Journal of South Asian Federation of Obstetrics and Gynaecology

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2019 | May-June | Volume 11 | Issue 3

EDITORIAL

Can Human Papillomavirus Testing Replace Papanicolaou Smear in Near Future as a Screening Modality for Cervical Cancers?

[Year:2019] [Month:May-June] [Volume:11] [Number:3] [Pages:3] [Pages No:141 - 143]

PDF  |  DOI: 10.5005/jp-journals-10006-1694  |  Open Access |  How to cite  | 

Original Article

Garima Goel, Saroj Singh

A Comparison of Intraoperative and Postoperative Morbidity in Women Undergoing a Nondescent Vaginal Hysterctomy by Debulking Procedures vs the Conventional Method

[Year:2019] [Month:May-June] [Volume:11] [Number:3] [Pages:4] [Pages No:144 - 147]

Keywords: Intraoperative blood loss, Nondescent vaginal hysterectomy, Postoperative morbidity

PDF  |  DOI: 10.5005/jp-journals-10006-1702  |  Open Access |  How to cite  | 

Abstract

Introduction: Hysterectomy of an undescended uterus via the vaginal route (i.e., nondescent vaginal hysterectomy) has promising advantages over hysterectomy done via the abdominal route because of its lesser intraoperative and postoperative morbidity, better outcome, and patient acceptance. Performing a nondescent vaginal hysterectomy via the conventional method has certain limitations, as in the cases of uterine enlargement beyond 12 weeks, where debulking procedures are being used to reduce the bulk of the uterus to facilitate the vaginal delivery of the uterus. Materials and methods: This study was conducted in the Department of Obstetrics and Gynaecology, Sarojini Naidu Medical College, Agra from July 2017 to July 2018. An estimated 100 women underwent a hysterectomy via the debulking procedure (which were designated as the study group), and another set of 100 women underwent a nondescent vaginal hysterectomy via the conventional method (which were designated as the control group). Informed consent was obtained from all the participants. Both groups were evaluated for intraoperative time required, intraoperative blood loss, incidence of bladder and rectal injuries, postoperative sepsis, postoperative duration of catherization and mobilization, duration of postoperative intravenous fluid requirement and hospital stay, and overall morbidity. Results: It was found that overall morbidity is less in cases of NDVH done by using debulking procedures than via conventional methods. The debulking procedure may appear to be more mutilating, but, by virtue of conserving operating time and avoidance of an undue pull on the suspensory ligaments, a better postoperative recovery, lesser morbidity, and better overall acceptance of the procedure was achieved. Conclusion: It is therefore recommended that when the NDVH becomes difficult in delivering the uterus in masse, there should be no hesitation in adopting a particular debulking procedure as the situation may demand.

Original Article

Rumi Bhattacharjee, Nitin Raithatha, Shilpa Sapre, Smruti B Vaishnav, Vishal Sheth

An Analysis of Large Volume Blood and Blood Product Transfusion in Critically Ill Obstetric Patients: A Retrospective Study

[Year:2019] [Month:May-June] [Volume:11] [Number:3] [Pages:5] [Pages No:148 - 152]

Keywords: Massive blood transfusion, Maternal mortality, Postpartum hemorrhage, Severe obstetric hemorrhage

PDF  |  DOI: 10.5005/jp-journals-10006-1670  |  Open Access |  How to cite  | 

Abstract

Objectives: (1) To study the clinical profile of patients requiring massive blood transfusion (≥4 units). (2) To study the pattern of component requirement in these patients. (3) To study the maternal and fetal outcome. Materials and methods: Design: It is a retrospective database analysis over 2.5 years from January 2014 to June 2017. Setting: Rural tertiary care center in Anand, Gujarat, India. Population/sample: Cases with severe obstetric hemorrhage requiring acute transfusion ≥4 units were included. Samples size is 69. Data were obtained from the medical record department. Parameters analyzed were demographic and obstetric profile, transfusion and laboratory data, adverse maternal and neonatal outcome, data pertaining to intensive care unit (ICU), critical surgical intervention, and complications. Statistical analysis was done using Stata 14. Results: Of total 2619 institutional deliveries and 185 postpartum women referred from outside in the study period, 69 patients required large volume blood transfusion (2.4%). 95% were referred from the government and private setups. Postpartum hemorrhage (PPH) was the leading cause of hemorrhage with high case fatality index and maximum blood product consumption. p value = 0.0033 (nonparametric test). 76.8% required ICU admission and 40.5% required ventilatory support. 23% underwent peripartum hysterectomy. Maternal mortality occurred in 10% patients. Conclusion: Major blood loss in obstetric practice is the leading cause of maternal morbidity and mortality. Improper transfusion practices contribute to a lot of avoidable complications. Rapid recognition of anticipated and unanticipated hemorrhage, early aggressive hemostatic resuscitation, and multidisciplinary intervention can ensure optimal fetomaternal outcome.

