Indian Journal of Obstetrics and Gynecology

Aim: To evaluate the abnormal invasion of placenta in placenta previa using Ultrasonography, Colour Doppler and MRI and to study the maternal and fetal outcome.

Introduction: Placenta previa in which the placenta is implanted either near or over the internal cervical os, presenting ahead of the leading pole of the fetus is seen in 0.4-0.5% of all labours. Patients are at increasedrisk of abortions and premature deliveries, fetalmal-presentations, Caesarean sections, intrapartum haemorrhage, peripartum hysterectomy, birth asphyxia and maternal and perinatal morbidity and mortality. This study was conducted on 50 pregnant mothers who were diagnosed to have placenta previa.

Material and Methodology: A prospective study was done at Gandhi Hospital between October 2015 and 2016 on 50 pregnant women with diagnosed placenta previa after written informed consent. History of
period of gestation, previous uterine manipulations and surgeries, complaints like bleeding per vaginum, complications during present and past pregnancy and particulars like post partum period, fetaloutcomes like maturity, birthweight and perinatal morbidity and mortality were studied and entered in a Proforma. Blood Investigations like CBP, Renal function tests, Ultrasonography, Colour Doppler and MRI
were done. The data of imaging techniques was compared to the intraoperative data using t-test.

Results: Three quarters were unbooked cases. 46% presented with bleeding per vaginum. The incidence of placenta previa was highest
in women with third pregnancy and in those withprevious Caesarean section.On Ultrasonography, 64% had major and 26% had
minor Placenta previa. On Colour Doppler, 76% did not have invasion of
placenta which was confirmed with MRI. Caesarean section was done in 58%, andHysterectomy in 16%. 18% had adhesion between uterus and bladder in 18%. Placenta could not be separated in 14%.
B-Lynch sutures, Devascularization procedures like bilateral uterine artery ligation and bilateral internal Iliac artery ligation were needed. Bladder was repaired in 10%. Uterine wall was excised in 4%
of the cases. Complications included Hemorrhage in 20%, Hypovolaemic shock in 12%, bladder injury in 8%, and Renal failure in 2%. 8% required ventilatory support. The maternal mortality was 2%. Preterm babies constituted 58%. 26% of babies died.

Introduction and Aim: Critically ill obstetric women in the obstetrics high dependency unit are a challenging situation to the obstetricians.
The frequency of obstetric admissions that require admissions for critical care in the ICU and HDU is on the rise. Overall the obstetric admission in ICU in our institute varies from 4-6% of the deliveries. This study
attempts to evaluate the occurrence, indications, progression, interventions and outcomes of these obstetric patients admitted in the obstetric HDU.

Materials and Methods: This is prospective observational study of obstetric patients admitted in the obstetric HDU in one year from January 2019 to December 2019 at Bharati Hospital and Research
centre attached to Bharati Vidyapeeth Medical college Pune, Maharashtra. All the admissions in a dedicated 6 bed HDU were included in the study. The course of events and outcomes were documented and tabulated. The data will be analysed against the total
no of deliveries for the study period. Incidence and prevalence of various obstetric conditions requiring HDU support was studied.

Results: In total 414 patients required HDU care during the study duration. 19.11% of all the births during the year required HDU care indicating a high number of high risk pregnancy case load. Maximum
admissions to HDU were in second half of gestation or postpartum. Most common indication for admission to HDU was preeclampsia 185 patients (44.68%). Maximum patients (55.31%) were referred from other
nursing homes. 35 patients had associated heart disease, 27 had diabetes, 26 patients had associated other endocrine disease.

Conclusions: A high incidence of Obstetric HDU admissions was observed in the study as it was conducted in a tertiary care referral teaching hospital with dedicated Obstetric HDU and ICU. nAn increasing trend of Obstetric admissions is seen due to an increased incidence of high risk pregnancy with maternal age, assisted conception, obesity and
underlying medical conditions acting as a major confounding factors.Obstetric HDU will go a long way in prevention of maternal morbidity and mortality.

