Journal of South Asian Federation of Obstetrics and Gynaecology

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2019 | July-August | Volume 11 | Issue 4

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[Year:2019] [Month:July-August] [Volume:11] [Number:4] [Pages:1] [Pages No:0 - 0]

   DOI: 10.5005/jsafog-11-4-iv  |  Open Access |  How to cite  | 


Original Article

Aparna Baliga

Significance of Sonological Evaluation of Nuchal Translucency and Correlation with Pregnancy Outcome

[Year:2019] [Month:July-August] [Volume:11] [Number:4] [Pages:5] [Pages No:225 - 229]

Keywords: Chromosomal anomalies, First trimester, Nuchal translucency, Prospective study

   DOI: 10.5005/jp-journals-10006-1692  |  Open Access |  How to cite  | 


Aims and objectives: To determine the effectiveness of the first-trimester nuchal translucency (NT) scan and prospective study with pregnancy outcome. (1) The study involves prenatal sonological evaluation of NT between 11 weeks and 13 weeks 6 days of gestation. (2) To correlate NT and congenital anomalies. Materials and methods: Study design: This study was performed on pregnant women with gestational age of 11 weeks and 13 weeks 6 days at Kasturba Medical College and Govt. Lady Goschen Hospital, Mangaluru, from March 2, 2009 to March 10, 2011. Pregnant women undergone screening are followed up till delivery and assessment of congenital anomalies done. Inclusion criteria: (1) Pregnant women with gestational age of 11 weeks and 13 weeks 6 days. (2) Crown-rump length between 45 mm and 84 mm. Subjects: Subjects are screened with ultrasonography and data entered. The subjects are followed up till the pregnancy outcome. The clinical assessment of the newborn baby was done to look for any congenital anomalies. The statistical analysis was done by using the Chi-square test. p < 0.05 is considered to be significant. Techniques: (1) NT measurements done in the sagittal view of the fetus in the neutral position. (2) Magnification was such that only upper two-thirds of fetus were included in images. (3) Maximal subcutaneous translucency overlying neck was measured. (4) Measurement was taken with the horizontal lines placed on the lines that define the nuchal translucency thickness. Results: (1) Increase in NT is associated with congenital abnormalities. (2) Increased NT is 551.41 times likely to have anomalies compared with normal NT. Conclusion: Nuchal translucency is a strong predictor of congenital and chromosomal anomalies.


Original Article

Tanzeem S Chowdhury, Mehnaz Mustary, Towhidul Anowar Chowdhury

A Randomized Controlled Trial Depicting Postoperative Pain Score Following Port-site Infiltration during Laparoscopy

[Year:2019] [Month:July-August] [Volume:11] [Number:4] [Pages:5] [Pages No:230 - 234]

Keywords: Bupivacaine, Laparoscopy, Port-site pain, Postoperative analgesics

   DOI: 10.5005/jp-journals-10006-1693  |  Open Access |  How to cite  | 


Aim: This study was aimed to determine the efficacy of local bupivacaine injection into the incision site before diagnostic laparoscopy to reduce postoperative pain among infertile patients. Materials and methods: This was a randomized controlled study on 168 consecutive infertile women who underwent diagnostic laparoscopy at Farida Clinic and Infertility Management Center, Dhaka, from February to November 2018. Twenty-two patients were excluded from the study due to not meeting the criteria and 144 patients were finally taken for randomization. Results: In this study, majority of patients (n = 79) belonged to age 21–30 years. The mean age was found to be 29.7 ± 4.5 years in group I and 30.2 ± 4.7 years in group II. Majority of the patients had primary infertility in both groups, which was 47 (65.3%) in group I and 57 (79.2%) in group II. The commonest comorbidity was hypothyroidism found in both groups, 9 (12.5%) in group I and 7 (9.7%) in group II. Nine (12.5%) patients had previous operation in group I and 13 (18.1%) in group II. This study showed that majority of patients had mild pain 1 hour after surgery-48 (66.7%) in group I and 50 (69.4%) in group II. Three hours after surgery majority of patients in both groups had no pain 43 (59.7%) in group I and 40 (55.6%) in group II. Twelve hours after surgery, there was no pain in 64 patients (88.9%) in group I and 65 patients (90.3%) in group II. After 7 days of surgery, postoperative pain was absent in 45 (62.5%) patients in group I and 42 (58.3%) patients in group II, respectively. Conclusion: Considering the result of the study, at 1, 3, 12 hours and 7 days after surgery, pain score was not statistically significant (p > 0.05) between intervention and nonintervention groups. So, port-site infiltration of bupivacaine does not reduce the postoperative pain following laparoscopy.


