Journal of South Asian Federation of Obstetrics and Gynaecology

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2023 | July-August | Volume 15 | Issue 4

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Editor's Desk

[Year:2023] [Month:July-August] [Volume:15] [Number:4] [Pages:1] [Pages No:iv - iv]

   DOI: 10.5005/jsafog-15-4-iv  |  Open Access | 

108

Original Article

Malitha Patabendige, Sajith U Kodithuwakku, Mandadige Nisansala Ishara Perera, Tiran D Dias

Fetal Echocardiographic Assessment: Impact of Gestational Age and Maternal Obesity

[Year:2023] [Month:July-August] [Volume:15] [Number:4] [Pages:5] [Pages No:377 - 381]

Keywords: Congenital heart disease, Fetal echocardiography, Gestational age categories, Obesity, Prenatal diagnosis

   DOI: 10.5005/jp-journals-10006-2227  |  Open Access |  How to cite  | 

Abstract

Aim: To identify the ability to acquire various fetal cardiac views using two-dimensional ultrasound at different gestational age and body mass index (BMI) categories. Materials and methods: We performed a prospective observational study among low-risk women with singleton pregnancies attending the University Obstetrics Unit, North Colombo Teaching Hospital, Ragama, Sri Lanka. The ability to obtain satisfactory views of the situs, four chambers, right and left outflow tracts, three vessels, aortic arch, ductal arch, and superior and inferior vena cava of fetal heart was studied. Results: A total of 314 eligible pregnant women underwent fetal echocardiography and 288 had complete data. All eight cardiac views were obtained with 100% success at the gestational age of 18 – 21 + 6 weeks and days. All eight cardiac views were satisfactory in more than 97% at the gestational age of 22 – 25 + 6 weeks and days. Body mass index was not significantly associated with acquisition of cardiac views at all gestations (p = 0.62). All eight cardiac views were obtained with 50% success at 14 – 17 + 6 weeks and 5.4% success at 11 – 13 + 6 weeks and days. Conclusions: Acquisition of all fetal cardiac views was best at 18 – 21 + 6 weeks and days of gestation, but reasonably successful till 26 weeks. Acquisition was sub-optimal in first trimester, below 18 weeks and for some cardiac views after 26 weeks. BMI does not hamper the ability to obtain cardiac views during fetal echocardiography. Clinical significance: This could be used as a guide for the timing of echocardiography when a particular cardiac defect is suspected in the fetus, where specific cardiac view(s) are used to confirm the particular diagnosis as well as the most appropriate gestational age period.

364

Original Article

Subbiah Shanmugam

Retrospective Analysis on the Need for Surgery for Residual Disease after Chemoradiation in Carcinoma Cervix

[Year:2023] [Month:July-August] [Volume:15] [Number:4] [Pages:3] [Pages No:382 - 384]

Keywords: Cervical cancer, Cervical malignancy, Cervix, Chemoradiation, Magnetic resonance imaging

   DOI: 10.5005/jp-journals-10006-2232  |  Open Access |  How to cite  | 

Abstract

Introduction: Concurrent chemoradiation is the treatment of choice for patients from stage IB3–IVA disease. We analyzed patients with carcinoma cervix who underwent definitive chemoradiation, and had residual disease either clinically or radiologically during the period from July 2021 to August 2022. In the past 1 year, we treated 11 patients with definitive chemoradiation residue. We did radical surgery for those patients. Results: Out of the 11 patients who had residual disease after definitive chemoradiation, 4 patients had clinical residual disease and 7 patients on imaging. Postoperative histopathological examination (HPE) showed 4 out of 10 patients were without any disease and all those patients were diagnosed by imaging. Out of 11 patients, 1 had an intraoperative ureteric injury, 2 patients had postoperative ureteric/vesicovaginal fistula, 1 patient had intraoperative bleeding, 1 patient had intraoperative bowel injury and there was 1 death. Three patients had minor complications. Conclusion: Even though our numbers are less, we found out that there is a possibility of misinterpretation of postradiation changes as a residual disease by magnetic resonance imaging (MRI) and while operating for these patients, we should anticipate more complications and chances of no residual disease. We suggest a strong clinical correlation along with histopathological confirmation before surgical intervention, which may avoid unwanted radical surgery for such patients. At the same time, we cannot neglect the possibility of a real risk of residual disease (6/10 had residual disease) progressing further leading to a missed opportunity for a cure.

377

Original Article

Vaishali Choudhari, Yogini Patil, Kamalapriya Thiyagarajan, Kshama Shah, Vijaykumar Gawali

To Evaluate Early Feed vs Late Feed in Post-lower-segment Cesarean Section Patients at a Tertiary Care Center: A Randomized Controlled Study

[Year:2023] [Month:July-August] [Volume:15] [Number:4] [Pages:4] [Pages No:385 - 388]

Keywords: Cesarean, Early feed, Late feed, Postoperative ileus, Satisfaction

   DOI: 10.5005/jp-journals-10006-2265  |  Open Access |  How to cite  | 

Abstract

Background: Cesarean section is one of the routinely performed surgeries in gynecology and obstetrics. Deliveries done by cesarean section have been seen to impact the postoperative feed in women. Usually, postdelivery by cesarean section the woman is given food through intravenous (IV). The feed is not given to the mother by mouth for some amount of time which is based on the opinion of different clinicians and hospitals. There is an assumption noted that if early feeds are given then the patient might suffer from postoperative ileus. This assumption, however, has not been evidenced by the available literature. It has been noted that early feed aids in faster recovery, quicker wound healing, and early discharge from the hospital. Therefore, early feed postcesarean operation is generally emphasized. Materials and methods: This was a prospective, single-centre, randomized controlled study conducted over a period of 1 year from 2020–2021. Subjects were randomized into group I (early feed) and group II (late feed). Various parameters were assessed and compared statistically in both groups. Results: Various functions and complications of gastrointestinal indications and psychosomatic parameters related to postoperative cesarean delivery were evaluated, and it was observed that there is no statistically significant difference between the early feed and the late feed. Conclusion: Early oral intake of food is safe and well tolerated; clinical outcomes are similar to delayed feeding. It does not cause a significant increase in postoperative paralytic ileus, and the results are equally good for patient satisfaction when compared with delayed feeding.

502

Original Article

Geetanjali Nabiyal, Mohini Paul, Vinita Sarbhai

Correlation of Paired Umbilical Cord pH with Abnormal Cardiotocograph in Singleton Non-high-risk Term Pregnancies

[Year:2023] [Month:July-August] [Volume:15] [Number:4] [Pages:6] [Pages No:389 - 394]

Keywords: Acidosis, Base deficit, Blood gas, Cardiotocography, Intrapartum monitoring

   DOI: 10.5005/jp-journals-10006-2251  |  Open Access |  How to cite  | 

Abstract

Background: Early and accurate detection of fetal asphyxia is crucial to prevent perinatal mortality and morbidity. This study aims to study the relationship between the intrapartum fetal condition by cardiotocography (CTG) and paired umbilical cord pH and to correlate the CTG to the paired umbilical cord pH. Methods: A cross-sectional observational study was conducted in the Department of Obstetrics and Gynaecology in Kasturba Hospital, Delhi. Only singleton-term non-high-risk pregnancies with cephalic presentation admitted in active labor were included in the study. About 360 participants were recruited, and CTG was performed on all of them at admission, at rupture of membranes (ROM), and before delivery. Those with normal and indeterminate CTG were labeled as controls, and those with abnormal CTG were labeled as the study group. There were 300 controls and 60 subjects in the study group. Cardiotocography was performed at admission, at ROM, and before delivery. Immediately after delivery, paired cord samples were collected for blood gas analysis. Umbilical arterial (UA) pH < 7.1 and umbilical venous (UV) pH < 7.2 were taken as acidosis according to institutional guidelines. Results: There was a significant association between CTG at ROM and acidosis by UA pH (p = 0.0015), UA base deficit (p < 0.0001), and UV pH (p < 0.00001). Also, a significant association between CTG before delivery and acidemia by UA pH (p < 0.00001), UA base deficit (p < 0.00001), and UV pH (p < 0.00001) was found. Conclusion: An abnormal CTG trace predicts a greater possibility of intrapartum fetal acidosis. Therefore, screening by CTG before delivery as a routine is recommended. The practice of performing CTG in labor rooms in peripheral health centers where blood gas analysis machines are not available would enable early prediction and risk estimation in short-term neonatal outcomes, thereby decreasing associated morbidity and mortality.

