Journal of South Asian Federation of Obstetrics and Gynaecology

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2024 | March-April | Volume 16 | Issue 2

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EDITOR’S DESK

Editor’s Desk

[Year:2024] [Month:March-April] [Volume:16] [Number:2] [Pages:1] [Pages No:iv - iv]

   DOI: 10.5005/jsafog-16-2-iv  |  Open Access | 

51

Original Article

Priya Dharshini, KS Rajeswari, Preet Agarwal

Endometrial Histology in Epithelial Ovarian Tumors: A Critical Analysis

[Year:2024] [Month:March-April] [Volume:16] [Number:2] [Pages:3] [Pages No:65 - 67]

Keywords: Bioactive E2, SF-1, Stromal steroidogenesis

   DOI: 10.5005/jp-journals-10006-1913  |  Open Access |  How to cite  | 

Abstract

Objective: The aim of the present study is to determine the prevalence of abnormal endometrial histology, premalignancy, and malignancy in women diagnosed with epithelial ovarian tumors and tumor-like conditions (PCOS, endometriosis, stromal hyperplasia, and stromal hyperthecosis). Materials and methods: Endometrial and ovarian specimens of 71 patients with epithelial ovarian tumors were retrospectively selected, and the histopathology was analyzed. Moreover, 79% had serous tumors, 15.4% had mucinous tumors, and 5.6% other tumors (fibrothecoma, cystadenofibroma). Ovarian histopathology was compared with the concurrent endometrial pathology. Results: Among the samples analyzed, 41% had abnormal endometrial histology, of which 29% is polypoidal endometrium and 12% is disordered proliferation, both of which represent hyperestrogenic state. Conclusion: Abnormal endometrial histology due to stromal steroidogenesis and its biological action on endometrium is well-known; hence, endometrial evaluation is mandatory for planning treatment and understanding the disease process of epithelial ovarian tumors.

99

Original Article

Divya Pandey, Jyotsna Suri, Rekha Bharti, Pratima Mittal

Pregnancy Outcome in Eisenmenger Syndrome at an Indian Tertiary Center

[Year:2024] [Month:March-April] [Volume:16] [Number:2] [Pages:6] [Pages No:68 - 73]

Keywords: Cyanotic heart disease in pregnancy, Pulmonary hypertension in pregnancy

   DOI: 10.5005/jp-journals-10006-2061  |  Open Access |  How to cite  | 

Abstract

Aim: To evaluate the materno-fetal outcome of pregnancy with Eisenmenger syndrome (ES). Materials and methods: This retrospective observational study was carried out at a tertiary teaching institute over a 1-year period. The occurrence of ES in pregnant women with the cardiac disease along with their materno-fetal outcomes was analyzed. Results: Among 27,259 antenatal women who delivered over a period of 1 year, 104 had cardiac disease with 31 congenital heart disease (CHD). Only three cases of pregnancies with ES were found among 104. Thus, ES was seen in 1:9086 pregnant women, 1:35 pregnant women with cardiac disorders, and 1:10 pregnant women with CHD. The mean age was 25.3 ± 0.58 years while the mean gestational age (GA) at delivery was 35.23 ± 0.67 weeks. The mean pulmonary arterial pressure was 68.7 ± 13.3 mm Hg. All had preterm deliveries. Vaginal delivery was conducted in 66.7% while 33.3% had a cesarean delivery. No maternal mortality was seen. Fetal demise was seen in one of three cases. Conclusion: Multidisciplinary care with the availability of a critical care unit can help achieve a positive materno-fetal outcome in ES during pregnancy which till now has been known to have a very high mortality rate. Clinical significance: Of all CHD in pregnancy, ES is associated with a very high maternal mortality rate. However, with multidisciplinary effort and approach, optimum outcomes are achievable.

141

Original Article

Uma P Vasanth, Zenab Y Tambawala, Shabnam Saquib, Ikram Shinko, Muna Mubarak, Kinda Al Ani

Trends in Operative Vaginal Delivery at Dubai Hospital: 5-year Retrospective Study

[Year:2024] [Month:March-April] [Volume:16] [Number:2] [Pages:5] [Pages No:74 - 78]

Keywords: Cephalohematoma, Emergency cesarean delivery, Forceps delivery, Maternal morbidity, Operative vaginal delivery, Perineal tears, Vacuum delivery

   DOI: 10.5005/jp-journals-10006-2392  |  Open Access |  How to cite  | 

Abstract

Background: Operative vaginal delivery (OVD) refers to the use of forceps or a vacuum during vaginal delivery, a fundamental component of emergency obstetric and newborn care. But, worldwide, there is a declining trend in the instrumental delivery and increase in cesarean delivery. Objective: This study aims to assess the current trends, risks, and complications associated with OVD at Dubai Hospital, United Arab Emirates (UAE). Study design: Retrospective observational study of all women who delivered by OVD over a 5-year period from 2018 to 2022. We collected data on maternal demographics, maternal, and neonatal outcomes and total deliveries. Results: During the study period, 2.8% of women had successful operative vaginal deliveries. Our incidence remained the same during the study period. We had a total of 273 instrumental deliveries during the study period; out of this, 54.6% were delivered by metal cup, 42% by Kiwi, and 3.3% by forceps. We also noticed the preference of Kiwi over the years as compared with metal vacuum. The most common indication for OVD was fetal distress, accounting for 85.7% of cases. We also noticed a significant increase in OVD for patients on epidural analgesia (14.7% in 2018 vs 43.6% in 2022). Among the patients who underwent instrumental deliveries, 13 cases (4.8% of the total) were identified with 3rd-degree perineal tears. Multiple vaginal lacerations and cervical tears were observed in 25% of the cases. Major perineal tears, the need for suturing in operation theater, and the need for blood transfusion were seen more in women delivered by metal cups as compared with Kiwi and forceps, but not statistically significant. About 13% babies developed neonatal jaundice, and 18.3% babies needed admission to the neonatal intensive care unit (NICU). Shoulder dystocia is more common in babies delivered by metal cups (4.6%). Conclusion: Operative vaginal delivery remains a crucial component of obstetric care, with stable incidence. We observed a shifting preference toward the Kiwi vacuum extractor over metal cups while fetal distress remained the primary indication.

116

Original Article

Akhil Pratap Singh, Satakshi Jaiswal, Prabhat Agrawal

Lest the Doctor in Making Forget the Art of Visiting the Library: An Institutional Survey

[Year:2024] [Month:March-April] [Volume:16] [Number:2] [Pages:4] [Pages No:79 - 82]

Keywords: Books, Coronavirus disease-2019, Library

   DOI: 10.5005/jp-journals-10006-2369  |  Open Access |  How to cite  | 

Abstract

The word library comes from the Latin word liber which translates to “book.” This study has taken library synonymous with books-textbooks, journals, reference books—all conventional methods of gaining knowledge. There has been a rapid decline in the use of traditional methods, including bedside teaching, owing to the new, digital sources of learning which has been precipitated by the deadly pandemic of coronavirus disease-2019 (COVID-19) among various other reasons. This research is focused on drawing conclusions regarding learning from actual, physical books, traditional classroom teaching, and the new-onset era of digital learning. Digital learning has grown tremendously through the unfortunate COVID-19.

