectively (p<0.001). Study group had a SB rate of 20% vs 2% in controls and 12% neonatal mortality in NICU vs 8% in controls. Maternal vitamin D  levels in patients with still borns was 5.71±2.22ng/ml in comparison to 10.95±7.71ng/ml in those with Live birth (p<0.001). Mean birth weight for study group was 2.04±0.60kg and control group was 2.63±0.37kg (p<0.01). Maternal Vitamin D level for neonates weighing >2.5kg was 12.76±3.91 ng/ml (p<0.01). Low BMI patients (<18.5) had a mean neonatal birth weight of 1.89±0.47kg. For Maternal BMI >24.9, the mean neonatal birth weight was 2.47±0.85kg (p<0.05). Conclusion : Low Maternal Vitamin D is associated with an increased risk of preeclampsia and poorer feto-maternal outcome. This could be a modiûable risk factor with important public- health implications. 

Keywords: Vitamin D; Pre-Eclampsia; Eclampsia; Thyroid Stimulating Hormone (TSH).  

Objective: Objective of the study is to anaLyse the prognosis of CVT in pregnancy and puerperium. Methods: It’s a retrospective Case study in which epidemiological, clinical picure, risk factors & prognosis are assessed in 24 patients with CVT admitted in the dept of O & G, Govt. Rajaji Hospital Madurai during the period from June 2016 – March 2017. Results: Diagnosis were reached through by Magnetic Resonance Imaging Of the 24 patients, 2 patients were AN and all the rest were PN. The main risk factors were anaemia & dehydration in pregnancy & puerperium. The veins affected were transverse sinus & superior sagital sinus (SSS) 16 (60.6%)of them had seizures and 4 had (16.6%) neurological deficit and 4 died due  to ICH. Conclusion: Treatment with heparin in the acute phase followed by oral anticoagulants was shown as safe & efficient to prevent worsening of the disease, recurrence and for quick improvement of neurological symptoms of all treated patients. 

Keywords: CVT; Heparin; Puerperium.  

 Context: Pre labour rupture of  membrane (PROM) is a common event in obstetrics.There is still controversy regarding the best method of induction of labour. So purpose of this study is to verify the efficacy and safety in between the two methods of induction i.e. oxytocin alone or dinoprostone followed by oxytocin. Aims: Comparison of efficacy of oxytocin versus dinoprostone gel followed by oxytocin for induction of labour in PROM in terms of induction delivery interval, mode of delivery and maternal & fetal outcome. Settings and Design: This study was carried out at a tertiary care hospital. Admitted women from the labour ward and obstetric wards were enrolled in the study after taking written informed consent. Material and Methods: Randomized control study in a tertiary care hospital and referral centre for one year. Two hundred women randomly allocated to study group A & control group B after fulfilling inclusion/ exclusion criteria. Group A patients were induced with dinoprostone gel  0.5 gm followed by oxytocin six hours later. Group B patients were induced with oxytocin alone. Results: There was no difference in mean induction to delivery interval of both groups. Proportion of vaginal delivery in Group A was significantly higher than that of   Group B because of higher proportion of failed induction and non progress of labour in later. There was no significant difference in maternal and fetal outcome in both the groups. Conclusion: Study showed that use of sustained released dinoprostone followed by oxytocin for induction of labour in term PROM led to a significantly higher proportion of women with vaginal delivery within 24 hours of induction, and a small proportion of women who required cesarean section compared with the use of oxytocin alone.

Keywords: Premature Rupture of Membrane (PROM); Oxytocin; Dinoprostone.  