Original Article

Gottipati Geya, Kantharaju Supriya

Maternal Serum Cancer Antigen 125: A Marker of Severity of Preeclampsia

[Year:2019] [Month:May-June] [Volume:11] [Number:3] [Pages:3] [Pages No:153 - 155]

Keywords: CA-125 levels, Gestational hypertension, Preeclampsia

PDF  |  DOI: 10.5005/jp-journals-10006-1671  |  Open Access |  How to cite  | 

Abstract

Aim: To study the levels of cancer antigen 125 (CA-125) in normal, preeclampsia, and gestational hypertension study groups and correlate with other parameters which mark the severity of the disease. Materials and methods: A cross-sectional study was conducted at a Tertiary Care Hospital, Mangaluru, India. A total of 165 subjects were divided into three study groups of preeclampsia, gestational hypertension, and normal pregnancy, and each group consisted of 55 subjects. Cancer antigen 125 levels were measured in these study groups. Results: Mean value of CA-125 value in the preeclampsia group was 56.7 IU/mL which was significantly higher compared to other two study groups. Cancer antigen 125 was found to have a positive correlation with systolic blood pressure (r value = 0.4, p value = 0.001), diastolic blood pressure (r value = 0.3, p value = 0.001), uric acid (r value = 0.2, p value = 0.001), and also an association was observed between increasing CA-125 and proteinuria (p value = 0.001) oligohydramnios (p value = 0.001) fetal growth restriction (p value = 0.03) and onset of the disease (p value = 0.001). However, a negative correlation with platelets (r value = −0.14, p value = 0.06) and birth weight (r value = −0.113, p value = 0.15) was observed. Conclusion: Cancer antigen 125 is a marker indicating increasing severity of the disease. It is a biochemical marker which can be used in screening of preeclampsia. Further studies are needed for the evaluation of raising serial CA-125 levels as a marker of progression of disease. Clinical significance: Hypertensive disorders of pregnancy are one of the most common causes of death due to pregnancy. Cancer antigen 125 was proposed to be elevated in patients with hypertension due to chronic inflammation. Hence CA-125 levels if used as screening tool can estimate the severity of the disease and help clinicians in identifying women who are at risk for further complications and act accordingly.

Original Article

Pooja Agarwal, Ruchika Gupta, Megha Kakkar, Tarun Mishra, Divya Agrawal, Surbhi Dahiya

Comparison of Liquid-based Cytology and Conventional Papnicolaou Smear as a Screening Tool in High-risk Females

[Year:2019] [Month:May-June] [Volume:11] [Number:3] [Pages:5] [Pages No:156 - 160]

Keywords: Conventional Papnicolaou smear, High-risk females, Liquid-based cytology

PDF  |  DOI: 10.5005/jp-journals-10006-1673  |  Open Access |  How to cite  | 

Abstract

Introduction: Cervical cancer is the second most common cancer in women in India. Certain high-risk behavior is associated with an increased incidence of cervical cancers. Detection of its premalignant lesions is of utmost importance, which can be easily done by screening methods such as conventional Pap (CP) and liquid-based cytology (LBC). Aim: The aim of the present study was to ascertain the effectiveness of CP and LBC as screening methods in high-risk group females and to determine if any one method is superior to the other. Materials and methods: This study was conducted over a period of 6 months at SN Medical College, Agra. All high-risk group females were included in the study and paired samples for CP and LBC were collected from such patients. A total of 40 such cases were encountered during our study period. Patients having abnormal vaginal bleeding with known uterine or hormonal cause and known case of invasive carcinoma cervix were excluded from the study. Results: A maximum number of cases were in the reproductive age group, most common age of presentation being 31–40 years (35%) followed by 20–30 years (32.5%). A majority of patients were presented with a history of early sexual activity (<18 years) (52.5%), followed by multiparity (25%). Overall CP had 100% sensitivity while LBC had a sensitivity of 91.6%. However, LBC detected one additional case of ASCUS and two additional cases of HSIL over CP. So LBC detected more cases but with a slightly decreased sensitivity over CP. Conclusion: Both the screening methods are very effective and sensitive in the detection of premalignant lesions with slight discordance of grade on histology. Thus, we conclude that cervical cytology is very effective in the detection of premalignant lesions with the sensitivity of almost 100%. In developing countries such as India, where finances pose a major problem, conventional method is as good as LBC.

