Journal of South Asian Federation of Obstetrics and Gynaecology

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2020 | March-April | Volume 12 | Issue 2

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Anushri Rawat

Polycystic Ovarian Syndrome: Role of Nutrition, Vitamins, and Minerals—Myoinositol and Vitamin D3

[Year:2020] [Month:March-April] [Volume:12] [Number:2] [Pages:2] [Pages No:63 - 64]

   DOI: 10.5005/jp-journals-10006-1757  |  Open Access |  How to cite  | 


Original Article

Shahid A Mujawar, Vinayak W Patil, Rekha G Daver

Assessment of Serum Reproductive Hormone Concentrations in Normal Pregnancy

[Year:2020] [Month:March-April] [Volume:12] [Number:2] [Pages:3] [Pages No:65 - 67]

   DOI: 10.5005/jp-journals-10006-1778  |  Open Access |  How to cite  | 


Background and objectives: Gestation is associated with profound hormonal and metabolic changes in the mother. These alterations facilitate the placenta to take over the dominant role of steroid production. The present study was designed to assess the concentrations of estrogen, progesterone, and total testosterone in normal pregnancy. Materials and methods: Fifty normotensive normal pregnant subjects with mean age 26.4 ± 4.48 years with no history of hypertension, vomiting, fever, cough, and cold were taken. Their mean ± SD gestational age at the time of study was 23.8 ± 10.2 weeks, who attended to the gynecology OPD were included in the study. Age-matched 50 nonpregnant subjects, not having any acute illness, thyroid, liver, and renal diseases, were taken as control. Serum estrogen, progesterone, and total testosterone were estimated by chemiluminescent method on Immulite 1000. Results: The alterations of serum reproductive hormone levels in normotensive pregnant subjects were found when compared to those of non-pregnant control group. Study group showed a significant (p value < 0.001) increase in serum estrogen, progesterone, and total testosterone levels due to production of prostaglandin before labor, subsequent conversion of cholesterol to progesterone in the placenta, and defect in newborn growth and size, respectively. When compared to nonpregnant control group. Conclusion: Reproductive hormones such as estrogen, progesterone, and total testosterone in normal pregnancy are of paramount importance during pregnancy. This study suggests that levels of abovementioned parameters were altering in normal physiological changes during pregnancy.


Original Article

Pritesh Jain, Sandeep Gupta, Dilip K Pal

Scrutinization and Management of Urological Complications Attributed to Obstetrics and Gynecological Surgery

[Year:2020] [Month:March-April] [Volume:12] [Number:2] [Pages:5] [Pages No:68 - 72]

   DOI: 10.5005/jp-journals-10006-1764  |  Open Access |  How to cite  | 


Aim: To review iatrogenic urological injuries due to obstetric and gynecological surgeries treated in the urology and gynecology department analyzing urinary tract anatomy, etiologic factors, diagnosis, treatment, and outcomes. Materials and methods: We reviewed all cases of urological injuries managed in our institution from January 2009 to December 2016 which were associated with obstetric and gynecological procedures. Results: Eighty-one patients were treated in the department during our study period. The most commonly injured organ was the bladder in 64.7% followed by ureter in 31.8%. Intraoperative diagnosis was made in 11.1% (9) cases, whereas 88.89% (72) cases were diagnosed postoperatively. Out of 81 cases, 66.7% (54) patients succumbed to urologic injuries as a result of gynecological procedures, while 33.3% (27) cases were due to obstetrical procedures. Vesicovaginal fistula (VVF) was the most common sequel followed by ureterovaginal fistula (UVF) in 42 (51.8%) and 15 (18.5%) cases, respectively. VVF combined with UVF and rectovaginal fistula were seen in 2 cases each. Although rare among various urogenital fistulas, vesicouterine fistula was encountered in three (3.7%) cases. All cases were managed with open or laparoscopic surgery with success in all but two patients. Conclusion: Complex gynecological procedures are gradually emerging as an important cause of urological injuries, second to obstetrical causes. Intraoperative detection and correction takes a vital part in determining structural integrity of the tissue and eliminating misery of the patient. Delayed diagnosis and improper treatment may result in severe complications. Clinical significance: Thorough knowledge of pelvic anatomy, meticulous surgical technique, early diagnosis of injury, and collaboration with a urologists in complex cases is required to reduce urological complications in obstetrics and gynecological procedures.


