Journal of South Asian Federation of Obstetrics and Gynaecology

Register      Login

Table of Content

2023 | January-February | Volume 15 | Issue 1

Total Views

Editor's Desk

Jaideep Malhotra

Editor's Desk

[Year:2023] [Month:January-February] [Volume:15] [Number:1] [Pages:1] [Pages No:iv - iv]

   DOI: 10.5005/jsafog-15-1-iv  |  Open Access | 

59

Original Article

Anjali Lakhani, Ramadevi Vivek Wani, Ganga S Pilli

Expression of PTEN Marker in Endometrial Hyperplasia without Atypia: One-year Observational Study

[Year:2023] [Month:January-February] [Volume:15] [Number:1] [Pages:4] [Pages No:1 - 4]

Keywords: Endometrial cancer, Endometrial carcinoma, Endometrial hyperplasia, PTEN

   DOI: 10.5005/jp-journals-10006-2160  |  Open Access |  How to cite  | 

Abstract

Aim: To evaluate phosphatase and tensin homolog (PTEN) expression in endometrial hyperplasia without atypia. Materials and methods: Sixty paraffin-embedded blocks with endometrial hyperplasia without atypia histopathology were obtained. Immunohistochemical staining with PTEN antibody was done and was evaluated for staining intensity and proportion score. Results: The study population consisted of a total of 60 cases of endometrial hyperplasia without atypia. 52 cases had (86.70%) simple hyperplasia and 8 cases (13.30%) had complex hyperplasia. Out of the total 60 cases, only 2 cases of complex hyperplasia showed negative staining depicting the loss of PTEN. The correlation of endometrial hyperplasia with color intensity and proportion score was highly significant (p-value = 0.001). Conclusion: Phosphatase and tensin homolog expression is seldom lost in cases of endometrial hyperplasia without atypia, and if seen, needs closer monitoring to evaluate for atypia and endometrial carcinoma. Clinical significance: We propose that endometrial hyperplasia without atypia with loss of PTEN should be closely followed up to assess for atypia or carcinoma.

114

Original Article

Purnima Upreti, Punam Godara

COVID-19 Vaccine: Knowledge and Acceptance among Obstetric Population in Garhwal Region of Uttarakhand

[Year:2023] [Month:January-February] [Volume:15] [Number:1] [Pages:7] [Pages No:5 - 11]

Keywords: COVID-19, Pregnant women, Vaccine acceptance, Vaccine hesitancy

   DOI: 10.5005/jp-journals-10006-2174  |  Open Access |  How to cite  | 

Abstract

Background: Coronavirus disease-2019 (COVID-19) poses expectant mothers to a higher risk of serious complications and mortality. Following a risk–benefit review, a number of governmental and professional bodies from across the globe recently approved the COVID-19 vaccination during pregnancy. Aim: This study aimed to investigate knowledge, actual acceptance, and concerns about the COVID-19 vaccine among the obstetric population. Materials and methods: Participants were selected from among the expecting women who came for antenatal checkup during the study period (October 1, 2021–November 30, 2021). About 150 pregnant women who met the inclusion criteria and consented were recruited into the study. Data related to socio-demographic and clinical characteristics as well as knowledge, actual acceptance, and concerns about COVID-19 vaccine were collected through in-person interviews using a prestructured questionnaire. The SPSS version 23 was used to analyze data. The association between the attitude (acceptance and hesitance) of participants toward the COVID-19 vaccine and their sociodemographic and clinical profile was found by Fisher's exact test. Results: The actual acceptance of the COVID-19 vaccine among expecting women was 52.0%. The primary motive for accepting COVID-19 immunization was to protect the fetus, followed by the protection of one's own health. A significant association was found between COVID-19 vaccine acceptance and the level of education, socio-economic status, and presence of comorbidities. The leading causes for vaccine reluctance were concerns about the efficacy and safety of the vaccines and lack of awareness about their usage during pregnancy. Conclusion: Multifaceted activities are required to promote the effectiveness and safety profile of the COVID-19 vaccine as well as disseminate knowledge about its usage during pregnancy. Clinical significance: Unlike numerous other studies that have investigated the accepting attitude only, the present one has investigated the actual COVID-19 vaccine uptake among the obstetric population.

110

Original Article

Reena De, Rudraprasad Acharya, Saranya Sasikumar, Pattianchi T Sangma

A Comparative Study of Peripartum Mental Health Disorders between COVID-19-infected and Non-infected during the Pandemic

[Year:2023] [Month:January-February] [Volume:15] [Number:1] [Pages:7] [Pages No:12 - 18]

Keywords: COVID-19 anxiety scale, COVID-19 infection, Edinburgh postnatal depression scale, Peripartum anxiety, Peripartum depression, Peripartum mental health disorders

   DOI: 10.5005/jp-journals-10006-2175  |  Open Access |  How to cite  | 

Abstract

Introduction: This study was done to compare the prevalence of mental health disorders between COVID-19-infected and non-infected mothers during the COVID-19 pandemic. The secondary objective was to find out the risk factors and long-term outcome of peripartum depression (PPD). Material and methods: This was an observational and comparative study using a questionnaire-based direct interview, conducted in a tertiary hospital. After judging the inclusion and exclusion criteria, 842 subjects were selected between September 2020 to December 2020. The Edinburgh postnatal depression scale (EPDS) and COVID-19 anxiety scale (CAS) was used for evaluation of the mental health. Subjects with PPD were followed up for a year. Results: The mean age of the subjects was 24.8 ± 3.9 years, 142 (16.8%) were confirmed COVID-19 positive. Overall, 317 (37.6%) had possible PPD (EPDS ≥14) and 763 (90.6%) had peripartum anxiety (EPDS anxiety subscore ≥4). While there was no significant difference in the prevalence of PPD (32.6% vs 39%, p = 0.12), peripartum anxiety was higher among COVID non-infected subjects (91.6% vs 86.6%, p = 0.04). Furthermore, COVID-19-related anxiety was higher among COVID-19-infected compared to the non-infected [17 (10–28) vs 15 (8–25), p = 0.00]. In multivariate analysis, medical comorbidities (p = 0.000), history of psychiatric illness (p = 0.002), domestic violence (p = 0.032) and obstetric complications (p = 0.000) were significant risk factors for PPD. Among the subjects who had PPD, only 35% still had depression after a year. Conclusion: This study provides an in-depth analysis of PPD and anxiety during the COVID-19 pandemic, the risk factors, and the long-term effects. Clinical significance: It highlights the importance of routine screening for perinatal mental health disorders and early psychiatric consultation when required.