Introduction: Charge syndrome is a rare genetic disorder caused due to mutation in CHD7 gene and characterised by the presence of multiple
congenital defects. Congenital genital defect is a minor abnormality of this syndrome. Here we are reporting a very rare case of Charge syndrome with vaginal atresia where vaginoplasty was done with
uterovaginal tract recanalisation.

Case: A 15yr old girl presented with complaintsof primary amenorrhoea and cyclical crampy lower abdominal pain for 7 months. It was also found that she had a poor scholastic performance, reduced vision in her left eye and difficulty in hearing sinceher childhood which however was unevaluated. Her cardio vascular system examination revealed
pansystlic murmur. The ECHO cardiogram suggested a large restrictive ostium secundum atrial septal defect (ASD) with mild tricuspid regurgitation (TR) & mild pulmonary artery hyperplasia (PAH).
Ultrasonography (USG) showed collections inside the uterine cavity suggestive of hematometra and examination of external genitalia revealed the presence of a blind vaginal pit suggestive of vaginal
atresia. Presence of all the above clinical findings directed towards further evaluation which further revealed presence of multiorgan defects fullfilling all the criteria of Charge syndrome. She underwent
ASD closure followed by Mc Indoe’s vaginoplasty successfully.

Conclusion: While approaching a patient with multiorgan/multisystem abnormalities, a keen observation of its relation to any syndrome paves
a path for its easy management, by prioritizing the immediate treatment and interval treatment. A multidisciplinary approach is always prudent.
Vaginal atresia with presence of uterus could be managed successfully by surgical intervention, amongst which Mc Indoe’s vaginoplasty may be
preferred over other techniques.
 

Achodnroplasia is one of the most prevalent form of dwarfism. There is very less literature or protocol for antenatal management of achondroplasia mother. We had a case of an achondroplasia mother who came in labour at 34 weeks of gestation. Her partner was also achondroplasic. Emergency LSCS was done and a healthy baby was extracted. Baby had no features of achondroplasia with normal radiologic and karyotypic evaluation. As achondroplasia is an autosomal dominant disease, the chances of healthy baby for aachondroplasia couple is very rare. There is a 25% chance of healthy baby if both the parents are heterozygouslyachondroplasic.

Keywords: Achondroplasia; Autosomal; Karyotype; Heterozygous; Mutation; Rhizomelic; Hypoplastic.
 

Background: Ectopic pregnancy is defined as when gestational sac implants itself outside the uterine cavity in the fallopian tubes, ovary, cervix, and peritoneum. Ectopic pregnancy is one of the commonest acute abdominal emergencies a gynaecologist has to meet  in his day to day practice. It is also a matter of great concern that a woman might have to face any time during her childbearing period. It not only threatens the life if not treated timely and effectively but also
tells upon her future fertility unavoidably by causing mutilation of an essential organ of reproduction, namely the fallopian tube with or without ovary and sometimes even the uterus.

Methods: This prospective observational study was conducted by the Department of OBG at KMCT medical college and research institute from November 2018 to October 2019. A total of 30 patients were included in the study. A comprehensive history taken from each patient followed by a thorough physical examination and were recorded in the predesigned profoma and analyzed.

Results: The maximum 16 (53.3%) were in the agegroup of 26-30 years followed by 7 (23.3%) from theage group 20-25 years. The mean age of the patientswas 26.62 (SD14.66) years ranging from 20 to 40 yrs.
The typical triad of amenorrhoea, pain abdomenand bleeding was observed in majority of the cases.Amenorrhea and Abdominal pain were the mostsignificant symptoms present in 100% and 93.3% of
the cases. Bleeding was present in 24 (80%) cases.
 

Introduction: According to the definition by World Health Organization normal labour as“spontaneous in onset, low risk at the start of labour
and remaining so throughout labour and delivery.Induction of labour is the non spontaneous initiationof uterine contractions that result in progressive cervical effacement and dilatation with descent of the presenting part to achieve vaginal delivery. Themethod of administration that has been explored thoroughly is PGE2 i.e, cerviprime gel. Though this is widely used, it is expensive and requires refrigeration
for storage. The second method of administrationused is Misoprostol or PGE1 tablets which is comparably cheap, safe and cost effective.

