Journal of South Asian Federation of Obstetrics and Gynaecology

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2023 | November-December | Volume 15 | Issue 6

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Editor's Desk

Artificial Intelligence (AI) in Gynecology Practice: Transforming Women's Health Care

[Year:2023] [Month:November-December] [Volume:15] [Number:6] [Pages:2] [Pages No:iv - v]

   DOI: 10.5005/jsafog-15-6-iv  |  Open Access | 

141

Book Review

Operative Obstetrics: An Illustrated Manual

[Year:2023] [Month:November-December] [Volume:15] [Number:6] [Pages:1] [Pages No:641 - 641]

   DOI: 10.5005/jsafog-15-6-000  |  Open Access |  How to cite  | 

259

ORIGINAL RESEARCH

Shashi Lata Kabra, Richa Madaan, Sonal Maheshwari, Pratibha Nanda

Robson's 10-group Classification System Analysis of Cesarean Deliveries Performed at a Tertiary Care Teaching Institution

[Year:2023] [Month:November-December] [Volume:15] [Number:6] [Pages:4] [Pages No:643 - 646]

Keywords: Cesarean section, Pregnancy, Robson's 10-group classification

   DOI: 10.5005/jp-journals-10006-2324  |  Open Access |  How to cite  | 

Abstract

Background: Cesarean section (CS) is defined as the delivery of a fetus through surgical incisions made through the abdominal wall (laparotomy) and the uterine wall (hysterotomy). Cesarean section delivery is to be performed only when it is necessary, as it increases maternal morbidity. There is a substantial rise in the CS rate over the previous three decades, and an objective and scientific analysis of the indications of CS deliveries is necessary to decrease the number. As a result, Robson's classification of global standards has become indispensable. To reduce the rising CS rate, this study used Robson's criteria to analyze the CS trend at a tertiary care teaching hospital. It also identified the proportion of women in each category according to Robson's 10-group categorization scheme and the CS rate among them. Methods: The Deen Dayal Upadhyay Hospital, a tertiary care teaching hospital in New Delhi, served as the site of this retrospective study. Data were gathered from women who underwent cesarean deliveries between January 2022 and January 2023, and proportions in various categories were computed using Robson's 10-group classification scheme. Results: About 33.33% of deliveries at DDU Hospital throughout the study period were CS. Robson group I (21.95%) had the highest level of representation in the study group, followed by Robson groups III (20.89%) and 2 (18.74%), while Robson groups VIII (1.23%) and 9 (0.32%) had the lowest levels. Group II came in second at 7.3%, while the Robson group V contributed the most overall to the CS rate at 12.42%. Group IX had a 100% CS rate despite comprising the smallest proportion of the study group. Conclusion: The most common indication for previous lower segment cesarean section can be reduced by judicious use of trial of labor after cesarean. Every effort must be done to reduce primary CS.

322

ORIGINAL RESEARCH

Nagarathna Gopal, KMD Sudeep, Sudhir Prabhu Haladi, Ashwini Patil

Impact of Antenatal Corticosteroids on Glycemic Variations in Gestational Diabetes Mellitus: A Single Center Observational Study

[Year:2023] [Month:November-December] [Volume:15] [Number:6] [Pages:7] [Pages No:647 - 653]

Keywords: Antenatal corticosteroids, Gestational diabetes mellitus, Insulin therapy, Medical nutritional therapy

   DOI: 10.5005/jp-journals-10006-2305  |  Open Access |  How to cite  | 

Abstract

Aim: The study evaluated the effect of prophylactic antenatal corticosteroids (ACSs) on maternal blood glucose (MBG) changes and insulin requirement in gestational diabetes mellitus (GDM). Materials and methods: Patients with GDM received a conventional ACS regimen. Pre-meal glucose levels determined initiation of insulin or dose titration if already on insulin. All were monitored for 72 hours after the first dose of ACS. From day 3, fasting blood glucose, one hour post-meal glucose levels were assessed. Glycemic monitoring was continued for five days in those who had hyperglycemia during the first 72 hours after ACS. Results: Of the 52 patients, 12 required insulin for the first time and 14 were already on it before ACS, remaining were managed with medical nutritional therapy (MNT). Maternal blood glucose declined from day 3 onwards, euglycemic status was reached on day 4 and sustained on day 5. There was no significant change in the mean MBG during the first two days following ACS, but a gradual decline from day 3 was noticeable. The mean MBG change was independent of duration. There was a significant difference between the average insulin requirements. There was no fetal loss. Conclusion: Antenatal corticosteroid-induced hyperglycemia increases the requirement of insulin, or add on oral hypoglycemic agents. Well-controlled glycemic status is achievable with MNT alone or in combination with pharmacotherapy under continued monitoring. Clinical significance: Continuous monitoring, MNT to meet the increased nutritional needs, not increase MBG levels at the same time, and add on pharmacotherapy should be included in the treatment strategy.

390

ORIGINAL RESEARCH

Asna Aafreen, Apoorv Pankaj, Aprajita Pankaj

A Prospective Study to the Evaluate Umbilical Coiling Index as a Marker of Maternal Outcome

[Year:2023] [Month:November-December] [Volume:15] [Number:6] [Pages:4] [Pages No:654 - 657]

Keywords: Abnormal coiling index, Hypercoiling, Hypocoiling, Maternal outcome

   DOI: 10.5005/jp-journals-10006-2350  |  Open Access |  How to cite  | 

Abstract

Aim: A prospective study to evaluate the umbilical coiling index as an indicator of maternal outcome. Research is being undertaken to calculate the abnormal coiling index (hypercoiling or hypocoiling) and determine its adverse pregnancy outcomes. Materials and methodology: Prospective observational research was done in the Department of Gynaecology & Obstetrics at Lilavati Hospital, India, from February 2018 to March 2019. The sample size was 141 (patients admitted to the hospital for delivery). Results: Abnormal cord coiling is hypocoiled or hypercoiled. The present study reveals that abnormal cord coiling is not associated with a period of gestation at delivery, age of the mother, mode of delivery, chronic hypertension (HTN), pregnancy-induced hypertension (PIH), or gestational diabetes in the mother. Conclusion: Abnormal cord coiling causes adverse outcomes. The reason for this abnormal coiling is not identified. Not many studies have been undertaken to determine the coiling index and its pregnancy outcome. Thus, prospective studies should be carried out to find the reason for abnormal umbilical cord coiling, and thus, to find means for preventing adverse pregnancy outcomes. Umbilical cord coiling index (UCI) assessment antenatally can also become an important variable to be assessed. This can help us in identifying patients who may have adverse outcomes. Clinical significance: Abnormal umbilical coiling index is linked with poor pregnancy outcomes and its antenatal as well as postnatal determination should be incorporated into clinical practice.