Original Article

Dilip Kumar Maurry, Susmitha S Reddy, Ravindra P Nagendra

Correlation of the Protein to Creatinine Ratio with the 24-hour Urine Protein Level in Pregnancy Complicated by Hypertension

[Year:2019] [Month:July-August] [Volume:11] [Number:4] [Pages:4] [Pages No:235 - 238]

Keywords: Hypertension in pregnancy, Protein to creatinine ratio, Proteinuria in pregnancy

   DOI: 10.5005/jp-journals-10006-1695  |  Open Access |  How to cite  | 


Objectives: This study was undertaken to compare the urine protein to creatinine ratio with 24-hour urine protein estimation in pregnancy complicated by hypertension and to establish the cutoff value of the urine protein to creatinine ratio for predicting significant 24-hour proteinuria. Design: This is a comparative study and consists of a single group of 240 subjects. Setting: This study was conducted in the Department of Obstetrics and Gynecology in collaboration with the Department of Biochemistry, JIPMER, Puducherry, India, from February 2011 to January 2013. Population: The subjects included 240 pregnant women admitted after 20 weeks of gestation to the Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER) Hospital with hypertension (≥140/90 mm Hg). Patients with known cases of renal diseases, diabetes, and urinary tract infection were excluded. Materials and methods: A first voided morning sample was obtained for urine protein and creatinine estimation, and urine culture. Subsequent urine samples were collected for the 24-hour urine protein estimation. Main outcome measures: The spot urine protein to creatinine ratio and 24-hour urine protein were significantly correlated (r = 0.98; p < 0.0001). The cutoff value for the protein to creatinine ratio as an indicator of protein excretion ≥300 mg/day was 0.285. The sensitivity and specificity were 100% and 99.02%, respectively. The positive and negative predictive values were 100% and 99%, respectively. Results: The cutoff value for the protein to creatinine ratio as an indicator of protein excretion ≥300 mg/day was 0.285 with significant correlation. Conclusion: The spot urine protein to creatinine ratio is valuable for clinical purposes.


Original Article

Namrata M Rajput

Postpartum Depression Prevalence in a Tertiary Care Hospital in Mumbai, Maharashtra, India

[Year:2019] [Month:July-August] [Volume:11] [Number:4] [Pages:4] [Pages No:239 - 242]

Keywords: Cesarean delivery, Mental health, Postpartum depression

   DOI: 10.5005/jp-journals-10006-1696  |  Open Access |  How to cite  | 


Aim: To assess the prevalence and risk factors associated with postpartum depression in India. Material and methods: Screening for postpartum depression was done with questionnaires distributed to our postdelivery women after informed consent. We used a 10-point questionnaire called “Edinburgh Postpartum Depression Scale” (EPDS), as it was easy to use and validate. We analyzed the data to identify risk factors and find the prevalence of postpartum depression in our patients over a 6-month period in a tertiary care hospital in central Mumbai which caters to low- and mid-income groups of patients. Results: We found the prevalence of postdelivery depression identified by EPDS questionnaires at day 3 and day 14 of delivery to be 4%. Conclusion: This shows the necessity to address mental health problems in our postpartum women. If 1 in 25 women has serious mental health issues postdelivery, it can affect the immediate postpartum recovery of mother and also have significant negative impact on maternal and fetal bonding. Clinical significance: The postpartum period which is immediately after delivery to 42 days later is an important and critical period for all mothers with physical, emotional, and psychological ramifications. Maternal mental health is an oft neglected area, and we need to provide more support after identification of such women.


Original Article

Purnima Satoskar, Anamika Singh

A Study to Assess the Association between Umbilical Cord Coiling Index and Perinatal Outcomes

[Year:2019] [Month:July-August] [Volume:11] [Number:4] [Pages:3] [Pages No:243 - 245]

Keywords: Measuring coiling index, Perinatal outcome, Umbilical cord

   DOI: 10.5005/jp-journals-10006-1697  |  Open Access |  How to cite  | 


Aim: To analyze whether antenatal second trimester umbilical coiling index measurement could predict adverse perinatal outcome. Materials and methods: A study designed was a prospective observational study, enrolled total 100 singleton pregnancies, who were fulfilling inclusion criteria, attending regular antenatal checkup and willing for institutional deliveries. Each case was evaluated by sonographic study for umbilical coiling index at the time of routine fetal anatomical survey between 18 weeks and 24 weeks and then followed up for evaluation of perinatal outcome. Results: In present study, 79% had normocoiling while 10% had hypocoiling and 11% had hypercoiling of cord. Of these, 5% had preterm deliveries which was statistically significant (p = 0.046). Also, meconium-stained liquor was noted in 10% cases, among which 50% had abnormal coiling index. This was statistically significant (p = 0.008). Conclusion: Measuring coiling index can help in predicting adverse perinatal outcomes resulting in closer fetal monitoring and improved fetal outcome. Clinical significance: Antenatal umbilical cord coiling index (aUCI) is an important parameter to be studied during second trimester which may help to screen patients at risk of adverse perinatal outcome.