Original Article

Anubha Kataria, Spoorthi R Nadipally, Kamal Patil

Incidence of Wound Dehiscence Following Obstetric and Gynecological Surgeries at a Tertiary Care Hospital: A Retrospective Study

[Year:2020] [Month:March-April] [Volume:12] [Number:2] [Pages:6] [Pages No:73 - 78]

   DOI: 10.5005/jp-journals-10006-1763  |  Open Access |  How to cite  | 


Aim: A retrospective analysis with an aim to find out the incidence of wound dehiscence following obstetric and gynecological surgeries was carried out at a referral hospital and to review some of the practices in the hospital surgical and postoperative care of the surgical wound. Materials and methods: This study was carried out in the Department of Obstetrics and Gynecology at KLEs Dr Prabhakar Kore Charitable Hospital, a tertiary referral hospital in Belagavi, Karnataka, India, from May 2016 to August 2017 by obtaining data from medical records in the hospital. Results: During the study period, 3,172 women underwent major obstetric and gynecological surgeries; out of which 97 women developed wound dehiscence (3.05%). A total of 82 women had wound dehiscence following obstetric surgeries (84.54%) and 15 women following gynecological surgeries (15.46%). The number of emergency surgeries were 79 (81.44%), which included emergency lower segment cesarean section (LSCS) and the elective cases were 18 (18.56%), which comprised of elective LSCS, tubal ligation, and gynecological surgeries. Conclusion: The aim of this study was to review some of the practices during surgery and postoperative care in our hospital. The practice of scrubbing the abdomen prior to the day of surgery was followed. Subcutaneous fat suturing before closing the skin with subcuticular sutures was never practiced even when the fat layer was quite thick. Dressing was routinely changed on the 3rd day in the postnatal ward (exposing the wound to dirty linen particles when the wound had still not healed). However, preoperative antibiotics were routinely given prior to incision and also postoperative antibiotics for a total of 5 days. Clinical significance: Intraoperative and postoperative factors are significant in wound healing in addition to patient factors. Dressing should probably be done first only on the 5th postoperative day, which may prevent introduction of infection.


Original Article

Asha N Gokhale, Sushma Surve, Akriti Agarwal

Evaluation of the Efficacy of Saline Infusion Sonohysterography in Patients with Postmenopausal Bleeding

[Year:2020] [Month:March-April] [Volume:12] [Number:2] [Pages:6] [Pages No:79 - 84]

   DOI: 10.5005/jp-journals-10006-1765  |  Open Access |  How to cite  | 


Objective: To evaluate the efficacy of saline infusion sonohysterography as a primary screening tool in cases of postmenopausal bleeding and correlate the results with the findings of histopathological examination. Materials and methods: This prospective observational study involved 34 postmenopausal patients with postmenopausal bleeding who attended the OPD of Obstetrics and Gynaecology at Deenanath Mangeshkar Hospital over a period of 4 years and were advised saline infusion sonohysterography (SIS). All women underwent transvaginal sonography (TVS) and saline infusion sonohysterography (SIS) followed by histopathological examination. The sensitivity, specificity, PPV, and NPV for TVS and SIS were analyzed using the HPE report as a gold standard. The advantages and limitations of the screening test were evaluated. Results: The most common abnormalities detected on SIS were thickened endometrium seen in 13 cases (38.2%), followed by polyps (11 cases, 32.4%), thin endometrium (6 cases, 17.6%), submucous fibroids (3 cases, 8.8%), and undetermined (1 case, 2.9%) among our study population with a mean age of 52 ± 7.4 years. Diagnostic accuracy of SIS in identifying patients with intrauterine abnormalities was 91.2%, better than TVS. The sensitivity, specificity, PPV, and NPV of SIS in the detection of intrauterine abnormality was 96.2%, 71.4%, 92.9% and 83.3%, respectively. In this study, the diagnostic accuracy of SIS in identifying patients with abnormal histopathology was 88.2%. Conclusion: Saline infusion sonohysterography can be considered to be a valuable tool in the early workup of postmenopausal bleeding as it is an outpatient, lesstime-consuming procedure and noninvasive with no requirement for anesthesia. Clinical significance: Saline infusion sonohysterography is a sensitive tool and is superior to TVS used alone for evaluation of the uterine cavity. Saline contrast hysterosonography, in combination with HPE if necessary, can become the standard diagnostic procedure in women with postmenopausal bleeding, the gold standard being hysteroscopy.


