Journal of South Asian Federation of Obstetrics and Gynaecology

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2021 | September-October | Volume 13 | Issue 5

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Guest Editorial

Prof Dr Ganesh Dangal, Dr Rekha Poudel

A Global Epidemic of Rising Trend of Cesarean Section: Needed Serious Efforts by All Stakeholders to Curb It

[Year:2021] [Month:September-October] [Volume:13] [Number:5] [Pages:1] [Pages No:iv - iv]

   DOI: 10.5005/jsafog-13-5-iv  |  Open Access | 



Sanjay Rathod, Geetika G Syal, Rajeev Sood, Kartik Syal

Intrathecal Labor Analgesia Using Dexmedetomidine: A Viable Alternative to Epidural Analgesia

[Year:2021] [Month:September-October] [Volume:13] [Number:5] [Pages:4] [Pages No:279 - 282]

Keywords: Dexmedetomidine, Intrathecal analgesia, Labor analgesia

   DOI: 10.5005/jp-journals-10006-1949  |  Open Access |  How to cite  | 


Aims and objectives: The aims and objectives of the study were to compare the safety and efficacy of single dose intrathecal analgesia using bupivacaine and fentanyl with either dexmedetomidine or morphine on maternal and fetal outcome. Materials and methods: One-hundred and twenty parturients with uncomplicated pregnancy in spontaneous or induced labor at cervical dilatation 4–6 cm were enrolled for the study. They were randomized into two groups of 60 each. Group I received dexmedetomidine 5 µg (1 mL) and group II received morphine 250 µg (1 mL) along with 0.5% bupivacaine heavy 2.5 mg (0.5 mL) + Fentanyl 25 µg (0.5 mL). Progress of labor, duration of analgesia, and neonatal APGAR score was recorded and compared between the two groups. Result: The mean rate of cervical dilatation in group I was 1.63 ± 0.135 cm/hour whereas it was 1.54 ± 0.156 cm/hour in group II (p = 0.001). The mean total duration of labor in group I was 682.35 ± 60.920 minutes whereas it was 771.63 ± 52.016 minutes (p = 0.005). In the group I, 98.3% (59/60) had NVD, 1.7% (1/60) had IVD, and none had cesarean delivery. Similarly 75% (45/60) had NVD, 15% (9/60) had IVD, and 10% (6/60) had cesarean delivery in the group II. This difference was statistically significant (p = 0.001). However, duration of the second stage of labor, duration of labor analgesia, maternal satisfaction, and APGAR score did not differ in the two groups. Conclusion: Single-shot intrathecal labor analgesia using combination of bupivacaine (2.5 mg), fentanyl (25 µg), and dexmedetomidine (5 µg) is a safe, effective, reliable, cheap, and satisfactory method of pain relief for labor and delivery.



Sathya Prabha Jagannathan, Hingmire M Sunil, Prema Nalligounder

A Comparative Study of Fetomaternal Outcome of Elective Cesarean and Vaginal Birth after Cesarean Section in a Tertiary Care Center in South India

[Year:2021] [Month:September-October] [Volume:13] [Number:5] [Pages:5] [Pages No:283 - 287]

Keywords: Cohort study, Elective repeat cesarean section, Maternal and neonatal outcome, Trial of labor after cesarean section

   DOI: 10.5005/jp-journals-10006-1958  |  Open Access |  How to cite  | 


Aims and objectives: To provide evidence-based information to choose the mode of delivery following a single cesarean section in a tertiary center in South India. The objective is to study the success rate, safety, and efficacy of vaginal birth after cesarean section (VBAC) by comparing the maternal and perinatal outcome with the elective repeat cesarean section (ERCS). Materials and methods: This was a prospective, cohort study done over a period of 12 months in a tertiary care center. Based on the patients’ preference, a total of 211 women who satisfied the inclusion criteria were divided into two groups—either trial of labor after cesarean section (TOLAC) or ERCS group. Results: Success rate of VBAC was found to be 47.9%. About 15% of failed VBAC was due to the tendency to abandon TOLAC midway. Although the maternal complications were found to be higher in TOLAC, p value (0.347) was not found to be significant. There was no increased risk of neonatal morbidity and mortality in the TOLAC group when compared to ERCS (p = 0.814). There was also no difference found in Apgar scores (<7) at 5 minutes and newborn intensive care unit (NICU) admissions in the TOLAC group and in the ERCS group (p = 0.899). Conclusion: The success rate of VBAC was found to be 47.9%. There was no significant risk of maternal and perinatal complications compared to ERCS. Clinical significance: Although VBAC was found to be successful in developed countries, we need more of studies in our Indian setup with the local population to improve the quality of health care and create awareness among patients. This present study might boost the obstetricians in the tertiary care setup to counsel more for TOLAC.



