Indian Journal of Obstetrics and Gynecology

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Introduction: Severe Acute Maternal Morbidity (SAMM) is a tool which is more advantageous compared to maternal mortality as an indicator of obstetric care. The global MMR shows a reduction from 342 to 211 death per 1 lakh live birth from 2007 to 2017 with a 38% over 10 years. Under Millennium development goals (MDG)-5, goal was to reduce maternal mortality by 75% between 1990-2015. By the end of year 2020 MMR in India was 97 per lakh. Now the Sustainable development goal (SDG) is to reach MMR below 70 by 2030. Aims and Objectives: * To as certain the incidence of maternal near-miss indices * To as certain the reasons behind maternal mortality * To as certain the occurrences of near-miss instance Materials and Methods: A retrospective study was conducted at Cheluvamba hospital, Mysore, Karnataka, India during January 2022 to December 2022. Maternal fatalities and near miss incidents are included in the study population. Case definitions were made using the 2009 WHO criteria. Diagnoses of life-threatening illnesses were made, and cases that satisfied WHO 2009 criteria were chosen. Analyses of maternal mortality from the same time frame were also conducted. Anemia and other medical conditions were viewed as secondary causes leading to the mother's near-miss and death, while hemorrhage, hypertension, sepsis, and other conditions were classified as primary causes for patients based on their final diagnosis. Results: In our Institute, 8632 deliveries took place. In this study, the MMR was 251/100,000 live births, while the MNMIR (Maternal Near Miss Incidence Ratio) was 14/1000 live births. The ratio of MNM to MM was 5.7:1. The MI (total mortality) was 14.8%. The ratio of severe maternal outcomes to live births, or SMOR, was 16.8/1000. Hypertensive disorder (42.85%) was the leading cause of maternal mortality, with antepartum eclampsia being the main leading cause in our setup, followed by hemorrhage (19.04%). Among the near miss events, hypertensive disorder was the leading cause with 49.16%, followed by hemorrhage (31.66%), severe anemia, and abortion, which account for approximately 7.5%. Conclusion: Maternal morbidity and mortality can be decreased by recognizing the risk factors, identifying high-risk cases, promptly referring them, and stabilizing the referral system.

Background: Women who had undergone hysterectomy have to overcome problems related to physical, social and emotional well being. As the hysterectomy is one of the most common surgeries, a study was conducted to answer the question for the optimal surgical recovery. This study aims to describe the relationships between recovery time and the components of quality of life after hysterectomy. Aims and Objectives: To study the physical, social, and emotional well being of post hysterectomised patient. Methodology: Study was conducted in Department of Obstetrics and Gynaecology at Bharati hospital, Pune. It was a prospective observational study of patient related outcomes to study the physical, social, and emotional well being of post hysterectomised patient. Post hysterectomized women above 40 years were included in this study. 196 post hysterectomised women were included. Study was conducted from October 2021 to January 2024. Results: From third month onwards, degree of difficulty of majority of patients was reduced in all mentioned activities. Majority of cases there was gradual health improvement noted. The pain score was reduced over 3 months in 92% cases and in almost all patients over 6 months. Conclusion: It is important to assess quality of life after any surgery, so timely intervention such as physiotherapy, counselling, psychotherapy and medical therapy can aid in improvement of both physical and emotional health for betterment of patient care.

Background: A High risk pregnancy is identified as pregnancy in which there is a risk of adverse outcome in the mother and / or baby that is greater than the incidence of that outcome in general population. All pregnancies are at risk even though most of the pregnancies and childbirth worldwide are uneventful. Almost 15% of all the pregnant women can develop potentially life-threatening complications which might require skilled care with some requiring major intervention for survival. Methods: This prospectivestudy was carried out in 220 cases being brought in OBG dept of AL Ameen Medical College, Bijapur, from July 2023 to December 2023. A detailed data of sociodemographic profile, general examination and obstetric examination were carried out. Results: Of the 220 antenatal cases studied, 99 cases (45%) of them had pre-eclampsia. Malpresentation pregnancies contributed to about 36% of cases and Anemia were seen in 13 cases (6%). The mode of delivery was caesarean section in 70 cases (31.2%). Normal vaginal delivery were done in 94 cases (42.8%). Instrumental deliveries were seen in 11 cases (5%). Conclusion: High risk pregnancy, Caesarian section, Normal vaginal delivery of active phase of labour by making cervical dilatation faster and lowering the duration of usage of labour analgesics, which makes labour a pleasant experience for woman.

