Indian Journal of Obstetrics and Gynecology

Background: Caesarean Section is the operation which is commonly performed worldwide. Caesarean section is a boon to medical field where it has become an safe procedure for the delivery of the baby where delivery is associated with complications. The evolution of caesarean delivery has definitely reduced maternal and fetal mortality in practice of modern obstetrics. A caesarean delivery is typically performed when complications from pregnancy make traditional vaginal birth difficult which makes the life of the mother or child at risk. But there is an alarming increase in conducting caesarean section worldwide as most doctors have started practising defensive medicine.

Methods: This prospective observational study was conducted by the Dept of OBG, Melmaruvathur Adhiparaskthi Institute of Medical sciences, Melmaruvathur, Tamil nadufrom November 2018 to April 2019.A total of 92 patients were included in the study on the basis of inclusion criteria.

Results: The maximum cases 48(52.2%) were in the age of 21-25 yrs followed by 32(34.8%) in the age group 26-30years. The mean age of the patients was 28.76 (SD16.86) years .Themost common indications for caesarean sections were fetal distress which were seen in 39 cases(42.4%) followed by cephalopelvic disproportion seen in 21 cases (22.8%).Obstructed labour was the least indication noticed which was seen in 4 cases (4.4%).

Implantation of the fertilized ovum outside the uterine cavity is called ectopic pregnancy. It is associated with adverse outcome if not treated earlier. The fate of ectopic pregnancy depends on many factors. Important among them being site and duration of ectopic pregnancy. The main serious outcome is rupture. If the ectopic pregnancy ruptures and the patient survives this catastrophe, the ectopic mass gets organized and presents as pelvic mass with pain. Methotrexate is a folic acid analog that inhibits dihydrofolate reductase and thereby prevents synthesis of DNA. It affects actively growing cells including trophoblastic tissues, malignant cells, bone marrow, intestinal mucosa and respiratory epithelium. Medical management of ectopic pregnancies with methotrexate is safe and effective, therapy can be considered for patients with confirmed ectopic pregnancy who are hemodynamic ally stable with no evidence of rupture. It should be used with caution and severe toxicity should be kept in mind.

Introduction: Hysterectomy can be performed by Abdominal, Vaginal, Laparoscopic and Robotic routes. Aim: Study compares the outcomes of patients undergoing Vaginal hysterectomy with that of Laparoscopic assisted vaginal hysterectomy. Materials and Methodology: This prospective randomized study, was done in the Department of OBG in Gandhi hospital, between February 2014 and July 2015, after ethical committee approval. 50 women underwent Vaginal hysterectomy and another 50 Laparascopic assisted Vaginal Hysterectomy. Parameters like Age, Parity, BMI, History of Previous Caesarean, Medical illnesses like Hypertension and Diabetes, Uterine size, Indication for Hysterectomy, Operating time, blood loss, visceral injury, Postoperative fever, Urinary tract infection, Fall in Haemoglobin, Blood transfusions, Pain on day three, Day of Ambulation and Hospital stay were studied. Statistical analysis was done between the two groups on the parameters, using Chi-square test for qualitative parameters and Student “t” for quantitative variances. Results: There was no gross discrepancy in the “Mean value” in two groups regarding the above studied parameters, excepting the Operating time, which was almost double in Laparoscopic assisted vaginal hysterectomy. Indications constituted the same for both the groups. Discussion: “P’ value was insignificant in relation to age, parity, BMI, Previous Caesareans, medical illnesses, uterine volume, blood loss, fall in hemoglobin, blood transfusions, visceral injuries, postoperative fever, UTI, Pain, and day of ambulation. Indications for hysterectomy are comparable with other studies. The “P” value was significant for the operation time. Conclusions: Operating time is less in SVH. LAVH has higher complication rate. Key words: Simple Vaginal Hysterectom (SVH); Laparoscopic Assisted Vaginal Hysterectomy (LAVH); Intra Operative Outcomes; Postoperative Outcomes; Demographic Data; Operating Time; Visceral Injuries.