382

Original Article

Inlo Miuli, Sendhil Coumary Arumugam, Swathy Srinivasan

Prevention of Postpartum Hemorrhage Using Vacuum Retraction Cannula during Cesarean Section in Major Degree Placenta Previa

[Year:2023] [Month:July-August] [Volume:15] [Number:4] [Pages:4] [Pages No:395 - 398]

Keywords: Cesarean section, Maternal morbidity, Placenta previa, Postpartum hemorrhage, Vacuum retraction cannula

   DOI: 10.5005/jp-journals-10006-2260  |  Open Access |  How to cite  | 

Abstract

Aim: To evaluate the effectiveness of a vacuum retraction cannula (VRC) for the prevention of postpartum hemorrhage (PPH) in major degree placenta previa (PP). Materials and methods: The study was an ambidirectional interventional cohort study undertaken in the Department of Obstetrics and Gynaecology, for 18 months in the tertiary care center, after obtaining the Institute Human Ethical Committee (IHEC) clearance. The effectiveness of a VRC was evaluated in pregnant women undergoing an elective or emergency cesarean section for major degree placenta previa. The primary outcome was the number of cases that were prevented from PPH. Results: Out of a total of 15 patients, the treatment prevention rate in our study was estimated to be 20% (95% confidence interval [CI]: 17.5–22.5). The mean total blood loss intraoperatively was 1218.57 mL (1132.23–1304.91). The total mean duration for the cannula kept in situ was 940.71 minutes (821.12–1060.31). In total, 6 (40%) patients had received blood products. The average of preoperative hemoglobin was 11.06 g/dL (10.76–11.37) and the postop day 2 hemoglobin was 9.05 mg/dL (8.67–9.42). The median length of hospital stay was 5.46 ± 0.84 days. Device-related superficial vaginal tear incurred in 2 (14.29%) patients. Conclusion: Prophylactic application of a VRC in major degree placenta previa can prevent catastrophic bleeding. Clinical significance: The device is cost-effective and provides a rapid modality of treatment options for one of the highest risk cases in obstetrics and gynecology.

600

Original Article

Kiran R Konda, Pranay K Phukan, Anuradha Baruah

A Tale of Stillbirths at a Tertiary Care Center in Northeast India

[Year:2023] [Month:July-August] [Volume:15] [Number:4] [Pages:5] [Pages No:399 - 403]

Keywords: Demographic factor, Hypertensive disorders of pregnancy, Observational study, Socioeconomic factor, Stillbirths, Stillbirth rate

   DOI: 10.5005/jp-journals-10006-2266  |  Open Access |  How to cite  | 

Abstract

Aims and objectives: To evaluate socioeconomic, demographic, and fetomaternal factors associated with stillbirths. Materials and methods: An observational study conducted in Assam Medical College, India, over 1 year, included 542 stillbirths between 24 and 42 weeks of gestation. Continuous variables were studied using Mann–Whitney U/Independent t-test, other variables using Chi-square/Fisher's exact test as appropriate. Results: Stillbirth rate (SBR) at our institution was 52.41/1000 births. Antepartum stillbirths were 67%. Mean age of mothers was 24.75 ± 4.78 years (p > 0.05). Most belonged to rural place of residence (62.36%, p = 0.0013), lower socioeconomic status (31%, p = 0.046), lacked regular antenatal checkups (65.31% unbooked, p = 0.0142), and traveled long distances to reach our center (47.97% traveled >20 km). Obstetrical (28%) and hypertensive (26%) complications were commonest causes (p < 0.05). Most were multigravida (55.34%, p > 0.05). Singleton pregnancies dominated at 92.62%, with mostly preterm (49.45%, p = 0.009), mean birth weight of 2015 gm (p = 0.0023), and 56.46% male fetuses (p > 0.05). Maceration noted in 15.87% (p = 0.0002). Conclusion: Sociodemographic factors play an important role in stillbirths. Health education, strengthening peripheral health services, and proper care for reproductive age women can go a long way in prevention. To tackle stillbirths, one needs to detect and manage risk factors right from preconceptional period. The patient should be counseled regarding the importance of regular antenatal checkups and need for immediate care in case of appearance of red flag signs. Clinical significance: Most of the stillbirths may have a common pathology behind their development. Hence, detailed evaluation, classification, and regular review of the causes will help better management and prevention of stillbirths in at-risk patients.

569

Original Article

Raji Pambinkavil, Anitha Thomas, Dhanya Susan Thomas, Vinotha Thomas, Rachel George Chandy, Sherin Daniel, Abraham Peedicayil, Ajit Sebastian

Factors Predicting Recurrence of Cervical Intraepithelial Neoplasia after Excisional Procedure-A 10-year Experience from A Tertiary Care Center

[Year:2023] [Month:July-August] [Volume:15] [Number:4] [Pages:5] [Pages No:404 - 408]

Keywords: Cervical intraepithelial neoplasia, Excisional procedure, Follow-up, hysterectomy, Recurrence

   DOI: 10.5005/jp-journals-10006-2270  |  Open Access |  How to cite  | 

Abstract

Aim: Cervical intraepithelial neoplasia (CIN) is a precancerous condition of the uterine cervix commonly encountered in clinical practice. Treatment of CIN is excisional or ablative. This study aims to elucidate and evaluate the possible risk factors commonly associated with the recurrence of CIN following an excisional procedure. Materials and methods: This was a retrospective study conducted between 2010 and 2019. Patients who underwent excisional procedures for CIN2/3 were included. The information was collected from the hospital database. Clinical and sociodemographic data, recurrence characteristics, and follow-up data were analyzed. Results: Recurrent lesions were noted in 26 (15.4%) patients. The pattern of recurrence was CIN in 13 patients (50%), vaginal intraepithelial neoplasia (VAIN) in 11 (42.3%), and cervical cancer in 2 (7.7%) patients. The median follow-up time was 8 (1–117 months). Univariate analysis showed HIV-positive women were at greater risk of recurrence (HR = 2.8, 95% CI = 0.93–8.5; p = 0.009) but advanced age, presence of involved margins, endocervical gland or crypt involvement, and high-risk HPV status post-procedure were not (p > 0.1) associated with recurrence in our study. Conclusion: Excisional procedures are successful and patients with risk factors like HIV seropositivity and positive margins should be targeted for close surveillance or offered a hysterectomy. Clinical significance: Following excisional procedures, patients with risk factors for recurrence should be advised of close surveillance or offered a hysterectomy.

