Indian Journal of Obstetrics and Gynecology

Background: In developing countries most deliveries take place at home or peripheral settings, therefore, information on causes of still birth remain insufficient. ReCoDe (Relevant condition at death) is a classification system that helps to understand causes of still births in low resource settings. Aims: Present study was conducted to identify various clinical conditions that could lead to still births and to classify the still births according to Re.Co.De system. Materials and Methods: An observational study was conducted for six months and records of all the deliveries including still births were reviewed. The causes were classified according to the ReCoDe classification. Any association between maternal factors and still births was analysed. Results: During study period 11,748 births occurred and 283 of them were still births. Still birth rate was 2.41% (24.1/1000 births). 9.5% (27) of still births were intrapartum and 90.5% (256) were ante partum. 9.4% of still births occurred in women having antepartum haemorrhage and 8.1% with fetalgrowth restriction. This was followed by multiple pregnancy, hypertensive disorders of pregnancy and obstructed labour. When classified as per ReCoDe cause of still birth could not be explained in 9.4% cases. Conclusion: ReCoDe is an effective method to classify the causes of still births without extensive workup. Health care providers should be encouraged to use RecoDe to decrease the number of unexplained still births even in low resource setting.

Objective: To determine the effect and rate of adverse obstetrical and perinatal out-comes due to occupational factors and effects of sociodemographic factors, work characteristics, and type of occupation on obstetrical and perinatal outcomes in pregnant working women. Study design: A Hospital-based observational study, conducted over one year and six months at a tertiary care center, AIIMS Rishikesh among pregnant women who were working at AIIMS Rishikesh. Results: Out of 90 working women, 9 (10%) had an abortion, 7 (8.6%) developed anemia, 15 (18.5%) developed hypothyroidism, 15 (18.5%) had intrahepatic cholestasis of pregnancy (IHCP), 12 (14.8%) had pregnancy-induced hypertension (PIH), 9 (11.1%) had gestational diabetes Mellitus (GDM), 7 (8.6%) had intrauterine growth retardation (IUGR), 6 (7.4%) had oligohydramnios, 12 (14.8%) had a preterm birth (PTB), 16 (19.8%) had small for gestational age (SGA), 5 (6.2%) had antepar-tum hemorrhage (APH), 9 (11.1%) had premature rupture of membrane (PROM), 1 (1.2%) had a stillbirth and 17 (21%) had low birth weight (LBW). Elderly gravida, preobese/obese, urban, and stressed women were at high risk for PIH, FGR, SGA, and GDM. Conclusion: In working women, adverse pregnancy outcomes such as abortion, PIH, GDM, PTB, SGA, etc. were reported. The main occupational predictors among health professionals for adverse pregnancy outcomes were advanced age, higher BMI, urban residency, upper or upper-middle socioeconomic class, long working hours, shift duties including night, more physical activity, and moderate stress levels.

Fibroids are the most common benign tumour of the uterus. Prevalence of fibroid during pregnancy is increasing as more and more women delay childbearing to later in life and incidence of uterine fibroid increases with age, few rare, but extremely difficult complications of fibroid include: abortion, APH, dystocia, obstructed labor, PPH, sepsis, sub evolution of uterus. Myomectomy should not be performed in pregnant women because of the increased risk of complications. Pregnancy with fibroid increases the risk of obstetric complications so it is important to have regular antenatal checkup during an antenatal period for proper management of fibroid.

Ectopic pregnancies pose a formidable threat to the life and future fertility of women of reproductive age group.The risk of recurrence of such an event further increases in women who have an undergone a partial salpingectomy previously. We present in this paper, a case of a spontaneous recurrent ectopic pregnancy (REP) developed in a salpingectomy stump highlights the importance of performing a complete salpingectomy, as leaving a stump can pose a significant risk for REP.

Wandering or parasitic fibroid are rare variant of gynecologic entity and are extrauterine neoplasms occurring in unusual locations where the patient presents atypically or incidentally and at times mislead the radiological findings due to its atypical presentations. Due to the rarity of its presentation and an incidental finding, we present a case of 38 yrs old nulligravida with a myoma of 10 weeks sized, failed medical treatment with an incidental finding of a parasitic degenerated fibroid resembling a stone which was later confirmed as a case of degenerated wandering fibroid.

Vaginal vault endometriosis, a very rare complication of hysterectomised women with a prior history of endometriosis or adenomyosis. We the case a case of a 42-year-old a multiparous woman who underwent hysterectomy for the erosion of cervix. She developed bleeding per vaginum after 3 years of surgery. On examination, around 2 cm growth was noticed on the vault. The entire growth was excised, and histopathology of the growth revealed endometriotic tissue suggestive of vault endometriosis. After the excixion of the growth, the patient reported no further episodes of bleeding. Injection Leuprolide acetate was given as maintenance therapy for 3 months.