Journal of South Asian Federation of Obstetrics and Gynaecology

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2018 | October-December | Volume 10 | Issue 4

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Guest Editorial

Antenatal Fetal Neurodevelopmental Assessment

[Year:2018] [Month:October-December] [Volume:10] [Number:4] [Pages:3] [Pages No:233 - 235]

Keywords: Antenatal fetal neurodevelopmental test, developmental disorder, ethnic difference, Kurjak's antenatal neurodevelopmental test, psychotropic drug, sex difference

   DOI: 10.5005/jp-journals-10006-1597  |  Open Access |  How to cite  | 



Pushpa Pandey, Shubhada Neel, EV Swaminathan, Joseph Lazar, PB Neel, Ramdevsri , Kashmira , Pradnya Pawar

Impact of Comprehensive Antenatal Care to Reduce the Complications During Pregnancy like Pregnancy-induced Hypertension and Intrauterine Growth Retardation

[Year:2018] [Month:October-December] [Volume:10] [Number:4] [Pages:9] [Pages No:236 - 244]

Keywords: Comprehensive antenatal care, Intrauterine growth retardation, Pregnancy-induced hypertension, Stress management, Rajayoga meditation

   DOI: 10.5005/jp-journals-10006-1598  |  Open Access |  How to cite  | 


Aim and objectives: The impact of comprehensive antenatal care to reduce the complications during pregnancy like pregnancy-induced hypertension (PIH) and intrauterine growth restriction (IUGR). Materials and methods: Five hundred thirty-two women attending the antenatal clinic at Neel clinic in Panvel, Navi Mumbai, India were enrolled between 18–28 weeks of pregnancy from May 2015 and April 2017, in prospective non-randomized, matched, interventional study. A total of 254 women were enrolled in the study group; 278 women were enrolled in the control group. Women were matched for age, gravida, parity, educational, religion, and residential area. Comprehensive antenatal care included: • Stress management through rajayoga meditation (Brahma kumaris) • Nutritious and satwik food • Antenatal physical and breathing exercises Exercises, walking and Meditation were practiced by the study group from date of entry into the study until delivery. The control group walked half an hour twice a day (standard obstetric advice) during the study period. Compliance in both groups was ensured by frequent telephone calls and maintenance of daily activity charts. Results: Complications such as isolated intrauterine growth retardation (IUGR) (p 0.002) and pregnancy-induced hypertension (PIH) with associated IUGR (p 0.001) were also significantly lower in the comprehensive antenatal care group. Conclusion: Stress management through meditation as well as exercise and nutritional management may contribute to decreasing risk of isolated intrauterine growth retardation (IUGR) (p 0.002) and pregnancy-induced hypertension (PIH) with associated IUGR, and eventually would decrease problems in the infant, children, adolescent and fetal origin of adult diseases. “Comprehensive antenatal care is safe, relatively cheap to implement and would reduce the costs of long-term health care.”



Sindhu Sree G, Sujatha MS, Suma MN

A Study of Urinary Calcium/Creatinine Ratio and Microalbuminuria as a Predictor of Preeclampsia

[Year:2018] [Month:October-December] [Volume:10] [Number:4] [Pages:4] [Pages No:245 - 248]

Keywords: Preeclampsia, Urinary calciumcreatinine ratio, Urinary microalbuminuria

