Journal of South Asian Federation of Obstetrics and Gynaecology

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2021 | March-April | Volume 13 | Issue 2

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Original Article

Sangita N Ajmani, Shobhika Singh

Correlation of the Levels of Vitamin D with Size of Leiomyoma in a 450-bedded Maternity Hospital of Delhi

[Year:2021] [Month:March-April] [Volume:13] [Number:2] [Pages:4] [Pages No:77 - 80]

   DOI: 10.5005/jp-journals-10006-1869  |  Open Access |  How to cite  | 


Introduction: The pathogenesis of fibroids has been hypothesized to involve a positive feedback loop between extracellular matrix production and cell proliferation, and vitamin D might act to block the positive feedback. Hence, this study was carried out to know the correlation of vitamin D levels with the size of fibroids. Methods: Seventy-five patients diagnosed with leiomyoma on ultrasound scan were labeled as the case group. Control group comprised of 75 women whose pelvic ultrasound was normal and there was no fibroid. On trans-vaginal sonography (TVS), we measured the volume of each of them. The quantitative detection of serum vitamin D levels was performed using a kit based on chemiluminescence in cases and control. Results: The mean value of vitamin D levels in cases was 12.58 + 4.09 ng/mL while in controls it was 18.99 + 5.72 ng/mL with p-value <0.001. Thus it was statistically significantly lower in cases than in controls. Pearson correlation of total volume of the fibroid (cm3) and vitamin D level (ng/mL) was −0.292 with p-value of 0.011. Conclusion: The volume of fibroid and serum vitamin D levels are inversely related to each other, i.e., the less is the vitamin D levels, the more will be the volume of the fibroid.


Original Article

COVID-19 in Pregnancy: An Experience at a Dedicated Tertiary Care COVID Facility in Western Uttar Pradesh

[Year:2021] [Month:March-April] [Volume:13] [Number:2] [Pages:3] [Pages No:81 - 83]

   DOI: 10.5005/jp-journals-10006-1874  |  Open Access |  How to cite  | 


Introduction: COVID-19 in pregnancy has put all perinatal services at a slog pace due to restricted movement and fear associated with the unknown challenges that the entire world is facing. At a tertiary care center, where a majority of the cases are referred from adjoining areas, the incidence of complications encountered was more. The present study discusses the impact of COVID-19 in pregnant females and subsequent perinatal outcomes. Aims: To study the perinatal outcomes in COVID-19-diagnosed pregnancy. Type of study: Observational analytical study. Methodology: All the pregnant females with COVID-19-diagnosed pregnancy were studied for their demographic profile, symptomatology, laboratory results, obstetric outcome, and neonatal performance between June 18, 2020, and September 30, 2020. Results: A total of 114 obstetric patients were admitted at this particular level two-facility center. Out of this, 21 were symptomatic, 22 delivered by cesarean, two cases of ruptured tubal ectopic pregnancy were seen, two cases of ruptured uterus were there, nine cases were received in obstructed labor, four cases of incomplete abortion, and three stillbirths were reported at our center. None of the neonates was tested positive for COVID-19. Oligohydramnios was seen in 25.4% of cases and thrombocytopenia was a significant finding in 33.3% of the patients. Conclusion: COVID-19 has affected the obstetric population with varied outcomes all throughout pregnancy. Even in asymptomatic patients, complications like oligohydramnios and thrombocytopenia were seen. Obstetric services were poorly catered at the periphery as many patients were received in emergency as cases of obstructed labor and ruptured uterus. COVID-19 has negatively affected each dimension of service care provisions and the health and outcome of the obstetric population.


