Indian Journal of Obstetrics and Gynecology

Pancreatic pseudocyst may be consequences of acute or chronic pancreatitis or trauma is a benign pancreatic disease. Pancreatic pseudocysts complicate 5% of cases of pancreatitis, or fewer than 1 in 60,000 deliveries, and the management of this rare situation is not consistent. A patient who was 33 weeks of pregnancy diagnosed as a case of puedopancreatic cyst treated with cystogastrostomy in puerperium has been presented. The natural history of pancreatic pseudocysts in pregnant patients seems to be similar to that of nongravid patients

Amniotic fluid is a dynamic medium that plays a significant role in fetal well-being. It is essential during pregnancy for normal fetal growth and organ development. About 4% of pregnancies are complicated by oligohydramnios. It is associated with an increased incidence of perinatal morbidity and mortality due to its antepartum and intrapartum complications. Gerbruch and Hansman described a technique of Amnioinfusion to overcome these difficulties to prevent the occurrence of fetal lung hypoplasia in pregnancies complicated by oligohydramnios. Amnioinfusion reduces both the frequency and depth of FHR deceleration. The mechanisms through which amnioinfusion acts include mechanical cushioning of the umbilical cord to prevent recurrent umbilical compressions that lead to fetalacidemia, predisposition to meconium aspiration Syndrome (MAS).

Counseling refers to confidential interaction between health professional and a client, enabling her to cope with stressful situations and take personal decisions related to problems. Of all the rights of women, the greatest is to be a mother. Journey towards search for causative factor in infertility may be exhaustive for the couple. Gynecologist also must have patience for this difficult journey which may be rewarding at the end. Psychosocial interventions for the infertile couple have immense value. Confidentiality is vital for successful counseling. Gynecologist is communicator as well as a counselor and a professional who is committed for the best ethical, legal, social and human aspects.

Introduction:Twin gestation is a challenge in obstetrics constituting nearly 1% pregnancies. Associated with maternal and fetal complications, approximately 10% perinatal mortality. Aims and objectives: Studying the maternal risk factors, its effects, complications and perinatal outcome in twin gestation. Materials and methods: A retrospective analysis of 28 twin pregnancies done, JSS Research and Medical Hospital, Mysore, during 20 months study. Maternal factors like age, pregnancy complicating factors, method of child birth. Fetal outcome like newborn weight and difference, NICU care was studied. Results: This study had shown that, 75.3% mothers age was 20 to 24.5 years, 76% had spontaneous conception, 23.3% had infertility treatment 60% of the multigravida and 59% had twins. Half of the mothers had risk factor like anemia 50%, hypertension 30%, 75.6% had premature babies, 23% full-term regnancies. Of the 56 babies, 53% had very low birth weight, 28 babies needed NICU care. Fetal death of 12. No maternal mortality noted. Conclusion: Health sector has to give proper guidance to the antenatal woman for better output of mother and baby. Government has to implement necessary programmes to take care of multiple gestation mothers. Better obstetric care, neonatal care, good health services are needed.

Introduction: Complications during first trimester pregnancy is a common problem which affects both the mother’s and her child’s health. Life-threatening complications like ectopic gestation can occur in early pregnancy. It is therefore important to assess the level of awareness in our communities. Methods: This prospective cross sectional study was conducted among hundred women whose pregnancy test positive and pregnancy was confirmed with USG showing gestational sac and attending the outpatient department of obstetrics and gynecology department of Saveetha Medical College. Women were interviewed with semi-structured questioner. Early pregnant women were included. Pregnant women who were unable to communicate, psychiatric problem and very sick women were excluded. Result: In this study maximum number of participants were between 20 and 25 years of age, about 45% were primi, about 50% of women belong to upper middle class and about 40% completed their primary school education and about 44% had vague knowledge about complication of first trimester pregnancy. Overall results showed insufficient knowledge and awareness about complications of first trimester pregnancy. Original Research Article Conclusion: Our participants did not have ample knowledge and awareness about the complications. Rural women require more of awareness.