229

ORIGINAL RESEARCH

Saloni Satyanarayan Zunzunwala, Niranjan Narayanrao Chavan

Comparison of Four Risk of Malignancy Indices in Preoperative Evaluation of Patients with Adnexal Masses

[Year:2023] [Month:November-December] [Volume:15] [Number:6] [Pages:4] [Pages No:658 - 661]

Keywords: Adnexal mass, CA 125, Risk of malignancy indices

   DOI: 10.5005/jp-journals-10006-2351  |  Open Access |  How to cite  | 

Abstract

Background: The purpose of the study was to evaluate the efficacy of the risk of malignancy index (RMI) in differentiating benign from malignant adnexal lesions. This study also aims to find out the most appropriate index to diagnose the malignancy of the adnexal mass by comparison of four RMIs. Materials and methods: Cross-sectional observational study of 75 women of all ages attending a gynecology outpatient clinic and admitted for exploratory surgery for a pelvic mass in a tertiary care hospital in central India during 2018–2020 has been carried out. Study parameters included the menopausal status, ultrasound features and sensitivity, specificity and positive predictive value of serum CA125 and RMI 1, RMI 2, RMI 3, and RMI 4 were calculated to determine whether the pelvic mass was benign or malignant. Results: All four indices (RMI 1, RMI 2, RMI 3, and RMI 4) were significantly correlated with histopathological findings with a p-value < 0.001. On comparison, no statistically significant difference was observed among the four RMIs to differentiate malignant from benign ovarian masses (p > 0.05). Conclusion: We concluded that the RMI is a simple, noninvasive, easily accessible and applicable, affordable, and inexpensive scoring system for assessing the adnexal masses. The four malignancy risk indices (RMI 1, RMI 2, RMI 3, and RMI 4) can precisely distinguish the benign from malignant pelvic masses.

309

ORIGINAL RESEARCH

Melissa Guevara-Inostroza, Alexandra Tembladera-Salguerano, John Barja-Ore, Natalia Valverde-Espinoza

Profile of Users of Short- and Long-acting Contraceptive Methods: A Cross-sectional National Study of 12,973 Women

[Year:2023] [Month:November-December] [Volume:15] [Number:6] [Pages:4] [Pages No:662 - 665]

Keywords: Contraception, Contraceptives, Family planning, Health profile

   DOI: 10.5005/jp-journals-10006-2353  |  Open Access |  How to cite  | 

Abstract

Aim: To compare the profile of users of short- and long-acting contraceptive methods (CM). Materials and methods: Cross-sectional study that analyzed population-based databases in Peru. A total of 12,973 users of short- and long-acting CM were included. Social, demographic, and reproductive characteristics were studied, as well as the type of contraceptive method. Descriptive statistics were calculated; and the Chi-square test was applied with 95% confidence. Results: Short-acting contraceptives (87.7%) are more used than long-acting contraceptives (LARCs) (12.3%). Among users of LARCs, the proportion of women with higher education (47.7%) was significantly higher. Women from the highlands (21.9%) used mostly short-acting methods; and those residing in urban areas (85.5%) and with a high wealth index (23.7%) used long-acting methods. Childlessness (18.8%) and non-desire for parity (62.5%) were higher in users of short- and LARCs, respectively. The initiation of sexual intercourse was not different in both groups of users. Conclusion: Social, demographic, and reproductive characteristics are different in women users of short- and long-acting methods, except for age at sexual debut. Clinical significance: The wide range of CM currently available allows women and their partners to satisfy their reproductive demands, although their choice depends on various conditions internal or external to the woman.

234

ORIGINAL RESEARCH

Deepika Chandrasekaran, Chitra Andrew, Ramesh Babu, Arun Prasad Dharmalingam

Role of the New UTD Classification System in Prenatal Prediction of Severity and Correlation with Postnatal Outcomes

[Year:2023] [Month:November-December] [Volume:15] [Number:6] [Pages:4] [Pages No:666 - 669]

Keywords: Antenatal ultrasound, Fetal urinary tract dilation, Fetomaternal outcomes

   DOI: 10.5005/jp-journals-10006-2359  |  Open Access |  How to cite  | 

Abstract

Aim: Fetal urinary tract dilation (UTD) abnormalities affect 1–5% of all pregnancies. The new UTD classification system was introduced in the year 2014 in order to have uniformity in its diagnosis and management. The present study aims to investigate the clinical utility of the new UTD classification system in antenatal prediction/prognostication of severity. Materials and methods: We conducted a single-center audit of 66 consecutive patients (Jan–Dec 2021) with antenatally diagnosed UTD delivered in our hospital and managed in our pediatric unit postnatally. Ultrasound evaluation of the fetal renal system, both antenatal and postnatal were observed, and UTD-A and UTD-P classification were applied prospectively and retrospectively in all cases as per criteria defined in the new UTD classification. Postnatal outcomes in all cases were evaluated in terms of the need for immediate postnatal surgical intervention and the presence of persistent UTD pathology. Results: There were 51 fetuses in the UTD A1 risk group (Group A) and 15 fetuses in the UTD A2–3 risk group (Group B). Among the groups 10/51 (20%) in UTD A1 group had persistent abnormality [vesicoureteric reflux (VUR) n = 2, non-obstructive dilation (NOD) n = 8] while 12/15 (80%) in UTD A2–3 group had persistent abnormality [pelviureteric junction obstruction (UPJO) n = 1, (NOD) n = 4, (VUR) n = 3, megalourethra n = 1, posterior urethral valve (PUV) n = 3] and this difference was statistically significant (p = 0.001). Among UTD A1, 1/51 (2%) needed surgical intervention [(VUR) with urinary tract infection, n = 1], while in UTD A2–3 group 5/15 (33%) [(UPJO) n = 1, megalourethra n = 1, posterior urethral valve (PUV) n = 3] needed surgical intervention (p = 0.001). Conclusion and clinical significance: We found an increased frequency of complications and surgical interventions in infants with antenatal UTD A2–3 grades in the last prenatal scan in comparison with those with UTD A1 grades. The present study reiterates the usefulness of UTD classification.

