Journal of South Asian Federation of Obstetrics and Gynaecology

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2022 | July-August | Volume 14 | Issue 4

Original Article

Christy Vijay, Ashima K Thuruthayil, Annamma Thomas

Perinatal Outcomes of Patients with Hepatitis B Viral Infection in Pregnancy

[Year:2022] [Month:July-August] [Volume:14] [Number:4] [Pages:7] [Pages No:349 - 355]

Keywords: Hepatitis B, Hepatitis B surface antigen, Lower-segment cesarean section, Pregnancy, Prematurity

   DOI: 10.5005/jp-journals-10006-2015  |  Open Access |  How to cite  | 

Abstract

Purpose: Hepatitis B virus (HBV) virus has been established to infect about 350 million individuals on a worldwide scale. Nearly half of the infection is acquired either perinatally or in early childhood. The infection represents a significant cause of cirrhosis and hepatocellular carcinoma–related morbidity and mortality. Materials and methods: This is a retrospective record study conducted at a tertiary care hospital (St John's Medical College Hospital, Bengaluru) by review of records over the past 5 years (January 2015–June 2021). Results: We identified 85 pregnant women diagnosed as HBsAg-positive during our study period; of which 67 (78.8) patients were <30 years of age while the remaining 18 (21.2) were >30 years of age. The mean gestational age at the time of admission was 37.6 ± 2.5 weeks of gestation. Women who were >30 years of age who are married for >5 years 10 (55.6) and those who are <30 years of age and married for 1–5 years 33 (49.3) were HBsAg-positive, p = 0.014b. It was noticed that gamma-glutamyl transferase was two times elevated in primigravida when compared to multigravida, which was statistically significant (p = 0.037). Meconium-stained liquor 3 (3.5) was the most common intraoperative finding seen in pregnant women who were HBsAg-positive. Conclusion: The development of chronic hepatitis B infection is inversely proportional to the age at which infection occurs. Close monitoring of liver function tests, particularly gamma-glutamyl transferase and antepartum fetal surveillance is important to increase the chance of good outcomes in these pregnancies. Key message: The better association of gamma-glutamyl transferase to obstetric score in HBsAg-positive pregnant women.

Original Article

Avir Sarkar, Isha Wadhawan, Bhawana Garg

Prospective Evaluation of Hematological Indices in Prognostication of COVID-19 Infection in Pregnant Population

[Year:2022] [Month:July-August] [Volume:14] [Number:4] [Pages:5] [Pages No:356 - 360]

Keywords: COVID-19 in pregnancy, Hematologic indices, Neutrophil-to-lymphocyte ratio, Platelet-to-lymphocyte ratio, Prognosis, Severe COVID-19

   DOI: 10.5005/jp-journals-10006-2062  |  Open Access |  How to cite  | 

Abstract

Background: Neutrophil-to-lymphocyte ratio (NLR) is a well-established inflammatory marker that has been studied in COVID-19 inflicted patients. Pregnancy per se is associated with its own physiological changes in hematological parameters. No study has specifically been done on the pregnant population to evaluate the role of various hematological markers for prognosticating the severity of COVID-19 infection. Aim: The aim of this study was to prospectively evaluate changes in NLR and other indices in a cohort of pregnant women with severe and non-severe COVID-19. Materials and methods: Prospective cohort study at a COVID dedicated tertiary care center of a low-middle income country for a period of 6 months involving hospitalized COVID-19 positive pregnant women. Results: In total, 8/8 (100%) and 6/8 (75%) of the pregnant women with severe COVID-19, had a raised NLR and platelet-to-lymphocyte ratio (PLR), respectively, compared to only 3/47 (6.4%) and 1/47 (2.13%) with non-severe COVID-19 (p <0.0001, p <0.0001). These ratios were noted to normalize at 2 and 4 weeks follow-up in the survivors of severe COVID-19. Conclusion: This is the first prospective study demonstrating an association between COVID-19 disease severity in pregnant women and NLR and PLR on admission. These indices may be utilized for prognostication and better preparations for the care of pregnant women hospitalized with COVID-19 infections.

Original Article

Kanan P Kotdawala, Manjusha Agrawal, Parul Kotdawala

A Comparative Study of Bacterial Vaginosis in Preterm and Term Labor

[Year:2022] [Month:July-August] [Volume:14] [Number:4] [Pages:4] [Pages No:361 - 364]

Keywords: Amsel's criteria, Anemia, Bacterial vaginosis, Lower socioeconomic class, Preterm labor

   DOI: 10.5005/jp-journals-10006-2091  |  Open Access |  How to cite  | 

Abstract

Purpose: Is there a difference in association of bacterial vaginosis (BV) with preterm labor as compared to term labor? Successful treatment of BV during pregnancy may reduce the incidence of preterm birth as low as 50%. It is important to work toward predicting, and diagnosing the causative factors, and finally taking steps to minimize the preterm deliveries which is of utmost priority in developing countries like India. Therefore, this study is carried out to analyze the occurrence of BV in preterm and term labor. Materials and methods: This cross-sectional study of 100 laboring women in each group divided in to two groups depending on the gestational age into preterm group and term group and was carried out in a tertiary care center over 2 years (from September 2019 to September 2021) using non-probability simple random sampling technique. The women of both groups were independently segregated as those who fulfilled Amsel's criteria (≥3 out of 4) and those who did not. Results: In this study, the incidence of BV was found to be 38% in preterm group and 13% in the term group with χ2 = 16.449, p = 0.00005, and odds ratio (OR) = 4.1, that is, OR >1 with the whiff test being most sensitive among four criteria of Amsel's. Conclusion: Bacterial vaginosis was noted more frequently in women with preterm labor compared to women in term labor. There was a significant impact of socio-demographic factors on occurrence. Amsel's criteria should be utilized as a low cost, easily available screening-diagnostic tool in symptomatic women.

Original Article

Richa Aggarwal, Astha Srivastava, AG Radhika, Preeti Sharma, Amita Suneja

Childbirth Experience of Mothers in COVID Times

[Year:2022] [Month:July-August] [Volume:14] [Number:4] [Pages:5] [Pages No:365 - 369]

Keywords: Anxiety, Childbirth experience, COVID-19, Perceptions

   DOI: 10.5005/jp-journals-10006-2088  |  Open Access |  How to cite  | 

Abstract

Background: The present study aims to understand the perceptions, apprehensions, and fears of peripartum COVID-positive women in low-resource settings. Study design: Cross-sectional observational study. Methodology: All COVID-positive postpartum women who delivered in the institution (vaginal delivery and cesarean section) were included in the study. Exclusion criteria included ICU admission and known mental illness. Results: A total of 61 COVID-positive women delivered in the facility during the study period. About 33 out of 61 women were nulliparous, while 28 were multigravida. Two babies tested positive for COVID-19 within 24 hours of birth. Majority of the patients were anxious prior to coming to hospital (51/61, i.e., 83.6%). The most common perceived fear reported by patients was fear of not receiving support from partner and provider (80%). Due to restrictions imposed on birth companion, 80% (49/61) women feared loneliness during labor. Apprehension of not receiving respectful maternity care was experienced by 75.4% (46/61) of women. Only 16 (26.2%) patients feared progression of disease, and 32 women (52%) were afraid of infection being transmitted to baby. However, 85% of the women reported a positive birthing experience. Good support from the family was observed in 76% of women. Despite regular visits by the doctors, eight patients (13%) felt a lack of connect due to the prevailing situation. Inability to celebrate joyful moments with family, neonatal separation, and delay in discharge were the major causes of discontent among the postpartum women. Conclusion: The study shows that the excitement and joy of pregnancy and delivery in pre-COVID times has been replaced by fear, anxiety, and uncertainty in this COVID era. Strategies, like good communication and provision of adequate support, may be particularly useful to help these women have a positive birthing experience.

