Journal of South Asian Federation of Obstetrics and Gynaecology

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2021 | November-December | Volume 13 | Issue 6

Editor's Desk

Editor's Desk

[Year:2021] [Month:November-December] [Volume:13] [Number:6] [Pages:1] [Pages No:iv - iv]

   DOI: 10.5005/jsafog-13-6-iv  |  Open Access |  How to cite  | 

ORIGINAL RESEARCH

Aarzoo Hoda, Manazir Ali, Ummay K Kulsoom

A Prospective Comparative Study of Mifepristone and Misoprostol vs Misoprostol Alone for Induction of Labor in Intrauterine Fetal Death

[Year:2021] [Month:November-December] [Volume:13] [Number:6] [Pages:4] [Pages No:355 - 358]

Keywords: Intrauterine fetal death, Labor induction, Mifepristone, Misoprostol

   DOI: 10.5005/jp-journals-10006-1942  |  Open Access |  How to cite  | 

Abstract

Introduction: Intrauterine fetal death (IUFD) is an important indicator of maternal and perinatal health of a given population. Aim and objective: The objective of the study was to assess the efficacy of mifepristone and misoprostol vs misoprostol alone for induction of labor in IUFD and to determine risk-benefit ratio. Materials and methods: The present study was a prospective observational analytical study which was conducted in the Department of Obstetrics and Gynecology, JNMCH, Aligarh, from January 2018 to January 2021and includes 110 pregnant women with confirmed IUFD on USG. After taking informed consent, a predesigned pro forma was used to collect relevant sociodemographic profile, detailed logical history, and examination from all those participating in the study. Results: Age (mean ± SD) was 25.98 ± 4.49 vs 25.69 ± 4.78 years, parity was 2.31 ± 1.3 vs 2.44 ± 1.61, and gestational age was 31.04 ± 6.89 vs 32.71 ± 5.17 weeks in group I and group II, respectively. Modified Bishops score was >6 in 35 (63.64%) vs 32 (14.55%) women, mean dose of misoprostol required was 0.95 ± 1.5 vs 2.64 ± 1.89, mean induction labor interval was 2.42 vs 7.53 hours, and mean induction to delivery interval was 6.68 vs 16.61 hours in group I and group II, respectively, and the difference was found to be statistically significant. Mean birth weight was 1431.35 vs 1758.60 g, respectively, in the two groups. Four women (7.27%) in group I and 17 women (30.9%) in group II required augmentation with oxytocin which is statistically significant. Nausea, vomiting, loose stools, and hyperthermia were recorded as adverse effects. Among the identifiable causes, abruption was the most common cause in group II, whereas anemia and preeclampsia in group I. Conclusion: The combination of mifepristone with misoprostol was more effective for the induction of labor in IUFD, in terms of lesser amount of misoprostol dosage, oxytocin augmentation, improvement in modified Bishops score, and shorter induction labor and delivery interval when compared to misoprostol alone. Both the regimens were equally safe and easy to administer.

ORIGINAL RESEARCH

Deepika Naidu, Meena Priyadharshini, Krithika V Senthilkumar, Usha Sekkizhar, Jeevithan Shanmugam

Comparison of Inflammatory Parameters in Coronavirus Disease 2019-infected Pregnant Women and Age-matched Nonpregnant Women

[Year:2021] [Month:November-December] [Volume:13] [Number:6] [Pages:4] [Pages No:359 - 362]

Keywords: Coronavirus disease-2019, Cross-sectional study, Interleukin-6, Inflammatory markers, International normalized ratio, Lymphocytes, Neutrophil, Pregnant, Pregnant vs nonpregnant

   DOI: 10.5005/jp-journals-10006-1982  |  Open Access |  How to cite  | 

Abstract

Aim: This study aims to compare inflammatory parameters in coronavirus disease-2019 (COVID-19)-infected pregnant women and age-matched nonpregnant women. Materials and methods: It was a cross-sectional study, and data were collected retrospectively. Pregnant women (cases) with COVID infection admitted to the hospital between July 2020 and December 2020 were included in the study. Age-matched nonpregnant women who were also COVID-positive were taken as controls. Their demographic data, comorbidities, and inflammatory markers were compared. The results were compared using descriptive analysis (clinical profile and outcome of patients). Bivariate analysis was done using Chi-square/Fischer exact test; t-test was used to compare the mean biochemical/pathological parameters between the groups. The clinical outcomes (intensive care unit [ICU] admission, O2 requirement, and mortality) were also noted. Results: A total of 228 women (116 pregnant and 112 nonpregnant) were enrolled in the study. The average age of cases was 27 years, while that of controls was 29 years. There was no statistically significant difference in the incidence of comorbidities (anemia, hypertension, diabetes mellitus, asthma, and hypothyroidism) between the two groups. Compared to the controls, pregnant women did not have any significant difference in the levels of D-dimer, lactate dehydrogenase, and serum ferritin, but there were significant differences (p <0.05) in the values of total count neutrophils, lymphocytes, interleukin-6, and international normalized ratio. We did not have any mortality in either group, and only one patient from the study group needed ICU admission. Conclusion: We were able to point out the inflammatory markers that were significantly altered in COVID-positive pregnant women. The markers may help us understand the severity and clinical outcome of the disease better in the future, so that appropriate preventive measures can be taken. Clinical significance: From our study, we were able to identify the markers that were significantly altered due to COVID-19 infection in pregnant women. These markers may play a role in predicting the outcome of the disease and help in deciding an effective treatment plan.