299

ORIGINAL RESEARCH

Swarada Jayant Kulkarni, Vibha Subhash More, Shrutika Omprakash Makde, Mitali Vijay Sharma, Rachana Suhas Barkale, Swati Tukaram Baswant

A Cross-sectional Study to Assess Contraceptive Awareness and Practices among Married Women of Reproductive Age Group in a Tertiary Care Institute

[Year:2023] [Month:November-December] [Volume:15] [Number:6] [Pages:5] [Pages No:670 - 674]

Keywords: Awareness, Contraception, Practices

   DOI: 10.5005/jp-journals-10006-2348  |  Open Access |  How to cite  | 

Abstract

Aim: To analyze the acceptance and use of various contraceptives and to determine the reasons behind the unmet need for contraception. Materials and methods: We conducted a cross-sectional observational study among 300 married women of reproductive age group over a period of 2 months. Age, education, use, and experience of contraception in the past and a few questions to assess their knowledge and acceptance toward contraceptive methods were asked. Results: Awareness regarding contraception among these women was 97.3%, but the use was only 44%. Maximum women were using condoms, 20%; followed by Copper-T, 8%; oral contraceptives, 7%; and injectable contraception, 1%. The most common reason for not using contraception was lack of guidance 15%, followed by misconceptions regarding contraception 13.3 and 6% due to family pressure. Out of 300, 19.3% of women had misconceptions regarding Copper-T, 9.7% of them regarding oral contraceptives, 1.3% regarding condoms, and 1% regarding tubal ligation. A total of 84.3% of women had received an education at primary, secondary, or graduate level and 15.7% were uneducated. The most common source of knowledge regarding contraception was through media 36%, followed by 31.3% from healthcare workers and family members. Out of 300 women, 10.3% had unwanted pregnancies and 8% had undergone abortion. After counseling and guidance 61.3% of women were willing to use contraception in the future. Conclusion: We concluded that even though many women were aware of contraception, very few were actually using it and proper guidance and refuting misconceptions can help to increase this number. Clinical significance: Family planning is an effective tool for population stabilization and as an intervention to improve maternal and child health. Effective use of contraception can help to prevent unwanted pregnancies and unsafe abortions. It has been estimated that meeting women's needs for contraceptives would prevent one-quarter to one-third of all maternal deaths.

215

ORIGINAL RESEARCH

Shaziya Azmathulla, Nandini Gopalakrishna, Jessica Celilna Fernandes, Kogali Suresh Shrichetan

Study of Maternal Blood Glucose Levels and Blood Count after Betamethasone Therapy in Preterm Pregnancy

[Year:2023] [Month:November-December] [Volume:15] [Number:6] [Pages:4] [Pages No:675 - 678]

Keywords: Betamethasone, Corticosteroids, Fasting blood glucose, Hyperglycemia, Postprandial blood glucose

   DOI: 10.5005/jp-journals-10006-2355  |  Open Access |  How to cite  | 

Abstract

Background: Premature birth is one of the largest problems in obstetrics today and the most significant cause of neonatal morbidity and mortality. An important complication of preterm birth is respiratory distress syndrome. Corticosteroids to the mother will help in accelerating the fetal lungs maturity. This study was undertaken to evaluate the blood sugar changes and white cell count in the mother, respectively, following antenatal corticosteroids. Objectives of the study: To evaluate changes in blood glucose levels, total leukocyte count, and differential count following betamethasone therapy in preterm labor. Materials and methods: A prospective cohort study was performed in women at 28–34 weeks of gestation with preterm labor receiving betamethasone. Fasting and postprandial blood sugar glucose values were obtained on days 2, 4, and 6 after betamethasone therapy from the day of admission. Total count (TC) and differential count (DC) were also measured on day 2 and day 4 from the day of admission. Results: In this study, FBS started rising from day 2 of betamethasone, with 93% having increased blood sugar. There was a significant change in FBS levels (p < 0.001) and PPBS levels (<0.001) following antenatal steroid therapy. Corticosteroid induced a significant neutrophilia and lymphocytopenia on day 2 following administration. Conclusion: Betamethasone resulted in an acute rise in fasting blood sugar and postprandial blood sugar, and leukocytosis is expected to peak in 24 hours, and the magnitude is small.

397

ORIGINAL RESEARCH

Amitha Vijay Kamat, Sucheta Suresh

A Clinical Trial of Oral Hydration Therapy for the Management of Very Preterm Nonsevere Preeclampsia

[Year:2023] [Month:November-December] [Volume:15] [Number:6] [Pages:4] [Pages No:679 - 682]

Keywords: Mean arterial pressure, Oral hydration therapy, Preterm preeclampsia, Prolongation of pregnancy

   DOI: 10.5005/jp-journals-10006-2354  |  Open Access |  How to cite  | 

Abstract

Background and objectives: To compare the effectiveness of oral hydration therapy compared with controls in decreasing mean arterial pressure and extending the duration of pregnancy in very preterm preeclampsia. Materials and methods: Forty-five cases of preterm preeclampsia between 20 and 34 weeks of gestation who were admitted to the Department of Obstetrics and Gynaecology, KIMS, Hubballi, were included in the study. They were randomized into two groups and intervened with oral hydration therapy and a control group, which was not on any intervention. Both groups were given adequate antihypertensives for control of BP. Outcome measures were a fall in BP, prolongation of pregnancy, and improved maternal and neonatal outcomes. Results: It was observed that diastolic BP significantly reduced in oral hydration group after 5 days of starting treatment (p = 0.020). The average weight of babies in oral hydration therapy group was 2.5 kg (p = 0.011) and 2 kg in controls. Mean prolongation of pregnancy among oral hydration group was 38.6 days (p = 0.037) and 26.7 days (p = 0.249) in controls. Conclusion: Oral hydration therapy was more useful to improve fetal outcome compared with maternal outcome. It was useful to prolong pregnancy and to increase fetal birth weight. It was not found as useful for improving maternal outcome or in decreasing mean arterial pressure. Though most of the outcomes were better in oral hydration therapy clinically, it was not statistically significant. Hence, larger studies maybe required to prove their difference in outcome.

251

Original Article

Monika Bhaskar, Sudha Hittamadu Chikkasiddaiah, Radhika Chethan, Tejeswini Kolige Krishnappa, Sukanya Suresh, Savitha Chandraiah, Anitha Gabbalkaje Shiva

Maternal Near-miss in Tertiary Referral Center: A Prospective Observational Study from Urban Bengaluru

[Year:2023] [Month:November-December] [Volume:15] [Number:6] [Pages:3] [Pages No:683 - 685]

Keywords: Maternal mortality, Maternal near-miss, Near miss indicators, Severe maternal outcome

   DOI: 10.5005/jp-journals-10006-2341  |  Open Access |  How to cite  | 

Abstract

Introduction: Severe maternal morbidity or maternal near-miss (MNM) is now recommended as a better indicator for the quality of maternity care as compared to maternal mortality rates or ratios. Methods: All patients fulfilling the criteria of “Near-miss” admitted in the Department of Obstetrics and Gynaecology, Bangalore Medical College and Research Institute, Bengaluru, between September 2018 and August 2019 were included in this hospital-based prospective study. The results were tabulated and analyzed using SPSS version 21. Results: Severe preeclampsia/impending eclampsia/eclampsia/HELLP was the leading cause for both maternal near-miss (57, 26.15%) and maternal mortality (13, 8.84%). In 287 cases of severe maternal outcomes, 218 cases were MNM and 69 cases were MD. Mortality index was highest with peripartum cardiomyopathy (66.67%), followed by metabolic encephalopathy (50%). Conclusion: The current study was a prospective 1-year study in a tertiary care hospital. While maternal deaths are now in a downward trend, this study on MNM shows that pregnancy-induced hypertension, PPH, sepsis, and anemia continue to prevail. Maternal near-miss continues to burden the healthcare system and the pregnant women with long duration of hospitalization, interventions, and resources. This calls for consistent efforts to strengthen the maternal healthcare services at all levels.