100

Original Article

Kahandhawa Appuhamillage Madhavi Priyangika Gunathilake, Vindya Kumarapeli, Athula Kaluarachchi, Rajaguru Mudiyanselage Chaminda Bandara Hunukumbure

Prevalence of Abnormal Ovarian Masses/Cysts in Sri Lankan Women over 40 Years of Age

[Year:2023] [Month:January-February] [Volume:15] [Number:1] [Pages:5] [Pages No:19 - 23]

Keywords: Ovarian cyst, Ovarian mass, Postmenopausal, Premenopausal, Prevalence, Ultrasound assessment

   DOI: 10.5005/jp-journals-10006-2176  |  Open Access |  How to cite  | 

Abstract

Aim: For any unsuspecting woman, the finding of an ovarian cyst/mass that has the potential to be either malignant or end up in a cyst accident (torsion, rupture, or hemorrhage) and hence requires intervention, is of paramount importance. Based on ultrasound-guided explicit criteria, this study was aimed at determining the prevalence of abnormal ovarian masses, both malignant and benign, in the most vulnerable age group. Materials and methods: A community-based; descriptive cross-sectional study was conducted among 931 females aged over 40 years who were selected by probability proportionate to the cluster sampling technique. All the study participants underwent trans-abdominal ultrasound scanning. Married subjects were offered a subsequent transvaginal scan (TVS) if indicated. Results: The prevalence of abnormal ovarian masses based on ultrasound assessment was 2.9% [95% confidence interval (CI): 1.8–4.0]. Thirteen subjects (1.4%) had complex cysts between 3 and 5 cm diameter (95% CI: 0.8–2.3) and five (0.53%) had complex cysts larger than 5 cm (95% CI: 0.2%–1.2%). The prevalence of simple ovarian cysts exceeding 5 cm was 0.97% (95% CI: 0.5–1.8). Histopathological examination of abnormal ovarian masses that needed surgery revealed; endometrioma (n = 6), mature cystic teratoma (n = 1), mucinous cyst adenoma (n = 1), serous cyst adenoma (n = 1), and serous papillary cyst adenocarcinoma (n = 1). Conclusion: Abnormal ovarian cysts/masses were more prevalent among women aged above 50 years, and those who had attained menopause. Pelvic ultrasound assessment of women in their 50s belonging to potential high-risk groups can be recommended on an annual basis.

152

Original Article

John Barja-Ore, Cesar Mauricio-Vilchez, Roman Mendoza, Arnaldo Munive-Degregori, Natalia Valverde-Espinoza, Frank Mayta-Tovalino

Side Effects of COVID-19 Vaccine in Pregnant Women: A Bibliometric Study

[Year:2023] [Month:January-February] [Volume:15] [Number:1] [Pages:5] [Pages No:24 - 28]

Keywords: COVID-19, Pregnancy, Side effects, Vaccines

   DOI: 10.5005/jp-journals-10006-2178  |  Open Access |  How to cite  | 

Abstract

Introduction: Side effects related to COVID-19 vaccination are short-lived and disappear within a few days and can affect both pregnant and nonpregnant women. Aim: To evaluate the bibliometric profile of the worldwide scientific production on the side effects of COVID-19 vaccine in pregnant women, in Scopus. Materials and methods: A retrospective, cross-sectional, bibliometric study that analyzed metadata published in scientific journals indexed in Scopus during 2019 and 2021. The search and download of the papers were performed on May 13, 2022, and the SciVal program was used for the measurement of the bibliometric indicators. Results: The Lancet Infectious Diseases and International Journal of Gynecology and Obstetrics had the highest impact with 24.8 and 14.3 citations per publication, respectively. The institutions with the highest number of papers were Harvard University and National Institutes of Health, with 13 papers, respectively. Goldfarb Ilona Telefus, Kampmann Beate, and Khalil Asma were the authors with the highest number of papers, with 3 each. Only one publication on the side effects of COVID-19 vaccine in pregnant women was identified in 2019, whereas the highest scientific output was identified in 2021, with 127, of which 67 were from Q1. Conclusion: In Scopus, there is an increase in the production of papers on the side effects of the vaccine against COVID-19 in pregnant women, with the United States being the country with the most institutions with the highest scientific production. However, over the years, the quartile of the journals where these studies were published decreased.

99

Original Article

Nithya Rengaraj, NS Kubera, Nivedita Mondal, Thyagaraju Chitra, Nivedita Jha, Anusuya Ram

Maternal and Perinatal Outcomes among Women after a Period of Infertility: A Cross-sectional Analytical Study

[Year:2023] [Month:January-February] [Volume:15] [Number:1] [Pages:5] [Pages No:29 - 33]

Keywords: Gestational diabetes mellitus, Hypertensive disorders, Infertility, Low birth weight, Maternal outcome, Neonatal morbidity, Perinatal outcome, Preterm labor

   DOI: 10.5005/jp-journals-10006-2181  |  Open Access |  How to cite  | 

Abstract

Purpose: Infertility has been highly prevalent in recent years and has social implications. With the development of novel treatments, there is a rise in complications. This study aims to assess the maternal and perinatal outcomes of pregnancies following a period of infertility. Materials and methods: A cross-sectional analytical study of 140 women admitted to the labor room in a tertiary care center in South India from September 2014 to May 2016 with conceptions following a period of infertility was recruited in group I. A total of 140 controls with spontaneous conceptions within 1 year of married life were recruited in group II. Data were collected using a pre-designed proforma after obtaining informed consent. Various maternal and perinatal outcomes between the two groups were analyzed and compared. Chi-squared test/Fischer's exact test was used to compare the two groups’ outcomes. Results: The incidence of hypertensive disorders [odds ratio (OR) = 2.2; 95% confidence interval (CI): 1.2–4.2], gestational diabetes mellitus (GDM) (OR = 3.6; 95% CI: 1.7–7.5), and preterm labor (OR = 3.5; 95% CI: 1.6–7.8) were significantly higher in group I compared to group II. Among the fetal outcome, the number of neonatal intensive care unit (NICU) admissions (OR = 5.57; 95% CI: 2.5–13.1), low birth weight (LBW) (OR = 3.02; 95% CI: 1.8–4.9), and neonatal morbidity (OR = 7.8; 95% CI: 1.5–14.8) were significantly higher among group I. However, there were no statistically significant differences in the perinatal outcome among the different treatment groups. Conclusion: Pregnancies following infertility are at a higher risk of some obstetric complications and adverse perinatal outcomes than spontaneous conceptions and hence require close follow-up and timely intervention.

69

Original Article

Hiral Ashok Chaudhary, Dipa Pitre

Fetomaternal Outcomes among Patients with Sickle Cell Disease: A Retrospective Study

[Year:2023] [Month:January-February] [Volume:15] [Number:1] [Pages:5] [Pages No:34 - 38]

Keywords: Heterozygous, Homozygous, Pulmonary hypertension, Vaso-occlusion

   DOI: 10.5005/jp-journals-10006-2187  |  Open Access |  How to cite  | 

Abstract

Introduction: We are presenting a study on pregnancy with sickle cell disease (SCD), which is the most common genetic disorder with high mortality and morbidity with varying severity. It is an increasing global health problem. Materials and methods: The cases were retrieved and a case–control study was done at GMERS Medical College and Hospital over a duration of 3 years from November 2019 to September 2022. General characteristics of 32 pregnancies and their fetomaternal complications were studied. A descriptive statistical analysis of the above-mentioned data was performed, and percentages were calculated. Results: Among 32 cases, 62.5% of cases were multigravida. Anemia (moderate and severe anemia) was the most common complication (71.87%). Hemolytic crisis was seen in 18.75%, and painful crises were seen in 6.25% cases, 9.37% of cases had acute chest syndrome. Complications such as urinary tract infection (UTI) were seen in 6.25%, preeclampsia in 34.37%, 56.25% had preterm deliveries, and history of miscarriage and stillbirth was seen in 34.37%. Intrauterine growth restriction (IUGR) was seen in 9.37%, neonatal death – 3.12%, low birth weight – 62.5%, fetal distress – 12.50%, and intrauterine fetal death (IUFD) – 6.25%. Maternal mortality was seen in 12.50% cases. Discussion: Because of physiological adaptations along with sickle cell crisis, maternal and fetal complications are more in SCD patients. Conclusion: The study will help understand the outcomes of pregnancy in SCD patients and will help for a better approach in treating these patients.