Aim and Objective: In the present study, our traditional methods of cervical ripening with endocervical prostaglandin E2 gel, and intravaginal prostaglandins PGE1 was used, to know the outcome
after using these two drugs. Material and Methods: The present Prospective Observational study was conducted in a Tertiary Care hospital during October 2015 to October 2017 amongst 100 patients admitted in labor room with following indication, Induction of labor in women at or beyond term, Induction of labor in women with pre-labor rupture of membranes, IUGR with or without Oligohydrominos, I.U.F.D and Hypertensive disorder of pregnancy. For induction, Misoprostol
was used in 26 patients and Dinoprostone (cerviprime) was used in 74 patients. Obstetrician were free to use their choice of drugs, between two, we have observed that Dinoprostone was more commonly used.

Result: Percentage of induction was more in Primigravida, but parity wise it was comparable. Dinoprostone used slightly more in Primigravida. It was found that irrespective of bishop scorevaginal delivery was found to be more. Overall vaginal delivery with misoprostol group was more. It is statistically significant. The time required for
delivery with misoprostol is less as compared with Dinoprostone which is statistically significant. It was found that induction done with Tab. Misoprostol has the highest vaginal delivery rate with 1 or 2 doses, and in Dinoprostone maximum 3 doses were required. 11.3% required LSCS for foetal distress and around 17% of patients landed up in failure of induction. None of the misoprostol group had failure of Induction. No any complications were found like hypertonous, tachysystole, and rupture of uterus.

Conclusion: From the present study it was concluded that PGE2 (Dinoprostone) and PGE1(Misoprostol) are equally safe, Obstetrician was freeto use their choice of drugs, and we have observed
that Dinoprostone was commonly used. Considering its safety it is observed that both are equally safe, but the cost effectiveness of misoprostol is more, whichmay be the drug of choice in coming years.

Introduction: According to the definition byWorld Health Organization normal labour as“spontaneous in onset, low risk at the start of labour
and remaining so throughout labour and delivery.Induction of labour is the non spontaneous initiationof uterine contractions that result in progressiv ecervical effacement and dilatation with descent of
the presenting part to achieve vaginal delivery. Themethod of administration that has been exploredthoroughly is PGE2 i.e, cerviprime gel. Though this iswidely used, it is expensive and requires refrigeration
for storage. The second method of administration used is Misoprostol or PGE1 tablets which is comparably cheap, safe and cost effective.

Aim and Objective: In the present study, our traditional methods of cervical ripening with endocervical prostaglandin E2 gel, and intravaginal prostaglandins PGE1 was used, to know the outcome
after using these two drugs.

Material and Methods: The present Prospective Observational study was conducted in a Tertiary Care hospital during October 2015 to October 2017amongst 100 patients admitted in labor room with
following indication, Induction of labor in women at or beyond term, Induction of labor in women with pre-labor rupture of membranes, IUGR with orwithout Oligohydrominos, I.U.F.D and Hypertensivedisorder of pregnancy. For induction, Misoprostol was used in 26 patients and Dinoprostone (cerviprime) was used in 74 patients. Obstetrician were free to use their choice of drugs, between two, we have observed
that Dinoprostone was more commonly used.

Result: Percentage of induction was more in Primigravida, but parity wise it was comparable.Dinoprostone used slightly more in Primigravida.
It was found that irrespective of bishop scorevaginal delivery was found to be more. Overallvaginal delivery with misoprostol group was more.
It is statistically significant. The time required fordelivery with misoprostol is less as compared with Dinoprostone which is statistically significant. It was found that induction done with Tab. Misoprostolhas the highest vaginal delivery rate with 1 or 2 doses, and in Dinoprostone maximum 3 doses wererequired. 11.3% required LSCS for foetal distress
and around 17% of patients landed up in failure of induction. None of the misoprostol group had failure of Induction. No any complications were found like hypertonous, tachysystole, and rupture of uterus.