ORIGINAL RESEARCH

Rini R Naik, Jagadish Cacodkar, Guruprasad N Pednekar

Effects of Teenage Pregnancy on Obstetric and Perinatal Outcomes at a Tertiary Health Institution in Goa

[Year:2021] [Month:November-December] [Volume:13] [Number:6] [Pages:6] [Pages No:363 - 368]

Keywords: Adolescence, Obstetric complications, Perinatal outcomes, Teenage pregnancy

   DOI: 10.5005/jp-journals-10006-1979  |  Open Access |  How to cite  | 

Abstract

Introduction: Teenage pregnancy is a serious health problem worldwide due to the several adverse maternal and perinatal outcomes associated with it. The present study was hence undertaken to study the obstetric outcomes of teenage mothers delivering in Goa Medical College. Methods: A case–control study was conducted in the Department of Obstetrics and Gynaecology, Goa Medical College, for a period of 1 year (December 2018–2019). All teenage mothers <20 years of age delivering in this institution during the said period were included in the study and their maternal and perinatal outcomes were recorded and compared with the same number of randomly selected adult mothers in the age-group of 20–29 years. Results: The incidence of teenage pregnancy in the present study was found to be 2.9%. Obstetric complications like preeclampsia (28.6%), anemia (26.3%), intrauterine growth restriction (25.4%), meconium-stained amniotic fluid (14%), and preterm labor (14%) were found significantly high among teenage mothers. The neonates born to teenage mothers were at risk of developing complications like low birth weight (44%), prematurity (14%), hypoglycemia (30%), hyperbilirubinemia (67%), and increased neonatal intensive care unit admissions (37%) in comparison to those born to adult mothers. Conclusion: Thus, there is a need to implement strong health policies which will help us to reduce the incidence of teenage pregnancy and its associated adverse outcomes.

ORIGINAL RESEARCH

Shuchi Jain, Nisha R Agrawal, Vijai Tilak, Krishna S Piplani

Prevalence of von Willebrand Disease in Patients with Heavy Menstrual Bleeding: An Indian Perspective

[Year:2021] [Month:November-December] [Volume:13] [Number:6] [Pages:5] [Pages No:369 - 373]

Keywords: Case–control study, Congenital bleeding disorder, Heavy menstrual bleeding, Inherited bleeding disorder, von Willebrand disease, von Willebrand factor

   DOI: 10.5005/jp-journals-10006-1968  |  Open Access |  How to cite  | 

Abstract

Aim: The von Willebrand disease (vWD) is said to be the most common hemostatic disorder among the nonstructural causes of heavy menstrual bleeding (HMB). This study was carried out to find prevalence of vWD and its subtypes in patients with HMB referred to a tertiary healthcare center. Materials and methods: Two hundred patients with HMB and equal number of age-matched control were subjected to laboratory tests such as complete blood count, bleeding time, and clotting time. Prothrombin time (PT), activated partial thromboplastin time (APTT), and factor VIII (FVIII):C assay were done manually. von Willebrand factor (vWF:Ag) antigen assay and vWF:Ag collagen binding (CB) were done by enzyme-linked immunosorbent assay (ELISA). Platelet aggregation study with ristocetin was done to find the different subtypes of vWD. Results: vWD and its subtypes were diagnosed in 25 out of 200 women with HMB with a prevalence of 12.5%. Type III vWD was the commonest (15/25, 60%), followed by type II (7/25, 28%) and type I (3/25, 12%). Among the various subcategories of type II, type IIB was conspicuously absent and type IIN was the most frequent (5/7, 71%). Conclusion: vWD should always be considered as one of the possible bleeding disorders in patients with HMB particularly in those referred to a tertiary care center. It was detected in 12.5% of such women, and type III was the most frequent type encountered among its various subtypes. Clinical significance: Detection of vWD and its various subtypes at the earliest opportunity would help the treating physician to plan out a definite line of management and save many women from unwarranted hysterectomies and also improve their quality of life and reproductive potential.

Original Article

Uzma Khawaja, Nasira Tasnim, Kausar T Bangash

Modified Radical Vulvectomy for Carcinoma Vulva: Are We Following Key Quality Standards?