   DOI: 10.5005/jp-journals-10006-1599  |  Open Access |  How to cite  | 


Objectives: To determine the predictive values of low urinary calcium/creatinine ratio and microalbuminuria for preeclampsia in a spot urine sample in asymptomatic pregnant women between 20 weeks and 32 weeks of gestation. Materials and methods: One hundred fifty pregnant women who attended the obstetrics and gynecology (OBG) OPD, JSS Hospital, Mysuru for routine antenatal care between 20 weeks and 32 weeks of gestation were included in the study and was followed up till term for clinical pieces of evidence of preeclampsia. Results: The incidence of preeclampsia was high among primigravidas (69.3%) compared to multigravidas (30.7%). Total 16 out of 150 pregnant women developed preeclampsia. Out of 16, 13 developed preeclampsia among cases and 3 in controls. The value of urinary calcium/creatinine ratio (UCCR) < 0.04 is taken as cut off value. 14 out of 16 patients have low urinary calcium/creatinine ratio out of which 11 (68.8%) patients developed preeclampsia subsequently. In the study group 11 (84.6%) patients, with urinary calcium/creatinine ratio < 0.04 developed preeclampsia and 2 (15.4%) patients with urinary calcium/ creatinine ratio > 0.04 developed preeclampsia. In the control group, one patient with significant urinary calcium/creatinine ratio did not develop preeclampsia. Conclusion: The study shows that urinary calcium/creatinine ratio < 0.04 is an excellent screening tool for the prediction of preeclampsia with a specificity of 97%, sensitivity 68%, positive predictive value 78%, and negative predictive value 96% and microalbuminuria as a fair predictor of preeclampsia



Nahid Shahbazian, Mojgan Barati, Kobra Shojaei, S Saheb Hoseininejad, Azadeh M Dehghani

Cell-free Fetal Deoxyribonucleic Acid Results in Low-risk Pregnancy Screenings for Aneuploidies

[Year:2018] [Month:October-December] [Volume:10] [Number:4] [Pages:4] [Pages No:249 - 252]

Keywords: Aneuploidy risk, Aneuploidy screen, Cell-free DNA, Low-risk pregnancy

   DOI: 10.5005/jp-journals-10006-1600  |  Open Access |  How to cite  | 


Introduction: Chromosomal aneuploidies are a common type of chromosomal defect that may impose heavy burdens on society and families. The most common chromosomal aneuploidies among the embryos are trisomies 21, 18, and 13. Prenatal screening and diagnosis are often used in prenatal care, and it seems to be a handy tool for doctors and women to make informed decisions about the continuation of pregnancies involved with genetic diseases. Prenatal noninvasive tests using cell-free fetal deoxyribonucleic acid (cff DNA) are a method for testing trisomy in embryos using the peripheral blood sample of the pregnant mother. Because most of the studies carried out on cff DNA have been in high-risk populations, this study attempted to examine the results of cff DNA in a population of low-risk aneuploidy pregnant women. Materials and methods: In this retrospective study, the study population was all pregnant women (n = 410), who underwent aneuploidy screening during the first or second trimester (with a low-risk result in quad test) in 2015–2016 and were at the risk of trisomies 13, 18, and 21 evaluated using cell-free fetal DNA test. Results: The mean age of pregnant women was 31.5 years, and 92.0% of the subjects were naturally pregnant, and only 8.1% had used assisted reproductive techniques (ART). Of these, 5.9% were fertilized by In vitro fertilization (IVF) and 2.2% by IUI method. Results of cff DNA in all pregnant women were negative. Conclusion: According to the results of this study, cff DNA testing results in all low-risk pregnant women were negative, and it is not recommended as a routine test in pregnant women reported as a low-risk pregnancy in serum screening.



Jyothi GS

Birth Asphyxia and Birth Injuries in Viable Term Neonates: Obstetrician's Role

[Year:2018] [Month:October-December] [Volume:10] [Number:4] [Pages:5] [Pages No:253 - 257]

Keywords: Birth asphyxia, Birth injuries, Cephalopelvic disproportion, Emergency lower segment cesarian section, Fetal heart declarations, Vaginal birth after cesarian section