Irwin L Lumbanraja, Muhammad FG Siregar, Sarma N Lumbanraja, Ichwanul Adenin, Letta Sari Lintang, Binarwan Halim

Association of Vaginal Maturation Index and Vaginal pH with the Most Bothersome Symptoms of Genitourinary Syndrome of Menopause

[Year:2021] [Month:September-October] [Volume:13] [Number:5] [Pages:4] [Pages No:288 - 291]

Keywords: Genitourinary syndrome of menopause, Menopause, Vaginal cytology, Vaginal maturation index

   DOI: 10.5005/jp-journals-10006-1950  |  Open Access |  How to cite  | 


Introduction: Genitourinary syndrome of menopause (GSM) is a term used to characterize the symptoms and manifestations of estrogen deficiency in the female genitourinary tract. This syndrome has commnly occurred in postmenopause women yet often undertreatment due to lack of awareness either by physician or the patient herself. Aims and objectives: To assess the association between vaginal maturation index (VMI) and vaginal pH with the most bothersome symptoms of GSM. Methods: This was a cross-sectional study carried out from August to December 2020 in Medan, Sumatera Utara, Indonesia. A total of 150 postmenopause women who meet the criteria were recruited. This study data consisted of primary data of characteristic background, estradiol level, score of VMI, and vaginal pH. The subjects were divided into two groups regarding the existence of GSM related symptoms. The symptomatic women were asked for the most bothersome symptoms and analyzed based on its severity. Result: The majority of menopausal women (70.7%) did not report any GSM-related symptom. The most bothersome symptom (MBS) for this study is vaginal dryness and dyspareunia. The women with mild symptoms showed statistically higher vaginal pH and lower VMI compared to the subjects with moderate/severe symptoms (p <0.05). Conclusion: Lower VMI and higher vaginal pH associated with the severity of GSM symptoms.



Bhavya Doshi, Arun H Nayak, Archana A Bhosale, Rashi Koria

Study of Anxiety, Fear and Depression Associated with Breastfeeding in COVID-positive Mothers

[Year:2021] [Month:September-October] [Volume:13] [Number:5] [Pages:5] [Pages No:292 - 296]

Keywords: Anxiety, Breastfeeding, COVID-19, Depression, EPDS, Pandemic, Pregnancy

   DOI: 10.5005/jp-journals-10006-1931  |  Open Access |  How to cite  | 


Aim and objective: To study anxiety, fear and depression associated with breastfeeding in coronavirus disease (COVID)-positive mothers. Materials and methods: The following three standard scales were used to measure fear anxiety, and depression namely fear of coronavirus disease-2019 (COVID-19) scale (FCV-19S), corona disease anxiety scale (CDAS), and Edinburgh postnatal depression scale (EPDS) among postpartum women along with a self-made breastfeeding questionnaire by the author to assess the association with breastfeeding. Results: Among the total of 62 respondents, a mean of 17 was obtained on the EPDS which is more than the cutoff value. FCV-19S and CDAS did not show extreme results except for few cases. The breastfeeding questionnaire suggested that most women are afraid of transmitting the infection to their newborns and they lack the knowledge about the importance of breast milk in warding off other infections. Also, women found it difficult to take care of their newborns on their own. Conclusion: With this study, we could determine the effects of this pandemic on anxiety levels, depression, and fear of COVID infection in postpartum women. In the current scenario with the possibility of the next pandemic wave in India, there is an urgent need to provide emotional and psychosocial support to this group of the population during the crisis. Otherwise, the adverse outcome is possible involving both mother and newborn. Clinical significance: The COVID-19 outbreak that began in China has turned into a pandemic that affects global health, thereby prompting the concentration of studies and clinical routines on treating and preventing the disease with measures like vaccination. Still, the clinical data regarding psychological manifestations of the ongoing pandemic among the general public, especially postpartum women and breastfeeding mothers, are inadequate. In this study, we analyzed experiences of breastfeeding mothers during the COVID-19 pandemic, specifically concerning how COVID-positive status affected their infant's feeding decisions. It clearly showed that being COVID positive created, affected, and exacerbated mental health issues for mothers.