[Year:2021] [Month:November-December] [Volume:13] [Number:6] [Pages:4] [Pages No:374 - 377]

Keywords: Carcinoma vulva, Key quality standards, Modified radical vulvectomy

   DOI: 10.5005/jp-journals-10006-1922  |  Open Access |  How to cite  | 

Abstract

Objective: To determine the outcomes of modified radical vulvectomy for carcinoma vulva in terms of compliance with key quality standards set by southwest gynecological tumor panel.1 Design: Cross-sectional study of prospectively collected data with cross-checking against the histopathology report. Setting: MCH Unit II, Pakistan Institute of Medical Sciences, Islamabad, Pakistan. Duration: Patients presenting with carcinoma vulva to MCH Unit II of 4 years’ duration from June 2013 to May 2017. Methods: The study includes prospectively maintained data of patients presenting with advanced carcinoma vulva and undergoing modified radical vulvectomy as a primary surgical procedure. Data analysis was done to determine the outcome of the procedure in terms of compliance with the key quality standards. Results: During the study period, 16 patients presented with vulval carcinoma. The majority of patients were at an advanced stage, with stage III 81% (n = 13) at presentation. Squamous cell carcinoma was the most common tissue variant. Modified radical vulvectomy with inguinofemoral lymphadenectomy was performed up to stage III disease, while patients with stage IV disease were referred to the oncology department. Regarding compliance with international quality standards, optimum inguinofemoral node dissection and surgical excision margin of >2 cm were achieved in 100% of cases, and histopathologically confirmed tumor-free margins were achieved in 94% of cases. Conclusion: Modified radical vulvectomy with inguinofemoral node dissection is the procedure of choice for stage Ib, II, and III diseases. The high compliance rate with international standards in our study reflects an optimum standard of care provided for the management of these patients at our tertiary care hospital. The audit and subsequent dissemination of results may prove useful in the centralization of care for this rare gynecological cancer.

Original Article

Reeta Singh, Manisha Chaudhary, Kanchan Shrivastava, Babita Vaswani Agarwal, Shaila Mitra

Seroprevalence of Hepatitis B Infection among Antenatal Women in a Tertiary Care Center in Eastern UP and Assessment of the Associated High-risk Factors

[Year:2021] [Month:November-December] [Volume:13] [Number:6] [Pages:4] [Pages No:378 - 381]

Keywords: Antenatal, Hepatitis, Mother-to-child transmission, Vaccination

   DOI: 10.5005/jp-journals-10006-1969  |  Open Access |  How to cite  | 

Abstract

Introduction: Hepatitis B virus (HBV) infection is seen in more than 300 million people worldwide and is a common cause of liver disease and liver cancer. There is a lack of large-scale population-based studies on the prevalence of HBV in India. In endemic areas, HBV infection occurs mainly during infancy and early childhood, with mother-to-child transmission (MTCT) accounting for approximately half of the transmission routes of chronic HBV infections. Immunoprophylaxis to newborns is an excellent way to block natal transmission and hence to decrease the overall carrier rate. This study aimed to assess the prevalence of Hep B infection among pregnant females and to identify the high-risk factors. Materials and methods: All pregnant women attending the OPD as well as the emergency OBGY Department of Baba Raghav Das (BRD) Medical College, Gorakhpur, during the period from July 1, 2020, to June 30, 2021, were tested for hepatitis B surface antigen (HBsAg) and those who came out to be positive were further enrolled as cases in the study. Two hundred and sixty-five HBsAg-negative pregnant women were taken as controls for the study. A detailed history was taken and data analyzed. Results: In our study, the seroprevalence of HBsAg-positive pregnant patients was found to be 1.15% in our study area. Tattooing was found to be a significant risk factor for hepatitis B infection in our study. Those with previous history of parenteral drug use, piercings, and blood transfusions were found to be at an increased risk for hepatitis B infection. Conclusion: Although our area falls in the low endemicity category for hepatitis B, there is a need for routine vaccination against HBV. It is necessary to create awareness on the routes of transmission especially in the rural areas and among the lower socioeconomic classes. Universal screening of all pregnant women for HBV infection is needed in order to prevent the evolution of new carriers.

Original Article

Preeti Priyadarshani, Roli Purwar, Vibha R Pipal, Ratna P Mall

Patient Satisfaction with Telemedicine Services in Obstetrics and Gynecology during the COVID-19 Pandemic

[Year:2021] [Month:November-December] [Volume:13] [Number:6] [Pages:5] [Pages No:382 - 386]

Keywords: COVID-19, Obstetrics and gynecology, Patient satisfaction, Telemedicine

