Indian Journal of Obstetrics and Gynecology

Ectopic pregnancy is the most life threatening emergency in pregnancy and common cause of morbidity and mortality in first trimester of
pregnancy. 23 Yrs old female presented with history of 5 months amenorrhoea with slight bleeding per vaginum. Patient is primigravida. On Per abdomen examination, abdomen was tense. On USG Diagnosis, it was clear and the patient was taken for Laprotomy and the patient stood up the procedure well.
 

The caudate nucleus is important in the modulation of motor functions and may influence cognitive and mental functions. However, cases of cognitive and behavioral disorders caused by caudate stroke are rare in practice. We report a case of 26 year-old female patient who presented with abrupt onset of cognitive and behavioural dysfunctions in post partum period on 4th day of elective caesarean section. Her prominent symptoms include fever, abnormal behaviour in form screaming, not identifying family members and not feeding baby. Computed tomography revealed no significant abnormality and magnetic resonance imaging of the brain revealed an acute infarction in the head of the left caudate nucleus in post portum period.

Misoprostol is a commonly preferred drug for induction of labor but it should be strictly avoided in scarred uterus because of high chances of uterine rupture. Here presented a 31 year old female with intrauterine death of twin pregnancy at 20 weeks of gestation who had uterine rupture probably due to vaginal misoprostol. This report elaborates about the uterine rupture, a rare presentation and its successful
management.
 

Conjoined twins is a rare entity experienced by any obstetrician. The management of the same requires early diagnostic work up antenatally
and involvement of parental decision making. A 27-year-old woman of term gestation presented with conjoined twins-thoraco-omphalophagus and was taken up for elective LSCS and delivered. This article reports presentation of conjoined twins and the literature is reviewed.

Introduction: Cesarean section is the delivery of an infant (live or dead) through an abdominal incision after the period of viability. An incomplete uterine rupture, also referred to as uterine dehiscence, is defined as a clinically occult and incomplete disruption that does not lead to any serious neonatal or maternal consequences. Case report: This is a case report of a pregnant women with previous 1 cesarean section, with silent scar dehiscence found accidental on repeat cesarean section, and its successful management during the procedure. Conclusion: Uterine scar dehiscence when detected early can be prevented from progressing further to scar rupture. Prompt decision making and skilled surgical repair may aid in reducing the incidence of such complications.

Infertility is a major health problem in couples of reproductive age group. Female factor is responsible for most of the cases of infertility. This review is done to enlighten the various risk factors causing infertility and its management. The aim of this review is to give information about female infertility to make it easy to evaluate a case of infertility. The conclusion is made from the review that by living healthy lifestyle, reducing body weight and proper treatment of medical diseases and sexually transmitted diseases, fertility can be achieved in infertile woman.
 

Gestation Diabetes mellitus is a condition which leads to unfavorable maternal as well as fetal outcomes. Although the traditional method of screening GDM in pregnant women by OGTT has been widely used and accepted for decades, but there is always a need for better and more easier test for diagnosis of GDM. In our systematic review we have critically appraised few published studies for the demonstration of HbA1c as a diagnostic tool for GDM. It is understood from all these studies HbA1c evaluation have various advantages over the traditional OGTT because of the high reproducibility and improved instrumentation and standardization of HbA1c assay, less biological variability and it is not affected by short term lifestyle changes. It can be used as a primary screening test for all the pregnant women as does not require extensive patient preparation and less time consuming. But once the HbA1c value falls above the reference range it is mandatory to perform a confirmatory test for the diagnosis of GDM. In near future HbA1c can be used as a marker for diagnosis.

Objectives: This randomized controlled trial was conducted to evaluate efficacy and safety of glyburide (glibenclamide as available in India) compared to insulin for treatment of hyperglycaemia in pregnancy (HIP) including gestational diabetes mellitus and type-2 DM, with offspring follow up to 7-10 years for long-term consequences. Materials and Methods: Total 80 cases of GDM diagnosed on OGTT (100 gm) by Carpenter-Coustan cut-offs and remained uncontrolled on MNT type-2 DM, between 12 to 34 weeks gestation, were enrolled after taking informed consent and randomized into two groups. Group-I (n=40) received oral glibenclamide and group-II (n=40) received Insulin. Glibenclamide therapy was considered failed if targets BS could not be achieved with maximum glibenclamide dose (20 mg) and patient was switched over to insulin.Primary outcome measures wereglycemic control and time taken for achieving normoglycemia and failure of therapy. Secondary outcomes were dose requirement, maternal hypoglycemia, fetal complications- macrosomia, intrauterine death (IUD), congenital malformations, neonatal hypoglycemia and neonatal intensive care unit (NICU) admission and long-term follow up of children born. Results: Baseline profile of patients in both groups was comparable. In group I, 31 subjects required twice daily doses. Mean ±SD (range) of daily glibenclamide dose was 5.5±3.6 (2.5-17.5) mg. Mean glibenclamide dose was 3.75 for morning single dose, 3.55 mgfor evening single dose and 2.7 mgeach in patients requiring twice daily dose.In group-II the mean insulin required was 28.8 ± 9.6 (8-45) units in 4 divided dosages of approximately 6-7 units. There was no difference in the time taken to attain glycemic control in the two groups which was 17 days and 15.5 days in group I and II respectively (p=0.57). At recruitment the mean HbA1c (in %) was 6.2±0.28 and 6.4±0.43(p=0.22) which reduced to 5.3±0.53 and 5.8±0.(p=0.01) at delivery in group I and group II respectively indicating better control of HbA1c levels with glibenclamide. None of the babies in group-I including two cases of type 2DM who continued glibenclamide in first trimesterhad any congenital malformation. In group II, two babies had congenital malformations: BS-F was more significantly correlated to the control on nutrition alone vs treatment requirement. All patients with BS-F<95 mg/dL achieved normoglycemia on MNT and did not require pharmacologic treatment. Patients with BS-F >110 mg/dLcould not be controlled on diet alone throughout pregnacy. Fasting value <135 could not be controlled on diet initially also in GDM cases. Nutan GDM grading is proposed on basis of fasting blood sugar lavels. Two cases (5%) had failure of therapy with glibenclamide and switched over to insulin therapy both had hypothyroidism. In group I, hypoglycemic attacks were seen in 4(10%) cases. In insulin group,  hypoglycemia was seen in 3 (7.5%) cases. There were two IUD in group I, both had preeclampsia. One neonatal death occurred in group 2. Neonatal outcome was comparable in both groups. Offsprings of glibenclamide group showed no adverse consequences at 7-10 year follow up Conclusions: Glibenclamide is comparable to insulin in treating diabetes in pregnancy with similar obstetrical, maternal or perinatal outcomes andis not associated with any long term adverseconsequences in the offspring.