Objective: To evaluate endometrial and subendometrial blood flow parameters, follicular vascularity, assess the relationship between blood flows and pregnancy outcome. Material and method: A prospective study done in tertiary care center. 204 women with infertility undergoing controlled ovarian stimulation and intrauterine insemination were enrolled. Transvaginal ultrasound with the Doppler flows was performed, on the day of hCG trigger. Endometrial blood flow, endometrial morphology, follicular vascularity and pulsatility index of uterine artery was studied. These findings were correlated with the pregnancy outcomes. The primary outcome was clinical pregnancy rate and secondary outcomes were miscarriages and ectopic pregnancy. Results: The maximum clinical pregnancy rate (11.18%) was observed with triple line endometrium and endometrial thickness more than 8 mm on the day of trigger. 11 cases who conceived and continued the pregnancy had endometrial blood flow till Zone 3. 15.59% clinical pregnancy rate when follicular vascularity was between 51% and 75%. The clinical pregnancy in 16 cases (p-value = 0.323) was observed when the pulsitality index of uterine artery was between 2 and 3.2 on the day of trigger. Conclusion: The pregnancy outcome is poor if the endometrial flows are absent, PI of uterine artery is less than 2 or more than 3.2 and follicular vascularity is less than 50% on the day of trigger. The endometrial blood flow Doppler studies and follicular vascularity on the day of trigger in COS cycles with intrauterine insemination can be useful in predicating pregnancy outcomes. Interventions can be planned in COS cycles to improve pregnancy outcomes.

Introduction: Pregnancy induced hypertension (PIH) is a disorder of blood pressure (BP) that arise because of the presence of pregnancy. This can have grave consequences for both mother and fetus. The purpose of the present study is to determine the prevalence of retinal changes in PIH and any association between the retinal changes and fetal outcomes. Aims: This study was undertaken to evaluate the role of fundoscopy changes for predicting adverse perinatal outcome in Pregnancy induced hypertension. Materials and methods: Study done on 100 patients group of 50 patients of pregnancy induced hypertension and 50 normotensive controls were selected from antenatal clinics and antenatal wards. The fundoscopic changes in the last week of delivery were used for correlation of fetal outcome in Pregnancy induced hypertension. Results: Pre-eclampsia was associated with high incidence of preterm delivery (60%), small for date infants (45%), low Apgar scores (73%), operative interference (37%), perinatal loss (33%) and poor fetal outcome (77%). Among 50 cases of 6 cases of preeclampsia had abnormal fundoscopic changes. Among the 6 cases, Grade I and Grade III had one patient none had Grade II changes, four had Grade IV changes. No correlation found between pre-eclampsia and fundoscopy. Original Research Article Conclusion: A satisfactory relation between decreased visual acuity and increase in hypertensive grade could not be elicited as none of the study group had visual acuity changes.

Background: The contraceptive methods that are offered to a woman with previous cesarean section are either tubectomy at the time of aesarean section or contraception at a later postnatal visit. Transcesarean Intrauterine contraceptive device placement gives an opportunity to provide a long-term, reversible and cheap contraception with minimal side effects. It has no interference with lactation and also helps in spacing. Aims and Objectives: The primary objective was to study about the acceptability of IUCD as a choice for Transcesarean contraception among women undergoing repeat cesarean section and the influence of sociodemographic factors on their choice; the other objectives were to calculate the uptake of transcesarean IUCD in these patients and to evaluate its safety Method: Prospective cohort study conducted in Department of Obstetrics and Gynecology at Apollo institute of medical sciences and research, Hyderabad, India with 200 women with previous one cesarean section. They were counselled regarding various methods of contraception and the option of Transcesarean IUCD insertion also was discussed. Their choices along with factors such as age, education, religion, previous child age, reasons for nonacceptance were noted in the form of a questionnaire. After placement of IUCD, they were observed for any side effects during immediate postoperative period, at the time of discharge and at 6 weeks postpartum. Results: The acceptability of Transcesarean IUCD is Original Research Article 34% while Tubectomy is 29%. IUCD is preferred over Tubectomy among women in age group of 20–25, educated couples who have previous female child and are planning spacing. 37.8% do not prefer IUCD due to its side effects. Expulsion rate of Transcesarean IUCD is 2.9% at one week and 10% at 6 weeks after insertion. Conclusion: Acceptability of Transcesarean IUCD is low due to various social factors and also due to fear of side effects. These barriers can be overcome by regular antenatal counseling so that its uptake increases and unmet needs of family planning can be met.

