Current Issue Volume 10, Number 3 , July-September 2018

EDITORIAL
Jaideep Malhotra

Editorial

[Year:2018] [Month:July-September] [Volumn:10 ] [Number:3] [Pages:76] [Pages No:iv]



Women include half of the worlds’ population. In Africa 80% of the agriculture is looked after by women and in Asia 50% of the agriculture is taken care by women. 84% of all the household chores are done by women and they do not get paid for it. In many families, almost 4 out of 10 times the household runs on women’s salaries and yet women make up two third of the illiterates in our region. One, out of three women experiences domestic violence and gender discrimination is rampantly experienced and they mostly have no role in decision making either for themselves or their families. Where are we going from here; for the same job, more sincerely done by a woman gets paid lesser than the man, and their health is not a priority at all.


ORIGINAL ARTICLE
Amruta Gadge, Neema Acharya, Samarth Shukla, Suresh Phatak

Comparative Study of Transvaginal Sonography and Hysteroscopy for the Detection of Endometrial Lesions in Women with Abnormal Uterine Bleeding in Perimenopausal Age Group

[Year:2018] [Month:July-September] [Volumn:10 ] [Number:3] [Pages:76] [Pages No:155-160]



Aim: The aim of the study is to compare the diagnostic accuracy of transvaginal ultrasound and hysteroscopy correlated with histopathology in evaluation of endometrial lesions in perimeno-pausal women with abnormal uterine bleeding.

Settings and design: A cross-sectional study done in Department of Gynecology, from August 2015 to June 2017.

Materials and methods: A total of 100 perimenopausal women with abnormal uterine bleeding (AUB) were included in the age group 40 to 55 years. Transvaginal ultrasound (TVS), hyster-oscopy and endometrial biopsy were performed on all patients. Findings were compared with histopathogical examination taken as gold standard.

Results: Menorrhagia was most common bleeding pattern seen in 44% cases. The TVS findings in correlation with HPE where fibroid and hyperplasia with polyp were 100% diagnosed while hyperplasia, polyp and normal findings were diagnosed 53.33%, 88.89% and 53.33% respectively. Hysteroscopy findings in correlation with HPE where fibroid, hyperplasia and hyperplasia with polyp were 100% diagnosed while polyp and normal findings were diagnosed 83.33%, 73.33% respectively. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and accuracy of TVS and hysteroscopy were 82.05%, 72.73%, 91.43%, 53.33%, 80% and 89.74%, 100%, 100%, 73.33%, 92% respectively.

Conclusion: We conclude that TVS is a good diagnostic initial modality for the diagnosis of endometrial lesions in AUB. But hysteroscopy should be done as a basic investigation even in cases where TVS is normal and endometrial biopsy should be taken where hysteroscopy shows normal findings.

Keywords: Endometrial polyp, Hysteroscopy, Submucous fibroid, Transvaginal ultrasound (TVS).

How to cite this article: Gadge A, Acharya N, Shukla S, Phatak S, Comparative Study of Transvaginal Sonography and Hysteroscopy for the Detection of Endometrial Lesions in Women with Abnormal Uterine Bleeding in Perimenopausal Age Group. J South Asian Feder Obst Gynae 2018;10(3):155-160.

Source of support: Nil

Conflict of interest: None

Date of received: 10/4/2017

Date of acceptance: 15/7/2018

Date of Publication: December 2018


ORIGINAL ARTICLE
Navneet Kaur, Promila Jindal

Study of ‘Non Stress Test at Admission’ and its Correlation with Maternal and Fetal Outcome

[Year:2018] [Month:July-September] [Volumn:10 ] [Number:3] [Pages:76] [Pages No:161-166]



Introduction: Non stress test (NST) is the most widely used test for assessment of fetal health and reflects oxygenation of brain. NST is usually recommended after 30 to 32 weeks of the pregnancy. The false negative rate of NST (reactive NST in a fetus who actually is in distress) is 3.2/1000 which is very low and thus NST is considered as a good predictor of fetal health.

Objectives: To evaluate the ‘NST at admission’ in all the admitted women > 32 weeks of gestation and to correlate it with type of labour and mode of delivery and maternal and neonatal outcome.

Materials and methods: This prospective study was conducted on all the pregnant women only at > 32 weeks of gestation admitted to Dayanand Medical College and Hospital (DMCH), Ludhiana from 1/1/2011 to 31/12/2011. Non stress test was done in all women using TOCODYNAMOMETER for 20 minutes and was extended to next 20 minutes in case of inconclusive NST. Both the mother and neonate were followed up till discharge from hospital. The data was analysed statistically using T test for quantitative variables and Chi square/Z test for qualitative variables.

Results: In 228 women, 233 NSTs (5 twins) were done and 24 NSTs needed 20 minutes extension to reach to conclusion.179 (76.82%) NST were reactive while 54 (23.18%) were non reactive. Women admitted with reactive NST had significantly higher vaginal delivery rates i.e. (39.78% vs 11.54%). Operative delivery in non reactive NST group was significantly higher than reactive NST group, i.e., (88.46% vs 60.22%). All 233 babies were born alive irrespective of the NST status and 47.21% (110) required NICU admission.