Original Article

Indu Verma, Gaurika Joshi, Dinesh Sood, RK Soni

Menstrual Problems in Undergraduate Medical Students: A Cross-sectional Study in a Medical College of North India

[Year:2020] [Month:March-April] [Volume:12] [Number:2] [Pages:6] [Pages No:85 - 90]

   DOI: 10.5005/jp-journals-10006-1774  |  Open Access |  How to cite  | 


Introduction: Regular menstruation symbolizes a normal reproductive health of woman; however, virtually all women experience some form of menstrual problem in their lifetime. Medical undergraduates are mostly in the age group of late adolescence and early twenties. Females in this age group frequently experience different menstrual problems that commonly affect their quality of life. These disorders may be so severe that they influence the routine physical activity of the girls and also force them to skip their classes. Aim: This study was done to determine the menstrual pattern, menstrual problems, and associated factors among undergraduate medical students. Materials and methods: This college-based cross-sectional prospective study was conducted on 183 unmarried undergraduate female medical students. They were asked to fill and return a semi-structured self-explanatory questionnaire prepared in English containing details of sociodemography, menstrual history and menstrual problems, diet, and exercise. Results: Mean age of menarche was 13.37 ± 1.40 years, and most of them were residing in the hostel. Premenstrual syndrome (PMS) was the most common menstrual problem faced by the students (85.24%), and mood swing being the commonest symptom noted in 132 participants. Dysmenorrhea was seen in 111 (60.66%) out of which 68 needed some form of medication and 12 reported absenteeism from the college. An abnormal bleeding pattern was reported by 89 (48.63%). In our study, 73.22% students were doing regular exercise and 71.04% were consuming unhealthy diet. Students doing regular exercise had less prevalence of dysmenorrhea, which was statistically significant (p = 0.032). Dysmenorrhea was significantly associated with PMS (p = 0.022) and severity of PMS (p = 0.001). There was no significant association of dysmenorrhea with the menstrual cycle pattern, BMI, or food. No significant association of PMS or its severity was noted with menstrual cycle, BMI, food, or exercise. Oligomenorrhea was significantly associated with normal BMI (p = 0.019). Conclusion: The commonest menstrual problem seen in our study was PMS. The psychological symptoms of PMS were more as compared to physical symptoms. Some form of medication was required in 61.26% of dysmenorrhic students. A strong association was seen between dysmenorrhea and exercise; students exercising regularly had low incidence of dysmenorrhea. Since there is a high prevalence of menstrual problems in medical students, so these issues need to be addressed timely along with counseling and appropriate treatment.



Poonam Mani, Lalita Yadav, Arushi Singh, Tuheena Gupta

Value of Hysteroscopy and Transvaginal Sonography in Endometrial Pathology in Bleeding and Nonbleeding Postmenopausal Women

[Year:2020] [Month:March-April] [Volume:12] [Number:2] [Pages:5] [Pages No:91 - 95]

