Journal of South Asian Federation of Obstetrics and Gynaecology

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Volume 13, Number 1, January-February 2021

Original Article

Christy Maria, Naveen Ramesh, Avita R Johnson, Priya M Prince, Aleena Rodrigues, Anu Lekha, Anju Elias

Prevalence and Determinants of Postpartum Anxiety among Women Availing Health Services at a Rural Maternity Hospital in South India

[Year:2021] [Month:January-February] [Volume:13] [Number:1] [Pages:5] [Pages No:1 - 5]

Keywords: Anxiety, Depression, Hospital, Postpartum, Rural

PDF  |  DOI: 10.5005/jp-journals-10006-1858  |  Open Access |  How to cite  | 

Abstract

Introduction: Anxiety is defined as a feeling of worry, nervousness, or unease about something with an uncertain outcome. Though depression is the leading cause of disability for women worldwide, there is a paucity of literature regarding postpartum anxiety among rural Indian women. Aims and objectives: To estimate the prevalence of postpartum anxiety and its determinants among women availing health services at a rural maternity hospital in the Ramanagara district of south Karnataka. Materials and methods: The study included 231 postpartum women from the second day of delivery to 6 months postpartum attending the rural maternity hospital. Results: Our study consists of 46.7% of women belonging to 20–24 age-group and 76.2% belonging to lower middle/lower class. Prevalence of mild postpartum anxiety was found to be 88.17%, generalized anxiety being 10%, and severe anxiety as 1.3%. There was significant association between postpartum anxiety and depression (p-value = 0.00). Conclusion: There is a need for screening women for mental ill-health during and after pregnancy. National programs should include these assessments at the primary healthcare level.

Original Article

IPG Kayika, Lucas Christiawan, Atikah Sayogo Putri

Analysis of Adverse Events in the Department of Obstetrics and Gynecology, Cipto Mangunkusumo Hospital, in 2015

[Year:2021] [Month:January-February] [Volume:13] [Number:1] [Pages:5] [Pages No:6 - 10]

Keywords: Adverse events, Public service coordinator, Quality committee of patient safety and performance, Root cause analysis

PDF  |  DOI: 10.5005/jp-journals-10006-1862  |  Open Access |  How to cite  | 

Abstract

Background: Medical errors are a serious threat for they can lead to injury and death of the patients, as well as increased healthcare cost. According to the Institute of Medicine 2000 report, there were 3 to 16% of adverse events (AEs) occurred in inpatient care in United States, Denmark, United Kingdom, and Australia. However, AEs data in Indonesia is still limited. This study aimed to identify the distribution of AEs in the Department of Obstetrics and Gynecology (Ob-gyn) of Cipto Mangunkusumo Hospital based on locations, contributing factors, failure to prevent the occurrence, and additional length of stay. Materials and methods: Cross-sectional study was conducted towards AEs occurring in the Department of Ob-gyn of Cipto Mangunkusumo Hospital during January to December 2015. Data were obtained from Public Service Coordinator which had been clinically audited with the root cause analysis method. Results: During 2015, 36 AEs were reported, followed by a clinical audit by clinical risk management team. Twenty-four cases were included in this study. Based on the location, 13 (54%) cases occurred in the emergency room (ER), 4 (17%) in intensive care unit (ICU), 4 (17%) in operation theatre, and 3 (12%) in the hospital ward. Based on the contributing factor, 18 cases (75%) were due to lack of knowledge and skill of the medical personnel, 4 (17%) were due to other causes, and 2 (33%) were due to technical error. Based on the failure to prevent the occurrence, there were eight cases (33%) of delayed medical care or intervention, six (25%) of malpractice, five (21%) of misdiagnosis, three (13%) of failure to act based on test results, and two (8%) of failure to take precautions. The median of additional length of stay was of 2 days (0–34 days; 95% CI). Conclusion: Most of AEs in Department of Ob-gyn of Cipto Mangunkusumo Hospital, in 2015 occurred in ER (54%). The most frequent cause was lack of knowledge and skill of the medical personnel (75%), with delayed medical care or treatment as the most frequent failure to prevent the occurrence (33%).