Background and Purpose: Over many decades, studies have been conducted in various parts of the world in an attempt to correlate the AFI with fetal and maternal  outcome. Recent studies, however, have challenged the relationship between amniotic fluid volume and poor perinatal outcome, especially the relationship between oligohydramnios and poor outcome near term, but still a lot of questions remain unanswered. Through this study we plan to look in Indian scenario for maternal and fetal outcome to correlate the AFI. Method: The present study was conducted in Department of Obstetrics & Gynaecology, Batra Hospital & Medical Research Centre, and New Delhi from 1st November 2014 to 30th April 2016. A total number of 100 women were recruited in this study. The women were divided into two groups each of 50 i.e. Group I (Study group) had women with low amniotic fluid index (AFI 8) and Group II (Control group) had women with AFI (8.1cm -20cm). All subjects were evaluated on the basis of predesigned and pretested proforma with respect to history, clinical examination and ultrasonography. Results: Majority of the women i.e. 66% and 62% were less than 25 years of age in the study group and control group respectively. A vast majority of the women (40% and 48%) were primigravida. Labour had to be induced in 80% of the women in study group but only in 10% in   control group and the difference was highly significant (p <0.001). The caesarean section rate was 52% in the study group as compared to 22% in the control group which was significant (p value= 0.0018). There was no statistical difference in the meconium staining of the liquor in the two groups. There was statistically significant difference (p <0.05) in the rate of fetal distress in the two groups (34% in group I and 12% in group II), thus indicating that oligohydroamnios is associated with high rate of intrapartum fetal heart rate abnormalities. 35% of the women with induced labour had fetal distress in study group and 20% of women with induced labour had fetal distress in control group (p= 0.50), Thus, induction of labour does not seem to be cause of increased rate of fetal distress. There was no neonatal death.  Perinatal complication was found in only 10% of neonates in study group and 4% in control group and difference was not significant. Interpretation: The present study supports the association of low amniotic  fluid index (<8cm) with higher rate of intrapartum fetal distressin Indian pregnant women. This study also supports the association of low amniotic fluid volume to higher rates of caesarean section but no association was found between amniotic fluid volume and incidence of meconium staining of liquor. The present study also didn’t suggest any association of poor Apgar score at 5 min and neonatal complications with low amniotic fluid volume. 

Keywords: Maternal and Fetal Outcome; Singleton Pregnancies.   

Objective: To compare the effects of AMTSL only, AMTSL without uterine massage, AMTSL with vacuum retraction cannula in prevention of post partum hemorrhage and to compare the effectiveness of vacuum retraction cannula with same pressure maintained at different duration of 5mins, 10 mins, 15 mins. Study  Design: Randomised comparison study. Setting: Labour ward of a tertiary care hospital,Government  Rajaji Hospital, Madurai. Participants: 100 patients in whom AMTSL only performed, 100 patients AMTSL performed without uterine massage, 100 patients in whom AMTSL with vaccum Retraction cannula performed. Methods: Informed and written consent was obtained from all patients who participated in this study. After dividing 300 participants into three study groups in AMTSL only group after delivery of the baby, inj Oxytocin 10 units IM given and then controlled cord traction done & placenta is removed. Uterine massage is done. In AMTSL without uterine massage group, AMTSL as in AMTSL only group with the exception of uterine massage is performed. In AMTSL with Cannula group, Along with AMTSL, Vacuum reraction cannula is applied in sequential manner and suction pressure of 650mmHg is maintained for 5,10,15 minutes. Finally in all three groups the blood loss was assessed using surgical drape. Outcome variable: various   grades of postpartum hemorrhage after cannula application. Results: Mean blood loss in routine AMTSL only group is 299.0 ml, in AMTSL with cannula group is 223.6 ml, in AMTSL without uterine massage group is 280.8 ml (p value < 0.001). in subgroups of AMTSL with cannula group where same pressure maintained at different durations of 5 mins,10 mins,15 mins, mean blood loss was 273ml if pressure was maintained for 5mins and 194 and 208ml if pressure was maintained for 10 and 15minutes respectively (p value 0.003). Conclusion: Vacuum retraction cannula significantly reduces the amount of blood loss and there by improves the grades of post partum hemorrhage as compared to AMTSL with or without uterine massage only and it also stops significant bleeding when applied for 10 and more minutes. 

Keywords: Post Partum Hemorrhage; Vacuum Retraction Cannula; AMTSL.   

 Introduction: Chromosomal aneuploidies are a common type of  chromosomal defect that may impose heavy burdens on society and families. The most common chromosomal aneuploidies among the embryos are trisomies 21, 18, and 13. Prenatal screening and diagnosis are often used in prenatal care, and it seems to be a very useful tool for doctors and women to make informed decisions about the continuation of pregnancies involved with genetic diseases. Prenatal non-invasive tests using cell-free fetal DNA (cff DNA) are a method for testing trisomy in embryos using the peripheral blood sample of the pregnant mother.Considering the fact that most of the studies carried out on cellfree DNA have been in high-risk populations, this study attempted to  examine the results of cell-free DNA in a population of low-risk aneuploidy pregnant women. Materials and Methods: In this retrospective study, the study population was all pregnant women (n= 410), who underwent aneuploidy screening during the first or second trimester (with a lowrisk result in Quad test) in 2015- 2016 and were at the risk of trisomies 13, 18, and 21evaluated using cell-free DNA test. Results: The mean age of pregnant women was 31.5 years and 92.0% of the subjects were naturally pregnant and only 8.1% had used Assisted Reproductive Techniques (ART). Of these, 5.9%  were fertilized by IVF and 2.2% by IUI method. Results of cf DNA in all pregnant women were negative. Conclusion: According to the results of this study, cf DNA testing results in all low risk pregnant women were negative and it is not recommended as a routine test in pregnant women reported as a low risk pregnancy in serum screening. 