Original Article

Shilpi Singh, M Munikrishna

Diagnostic Dilemma: Neurocysticercosis—A Differential Diagnosis for Seizures in Pregnancy and Early Postpartum Period

[Year:2021] [Month:March-April] [Volume:13] [Number:2] [Pages:3] [Pages No:84 - 86]

   DOI: 10.5005/jp-journals-10006-1873  |  Open Access |  How to cite  | 


The most common helminthic infestation of the brain worldwide is neurocysticercosis (NCC). When a woman presents with seizures during pregnancy, eclampsia is the go to provisional diagnosis. NCC may be misdiagnosed because of its symptoms like headache, vomiting and nausea, neurological and visual disturbances, and seizures. Hence, radiological findings help to diagnose NCC. Treatment is with antiepileptics and antihelminthic agents. We reported the cases of three Indian women in our tertiary care center, aged 19, 20, and 22 years, respectively, with NCC, one of whom presented with seizures in the first trimester of pregnancy and other two during the postpartum period. All patients were normotensive with urine albumin nil and no history of increased blood pressure in the past. The confirmation was done on the basis of MRI brain, which showed spherical ring-enhancing lesions that were calcified in the brain. In the first patient aged 19 years, pregnancy was terminated on patient request and she was discharged on albendazole and levetiracetam. The second and the third patients whose antenatal period was uneventful with postpartum convulsions were also put on levetiracetam and albendazole for 21 days.


Original Article

Mansi J Shah, Sulabha Joshi

Lateral Placental Location as a Predictor of Preeclampsia Development: A Prospective Study

[Year:2021] [Month:March-April] [Volume:13] [Number:2] [Pages:5] [Pages No:87 - 91]

   DOI: 10.5005/jp-journals-10006-1876  |  Open Access |  How to cite  | 


Objective: To find whether placental laterality as determined by ultrasound can be used as a predictor of the development of preeclampsia and to find its correlation with severity of preeclampsia and obstetric outcome. Material and methods: Antenatal care (ANC) patients attending the ANC clinic at 18 to 24 weeks fulfilling inclusion criteria were included. The location of the placenta was determined by ultrasonography at 18 to 24 weeks. The placenta was classified as central when it is equally distributed on the left or right side of the uterus. When 75% of the placenta is to one side of the midline, it was classified as right or left lateral. All subjects were followed throughout pregnancy for the development of signs and symptoms of preeclampsia which was diagnosed as per ACOG criteria. Results: Among 397 women studied, 53 cases were diagnosed with preeclampsia, while remaining 344 women were normal. Out of 53 cases, 41 (77.3%) had mild preeclampsia, while12 (22.7%) had severe preeclampsia. Out of 397 women studied, 205 (51.63%) women had lateral placenta and 192 (48.36%) women had central placenta. Out of 205 women with lateral placenta, 38 (18.53%) women developed preeclampsia. Out of 192 women who had central placenta only 15 (7.81%) developed preeclampsia. Conclusion: Thus the present study concludes that the incidence of preeclampsia is 13.35%. The incidence of lateral placental location is 51.63%. Patients with lateral placenta show a higher incidence of development of preeclampsia that is 71.69%. Women with lateral placental location have 1.77 times greater risk of development of preeclampsia than ones with central placental location. Clinical significance: This cheap, simple, easy, and feasible investigation could be helpful not only to predict the development of preeclampsia but also to reduce its severity, maternal complications, and neonatal complications associated with it.


Original Article

Eka R Gunardi, Ribkhi A Putri, Yogi Pasidri

A Prospective Study of Effectivity, Expulsion, and Acceptability of Post-placental IUD Cu T380A Insertion Using Clamp in a Tertiary Hospital

[Year:2021] [Month:March-April] [Volume:13] [Number:2] [Pages:5] [Pages No:92 - 96]

