Indian Journal of Obstetrics and Gynecology

This is a case report of a pregnant woman with previous 1 cesarean and 1 ectopic exploration whose uterus herniated in an incisional hernia of the anterior abdominal wall at 33 weeks + 6 days of pregnancy. Incarceration of the pregnant uterus in an incisional hernia is a rare but serious obstetric situation1. Treatment is conservative until term followed by delivery and repair of incisional hernia thus resulting in a successful outcome.

 

Introduction: In preeclampsia, there is failure of estrogen production due to placental dysfunction resulting in lowering of TBG, TT3, TT4 along with growth retardation of the foetus. It has been shown that individuals with subclinical hypothyroidism have impaired endothelium derived vasodilatation from diminished nitric oxide secretion that is restored after thyroxine (T4) replacement. The present study is proposed to evaluate the association of preeclampsia and thyroid dysfunction in pregnant women and perinatal outcome. Methods: The present study was carried out on pregnant women with preeclampsia admitted to or attending the Outpatient Department of Obstetrics and Gynecology GSL medical college and hospital, between June 1st 2018 to May 31st 2019. Similar number of age & parity-matched normotensive pregnant women served as controls. Battery of investigations focusing on thyroid hormones were performed and both groups were compared in terms of thyroid status, perinatal outcome and complications. Results: Incidence of hypothyroidism is high but mostly subclinical.Women with preeclampsia had higher TT3, TT4 levels as compared to non pregnant women. TSH levels were higher significantly higher in preeclamptic women than normotensive pregnant women. A significant negative correlation was observed between birth weight and TSH levels serum albumin and TSH levels in preeclamptic women. Conclusion: These findings indicate that there is state of hypothyroxinemia in normal pregnancy and in preeclampsia. Identification of changes in thyroid hormones in preeclampsia might be of help in preventing the occurrence of preeclampsia.
 

This is a case report of 30 year old lady married since 10 years, with two living issues, previous two cesarean sections and tubectomised 5 years back, with complaints of pain in lower abdomen, on and off since 3 months. Also presented with lump in abdomen, which was slowly increasing since 3 months. Xanthogranulomatous oophoritis is chronic inflammatory condition, characterized by presence of large number of lipid laden histiocytes admixed with other inflammatory cells leading to destruction of affected tissue. It is commonly seen in kidney and gallbladder, stomach, anorectal areas, bones, urinary bladder, testis, epididymis, ovary, vagina and endometrium. Xanthogranulomatous inflammation of female genital tract is rare.
 

A pregnant woman suffered a massive cerebrovascular accident at 24 weeks’ gestation. She became comatose, but she successfully carried the fetus till 33 weeks. The patient remained in a comatose state and required enteric feeding and skilled nursing care. Premature labor began at 33 weeks’ gestation, and there was a vaginal delivery of a live 1.5 kg female. The puerperium was complicated by disseminated intravascular coagulation, and the mother died on postnatal day 6. The child is developing normally at 1 year. Generally these women do not carry up to term and deliver prematurely, though in some cases pregnancy can be successfully stretched until period of maturity despite severe maternal brain damage. The maternal and fetal prognosis along with the period of gestation should be taken into consideration before taking decisions. Only a few cases of coma and pregnancy have been reported in literature. The management requires multidisciplinary approach. Supportive nursing care is vital and most of these women deliver with assistance, though prematurely.
 

The umbilical cord is an important part of the fetoplacental unit. Single umbilical artery (SUA) is the most frequent anomaly, not only of the umbilical cord but probably among all birth defects. When there is only one umbilical artery in an umbilical cord it is called single umbilical artery. Many abnormalities of cord length and low placental weight have been associated with SUA. Fetal anomalies included are; diaphragmatic hernia, gastrointestinal, cardiac, musculoskeletal and renal anomalies. SUA is included in pathognomic feature of Sirenomelia. Fetal growth restriction is common in them due to anomalies, chromosomal abnormalities and impaired placental development and perfusion. Perinatal morbidity and mortality are increased mainly due to underlying
structural and chromosomal anomalies. When SUA is diagnosed , prompt search should be made to detect other associated anomalies in the baby.
 