A Case Series of Peritonectomy done in Different Histopathological Patterns of Ovarian Cancer Cases: A Critical Analysis

[Year:2021] [Month:September-October] [Volume:13] [Number:5] [Pages:4] [Pages No:297 - 300]

Keywords: Cytoreductive surgery, Epithelial ovarian cancer, Peritonectomy, Surgical complexity score

   DOI: 10.5005/jp-journals-10006-1923  |  Open Access |  How to cite  | 


Background: Peritoneal dissemination is the most common mode of spread for cancer ovary. Total peritonectomy (PRT) refers to removal of all peritoneum and total omentectomy. Here we have analyzed PRT in five different histopathological variants of ovarian cancer. Case descriptions: Five different cases were operated in our institute in last 1 month. All are having different histopathological patterns and underwent cytoreductive surgery (CRS) with PRT achieving surgical complexity score (SCS) of 8. They were not associated with any major complications due to proper PRT. PRT has been done here by blunt dissection. Discussion: The PRT is feasible with acceptable complication rate and hospital duration. In our case series, only two people had major injury that too due to the tumor properly not due to PRT. Conclusion: The PRT must be done in all cases of carcinoma ovary as part of the CRS procedure. It is reproducible, feasible, and without much complication.



Bhuvana Srinivasan, Kamjula Pragna

Comparison of Umbilical Arterial and Venous Lactate and Base Excess Values and Its Neonatal Outcome in High-risk Pregnancies

[Year:2021] [Month:September-October] [Volume:13] [Number:5] [Pages:5] [Pages No:301 - 305]

Keywords: Adverse perinatal outcome, Amniotic fluid index, APGAR score, Fetal outcome, High-risk pregnancy, Maternal and perinatal outcomes, Nonstress test, Perinatal mortality, Perinatal outcome

   DOI: 10.5005/jp-journals-10006-1939  |  Open Access |  How to cite  | 


Aim and objective: The aim and objective of the study was to compare the paired umbilical arterial and umbilical venous blood gas analysis and its neonatal outcome in high-risk pregnancies at a risk of perinatal asphyxia. Materials and methods: A 10–20 cm segment of umbilical cord was doubly clamped above the previous clamp immediately after delivery. Both the samples were sent for analysis immediately not exceeding 15 minutes. Blood gas analysis was done by ABG analyzer. Results were collected and compared. APGAR at 1 and 5 minutes of the neonate was noted. Results: Sensitivity for APGAR at 5 minutes obtained for a mean value of 4.5 mmol/L for arterial lactate was 94% and the specificity was 32%. For a base excess mean value of −10 mmol/L in the arterial sample, sensitivity was 81% and specificity was 32% observed for APGAR. When lactate was compared to arterial base excess, the area under the receiver operating characteristic (ROC) curve was higher for base excess. Conclusion: Comparison of paired cord blood gas analysis of pH, lactate, and base excess is a valuable adjunct to guide the management of newborns in high-risk pregnancies. In our study, umbilical arterial sample was superior to venous sample in predicting neonatal outcome. Clinical significance: Paired umbilical gas analysis is an effective method of practice for predicting neonatal acidemia in high-risk pregnancies. Both lactate and base excess had a high negative predictive value for predicting birth asphyxia that will work as an obstetric quality measure as well as an audit tool.



Seetha Panicker

Analysis of Classification Systems and Outcome of Labor in Women Undergoing Induction of Labor in South Indian Population

[Year:2021] [Month:September-October] [Volume:13] [Number:5] [Pages:5] [Pages No:306 - 310]

Keywords: Cesarean section, Labor induction, Neonatal outcome, Obstetric complications, Obstetric outcome, Preinduction cervical ripening