   DOI: 10.5005/jp-journals-10006-1769  |  Open Access |  How to cite  | 


The evaluation of the endometrium has evolved with varying amounts of evidence and often little validation of what has dominated the clinical practice. Aims and objectives: To study the value of hysteroscopy and transvaginal sonography (TVS) in endometrial pathology in bleeding and nonbleeding postmenopausal women. Materials and methods: A prospective study was conducted in the Department of Obstetrics and Gynecology, Subharti Medical College, Meerut, Uttar Pradesh, India. A total of 280 menopausal patients with or without postmenopausal bleeding (PMB) were included in our study. Out of 280 women, 204 women who had PMB were put in group I, and 76 women with no PMB were put in group II after exclusion criteria were met. Results: In our study, majority (46.6%) had polyp, 9.47% had atrophic endometrium, 29.29% had normal endometrium, 2.4% women had endometrial hyperplasia, and 2.1% had endometrial carcinoma on histopathology, which positively correlated with hysteroscopy. For diagnosing any pathology, hysteroscopy had better specificity (p < 0.001), although the two methods did not differ with regard to sensitivity (p = 0.188). For the diagnosis of polyps of any size, hysteroscopy had better sensitivity (p < 0.001); however, specificities did not differ (p = 1.0). Conclusion: There seems to be great confusion about appropriate evaluation in symptomatic menopausal women using TVS and/or hysteroscopy as well as how to proceed with incidental findings in asymptomatic postmenopausal women. A significant number of patients without PMB had abnormal findings on hysteroscopy like polyps. However, none had malignancy in this group.



Salleha Khalid, Hairel ZM Tarmidzi, Norhasniza M Nor, Wan AH Wan Ghazali

Timing for Elective Cesarean Sections: Have We Got It Right? A 5-year Retrospective Study among Healthy Mothers in Hospital Putrajaya, Malaysia

[Year:2020] [Month:March-April] [Volume:12] [Number:2] [Pages:4] [Pages No:96 - 99]

   DOI: 10.5005/jp-journals-10006-1773  |  Open Access |  How to cite  | 


Introduction: Studies have shown that elective cesarean sections performed before the 39-week period of gestation have increased risks of neonatal morbidity and mortality. Despite this, many elective cases are still performed before this in view of risk associated with emergency cesarean sections. The objective of this study is to determine the neonatal outcome among patients who had elective cesarean section earlier than the 39-week period of gestation. Materials and methods: Based on the elective cesarean section list from 2013 to 2017, patients with no comorbidity who had elective cesarean section for malpresentation, subfertility, and those who declined the trial of vaginal delivery were identified. The outcome of the delivery particularly looking into neonatal NICU admission and reasons of admission were then explored. Data were analyzed using SPSS version 25. Results: A total of 435 of 918 (47.36%) healthy patients had elective cesarean sections. There was significant differences in neonatal admission who had cesarean section at 37, 38, and 39 weeks among the healthy [X2 (4, N = 438) = 10.276, p = 0.036]. There were 26 (2.83%) patients who had an uncomplicated emergency cesarean section prior to an elective date given. Conclusion: Neonates who were born to healthy mothers had significantly less NICU admissions if they were delivered after the 39-week period of gestation between the patients.



Shilpa Thaker

Recognizing and Avoiding Significant Maternal Hyponatremia

[Year:2020] [Month:March-April] [Volume:12] [Number:2] [Pages:4] [Pages No:100 - 103]

   DOI: 10.5005/jp-journals-10006-1770  |  Open Access |  How to cite  | 


Hyponatremia during peripartum period is a recognized but underreported complication. Hyponatremia has significant adverse effects on mother as well as infant. Hyponatremia can be dilutional or nondilutional. Dilutional or hypervolemic hyponatremia is more common during the labor and postpartum period. The blood sodium concentration during pregnancy is lower, 130–140 mmol/L, which is being considered normal compared to 135–145 mmol/L in nonpregnant women. Thus, when the blood sodium level is below 130 mmol/L, we should consider it as hyponatremia of pregnancy. Oxytocin can play a major role to cause dilutional hyponatremia if large volumes of hypotonic fluids are consumed or infused intravenously simultaneously. Hyponatremia during labor is such a complex problem that it can be the result of several factors. In hyponatremia, there is progressive dysfunction of the neurological system, which in association with cerebral edema results in various symptoms. Symptoms may vary from headache, nausea, vomiting, lethargy, muscle cramps, and disorientation, progressing to seizures, coma, respiratory arrest, and death. A proper clinical history and various blood tests including serum sodium are important to diagnose the severity of hyponatremia. Women in labor should be advised to drink water only up to their thirst impulse; excessive fluid intake should be avoided. The treatment depends on cause, severity, and duration of hyponatremia, as well as clinical status of patient, and associated comorbidities. Once acute water intoxication and hyponatremia have been diagnosed, it is necessary to correct the hyponatremia by water restriction and to watch sodium concentration in the blood. Severe hyponatremia (sodium <125 mmol/L + symptoms) is a medical emergency. The primary idea of treatment should be to improve symptoms instead to normalize the blood sodium level.