   DOI: 10.5005/jp-journals-10006-1601  |  Open Access |  How to cite  | 


Aims and objectives: To identify and analyze the causes of birth asphyxia and birth injuries in viable term neonates. Materials and methods: The neonatal intensive care unit (NICU) admissions of all viable term neonates for birth asphyxia and birth injuries were analyzed between July 1, 2016 and June 30, 2018 in a tertiary care hospital. Those cases where the patient was referred in a state of emergency and was promptly taken up for emergency lower segment cesarian section (LSCS) were excluded. Only those cases, both registered and referred, where a vaginal trial was attempted were considered. The reasons why delivery was not expedited were analyzed to understand if birth asphyxia and birth injuries are preventable in viable term neonates. Results: Birth asphyxia and birth injuries are largely avoidable unless the patient has come in a state of acute emergency and the patient has been promptly taken up for emergency LSCS. The reasons for birth asphyxia and birth injuries in a viable term neonates are—the inability of the attending consultant (i) to decide when the induction of labor has failed, (ii) when not to attempt instrumental delivery and (iii) when to abandon further trial of labor. Conclusion: Birth asphyxia and birth injuries in viable term neonates should ideally never happen. Proper assessment before induction of labor and instrumental delivery is essential and every fetal heart deceleration recorded has to be taken seriously, though every heart deceleration need not be ominous. This will go a long way in preventing NICU admissions and suboptimal outcomes in viable term neonates and the ignominy of having to face litigation.



Bushra M Majeed

Effect of Leptin Level in Pregnancy Complicated by Preeclampsia and Pregnancy Outcome

[Year:2018] [Month:October-December] [Volume:10] [Number:4] [Pages:5] [Pages No:258 - 262]

Keywords: Birth weight, Delivery, Leptin, Preeclampsia, Pregnancy outcome

   DOI: 10.5005/jp-journals-10006-1602  |  Open Access |  How to cite  | 


In this research article, a descriptive study was applied during the period from January to August 2017 to evaluate maternal levels of leptin and make a comparison of serum leptin levels in typical pregnancies with those who are problematical by preeclampsia. A case study about (80) terms of primigravidas pregnant women who were attending AL Nomaan Teaching Hospital during the study period, 40 were known cases of preeclampsia and 40 were normotensive without another disease. Women have been monitored from admission time to delivery. Leptin levels have been determined in serum samples from the whole women. Mode of delivery and birth weight were identified as pregnancy outcome. The results revealed a statistically significant association between the disease and both decreased birth weight (small for gestational age) (p = 0.026) along with the delivery via cesarean section (p = 0.001). While neonatal birth weights have been considerably lower in women with preeclampsia in comparison to the control group (p < 0.001). Leptin levels have been greater in preeclamptic pregnant women as compared with normotensive, and high leptin in preeclampsia levels might be associated with increased adverse maternal and fetal outcome like low birth weight and raise the delivery hazard by cesarean section for different reasons.



GS Jyothi, Apeksha Kumar, Nandagudi S Murthy

Correlation of Anthropometry and Nutritional Assessment with Menstrual Cycle Patterns

[Year:2018] [Month:October-December] [Volume:10] [Number:4] [Pages:7] [Pages No:263 - 269]

Keywords: Anthropometry, BMI, Cross sectional study, Irregular menstruation, Nutrition

   DOI: 10.5005/jp-journals-10006-1603  |  Open Access |  How to cite  | 


Aim: The objective of this study was to create awareness about the significance of the various anthropometric measurements and nutritional status on menstrual cycle and to evaluate and scrutinize the association between various anthropometric measurements like body mass index (BMI), mid-upper arm circumference (MUAC), waist–hip ratio, triceps skin-fold thickness with menstrual cycle patterns. Materials and methods: Three hundred adult females belonging to age group between 18 years and 24 years studying in Ramaiah Health Institutions were included. The questionnaire was forward to the subject and relevant details elicited. Anthropometric assessment and thorough general physical examination (GPE) were done and categorized into various groups as per the standards proposed by the World Health Organization (WHO). Results: Out of the 300 subjects, 61.3% belonged to total normal weight, 22.9% underweight and 15.8% overweight. 83.7% belonged to the upper class and 16.3% upper middle class. The mean age of menarche was 12.77 years. The prevalence of irregular menstrual cycle was 35.7%. The prevalence of pubertal menorrhagia was 23.7%. Total 22% had high waist circumference and 2.9% high waist to hip ratio. According to the mid upper arm circumference, 3.7% were malnourished and 31.3% over-nourished Amongst those with a normal BMI, 62.8% had normal menstrual cycle length and amongst them, 37.2% had a longer menstrual cycle. 74.3% had dysmenorrhea. 60.3% of the women had abnormal BMI in which 8.7% were underweight and 51.6% overweight. 74.3% had dysmenorrhea. Less than 36% had an irregular menstrual cycle. Conclusion: Women have to maintain normal BMI and engage in regular physical activity to regulate their menstrual cycle which is a determinant of women's health. Findings of the present study have greater value for irregular menstruation. Clinical significance: Most of the parameters analyzed were statistically significant and have derived the implications that both nutrition and anthropometry play an important role in regulating the menstrual cycle patterns.