   DOI: 10.5005/jp-journals-10006-1974  |  Open Access |  How to cite  | 

Abstract

Aim: This study aims to explore the patient's experience with telemedicine (TM) as a method of care as well as its long-term implications for the Department of Obstetrics and Gynecology during the COVID-19 pandemic. Methods: Telephonic interview was conducted for 78 patients who had availed TM services from April 23, 2020, to June 30, 2020. A predetermined indigenous questionnaire was used to evaluate patient's experiences with TM. Primary outcome was the measurement of level of patient satisfaction and secondary outcome was evaluating the demographic profile of patients. Results: Most respondents were of 21–30 years (42.3%) and 64.1% of respondents were from urban areas. 87.1% respondents were satisfied with the medical care they received; 94.8% respondents did not feel that their doctors hurried through their consultation. 19.2% respondents had encountered difficulty in using smartphones. 70.5% respondents perceived a positive role of TM in reducing their risk of contracting COVID-19. 62.8% respondents showed willingness to continue using TM services after the resumption of routine OPD services. 76.9% respondents felt that currently provided TM services did not need any improvements. 25.6% respondents needed physical visits to doctors even after availing TM services, for routine or emergency complaints. Conclusion: Patient satisfaction is high with TM services, and it can be adopted and incorporated into routine patient care especially in low-resource countries. Clinical significance: TM is expected to increase access to healthcare, while limiting patients’ geographic mobility. The implications and full potential of this service will be clear with long-term studies.

Original Article

Shelly Agarwal, Samta Gupta, Neerja Goel, Shivangini Sahay, Niharika Aggarwal

Impact of COVID-19 Severity on Menstrual and Mental Health in Women of Reproductive Age: A Cross-sectional Survey at a Tertiary Healthcare Center

[Year:2021] [Month:November-December] [Volume:13] [Number:6] [Pages:5] [Pages No:387 - 391]

Keywords: Anxiety, COVID-19, Depression, Menstruation, Mental health, Stress

   DOI: 10.5005/jp-journals-10006-1973  |  Open Access |  How to cite  | 

Abstract

Background: Coronavirus disease-2019 (COVID-19) has claimed innumerous lives globally resulting in increased stress affecting woman's menstrual, sexual, and mental health, an area of significant concern. The study was aimed to understand the effect of COVID-19 severity on menstrual and mental health. Method: A cross-sectional survey using a closed-ended questionnaire was conducted on COVID-19 positive women of reproductive age (18–45 years), admitted at School of Medical Sciences and Research, Greater Noida, during the period of April 1, 2021, to May 31, 2021. One-hundred and thirteen patients were enrolled to evaluate any change in a menstrual pattern along with alteration in sleep and sexual drive. Depression Anxiety Stress Scale-21 was used to assess mental health. Results were analyzed using the Chi-square test. Results: Nearly, 52.2% of patients reported changes in their menstrual patterns. Change in cycle length was observed in 37.8% of patients, 18% of cases reported heavy or decreased flow while 16.2% of patients had prolonged or short cycles. Patients with moderate-to-severe disease had statistically increased incidence of infrequent cycles, scanty flow, and short cycles and significantly correlated with increased levels of depression, anxiety, and stress. Conclusion: This study highlights the implication of COVID-19 severity on emotional and menstrual disturbances, an aspect which is least addressed and discussed. It also emphasized the need for more frequent post-COVID counseling sessions to improve women's health.

Original Article

Rashmi Yadav, Amitesh Yadav, Alka Kumari

Role of Sildenafil Citrate Therapy in Early-onset Fetal Growth Restriction

[Year:2021] [Month:November-December] [Volume:13] [Number:6] [Pages:4] [Pages No:392 - 395]

Keywords: Amniotic fluid index (AFI), Effective fetal weight (EFW), Fetal growth restriction (FGR), Sildenafil citrate

   DOI: 10.5005/jp-journals-10006-1976  |  Open Access |  How to cite  | 

Abstract

Objective: Fetal growth restriction (FGR) refers to a condition in which a fetus is unable to achieve its genetically determined potential size. The common consequences of FGR are neonatal mortality and neurological and neurodevelopmental delays. In this study, we investigated the use of sildenafil citrate therapy in the management of early-onset FGR. Methods: In this prospective randomized controlled study, women aged 20–35 years with singleton pregnancy with 22–32 weeks gestation age, who were having abdominal circumference (AC) less than the 10th percentile, effective fetal weight (EFW) less than the 10th percentile, or amniotic fluid index (AFI) less than or equal to 7 cm were enrolled in the study after obtaining written informed consent. These patients were randomized according to a computer-generated random numbers table and were divided into two groups, namely, group A and group B. Group A women were treated with sildenafil citrate 25 mg per oral three times daily until delivery. Group B women were not treated with sildenafil. Results: On follow-up, the abdominal circumference growth was significantly higher in group A (p = 0.0001) than in group B. Enrollment to delivery duration was average 64.85 ± 13.86 days in group A and 55.35 ± 16.18 days in group B, which is statistically significant (p = 0.0001). Mean birth weight of babies was 2040.92 ± 478.73 g in group A and 1665.60 ± 464.74 g in group (p = 0.007). Conclusion: Sildenafil therapy 25 mg twice a day from the diagnosis of FGR to delivery was beneficial to pregnant women in terms of increase in fetal AC, fetal weight, and pregnancy duration. Clinical significance: Sildenafil therapy 25 mg twice a day from the diagnosis of FGR to delivery was beneficial to pregnant women with FGR in terms of increase in fetal AC, fetal weight, AFI, and pregnancy duration (gain in intrauterine life).

