Journal of South Asian Federation of Obstetrics and Gynaecology

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Volume 14, Number 1, January-February 2022

Original Article

Shivi Jain, Ram C Shukla, Madhu Jain, Usha Singh, Tej B Singh

A Correlation between Antral Follicle Count and Anti-Müllerian Hormone in Healthy Indian Women of Reproductive Age

[Year:2022] [Month:January-February] [Volume:14] [Number:1] [Pages:5] [Pages No:1 - 5]

Keywords: Anti-Müllerian hormone, Antral follicle count, Cross-sectional study, Fertile women, Reproductive aging

   DOI: 10.5005/jp-journals-10006-2005  |  Open Access |  How to cite  | 

Abstract

Aim: To determine which of the two parameters between antral follicle count (AFC) and anti-Müllerian hormone (AMH) had better correlation with age in healthy females, and also to estimate the strength of correlation between AMH and AFC. Materials and methods: This was a prospective, cross-sectional study comprising 1,181 fertile women of age 20–40 years, who were divided into four age groups, i.e., group I (20–24 years), group II (25–29 years), group III (30–34 years), and group IV (35–40 years). AFC and AMH were measured on third day of menstrual cycle. Pearson correlation and linear regression analysis were used. Statistical Package for Social Sciences, trial version 20, was used for the statistical analysis. A p-value of <0.05 was considered statistically significant. Results: The correlation coefficients between AFC and age, AMH and age, AMH and AFC were r = −0.403, r = −0.824 and r = 0.328; p <0.001, respectively. A strong positive correlation (r = 0.986, p <0.001) was noted between AMH and age in group I, while strong negative correlations (p <0.001) were noted in other groups. The correlations between AFC and age (r = −0.177) and AMH and AFC (r = 0.175) were significant (p <0.05) only in group IV. Age accounted for 16.3% variation in AFC and 67.8% variation in AMH. Conclusion: AMH correlated better with age than AFC. There was a weak correlation between AMH and AFC. Clinical significance: The counselling of a woman about her reproductive potential should be based on both AFC and AMH taken together, apart from chronological age, to avoid false sense of security or unnecessary alarm.

Original Article

Mercy M Jafrin, Rajesh K Konduru, Murugan Natesan, Anil J Purty

Unmet Needs of Contraception among Married Women: A Rural Qualitative Study

[Year:2022] [Month:January-February] [Volume:14] [Number:1] [Pages:5] [Pages No:6 - 10]

Keywords: Contraception, Focused group discussions, Qualitative study, Unmet needs

   DOI: 10.5005/jp-journals-10006-1994  |  Open Access |  How to cite  | 

Abstract

Aim and objective: To identify the factors influencing the unmet needs of contraceptive use by Qualitative research methods. Materials and methods: A community-based qualitative study with the help of focused group discussions (FGD) and an interview guide was formulated after assessing micro- and macrolevel factors for not using contraceptive methods. A sociogram was used to visually depict the flow of information in the discussion. Results: From the FGD the hindering factors to practice contraception were found to be lack of knowledge in selecting a method, fear of side effects, and hesitancy to seek help from care providers. Some stated that they have self-control and they lack co-inhabitation with the spouse. Also the utility of family planning services is also unacceptable and inaccessible and unaffordable. The facilitating factors for practicing the contraceptive practices were women who wanted to prevent unwanted pregnancy. Some expressed their views as practicing contraception will take care of population explosion. After the session women also expressed their interest in knowing and practicing the different methods of contraception as a behavior change. Conclusion: It was found that factors contributing toward the unmet needs of contraception were client factors, family factors, and health system factors. Clinical significance: This study brought out the factors responsible for the unmet needs of contraception and paved the way to prevent unwanted pregnancies and providing a platform for improving the health status of women by following contraception methods.

Original Article

Syed H Ala, Samia Husain

Outcome of Vesicovaginal Fistula Repair: An Experience at Hamlin Fistula Hospital, Ethiopia

[Year:2022] [Month:January-February] [Volume:14] [Number:1] [Pages:3] [Pages No:11 - 13]

Keywords: Fistula, Urinary incontinence, Vesicovaginal fistula

   DOI: 10.5005/jp-journals-10006-1992  |  Open Access |  How to cite  | 

Abstract

Aim and objective: The purpose of this study was to assess the outcomes of surgical repair of obstetric vesicovaginal fistula repairs at Hamlin Fistula Hospital, Ethiopia. Materials and methods: This is a case series study of vesicovaginal fistula repair at Hamlin fistula hospital, Addis Ababa and Hamlin Fistula Centre, Yirgalem, Ethiopia. All women were operated under spinal anesthesia. Bladder was kept empty with free drainage for 14 days. Upon removal of catheter woman was asked to pass urine and postvoid ultrasound was done. They were followed up at 6 and 12 months. The fistula was classified according to the Goh classification system. Surgical outcomes of the surgery were “Fistula closed + patient continent,” “Fistula closed + patient incontinent,” “Fistula not closed + patient incontinent.” Results: A total of 17 cases operated independently. All the fistulas were associated with complications of labor and delivery. Prolonged obstructed labor was found in all 17 women. Sixteen out of seventeen patients were dry during immediate postoperative period. Successful closure was achieved in 11 patients (65%), despite fistula closure; stress incontinence was present in 5 (35%) patients at 6 months and 1 year follow-up. However, one patient was wet on operative evening. Her left ureter was in the scar and unidentifiable during surgery. Conclusion: The successful repair depends upon site, size, duration of fistula, and degree of scarring. However, some patients remained wet after successful closure due to incontinence problems. Clinical significance: The Goh classification has good prognostic value in determining the risk of urinary incontinence after anatomical closure of vesicovaginal fistulae.