Original Article

Prasad Deshmukh, Shruti A Panchbudhe, Aditya R Nimbkar

A Study and Analysis of Cesarean Sections by Robson's Ten Group Classification System

[Year:2022] [Month:July-August] [Volume:14] [Number:4] [Pages:4] [Pages No:370 - 373]

Keywords: Cesarean section, Instrumental delivery, Robson's criteria, Trial of labor

   DOI: 10.5005/jp-journals-10006-2084  |  Open Access |  How to cite  | 

Abstract

Background: The hitherto rising rate of cesarean sections is affecting women's obstetric careers by its inherent operative complications and on the other hand, the fetal complications arising from morbid trials of labor has its own medicolegal repercussions. In this scenario, Robson's Ten Group Classification System (TGCS) provides a comprehensive and conclusive system for classifying indications of cesarean sections and helps to curb down rates of cesarean sections. Methodology: The present study was conducted by retrospective data collection in a tertiary care center from January 2019 to December 2019. The study center is a major teaching hospital in Mumbai, which is also a referral center for all peripheral hospitals as well. Result: The rate of cesarean sections in our institute is 44.24%. The rate of cesarean sections (CS) is undoubtedly high. This is attributable to high-risk women coming into labor, and the condition in which these women come warrants the doctor to proceed for CS directly for maternal and fetal salvage. Conclusion: The major focus to bring down CS rates should be to reduce primary CS rates by encouraging good and ethical trials of labor. Encouraging instrumental vaginal delivery, whenever not contraindicated, also will bring down CS rates. Clinical significance: This study helps us understand the lost art of vaginal delivery and rising rates of poorly indicated cesarean sections and the type of indications for which cesarean sections are performed. It helps us introspect and improvise our clinical judgment on this topic.

Original Article

Medha Goyal, Dwayne Mascarenhas, Juhi Shah, Angad Ranadive, Ruchi Nanavati, Niranjan Mayadeo

Perinatal COVID-19 Infection and Outcomes: A Retrospective Observational Study from a Low–Middle Income Setting

[Year:2022] [Month:July-August] [Volume:14] [Number:4] [Pages:7] [Pages No:374 - 380]

Keywords: India, Neonatal outcome, Observational study, Perinatal outcome, Pregnant women, SARS-CoV-2

   DOI: 10.5005/jp-journals-10006-2097  |  Open Access |  How to cite  | 

Abstract

Aim: Coronavirus disease 2019 (COVID-19) pandemic is an ongoing emergency with limited data on perinatal outcomes. The aim of the study was to describe key maternal, perinatal, and neonatal outcomes of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection from low–middle income settings. Materials and methods: We conducted a retrospective observational study in a tertiary level public hospital in India. All pregnant women admitted from May 2020 to July 2020 were included in the study. Maternal demography, medical and obstetric complications, clinical characteristics, and investigations were described. Symptomatic infected women were compared with the asymptomatic group for important outcomes. Key perinatal outcomes such as early pregnancy losses, fetal distress, stillbirths, and placental changes were evaluated. Neonatal characteristics of SARS-CoV-2 positive and negative pregnancies were described and compared. Results: Among the 702 pregnant women enrolled, the incidence of SARS-CoV-2 infection was 16.2%, with the majority being asymptomatic. Infected women had an increased mortality, while symptomatic women had a significant risk of stillbirth. Mean placental weight of infected women was significantly higher. Neonatal infection rate was 9.1%, with 50% manifesting mild respiratory symptoms without any mortality. Conclusion: This study provides a comprehensive description of important antenatal, intrapartum and neonatal complications and outcomes in a low–middle income setting characterized by high disease burden and an overwhelmed health care system. Clinical significance: Incidence of SARS-CoV-2 infection in pregnancy was 16.2%. The symptomatic infected women had increased stillbirth and mortality. Neonatal transmission was seen in 9.1% with good survival.

Original Article

Shikha Manohar Toshniwal, Saunitra Inamdar, Sakshi Rajesh Sharma

Foley's Catheter and Vaginal Misoprostol vs Vaginal Misoprostol Alone for Labor Induction

[Year:2022] [Month:July-August] [Volume:14] [Number:4] [Pages:6] [Pages No:381 - 386]

Keywords: Bishop's score, Foleys catheter, Labor induction misoprostol

   DOI: 10.5005/jp-journals-10006-2094  |  Open Access |  How to cite  | 

Abstract

Objectives: To compare the efficacy of transcervical Foley's catheter and vaginal misoprostol vs vaginal misoprostol alone in the induction of labor at or after 39 weeks of gestation. Methods: This randomized comparative study included 110 women with a singleton gestation, vertex presentation, gestation>39 weeks, Bishop's score <6, and no contraindication for normal vaginal delivery. General examination, systemic examination, obstetric examination, and pelvic examination were done to note the Bishop's score and adequacy of pelvis, and the patients were grouped in two categories: Group A: Tablet Misoprostol 25 μg and Group B: Tablet Misoprostol 25 μg plus Foley's catheter (No. 16). Results: Mean ± SD of induction to delivery interval (hours) in group B (14.6 ± 2.26) was significantly lesser as compared to group A (17.9 ± 2.82) (p value 0.05). The intrapartum complications were comparable between groups A and B (fever, diarrhea, tachysystole, hypertonic contraction, hyperstimulation syndrome, p = 0.495). The postpartum complications were comparable between groups A and B (atonic PPH, traumatic PPH: p >0.05). The abnormal heart rate (bradycardia: 3.64% vs 5.45%, p = 1 and persistent tachycardia: 3.64% vs 1.82%, p = 1) and presence of meconium-stained liquor (7.27% vs 5.45%, p = 1) were comparable between groups A and B. Group A and B had comparable neonatal outcomes [NICU admission, reason for NICU admission, early neonatal death, mean Apgar at 1 minute (7.8 vs 7.85, p = 0.524), and Apgar at 5 minutes (8.85 vs 8.95, p = 0.242)]. Conclusion: To conclude, the combination of Foley's catheter + vaginal misoprostol resulted in significant improvement in Bishop score and shorter induction to delivery interval than vaginal misoprostol alone. Thus, it is more preferable to use a combination of vaginal misoprostol and Foley's catheter for induction of labor. However, both techniques were equally effective in terms of mode of delivery, indication for cesarean section, intrapartum and postpartum complications, abnormal heart rate, meconium-stained liquor, and neonatal outcomes.

Original Article

Sumam John, Narayana Panicker Sethu Bai Sreedevi, Rajamma John

Threatened Miscarriage and Adverse Fetomaternal Outcome Late in Pregnancy—A Prospective Study

[Year:2022] [Month:July-August] [Volume:14] [Number:4] [Pages:6] [Pages No:387 - 392]

Keywords: Fetomaternal outcome, Prospective study, Threatened miscarriage, Vaginal bleeding in pregnancy

   DOI: 10.5005/jp-journals-10006-2100  |  Open Access |  How to cite  | 

Abstract

Aim: The study was aimed to analyze the effect of threatened miscarriage on fetomaternal outcomes late in pregnancy and thereby reduce the morbidity through better antenatal care. Materials and methods: A 1-year prospective observational study on 50 pregnant women with threatened miscarriage and 50 pregnant women with no history of vaginal bleeding was undertaken at Pushpagiri Institute of Medical Sciences and Research Centre from August 2016 to July 2017. Adverse fetomaternal outcomes late in pregnancy were evaluated in both groups. Relative risk was assessed, and the association between threatened miscarriage and various outcomes was analyzed using the Chi-square test. p value <0.05 was considered statistically significant. Results: The outcomes found to be significantly increased in threatened miscarriage group were preterm labor [18% vs 2%, p = 0.016, OR 10.75 (CI 1.3–88.4)], NICU admission [30% vs 10%, p = 0.023, OR 3.857 (CI 1.278–11.638)], and low birth weight (mean 2.67, SD = 0.53 vs mean 3.03, SD = 0.42). Most of the other outcomes studied were increased in the exposed group compared to the normal pregnancies, but the association was not significant. Conclusion: Preterm labor, low birth weight, and NICU admissions were significantly increased in the threatened miscarriage group. Clinical significance: Anticipation of such outcomes and measures for prediction and prevention is a question to be considered in such pregnancies to optimize the fetomaternal outcome.

