Journal of South Asian Federation of Obstetrics and Gynaecology

Register      Login

Table of Content

2024 | May-June | Volume 16 | Issue 3

Total Views

Editor's Desk

Jaideep Malhotra

Editor's Desk

[Year:2024] [Month:May-June] [Volume:16] [Number:3] [Pages:1] [Pages No:iv - iv]

   DOI: 10.5005/jsafog-16-3-iv  |  Open Access | 

84

Original Article

Padmahasta Pilla, Shobha N Gudi

Prevalence of Impaired Glucose Tolerance in Nonpregnant Polycystic Ovarian Syndrome Patients in a Hospital

[Year:2024] [Month:May-June] [Volume:16] [Number:3] [Pages:6] [Pages No:203 - 208]

Keywords: Diabetes mellitus, Glucose intolerance, Obesity, Prevention of gestational diabetes mellitus and diabetes mellitus, Polycystic ovarian syndrome

   DOI: 10.5005/jp-journals-10006-2409  |  Open Access |  How to cite  | 

Abstract

Aim: To determine the prevalence of impaired glucose intolerance in nonpregnant women with polycystic ovarian syndrome (PCOS) attending the outpatient department of St. Philomena's Hospital in Bengaluru, Karnataka, India. To observe the effect of body mass index (BMI), family history of diabetes mellitus (DM), age, parity, and other contributing factors on glucose tolerance state among individuals with PCOS. Materials and methods: This observational study included an oral glucose tolerance test (OGTT) of 200 nonpregnant PCOS women aged (15–35 years) over a period of 2 years from December 2013 to November 2015 in the Department of Obstetrics and Gynaecology, St. Philomena's Hospital in Bengaluru, Karnataka, India. Based on the results, they were classified into three groups, normal glucose tolerance (NGT), impaired glucose tolerance (IGT), or newly diagnosed DM. Results: Among the 200 women with PCOS, 64 women had IGT and 14 were newly diagnosed diabetics. Most of them were in the age group of 26-30 years. Conclusion: Impaired glucose tolerance is found in 32% of the study population. Type 2 DM is found in 7% of the study population. Clinical significance: There is an increased incidence of glucose intolerance in PCOS women. Awareness about this will help to bring in regulated screening programs for diabetes in this population with emphasis on exercise and stricter modification of diet. It will also help in providing preconception counseling to avert immediate and long-term maternal and fetal complications of gestational diabetes mellitus (GDM), and preventing and postponing the early onset of DM and other features of the metabolic syndrome.

185

Original Article

Sharanya Hemant, Preet Agarwal, KS Rajeswari

Acute Pancreatitis in Pregnancy: A 2-year Experience at a Tertiary Care Center

[Year:2024] [Month:May-June] [Volume:16] [Number:3] [Pages:5] [Pages No:209 - 213]

Keywords: Diagnosis, Pancreatitis in pregnancy, Treatment

   DOI: 10.5005/jp-journals-10006-2301  |  Open Access |  How to cite  | 

Abstract

Aim: To present a 2-year experience of acute pancreatitis in pregnancy in our institution. Background: Acute pancreatitis during pregnancy is a rare event with incidence, ranging from 1:1,000 to 1:10,000. Biliary tract diseases are the most common cause of acute pancreatitis in pregnancy, with gallstone disease being responsible for more than 70% of cases. Gallstone formation during pregnancy is attributed to the lithogenic effect of pregnancy through estrogen and progesterone. Results: Seven pregnant women with clinical and biochemical diagnosis of acute pancreatitis were studied. The mean gestational age of presentation was 28 weeks, The most common presenting complaint was the upper abdominal pain with vomiting (72%). The maximum amylase level was observed to be 2696 IU/L and the maximum lipase level was 4788 IU/L showing the condition hypertriglyceridemia with the maximum level 757 mg/dL) (28%). One patient had hypocalcemia (5.7 mg/dL) (14%). Six of the seven patients had leukocytosis maximum 22,400/cmm. The corticosteroid-binding globulin (CBG) levels of all patients were normal. The liver function tests (LFTs) of all patients were normal. Three patients had USG features of gallbladder sludge, one patient had gallstones. Three patients required ICU admissions. One patient (14%) had late phase symptoms at 29 weeks gestation requiring UGI Scopy TPN, IV octreotide. Two patients (28%) had moderately severe acute pancreatitis (according to revised Atlanta classification). Clinical significance: It mimics the symptoms of acute fatty liver of pregnancy (AFLP), preeclampsia/hemolysis, elevated liver enzymes and low platelets (HELLP) syndrome, and GERD. Hence a thorough understanding of the presentation and differences in management of each condition is required to reduce significant maternal morbidity. Conclusion: Acute pancreatitis in pregnancy is associated with significant maternal morbidity. Early diagnosis, classifying the severity of disease and treatment with multidisciplinary approach was the gold standard treatment.