   DOI: 10.5005/jp-journals-10006-1884  |  Open Access |  How to cite  | 


Aim: Intrauterine device (IUD) has a high effectivity of long-term contraception method. Post-placental IUD increases the number of contraception use and decreases the unmet need for contraception. The purposes of this study were to evaluate the effectivity, expulsion, acceptability, and side effects of post-placental IUD insertion using a clamp at Dr. Cipto Mangunkusumo National General Hospital. Materials and methods: This prospective longitudinal observational study was conducted at a tertiary teaching hospital (Dr. Cipto Mangunkusumo General Hospital, Jakarta, Indonesia) from April 2018 to March 2019. Post-placental IUD was inserted using a clamp. We interviewed the patients at 3 months and 6 months after insertion to evaluate the outcome. A total of 94 women were included in this study. Results: The effectivity was 100%. The expulsion rate was 2.13, 3.45, and 0% at 6 weeks, 3 months, and 6 months, respectively. The total acceptability rate at 6 weeks, 3 months, and 6 months was 96.81, 93.3, and 90.8%, respectively. Most of the subjects were satisfied with the IUD contraception at 3 months and 6 months. Conclusion: Post-placental IUD insertion using a clamp had good safety, effectivity, acceptance, and satisfaction. This data could be used for family planning counseling in daily practice. Post-placentaI IUD insertion should be routinely offered to all eligible postpartum women undergoing institutional deliveries.


Original Article

Mayanglambam Ronita Devi, Helen Kamei, Madhuri Laishram, Umalakshmi Lairellakpam, Kimthianmuang Guite, Ishor Kharel

Retrospective Analysis of Hysterectomy Cases in a Tertiary Care Institute, JNIMS

[Year:2021] [Month:March-April] [Volume:13] [Number:2] [Pages:4] [Pages No:97 - 100]

   DOI: 10.5005/jp-journals-10006-1877  |  Open Access |  How to cite  | 


Aim: To study the indications and clinical profile of patients undergoing hysterectomy in Jawaharlal Nehru Institute of Medical Sciences (JNIMS). Materials and methods: A chart review of 132 hysterectomy cases in JNIMS, from January 2016 to January 2017, was done. Peripartum hysterectomy was excluded. The data regarding age, parity, indications of hysterectomy, length of hospital stay (LOHS), and additional surgical procedures were collected and analyzed. Results: Age distribution ranged from 34 to 73 years. The most common age-group was 41 to 50 years (57 patients, 43.18%), and multiparas (>2 parity) had maximal rate (68 patients, 51.52%) of hysterectomies. The most common indication for hysterectomy was abnormal uterine bleeding (AUB) (56 patients, 4242%). The abdominal route (75.76%) was more common than the vaginal route (23.48%) and minimal access surgery (MAS) (0.76%). Eighty-seven patients (65.91%) underwent bilateral salpingo-oophorectomy. The most noted frequency of hospital stay was 4 days (29 patients, 21.97%). Eleven appendectomies and one cholecystectomy were done as an additional surgical procedure. Conclusion: Nondescent vaginal hysterectomy (NDVH) is an established safe surgical procedure but such route is lesser used. The reason may be due to less exposure to such a procedure. Additional surgical procedure is an advantage in the abdominal route, but studies of the plausible risks that may be associated with such procedures are also lacking. The impact of preservation of the ovary is also a lesser-explored area. Hysterectomy seems to be the first option in treatment where resources are limited. It is time to review our approach to benign conditions before considering surgery as the first option. Clinical significance: Symptomatic relief is palpable by hysterectomy, but lack of studies involving the impact of hysterectomy, for example, psychological, social, economical, etc., is a cause of concern. More prospective data comparing indications of hysterectomy with its impact may be helpful in streamlining absolute indications, and patients may be benefitted from the adverse effects of surgical interventions.