Original Article

Chethana Bolanthakodi, Murali Shankar Bhat, Raghavendra R Huchchannavar

Obstetric Comorbidity Index—A Promising Tool to Predict Maternal Morbidity

[Year:2022] [Month:July-August] [Volume:14] [Number:4] [Pages:7] [Pages No:393 - 399]

Keywords: Comorbidity, Early diagnosis, High-risk pregnancy, Labor monitoring

   DOI: 10.5005/jp-journals-10006-2101  |  Open Access |  How to cite  | 

Abstract

Introduction: In India's immense population, the maternal mortality ratio in 2016–2018 was 113. We are still away from the sustainable development goals (SDGs) of MMR less than 70 per 100,000 live births set by the United Nations.1 In obstetric patients, due to the occasional occurrence of critical conditions, it is hard to identify the initial signs of grievous illness. Focusing on mothers whose comorbidities place them at risk of severe maternal morbidity is a strategy for risk reduction. The obstetric comorbidity index (OB-CMI) is one such tool that summarizes the burden of maternal comorbidities with a quantified approach. Aim: To evaluate the performance of OB-CMI in identifying women at risk of severe maternal morbidity (SMM) during labor. Material and methods: We did a retrospective analysis of hospital records of pregnant women >28 weeks gestation admitted to the labor room, in labor, or planned for delivery (January–June 2019). On admission, the OB-CMI was calculated for each patient based on history, examination, and investigations. Any SMM (ACOG and Society for Maternal-Fetal Medicine consensus definition) experienced before discharge was recorded. Association between OB-CMI and SMM was analyzed. Results: Out of the 1678 women included in the study, 36 women experienced SMM (2.1%). The OB-CMI ranged from 0 to 10, with a median of 0. The median of patients experiencing SMM was 5 as compared to 0 in those who did not (p <0.000). For every 1-point increase in the score, patients experienced a 2.02 increase in odds of severe maternal morbidity (95% confidence interval, 1.75–2.34). The ROC analysis revealed good discrimination between OB-CMI and SMM (0.841, 95% confidence interval 0.752–0.930). Conclusion: The prevention of SMM is a priority and OB-CMI is a clinically valid tool to identify women at risk during delivery. It is useful as a screening tool, for triaging high-risk patients in specialized institutions that are well equipped. It could also complement physiologic-based screening tools and help in early intervention.

Original Article

Sunita Mishra, Neeta Natu, Nootan Chandwaskar, Bhanu Pratap Singh Dhakar, Susmit Kosta

Comparative Study of Maternal Mortality in SARS-CoV-2 Infected Pregnant Women in the First and Second Waves of COVID-19 Pandemic in Tertiary Care at Madhya Pradesh, India

[Year:2022] [Month:July-August] [Volume:14] [Number:4] [Pages:4] [Pages No:400 - 403]

Keywords: COVID-19, Maternal mortality, Pandemic, Pregnant women, Severe acute respiratory syndrome coronavirus 2

   DOI: 10.5005/jp-journals-10006-2106  |  Open Access |  How to cite  | 

Abstract

Objectives: To evaluate the obstetrics outcome in terms of maternal mortality in severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infected pregnant women in both the waves of coronavirus disease 2019 (COVID-19) pandemic. Design, settings, and participants: This is a prospective cohort study of obstetrics outcomes in SARS-CoV-2 infected pregnant women in both the waves of COVID-19 pandemic from 1 April 2020 to 30 May 2021 at Sri Aurobindo Institute of Medical Sciences with wide spread access to SARS-CoV-2 testing in outpatients, emergency department, and inpatient settings. Result: The primary outcome composed of maternal mortality in SARS-CoV-2 infected females during both waves of COVID-19 pandemic. Study shows that the second wave was more intense and fatal as compared to the first wave of COVID-19 pandemic in India with higher maternal mortality rate in the second wave than the first wave. Study also showed that an overall higher mortality with cesarean section was noted. Thus, our study concluded that the cesarean section is not the preferred mode of delivery in COVID-19 females suffering from respiratory distress. Conclusion: Our study concluded that cesarean section is not the preferred mode of delivery in COVID-19 with females suffering from respiratory distress. The SARS-CoV-2 infection during pregnancy was associated with adverse maternal outcomes post-delivery.

ORIGINAL RESEARCH

Kirti Singh, Hafizur Rahman

Fertility Awareness, Knowledge, Attitude, and Practices among Nursing Students of a Tertiary Care Hospital of East Sikkim

[Year:2022] [Month:July-August] [Volume:14] [Number:4] [Pages:6] [Pages No:404 - 409]

Keywords: Fertility, India, Knowledge–attitude–practices, Nursing student, Sikkim

   DOI: 10.5005/jp-journals-10006-2073  |  Open Access |  How to cite  | 

Abstract

Background: Sikkim has an alarming fertility rate of 1.1 as compared to the rest of the national average of 2.0. This might increase in the future as people don't want to talk about fertility issues openly. Nursing students are the future of nursing care. Nurses play an important role in imparting knowledge regarding fertility among the general public. This study was done to assess fertility awareness, knowledge, attitude, and practices among nursing students of a tertiary care hospital in Sikkim. Materials and methods: It was a cross-sectional study conducted among nursing students of a tertiary teaching hospital in East Sikkim. A total of 349 students who gave consent to participate in the study were asked to fill a predesigned, pretested, semi-structured, self-administered multiple response questionnaires with a fixed list of questions in a standard sequence. Based on the responses their knowledge, attitude, and practices were assessed. Results: Among the 349 participants, although 80% of the participants were aware of their fertile days, only about half of them had adequate knowledge. Although the actual level of knowledge was low, it was interesting to observe that more than 90% of participants had a positive attitude. Many participants had a false perception of practical fertility issues. Conclusion: Fertility-related knowledge was low among nursing students in Sikkim. Fertility-related issues should be included in the training curriculum for the nursing students.

ORIGINAL RESEARCH

Anupama, Uma Pandey, Kiran Singh, Deepak Singh Patel

Case-control Association Study of TLR4 (rs 1927914) Polymorphism with the Risk of Low Birth Weight and Fetal Growth Restriction in North Indian Women

[Year:2022] [Month:July-August] [Volume:14] [Number:4] [Pages:5] [Pages No:410 - 414]

Keywords: Fetal growth restriction, Low birth weight, Single-nucleotide polymorphism, Toll-like receptors

   DOI: 10.5005/jp-journals-10006-2074  |  Open Access |  How to cite  | 

Abstract

Background: Compared to newborns of normal birth weight at term gestation, the mortality and morbidity rates for low birth weight (LBW) and fetal growth restriction (FGR) babies are absurdly high. This is because these babies are more vulnerable to infections. Aims and objectives: To study the association of toll-like receptor (TLR) 4 gene T>C (rs 1927914) polymorphism with the risk of LBW and FGR at term gestation in north Indian women. Materials and methods: One hundred and eighty-two pregnant women (50 LBW and 32 FGR cases and 100 controls), 18–45 years of age, who attended the antenatal clinic or labor room were studied. We studied different maternal factors like maternal height, body mass index, number of antenatal visits, pre-pregnancy weight, and weight gain during pregnancy. In newborns, parameters like birth weight, gender, Apgar score after 1 and 5 minutes, NICU admission, and different anthropometric data were assessed. Polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) was studied to analyze the single-nucleotide polymorphism of TLR4 (rs1927914) T>C. Results: There was no significant association between TLR4 (rs 1927914) T>C polymorphism and risk of LBW and FGR. Genotype, TC, and CC of TLR4 T>C polymorphism showed a slight increase in the risk of LBW (p = 0.38). Conclusions: The present study suggests that several inter-related factors increase the risk of LBW and FGR. The complex interplay and co-existence of many maternal and fetal factors are the leading cause of the increased risk of LBW and intrauterine growth restriction. Early prediction, identification of these risk factors, and proper management may prevent infant morbidities.