Introduction: One third of first trimester bleedings happen in pregnancies that are otherwise normal. Nearly 50% of pregnancies end in pregnancy loss, if pregnancy continues, poor maternal and fetal outcomes such as preterm delivery, Preterm preLabor rupture of membranes, preeclampsia, placental abruption and intrauterine growth restriction occur. Aims: To know the obstetric outcome of pregnancy complicated by first trimester vaginal bleeding. Materials and Methods: Prospective study where All pregnant women reporting to Government Maternity Hospital, Hanmakonda with first trimester vaginal bleeding were included. Minimum 100 participants meeting inclusion criteria from January 2018 to July 2019 were there. Results: 62% of early vaginal bleeding had pregnancy loss (miscarriage). Only 37% had threatened abortion where pregnancy continued. Recurrent vaginal bleeding had higher risk of pregnancy loss than single episode of bleeding PV, of which most of them had inevitable abortion. Most of the cases of threatened abortion were induced (38%), mainly for PROM, IUGR and prolonged pregnancy. Other indications were PPROM, gestational hypertension, GDM. Only 22% had spontaneous onset of Labor. Cesarean section rate was not significantly high (22%) and main indication was post LSCS status, malpresentation, NPOL followed by APH and fetal distress. Conclusion: To conclude, adverse maternal and fetal outcome predicted following threatened miscarriage should be taken into consideration when deciding upon antenatal surveillance. The identification of these high risk groups should enable better management protocols to improve neonatal outcome.
 

Introduction: The present study aimed to assess OGCT and BSL (fasting and post prandial) as a mode of screening of GDM in pregnancy. The study was intended as there is considerable controversy
regarding the type and timing of test used to screen for GDM. Methods: A total of 500 antenatal patients matching the inclusion and exclusion criteria was taken up for this study. Each subject was asked to consume 75g OGCT and was also asked to do fasting and post prandial blood sugars within 1 week and values were noted and compared. Results: Out of 500 women in the study, 247 had impaired blood sugar parameters as per oral glucose test, in the form of impaired oral glucose test (28%), gestational diabetes (17.4%) and frank diabetes(3.2%). 232 women has impaired fasting levels (46.4%). Astonishingly only 75 women had deranged post prandial values. The correlation of OGCT to BSL fasting was found to have statistical significance with p value 0.01 and as noted in (table), OGCT and fasting BSL have a good correlation. On the contrary the correlation of OGCT with abnormal PP was insignificant. Conclusion: Fasting glucose measurement performs comparably to 75-g OGCT, but post prandial glucose does not.
 

Introduction: Higher than normally accepted Cesarean Section (CS) rates raise concerns about their inappropriate use. The aim of the present study was to examine cesarean delivery rates at the Department of Obstetrics and Gynecology, ESIC Medical College Faridabad based on the Robson’s Ten Group Classification System (TGCS). Methodology: In the present retrospective study, hospital records of patients who delivered in our department during the study period (Jan’19 to June’19) were extracted and cases were classified according to Robson’s TGCS of CS. Results: In the present study a total of 1297 patients were included, of which 462 underwent CS and rest had vaginal deliveries. Applying Robson’s TGCS revealed that majority of the patients were from Group 1 (30.2%) and Group 3 (31.2%). Highest CS rate was observed in Group 5 (98.1%), Group 6 (100%),
and Group 9 (100%). Of all the CS done in our study population (n=462), highest contribution was made by Group 5 patients (45.5%). Group 1 contributed 25.1% and Group 2 11.5% to the total CS performed in this population. For the CS performed, previous CS was the most common indication (46%). Conclusions: Obstetric audits at the institution level and practicing evidence-based obstetrics is required to reduce morbidity associated with CS. The Robson TGCS was found to be an easy to use tool for identifying the obstetric groups of women contributing to elevated CS rates.
 