185

Original Article

Radha Bai Prabhu Thangappah, Gayathri Sureshbabu, Sri Varshitha Desu, Vidhya Subramanian

A Retrospective Case Control Study to Evaluate the Frequency of Pap Smear Abnormalities among HIV-seropositive and HIV-seronegative Women

[Year:2023] [Month:November-December] [Volume:15] [Number:6] [Pages:5] [Pages No:686 - 690]

Keywords: Cervical carcinoma, Human immunodeficiency virus, Pap smear abnormalities, Risk factors

   DOI: 10.5005/jp-journals-10006-2342  |  Open Access |  How to cite  | 

Abstract

Introduction: WHO has recommended global action to eliminate cervical cancer by the 21st century. HIV-infected women are at increased risk of acquiring HPV infection, progressing to pre-invasive, and invasive cervical cancers. Objectives: The objective was to assess the frequency of and the risk factors for pap smears abnormalities in HIV-seropositive and HIV-seronegative women. Materials and methods: This retrospective case control study conducted in a Medical College Hospital from January 2016 to December 2019 included case records of 330 married women aged more than 19 years. About 270 participants were eligible for controls and 60 for cases. Demographic details, CD4 count, and pap smear findings were noted, and statistical analysis was carried out. Results: Pap smear abnormalities were noted in 13.3% of HIV-infected women and 1.85% of HIV-negative women. The preponderance of inflammatory smear was 61.7% among seropositive women and 47% among seronegative women. The mean CD4 count among HIV-positive women was 534.34 ± 242.24 and in 64.14%, the CD4 count was >400. No statistically significant association between the abnormal pap smear results and the age of the individual, parity, and age at first intercourse was noted. Conclusion: Abnormal cervical cytology was seven times higher in HIV-infected women when compared with HIV-negative women and immunosuppression may be the predominant risk factor leading to cytological abnormalities in HIV-infected women. HIV-positive women showing inflammatory smears need further evaluation.

137

Original Article

Adithi Mohan, Neetha Nandan

Evaluation of Sociodemographic Factors on Menopausal Symptoms in Women of 40–60 Years

[Year:2023] [Month:November-December] [Volume:15] [Number:6] [Pages:5] [Pages No:691 - 695]

Keywords: Menopausal rating scale, Menopausal symptoms, Perimenopause, Social factors

   DOI: 10.5005/jp-journals-10006-2343  |  Open Access |  How to cite  | 

Abstract

Background: Though menopause is a natural phenomenon in a woman's life, several factors affect the severity of menopausal symptoms. Aim and objectives: To assess the effects of sociodemographic components on menopausal symptoms in women aged 40–60 years. Materials and methodology: It is a hospital-based observational study. All women between the age of 40 and 60 years were made to answer a 11-item questionnaire (menopausal rating scale). A total of 300 participants were included. Out of which 106 were premenopausal, 111 were perimenopausal, and 83 were postmenopausal. Overall 47% of participants had one or the other menopausal symptoms. Hot flushes and irritability were more in age-group of 46–55 years. Bladder problems were more in 51–60 years, and depressive mood was common in 46–50 years of age. Though socioeconomic status did not have statistically significant effect on menopausal symptoms, it is observed that hot flushes, depressive mood, and muscle and joint pain were higher in upper class group. Whereas sexual problems, dryness of vagina, and bladder problems were more in lower class group. Irritability, heart discomfort, and hot flushes were more common in obese category patients. Depending on education status, it was noted that participants who were illiterate had significant bladder problems and heart discomfort and who had primary education had hot flushes and irritability. Conclusion: Menopausal symptoms were maximum in the age-group of 46–55 years. Lesser educated people and people with higher body mass index (BMI) had more menopausal symptoms. Lower socioeconomic group had more urogenital problems and upper class had more of somatic symptoms.

193

Original Article

Sakshi Pradip Nimbhorkar, Prashil Prakashrao Jumade, Nachiket Prashant Rahate

Knowledge, Perceptions, Taboos, and Practices of Menstrual Hygiene among Adolescent Girls in Urban and Rural Areas of Central India

[Year:2023] [Month:November-December] [Volume:15] [Number:6] [Pages:7] [Pages No:696 - 702]

Keywords: Adolescent girls, Knowledge, Menstrual hygiene, Myths, Perception, Taboos

   DOI: 10.5005/jp-journals-10006-2344  |  Open Access |  How to cite  | 

Abstract

Background: Menstrual hygiene has been an issue since antiquity and recently gained some attention. Nevertheless, it is hindered by taboos, myths, and restrictions surrounding it in some rural and urban areas of Central India. Adolescent girls often lack knowledge about practices regarding menstruation, thus affecting their overall health and development. There are discrepancies in the data among pubescent girls in urban and rural India. Objective: The objective is to assess and compare knowledge, perceptions, taboos, and practices among adolescent girls about menstrual hygiene. Methodology: In the Wardha district's urban and rural regions, a cross-sectional study was undertaken at schools. A total of 400 girls were selected as study participants between the age group range of 12–16 years by random selection. Data were collected with the help of a semi-structured pre-tested questionnaire. Girls were motivated to complete the questionnaire without any additional information on the subject of interest. Results: The mean age of our study participants was 15 years, and the mean age of menarches among them was 13 years. We found that around 5% of adolescent girls from rural and urban areas still believe menstruation is linked to God's blessing/curse. A significant portion (18%) of rural girls use just cloth compared to nil cloth usage in urban areas. Conclusion: While there is a need for improving knowledge about menstruation among urban and rural students, the lack of knowledge is greater in rural areas, and students from rural areas are more distressed during their periods.

1,119

Original Article

Varsha Bhausaheb Nimbalkar, Pankti Rajendra Ghelani, Shaikh Ambreen Anzar Ahmed

Study of Prevalence of Severe Anemia in Pregnancy and the Associated Adverse Maternal and Fetal Outcomes

[Year:2023] [Month:November-December] [Volume:15] [Number:6] [Pages:4] [Pages No:703 - 706]

Keywords: Fetal outcome, Maternal outcome, Severe anemia, Pregnancy

   DOI: 10.5005/jp-journals-10006-2345  |  Open Access |  How to cite  | 

Abstract

Background: Anemia in pregnancy remains a worldwide public health problem, particularly affecting developing countries. It is observed to be associated with multitudes of both maternal and fetal complications. The present study was undertaken to study the prevalence of severe anemia in pregnancy and assess the associated adverse maternal and fetal outcomes. Materials and methods: A total of 680 patients diagnosed with severe anemia in pregnancy during the study period were included and relevant parameters were analyzed. Results: The prevalence of severe anemia was 4.4%, with 21.80% of those having very severe anemia. Preterm labor (26.2%) was the most common adverse maternal outcome, followed by preeclampsia/eclampsia (10.3%), sepsis (6.5%), and wound gape (5%). Low birth weight (LBW)–intrauterine growth restriction (IUGR) (45.0%) was the commonest adverse fetal outcome, followed by LBW-prematurity (28.8%), birth asphyxia (6.1%), and intrauterine device (IUD)/stillbirth (3.3%). Associated risk factors were rural residence (60.4%), referral from periphery (59.3%), lower socioeconomic status (89.1%), unbooked pregnancy (76.2%), multigravida (63.8%), and no iron/folic acid supplementation during pregnancy (44.7%). Conclusion: Severe anemia in pregnancy remains a major concern, both from the maternal and fetal point of view. Early detection and management are recommended to prevent adverse obstetric outcomes.