Original Article

Vasudha Sawant, Sreesti Jaiswal, Manjiri Desai

Impact of Socioeconomic and Demographic Factors on Reproductive Tract Infections during Reproductive Age Group (18–45 Years)

[Year:2019] [Month:July-August] [Volume:11] [Number:4] [Pages:3] [Pages No:246 - 248]

Keywords: Demographic, Reproductive tract infection, Socioeconomic

   DOI: 10.5005/jp-journals-10006-1699  |  Open Access |  How to cite  | 


Introduction: The aims of this study were to identify the prevalence of reproductive tract infection (RTI) in married women of reproductive age group (18–45 years), to analyze the impact of socioeconomic and demographic factors on RTIs, to treat the underlying cause. Materials and methods: A total of 500 women were examined; out of those, 300 women were found to have RTIs and were enrolled for further study and evaluation. Appropriate antibiotics were given to them and then followed. Results: The study results showed a high prevalence of RTI (60%). The highest prevalence was found among the age group between 26 years and 29 years, followed by 30–33 years and 34–37 years. The most affected women were from rural population (80%), low socioeconomic group (63.4%), and illiterate (59%). Conclusion: The present study showed a high prevalence of RTI. It needs a further deep study on their literacy and economic factors to evaluate and analyze the impact of these factors on RTIs.


Original Article

Abha Singh, Ruchi Kishore, Jayanti Chandrakar

Usefulness of Imprint Cytology in Cancer Cervix

[Year:2019] [Month:July-August] [Volume:11] [Number:4] [Pages:3] [Pages No:249 - 251]

Keywords: Cancer, Cervix, Cytology, Imprint

   DOI: 10.5005/jp-journals-10006-1703  |  Open Access |  How to cite  | 


Introduction: Tissue diagnosis in cancer cervix is much prior to its definitive management. Though histopathologic examination is accurate but it consumes time. Imprint cytology is a simple, quick and inexpensive diagnostic modality which can reduce the waiting period for management effectively. Objective: The aim of this study was to compare the diagnostic accuracy of imprint cytology with histopathology in cancer cervix. Materials and methods: The study included 150 women with clinical diagnosis of cancer cervix. All women underwent punch biopsy from the cervical growth. Imprint cytology slides were prepared and tissue was then sent for histopathology examination. Result: The diagnostic accuracy of imprint cytology was 92% as compared to 98% for histopathology. The time taken for interpretation for imprint cytology was 1.5–2.5 hours while for histopathology, it was 7–10 days. Conclusion: Imprint cytology is a simple, rapid and inexpensive diagnostic modality with very good accuracy. It can effectively reduce the time in tissue diagnosis in cancer cervix.


Original Article

Krutika Bhalerao

Pattern of Congenital Anomalies at Birth: A Hospital-based Study

[Year:2019] [Month:July-August] [Volume:11] [Number:4] [Pages:3] [Pages No:252 - 254]

Keywords: Congenital anomaly, Prematurity, Prevalence, Risk factors

   DOI: 10.5005/jp-journals-10006-1705  |  Open Access |  How to cite  | 


Background: Congenital anomalies form the major cause of adverse neonatal outcome as stillbirths and neonatal mortality. The distribution and prevalence of congenital anomalies may be different with time or with geographical location. Aims and objectives: The aim of this study is to determine the pattern of congenital anomalies in obstetrics and gynecology department of a rural tertiary medical college and hospital during the period of May 2013 to December 2015. All the babies delivered in this tertiary hospital during this period were included. The newborns were examined by obstetricians and pediatricians for the presence of congenital anomalies and mothers were interviewed using a case record form for sociodemographic variables. Results: During the study period, 6,076 babies were born; of which, 84 babies had congenital malformations, giving the prevalence of 1.38%. Majority of the women (55.7%) belonged to the age group between 21 years and 30 years. Congenital anomalies were seen more commonly (2.57%) in the multiparae in comparison with the primiparae (0.42%). The predominant system involved was the musculoskeletal system (36.90%) followed by the central nervous system (CNS) (25%) and the gastrointestinal (GI) system (16.6%). Talipes (17.1%) was the most common anomaly in the musculoskeletal group followed by cleft lip and cleft palate in the GI system. It was seen that majority of congenital anomalies were associated with low birth weight (LBW), prematurity, multiparity, and consanguinity. Conclusion: Health education and awareness for preventable risk factors is to be emphasized in general population, and early prenatal diagnosis and management of common anomalies is strongly recommended for better outcome.