ORIGINAL RESEARCH

L Kavin Nilavu, Manoranjan Mahapatra, Janmejaya Mohapatra, Jita Parija, Bhagyalaxmi Nayak, Ashok Kumar Padhy, Kusumbati Besra

Clinicopathological Profile, Surgical Practices and Outcomes of the Patients with Uterine Sarcoma: A Single Institutional Study from Eastern India

[Year:2022] [Month:July-August] [Volume:14] [Number:4] [Pages:5] [Pages No:415 - 419]

Keywords: Adenosarcoma, Endometrial stromal sarcoma, Fertility sparing surgery, Leiomyosarcoma, Ovarian preservation, Uterine sarcoma, Uterine smooth muscle tumors of uncertain malignant potential

   DOI: 10.5005/jp-journals-10006-2078  |  Open Access |  How to cite  | 

Abstract

Aim: The study aimed to analyze the clinicopathological profile, surgical practices, and survival outcomes of the patients with uterine sarcoma in eastern India. Background: Uterine sarcomas are a rare entity among gynecological malignancies with a very unfavorable prognosis. Due to its rarity, there is no consensus on a standardized treatment approach. Materials and methods: A retrospective analysis of all patients with a histopathological diagnosis of uterine sarcomas who were treated in our institute from 2012 to 2016 was done. The clinical parameters, treatment given, histopathological report, stage, and follow-up details of all patients were reviewed. Survival analysis was done using Kaplan–Meier method. Results: From 2012 to 2016, 40 patients with a diagnosis of uterine sarcoma were recorded. The median age of the patients was 44 years (range, 18–68 years). The youngest patient who got treated was an 18-year-old with low-grade endometrial stromal sarcoma (LGESS) with stage IIIC disease. Majority of the patients presented with abnormal uterine bleeding (60%) followed by abdominal pain (30%). Low-grade endometrial stromal sarcoma (42%) was the most frequent histological subtype of uterine sarcoma encountered followed by leiomyosarcoma (LMS) (40%), adenosarcoma (AS) (7.5%), undifferentiated endometrial sarcoma (UES) (5%), high-grade endometrial stromal sarcoma (HGESS) (2.5%), and uterine smooth muscle tumor of uncertain malignant potential (STUMP) (2.5%). Majority of the patients were diagnosed at stage I (92.5%) and only 2.5% of patients had stage IIIC disease. The patients were followed up for a median duration of 15 (range, 4–180) months. The median survivals of the patients diagnosed with different histological subtypes were 32, 11, 4, 9.5, 26, and 42 months for LGESS, LMS, HGESS, UES, AS, and STUMP, respectively. Median disease-free survival (DFS) for the entire cohort of uterine sarcoma was 32 months, and median overall survival (OS) was 57 months. Conclusion: Uterine sarcoma, when diagnosed even at an early stage was associated with increased recurrence rate and mortality. Clinical significance: Due to its aggressive behavior, an early diagnosis and a multimodal treatment approach should be considered.

ORIGINAL RESEARCH

Monal Garg, Richa Sharma, Basu Dev Banerjee, Amita Suneja, Kiran Guleria

Association of HOXA13 Gene Expression among Premenopausal Women with the Severity of Pelvic Organ Prolapse: A Cross-sectional Study

[Year:2022] [Month:July-August] [Volume:14] [Number:4] [Pages:4] [Pages No:420 - 423]

Keywords: Pelvic organ prolapse, Premenopausal women, Severity

   DOI: 10.5005/jp-journals-10006-2079  |  Open Access |  How to cite  | 

Abstract

Aim: To determine the association of HOXA13 gene expression in vaginal wall tissue with the severity of pelvic organ prolapse (POP) among premenopausal women. Materials and methods: A cross-sectional study was conducted on a total of 60 premenopausal women. Subjects with ≥stage II POP were enrolled as cases, while those with benign gynecological conditions other than prolapse were taken as controls. Vaginal tissues were obtained during surgical procedures and HOXA13 gene analysis was done using real-time polymerase chain reaction. Spearman rank correlation coefficient was used for the correlation of true fold change of HOXA13 gene with other parameters. Results: Overall, HOXA13 gene was observed 1.21-fold downregulated in women with POP (p = 0.38). The gene was diminished in higher stages (stage III and stage IV) of POP (p = 0.007). It was found downregulated in most (84.21%) of the females above 40 years (p = 0.01). Conclusion: Downregulation of HOXA13 gene was seen in the majority of the women with POP, though not statistically significant. The gene expression was significantly diminished in women with advanced stages of prolapse (stage III and stage IV) as well as in women with age above 40 years. Clinical significance: Downregulation of HOXA13 gene can be one of the etiological factors of POP. Hence, preventive strategies may be developed using its gene expression analysis in future.

ORIGINAL RESEARCH

Arun Harishchandra Nayak, Deepali Kapote

An Experience with Management of COVID-19 Positive Pregnant Patients in a Tertiary Care Institute

[Year:2022] [Month:July-August] [Volume:14] [Number:4] [Pages:5] [Pages No:424 - 428]

Keywords: Antibiotic, Apgar score, COVID-19, Hypothyroidism, Multigravida, Multivitamin, Pandemic, Pneumonia, RT-PCR

   DOI: 10.5005/jp-journals-10006-2083  |  Open Access |  How to cite  | 

Abstract

Background: The new coronavirus disease 2019 (COVID-19) is a worldwide pandemic. Concerns have been raised about the influence of SARS-CoV-2 infections on pregnant mothers and their fetuses, and patient care in the setting of COVID-19 is difficult. As a result, the current study was conducted to determine the outcomes of pregnant females with COVID-19 infection and their obstetric care of COVID-19. Materials and methods: The study enrolled 8622 pregnant women from April 1st, 2020 to September 30th, 2020 at Lokmanya Tilak Medical College and Sion Hospital, a tertiary care hospital. There were 455 women who tested positive for COVID, whereas the remaining 8167 patients tested negative for COVID. The results obtained were compared in both groups. Results: The percentage of pregnant women who tested positive for COVID was determined to be 5.27%. Most patients were delivered by LSCS in the COVID-positive group (49.45%) than in the COVID-negative group (43.95%) (p >0.05). Among 455 COVID-positive women, 401 were asymptomatic, whereas 54 patients showed COVID-19 symptoms like fever and cough (12%). All patients with mild symptoms were adequately handled with a multivitamin supplement, high-protein diet, fluid-electrolyte balance, regular vitals monitoring, and prophylactic antibiotic therapy. In total, 23 women were admitted to the intensive care unit after developing severe COVID-19 pneumonia with ARDS. The risk of maternal mortality in COVID-positive patients was somewhat higher 16 (3.51%) than in COVID-negative pregnant women 39 (0.47%) (p <0.05). In the majority of neonates in both the COVID-positive and -negative women, Apgar score was normal 7–10, and birth weight between 2.6 and 3 kg. Low Apgar scores (0–3) were seen in 6 (1.43%) of COVID-positive mothers’ neonates and 197 (2.60%) of COVID-negative mothers’ neonates. Overall, the majority of the newborns were healthy. Swabs from seven neonates were first determined to be positive, but were retested on day five and proved to be negative. Conclusions: In times of global pandemic, quick and judicious management of COVID-19 positive pregnant women is a critical notion for safe motherhood and healthy children. However, our findings reveal that COVID infection has no substantial influence on maternal and fetal outcomes in pregnancy, and there is no indication of vertical transmission of the COVID-19 infection, but long-term monitoring of these newborns is suggested.