179

Original Article

Pratima Mittal, Harsha S Gaikwad, Nishi Choudhary

Antenatal Care: Is It Really a Modifiable Factor for Stillbirth Prevention?

[Year:2024] [Month:May-June] [Volume:16] [Number:3] [Pages:5] [Pages No:214 - 218]

Keywords: Antenatal care, Stillbirth, Unbooked pregnancy

   DOI: 10.5005/jp-journals-10006-2277  |  Open Access |  How to cite  | 

Abstract

Stillbirth is a major cause of perinatal death in India. Deciphering the cause of stillbirth will help in formulating prevention strategies to bring down the stillbirth rate. Our objective is to explore the antepartum and intrapartum causes and risk factors of stillbirths. Materials and methods: This was a prospective observational study done under WHO-SEARO project. This study included all stillbirths occurring in Safdarjung Hospital from August 2015 to December 2018. Verbal autopsies were done, and thorough antenatal records were documented and analyzed. Results: Out of 1,09,578 deliveries, 2,689 were stillbirths (2.4%). Among these, 1,583 (58.9%) were unsupervised and unbooked pregnancies, whereas 1,106 (41.1%) pregnancies were supervised and booked. Significantly lower percentage of patients in unbooked pregnancies had iron–folic acid intake; significantly higher percentage of mothers had anemia, hypertension, diabetes, and antepartum hemorrhage compared with booked pregnancies. Among antepartum causes, hypertension (23.4%), abruption (18.5%), and infection (3.4%) were the leading causes for stillbirths. Intrapartum causes constituted 39% of total stillbirths; a higher percentage was in the unbooked pregnancies. Approximately, 89% of patients with stillbirth had delayed seeking of healthcare facility. Conclusion: The most common cause of stillbirth was hypertensive disorders of pregnancy followed by abruptio placentae in this cohort. Various maternal-related factors are significantly higher in unbooked pregnancies. Reducing these factors might reduce the prevalence of stillbirth.

231

Original Article

Bharat Talukdar, Deepjyoti Kalita, Sangita Deka

Prevalence and Its Antibacterial Susceptibility Pattern of Asymptomatic Bacteriuria in Pregnancy of a Teaching Hospital

[Year:2024] [Month:May-June] [Volume:16] [Number:3] [Pages:4] [Pages No:219 - 222]

Keywords: Antibiotic sensitivity, Asymptomatic bacteriuria, Pregnancy, Urine culture

   DOI: 10.5005/jp-journals-10006-2406  |  Open Access |  How to cite  | 

Abstract

Objective: The aim of this study was to evaluate the prevalence and risk factors of asymptomatic bacteriuria (ASB) to identify commonest microorganisms and their antimicrobial susceptibility in pregnant women. Materials and methods: A total of 230 healthy pregnant women who attended antenatal out patient department for first visit were evaluated for bacteriuria. Results: The prevalence of ASB in pregnant women was 10%. Demographic and obstetric parameters did not significantly influence the prevalence of ASB except in rural dwelling (χ2 = 4.454, p = 0.0348). The dominant bacteria were Escherichia coli (52.17%). Uropathogens were highly sensitive to imipenem and aminoglycosides and less sensitive to nalidixic acid, ampicillin, amoxicillin, and cotrimoxazole. Conclusion: There is a high prevalence of ASB among pregnant women in the study. With the exception of rural dwelling, demographic and obstetric parameters did not significantly influence the risk of ASB. Therefore, routine ASB screening among pregnant women is suggested in our environment.