Keywords: Low-Risk Pregnancy; Aneuploidy Risk; Aneuploidy Screen; Cellfree DNA.

Objective: 1. To assess the ovarian reserve in infertile women by clinical, biochemical and radiological evaluation. 2. Controlled Ovarian Stimulation in female infertility by clomiphene  citrate challenge test. 3. To monitor growth of ovarian follicle by ultrasonography and assess the response of ovarian stimulation in term of follicular development.  Study Design: It is a prospective interventional study of 170 cases with complain of infertility attending OPD of obstetrics and gynaecology Mahatma Gandhi Medical College and Hospital. After the enrolment, demographic data i.e. age, education, occupation were obtained and recorded. Detailed history including details of infertilityand complaints other than infertility, duration of active married life, menstrual history, obstetric history, occupational and past history were documented and systemic examination followed by per speculum and per vaginal examination was performed. Clinical parameters including age, body mass index, menstrual cycle length was recorded. Local examination was done for breast andb hirsutism. Grading of hirsutism was done according to Ferriman and Gallwey scoring system. Hysterosalpingography (HSG) or Video hysterolaproscopy (VHL)  was done to rule tubal factor infertility. BloodInvestigations including blood group, CBC, blood sugar, HIV, HBs antigen, VDRL were done. Husband semen analysis was done to rule out male factor infertility. Specific investigations like TSH, prolactin, day 3 FSH, LH, Estradiol, AFC were recorded. Patients who fulfilled the inclusion criteria were included in the study and all the details were recorded on preformed Proforma for all subjects. After preliminary interrogation and recording of details the subjects were called on second day of menstrual cycle, reviewed, baseline TVS done for AFC and tablet clomiphene citrate 100mg daily given from day 5 to day 9. Patients were instructed to take tablets daily and to inform immediately if any side effects like flushing, nausea, vomiting, visual disturbance, headache, diarrhoea, abdominal discomfort or pelvic mass or tenderness are seen. For the purpose of clomiphene citrate challenge test, Day 10  FSH level recorded and serial ultrasonography was done from day 7 to day 16 for monitoring of endometrial thickness, number and size of dominant follicle. All transvaginal sonography was done on the same machine. At each transvaginal ultrasonography (TVS) internal diameter of each visible follicle were measured in two dimensions. The endometrial thickness defined as the maximum distance between the echogenic interphase of myometrium which was measured in the plane through the central longitudinal axis of uterus. When at least one dominant follicle had a diameter of 18 mm. injection HCG 10,000 IU was given intra muscularly as ovulation triggering agent and women were instructed to have planned relation. TVS was repeated after 48 hours to look for evidence of ovulation i.e. disappearance of dominant follicle which was seen previously and presence of free fluid in cul-de-sac. If the follicle was   unruptured then ultrasound was repeated after 48 hours and 72 hours of the HCG injection to observe luteinized unruptured follicle (LUF). Women were instructed to follow up on the second day of next cycle or immediately after missed period. If the patient is not pregnant, tablet clomiphene citrate 100mg was given in next cycle and similar protocol was followed. Before starting the ovulation induction in the next cycle all subjects were taken for transvaginal ultrasonography on day 2 of periods to rule out the presence of any ovarian cyst. All subjects were followed up for total three cycles. Women who missed their period urinary pregnancy test was done and pregnancy were recorded. All the recorded data of all subjects for 3 cycles were recorded in MS XL sheet. Outcome was measured in the form of utility of clomiphene citrate challenge test as a marker of ovarian reserve. Result: The ovarian reserve testing helps us to give the estimation of pool of primordial follicles and it is a useful in detecting ovulation induction response. Any of the tests for ovarian reserve does not have sensitivity and specificity of 100% for the detection of poor ovarian reserve. So, clinical, biochemical and radiological parameters are combined in an effort to increase the prognostic reliability of each test. A scoring system is used by combination of age, BMI, AFC, FSH, estradiol, etc for the prediction of ovarian response more accurately than each of the parameters alone. In our study, CCCT is found as the most reliable test followed by basal AFC and basal FSH.

 Keywords: Ovarian Reserve; Ovulation; CCCT .