   DOI: 10.5005/jp-journals-10006-1940  |  Open Access |  How to cite  | 


Aim and objective: To identify women undergoing induction of labor (IOL) for 1 year in our tertiary care hospital, apply the classification systems, correlate with the maternal and fetal outcomes, and determine the ease and effectiveness of audit of the IOL practice. Materials and methods: All patients who delivered in the year 2019 were analyzed, and the cohort of women who underwent IOL was identified. The age, parity, gestational age at induction, indication for induction, and the maternal and fetal outcomes were analyzed. The two classification systems were applied and the results were analyzed. Results: The total number of deliveries for the year was 3,668, and the number of women undergoing IOL was 1,450, with an incidence of 39.5%. The maximum number of women, 1,212, (83.5%) were in the 20–30-year age-group; in that, 1107 (76.34%) were primiparous and 343 (23.66%) were multiparous. The commonest indication for IOL was postdates, with the commonest mode being PGE2 gel in 699 (48.2%) women. Of 1,450 women induced, 1,083 (74.69%) had a vaginal delivery and 367 (25.31%) delivered by a cesarean section. This was similar to the rate seen in women with spontaneous labor. Further, a 10-group classification system according to Nippita et al. and classification of IOL according to the indication for induction proposed by Mahomed et al. was applied to this cohort. Conclusion: The classification systems are useful to determine whether the induction is done according to the established guidelines and makes our audit easier. A prospective audit would better identify some of the adverse maternal and fetal outcomes. Clinical implications: The safety of IOL in modern obstetrics should not give us a false sense of security, and regular audits of the practice of IOL are useful to ensure that the adherence is according to the established guidelines.



Anupama Dave, Pushplata Mourya, Atisha Dave

Role of Isosorbide Mononitrate as an Agent for Cervical Ripening in Second-trimester Abortions

[Year:2021] [Month:September-October] [Volume:13] [Number:5] [Pages:5] [Pages No:311 - 315]

Keywords: Cervical ripening, Second-trimester termination of pregnancy, Vaginal isosorbide mononitrate

   DOI: 10.5005/jp-journals-10006-1961  |  Open Access |  How to cite  | 


Objective: To compare the effectiveness and safety of isosorbide mononitrate (IMN), misoprostol (MP), and mechanical dilatation (MD) for cervical ripening in second-trimester abortions. Methodology: The present study was conducted in the Department of Obstetrics and Gynaecology, MGM Medical College, Indore, Madhya Pradesh, from September 2014 to August 2015. One-hundred and fifty women who had a valid indication for termination were included after informed consent and randomized into three groups of 50 each. Women with hypotension BP 8 mm were excluded. Results: In the study, indications for termination were fetal conditions (14.6%), maternal conditions (19.3%), contraceptive failure (39.3%), IUFD (16.6%), and others (10%). The mean ± SD of Bishop score before and after IMN were 1.18 ± 1.43 and 4.54 ± 1.70, whereas for MP, 1.2 ± 1.525 and 4.76 ± 1.80, and for MD, 1.3 ± 1.46 and 4.36 ± 1.56, respectively (p = 0.000 significant). The mean ± SD of induction ripening interval of 10.9 ± 3.23, 9.76 ± 3.17, and 12.92 ± 2.65 for IMN, MP, and MD (p = 0.000) shows that it was least for MP followed by IMN and MD. Comparison of induction–abortion interval showed mean ± SD of 28.32 ± 9.84, 29.00 ± 7.22, and 38.76 ± 9.87 for IMN, MP, and MD, respectively (p = 0.000). All cases of IMN and MP aborted vaginally; in MD group, 4% had a hysterotomy. Side effects were minimal in IMN group with only headache which was tolerable. Conclusion: IMN when compared with MP and MD proved to be a good cervical ripening agent for second-trimester abortions. It is safe, effective, and has minimum side effects. More studies are required for establishment of IMN as a ripening agent.



Rahila Imtiaz, Syed Hassan Ahmed Rizvi, Syed Hussain Ahmed Rizvi

Frequency, Predisposing Factors, and Fetomaternal Outcomes of Uterine Rupture

[Year:2021] [Month:September-October] [Volume:13] [Number:5] [Pages:3] [Pages No:316 - 318]

Keywords: Cesarean section, Maternal death, Perinatal outcome

   DOI: 10.5005/jp-journals-10006-1951  |  Open Access |  How to cite  | 


Aim: To assess the frequency of uterine rupture and its associated fetomaternal outcomes. Methods: This retrospective study was conducted at the Department of Obstetrics and Gynecology, Unit 1, Abbasi Shaheed Hospital from January 2019 to December 2019. Women with ruptured uterus diagnosed prior to or during surgery at the hospital were included. Those who had ruptured uterus secondary to congenital abnormality were excluded. Data were analyzed using SPSS version 16.0. Results: There were 1,054 deliveries during the year 2019 and rupture was diagnosed in nine cases (0.8%). Two women with rupture were booked and the rest were un-booked. Neglected obstructed labor was the major cause of ruptured uteri, while 44.44% cases had previous cesarean section scar. With respect to site, 66.66% of cases had ruptured anterior wall. Rupture was complete in 77.7% of cases. Hysterectomy was performed in 44.44%. Two maternal and seven intrauterine deaths (77.78%) took place in this study. Live birth rate was 22.22%. Conclusion: Our study proved that neglected prolonged labor is still claiming maternal lives in the region. Antenatal care should be made more accessible and training should be provided to traditional birth attendants to recognize and refer such cases. Clinical significance: Traditional birth attendants need to be supervised and trained to use oxytocin. Women should be advised strictly to deliver in hospitals after a cesarean birth.