Conclusion: From the present study it wasconcluded that PGE2 (Dinoprostone) and PGE1 (Misoprostol) are equally safe, Obstetrician was free to use their choice of drugs, and we have observed
that Dinoprostone was commonly used. Considering its safety it is observed that both are equally safe, but the cost effectiveness of misoprostol is more, which may be the drug of choice in coming years.

Introduction: Amniotic fluid provides the fetus with an environment to move and grow. The present study was conducted to assess maternal and fetal outcomes in cases with oligohydramnios.

Methodology: This prospective study was conducted in the Department of Obstetrics and Gynecology of a tertiary care teaching hospital Faridabad, Haryana from February 2019 till January 2020. Oligohydramnios was defined as amniotic fluid index (AFI) of less than
5 cm on ultrasonography. Additionally, we included a control group of pregnant women from the same antenatal clinic who had AFI of more than 5 cm.

Results: During the study period, we included 80 patients with oligohydramnios and another 80 mothers who did not have oligohydramnios. Among those with oligohydramnios, 69% underwent
LSCS, while in the other study group, only 38% underwent LSCS. We observed that fetal distress was significantly more common among cases with oligohydramnios as compared to those without oligohydramnios (39% vs 9%, p value < 0.001). Nonreactive NST was observed in 65% in those with oligohydramnios, while it was observed in only 21% in those without oligohydramnios (p value < 0.001).
Significantly higher proportion of cases had AGPAR score of less than 7 in the oligohydramnios groups as compared to the non-oligohydramnios group at 1 and 5 minutes (p value < 0.01).

Conclusions: We recommend screening antenatal mothers with AFI to detect possible high risk cases atan early stage, so that the obstetric team can prepare accordingly.
 

Background: Abnormal uterine bleeding is the commonest presenting symptom and major gynecological problem responsible for as many
as one-third of all out patient gynecologic visit. Abnormal uterine bleeding is defined as bleeding from the uterine corpus that is abnormal in regularity, volume, frequency, or duration and occurs in absence
of pregnancy and may be acute or chronic.Abnormal Uterine Bleeding (AUB) is a significant debilitating clinical condition and affects 14-25% of women of reproductive age and up to 50% of perimenopausal women.

Methods: This prospective observational study was conducted by the Department of OBG at KMCT medical college and research institute from January 2019 to December 2019. A total of 180 patients were
included in the study.A comprehensive history taken from each patient followed by a thorough physical examination and were recorded in the pre-designed profoma and analyzed.

Results: The maximum 61 (33.9%) were in the age group of 46-50 years followed by 58 (32.2%) from the age group 41-45 years. The mean age of the patients was 44.23 (SD12.76) years ranging from 30 to 50 yrs. The difference in clinical and histopathological diagnosis of the categories AUB-P, AUB-A, AUB-L and AUB-M were not statistically significant but was highly significant in the category AUB-M and
AUB-E(<0.001).
 

Introduction: Hypertensive disease of pregnancy (HDP) is also known as maternal hypertensive disorder is a group of diseases such as preeclampsia gestational hypertension and chronic hypertension. A
study was undertaken to evaluate the cardiovascular  hemodynamic alterations in hypertensive disorders of pregnancy on echocardiography and assess its impact on maternal outcome.

Methods: A total of 100 pregnant patients presenting in our hospital with hypertension in 3rd trimester  were selected for the study matching the inclusion and the exclusion criteria. A detailed history of each case was recorded and a detailed examination wasperformed. Echocardiography was done to note structural changes noted in the heart along with
severity of disease.