Original Article

Sumesh Choudhary, Vineet V Mishra, Saiprasad Shinde, Himanshu Patel, Rohina Aggarwal, Khushali Gandhi

Chronic Kidney Disease with Pregnancy: Hemodialysis can be considered for Better Maternal and Fetal Outcomes

[Year:2021] [Month:January-February] [Volume:13] [Number:1] [Pages:4] [Pages No:11 - 14]

Keywords: Chronic kidney disease, Hemodialysis, Pregnancy

PDF  |  DOI: 10.5005/jp-journals-10006-1859  |  Open Access |  How to cite  | 

Abstract

Aim and objective: To analyze five patients with chronic kidney disease (CKD) with pregnancy managed with hemodialysis for better maternal and fetal outcomes. Design: Original article. Setting: A hospital-based prospective study. Patients: Five women with CKD reported in second trimester of pregnancy. Interventions: Hemodialysis done in all antenatal patients. Main outcome measures: Analyze maternal and fetal outcomes in patients with CKD treated with hemodialysis during pregnancy. Using hemodialysis to prolong the pregnancy by preventing preterm delivery. Results: Out of five patients, three patients had live fetuses and two patients’ fetuses had intrauterine growth retardation and low birth weight babies. Pregnancy was prolonged to 9 weeks in two patients, 4 weeks in two patients, and 21 days in the fifth patient. Conclusions: Possible return of fertility to the dialysis patient and pregnancy is most often unexpected. Hemodialysis to be considered for better maternal and fetal outcomes. Hemoglobin, electrolyte, nutrition, and proper weight gain to be monitored. Careful monitoring of the patient to avoid intradialytic hypotension is important. The close collaboration and motivation of the different medical and paramedical staff also depend on the outcome of the pregnancy. It is strongly advised to the dialyzed woman to wait for having been transplanted successfully to plan a pregnancy.

Original Article

Anita Bablad

Cesarean Section in Primiparous Women: A Retrospective Study

[Year:2021] [Month:January-February] [Volume:13] [Number:1] [Pages:3] [Pages No:15 - 17]

Keywords: Caesarean section, Complications, Indications, Maternal, Primipara, Rate

PDF  |  DOI: 10.5005/jp-journals-10006-1864  |  Open Access |  How to cite  | 

Abstract

Background: A cesarean section is a surgical procedure that when undertaken for medical reasons can save the life of women and their babies. The primary cesarean section rate is increasing. Many cesarean sections are undertaken unnecessarily, however, which can put the lives and well-being of women and their babies at risk—both in the short-term and in the long-term. Aims and objectives: To determine the rate, antenatal risk factors, indications, intraoperative, and postoperative complications of cesarean delivery in primiparous women. Materials and methods: This was a retrospective study conducted from January 2019 to December 2019. The study included all primiparous women who delivered by cesarean section after 28 weeks of gestation. The detailed information was collected from the records and then analyzed. Results: The total number of deliveries during the study period was 790; out of which cesarean deliveries were 456 (57.72%), and the number of primiparous women who underwent cesarean section was 150 (18.98%). The most common age-group in the study group was 18–25 years. Out of 150 women, 32 (21.33%) were preterm, 86 (57.34%) were term, and 32 (21.33%) were postdated pregnancy, respectively. Most (101/67.34%) of them were unbooked, while 49 (32.66%) were booked cases. The most common antenatal risk factors were anemia (43.34%) and postdated pregnancy (21.34%). The most common indication of cesarean section was non-reassuring fetal heart rate (FHR) (22%). Out of 150 women, 103 (68.66%) had undergone emergency cesarean section. Intraoperative and postoperative complications were less. There was one maternal mortality (0.66%) postoperatively during the study period. Conclusion: When medically necessary, cesarean delivery can effectively prevent maternal complications. Hence, women who need cesarean section should be identified accurately to reduce the rate of cesarean section in primipara and also to reduce maternal complications in short and long terms.

Original Article

Kemine Uzel, Igor Victorovich Lakhno

Effect of B-Lynch Suture: Bleeding Control and Asherman's Syndrome

[Year:2021] [Month:January-February] [Volume:13] [Number:1] [Pages:4] [Pages No:18 - 21]

Keywords: Asherman\'s syndrome, B-Lynch, Fertility, Hysteroscopy

PDF  |  DOI: 10.5005/jp-journals-10006-1854  |  Open Access |  How to cite  | 

Abstract

Aim and objective: The study was aimed to investigate possible complications such as intrauterine synechiae following the B-Lynch suture, which was used to control postpartum hemorrhage (PPH). Materials and methods: Our study included 36 patients, which underwent B-Lynch suture due to PPH from 2013 to 2015. Results: Asherman\'s syndrome was found in 3 (8.3%) of 36 patients who participated in the study. Two patients with Asherman\'s syndrome had a history of placenta accreta and one patient placenta previa. Conclusion: Compared to procedures that require experiences such as hysterectomy or internal iliac artery ligation, B-Lynch suture is a high-level PPH approach that preserves fertility potential with preventing complications.