Masihon Murmu, Nurejjaman , Mahua Mondal, Shermin Siria Begum

Endometrial Histopathological Evaluation in Antepartum Hemorrhage for Placental Etiology

[Year:2021] [Month:September-October] [Volume:13] [Number:5] [Pages:6] [Pages No:319 - 324]

Keywords: APH, Decreased fibrin deposition, Endomyometrial biopsy, Hemorrhage, Less physiological changes, Trophoblast invasion

   DOI: 10.5005/jp-journals-10006-1954  |  Open Access |  How to cite  | 


Aims and objectives: The aims of the study were to investigate and identify the structural changes in endomyometrium in association with placental causes of antepartum hemorrhage (APH). Background: The microscopic comparative evaluation of endomyometrium in upper and lower segments including placental bed in APH and non-APH. Type of study: This is a clinical, interventional, prospective, randomized controlled trial (RCT). Place, duration, and sample size: The study was conducted in the Department of Gynaecology and Obstetrics, IPGMER-SSKM Hospital, Kolkata, West Bengal, India, prior to more than a year. Methods and materials: After getting ethical approval, sixty-four (64 cases) APH and non-APH patients were selected, randomized, and allowed into two groups for management point of view by cesarean delivery like Gr-A (N = 32) = cases (APH); Gr-B (N = 32) = controls (non-APH). Four samples from each patient during cesarean delivery of randomly selected cases and controls each from upper lower, anterior, and posterior with one must from placental bed were taken and studied microscopically. The results of microscopic features revealed that there were hemorrhage, an unusual, abnormal vascular structure, absent deciduas changes, direct contact between placenta and myometrium with higher trophoblast infiltration into deciduas, myometrium, and vessels with decreased villous fibrin deposition. Conclusion: The decidua has a major role to play in negotiating “the treaty of compromise” ultimately signed between fetal and maternal tissues if such a treaty is not signed or broken, defective placentation (imperfect fibrinoid—Nitabuch layer) and its consequence must follow.



Vaidehi A Duddalwar

Comparative Study to Evaluate Intersystem Association between Pelvic Organ Prolapse Quantification System and Simplified Pelvic Organ Prolapse Scoring System

[Year:2021] [Month:September-October] [Volume:13] [Number:5] [Pages:5] [Pages No:325 - 329]

Keywords: Intersystem association, Pelvic organ prolapse quantification system, Simplified pelvic organ prolapse scoring system

   DOI: 10.5005/jp-journals-10006-1963  |  Open Access |  How to cite  | 


Aim: To study the intersystem association between pelvic organ prolapse quantification (POP-Q) system and simplified pelvic organ prolapse (S-POP) scoring system. Materials and methods: This hospital-based prospective, randomized controlled trial was conducted in 65 women of reproductive, perimenopausal, and postmenopausal age-group with pelvic organ prolapse having urinary or bowel complaints and admitted to gynecology ward of Lata Mangeshkar Hospital, Nagpur, during the period from October 1, 2016, to October 31, 2018. Women willing to participate in the study were assessed and enrolled in the study after fulfilling inclusion and exclusion criteria. Women were assessed by both the assessment systems—POP-Q system and S-POP scoring system preoperatively for evaluating intersystem association between them. Results: There was FAIR association between POP-Q and S-POP of stage II and stage III for anterior wall prolapse. The association was GOOD of stage II and FAIR of stage III for central compartment and VERY GOOD of stage II and FAIR of stage III for overall prolapse. Conclusion: Though POP-Q system appears complex; it is simple and has a learning curve. With respect to pelvic floor repair and significant anatomical and functional improvement postoperatively, POP-Q system should be the preferred method of assessment of pelvic organ prolapse. Clinical significance: We hope to find a suitable, reproducible, standardized, and user-friendly method for quantification of pelvic organ prolapse to relate the result of the test to the outcome of treatment.