Original Article

Atakan Tanacan, Murat Cagan, Mehmet Sinan Beksac

Changing Trends in the Delivery of Breech Presentation throughout the Last Four Decades

[Year:2019] [Month:May-June] [Volume:11] [Number:3] [Pages:3] [Pages No:161 - 163]

Keywords: Birth, Breech presentation, Delivery, Pregnancy

PDF  |  DOI: 10.5005/jp-journals-10006-1678  |  Open Access |  How to cite  | 

Abstract

Background: To demonstrate the changing trends in the delivery of breech presentations throughout the last four decades. Materials and methods: We retrospectively evaluated the birth data in the last four consecutive decades (1980s, 1990s, 2000s, and 2010s) for breech deliveries. A total of 25,513 deliveries between January 1980 and December 2017 were evaluated, with 371, 269, 292, and 275 breech deliveries in the 1980s, 1990s, 2000s, and 2010s groups, respectively. Results: The incidences of breech presentation for the 1980s, 1990s, 2000s, and 2010s groups were 4.3%, 4.8%, 5.6%, and 4.6%, respectively, and the mean gestational weeks at birth were 37.84 ± 3.23, 36.90 ± 3.22, 36.15 ± 3.22, and 36.35 ± 2.77, respectively. The average gestational week at birth had statistically significantly decreased over the decades (p < 0.001). However, the appearance, pulse, grimace, activity, respiration (APGAR) scores gradually increased (p < 0.001). The cesarean section (CS) rates were 67.6% (251/371), 90.3% (243/269), 96.6% (282/292), and 99.3% (273/275) for the 1980s, 1990s, 2000s, and 2010s groups, respectively, which were statistically significantly different (p < 0.001). The CS rate had gradually increased over the decades. Conclusion: Cesarean section rates in fetuses with breech presentation have gradually increased over the decades. Choosing vaginal delivery for selected breech presentations, providing proper education to obstetricians regarding breech delivery, regulating medicolegal issues, and encouraging physicians to perform more vaginal deliveries for breech presentation should be the key points in decreasing CS rates associated with breech presentation.

Original Article

Shailza Vardhan, Poonam Yadav, Rachana Agarwal, Urvashi Verma, Mohita Pengoria

Effect of Sildenafil Citrate and Estradiol Valerate on Endometrial Characteristics in Ovulation-induced Cycle in Women with Dysovulatory Infertility

[Year:2019] [Month:May-June] [Volume:11] [Number:3] [Pages:3] [Pages No:164 - 166]

Keywords: Endometrial thickness, Estradiol valerate, Infertility, Sildenafil citrate

PDF  |  DOI: 10.5005/jp-journals-10006-1687  |  Open Access |  How to cite  | 

Abstract

Objective: The objective of this study was to study the effect of sildenafil citrate and estradiol valerate on endometrial thickness, blood flow, and pregnancy outcomes in women with dysovulatory infertility. Materials and methods: It is a comparative prospective study, including 80 women with primary or secondary dysovulatory infertility. Women with thin endometrium were randomly distributed in two groups. In group I (estradiol group), 40 women were included and given estradiol valerate tablets orally by the step-up method, and in group II (sildenafil plus estradiol group), 40 women were included and given sildenafil citrate tablets orally 25 mg TDS daily in addition to the estradiol valerate tablets as per above the step-up method from day 1 of the cycle until 12th day. Patients were reevaluated by transvaginal sonography (TVS) from day 10th until documentation of ovulation for endometrial thickness and pattern with number and size of graffian follicle. Results: Mean endometrial thickness posttreatment on day 14th was 9.0175 ± 2.58 mm in group I and 9.375 ± 1.989 mm in group II. Only 45% in group I had vascularity up to zone 3, whereas 62.5% patients in group II had zone 3 endometrial vascularity (p value < 0.05). Clinical pregnancy rate in group I and group II was 22.5% and 35%, respectively (p value < 0.05). Conclusion: Both oral estradiol valerate and sildenafil citrate significantly improve endometrial thickness, vascularity, and echogenicity. When compared to estradiol alone (which increases endometrial thickness and echogenicity) but the addition of sildenafil citrate improves endometrial blood flow.