Conclusion: The ’NST at admission’ is a simple method and is easy to perform for assessing fetal status antenatally and its reactivity assures good maternal and fetal outcome while non reactivity increases the chances of operative delivery and NICU admission.

Keywords: Cesarean, Diabetes, Perinatal outcome, Placenta previa, Pregnancy, Primigravida.

How to cite this article: Kaur N, Jindal P. Study of ’Nonstress Test at Admission’ and its Corelation with Maternal and Fetal Outcome. J South Asian Feder Obst Gynae 2018;10(3):161-166.

Source of support: Nil

Conflict of interest: None

Date of received: 09/24/2016

Date of acceptance: 11/06/2016

Date of publication: December 2018


ORIGINAL ARTICLE
Amit Kyal, Atri Pal, Aprateem Mukhopadhyay, Partha Mukhopadhyay

Does Cabergoline Help in Decreasing Chronic Pelvic Pain Due to Endometriosis Compared to Medroxyprogesterone Acetate? A Prospective Randomized Study

[Year:2018] [Month:July-September] [Volumn:10 ] [Number:3] [Pages:76] [Pages No:167-169]



Introduction: Endometriosis is a chronic debilitating disease which adversely affects the equality of life of the woman. The exact pathophysiology of the disease and cause of pain is not clearly understood and so confounds an attempt to select the most favourable clinical management. The study aims to assess the safety and efficacy of cabergoline with respect to medroxyprogesterone acetate in treatment of chronic pelvic pain (CPP) due to endometriosis.

Materials and methods: This study was conducted in Medical College, Kolkata from June 2015 to June 2016. Eighty patients of chronic pelvic pain due to endometriosis (diagnosed by USG and laparoscopy) were randomly assigned into two groups of 40 each receiving either medroxyprogesterone acetate (10 mg TDS) or cabergoline (0.5 mg twice weekly) for 12 weeks. Response for pain was measured on a visual analog scale (VAS) of 0-10 scale at the beginning of treatment and at intervals of 1, 3, 4 and 6 months.

Results: The study shows that the decrease in pain scores at various time points was statistically significant in both the groups. However, when the two groups were compared among themselves the reduction in VAS score at various time points were not statistically significant. Patients receiving medroxyprogesterone acetate had more side effects (67.5%) compared to cabergoline (47.5%). The most common side effect in medroxyprogesterone acetate group was amenor-rhea (25%) whereas, in the cabergoline group, it was nausea and vomiting (45%).

Conclusion: Cabergoline and medroxyprogesterone acetate are equally effective in decreasing chronic pelvic pain due to endometriosis. However, due to lesser side effects and less frequent dosing, cabergoline has a better acceptance and compliance than medroxyprogesterone acetate. Thus cabergo-line can be a better alternative to medroxyprogesterone acetate.

Keywords: Cabergoline, Chronic pelvic pain, Endometriosis, Medroxyprogesterone acetate.

How to cite this article: Kyal A, Pal A, Mukhopadhyay A, Mukhopadhyay P. Does Cabergoline Help in Decreasing Chronic Pelvic Pain Due to Endometriosis Compared to Medroxypro-gesterone Acetate? A Prospective Randomized Study. J South Asian Feder Obst Gynae 2018;10(3):167-169.

Source of support: Nil

Conflict of interest: None

Date of recived: 03/04/2016

Date of acceptance: 15/05/2017

Date of Publication: December 2018


ORIGINAL ARTICLE
Richa Singh, Saroj Singh, Poonam Yadav, Hari Singh, Shweta Gupta, Shailza Vardhan

A Comparative Study to assess the Efficacy of Sildenafil Citrate and L-arginine in the Management of Fetal Growth Restriction

[Year:2018] [Month:July-September] [Volumn:10 ] [Number:3] [Pages:76] [Pages No:170-174]



Objective: To evaluate the efficacy of sildenafil citrate and L-arginine in the pregnancies complicated with fetal growth restriction (FGR) in terms of improvement in color Doppler parameters and perinatal outcome.

Materials and methods: In this study, we included 218 antenatal patients with FGR. After randomization, 110 women received sildenafil and 108 women L-arginine. Various fetal color Doppler parameters of umbilical artery (UA) and middle cerebral artery (MCA) were studied and followed until delivery, and perinatal outcome was evaluated.

Results: There was significant improvement in mean pulsatility index (PI) of the UA and MCA (p < 0.05). The systolic/diastolic (S/D) ratio and cerebroplacental ratio (CPR) also improved to a significant level. Perinatal outcome appears better in sildenafil group as compared with the L-arginine group.

Conclusion: Sildenafil citrate, as a vasodilator, has emerged as a potential management option in the treatment of FGR by later normalization in velocimetric profile.

Keywords: Cerebroplacental ratio, Fetal growth restriction (FGR), L-arginine, Middle cerebral artery (MCA), Pulsatility index (PI), Sildenafil citrate, Umbilical artery.