ORIGINAL RESEARCH

Anshu Baser, Sunil Sharma, Sushil Kumar, Annabelle Sabu, Akriti Gupta, Sadaf S Shaikh

Indication for Cesarean Section as per Robsons's Criteria: An Analysis of 5000 Consecutive Cesarean Cases

[Year:2021] [Month:January-February] [Volume:13] [Number:1] [Pages:4] [Pages No:22 - 25]

Keywords: Cesarean section, Cesarean section rates, Robson\'s criteria

PDF  |  DOI: 10.5005/jp-journals-10006-1861  |  Open Access |  How to cite  | 

Abstract

Background: The increasing incidence of cesarean section around the world is becoming a matter of concern. Many obstetricians consider it to be the easier option as opposed to vaginal delivery. However, we must not forget that cesarean section is associated with increased morbidity to the patient. World Health Organization (WHO) in 2015 introduced Robson\'s criteria as a standardized method to determine the rate and indications of cesarean section within a healthcare facility. We here present a retrospective analysis of 5000 cesarean sections by Robson\'s criteria. Aim and objective: This study aims to analyze the indications for cesarean section at a tertiary care center. We also aim to determine whether Robson\'s classification can be used as an effective auditing tool to classify and collect data regarding cesarean sections. Materials and methods: A retrospective analysis of a total of 5000 lower segment cesarean section (LSCS) as per Robson criteria was carried out at MGM Hospital, Kalamboli from January 1, 2015 to December 30, 2019. The indications for LSCS and the maternal and fetal complications were noted. Results: The overall cesarean section rate during the study period was 28%. Out of the 5000 study population, 32.7% comprised of group 5 (previous cesarean section) of Robson\'s classification followed by 23.04% in group 2 (labor induced or LSCS before labor starts). Conclusion: Robson criteria can be used as an auditing tool for the increasing number of cesarean sections being performed around the world. As per Robson\'s criteria, group 5 (previous LSCS) remains the main indication for cesarean section (33%) followed by group 2 (nulliparous not in spontaneous labor) (23%), and group 1 (nulliparous in spontaneous labor) (17%), respectively. Groups 1 and 2 indicate cesarean sections in nulliparous women. Therefore, it is clear that increasing rates of primary cesarean sections, mainly in nullipara are responsible for the increase in cesarean section rates. Unless we reduce the rate of primary cesarean section, it may not be possible to reduce the cesarean section rate. Clinical significance: Cesarean sections are increasing worldwide. WHO recommends an ideal rate of 10–15%. If we can determine the indications of the cesarean section we can aim to reduce the cesarean section rate by reducing the primary indication itself. This in turn can help in reducing the morbidity and mortality associated with cesarean sections. Robson\'s criteria can be used as an effective tool due to its simplicity to classify these indications.

RESEARCH ARTICLE

Grisilda V Bernhardt, Malay Jhancy, Liegelin Kavitha Bernhardt, Pooja Shivappa, Suresh Kumar, Janita RT Pinto

Cord Blood Neutrophil Phagocytic Index in Neonates Born to Anemic Mothers and in Neonates Born with Risk of Early-onset Sepsis

[Year:2021] [Month:January-February] [Volume:13] [Number:1] [Pages:5] [Pages No:26 - 30]

Keywords: Cord blood, Innate immunity, Maternal anemia, Neonatal sepsis, Neutrophil phagocytic index, Phagocytic capacity