Original Article

Suman Poddar, Saikat Tripathy

Double-blind Randomized Controlled Trial Comparing the Effect of Closure vs Nonclosure of Peritoneum during Cesarean Section on Postoperative Pain

[Year:2019] [Month:May-June] [Volume:11] [Number:3] [Pages:5] [Pages No:167 - 171]

Keywords: Peritoneal suturing, Postoperative pain, Verbal rating scale, Visual analog scale

PDF  |  DOI: 10.5005/jp-journals-10006-1691  |  Open Access |  How to cite  | 

Abstract

Background: Postoperative pain is one of the major discomforts interfering with baby-care after cesarean section. In our resource-poor hospital setup, we have addressed the issue of impact on postoperative pain, with peritoneal suturing keeping a standardized anesthetic and surgical technique; and postoperative conditions. Aim: To compare postoperative pain intensity after peritoneal closure vs nonclosure during cesarean section. Materials and methods: All total of 140 eligible subjects were allocated over one year into two equal groups as per the randomization list. In the control group, both visceral and parietal peritoneum was closed using absorbable suture; whereas in the study group, both peritoneal layers were left un-sutured. All patients received similar anesthetic and surgical techniques. Postoperative pain assessment was done at regular intervals by a 100 mm visual analog scale (VAS) at rest and on movement. Patient satisfaction was assessed by verbal rating scale (VRS). Per rectal diclofenac was given as an on-demand analgesic and recorded with dose. Both subjects and outcome assessors were blinded in the study. Results: Two groups were found to be matched with respect to basic characteristics, i.e., age, body mass index (BMI), gestational age, gravida, and surgical skill. Operative time was significantly (p < 0.00001) shorter in a nonclosure group. There was no significant difference found in the VAS score for postoperative pain (both at rest and on movement) observed at regular intervals (6/12/24/48 hours) between the two groups. Patient satisfaction level was also not significantly different, as demonstrated with a VRS score after 24 hours and 48 hours (p = 0.5776 and 0.2354, respectively). Postoperative on-demand analgesic dose was found significantly higher in closure group during the first 24 hours and later (p < 0.00001 and 0.00034, respectively). Conclusion: Peritoneum suturing can safely be avoided during the cesarean section. This would be significantly cost-effective with adequate patient satisfaction.

RESEARCH ARTICLE

Shailja S Bhamri

Association of Mean Platelet Volume in the Late First Trimester of Pregnancy and Development of Preeclampsia

[Year:2019] [Month:May-June] [Volume:11] [Number:3] [Pages:3] [Pages No:172 - 174]

Keywords: Mean platelet volume, Predictive value, Preeclampsia

PDF  |  DOI: 10.5005/jp-journals-10006-1672  |  Open Access |  How to cite  | 

Abstract

Aim: The aim of the study was to find out the correlation between the mean platelet volume in the late 1st trimester of pregnancy and development of a Preeclampsia later on. Materials and methods: It was a prospective cohort study in which 500 pregnant women (11–14 weeks of gestation) were enrolled and their mean platelet volume (MPV) was measured. They were followed till delivery. MPV of pre-eclamptic and normotensive women was compared. Results: MPV of pre-eclamptic women was significantly higher than that of the normotensive women (p = 0.001). Conclusion: MPV >10.55 fL was found to be 68.7% sensitive and 55.9% specific for the prediction of Preeclampsia with a negative predictive value of 87.6%.

RESEARCH ARTICLE

Priyanka Sharma, Raina Chawla, Rashmi Ahuja, Usha Gupta

Anti-Müllerian Hormone as a Surrogate Marker for Hormonal Dysfunction and Sonographic Pattern in Polycystic ovarian syndrome

[Year:2019] [Month:May-June] [Volume:11] [Number:3] [Pages:6] [Pages No:175 - 180]

Keywords: Anti-Müllerian hormone, Hyperandrogenemia, Polycystic ovarian syndrome

PDF  |  DOI: 10.5005/jp-journals-10006-1674  |  Open Access |  How to cite  | 

Abstract

Aim: To examine the association of serum anti-Müllerian hormone (AMH) levels with biochemical derangement and sonographic appearance in PCOS women and to examine its role as a possible marker for diagnosis and prognosis of polycystic ovarian syndrome (PCOS). Materials and methods: This case-control study was conducted on patients attending the Gynecology OPD at ESIC Medical College and Hospital, Faridabad, Haryana from March 2017 to September 2017. 45 PCOS women and controls between 18 years and 45 years were recruited. Relevant clinical, biochemical, and sonographic data were collected. Linear regression was used to study the association between biochemical and sonographic variables and PCOS. Receiver-operating characteristic (ROC) curve analysis was performed for AMH, LH/FSH ratio, antral follicle count (AFC), and mean ovarian volume. The AMH cut-off value was determined for the prediction of PCOS. Results: Mean AMH levels were significantly higher in the PCOS group (5.9 v/s 2.36 ng/mL). In PCOS women, AMH levels positively correlated with AFC, mean ovarian volume, as well as androstenedione and testosterone levels. In controls, a significant positive correlation was found with serum testosterone and mean ovarian volume. An AMH had greater diagnostic potential for detecting PCOS compared to AFC, mean ovarian volume, and LH/FSH ratio. A threshold AMH value of 3.98 ng/mL had a sensitivity of 82.2% and a specificity of 93.3% for diagnosing PCOS. Conclusion: Serum AMH levels correlate well with hyperandrogenemia and sonographic features of PCOS and could be used as a marker for hormonal dysfunction and disease severity. Clinical significance: An AMH is a promising marker that could improve the diagnosis of PCOS and also help in establishing disease severity.