532

Original Article

Divya Yadav

Efficacy and Safety of Mifepristone Followed by Vaginal PGE1 vs PGE2 Gel Alone for Induction of Labor in Late Intrauterine Fetal Demise

[Year:2023] [Month:July-August] [Volume:15] [Number:4] [Pages:3] [Pages No:409 - 411]

Keywords: Dinoprostone, Intrauterine fetal death, Mifepristone, Misoprostol

   DOI: 10.5005/jp-journals-10006-2274  |  Open Access |  How to cite  | 

Abstract

Objective: To compare the efficacy and safety of mifepristone followed by vaginal misoprostol vs dinoprostone gel alone in induction of labor in late intrauterine fetal demise. Methods: We conducted a randomized controlled study in 70 patients in tertiary care center from October 2020 to March 2022. In group I, 35 women were induced by using mifepristone (200 mg) orally followed by misoprostol. The dose was 100 µg per vaginal in patients with less than 37 weeks of gestation every 4 hourly and 50 µg in patients with more than 37 weeks of gestational age. In women with previous lower segment cesarean section, one dose was of 50 µg of misoprostol. In group II, 35 women were induced by intravaginal PGE2 (dinoprostone) gel 0.5 mg intravaginally (maximum two doses in 24 hours). Oxytocin was given in both groups for augmentation when needed. Results: The mean induction delivery interval in group I was 10.67 ± 6.751 hours and in group II was 14.51 ± 5.338 hours. Mean induction delivery interval was significantly shorter in the combined regimen than dinoprostone gel-alone group (p-value=0.0103). Conclusion: To conclude our regimen using mifepristone and misoprostol for induction of labor is an effective, less invasive, and safe combination. It results in shorter induction-to-delivery interval than dinoprostone gel.

464

Original Article

Vishnupriya Katam Mohini Naga, Shashikala Karanth, Chandrakala Bada Shekharappa, Christy Vijay, Gayatri Ravikumar, Mamatha, Annamma Thomas

Obstetric, Neonatal Outcomes and Histopathological Changes in COVID-positive Pregnancies in a South Indian Population

[Year:2023] [Month:July-August] [Volume:15] [Number:4] [Pages:7] [Pages No:412 - 418]

Keywords: Coronavirus disease-19, Lower segment cesarean section, Maternal health, Placenta, Real-time polymerase chain reaction, Vertical transmission

   DOI: 10.5005/jp-journals-10006-2275  |  Open Access |  How to cite  | 

Abstract

Introduction: COVID-19 might be transmitted vertically from mother to fetus and causes clinically significant infection. Limited evidence about the in utero infectivity of the COVID-19 virus and early positive neonatal testing is present. Aims and objectives: To determine the incidence of vertical transmission in COVID-positive pregnancies was the primary objective and to correlate the maternal demographic details and neonatal outcomes to maternal COVID-19 infection. Materials and methods: This was a cross-sectional study done during the SARS-CoV-2 pandemic over 6 months, in a tertiary care center, in south India. Neonates whose mothers were tested positive for COVID-19 infection by real-time polymerase chain reaction (RT-PCR) were included (who were tested by RT-PCR after 24 hours of life). Maternal and neonatal data were collected from their case charts. Results: In total, 82 pregnant women were diagnosed to be COVID-19 positive by the RT-PCR or rapid antigen test (RAT). The mean gestational age of the study population was 37.91 ± 2.08 weeks. In total, 58 (70.7%) of the women were detected to be COVID-positive by the RT-PCR test. In total, 45 (54.9%) women were primigravidae. In total, 75 (91.5%) women had mild COVID infections. During the study period of 1/7/2020–31/1/2021, there were 983 mothers and 112 (11.3%) tested positive for COVID-19 infection. There were 39 (47.6%) boys and 43 (52.4%) girl babies. Out of 82 COVID-19 exposed neonates, 4 (4.8%) of the neonates were tested positive for COVID-19 infection. All babies were discharged home. About 89% of neonates were breastfed at discharge and 92% of the total were breastfeeding at 3 months of age. Conclusion: The incidence of vertical transmission in COVID-positive pregnancies in a South Indian population during the COVID-19 pandemic appears to be low (3.6%). COVID-19 status will not affect the breastfeeding rates at discharge and follow-up.

420

Original Article

Nidhi Sharma, Kanad D Nayar

The Effect of Transdermal Testosterone Gel Pretreatment on IVF Outcomes in Patients with Poor Ovarian Reserve

[Year:2023] [Month:July-August] [Volume:15] [Number:4] [Pages:5] [Pages No:419 - 423]

Keywords: Poor ovarian reserve, POSEIDON classification, Testosterone gel

   DOI: 10.5005/jp-journals-10006-2278  |  Open Access |  How to cite  | 

Abstract

Aim: To investigate the effect of pretreatment with testosterone gel on IVF outcomes in patients with poor ovarian reserve. Materials and methods: In this prospective, single-blinded, randomized controlled trial, 87 patients, young or old (< or ≥35 years) with diminished ovarian reserve (DOR) (AFC ≤5, AMH ≤1.2 ng/mL) undergoing IVF treatment were enrolled and randomly divided into two groups. In the treatment group, 41 patients received pretreatment with testosterone gel (12.5 mg/day; from the 6th day of the previous menstrual cycle to 2nd day of stimulated cycle), and in the control group, 46 patients received lubricant gel. Results: Total number of oocytes retrieved (4.05 vs 2.72; p < 0.05) was significantly more in the treatment group than in the control group. Similarly, the number of grade A embryos (2.78 vs 1.96; p < 0.05) was significantly greater in the TTG group. The clinical pregnancy rate per patient was higher in the TTG group (37% vs 29.3%) but the difference was not statistically significant. Conclusion: Testosterone gel application before stimulation helps in reducing the dose and duration of gonadotrophins and to increase the number of oocytes retrieved and the quality of embryos formed in DOR patients. Clinical significance: Pretreatment with androgen before ovarian stimulation can be offered to patients with poor ovarian reserve.

543

Original Article

Rekha Wadhwani, Poorva Badkur, Juhi Agarwal, Bharti Lodhi, Farheen Fathima

Effectiveness of Single-dose Ferric Carboxymaltose in Enhancing Hemoglobin Levels in Pregnant Women with Moderate-to-Severe Iron-deficiency Anemia

[Year:2023] [Month:July-August] [Volume:15] [Number:4] [Pages:4] [Pages No:424 - 427]

Keywords: Anemia, Ferric carboxymaltose, FCM, Hemoglobin, Iron deficiency, Pregnancy

   DOI: 10.5005/jp-journals-10006-2279  |  Open Access |  How to cite  | 

Abstract

Background: Anemia contributes to increased pregnancy-associated morbidity and mortality; hence warranting rapid correction. Parenteral ferric carboxymaltose (FCM) has FDA and DCGI approval for use in pregnancy-linked iron-deficiency anemia, with minimal and nonserious side effects. Ferric carboxymaltose is given as a single-dose administration, requiring lesser hospital visits and costs. FCM has been accepted for clinical use in the Indian population. However, there is limited evidence about its use for moderate or severe anemia among antenatal women. This study aims to analyze the efficacy and safety of single-dose intravenous ferric carboxy maltose among anemic pregnant females. Methods: Prospective observational study comprising 150 iron-deficiency anemic pregnant women between 16 and 32 weeks of gestation with hemoglobin between 5 and 9 gm/dL. Single dose of FCM (dose calculated by Ganzoni's formula) was administered and treatment effectiveness was assessed by serial hemoglobin measurement at 2 weeks and 6 weeks after administration of FCM and then at the time of delivery. Safety was determined by analysis of adverse drug reactions and biochemical tests at the aforesaid time intervals. Results: The mean rise in hemoglobin at 2 weeks was 1.35 gm/dL, at 6 weeks was 3.08 gm/dL and at delivery was 4.80 gm/dL (p < 0.001). No serious adverse effects were found. Conclusions: The present study bolsters clinical use of intravenous FCM in anemic pregnant females in view of its efficacy and safety. Low-risk single dose dispensation and subsequent upsurge in hemoglobin levels should place FCM as a preferred alternative in moderate-to-severe anemia management during pregnancy.