Placenta Accreta Spectrum is a well-established life threatening complication during pregnancy. It is commonly seen due to an iatrogenic etiopathogenesis resulting from a previous surgery of the uterus. The presentation of these cases has been intriguing. A holistic approach by the obstetrician and radiologist is important in identifying such cases early to reduce the morbidity and mortality.This series highlights the experience of the cases of MAP that we managed at our institution. Aim and objectives: to study the diverse clinical course of placenta accrete spectrum which will help in early diagnosis using various diagnostic modalities and deciding the management of adherent placenta. This series highlights the challenges faced in the diagnosis, evaluation and management antepartum, intrapartum period as well as postpartum period. Materials and methods: A Hospital based observational case series conducted in the Department of Obstetrics and Gynecology of Bharati Hospital, Puneof patients who had morbidly adherent placenta Result: Previous LSCS and curettage were associated with higher incidence of adherent placenta. all the cases were associated with prematurity. Conclusion: Placenta accreta spectrum is associated with high feto-maternal morbidity and mortality which is preventable.. Incidence of MAP is increasing, previous caesarean section and placenta previa are important risk factors, so there is a need to keep the primary caesarean section rates low. Early preoperative diagnosis in the suspected women and careful planning of delivery involving multidisciplinary team is the key to save the woman’s life.

 One of the core strategies of NRHM was to promote access to improved health care at household level through ASHA. A community based research study was conducted to assess the knowledge and functioning of ASHA with respect to three selected districts of Kerala and to analyze the problems faced by them in the delivery of Primary Health Care Services at the village level. A survey approach with selective employment of qualitative method was used.A descriptive cross sectional survey design was used. To represent the entire state of Kerala one district each from Northern (Wayanad, Central (Kottayam), and Southern (Thiruvananthapuram) region of Kerala was randomly selected. The Sample consists of 405 ASHAs and 73 JPHNs and they were selected using cluster sampling technique. Data collection instruments were structured knowledge questionnaire, self administered rating scale ,focus group interview guidelines, in-depth interview guidelines and opinionnaire. Quantitative analysis revealed that almost half (42.3%) of the ASHAs from Thiruvananthapuram belongs to the category of good knowledge level ,Thiruvananthapuram (good- 36.3%) has better functioning than Kottayam and Wayanad and Significant association was found between knowledge scores and educational status and level of satisfaction of ASHA workers(P>0.05). Themes derived from qualitative analysis are problems related to Maternal Child Health services, adoption of Family planning services, Communicable and Non communicable Disease monitoring, work load, Lack of transportation facilities, Inadequate payment structure, inappropriate Government health infrastructure ,lack of recognition by the Panchayat, lack of medicine kit, lack of follow up after initial training, inadequate knowledge and communication skill, lack of supervision and lack of co-operation from the families. Majority (49.3%) of the JPHNs have only average opinion regarding the functioning of ASHAs in the community. Only 16(21.9%) had good opinion about the services rendered by the ASHAs in the community.