77

Original Article

G Geeta Devi, Ruchi Hooda, KK Gopinathan

A Prospective Study on Perinatal Outcomes of In Vitro Fertilization-conceived Dichorionic Diamniotic Twins with Crown–Rump Length Discordancy

[Year:2023] [Month:January-February] [Volume:15] [Number:1] [Pages:4] [Pages No:39 - 42]

Keywords: Artificial reproductive techniques, Crown–rump length, Discordant, Maternal outcome, Perinatal outcome, Twin pregnancy

   DOI: 10.5005/jp-journals-10006-2188  |  Open Access |  How to cite  | 

Abstract

Aim: To study the perinatal outcome of dichorionic diamniotic (DCDA) twin pregnancies conceived by in vitro fertilization (IVF) with respect to crown–rump length (CRL) discordance at 11–14 weeks. Materials and methods: This was a prospective observational cohort study conducted over a period of 1 year. All antenatal patients conceived with IVF and DCDA twin gestation were enrolled in the study at 11–14 weeks. They were classified into two groups based on the presence of significant CRL discrepancy of more than or equal to 10% into a discordant and concordant group and followed up till delivery and neonatal period to study the perinatal outcome. Results: Of the 176 DCDA twins, 30% were discordant for CRL and 70% were concordant for CRL. Primary outcome measures like total pregnancy loss below 24 weeks and preterm birth (PTB) below 32 weeks as well as secondary oucome measures like discordant anomalies, selective fetal growth restriction (FGR), discordant birthweight were significantly more in discordant group. Conclusion: First-trimester determination of chorionicity is vital for planning antenatal visits and further management of gestation. The significant discrepancy will help us to categorize the dichorionic twins into two groups. Intertwin CRL discordance entails an increased risk of adverse conditions mainly of fetal loss below 24 weeks, selective FGR, and PTB below 32 weeks. Clinical significance: The CRL discordant twins in IVF-conceived DCDA twins are strongly associated with discordant structural abnormalities and selective FGR at later gestations and thus increasing the incidence of PTB less than 32 weeks in this group. Identification of this group may help in counseling and closer surveillance.

70

Original Article

Basanta Manjari Hota, Naimisha Movva, Kavitha Bakshi, Geetha Lokam

Analysis of Cesarean Section by Robson's Ten-group Classification System: A Step toward Reduction in Rate of the Surgery

[Year:2023] [Month:January-February] [Volume:15] [Number:1] [Pages:4] [Pages No:43 - 46]

Keywords: Analysis, Audit, Cesarean section, Robson's ten-group classification system

   DOI: 10.5005/jp-journals-10006-2189  |  Open Access |  How to cite  | 

Abstract

Background: Increasing the cesarean section rate with its complications is a global concern now. High economical background, education, limited family size, comfort of both; the patient and the care provider as well as the availability of facility and advanced technology are the responsible factors for the high rate of the surgery. In an attempt to reduce the rate, World Health Organization (WHO) has introduced Robson's Ten-group Classification System (RTGCS) for auditing, analyzing, and finding the largest contributor to the surgery so that steps can be taken to limit it. Aims: (i) Finding out the group contributing more to the total cesarean section. (ii) Discussing the possible remedial measures to reduce the rate of the surgery. Materials and methods: This retrospective study was conducted in the Obstetrics and Gynaecology Department of Mamata Medical College, Khammam, Telangana State, India, over 5 years period, which included all the cesarean deliveries at and beyond 28 completed weeks of gestation. Results: Total cesarean deliveries were 778 and the rate of cesarean section was 31.39% of total deliveries. Group X of RTGCS had a maximum contribution (31.10%) followed by group V (29.43%), group II (20.95%), and group I (06.68%) to the total cesarean deliveries. Conclusion: Robson's ten-group classification system, as the preliminary step in reducing the rate of cesarean delivery, is good to find the maximum contributors to the surgery. Detailed auditing and analysis will help to limit the rate of surgery by taking necessary steps, without affecting the mother and the baby. The role of the institution and care provider is important in the success of the mission. Clinical significance: Attempt to reduce the rate of the cesarean section without compromising pregnancy outcome.

103

Original Article

Vidyashree Ganesh Poojari, Prashanth Adiga, Anjali Mundkur, Pratap Narayan, Shreya Sharma

Endometrial Compaction in Response to Progesterone Administration and Good Endometrial Vascularity Improves the Clinical Pregnancy Rates in Hormone Replacement Frozen Embryo Transfers

[Year:2023] [Month:January-February] [Volume:15] [Number:1] [Pages:6] [Pages No:47 - 52]

Keywords: Clinical pregnancy rate, Endometrial compaction, Endometrial thickness, Endometrial vascularity, Frozen embryo transfer, Progesterone, Prospective observational study

   DOI: 10.5005/jp-journals-10006-2199  |  Open Access |  How to cite  | 

Abstract

Purpose: The current study assessed the effect of endometrial compaction and vascularity on clinical pregnancy rates (CPR) in women undergoing frozen embryo transfer (FET). Methods: Prospective observational study. Endometrial compaction and its vascularity were studied by transvaginal ultrasound (TVS) and evaluated CPR. Results: Out of 156 women, 81 had endometrial compaction, 64 had no change in the endometrium, and 11 had an increase in endometrial thickness (ET). Clinical pregnancy rate was 58% among those with endometrial compaction compared to 20.3% among those with no change in ET and 9.1% among those with an increase in ET on the day of FET (p-value < 0.001). Women with 5–10% endometrial compaction, CPR was 61.24%, those with 11–15% compaction had the highest pregnancy rate of 88.2%, and those with compaction of >15% had CPR of 66.6%. Endometrial compaction with zone 3 vascularity had a CPR of 64.2%, and those with zone 4 had 91.7% CPR compared to those with zone 2 vascularity (12.5%), p-value < 0.001. There was poor CPR in women with an increase in ET, though the endometrial vascularity was good. Conclusion: A significant increase in CPR was observed in women who had endometrial compaction with good vascularity of the endometrium, unlike those with poor vascularity. Women with no change or increase in ET had poor pregnancy rates. Hence, assessing the endometrium on the day of starting progesterone and on the day of embryo transfer is essential. If the endometrial compaction has not occurred and/or the endometrial vascularity is poor, the cycle should be considered for cancellation. Clinical significance: Endometrial compaction and good endometrial vascularity are essential for embryo implantation in FET cycles.