219

Original Article

Indrani Dutta, Atima Bharti

Study on Changes in Contraceptive Behavior during COVID-19 Pandemic in a Tertiary Care Hospital of Jharkhand

[Year:2024] [Month:May-June] [Volume:16] [Number:3] [Pages:4] [Pages No:223 - 226]

Keywords: Barriers, Challenges, Contraceptive, COVID-19, Pandemic

   DOI: 10.5005/jp-journals-10006-2412  |  Open Access |  How to cite  | 

Abstract

Background: The COVID-19 pandemic had widespread impact namely lockdown, movement restrictions, and limited availability of services. This led to tremendous change in people's decision and changed behavior toward contraceptive access and usage. This study was conducted at Rajendra Institute of Health Sciences, Ranchi to assess the changes in contraceptive behavior during first wave of COVID-19 pandemic. Aims and objectives: To study changes in contraceptive behavior during first wave of COVID-19 Pandemic in a Tertiary Care Hospital of Jharkhand and assess contraceptive preference and acceptance in women during COVID-19 pandemic. Results: A total of 370 participants were included in this study. Participants from different age groups were found in this study ranging from <20 years to ≥40 years. Most respondents belonged to age group 30–39 years (43.24%). Respondents were mostly graduates 160 (43.24%). Yearly income of most respondents (43.24%) was approximately rupees 20,000–50,000. Non tribals were more in number in our study (70.27%) than tribal population (29.72%). Most respondents (59.45%) had lack of money to go to health facility, 29.72% faced lack of transportation, 21.62% had no companion to accompany them to facility, 18.91% reported that clinics had closed during lockdown and 16.21% feared that they would get COVID infection if they stepped out of their homes. There were respondents who despite lockdown tried to get contraceptive advise, but faced several challenges. Approximately 32.43% could not get prescription for an old method, 24.32% could not get DMPA injection, 21.62% could not get IUCD removed, 18.91% could not start a new method, and 16.21% could not get medical abortion when they wished. Conclusion: Understanding the impact of the COVID-19 pandemic on contraceptive care experiences, use and decision making can lead to interventions in mitigating adverse effects on sexual and reproductive health outcomes. Also, contraceptive decision making should be choice of women solely and not influenced by family or male partner. Clinical significance: COVID-19 pandemic was an eye opener for the entire world. It has made us think that contraceptive choices, availability, and healthcare of women in general takes a back seat whenever there are situations which disturb the infrastructure of the society and country in general. Hence, steps should be taken so that healthcare is not compromised at any situation, so that women are empowered to avail contraceptive and healthcare facilities without any barriers or challenges.

132

Original Article

Poojashree Kaje, Bharti Singh, Kameshwarachari Pushpalatha, Ayush Gupta

Evaluation of Endocervical Microbial Colonization in Premature Rupture of Membranes and Pregnancy Outcomes: A Cross-sectional Observational Study

[Year:2024] [Month:May-June] [Volume:16] [Number:3] [Pages:6] [Pages No:227 - 232]

Keywords: Antibiotic sensitivity, Maternal morbidity, Neonatal morbidity, Premature rupture of membranes, Preterm premature rupture of membranes, Treatment protocol, Vaginal microbiota

   DOI: 10.5005/jp-journals-10006-2417  |  Open Access |  How to cite  | 

Abstract

Objective: Premature rupture of membranes (PROMs) is one of the common causes of preterm birth which has a major contribution to maternal and fetal adverse outcomes. Infection may be contributing to premature rupture of membrane or it may be a consequence. The aim of our study was to assess the common pathogens colonizing the endocervix in women with PROM and pregnancy outcomes. Materials and methods: In this prospective observational study, seventy antenatal women with PROM after 24 weeks of gestation were studied from January 2020 to July 2021. Two swabs were taken from the endocervix. Swabs were subjected to gram staining and culture. The association of endocervical culture positivity with chorioamnionitis, mode of delivery, and neonatal outcome was evaluated. Results: In the study, 24.2% of endocervical cultures were positive. The pathogens isolated were Escherichia coli in 11.4%, Staphylococcus hemolyticus in 2.9%, budding yeast in 2.9%, 1.4% each with Klebsiella pneumoniae and Methicillin-resistant Staphylococcus aureus (MRSA). The culture was positive in 30.3% of subjects with preterm PROM and 18.9% with PROM (p = 0.40). The incidence of chorioamnionitis was higher with endocervical culture-positive cases as compared to culture-negative women (p = 0.05). There was no association of endocervical culture positivity with the neonatal intensive care unit (NICU) admission, duration of membrane rupture, and mode of delivery. Conclusion: In our study, the most common bacteria inhabiting the endocervix in PROM was E. coli. There is a definite influence of bacterial endocervical colonization on pregnancy outcomes but further studies are needed to corroborate the findings.