Original Article

Ashwini L Vishalakshi

Adenomyosis or Fibroid? Making the Right Diagnosis

[Year:2022] [Month:January-February] [Volume:14] [Number:1] [Pages:3] [Pages No:14 - 16]

Keywords: Adenomyosis, Fibroid, Impedence indices, Power Doppler, Prospective observation study

   DOI: 10.5005/jp-journals-10006-2004  |  Open Access |  How to cite  | 

Abstract

Background: Differentiating adenomyomas from fibroids may be challenging at times when we use routine morphological criteria. Using Doppler in addition to routine B mode ultrasound can help in differentiating adenomyomas from fibroid uterus. Materials and methods: This is a prospective study done on patients diagnosed with fibroid or adenomyosis who were planned for hysterectomy. Routine ultrasound with Power Doppler was done for all patients and the blood flow impedance between the two was compared. Results: There was a significant difference between the blood flow in adenomyosis and fibroid. Fibroids had peripherally distributed vascularity with low impedance and adenomyosis had intralesional vascularity with high resistance flow. Conclusion: Use of Doppler in addition to morphological features on routine ultrasound helps to differentiate the uterine lesions like fibroid and adenomyosis.

Original Article

Pramila D\'Souza, Devina E Rodrigues, Raja Gopal Kaipangala, Leena Kunnath Chacko, Joylene D Almeida

Correlation between the Physical Signs, Clinical Parameters, and the Quality of Life in Young Women with Polycystic Ovarian Syndrome: An Explorative Study

[Year:2022] [Month:January-February] [Volume:14] [Number:1] [Pages:5] [Pages No:17 - 21]

Keywords: Acne, Body mass index, Lifestyle, Psychological health

   DOI: 10.5005/jp-journals-10006-1993  |  Open Access |  How to cite  | 

Abstract

Aims and objectives: The study was aimed to investigate the relationship between the physical signs, clinical parameters, and the quality of life in young women with PCOS. Materials and methods: A prospective cross-sectional survey was conducted among 140 women diagnosed with PCOS. The subjects who attended the outpatient department of obstetrics and gynecology were selected through the kth sampling technique. Baseline information was collected by an interview technique. The following parameters were then noted and assessed: BMI, waist/hip ratio, hirsutism, and acne. The standardized tool, WHOQOL-BREF scale, was used to find the quality of life. Results: The majority of the subjects were between the age-group of 21–25 years (41.4%), and the mean age was 22.0 ± 0.74. Out of 140 PCOS women, 84 of them adopted the sedentary lifestyle category, 88 of women were residing in the urban area, and 106 subjects did not have a family history of PCOS. The total of 52.9% of the subjects were with amenorrhea, 55.8% of them were obese, 66.43% of subjects were with increased waist/hip ratio, 98.58% of the subjects had complaints of hirsutism, and 42.86% of subjects were with mild and moderate types of acne. The mean and SD of quality of life score in various domains were as follows: physical health, 20.07 ± 2.79; psychological health, 16.85 ± 3.06; social relationships, 18.17 ± 1.82; and environment, 40.00 ± 22.73. The overall perception of the quality of life is 22.73 ± 4.20, and the overall perception of satisfaction with health is 2.64 ± 0.89. There was no relationship between the PCOS symptoms and quality of life. Conclusion: The research underlined the poor health-related quality of life. Acne is one of the leading factors that affected the health-related quality of life. Clinical significance: The article is relevant in the present context where our current sedentary lifestyle and stressful living have induced changes among women, causing a sharp rise in the incidence of PCOD.

Original Article

Jaishree S Bamniya, Mubassirabanu I Pathan, Harshad M Ladola

Prevalence of Vaginal Infections in Urban Pregnant Women Attending Obstetric Unit at Tertiary Care Hospital, Ahmedabad: A Prospective Study

[Year:2022] [Month:January-February] [Volume:14] [Number:1] [Pages:4] [Pages No:22 - 25]