Introduction: An adnexal mass is a common gynecological problem, diagnosis of which is based on clinical presentation, various radiological imaging and biomarkers. To evaluate adnexal masses in context of clinical, radiological and pathological diagnosis. Methods: A total of 100 consecutive patients presenting in our hospital with adnexal mass were selected for the study matching the inclusion and the exclusion criteria. A detailed history of each case was recorded with special attention to the presenting complain and a detailed examination was performed. Cases were investigated by radioimaging and serum biomarkers. Various adnexal masses were studied with respect to the manifestations and radiological and biochemical findings. Results: Most common presenting complaint was pain (68%) followed by no complains (15%) and abdominal distention (7%). Other symptoms include lump in abdomen, nausea and vomiting. Most of the adnexal pathologies were unilateral (83%) on presentation with 47% involving left side. Most common pathology identified in the left adnexa was ovarian cyst, followed by ectopic pregnancy. Most common benign pathology diagnosed as per sonography was ovarian cyst (40%). Conclusions: Ultrasonography is an important noninvasive investigation helpful in diagnosing most cases of adnexal masses. Bimanual palpation can be useful as a first step in assessment of adnexal masses. However no single diagnostic aid can be used to determine the pathological adnexal masses. Hence a multifaceted diagnostic approach should be used for a definite diagnosis and management of adnexal mass.

Introduction: Critical care in Obstetrics (CCOB) is an emerging area of Obstetrics with many pregnant mothers requiring critical care due to better primary care. Present study is done to evaluate use of maximum SOFA score in predicting mortality amongst mothers admitted at Obstetric ICU in a tertiary care center at Gujarat, India. Methodology: The maximum SOFA score of 212 pregnant mothers admitted to Obstetric ICU during the study period was calculated using the sum of the result of each of the six components of scoring. Interventions required during ICU stay and outcome of pregnant mothers with respect to maximum SOFA score was noted. Results: Majority (74.5%) pregnant mothers had maximum score of 6 to 10, 13.2% had score of 11 to 15, 8.9% had scores between 16 and 20, while 3.4% had score of between 21 and 25. There was no mortality in the SOFA score group of 6–10, while 7.1% mortality was noted in SOFA group 11 to 15, 84% mortality in SOFA group of 16–20 and 100% in 21 to 25 group. Conclusion: SOFA score is a good indicator of risk of mortality amongst the Obstetric ICU admissions. Higher SOFA score is associated with higher mortality. Anyone with SOFA score with less than 15 has good chances of survival subject to appropriate care in critical care unit. Furthermore, data is very well comparable with international standards and suggest availability of similar quality care in Indian settings.

Introduction: Hyperbilirubinemia is one of the commonest problems that can occur in newborns. The vasopressin-like action of oxytocin causes osmotic swelling of erythrocytes leading to decreased deformability and hence more rapid destruction with resultant neonatal hyperbilirubinemia (NNH). Objectives: To determine dosage and duration of oxytocin for mother during augmentation of labor. To determine the incidence of neonatal hyperbilirubinemia in mothers given oxytocin and those in spontaneous labor. To find association between maternal oxytocin augmentation and neonatal hyperbilirubinemia. Materials & method: 306 full-term parturients with normal vaginal delivery from January 2017 to June 2018 were selected after ruling out exclusion criteria. Group A: 153 term babies of oxytocin augmented labor & Group B: 153 term babies of spontaneous labor. Oxytocin dosage was 5 units in 500 ml normal saline, @ 5 mIU/min and increased by 5 mIU/min half hourly until effective uterine contractions were attained. The total duration and volume of oxytocin infused were recorded in each subject. In neonatal period serum bilirubin was measured by trans cutaneous bilirubinometer on day 1 and day 3. Results: Incidence of NNH requiring phototherapy in Group A was 38% and in Group B was 18% and the difference between 2 groups were statistically significant (p-value = 0.0001 ). The cut-off duration and volume of oxytocin infusion for a statistically significant increase of NNH was 292.5 minutes (p-value 0.0001) and 5101 mIU (p-value 0.0001) respectively. Conclusion: Oxytocin is an important therapeutic agent in labor and probably its use cannot be stopped and thus its effect on erythrocytes also cannot be prevented. Oxytocin can produce neonatal hyperbilirubinemia as evidenced by this study and therefore it would be logical to prevent the hyperbilirubinemia by reducing the dose of oxytocin and by its selective use.