93

Original Article

Hemapriya Lalchand, MR Anil Kumar, Hiteshi Venkatamurthy

Analgesic Effectiveness of Surgical Transversus Abdominis Plane Block after Cesarean Delivery

[Year:2024] [Month:March-April] [Volume:16] [Number:2] [Pages:5] [Pages No:83 - 87]

Keywords: Cesarean section, Multimodal analgesia, Surgical transversus abdominis plane block

   DOI: 10.5005/jp-journals-10006-2379  |  Open Access |  How to cite  | 

Abstract

Background: Surgical block of the transversus abdominis plane (TAP) provides effective pain relief of the somatic component of pain after surgery. This study was carried out to determine the efficacy of the TAP block administered during surgery as a part of multimodal analgesia after lower segment cesarean section. Materials and methods: We conducted a prospective case–control study with 160 antenatal women with 80 cases (group I) and 80 controls (group II) undergoing cesarean section from JSS Hospital, Mysuru, Karnataka, India, who were randomized to be given surgical TAP block with 30 mL of bupivacaine (0.25%) after getting written, informed consent from the participants. All women received the conventional regimen of 75 mg of diclofenac sodium every eight hours for postoperative pain relief. Tramadol hydrochloride was used as rescue analgesia. Postoperatively visual analog scale (VAS) score was assessed at 1, 2, 4, 12, and 24 hours. The pulse rate and blood pressure of all women were monitored at the same intervals. Results: Age, height, body mass index (BMI), and duration of surgery were comparable between groups I and II. The mean postoperative time required to start analgesics was comparatively longer in group I when compared to group II. The difference in pulse rate and mean arterial pressure within the groups was found to be statistically significant. The mean of VAS score at all the intervals was found to be significantly lower in group I. About 33.8% of women in group II needed additional analgesia, whereas only 3.8% patients required additional analgesics in group I. Conclusion: Surgical TAP block is a safe and efficacious method to provide pain relief in the postoperative period with minimal side effects and complications.

129

Original Article

Anupriya Kaliamoorthi, Chitra Bhat, Sumangali Thirunavukkarasu, Latha Maheswari Subbarayan

Cesarean Scar Ectopic Pregnancy Management Dilemmas: A 5-year Study

[Year:2024] [Month:March-April] [Volume:16] [Number:2] [Pages:5] [Pages No:88 - 92]

Keywords: Cesarean scar pregnancy, Human chorionic gonadotropin, Methotrexate, Previous lower-segment cesarean section, Uterine artery embolization

   DOI: 10.5005/jp-journals-10006-2390  |  Open Access |  How to cite  | 

Abstract

Background: Management of cesarean scar pregnancy (CSP) is challenging as there are no specific treatment guidelines and management ought to be individualized. Aim: This study aims to analyze the various treatment modalities done for CSP. Materials and methods: This single-center retrospective study was done between 2017 and 2021 in a tertiary care hospital in South India. Data of all patients with a diagnosis of CSP between 2017 and 2021 were taken from the hospital database, and the cases were analyzed. The patients were divided into the following two groups based on gestational age at diagnosis: Group I, below 8 weeks at diagnosis and group II more than 8 weeks at diagnosis. Statistical analysis was performed, and the results were analyzed and compared between the two groups using Fisher's exact test for categorical variables and analysis of variance (ANOVA) for continuous variables, and p-value significance was considered as below 0.05. Results: During the 5-year period, there were a total of 23 cases of CSP. The mean age of the women in the study was 30.8 years; 14 belonged to group I and 9 women were in group II; 2.60% had vaginal bleeding; and 30.4% were asymptomatic. Transvaginal ultrasound is used as a diagnostic modality. Most of our patients had combined treatment modalities. Systemic methotrexate (MTX) or uterine artery embolization (UAE) was done prior to the procedure which was followed by either suction and evacuation or excision of scar pregnancy by laparotomy. Suction and evacuation under ultrasound guidance were performed on 12 of 14 patients in group I. The procedure was uneventful in all patients, without any complications during the procedure or post-procedure. There was no significant blood loss requiring a blood transfusion. In group II, laparotomy with excision of scar pregnancy was done in seven out of nine patients. Among them, in two patients suction and evacuation was done initially and proceeded to laparotomy because of increased bleeding. Patients were followed up with day 7 beta-human chorionic gonadotropin (β-HCG). Mean pre- and posttreatment β-HCG levels were calculated. The percentage decrease in β-HCG in group I was 87.66% and in group II was 80.56%. Conclusion: Early diagnosis is very important not only in catastrophic in reducing complications but also in successful management. Patients with early gestational age can be managed successfully with suction and evacuation and for those with higher gestational age and higher beta HCG level, laparotomy and scar pregnancy excision can be done.

121

Original Article

Mangesh M Londhe, Tushar V Patil, Shwetali Akhare

Histopathological Evaluation of Placentas from COVID-19-positive Mothers: A Study of 100 Placentas

[Year:2024] [Month:March-April] [Volume:16] [Number:2] [Pages:5] [Pages No:93 - 97]

Keywords: Pathology, Placenta, SARS-CoV-2

   DOI: 10.5005/jp-journals-10006-2397  |  Open Access |  How to cite  | 

Abstract

Aims and background: There is a limited availability of data regarding the consequences of COVID-19 disease on placenta and pregnancy outcome. Pregnant females are more vulnerable to COVID-19 infection. In such case scenario, histological study of the placenta gives the best clue of the undergoing disease process, thus helping in management and improvement of pregnancy outcome. Hence, this study was undertaken to evaluate pathological changes in placentas of COVID-19 mothers. Materials and methods: This is a cohort-based, prospective observational study undertaken in tertiary care center. The duration of study is 6 months (July 2020 to December 2020). The placentas of 100 COVID-19 positive mothers were included in this study. Due to the highly infectious nature of the tissue, the placentas were fixed in 10% neutral buffered formalin for 48 hours, followed by grossing, sectioning as per Amsterdam placental workshop group consensus and subjecting it to standard tissue processing protocol. The data were subjected to analysis by MS Excel and SSPS software version 27. Results: The mean age was 27 years. The majority were asymptomatic. On clinical examination, 42% revealed tachycardia, 4% revealed hypertension. The laboratory parameters revealed anemia in 23%, leukocytosis in 5% and raised neutrophil lymphocyte ratio (NLR) in 46. Full-term placentas were observed in 87% with mean weight of 473 grams. The most common finding of maternal malperfusion was increased perivillous fibrin deposition while of fetal malperfusion was chorangiosis. The inflammatory changes were chorioamnionitis and villitis. Conclusions: A causal relationship between maternal COVID-19 infection and its consequences in pregnancy is essential for improving the outcome. Hence, detailed histopathological examination of the placenta is essential. Clinical significance: Due to limited research available on the histopathological changes in the placenta of COVID-19 mothers, its consequences on maternal as well as fetal health need to be established. The detailed knowledge of pathology of the placenta will be helpful in unveiling the causal relationship, thus helping the management of COVID-positive pregnant females.