Keywords: Amsel\'s criteria, Candidiasis, Gram\'s stain, Nugent\'s scoring

   DOI: 10.5005/jp-journals-10006-2001  |  Open Access |  How to cite  | 

Abstract

Aims and objectives: To study the prevalence of vaginal infections in pregnant women and its implications in pregnancy. Study design: Prospective case control study. Setting: Obstetric unit of tertiary care hospital. Materials and methods: Overall 200 cases were enrolled, 100 symptomatic and 100 asymptomatic women. A thorough general physical examination and P/S examination were carried out and the vaginal mucosa was inspected for the presence of erythema, lesions, and discharge. High vaginal swabs were then collected from the posterior fornix with cotton-swab, avoiding contamination with the cervical mucus. Subjected to KOH test followed by wet mount preparation and Gram\'s staining, each second high-vaginal swab was then cultured using a Sabouraud\'s Dextrose agar plate for Candida spp., MacConkey\'s agar, and Chocolate agar in aerobic conditions, respectively, for gram-negative bacilli and chocolate agar for the isolation of group B streptococci. Identification of the aerobic culture isolates was performed using 41 standard biochemical tests. Afterward, colonies grown on SDA agar were subjected to growth on CHROM agar for speciation of Candida. Diagnosis of BV was made using Amsel\'s criteria and Gram\'s stain Nugent\'s scoring system. Results: The prevalence of vaginal infections in the present study was 22.5%. Incidence of BV was found to be 9%. Incidence of candidiasis was found to be 13.5%. The analysis in the present study also showed that there were greater odds of vaginal infections among women with clinical symptoms (37%) as compared to asymptomatic women (8%). Conclusion: In conclusion, vaginal infections are highly prevalent among pregnant women and a frequent cause of adverse obstetric outcome and their clinical diagnosis should be a two-stepped approach combining both clinical and microbiological diagnostic methods.

Original Article

Malvika S Jain, PSNRS Sirisha

Uterine Artery Embolization in Treatment of Fibroid Uterus: A Case Series

[Year:2022] [Month:January-February] [Volume:14] [Number:1] [Pages:3] [Pages No:26 - 28]

Keywords: Fibroid, UAE, Uterine artery embolization

   DOI: 10.5005/jp-journals-10006-1997  |  Open Access |  How to cite  | 

Abstract

Background: Uterine artery embolization (UAE) for the management of fibroid uterus is now a widely used modality for management of fibroid uterus. It has an advantage over the gold standard options of hysterectomy of being minimally invasive, uterus conserving, and has faster recovery. We here discuss our experience of the use of UAE for treatment of fibroid uterus in seven patients who had UAE between 2015 and 2020. Materials and methods: Seven patients who had undergone uterine artery embolization for the treatment of fibroid uterus in our institute between 2015 and 2020 were selected and retrospectively inquired about their symptoms before the procedure and their outcome postprocedure was followed. Bilateral uterine arteries were embolized by interventional radiologist using polyvinyl alcohol (PVA) in all cases. Result: Out of the seven women who underwent UAE, six presented with a spectrum of menstrual complaints in the form of heavy menstrual bleeding and/or dysmenorrhea. One patient had pressure symptoms. Out of the six women with menstrual complaints, on follow-up, five of the six patients had symptomatic relief of heavy menstrual bleeding, whereas four of the six were symptomatically relieved of dysmenorrhea. Four of the seven patients had postprocedure radiological imaging which showed a comparative (10–50%) reduction in the size of the fibroids. None of the patients had other complications such as persistent postembolization syndrome, infection, or vaginal discharge. Conclusion: UAE as an alternative treatment modality for symptomatic fibroid uterus showed a good patient satisfaction with most of the patients being relieved of their symptoms in our study. However, long-term outcomes in the form of fertility issues, recurrence of symptoms, and need for reintervention could not be assessed in the study. Clinical significance: UAE as a treatment modality was met with high-level patient satisfaction in our study group. There were minimal complications associated with the procedure. Longer follow-up will be required to comment on the effect of UAE on fertility outcome.

Original Article

Nina Mishra, Ruchi Mishra

Clinicobiochemical Analysis of Polycystic Ovary Syndrome and Metabolic Syndrome: Do They Go “Hand in Glove”?

[Year:2022] [Month:January-February] [Volume:14] [Number:1] [Pages:6] [Pages No:29 - 34]

Keywords: Insulin resistance, Metabolic syndrome, Obesity, PCOS

   DOI: 10.5005/jp-journals-10006-2000  |  Open Access |  How to cite  | 

Abstract

Aims and objectives: To study the clinical and biochemical markers for metabolic syndrome in women diagnosed with polycystic ovary syndrome (PCOS). Materials and methods: This is an observational (cross-sectional) study involving 105 patients of PCOS, carried out over 2 years (2018–2020) in a tertiary care hospital of Berhampur, Odisha. Weight, height, waist circumference, hip circumference, and blood pressure were measured. The W to H ratio (WHR) and body mass index (BMI) was calculated. Venous blood samples were collected after an overnight fast for glucose, serum triglycerides, and high-density lipoprotein- cholesterol. A 2-hour 75 g glucose tolerance test was done, along with fasting insulin. Homeostatic model assessment-insulin resistance (HOMA-IR) was calculated. Statistical analysis was performed by the SPSS program for Windows (v 25.0). Tests of significance were carried out. Results: The patients fell into the age range of 16–30 years. The average body mass index (BMI) was 27 ± 5.3 kg/m2, with central obesity in 40% cases. Thirty-seven patients (35.2%) fulfilled three or more criteria of metabolic syndrome, maximum cases (49%) in the age group of 20–24 years. Central obesity (Waist circumference ≥80 cm) is the most deranged parameter among 32/37 (86.5%) followed by dyslipidemia—serum HDL-C ≤50 mg/dL in 27/37 (73%). Fasting plasma glucose levels are least deranged in 43.2% of cases (16/37). Women with PCOS had a significant association with all parameters of metabolic syndrome (p ≤0.05). Conclusion: Several studies have proved a consistent association between PCOS and metabolic dysfunction. It is, thus, imperative to screen every case of PCOS, with appropriate follow-up, to catch derangements at the earliest. Encouraging healthy lifestyle practices is important to improve ovulatory and menstrual symptoms as well as prevent future morbid metabolic ailments.