ORIGINAL RESEARCH

Sarbeswar Mandal, Chaitali Karmakar, Abha Aishwarya, Nisha Yadav, Ayesha Khatun, Amitava Mandal

The Role of Peritoneal Toileting and Abdominal Drainage during Exploratory Laparotomy for Hemoperitoneum due to Gynecological and Obstetrical Etiology

[Year:2022] [Month:July-August] [Volume:14] [Number:4] [Pages:6] [Pages No:429 - 434]

Keywords: Abdominal toileting and drain, Beneficial/harmful, Exploratory laparotomy, Hemoperitoneum

   DOI: 10.5005/jp-journals-10006-2075  |  Open Access |  How to cite  | 

Abstract

Aims and objectives: The role of abdominal drainage and peritoneal toileting/irrigation as beneficial or harmful, to compare between two groups, the evidence-based usefulness, and to evaluate the effect of postoperative morbidity. Type of study: Prospective randomized control study, clinical trial, comparative study, research journal publication. Materials and methods: After getting ethical approval, this research work was carried out in the Department of Obstetrics and Gynaecology in the Institute of Post-Graduate Medical Education and Research—Seth Sukhlal Karnani Memorial (SSKM) Hospital, Kolkata, West Bengal, India, with proper diagnosis, selection, and allocation of total 66 cases for exploratory laparotomy for hemoperitoneum in different gynecological and obstetrics indications was categorized into two cohorts of Gr-DI-n-33 (abdominal drainage and peritoneal toileting/irrigation) and Gr-Non-DI-n-33 (no abdominal drainage drain and peritoneal toileting/irrigation). As per the standard data collecting procedure, we had collected data from two groups [Gr-DI (n = 33) and Gr-NDI (n = 33)], the results of each group in the form of primary and secondary outcomes elaborated and the statistical significance analyzed and calculated with the help of GraphPad Software and expressed in Tables 1 to 3. Result: The peritoneal irrigation and abdominal drainage in this operation (exploratory laparotomy for hemoperitoneum in different gynecological and obstetrics indications) are not required, and in fact, these procedures cause increased adverse events. In our study, it had been established that placement of such drain is not only beneficial but also unnecessary. At the same time, it had been revealed that it was time-consuming, prolongation of hospital time, and increased wound infection rate. Conclusion: In this research study, there were minimal complications with the help of broad spectrum antibiotics and primary wound closure without peritoneal irrigation and abdominal drainage. With coverage of potent, high-level antimicrobial in such complicating operations, there was no need of such procedures.

ORIGINAL RESEARCH

Aruna Verma, Monika Kashyap, Abhilasha Gupta, Deepti Kaur

Evaluation of Visual Inspection after Acetic Acid/Cervicography as an Alternative to Colposcopy for Detection of Cervical Intraepithelial Neoplasia

[Year:2022] [Month:July-August] [Volume:14] [Number:4] [Pages:5] [Pages No:435 - 439]

Keywords: Cervicography, Cervical biopsy, Colposcopy, Pap smear, Visual inspection after acetic acid

   DOI: 10.5005/jp-journals-10006-2086  |  Open Access |  How to cite  | 

Abstract

Objective: The study was conducted to (1) find out if visual inspection after acetic acid (VIA)/cervicogram can be used as an alternative to colposcopy and (2) compare the sensitivity and specificity of VIA/cervicogram with conventional Pap smear. Methods: A total of 540 sexually active women aged between 20 and 60 years attending gynecology outpatient (OPD) treatment were included in the study. After the complete evaluation and informed consent, the patients were subjected to the following tests: Pap smear, visual inspection after acetic acid (VIA) application, cervicography, and finally colposcopy. Cervical biopsy was done (a) in women with any of these three tests positive and (b) in patients with unsatisfactory colposcopy. Cervical tissue was obtained with the help of loop electrosurgical excision procedure (LEEP). Biopsies revealing mild dysplasia or worse lesions on histopathology were considered as true positive cases. Biopsies showing chronic cervicitis were considered negative. All results were compiled and subjected to statistical analysis. Results: Our study revealed sensitivity, specificity, positive predictive value, negative predictive value of Pap smear for LSIL or above as 28, 99.7, 25, and 97.9. Sensitivity, specificity, positive predictive value, negative, predictive value of VIA was 71.4, 92, 20, and 99.1. The sensitivity, specificity, positive predictive value, negative predictive value of cervicography in our study was 71.4, 93.9, 23, and 99%. The sensitivity of colposcopy was 78 and specificity 56.66%. Conclusion: Results of VIA and cervicography are quite promising and can be considered as primary screening in low-resource settings.

ORIGINAL RESEARCH

Ritu Goyal, Pinkee Saxena, Mehak Mittal, Gunjan Chaudhary, Monika Suri Grover

Clinical Profile of COVID-19 Positive Obstetric Patients Admitted to a Tertiary Care Hospital during the Two Waves of COVID-19

[Year:2022] [Month:July-August] [Volume:14] [Number:4] [Pages:5] [Pages No:440 - 444]

Keywords: COVID-19 pandemic, COVID-19 and pregnancy, Pregnancy, Pregnancy outcome

   DOI: 10.5005/jp-journals-10006-2087  |  Open Access |  How to cite  | 

Abstract

Background: Coronavirus disease 2019 (COVID-19), a global pandemic which undoubtedly hit the whole world so hard. There have been multiple waves across the globe of varying time, duration, and intensity, India has also witnessed two waves sweeping the entire nation. The second wave had startling intensity with massively increased oxygen requirement, intensive care unit (ICU) admissions. The effect was even more pronounced in the pregnant women as there was increased maternal morbidity and mortality. However, there are limited reports on the impact of COVID-19 during pregnancy. Objective: This study is aimed at highlighting the variance in clinical profile of pregnant patients in first and second wave of COVID-19 in India. Materials and methods: A retrospective observational comparative hospital-based study was conducted in a tertiary care hospital in Delhi during the two waves of COVID-19. The first wave in India lasted from May 2020 to October 2020, and the second wave lasted from April 2021 to June 2021.We obtained the medical records and compiled clinical and outcome data for all pregnant patients, who were admitted in the Department of Obstetrics and Gynaecology of our Hospital during the first and second wave of pandemic with a laboratory-confirmed report of SARS-CoV-2. Results and conclusion: The second wave definitely saw more number of symptomatic patients, an increase in symptom of shortness of breath, increase in oxygen requirement, ICU admissions, marginally increase lower segment cesarean section (LSCS) rates and associated comorbidity such as hypertensive disease of pregnancy.

ORIGINAL RESEARCH

Anak Agung Ngurah Jaya Kusuma, Made Bagus Dwi Aryana, I Nyoman Bayu Mahendra, Daniel Hadinata Susanto

Description of Neutrophil-to-lymphocyte Ratio, C-reactive Protein, and Procalcitonin Levels in Pregnancy with COVID-19 at Sanglah General Hospital Period of April 2020–April 2021

[Year:2022] [Month:July-August] [Volume:14] [Number:4] [Pages:8] [Pages No:445 - 452]

Keywords: COVID-19 in pregnancy, C-reactive protein, Neutrophil-to-lymphocyte ratio, Pregnancy

   DOI: 10.5005/jp-journals-10006-2105  |  Open Access |  How to cite  | 

Abstract

Background: Theoretically, pregnant women are more susceptible to infection of coronavirus disease 2019 (COVID-19) and severe pneumonia due to presentation of physiological changes adaptation and immunosuppression during pregnancy. Based on the immune clock theory, if pregnant women had COVID-19 in the first and third it can appearance of cytokine storm due to hyperinflammation state, and lead to poor maternal and neonatal outcomes. Hyperinflammation state is characterized by an increase in inflammatory biomarkers in the serum, including the neutrophil-to-lymphocyte ratio (NLR), C-reactive protein (CRP), and procalcitonin levels. This study aims to determine the characteristic of NLR, CRP, and procalcitonin in pregnancy with COVID-19 at Sanglah General Hospital, Denpasar, Bali, Indonesia. Methods: This study is a cross-sectional descriptive study using secondary data from patient's medical records and is conducted in the delivery room and medical record department at Sanglah General Hospital, Denpasar from April 2020 to April 2021. Result: Pregnancy cases with COVID-19 in this study were in the 26–30-year age group, as much as 26 cases (37.14%) with most common comorbidities found were preeclampsia and electrolyte imbalance, as much as nine cases each (12.86%). Most of the neonates born at term, with birth weight 2,500 gm, and vigorous baby. The highest median NLR value was found in pregnant women with COVID-19 in comorbid with obesity, 6.79 (2.88–9.14). In this study, the cases with a length of stay more than or 10 days had a median NLR value of 6.93 (2.57–20.69), CRP 59.83 (1.60–151.56), and procalcitonin 0.145 (0.03–2.56), which are all higher than those whose length of stay was less than 10 days. Conclusion: NLR, CRP, and procalcitonin values are affected by the trimester of pregnancy, the maternal comorbidities, the commonly found chest X-ray features, the length of hospital stay, the prognostic value to be determined to find the disease severity, the needs of oxygen supplementation, and the intensive care treatment, and also they could be the predictors for neonatal outcome in pregnancy with COVID-19.