Background and aim: Hypertensive disorder in pregnancy is a common medical complication of pregnancy and contributes about 12–22% of all pregnancies. It is a major cause of maternal mortality and morbidity. Aim of our study is to determine frequency of hypertensive disorder in pregnancy and to determine maternal and neonatal outcome of patients delivering at our hospital with hypertensive disorder in pregnancy. Materials and methods: This is a retrospective study conducted in the department of Obstetrics and Gynaecology in a tertiary care teaching hospital. Retrospectively data was collected for a period of one year from July 2018 to June 2019. It included all the patients delivered during study period with any type of hypertensive disorder of pregnancy. Results: Incidence of hypertensive disorder in pregnancy was more common in younger age group (18–25 years) that is 41.9%. Mild preeclampsia was the commonest type around 47.7%. Incidence of hypertensive disorder of pregnancy was more common in term pregnancy 38.1% (37–40 weeks). Mode of delivery by Cesarean section was common in our study 63.2%. Conclusion: Hypertensive disorder of pregnancy is the dreaded complication of pregnancy if left untreated. The outcome in hypertensive disorder of pregnancy can be improvised with good antenatal care, preconceptional counseling, risk stratification, properly planned investigations and markers, ultrasonography and with good NICU and ICU care. This study about outcomes will help formulate preventive strategies of hypertensive disorder of pregnancy.

Introduction: The causes of abnormal uterine bleeding include a wide spectrum of diseases of the reproductive system and non-gynecologic causes as well. It is a common clinical problem encountered in routine gynecologic practice. Aim of the study: To study the clinicopathological evaluation of abnormal uterine bleeding in a teaching hospital in Telangana. Materials and methods: This was a prospective study done on patients presenting with AUB from June 2018 to July 2019 in the department of Obstetrics and Gynaecology at Maheshwara Medical College and Hospital, Patancheru, Telangana. Patient demographics, clinical presentation, parity and histopathology findings were studied in 120 AUB cases. Results: A total of 120 cases were included in the study. The patient age ranged from 20 to 55 years. Most of the cases 63/120 (52.5%) were seen in the 41–45 years. Most of the cases of AUB were multiparous 70.8% (85/120). According to clinical presentation majority of women presented with menorrhagia 73.3% (88/120). According to Pap smear findings in AUB cases, most of them 91.6% (110/120) had no abnormality on Pap smears. Conclusion: Abnormal uterine bleeding is common in perimenopausal period in the fifth and sixth dacades of life. Most common clinical presentation is of menorrhagia. Endometrial biopsy study is important in these cases to diagnose the pathological processes and also helps in diagnosing the more ominous hyperplasias and carcinomas of the endometrium.

Keywords: AUB; Clinicopathological evaluation of AUB; Postmenopausal bleeding.

Giant cell tumor (GCT) of the ovary is a rare condition, found almost invariably in the context of a mucinous tumor and presenting a microscopic picture indistinguishable from GCT of bone. Here we describe a case arising from mature cystic teratoma of ovary. An immunohistochemical study was performed using a panel of antibodies to epithelial, mesenchymal and leukocyte antigens. CD68 and vimentin were positive. Along with morphological presence of giant cell and immunohistochemistry findings, Giant cell tumor of ovary was diagnosed arising from mature cystic teratoma of ovary.