Background: Hypertension in pregnancy, called a disease of degree is more of a sign than a disease by itself. Hypertensive disorders of pregnancy, including chronic hypertension, with or without superimposed pre-eclampsia/eclampsia, gestational hypertension, HELLP syndrome, pre-eclampsia with or without severe features or eclampsia present a significant risk of morbidity to both mother and fetus. Effective pharmacologic therapy modifies the course of the disease. The effective use of anti-hypertensive therapy should be based on well designed controlled clinical trials and the experience of the clinician with the drugs. Hypertensive disorders complicate 5-10% of all pregnancies worldwide.1 Dangerous hypertension is a harbinger of cerebrovascular accidents, eclampsia, hypertensive encephalopathy and other end organ damage with a poor perinatal outcome.2 Methods: This prospective randomized double blind comparative clinical trial with randomization done using computer generated numbers study was carried out in 100 cases being brought in OBG department of AL Ameen Medical College, Bijapur, from July 2023 to December 2023. A detailed data of sociodemographic profile, general examination and obstetric examination were carried out. The pregnant women were randomized with computer generated numbers into two groups to receive either oral nifedipine or intermittent intravenous labetalol injections. Results: There is no significant difference in the parity of both the groups. Majority of the patients constituting 80% of group A and 58% of group B were primigravida. 69% enrolled in the study were primigravida. There is a higher incidence of pre-eclampsia in the first pregnancy. The majority of the patients had gestational age of 34 to 36 weeks constituting 48% on the whole with 50% and 46% respectively in group A and B. The recruited patients did not significantly differ in gestational age.

Mullerian cysts arise from the remnant of the Mullerian duct. They are usually asymptomatic and are diagnosed incidentally. Ultrasonography and Magnetic Resonance Imaging can help to determine the location and its relation to the surrounding structures, but thorough clinical knowledge and meticulous clinical examination help to rule out other causes and come to a precise diagnosis. The diagnosis is only made by histological examination. Surgical excision is often preferred. Here we report the case of a middle aged woman who presented with an anterior vaginal wall cyst, which turned out to be a Mullerian cyst on histopathological examination.

Background: Xanthogranulomatous salpingo-oophoritis is an infrequent and challenging diagnosis of the female genital tract. It involves the destruction of the fallopian tube and ovarian tissue by infiltrating inflammatory cells comprising lipid laden macrophages, lymphocytes, plasma cells, and multinucleated giant cells. While more commonly found in gall bladder and kidney, its occurence in female genital tract is rare. This is a case of Xanthogranulomatous salphingo-oophoritis in a 48 year woman who presented with chronic lower abdomen pain and frequent heavy menses for two months. On per abdomen examination a non tender 24 weeks size mass was felt and on vaginal examination the same mass was appreciated, seperate from the uterus. PAP was reported NILM. Ultrasound revealed uterine adenomyoma with bilateral endometrioma of ovaries and associated left hydrosalphinx. Patient underwent hysterectomy with bilateral salphingo-oopherectomy. Histopathological examination revealed uterine adenomyosis, chronic cervicitis with xanthogranulomatous salpingo-oophoritis. The patient recovered well and doing good on follow-up. Conclusion: Xanthogranulomatous salpingo-oophoritis, though rare is a significant entity because clinically it can mimic chronic pelvic inflammatory disease or endometrioma and even in some cases malignancy. Even clinical examination and imaging might not help much. Therefore, knowledge and awareness about the condition with the help of histopathology can clinch the diagnosis and also prevent radical cancer surgery.

Ovarian ectopic pregnancy is rare and constitutes around 3% of all ectopic pregnancies. Its presentation is similar to tubal ectopic pregnancy and is difficult to diagnose based on the presentation and ultrasound findings. Here, we describe one such case which we encountered in our practice. Primigravida patient at early gestation presented with vaginal spotting and pain in lower abdomen. She was suspected as ruptured ectopic pregnancy based on examination and ultrasound findings. Immediate laparotomy was performed and patient was diagnosed to have ruptured ovarian pregnancy intraoperatively. Partial ovariotomy was performed and the case was successfully managed. Histopathology confirmed the diagnosis. Surgery is the mainstay of definitive diagnosis and treatment. Identifying these cases early is imperative as such patients can collapse suddenly and there are high chances of maternal morbidity and mortality.