605

Original Article

Nina Mahale, Prashanthi Reddy, Ajit Mahale, Sonali Ullal, Merwyn Fernandes, Sonali Prabhu

Doppler in Ductus Venosus, Myocardial Performance Index and Aortic Isthmus in Fetal Growth Restriction and Comparison with Cerebroplacental Ratio

[Year:2023] [Month:July-August] [Volume:15] [Number:4] [Pages:5] [Pages No:428 - 432]

Keywords: Aortic isthmus, Ductus venosus, Fetal growth restriction, Myocardial performance index

   DOI: 10.5005/jp-journals-10006-2281  |  Open Access |  How to cite  | 

Abstract

Objectives: We studied the role of Doppler in the cerebroplacental ratio (CPR), ductus venosus (DV), aortic isthmus (AoI), and myocardial performance index (MPI) in early diagnosis late onset of fetal growth restriction (FGR) in relation to pregnancy outcomes. Materials and methods: Longitudinal case–control study was conducted over a period of 2 years between 2016 and 2018, and pregnant women of gestational age more than 28 weeks were included in the study. A total of 64 patients (32 controls and 32 patients with FGR) was evaluated with Doppler twice at entry and exit before termination of pregnancy. The perinatal outcome was analyzed. Results: Cerebroplacental ratio was abnormal in 14 patients out of 32 patients in FGR who had adverse perinatal outcome p-value of 0.001. The MPI was abnormal in adverse perinatal outcomes in 13 patients; a p-value of 0.9 was not considered significant. The DV-pulsatility index (PI) was abnormal in eight patients; a p-value of 0.7 was not considered significant. AoI Doppler was abnormal in six patients with a p-value of 0.9 and was not considered significant. Conclusion: We concluded that DV Doppler was the most useful parameter in the short-term prediction of perinatal mortality. The myocardial performance index may become abnormal earlier than ductus venous followed by AoI and are all associated with adverse perinatal outcomes. The CPR was also useful in deciding outcome measures such as emergency lower segment cesarean section (LSCS), and neonatal intensive care unit (NICU) admissions.

423

Original Article

Devika Vijayan, Prema Nalligounder, Reji Mohan, Sheila Balakrishnan

Pregnancy Outcomes of Intracytoplasmic Sperm Injection in the Reproductive Medicine Unit of a Tertiary Care Center

[Year:2023] [Month:July-August] [Volume:15] [Number:4] [Pages:3] [Pages No:433 - 435]

Keywords: Cesarean delivery, Intracytoplasmic sperm injection, Miscarriage, Multiple pregnancy

   DOI: 10.5005/jp-journals-10006-2294  |  Open Access |  How to cite  | 

Abstract

Aims and objectives: To study and quantify the fetomaternal outcomes of intracytoplasmic sperm injection (ICSI) conceptions. Methodology: Descriptive study of the fetomaternal outcomes was done in 60 ICSI conceived patients and percentage of each outcome was calculated and the major outcome was identified. Results: Out of 60 ICSI conceived subjects (n = 60), 8.3% of patients had biochemical pregnancies, 1.7% had anembryonic pregnancies and 18.3% of patients had missed abortions. About 3.3% had cervical insufficiency and preterm premature rupture of membranes (PPROM). About 8.3% had gestational diabetes mellitus. And 3.3% had placenta previa, 20% of women experienced preterm birth, 21.7% experienced multiple pregnancies,1.7% experienced intrauterine death. About 56.7% had cesarean delivery; 21.7% had NICU admissions due to prematurity followed by sepsis, low birth weight, and jaundice. About 1.7% of babies had congenital anomalies, 67% of mothers experienced live births and 3.33% had neonatal deaths; 80% of the babies weighed between 2.5 and 4 kg. We did not have cases of ectopic pregnancy which can be due to proper technique of embryo transfer. No cases of placental abruption, intrauterine growth restriction (IUGR), stillbirth, and eclampsia due to the use of antenatal aspirin. The major outcomes from this study were cesarean delivery (56.7%), followed by miscarriages (28.3%) and multiple pregnancy (17%). Conclusion: The major outcomes of ICSI pregnancies were cesarean delivery (56.7%), followed by miscarriages (28.3%) and multiple pregnancy (17%). Clinical significance: This review summarizes the data available on the fetomaternal outcomes after ICSI and also the follow-up of assisted reproductive techniques pregnancies.

461

ORIGINAL RESEARCH

Abha Hada, Jyotsna Yadav, Pritha Basnet, Anamika Das, Punita Yadav

Clinical Epidemiological Profile of De Novo Postpartum Hypertensive Disorder in BP Koirala Institute of Health Sciences, a Tertiary Care Center in Eastern Nepal

[Year:2023] [Month:July-August] [Volume:15] [Number:4] [Pages:4] [Pages No:436 - 439]

Keywords: De novo postpartum hypertension, Delayed onset preclampsia, Hypertensive disorders of pregnancy, Postpartum hypertension

   DOI: 10.5005/jp-journals-10006-2267  |  Open Access |  How to cite  | 

Abstract

Aim: To identify the incidence, clinical risk factors, and clinical course of women with de novo postpartum hypertensive disorder without prior antepartum or chronic hypertensive disorders. Methods: This is a retrospective cross-sectional study. Postpartum records of all pregnant women normotensive in the antepartum and prepregnancy period, delivered in this institute and women (within 6 weeks postpartum period) admitted with the diagnosis of new-onset postpartum hypertension in the reference time period (March 2020–May 2020) were evaluated. Women with an antenatal diagnosis of preeclampsia or chronic hypertension were excluded. Relevant information regarding demographic characteristics, history, pregnancy course, postpartum course, and significant morbidity was collected. The incidence of de novo postpartum hypertension (dPPHTN) was calculated. The medians were compared using the Wilcoxon rank-sum tests. The association between outcome variables and epidemiological and clinical variables was assessed using the Chi-square test. For follow-up of the course of HTN, patients with dPPHTN were inquired via telephone conversation regarding duration of treatment, adherence to home BP charting, and complications. Results: Among 1,080 women who were normotensive 54 women developed dPPHTN giving us the incidence of 4.9%. Cesarean delivery was found to have a statistically significant association with dPPHTN. No statistically significant association was found in terms of parity, family history of HTN in first-degree relatives, and multiple gestations in the development of dPPHTN. No statistically significant difference was found between the medians of maternal age, gestational age at delivery, and that of birth weight among the two groups. The median postpartum day of presentation was 1st postpartum day with range of 0–7th postpartum day. The majority (92%) of cases were asymptomatic and were detected upon routine inpatient blood pressure monitoring, 5% patients had headache as the presenting symptom, and 1 patient presented with seizure. Median (range) peak systolic and diastolic blood pressures were 140 (120–170) mm Hg and 100 (70–110) mm Hg, respectively. The median length of hospital stay was 2 days with range of 2–7 days. About 19 (35%) patients were discharged with daily home blood pressure charting instructions, and 35 (65%) were discharged on oral medications. Regarding follow-up, 17 (31.48%) patients could not be contacted, 15 (27.77%) patients complied with home BP charting and discontinued antihypertensive therapy after physician consultation with duration of use of antihypertensive ranging from 7 to 14 days, 21 (38.88%) were noncompliant and lost to follow-up, 1 (1.8%) patient developed chronic hypertension. Conclusion: De novo postpartum hypertension is an underrecognized disorder with potential serious maternal morbidity. Our study elucidates the need for the development and implementation of stringent postpartum surveillance and follow-up protocols in order to detect, manage, and prevent morbidity due to this disorder.