How to cite this article: Singh R, Singh S, Yadav P, Singh H, Gupta S, Vardhan S. A Comparative Study to assess the Efficacy of Sildenafil Citrate and L-arginine in the Management of Fetal Growth Restriction. J South Asian Feder Obst Gynae 2018;10(3):170-174.

Source of support: Nil

Conflict of interest: None

Date of received: 20/4/2016

Date of acceptance: 15/6/2017

Date of publication: December 2018


ORIGINAL ARTICLE
Garima Sharma, Shashank V Parulekar

Accuracy of Clinical Evaluation of Patients with Site-specific Vaginal Wall Prolapse and Its Co-relation to Surgical Diagnosis

[Year:2018] [Month:July-September] [Volumn:10 ] [Number:3] [Pages:76] [Pages No:175-181]



Introduction: Pelvic organ prolapse (POP) is a defect of a specific vaginal segment characterized by descent of the vagina and associated pelvic organ. An understanding of normal pelvic support structures provides the basis for the identification of the defect and anatomic approach to repair.

Aims and objectives:

• To clinically evaluate the patients of uterovaginal prolapse for site-specific defects and levels of damage.

• To corelate the clinical evaluation with evaluation during surgery.

• To perform the site-specific repair of the defects.

Materials and methods: A prospective observational study was conducted on 45 women admitted to the gynecological ward of King Edward Memorial (KEM) Hospital, Mumbai, India with symptoms of POP during a period of 13 months after seeking ethical clearance. After obtaining written informed consent, patients were subjected to detailed clinical evaluation for the type of prolapse, degree, and the site-specific defect. Patients were taken for surgery. Identification of the site-specific defect followed by restoration of the anatomic relationships by either repairing connective tissue supports or by creating a compensatory support mechanism was done.

Results: On analysis of our study, it was observed that there is mild agreement (0.4-0.6) between the clinical and operative diagnosis of transverse defect and unilateral paravaginal defect of anterior compartment. However, there is good agreement (0.6-0.8) between the clinical and operative diagnosis of bilateral paravaginal defects of anterior compartment. The clinical diagnosis for transverse defect of posterior compartment has accuracy of 88.2%.

Conclusion: The intraoperative diagnosis of site-specific defects remains the gold standard for detection of these defects.

Keywords: Arcus tendineus fasciae pelvis, Arcus tendineus fasciae rectovaginalis, Paravaginal defect, Pelvic organ prolapse, Prospective observational study, Site-specific defect, Transverse defect.

How to cite this article: Sharma G, Parulekar SV. Accuracy of Clinical Evaluation of Patients with Site-specific Vaginal Wall Prolapse and Its Corelation to Surgical Diagnosis. J South Asian Feder Obst Gynae 2018;10(3):175-181.

Source of support: Nil

Conflict of interest: None

Date of received: 06/18/2017

Date of acceptance: 04/16/2018

Date of publication: December 2018


RESEARCH ARTICLE
Avantika Sharma, Nupur Hooja, Apoorv Shastri, Rajani Nawal, Smriti Bhargava, Manisha Kala, Bhomraj Kumawat, Richa Manish

Postoperative Outcome of Caesarean Section in Closure Versus Nonclosure of Parietal Peritoneum

[Year:2018] [Month:July-September] [Volumn:10 ] [Number:3] [Pages:76] [Pages No:182-185]



Aim: Caesarean section is the commonest obstetric surgery. Any change in the operative technique however small, affects the postoperative outcome.Effect of nonclosure of peritoneum on postoperative outcome was evaluated.

Method: This was an interventional study. Postoperative condition of the women was assessed after caesarean section. Peritoneum was either closed or left open and outcome was compared.Statistical analysis was done.

Results: Most women in the nonclosure group had earlier ambulation and return of bowel activity and breastfed early in comparison to the closure group. More postoperative pain, nausea and vomiting was observed when peritoneum was closed. Since the stay in hospital was less in women with peritoneal nonclosure and because of use of lesser suture material, this was more cost effective too.

Conclusion: Leaving the peritoneal open was a better method than closing it because patient was more comfortable, there was lesser morbidity and shorter hospital stay and cost effectiveness.

Clinical significance: The policy of peritoneal nonclosure will help in decreasing maternal discomfort, shorter hospital stay and overall economical.

Keywords: Caesarean, Closure, Nonclosure, Peritoneum.

How to cite this article: Sharma A, Hooja N, Shastri A, Nawal R, Bhargava S, Kala M, Kumawat B, Manish R. Postoperative Outcome of Caesarean Section in Closure Versus Nonclosure of Parietal Peritoneum. J South Asian Feder Obst Gynae 2018;10(3):182-185.