91

Original Article

Renuka Malik, Kanika Kumari, Himanshi Goel, Ayushi Hada

Effectiveness of Low Dose Mifepristone in Medical Management of Fibroids

[Year:2024] [Month:March-April] [Volume:16] [Number:2] [Pages:5] [Pages No:98 - 102]

Keywords: Fibroids, Fibroid volume, Heavy menstrual bleeding, Leiomyoma, Medical management of fibroids, Mifepristone, Selective progesterone receptor modulators

   DOI: 10.5005/jp-journals-10006-2398  |  Open Access |  How to cite  | 

Abstract

Introduction: Uterine fibroids can adversely affect the quality of life of women of reproductive age. Symptomatic fibroids are managed medically or surgically. Medical treatment of fibroids includes selective progesterone receptor modulators (SPRM) like ulipristal and mifepristone and GnRH analogs, which reduce bleeding and inhibit the growth of Leiomyoma. At present, ulipristal and GnRH analogs are available in India for medical management which are expensive and associated with side effects which precludes their long use. Mifepristone is used as an off-label indication in medical management of fibroid. This study was conducted using 5 mg dose to see efficacy in reducing blood loss in symptomatic fibroids and associated side effects. Materials and methods: A single arm interventional clinical trial was conducted at a tertiary Government Hospital in New Delhi enrolling 70 women aged 14–49 years, having fibroids causing heavy menstrual bleeding (AUB-L). Uterine size >14 weeks, suspected or confirmed uterine malignancy and those with severe medical disease were excluded. Study participants were given 5 mg oral mifepristone daily for 3 months. The primary outcome studied was reduction in uterine bleeding measured by pictorial blood loss assessment chart (PBAC) at 1, 3, and 6 months. Reduction in fibroid size, uterine volume, and endometrial thickness was measured by ultrasonography at 3 months. Side effects were noted and at 6 months of enrollment PBAC was further assessed for any residual effect. Results: A total of 49 (70%) and 55 (78.5%) women were found to be amenorrheic after 1 and 3 months of starting mifepristone, respectively. After 3 months, there was a statistically significant improvement of 21.6% in hemoglobin (p < 0.0001). There was statistically significant reduction in fibroid and uterus volume (p = 0.005 and 0.046, respectively). No significant change in endometrial thickness was noted. The side effects reported were minor. Conclusion: Low-dose mifepristone can be considered as an effective, safe, and cheap alternative for medical management of myoma-related abnormal uterine bleeding as well as for preoperative correction of anemia.

136

Original Article

Gayathri Kaveriappan, Pushpa Kotur, A Thumjaa, Sasmita Mishra

Association of HbA1c Value in Early Pregnancy in Nondiabetic Pregnant Woman with Obstetric Outcome: A Prospective Observational Study

[Year:2024] [Month:March-April] [Volume:16] [Number:2] [Pages:4] [Pages No:103 - 106]

Keywords: Gestational diabetes mellitus, Hemoglobin A1c, Pregnancy outcome

   DOI: 10.5005/jp-journals-10006-2391  |  Open Access |  How to cite  | 

Abstract

Introduction: Normal pregnancy is a diabetogenic state since during pregnancy there is an increase in insulin resistance. Gestational diabetes mellitus (GDM) is now emerging as the most common medical complication during pregnancy which leads to serious consequences. It is observed that women with GDM had a 7 times higher chance of manifestation of developing impaired glucose tolerance (IGT) or type 2 diabetes mellitus (T2DM) during the later part of life. The present study was planned to find out the association between HbA1c level before 14 weeks of gestation and cut-off values for better pregnancy outcomes. Materials and methods: This hospital-based prospective observational study was conducted with 112 patients at the Department of Obstetrics and Gynaecology, Aarupadai Veedu Medical College & Hospital, Vinayaka Mission's Research Foundation (Deemed to be University), Puducherry, India, during the period of January 2021 to June 2022. Healthy 112 patients fulfilling the inclusion criteria were included in this study. The patient was asked to undergo screening for GDM at 24–26 weeks of gestation [International Association of Diabetes and Pregnancy Study Groups (IADPSG)]. Patients were followed up closely throughout pregnancy till delivery and 5 days postnatal period. Chi-square test and multivariate analysis were adapted to analyze the data by using the statistical package for the social sciences (SPSS), version 25.0, software. Results: A total of 112 participants fulfilling the criteria for inclusion were evaluated for HbA1c levels during pregnancy. The oral glucose tolerance test (OGTT) was used for the detection of gestational diabetes between 24 and 28 weeks. The occurrence of GDM in the study population is 23.5%. The participants who had HbA1c ≥ 5.7% developed maternal, fetal, and neonatal complications. In the present study, it was observed that HbA1c ≥ 5.7% has a sensitivity of 89% and specificity of 80%. Conclusion: The HbA1c value estimated during early pregnancy (<14 weeks) is useful in the prediction of GDM and it correlates well with adverse pregnancy outcomes. The cut-off value of 5.7% can be used for the prediction of GDM with good sensitivity and specificity. It can be an additional screening tool for GDM in addition to OGTT.

100

Original Article

Pradeepa Sudhakar, KJ Jeevitha, Dhanabagyam Kandasamy, Saranya Manivannan, Shyla Usman, Nagendran Selvarajan

Surgical Treatment for Polycystic Ovary Syndrome and Reproductive Outcomes: A Retrospective Study

[Year:2024] [Month:March-April] [Volume:16] [Number:2] [Pages:4] [Pages No:107 - 110]

Keywords: Clomiphene citrate resistant, Ovarian drilling, Polycystic ovary syndrome

   DOI: 10.5005/jp-journals-10006-2363  |  Open Access |  How to cite  | 

Abstract

Aim: To assess the reproductive outcome after ovarian drilling by laparoscopic technique, and also to analyze a number of penetrations per ovary to improve the ART outcome. Materials and methods: A retrospective study was performed at Sudha Hospital and Research Institute, Erode, Tamil Nadu over a period from January 2018 to December 2020. This study includes 254 infertile women with polycystic ovary syndrome (PCOS) and clomiphene–citrate resistance, who were subjected to ovarian drilling by laparoscopy using a drilling needle. Patients are divided into 2 groups, 1st group had less than 4 penetrations per ovary and 2nd group had above 4 penetrations per ovary. The results elicited from both the groups were compared. Results: The 2 groups did not show any significant difference about body mass index (BMI), insulin, and glucose levels before and after the procedure. The confirmed pregnancy was 79.2% in the group with 4 punctures and it was 74.6% in the group with more than 4 punctures. The miscarriage rate was 8.1% and 13.9% in the group with punctures less than 4 and more than 4 respectively. Significant improvement (p-value = 0.029) in live birth rate (70.3%) was observed in the group with less than 4 punctures. Conclusion: Ovarian drilling is a successful treatment in patients with clomiphene citrate-resistant PCOS. A remarkable improvement was observed in the confirmed pregnancy rate in patients who were subjected to ovarian drilling. It was observed that 4 penetrations per ovary were adequate to increase the outcome in comparison to more than 4 punctures per ovary.