Original Article

Rao Preethi Venkatachala, Shashikala Karanth, S Sivakami Sundari

Preterm Birth Outcomes in COVID-positive and COVID-negative Pregnancies during SARS-CoV-2 Pandemic in a Tertiary Care Center in India: A Cohort Study

[Year:2021] [Month:November-December] [Volume:13] [Number:6] [Pages:7] [Pages No:396 - 402]

Keywords: Coronavirus disease-2019, Maternal outcome, Neonatal outcome, Perinatal outcome, Preterm birth

   DOI: 10.5005/jp-journals-10006-1984  |  Open Access |  How to cite  | 

Abstract

Objective: To compare the maternal and neonatal outcomes, particularly the incidence of preterm birth, and identify their risk among pregnant women who were seropositive or seronegative for SARS-CoV-2, during the pandemic. Method: Pregnant women who got admitted to an urban tertiary care center for delivery during the period August 1, 2020, to October 30, 2020, and consented to participate in the study were recruited and followed up until delivery. Among 230 women, 73 pregnant women who tested positive for SARS-CoV-2 were included in the positive cohort and the remaining in the negative cohort. Demographic details, symptoms at presentation, gestational age, laboratory tests done, and treatment given were noted. The outcome measures studied were the incidence of preterm birth, gestational age at admission and delivery, risk factors for preterm birth (PTB), obstetrics/medical complications, drugs given, mode of delivery, and neonatal outcomes, such as birth weight, Apgar scores at 1 and 5 minutes, neonatal complications, need for NICU admission, and SARS-CoV-2 positivity. Results: Among the 73 SARS-CoV-2 pregnant women, 95% were asymptomatic. The incidence of preterm birth was similar in the SARS-CoV-2-positive and SARS-CoV-2-negative cohorts (20.5 vs 22.5%). There were four SARS-CoV-2-positive babies in the positive cohort and none in the negative cohort. The distribution of known risk factors of preterm births and other maternal and neonatal outcomes were also comparable between the positive and negative cohorts. Conclusion: There is no increase in incidence of preterm births in SARS-CoV-2-positive compared to SARS-CoV-2-negative cohort, during the pandemic. Majority of them have asymptomatic infection, and good pregnancy outcomes can be anticipated.

Original Article

Rahi Pednekar, Shailesh J Kore, Saurabh Sankalecha, Geeta Kulkarni, Maitreyee Athavale, Padmaja Kumbhar, Smita D Mahale, Rahul K Gajbhiye, Niraj N Mahajan

Impact of Both the Waves of COVID-19 Pandemic on Ectopic Pregnancy in India

[Year:2021] [Month:November-December] [Volume:13] [Number:6] [Pages:4] [Pages No:403 - 406]

Keywords: Cesarean scar pregnancy, Coronavirus disease-2019, Ectopic pregnancy, Low-income and middle-income country, Pregnancy, Severe acute respiratory syndrome coronavirus 2 infection

   DOI: 10.5005/jp-journals-10006-1956  |  Open Access |  How to cite  | 

Abstract

Aim and objective: Although two-wave pattern of the coronavirus disease-2019 (COVID-19) pandemic was observed in many countries, there is limited information on the impact of both the waves on clinical presentations of ectopic pregnancy (EP) with COVID-19. Therefore, we aimed to understand the impact of the first wave and second wave of COVID-19 pandemic on women with EPs in India. Materials and methods: We conducted a retrospective study at BYL Nair Charitable Hospital (NH), a dedicated COVID-19 tertiary care hospital in Mumbai, India. We analyzed the impact of the first wave and second wave on women with EPs and the challenges encountered for management during the pandemic in our hospital. Results: A total of 1,660 pregnant and postpartum women with confirmed diagnosis of COVID-19 were admitted at NH during the first wave and the second wave of the COVID-19 pandemic. All cases of EP were asymptomatic for COVID-19. During the prepandemic period of 4 years, there were 220 (15.2 per 1,000 births) women with EPs, which was higher compared to seven EPs (6.3 per 1,000 births) during the COVID-19 pandemic. EP rate per 1,000 births during the second wave was found to be 9.6, which is comparatively higher than the first wave (3.8) (p = 0.24). Conclusion: Increased frequency of EPs during the second wave of the COVID-19 pandemic could be due to the new variant of concern B.1.617. 2 (Delta). For ruptured EP, we recommend surgical management with laparotomy as a treatment option as it is useful in reducing the risk of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection to healthcare workers. Clinical significance: The COVID-19 pandemic is likely to last longer and hence healthcare providers should ensure that pregnant women have access to medical assistance whenever needed.