292

Original Article

Aparna Jha, Amrutha Pentakota

Cesarean Myomectomy: Transforming Outlook

[Year:2023] [Month:November-December] [Volume:15] [Number:6] [Pages:6] [Pages No:707 - 712]

Keywords: Cesarean myomectomy, Fibroid In pregnancy, High risk pregnancy, Myomectomy, Opportunistic myomectomy

   DOI: 10.5005/jp-journals-10006-2346  |  Open Access |  How to cite  | 

Abstract

Objective: To describe the clinical characteristics, obstetric parameters, intraoperative findings and postoperative issues among patients with fibroid in pregnancy who were considered for cesarean myomectomy. Materials and methods: A prospective observational study conducted in a private maternity home under one senior consultant for a period of 4 years. After taking consent, pregnant with fibroid uterus that underwent a cesarean section (CS) were taken as study population. Women with miscarriages who did not reach viability and viable pregnancies who delivered vaginally were excluded from the study. Demographic details, obstetric parameters, intraoperative findings and postoperative issues were studied. Results: A total of 12 cases were recruited for the study. However, cesarean myomectomy was successful in 10 cases. About two cases were deferred on table due to inaccessible nature and highly tortuous vascularity. The average age of the study population was 34.1 years. Out of 10 only 1 had previous living issue. Out of the 10 cases, elective C-section was performed in all except for two, who underwent a vaginal trial. Diabetes and hypothyroidism were the comorbidities noted. About 8 had upper segment fibroid while 2 had lower segment location. A low transverse incision was taken for cesarean in all the cases. And 9 patients presented with longitudinal lie where as 1 patient presented with transverse lie. About 60% of the patients presented with multiple fibroids while 40% of them presented with solitary fibroid. Five cases presented with pure intramural location of fibroid, 3 cases with a mix of intramural + subserosal, 2 cases with purely subserosal variety. Breech extraction in 2 cases, instrumental delivery in 2 cases and atonic postpartum hemorrhage (PPH) in 1 case were the complications observed. Liberal blood and blood products were transfused as per demand. None of the patients required an ICU admission. Only baby required NICU care for preterm birth. Postoperative stay was prolonged in two cases for a couple of more days. Conclusion: From the patient's perspective of avoiding separate operative procedures for fibroid uterus, the CS can be used as an opportunity to perform myomectomy when a small risk of blood transfusion is acceptable.

143

RESEARCH ARTICLE

C Vinod Kumar, Divya Ramalingam, S Kalyani

Incidence and Indications of Transfusion of Blood and Blood Products among Women Admitted for Obstetric Care in a Tertiary Care Hospital: A Cross-sectional Study

[Year:2023] [Month:November-December] [Volume:15] [Number:6] [Pages:4] [Pages No:713 - 716]

Keywords: Anemia, Blood transfusion, Obstetric care, Postpartum hemorrhage

   DOI: 10.5005/jp-journals-10006-2352  |  Open Access |  How to cite  | 

Abstract

Background: The three main scourges which account for a majority of MMR are postpartum hemorrhage (PPH), preeclampsia, and sepsis. Postpartum hemorrhage remains most common direct cause for maternal mortality and the most common indirect causes are anemia, preeclampsia, and sepsis in India. The main objective of our study is to determine the incidence and indications of blood and blood products transfusion in women admitted for obstetric care and to assess the timing and type of transfusion. Materials and methods: Type of study: Cross-sectional Study The study was conducted in the Department of Obstetrics and Gynecology, Southern Railway Headquarters Hospital, Ayanavaram, Chennai, over 18 months between December 2017 and May 2019. The study area includes all the women admitted in antenatal, labor, postnatal wards, ICU, those seeking an abortion, and emergency inpatient services of obstetrics. Results: The incidence of blood and blood products transfusion was 2.4%. Postpartum hemorrhage followed by anemia complicating pregnancy is the commonest cause for the need for transfusion. Conclusions: Vigilant monitoring during the fourth stage of labor for early identification of signs and symptoms of ongoing acute bleeding in the diagnosis of obstetric hemorrhage is recommended. All pregnant women should be counseled regarding the intake of an iron-rich diet and factors affecting iron absorption, and compliance to oral iron supplementations so that hemoglobin could be optimized well in advance, thus avoiding a situation requiring blood transfusion. Each institute should have its transfusion protocol and audits which will aid in identifying triggers for transfusion, to ensure quality transfusion practices.

184

RESEARCH ARTICLE

Sivalingarajah Raguraman, Kopalasundaram Muhunthan

The Psychological Impact of the COVID-19 Pandemic on Pregnant Women

[Year:2023] [Month:November-December] [Volume:15] [Number:6] [Pages:4] [Pages No:717 - 720]

Keywords: Anxiety, Coronavirus disease-2019, Psychological impact

   DOI: 10.5005/jp-journals-10006-2338  |  Open Access |  How to cite  | 

Abstract

Background: Pregnancy is the most crucial phase of a woman's life in which she experiences many physical and psychological changes. Women will experience some level of stress and anxiety during this period mainly due to focus on the baby's health, fear of birthing experience, and adverse obstetric outcomes. Pregnant women are one of the vulnerable populations to psychological impact during this period of the coronavirus disease-2019 (COVID-19) outbreak. Aim: To assess the psychological impact of the COVID-19 pandemic and associated sociodemographic factors among pregnant women attending prenatal clinics and delivering at the University Professorial Unit – Teaching Hospital Jaffna. Methodology: It was a hospital-based descriptive cross-sectional study on the psychological impact of the COVID-19 pandemic among pregnant women, conducted at Teaching Hospital Jaffna from July 2021 to July 2022 among 268 pregnant women attending the prenatal clinic and delivering at Teaching Hospital Jaffna. Results: The study included 217 participants, and the response rate was 80.97%. The majority of the participants (64.5%) fell in the age category of 20–30 years, most of the participants (99%) were Sri Lankan Tamils in ethnicity, and 77.4% were Hindus. Nearly half of the participants (47.5%) completed their General Certificate of Education O level (GCE O/L), and most (81.1%) of them were unemployed. About half of the participants had psychological impact due to the COVID-19 pandemic and were concerned about their prenatal, intrapartum, and postnatal care. Among them, more than three-quarters (77%) of them had anxiety about their prenatal care, about 61% of them had anxiety about labor and intrapartum care; only 46.1% had anxiety about postnatal care. The present study shows that age and educational level are statistically significant (p < 0.05) factors influencing psychological impact among mothers regarding prenatal care. Educational levels also had a statistically significant (p < 0.05) influence on the psychological impact regarding labor and intrapartum care as well as postnatal care among mothers. Conclusion: There is a psychological impact on pregnant women due to COVID-19 regarding their pregnancy care. Hence, it is vital to give attention to the mental status of pregnant women, especially during pandemic situations like COVID-19.