Sunil K Samal, Setu Rathod

Correlation between Maternal Body Mass Index and Anovaginal Distance in Term Primiparous Women at the Time of Active Labor

[Year:2021] [Month:September-October] [Volume:13] [Number:5] [Pages:4] [Pages No:330 - 333]

Keywords: Anovaginal distance, Body mass index, Obese

   DOI: 10.5005/jp-journals-10006-1960  |  Open Access |  How to cite  | 


Introduction: The incidence of obstetric anal sphincter injuries (OASIs) is less in overweight and obese women compared to normal weight women. Aim and objective: The aim of the study was to find a correlation in the thickness of anovaginal distance (AVD) as obtained by transperineal ultrasound between term obese and normal weight primiparous women at the time of active labor. Materials and methods: The study was conducted in the department of obstetrics and gynecology in a tertiary care center in South India. This was a cohort study where term primiparous women at the time of active phase of labor were taken as study population after fulfilling the inclusion criteria. To measure the AVD, a transvaginal ultrasound probe was used in the perineum similar to transperineal ultrasound. The data regarding maternal characteristics, pregnancy details, and the findings at the time of labor were collected from woman's case sheets from the labor ward. The study population after considering the inclusion criteria were divided into three body mass index (BMI) groups considering the prepregnancy or early pregnancy maternal weight: normal weight (BMI <25), overweight (BMI 25–29.9), and obesity (BMI ≥30). All the three groups were compared according to the measured AVD at the time of labor. Results: There were no significant differences in baseline parameters between the groups. The different BMI groups had mean AVD of 24.2 mm in normal weight group, 24.7 mm in overweight group, and 27.3 mm in the obesity group. There was significant difference (p = 0.028) in AVD between the groups and obese women had significantly thicker AVD as compared to their normal and overweight counterparts. Conclusions: The AVD in obese primiparous group was significantly thick which could be a factor for lower rates of OASI in the obese group. The anal sphincter complex might have been protected by this thicker AVD during the second stage of labor. We recommend further large randomized control trials to evaluate whether there is a correlation between the thickness of the AVD and the incidence of OASI.



Anjum Ara, Sushma Rani, Indu Chawla, Vaddi S Babu, Sunayana Misra

Tubocutaneous Fistula: A Rare Entity

[Year:2021] [Month:September-October] [Volume:13] [Number:5] [Pages:3] [Pages No:334 - 336]

Keywords: Computed tomography sinogram, Genital tuberculosis, Tubocutaneous fistula

   DOI: 10.5005/jp-journals-10006-1964  |  Open Access |  How to cite  | 


Fistula between fallopian tube and skin, i.e., tubocutaneous, is extremely a rare entity. Very few cases were reported in the literature. We report a case of a 38-year-old woman who presented with chronic discharging left inguinal wound secondary to genital tuberculosis (TB) for which she had taken 6 months antitubercular treatment (ATT). It was diagnosed as tubocutaneous fistula on computed tomography (CT) sinogram. Complete surgical resection in the form of salpingectomy or salpingo-oophorectomy with complete fistula excision and supplementing it with long-term ATT is the treatment of choice in such patients.



Sujata Datta, Ritisha Basu

Spontaneous Primary Umbilical Endometriosis Preceding Severe Pelvic Endometriosis: A Case Report

[Year:2021] [Month:September-October] [Volume:13] [Number:5] [Pages:2] [Pages No:337 - 338]

Keywords: Cutaneous sinus, Umbilical bleeding, Umbilical endometriosis, Umbilical nodule

   DOI: 10.5005/jp-journals-10006-1965  |  Open Access |  How to cite  | 


Primary spontaneous umbilical endometriosis accounts for a minority of the cases of umbilical endometriosis, the incidence of which is 0.5–1% of all extragenital endometriosis. Cyclical umbilical bleeding without any accompanying symptom of pelvic endometriosis or any prior history of surgery is an extremely rare condition that throws up diagnostic challenges, in the absence of overt clinical signs. We present a case of solitary primary umbilical endometriosis, which progressed to severe grade 4 endometriosis over a span of 4 years for poor patient compliance. Imaging difficulties as well as laparoscopic challenges in therapy, especially with the insertion of the primary port in the presence of an umbilical endometriotic nodule, are also discussed.