RESEARCH ARTICLE

Arati Mahishale, Joyner C Mesquita

Association of Premenstrual Syndrome with Body Mass Index and its Effect on Quality of Life: A Cross-sectional Study

[Year:2019] [Month:May-June] [Volume:11] [Number:3] [Pages:4] [Pages No:181 - 184]

Keywords: Body mass index, Moos menstrual distress questionnaire, Premenstrual syndrome, Quality of life, SF-36 questionnaire

PDF  |  DOI: 10.5005/jp-journals-10006-1684  |  Open Access |  How to cite  | 

Abstract

Background: It has been estimated from retrospective community surveys that nearly 90% of women have experienced at least one premenstrual syndrome (PMS). Premenstrual syndrome is more prevalent among younger women. It also has a negative impact on the quality of life (QoL) to such a degree that work and lifestyle may get affected. Objective: To find the association between PMS and the body mass index (BMI) and its effect on the QoL. Materials and methods: A total of 207 females in the age group of 18–25 years were screened using the Moos menstrual distress questionnaire for PMS, of which 57 volunteers were diagnosed with PMS. Baseline characteristics were recorded, BMI was calculated, and QoL of all subjects was measured using the SF-36 questionnaire. Outcome measures: Body mass index, Moos menstrual distress questionnaire, SF-36 questionnaire. Results: The results showed a significant correlation between PMS and the physical component summary (r value = −0.4228, p value = 0.0011) and also between PMS and the mental component summary (r value = −0.4326, p value = 0.0008). However, there was no significant correlation between PMS and BMI. Conclusion: Premenstrual syndrome has a negative impact on QoL; however, no association with BMI was observed.

RESEARCH ARTICLE

Krupa H Shah, Ruby Sultana, Rema Nambiar, Parvati Bhat, Shashikala Bhat

Prediction of Early Pregnancy Loss by Ultrasound Markers

[Year:2019] [Month:May-June] [Volume:11] [Number:3] [Pages:5] [Pages No:185 - 189]

Keywords: Early pregnancy loss, Fetal bradycardia, Small gestational sac, Ultrasound, Yolk sac miscarriage

PDF  |  DOI: 10.5005/jp-journals-10006-1685  |  Open Access |  How to cite  | 

Abstract

Background: The purpose of the present study is to determine the performance of ultrasound markers in transvaginal scan (TVS) for the diagnosis of early pregnancy loss (EPL). Materials and methods: This was a prospective observational study of 365 women undergoing initial TVS at between 6 weeks and 10 weeks of gestation. Demographic data were collected. Ultrasound parameters like gestational sac diameter (GSD), yolk sac diameter (YSD), crown rump length (CRL), and embryonic heart rate (HR) were studied at the booking visit, and patients with an inconclusive scan report were asked for follow up after a week or 10 days. Outcome: The measured outcome was first trimester (up to 14 weeks) pregnancy loss. Univariate analysis was done to compare both groups. Receiver-operating curve (ROC) was derived to find out the best cutoff value for studied parameters. Results: Among 365 recruited patients, outcome was known for 91.7% (n = 335). Of 335 analyzed subjects, 272 had ongoing pregnancy (group I) and 63 had miscarriage (group II). Univariate analysis showed significant association of age, symptoms like bleeding per vagina, suprapubic pain, and low GSD, CRL, HR, and difference of GSD CRL with EPL (p < 0.05). Detection of EPL was highest for HR below 5th centile (57%). Best cutoff values were derived for all parameters in ROC and it was found that GSD value of less than 20 mm had sensitivity of 60% with 77% specificity; for CRL of less than 7.5 mm, it was 61% and 75%; and for HR less than 85 bpm, it was 85% and 99%, respectively. The GSD CRL difference of less than 8.5 mm was found highly sensitive (91%) for prediction of EPL on ROC cutoff. Conclusion: We conclude that calculating GSD, YSD, CRL, and HR at 6th–10th gestational weeks was significant in predicting gestational prognosis. Low embryonic HR (<85 bpm) was found to be an excellent performer in prediction of EPL through ROC. This study emphasizes further on the importance of performing obstetric ultrasound scan with precision and mindfulness.