Aravind Menon, Alagesan Ganapathi

Rectus Abdominis Endometrioma: A Rare Occurrence

[Year:2020] [Month:March-April] [Volume:12] [Number:2] [Pages:4] [Pages No:104 - 107]

   DOI: 10.5005/jp-journals-10006-1760  |  Open Access |  How to cite  | 


Endometriosis is defined as the presence of endometrial tissue outside the uterine cavity. Though the commonest site of occurrence is the pelvis, there have been cases of extrapelvic endometriosis reported in the literature. One of such rare sites is the rectus abdominis muscle, with only around 20 cases reported in the literature. Our patient was a 31-year-old female with a previous history of two cesarean sections who presented with cyclical pain over the scar. Imaging revealed the presence of endometrial tissue localized to the rectus abdominis muscle. Excision of the endometrioma with abdominal wall reconstruction using a polypropylene mesh was done. Herein, we present this case for its rarity with a short review of the literature on extrapelvic endometrioma.



Himanshi D Agarwal, Surekha Tayade, Kiran Dhurve

Living with Discordance: Pregnancy in HIV-discordant Couple

[Year:2020] [Month:March-April] [Volume:12] [Number:2] [Pages:3] [Pages No:108 - 110]

   DOI: 10.5005/jp-journals-10006-1762  |  Open Access |  How to cite  | 


Background: The term “serodiscordant couple” refers to “a couple where one partner is human immunodeficiency virus (HIV)-positive and the other HIV-negative.” The approximate patients with HIV/AIDS were 37.9 million people all over the world in 2018 of which, 1.7 million were children (<15-years-old) and 36.2 million were adults. Approximately, 60% of new cases occur in HIV-serodiscordant couples mainly because 30% of married HIV positives have HIV-negative spouse. With the advent of newer and better antiretroviral treatment (ART) to prevent the sexual transmission of HIV, there is increase in the number of serodiscordant couple who are considering natural conception. Pregnancy is a marker of unprotected intercourse rather than the motivation for engaging in unprotected intercourse and indicates an unmet need of counseling for exposure prophylaxis and contraceptive practice in future. Once pregnancy has been diagnosed, there is further need to ensure prevention of parent-to-child transmission of HIV. Strict adherence to protocols and guidelines is mandatory to ensure successful outcome.



Shraddha A Mevada

Ruptured Scar Ectopic Pregnancy: A Near Miss Case

[Year:2020] [Month:March-April] [Volume:12] [Number:2] [Pages:2] [Pages No:111 - 112]

   DOI: 10.5005/jp-journals-10006-1766  |  Open Access |  How to cite  | 


Aim: Successful management of near miss case of ruptured scar ectopic pregnancy. Background: Cesarean scar pregnancy (CSP) is an uncommon and potentially life-threatening form of ectopic pregnancy. The incidence of CSP is estimated at between 0.05 and 0.4% of all pregnancies and is expected to increase in prevalence in parallel with rising cesarean section rates. Case description: We present a case report of 30-year-old gravida 2 para 1 live 1 with previous 1 LSCS done 2 years back i/v/o fetal distress with 8.5 weeks. By date, with pain in abdomen since 2 days which aggravated since 6 hours followed by per vaginal spotting since 1 day came in emergency to our hospital. General condition of the patient on arrival was pulse 140 beats per minute, blood pressure 90/60 mm Hg, per abdominal examination was tenderness present in lower abdomen, per vaginal examination revealed uterus bulky, cervical os admits tip of finger, right fornical tenderness present, and bleeding present. Conclusion: On emergency laparotomy, after opening the abdominal cavity, ruptured scar ectopic pregnancy was noted, with 4 × 3 cm in dimension with hemoperitoneum with 300 mL of blood, and 80 g of blood clots were evacuated. Excision of scar with adherent ectopic tissue was done followed by resuturing of remnant uterine wall with continuous interlocking manner with polyglactin 910. Patient was transfused blood accordingly, and postoperative period was uneventful. Clinical significance: Although clinical and ultrasonography findings can mislead us, ruptured scar ectopic pregnancy should always kept in mind with proper counseling and possibility of torrential hemorrhage and hysterectomy along with availability of senior skilled obstetrician around.