110

Original Article

Iqra Rehman Wani, Samina Sultana, Mujtaba Waris, Abhijith Rajaram Rao

Sociodemographic Factors Influencing Choice of the Mode of Delivery in Pregnant Women: A Cross-sectional Study from Tertiary Hospital in Srinagar, India

[Year:2024] [Month:March-April] [Volume:16] [Number:2] [Pages:5] [Pages No:111 - 115]

Keywords: Cesarean delivery, Mode of delivery, Preference, Vaginal delivery

   DOI: 10.5005/jp-journals-10006-2360  |  Open Access |  How to cite  | 

Abstract

Background: Cesarean delivery (CD) rates in India (21.5%) and in Jammu and Kashmir (41.7%), in particular, are way above the World Health Organization (WHO) accepted threshold of 10–15%. The study aimed to recognize the sociodemographic components associated with preference for the mode of delivery. These may form the target for future intervention. Methodology: This was a cross-sectional, hospital-based study to examine the sociodemographic factors influencing expecting mother's choice of delivery: Cesarean delivery or vaginal delivery (VD). Gravid women attending antenatal clinics were interviewed using a structured questionnaire, and data were analyzed. Results: Between August 2017 and July 2019, 1000 pregnant women participated in the study. Among them, 561 (56.1%) preferred CD. Univariate analysis revealed that patients with increasing age (30–34: OR: 1.61, p-value = 0.001; 35–39: OR: 1.94, p-value < 0.001) preferred CD over VD. Participants residing in urban areas (OR: 1.93, p-value < 0.001) and multigravid women (OR: 1.71, p-value < 0.001) preferred CD. Participants who had undergone both lower segment caesarean section (LSCS) and VD in the past and those who received information from healthcare professionals (OR: 0.17, 95% confidence interval (Cl): 0.09–0.28, p-value < 0.001) did not choose CD. Multivariate analysis revealed that urban residency adjusted odds ratio (AOR): 1.73, p-value = 0.001), multigravid women AOR: 1.56, p-value = 0.009) preferred CD whereas patients who received information from a healthcare professional (AOR: 0.15, 95% CI: 0.09–0.27, p-value < 0.001) did not choose CD. Conclusion: More than half of the women preferred CD as a mode of delivery, which is a matter of concern for both health authorities and society. The findings of this study help us better understand the variables affecting childbearing women's decisions regarding the technique of delivery. This study also emphasizes the important role that medical personnel plays in educating patients and their partners about the advantages and process of normal vaginal birth.

162

Original Article

Akrishti Gupta, Bharti Maheshwari, Nidhi Gupta, Narendra Malhotra

Cerebroplacental Ratio: Can It Be Taken as a Single Predictor of Adverse Perinatal Outcome in Singleton Uncomplicated Pregnancy at Term

[Year:2024] [Month:March-April] [Volume:16] [Number:2] [Pages:5] [Pages No:116 - 120]

Keywords: Cerebroplacental ratio, Color Doppler, Intrapartum fetal compromise

   DOI: 10.5005/jp-journals-10006-2361  |  Open Access |  How to cite  | 

Abstract

Introduction: The brain-sparing (BS) phenomenon is considered an adaptive mechanism of the fetus, which is activated to protect the fetal brain in adverse conditions. The current challenge is, therefore, to identify vulnerable fetuses at risk of hypoxic complications, particularly within an apparently low-risk cohort before the onset of labor. The cerebroplacental ratio (CPR) is emerging as an important predictor of adverse pregnancy outcomes, and this has implications for assessment of the well-being of SGA and AGA fetuses close to term. Materials and methods: It was a hospital-based prospective observational study. After obtaining informed consent from the patient, she was subjected to detailed history-taking and examination and underwent antenatal USG with color Doppler for CPR calculation. Observations and results: The mean age of females enrolled in the study was 25.95 ± 3.50 years. About 63.5% patients had normal vaginal delivery, 35.0% had cesarean delivery, and 1.5% had instrumental delivery for intrapartum fetal compromise. Patients were divided into groups on the basis of Doppler findings, i.e., CPR ≤1.08 (n = 50) and CPR >1.08 (n = 150), adverse outcomes were significantly higher in groups with CPR ≤1.08 than in groups with CPR >1.08. CPR ≤1.08 was found to be 56.25% sensitive and 95.83% specific in predicting the poor outcome. Conclusion: With the high specificity and positive predictive value of CPR, it is likely that those having normal CPR will have very less chance of adverse perinatal outcomes and, therefore, their delivery can be conducted at a peripheral center, and those with low CPR should be timely referred to a higher center where there are facilities for extensive fetal monitoring during the intrapartum period with availability of the neonatal unit (NNU).

96

REVIEW ARTICLE

Tyas Priyatini, Raymond Surya, Suskhan Djusad, Budi Iman Santoso

Is Vaginal Laser Promising for Stress Urinary Incontinence Treatment? A Systematic Review

[Year:2024] [Month:March-April] [Volume:16] [Number:2] [Pages:5] [Pages No:121 - 125]

Keywords: CO2 laser, Er:YAG laser, Sexual function, Stress urinary incontinence

   DOI: 10.5005/jp-journals-10006-2399  |  Open Access |  How to cite  | 

Abstract

Introduction: The treatment for stress urinary incontinence (SUI) includes conservative and surgical management. Apart from advantages and disadvantages, vaginal laser is considered as an alternative therapy for SUI. This study aims to review the effectiveness of laser therapy either erbium-doped yttrium–aluminum–garnet (Er:YAG) or carbon dioxide (CO2) laser for female SUI. Methods: We used preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines for the appraisal. Eligibility criteria was SUI women undergoing Er:YAG or CO2 lasers compared with conservative or surgical management concerning the outcome such as improvement of SUI severity, sexual function, and quality of life. Results: Three studies consisting of one randomized controlled trial (RCT) and two prospective studies were included and assessed for risk of bias using the revised Cochrane risk-of-bias tool (RoB 2) and the risk of bias in nonrandomized studies – of interventions (ROBINS-I) assessment tool. All studies showed improvement of SUI in Er:YAG laser therapy, subjectively; however, they were still inconsistent objectively. Meanwhile, based on data on sexual function, both lasers showed little improvement and were not statistically significant (p = 0.066). Conclusion: Current evidence shows Er:YAG laser has a superior effect to sham laser in SUI patients subjectively. On the contrary, there is only a little evidence comparing Er:YAG laser with both conservative and surgical management of SUI.