Source of support: Nil

Conflict of interest: None

Date of received: 5/3/2017

Date of acceptance: 13/12/2017

Date of publication: December 2018


RESEARCH ARTICLE
Nithya P Jayakumar, Sharan J Pal

Mysterious Oddities of Conception–An Insight into Congenital Malformations: A 2 Year Study

[Year:2018] [Month:July-September] [Volumn:10 ] [Number:3] [Pages:76] [Pages No:186-190]



Introduction: ’A flower bloomed already wilting. Beginning its life with an early ending’. Some babies with birth defects are unfortunate whose birth is clouded with sadness and worry for the parents because of the birth defects in them which manifest either immediately after birth or after a while, depending on the nature of the congenital abnormality.

Aims and objectives: To study the prevalence of fetal anomalies over 2 years in a tertiary care hospital and its relation to maternal and fetal factors.

Materials and methods: A retrospective study from January 2014 to December 2015. Cases with anomalous babies were identified from the birth registry and the corresponding files were retrieved from the hospital medical records section.The details were recorded in the designed proforma and influences of variables such as age, parity, consanguinity,gender, the type of anomalies, mode of termination,associated antenatal complications were studied. Collected data were analyzed by proportions.

Results: Out of 12650 deliveries in 2 years, the overall prevalence of anomalous babies was found to be 0.5% (63). Incidence of anomalies was found to be more in multipara than primi-gravida. Among the anomalies detected central nervous system accounted to be the highest-52.4%, followed by cardiac-14.3%. Among the various other anomalies facial defects-9.5%, muscu-loskeletal-4.8%, chromosomal-4.8%, Gastrointestial system-4.8%,abdominal wall defects-1.6%, genitourinary-1.6% and some had combination of one or more systems. Male gender was found to be predominant among the anomalous fetus,73% of the mothers had no associated antenatal complications.Two mothers were diagnosed with toxoplasma gondii, other viruses, rubella, cytomegalovirus and herpes simplex (TORCH).

Conclusion: Prevalence of anomalies was found to be 0.5% over 2 years in our hospital which is comparatively lower than the national average of 2 to 3% and it was 1.2% in a study conducted over 5 years (Jan 2008-Dec 2012) in the same hospital settings. Timely antenatal diagnosis of malformations before 20 weeks of pregnancy will provide an opportunity to consult, counsel, intervene and reduce the high morbidity and mortality.

Keywords: Antenatal scan, Congenital anomalies, Prevalence.

How to cite this article: Jayaakumar NP, Pal SJ. Mysterious Oddities of Conception-An Insight into Congenital Malformations: A 2 Year Study. J South Asian Feder Obst Gynae 2018;10(3):186-190.

Source of support: Nil

Conflict of interest: None

Date of received: 12/24/2016

Date of acceptance: 01/20/2017

Date of publication: December 2018


RESEARCH ARTICLE
Pratibha Singh, Neha Mathur

Sexual Problems and the Gynaecologist: Are We Doing Enough?

[Year:2018] [Month:July-September] [Volumn:10 ] [Number:3] [Pages:76] [Pages No:191-193]



Introduction: Sexual health is an important part of womens’ life and wellbeing. Female sexual dysfunction is a complex problem involving an interplay of various physical, emotional, psychological factors often less understood by the general doctors. Gynecologists are many a time first contact person for the woman, where she comes for help. As there are very few or maybe no specialist in this field, in most of the developing countries, responsibility to adequately address and manage these issues in women comes to gynecologists. How does a gynecologist see these issues? Are they comfortable and confident in handling these problems? This study was undertaken to address all these issues.

Materials and methods: This was a questionnaire based study conducted on gynecologists in Jodhpur, Rajasthan and neighboring areas of Rajasthan, India. Gynecologists were contacted by personal contact or mail and were asked to fill out a questionnaire, which was analysed.

Results: Most gynecologists were females (95%). The average duration of practice was 7.8 years. Most of the gynecologist (77.8%) responded that they do not take a sexual history routinely. Gynecologists who were doing mainly infertility practice were more likely (80% vs 4.46%) to take a sexual history. A total of 85.4% admitted that they do not feel confident in managing these problems, though they were open to discussion. They suggested that training during the graduation and postgradua-tion in this area could be helpful.

Conclusion: All gynecologists should include screening questions regarding sexual well-being as a standard of practice. The gynecologists should be comfortable in discussing the issue of sexual health with their patients and skilled to treat them. The academic medical organization should ensure that students have sufficient knowledge, attitude, and skills to address issues of sexual health.

Keywords: Gynecologist, Questionnaire based study, Sex education, Sexual problems

How to cite this article: Singh P, Mathur N. Sexual Problems and the Gynaecologist: Are We Doing Enough? J South Asian Feder Obst Gynae 2018;10(3):191-193.

Source of support: Nil

Conflict of interest: None

Date of received: 09/12/2017

Date of acceptance: 03/05/2018

Date of publication: December 2018


RESEARCH ARTICLE
Shweta Mittal, Banashree Das, Ritu Khatuja

Quest for Labor Analgesia in Second Stage in Resource Poor Setup

[Year:2018] [Month:July-September] [Volumn:10 ] [Number:3] [Pages:76] [Pages No:194-198]



Aim: To assess the analgesic effect of pudendal nerve block (PNB) as labor analgesia in the second stage of labor, its effect on the duration of the second stage and to assess any adverse maternal and fetal outcome.