215

Original Article

Krishna Priya Leela, Poornima Chinnappa, Poorani Devi, Anuja S Panicker, Ramya Thangavelu, Keerthiga Jothimani

A Prospective Study to Evaluate the Psychosocial Effects of COVID-19 on Antenatal and Postnatal Women in a Tertiary Care Hospital in South India

[Year:2024] [Month:May-June] [Volume:16] [Number:3] [Pages:6] [Pages No:233 - 238]

Keywords: Coronavirus disease-19, Patient preference, Patient safety, Questionnaires, Surveys

   DOI: 10.5005/jp-journals-10006-2418  |  Open Access |  How to cite  | 

Abstract

Aim and background: Pandemics are known to have effects on the mental health of the populace. Studies on the effect of coronavirus disease-19 (COVID-19) on the general population have brought out the psychological effects of the pandemic. However, the psychosocial impact of COVID-19 on pregnant and postnatal women has not been assessed. The study aimed was to assess the level of psychosocial stress in postnatal and antenatal women during the pandemic and its association of various sociodemographic and pregnancy-related factors with high fear of COVID-19 scores. Materials and methods: This cross-sectional study included antenatal and post-natal women attending the outpatient clinic. Patients were given questionnaires to document the sociodemographic details, pregnancy-related fear during a pandemic, and fear of COVID-19 scale. Results: A total of 648 women participated in the study. Among the stressors assessed, better support from the partner (n = 623), satisfactory interaction with healthcare workers (n = 627), and lower social deprivation (n = 371) was reported; the participants denied domestic abuse (n = 574) or fear of infecting the newborn (n = 482). Positive associations were observed between high fear of COVID-19 scores and sociodemographic factors like low-income status (p = 0.026), domestic abuse during lockdown (p = 0.0034), difficulty in getting together with family and friends (p = 0.0001), and adverse effect on the financial status of the family (p = 0.0008), difficulty in transport to the hospital (p = 0.007) and fear of the newborn getting affected (p = 0.0002). Conclusion: COVID-19 did not appear to negatively affect the mental health of pregnant and postnatal women or factors assessed in the present study. A high anxiety score was associated with increased anxiety and stress related to COVID-19. Clinical significance: This prospective study provides a basic idea of different risk factors that could affect psychosocial stress in antenatal and postpartum women. The study also emphasizes the importance of support from partners and interactions with healthcare workers to improve the psychosocial status of pregnant and postnatal women.

159

Original Article

Kshama Hinchigeri, Kamal P Patil, Ankita Patil, Mrityunjay C Metgud

Injection Tranexamic Acid in Preventing Postpartum Hemorrhage Following Vaginal Delivery: A One-year Hospital-based Randomized Placebo-controlled Trial

[Year:2024] [Month:May-June] [Volume:16] [Number:3] [Pages:4] [Pages No:239 - 242]

Keywords: Adverse effects, Blood loss, Postpartum hemorrhage, Tranexamic acid, Uterotonics

   DOI: 10.5005/jp-journals-10006-2413  |  Open Access |  How to cite  | 

Abstract

Introduction: Tranexamic acid (TXA) injections, known for their antifibrinolytic properties, are gaining wider acceptance as a treatment for postpartum hemorrhage (PPH) on a global scale. Aims and objectives: The purpose of this study was to evaluate the effectiveness of TXA and its potential side effects in preventing PPH following vaginal birth. Materials and methods: This randomized controlled trial, conducted in a multispecialty hospital in Belagavi, India, involved 210 term patients over 1 year from January to December 2019. Subjects were randomly assigned into two cohorts using computer-based randomization. Each cohort received 10 prophylactic units of oxytocin. One group received 1 gm of intravenous TXA, while the other received 10 mL of normal saline intravenously within 2 minutes after delivery. Blood loss was measured using calibrated drapes, and mean changes in hemoglobin (Hb) and packed cell volume (PCV) were assessed from pre-delivery to postnatal day 2. Data assessment was carried out using the statistical program R i386 3.6.3. Results: Patients in the research had an average age of 23.43 years with a standard deviation (SD) of 3.26 years. The occurrence of PPH was observed in 5 individuals (4.85%) in the TXA group and 12 individuals (11.21%) in the placebo group (p = 0.0912). Furthermore, the mean blood loss was significantly lesser in the TXA group, measuring 250.10 mL with an SD of 133.54 mL, compared to 334.2 mL with an SD of 141.78 mL in the placebo group (p < 0.0001). Conclusion: Tranexamic acid can serve as a supplementary treatment alongside uterotonics during the third stage of labor, given its demonstrated clinical effectiveness and safety in preventing PPH.