211

CASE REPORT

Sakshi Dinesh Firke, Gajanan Patil, Kamlesh Chaudhari

An Atypical Case of Complete Androgen Insensitivity Syndrome Presenting in Adulthood

[Year:2023] [Month:November-December] [Volume:15] [Number:6] [Pages:4] [Pages No:721 - 724]

Keywords: Androgen insensitivity syndrome, Case report, Sex differentiation disorder, Testosterone

   DOI: 10.5005/jp-journals-10006-2332  |  Open Access |  How to cite  | 

Abstract

Aim and background: A report about case presenting at atypical age, adulthood in a female; later diagnosed to be complete androgen insensitivity syndrome. Virtue of this case is to give message for practicing and budding gene experts, gynecologist, about early diagnosis for prenatal screening of fetus and prevention of malignancy. Case description: A 23-year-old phenotypically female came with a chief complaint of primary amenorrhea, and examination and investigations were carried out. Later case was diagnosed as complete androgen insensitivity syndrome and managed with orchidectomy with achievement of satisfactory vaginal length with serial vaginal lengthening and dilation followed by estrogen supplements and psychological counseling. Conclusion: Collaboration of experts and sympathetic handling via psychologist, endocrinologist, and gynecologist counseled for current gender acceptance, sexual functioning, and quality of life are backbones. Clinical significance: Androgen insensitivity syndrome otherwise known as testicular feminization syndrome is a rare inherited, sex differentiation disorder. It is a testosterone hormone-resistant disorder usually presenting in their childhood to puberty period range. The most concerning negative outcome for women is malignant alterations within the gonads, but their removal to prevent cancer is contested. Main three-pronged treatment focuses on orchidectomy, interventions in external genitalia reconstruction, and suitable post operatively hormonal therapy of estrogen. Action plan for achieving fertility is not yet stabilized.

248

RESEARCH ARTICLE

Shaila Chikkagowdra, Afia A Tabassum, Veerendra Kumar Chowdapura Mathada

Study of Spectrum of Congenital Anomalies at Tertiary Care Hospital

[Year:2023] [Month:November-December] [Volume:15] [Number:6] [Pages:5] [Pages No:725 - 729]

Keywords: Congenital anomalies, Neonatal death, Neural tube defects

   DOI: 10.5005/jp-journals-10006-2362  |  Open Access |  How to cite  | 

Abstract

Aims and objectives: Globally congenital anomalies affect 2–3% of births and constitute the fifth largest cause of neonatal death. It is difficult to ascertain a single cause for defects as most of them have multifactorial etiology. They have a consequential impact on affected parents, their families, the health care system, and society as they are associated with long-term disability. In this study, efforts are made to determine the incidence of congenital anomalies, patterns, and epidemiological features in these mothers and to help develop strategies for patient counseling and management in our setting. Materials and methods: Medical records of one year were reviewed and all women who delivered after 12 weeks of gestation with congenital anomalies were studied. Their demographic data, significant history, investigations, and management details were documented and analyzed. Results: In 63 cases congenital anomalies were noted among 8,529 birth records. Incidence was 7.3 per 1,000 live births 54% were 12–28 weeks, central nervous system (CNS) anomalies were most common (42.5%), followed by cardiovascular system (CVS) anomalies (17.8%). Among CNS anomalies neural tube defects form the major proportion followed by hydrocephalus. Anencephaly is the most common neural tube defect. Conclusion: Survivors of congenital anomalies might have lifelong physical, mental, visual, and auditory disabilities if not managed appropriately, which can negatively affect the human and economic life of the person concerned, as well as their families and communities. Clinical significance: It is important to promote national programs for mitigating congenital anomalies, research to discover etiology, and maintain of national registry for formulating protocols for better counseling and management options. Strengthening the community-level strategies to decrease the incidence of NTD by way of folic acid supplementation.

237

CASE SERIES

Kokila Bagavathy Thanappan, Jayakrishnan Krishnanpillai, Niranjana Jayakrishnan

Prophylactic Gonadectomy in an Unmarried Individual: A Moral Dilemma

[Year:2023] [Month:November-December] [Volume:15] [Number:6] [Pages:4] [Pages No:730 - 733]

Keywords: Complete androgen insensitivity syndrome, Karyotyping, Laparoscopic gonadectomy, Mosaic Turners syndrome, Prophylactic gonadectomy

   DOI: 10.5005/jp-journals-10006-2328  |  Open Access |  How to cite  | 

Abstract

Background: Prophylactic gonadectomy can only be proposed to patients at risk of gonadal germ cell tumors (GGCTs) in disorders of sex development (DSDs) patients. However, this does not justify prophylactic gonadectomy given that they are uncommon and nearly always benign. In these cases, the survival rate of a malignant GGCT is better (approximately 95% at 5 years), but, chemotherapy also has its own lifelong side effects such as metabolic syndrome and cardiovascular risk. Case presentation: This paper highlights 2 cases of young individuals aged 16–22 years who presented to KJK Hospital, Thiruvananthapuram with amenorrhea. After initial clinical and routine hormonal and radiological investigation, they were diagnosed with Androgen insensitivity syndrome and Mosaic Turner syndrome respectively on karyotyping. After discussing the condition and options of treatment with the patients and family, laparoscopic prophylactic gonadectomy was planned and performed, with removal of bilateral undescended testes and streak ovary in respective cases followed by hormonal replacement therapy. Conclusion: Usually, the external genitalia in DSD are normal which makes it difficult to diagnose before puberty without any significant clinical indication. In our cases, it demonstrates that mere physical or clinical examination will not be sufficient to identify such cases. Therefore, in females with amenorrhea, genetic testing should be performed along with a general examination. The procedure risks are very low, as laparoscopic gonadectomy can be done as a daycare procedure and can be performed in 30–60 minutes duration with no visible scar. Added benefits of Laparoscopy include a provision to take biopsies or do gonadopexy. It is always advised to postpone gonadectomy till puberty as it allows spontaneous puberty, and allows informed decision-making by the patient.