Materials and methods: The prospective, randomized, case-control study (parallel group trial) was conducted with a total of 110 parturient women. They were randomly allocated to either study group (n = 55) or control group (n = 55). The study was performed after the approval of the institutional ethical committee. All the women recruited for the study were given first stage analgesia. The pain was assessed using the verbal rating scale. In the second stage of labor, the women in the study group were given transvaginal PNB (5 mL of 1% Lignocaine + 5 mL of 0.25% bupivacaine) bilaterally, whereas, in control group, no added analgesia was given.

Statistical analysis: Quantitative data were compared using the unpaired t-test and qualitative data was compared using chi square test. p < 0.05 has been taken as the level of statistical significance. The data were analyzed by Statistical Package for the Social Sciences (SPSS) statistical software version 17.0.

Results: It was observed that in the second stage of labor, Pudendal Nerve Block produced pain relief in 98.2% women, out of which 14.6% had excellent pain relief and 52.7% had moderate pain relief. This was found to be statistically significant (p < 0.05). The mean duration of the second stage of labor was longer in the study group (29.02 minutes) than in the control group (16.86 minutes) (p < 0.05). There was no significant adverse maternal and fetal outcome.

Conclusion: The PNB provides an effective analgesia in the second stage of labor without the major neonatal and maternal morbidity.

Clinical significance: The PNB can be provided by obstetricians in any delivery setup, even in low resource settings, without the need for skilled anesthetists.

Keywords: Analgesia, Case-control study, Pudendal nerve block (PNB), Randomized clinical trial, Second stage of labor

How to cite this article: Mittal S, Das B, Khatuja R. Quest for Labor Analgesia in Second Stage in Resource Poor Setup. J South Asian Feder Obst Gynae 2018;10(3):194-198.

Source of support: Nil

Conflict of interest: None

Date of received: 08/06/2017

Date of acceptance: 12/10/2018

Date of publication: December 2018


RESEARCH ARTICLE
Jwal M. Banker, Uday J. Patel, Viral S. Modi, Bakul R. Leuva

Awareness and Attitude About Prenatal Sex Determination and the Preconception and Prenatal Diagnostic Tehniques Act Among Pregnant Women Attending the Antenatal Clinic

[Year:2018] [Month:July-September] [Volumn:10 ] [Number:3] [Pages:76] [Pages No:199-203]



Introduction: Preconception and prenatal diagnostic techniques (PCPNDT) Act 1994, was put into effect and was further amended in 2003 for improving the sex ratio in our country. But even after its introduction, there has been no improvement in the sex ratio. We conducted this study to find out the awareness and attitude of the ‘end user’ - the pregnant patient - towards it and to know whether this Act was really the answer to the problem.

Aim: To know the awareness and attitude of the women regarding the PCPNDT Act.

Method: This cross-sectional study was carried out in the antenatal clinic of Dhiraj Hospital, Vadodara which is a tertiary care hospital. A total of 1000 Pregnant women attending the Obstetrics out outpatient department (OPD) during the study period of 3 months were given pre-tested semi-structured multiple-choice questionnaires. Data collected was analysed.

Results: A total of 91.2% of women were aware about the PCPNDT Act. 12.7% wanted to know the sex of their child and of those, 12.6% were willing for feticide in case of a female child. None of the nulliparous women wanted sex determination. Total 8.9% women wanted a male child and the main cause was family pressure (67.4%). If sex determination was made legal, 7.3% more women wanted sex determination. 85% women believed that doctor and patient both were liable to be punished if found guilty.

Conclusion: There is considerable awareness about PCPNDT Act but the Act has failed to fulfil its purpose as it ignores social pressures. We must raise the status of women in society and change mentality of the people.

Keywords: Feticide, Male preference, Preconception and prenatal diagnostic techniques (PCPNDT) Act, Sex ratio

How to cite this article: Banker JM, Patel UJ, Modi VS, Leuva BR. Awareness and Attitude About Prenatal Sex Determination and the Preconception and Prenatal Diagnostic Techniques Act Among Pregnant Women Attending the Antenatal Clinic. J South Asian Feder Obst Gynae 2018;10(3):199-203.

Source of support: Nil

Conflict of interest: None

Date of received: 05/07/2017

date of acceptance: 10/08/2018

Date of publication: December 2018


RESEARCH ARTICLE
Poovini Soundararajan, Anupama Chandrasekharan, Rajeswaran Rangasami, Arunan Murali, Rajoo Ramachandran

Adnexal Masses in Pregnancy : Added Value of Magnetic Resonance Imaging in Guiding Patient Management—Our Initial Experience.

[Year:2018] [Month:July-September] [Volumn:10 ] [Number:3] [Pages:76] [Pages No:204-208]



Aim: To assess the role of magnetic resonance imaging in management of adnexal masses encountered during pregnancy.