Introduction: Child birth is an important milestone in any women’s life. Illness or death during or after childbirth has impacts not only on the mother and her family but has serious consequences on the nation’s sociodemographic goals. Safe motherhood is considered a human rights issue. Maternal death is thus, a reflection of social disadvantage and not merely a health disadvantage. Methods: A retrospective study was done from August 2018 to September 2019 in Pannadhay Rajkiya
Mahila Chikitsalaya Udaipur. Medical records of all maternal deaths over the chosen period were analyzed. Result: The MMR in this study period was around 451.46/100,000 live births. Unbooked cases accounted for majority of the deaths. Most cases were referred to our tertiary care hospital. Maximum deaths occurred between 21 & 30 years of age. Anemia was widely prevalent. Most deaths were due to indirect
causes, most common being sepsis which was closely followed by hypertension and haemorrhage. Conclusion: Strengthening of peripheral centres, hiring competent staff and adequate blood bank facilities together with reference linkages must be done. Auditing the causes for maternal mortality is extremely helpful to identify preventable causes and delay.
 

Polycystic ovarian syndrome (PCOS), the commonest endocrinological abnormality of women in the reproductive age, is adversely affected by associated thyroid dysfunction. Both have independent risks for ovarian failure and complications related to pregnancy. Aim of the study: The present study aims to investigate the prevalence of different thyroid disorders in PCOS patients. Settings and Design: Observational case control study. Materials and methods: This hospital based observational case-control study was done in 90 cases who were defined as having PCOS according to the revised 2003 Rotterdam criteria and another 90 age-matched women were studied as the control population. Thyroid function was evaluated by measuring serum thyroid stimulating hormone (TSH), free T3 and free T4 levels, anti-thyroperoxidase antibody (anti-TPO Ab) and thyroid morphology by clinical examination and ultrasound (USG) of the thyroid gland. Statistical Analysis: It was done by Student’s t-test and Chi-square test using appropriate software (SPSS version 25). Results: This case-control study revealed statistically significant higher prevalence of autoimmune thyroiditis, detected in 17 patients (18.9% vs. 1% of control) as evidenced by raised antiTPO antibody levels. PCOS patients were found to have higher mean TSH level than that of the control population (4.52 ± 2.56 and 2.54 ± 3.15 respectively; p value < 0.05). Also a high prevalence of goiter was observed among PCOS patients (27.8% vs. 8.9% of control, p value < 0.001). On thyroid USG, 16.67%of PCOS patients and 4.44% of controls had hypoechoic USG pattern which was also compatible with the diagnosis of autoimmune thyroiditis. Conclusions: High prevalence of thyroid disorders in PCOS patients necessitates the importance of early screening and correction of hypothyroidism in managing infertility associated with PCOS.

Background: Thrombocytopenia is a common hematologic abnormality during pregnancy. Pregnant women with thrombocytopenia have a higher risk of bleeding during orafter childbirth, particularly if they need to have a cesarean section or other surgical intervention during pregnancy, Labor or in the puerperium. The main aim of this study was to determinethe incidence of thrombocytopenia at GGG hospital Jamnagar among pregnant women attending antenatal care service. Objectives: To access incidence of thrombocytopenia in pregnancy and it’s outcome. To access theincidence of thrombocytopenia among pregnant women a cross sectional study was used on pregnant women attending antenatal care service GGG Hospital, Jamnagar from January to December 2018. A total of 9328 pregnant women taken visit 1110 diagnosed had thrombocytopenia. 100 were included in the study. Blood samples were collected for platelet count and other platelet parameters. Result: A total of 9328 women receiving antenatal care service at GGG Hospital, Jamnagar participated in the study. Thrombocytopenia among 1110 pregnant women showed incidence of 11.9%. The mean ± standard deviation platelet count was 238.85×109/L (±74.57). Thrombo-cytopenia was significantly associated with age group 20-25 year. Conclusion: The incidence of thrombocytopenia was 11.9% predominantly with mild type of thrombocytopenia. Thrombocytopenia was higher among pregnant women who belongs to age group 20-25 year. Health care providers should screen routinely for thrombocytopenia to avoid excessive bleeding during pregnancy, especially in women who belongs to 20-25 year of age.
 