159

REVIEW ARTICLE

Hanif Shaikh, Priyanka V Mahadik, Parveen Shaikh, Anil Pardeshi, Shravani P Wakte, Krishna S Dakh, Mahesh Asalkar, Vaishali R Undale, Anand S Kawade, Chandrashekhar Upasani

Inclusion of Pregnant Women in Clinical Trials: Need, Ethical and Scientific Considerations and Current Status

[Year:2024] [Month:March-April] [Volume:16] [Number:2] [Pages:8] [Pages No:126 - 133]

Keywords: Clinical trials, Current status, Ethical considerations, Pregnant women, Scientific consideration

   DOI: 10.5005/jp-journals-10006-2401  |  Open Access |  How to cite  | 

Abstract

This article summarizes all aspects related to the exclusion and inclusion of pregnant women in clinical trials. Historically to date, pregnant women were observed as most excluded population from clinical research. There are various scientific as well as ethical reasons behind their exclusion. However, given the burden of various illnesses and diseases during pregnancy, there is a need to include them in clinical research. Available data regarding safety and efficacy of medicinal products were also collected from accidental exposure. But these evidences are insufficient to give results. Various ethical aspects and scientific reasons are also given proper evidences to include pregnant women in clinical trials. In this review, we have summarized data from clinicaltrials.gov.in on completed clinical trials exclusively on pregnant women and ongoing clinical trials in pregnant women to find out the current status of pregnant women in clinical research. There is a need to consider designing of clinical trials in pregnant women in such a way that fear of any harm should be overcome, such that more pregnant women can participate in clinical trials.

206

REVIEW ARTICLE

Mosammat Rashida Begum, Mariya Ehsan, Nazia Ehsan, Fahmida Rashid

How to Protect Fertility Potential in Endometriosis

[Year:2024] [Month:March-April] [Volume:16] [Number:2] [Pages:11] [Pages No:134 - 144]

Keywords: Aromatase inhibitors, Endometriosis, Fertility preservation, GnRH agonist, GnRH antagonist, Modified surgery, Ovarian reserve

   DOI: 10.5005/jp-journals-10006-2380  |  Open Access |  How to cite  | 

Abstract

Endometriosis is a chronic condition affecting fertile women with many adverse effects. Subfertility is one of the main issues. The ovarian reserve (OR) gradually decreases due to physical and immunological factors associated with endometriosis. Hence, early and prompt treatment of endometriosis and subfertility caused by endometriosis can improve a woman's quality of life. The article aims to shed light on the currently available options for fertility-preserving management of endometriosis. Endometriosis-related subfertility should be managed judiciously and individually according to age, parity, the extent of the disease, and the patient's social aspect. Subfertility management is approached by medical management but sometimes demands a surgical approach. But, surgery is very detrimental to OR. That is why, while managing endometriosis, one should aim to protect fertility potential. To approach fertility protection, suppressive therapy, which halts the disease process and prevents follicular loss due to “OMA,” is an option for adolescents and women who want to postpone pregnancy for a certain period. If one needs surgical intervention for treatment, a modified surgical approach to minimize follicular loss would be preferable to protect the OR. Also, while treating subfertility, the approach should be to reduce the time to live birth to avoid the consequences of the recurrence of the disease. And finally, in adolescent endometriosis and women who need repeated surgery, fertility preservation by tissue freezing might help them for future fertility in the present day.

147

REVIEW ARTICLE

Abbas Khalili, Bamdad Sadeghi

Chronic Urticaria in Pregnancy: Physiologic and Hormonal Background for an Immune Skin Disease

[Year:2024] [Month:March-April] [Volume:16] [Number:2] [Pages:5] [Pages No:145 - 149]

Keywords: Autologous serum skin test, Chronic spontaneous urticaria, Cyclosporine, Estrogen, Leptin, Omalizumab, Progesterone, Prolactin, T regulatory

   DOI: 10.5005/jp-journals-10006-2381  |  Open Access |  How to cite  | 

Abstract

Chronic urticaria (CU) is a cluster of manifestations specified as recurrent pruritic erythematous wheals or angioedema (AE), lasting for more than 6 weeks and complicating 1–2% of the population. Widespread presence of CU is higher in middle-aged women than men (1.3 vs 0.8%). It is proposed that this higher prevalence in women may be linked to female sex hormones, although the precise relationship between sex hormones and immune system function remains to be fully understood. Pregnancy is a condition that impacts CU activity in susceptible individuals. Likewise, CU can have effects on pregnancy, and conversely, pregnancy may alter the presentations of CU. Studies have shown Increased number of mast cells present in skin, and elevated serum levels of autoantibodies such as IgE anti-TPO, IgE anti-dsDNA, and IgE anti-IL-24 in chronic spontaneous urticaria (CSU) patients. The role of autoimmune diseases is crucial in these patients. Based on some evidence, immunologic tolerance is outside of the placenta milieu; and some other inflammatory conditions are alleviated during pregnancy. Chronic urticaria severity, medication before pregnancy, and AE before pregnancy were compromising factors leading to intensified urticaria in pregnancy. Managing CU in pregnant women presents unique challenges. There is little evidence about the safety and efficacy of medications in pregnant women with CU, and the cost/benefit of such treatments should be evaluated. Some studies recommend H1-antihistamines. First-generation H1-antihistamines induce sleepiness and decreased attention by passing blood–brain barrier in CNS. However, second-generation H1-antihistamines have minimal CNS complication with most negligible side effects. Omalizumab, a biological monoclonal antibody against IgE molecules, is recently recommended by the guidelines as one of the therapeutic options in patients with uncontrolled CU. Cyclosporine and systemic corticosteroid are the other reserved options for the treatment of CU in pregnancy. In this review, we focused on the effect of underlying physiologic, hormonal, and immunologic changes during pregnancy over CU. Then assessed the noteworthy changes in the natural course of CU during pregnancy; the therapeutic challenges faced, and the complications associated with of CU and complications of CU during pregnancy.