118

Original Article

Niranjan N Chavan, Akanksha Arun Barkase, Darshana Ajmera, Deepali Kapote, Ashwini Sakhalkar, Shreya Kampoowale, Manan Boob, Divita Arun Kamble, Pradnya Changede, Shruti Rane, Radhika Bhutada, Rakesh Dadmal, G Priyanka Damodar, Sonam Simpatwar, Zeba Pathan, Umme Ammara Mohammad Ibrahim Iqbal, Hera Mirza, Shalini Mahapatra, Hitendrasing Rajput, Shikhanshi, Prasad Deshmukh, Zubin Sheriar

A Retrospective Observational Study of Cases of Sexual Assault at Tertiary Care Center

[Year:2023] [Month:January-February] [Volume:15] [Number:1] [Pages:4] [Pages No:53 - 56]

Keywords: Physical assault, Rape victim, Sexual assault

   DOI: 10.5005/jp-journals-10006-2161  |  Open Access |  How to cite  | 

Abstract

Aim: To conduct a retrospective study to determine the profiles of victims of sexual assault and to study demographical factors in them. Materials and method: This retrospective observational study was conducted at the Department of Obstetrics and Gynaecology, Lokmanya Tilak Municipal Medical College and General Hospital, Mumbai, Maharashtra, India for a duration of 8 years (from January 2014 to July 2022). Data were collected from case records of the hospital. Results • A total of 75 cases were below the age of 18 years, 36 cases were falling into the age group of 18–25 years, 16 cases were in the age group of 25–40 years while only 3 cases were above 40 years of age. • A total of 25.38% (33 cases) gave a history of sexual assault while 74.61% (total of 97 cases) victims had both physical and sexual assault. • The time interval between incidence and reporting to professionals were noted, and as per the observation, 20.7% (27 cases) reported the incidence within 24 hours, while 11 cases (8.4%), 41 cases (31.53%), and 44 cases (33.84%) reported within 1 week, 1 month, and within 1 year, respectively. • A total of 43 cases (33.07%) were having intact hymen while 60 cases (46.15%) had hymenal tears at multiple sites. Conclusion and clinical significance • The more commonly affected age group is found to be between 0 and 18 years. Considering their educational background, mainly students of primary school are victims of assault. • Maximum incidences were reported within 1 month to 1 year of the assault which indicates a delay in reporting the incidence and also a delay in medical examination of the victim. • There is an increased rate of unwanted pregnancies in victims and delayed diagnosis. Most of these were teenage pregnancies, increasing physical and emotional stress on unmarried mothers. • Most of the victims were the target of both physical and sexual abuse. • Only 24.16% of cases had been reported within 72 hours of the incidence and were eligible for taking samples. • For the majority of the assaults, the accused was a ”known to” victim.

97

ORIGINAL RESEARCH

Indumathi H Kantharaja, Shashikala B Patil, Rashmi Kumar Karning, Radhika Chetan, Geetha Shivamurthy, Bevinahalli Nandisha Prashanth

Comparison of Immediate Adverse Effects of COVID-19 Vaccine (COVAXIN BBV152) in Pregnant vs Nonpregnant Women

[Year:2023] [Month:January-February] [Volume:15] [Number:1] [Pages:4] [Pages No:57 - 60]

Keywords: Adverse events, SARS COV 2, Vaccination

   DOI: 10.5005/jp-journals-10006-2184  |  Open Access |  How to cite  | 

Abstract

Aims and objectives: The aim of this study was to compare the immediate adverse effects of the coronavirus disease 2019 (COVID-19) vaccine (COVAXIN) in a pregnant woman with that of a nonpregnant woman. Materials and methods: It is a prospective observational study done at Vanivilas Hospital, Bangalore Medical College & Research Institute (BMCRI) for 2 months. The sample size was 100 pregnant and 100 nonpregnant women. Telephonically, patients were followed-up, and details of the side/adverse effects were collected in a proforma after 2 and 14 days. Data collected from both groups were analyzed using the Chi-square test or Fisher's exact test. Results: The majority of women were in the age group of ≤25 years (64.0% and 36.0%, respectively) with a mean age of 25.01 ± 3.71 years among the pregnant and 28.52 ± 6.00 years among nonpregnant women. About 25.0% of pregnant women and 38.0% of nonpregnant women reported side effects. About 15.0% and 22.0% had taken treatment for side effects among pregnant women and nonpregnant women, respectively. Among the pregnant women, the common side effects reported were injection site pain (17) followed by fever (5), fatigue (4), and myalgia (03). Whereas among the nonpregnant women, the common side effects reported were injection site pain (28) followed by fever (6), myalgia (3), headache (2), and fatigue (1). Conclusion: Side effects reported following the administration of Covaxin in pregnant and nonpregnant women are fever, fatigue, injection site pain, myalgia, and headache. The proportion of side effects was not significantly different in the pregnant and nonpregnant women following Covaxin administration. Clinical significance: Covaxin is an inactivated killed vaccine against COVID-19 by Bharat Biotech. The vaccine has been recommended for pregnant women by the Government of India during corona pandemic. Studies are lacking regarding the difference in adverse events in pregnant versus nonpregnant women, after vaccine administration.

86

ORIGINAL RESEARCH

Nikita Sharma, Seetesh Ghose, Setu Rathod

Cervical Ripening Using Mifepristone before Induction of Labor in Term Pregnancy: Prospective Randomized Comparative Study

[Year:2023] [Month:January-February] [Volume:15] [Number:1] [Pages:4] [Pages No:61 - 64]

Keywords: Labor induction and augmentation, Labor management, Neonatology

   DOI: 10.5005/jp-journals-10006-2186  |  Open Access |  How to cite  | 

Abstract

Background: Mifepristone is a pharmacological agent (antiprogestin). When used in late pregnancy as an inducing agent, it antagonizes the action of progesterone at the cellular level and promotes cervical ripening. This study aims to compare the efficacy of mifepristone and prostaglandin (PGE2) gel for cervical ripening. Methodology: Women fulfilling inclusion criteria were enrolled either into the study group (mifepristone) or the control group (PGE2 gel). After assessment of the initial Bishop's score in both the groups, the study group was administered mifepristone 200 mg orally once and the control group was administered intracervical PGE2 gel at intervals of 6 hours for a maximum of three doses. Subsequent Bishop's score was assessed at 6, 12, 18, and 24 hours in both groups. An artificial rupture of membrane (ARM) with oxytocin augmentation was done when required. Parameters measured were the demographic profile of patients, Bishop's score, the requirement of misoprostol and augmentation with oxytocin, mode of delivery, induction delivery interval, outcome (successful/failed induction), appearance, pulse, grimace, activity, and respiration. (APGAR) score at 1 minute, and 5 minutes, neonatal intensive care unit (NICU) admission above 24 hours. Result: Improvement of Bishop's score was significantly higher in the control group at 6, 12, and 18 hours as compared to the study group. A total of 94% of patients required misoprostol only in the study group. Augmentation with oxytocin rate was higher in the control group (73%) as compared to the study group (71.1%). The induction delivery interval was significantly shorter in the control group with a p < 0.001. The vaginal delivery rate was higher in the study group. No significant difference was noted in neonatal outcomes in both groups. Conclusion: Mifepristone is not a better primary ripening agent than PGE2 gel.