431

ORIGINAL RESEARCH

Preeti Frank Lewis, Bindu Gundaiah, Nitin Bhimrao Bavdekar

Analytical Study of Near-miss Cases at Tertiary Care Center

[Year:2023] [Month:July-August] [Volume:15] [Number:4] [Pages:5] [Pages No:440 - 444]

Keywords: Audit, Hemorrhage, High-risk pregnancy, Maternal near-miss

   DOI: 10.5005/jp-journals-10006-2263  |  Open Access |  How to cite  | 

Abstract

Background: “Childbirth is a rebirth for the mother”—an ancient saying summarizes the unpredictable life-threatening conditions that might occur during pregnancy. Maternal deaths form only the tip of the iceberg, while a large part of it is the maternal comorbid conditions that remain largely undescribed. Materials and methods: A retroprospective observational study was conducted in the Department of Obstetrics and Gynaecology in collaboration with ICU, including the COVID-ICU in a Tertiary Care Hospital. The audit involves all women who are very ill, pregnant or recently delivered women who nearly died but survived a complication during pregnancy, and childbirth or within 42 days of termination of pregnancy, fulfilling the WHO criteria admitted at the tertiary center at the study period of 18 months. Results: The audit revealed MNM incidence ratio of 34/1,000 live births and mortality ratio of 1,261/1,00,000 live births with maternal near-miss: maternal mortality ratio of 2.7:1 in 3,604 deliveries. The most common factor leading to near-miss is found to be hemorrhage followed by hypertensive disorders. Most of them were between 26 and 30 years, multigravida. Type-II delay is most commonly seen due to a lack of facilities at the peripheral centers. Conclusion: Setting up “High-risk pregnancy clinics” at the taluka level for early recognition and referral of high-risk patients, upgrading the infrastructure of peripheral centers, and need of increase in tertiary care hospitals in every district for provision of quality care. Encouraging blood donation from a family member of every patient registering their pregnancy.

378

ORIGINAL RESEARCH

Sunantha Perumal, Chitra Andrew

Cerebroplacental Ratio Percentile: A Predictor of Adverse Pregnancy Outcome

[Year:2023] [Month:July-August] [Volume:15] [Number:4] [Pages:6] [Pages No:445 - 450]

Keywords: Adverse pregnancy outcome, Cerebroplacental ratio percentile, Fetal cerebral redistribution, Fetal hypoxia

   DOI: 10.5005/jp-journals-10006-2285  |  Open Access |  How to cite  | 

Abstract

Aim: To evaluate the predictive efficacy of cerebroplacental ratio (CPR) percentile in the third trimester, to identify fetuses at risk of adverse pregnancy outcome (APO) in a tertiary care center. The secondary objectives were to compare the performance of CPR percentile to conventional parameters—estimated fetal weight (EFW), umbilical artery-pulsatility index (UA-PI), and CPR (<1). Materials and methods: This study was a retrospective cohort study conducted at the Fetal Medicine Unit, Sri Ramachandra Institute of Higher Education and Research, Chennai, Tamil Nadu, India (from September 2018 to September 2019). Following institutional ethics committee approval, 600 women with a singleton non-anomalous fetus, delivered within 3 weeks of fetal Doppler study in the third trimester were included in the study. The parameters EFW (<5th percentile), UA-PI (>95th percentile), and CPR (<5th percentile) were calculated using ultrasound software and were evaluated separately and in combination. Perinatal outcomes assessed were intrapartum cardiotocography (CTG) abnormalities, operative delivery for fetal distress, preterm delivery, stillbirth, low birth weight (BW) percentiles stillbirth, and a composite neonatal outcome. Statistical indices calculation and analysis were done using the statistical package for the social sciences (SPSS) software, version 16. Results: Cerebroplacental ratio (<5th centile) has better sensitivity of 47% when compared to other parameters. 50% of fetuses with abnormal CPR percentile had adverse outcomes even when other parameters were normal. Combination of CPR percentile and EFW has high specificity of 99.8% and positive predictive value of 97.1%. Conclusion: Comparatively, the CPR percentile is a better predictor of adverse outcomes. The addition of the CPR percentile to EFW improves the positive predictive value of the test to predict adverse outcomes. Significance: The CPR percentile can be used to risk stratify apparently low-risk pregnancies, and reallocate them for closer monitoring to optimize the perinatal outcome without increasing unnecessary interventions. However, since the sensitivity was 47% further studies are required to define the risk–benefit ratio of such a protocol.

547

ORIGINAL RESEARCH

K Leeja Samuel, Srijana Mathai, Rachel Mathew, Susan Mathew, NS Sreedevi

A Prospective Study of Factors Affecting Pregnancy Rate Following Fresh Embryo Transfer

[Year:2023] [Month:July-August] [Volume:15] [Number:4] [Pages:5] [Pages No:451 - 455]

Keywords: Assisted reproductive techniques, Infertility, Fresh embryo transfer

   DOI: 10.5005/jp-journals-10006-2291  |  Open Access |  How to cite  | 

Abstract

Background: Couples often want to know their chance of having a positive outcome if they opt for assisted reproductive techniques (ARTs) and hence this prospective study was aimed to examine variable predictor parameters for its success. Aim: The aim of the study was to assess factors favoring positive outcome following fresh embryo transfer (FrET). Materials and methods: In this study, 200 couples—both with primary and secondary infertility—undergoing embryo transfer (ET) following controlled ovarian hyperstimulation and those obtaining at least one transferable embryo were included. In addition to the routine infertility data, the couples underwent long protocol which started on day 21 of menstrual cycle and continued till oocyte retrieval in next cycle. After that either FrET or were planned for “freeze all” embryos followed by frozen embryo transfer (FET). The success was measured in terms of serum beta human chorionic gonadotropin (β-HCG) on day 15 and by transvaginal ultrasonography (TVS) at 6 weeks. The data was analyzed using descriptive and inferential statistical analysis. Results: Primary infertility was the most common type of infertility (84.5%). Although 42% patients became HCG positive but clinical pregnancy was achieved only in 39.5%. Clinical pregnancy was achieved in 84.8% of cases of primary infertility and 15.20% of cases of secondary infertility. Among the causes of infertility, combined factor infertility (41.5%) was the most common cause. The pregnancy rate was less when very high doses (5.1%) and longer duration (39.2%) of gonadotropins were used. There was a significant association between clinical pregnancy and the total number of oocytes (p = 0.008), the total number of metaphase II (MII) oocytes (p = 0.003), and the total number of embryos (0.002) but not with endometrial thickness (ET) in the range of 8– 14mm (p = 0.702). Conclusion: Familiarity with the predicting factors can help to prevent overtreatment and balance the decision to achieve pregnancy either through ART or by natural conception.