ORIGINAL RESEARCH

Prabhat Agrawal, Ashish Gautam, Akhil Pratap Singh, Nikhil Pursnani, Prashant Gupta, Ruchika Garg, Arti Agrawal, Ajeet Singh Chahar

Prospective Randomized Double-blind Placebo-controlled Study to Assess the Effects of Nano-ozonized Hydrogen Peroxide Nebulization on Results of RTPCR for Novel Coronavirus thus Infectivity and Clinical Course among Moderately Sick COVID-19 Patients Hope in COVID-19 (Hydrogen Peroxide Inhalation)

[Year:2022] [Month:January-February] [Volume:14] [Number:1] [Pages:6] [Pages No:35 - 40]

Keywords: COVID-19, Hydrogen peroxide, Nebulization

   DOI: 10.5005/jp-journals-10006-1986  |  Open Access |  How to cite  | 

Abstract

Importance: Given the high mortality and cost of health care, especially in isolation settings, the idea of using nebulized hydrogen peroxide may play a very significant role in inactivation of coronavirus, thus reducing the infectivity period leading to reduced requirement of isolation and improving morbidity and mortality in people suffering with coronavirus disease-2019 (COVID-2019). Aim and objective: Objective of this study was to determine the efficiency of nebulized hydrogen peroxide (H2O2) in reducing the viral load and disease severity of patients suffering with COVID-19. Design: Double-blinded randomized control trial. HOPE in COVID-19 study. Setting: Tertiary care COVID hospital (single center). Participants: Moderate sick COVID-19-positive patients were included in the study after they qualified the inclusion criteria. Intervention: Patients were nebulized using 1 mL of ozonized 3% H2O2 after diluting with 4 mL of normal saline three times a day for 5 days. The control group was nebulized with normal saline only. Main outcome: Outcome was assessed for reduction in oxygen requirement (number of days on oxygen), symptoms resolution (dyspnea, cough, and fever), and number of days it took to be RT-PCR negative for COVID-19. Results: The early data from trial showed promising trends toward a better outcome. The study showed that in the case group who were nebulized with hydrogen peroxide resulted in better outcome in terms of parameters assessed in the study and the differences from the control group were statistically significant (p ≤0.001, CI 95%). Outcome in the form of mortality (odds ratio 0.29, 95% CI 0.02–3.14, p = 0.31, z = 1.007) was statistically insignificant. The number needed to treat for our study was 10.

ORIGINAL RESEARCH

Tony Jose, Raju Agarwal, Monica Saraswat

Preoperative Triage of Early Stage Operable Ca Cervix

[Year:2022] [Month:January-February] [Volume:14] [Number:1] [Pages:5] [Pages No:41 - 45]

Keywords: Adjuvant radiotherapy, Carcinoma cervix, Depth of stromal invasion, Parametrial metastasis, Preoperative triage, Tumor diameter

   DOI: 10.5005/jp-journals-10006-1995  |  Open Access |  How to cite  | 

Abstract

Aim: Carcinoma (Ca) cervix is staged clinically and early stages undergo radical hysterectomy but many cases need adjuvant radiotherapy (RT)-based on the high and intermediate risk factors on histopathology, thus increasing morbidity and cost. This study evaluated the role of preoperative MRI in triaging patients of early stage operable Ca cervix to identify patients likely to require adjuvant RT after surgery. Materials and methods: In total, 28 cases of operable Ca cervix clinically staged as I B1 underwent a preoperative MRI and based on the criteria of tumor size, depth of stromal invasion (DOSI), and parametrial involvement were triaged into low and high risk for receiving adjuvant treatment. They underwent radical hysterectomy and the specimen was subjected to pathologic examination. The pathologic characteristics and need for adjuvant treatment were studied. Results: MRI evaluation could accurately evaluate the tumor size and DOSI and parametrial metastasis in all cases of Stage B1 Ca cervix. Based on these risk criteria, the cases were triaged into low risk (13) and high risk (15) to predict the requirement of adjuvant treatment. There was a statistically significant difference in the requirement of adjuvant RT in the two risk groups (15.38 vs 66.66%). Conclusion: MRI can effectively estimate the tumor size and DOSI and parametrial metastasis in early stage (Stage I B1) Ca cervix and can further triage them to high- and low-risk groups to effectively predict the requirement of postoperative adjuvant RT. Clinical significance: Surgery could be avoided in patients likely to require adjuvant RT by this triage, thus reducing morbidity.