471

Original Article

G Umamaheswari, Lalitha Natarajan, Tadury M Subbarao, V Chaitra, S Lathamaheswari, T Ramya, Poornima

Placental Pathology in Correlation with Inflammatory Markers and Perinatal Outcomes in Maternal COVID: A Prospective Study

[Year:2024] [Month:May-June] [Volume:16] [Number:3] [Pages:9] [Pages No:243 - 251]

Keywords: Coronavirus disease-19 infection, Gestation at infection, Inflammatory markers, Perinatal outcome, Placental pathology

   DOI: 10.5005/jp-journals-10006-2426  |  Open Access |  How to cite  | 

Abstract

Aim: The purpose of this study is to analyze the morphological findings in the placenta of coronavirus disease-2019 (COVID-19)-positive women in correlation with the severity of infection, elevated inflammatory markers, gestational age at diagnosis and perinatal outcomes. Materials and methods: This is a prospective observational study of 66 singleton placentas of COVID-positive pregnant women over a period of 18 months. Clinical details, inflammatory markers, and perinatal outcomes were collected and analyzed in correlation with placental morphology. Results: Out of 66 pregnancies, 57 (86.3%) culminated in live births, of which 23 (40%) were small for gestation (SGA). Out of 66 cases, 9 (13.7%) experienced complications involving fetal demise intrauterine fetal death (IUFD). Based on the increase in inflammatory markers and gestational age at infection, the pregnancies were analyzed with regard to fetal outcome. Out of 66 pregnancies, 26 (39.4%) had moderate to marked elevation of two or more inflammatory markers. Fetal outcomes in these pregnancies were IUFD (34.6%), SGA (34.6%), appropriate for gestation (AGA) (26.9%) and neonatal death (ND) (3.8%). In women with elevated markers, 20% fetal or neonatal mortality was noted when the infection occurred in the third trimester whereas it was 100% when the infection occurred in the second trimester. All pregnancies affected in the third trimester and without an increase in markers (n = 40) resulted in live birth. The most significant placental finding observed was chronic inflammatory pathology (80%), followed by maternal vascular malperfusion (MVM) with or without fetal vascular malperfusion (FVM) (75.7%), and massive perivillous fibrin deposition (MPVFD) (12%). Conclusion: This study reemphasizes that in maternal COVID, the gestational age at infection, elevated inflammatory markers and severity of placental lesions could explain the perinatal outcomes.

120

Original Article

Aditi Mollera Singh, Joshua Jacob Mathew, Jyothi G Seshadri

Awareness and Practice of Breast Self-examination for Early Detection of Breast Lesions in Pregnant Women

[Year:2024] [Month:May-June] [Volume:16] [Number:3] [Pages:6] [Pages No:252 - 257]