Sakshi Sharma, Himanshi D Agarwal

Impact of Diabetic Ketoacidosis in Pregnancy

[Year:2020] [Month:March-April] [Volume:12] [Number:2] [Pages:3] [Pages No:113 - 115]

   DOI: 10.5005/jp-journals-10006-1761  |  Open Access |  How to cite  | 


Background: Pregnant women with type 2 diabetes mellitus (T2DM) pose an important public health problem, because diabetes not only affects the maternal and the fetal outcome but the women suffering with DM, their fetuses are also at an increased risk of developing diabetes and related complications later in their life. Case description: A 28-year-old woman with the diagnosis of G3P1L1A1 with 32 weeks’ gestational age with previous vaginal delivery and known case of chronic T2DM and hypothyroidism since 4–5 years. On admission, she was having altered sensorium, breathlessness, and palpitations. She was in latent phase of labor. Fetal heart sound was not heard on Doppler. Ultrasonography (USG) revealed intrauterine death of fetus. Her investigation reports suggested severe diabetic ketoacidosis (DKA). She was managed in medicine intensive care unit (ICU) where her labor progressed spontaneously and delivered a male dead baby, weighing 1500 g. It was sent for autopsy. Patient had postpartum hemorrhage and managed medically. But medical management did not suffice for her and so decision of laparotomy was taken with the plan of obstetric hysterectomy. Objectives: We examined the precipitating factors, laboratory abnormalities, treatment strategies, and clinical recovery in pregnancies complicated by DKA. Conclusion: Diabetes during pregnancy is associated with higher maternal and fetal morbidity. Early screening, detection of complications, close monitoring, and intervention are essential to reduce maternal and fetal short- and long-term adverse effects, especially in high-risk pregnancies. Pregnancy provides an opportunity to clinician to control the disease process and inculcate healthy lifestyle practices in these patients.



Rama Bajoriya, Manjiri Makde, MM Kamal

Immunohistochemistry and Tissue Microarray Techniques to Demonstrate Human Papilloma Virus Antigen and Cell Cycle Proteins in Squamous Intraepithelial Lesions and Cancer Cervix

[Year:2020] [Month:March-April] [Volume:12] [Number:2] [Pages:2] [Pages No:116 - 117]

   DOI: 10.5005/jp-journals-10006-1780  |  Open Access |  How to cite  | 


Cervical cancer remains the second most common cancer among women of developing countries. Human papilloma virus (HPV) infection has been identified as leading etiological agent for cervical cancer. Cell cycle dysregulation has a central role in cervical cancer carcinogenesis. p16INK4 is a tumor-suppressor protein whose increased expression has been associated with HPV-infected dysplastic epithelium and cancer of cervix. Ki-67 is a non-histone protein expressed in nucleus during whole cell cycle except G0 and G1. It constitutes an efficient marker of proliferating cells. It has its utility in distinguishing non-diagnostic atypia from squamous intraepithelial lesion (SIL). Our aim was to evaluate the usefulness of p16INK4 and Ki-67 in the diagnosis of spectrum of SIL cervical carcinoma, to know the genotype of HPV positivity in invasive cervical cancers using the TMA technique and to demonstrate the importance of the technique of tissue microarray (TMA) as an educational activity. Paraffin blocks, histology slides, and clinical data of 354 cervical biopsies sent to department's histology laboratory at GMC Nagpur were retrieved. The lesions were classified as LSIL, HSIL, and cervical carcinoma as per WHO guidelines. All cases of adenocarcinoma and randomly selected cases of squamous cell carcinoma were subjected to p16INK4 and Ki-67 labeling using TMA technique. Ki-67 and p16INK4 are aberrantly expressed in LSIL–HSIL–carcinoma sequence. p16 has significant association with severity of histological lesions. Also, HPV positivity with 16 and 18 was 100% in all the carcinomas.


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