RESEARCH ARTICLE

Fitriyadi Kusuma, Rahimi Rahim, Sri M Sekarutami, Sahat BRE Matondang

Comparisons of Radiotherapy Outcomes in Cervical Squamous Cell Carcinoma Stage IIIB with and without Lymph Node Enlargement

[Year:2022] [Month:January-February] [Volume:14] [Number:1] [Pages:3] [Pages No:46 - 48]

Keywords: Lymph node enlargement, Magnetic resonance imaging, Radiotherapy, Stage IIIB SCC

   DOI: 10.5005/jp-journals-10006-1926  |  Open Access |  How to cite  | 

Abstract

Aim: Cervical cancer is the second rank as the most common cancer worldwide. Squamous cell carcinoma (SCC) is the most common histopathology type for cervical cancers. The radiotherapy prognostic and survival rate becomes important information for patients and clinicians. Materials and methods: This is a historical cohort study in patients with stage IIIB cervical SCC at RSUPN Dr Cipto Mangunkusumo or RSCM from 2016 to 2017. Patients are grouped into two: stage IIIB cervical SCC with lymph node enlargement (LNE) and stage IIIB cervical SCC without LNE. Univariate, bivariate, and multivariate analyses were performed. The 1-year survival rate was analyzed using the Kaplan–Meier method. Results: Research subjects were divided into two groups of which 36 patients (47.4%) with LNE and 40 patients (52.6%) without LNE. The radiotherapy response for patients with stage IIIB cervical SCC with LNE is worse than those without LNE, RR 4.26 (1.96–9.27, 95% IK). Sociodemographic and clinicopathologic descriptions were comparable between the two groups. The 1-year survival of patients with stage IIIB cervical SCC without LNE is better than those with LNE, hazard ratio (HR) 9.57 (3.28–27.88 95% IK). Predictor score of ≥2.1 as the cutoff point to determine negative response on radiotherapy was chosen (LR + 2.31, sensitivity 96.3%, specificity 58.3%, and accuracy 77.3%). Conclusion: There was a significant difference in radiotherapy response between the patients with stage IIIB cervical SCC with LNE and without LNE. Clinical significance: To improve the prognosis and efficacy of radiotherapy in patients with LNE, consideration should be given to further studies on the removal of the LNE prior to undergoing radiotherapy.

RESEARCH ARTICLE

Anak Agung Ngurah Jaya Kusuma, Sugianto Sugianto, Anak Agung Gede Raka Budayasa, Tjokorda Gde Agung Suwardewa, Ida Bagus Putra Adnyana, I Gusti Ngurah Harry Wijaya Surya, Pande Kadek Aditya Prayudi, William Alexander Setiawan

The Rate and Characteristics of Cesarean Section Performed at a Tertiary Referral Hospital and District Hospital in Bali, Indonesia, Using Robson Classification System during the Period of January to December 2018

[Year:2022] [Month:January-February] [Volume:14] [Number:1] [Pages:5] [Pages No:49 - 53]

Keywords: Cesarean section, Characteristics, Robson classification

   DOI: 10.5005/jp-journals-10006-1959  |  Open Access |  How to cite  | 

Abstract

Aim: This study is aimed to compare the rates and characteristics of cesarean section (CS) based on the Robson classification system in a tertiary referral hospital and district hospital in Bali, Indonesia. Materials and methods: A retrospective descriptive study was conducted at Sanglah Tertiary Hospital, Denpasar, and Sanjiwani District Hospital from the period of January to December 2018. The data were collected from the medical records and analyzed using simple statistical measures. Results: CS rates at Sanglah Tertiary Hospital and Sanjiwani District Hospital were 34.3% (385/1121) and 21.5% (212/984), respectively. In Sanglah Tertiary Hospital, the highest CS rate was found in the age-group of 20–35 years, primigravida, term pregnancy, and among Robson group X. Compared to Sanjiwani District Hospital, the clinical characteristics were almost similar but the highest CS rate was found among Robson group IV. Conclusions: Interventions, such as audit feedback, quality improvement, and multifaceted strategies, are needed to change clinical practice and reduce the rate of CS. The Robson classification is recommended to be used as a CS audit tool. Clinical significance: A safe and timely CS remains a major challenge in countries with a high maternal mortality ratio, which poses new challenges to these countries in reducing CS performed without appropriate indications.