Background: Abnormal uterine bleeding (AUB) is bleeding from the uterus which is more than the usual or which occurs for a longer period than normal or which occurs at an irregular time. AUB can occur in all age groups with different modes of presentation and is also one of the important symptom or presenting complaint where in people tend to see their doctors. There are wide range of causes which include fibromyoma, adenomyosis, endometrial polyp, ovarian tumor, pelvic inflammatory disease (PID), endometrial hyperplasia, endometrial carcinoma, hormonal imbalance (like hypothyroidism) or hypothalamic pituitary diseases. Methods: This prospective observational study was conducted by the department of OBG at Narayana medical college, Nellore, Andhra Pradesh from December 2019 to May 2020. A total of 102 patients were included in the study on the basis of inclusion criteria. Results: The maximum cases 52 (50.1%) were in the age of 41-50yrs followed by 30(29.4%) in the age group 31-40 years. The mean age of the patients was 44.87(SD9.67) years. The most common mode of presentation was heavy menstrual bleeding seen in 55 cases (53.9%) followed by prolonged menstrual bleeding in 22 cases (21.6%). Proliferative endometrium was found in 44 (43.1%) cases followed by secretory endometrium in 36 (35.3%) cases and endometrial hyperplasia in 15 (14.7%) cases.

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 has become one of the commonest acute abdominal emergencies encountered by gyneacologist in todays setup. The frequency of ectopic pregnancy is increasing throughout the globe and it is the most life threatening emergency in first trimester of pregnancy. Not only it increases the mortality rate but it also effects the fertility of the patient. Methods: This prospective observational study was conducted by the department of OBG at Narayana medical college, Nellore, Andhra Pradesh from December 2019 to May 2020. A total of 42 patients were included in the study on the basis of inclusion criteria. Results: The maximum 21(50%) were in the age group of 26-30 years followed by 14(33.3%) from the age group 20-25 years. The mean age of the patients was 26.62 (SD14.66) years ranging from 20 to 40 yrs. The study of previous reproductive performance revealed that the maximum incidence of ectopic gestation (71.3%) occurred among the third (42.9%) and fourth gravida (28.4%). There were no significnt corelations betweem other sites of ectopic pregnancy and condition of the tube.

Introduction: Pregnancy with a previous cesarean section(CS) may lead to several concerning maternal, fetal, and neonatal complications in subsequent pregnancies such as placenta accreta and uterine rupture.Trial of labour after cesarean (TOLAC) and Vaginal Birth After Cesarean (VBAC) has a quantifiable effect on decreasing total cesarean deliveries. Aim: To assess maternal and fetal outcome of vaginal birth after one lower segment cesarean section in selected cases. Materials And Methods: Prospective observational study of maternal and fetal outcome included 100 ANC patients with singleton pregnancy of more than 34 weeks gestation and one previous lower transverse cesarean delivery admitted in SMIMER hospital between January 2018 to June 2019. Results: 57% patients had vaginal delivery without any assistance, while 18% patients required vacuum assistance and 25% patients required repeat LSCS after failure of TOLAC.Among successful VBAC none had any complications, while among repeated CS patients, 4% patients had PPH, 2%had intraoperative finding of uterine dehiscence and 1%had intraoperative finding of uterine scar rupture.67% had interval of ≤ 3 years between current and previous pregnancy. Bishop’s score of less than 8 resulted in 100% CS whereas Bishop’s score of more than 9 resulted in 100% VBAC.Among VBAC, 5.3% babies required NICU admission, while among repeated CS, 16% babies required NICU admission. Conclusion: This study has found ahigh success rate of VBAC (75%).