94

ORIGINAL RESEARCH

Kadek Ary Widayana, I Gede Mega Putra, I Wayan Megadhana, Tjok Gde Agung Suwardewa, I Nyoman Bayu Mahendra, Anak Agung Gede Putra Wiradnyana, Ida Bagus Gede Fajar Manuaba

The Matrix Metalloproteinase-9 Gene Polymorphisms as Risk Factor for Pelvic Organ Prolapse in Balinese Women

[Year:2023] [Month:January-February] [Volume:15] [Number:1] [Pages:6] [Pages No:65 - 70]

Keywords: Matrix metalloproteinase-9, Pelvic organ prolapses, Polymorphism

   DOI: 10.5005/jp-journals-10006-2190  |  Open Access |  How to cite  | 

Abstract

Aim: Pelvic organ prolapse (POP), although not life-threatening, is a serious condition that can affect a patient's quality of life. As life expectancy rises, the number of women with POP continues to rise. The weakness of the pelvic floor is always found underlying each case of POP. This weakness in the pelvic floor is associated with repeated damage to muscles and connective tissue due to the process during pregnancy and delivery. Balinese women have risk factors for developing POP related to the obligation to continue their offspring by conceiving and giving birth more than 4 times and working as heavy workers. The presence of genetic factors is also thought to play a role as a risk factor for POP in Balinese women. The purpose of this study was to prove the existence of polymorphism matrix metalloproteinase-9 (MMP-9) rs17576 as a factor that puts Balinese women at risk for POP. Materials and methods: A paired case–control study was conducted on each of 30 Balinese women with POP and without prolapse, which was done matching based on parity and occupation variables at Sanglah Hospital, Denpasar and Integrated Biomedical Laboratory, Faculty of Medicine, Udayana University. The EDTA tube contains 3 milliliters of venous blood, from which the sample material is taken. DNA isolation, PCR, and sequencing examinations were performed to determine the presence of MMP-9 rs17576 gene polymorphism. Results: Balinese women's POP risk was quadrupled by the gene polymorphism of the MMP-9 rs17576 genotype AG compared to without prolapse (OR = 4.00, 95% CI 1.13–14.18, p = 0.04). Conclusion: In Balinese women, the presence of MMP-9 rs17576 gene polymorphism raises the risk of POP.

102

ORIGINAL RESEARCH

Sneha Tadu, Karuna Yerroju, Sharmila Gudey

A Comparative Study of Coagulation Profile in Normal Pregnancy, Mild Preeclampsia, and Severe Preeclampsia Patients

[Year:2023] [Month:January-February] [Volume:15] [Number:1] [Pages:5] [Pages No:71 - 75]

Keywords: Acute fatty liver in pregnancy, Adverse pregnancy outcome, Coagulation profile in preeclampsia, Disseminated intravascular coagulation, Eclampsia, FFP, Hypertension pregnancy induced, LSCS, Preeclampsia, Preeclampsia profile blood test

   DOI: 10.5005/jp-journals-10006-2192  |  Open Access |  How to cite  | 

Abstract

Introduction: Disorders of hypertension complicate approximately 5–10% of all pregnancies. Preeclampsia is a severe health issue that needs to be treated, especially in developing countries where it is more common and its risk of having detrimental effects is higher. This study assessed the severity of preeclampsia and coagulopathy to aid in the management of both situations before patients experienced complications as it is well known that an underlying coagulation disorder increases the risk of bleeding complications. Aim: The aim of this study was to compare coagulation profile in normal pregnancy, mild preeclampsia, and severe preeclampsia patients. Results: Preeclampsia patients’ platelet counts were found to be significantly lower, their bleeding times to be noticeably longer, and their D-dimers to be noticeably greater in the current study when they were contrasted with normotensive pregnant women. Conclusion: The coagulation profile is a crucial tool in the early detection of coagulation failure and its therapy to prevent the situation from getting worse. For a definitive diagnosis and therapy of the coagulation failure in preeclampsia and eclampsia patients, the use of additional parameters such as thrombin time, euglobulin clot lysis time, fibrinogen levels, and fibrinopeptide A is also recommended.

108

ORIGINAL RESEARCH

Shrutika Omprakash Makde, Vibha More, Mitali Sharma, Shivani Sakarkar, Arun Haishchandra Nayak

Study of Postnatal Umbilical Coiling Index and Its Correlation with Maternal and Perinatal Outcome

[Year:2023] [Month:January-February] [Volume:15] [Number:1] [Pages:5] [Pages No:76 - 80]

Keywords: Hypercoiling, Hypocoiling, Normocoiling, Perinatal outcome, Umbilical coiling index

   DOI: 10.5005/jp-journals-10006-2193  |  Open Access |  How to cite  | 

Abstract

Aim: To study of postnatal umbilical coiling index (pUCI) and its association between maternal high-risk factors and neonatal outcome. Materials and methods: A prospective analytical study was conducted after ethical clearance over a period of 6 months among 150 women giving birth in the labor room of a tertiary care center in Mumbai, Maharashtra, India. The pUCI was determined by dividing the total number of coils by the total umbilical cord length in centimeters. Its association with maternal high-risk factors and fetal outcome was noted. The statistical test was the Chi-squared test and was assessed with a statistical package for the social sciences (SPSS), version 26; p < 0.05 was considered significant. Results: The mean pUCI was 0.257 ± 0.09. The cutoff for the tenth percentile was 0.157 and the nineteenth percentile was 0.367. Hypocoiling was significantly associated with hypertensive disorder in pregnancy (HDP), gestational diabetes mellitus (GDM), and post-term pregnancy, while anemia is associated with hypercoiling. Adverse neonatal outcomes including low birth weight (LBW), intrauterine fetal death, low appearance, pulse, grimace, activity, and respiration (APGAR) score at 1 minute, and neonatal intensive care (NICU) admission are associated with hypercoiling. Meconium-stained amniotic fluid (MSAF) is significantly associated with hypocoiling. Conclusion: Abnormal pUCI translates reliably into many maternal high-risk factors and perinatal outcomes. Antenatal assessment of umbilical coiling index (UCI) can be used as a prognostic tool to help predict and prevent adverse perinatal outcomes so as to improve maternal and fetal well-being by providing a healthy pregnancy which is the right of every birthing mother. Clinical significance: Antenatal determination of UCI can help identify high-risk pregnancies to be managed with greater vigilance and monitoring.

121

RESEARCH ARTICLE

Shruthi Srinivas Subhedhar, Sharda Patra, Tomesh Shrimali

Diagnostic Accuracy of TVS-based Soft Markers in the Evaluation of Women with Chronic Pelvic Pain

[Year:2023] [Month:January-February] [Volume:15] [Number:1] [Pages:4] [Pages No:81 - 84]

Keywords: Adhesions, Chronic pelvic pain, Endometriosis, Laparoscopy, Soft markers, Transvaginal ultrasonography

   DOI: 10.5005/jp-journals-10006-2185  |  Open Access |  How to cite  | 

Abstract

Objective: To determine the diagnostic accuracy of transvaginal ultrasonography (TVS)-based soft markers and its correlation with diagnostic laparoscopy in the detection of pelvic pathology and the evaluation of women with chronic pelvic pain (CPP). Materials and methods: A prospective observational study was conducted in the Department of Obstetrics and Gynaecology, Lady Hardinge Medical College, New Delhi, in which a total of 100 women between the ages of 18 and 50 with complaints of CPP lasting for more than 6 months, fulfilling the inclusion criteria were enrolled. Women were first subjected to clinical examination followed by TVS soft marker analysis, i.e., site-specific pelvic tenderness, ovarian mobility, and presence of loculated peritoneal fluid in the pelvis. Those who had either presence of TVS soft markers or clinical findings, or both, underwent diagnostic laparoscopy to see for pelvic pathology. Transvaginal ultrasonography soft marker findings were correlated with diagnostic laparoscopy and subjected to statistical analysis. Results: The mean age of the total study population was 30.9 + 4.02 years and mean duration of abdominal pain was 3.66 + 3.06 years. Transvaginal ultrasonography soft markers were present in 85 women in whom Laparoscopy confirmed pelvic pathology in 75 women, with 51 had minimal adhesions, 14 had subtle endometriotic lesions, and 10 had pelvic congestion. The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of TVS soft markers were 100%, 68%, 90%, and 100% with p < 0.001. The diagnostic accuracy of TVS soft markers was 92% with a likelihood ratio of 3.13 and a good correlation was established between TVS soft markers and laparoscopic findings (κ = 0.69) (p < 0.001). Conclusion: In conclusion, TVS-based soft markers should be regarded as the first line imaging modality in the evaluation of patients with suspected endometriosis and pelvic adhesions as this could facilitate more effective triaging of women, resulting in shorter, safer, more rational, and cost-effective management and in turn reduce the need for invasive procedures like laparoscopy for evaluation of CPP.