RESEARCH ARTICLE

Prachi Dahiya, Shubhra Agarwal

Retrospective Analysis of Second Stage of Cesarean Section and Pregnancy Outcomes: An Observational Study

[Year:2022] [Month:January-February] [Volume:14] [Number:1] [Pages:5] [Pages No:54 - 58]

Keywords: Cesarean section, Labor, Second stage

   DOI: 10.5005/jp-journals-10006-1991  |  Open Access |  How to cite  | 

Abstract

Background: A cesarean section (CS) at second stage occurs when mother requires delivery at full dilatation of cervix, which poses a risk to mother and the fetus. In the present obstetric practice, one of the huge challenges is to make a firm decision regarding CS during the second stage of labor periods. The present study was done for the retrospective analysis in regard to second stage in terms to the CS along with its association with the pregnancy outcomes. Materials and methods: It was an observational and retrospective study that depended on some clinical records related to more than 37 weeks’ gestation. The neonatal as well as maternal outcomes have been evaluated for CS among those who were observing the second stage in their labor period. Dichotomous variables were compared to that of the χ2 test, and the Mann–Whitney U test was applied to analyze differences in continuous variables. Results: The most common indications for the cesarean category was arrest in the second stage of their labor (56.1%), and the most common technique of delivery of engaged head was modified Patwardhan method (28.3%). The most common intraoperative complications reported was extension of uterine incision (16.0%), and postoperative complications were febrile illness (14.1%). The neonatal complications that required NICU admission were birth asphyxia (16%), meconium aspiration (14.1%), neonatal jaundice (4.7%), respiratory distress syndrome (11.3%), and fresh stillbirth (5.6%). Conclusion: CS\'s that have been performed during the second stage of the labor period reflect to be a very undesirable phenomenon which is linked to the maternal as well as fetal complications.

RESEARCH ARTICLE

S Naveen Chandra, Pradeep Musale Ramachandra, Shashikumara

Clinical Outcomes of COVID-19-positive Pregnant Women Admitted for Delivery at a Tertiary Care Center, Chamarajanagar

[Year:2022] [Month:January-February] [Volume:14] [Number:1] [Pages:4] [Pages No:59 - 62]

Keywords: COVID-19, Maternal outcome, Neonatal outcome, Pneumonia, Vertical transmission

   DOI: 10.5005/jp-journals-10006-1920  |  Open Access |  How to cite  | 

Abstract

Purpose: The purpose of the study is to determine the maternal and fetal outcomes among the coronavirus disease-2019 (COVID-19)-positive pregnant women. Methodology: This is a retrospective cross-sectional study conducted among all the COVID-19 pregnant women who were admitted at Chamarajanagar Institute of Medical Sciences for delivery. Results: The mean age of the study subjects was 26.00 ± 4.89 years, and it ranged between 19 and 37 years. Most of the patients were gravida 2 (51.6%) and primigravida (41.9%); Lower segment cesarean section was the commonest mode of delivery (38.7%). Cough and breathlessness were the symptoms recorded in 1.6% of the patients. Premature rupture of membranes (PROM) (9.7%) and decreased saturation (6.5%) were the maternal complications noted. A majority of the neonates weighed 2.5–3.5 kg (46/63, 73.0%). The mean birth weight of the neonates was 2.97 ± 4.89 kg with the minimum weight recorded being 1.75 kg and maximum was 3.8 kg. The commonest neonatal complication (14.3%) noted was low birth weight (LBW), and among them, eight of them had COVID-19 negative status but for one who was diagnosed COVID-19 positive. There were no deaths recorded among both mother and the neonates. Conclusion: Our results suggest that there are no maternal and neonatal deaths noted among COVID-19 pregnant women, and PROM and decreased saturation were the maternal complications affecting 10.0 and 7.0% of them and LBW was the neonatal complication found among 14.0% of them. Vertical transmission cannot be ruled out 100.0 as 1.6% (1/63) newborn was found to be COVID-19 positive.

RESEARCH ARTICLE

Deepa V Kanagal, BK Praveen

Intrapartum Fetal Monitoring and Its Correlation with Umbilical Cord Blood pH and Early Neonatal Outcome: A Prospective Cohort Study

[Year:2022] [Month:January-February] [Volume:14] [Number:1] [Pages:5] [Pages No:63 - 67]

Keywords: Cord blood pH, CTG, NICU, Nonreassuring

   DOI: 10.5005/jp-journals-10006-2007  |  Open Access |  How to cite  | 

Abstract

Aim: Intrapartum fetal hypoxia leads to neonatal morbidity and mortality. Though cardiotocography (CTG) plays an important role in detecting fetal hypoxia, it has high false-positive rate and is a poor predictor of acidosis. Umbilical artery pH identifies infants at risk for hypoxia and better predicts neonatal outcome. Hence the study was done to correlate nonreassuring CTG findings with umbilical artery pH and neonatal outcome. Materials and methods: The study included 255 pregnant women in labor with nonreassuring CTG. The findings were categorized as suspicious and pathological. Umbilical arterial cord blood analysis was done in all newborns. The umbilical arterial cord blood pH of <7.2 was defined as fetal acidosis. The correlation between CTG findings, cord blood pH, and neonatal outcome was recorded. Results: In the study, among 255 women, 54.9% had suspicious and 45.1% had pathological CTG. The rate of cesarean section, Apgar score, was similar in both the groups. Subjects with pathological CTG had more babies with low cord pH compared to suspicious CTG (62.6 vs 26.4%). 55% of babies with pH <7.2 needed neonatal intensive care unit (NICU) admission compared to 11.6% with normal pH. Babies born with pathological CTG and low cord pH were more likely to have NICU admission and other morbidities. Conclusion: Detection and management of fetal compromise at the earliest is of utmost importance. Though cardiotocography is a simple test to analyze fetal condition, it is a good practice to analyze umbilical cord blood pH to find neonates with acidosis and prevent complications. Clinical significance: The umbilical artery pH is a good predictor of adverse neonatal outcome and is a useful tool for screening newborns at risk. Also an umbilical cord pH less than 7.2 can be used as a prognostic factor for prediction of neonatal outcome. Our study is one of the very few studies that compare CTG findings based on National Institute for Health and Care Excellence (NICE) guidelines with umbilical artery pH and neonatal outcome.