384

REVIEW ARTICLE

Priya Alva, Srinidhi Rai, Sriram Naresh, Preethika Anand

An Update on Gut Microbiome and Postmenopausal Health with Clinical Implications

[Year:2024] [Month:March-April] [Volume:16] [Number:2] [Pages:6] [Pages No:150 - 155]

Keywords: Cancer, Estrobolome, Gut microbiome, Obesity, Osteoporosis, Postmenopausal women, Type 2 diabetes

   DOI: 10.5005/jp-journals-10006-2402  |  Open Access |  How to cite  | 

Abstract

The decline of estrogen levels in postmenopause triggers significant health changes. Recent insights reveal a dynamic link between gut microbiome and estrogen, suggesting combined influence on postmenopausal health care. Reduced gut microbiome diversity is a sign of intestinal dysbiosis, linked with aging, western lifestyle, and a number of illnesses conditions. Several physiological reactions are changed when dysbiosis develops in postmenopausal state which contributes to the illness states obesity, metabolic syndrome, cancer, osteoporosis to name a few. Investigating the interplay between gut microbiota and estrogen deficiency holds promise for enhancing postmenopausal well-being and health outcomes.

177

REVIEW ARTICLE

Sharvi R Chavan, Amardeep Tembhare

Cardio-obstetrics: A Potential Global Development in the Reduction of Maternal Mortality

[Year:2024] [Month:March-April] [Volume:16] [Number:2] [Pages:5] [Pages No:156 - 160]

Keywords: Adverse maternal outcomes, Cardio-obstetrics, Cardiovascular disease in pregnancy, Cardiovascular monitoring, Maternal health

   DOI: 10.5005/jp-journals-10006-2393  |  Open Access |  How to cite  | 

Abstract

Maternal mortality remains a global health concern, particularly in areas with limited access to quality healthcare. An innovative strategy known as cardio-obstetrics is gaining popularity because it has the potential to lower maternal mortality by emphasizing the complex interactions between cardiovascular health and obstetric outcomes. An overview of the developing area of cardio-obstetrics and its contribution to reducing maternal mortality globally is given in this abstract. The utilization of cutting-edge diagnostic technologies, risk assessment techniques, and individualized treatment strategies based on each patient's particular medical history are essential to the effectiveness of cardio-obstetric therapies. The field of cardio-obstetrics is aware of the crucial connection between poor fetal and maternal outcomes and pre-existing cardiovascular problems. It emphasizes how crucial it is for obstetricians and cardiologists to work together to provide complete treatment to expectant mothers with cardiovascular risk factors. By detecting and controlling these risks early in pregnancy, cardio-obstetrics seeks to prevent problems including thrombo-embolic events, heart failure, and hypertensive disorders, which are significant causes of maternal death. Cardio-obstetrics has a tremendous deal of potential to reduce maternal mortality, but to achieve fair worldwide adoption, problems such unequal access to healthcare, lack of infrastructure, and the need for continued professional development must be addressed. Cardio-obstetrics is a progressive and all-encompassing approach to reducing maternal mortality. Recognizing the complex relationship between cardiovascular health and maternal outcomes allows healthcare systems to collaborate to implement strategies that save lives and improve maternal well-being around the world. This abstract highlights the importance of cardio-obstetrics as a developing discipline and its potential to make significant contributions to achieving the Sustainable Development Goals for maternal health.

117

REVIEW ARTICLE

Akila Kannaiyan, Sovan Bagchi, Vinaya Vijayan, Polevoy Georgiy, Sasikala Manickavasagam, Devika Sanil Kumar

Revolutionizing Women's Health: Artificial Intelligence's Impact on Obstetrics and Gynecology

[Year:2024] [Month:March-April] [Volume:16] [Number:2] [Pages:8] [Pages No:161 - 168]

Keywords: Artificial Intelligence on gynecology, Assisted reproductive technology, Gynecology, Obstetrics, Premature labor, Women's health

   DOI: 10.5005/jp-journals-10006-2394  |  Open Access |  How to cite  | 

Abstract

Health care has a tremendous growth in using artificial intelligence (AI). The AI technologies may serve as instruments for developing algorithms that can detect untreated women with a small cervical length, indicating a higher risk of premature delivery. Moreover, using the huge data capacity of AI storage might aid in identifying the risk factors for PRT labor by utilizing multiomics and comprehensive genetic data. This review examines the relevant elements of AI in obstetrics and gynecology (OB/GYN). It explores whether they enhance patient benefits and decrease medical professional expenses and burdens. Ultimately, the goal is to decrease the rates of illness and death among both mothers and infants. The review paper provides a comprehensive overview of crucial aspects of women's health, encompassing various subtopics. Maternal–fetal monitoring, pregnancy-induced diabetes, premature labor, labor, and delivery, assisted reproductive technology (ART), oncologic screening, and gynecological surgery procedures are covered. This review aims to address the growing need for consolidated information on these subjects, owing to their profound impact on maternal and fetal well-being, and holds immense importance in contemporary health care, influencing the diagnosis, management, and treatment of complex conditions. The review focuses on using AI to analyze fetal health surveillance. The aim is to assist in the identification of preterm (PRT) labor, pregnancy complications, and differences in interpretation among healthcare professionals. Understanding these areas is crucial for healthcare professionals to implement effective strategies, improve outcomes, and ensure better care for women during pregnancy, childbirth, and gynecological conditions.

288

REVIEW ARTICLE

Ruchika Garg, Vejainty Chauhan, Prabhat Agrawal, Surabhi Kumari

Polycystic Ovary Syndrome Till Date and Possibilities in Coming Years

[Year:2024] [Month:March-April] [Volume:16] [Number:2] [Pages:5] [Pages No:169 - 173]

Keywords: Cardiovascular, Imeglimin, Insulin sensitizers, Neuroendocrine, Polycystic ovarian syndrome

   DOI: 10.5005/jp-journals-10006-2371  |  Open Access |  How to cite  | 

Abstract

Polycystic ovary disease and syndrome are the less understood entities affecting the structure of the ovaries and thereby leading to various metabolic diseases. Here, an insight into the pathophysiology of polycystic ovarian syndrome (PCOS) and biochemical and genetical alteration is discussed based on the various researches held in last years. Impaired biosynthesis of the specific steroidogenic enzymes causing hormonal imbalances are yet to be studied. Exposure of the androgen in female offsprings leading to insulin resistance in adulthood seen in multiple animal studies needs to be proved in humans too. Animal studies have shown that nerve growth factor is associated with the sympathetic nervous system and raised in the PCOS also contributing to raised levels of catecholamine. The role of Kit Ligand intraovarian cytokine KL signaling and its regulation in human ovaries is to be cleared. More studies like impact of weight reduction, the use of oral contraceptive treatment reduces androgens in PCOS female. Also the role of insulin sensitizers is to be studied in the management of adolescents with PCOS. Polycystic ovarian syndrome demands a broad experimental approach from its identification to treatment. New ‘omic’ technologies are needed to be utilized to identify the responsible genes/proteins or molecules to treat this disease. It is better to identify the women with PCOS and preventing them against the type 2 diabetes, cardiovascular diseases, and few hormone-dependent cancers. While more human studies are to be done for a long time on small and large scales to identify the causing factors, risk-reducing factors, treatment and prediction of the other comorbidities or cancers in future due to PCOS.