Indrani Mukhopadhyay, V Pruthvi Raj, Rohit Aggarwal

A Randomized Controlled Trial of Entonox and Oxygen in Labor Analgesia

[Year:2021] [Month:March-April] [Volume:13] [Number:2] [Pages:5] [Pages No:101 - 105]

   DOI: 10.5005/jp-journals-10006-1868  |  Open Access |  How to cite  | 


Background and objectives: Labor pain is a severe form of pain experienced by a woman, leading to tremendous stress. Several routes for labor analgesia have been tried. Entonox is a premixed homogeneous gas mixture of nitrous oxide and oxygen in the ratio of 50:50 providing conscious sedation in obstetrics during labor. It is a safe and effective analgesia for obstetrics use due to its properties of rapid onset, short half-life, and rapidly disappearing symptoms on withdrawal of the gas. Therefore, we aimed to evaluate the effect of Entonox on the severity and relief of labor pain during its various stages and its associated maternal or fetal side effects. Materials and Methods: A prospective randomized controlled trial (RCT) of 200 term pregnant mothers reporting in labor over a period of 2 months who were randomized into Entonox group and placebo oxygen control group was included in the study. Administration of both gases was done, and the pain scoring was recorded. Maternal and fetal complications were noted. Results: The intensity of labor pain was significantly lower in Entonox group as evident by lower pain scoring values. The mean duration of the active phase of labor in the Entonox group was comparable to the oxygen group. Maternal and fetal side effects were not significant in both groups. The mode of delivery is also comparable in both groups. Conclusion: Entonox usage in labor analgesia is a safe, effective, and inexpensive method of relieving labor pain, achieving immense patient satisfaction and making labor a pleasurable experience.



Shreyasi Karmakar, Sabyasachi Bid, Tapan K Maiti

Effects of Induction of Labor on Maternal and Perinatal Outcome in Postdated Nulliparous Pregnancy

[Year:2021] [Month:March-April] [Volume:13] [Number:2] [Pages:5] [Pages No:106 - 110]

   DOI: 10.5005/jp-journals-10006-1870  |  Open Access |  How to cite  | 


Objective: This study aimed at determining the mode of delivery, maternal, and perinatal outcomes of induction of labor (IOL) in postdated pregnancies. Methods: It was a prospective observational study. Nulliparous women with uncomplicated singleton pregnancies who have crossed their estimated date of delivery (EDD) were included in the study. Inclusion and exclusion criteria were strictly followed. A total of 280 patients were divided into study and control groups. Those who underwent IOL immediately after EDD were compared with women who were managed expectantly up to 42 weeks. Results: The study group and control group consisted of 150 and 130 women, respectively. The rate of cesarean section (CS) (64.62%) was significantly higher in an expectantly managed group. The most common indication of the CS was fetal distress in both groups, and the occurrence of oligohydramnios was quite higher in the control group. The rate of shoulder dystocia, cervical tear, and third- and fourth-degree perineal tear was significantly more in an expectantly managed group. Fetal distress was also more in that group. Conclusion: Our study suggests that labor should be induced after crossing EDD if gestational age is confirmed so that the incidence of maternal and perinatal complications can be brought down to an acceptable level.



Suthida Intaraphet, Supatra Kongpechr, Sukanda Mahawerawat, Ratchanee Potchana

Risk Factors and Outcomes of Preterm Birth among Northeastern Thai Teenage Mothers in Thailand

[Year:2021] [Month:March-April] [Volume:13] [Number:2] [Pages:6] [Pages No:111 - 116]

   DOI: 10.5005/jp-journals-10006-1871  |  Open Access |  How to cite  | 


Background and objectives: Teenage pregnancy itself is a risk factor for preterm birth in general. However, risk factors for preterm birth comparing teenage mothers who have preterm and no preterm birth are unaware. This study aimed to evaluate risk factors for preterm birth and outcomes of pregnancy among teenage mothers. Materials and methods: A retrospective cohort study of all singleton teenage pregnancy cases giving birth from January 2014 to December 2015 at Khon Kaen Hospital, a tertiary hospital in Thailand, was conducted. Data on the characteristics of teenage mothers and outcomes of pregnancy were extracted from electronic files of medical records. Teenage mothers were classified into two groups according to gestational age at the time of delivery: term and preterm, to identify risk factors of preterm birth among teenage mothers. Multivariable logistic regression analysis was used to evaluate independent risk factors for preterm births among teenage mothers. Results: During the study period, 1042 teenage mothers were identified. The preterm birth rate among teenage mothers was 16.8%. BMI before pregnancy <18.5 kg/m2 (OR, 1.89; 95% CI, 1.28–2.81), weight gain <5 kg (OR, 5.11; 95% CI, 2.96–8.81), prenatal care visit <4 times (OR, 5.16; 95% CI, 3.50–7.61), premature rupture of membranes (OR, 4.22; 95% CI, 2.20–8.11), and previous preterm birth (OR, 46.56; 95% CI, 13.15–164.88) were found to be independent risk factors for preterm births among teenage mothers. Conclusion: Previous preterm birth showed a very strong effect on current preterm birth. All risk factors for preterm birth should be considered to prevent preterm births among teenage mothers. Emphasizing the importance of prenatal care visits and proper nutrition for teenage pregnancy women would be beneficial.