CASE REPORT

R Deepa, Theresa Terence, Christy Vijay, Annamma Thomas

Pregnancy Outcome in Cancer Survivors

[Year:2022] [Month:January-February] [Volume:14] [Number:1] [Pages:3] [Pages No:68 - 70]

Keywords: Bronchogenic carcinoma, Chemotherapy, Choriocarcinoma, Chronic myeloid leukemia, Cystadenocarcinoma, Gestational trophoblastic neoplasia, Papillary carcinoma thyroid, Perinatal outcome, Pregnancy, Survivors

   DOI: 10.5005/jp-journals-10006-1990  |  Open Access |  How to cite  | 

Abstract

Introduction: Advances in cancer detection and treatment have resulted in increased prevalence of female cancer survivors at child-bearing age-group. However, data regarding pregnancy outcome of cancer survivors are scarce. Aims and objectives: This article aims to determine whether cancer survivors have increased risk of obstetric complications. Results: We identified eight patients who have been treated for various types of malignancy and their maternal and fetal outcome during pregnancy. We identified the outcomes and possibilities of various diseases like choriocarcinoma, gestational trophoblastic neoplasia, synovial cell carcinoma, bronchogenic carcinoma, acoustic schwannoma, papillary carcinoma thyroid, chronic myeloid leukemia (CML), and cystadenocarcinoma of ovary. Conclusion: As developments in oncology continue, it is likely that we will see an increasing number of women with a history of cancer within obstetric services.

CASE REPORT

Shazia Parveen, Nasreen Noor, Aleena Haider, Iffat Zaman

Urethral Diverticulum Stone Causing Obstructed Labor

[Year:2022] [Month:January-February] [Volume:14] [Number:1] [Pages:2] [Pages No:71 - 72]

Keywords: Cesarean section, Fetal distress, Labor, Urinary bladder

   DOI: 10.5005/jp-journals-10006-1988  |  Open Access |  How to cite  | 

Abstract

Obstructed labor though being a well-known entity, cephalopelvic disproportion is the most common cause causing labor dystocia. Urethral diverticulum stone is a rare cause of obstructed labor. We report a case of urethral diverticulum stone obstructing the labor in a primigravida where cause of obstruction was confirmed by sonographic modality.

CASE REPORT

Agniv Sarkar, Manoranjan Mahapatra, Jita Parija, Richi Khandelwal

Nongestational Choriocarcinoma Managed by Neoadjuvant Chemotherapy and Interval Surgery: A Case Report

[Year:2022] [Month:January-February] [Volume:14] [Number:1] [Pages:2] [Pages No:73 - 74]

Keywords: Fertility-sparing surgery, Malignant germ cell tumor, Neoadjuvant chemotherapy in germ cell tumor, Nongestational choriocarcinoma

   DOI: 10.5005/jp-journals-10006-2002  |  Open Access |  How to cite  | 

Abstract

Ovarian cancer is the third commonest gynecological malignancy worldwide. Among ovarian cancer, epithelial carcinoma is the commonest followed by germ cell tumor. Choriocarcinoma of the ovary can be gestational or nongestational. Pure nongestational choriocarcinoma (NGCO) of the ovary is extremely rare. Histologically, it has the same appearance metastatic gestational choriocarcinoma to the ovaries. Here is a case of 15-year-old premenarchal girl referred with abdominal distension with ascites. Among her markers, beta-hCG was 860 IU/L and imaging showed a large mass with central necrosis. USG showed an ovarian mass with empty uterus. Due to her poor ECOG status, she was given etoposide + cisplatin for four cycles post-FNAC diagnosis of choriocarcinoma diagnosis. Post-neoadjuvant chemotherapy (NACT) her beta-hCG came down to be 2.16 IU/L. She subsequently underwent right salpingo-oophorectomy with surgical staging. Postoperative period was uneventful and further two cycles of etoposide + cisplatin were planned to be given. There is only a case series of 21 cases in India where NACT was given in advanced germ cell tumor followed by fertility-sparing surgery.