 Purpose: We aimed to evaluate the comparative efficacy of metformin and pioglitazone coadministered with high dose VD on clinical, biochemical, hormonal and insulin sensitivity parameters in women with PCOS. Material and Methods: In this open label randomised study, a total of 136 women, aged 18-40 years, diagnosed with PCOS as per the AE PCOS 2009 criteria, were randomly assigned into four groups (n=34 per group). The four groups received Metformin-1gm/day alone, metformin-1gm/day+cholecalciferol4000IU/ d,pioglitazone-30mg/day alone and pioglitazone- 30mg/day+cholecalciferol-4000IU/d.The clinical, biochemical, hormonal and insulin sensitivity parameters were evaluated at 0, 3 months and 6 months after the intervention. Results: The mean age of subjects was 21.89±4.99 years with mean BMI of 22.19±3.24kg/m2. The mean serum 25OHD level at the baseline in the metformin+VD and pioglitazone+VD group was 13.28±8.44ng/ml and 11.17±7.46ng/ml and it improved to 63.33±19.76ng/ml and 57.69±14.43ng/ ml respectively after six months of intervention. The mean no. of cycles/year and Ferriman-Gallwey (FG) score improved in all four arms. Significant decrease in the total serum testosterone level was observed in the groups that received VD in addition to metformin and pioglitazone, the effect being more significant in the metformin+VD group (64.60±23.59ng/dl at 0 months to 41.24±12.83ng/dl after 6 months). Plasma glucose and insulin levels from a two-hour OGTT showed a significant improvement in subjects receiving VD in addition to pioglitazone. Conclusion: Metformin and pioglitazone are equally efficacious for treatment of women with PCOS. High dose oral cholecalciferol co-administration significantly improved the metabolic outcomes among these women.

Background: WHO declared coronavirus disease 2019(COVID-19) as a public health emergency of International concern on January 30,20201. Coronavirus disease 19(COVID-19) has become a global pandemic

Aim: To study the effects of COVID-19 on maternal and perinatal outcome.

Materials and Methods: Retrospective study was conducted in obstetrics and gynecology department, gandhi hospital,Secunderabad. Studied medical records of 300 pregnant women diagnosed with COVID-19,who delivered between 01-05-2020 to 31- 08-2020.

Results: Out of 300 pregnant women, 176(58%) in the age group of 21-25 years.80.8% patients were asymptomatic. In symptomatic patients (19.2%) common presenting complaint was Dry cough (11.3%). Majority of patients (78%) were diagnosed with RTPCR.60 presented with comorbidities hypothyroidism being most common(40)%.Corticosteroids were given for 44 patients (14.6%),12(4%) patients for fetal lung maturity and 32(10.6%) patients for maternal lung inflammation admitted in ICU.207(69%) caesarean and 93(31%) vaginal deliveries.Previous caesarean section followed by fetal distress are the most common indications.252(84%) term deliveries (>37weeks) and 48(16%) preterm (<37weeks) deliveries.32 were admitted in maternal intensive care unit(10.6%) and 7 maternal deaths, 3 Neonatal deaths and 2 Intrauterine fetal deaths were reported.Case fatality rate was 2.3% for pregnant women and 1% for neonates.Out of 298 alive babies,9 COVID-19 positive and 289 COVID-19 negative.None of these neonates had contact with infected mothers except during delivery, which suggests vertical transmission risk(3%).

Conclusion • 97.66% of mothers and 98.3% neonates discharged without any complications.10.6% maternal morbidity and Case fatality rate 2.3% for pregnant women and 1% for neonates. • Maternal-fetal transmission risk(3%) of SARS-C0V-2. • Careful monitoring of pregnancies with COVID-19 and measures to prevent neonatal infection was warranted. 

Background: A ruptured ectopic pregnancy is a true emergency and remains the leading cause of pregnancy related deaths worldwide. The objective is to study the clinical profile of ectopic pregnancy in a tertiary care hospital.

Methods:A retrospective study conducted at Coimbatore Medical College Hospital from Jan 2019 to Dec 2020. A total of 149 patients with ectopic pregnancy were analysed on patient characteristics, risk factors, intraoperative findings and treatment modality.

Results: A majority of patients with ectopic pregnancy (64.5%) did not have any risk factors, while 33.5% had predisposing risk factors associated with ectopic pregnancy. Most common presentation was ruptured tubal ectopic and the commonest site was ampulla (85.9%). There was 1 maternal death out of 149 cases reported (0.67%).

Conclusion: Ectopic pregnancy still remains one of the major causes of maternal morbidity and mortality. Early diagnosis and referral in hemodynamically stable state along with use of minimal access surgery or medical management can change the scenario of ectopic pregnancy in the developing world.