Results: Out of Total 100 cases, 39 were gestational hypertension, 48 had pre eclampsia, 4 had eclampsia and 9 had chronic hypertension. Stroke volume was found to be significantly higher in eclampsia group.
Also the diastolic dysfunction (29%) was associated with severity of disease and 10 women had pulmonary hypertension in pre eclampsia and eclampsia group. There was significant change in LVID(S) and LVID
(D) showing changes of left eccentric ventricular hypertrophy in preeclampsia group and concentric left ventricular hypertrophy in chronic hypertensive group. An important finding in our study was the
structural parameters such as LVID D, LVID S, IVS and LWPW D were on higher side of normal or raised in HDP and the values were statistically significant in pre-eclampsia and eclampsia groups as compared with the normal reference values .

Conclusions: The study concluded that cardiac structure and function using echocardiography are altered in HDP. The severity of adverse changes seen in HDP is seen more in pre eclampsia and is proportional to the severity of the pre eclampsia. The cardiac functions which help in determination of impending dysfunction are the: LV end-diastolic
volume, LV end-systolic volume, ejection fraction, stroke volume, left atrial diameter and pulmonary hypertension. Out of these diastolic dysfunction and increased peripheral vascular resistance correlate
with disease severity.
 

Aim: To study risk factors, clinical presentation, maternal complications and neonatal outcome in placental abruption.

Materials and method: An observational study was conducted from 1st April 2018 to 31st March 2019. All pregnant women who presented to labor room with ante partum hemorrhage in the last one year were
taken into the study. Details of these patients were recorded at the time of presentation and immediate postpartum.

Observations: The incidence of placental abruption was 2%. Majority of the cases were primiparous (35.29 %), while common age group was between 26–30 years. The associated risk factors were hypertensive disorder of pregnancy (38.23%), anemia (11.76%), assisted reproduction techniques (14.7%),placental insufficiency (5.88%), preterm labour
(5.88%), twin pregnancy (5.88%), and intrauterine transfusion (2.94%). The maternal complications included atonic PPH (44.11%), HELLP syndrome (17.64%), severe anemia, DIC, acute renal failure
and peripartum hysterectomy (5.88%). Cesarean delivery was required in 55% cases. The live births were around 47% out of which 41% needed NICU admission at birth. Majority of cases were grade III
abruption explaining the higher perinatal mortality (52.93%). There was no maternal mortality among the cases.

Conclusion: Placental abruption or accidental hemorrhage is associated with severe maternal and neonatal morbidity and mortality. This study thus, enables to identify the risk factors associated with
placental abruption and further, help in prompt and appropriate management of cases.
 

Background: Cervical cancer has a huge emotional and financial burden on the society. To curb the disease, there is a need to develop a cost-effective screening tool with good sensitivity and specificity.
The present study is aimed to find out effectiveness of Visual Inspection with Acetic Acid (VIA) in picking up premalignant and malignant lesions of the cervix after comparing it with colposcopy and histopathology.

Aims and objectives: 1. To screen women of 30-45 years of age for precancerous cervical lesions with VIA., 2. To compare accuracy of VIA with Colposcopy., 3. To confrm the fndings with histopathology
examination.

Material and Methods: This was a prospective observational study conducted in the Department of Obstetrics and Gynecology among 500 women of 30-45 years of age group. VIA was carried out and all
VIA positive women were subjected to colposcopy.All women with colposcopy interpretation as CIN I,CIN I -II, CIN II-III and as unsatisfactory under wentcervical biopsy. Later on, colposcopy findings were correlated with histopathological findings.

Results: Out of 500 study group, 364 (72.8%) women were VIA negative and 136 (27.2%) were VIA positive. Out of 136 VIA positive women, 65 (47.8%) women were positive on colposcopy (either of CIN
I/I-II/II-III) and after biopsy 50 (82%) women had positive reports. (either of intraepithelial or invasive cervical lesions)

Conclusion: These results establish VIA as an effective screening test for cancerous and precancerous conditions of the cervix. Colposcopy can further interpret the VIA positive lesions with almost 100 %
sensitivity, specificity, NPV in high grade lesions.