CASE REPORT

Ektha M Shetty

Primary Malignancy of the Salpinx: A Case Series and Review

[Year:2022] [Month:January-February] [Volume:14] [Number:1] [Pages:3] [Pages No:75 - 77]

Keywords: Carcinoma, Chemotherapy, Fallopian tube, Ovarian cancer

   DOI: 10.5005/jp-journals-10006-1999  |  Open Access |  How to cite  | 

Abstract

Aim: To analyze the case series of an incidentally detected primary fallopian tube cancer with various presentations, histopathological types, and management. Background: Carcinoma of the fallopian tube/salpinx being one of the rarest gynecological malignancies is most often incidentally diagnosed while operating for benign gynecological diseases. These carcinomas have been included under the term epithelial ovarian cancers which include ovarian, fallopian tube, and pelvic carcinomas, and the management techniques are the same for all three diseases. Case description: We have discussed a case series of two patients with incidentally detected fallopian tube carcinoma who presented with different clinical presentation and were incidentally detected during surgery with the management strategies undertaken for these patients along with a review of the literature in an attempt to clarify issues regarding presentation, diagnosis, and management of this condition. Conclusion: A correct preoperative diagnosis is made in very few cases. The Latzko\'s triad of watery vaginal discharge, a colicky lower abdominal pain, and a pelvic mass typical of a fallopian tube carcinoma are noted in very few patients. These two cases are being reported for their diagnostic dilemma, which resulted due to its rarity, in spite of having a classical clinical presentation. Clinical significance: Fallopian tube carcinoma has been a very infrequently encountered, often misdiagnosed genital malignancy which has been on a constantly rising trend, but once diagnosed, its treatment is very similar to epithelial ovarian cancer.

CASE REPORT

Ma S Oo, Nik Rafiza Afendi, Mya Mya Thwin

Cerebral Arteriovenous Malformation in Pregnancy

[Year:2022] [Month:January-February] [Volume:14] [Number:1] [Pages:3] [Pages No:78 - 80]

Keywords: Cerebral arteriovenous malformation, Hemorrhage, Multidisciplinary team, Pregnancy, Surgical management

   DOI: 10.5005/jp-journals-10006-2008  |  Open Access |  How to cite  | 

Abstract

Background: Cerebral arteriovenous malformations (CAVMs) are rare congenital lesions but the life-threatening condition with the possibility of rupturing during pregnancy. Case description: The case was a 25-year-old primigravida at 17 weeks gestation who was presented with recurrent prolonged excessive vomiting for a 1-month duration and treated as hyperemesis gravidarum. Subsequently, she had right hemiparesis and it was preceded by throbbing headache. The clinical diagnosis of paradoxical emboli or ruptured CAVM is made based on the clinical findings. Magnetic resonance imaging (MRI) brain showed subacute bleeding of ruptured AVM at the left parietal region. Angiogram revealed the site of bleeding vessels for excision of AVM and helped to arrest the bleeding. The benefit of surgery was outweighing the risk of miscarriage and proceeded with craniotomy, evacuation of hematoma, and excision of AVM at 22 weeks of gestation. Her postoperative course was uneventful and there was no issue of teratogenicity as a fetus at 24 weeks gestation. She had delivered a baby boy 2.8 kg via elective cesarean section at 38 weeks gestation without maternal and fetal complications. Conclusion: Cerebral arteriovenous malformations are relatively uncommon lesions in the general population and rare among pregnant females with significant maternal and fetal morbidity and mortality. The various clinical presentations warrant the different management approaches. Hence, a multidisciplinary team approach tailored to the individual case with appropriate management should be employed for pregnant women with CAVMs regardless of clinical presentation at gestational age and risk of rupture during pregnancy.

REVIEW ARTICLE

Richi Khandelwal, Sushil K Giri

Growing Teratoma Syndrome: A Review Article

[Year:2022] [Month:January-February] [Volume:14] [Number:1] [Pages:3] [Pages No:81 - 83]

Keywords: Chemotherapy, Complex cyst, Growing teratoma syndrome

   DOI: 10.5005/jp-journals-10006-1989  |  Open Access |  How to cite  | 

Abstract

It is a rare entity described among patients with non-seminomatous germ cell tumors (NSGCTs), characterized by enlarging metastatic masses despite appropriate systemic chemotherapy and normalized serum markers. The prevalence of growing teratoma syndrome (GTS) is only 1.9–7.6% after testicular NSGCT and 12% after ovarian germ cell tumor although more commonly seen is post-testicular and generally affects young adults and adolescents. The etiology remains unclear. They are mostly asymptomatic but abdominal pain/distension may be seen. Their prognosis is highly dependent on the timing of diagnosis, and early diagnosis has an excellent prognosis. There is no effective medical treatment for GTS and it is unresponsive to chemotherapy or radiotherapy. Total surgical removal of mature teratomas is currently the gold standard treatment of this condition. Hence, in this article, we have covered the complete review of this rare entity called GTS.

Book Review

YM Mala, Madhavi M Gupta, Asmita M Rathore, Neharika Malhotra, Ruchika Garg

Case Discussions in Obstetrics & Gynecology

[Year:2022] [Month:January-February] [Volume:14] [Number:1] [Pages:1] [Pages No:84 - 84]

   DOI: 10.5005/jsafog-14-1-84  |  Open Access |  How to cite  | 

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