Journal of South Asian Federation of Obstetrics and Gynaecology

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2020 | January-February | Volume 12 | Issue 1

EDITORIAL

Anushree Rawat, Pavika Lal

Evidence-based Approach for Preventing Preterm Birth: Cervical Stitch (Cerclage) vs Role of Arabin Pessary for Cervical Insufficiency

[Year:2020] [Month:January-February] [Volume:12] [Number:1] [Pages:4] [Pages No:1 - 4]

PDF  |  DOI: 10.5005/jp-journals-10006-1745  |  Open Access |  How to cite  | 

Guest Editorial

Asim Kurjak

Pandemic Coronavirus Issue: How do We Respond?

[Year:2020] [Month:January-February] [Volume:12] [Number:1] [Pages:2] [Pages No:5 - 6]

PDF  |  DOI: 10.5005/jp-journals-10006-1747  |  Open Access |  How to cite  | 

Original Article

Maruf Siddiqui, Nusrat Ghafoor, Fahmida Naznine, Rusmila S Abdullah, Towhid A Chowdhury

Hysteroscopic Evaluation in Infertility: Bangladesh Perspective

[Year:2020] [Month:January-February] [Volume:12] [Number:1] [Pages:3] [Pages No:7 - 9]

PDF  |  DOI: 10.5005/jp-journals-10006-1740  |  Open Access |  How to cite  | 

Abstract

Aims and objectives: Hysteroscopy is now accepted as a gold standard method not only to access the uterine cavity but also to make therapeutic interventions for restoring the endometrial environment required for pregnancy. Uterine factors can compromise the fertility rate in infertility treatment or in assisted reproduction. This prospective study is done to diagnose different intrauterine pathologies responsible for subfertility in Bangladeshi population. Duration: November 2017 to August 2019 Setting: Department of Infertility and Reproductive Medicine, Anwer Khan Modern Medical College, Dhaka, Bangladesh. Study population: A total of 273 patients who had undergone hysteroscopy as a part of their infertility workup were included. Patients with spontaneous ovulation, anovulatory patients who underwent at least six cycles of documented successful ovulation induction, and patients with suspected intrauterine pathology in transvaginal sonography (TVS) were the subjects for this study. All of them underwent hysteroscopy with laparoscopy simultaneously. Patients with both primary and secondary infertility were included in the study. Materials and methods: Hysteroscopy was performed in a standard gynecological operation theater setup under general anesthesia (G/A). A 2.9-mm 30° telescope (Karl Storz) with a 5-mm continuous-flow operative sheath was used in all the cases. Any pathological findings during the procedure were documented. However, different therapeutic modalities, such as polypectomy, complete or partial resection of the septum, or tubal cannulation, were all performed in the same time whenever indicated. A prestructured questionnaire was used to collect the data following hysteroscopy. All the data were then processed and analyzed using the computer software: statistical package for social sciences (SPSS). The test statistics used to analyze the data were descriptive statistics and the Chi-square (χ2) test. The level of significance was set at 0.05 and the p value of <0.05 was considered significant. Summarized data were presented in the form of tables and figures with due statistical interpretation. Results: Causes of subfertility found on hysteroscopy were endometrial polyp (n = 27), endometritis (n = 15), uterine synechiae (n = 24), blocked tubes (n = 30), uterine septum (n = 7), bicornuate uterus (n = 3), cervical stenosis (n = 2), and submucosal fibroids (n = 1). Recommendations: It is therefore recommended to practice routine hysteroscopy with concurrent laparoscopy in all cases of primary and secondary subfertility in Bangladeshi population.