PDF  |  DOI: 10.5005/jp-journals-10006-1851a  |  Open Access |  How to cite  | 

Abstract

Introduction: During early life, the neutrophils as components of the innate immune system help to defend against pathogenic infections. Evaluation of cord blood neutrophil phagocytic index (NPI) has considerable value for understanding innate immune status. Few previous studies have investigated the association of maternal iron levels and neonatal immune status. The association of prenatal factors leading to increased risk of early-onset sepsis (EOS) in neonates is well understood. Neutrophils as components of the innate immune system represent the first line of defense against pathogens and are important especially during early life. Compromised neutrophil phagocytic functions and immune responses have been linked to the development of EOS in neonates. Aims and objectives: (1) To evaluate the phagocytic index of the neutrophils in the cord blood obtained from neonates born to anemic mothers. (2) To evaluate the phagocytic index of the neutrophils in the cord blood obtained from neonates born with risk factors for developing EOS. Materials and methods: To study NPI in neonates born to anemic mothers, 60 mothers and newborn pairs were recruited and subdivided into anemic and nonanemic groups, based on hemoglobin (Hb) levels of maternal blood. To study NPI in cord blood of neonates born with risk factors for EOS, 61 neonates with two or more risk factors for developing sepsis were recruited, along with 48 healthy infants who served as controls. Venous blood samples were collected 1.5 hours ± 20 minutes before the delivery. Five milliliters of cord blood was collected soon after childbirth. Results: The mean NPI values and also the mean gestational age and birth weight were significantly lower (p <0.05) in neonates of anemic mothers. Positive linear correlation (inverse relationship) of r = 0.67 and p <0.05 was observed between maternal Hb and NPI. Neonates with risk of EOS had significantly (p <0.05) lower values of NPI and significantly elevated levels of C-reactive proteins (CRP). Conclusions: There exists a significant association between maternal iron status and lowered phagocytic capacity of neutrophils, suggesting compromised innate immunity in neonates. Lowered NPI in the cord blood of infants born with risk of EOS is suggestive of the compromised immune response, which may add to the risk of developing EOS. Lowered cord blood NPI may mark early neonatal immune deficiency and immune processes in neonates. Further studies on cord blood NPI can lead to identifying NPI as an early predictor of EOS.

RESEARCH ARTICLE

Chanil D Ekanayake, Arunasalam Pathmeswaran, Sanjeewa Kularatna, Rasika Herath, Prasantha Wijesinghe

Randomized Controlled Trial on Nondescent Vaginal Hysterectomy and Total Laparoscopic Hysterectomy versus Total Abdominal Hysterectomy: A Cost-effectiveness Analysis

[Year:2021] [Month:January-February] [Volume:13] [Number:1] [Pages:7] [Pages No:31 - 37]

Keywords: Cost-effectiveness analysis, Nondescent vaginal hysterectomy, Randomized controlled trial, Total abdominal hysterectomy, Total laparoscopic hysterectomy

PDF  |  DOI: 10.5005/jp-journals-10006-1856  |  Open Access |  How to cite  | 

Abstract

Aim and objective: Hysterectomy is the commonest major gynecological procedure. There is little information from randomized controlled trials (RCTs) in low-resource settings. Therefore, the aim was to study outcomes and cost-effectiveness of nondescent vaginal hysterectomy (NDVH) and total laparoscopic hysterectomy (TLH) versus total abdominal hysterectomy (TAH). Materials and methods: A pragmatic multicenter three-arm (49 per arm) RCT was done on patients needing hysterectomy for benign uterine causes. Exclusion criteria were uterus larger than 14 weeks, previous pelvic surgery, any medical illness that contraindicated laparoscopy, and any patient requiring surgery for incontinence or uterovaginal prolapse. The main clinical outcome measure was time to recover. Incremental cost-effectiveness ratios (ICERs) were calculated for NDVH and TLH. Cost-effectiveness acceptability curves of NDVH and TLH were formulated. Results: There was no significant difference in time to recover [median (inter-quartile range) days] [TAH, 35 (30–45) days; NDVH, 32 (24–60) days; and TLH, 30 (26–45) days, p = 0.89]. The direct cost (USD) of TAH [659 (632–687)] was significantly lower compared to NDVH [800 (622–1116)] and TLH [752 (719–795)] (p = 0.03). The ICERNDVH showed TAH was dominant. ICERTLH was 11 USD/day. Worst-case scenario ICERs showed that TAH was dominant. NDVH and TLH were dominant to TAH in the best-case scenario. The probability of cost-effectiveness (threshold of 3 USD/day) was 1.15 versus 0% in the study setting, 0.2 versus 0% in the worst-case scenario, and 76.1 versus 79% in the best-case scenario for NDVH and TLH, respectively. Conclusion: The main clinical outcome, time to recover, showed an insignificant difference between TAH, NDVH, and TLH. However, when considering cost-effectiveness, TAH is likely to be the cost-effective method for the generalist, while the alternate routes NDVH and TLH are likely to be cost-effective in specialized centers.