RESEARCH ARTICLE

Varsha Priyadarshini, Alpana Singh, Gita Radhakrishnan

Association of Serum and Cervical Tissue Levels of Organochlorine Pesticides with Cervical Cancer in Women of East Delhi: A Case Control Pilot Study

[Year:2019] [Month:May-June] [Volume:11] [Number:3] [Pages:4] [Pages No:190 - 193]

Keywords: Bioaccumulation, Cervical cancer, Organochlorine pesticides

PDF  |  DOI: 10.5005/jp-journals-10006-1690  |  Open Access |  How to cite  | 

Abstract

Aim and objectives: Organochlorine pesticides (OCPs), known to have estrogenic activity, have been implicated in pathogenesis of reproductive tract cancers. Our study was aimed at understanding the role of OCPs in cervical cancer. Materials and methods: Approximately 3 mL of blood and 1 g of cervical tissue was taken from 30 cervical cancer patients and 30 controls and subjected to OCP analysis. Blood and tissue levels of OCPs were compared between cases and controls and correlation was assessed between OCP levels in blood and cervical tissue in each subject. Results: Blood levels of endosulfan-I (1.72 vs 1.23 ppb, p = 0.001), ppDDD (1.66 vs 0.002 ppb, p = 0.001) and cervical tissue levels of βHCH (4.23 vs 1.38 ppb, p = 0.000), heptachlor (3.54 vs 1.87 ppb, p = 0.008) and endosulfan-II (1.20 vs 0.66 ppb, p = 0.000) were significantly raised in cervical cancer patients compared to controls. No correlation was found between OCP levels in blood and cervical tissue in either case or control. Conclusion: OCP exposure may be associated with increased risk of cervical cancer. Also, there does not seem to be any correlation between blood and cervical tissue levels of pesticides.

REVIEW ARTICLE

Ashraf Ghiasi

Prevalence of Polycystic Ovarian Syndrome in Iranian Adolescents: A Systematic Review and Meta-analysis

[Year:2019] [Month:May-June] [Volume:11] [Number:3] [Pages:4] [Pages No:194 - 197]

Keywords: Adolescence, Polycystic ovarian syndrome, Systematic review

PDF  |  DOI: 10.5005/jp-journals-10006-1681  |  Open Access |  How to cite  | 

Abstract

Objective: Polycystic ovarian syndrome (PCOS) is an endocrine disorder that frequently manifests during adolescence. The studies performed in Iran have reported a different prevalence of PCOS in adolescents. Therefore, the aim of this systematic review and meta-analysis study was to estimate the pooled prevalence of PCOS in Iranian adolescents. Materials and methods: An electronic search was performed using Web of Science, PubMed, Scopus, Magiran, SID, and also search engine of Google Scholar from inception until November 2018 to identify published papers on the prevalence of PCOS in Iranian adolescents. Of 458 articles that were assessed for eligibility with the PRISMA statement, a total of 8 studies met inclusion criteria. Data were analyzed using Review Manager Software (RevMan v5.3). Results: The included studies in the review involved 12,796 participants, with a minimum of 895 and a maximum of 3,190. Pooled estimates revealed that the prevalence of PCOS in Iranian adolescents according to the NIH criteria and Rotterdam criteria were 3% (95% CI: 2–4%), and 7% (95% CI: 6–8%) respectively. Conclusion: Considering the significant effect of PCOS on fertility and public health of women, interventions for prevention, diagnosis, and management of this syndrome from adolescence are necessary.

REVIEW ARTICLE

Pritti K Priya, Priyankur Roy, Hetvi Patel

Role of Prenatal Diagnosis in Parents with Sex Chromosomal Abnormality: A Review

[Year:2019] [Month:May-June] [Volume:11] [Number:3] [Pages:5] [Pages No:198 - 202]

Keywords: Down syndrome, Klinefelter\'s syndrome, Prenatal diagnosis, Sex chromosome abnormality, Triple X syndrome, Turner syndrome