Original Article

Anirudha R Podder, Jyothi G Seshadri

Management of Pelvic Abscess—Challenges for a Gynecologist

[Year:2020] [Month:January-February] [Volume:12] [Number:1] [Pages:8] [Pages No:10 - 17]

PDF  |  DOI: 10.5005/jp-journals-10006-1742  |  Open Access |  How to cite  | 

Abstract

Objectives: To analyze the difficulties in diagnosis, treatment, and postoperative care in patients with pelvic abscess. Study design: This is an observational study; 11 patients underwent laparotomy for drainage of pelvic abscess between January 1, 2015, and December 31, 2018. The diagnosis of pelvic abscess was a spot diagnosis only in one patient. It was a surprise finding, on table, in three patients. The most common confounding diagnosis was ovarian torsion. Two patients had subacute intestinal obstruction like clinical features. Results: All patients improved following laparotomy and drainage of pus. In the first six patients in our series, the skin was closed immediately following closure of the rectus sheath, and all of them developed wound dehiscence. In the last five patients in our series, delayed primary closure was performed. The skin was closed after wound turned healthy and comorbid conditions controlled and corrected. All five patients had a healthy scar. The shortest duration of hospital stay was 18 days, and the longest duration of hospital stay was 55 days. Conclusion: Pelvic abscess is one condition which can test the clinical acumen of a gynecologist to make a prompt and correct diagnosis and to manage multiple postoperative problems like uncontrolled diabetes, sepsis, and a wound which will require daily dressing for several days. This is one of the few gynecological conditions where a delayed primary closure should be performed. And most importantly, the gynecologist has to manage spiraling treatment costs and a falling patient morale.

Original Article

Tita H Madjid, AD Anwar, R Anwar, RD Angganiawati, K Mantilidewi, B Handono

Relationship between Lifestyle, Body Mass Index, and Dietary Factors with the Equol Production

[Year:2020] [Month:January-February] [Volume:12] [Number:1] [Pages:5] [Pages No:18 - 22]

PDF  |  DOI: 10.5005/jp-journals-10006-1749  |  Open Access |  How to cite  | 

Abstract

Aim: This study was aimed to find the relationship between lifestyle factor (smoking and physical activity), body mass index, and dietary component with equol-producing phenotype. Our work can be useful as basic data to modify lifestyle and nutrition to improve the metabolism of equol production, which is needed for women\'s health. Materials and methods: Data were collected using interview and semiquantitative food frequency questionnaire. Equol was measured in urine and was collected after a 3-day soy challenge to determine equol-producing phenotypes. Results: Correlation analysis among lifestyle factors and dietary component with equol-production phenotpe was performed. Data show that equol producers accounted in 60.7% of the participants. Smoking was significantly correlated to equol-producing phenotype (p = 0.030; r = 0.224). Carbohydrate and dietary fiber were positively correlated with equol-producing phenotypes (p = 0.011; r = 0.202) and (p = 0.004; r = 0.218). No significant correlation observed between physical activity, BMI, dietary protein, and fat intake with equol-producing phenotypes (p = 0.677; r = 0.035), although we observed a lower dietary fat intake in equol producer compared to nonequol producer. Conclusion: These findings suggest that smoking habit, carbohydrate, and dietary fiber significantly influence equol-producing phenotypes. Clinical significance: Our study may be useful as basic data to modify lifestyle and nutrition to improve the metabolism of equol production, which is needed for women\'s health.

Original Article

Aparna Rajesh, Anupama Suresh, Vandana Muralidharan

Serum Lipid Profile in Second Trimester as a Predictor of Gestational Hypertension

[Year:2020] [Month:January-February] [Volume:12] [Number:1] [Pages:4] [Pages No:23 - 26]

PDF  |  DOI: 10.5005/jp-journals-10006-1750  |  Open Access |  How to cite  | 

Abstract

Aim: To determine serum lipid profile early in second trimester of antenatal women and to study whether antenatal women with abnormal lipid profile in 2nd trimester are prone to develop gestational hypertension or preeclampsia and to determine whether dyslipidemia can be used as a marker in predicting PIH. The study is done to evaluate relationship between serum lipid concentrations and risk of preeclampsia. Materials and methods: Serum lipid profile was measured enzymatically by standardized assay in 90 pregnant women between 14 weeks and 20 weeks of gestation. Results were measured in terms of pregnancy induced hypertension. Out of these total number, 12 subjects developed PIH (study group), while 69 subjects remained normotensive (control group). Results: Out of these total number, 12 subjects developed PIH (study group), while 69 subjects remained normotensive (control group). The mean serum total cholesterol (TC) level was 233.25 mg/dL with p value <0.001, triglycerides (TG), and low-density lipoprotein cholesterol (LDL-C) was significantly higher in PIH women as compared to normotensive pregnant women. PIH women showed no significant change in high-density lipoprotein cholesterol (HDL-C) level and very low-density lipoprotein cholesterol (VLDL-C) to normal pregnant women. Conclusion: Serum lipid level in early pregnancy is a very good noninvasive method to predict the of PIH before the clinical onset.