Background: Obstructive uropathy is a recognized complication in advanced cervical cancer. Urinary diversion is commonly used to bypass the obstruction and improve renal function. The degree of survival benefit that diversion offers is not well established and its impact on Quality of life (QoL) is uncertain. This study considered these factors in order to inform treatment decisions. Over 70% of the carcinoma cervix cases present in advanced stages of the disease and are associated with poor prognosis and high mortality rates. we evaluated our experiences with PCN in the management of cervical cancer patients presenting with obstructive uropathy with a detailed analysis of outcome, morbidity, mortality and survival rates and quality of life. Materials and Methods: A prospective study was performed with 52 patients with carcinoma cervix stage 111 and IV who underwent percutaneous nephrostomy during a 12 month period. The median age was 45 years. Follow up period was ranging from 3 months to 20 months. Quality of life was measured by web based QualityMetric’s SF12v2 Health Survey. Results: Of the 52 patients under assessment, significant improvement occurred in 40 patients (76.9%) and 40 patients (76.9%) presented normalization of their BUN and creatinine levels within 3 weeks Postoperative complications occurred in 28.46 of the patients. Mean survival at 6 and 12 months was, respectively, 48.07% and 23.07%. 4 patients developed VVF fistulas. Post procedure 15 patients 28.84% received palliative radiotherapy. There was considerable improvement in physical and emotional well being of the patients in 1st week,fourth week, and third month web based Quality Metric’s SF-12v2 Health Survey. Conclusion: In the present study we have concluded that the presence of malignant ureteric obstruction, palliative percutaneous urinary diversion may be performed and is effective in improving renal function. Urinary diversion by percutaneous
nephrostomy will definitely provide considerable physical and emotional wellbeing of the patient.
 

Aim: To assess attitude of woman towards PPIUCD. Study: Hospital based cross-sectional study done in G.G. Govt. Hospital-Jamnagar from july 2019 to December 2019 Materials and Methods: Between this duration of period total number of post partum patients were 4060 including Vaginal delivery & Cesarean section, out of these patients 2842 patients choose PPIUCD as method of contracecption. Out of these 2842 patients I selected 500 random cases for this study Observation: PPIUCD insertion rate was 70%. 90.9% of women belonged to age group of 20–30 years of which 74% having education of class 8 and above. The overall contraceptive knowledge was 91.8%, only 52% of 74% were aware of PPIUCD. Conclusion: Total acceptance of PPIUCD in our study 84%. The awareness of PPIUCD is low leading to high refusal rates. The commonest reason for refusal is high prevalence of myths regarding PPIUCD in community, and not only women but the husband and mother-in-law also must be provided knowledge of it as they play important role in our society.

Background: Dengue is a vector borne viral disease. Female Anopheles mosquito is the vector for the disease. There is increased incidence of dengue infection in the adult population of South Asian countries. The outcome of dengue in pregnancy is similar to that in non pregnant woman. There is increased incidence of abortions, preterm births, IUGR babies, and bleeding manifestations like PPH, epistaxis. Timely intervention can improve the maternal and fetal outcome. This study aims to study the maternal and fetal outcome of dengue during
pregnancy. Methods: Pregnant women, admitted with fever during the seasonal outbreak of dengue, between August 2018 to October 2018 were studied in the department of Obstetrics & Gynecology, SHKBM, Jhalawar, Rajasthan. Serological testing for dengue virus specific antigen and antibody was done for the diagnosis of dengue fever. The World Health Organization (WHO) classification and case definitions 2009 were used to categorize the dengue patients. Maternal surveillance and fetal surveillance was done. Data was collected related to maternal and fetal consequence both during pregnancy and birth, as well as the effect on newborn. Informed and written consent was taken from all those who participated in the study. Results: The mean age at admission was 22 years. Thrombocytopenia (<50,000/cu mm) in 4 women (7.84%). Blood product transfusion was required in 5 (9.8%) of women. 23 (45.09%) had oligohydramnios, 27 (52.94%) had bleeding manifestations, 7 (13.72%) were admitted in the ICU. Adverse fetal outcome was seen as, 9 (17.64%) babies were premature, 17 (21.56%)
were admitted in NICU, and 1 (1.9%) had IUD. Conclusion: Dengue fever is associated with increased materno fetal morbidity and mortality.
Early detection and treatment are the mainstay to improve the prognosis of this viral infection.
 