Sreejisha Puthu Kudi, Madhuripu Pattali, Jazeel Nadukandy Meethal, Riyas Basheer Kariyadath Basheer, Nafia Tharol

Effect of Russian Current Followed by Exercise in Postpartum Diastasis Recti Abdominis: A Single Case Study

[Year:2021] [Month:March-April] [Volume:13] [Number:2] [Pages:4] [Pages No:117 - 120]

   DOI: 10.5005/jp-journals-10006-1872  |  Open Access |  How to cite  | 


Aim: To find out the effect of Russian currents followed by exercises in diastasis recti postpartum. Materials and methods: A single case study was done by fulfilled inclusion criteria. Inter-recti distance (IRD) was assessed by dial caliper and waist-hip circumference by inch tape. Russian current was given for 30 minutes/day with a duty cycle of 20 seconds on period and 40 seconds off period for 5 days/week for 6 weeks. Exercises given are isometric contraction of abdominal muscle and Noble's correction exercise of 30 minutes/day for 5 days/week for every 6 weeks. Results: The study shows IRD reduction of 1.4 cm above the umbilicus, 1.3 cm at the level of the umbilicus, and 1.3 cm below the level of the umbilicus. Conclusion: The present study opens a wide scope to practice Russian currents for reducing IRD along with exercises for the postpartum period. Clinical significance: Russian currents can be introduced to the postpartum physiotherapy management along with exercises as it is giving more amount of feedback to the clients.



K Soumya Raj, Rakhi R Pillai

Effectiveness of Benson's Relaxation Therapy on Reduction of Postcesarean Pain and Stress among Mothers in a Selected Hospital at Kochi

[Year:2021] [Month:March-April] [Volume:13] [Number:2] [Pages:4] [Pages No:121 - 124]

   DOI: 10.5005/jp-journals-10006-1875  |  Open Access |  How to cite  | 


Pain and stress presented in postcesarean mothers make the recovery hard, and it affects the mother's connection with the newborns. Benson's relaxation therapy is a simple practice that can help to relieve pain and stress. Aim of the study: Main aim is to evaluate the effectiveness of Benson's relaxation therapy in pain and stress among postcesarean mothers between the experimental and control groups. Methodology: In this study, researchers used quasi-experimental design with pretest ± posttest control group design. The setting of the study was Amrita Hospital, Kochi. A sample of 60 postcesarean mothers (30 in each group) were selected by using the convenient sampling technique. Result: Present study reveals a significant difference between pretest and posttest stress and pain in the experimental group, which is statistically significant with p-value <0.05. In the control group, pretest stress and posttest stress were not significantly different and there is a difference in pretest and posttest pain scores as p-value is <0.05. When comparing percentage distribution of posttest pain in both groups, majority of experimental group (76.7%) had mild pain and 23.3% of them had moderate pain. On the contrary, in the control group, only 16.7% of the postcesarean mothers had mild pain and about 50% had moderate pain, and 33.3% had severe pain. Conclusion: Benson's relaxation therapy can use effectively by the midwife for a significant reduction in pain and stress among postcesarean mothers.