Original Article

Rekha B Raghavendrachar, Rani A Bhat, Vibhawari Dhakaria

Surgical and Survival Outcomes with Neoadjuvant Chemotherapy in Advanced Epithelial Ovarian Cancer: A Longitudinal Study in a Tertiary Cancer Center

[Year:2020] [Month:January-February] [Volume:12] [Number:1] [Pages:4] [Pages No:27 - 30]

PDF  |  DOI: 10.5005/jp-journals-10006-1751  |  Open Access |  How to cite  | 

Abstract

Aims: To evaluate surgical and survival outcomes following neoadjuvant chemotherapy followed by interval debulking surgery (IDS) in advanced epithelial ovarian cancer (AEOCs). Materials and methods: Fifty patients who were diagnosed with stage III–IV ovarian cancer/primary peritoneal cancer/fallopian tube cancer were followed up following three cycles of neoadjuvant chemotherapy and debulking surgery followed by adjuvant chemotherapy in a comprehensive cancer center. This longitudinal study was conducted over four years from 2013–2017. Primary outcome measured was progression-free survival and secondary outcomes that included overall survival and effect of optimal and suboptimal surgeries on survival outcomes. In this study, we compared the difference in survival outcomes following various types of debulking (complete vs optimal vs suboptimal). Results: Among 50 patients who underwent debulking, 78%, 8%, and 14% underwent complete, optimal, and suboptimal debulking, respectively. The mean estimate of progression-free survival (PFS) at 24 months was 20.324 ± 0.97 months (95% CI) and the overall survival was 21.234 ± 0.788 months. There was a significant increase in PFS in those who had complete debulking (21.47 ± 0.95 months, 95% CI 19.6 to 23.3 months) compared to those in optimal debulking (20.53 months) and suboptimal groups (10.3 months) (Log-rank Mantel–Cox = 12.01, p = 0.001). Seventy-eight percent had no postoperative complications while 16% had grade I complications. Grade II, IV, and V complications were 2% each. Conclusion: Neoadjuvant chemotherapy followed by IDS gives better chance of complete debulking and better survival outcomes with acceptable postoperative complications.

Original Article

Suman Chaudhary, Manju Hiranwal, Deepa Chaudhary, Pradeep Dudi

Hyperlipidemia of Pregnancy: Normal or Predictor of Preeclampsia

[Year:2020] [Month:January-February] [Volume:12] [Number:1] [Pages:3] [Pages No:31 - 33]

PDF  |  DOI: 10.5005/jp-journals-10006-1752  |  Open Access |  How to cite  | 

Abstract

Aim: Pregnant women develop physiological dyslipidemia that can be measured in the laboratory by the lipid indexes. The atherogenic lipid profile of human gestation is further enhanced in preeclampsia. Our study has two purposes. First, the study of the alterations of total cholesterol (TCH), triglycerides (TG), low-density lipoprotein (LDL), very-low-density lipoprotein (VLDL), and high-density lipoprotein (HDL) during the pregnancy. The values were compared between early and late pregnancy. Second, the values of women who remained normotensive throughout pregnancy were compared to those who developed hypertension later on. Materials and methods: A total of 500 pregnant women with gestational age of 20 weeks. All of them were followed till delivery and maternal and fetal outcome was noted. Results: Out of 500 pregnant women, 45 were lost to follow-up. The mean age of study population was 23.27 ± 3.54 years. A total of 47 (10.33%) developed preeclampsia–22 had severe and 25 had mild hypertension. All plasma lipid levels increase as gestational age progresses except HDL. This change is statistically significant. It is observed that pregnant women with high TCH and LDL levels at <20 weeks are more likely to develop hypertension later (p value <0.05). Hypertensive pregnant women has very high TCH and LDL levels at >37 weeks (p value <0.05) as compared to normotensive pregnant women. Conclusion: Pregnancy, in general preeclamptic pregnancy, in particular is associated with marked hyperlipidemia. The study suggests that alterations in lipid metabolism observed in preeclampsia are present at early gestational age <20 weeks. Any pregnant women with higher plasma lipid levels may be observed and evaluated for preeclampsia.