82

RESEARCH ARTICLE

Vinita Sarbhai, Surbhi Kumari

Ormeloxifene: The Perfect Alternative for the First-line Management of Abnormal Uterine Bleeding

[Year:2023] [Month:January-February] [Volume:15] [Number:1] [Pages:3] [Pages No:85 - 87]

Keywords: Abnormal uterine bleeding, Centchroman contraception, Ormeloxifene pictorial blood assessment chart Score

   DOI: 10.5005/jp-journals-10006-2191  |  Open Access |  How to cite  | 

Abstract

Aim: The aim of this work was to study the role of Ormeloxifene in the management of abnormal uterine bleeding (AUB). Methods: Fifty-one patients with heavy menstrual bleeding with ages between 18 and 50 years were included in the study. The women with post-menopausal bleeding, fibroids, uterus size of more than 8 weeks, polycystic ovarian syndrome (PCOS), and ovarian cysts were excluded. Ormeloxifene (60 mg) twice a week for 12 weeks and then once a week for the next 12 weeks was given to every patient in the study group. The outcome was assessed by the pictorial blood assessment chart (PBAC) score, hemoglobin (HB) level, and endometrial thickness. Results: About 88.24% of patients responded well to treatment as depicted by a significant reduction in the PBAC score to a level <100. The mean PBAC score decreased linearly from 354 to 40 at the end of 24 weeks of treatment. Mean endometrial thickness reduced from 8.25 to 6.01. The mean level of hemoglobin level increased from 11.41 to 11.86. P-value of all the parameters were <0.05 and hence statistically significant. Conclusion: Ormeloxifene can be used as a first-line drug for the management of AUB.

116

REVIEW ARTICLE

Ni Luh Wita Astari Widhusadi, Anak Agung Ngurah Anantasika

The Role of Epigenetics in Endometriosis

[Year:2023] [Month:January-February] [Volume:15] [Number:1] [Pages:9] [Pages No:88 - 96]

Keywords: Endometriosis, Epigenetics, Gene, MicroRNA

   DOI: 10.5005/jp-journals-10006-2183  |  Open Access |  How to cite  | 

Abstract

Epigenetics is a field that studies that study the changing in the regulation of gene activity and expression that are independent of the DNA sequence of genes and can be inherited or inherited. This refers to a change in phenotypic status that is not based on a change in genotype. Epigenetics is known to have a part in the pathogenesis of endometriosis. Epigenetics can cause endometriosis is known through mechanisms such as DNA methylation, histone modification, and microRNA (miRNA). These various mechanisms are also related to environmental, immune, and hormonal factors that trigger endometriosis. Endometriosis is a gynecological problem involving the stroma of the endometrium and glands which normally line the uterine cavity but is found outside the uterine cavity (endometrial-like tissues). Until now, the etiopathogenesis of endometriosis is still under debate. Etiopathogenesis of endometriosis is said to be related to the genetic system and epigenetic abnormalities. Reversibility is the key to epigenetic change therefore it is used as a potential epigenetic therapy option. Enzymes that control epigenetic change are the goal of studies into pharmacological interventions in endometriosis. Therefore, the role of epigenetics requires further attention in the diagnosing, management, and prognosis of endometriosis condition so that the patient's quality of life will be better.

148

REVIEW ARTICLE

Purvi Rajendra Thakkar, Sandhya Pajai, Ketav Samir Joshi

Insights on Postoperative Infections in Gynecology: A Narrative Review

[Year:2023] [Month:January-February] [Volume:15] [Number:1] [Pages:5] [Pages No:97 - 101]

Keywords: Pelvic pathologies, Prophylactic antibiotics, Surgical site infections, Urinary tract infections

   DOI: 10.5005/jp-journals-10006-2198  |  Open Access |  How to cite  | 

Abstract

Aim: Postoperative infections in gynecology are common throughout the surgical field. Infections create a major impact on surgeons as well as on patients. With the appropriate use of antibiotics, the chances of infections reduce immensely and prevent morbidity for the same. This review helps to understand the occurrence, preventable risk factors, and complications of postoperative infections with various gynecology surgeries. Background: The literature reviewed in this narrative article is obtained from various databases such as pubMed, Scopus, and Web of Science using medical subject headings (MeSH) compliant keywords such as surgical site infections, wound abscess, pelvic pathologies, and consulting-related books. References from year old to new were assessed and relatable information was included. Review results: Studies included reflect the impact of postoperative infections in various surgeries and the timely use of antibiotics in controlling the outcome. Many factors like gender, duration of hospital stay, and co-morbidities also play a significant roles in the outcome. Conclusion: Studies depict the importance of recognizing the symptoms of the patient, and with the use of appropriate investigations, identifying the pathogens involved in postoperative period; eventually timely use of antibiotics in preventing such cases in the future. These steps shall help in reducing the overall burden for doctors, nurses, and on the patient's side as well. Clinical significance: The most common complications of gynecological surgeries include cellulitis, endometritis, and urinary tract infections (UTI). Early diagnosis and timely use of antibiotics to prevent further complications and morbidity in these patients are of utmost importance. Priority should be given to early detection and identification of risk factors associated with postoperative surgeries. Most of the common pathogens involved awareness regarding the use of antibiotics prophylactically and eventually prevention of postoperative infections under various gynecological surgeries.

115

REVIEW ARTICLE

Manisha Andela, Deepika Dewani

Postpartum Mood Disorders: A Short Review

[Year:2023] [Month:January-February] [Volume:15] [Number:1] [Pages:6] [Pages No:102 - 107]

Keywords: Maternity blues, Mood disorders, Postpartum depression, Postpartum psychosis

   DOI: 10.5005/jp-journals-10006-2170  |  Open Access |  How to cite  | 

Abstract

Background: Mental health is considered one of the most significant contributors to the global burden of disease. During the puerperium, the most important mood disorders are maternity blues, postpartum depression, and postpartum psychosis. Above 75% of women are found to experience some type of mood disturbance during the postpartum period. Aim: Considering the high global burden of mood disorders, a short review of this problem was done on the aspects like the prevalence, clinical manifestations, and management. Review results: During the puerperium, mood disorders constitute entities with higher prevalence both at the worldwide as well as in our country. Conclusion: This review not only helps health-care professionals become aware of these conditions but also aids in providing adequate and timely management. Clinical significance: In addition to pharmacological treatment, interpersonal or cognitive-behavioral therapy, as well as family therapy plays significant role in management of mood disorders during pregnancy and puerperium.