Shital N Kapadia, Amiya Mehta, Charul R Mehta, Sumeeta T Soni, Neelam Joharwal, Monica Dixit, Jolly G Vaishnav

Study of Pregnancy with COVID-19 and its Clinical Outcomes in a Tertiary Care Teaching Hospital in Western India

[Year:2021] [Month:March-April] [Volume:13] [Number:2] [Pages:6] [Pages No:125 - 130]

   DOI: 10.5005/jp-journals-10006-1886  |  Open Access |  How to cite  | 


Objectives: To study cases of pregnancy with coronavirus disease-2019 (COVID-19) and its clinical outcome. To study evidence of the vertical transmission in pregnant women infected with COVID-19. Materials and methods: A prospective study was performed in BJ Medical College and Civil Hospital, Ahmedabad, one of the biggest designated (1200 beds) COVID hospitals in India. It was carried out from June 2020 to mid-October 2020. A total of 50 pregnant patients who were COVID-19 positive and admitted to the labor room were studied. Results: The mean age of the mothers was 27.40 ± 4.76 years (range: 19–36 years) and mean gravidity was 1.67 ± 1.41 (range: 1–4). The mean gestational age was 38.31 ± 1.67 weeks. The main complaint was fever in 22 (44%), followed by dry cough in 9 (18%), sore throat in 4 (8%), headache in 2 (4%), malaise in 7 (14%), and diarrhea in 2 (4%) patients. Twenty-two (44%) patients showed an elevated C-reactive protein level, 17 (34%) had lymphopenia, 19 (38%) had mild elevation of the D-dimer level, and 16% of the patients had increased interleukin 6 levels. Most of the patients had normal renal function test (RFT) and liver function test (LFT) results. A majority of them (86%) had normal chest X-ray, whereas rest of them (14%) had haziness in bilateral lung fields. Twenty-six (52%) patients underwent C-section, and 23 (46%) delivered vaginally. Four (8%) babies required the admission in the newborn intensive care unit for mild birth asphyxia but were discharged well. Five babies developed physiological jaundice and required single surface phototherapy (SSPT). Forty-eight (96%) out of 50 had negative vaginal swab by reverse transcription polymerase chain reaction (RT-PCR), 48 (96%) did not show any evidence of the virus in the expressed breast milk by RT-PCR. We collected the cord blood sample of 35 patients after delivery which was found to be negative in all (100%). The nasopharyngeal swab of all the babies was negative on the very first day. Day 7 repeat swab was found positive only in one baby. This transmission was mostly via respiratory droplets during intermittent assisted breastfeeding. Most of the cases were having mild disease without acute respiratory distress syndrome (ARDS), which responded to the supportive treatment. Four patients (8%) had severe anemia and required blood transfusion. Conclusion: Most of the cases were having mild disease without ARDS, which responded to supportive treatment. Reassuringly, there was no evidence of poor fetal outcome, intrauterine fetal deaths, or premature deliveries. We did not find any evidence of the virus in the vaginal fluid, cord blood, or breast milk supporting vertical transmission of COVID-19 in the third trimester of pregnancy, even if patient delivered vaginally.



Rajesh Panicker, Shyamoli Mustafa

Immunohistochemistry: A Valuable Tool in the Management of Common Female Genital Tract Tumors—A Clinicians’ Perspective

[Year:2021] [Month:March-April] [Volume:13] [Number:2] [Pages:4] [Pages No:131 - 134]