RESEARCH ARTICLE

Chanil D Ekanayake, Swetha Thangasamy, Arunasalam Pathmeswaran, Rasika Herath, Sanjeewa Padumadasa, Sunil Fernando, Tiran Dias, Prasantha Wijesinghe

Vaginal Birth after Cesarean Section vs Elective Repeat Cesarean Section: A Cost-consequence Analysis

[Year:2021] [Month:January-February] [Volume:13] [Number:1] [Pages:6] [Pages No:38 - 43]

Keywords: Cost-consequence analysis, Elective repeat cesarean section, Vaginal birth after cesarean section

PDF  |  DOI: 10.5005/jp-journals-10006-1849  |  Open Access |  How to cite  | 

Abstract

Aim: There is limited evidence on the cost-effectiveness of vaginal birth after cesarean section vs elective repeat cesarean section. The aim of this study was to compare the outcomes and costs of vaginal birth after cesarean section vs elective repeat cesarean section. Materials and methods: A cost-consequence study was done from April 1, 2018 to March 31, 2019. Women admitted for delivery with one previous cesarean section were selected. Exclusion criteria were: multiple gestations, placenta previa, morbidly adherent placenta, birth weight <2.5 kg or >4 kg, and patients undergoing emergency cesarean section for antepartum emergencies. The outcomes and costs of vaginal birth after cesarean section vs elective repeat cesarean section were compared. Results: The vaginal birth after cesarean section was successful in 34 (50.7%) cases. There was no difference in median postpartum hospital stay between vaginal birth after cesarean section (n = 67)[2 (1–3) days] and elective repeat cesarean section (n = 158) [2 (2–2.25) days] (p = 0.15). There was no significant difference in total costs between vaginal birth after cesarean section and elective repeat cesarean section [USD 476 (420–566) vs USD 470 (452–494), p = 0.78]. The direct cost of the vaginal birth after cesarean section successful group (n = 34) was USD 427 (361–462) vs failed vaginal birth after cesarean section group (n = 32) USD 505 (476–716) (p <0.001). There was a significant difference in postpartum hospital stay between successful vaginal birth after cesarean section [2 (1–3) days], failed vaginal birth after cesarean section [2 (2–3.75) days], and elective repeat cesarean section [2 (2–2.25) days] (p < 0.01). Conclusion: The absence of a significant difference in postpartum hospital stay and cost between vaginal birth after cesarean section and elective repeat cesarean section raises serious clinical concerns with possible implications for health policy stakeholders.

RESEARCH ARTICLE

Moushmi Parpillewar Tadas, S Prashanthi, Manjushree Waikar

Maternal and Neonatal Outcomes of Pregnant Women with COVID-19: A Case–Control Study at a Tertiary Care Center in India

[Year:2021] [Month:January-February] [Volume:13] [Number:1] [Pages:6] [Pages No:44 - 49]

Keywords: Case–Control, COVID-19 in pregnancy, Maternal and neonatal outcome, Medical morbidity, Pregnancy-related morbidity

PDF  |  DOI: 10.5005/jp-journals-10006-1850a  |  Open Access |  How to cite  | 

Abstract

Aim and background: Coronavirus disease-2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), how it affects pregnancy very little is known. To identify maternal and neonatal risks associated with COVID-19 in pregnancy and to describe outcome a matched case–control study was done. Materials and methods: In this study, COVID-19 reverse transcription polymerase chain reaction (RT-PCR) positive women who delivered from May 1, 2020, to August 31, 2020, were included. Cases were classified according to their severity and investigations. Controls were selected from COVID-19 negative women in a 1:1 ratio who delivered in the study period. Data were collected, analyzed in terms of maternal and neonatal outcomes. Results: Of the total 181 COVID-19 cases delivered during the study period, there were 97.23% mild, 2.76% moderate, and 0.55% severe cases. A total of 178 (98.34%) were diagnosed in the third trimester. More COVID-19 cases were from urban areas. Mean gestational age in the mild category was 38.1 weeks and the moderate/severe category was 37.5 weeks. Around 154 (85.08%) were asymptomatic. Cases had more medical and pregnancy morbidity than controls, which was statistically significant. About 52.49% of cases and 33% of controls had cesarean. Length of hospital stay was more in cases. Mean birth weight was 2.7 ± 0.59 kg in cases and 2.5 ± 0.56 kg in control. There were 7 stillbirths in each group. A total of 14 in cases and 16 in controls were transferred to the newborn intensive care unit (NICU). Conclusion: The majority of COVID-19 infected women who are asymptomatic are in the mild category and there are no adverse maternal and neonatal outcomes due to the disease. The adversity of maternal and neonatal outcomes depends on the severity and severity of the disease is dependent on advanced maternal age and presence of comorbidities.