Sunesh Kumar, Neeta Singh, Richa Vatsa, Jyoti Meena, Aishwarya Parthsarthy

An Unusual Case of Vulvovaginal Mass: Aggressive Angiomyxoma

[Year:2018] [Month:October-December] [Volume:10] [Number:4] [Pages:3] [Pages No:270 - 272]

Keywords: Aggressive angiomyxoma, Recurrence, Vulvovaginal mass

   DOI: 10.5005/jp-journals-10006-1604  |  Open Access |  How to cite  | 


Aim: To sensitize clinician about aggressive angiomyxoma as an unusual cause of vulvovaginal mass. Background: Aggressive angiomyxoma (AA) is not a well known entity. Preoperative diagnosis is often incorrect, and most of the cases are detected on histopathological examination. Case description: A 45-year-old female, presented with the complaint of slow-growing mass in perineal area for 2 years. A large irregular firm to cystic mass, arising from the posterior wall of the vagina and protruding out of introitus extending into right ischiorectal fossa. Contrast enhanced computed tomography (CECT) revealed a well-defined mass in right perineum arising from the right lateral vaginal wall with ischiorectal fossa extension. Wide local excision was done under general anesthesia. Histopathology showed AA. Conclusion: Aggressive angiomyxoma (AA) is often misdiagnosed due to the rarity of this entity and absence of diagnostic features, but it should be considered in case of masses in the perianal region in reproductive age females. Complete surgical excision is the first line of management. Long-term follow-up is necessary. Clinical significance: Correct diagnosis of aggressive angiomyxoma is important as these tumors are benign and does not need radical surgery but recurrence is common, so long-term follow up of the patient is required. So, we reported this case to sensitize clinician about this unusual entity.



Dipak Limbachiya, Heena Chawla, Preeti Gandhi, Abeer Alzaydai

Oophorexy and Ovarian Bivalving in Recurrent Ovarian Torsion in Premenarchial Patient: Review of the Technique

[Year:2018] [Month:October-December] [Volume:10] [Number:4] [Pages:3] [Pages No:273 - 275]

Keywords: Adolescent girls, Ovarian bivalving, Ovarian fixation, Ovarian torsion

   DOI: 10.5005/jp-journals-10006-1605  |  Open Access |  How to cite  | 


Oophorexy for ovarian torsion is a simple procedure which seems justifiable in order to avoid devastating consequences. In premenarchial girls, pexy of the untwisted ovary, the contralateral ovary or both should be considered. We present an interesting case of 9-year-old girl with recurrent left ovarian torsion. This was the third episode of left ovarian torsion. She underwent right oopherectomy in the past for right ovarian torsion. Oophorexy along with detorsion had been done twice before with no success. So, during her third episode of left ovarian torsion ovarian bivalving after detorsion along with oophoropexy with multiple ligament fixations was done. After the untwisting of ischemic adnexa, ovarian bivalving is an effective technique to decrease ovarian intracapsular pressure, increase arterial perfusion, and facilitate adnexal reperfusion and recovery. As ovarian torsion may recur after detorsion unilateral or bilateral oophoropexy with multiple ligament fixations along with ovarian bivalving following detorsion may be performed to prevent recurrence.