158

REVIEW ARTICLE

Ruchika Garg, Savita Somalwar, Prabhat Agrawal, Prashant Gupta

Long COVID and Perimenopause

[Year:2024] [Month:March-April] [Volume:16] [Number:2] [Pages:3] [Pages No:174 - 176]

Keywords: Coronavirus disease-2019, Perimenopause, Women

   DOI: 10.5005/jp-journals-10006-2400  |  Open Access |  How to cite  | 

Abstract

Coronavirus disease-2019 (COVID-19) has created a huge impact globally. It created great havoc and claimed many lives. It left a trail on those who survived. Long COVID also known as post-acute sequelae of SARS-CoV-2 infection (PASC) affects 50–70% of people who survive for 3 months or longer after acute COVID-19 infection. It is an emerging syndrome and involves multiple systems due to alterations in cellular energy metabolism and reduced oxygenation to tissues.

247

CASE REPORT

Prerna K Gupta, Aishwarya P Agrawal, Agraj S Doshi, Madhuri A Mehendale, Meenal S Sarmalkar

Molar Pregnancy in a Quadruplet Conception Following IVF: A Case Report

[Year:2024] [Month:March-April] [Volume:16] [Number:2] [Pages:2] [Pages No:177 - 178]

Keywords: Case report, IVF, Molar pregnancy, Multifetal pregnancy

   DOI: 10.5005/jp-journals-10006-2376  |  Open Access |  How to cite  | 

Abstract

Aim: This case report aims to discuss the management of quadruplet pregnancy complicated by one sac having molar pregnancy following IVF conception. Background: Molar pregnancy results from hydropic changes and proliferation of trophoblasts and may progress to trophoblastic malignancy. IVF on the other hand has emerged as a boon for infertile couples. In spite of these, the risk of vesicular mole is not completely eliminated. Case description: We report a rare case of 35 years old primigravida with quadruplet pregnancy with one sac having molar pregnancy following IVF conception. Suction and evacuation was done under USG guidance and the patient was followed with serial beta-HCG levels till it was in the normal range. Conclusion: In cases of untoward events such as molar following IVF elective termination needs to be done with regard to the potential maternal harm that comes across in due course of time. Clinical significance: It is important to follow embryo transfer guidelines in IVF with regular follow-up.

137

CASE REPORT

Krutika Vivek Bhalerao, Sandhya Pajai, Neema Acharya

Creation of Neovagina Using Dental Impression Compound Mold and Skin Graft in Mayer–Rokitansky–Küster–Hauser Syndrome

[Year:2024] [Month:March-April] [Volume:16] [Number:2] [Pages:2] [Pages No:179 - 180]

Keywords: Dental impression mold, McIndoe's technique, Mayer–Rokitansky–Küster–Hauser syndrome, Vaginoplasty

   DOI: 10.5005/jp-journals-10006-2071  |  Open Access |  How to cite  | 

Abstract

Background: In Mayer–Rokitansky–Küster–Hauser (MRKH) syndrome goal of treatment is to create a sexually functioning neovagina. There are various options available, but the search for the ideal one is still on. The use of dental impression compound for mold covered with skin graft is new. Its mention in literature is very uncommon. Aim: Vaginoplasty using impression compound used by dentists covered by skin graft is being reported to assess anatomical and functional outcomes and to showcase the evolution of vaginoplasty. Case description: A 22-year-old woman with primary amenorrhea due to MRKH syndrome, about to get married in 4 months, underwent vaginoplasty using a dental impression compound covered with a skin graft. The anatomical and functional outcome was satisfying in this woman. On day 8, of vaginoplasty, the length of the vagina formed was 9.4 cm. The vaginal width was three fingers breadth. The functional outcome in relation to sexual satisfaction was good after 1 year of follow-up. Conclusion: Dental impression compound mold with skin graft is an alternative in vaginal genesis as it is cheap and easily available. Proper patient selection, counseling regarding self-replacement, and psychological support are key to the success of vaginoplasty. Clinical significance: The surgical development of a neovagina in MRKH syndrome has been attempted for a long time, with varying degrees of success. So the search for an ideal method is still on.

83

CASE REPORT

Hilary Godsman, Santanu Acharya, Sonal Anderson, Prasad Konamme

A Case Series of Four Cesarean Section Scar Ectopic Pregnancies

[Year:2024] [Month:March-April] [Volume:16] [Number:2] [Pages:2] [Pages No:181 - 182]

Keywords: Case report, Cesarean section, Cesarean scar ectopic pregnancy, Ectopic pregnancy

   DOI: 10.5005/jp-journals-10006-2386  |  Open Access |  How to cite  | 

Abstract

Cesarean section scar ectopic pregnancy is associated with high morbidity and mortality. With increasing number of cesarean sections being performed, it is likely that we will see increasing rates of cesarean section scar ectopic pregnancies. Ultrasound remains the mainstay of diagnosis however as in two of our cases the diagnosis may not be evident until during management of miscarriage. We present four cases at our hospital, two women with a history of two previous cesarean sections and two women with a history of four previous cesarean sections. We aim to highlight the importance of suspecting cesarean section scar ectopic pregnancy.

103

CASE REPORT

Vanithamani Sivapragasam, Likhitha Nellore

Serous Papillary Cystadenofibroma of Ovary with Extremely Elevated CA 125—A Masquerader of Malignancy: A Case Report

[Year:2024] [Month:March-April] [Volume:16] [Number:2] [Pages:3] [Pages No:183 - 185]

Keywords: Case report, CA 125 antigen, Cystectomy, Frozen section, Torsion of Adnexa

   DOI: 10.5005/jp-journals-10006-2387  |  Open Access |  How to cite  | 

Abstract

Background: Benign serous papillary cystadenofibroma (SPCAF) of the ovary is a very rare subtype of serous tumors of the ovary. Commonly occurs between 15 and 65 years of age. They are usually asymptomatic or diagnosed as an incidental finding. Routine imaging features masquerade malignancy and lead to extensive surgeries. Intraoperative frozen section helps in avoiding radical surgeries. Case description: A 28-year-old multiparous, sterilized woman presented with complaints of lower abdominal pain, but no menstrual complaints. Abdominal examination revealed 14 × 14 cm solid with cystic lesion occupying lower abdomen. Ultrasound (US) and contrast enhanced computed tomography (CECT) of the abdomen showed a complex left ovarian cyst with torsion. CA 125 was extremely elevated 3646 U/mL. Other tumor markers were normal. A staging laparotomy was done. Intra-operative findings showed the left ovary replaced by 14 × 14 cm cyst, which underwent torsion 2 times. The ovarian cyst was untwisted and a left salpingo-oophorectomy was done. The cut section of the specimen showed papillary projections of 2 × 2 cm over the inner wall of the cyst. The frozen section histopathology report was benign SPCAF. Hence radical surgery was avoided. The final histopathology report revealed benign SPCAF of the left ovary. Conclusion: This case is presented in view of its rarity and atypical presentation. The presentation was atypical, since CA 125 was extremely elevated and imaging features suggested a malignant neoplasm. But intraoperative frozen section histopathology turned out to be a benign tumor thus avoiding radical surgery in a young patient. Clinical significance: Diagnosis of benign SPCAF ovary is difficult as imaging features masquerade malignancy, hence intraoperative frozen section plays a crucial role in definitive diagnosis and helps in avoiding extensive surgeries.