Muhammad IA Akbar, Hapsari Kinanti, Ernawati E Ernawati, Pudji Lestari

Maternal and Perinatal Outcomes of Early-onset and Late-onset Preeclampsia at a Tertiary Center Hospital

[Year:2021] [Month:September-October] [Volume:13] [Number:5] [Pages:5] [Pages No:338 - 342]

Keywords: Cross-sectional study, Early-onset preeclampsia, Late-onset preeclampsia, Maternal outcome, Perinatal outcome

   DOI: 10.5005/jp-journals-10006-1915  |  Open Access |  How to cite  | 


Aim: Preeclampsia is still a major health problem in Indonesia, that causes maternal and perinatal morbidity and mortality. This study compares the maternal and perinatal outcomes between early-onset preeclampsia (EO-PE) and late-onset preeclampsia (LO-PE) at a tertiary care center in Indonesia during 2016. Materials and methods: This cross-sectional study includes 102 patients with preeclampsia. Preeclampsia was divided based on the gestational age: <34 weeks as EO-PE and ≥34 weeks as LO-PE. The primary outcomes were maternal and perinatal outcomes. Results: The incidence of all preeclampsia in this study was 12.5% during 2016. EO-PE is associated with a longer length of stay compared to LO-PE [8 (5) vs 6 (3); p <0.0001]. Other maternal outcomes, such as mode of delivery, maternal death, eclampsia, HELLP syndrome, gestational diabetes mellitus, and lung edema, were not significantly different. EO-PE was also correlated with worse perinatal outcomes, such as preterm birth (97.6 vs 38%; p <0.001; OR 66.9; 95% CI: 8.49–527.1), baby birth weight [1,525 (763) vs 2,650 (650); p <0.001], baby birth length [41 (6) vs 47 (4); p <0.001], lower Apgar score at first minute [5 (5) vs 7 (2); p <0.0001], and lower Apgar score at fifth minute [7 (5) vs 8 (2); p <0.0001]. Conclusion: EO-PE is associated with worse maternal and perinatal outcomes compared to LO-PE. The presence of EO-PE should be responded to with tight monitoring and early intervention to reduce the risk of maternal and perinatal complications.



Monika Anant, Sonam Yadav, Anita Paswan, Mrinal Sharma, Priyanka Raj, Anuja Pritam

Protein-C Deficiency and Bad Obstetric History: A Rare Successful Outcome in Twin Pregnancy

[Year:2021] [Month:September-October] [Volume:13] [Number:5] [Pages:3] [Pages No:339 - 341]

Keywords: Bad obstetrics history, Multiple pregnancy, Perinatal outcome, Protein C deficiency

   DOI: 10.5005/jp-journals-10006-1955  |  Open Access |  How to cite  | 


Inherited thrombophilias in pregnant females have increased risk of venous thromboembolism as well as adverse outcomes in pregnancy like miscarriage, fetal demise, fetal growth restriction, and abruptio placenta. Majority (50–60%) of cases of inherited thrombophilias are due to FVL (factor V Leiden) and prothrombin G20210A (also called the prothrombin gene mutation [PGM]) whereas deficiencies in protein S, protein C, and antithrombin account for the remaining cases. Pregnancy with thrombophilias requires adequate thromboprophylaxis during antenatal and postnatal periods depending upon the type and other factors, but the available evidence for their management is not sharply defined. This case reports a successful outcome in case of twin pregnancy with protein C deficiency with a personal history of venous thromboembolic (VTE) event and a bad obstetric history (BOH). She had multiple factors increasing her VTE risk: (1) previous thrombosis history; (2) inherited thrombophilia; (3) multiple pregnancy and hence was on continued anticoagulant therapy in antenatal and puerperal period. Although only a possible weak association with pregnancy losses has been suggested for protein C deficiency, this case emphasizes that thromboprophylaxis throughout antenatal course improves pregnancy outcome in those with recurrent pregnancy losses.



Ruchi Bisht, Vishakha P Kandalgaonkar, Kunaal K Shinde

Cesarean Section Rate among COVID-19 Mothers and Its Classification through Robson's Criteria

[Year:2021] [Month:September-October] [Volume:13] [Number:5] [Pages:5] [Pages No:342 - 346]