Tshering Tamang, Ugyen Tshomo

Gestational Choriocarcinoma with Varied Clinical Presentation and Treatment Outcome: A Case Series

[Year:2018] [Month:October-December] [Volume:10] [Number:4] [Pages:5] [Pages No:276 - 280]

Keywords: Choriocarcinoma, Gestational trophoblastic neoplasia, Molar pregnancy

   DOI: 10.5005/jp-journals-10006-1606  |  Open Access |  How to cite  | 


Gestational choriocarcinoma is a highly malignant form of gestational trophoblastic neoplasia often seen with local and distant metastasis. It can arise from any type of pregnancy and presents with varied clinical signs and symptoms. Here, we present gestational choriocarcinoma cases diagnosed at Jigme Dorji Wangchuck National Referral Hospital with a variety of clinical presentation and the treatment outcomes. Six cases were confirmed in 2 years. Two cases presented with lung metastases; one with hemoptysis and the other with a chronic cough and lung mass. Three had large pelvic masses and abnormal vaginal bleeding. One patient had persistent uterine bleeding after a miscarriage. Two of the six patients had failed to follow-up after the diagnosis of molar pregnancy. Multiagent chemotherapy with selective hysterectomy and beta-hCG surveillance led to favorable outcomes. Teaching points: • A high degree of clinical suspicion is necessary for early diagnosis and appropriate treatment • Strict adherence to follow-up after molar pregnancy is important to avoid complications



Sunita R Tandulwadkar, Dilpreet K Kochar, Vaishali V Giri, Vaishali K Nayak

Pulmonary Adenocarcinoma in Pregnancy: A Challenging Case

[Year:2018] [Month:October-December] [Volume:10] [Number:4] [Pages:3] [Pages No:281 - 283]

Keywords: Case report, Pregnancy, Pulmonary adenocarcinoma, Targeted chemotherapy

   DOI: 10.5005/jp-journals-10006-1607  |  Open Access |  How to cite  | 


Aim: To understand the challenges associated with diagnosis and management of pulmonary adenocarcinoma in pregnancy. Background: Lung cancer during pregnancy is a rare condition and most of the patients are diagnosed in advanced stages, thus have adverse outcomes even after treatment. Management of such cases pose a singular challenge to the treating doctors. Case report: We are reporting a case of in vitro fertilization (IVF) conceived 38-year-old female with dichorionic diamniotic twin pregnancy, who was diagnosed with adenocarcinoma lung stage IV at 22 weeks of pregnancy. Ultrasound of thorax revealed right-sided pleural effusion with underlying lung collapse. Cytological examination of pleural fluid and pleural biopsy revealed adenocarcinoma. Computed tomography (CT) scan of the spine showed small lytic lesion in the D10 vertebral body. Magnetic resonance imaging (MRI) abdomen, MRI brain and ultrasound neck was negative for metastasis. The patient received targeted chemotherapy in form of oral gefitinib throughout pregnancy. Elective cesarean section was performed at 34 weeks of pregnancy, and targeted therapy was continued after delivery. Patient responded well to the management. Conclusion: Pulmonary adenocarcinoma in pregnancy is a challenging clinical situation to diagnose and manage. Early stage diagnosis and individualised management is the key to success. As there is limited data on use of targeted therapy in pregnancy, further trials and research is needed. Clinical significance: Pulmonary adenocarcinoma in pregnancy is a life-threatening condition with aggressive behavior and high mortality rates. It is of utmost importance to be thorough with the emerging trends in its diagnosis and management.



Shivali Bhalla, Seema Grover Bhatti, Roopam Garg

Placental Chorioangioma: A Rare Cause for Polyhydramnios and Fetomaternal Complications

[Year:2018] [Month:October-December] [Volume:10] [Number:4] [Pages:4] [Pages No:284 - 287]

Keywords: Nontrophoblastic placental tumors, Placental chorioangioma, Polyhydramnios, Preterm labor