273

REVIEW ARTICLE

Ruchika Garg, Vejainty Chauhan, Prabhat Agrawal, Prashant Gupta, Urvashi

Hypoactive Sexual Desire Disorder (HSDD) in Women

[Year:2023] [Month:January-February] [Volume:15] [Number:1] [Pages:3] [Pages No:108 - 110]

Keywords: Female sexual dysfunction, Genito-pelvic dysesthesia

   DOI: 10.5005/jp-journals-10006-2172  |  Open Access |  How to cite  | 

Abstract

Female sexual dysfunction is a less discussed entity, which is difficult to screen or identify and treat as compared to male sexual dysfunction like erectile dysfunction, which is easy to diagnose and treat. Postmenopausal females with decreased sexual desire can be improved moderately by testosterone therapy. Genito-pelvic dysesthesia (GPD) is poorly understood. Hence, it requires a multidisciplinary biopsychosocial approach to identify the condition and thereby managing it. Managing the end organ, neurologic, pharmacological, vascular and emotional components improve the morbidity of affected ones. This will somehow prevent the patients from distress and life threatening consequences. In present scenario direct communication followed by assessment and thereby formulating the essential guidelines for treatment is on emphasis. The gap is being tried to be narrowed by more studies in this field. Topical sildenafil ointment under trail phase 2b results-eagerly awaited, Flibanserin- an oral medication, bremelanotide- an injectable are new to this field. Also the hormonal therapy along with the cognitive behavioral therapy is on research and trying to decrease the suffering from sexual or arousal disorders in coming eras.

70

REVIEW ARTICLE

Ruchika Garg, Shubhangi Sharma, Prabhat Agrawal, Laxmi Narayan Sahoo, Prashant Gupta

Monkeypox in Pregnancy

[Year:2023] [Month:January-February] [Volume:15] [Number:1] [Pages:3] [Pages No:111 - 113]

Keywords: Monkeypox Obstetrics Gynecology, Obs, Pregnancy with monkeypox

   DOI: 10.5005/jp-journals-10006-2173  |  Open Access |  How to cite  | 

Abstract

Monkeypox infection is characterized by rash developing 1–4 days after prodromal symptoms, as deep-seated, vesicular, or pustular. It begins centrally and spread to the limbs. The rash can last 2–4 weeks, progressing to macules, papules, vesicles, pustules, and eventually scabs and crusts. So, perform a visual inspection of the skin and oral, genital, and perianal areas in women with a new rash. Symptomatic individuals should be isolated, lesions should be covered, and wear masks as monkeypox is contagious.

87

REVIEW ARTICLE

Ruchika Garg, Juhi Srivastava, Prabhat Agrawal, Prashant Gupta, Priyankur Roy

Advances in Neuroendocrine Research on Polycystic Ovary Syndrome: New Hope for Treatment Decoding the Link between Hormones and the Brain

[Year:2023] [Month:January-February] [Volume:15] [Number:1] [Pages:6] [Pages No:114 - 119]

Keywords: PCOS etiology neuroendocrine, Polycystic ovarian syndrome

   DOI: 10.5005/jp-journals-10006-2195  |  Open Access |  How to cite  | 

Abstract

Introduction: The etiopathogenesis of polycystic ovary syndrome (PCOS) is multifactorial. In healthy women, neurokinin B (NKB) controls the release of gonadotropins, the growth of follicles, and the time of ovulation. Materials and methods: The regulation of estrogen-negative feedback, which has been demonstrated to be changed in PCOS, is influenced by NKB and kisspeptin signaling. Results and Conclusion: Disruption in NKB secretion can influence the emergence of PCOS. In PCOS women, suppressing the stimulatory effects of kisspeptin by certain receptor antagonists and lowering GnRH production may be therapeutic targets. Kisspeptin antagonists have not yet been employed in this indication, however, NKB antagonists have been extensively studied in this setting.

115

CASE SERIES

Trisha Mukherjee, Shruti Ashoke Panchbudhe, Sumedha Sharad Pathade, Arun Harishchandra Nayak

Genital Tuberculosis: Myriad Presentations and Clinical Scenarios

[Year:2023] [Month:January-February] [Volume:15] [Number:1] [Pages:5] [Pages No:120 - 124]

Keywords: Acute abdomen, Chronic pelvic pain, Fallopian tube, Genital tuberculosis, Hydrosalpinx, Infertility, Pelvic inflammatory disease, Pelvic tuberculosis

   DOI: 10.5005/jp-journals-10006-2194  |  Open Access |  How to cite  | 

Abstract

Aim: To describe various typical and atypical presentations of genital tuberculosis (TB) in females in endemic areas, explore the various methods of earlier detection, and the approach toward successful management of such cases. Background and objectives: In endemic areas, genital TB is a common cause of PID, yet is not easily picked up due to its indolent course. Increasing our insight into genital TB helps in earlier detection of such cases, providing us with more conservative management options, thus decreasing operative interventions and patient morbidity with brighter prognosis for patients and better fertility outcomes. Case description: We describe a series of seven gynecological cases with various presentations and outcomes for whom genital TB was found to be the culprit, ranging from those treated conservatively, to those requiring emergent management; as well as describing operative procedures and postsurgical complications such as surgical site infection (SSI). Clinical significance: Enlisting presentations of genital TB increases the index of suspicion in endemic areas for TB, helps in identifying better sampling methods and diagnostic methods for genital TB, helps in early eradication of the disease, and decreases patient morbidity. Conclusion: Tuberculosis is silent and can pose a nasty surprise to the unsuspecting clinician. So, a differential for a PID-like clinical scenario should always include TB and proper sampling methods to be identified for accurate detection and management.

110

CASE REPORT

Aditi Shah, Samatha Polisetti, Padma Vishnu, S Kameshwari

Isolated Hypogonadotropic Hypogonadism on the Rise. A Case Report

[Year:2023] [Month:January-February] [Volume:15] [Number:1] [Pages:3] [Pages No:125 - 127]

Keywords: Hormone replacement therapy, Hypogonadism, Infertility, Kallmann syndrome, Puberty disorders

   DOI: 10.5005/jp-journals-10006-2177  |  Open Access |  How to cite  | 

Abstract

Objective: The objective of this study was to study the presentation of isolated hypogonadotropic hypogonadism (IHH) in the youngest reported case till date. Introduction: Isolated hypogonadotropic hypogonadism is a clinical syndrome associated with gonadal dysfunction and altered pituitary gonadotropin levels, while the other pituitary hormones remain within normal limits. No olfactory symptoms were present hence differentiating it from congenital hypogonadotropic hypogonadism (CHH). Case presentation: A 16-year-old girl presented with primary amenorrhea, delayed breast and pubic hair development, and low gonadotropins, but other anterior pituitary hormones were within normal limits. Imaging of the hypothalamic–pituitary region was normal. Hormonal therapy was started to induce secondary sexual characters and increased later to induce puberty. Discussion: Early diagnosis and treatment play a crucial role in physical and psychological development. We need to continuously monitor the patient as possibility of gonadal axis reversal can occur. Conclusion: This is the youngest case of IHH reported in literature till date. Early identification and treatment of IHH have improved outcomes according to various studies, but compliance to treatment and constant surveillance are of utmost importance.