Keywords: Awareness, Breast cancer, Breast self-examination, Practice pregnancy

   DOI: 10.5005/jp-journals-10006-2422  |  Open Access |  How to cite  | 

Abstract

Aim and background: Breast cancer stands out as the most commonly identified cancer among women in the majority of countries globally and is the second most common malignancy affecting pregnancy. Utilizing breast self-examination (BSE) emerges as a valuable screening technique for women that enhances awareness of their breast health, and aids in the detection of any abnormalities that may arise. While BSE is not a substitute for professional screening methods like mammography, it serves as a valuable complement especially in economically challenged areas, contributing to early diagnosis and increased chances of successful treatment. This study aims to assess the awareness and practice of BSE, as well as the sociodemographic factors affecting them, among pregnant women from rural and urban areas of Bengaluru. Materials and methods: Place of study—Obstetrics and Gynecology and Outpatient Departments (OBG and OPD) of Ramaiah Hospitals and its Rural Centers. Patients were asked to fill out a semi-structured questionnaire, after which BSE was taught and assessed. Results: A total of 100 subjects from rural and urban localities each took part in this study. Out of which, 7% from rural areas and 45% from urban areas were aware of BSE. A total of 5% and 44% respectively from rural and urban areas knew why BSE was done. The most significant sociodemographic factor was education—in rural areas, awareness of BSE was 4.4% among those with a higher secondary education, compared to 28.6% for degree holders and 33.3% for post-graduates. Similarly, in urban areas, only 28.1% of higher secondary level subjects were aware of BSE, in contrast to 48.8% of degree holders and 59.3% of post-graduates. Conclusion: There is a notably low level of understanding and practice of BSE among pregnant women, especially in rural areas. It is crucial to promptly establish extensive health education programs to raise awareness and knowledge regarding the importance of BSE.

165

REVIEW ARTICLE

Sanjoy Kumar Bhattacharyya, Dipnarayan Sarkar, Subhadeep Basak, Rumina Bagchi, Prithwikar Mandal, Alapan Halder

Magnesium Sulphate Prophylaxis in Severe Preeclampsia-lessons Learnt from Recent Trials Conducted in Low-Middle-Income-Countries: A Systematic Review

[Year:2024] [Month:May-June] [Volume:16] [Number:3] [Pages:12] [Pages No:258 - 269]

Keywords: Eclampsia, Low dose, Magnesium sulphate, Preeclampsia, Prophylaxis

   DOI: 10.5005/jp-journals-10006-2383  |  Open Access |  How to cite  | 

Abstract

Aim and background: Searching is ongoing to find an alternative prophylactic magnesium sulphate regimen for severe preeclampsia despite 24 hours recommendation of the World Health Organization (WHO). This review finds the provision of any such substitute prophylactic instead of the recommended ones searching through the recently published trials. Objectives: To endorse any alternative prophylactic magnesium sulphate regimen effective for severe preeclampsia. Methods: Data sources: Studies are retrieved from the bibliographic databases of PubMed, Scopus, and Cochrane Library. Eligibility Criteria, Participants, and Interventions: Included studies are recently published trials intended to compare the efficacy of different modified regimens of magnesium sulphate prophylaxis for women with severe preeclampsia in contrast to the standard regimen. Results: Out of a total of fifteen, eight studies evaluated different abbreviated regimens of magnesium sulphate prophylaxis. A lower maintenance dose of magnesium sulphate as preeclampsia-prophylaxis was assessed by two. In addition, four studies evaluated the efficacy of only loading doses of magnesium sulphate as prophylaxis. Finally, one study estimated a placebo in the postpartum period compared to the standard regimen. No incidence of eclampsia was reported in any group of eight studies. Even in the rest seven studies, eclampsia incidences did not appear significantly higher in the study group allocated for either abbreviated or low dose or loading-dose regimens. However, a statistically significant number of women in the study groups needed extension/reinstitution of prophylaxis. Low-dose and loading dose prophylaxis are found unsuitable for a recommendation. Apart from the established safety potential, abbreviated/short-course prophylaxes of magnesium sulphate have been found to generate different secondary benefits. Conclusions: The abbreviated postpartum regimen of magnesium sulphate can be recommended as prophylaxis for severe preeclampsia instead of recommended schedule if applied judicially.

289

REVIEW ARTICLE

Ojas V Bondre, Anuja Bhalerao, Risha Patel

Vertical Maternal Positions during Parturition in the Second Stage of Labor: A Scoping Review

[Year:2024] [Month:May-June] [Volume:16] [Number:3] [Pages:4] [Pages No:270 - 273]

Keywords: Blood loss, Labor stage second, Parturition, Perineal trauma, Upright birthing positions

   DOI: 10.5005/jp-journals-10006-2404  |  Open Access |  How to cite  | 

Abstract

The comfort level of the laboring mother is greatly affected by her choice of delivery position. The fact that giving birth is often difficult has a profound effect on women's satisfaction with both the experience itself and the care they get. Different birthing positions are available to a pregnant woman at the time of delivery. Currently, most births occur with the mother resting on her back or sitting up in an almost-seated position. Birthing in an upright posture is less common than lying on one's side, on one's back, or on one's hands and knees. The optimal posture for women to be in during the second stage of labor is not well supported by research. The purpose of this article was to assess the level of knowledge about various birthing positions among pregnant women and to evaluate the benefits and hazards of the most frequently used birthing positions.