RESEARCH ARTICLE

M Raksha, HC Sudha, Swagatha Mukherjee, Rekha Varadaraj, KV Malini

Fetal Blood Sampling: Indications, Outcome and Complications

[Year:2022] [Month:July-August] [Volume:14] [Number:4] [Pages:5] [Pages No:453 - 457]

Keywords: Cordocentesis, Fetal blood sampling, Fetal therapy, Karyotyping

   DOI: 10.5005/jp-journals-10006-2077  |  Open Access |  How to cite  | 

Abstract

Aims and objectives: To analyze the indications of fetal blood sampling, the advantages, and disadvantages of different routes employed to obtain the fetal blood, the complications due to gestational age vs procedure-related failures, and their incidences in fetal blood sampling. Also to study the outcomes of the pregnancies after fetal blood sampling and the association between placental position, and its effects on fetal blood sampling. Materials and methods: This is a prospective study done on patients coming from all over South India to Bhagwan Mahaveer Jain Hospital and the Bangalore Prenatal Diagnosis and Therapy Associates, Bengaluru. The study was carried out on pregnant women with at least one indication for fetal blood sampling. A total number of patients in the study period of 12 months will be enrolled irrespective of age, parity, period of gestation, and type of indication. Inclusion criteria: Previous offspring with chromosomal anomalies or other birth defects; Maternal age 35 years or more at first pregnancy; Recurrent pregnancy loss (or both paternal translocation and inversion); Suggestive fetal ultrasonographic findings; Positive maternal screening test findings; Pregnant woman/spouse has a family history of mental retardation/physical deformities/genetic disease/inborn errors of metabolism; Mother having a disease or being exposed to drugs, medications, or infections known to be associated with congenital malformations in the fetus; Any indication for fetal therapy. Exclusion criteria: Any patient with a history of bleeding diathesis or hematological disorders; Intrauterine death of the fetus. Procedure: All eligible patients who have signed the informed consent form are taken for the procedure. The patient had to sign Form G and Form F as per the PC and PNDT Act 2003. History and investigations were done. Under aseptic precautions, the procedure was performed under ultrasound guidance with continuous needle-tip visualization. About 2 mL of fetal blood was obtained and sent for chromosomal, DNA, or biochemical analysis. If indicated, fetal therapy was performed. Following the procedure, further, follow-up was done until the outcome of pregnancy. Post-procedure antibiotics were given and the patient was referred back to her primary obstetrician. The patients were followed up to the end of pregnancy. The outcome of pregnancy and its relation to indication, complications, and results were analyzed. Results: The pregnancy termination rate in this study was 3.85% (n = 2), and indications for termination were Turner’s syndrome and malascended right kidney with cystic dysplasia of left kidney with delayed fetal nasal bone ossification and single umbilical artery. Out of 96.15% (n = 50) who continued their pregnancy, 65.4% (n = 34) had normal live and healthy babies. Of the six patients who had stillbirth, the various causes were – 2 patients with Down’s syndrome, one patient with Glucose-6-phosphate dehydrogenase deficiency who underwent cardiocentesis, one patient with early hydrops fetalis with IUGR, esophageal fistula, and polyhydramnios, and one patient with soft + major marker, 46, add(15)(q25). One patient who underwent intrahepatic vein portion of umbilical vein sampling for the fetus with porencephaly, intraventricular hemorrhage, left vitreal hemorrhage with retinal detachment, delivered a congenitally malformed baby and the baby died 6 hours after birth. One patient who had left-sided congenital diaphragmatic hernia and liver up position had preterm delivery and the baby died after 2 hours of birth. Of the eight intrauterine deaths, the causes were Klinefelter’s syndrome, Down’s syndrome, 45,-14,-15t(14;15)(q10;q10) apparently balanced Robertsonian translocation, 46,inv(2)(p12;q21), 46,inv(9)(p11;q13), fetal hepatomegaly, bladder outlet obstruction with B/L hydroureter, and duodenal atresia, and one patient with severe IUGR, lissencephaly, and cerebellar hypoplasia. One patient with omphalocele, continued pregnancy till term, and later the baby was operated. In one patient with Fallot’s Tetralogy with a single umbilical artery and fetal thymic hyperplasia, cord blood was sent for FISH 22q deletion, which was normal, had term delivery but the baby was admitted to higher center, treated conservatively and baby recovered. Conclusion: Fetal blood sampling is a safe and effective prenatal diagnostic procedure in experienced hands, mostly performed at 21–24 weeks of gestation. Cordocentesis can be done as an alternative to amniocentesis after 18 weeks of pregnancy as results of karyotype can be obtained earlier. In such cases, FISH can be avoided to cut down the cost. The risk of culture failure and fetal loss is also acceptable. Methods like fetal blood sampling, which makes karyotyping possible within a short time, should be preferred to amniocentesis and FISH analysis because FISH does not detect chromosomal mosaicism and structural aberrations. Triple test screening is on an increase, but it requires an external quality control program and standardization of the variables. Soft markers of ultrasound are a reliable screening test. Major anomalies on ultrasound are likely to be associated with cytogenetic abnormality. Hence, these fetuses need a cytogenetic study preferably before termination. This would aid in counseling for future pregnancies. Cardiocentesis or intrahepatic portion of umbilical vein sampling may be used as alternate method when cordocentesis is difficult to perform. Complications were similar in both fundo-anterior and fundo-posterior placental locations. Although this study consists of 54 patients on whom fetal blood sampling was done, larger studies are needed to validate the conclusions of this study.

RESEARCH ARTICLE

Usha Saraiya

Current Trends in the Management of Cervical Intraepithelial Neoplasia

[Year:2022] [Month:July-August] [Volume:14] [Number:4] [Pages:7] [Pages No:458 - 464]

Keywords: Cervical intraepithelial neoplasia, Gynecologists role, Management of CIN current trends, Preventive Oncology

   DOI: 10.5005/jp-journals-10006-2098  |  Open Access |  How to cite  | 

Abstract

Aim: Several new technologies have been introduced in clinical practice for treatment of cervical intraepithelial neoplasia (CIN). This article will review the current therapies and their outcomes. Screening of all women in the age group of 30–65 will result in a certain number of screen positive women, who will then need a proper management. The management will depend on the type of lesion and clinical assessment of the patient. Material and methods: The current modalities of management available are cryotherapy, large loop excision of transformation zone (LLETZ), thermoablation, carbon dioxide (CO2) laser, and cold knife conization (CKC). Each therapy has its own advantages and disadvantages. One has to choose the correct modality for each individual case. There is also the issue of availability and affordability for each patient. The treating physician will also be confident of the procedure in which he has experience. All modalities of the treatment are simple, rarely require anesthesia and hospitalization. Centers for treatment of CIN must be widely made available in smaller towns. Results: Each modality will be individually discussed and the literature on each will be reviewed. In this review, WHO guidelines are usually followed. Discussion: The management of CIN is long-term, and a life-time follow-up is recommended. There are some special groups of women who need special attention. These include adolescent girls, pregnant women, immuno-compromised persons, and women with other health conditions. Conclusion: In the case of a revised diagnosis of invasive cancer on biopsy of a case diagnosed as CIN, the treatment will have to be also revised. It is also necessary not to alarm the patient and her family, but to give them ample time to arrange for the treatment. Clinical significance: WHO's call for “elimination of cervical cancer” which was launched in 2018 gives a sense of urgency to the understanding of these therapies. When the screening will be extensive, a large number of CIN will be detected. They will all need correct treatment and follow-up. Each gynecologist must know what to suggest and where to refer such a case. This article will fulfill that need.