RESEARCH ARTICLE

Manisha Gupta, Neelima Agarwal, Alpana G Agrawal

Impact of COVID-19 Institutional Isolation Measures on Postnatal Women in Level 3 COVID Facility in Northern India

[Year:2021] [Month:January-February] [Volume:13] [Number:1] [Pages:5] [Pages No:50 - 54]

Keywords: COVID-19 Isolation, Edinburgh Postnatal Depression Scale, Mental health, Original research article, Postpartum anxiety

PDF  |  DOI: 10.5005/jp-journals-10006-1855  |  Open Access |  How to cite  | 

Abstract

Aim: The COVID-19 pandemic has influenced many aspects of a woman\'s life. The aim of the present study was to explore whether hospital isolation and containment policies among women giving birth in COVID‐19 Level 3 facility enhanced psycho‐emotional distress in the immediate postpartum period. Methodology: The study was designed as an observational study. All women giving birth at Santosh Hospital, a Level 3 COVID facility in Ghaziabad, from June 2020 to October 2020, were studied. Data collection was done by a pretested structured questionnaire which was administered to the participants in isolation ward on the second postpartum day. The women were interrogated regarding the experiences of the COVID isolation ward with special reference to the problems faced during their stay there, the anxiety for the baby, loneliness, and other factors. The women were evaluated using Edinburgh Postnatal Depression Scale (EPDS). Result: The study group comprised 61 women who delivered in our hospital. The mean age of the subjects was 24.2 ± 1.2 years. In the study, majority of the patients were distressed with loneliness (54%) and anxiety for the baby (43%). As the policy of the institution was to hand over the newborn baby immediately to the attendants, the mother was bound to be distressed. Sleeplessness, loss of appetite, and boredom were other problems faced by the COVID-positive patients. The incidence of postnatal depression was 24.5% during COVID-19 pandemic in this institution. In the study, we found that patients with postnatal complications, patients who had symptoms of COVID, whose baby was handed over to the attendants, postpartum stay more than 7 days, and inability to connect to the family had a statistically significant correlation with those who had EPDS score >13. Conclusion: The COVID-19 pandemic has shown that perinatal mental health and well-being needs to be protected during this time.

RESEARCH ARTICLE

Ambreen Qureshi, Ufaque Muzaffar

Impact of COVID-19 Lockdown on Admissions to a Tertiary Maternity Hospital in Srinagar

[Year:2021] [Month:January-February] [Volume:13] [Number:1] [Pages:3] [Pages No:55 - 57]

Keywords: Abruption, Anemia, Eclampsia, Intrauterine death

PDF  |  DOI: 10.5005/jp-journals-10006-1857  |  Open Access |  How to cite  | 

Abstract

Introduction: The first case of new pneumonia of unknown origin was found in Wuhan (China) on December 31, 2019. The causative virus was identified from throat swab samples in the Chinese Centre for Disease Control and Prevention (CCDC) on January 7, 2020, and it was named severe acute respiratory syndrome coronavirus (SARS‐CoV‐2). Subsequently, World Health Organization (WHO) renamed it COVID‐19. COVID-19 was a highly infectious newly discovered coronavirus, which led to a worldwide pandemic. It has shown an equal number of cases between men and women, but a lower mortality rate in women. Materials and methods: A retrospective observational study was conducted in the Department of Obstetrics and Gynaecology of GMC, Srinagar, comparing the total number of emergency admissions including obstetric emergencies, such as ectopic pregnancy, intrauterine device (IUD), severe anemia, eclampsia, abruption, obstructed labor, and postpartum hemorrhage (PPH) during a period of 6 months from March 2020 to August 2020 with that from March 2019 to August 2019. Results: A total of 13,784 patients were admitted over a period of 6 months from March 2020 to August 2020, and there was a significant decline in the admissions as compared to pre-COVID-19 period of March 2019 to August 2019 (p-value, 0.007). Conclusion: The COVID‐19 lockdown greatly reduced the rate of admission to gynecological and obstetric emergencies. This reduction allowed for more effective and efficient use of emergency services and will inspire policymakers to implement policies for efficient utilization of emergency services in the future.