112

CASE REPORT

Renuka Malik, Neha Pruthi Tandon, Ayushi Hada

Recurrent Ovarian Torsion in an Adolescent! A Rare Case Report and Review of Literature

[Year:2023] [Month:January-February] [Volume:15] [Number:1] [Pages:3] [Pages No:128 - 130]

Keywords: Acute abdomen in adolescent, Hotdog in a bun, Ovariopexy, Recurrent ovarian torsion

   DOI: 10.5005/jp-journals-10006-2179  |  Open Access |  How to cite  | 

Abstract

Background: Ovarian torsion is a surgical emergency that can affect future fertility. Ovariopexy can be done to prevent recurrent torsion. However, despite ovariopexy, recurrent torsion can occur. Case description: On September 17, 2021, at 12 a.m., a 17-year-old unmarried girl presented to the gynecological emergency department. She gave a history of having had a sudden-onset of severe lower abdomen pain since 1 day. The patient gave a history of having had a laparotomy done for ovarian torsion 1 year back. On reviewing her discharge papers, it was seen that the patient had undergone right oophorectomy with contralateral ovariopexy 1 year ago. A provisional diagnosis of ovarian torsion was made, and at laparotomy, a torted left ovary was seen. Ovarian detorsion with oophoropexy using a new technique (hotdog in a bun) was done. Postoperatively, an ultrasound at 6 weeks follow-up showed a normal detorsion. Postoperatively, after ultrasound at 6 weeks follow-up, the patient is having normal ovary with normal AMH levels. Conclusion: Recurrence of torsion can occur even after oophoropexy. Timely intervention is a must to preserve ovarian function and future fertility.

74

CASE REPORT

Srisha Soundararajan, Lakshmipriyaa Ramachandran, A Parimala, M Rajalekshmi

Peripartum Cardiomyopathy: The Camouflage of Symptoms in Pregnancy

[Year:2023] [Month:January-February] [Volume:15] [Number:1] [Pages:3] [Pages No:131 - 133]

Keywords: Cardiac disease in pregnancy, Cardiovascular disease, Case report, Echocardiography in pregnancy, Heart failure, Left ventricle ejection fraction, Peripartum cardiomyopathy, Third trimester

   DOI: 10.5005/jp-journals-10006-2180  |  Open Access |  How to cite  | 

Abstract

Aim: This case report aims at increasing the awareness about peripartum cardiomyopathy (PPCM) in antenatal mothers and the need for a multidisciplinary approach, including a team of cardiologists, anesthesiologists, and neonatologists along with the obstetrician toward planning the management of this condition. Background: The most common causes of cardiomyopathy in a woman of childbearing age are viral infection, drug-induced cardiomyopathy, and PPCM. Peripartum cardiomyopathy is a rare incidence with unclear etiology in obstetric practice. The usual presenting symptoms are features of congestive cardiac failure, but some uncommon presentations like unstable arrhythmias and arterial thromboembolism are also present. Increased recognition of PPCM as a disease entity and advanced perinatal care have resulted in improved prognosis with a mortality rate of 0.5–16.5%. Case description: We present a case of PPCM in a 21-year-old Gravida 3, Para 2, with no live children at 36 weeks and 3 days of gestation with a past history of vaginal deliveries with early neonatal death following the first pregnancy and a stillbirth in her second pregnancy. She was referred to our hospital with chief complaints of breathlessness on exertion and swelling of the legs for a period of 3 days and abdominal pain on and off. She was diagnosed with a case of PPCM and was successfully managed in our tertiary care hospital with a team of obstetricians, cardiologists, neonatologists, and anesthetists. Conclusion: Peripartum cardiomyopathy is a rare obstetric complication that often presents with normal pregnancy symptoms which are exaggerated. A screening echocardiogram, especially in the third trimester of pregnancy, when there is even a slight increase in symptoms suggestive of heart failure, is important for prompt diagnosis and management. Peripartum cardiomyopathy also needs high vigilance and follow-up visits with a cardiologist after delivery. Clinical significance: Peripartum cardiomyopathy is reported to be associated with life-threatening complications like heart failure, cardiogenic shock, arrhythmia, and thromboembolism that can occur in PPCM.

102

CASE REPORT

K Mamatha, Neelamma Girish Patil, Pratyusha Karukola

Accessory and Cavitated Uterine Mass in a Perimenopausal Female

[Year:2023] [Month:January-February] [Volume:15] [Number:1] [Pages:3] [Pages No:134 - 136]

Keywords: Cavitated uterine mass, Congenital anomalies irregular menstrual cycles, Irregular menstruation, Perimenopausal age group

   DOI: 10.5005/jp-journals-10006-2182  |  Open Access |  How to cite  | 

Abstract

Background: An accessory and cavitated uterine mass (ACUM) is a rare congenital Mullerian anomaly where an accessory cavity with endometrial lining lies attached to the normal functioning uterus. It is located at the level of the insertion of the round ligament. It occurs due to Mullerian duct tissue's duplication or persistence, which originated from gubernaculum dysfunction, leading to accessory uterine tissue formation. It is common among young and nulliparous women presenting severe dysmenorrhea and infertility. It is mostly seen in women below 30 years of age. Rudimentary and uterine horns and degenerating fibroids are the possible differential diagnoses. Case description: A 45-year-old female presented with complaints of pain abdomen and irregular menstrual cycles for 2 months. On magnetic resonance imaging (MRI), a well-defined cystic lesion was seen in the left ovary measuring 54 mm × 40 mm × 36 mm, which was suggestive of a left ovarian benign cystic lesion – hemorrhagic cyst. On Pelvic ultrasound, a complex cyst of 74 mm × 52 mm with a hyperechoic area of 36 x 31 mm suggests a left ovarian tumor. The patient belonged to the perimenopausal age group and completed the family, so a total abdominal hysterectomy with bilateral salpingo–oophorectomy was done and sent for histopathological examination. Conclusion: Transvaginal ultrasonography (TUV) and MRI aid in diagnosis. Early surgical treatment of the accessory cavitary mass is recommended treatment in this case. Detailed histopathological examination is mandatory to meet the criteria for its complete diagnosis. Clinical significance: A rare congenital mullerian is a rare and challenging condition to diagnose. Especially when fertility is desired, a complete medical history, gynecological examination, and radiological analysis are necessary for a correct diagnosis. Laparoscopic excision of the ACUM can be performed in patients where fertility is desired.

94

CASE REPORT

Ruchika Garg, Sana Ismail

Full-term Live Secondary Abdominal Pregnancy: A Rare Case Report

[Year:2023] [Month:January-February] [Volume:15] [Number:1] [Pages:2] [Pages No:137 - 138]

Keywords: Abdominal pregnancy, Laparotomy, Tubal pregnancy

   DOI: 10.5005/jp-journals-10006-2196  |  Open Access |  How to cite  | 

Abstract

Background: Abdominal pregnancy is defined as pregnancy in the peritoneal cavity, excluding the tubes, ovary, and broad ligament. It is a rare and a life-threatening condition with an increased risk of maternal and perinatal mortality. It can be primary or secondary. Primary abdominal pregnancy can be differentiated by using Studdiford's criteria which include that the tubes and ovaries are normal at laparotomy, no evidence of uteroperitoneal fistula, and the presence of pregnancy closely related to the peritoneal surface and early enough to eliminate the possibility of secondary implantation after primary tubal nidation whereas in secondary abdominal pregnancy occurs following an extrauterine tubal pregnancy that ruptures or aborts and gets re-implanted within the abdomen. Here, we present a rare case of full-term live secondary abdominal pregnancy which was referred to us at SN Medical College, Agra, who was a 22-year-old primigravida and gave birth to a healthy female child of 2.7 kg in which placenta was removed after ligating the cornual stump, and left-sided salpingectomy was performed.

67

Book Review

Komal N Chavan, Ruchika Garg

Practical Guide to Recurrent Pregnancy Loss

[Year:2023] [Month:January-February] [Volume:15] [Number:1] [Pages:1] [Pages No:139 - 139]

   DOI: 10.5005/jsafog-15-1-139  |  Open Access |  How to cite  | 

47

© Jaypee Brothers Medical Publishers (P) LTD.