Background: Cervical cerclage is the main stay of surgical treatment for cervical insufficiency and is reasonable in the following situations. Cerclage can be accomplished either transvaginally or transabdominally. Aim: To evaluate the effectiveness of cervical cerclage by modified McDonald’s method in form of better perinatal, foetal and maternal outcome. Materials and Methods: This is a prospective cohort study conducted on 100 ANC pregnant women with history of previous spontaneous preterm birth, previous 2nd trimester abortion, previous early and late recurrent foetal loss and women with short cervix in pregnancy at PDZH, Udaipur. Result: Mean age 25.94±3.69 years, mean gravida 2.71 ± 1.27, mean gestational age at time of cervical cerclage 18.1 ± 3.76 weeks. Mean good APGAR among
93 live births was 94% babies between 7–10. Among 3 neonatal death all babies were <2.5 kg (p < 0.05). Maximum patient reach at term who had cervical cerclage between 14–18 week i.e. 49% (p < 0.05). In short cervix cases total foetal salvage by modified McDonald’s method is 84.61%, abortion 7.69%, NICU admission 23.07% and neonatal death is 7.69%. Conclusion: Cervical cerclage is a simple procedure, require little surgical expertise but has very good results. Advantage of our method over McDonald’s method is that it is simpler procedure having less stitches on cervix so that less chances of haemorrhage, at the time of surgery or postsurgery. Round body prolene suture does less trauma to cervix and less chances of infection to genital tract in comparison to
braided silk suture.
 

Introduction: Rubella is a febrile rash illness affecting children and adults: however, in women affected early during pregnancy, it can severely impact the fetus resulting in miscarriage, fetal death, or an infant born with a group of disabling conditions collectively called Congenital Rubella Syndrome (CRS). Immunity to rubella in the form of rubella specific antibodies in pregnant women can indirectly indicate the risk of acquiring CRS. The susceptibility of women in reproductive age group should be the first requirement in order to set plan for the
prevention of rubella infection and its transmission. Aim: To determine the seroprevalence of rubella specific immunoglobulin G antibodies in women of 18–40 years age group. Settings and Designs: It is a cross sectional observational study conducted at a tertiary care hospital. Materials and Methods: Blood sample collected from 150 women of reproductive age group was subjected to architect system, with the chemiluminiscent microparticle immunoassay for detection of Rubella
IgG. Statistical Snalysis: The results obtained were tabulated and chi-square test applied. Results and Conclusions: 91.33% women were seropositive for rubella IgG antibodies. Since the seroprevalence is high, the susceptibility to rubella infection during pregnancy is low and hence the risk of CRS in the population is also low.
 