Original Article

Parul Sinha, Bharti Malhotra, Shivra Batra, Dinesh K Jain

Evaluation of Diagnostic Value of Pouch of Douglas Fluid in Comparison to Endometrial Biopsy Samples for the Diagnosis of Genital Tuberculosis by Real-time Polymerase Chain Reaction

[Year:2019] [Month:July-August] [Volume:11] [Number:4] [Pages:3] [Pages No:255 - 257]

Keywords: Endometrial biopsy, Genital tuberculosis, POD fluid

   DOI: 10.5005/jp-journals-10006-1708  |  Open Access |  How to cite  | 


Objective: The aim of this study was to evaluate the benefits of using two types of samples: the endometrial biopsy (EB) and the pouch of Douglas (POD) fluid by real-time polymerase chain reaction (PCR) for an early and accurate diagnosis of female genital tuberculosis (FGTB). Materials and methods: Two samples, one EB and second POD fluid, from each patient (total 173 patients) were subjected to IS6110-based real-time PCR assay for the diagnosis of FGTB. Results: Among 173 patient samples received, a total of 32.94% (57/173) patients were positive for MTB by either or both sample types. Endometrial biopsy samples were positive in 19.60% (34/173) of all EB samples for MTB, and POD fluid samples were positive in 24.27% (42/173) of all POD fluid samples for MTB. Among the total MTB-positive patients, 26.31% (15/57) patients had only EB sample as positive, whereas in 40.35% (23/57) patients only POD samples were positive. Conclusion: When genital tuberculosis is suspected clinically, it is better to opt for performing less invasive procedure like testing of POD fluid for MTB, and if it is negative, then further invasive procedure to obtain EB may be chosen for diagnosis.



Nirmala C Shekar, Pandu Dasappa, Nagendra P Nagothi

Evaluation of Risk of Malignancy Index 5—A New Indicator in Differentiating Benign and Malignant Ovarian Masses

[Year:2019] [Month:July-August] [Volume:11] [Number:4] [Pages:5] [Pages No:258 - 262]

Keywords: CA125, Menopausal status, Risk of malignancy index, Ultrasound score

   DOI: 10.5005/jp-journals-10006-1706  |  Open Access |  How to cite  | 


Objective: To evaluate the effectiveness of the risk of malignancy index 5 (RMI5)—a new indicator in differentiating benign and malignant ovarian masses. To compare RMI5 with RMI1, RMI2, RMI3, RMI4, and the individual parameters (CA125, ultrasound score, and menopausal status). Materials and methods: It is a 5-year retrospective record analysis of women admitted with ovarian masses. The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), diagnostic accuracy of RMI1, RMI2, RMI3, RMI4, RMI5, and CA125, ultrasound score, and menopausal status were calculated. Results: Risk of malignancy index 5 is a better indicator of malignancy compared to the other indices. This study confirms that the five RMI indices were more accurate than menopausal status, CA125 level, and ultrasound score separately. RMI2 and RMI5 had p = 0.047 and 0.034, respectively, and hence were more accurate as compared to other indices by univariate analysis. Risk of malignancy index 5 had sensitivity and specificity of 61.5% and 93.17%, respectively, at a cutoff of 25. CA125 has better sensitivity of 80% in detecting malignant ovarian tumors than other individual parameters. Conclusion: Risk of malignancy index 5 better discriminates malignant from benign ovarian masses as compared to other malignancy indices.