183

CASE REPORT

Sakshi Nanda, Nitin Wadaskar, Mohammad Zuber

Near Miss: Disseminated Intravascular Coagulation with Acute Renal Failure and Sepsis

[Year:2023] [Month:November-December] [Volume:15] [Number:6] [Pages:3] [Pages No:734 - 736]

Keywords: Case report, Computed tomography, Disseminated intravascular coagulation, Hemoperitoneum, Maternal mortality, Transarterial embolization

   DOI: 10.5005/jp-journals-10006-2333  |  Open Access |  How to cite  | 

Abstract

Aim and background: Maternal mortality is one of the nightmares for obstetricians and also for the patient's family. There are many causes, but disseminated intravascular coagulation (DIC) with acute renal failure is one of the challenging cases, which requires a multidisciplinary approach. Case description: A 29-year-old second para patient with two live births, was presented in the emergency department with septic shock and DIC. She had gross hemoperitoneum with massive rectus sheath hematoma. Initially her blood pressure was stabilized by giving blood products and supportive treatment. As soon as her blood pressure became stable, she underwent computed tomographic angiography-guided embolization of right inferior epigastric artery. After 24 hours of embolization, she underwent laparotomy for abdominal compartment syndrome. Conclusion: Although primary treatment of DIC is to treat underlying cause, but transarterial embolization in addition to primary treatment, is also equally effective in controlling the on-going bleeding which in turn results in DIC. Clinical significance: Maternal mortality represents health state of a country and one should try to be safe as many near miss as possible with a multidisciplinary approach.

158

RESEARCH ARTICLE

Rahul Bhagchand Chavan, Yogesh Gadekar, Vaibhav Khairnar, Meenakshi Pawar

β-HCG and PAAP-A Levels during First Trimester as a Predictor of Gestational Hypertension and Growth-restricted Fetus

[Year:2023] [Month:November-December] [Volume:15] [Number:6] [Pages:5] [Pages No:737 - 741]

Keywords: β-human chorionic gonadotropin, First trimester, Gestational hypertension, Pregnancy-associated plasma protein-A, Preeclampsia, Pregnancy complications

   DOI: 10.5005/jp-journals-10006-2366  |  Open Access |  How to cite  | 

Abstract

Objective: The aim of this study is to study the association between abnormal serum analytes [pregnancy-associated plasma protein-A and β-human chorionic gonadotropin (β-HCG)] and the development of gestational hypertension (HTN) and intrauterine growth restriction (IUGR). Methods: A prospective observational study was carried out at ANC clinic of a hospital over a period of 18 months starting from January 2021 to June 2022. The ethical clearance was obtained from ethics committee of the institute. A total of 150 singleton pregnant women registered in the first trimester between 11 and 13.6 weeks were included in the study. The anthropometric measurements like height and weight were recorded and body mass index (BMI) was calculated. Results: Out of 17 subjects with low β-HCG, 2 (11.8%) developed gestational HTN, 2 (11.8%) developed IUGR, 2 (11.8%) developed both gestational HTN and IUGR, and 11 (64.7%) had no complications. Among subjects with normal β-HCG, 13 (10.3%) developed gestational HTN, 4 (3.2%) developed IUGR, 6 (4.8%) developed both gestational HTN and IUGR, and 103 (81.7%) had no complications. Among seven subjects with high βHCG level, two (28.6%) developed gestational HTN, two developed both gestational HTN and IUGR, and three (4.9%) had no complications. The result of Chi-square test indicated a significant association of gestational HTN and IUGR with the level of β-HCG (p < 0.05). Conclusion: The levels of β-HCG and PAAP-A during first trimester are significantly associated with the obstetric complications. Hence, in along with the routine check-ups and screenings, the levels of β-HCG and PAAP-A during first trimester might improve the chances of early identification of development of gestational HTN and IUGR.

233

CASE REPORT

Aishwarya Pravin Agrawal, Prerna Kailashchand Gupta, Namrata Babasaheb Walke, Madhuri Alap Mehendale, Meenal Shailesh Sarmalkar

A Diagnostic Conundrum of Hemoptysis: Rare Presentation of Pulmonary Thromboembolism and Its Successful Management in Pregnancy

[Year:2023] [Month:November-December] [Volume:15] [Number:6] [Pages:2] [Pages No:742 - 743]

Keywords: Case report, Hypercoagulable state, Maternal mortality, Pulmonary thromboembolism in pregnancy, Venous thromboembolism

   DOI: 10.5005/jp-journals-10006-2323  |  Open Access |  How to cite  | 

Abstract

Aim: This case report is aimed at studying the maternal and fetal outcomes in a case of pulmonary thromboembolism complicating pregnancy. Background: Pregnancy is a hypercoagulable state causing pulmonary thromboembolism to be one of the major causes of maternal morbidity and mortality. Case description: This is a case report of the successful management of a case of pulmonary infarct secondary to pulmonary thromboembolism in a primigravida with a rare presentation of repeated bouts of unexplained hemoptysis at 38 weeks gestation. Computed tomography of pulmonary arteries revealed a wedge-shaped infarct in the left lung lobe's lateral and posterolateral basal segment with a 5 mm thrombus in subsegmental branches of the left pulmonary artery. The patient was conservatively managed with the use of anticoagulant therapy and delivered a healthy fetus at term via a cesarean section. Anticoagulant therapy with low molecular weight heparin and subsequently by oral warfarin was continued for 3 months postpartum. Conclusion: Pulmonary thromboembolism presenting with hemoptysis is not quite common and hence requires a prompt diagnosis and treatment for a favorable maternal and fetal outcome as in our case. Clinical significance: Pulmonary thromboembolism can have deleterious effects that complicate pregnancy, causing significant maternal and perinatal morbidity and mortality. Hence, a multidisciplinary team approach becomes quintessential for its successful management in pregnancy.

192

CASE REPORT

Jamunarani Srirangaramasamy, Luck Chinnadurai Peermohamed, Sangeetha Belukurichi Sadasivam

Ovarian Actinomycosis: A Great Masquerader Mimicking Papillary Serous Tumor of Ovary

[Year:2023] [Month:November-December] [Volume:15] [Number:6] [Pages:2] [Pages No:744 - 745]

Keywords: Case report, Elevated Ca-125 levels, Ovarian actinomycosis, Papillary serous tumor, Psammoma bodies

   DOI: 10.5005/jp-journals-10006-2326  |  Open Access |  How to cite  | 

Abstract

Ovarian actinomycosis is a clinical mimicker of malignancy, especially papillary serous tumor, and hence ovarian actinomycosis should be in the differential diagnosis of papillary serous tumors of ovary.