CASE REPORT

Vinita Singh, Pragati Trigunait, Purnima Singh, Taru Shikha, Pushpawati Thakur, Chandrashekhar Shrivastava

Vaginal Leiomyosarcoma: Fundamental Dilemma Prevails

[Year:2022] [Month:July-August] [Volume:14] [Number:4] [Pages:3] [Pages No:465 - 467]

Keywords: Adjuvant radiotherapy, Chemotherapy, Immunohistochemistry, Vaginal leiomyosarcoma

   DOI: 10.5005/jp-journals-10006-2085  |  Open Access |  How to cite  | 

Abstract

Smooth muscle tumors, though rare, are reported to be the most common benign and malignant mesenchymal tumors in adult women. Leiomyosarcomas may originate from any part of the vagina and are mostly submucosal. Patients usually present with vaginal discharge or bleeding or rarely dyspareunia and micturition. Vaginal leiomyosarcoma is a very aggressive tumor with fast local invasion and metastasis to distant organs. Radical resection by surgery remains the best treatment, and we continue to recommend surgical resection as the primary treatment. The role of adjuvant radiotherapy and chemotherapy is not clearly defined and can be considered optional in high-grade sarcomas to prevent recurrence, invasion, or spreading of the tumor. However, usually, it does not improve the survival of the patient.

CASE REPORT

Sumedha S Pathade, Shruti A Panchbudhe, Prasad Deshmukh, Aditya R Nimbkar

A Near Miss Case of Heterotopic Pregnancy Coexisting with Uterine Perforation, Detected after Surgical Evacuation of an Intrauterine Pregnancy

[Year:2022] [Month:July-August] [Volume:14] [Number:4] [Pages:3] [Pages No:468 - 470]

Keywords: Assisted reproductive technique, Heterotopic pregnancy, Ruptured ectopic, Salpingectomy, Uterine perforation

   DOI: 10.5005/jp-journals-10006-2081  |  Open Access |  How to cite  | 

Abstract

Aim: The management of a missed diagnosis of heterotopic pregnancy complicated by uterine perforation. Background: Heterotopic pregnancy (HP) is an exceptional condition where at least two pregnancies are present simultaneously at different implantation sites and one of them is located in the uterine cavity. Case description: We report an interesting near miss case of a 23-year-old P3L3A1 with a heterotopic pregnancy who was misdiagnosed as a case of acute abdomen with hemoperitoneum due to uterine perforation, postsurgical evacuation for an intrauterine pregnancy. Exploratory laparotomy was performed which confirmed the diagnosis of heterotopic pregnancy where the ectopic pregnancy was located in the right fallopian tube which was managed by right-sided salpingectomy and uterine rent repair was performed. Conclusion: A high index of suspicion followed by an early surgical laparoscopic/laparotomy intervention can minimize maternal morbidity and mortality in a heterotopic pregnancy. Clinical significance: How a benign and assumably routine case of missed abortion escalated to an eventual diagnosis of a heterotopic pregnancy.

CASE REPORT

Sunita Aggarwal, Sheeba Khan, Ankitesh Kumar, Naresh Kumar, Abhishek Verma, Kapil Kumar

Acute Right Heart Failure in Postpartum Period: An Unusual Case of Ruptured Sinus of Valsalva Aneurysm

[Year:2022] [Month:July-August] [Volume:14] [Number:4] [Pages:2] [Pages No:471 - 472]

Keywords: Percutaneous intervention, Pregnancy, Ruptured sinus of valsalva aneurysm

   DOI: 10.5005/jp-journals-10006-2082  |  Open Access |  How to cite  | 

Abstract

Sinus of valsalva aneurysms are uncommon and can be congenital or acquired. They may have variable clinical presentation ranging from asymptomatic cases to congestive heart failure and, in extreme situations, cardiac arrest. Both ruptured and nonruptured valsalva sinus aneurysms can cause deadly consequences, though the prognosis is excellent after treatment. As a result, timely and precise diagnosis is essential. Rupture of sinus of valsalva (RSOV) aneurysm in pregnancy during antepartum is a dreaded complication and can be life-threatening for both mother and fetus. However, it is infrequent with only few cases reported during pregnancy. We report a case of ruptured sinus of valsalva aneurysm in postpartum period with acute right heart failure following uneventful normal vaginal delivery and favorable outcome postpercutaneous intervention.

CASE REPORT

Amit Basu, Rajni Bansal, Upasna Sharma, Srabani Auddy Basu

Cellular Angiofibroma of the Vulva: A Rare Case Report

[Year:2022] [Month:July-August] [Volume:14] [Number:4] [Pages:2] [Pages No:473 - 474]

Keywords: Cellular angiofibroma, Histopathology, Immunohistochemistry, Mesenchymal tumors, Vulva

   DOI: 10.5005/jp-journals-10006-2090  |  Open Access |  How to cite  | 

Abstract

Aim: To describe clinical, histological, and immunohistochemical features of cellular angiofibroma, a rare mesenchymal tumor of vulva. Background: Cellular angiofibroma are rare mesenchymal tumors. These tumors have two principal components spindle cells and hyalinized stroma with small to medium sized vessels. Cellular angiofibroma (CAF) are benign in nature. Cellular angiofibroma commonly occurs after fifth decade. Characterization requires histological and immunohistochemical evaluation. Case description: We report a case of 65-year-old postmenopausal woman presenting with a painless and gradually enlarging mass in the clitoral region of vulva near external urethral meatus. A simple excision of the mass was performed. Gross examination of the mass showed a well circumscribed lesion of 5.5 cm × 5.5 cm. Histological and immunohistochemical analysis established a diagnosis of cellular angiofibroma. The tumor can recur, but distant metastasis of the tumor has not yet been described in the literature. Conclusion: Cellular angiofibroma is a rare benign tumor of vulva for which simple excision is adequate treatment. Differentiation of this tumor from other sarcomatous lesions can be done with histological and immunological evaluation.

CASE REPORT

Vineet Mishra, M Anusha Mahalingam, Smit B Solanki, Rohina Aggarwal

Management of Pregnancy in a Rare Case of Budd–Chiari Syndrome: A Case Report

[Year:2022] [Month:July-August] [Volume:14] [Number:4] [Pages:2] [Pages No:475 - 476]

Keywords: Case study, Pregnancy, Upper gastrointestinal symptoms

   DOI: 10.5005/jp-journals-10006-2093  |  Open Access |  How to cite  | 

Abstract

Budd–Chiari syndrome is a rare liver disorder in which there is obstruction of hepatic veins causing liver cirrhosis and fulminant hepatic failure. It is a non-specific liver disorder of pregnancy, if it occurs in pregnancy, it should be managed by a multidisciplinary team approach involving an obstetrician, gastroenterologist, and interventional radiologist. We present a case of Budd–Chiari syndrome managed by right hepatic vein angioplasty and stenting, was on oral anticoagulants and became pregnant after that, and was managed in our hospital and had successful outcome of pregnancy.