PDF  |  DOI: 10.5005/jp-journals-10006-1682  |  Open Access |  How to cite  | 

Abstract

Sex chromosome aneuploidy is defined as a numeric abnormality of an X or Y chromosome and includes 45,X (Turner syndrome); 47,XXY (Klinefelter\'s syndrome); 47,XXX; and 47,XYY karyotypes. Individuals with 47,XXX and 47,XXY are generally fertile, but there is a risk of having a cytogenetically abnormal child in them. Turner and Klinefelter\'s syndromes are frequently associated with infertility, but few cases have been reported that they were able to give birth to a normal child as well as some children were born with similar or some other chromosomal abnormalities. Triple X syndrome occurs in 0.1% of live-born female newborns. Most of these newborns have a normal phenotype and only a few cases with 47,XXX karyotype have congenital malformations. These female patients may be mostly fertile, but there appears to be an increased risk of a cytogenetically abnormal child; the extent of this risk cannot yet be determined. Therefore, prenatal diagnosis and genetic analysis are therefore recommended. We report a rare case of triple X woman with a history of a Down syndrome child, for which she was advised a prenatal diagnosis in her subsequent pregnancy, and a review of other pertinent articles to establish the role of a prenatal diagnosis in parents with a sex chromosomal abnormality.

REVIEW ARTICLE

Nachimuthu Gomathy, Karukkupalayam R Dhanasekar

An Effective but Forgotten Therapy in Dysmenorrhea

[Year:2019] [Month:May-June] [Volume:11] [Number:3] [Pages:4] [Pages No:203 - 206]

Keywords: Dysmenorrhea, Humulus, Passiflora, Valerian

PDF  |  DOI: 10.5005/jp-journals-10006-1683  |  Open Access |  How to cite  | 

Abstract

Dysmenorrhea has no long-lasting therapeutic strategy despite the advances in medicine. The European medicinal plants such as Valeriana officinalis, Passiflora incarnata and Humulus lupulus have been used as folklore remedy in the past century. However, they have not reached the masses due to paucity of information in the leading medical journals. This article reviews the clinical benefits and possible mechanism of action of these medicinal plants in the treatment of dysmenorrhea. We also suggest this fixed dose combination in the management of dysmenorrhea in daily clinical practice.

REVIEW ARTICLE

Surahman Hakim, Budi I Santoso, Ali Sungkar, Raymond Surya, Adly N Al Fattah

Controversial Issue in Water Birth to Reduce Perineal Trauma

[Year:2019] [Month:May-June] [Volume:11] [Number:3] [Pages:5] [Pages No:207 - 211]

Keywords: Episiotomy, Perineal trauma, Water birth

PDF  |  DOI: 10.5005/jp-journals-10006-1688  |  Open Access |  How to cite  | 

Abstract

Introduction: Perineal trauma becomes a concern during childbirth. One method to reduce perineal trauma is through water birth; however, there is still a lack of publication about water birth. This study aims to appraise the benefit of water birth to reduce the perineal trauma. Materials and methods: Searching was conducted on Pubmed®, Cochrane Library®, and Medline® using keywords or MeSH. There were 4 eligible articles consisting of 1 case-control, 1 clinical trial, and 2 systematic reviews. Appraisal determining the validity, importance, and applicability (VIA) was conducted by two independent authors guided by British Medical Journal (BMJ) Evidence-based Medicine Toolkit. Results: There were no difference percentage of intact perineum (RR 1.16; 95% CI 0.99–1.35), episiotomy (RR 0.93; 95% CI 0.80–1.08), second degree tear (RR 0.94; 95% CI 0.74–1.20), and third/fourth degree tear (RR 1.37; 95% CI 0.86–2.17) between water birth and conventional birth in a systematic review. Another review showed that water birth decreased the use of episiotomy and the severity of perineal laceration. A prospective trial study concluded that water birth caused less requirement for obstetric intervention; however, it impacted to more perineal laceration. Another study showed lower episiotomy and higher intact perineum rates in water birth group. Conclusion: There is still inconsistency of water birth in reducing perineal trauma.

REVIEW ARTICLE

Eka R Gunardi, Raymond Surya

Outcome of Pregnancy with Intrauterine Device In Situ: A Meta-analysis

[Year:2019] [Month:May-June] [Volume:11] [Number:3] [Pages:5] [Pages No:212 - 216]