409

RESEARCH ARTICLE

Nupur Anand, AV Gokhale

Sequential Organ Failure Assessment Scoring Tool for Prediction of Outcome in Obstetric Intensive Care Unit at Tertiary Care Center

[Year:2023] [Month:July-August] [Volume:15] [Number:4] [Pages:6] [Pages No:456 - 461]

Keywords: Maternal mortality, Obstetric intensive care unit, Sequential organ failure assessment score

   DOI: 10.5005/jp-journals-10006-2290  |  Open Access |  How to cite  | 

Abstract

Introduction: World Health Organization defines maternal death as the death of a woman while pregnant or within 42 days of termination of pregnancy from any cause related to or aggravated by the pregnancy or its management, irrespective of the duration and the site of the pregnancy, but not from accidental or incidental causes. Different types of scores have been used to know the degree of organ failure and outcome or prognosis of the disease during ICU stay. The sequential organ failure assessment (SOFA) score is one of the recent scores, which is used to know the degree of organ failure. Aim and objectives: To validate that SOFA score can be used to know the prognosis of patients in the obstetric intensive care unit (ICU) and to decide treatment accordingly. Materials and methods: Organ failure was evaluated based on the maximum score for each one of its six components and from that total maximum SOFA score was calculated. The study was conducted in the Department of Obstetrics and Gynaecology, Baroda Medical College and SSG Hospital, Vadodara, Gujarat, India from 1 September 2017 to 31 August 2018. Results: The SOFA score trend in the patients who recovered was negative and showed a significant decrease with respect to time whereas the SOFA score trend in the patients who deteriorated and expired was positive and showed a significant increase. Interpretation of the area under the receiver operating characteristic (ROC) curve showed that the performance of the total maximum SOFA score was excellent [area under the curve (AUC) 0.972; 95% confidence interval (CI): 0.917–0.995]. Conclusion: Total maximum SOFA score proved to be an effective tool in obstetrics ICU in evaluating the severity of disease and estimating the prognosis of the patient.

367

RESEARCH ARTICLE

Shahreena A Syed, Sachin Wankhede, Sarika Thakare

Outcome of First Trimester Induced Abortions Using Misoprostol by Buccal and Vaginal Routes

[Year:2023] [Month:July-August] [Volume:15] [Number:4] [Pages:3] [Pages No:462 - 464]

Keywords: Abortion, Buccal, Misoprostol

   DOI: 10.5005/jp-journals-10006-2293  |  Open Access |  How to cite  | 

Abstract

Aims of study: To study the outcome of buccal and vaginal administration of Misoprostol in first-trimester induced abortions. To study the induction-abortion interval, duration of bleeding, failure rate, side effects, and patient satisfaction among both routes. Materials and methods: A prospective observational study was carried out on 110 women requesting for first-trimester abortion as per medical termination of pregnancy (MTP) Act. They were divided into two groups, i.e., vaginal and buccal. The vaginal group comprised 55 patients who were given oral Mifepristone, followed by vaginal Misoprostol (800 µg). In the buccal group, consisting of 55 patients, oral Mifepristone was administered, followed by buccal Misoprostol (800 µg). Results were compared between the groups in terms of induction-abortion interval, duration of bleeding, failure rate, side effects, safety, effectiveness, and patient satisfaction. Results: The rate of complete abortion was 92.7% in the vaginal group and 91% in the buccal group. No statistically significant difference was found in the rate of complete abortion among both groups. The side effect profile was similar among both the groups, except for altered taste in the buccal group. No statistically significant difference in patient satisfaction was observed in the groups. Conclusion: Buccal and vaginal routes of administration of Misoprostol have similar efficacy and patient satisfaction. Clinical significance: For first-trimester medical abortion, Misoprostol can be used in various routes. The vaginal route, requires repeated vaginal examinations which becomes inconvenient for the patients. The buccal route can be used as an effective alternative to the vaginal route.

382

CASE REPORT

Kalyani Sai Dhandapani, Prashanthi Selvaraj

Successful Pregnancy and Live Birth after Uterine Artery Embolization for Uterine AV Malformation—A Rare Entity: A Case Report

[Year:2023] [Month:July-August] [Volume:15] [Number:4] [Pages:3] [Pages No:465 - 467]

Keywords: Angiography, Case report, Fertility, Uterine artery embolization, Uterine arteriovenous malformation

   DOI: 10.5005/jp-journals-10006-2239  |  Open Access |  How to cite  | 

Abstract

Objective: This paper reports on a rare case of pregnancy after uterine artery embolization (UAE) for uterine arteriovenous (AV) malformation (AVM) following septic abortion. Traditionally, Pelvic AVMs were surgically treated with hysterectomy, abolishing the opportunity for future pregnancies endovascular treatments like UAE are the only fertility-preserving procedure for such life-threatening conditions in young women. There are many concerns about fertility issues after UAE. Embolization after symptomatic AVM not only resolves the symptoms but also gives the possibility to carry a pregnancy. Persistent amenorrhea and reduced ovarian reserve can occur due to this technique. However, the pathogenesis of such adverse effects that occur after the UAE is still not well explored. Case description: A 31-year-old young woman was admitted to our department after being unwell and with heavy bleeding following an elective termination of pregnancy by suction and evacuation. Transvaginal ultrasound and Doppler studies detected uterine AVM at the posterior wall and fundus. Conclusion: The peculiarity of this case was that spontaneous pregnancy occurred within a few years of follow-up after UAE and she gave birth to a live healthy baby at term with normal vaginal delivery with no complications.

383

CASE REPORT

Mridula Sharma, Shravi Singh, Natasha Singh

Pyometra and Its Enigmatic Presentation: A Case Series

[Year:2023] [Month:July-August] [Volume:15] [Number:4] [Pages:4] [Pages No:468 - 471]

Keywords: Case report, Endometritis, Postmenopausal, Pyometra

   DOI: 10.5005/jp-journals-10006-2249  |  Open Access |  How to cite  | 

Abstract

Aim: To see challenging presentations of pyometra in different age groups. Background: The collection of purulent substances in the uterine cavity is termed pyometra. It has been an entity with myriads of presentations, ranging from amenorrhea to vaginal discharge, to acute catastrophe like spontaneous perforation leading to pyoperitonitis and further increase in morbidity and mortality. It is an entity of rare occurrence and constitutes only 0.01–1.5% of gynecological cases. It assumes its importance in postmenopausal females as associated malignancy is found in as high as 22.2% of cases. The main pathological trigger is impaired drainage of shed endometrial lining due to cervical canal stenosis. Case description: We present four cases in this case series. One case presented as a spontaneous uterine rupture with pyoperitoneum, and an emergency laparotomy was performed for this patient with a hysterectomy and peritoneal lavage. Another patient with persistent vaginal discharge was diagnosed with genital TB, and pyometra was drained with endometrial sampling, and the patient was started on anti tubercular therapy (ATT). The third case of patient with persistent blood-mixed discharge had low grade squamous intraepithelial lesion (LSIL) and she was managed by hysteroscopy-guided endometrial biopsy and colposcopy followed by laparoscopic hysterectomy. The last and very interesting case was secondary amenorrhea with grade II Asherman's syndrome with pyometra. Hysteroscopic adhesiolysis was done followed by cyclic estrogen and progestin therapy. Conclusion: Pyoperitoneum presents in a wide spectrum of age groups, albeit with a rare frequency. Owing to its decreased exhibit in literature, the diagnosis is usually delayed. Complicated pyoperitoneum leads to considerable morbidity and even mortality. In postmenopausal females, atrophic endometrium is the most common cause, but in younger patients, the etiological array is quite varied. Timely diagnosis and personalized treatment approach improve outcomes in these patients. Clinical significance: In clinical practice, whenever we come across a case of pyometra, we not only think about tuberculosis but also other such modalities like those mentioned in this case series should be kept in mind. Another word that is to be given through this article is that the differential of pyometra should not be restricted to postmenopausal age group. It should be thought of in the reproductive age group as well.