163

CASE REPORT

Samta Gupta, Madhu, Shivangini Sahay, Surinder Singh Gulati, Megha Ranjan

Aggressive Angiomyxoma of Uterus—A Diagnostic Fallacy: A Case Report

[Year:2023] [Month:November-December] [Volume:15] [Number:6] [Pages:3] [Pages No:746 - 748]

Keywords: Angiomyxoma uterus, Case report, Female pelvic mass, Mesenchymal tumor, Uterine tumor

   DOI: 10.5005/jp-journals-10006-2334  |  Open Access |  How to cite  | 

Abstract

Angiomyxoma is an infrequent tumor that originates from the mesenchyme and is primarily found in the female pelvic and perineal regions. Its diagnosis before surgery can be challenging due to its vague clinical manifestations and non-specific radiological features. One common symptom of this condition is painless swelling occurring around the pelvis and perineum. We report here a case study of a 36-year-old woman who complained of a large abdominal mass initially suspected to be retroperitoneal. The magnetic resonance imaging (MRI) results pointed towards a serous cystadenoma, while further examination during surgery suggested an initial possible diagnosis of degenerative fibroid. However, subsequent histopathological analysis confirmed that it was actually an angiomyxoma. It is crucial to consider aggressive angiomyxoma (AA) as one of the potential diagnoses for painless swellings in the genitofemoral region, particularly among women who are fertile and capable of reproduction. This particular case exemplifies the significance of including uncommon tumors like uterine angiomyxoma when making a differential diagnosis for pelvic masses, regular follow-up and monitoring for patients with a history of uterine masses, and the significance of histopathological examination to confirm the diagnosis of rare tumors.

222

CASE REPORT

Snehal Suresh Mulik, Debarati Bhattacharjee Acharya

Large Vulval Acrochordon in Postmenopausal Woman—An Uncommon Presentation: Case Report

[Year:2023] [Month:November-December] [Volume:15] [Number:6] [Pages:3] [Pages No:749 - 751]

Keywords: Acrochordon, Case report, Fibroepithelial polyp, Postmenopausal woman

   DOI: 10.5005/jp-journals-10006-2335  |  Open Access |  How to cite  | 

Abstract

Aim: To highlight the uncommon manifestation of acrochordon in a postmenopausal woman. Background: Acrochordons are benign mesenchymal neoplasms. They are frequently noted in women of reproductive age group. Their occurrence in postmenopausal women is rare. Case description: A 56-year-old multiparous postmenopausal woman presented with a large vulval acrochordon of size 8 cm × 7.5 cm × 7.5 cm. Total surgical excision was performed under regional anesthesia and its diagnosis was confirmed on histopathology. Conclusion: Vulvar acrochordons are uncommon. Their occurrence in a postmenopausal age group is rare. Complete surgical excision is the cure. Clinical significance: Their clinical features mimic malignancy hence histopathology is important for definitive diagnosis. Ultrasonography aids in the initial diagnosis of the lesion.

265

CASE REPORT

Mily Pandey, Sarita Singh, Mukesh Kumar Singh

Successful Nonsurgical Management of Peripartum Pubic Diastasis with Bladder Injury: A Rare Case Report

[Year:2023] [Month:November-December] [Volume:15] [Number:6] [Pages:2] [Pages No:752 - 753]

Keywords: Case report, Peripartum complications, Pubic diastasis, Vaginal delivery

   DOI: 10.5005/jp-journals-10006-2299  |  Open Access |  How to cite  | 

Abstract

Background: Pubic diastasis is the abnormal widening of pubic bones at the symphysis pubis. It is a rare case entity seen after traumatic vaginal delivery. Here, we report a case of pubic diastasis with bladder injury after home delivery and its successful conservative management. Case description: A 33-year-old multiparous woman, with previous two cesarean deliveries, presented to gynecological emergency center 6 days after home delivery with the inability to pass urine and rectal incontinence after unsupervised home delivery 6 days back. On examination, there was a complete perineal tear of 4 cm and a complete distortion of perineal anatomy with pubic diastasis of 5 cm. She underwent an emergency laparotomy for the repair of bladder and bowel injury. A pelvic binder was applied for pubic diastasis and the perineal tear was repaired in 6 weeks. After 6 months of use of the pelvic binder, there was no difficulty or pain in walking, squatting, or weight-bearing. Conclusion: Pubic symphysis diastasis is a rare condition that should be kept in mind when peripartum women with excruciating pain in pubic symphysis present after a traumatic delivery. Clinical significance: Peripartum pubic diastasis can be successfully managed conservatively avoiding the need for surgery in many cases.

171

Review Paper

Sowrabhi Gowda

Transformative Impact of Menstrual Cup: A Game Changer

[Year:2023] [Month:November-December] [Volume:15] [Number:6] [Pages:3] [Pages No:754 - 756]

Keywords: Disposal waste, Health and safety, Leakage, Menstrual cup

   DOI: 10.5005/jp-journals-10006-2320  |  Open Access |  How to cite  | 

Abstract

The transformative impact of menstrual cups (MCs) transcends individual benefits and encompasses a broader shift toward sustainable and inclusive menstrual hygiene practices. As a game changer, menstrual cups offer a holistic solution that addresses health, environmental, economic, and cultural aspects, empowering menstruating individuals to embrace their periods with confidence and dignity. This manuscript underscores the significance of menstrual cups as a catalyst for positive change and calls for continued research, advocacy, and education to maximize their potential for global impact.

957

REVIEW ARTICLE

Laxmi Narayan Sahoo, Pavika Lal, Shivi Kulshreshtha, Prabhat Agrawal

Survey of Usage of Social Media among Medical Students: A Cross-sectional Study

[Year:2023] [Month:November-December] [Volume:15] [Number:6] [Pages:4] [Pages No:757 - 760]

Keywords: Medical graduates, Medical education, Social media, YouTube

   DOI: 10.5005/jp-journals-10006-2367  |  Open Access |  How to cite  | 

Abstract

Social media platforms provide MBBS students with a vast amount of medical information, research studies, and case studies shared by healthcare professionals and organizations. This can be beneficial for staying updated with the latest developments in the medical field. Materials and methods: A cross-sectional study with pre-validated questionnaire was built using Google Form to assess the type and frequency of social media usage as well as its impact on academic performance among medical students at SN Medical College, Agra, Uttar Pradesh and G.S.V.M. Medical College, Kanpur, Uttar Pradesh from January 2022 to March 2022 which was distributed via e-mails and through WhatsApp groups. A total of 1,179 participants which included all undergraduates, interns and postgraduates, responded to the survey. Results: The average duration of usage was 3–4 hours as responded by majority of the participants. Sleep disturbance was seen in 27% of respondents although most of them used social media at nighttime. Only 27.2% of students deactivate their social media accounts during exam; however, only 15.9% of students always deactivate their account. About 32.3% of students had positive impact of social media on grades whereas 35.9% have responded that their grades were not affected by use of social media. Conclusion: Our study has shown that MBBS students were quite familiar with various applications, but very few are using it for the purpose of study. However, it also presents challenges, such as distractions, potential negative impacts on mental health, and ethical considerations.

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