Keywords: Intrauterine device, Intrauterine pregnancy, Outcome

PDF  |  DOI: 10.5005/jp-journals-10006-1689  |  Open Access |  How to cite  | 

Abstract

Introduction: Intrauterine devices (IUDs) constitute the second-most used contraceptive method worldwide. Pregnancy in the presence of IUD results in obstetric complications. This study aims to review the outcome of intrauterine pregnancies among IUD removed, IUD retained, and no IUD. Materials and methods: There were 89, 8, and 52 studies found in Pubmed®, Cochrane Library®, and Ovid® database. We included cohort or case-control studies consisting of minimally two groups: (i) no IUD and IUD retained or (ii) IUD removed and retained. Several outcomes were assessed, including preterm birth, miscarriage, premature rupture of membrane (PROM), placental abruption, placental previa, intrauterine growth restriction, chorioamnionitis, and cesarean delivery. The analysis of this meta-analysis used review manager 5.3. Results: There were 7 studies included owing to language barrier and accessibility of article. Pregnancy with IUD in situ increased the risk of miscarriage (RR 6.50; 95% CI 4.56–9.28), PROM (RR 1.88; 95% CI 0.98–3.62), placenta previa (RR 2.33; 95% CI 1.14–4.73), placental abruption (RR 4.51; 95% CI 2.82–7.20), chorioamnionitis (RR 6.07; 95% CI 3.91–9.42), and cesarean delivery (RR 1.33; 95% CI 1.03–1.71). Meanwhile, IUD removed decreased the risk of miscarriage (RR 0.51; 95% CI 0.39–0.66) and preterm birth (RR 0.57, 95% CI 0.38–0.86) compared with IUD retained. Conclusion: Conceiving with IUD in pregnancy increases the rate of miscarriage, placenta previa, abruption, chorioamnionitis, and cesarean delivery. Meanwhile, IUD removed early in pregnancy decreases the rate of miscarriage and preterm birth.

CASE REPORT

Chandrakala Magudapathi, Jayamohan Unnithan, Gnanam Sathyamoorthy, Sahitya J Andluru

Swine Flu in Pregnancy with Severe Adult Respiratory Distress Syndrome on Ventilator—Normal Delivery

[Year:2019] [Month:May-June] [Volume:11] [Number:3] [Pages:3] [Pages No:217 - 219]

Keywords: Disease outbreaks, Influenza, Pregnancy, World Health Organization

PDF  |  DOI: 10.5005/jp-journals-10006-1680  |  Open Access |  How to cite  | 

Abstract

We report a 29-year-old primigravida at 31 weeks with severe dyspnea needing noninvasive ventilation. Chest X-ray revealed upper lobe infiltration, hence the patient was treated for atypical pneumonia for a day but ventilated due to poor saturation. D-Dimer was elevated hence heparinized and CTPA and echo done, but no evidence of pulmonary embolism. Suspected as H1N1 and started on Tamiflu after sending throat swabs, which came out as positive for H1N1. She was deteriorating despite respiratory and other supports. Hence labor was induced with prostaglandins and oxytocin with prophylactic steroids. She delivered normally with intact perineum on ventilator with atracurium. She made a dramatic recovery post delivery. Patient and baby were discharged home without any morbidity on the 15th post-natal day. We present this case for its good outcome despite the highest prediction of maternal mortality.

CASE REPORT

Shalini Singh, Vimla Charan, Sudha Gandhi

Fundal Rupture with Breech Expulsion through it in Primigravida: Role of Destructive Procedure (Decapitation) in Modern Obstetrics

[Year:2019] [Month:May-June] [Volume:11] [Number:3] [Pages:4] [Pages No:220 - 223]

Keywords: Decapitation, Destructive surgery, Fundal rupture, Obstructed labor, Ruptured uterus, Undelivered fetus

PDF  |  DOI: 10.5005/jp-journals-10006-1686  |  Open Access |  How to cite  | 

Abstract

Aim: The aim of the study was to point out the problems faced at peripheral hospitals such as difficulties in assessment and management, and ultimately late referral in inevitable stage, hence increasing risk of maternal mortality and morbidity. The study also discusses the measures to be taken for the betterment, especially in developing countries. Background: Uterus rupture secondary to obstructed labor especially in an unscarred uterus and primigravida is a rare and a life-threatening condition. It needs early detection and prompt management to avoid maternal morbidity, mortality, and stillbirths. Case description: This is a case about 21-year primigravida at term gestation referred to our tertiary hospital from a peripheral hospital in view of an undelivered IUFD baby obstructed at the level of scapula with the head, both arms, and placenta already expelled out and further could not be delivered despite their efforts; peroperatively, it was a fundal rupture through which breech had expelled into abdomen and obstructed. Thus, only destructive procedure of decapitation was the method of choice to deliver the trunk through a ruptured fundus. Conclusion: The patient remained stable throughout the surgery and in the postoperative period, and was discharged on the ninth day in a healthy condition. Clinical significance: The case hold significance because of various challenges faced by us in management and problems at peripheral centers to be handled, better assessment, early referral in order to reduce maternal mortality, and stillbirth in a developing country such as India. We also discuss the significance of destructive procedures in modern obstetrics for developing countries.

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