Original Article

Seema Mehrotra, Vandana Solanki, SM Natu, Shilpi Chauhan, Ruchita Sharma

Study of Prolactin in Cervicovaginal Secretion in Women with Preterm Labor and Normal Pregnancy

[Year:2020] [Month:January-February] [Volume:12] [Number:1] [Pages:4] [Pages No:34 - 37]

PDF  |  DOI: 10.5005/jp-journals-10006-1758  |  Open Access |  How to cite  | 

Abstract

Objective: To evaluate the diagnostic value of cervicovaginal prolactin levels for predicting preterm delivery in women with preterm labor. Materials and methods: The preterm labor group and normal pregnancy group consisted of 75 and 150 patients between 24 weeks and 36 weeks of gestation. The preterm group was further subdivided into two groups. Study group Ia: patients who came up with preterm labor and given tocolytic but had preterm delivery (n = 50). Study group Ib: patients who came up with preterm labor and given tocolytic and delivered full term (n = 25). A single cervicovaginal measurement was made in all the groups. Results: Cervicovaginal prolactin was highest in the study group Ia (11 ± 9.31 ng/mL) as compared to the study group Ib (4.61± 6.2 ng/mL) and control group (2.51 ± 5.1 ng/mL), and the difference was statistically significant (p = 0.0311; p = 0.0000). The optimal cut-off value of prolactin was greater than 7 ng/mL in study group Ia with sensitivity level of 78%, at a specificity of 80% with positive and negative predictive values of 88.64% and 64.52%, respectively. The area under the receiver operating characteristic (ROC) curve was 79% which indicates fair diagnostic accuracy of cervicovaginal prolactin in predicting preterm labor. Conclusion: Prolactin is a potential biochemical marker which can be used alone or complementary to other markers for predicting preterm labor.

REVIEW ARTICLE

Sheetal G Sawankar, Jaideep Malhotra, Neharika M Bora, Pinky R Shah, Narendra Malhotra

Pharmacological Options to Trigger Final Oocyte Maturation in In Vitro Fertilization

[Year:2020] [Month:January-February] [Volume:12] [Number:1] [Pages:7] [Pages No:38 - 44]

PDF  |  DOI: 10.5005/jp-journals-10006-1753  |  Open Access |  How to cite  | 

Abstract

Human chorionic gonadotropin (hCG) has been the gold standard in the induction of final oocyte maturation since the pioneer days of in vitro fertilization (IVF). But owing to its long half-life, it leads to increased risk of ovarian hyperstimulation syndrome (OHSS). Trigger of GnRH agonist is a more physiological trigger, effective, and safe, as it significantly reduces or eliminates risk of OHSS. Newer options of dual trigger and double trigger are discussed in this review, which can be used as modified luteal phase support in patients with expected suboptimal oocyte maturation. Newer pharmaceutical options such as Kissepeptins, key in central regulation of neuroendocrine system, and GnRH release need more studies before being implemented in general practice. This review includes details of various trigger options for final oocyte maturation and about combination of trigger options aiming safe and effective outcomes.