Objective: To study the demographic factors, etiological factors, maternal complications and maternal mortality in abruptio placenta in pregnancy. To study maternal morbidities and mortality associated with abruptio placenta in pregnancy. Materials and Methods: This was a prospective analytical study and we have enrolled 50 consecutive patients presenting in obstetric department of new civil hospital, Surat with clinical diagnosis of abruption placentae. A detailed history of the patient was taken regarding identification, age, address, occupation, socio economic status, amenorrhea, fetal movements and history of trauma, history suggestive of hypertensive disorders, previous medical disorders and outcome of previous pregnancy. After that, thorough clinical examination & ultra sound was performed for confirmation of clinical diagnosis. Patient were managed according to “standard
department protocol” Result: Highest incidence was found among the maternal age of 20–30 years. The majority of cases were in multipara (70%). The majority of the patients in my study were in lower class (48%) and upper lower class (28%). In the present study 60% of them were unbooked cases probably because of low socio economic condition. Among etiological factors, most common factor found in my study was hypertension which was present in 84%. among maternal complications, postpartum hemorrhage and coagulation failure, were most common present in 16% of patients. 12% patients having a shock and 8% patients having a acute renal failure. Most of the patients recovered after proper medical intervention. There were 2 maternal mortality in my study (4%). Conclusion: By improving socio economic status, avoiding high parity by timely sterilization, anticipation of abruption in high risk cases, proper antenatal care, timely admission, prompt action at the time of occurrence, strict surveillance etc. Can go a long way in bringing better results in dealing with this grave condition. Early referrals from the peripheral institution would help to bring down the perinatal and maternal mortality.
 

To determine incidence and nature of urological injuries in obstetric and Gynecological procedures and their complications and mode of management in a tertiary care hospital, Gynecological Sevices, SGPGIMS, Lucknow. A retrospective study of all obstetric and Gynecological surgeries over a period of 5 years from January 2014 to December 2018 was carried out at Gynecological Services, SGPGIMS, Lucknow, India. Cases with the documented urological injuries were analyzed further. A total of 1,526 patients underwent obstetric and Gynecological procedures like lower segment cesarean section, various types of hysterectomies, laparotomy were analyzed. Cases with urologic injuries were identified and analyzed for the type of injuries, timing of diagnosis, their management and consequences. Out of 1,526 patients undergoing various surgeries, 8 (0.52%) patients had bladder injury and
1 (0.06%) patients had ureteric injury. In gynecologic procedures, the incidence of bladder injury was highest in radical hysterectomy (1 out of 35, 2.8%) followed by VH (2 out of 123, 1.62%), laparotomy (1out of 194, 0.51%) and TAH (2 out of 635, 0.32%). Only 1 ureteric injury was noted in a case of TAH out of total 1094 Gynecological procedures (0.09%). Statistically, ureteric injuries are less frequent but are responsible for significant morbidity when compared to bladder injuries which are more common but with less complications as they are diagnosed and managed timely.
 

Introduction: The umbilical cord is the lifeline of the fetus. The umbilical cord plays an essential role in intrauterine life and is the pathway between mother, placenta and fetus during pregnancy and delivery. There are many umbilical cord abnormalities ranging from false knots, which have no clinical significance, to vasa previa, which could cause fetal demise. Aims and Objectives: To evaluate patterns of umbilical cord abnormalities. Methods: This retrospective study was conducted in ACPMMC Dhule. 100 pregnant women with singleton pregnancy who delivered after 28 weeks of gestation and who were diagnosed and documented as having umbilical cord abnormalities either antenatally or
during and after delivery were included. Various patterns of umbilical cord abnormalities were noted and neonatal outcome was assessed based on APGAR score, NICU admissions, live birth or still birth.
Result: Of all cord abnormalities identified, Nuchal cord was the commonest i.e. 67%. The other abnormalities identified were abnormal cord length 12%, coiling abnormality 9%, single umbilical artery 4%, cord knot 5%. Less commonly seen abnormalities were Cord prolapse 1% and velamentous insertion of cord 1%. Of the total study patients 64% delivered by Vaginal delivery whereas 36% underwent cesarean
section elective or emergency. Of all fetuses delivered 70% had live birth without any complication and did not require any NICU admission. 22% required NICU admission. 3% had early neonatal death, 2% late neonatal death whereas 3% was still birth. Conclusion: Evaluation of umbilical cord abnormalities ensures prevention of adverse neonatal outcome. Education of health personnel about proper examination of umbilical cord should be emphasized.

Keywords: Umbilical cord; Abnormalities; Nuchal cord; Vasa Previa.