   DOI: 10.5005/jp-journals-10006-1880  |  Open Access |  How to cite  | 


Immunohistochemistry (IHC) is a laboratory technique that can be used by the pathologist to add value to the diagnosis. The basic principle of IHC involves using specific antibodies to go and get attached to specific antigens present on biological tissue and then visualizing the antigen–antibody reaction thus identifying the cell type using its antigenic characteristics. The use of IHC in histopathological diagnosis can ensure a precise diagnosis thus helping the clinician to make appropriate therapeutic choices related to the management of common genital tract tumors. Cervix: IHC can help in differentiating reactive changes from cervical intraepithelial lesions. IHC can also improve the specificity of Pap smears while screening for squamous intraepithelial lesions. Corpus uteri: IHC has been used to identify cases of primary adenocarcinoma of the uterus metastasizing to the cervix and also to differentiate between type I and type II endometrial carcinoma. IHC can also be utilized to improve the positive predictive value of endometrial sampling to preoperatively diagnose uterine leiomyosarcomas. Ovary: One major problem faced by the clinician is the early intraoperative diagnosis of ovarian malignancy and IHC helps in obtaining an early and accurate diagnosis. Gestational trophoblastic diseases: The use of IHC techniques can help in accurate diagnosis of complete hydatidiform mole. Vulva: Coexistence of high-grade vulvar intraepithelial neoplasia or verrucous carcinoma of the vulva with condyloma acuminata, which is a benign condition, can be picked up using IHC and this is a big advantage to the clinician to plan a treatment protocol. Though IHC is an important tool, there are issues of standardization and reproducibility that need to be addressed. IHC is yet to evolve into a standalone method of laboratory diagnosis and must be used in conjunction with clinical assessment and histopathological findings.



Placenta Percreta Presenting as an Acute Obstetric Emergency in Mid-second Trimester: A Case Report

[Year:2021] [Month:March-April] [Volume:13] [Number:2] [Pages:3] [Pages No:135 - 137]

   DOI: 10.5005/jp-journals-10006-1881  |  Open Access |  How to cite  | 


Aim: To know the risks and management of placenta percreta in patients with previous lower segment cesarean section (LSCS) with postabortal hemorrhage. Background: Placenta percreta, a form of adherent placenta, is associated with significant postabortal hemorrhage often requiring emergency hysterectomy. Majority of these cases are seen in patients with a history of previous LSCS with anterior low-lying placenta. Case description: A 29-year-old female with previous two LSCS came at 19 weeks 4 days of gestational age with complaints of leaking per vaginum since 7 days and mild pain abdomen. Her ultrasonography showed single live intrauterine fetus (SLIUF) with anterior upper segment placenta with no evidence of accretion. She went into labor spontaneously and expelled a male baby weighing 300 gm. Subsequently, she had postabortal hemorrhage with the placenta in situ. Medical management of post-abortal hemorrhage (PAH) was given but she went into shock with massive blood loss. After stabilization of the patient with iv fluids and colloids, she was taken up for emergency laparotomy, in view of retained placenta with previous two LSCS with postabortal hemorrhage as medical management failed. On laparotomy, the placenta was anterior and was invading the wall of the uterus up to the serosa. As she was bleeding torrentially, an emergency hysterectomy was done without any delay in decision-making. She was transfused with four packed red blood cells (PRBC) and four fresh frozen plasma (FFPs). Her postoperative period was uneventful and she was discharged on day 7 in astable condition. Histopathological findings confirmed the absence of the placental basal plate and the presence of trophoblastic tissue in the myometrium and serosa. Conclusion: Good anticipation and timely decision are very important in decreasing maternal morbidity and mortality in cases of PPH with adherent placentas, like in other obstetric emergencies. Clinical significance: We wish to highlight the importance of good clinical knowledge with timely decision by OB/Gyn team in a patient with PPH and placenta percreta encountered in the mid-second trimester.