Paraneoplastic syndrome occurs as a consequence of tumor in the body, is not due to local presence of tumor but is due to humoral response released by tumor cells or by an immune response against the tumor. It commonly arises from tumor of lung, breast, ovaries and lymphatic system. A 25 year married female with no gynaecological symptoms came with complaints of involuntary jerky movements of both eyes with weakness and numbness in bilateral upper and lower limbs and instability in gait since 1 week. She had fever 3 months back. Initially considered post viral demyelinating disease. Symptoms worsened and in suspicion of Opsoclonus- Myoclonus- Ataxia syndrome, imaging studies and tumor markers done to rule out any tumors in the body. USG showed left adnexal mass which was confirmed on PET scan to have hot spots. Left salpingo-oophorectomy done which on HPE showed benign ovarian teratoma. Post operatively she improved symptomatically.

Introduction: Vaccination during pregnancy is a simple and effective way to protect the mother and child from infections. Immunization can protect the mother from vaccine-preventable diseases and also immunization can protect the fetus and infant directly via transferred antibodies. This is why the awareness, knowledge and attitude towards vaccination during pregnancy in women is very important. Objective: The purpose of the study was to assess the awareness, knowledge and attitudes towards vaccination during pregnancy in women of reproductive age. To raise awareness about the vaccines like Tdap, flu shot (influenza) which is mostly given to women during pregnancy. Methodology: A cross sectional questionnaire-based interview was conducted among 112 pregnant women, who attended outpatient department of obstetrics and gynecology department of Saveetha medical college, Chennai. Data were collected after informed consent and ethical clearance and it was analyzed. Results: Among the 112 reproductive women involved in the study, 20% of the participants had good awareness and knowledge about vaccination during pregnancy, 42% had satisfactory awareness and knowledge and the remaining 38% had poor awareness and knowledge. According to the results the participants between the age of 30 and 35 years had high percentage (41%) of awareness about vaccination during pregnancy and it was also observed the participants with poor education and low socioeconomic status had poor awareness and knowledge about vaccination during pregnancy. Conclusion: The awareness, knowledge and uptake of the vaccine among women are low, according to the study. Hence the women should be educated about vaccination given during pregnancy in order to promote awareness and emphasize the importance of vaccination during pregnancy.

Introduction: Worldwide Infertility rate prevails around 8–12% of all couples; approximately 80 million are infertile. Investigations for infertility are meant to intervene into the modifiable/treatable causes. In India 10–15% of couples are infertile. Therefore, the present study was undertaken to investigate the morphological patterns of endometrial tissue in women with primary infertility. Materials and Methods: The study included 16 cases with complaints of infertility (secondary). The premenstrual D&C was done to obtain endometrial biopsy. The present prospective study was a descriptive study and the values are mentioned in percentages. Results and Discussion: In present study a total of 16 cases were studied. Out of which 8 cases (50%) belonged to the 25–30 yrs age group. The predominant morphological pattern was that of secretory endometrium seen in 6 cases (37.5%) as opposed to proliferative, endometritic or tubercular pattern. The predominant menstrual pattern recorded was Regular; seen in 10 cases (62.5%) as opposed to irregular or menorrhagic patterns. Conclusion: The endometrial biopsy has a great role in screening the cases of infertility as it helps to assess the information about ovulation, ripening of the endometrial tissue and other abnormal endometrial reaction, hormonal imbalance. This is the only method to label the diagnosis of endometrial tuberculosis in an apparently healthy female.

Introduction: Infertility is nowadays a global problem affecting couples of reproductive condition. Infertility, prevalent among one in every four couples in the developing countries, is a neglected problem. A significant proportion of women postpone their pregnancy due to education and career to late into the fourth and fifth decades. ART includes in vitro fertilization (IVF) with or without intracytoplasmic sperm injection (ICSI), fresh or frozen embryo transfer, IVF with donor oocytes, intrauterine insemination (IUI) either with ovarian stimulation or in unstimulated cycles. As mother having ART treatment is mostly from higher age group, chronic hypertension and diabetes mellitus may be pre-existing leading to further exaggeration during pregnancy. And if not from higher age group then various factors like endometrial, ovarian, PID, endocrinal problem have significant effect on perinatal outcome and complication. Results: Total number of 193 patients who have taken ART have been included in our study. 51 (48.57%) out of 105 patients had PIH in singleton ART as obstetrical complication which is most common in our study. 41 (46.59%) out of 88 patients had preterm delivery in multiple gestation ART as a most common obstetrical complication in our study. 16 (15.24%) out of 105 patients had Chronic HTN in singleton ART and 14 (15.91%) out of 88 patients had Chronic HTN in multiple gestation ART as maternal complication which is most common in our study. Out of 283 fetus, 41 (14.48%) were IUGR, 9 (3.18%) were fetal anomaly and 17 (6.01%) were IUD. Conclusion: This study helps us to understand that these ART pregnancies are high risk for maternal and fetal complication.