CASE REPORT

Manvika Chandel, Indra Bhati, Balakrishna

Safe Abortions: Are They a Reality Yet? A Case Series

[Year:2022] [Month:July-August] [Volume:14] [Number:4] [Pages:4] [Pages No:477 - 480]

Keywords: Family planning, Illegal abortion, Safe abortion, Unmet needs of contraception, Unsafe abortion, Unskilled health workers

   DOI: 10.5005/jp-journals-10006-2099  |  Open Access |  How to cite  | 

Abstract

Objectives: Annually, 210 million women conceive globally and 3 in 10 resort to abortion with an estimated 45% unsafe abortions, majority being from the developing world. This case series highlights the issues of unintended pregnancies resulting from loopholes in family planning knowledge, accessibility, and provision and failure, leading to women seeking abortions from unauthorized providers and settings endangering their lives, along with increasing the financial, social, and psychological burden on women, their families, and on health systems. Materials and methods: Three case reports on unsafe abortion resulting into life-threatening complications, referred from peripheral centers are discussed. The data retrieved is a detailed discussion highlighting the reasons for unintended pregnancy, execution of unsafe abortion at periphery by untrained providers, its complications, and the management provided at our tertiary center in Jodhpur. Results: All the women were from rural areas, uneducated, and multiparous. None ever used any contraception. All had unwanted conceptions, and illegally procured medical termination of pregnancy (MTP) pills. One had rupture of the previous scar (from the previous two cesarean sections). The other two underwent dilatation and curettage at peripheral center by untrained staff, resulting in uterine and intestinal perforation. All underwent urgent laparotomies and admitted to intensive care unit for further management. One had bowel resection, anastomosis, and ileostomy. Two of the women required support from other medical specialties. All were discharged in healthy condition. Conclusion: A collective effort to strengthen family planning system, intensive training of health providers along with educating masses about the importance of contraception should be given utmost importance to save maternal mortality and morbidity due to unsafe abortions.

REVIEW ARTICLE

Grisilda Vidya Bernhardt, Kavitha Bernhardt, Sujatha Bhat, Pooja Shivappa, Janita RT Pinto

Prenatal Stress-induced Behavioral, Cognitive, and Psychopathological Modifications: A Mini Review of Literature

[Year:2022] [Month:July-August] [Volume:14] [Number:4] [Pages:5] [Pages No:481 - 485]

Keywords: Behavior, Cognition, Motor development, Prenatal stress

   DOI: 10.5005/jp-journals-10006-2072  |  Open Access |  How to cite  | 

Abstract

Background: Prenatal stress (PNS) can influence the development of the progeny, which undergoes complex physiological changes during intrauterine and early postnatal life, thus causing them to experience far-reaching undesirable consequences. Prenatal stress is particularly a challenging issue because, by reacting to the mother's stress through a sequence of biological mechanisms, the fetus is placed under risk of several neurobiological variations that give rise to behavioral and emotional alterations in the offspring. Various studies have been conducted over the last two decades, not only on various stressors that give rise to negative emotions during pregnancy but also on their impact on offspring's mental health during the entire course of their development. Objective: This review aims at discussing various studies on the effect of prenatal stress in animal models and human subjects, and to explore some of the controversies arising in this field. Materials and methods: We searched PubMed and Scopus for English language abstracts published from 1992 to 2021. Search terms were related to prenatal stress, infant or child cognitive and motor development, and developmental psychopathology. Results and conclusion: A vast number of studies have reported negative neurobiological outcomes in the offspring subjected to PNS, although a clear understanding about the underlying biological mechanisms is not available. Methodological challenges do exist in PNS research which has not been successfully overcome. At present, however, there is a definite need to identify, advise, and support pregnant women with some degree of stress with a hope to minimize any adverse consequences in the progeny.

BRIEF RESEARCH COMMUNICATION

Srushti Shailesh Joshi, Shruti Ashok Panchbudhe

Characterization of Thrombocytopenia in Pregnant Women at a Tertiary Care Center: A Preliminary Study of 121 Patients

[Year:2022] [Month:July-August] [Volume:14] [Number:4] [Pages:5] [Pages No:486 - 490]

Keywords: Gestational, Observational study, Pregnancy, Thrombocytopenia

   DOI: 10.5005/jp-journals-10006-2069  |  Open Access |  How to cite  | 

Abstract

Background: Partum-related hemorrhage is a major cause of maternal morbidity and mortality, the risk of which increases in women with thrombocytopenia. An accurate etiological diagnosis of thrombocytopenia in pregnancy is essential for optimal therapeutic management to prevent maternal and fetal morbidity and mortality. Our study aims to establish various prevalent causes of thrombocytopenia in pregnancy and its demographic characteristics. Materials and methods: In total, 121 pregnant patients visiting the Antenatal Outpatient Department and/or Emergency Department at a tertiary medical center with thrombocytopenia (platelet counts <1,50,000/µL) were recruited for the study. Detailed blood investigations were done to establish the accurate etiology of thrombocytopenia. Special attention was given to differentiating between pregnancy-associated causes and those incidental to pregnancy. Results: Gestational thrombocytopenia (GT) accounted for 56.2% of the total cases, and hemolysis, elevated liver enzymes, low platelets (HELLP) syndrome accounted for 13.2% of the cases, closely followed by idiopathic thrombocytopenic purpura (12.4%). Thrombocytopenia associated with nutritional deficiencies was seen in 5.8% of the cases. Other less common causes included fever-associated thrombocytopenia (2.5%), disseminated intravascular coagulation (DIC) (2.5%), acute fatty liver of pregnancy (AFLP) (0.8%), atypical hemolytic uremic syndrome (HUS) (0.8%), and antiphospholipid antibody (APLA) syndrome (0.8%). Conclusion: Gestational thrombocytopenia (GT) is the commonest cause of thrombocytopenia during pregnancy.

CLINICAL TECHNIQUE

Phornsawan Wasinghon, Auttaya Ratanakaew, Duangporn Panpeng

Utility of Surgical Glove made for Various Gynecologic Laparoscopic Surgery

[Year:2022] [Month:July-August] [Volume:14] [Number:4] [Pages:6] [Pages No:491 - 496]

Keywords: Hysterectomy, Laparoscopic staging, Laparoscopic surgery, Ovarian cystectomy

   DOI: 10.5005/jp-journals-10006-2107  |  Open Access |  How to cite  | 

Abstract

Aim: Laparoscopic surgery has more benefits of less blood loss, shorter hospital length of stay, and less postoperative pain when compared to open surgery. The purpose of this study is to elucidate the benefit of surgical gloves made for various gynecologic diseases in laparoscopy and technical skills in the patients. Materials and methods: The study was an observational study at Buddhachnaraj Hospital, Phitsanulok, Thailand. The eligible 347 patients were diagnosed gynecologic conditions for laparoscopy between January 2019 and January 2022. The patients were informed and consented to the operations. The closed technique and open technique had designed to create the pneumoperitoneum owing to the diagnosis. The patients were observed for the outcomes after the laparoscopy within 1 month. Results: The 347 patients were surgery by laparoscopy. The mean age was 44.89 ± 14.627, and the mean BMI was 22.68 ± 1.94 kg/m2. The mean blood loss and operative time were 89.26 ± 126.87 mL and 107.57 ± 26.07 minutes, respectively. The five most frequent diseases were leiomyoma in 83 patients (23.9%), endometrial carcinoma in 48 patients (13.8%), serous cystadenoma in 45 patients (13%), endometrioma in 33 patients (9.5%), and cervical carcinoma in 28 patients (8.1%). One hundred and sixty patients (46.1%) had undergone a hysterectomy. However, 69 patients (19.9%) had undergone complete surgical staging to diagnose ovarian and endometrial cancer. Fifty-one patients had undergone ovarian cystectomy (14.7%). The number of patients with salpingo-oophorectomy (SO), radical hysterectomy, and myomectomy were 23 (6.6%), 22 (6.3%), and 13 (3.7%), respectively. The patients got the benefit of various gynecologic laparoscopy free of charge on the universal health coverage project. Conclusion: A feasible handmade cylinder glove with gauzes was inserted transvaginally to accumulate the pneumoperitoneum. Also, the 12-mm trocar was prepared at the middle finger of a surgical glove to accommodate the 10-mm 0°-laparoscope. Clinical significance: Surgical glove is the advantage of laparoscopic gynecologic surgery.

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