REVIEW ARTICLE

Sangay Tshering, Namkha Dorji, Karma Lhaden

Implementing Enhanced Recovery after Surgery in Obstetrics: A Lesson from the Nationwide Lockdown

[Year:2021] [Month:January-February] [Volume:13] [Number:1] [Pages:3] [Pages No:58 - 60]

Keywords: Cesarean section, ERAS, Obstetrics

PDF  |  DOI: 10.5005/jp-journals-10006-1860  |  Open Access |  How to cite  | 

Abstract

Enhanced recovery after surgery (ERAS) has proven benefits to the patients and the health system at large. Implementing ERAS in obstetrics has the potential to decongest the maternity ward by reducing postoperative hospital stay with safe maternal and neonatal outcomes. Extrapolating outcomes from studies in a similar setting and from our experience, we hereby discuss the possibility of implementing modified ERAS in obstetrics adapted to our resource-limited setting. Contextual-based consensus on modifications and implementation has to come from all stakeholders for a successful program.

CASE REPORT

Prashanthi Selvaraj, Moushmi Parpillewar, Juzar Fidvi

Spectrum of Rudimentary Horn Pregnancy: A Case Series

[Year:2021] [Month:January-February] [Volume:13] [Number:1] [Pages:5] [Pages No:61 - 65]

Keywords: Rudimentary horn pregnancy, Rupture, Secondary abdominal pregnancy, Unicornuate uterus

PDF  |  DOI: 10.5005/jp-journals-10006-1852  |  Open Access |  How to cite  | 

Abstract

Unicornuate uterus occurs due to incomplete formation and fusion of the bilateral mullerian ducts. Pregnancy in this incompletely formed horn i.e., rudimentary horn pregnancy (RHP), can present with a wide range of symptoms that may be similar to ectopic pregnancies or may remain silent like a normal pregnancy. We present a case series of three women diagnosed with RHP in different periods of gestation at a tertiary care hospital in Central India. The need for high suspicion and the role of ultrasound in the accurate diagnosis of this obstetric emergency is highlighted. The literature is well stocked with case reports on RHP with different outcomes. These three cases are being reported because of their rarity.

CASE REPORT

B Rao Bahadur, Prabhadevi Kodey, Anantha Lakshmi Satyavathi Devi Rasamsetty

Uterine Smooth Muscle Tumor of Uncertain Malignant Potential in a Young Woman: A Rare Case Scenario

[Year:2021] [Month:January-February] [Volume:13] [Number:1] [Pages:2] [Pages No:66 - 67]

Keywords: Leiomyosarcoma, Radical hysterectomy, STUMP, Tumor

PDF  |  DOI: 10.5005/jp-journals-10006-1865  |  Open Access |  How to cite  | 

Abstract

Background: Smooth muscle tumor of uncertain malignant potential (STUMP) of uterus indicates a group of uterine smooth muscle tumors that are not diagnosed unequivocally as either benign or malignant. It is a rare tumor in young women. It is considered as a “transition” tumor between leiomyoma and leiomyosarcoma or possibly undiagnosed leiomyosarcoma. Case description: We herein report a case of uterine STUMP in a 28-year young nulliparous woman who presented with a symptom of continuous dull aching lower abdomen pain. MRI pelvis shows large transmural vascular mass. Underwent radical hysterectomy, histopathology report, and immunohistochemistry showed STUMP with ki67 <10%. Conclusion: STUMP is a rare tumor with inconsistent diagnostic criteria and has no definitive treatment protocols especially in young women who desire for fertility.

CASE REPORT

Kanan P Kotdawala, Manjusha Agrawal, Vaishali Ambatkar

Scar Endometriosis: A Case Report of a Rare Complication of Laparotomy for Ectopic Pregnancy

[Year:2021] [Month:January-February] [Volume:13] [Number:1] [Pages:3] [Pages No:68 - 70]

Keywords: Caesarean section, Ectopic pregnancy, Endometriosis, Laparotomy, Scar endometriosis