RESEARCH ARTICLE

Sangeeta S Kotrannavar, Rajendra S Humbarwadi, Shivalingappa B Javali

Postnatal Histomorphometric Study of Umbilical Vessels and their Relationship with Neonatal Anthropometry in Low-risk Pregnancies

[Year:2021] [Month:November-December] [Volume:13] [Number:6] [Pages:5] [Pages No:407 - 411]

Keywords: Histomorphometry, Low-risk pregnancies and neonatal anthropometry, Umbilical arteries, Umbilical vein, Umbilical vessels

   DOI: 10.5005/jp-journals-10006-1972  |  Open Access |  How to cite  | 

Abstract

Background: Umbilical vessels are an extension of the fetal cardiovascular system, which are essential parts of fetal circulation and fetal wellbeing. Umbilical vessels are altered in maternal and fetal conditions, so they can be used to predict adverse pregnancy outcomes. Prenatal sonographic studies have developed nomograms of umbilical vessels in normal pregnancies and established their relationship with fetal biometry. However, there is a scarcity of such studies in the postnatal period. Aim and objective: The aim and objective is to develop postdelivery histomorphometrical reference values for area and diameter of umbilical vessels across the available gestational age (GA) spectrum in low-risk pregnancies and secondly to examine the nature of its association with neonatal anthropometry. Materials and methods: A cross-sectional study was carried out on 164 low-risk pregnant women between GA of 32 and 42 weeks. Umbilical cord (UC) samples were procured soon after delivery. Formalin-fixed paraffin-embedded tissue blocks were processed, stained, and histomorphometric measurements of umbilical vessels were carried out by Olympus microscope. Neonatal anthropometry was noted. The mean and percentile were calculated for each GA. Pearson's Correlation was used to assess the relationship between umbilical vessels parameters with neonatal anthropometry. Results: Reference values and percentiles of diameter and area of umbilical vessels for each GA were calculated. Cross-sectional area and diameter of umbilical vein (UV) attained peak at 34 weeks of GA whereas both umbilical arteries (UAs) reached the peak at 36 weeks of GA and stabilized thereafter. A statistically significant positive correlation was observed between all umbilical vessels parameters with all neonatal anthropometric measurements (p <0.001). The regression equation for the prediction of newborn birth weight (y) according to the area (A) of umbilical vessels is 1.750 + 0.343(UA2A) + 0.248(UVA). It shows that the area of UA2 and UV are good predictors of newborn birth weight. Conclusion: The study provides reference values of umbilical vessels area and diameter of post-delivery from 32 to 42 weeks of gestation in low-risk pregnancies. These reference values of umbilical vessels provide baseline values for pathological and perinatal studies in the future. The study showed a positive relationship between umbilical vessels measurements and neonatal anthropometry. These results may be useful during perinatal pathological examination of UC and can be used as a predictor for neonatal complications.

RESEARCH ARTICLE

Anu Pathak, Deepa Singh

Maternal and Perinatal Outcome in Dengue Fever in Pregnancy in North India

[Year:2021] [Month:November-December] [Volume:13] [Number:6] [Pages:3] [Pages No:412 - 414]

Keywords: Dengue hemorrhagic fever, Dengue neonatal outcome, Dengue maternal outcome, Dengue pregnancy perinatal outcome

   DOI: 10.5005/jp-journals-10006-1978  |  Open Access |  How to cite  | 

Abstract

Aim and objective: The aim and objective of the study was to assess the maternal and neonatal complications in all the cases of dengue fever in pregnancy. Materials and methods: This was a prospective observational study of pregnant and postpartum women with dengue hemorrhagic fever. Results: Postpartum hemorrhage (PPH) was reported in 35/195 (18%); PPH occurred due to severe thrombocytopenia, atonic uterus, and deranged coagulopathy. Other complications seen were antepartum hemorrhage such as abruption (11.7%), preeclampsia (3.5%), and eclampsia (0.5%). Seven cases of dengue were seen in the first and early second trimesters and two of these had miscarriages. Oligohydramnios was reported in 21%, preterm birth in around one-fourth of the patients. Majority of the patients (80%) presented with thrombocytopenia. Around half (46%) pregnant women in late second and third trimesters presented without any complications. Conclusion: Dengue fever in pregnancy leads to adverse maternal and perinatal outcomes including PPH, preterm labor, oligohydramnios, and intrauterine fetal deaths.

RESEARCH ARTICLE

Shilpa Singh, Natasha Gupta

Sonographic Evaluation of Myometrial Thickness at Different Gestations for Prediction of Labor in Preterm Premature Rupture of Membranes

[Year:2021] [Month:November-December] [Volume:13] [Number:6] [Pages:7] [Pages No:415 - 421]