Nihar R Bhoi, Lalmohan Nayak, Mitanjali Sethy, Kumudini Pradhan, Prakash Mishra, Tusar Mahapatra, Prosun Bera

Lower Segment Cesarean Section in Second Stage of Labor: Comparison of Patwardhan Method with Conventional Pushing Method (A 3-year Study)

[Year:2019] [Month:July-August] [Volume:11] [Number:4] [Pages:3] [Pages No:263 - 265]

Keywords: LSCS, NICU, Patwardhan technique, Second stage of labor

   DOI: 10.5005/jp-journals-10006-1707  |  Open Access |  How to cite  | 


Objective: To compare the fetomaternal outcome in Patwardhan technique vs “Push” method when lower segment cesarean section (LSCS) done in second stage of labor. Materials and methods: A prospective analysis of all cesarean sections performed in advanced labor with deeply waged head in VSS Medical College and Hospital, Burla, Odisha, India, during the years from April 2012 to March 2015. The cases were divided into two groups randomly; group I (deliveries by Patwardhan technique) and group II (Push method). Results: Out of 420 number of LSCS needed operation in 2nd stage of labor, in 129 cases, babies were delivered by Patwardhan technique and in 291 cases, delivery was conducted by Push method. 11.5% of cases among push/pull group had unwanted extension of uterine incision, whereas none had extension in Patwardhan group (p < 0.0001). Thirteen percent cases in group II, whereas 4.5% in group I required blood transfusion (p < 0.0001). The mean duration of hospital stay was not significantly different in both the groups (p = 0.06). There was requirement of NICU care in 23.2% cases in group I vs 28.8% in group II. Conclusion: In cases with difficult extraction of the impacted fetal head during cesarean section in second stage, Patwardhan technique is very useful in reducing fetomaternal morbidity and is the preferred method as compared to push and pull method.



Tigor P Simanjuntak, Samuel A Andrian, Rian Wibowo, Stella A Kurniawan, Ni MU Elingasari

Hyperemesis Gravidarum: A Holistic Review and Approach to Etiopathogenesis, Clinical Diagnostic and Management Therapy

[Year:2019] [Month:July-August] [Volume:11] [Number:4] [Pages:7] [Pages No:266 - 272]

Keywords: Etiopathogenesis, Hyperemesis gravidarum, Incidence, Outcomes, Treatment

   DOI: 10.5005/jp-journals-10006-1700  |  Open Access |  How to cite  | 


Aim: To provide an overview of hyperemesis gravidarum (HG) and to present possible links between factors associated with the pathogenesis of HG also the effectiveness and safety of the nonpharmacologic and pharmacologic options available to treat HG. Background: Although HG incidence is 0.3–2% worldwide, it is the number one cause of hospitalization in the first-trimester pregnancy, costs greatly to one financially, and also reduces the quality of life. This literature review focuses on articles published over the last 7 years to examine current perspectives and recent developments in HG. Review results: Nausea and vomiting are common symptoms during early pregnancy. When vomiting is severe, it is referred to as HG. Despite its high prevalence, it tends to be underestimated. The etiopathogenesis remains unknown, but many risk factors have been determined. Currently, the therapy focused on improving the symptoms while minimizing risks to the mother and fetus. If HG is left untreated, it may lead to significant maternal morbidity and adverse birth outcomes. Conclusion: Hyperemesis gravidarum is a complex and multifactorial condition. The incidence is higher in developing countries rather than in developed countries. Hyperemesis gravidarum can manifest as mild to severe signs and symptoms. The therapy ranges from dietary and lifestyle changes, intravenous fluid rehydration, hospitalization, nonpharmacologic, and pharmacologic treatment. Hyperemesis gravidarum can result as a mild to severe maternal and fetal complications.



Mohammad Zuhdy, Khaled Gaballa, Omar Hamdy, Reham Alghandour, Mohamed G Elmadawy, Yasmin N Laimon, Gehad A Saleh, Mahmoud M Saleh, Amr Hosam

Parenchymal Splenic Metastasis from Ovarian Cancer: A Report of Two Cases and Literature Review

[Year:2019] [Month:July-August] [Volume:11] [Number:4] [Pages:5] [Pages No:273 - 277]

Keywords: Case report, Ovarian cancer, Splenic metastasis

   DOI: 10.5005/jp-journals-10006-1701  |  Open Access |  How to cite  | 


Aim: We report two cases of splenic metastasis from ovarian cancer. Background: Parenchymal splenic metastasis from ovarian cancer is rarely encountered. Case description: Two cases of ovarian serous carcinoma presented by isolated recurrent parenchymal splenic metastasis that was managed by splenectomy as secondary cytoreductive surgery. Conclusion: Thorough follow-up of ovarian cancer cases including careful clinical examination, computed tomography (CT), and tumor markers assessment, when clinically indicated, can early detect any recurrence events even isolated splenic recurrence. Clinical significance: Although being rare, parenchymal splenic metastasis from ovarian cancer should be suspected in advanced stage ovarian cancer.


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