PDF  |  DOI: 10.5005/jp-journals-10006-1866  |  Open Access |  How to cite  | 

Abstract

Background: The presence of endometrium outside the uterine cavity is known as endometriosis. Scar endometriosis is an endometriosis present in or connected to a previous scar and is a relatively rare entity. Generally, a history of prior laparotomy, mostly cesarean section, is elicited. Case Report: A 28-year-old female, Para-2 Live-2 with exploratory laparotomy for ectopic pregnancy; presented to our hospital with a complaint of pain in the abdomen during menses for the past 1 year. She also complained of swelling in the lower abdomen since 10 months. She had two normal vaginal deliveries and history of exploratory laparotomy 3 years back for ruptured ectopic pregnancy of 2 months. A curved incision was placed around the nodule The nodule of around 3 cm × 2 cm was excised from the subcutaneous tissue extending up to the right rectus muscle and the defect was repaired with Vicryl 2-0 RB and closure of fat plane and skin was performed. Discussion: Scar endometriosis is an infrequent type of extrapelvic endometriosis. The incidence of scar endometriosis is 0.03–0.15% of all cases of endometriosis. The generally accepted hypothesis for scar endometriosis is “Iatrogenic/accidental implantation of endometrium in the wound during a laparotomy/laparoscopy”. Ultrasonogram (USG) scan and computerized tomography (CT) scan would ascertain the diagnosis in most cases and also act as guiding tools for fine-needle aspiration of such masses; especially to exclude malignancy. Management generally involves a wide local excision of the lesion. Sometimes, surgical excision may be combined with postoperative adjuvant therapy like gonadotropin-releasing hormone (GnRH) analog or dienogest. Primary prevention is always better than treating it later. Conclusion: To conclude, we can say that women presenting with a painful nodule near any laparotomy scar with cyclical/continuous pain which increases in size during the menstruation cycle should be suspected of scar endometriosis.

CASE REPORT

Shanthi Ethirajan, Bavya Selvamuthu, K Jayashree, Santhosh Kumar, Nazeem Fathima

Labial Adhesion in a Pubertal Girl—A Commonly Misdiagnosed Entity: A Case Report

[Year:2021] [Month:January-February] [Volume:13] [Number:1] [Pages:3] [Pages No:71 - 73]

Keywords: Labial adhesion, Labial agglutination, Labial fusion, Labial synechiae

PDF  |  DOI: 10.5005/jp-journals-10006-1867  |  Open Access |  How to cite  | 

Abstract

Labial adhesion is a gynecological condition where adhesion of labia minora occurs in the midline. It is commonly seen in the prepubertal age group, causing parental anxiety, rarely seen in postmenopausal women, and very rarely seen in the reproductive age group. Hypoestrogenism and inflammation are usually considered as a cause of labial adhesion. Many cases present with urinary symptoms leading to misdiagnosis unless a clinical examination is done. Management can be observation, medical, or surgical. Management becomes difficult in case of recurrences. We present a case of a 12-year-old pubertal girl who came to our hospital. She was misdiagnosed and was treated elsewhere as a urinary tract infection. Here she was diagnosed with labial adhesion and was treated for the same. She had recurrent adhesions which were managed appropriately.

CLINICAL TECHNIQUE

Shazia Khan, Kuan-Gen Huang, Ala U’wais

Techniques for completing Colpotomy without Uterine Manipulator in a Total Laparoscopic Hysterectomy

[Year:2021] [Month:January-February] [Volume:13] [Number:1] [Pages:3] [Pages No:74 - 76]

Keywords: Colpotomy, Total laparoscopic hysterectomy, Uterine manipulator

PDF  |  DOI: 10.5005/jp-journals-10006-1853  |  Open Access |  How to cite  | 

Abstract

Aim: To describe techniques used in our setup as an aide to completion of colpotomy in total laparoscopic hysterectomy (TLH), in situations where usage of a uterine manipulator is not feasible. Background: Over the years, various uterine manipulators have flooded the markets to make the step of colpotomy easier. But there are certain conditions that render the usage of manipulators impossible like narrow vagina, virgin women, retracted or pulled up cervix, and non availability of advance manipulators due to financial constraints. Performing TLH in these conditions is challenging, and certain technical innovations aid in ensuring safe completion of the surgery. Technique: We describe the techniques utilizing a gauze on the sponge holder to delineate the cervicovaginal junction. The anterior approach, posterior approach, approach through uterosacral ligament, and cardinal ligament are described for completion of colpotomy. Conclusion: In situations where the application of vaginal manipulators is not feasible, certain technical modifications and varying approaches to the cervicovaginal junction can aid in the successful completion of colpotomy in TLH. Clinical significance: Vaginal manipulator is a useful instrument in laparoscopic hysterectomy. It manipulates the uterus in cephalad, lateral, and anteroposterior directions, making surgical steps in laparoscopic hysterectomy easier and quicker to perform. Its vital role in safely delineating anatomical landmarks like a uterocervical junction, uterosacral ligaments, and ureter cannot be denied. However, there are certain circumstances where the vaginal route is not accessible, and insertion of a uterine manipulator becomes impossible. In these circumstances, the surgeon should know the other options that help in opening the cervicovaginal junction so that he can complete the surgery safely. Our techniques provide an aid for such difficult situations.

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