Introduction: AUB is an overarching term used to describe any departure from normal menstruation or normal menstrual cyclic pattern and characteristics.Recently obesity has been suggested a risk factor for
AUB. Due to certain social and biological reasons, women of the reproductive age groups are amongst the most vulnerable to obesity. Thus in view of rising prevalence of excessive weight and obesity in
women, it has become very important to investigate their effects on women’s reproductive health.

Aims and Objectives: To study clinical presentation of AUB amongst women attending gynecology OPD and indoor to ward with AUB and to study association of AUB with BMI.

Materials and Methodology: All consenting women attending gynecology OPD and those who are indoor to gynecology ward with AUB (Uterine bleeding with clinically detectable organic, systemic and iatrogenic cause.) were included in study. A cross sectional study enrolled 200 consenting women who attended gynecology OPD or indoor to ward of tertiary care hospital with AUB over duration of 12 months. Data were collected by taking history, clinical examination
and investigations. Height and weight were recorded and BMI was calculated. The data were analyzed by using EMI software.

Results: Amongst 200 consenting women having AUB, the most common type was uterine leiomyoma which was present in 62 women and prevalence of obesity was 25%. Statistical significance found in
subjects presenting with AUB with grades of BMI. Subjects with AUB-L had maximum numbers of subjects who were obese (34%).

Conclusion: Early diagnosis and management of obesity and appropriate life style modification should be encouraged among women of reproductive age group to reduce the incidence of AUB. Promoting
healthy eating habits and maintains normal and optimum BMI should improve menstrual health.
 

Background: Evaluation of fetal well being ismajor concern in obstetrics especially in high risk pregnancy. Fetal monitoring is based on a diagnosticprocedure, among which Doppler sonographyhas become a top-level non-invasive method.Uterine Doppler evaluation predicts most of theoccurrences of the early-onset preeclampsia andintrauterine growth restriction, and its use in thesepregnancies will improve the perinatal outcomes. Doppler investigation of middle cerebral artery in
combination with umbilical artery seems toimprove the early prediction of adverse perinatal outcome in high risk pregnancies.

Method: 100 pregnant women with high risk factors (pre-Eclampsia, IUGR and GDM) after 34 weeks till term were evaluated for their colour Doppler findings and the perinatal outcome was analysed.

Results: UA PI had high specificity and low sensitivity for adverse perinatal outcome. MCA RI had highest sensitivity, MCA PI had highest
specificity. Ratio of MCA/Umibilical artery PI has highest specificity than independent vessel Doppler. All Doppler indices were highly specific in diagnosing abnormal perinatal outcome with comparatively low
sensitivity.

Conclusions: Adverse fetal outcome has been seen to be associated with abnormal Doppler finding. Thus prompt diagnosis of impaired feto-placental circulation in form of abnormal Doppler guides us forappropriate fetal surveillance and timely termination in high risk pregnancy. 
 

Background: Evaluation of fetal well being is major concern in obstetrics especially in high risk pregnancy. Fetal monitoring is based on a diagnostic procedure, among which Doppler sonography has become a top-level non-invasive method. Uterine Doppler evaluation predicts most of the occurrences of the early-onset preeclampsia and intrauterine growth restriction, and its use in these pregnancies will improve the perinatal outcomes. Doppler investigation of middle cerebral artery in combination with umbilical artery seems toimprove the early prediction of adverse perinatal outcome in high risk pregnancies.

Method: 100 pregnant women with high risk factors (pre-Eclampsia, IUGR and GDM) after 34 weeks till term were evaluated for their colour Doppler findings and the perinatal outcome was analysed.
Results: UA PI had high specificity and low Nsensitivity for adverse perinatal outcome. MCA RI had highest sensitivity, MCA PI had highest
specificity. Ratio of MCA/Umibilical artery PI has highest specificity than independent vessel Doppler. All Doppler indices were highly specific in diagnosing abnormal perinatal outcome with comparatively low
sensitivity.

Conclusions: Adverse fetal outcome has been seen to be associated with abnormal Doppler finding. Thus prompt diagnosis of impaired feto-placental circulation in form of abnormal Doppler guides us for appropriate fetal surveillance and timely termination in high risk pregnancy.