485

CASE REPORT

Edward Sugito Manurung, Yudianto Budi Saroyo, Rima Irwinda, Ramot Arif Banamtuan, Charles Yulian Boru, Leonard Evan Mella

Management of Abdominal Wound Dehiscence Following Cesarean Section in District Area of Indonesia: Honey as an Alternative Dressing

[Year:2023] [Month:July-August] [Volume:15] [Number:4] [Pages:3] [Pages No:472 - 474]

Keywords: Abdominal wound dehiscence, Case report, Honey, Primary re-closure, Wound dressing

   DOI: 10.5005/jp-journals-10006-2280  |  Open Access |  How to cite  | 

Abstract

Background: Honey through its antimicrobial properties has an effect on wound healing. We would like to report the clinical change of wound dehiscence after cesarean section using honey dressing before primary re-closure. Case illustration: A-29-year-old woman came with an open abdominal wound with smelly pus 7 day after cesarean section. We used honey “Madu Nusantara” for the wound dressing until the granulation tissue grew before we performed re-closure. We performed primary re-closure 9 days after wound care. Discussion: Wound healing as a complex process involves immunological mediators to bring back the cellular integrity from the damaged tissue. An alternative natural compound, honey, is known to have benefits in wound healing through the action of neutrophils to eradicate the reactive oxygen species. Honey is believed to reduce the wound size, fasten the healing time, decrease the extent of infection, dehiscence, and pain compared with placebo. Primary re-closure had demonstrated superiority over secondary intention healing. Conclusion: In abdominal wound dehiscence after cesarean section, honey can be an alternative method for dressings in district area of Indonesia due to effectivity and efficacy. Primary re-closure is useful to shorten the healing time.

703

CASE REPORT

Nalini Sharma, Princy Panthoi Khumujam, Kothuni Christina Chakre, Purnima Singh, Namitha Gowda, Suhrith Bhattaram, A Santa Singh

The Burning Mother: Pustular Psoriasis with Anemia in Pregnancy: A Case Report

[Year:2023] [Month:July-August] [Volume:15] [Number:4] [Pages:3] [Pages No:475 - 477]

Keywords: Case report, Challenges in psoriasis, Managing psoriasis, Pustular psoriasis in pregnancy

   DOI: 10.5005/jp-journals-10006-2288  |  Open Access |  How to cite  | 

Abstract

Aim: To convey a detailed account of the successful management of a 36-week pregnant woman with pustular psoriasis, including the diagnostic process, treatment plan, and outcomes. To describe the challenges and considerations involved in managing psoriasis in pregnant women as well as the importance of a multidisciplinary approach to care. Background: Psoriasis affects 1–3% of the pregnant population worldwide and 2–3% of the pregnant population in India. Pustular psoriasis, a rare form of psoriasis in pregnancy may have significant adverse fetomaternal outcomes and require close surveillance throughout pregnancy. The management of generalized pustular psoriasis during pregnancy can be challenging for the treating physician. The unpredictability of the pregnancy outcome coupled with the lack of data on the safety of drugs to treat the disease can be a danger to public health. Hence, improving the fetal outcome by alleviating the symptoms of the mother while considering the risks of drugs is of utmost importance. Case description: Our case study highlights generalized pustular psoriasis in third-trimester pregnancy successfully treated with systemic steroids and cyclosporine. Systemic prednisolone 32 mg intravenous once a day and oral cyclosporine 2 mg/kg showed significant symptomatic improvement and controlled the flare-up. Timely intervention with decision to terminate pregnancy at 37 weeks by medical induction with strict fetal surveillance throughout the course of pregnancy has helped us achieve this outcome. Conclusion: Combination of systemic steroids and cyclosporin along with topical calcipotriol maybe used in severe cases. Also, physicians should be aware of the different course of outcomes in subsequent pregnancies in a patient with a known case of psoriasis as seen in our case study. Clinical significance: By sharing this case, it is hoped that healthcare professionals can gain insight into effective strategies for managing psoriasis in pregnant women, and ultimately improve patient outcomes.

572

CASE REPORT

Preeti Vashistha, Mayank Sharma, Bhavya Gupta, Mariyam Haq

Wandering Fibroid Presented as Acute Abdomen: A Rare Case with Diagnostic Dilemma

[Year:2023] [Month:July-August] [Volume:15] [Number:4] [Pages:2] [Pages No:478 - 479]

Keywords: Case report, Diagnostic dilemma, Extrauterine fibroid, Fallopian tube torsion, Wandering fibroid

   DOI: 10.5005/jp-journals-10006-2292  |  Open Access |  How to cite  | 

Abstract

Background: Fibroids are the most commonly occurring benign uterine tumor in the reproductive phase of a woman's life. Wandering fibroid (Parasitic leiomyoma) is an extrauterine fibroid with a very low incidence. Case description: We are reporting an interesting case of a 20-year-old, nulliparous female with acute abdomen, who turned out to be a wandering fibroid with torsion of the right fallopian tube intraoperatively. Conclusion: Due to the unusual location of the parasitic fibroids, patients usually present with atypical clinical presentation and it is challenging to reach on accurate diagnosis preoperatively. With the help of a high index of suspicion and radiological imaging like ultrasound, we can reach close to the diagnosis and be able to do the proper management of the patients.

438

REVIEW ARTICLE

Smit B Solanki, Nita Mishra, Arminder Singh Dhiman

How Accurate Are We When It Comes to the Reprocessing and Reuse of Gynecological Equipment?

[Year:2023] [Month:July-August] [Volume:15] [Number:4] [Pages:6] [Pages No:480 - 485]

Keywords: Disinfection, Gynecology devices, Sterilizing

   DOI: 10.5005/jp-journals-10006-2272  |  Open Access |  How to cite  | 

Abstract

Despite high per capita income and strong health insurance coverage, healthcare is expensive for a sizable section of the population. Reprocessing of devices began in the late 1970s in an effort to lower procedure costs. Reprocessing involves a number of steps, including appropriate cleaning, disinfection, and sterilization techniques. Reprocessing has the potential to compromise patient safety due to cross-contamination following insufficient sterilization because it is intended to save costs. During the sterilization/disinfection processes, there is also a chance that the reconditioned equipment would work differently. Therefore, it is necessary to provide appropriate criteria to choose reprocessing procedures for diverse gynecological equipment. Additionally, it is important to talk about and resolve the issues that gynecologists confront. In September 2022, a PubMed search was conducted using several search terms, including “recycling of medical devices”, “Single Usage Devices”, “methods of reprocessing of equipment in medical practice”, “use of formalin chamber”, “gynecological disposable disinfection”, etc. All English articles were checked by title and abstract after duplicates were eliminated. After obtaining the whole contents of a few articles, we checked them against other connected articles to see if there were any. The articles were all examined. A product can be reused if it can be cheaply treated again using methods that have been proven effective while maintaining its functionality. After one use, it does not need to be thrown away. This procedure helps to limit the cost of a gynecological case and lessens the financial load. Food and Drug Administration regulations now in effect are rigorous. In medical practice, the contamination that is used to assess the sterilizing procedure is never truly present. New regulations that take the clinical research scenario into account are therefore preferred.