Keywords: Latency interval, Myometrial thickness, Prediction of labor

   DOI: 10.5005/jp-journals-10006-1981  |  Open Access |  How to cite  | 

Abstract

Aims and objectives: The aim of the study was to evaluate the role of sonographic measurement of myometrial thickness (MT) for the prediction of latency interval in women with preterm premature rupture of membranes (PPROM) at different periods of gestation between 28 and 34 weeks and to compare it with gestation-matched healthy antenatal women. Materials and methods: Ultrasonographic (USG) MT at different gestations were measured at anterior, fundal, posterior, and lower uterine segment (LUS) in both the groups and its correlation with latency interval compared. Results: One hundred and twenty women were enrolled for the study (90 women with rupture of membranes (ROM) and 30 healthy gestation-matched controls) between 28 and 34 weeks. Women with PPROM and preterm labor had a statistically significant difference in fundal and anterior MT, and no significant difference was observed in posterior and lower uterine segment (LUS) thickness. Women with PPROM having mean MT cutoffs of fundal 7.2087 ± 1.10324 standard deviation (SD) and anterior 7.4 ± 0.676 SD would deliver within 1 week, whereas those cutoffs of fundal 10.5200 ± 0.47430 SD and anterior 9.25 ± 1.030 SD would deliver after 2 weeks. Conclusion: A significant relationship exists between anterior and fundal MT and latency interval in PPROM (28–34 weeks).

RESEARCH ARTICLE

Mohita Agarwal, Asha Nigam, Abhilasha Yadav, Sana Ismail

Amniotic Fluid Optical Density in Spontaneous Onset of Labor and Elective Termination of Pregnancies beyond 34 Weeks of Gestation and Its Correlation with Neonatal Outcome

[Year:2021] [Month:November-December] [Volume:13] [Number:6] [Pages:4] [Pages No:422 - 425]

Keywords: Amniotic fluid optical density (AFOD), Preterm labor, Respiratory distress syndrome (RDS)

   DOI: 10.5005/jp-journals-10006-1985  |  Open Access |  How to cite  | 

Abstract

Aim and objective: To measure the AFOD levels in cases with spontaneous onset of labor and elective termination of pregnancies before term and after term and its correlation with the neonatal outcome. Materials and methods: This study was conducted in the labor room of Department of Obstetrics and Gynaecology in SN Medical College, Agra. One hundred antenatal patients fulfilling the inclusion and exclusion criteria were selected for the study and divided into two groups. Results: In our study no correlation between AFOD and gestational age and birth weight was observed and with AFOD <0.9 increased the chances of respiratory distress, NICU admissions, and low APGAR score, and increased perinatal morbidity and mortality was observed. Conclusion: AFOD estimation is cheap, easily available; results can be obtained within few minutes; and helps to make quick decisions when compared to L/S ratio estimation.

REVIEW ARTICLE

Krupa H Shah

Induced Abortion across the World and Evolution of Medical Termination of Pregnancy Law in India: A Review

[Year:2021] [Month:November-December] [Volume:13] [Number:6] [Pages:5] [Pages No:426 - 430]

Keywords: Abortion grounds, Global abortion law, Induced abortion, Medical termination of pregnancy law, Unsafe abortion

   DOI: 10.5005/jp-journals-10006-1971  |  Open Access |  How to cite  | 

Abstract

Induced abortion is in the world for a long time. It is an ancient universal practice and has gained attention for different reasons at different points in time. It depicts termination of pregnancy by artificial means and having political, religious, cultural, and social reflections. Laws on abortion vary across the world. Some countries are highly progressive in-laws and provide it on request, while others ban it. The liberalization of medical termination of pregnancy (MTP) law is a matter of intense controversy and in some countries, there is a challenge to already existing liberal laws. Access to abortion is considered as a women's right, human right, reproductive right, and health right by the proabortion movement group, support to the life of embryo (embryo right) is provided by antiabortion movement group. Induced abortion has been used as a method of fertility regulation and it is a key tool in population policies. It is an important subject for demographers and health professionals. Safe and unsafe abortions are the center of discussion in many countries. This article provides knowledge on the definition, grounds of abortion, the status of induced abortion around the world, unsafe abortion, and literature review of medical termination of pregnancy in India.

REVIEW ARTICLE

Tshering Wangden

Trend in Instrumental Vaginal Deliveries at the National Referral Hospital in Bhutan: A Review of Hospital Records

[Year:2021] [Month:November-December] [Volume:13] [Number:6] [Pages:5] [Pages No:431 - 435]

Keywords: Emergency obstetric and neonatal care, Healthcare worker, Instrumental vaginal deliveries

   DOI: 10.5005/jp-journals-10006-1987  |  Open Access |  How to cite  | 

Abstract

Instrumental vaginal delivery (IVD) is a core signal function in emergency obstetric and neonatal care. The revival of declining trend in IVDs worldwide against an alarming rise in cesarean section must be viewed in a holistic manner. Every country must devise its own evidence–yet context-based strategies to revive the dying art of this lifesaving obstetric procedure.