Keywords: COVID-19, Cesarean section, Robson's criteria

   DOI: 10.5005/jp-journals-10006-1921  |  Open Access |  How to cite  | 


Background: The COVID-19 epidemic that erupted in November 2019 has brought medical science to the fore in news and public perceptions. As the pandemic enters the next phase with new diversity, there are various concerns regarding pregnant women, its transmission to the unborn child, and the safe and secure method of childbirth. Both the method of vaginal delivery and the delivery phase are equally appropriate. The mode of birth a woman should go through must be personal and based entirely on the severity of the disease and obstetric indications. Methods: This was a 1-year retrospective study from April 2020 to April 2021 in the Department of Obstetrics and Gynecology of the Postgraduate Institute Yashwantrao Chavan Memorial Hospital, Pimpri, Pune. All pregnant women admitted irrespective of their gestational age or whether they were in labor or not were universally screened for COVID-19. All the delivered women were segregated based on the mode of delivery, vaginal or cesarean, and the information was then classified according to Robson's policy. Results: The rate of cesarean section in COVID-19 patients during this 1-year period was 31.59%. Also, it was noted that the maternal mortality was more in the cases of cesarean section (1.4%) compared to vaginal delivery (0.00%). The percentage of neonates affected by COVID-19 in cesarean delivery (0.46%) was more than in vaginal delivery (0.22%). Conclusion: We conclude that there is insufficient evidence to support that the outcome of lower-segment cesarean section (LSCS) was better than vaginal delivery to prevent direct transmission from a COVID-19 pregnant mother to the neonate. The mode of delivery should be individualized and based on the severity of the disease and obstetrical indications. Therefore, in mild cases, it is advisable to continue with vaginal delivery and LSCS should be reserved for women with severe respiratory problems, where termination of pregnancy will allow for better ventilation of the newborn.



The Unique Challenges Faced by Obstetricians of a Lower-middle Income Country during the COVID-19 Pandemic

[Year:2021] [Month:September-October] [Volume:13] [Number:5] [Pages:2] [Pages No:347 - 348]

Keywords: COVID-19, Low-middle income countries, Obstetrics

   DOI: 10.5005/jp-journals-10006-1911  |  Open Access |  How to cite  | 


Going through the euphoria of false victory due to herd immunity by the beginning of 2021, India stepped into the critical stage after the emergence of new strains of coronavirus disease-2019 (COVID-19). With more than 20.2 million cases being reported, a rolling average of 4,12,262 cases daily, and death tolls crossing 3,980 per day, hospitals and health workers are overwhelmed and exhausted across the country. With the virus spreading to 220 countries extensively, the human toll in India after the second wave is surely more than double the number of humans killed over 320 natural disasters during the recent two decades. COVID-19 pandemic has created the largest disruption in the social, political, and educational system in history till date. During such time of crisis, our dedicated obstetricians are facing some unique challenges during patient care in the COVID wards and operation theaters. This article highlights these major challenges faced in lower-middle income countries (LMI) of South Asia. It is a tribute to all the hard-working obstetricians who are trying their best to give maximum patient care despite the difficult working environments.



Gaurav S Desai, Niranjan M Mayadeo

Potential Applications of Augmented Reality in Gynecological Surgery

[Year:2021] [Month:September-October] [Volume:13] [Number:5] [Pages:2] [Pages No:349 - 350]

Keywords: Artificial intelligence, Augmented reality, Gynecologic surgery

   DOI: 10.5005/jp-journals-10006-1957  |  Open Access |  How to cite  | 


Background: Augmented reality use has been attempted in other specialties and has the potential to impact gynecological surgery. Objective: To make the readers aware of the use of augmented reality and its use in gynecological surgery. Materials and methods: A comprehensive review of the literature was undertaken to compile instances wherein augmented reality was used in the surgical specialties. Conclusion: Augmented reality has the potential to make gynecological surgery safer and change the way it is taught and practiced around the world. Its success will depend on the partnership between surgeons and technology scientists.



Prerana Nagabhushana, Vanita Suri, Subhash C Saha

Roadblocks in the Delivery of Cancer Care in India during COVID Pandemic

[Year:2021] [Month:September-October] [Volume:13] [Number:5] [Pages:2] [Pages No:351 - 352]

Keywords: Ca cervix, Ca ovary, Cancer, Cancer cervix, Chemotherapy, Malignancy, Mortality, Ovarian carcinoma, Rural, Screening

   DOI: 10.5005/jp-journals-10006-1966  |  Open Access |  How to cite  | 


The coronavirus disease (COVID) pandemic has impacted the health sector in massive proportions. Perhaps the worst affected aspect is that of oncological care. Cancer patients continue to suffer silently due to nonavailability of consultations and shortage of operating rooms. We need to brace ourselves for the impact of this backlog of nearly 18 months of neglected care of such patients.


Book Review

Sanja Kupesic Plavsic

Donald School The Fetus as a Patient Current Perspectives

[Year:2021] [Month:September-October] [Volume:13] [Number:5] [Pages:1] [Pages No:353 - 353]

   DOI: 10.5005/jsafog-13-5-353  |  Open Access |  How to cite  | 


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