CASE REPORT

Amruta Jaiswal, Shazia Khan

Laparoscopic En Bloc Resection of Colon Cancer with Ovarian Metastasis

[Year:2020] [Month:January-February] [Volume:12] [Number:1] [Pages:3] [Pages No:45 - 47]

PDF  |  DOI: 10.5005/jp-journals-10006-1755  |  Open Access |  How to cite  | 

Abstract

Most common primary malignancies linked to Krukenberg tumors are those arising from the gastrointestinal tract. Complete cytoreduction is the key to reduce reoccurrence. We report a case of a 34-year-old woman presented with bilateral Krukenberg tumor with no gastrointestinal symptoms or sign; further preoperative evaluation revealed malignant growth in the sigmoid colon. Laparoscopic total hysterectomy, bilateral salpingo-oophorectomy with anterior colonic resection was performed. Histopathology suggested Krukenberg tumor arising from moderately differentiated adenocarcinoma of the colon with further confirmation on immunohistochemistry. The patient had uneventful recovery with no documented evidence of locoregional reoccurrence till date. This case highlights the importance of thorough preoperative evaluation to detect occult primary in the case of Krukenberg tumor; further, it justifies the use of minimal access surgery for en bloc resection of Krukenberg tumor along with primary colonic malignancy.

CASE REPORT

Aarti Mishra, Saunitra Inamdar

Deep Venous Thrombosis in Pregnancy

[Year:2020] [Month:January-February] [Volume:12] [Number:1] [Pages:3] [Pages No:48 - 50]

PDF  |  DOI: 10.5005/jp-journals-10006-1759  |  Open Access |  How to cite  | 

Abstract

Deep venous thrombosis (DVT) is one of the rare yet important causes of maternal morbidity and mortality. In all, 2–3% of cases are fatal. Since pregnancy is a hypercoagulable state, it is more prone to develop DVT than normal females. Patient presents with swelling, pain, and warmth in the affected limb. Diagnosis is made by Doppler. Pulmonary embolism is the most fatal complication. First line of treatment is by broad-spectrum antibiotic and anticoagulants. Here, we review two cases: a 23-year-old primi with 32.3 weeks GA with acute history of DVT and a 30-year-old G4P1L1A2 with chronic DVT in right leg and acute DVT in left leg. We will be focusing on the clinical presentations, investigations, management of the case, the current state of literature, and the current standard treatment.

CASE SERIES

Indranil Dutta, Abhijit Haldar, Mainak Nath

Scar Pregnancy: A Case Series Involving Two Medical College Hospitals in West Bengal

[Year:2020] [Month:January-February] [Volume:12] [Number:1] [Pages:8] [Pages No:51 - 58]

PDF  |  DOI: 10.5005/jp-journals-10006-1756  |  Open Access |  How to cite  | 

Abstract

Scar pregnancy is increasing day by day due to the increasing number of cesarean section as well as operative intervention on uterus. Though there are improved diagnostic modalities in recent era, there is certain a deficiency of knowledge of specific diagnosis and treatment among the obstetricians and radiologists. Only few case reports are available online, but there are more cases of scar pregnancy which are underdiagnosed leading to high morbidity and even mortality. In this case series, we report 11 cases of scar ectopic pregnancy with different presenting features and treatment. Though in our case series there is no mortality, morbidity is seen to be high. We tried to increase the suspicion of scar ectopic pregnancy among obstetricians and radiologists to reduce these morbidities, especially in the cases of previous cesarean section and previous myomectomies.

Drug Review Prospective Self Control Study

Keshav Malhotra, Shally Gupta

Dehydroepiandrosterone: Is it a Magic Drug?

[Year:2020] [Month:January-February] [Volume:12] [Number:1] [Pages:3] [Pages No:59 - 61]

PDF  |  DOI: 10.5005/jp-journals-10006-1748  |  Open Access |  How to cite  | 

Abstract

With infertility populations in the developed world rapidly aging, treatment of diminished ovarian reserve (DOR) assumes increasing clinical importance. In developing countries like India, many patients due to economic and cultural restraints are not able to afford ovum donation or other assisted reproductive techniques. Thus, the possibility of a significant improvement in ovarian response with such an intervention in cases of DOR seems to be very promising. Our findings show only an improvement in anti-mullerian hormone (AMH) levels and antral follicle count in women with poor ovarian reserve, which was statistically significant. But we need a bigger sampling size.

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