CASE REPORT

Shefali Tyagi, Swapnil Bhagat

Rare Complication of Epidural Analgesia: Subcutaneous Cervical Emphysema

[Year:2021] [Month:November-December] [Volume:13] [Number:6] [Pages:2] [Pages No:436 - 437]

Keywords: Cervical emphysema, Epidural analgesia, Postdural puncture headache

   DOI: 10.5005/jp-journals-10006-1975  |  Open Access |  How to cite  | 

Abstract

As the demand for “painless labor” increases, lumbar epidural analgesia is increasingly being used in labor. It is generally a safe procedure; however, some rare cases of complications like subcutaneous cervical emphysema have been reported. Most common differential diagnosis is from postdural puncture headache (PDPH), definite diagnosis of which can be done with computed tomography (CT) and magnetic resonance imaging (MRI). We present a case of 34-year-old primigravida who went for epidural analgesia, underwent uneventful vaginal delivery. However, she had severe neck and shoulder pain postdelivery, which did not respond to regular treatment. After CT and MRI, diagnosis of subcutaneous cervical emphysema could be established, and after treating it, she settled down and was discharged.

CASE REPORT

Surya Malik, Shabbir A Sheikh

Solitary Kidney: Harbinger of Adverse Pregnancy Outcomes

[Year:2021] [Month:November-December] [Volume:13] [Number:6] [Pages:3] [Pages No:438 - 440]

Keywords: Pregnancy, Solitary kidney, Unilateral renal agenesis

   DOI: 10.5005/jp-journals-10006-1977  |  Open Access |  How to cite  | 

Abstract

Aim and objective: The aim of the article was to throw light on the potential risks associated with solitary kidney, especially in relation to maternal and fetal outcomes. Background: Solitary kidney can be caused by three main reasons: Being born with a single kidney, losing one because of a disease, or an injury, or donating a kidney to a family member or friend who has lost one of their own. Case description: A 38-year-old G7P4A2 patient with a 36.2-week period of gestation was admitted with antepartum hemorrhage. The patient was thoroughly examined and necessary investigations were done. On pelvic examination, there was mild spotting present. On routine investigations, she was found to be severely anemic and chronic kidney disease stage 5. According to the nephrology team's advice, an ultrasound of kidney, ureter, and urinary bladder (KUB) was done. It was detected as a case of congenital unilateral agenesis of the kidney. She had complaints of intermittent mild loin pain and dysuria. The patient was immediately transfused four units of packed cells for correction of anemia and was given steroid cover for fetal lung maturity. The patient was taken for hemodialysis in view of end-stage renal disease. After one session of hemodialysis, the patient was taken up for Cesarean section in view of placenta previa with a deranged renal profile. A single alive female baby weighing 2200 g was extracted with an Apgar score of 8, 9. The intraoperative period was uneventful. The patient was transferred to the intensive care unit for postoperative care. Conclusion: Solitary kidney from renal agenesis is a significant and independent risk factor for adverse maternal and fetal outcomes. Clinical significance: As unilateral renal agenesis (URA) is associated with potential risks, hence preconception counseling, close monitoring throughout their antenatal and postpartum period, and a multidisciplinary approach are required to have good pregnancy outcomes in these patients.

CASE SERIES

Kaustav Kar, Subhra Samantaroy, Jyochnamayi Panda, Pramila Jena

Sickle Cell Anemia Complicating Pregnancy in Coronavirus Disease Era: Managing Two Maladies

[Year:2021] [Month:November-December] [Volume:13] [Number:6] [Pages:2] [Pages No:441 - 442]

Keywords: Coronavirus, Coronavirus disease-2019, Gestational, Pregnancy, Sickle cell anemia, Sickle cell disease

   DOI: 10.5005/jp-journals-10006-1983  |  Open Access |  How to cite  | 

Abstract

Aim and objective: The aim and objective of this case series is to enlighten the effect of coronavirus disease-2019 (COVID-19) infection in pregnant patients with sickle cell disease. Background: The novel coronavirus or COVID-19 infection continues to challenge healthcare providers with the countless number of waves ravaging across the globe, questioning some of the intransigent beliefs regarding behavior of viruses. COVID-19 creates a milieu of thrombotic state which is of particular importance in cases who are already at risk like those with sickle cell disease especially that in a pregnant population. Thus, we share here three case reports of sickle cell disease patients who came out COVID-positive during pregnancy. Case description: We discuss three cases of pregnant patients with history of sickle cell disease who were COVID-19-positive and were treated on an in-patient basis. All of them presented with symptoms of crisis, but all three cases responded well to therapy and were subsequently discharged in a stable condition. Conclusion: Our experience with these three cases was that all of them presented with symptoms of crisis, however, were these caused by the presence of the coexisting COVID-19 infection is a subject to further research. Clinical significance: In the era of pandemic, especially in case of a new contagion, it is of immense importance to document and share as much as possible regarding the behavior of the virus in patients with different comorbid conditions. While there are much literature available of the clinical picture of COVID-19 in case of the more common comorbidities like diabetes mellitus and hypertension, there is a significant lack in availability of proper literary guidance in case of some rarer but significant conditions like hemoglobinopathies. We hope our case series creates a paradigm for future research on the role of COVID-19 in more uncommon comorbidities.

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