Materials and methods: A prospective study was conducted in 40 pregnant patients referred for magnetic resonance imaging (MRI) abdomen and pelvis after indeterminate findings on ultrasound examination. Total 13 of these 40 patients with adnexal lesions on both ultrasound and MRI were further studied in detail. The MRI images were acquired on 1.5 T machines. Only patients in whom follow up and final diagnosis were available were included in the study.

Results: The 13 cases of adnexal lesions included 9 benign pathologies and 4 malignant adnexal lesions. MRI had accurately diagnosed malignancy in three of these patients with torsion additionally detected in the fourth patient. The 9 remaining cases were correctly interpreted as benign pathologies on MRI, which included cases of benign serous cystadenomas (n = 2), mature cystic teratomas (n = 2), endometriotic cyst (n = 1), hemorrhagic corpus luteal cyst (n = 1), torsed ovary (n = 1), hyperstimulated ovaries (n = 1) and subserosal fibroid with red degeneration (n = 1). MRI played a definitive role in deciding course of management in all cases of adnexal masses that required further characterization following initial ultrasound. Following MRI, nine patients underwent surgery during the ongoing pregnancy, one patient underwent ovarian cystectomy concurrently at the time of caesarean section, two patients were managed conservatively with imaging follow up and surgery was deferred until after delivery in one case.

Conclusion: Although sonography is the primary imaging tool in evaluating obstetric patients, in selected cases where ultrasound is equivocal or indeterminate, MRI can serve as a problem solving tool to arrive at an accurate diagnosis and guide patient management.

Clinical significance: Adnexal masses discovered in pregnancy present a clinical and imaging challenge. The MRI can decide the course of management by delineating benign and malignant entities and dictating the need for surgical intervention versus feasibility of conservative treatment.

Keywords: Adnexal mass, Magnetic resonance imaging (MRI), Ovarian mass, Pregnancy, Red degeneration, Torsion, Ultrasound.

How to cite this article: Soundararajan P, Chandrasekharan A, Rangasami R, Murali A, Ramachandran R. Adnexal Masses in Pregnancy: Added Value of Magnetic Resonance Imaging in Guiding Patient Management—Our Initial Experience. J South Asian Feder Obst Gynae 2018;10(3):204-208.

Source of support: Nil

Conflict of interest: None

Date of received:01/24/2018

Date of acceptance: 05/14/2018

Date of publication: December 2018


REVIEW ARTICLE
Sharadhi Channegowda, Bharathi Rao, Prajwal Shetty, Divakar Rao

Effects of Occupational Tobacco Exposure on Mother and Foetus in Beedi Rollers

[Year:2018] [Month:July-September] [Volumn:10 ] [Number:3] [Pages:76] [Pages No:209-214]



Background and objectives: Beedi rolling is a popular household occupation amongst the economically poor female population of coastal Karnataka districts. This study aimed to identify the effects of occupational tobacco exposure on the beedi rolling pregnant mother and her neonate. The objectives were to study the maternal outcomes with respect to hypertension in pregnancy, anemia, abruptio-placenta, preterm labor and the neonatal outcomes such as low birth weight, low appearance, pulse grimace, activity, respiration (APGAR) and clinical assessment of nutrition status (CANS) score.

Methods: This prospective cohort study was conducted in a tertiary care hospital in Mangaluru from February 2014 to June 2015. A sample size of 500 was calculated with a 95% confidence level and 85% power. Cohort groups of 250 each were randomized as beedi rollers and non-beedi rollers based on the history of exposure and were prospectively followed till delivery.

Results: The study results showed overall complications of 37.6 % among the beedi rollers which was clinically and statistically significant. Among the beedi rollers, 22.4% mothers had hypertension in pregnancy, of which 13.4%, had gestational hypertension, 8.2% pre-eclampsia, 0.4% had eclampsia, 27.6% were anaemic, and 9.6% had fetal growth restriction. There was no increase in the incidence of preterm labor, abrubtio-placenta. Our study also showed an increased risk of low birth weight (29.4%), but no significant difference in APGAR scores and CANS score among both groups. Based on the ROC curve we found, rolling 425 beedis can be taken as a safe limit during pregnancy with a sensitivity of 73.4% and specificity of 53.2% and 22 weeks period of gestation can be taken as safe limit up to which beedis can be rolled during pregnancy with a sensitivity of 61.7% and specificity of 64.1%.

Clinical significance: In this study, dreadful complications can be attributed to beedi rolling. Majority of it can be prevented by health education and simple preventive measures such as using masks and gloves while rolling beedis for which further studies are warranted.

Keywords: Beedi rolling, Foetal growth restriction, Hypertension in pregnancy, Low birth weight, Tobacco exposure

How to cite this article: Channegowda S, Rao B, Shetty P, Rao D. Effects of Occupational Tobacco Exposure on Mother and Foetus in Beedi Rollers. J South Asian Feder Obst Gynae 2018;10(3):209-214.