   DOI: 10.5005/jp-journals-10006-1608  |  Open Access |  How to cite  | 


Aim: Placental chorioangioma is a rare cause for polyhydramnios which is often missed among its differential diagnosis, leading to grave fetomaternal complications. This case report aims to provide insight, that, despite their rarity, placental tumors are a potential cause for fetomaternal complications. Background: Chorioangioma is a nontrophoblastic benign vascular tumor leading to maternal complications and fetal complications. Timely diagnosis and intervention help improve fetomaternal outcomes. Case description: A 29-year-old, second gravida at 29 weeks 5 days gestation was admitted to labor room with preterm labor pains, history of a gush of watery discharge per vaginum, severe respiratory embarrassment, and bilateral lower limb edema. On per abdomen examination, liquor was increased, and the abdomen was distended up to xiphisternum. Ultrasonography revealed hyperechoic lesion approximately 6.6 x 4 cm arising from the placenta, suggestive of chorioangioma placenta. She delivered vaginally a live male baby weighing 1.9 kg. The baby had respiratory distress and was kept in neonatal intensive care unit on continuous positive airway pressure (CPAP) mode of ventilation. The woman had a bout of postpartum hemorrhage necessitating blood transfusion. Placental examination revealed lobular purplish red growth attached with a pedicle to the fetal surface of the placenta. Histological examination showed an angiomatous pattern of chorioangioma. As she presented late, we had no scope of providing conservative management for better fetomaternal prognosis. Conclusion: Adverse fetomaternal outcome in case of large chorioangioma warrants timely diagnosis and intervention. Clinical significance: Though rare, placental tumors must be considered as a differential diagnosis in cases of polyhydramnios.



Debabrata Barmon, Helen Kamei, Amal C Kataki, Mahamaya P Singh

Anterolateral Thigh Flap for Defect in Groin Area Following Resection of a Residual Disease of Vulvar Cancer: A Case Report

[Year:2018] [Month:October-December] [Volume:10] [Number:4] [Pages:3] [Pages No:288 - 290]

Keywords: Anterolateral thigh flap, Inguinofemoral lymphadenectomy, Reconstructive surgery, Vulvar cancer

   DOI: 10.5005/jp-journals-10006-1609  |  Open Access |  How to cite  | 


Introduction: Surgery for vulvar malignancies involves large defect, complicating wound healing and postoperative morbidity. However, it remains the mainstay of vulvar malignancy treatment. The prognosis for vulvar cancer is generally good with appropriate management. A multidisciplinary approach is desirable. Case report: A 69 years female presented with complaints of swelling in genital region and occasional bleeding from the mass for 9 months. With World Health Organization (WHO) performance score of 3, stage IIIC squamous cell was diagnosed. Palliative radiotherapy was given, 6 weeks later the primary lesion disappeared but the inguinofemoral mass size remained. With the improved general condition, excision was done (left-sided inguinofemoral lymphadenectomy) with flap grafting (Anterolateral thigh flap). Postoperative recovery was good. An additional 30GyEBRT was well tolerated. Conclusion: Advanced vulvar cancer surgery carries significant morbidity. With low incidence, the level of evidence for treatment of vulval cancer is low too. Reconstructive surgeries have shown reduction in morbidity and improvement in quality of life; but few studies are available evaluating the impact of such surgeries. ALT flap is a versatile perforator flap and hence, is useful in large vulvoperineal defect and large groin defect.



Ruchi Ohri, Varsha Vyas

Anesthetic Implications in a Primigravida Posted for Cesarean Section with Varicella Zoster Infection

[Year:2018] [Month:October-December] [Volume:10] [Number:4] [Pages:2] [Pages No:291 - 292]

Keywords: Anesthesia, Cesarean section, Pregnancy, Varicella zoster

   DOI: 10.5005/jp-journals-10006-1610  |  Open Access |  How to cite  | 


Varicella zoster (VZ) is a highly contagious deoxyribonucleic acid (DNA) virus. Varicella zoster infection (VZV) causes two distinct diseases; chicken pox as the primary infection and later when VZV reactivates shingles or herpes zoster. This infection has its clinical presentation as high fever followed by generalized vesicular lesions. Pruritic skin lesions start after 1 to 2 days of fever on the face and then progressed to all over body becoming pustular. The diagnosis of chickenpox is performed on the basis of clinical history and clinical classical sign and symptoms. It is a mild and self-limiting disease in children but severe complications like pneumonia, hepatitis, meningitis, encephalitis and bleeding diathesis can occur in adult and immuno-compromised person. We present the case of a primigravida with varicella who was posted for an emergency cesarean section and successfully managed.


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