95

CASE REPORT

Vinika Nimodia, Disket Dolkar, Kamna Datta, Neha Pruthi Tandon, Jaya Chawla, Ashok Kumar

Successful Outcome of Cesarean Myomectomy with Large Leiomyoma: A Case Report

[Year:2024] [Month:March-April] [Volume:16] [Number:2] [Pages:3] [Pages No:186 - 188]

Keywords: Caesarean myomectomy, Case report, Complications, Leiomyoma, Torsion

   DOI: 10.5005/jp-journals-10006-2388  |  Open Access |  How to cite  | 

Abstract

In women of reproductive age, the prevalence of fibroids is between 30 and 40 percent. Approx 20% of women with fibroid develop complications in pregnancy. Pregnancy-related uterine fibroids can cause many adverse effects including abdominal pain (due to degenerative changes, and torsion), preterm labor, antepartum and postpartum hemorrhage. Here we describe the case of 32-years-old nullipara woman with pregnancy at 36 weeks with large intramural fibroid with uterine torsion. The patient underwent an emergency cesarean along with a cesarean myomectomy and was discharged from the hospital in satisfactory condition.

161

CASE REPORT

Sumesh Choudhary, Vineet Mishra, Kunur Shah, Manisha Chhetry

Dilemmas and Difficulties in Dealing with Receptor-positive Breast Cancer Patients Seeking Fertility Care: A Case Report!

[Year:2024] [Month:March-April] [Volume:16] [Number:2] [Pages:3] [Pages No:189 - 191]

Keywords: Breast cancer, Case report, Fertility preservation, Oocyte cryopreservation, Oncofertility, Receptor

   DOI: 10.5005/jp-journals-10006-2378  |  Open Access |  How to cite  | 

Abstract

Aim: Addressing the fertility preservation needs of breast cancer patients with receptor-positive presents considerable dilemmas and difficulties. Case description: Presenting a case of a 35-year-old unmarried female with receptor-positive breast malignancy who was referred for fertility preservation. Counseling regarding remote risk with controlled ovarian stimulation using antagonist protocol was done. Antiestrogen therapy with letrozole was added to minimize the risk with supraphysiologic estrogen levels. Five mature metaphase II (MII) oocytes were retrieved and cryopreserved for future use. Conclusion: Oocyte cryopreservation in unmarried cancer patients is an acceptable option. The addition of antiestrogen-like letrozole is advisable in estrogen receptor-positive cases. Fertility concerns of young patients should be addressed with a multidisciplinary approach.

115

ABSTRACT

Neena Gupta, Garima Gupta, Uruj Jahan, Sonali Bisht

Ultraviolet Spectroscopy vs Congo Red Card Test—A Step Forward toward Early Prediction of Preeclampsia: A Case–Control Study

[Year:2024] [Month:March-April] [Volume:16] [Number:2] [Pages:6] [Pages No:192 - 197]

Keywords: Adverse maternal outcome, Congophilia, Congo red paper test, Misfolded proteins, Preeclampsia, Prevention, Spectroscopy

   DOI: 10.5005/jp-journals-10006-2325  |  Open Access |  How to cite  | 

Abstract

Aim: Comparative evaluation of ultraviolet–visible (UV–Vis) spectroscopy and Congo red card-based test in the diagnosis of preeclampsia. Materials and methods: In this case–control study, UV–Vis spectroscopy and Congo red card test were done using mid-stream clean catch urine samples collected from 98 cases and 98 controls. The results obtained were used to calculate the specificity and sensitivity of each test. Results: Out of 98 cases, 76 showed increased absorbance in UV–Vis spectroscopy while 69 showed Congo red positivity. Thus, the ultraviolet (UV)-absorbance method was found to be more sensitive (77.53) and specific (80.61) compared to the Congo red paper-based test (sensitivity, 70.40; specificity, 64.28) in the detection of the misfolded proteins present in the urine samples of the preeclamptic patients. Conclusion: The UV–Vis absorption spectroscopy is a renowned yet innovative technique in the diagnosis of preeclampsia. It is more sensitive and specific to the existing Congo red paper-based test. Clinical significance: Several studies show that urine of preeclampsia patients shows the presence of misfolded proteins which are present about 2 weeks before the onset of symptoms, that is, clinical diagnosis. This creates scope for early detection and diagnosis of preeclampsia. In this study, we establish the role of spectroscopy as a novel test in diagnosing misfolded proteins in preeclamptic patients and compare its diagnostic performance to the highly acclaimed Congo red card test.

77

SURVEY

Ashwini S Bulbuli, Vaishnavi A Kokate

Prevalence of Vaginismus in Reproductive Age Group: Observational Study

[Year:2024] [Month:March-April] [Volume:16] [Number:2] [Pages:4] [Pages No:198 - 201]

Keywords: Female sexual dysfunction, Reproductive age group, Prevalence, Vaginal penetration, Vaginismus

   DOI: 10.5005/jp-journals-10006-2395  |  Open Access |  How to cite  | 

Abstract

Background: Vaginismus is a multifaceted disorder encompassing increased muscle tension, pain, anxiety, and fear due to psychosocial perspectives which makes vaginal penetration impossible. Vaginismus has irreparable effects on self-identity. It also negatively impacts the quality of life. Aim: To find the prevalence of vaginismus in the female reproductive age group of 20–35 years. Materials and methods: The current observational study comprised 160 married females in the age group of 20–35 years residing in Belagavi city in Karnataka, India. Women were screened according to the criteria from a tertiary care hospital. Outcome measures: The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition by the American Psychiatric Association was used to assess vaginismus. Results: Females who were sexually active were included in this study. Out of the total sample, 28% were reported with primary vaginismus and 30% with secondary vaginismus. There was no specific relation between age and vaginismus. Conclusion: The study concludes that vaginismus is a common disorder that is highly prevalent in the Indian population and women hesitate to seek medical attention regarding it.

339

Book Review

Donald School Atlas of Fetal Anomalies

[Year:2024] [Month:March-April] [Volume:16] [Number:2] [Pages:1] [Pages No:202 - 202]

   DOI: 10.5005/jsafog-16-2-000  |  Open Access |  How to cite  | 

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