In developing countries like India the incidence of IUGR is accounting to 1/3rd live births every year. Aim: To study histopathology and Vascular Endothelial Growth Factor levels of placenta of healthy mothers giving birth to Intrauterine growth restricted babies at term. Materials and Methods: The study was conducted from August 2012 to August 2014 over a duration of two years. A total of 70 cases have been selected for present prospective observational study: 35 were study group mothers had delivered IUGR babies and 35 in control group with normal weight babies. Results: The mean birth weight of babies at term from Group A was 2.297 kg and mean birth weight of babies from Group B was 2.796 kg. The difference in the mean birth weight of babies was statistically significant between the two groups (p-value <0.001). The average Ponderal index (PI) in Group A babies is 2.2 which is significantly low and in Group B babies it is 2.7 with statistical significance (p-value <0.001). Placental weight of babies born in study and control group had high statistical significance (p-value 0.000). Conclusion: The structural abnormalities in the placentae of IUGR babies born at term is suggestive of placenta as the causative factor of IUGR. Co-relation of the VEGF levels with weights of the baby were estimated in both the groups and noticed that the VEGF levels were inversely related with the birth weight. In the IUGR babies the expression of VEGF in the placenta was found to be elevated than in the placenta of normal weight babies.

Objective: Our study aims to study the overall obstetrical and neonatal outcomes in spontaneous conception versus IVF conception. Study design: Hospital based prospective study Methods and Materials: The study was conducted at our hospital over a period of one and a half years from September 2014 to April 2016. It was a hospital based prospective study. A total of 100 (50 spontaneous conception and 50 IVF conception) women who were admitted for safe confinement at Obstetrics and gynecology department of hospital were included in the study. For the purpose of the study, the study group was divided in two groups IVF conception group and spontaneous conception group for comparison of obstetrical and neonatal outcome. A detailed history was taken and thorough examination findings were noted. The antenatal course was noted and also the obstetric and neonatal outcomes were noted. Results: It was observed that the obstetrical outcomes were poorer in IVF conception group than in the spontaneous conception group. Significant association was found between gestational duration, mode of delivery, NICU stay requirement with mode of conception. Association was also found between antepartum hemorrhage (APH), preeclampsia, gestational diabetes, postpartum hemorrhage (PPH) with mode of conception. Conclusion: Maternal age, gestational duration, preterm delivery, LSCS deliveries, low-birth weight babies, low APGAR score, and requirement of NICU stay in IVF conception group was significantly higher than in spontaneous conception group. Association was also found between antepartum hemorrhage, preeclampsia, gestational diabetes mellitus, preterm premature rupture of membranes, postpartum hemorrhage with mode of conception.

Background: The onset of menstruation is one of the most important changes occurring among girls during the adolescent years. A woman spends approximately 2100 days in menstruating that is almost 6 years of her life. A reusable device that can be worn throughout the day would hence be ideal. Menstrual cups have been in use since a long time but very few women are aware where in menstrual cups can be reused with safety for a period of 10 years. Methods: This was a pilot study in which 60 women who have been experiencing monthly periods and had no intention of becoming pregnant within 1 year were identified by a community health worker in OBG department, Sapthagiri Medical College, Bangalore from March 2018 to Dec 2018 were taken for the study. Results: The menstrual cups can replace the current methods of menstrual sanitation due to lower cost and improved hygiene. Increasing awareness and easy availability of this product can help in increasing the use. It could be concluded that menstrual cups could be an eco-friendly option in comparison to other used vaginal devices which have great disposal problems.