Shasthara Paneyala, Nemichandra Siddanakatte Chandrashekaraiah, Harsha Sundaramurthy, Vimala C Colaco

“Double” Trouble in Postpartum State

[Year:2021] [Month:March-April] [Volume:13] [Number:2] [Pages:6] [Pages No:138 - 143]

   DOI: 10.5005/jp-journals-10006-1882  |  Open Access |  How to cite  | 


Background: Guillain–Barre syndrome (GBS) is a perplexing neurological disease of autoimmune etiology with an incidence of 1.2 to 1.9 cases/100,000 population. The overall incidence remains almost the same in pregnancy. Posterior reversible encephalopathy syndrome (PRES) is a clinicoradiological entity most commonly encountered in peripartum preeclampsia; however, it can also be seen in other clinical scenarios such as immunosuppressant treatment, infection/sepsis, autoimmune diseases, and during cancer chemotherapy. GBS can be considered as an independent risk factor of PRES, due to acute dysautonomia and pain. Here we report the unique case of a patient who presented to the neurology department with flaccid quadriparesis in the immediate postpartum period, was diagnosed as having GBS and initiated on treatment for the same, and subsequently developed seizures secondary to PRES. Case description: A 22-year-old patient, with no previously known comorbidities, was admitted to the obstetrics department in her 37th week of gestation in labor. The patient underwent an emergency lower segment cesarean section (LSCS) (previous LSCS in labor) with no periprocedural complications. On the next day, she developed progressive ascending quadriparesis sparing sensory and sphincters. Nerve conduction studies done showed features of GBS, and cerebrospinal fluid studies done showed albuminocytological dissociation. The patient was then initiated on plasmapheresis in the intensive care unit setting and closely monitored for any deterioration in overall neurological picture and bulbar symptoms. The patient remained stable and showed positive response to the plasmapheresis. On the morning of postpartum day 6, the patient complained of sudden painless bilateral complete loss of vision followed by an episode of generalized tonic–clonic seizures. She had labile blood pressure with reactive pupils, normal fundus, and no other long-tract signs. Magnetic resonance imaging (MRI) brain and magnetic resonance venogram were done. MRI brain done showed features suggestive of PRES. She was managed with antiepileptic drugs, blood pressure optimization, and supportive care with rapid recovery in vision in 2 days. She showed steady improvement in motor power following plasmapheresis and subsequently was managed with physiotherapy to full functional recovery. Conclusion and clinical significance: GBS in pregnancy, PRES in the postpartum female, and PRES in GBS are all unique entities with no defined incidence and only documented case reports. GBS rarely complicates pregnancies; there are few case reports of the same, the exact incidence of which is not defined. Proposed mechanisms leading to PRES in patients with GBS are dysautonomia leading to acute rise in the blood pressure, activation of sympathetic nervous system secondary to pain, and intravenous immunoglobulin usage. Review of the literature shows that previous cases of PRES in combination with GBS is a very unique finding with only a few case reports making this case distinctive. In our patient who developed GBS in the peripartum period, the probable mechanism of PRES was the labile blood pressures secondary to dysautonomia. With management of GBS, a close watch on pressures and close neurological observation of the patient made a near-complete recovery.



Manali V Daga, Priyanka H Vora, Sukhpreet Patel, Mehernosh J Jassawalla

Is it Time to Revisit Your Cryotanks amidst the COVID-19 Pandemic? An Embryologist's Perspective

[Year:2021] [Month:March-April] [Volume:13] [Number:2] [Pages:3] [Pages No:144 - 146]

   DOI: 10.5005/jp-journals-10006-1883  |  Open Access |  How to cite  | 


Aim: To present options for management of errors resulting from the cryopreservation of large volumes of semen samples and long freeze-to-thaw intervals. Background: The cryopreservation of gametes is on the rise owing to its established safety and efficiency. Case description: We present a challenging case at our center of a lost semen vial due to a broken cryocane and a systematic approach to locating it. Conclusion: Systematic troubleshooting can help locating misplaced gamete samples in high-volume centers. Clinical significance: New guidelines for containment systems is the need of the hour.


Book Review

Kanthi Bansal, Pooja Sharma Dimri, Apoorva Pallam Reddy

Decoding Polycystic Ovarian Syndrome (PCOS)

[Year:2021] [Month:March-April] [Volume:13] [Number:2] [Pages:1] [Pages No:147 - 147]

   DOI: 10.5005/jsafog-13-2-147  |  Open Access |  How to cite  | 


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