446

REVIEW ARTICLE

Smit B Solanki

Diagnostic Laparoscopy in the Future: Negative Aspects

[Year:2023] [Month:July-August] [Volume:15] [Number:4] [Pages:4] [Pages No:486 - 489]

Keywords: Endometriosis, Laparoscopy, Surgical management

   DOI: 10.5005/jp-journals-10006-2273  |  Open Access |  How to cite  | 

Abstract

Endometriosis affects a woman's quality of life significantly in around 80% of cases of sterility and severe pelvic pain. Adolescent patients experience disproportionately long delays in receiving a diagnosis for this illness, which is very frequently diagnosed an average of 6 years later. Invasive procedures are used as the primary diagnostic, and access to specialist treatment is restricted, which contributes to this in some measure. While essential for the diagnosis and management of endometriosis, laparoscopy has been shown to be less cost-effective than empiric traditional therapy and to place more emphasis on the patient and the overall clinical course. We learn more about the complexity of this condition as new research becomes available. The effectiveness of laparoscopy has been proven to vary, with high rates of recurrence and varied symptom relief over time. Laparoscopy is more advantageous for advanced disease and deep infiltrating endometriosis. Studies have also shown a slight correlation between the amount of discomfort felt by patients and the stage and location of lesions. This article examines future prospects and alternatives while also evaluating present endometriosis care guidelines and the appropriateness of diagnostic laparoscopy.

441

REVIEW ARTICLE

I Gde Sastra Winata, I Wayan Megadhana, Endang Sri Widiyanti, Aldo Albert Lawu

Role of Oxygenation Factor Hypoxia-inducible Factor-1α (HIF-1α) as Prognostic Indicators in Cervical Cancer

[Year:2023] [Month:July-August] [Volume:15] [Number:4] [Pages:7] [Pages No:490 - 496]

Keywords: Cervical cancer, Human papillomavirus 16, Hypoxia-inducible factors-1α, Oxygenation factors

   DOI: 10.5005/jp-journals-10006-2222  |  Open Access |  How to cite  | 

Abstract

Objective: This literature aims to know the role of HIF-1a as a prognostic indicator of oxygenation in cervical cancer. Materials and methods: All references used in this literature review were searched in several databases such as PubMed (Medline), Google Scholar, and ScienceDirect. Results: Hypoxia can cause damage to cell death because the body's cells are very dependent on the oxygen constant supply to function and survive. Hypoxia inducible factor-1α plays an important role in tumor development through the regulation of gene expression (angiogenesis, cell survival, and drug resistance) especially under hypoxemic conditions such as embryogenesis, cardiovascular disease, and carcinogenesis. High HIF-1α expression can cause a decrease in tumor latency, an increase in blood vessel density, tumor volume, and tumor permeability, and promote tumor growth, while a decrease in HIF-1α activity will cause a decrease in growth progression, vascularization, and energy metabolism. Conclusion: The use of gene expression induced by hypoxia as a biomarker for tumor hypoxia has been investigated especially HIF-1α, which regulates tumor cell metabolism and metastasis in hypoxic states. The HIF-1α protein also contributes to more progressive tumor growth and it is possible that this effect is synergistic with the human papillomavirus (HPV) oncogene. Several studies have stated a strong relationship between HIF-1α protein and cancer.

435

REVIEW ARTICLE

Priyanjali Sinha, Sourya Acharya, Sunil Kumar, Samarth Shukla, Shazia Mohammad

The Association of Cardiovascular Disease Risk in Polycystic Ovarian Syndrome: A Qualitative Systematic Review

[Year:2023] [Month:July-August] [Volume:15] [Number:4] [Pages:4] [Pages No:497 - 500]

Keywords: Anovulation, Hirsutism, Hyperandrogenism, Hyperinsulinemia, Hyperlipidemia, Polycystic ovarian syndrome

   DOI: 10.5005/jp-journals-10006-2286  |  Open Access |  How to cite  | 

Abstract

Polycystic ovarian syndrome (PCOS) is a complex hormonal imbalance with increased amounts of androgen, luteinizing hormone, and insulin. It shows various symptoms like acne, hirsutism, irregular menstruation, and obesity. Besides these, it is accompanied by hyperinsulinemia, hyperandrogenism, hyperlipidemia, anovulation, and insulin resistance. More recently PCOS has been increasingly linked with the development of cardiovascular and thrombotic risks compared to normal women of the same age. According to research so far, PCOS women experience a considerable increase in oxidative stress (OS), which causes many of the metabolic and cardiovascular abnormalities that characterize this condition. In this article, we address the risks associated with both established and emerging cardiovascular risk factors, as well as the various research that suggests women with PCOS may be more susceptible for developing thrombosis and cardiovascular disease (CVD).

511

PICTORIAL ESSAY

Shreya Kampoowale, Manan Murlidhar Boob, Divita Arun Kamble, Radhika Bhutada, Deepali Kapote, Prasad Deshmukh, Zubin Sheriar

Separation of Labial Adhesions in a Case of Lichen Sclerosus in Postmenopausal Women: A Pictorial Essay

[Year:2023] [Month:July-August] [Volume:15] [Number:4] [Pages:2] [Pages No:501 - 502]

Keywords: Corticosteroids, Labial fusion, Lichen Sclerosus

   DOI: 10.5005/jp-journals-10006-2284  |  Open Access |  How to cite  | 

513

SHORT COMMUNICATION

Mohamed Rishard, Probhodana Ranaweera, Hemantha Senanayake, Marzia Lazzerini

Can a Nurse-led Counseling Clinic Improve the Success of Vaginal Birth after Cesarean Section? A Pilot Project Conducted at a Tertiary Care Center in Sri Lanka

[Year:2023] [Month:July-August] [Volume:15] [Number:4] [Pages:2] [Pages No:503 - 504]

Keywords: Birth, Cesarean section rates, Childbirth experience, Health education, Vaginal birth after cesarean, Women's choice

   DOI: 10.5005/jp-journals-10006-2282  |  Open Access |  How to cite  | 

Abstract

There is a lack of studies reporting successful counseling interventions to increase vaginal birth after cesarean section (VBAC) in low- and middle-income countries (LMIC). We report a pilot study conducted in Colombo, Sri Lanka, to assess the preliminary results of a nurse-led counseling clinic to improve the VBAC rate. Women who attended the VBAC clinic from January 2020 to May 2020 were recruited for this study. They were counseled by trained educator nurses on the VBAC process. The rate of women opting for VBAC almost tripled after counseling, while the rate of women opting for cesarean section (CS) has significantly reduced. In this pilot study, a nurse-led VBAC counseling clinic significantly increased the maternal choice towards VBAC. The observed effect is clinically relevant and warrants further consideration in larger studies.

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