Background: The aim of study is to determine whether maternal mortality due to anemia is preventable with focus on anemic cases in tertiary care hospital.

Materials and Methods: This is retrospective analysis of anemia patients referred to GRH, Department of Obstetrics and Gynaecology, Madurai from January 2018 to December 2018. Cases were stratified based of age, parity, gestationalage, severity of anemia.

Results: The total number of cases referred to GRH during the study period is 17556, in which anemia referral was 4120(23.4%), PIH 3400(19.3), others 10036 (57.16).53.6% were multigravida, 46.3% primigravida. Mean age of presentation is around 25 to 30 years. Anemia being more common in gestational age greater than 34 weeks. Among 53 maternal mortality,anemia as a direct or indirect cause of maternal mortality was found to be nil.

Conclusion: We concluded by this study that anemia as a cause of maternal mortality was found to be NIL. Anemia as a cause of maternal death was due to lack of antenatal care, inadequate quality of care in primary and secondary centres. Cases referred in GRH with regular follow up did not develop complications and attained safe delivery with no mortality.

Background: India being one of the developing country and wide importance have been given to take care of maternal health but still anaemia plays a major public health problem and also one of the most commonest nutritional diseases in the world. Anemia being more prevalent in women of reproductive age and more so rampant during pregnancy. Anemia also increases maternal morbidity and mortality.The requirement of nutrients increases during pregnancy and many causes like lack of proper education, poverty, early marriage, teenage pregnancy and poor nutritional supplementation increases the risk of anemia in pregnancy. Methods: This prospective observational study was conducted by the Department of OBG at Dr Patnam Mahender Reddy Institute of Medical Sciences, Chevella, Telanganafrom November 2018 to October 2019. A total of 120patients were included in the study on the basis of inclusion criteria. Results: Themaximum cases 65(54.2%) were in the age of 21-25 yrs followed by 43(35.9%) in the age group 26-30years. The mean age of the patients was 24.24 (SD12.66) years. The maximum incidence of anemia were present in multigravida 78 cases (65%) when compared to primi 42cases(35%).The majority of the cases presented with moderate anemia 62 cases (51.7%), 38 cases (31.7% )presented with mild anemia, 20 cases (16.6%) had severe anemia. Severity of anemia was classified as ICMR classification.

Background: Uterus is a very vital reproductive organ and is subjected to many benign and malignant diseases. Hysterectomy is one of the most frequently performed procedures all over the world. This is a retrospective study to evaluate the sensitivity between the indications, demographic features, clinical presentations, intra operative findings and histopathological diagnosis of patients who underwent hysterectomy. Methods: This study was conducted in the Shraddha hospital, Chiplun, Maharashtra, India. 100 patients were selected randomly. Data was recorded and analyzed from the case record of each patient, which was obtained from the medical record department of the hospital. Results: Abdominal hysterectomy was performed in 84% cases while vaginal hysterectomy accounted for 16% cases. The mean age for hysterectomy was 45 years with a range from 31 to 70 years. (Table no 1) Patients mostly presented with menstrual complaints i.e. menorrhagia and dysmenorrhoea (62%) followed by prolapse uterus (16%). (Table no 2) The principle indication of elective hysterectomy was leiomyoma and was present in 37% patients, followed bydysfunctional uterine bleeding (DUB) in 28 % patientsand prolapse uterus in 16%. (Table no 3)Maximum numbers of cases of leiomyoma and DUB were found in age group of 41-50 yrs. Postoperatively nausea and vomiting was experienced by 31.5% of patients, whereas 22.8% of the patients had urinary tract infection. No major post operative complications were observed. Conclusion The number of abdominal hysterectomy was more than vaginal hysterectomy. Most common presenting feature was menstrual related symptom followed by prolapsed. The main indication for elective hysterectomy was leiomyoma, prolapsed and DUB.