Source of support: Nil

Conflict of interest: None

Date of recived: 07/12/2017

Date of acceptance: 08/13/2018

Date of publication: December 2018


CASE REPORT
Igor V Lakhno

Systemic Inflammatory Response Syndrome as a Reason for the Multiple Organ Failure in a Postpartum Pre-eclamptic Patient

[Year:2018] [Month:July-September] [Volumn:10 ] [Number:3] [Pages:76] [Pages No:215-217]



Background: The increased level of the placental proinflammatory cytokines, vasoconstrictors and lipid peroxidation products is known to be involved in the pathogenetic scenario of pre-eclampsia. Systemic inflammatory response syndrome captures the severity of pre-eclampsia (PE). The opinion about the possible role of infection in the origin and progression of pre-eclampsia is rather unpopular nowadays.

Aim: To elucidate the involvement of the infectious agents in the pathogenesis of multiple organ failure syndrome in pre-eclampsia.

Case report: An unusual case of the prodromal symptoms of eclampsia and systemic inflammatory response syndrome in the postpartum period associated with group B streptococcus infection was reported. But the resistant to the cephalosporins microbial flora was a reason for the progression severity of pre-eclampsia and puerperal sepsis. Since uterus was the source of sepsis the hysterectomy procedure has given a possibility to avoid general peritonitis and septic shock.

Conclusion: The infectious inflammation could be involved in the pathogenesis of PE and contribute to the progressive severity of the disease.

Keywords: Hypertension, Infectious diseases, Intensive care Medicine.

How to cite this article: Lakhno IV. Systemic Inflammatory Response Syndrome as a Reason for the Multiple Organ Failure in a Postpartum Pre-eclamptic Patient. J South Asian Feder Obst Gynae 2018;10(3):215-217.

Source of support: Nil

Conflict of interest: None

Date of received: 05/22/2018

Date of acceptance: 07/05/2018

Date of publication: December 2018


CASE REPORT
Ma S Oo, Nik RB Affendi, San T Aung

Successful Outcome of Amniotic Fluid Embolism Complicated with Severe Postpartum Haemorrhage and Neurological Deficit

[Year:2018] [Month:July-September] [Volumn:10 ] [Number:3] [Pages:76] [Pages No:218-221]



An amniotic fluid embolism (AFE) is one of the rare obstetric emergency with a high maternal mortality rate. This condition is clinically characterized by three distinct phases: during the first phase, sudden onset of respiratory distress and cyanosis occur within seconds followed by hypotension, shock, and loss of consciousness within minutes. Of those who survive the initial insult, 40 to 50% enter the second phase characterized by coagulopathy and hemorrhage within hours. During the third phase, acute symptoms are over, and tissue injury of the brain, lung or renal is for the most part already established. The patient may succumb due to multisystem organ failure or infection acquired in the hospital.
We report an interesting case of a middle-aged pregnant mother who developed AFE during the caesarean section and complicated with severe postpartum hemorrhage, which was successfully aborted by intramyometrial prostaglandin F2 alpha injection, thus obviating the need for hysterectomy. Following that she also suffered from expressive dysphasia and have an uneventful recovery through the speech therapy. We concluded that early diagnosis and timely intervention that may be the best way to achieve the favorable outcome of amniotic fluid embolism and intramyometrial prostaglandin is the available simple drug for preventing a peripartum hysterectomy during amniotic fluid embolism.

Keywords: Amniotic fluid embolism (AFE), Coaguolopathy, Disseminated intravascular coagulation (DIVC), Intramyometrial prostaglandin, Obstetrics emergency, Postpartum hemorrhage.

How to cite this article: Oo MS, Affendi NRB, Aung ST. Successful Outcome of Amniotic Fluid Embolism Complicated with Severe Postpartum Hemorrhage and Neurological Deficit. J South Asian Feder Obst Gynae 2018;10(3):218-221.

Source of support: Nil

Conflict of interest: None

Date of received: 08/30/2017

Date of acceptance: 08/16/2018

Date of publication: December 2018


CASE REPORT
Phornsawan Wasinghon, Kuan-Gen Huang

An Extensive Extraperitoneal Insufflation due to Veress Needle Associated Complication

[Year:2018] [Month:July-September] [Volumn:10 ] [Number:3] [Pages:76] [Pages No:222-224]



Aim: The case report presented of the uncommon extensive extraperitoneal insufflation due to Veress needle (VN) procedure of laparoscopy.

Background: The minimally invasive surgery has become the method of choice for the most benign disease. Creation of pneumoperitoneum is the first step of a laparoscopy. The Veress needle is placed blindly into the abdomen. There are major and minor complications of laparoscopy. The purpose of this study was to expose the minor complication outcome of extraperitoneal insufflation with VN access. The complication of this operation occurred during the laparoscopic surgical staging of endometrial cancer.

Case description: A 61-year-old woman, para two of vaginal deliveries, had previous laparoscopic Gilliam uterine suspension owing to uterine prolapse. She had menorrhagia for 6 months after her menopausal age of 53 years. The uterine had undergone curettage, and the histopathology displayed endometrial carcinoma. The treatment was laparoscopic surgical staging. While the VN was inserted and CO2 insufflation was taking place with 15 mm Hg, a minor intraoperative complication had occurred. The laparoscopy revealed Gilliam uterine suspension (GUS) where the extraperitoneal emphysema had occurred. The extraperitoneal emphysema was released with a needle gauge No.18 exteriorly during surgery.

Conclusion: The extensive extraperitoneal insufflation image shows a minor complication that is very uncommon reviewed and can thus be educational for the endoscopist.

Clinical significance: The VN was inserted vertically following the creation of pneumoperitoneum at a pressure of 10 to15 mm Hg, the Veress needle was removed. Then a 10 mm disposable shielded trocar was introduced in the pelvic cavity.

Keywords: Extraperitoneal insufflation, Gilliam uterine suspension, Laparoscopic complication, Veress needle.

How to cite this article: Wasinghon P, Huang K. An Extensive Extraperitoneal Insufflation due to Veress Needle Associated Complication. J South Asian Feder Obst Gynae 2018;10(3):222-224.

Source of support: Nil

Conflict of interest: None

Date of received: 07/16/2018

Date of acceptance: 09/12/2018

Date of publication: December 2018


CASE REPORT
Wint-Thida Htay, Sukson Chaiviratttana, Amornrat Thanachiviwat, Kuan-Gen Huang

Triple Intrauterine Devices: A Rare Case

[Year:2018] [Month:July-September] [Volumn:10 ] [Number:3] [Pages:76] [Pages No:225-226]



This was the rare case of three intra-uterine devices (IUD) in one lady. One was lost, another was translocated intra-abdominally, and the other was still functioning for 20 years.This report highlighted the importance of in-depth knowledge of health education, proper diagnostic evaluation and the role of laparoscopy in this management.

Keywords: Extrauterine, Intrauterine device, Laparoscopy uterine perforation.

How to cite this article: Htay WT, Chaiviratttana S, Thanachiviwat A, Huang KG. Triple Intrauterine Devices: A Rare Case. J South Asian Feder Obst Gynae 2018;10(3):225-226.

Source of support: Nil

Conflict of interest: None

Date of received: 08/19/2018

Date of acceptance: 09/17/2018

Date of publication: December 2018


PROSPECTIVE OBSERVATIONAL STUDY
Renu Gupta, Pavika Lal, Shaily Agarwal, Neena Gupta, Ruchika Tahilyani, Namrata Dawani

Is Self-medication with over the Counter Abortion Pills Really Safe? An Experience at a Tertiary Care Centre

[Year:2018] [Month:July-September] [Volumn:10 ] [Number:3] [Pages:76] [Pages No:227-230]



Objectives: To study the clinical profile and outcome of patients in terms of maternal morbidity and mortality at a tertiary care center following self-medication of over the counter MTP pills.

Materials and methods: This is prospective observational study conducted at Upper India Sugar Exchange Maternity Hospital, Ganesh Shankar Vidyarthi Memorial Medical College (GSVMMC or GSVM) Kanpur between January 2016 to June 2017 for 18 months. A total of 587 women were enrolled in our study. Data were recorded with respect to socioeconomic status, clinical presentation and various adverse consequences in the study population. Analysis of a number of blood transfusions, sepsis, shock, anemia, any surgical interventions was done was noted. A questionnaire was prepared in the local language to know the source of information regarding the abortion pill and to analyze the reasons for self-medication.

Results: Majority of women were in totoal 30 to 40 yrs age group (54.51%) and were married (81.43%). 52.63% of women did not confirm their pregnancy either by a urine pregnancy test and or by ultrasound self-medication. Total 32.02% had consumed the abortion pill > 9 weeks period of gestation. The maximum number of women had chosen this method to avoid surgical intervention while 89.26% of women used it due to its easy availability without a prescription. The most common complication was anemia (92.5%) followed by sepsis.

Conclusion: Easy availability of over the counter medical abortion pills without prescription is a serious threat as it leads to grave consequences of maternal health and significantly contributes to unsafe abortion. Healthcare facilities should undertake measures to reduce the indiscriminate use of medical abortion pills and safeguard the health of the mother.

Keywords: Medical abortion, Over the counter, Self-medication, Unsafe abortions.

How to cite this article: Gupta R, Lal P, Agarwal S, Gupta N, Tahilyani R, Dawani N. Is Self-medication with over the Counter Abortion Pills Really Safe? An Experience at a Tertiary Care Centre, J South Asian Feder Obst Gynae 2018;10(3):227-230.

Source of support: Nil

Conflict of interest: None

Date of received: 15/5/2017

Date of acceptance: 20/10/2018

Date of publication: December 2018


BOOK REVIEW
Jaideep Malhotra, Ruchika Garg

Handbook of infertility and Ultrasound for Practicing Gynecologists

[Year:2018] [Month:July-September] [Volumn:10 ] [Number:3] [Pages:76] [Pages No:231]



Handbook of Infertility and Ultrasound for Practising Gynecologists is a perfect blend if clinical experience and scientific theories with clear dos and Donts. Its easy to read, simple to understand and reliable to apply. Its a short and precise book with ultrasound images.


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