208

REVIEW ARTICLE

Veeraswamy Seshiah, Vijayam Balaji, Hema Divakar, Rajesh Jain, V Bhavatharani, Anjalakshi Chandrasekar

Diagnosing Gestational Diabetes by a Single Step Procedure and Care is a Propitious Step Towards Containing the Epidemic of Diabetes

[Year:2024] [Month:May-June] [Volume:16] [Number:3] [Pages:4] [Pages No:274 - 277]

Keywords: Hyperglycemia in pregnancy, Diabetes in pregnancy study group India, Gestational diabetes mellitus

   DOI: 10.5005/jp-journals-10006-2424  |  Open Access |  How to cite  | 

Abstract

The prevalence of diabetes is increasing globally, based on the data published in the International Diabetes Federation Atlas (IDF) 9th edition 2019. The data in the Atlas revealed an alarming increase in the prevalence of type 2 diabetes in the world from 463 million in 2019 to 700 million in 2045, a 51% increase. While several reasons are ascribed for this rising trend including aging population, urbanization, genetic predisposition, nutrition and lifestyle transition, etc. One factor that has not received adequate attention is glucose intolerance that occurs during pregnancy, gestational diabetes mellitus (GDM). Gestational diabetes mellitus is defined as carbohydrates intolerance of varying degrees of severity with the onset or first recognition during pregnancy. The diagnosis of GDM has implication beyond the index pregnancy in that women with GDM are at increased risk of future diabetes, predominantly type 2 DM as are their offsprings. Gestational diabetes mellitus may play a crucial role in the increasing prevalence of diabetes and obesity. It is prudent to evaluate the preventive strategies for GDM management in terms of cost-effectiveness and disabilities averted by preventing complication of GDM.

90

REVIEW ARTICLE

Naina P Gupta, Arpita Jaiswal

Levothyroxine Therapy: Its Effect on Subclinical Hypothyroidism

[Year:2024] [Month:May-June] [Volume:16] [Number:3] [Pages:4] [Pages No:278 - 281]

Keywords: Levothyroxine, Pregnancy, Subclinical hypothyroidism

   DOI: 10.5005/jp-journals-10006-2405  |  Open Access |  How to cite  | 

Abstract

Thyroid hormones are necessary for the desired development and growth of the fetus. There is an essential correlation between thyroid dysfunction in mothers and cognition in children; maternal hypothyroidism also affects reproductive functions, including fertility, abortions, and preterm birth. Due to regular changes in the metabolism of thyroid hormone and thyroid function, trimester-wise thyroid-stimulating hormone (TSH) levels and free thyroxine should be estimated. However, due to variations in age, ethnicity, and iodine intake, it is restricted to one population, which can be misleading to diagnose a euthyroid woman as a patient of hypothyroidism. Therapeutic benefits of levothyroxine remain unclear; however, when an intervention was made during the first trimester, it indicated a reduction of abortions and preterm delivery in women. The harmful effects of treatment with levothyroxine include hypertension, diabetes in pregnancy, and preeclampsia. Intervention with levothyroxine in the second trimester is of no use in reducing cognitive impairment. Thus, routine screening of subclinical hypothyroidism should be performed in all pregnant women to prevent its complications. Intervention with levothyroxine depends on the TSH levels, which vary according to trimester. Hence, the benefits of levothyroxine therapy depend upon the timing of intervention, change in the requirement of thyroxine during pregnancy, and alteration of dose of levothyroxine as required following delivery.

200

REVIEW ARTICLE

Ruchika Garg, Prabhat Agrawal, Prashant Gupta, Kavita Chaudhary

Diagnosing Osteoporosis at Menopause: Options Available Apart from DEXA

[Year:2024] [Month:May-June] [Volume:16] [Number:3] [Pages:3] [Pages No:282 - 284]

Keywords: Bone, Osteoporosis, Quantitative computed tomography, Trabecular bone score

   DOI: 10.5005/jp-journals-10006-2414  |  Open Access |  How to cite  | 

Abstract

Bone resistance to fractures is helped by micro and macrostructures, bone marrow density (BMD), and adjacent tissues (e.g., cartilages, muscles). Such complementary factors shall be analyzed when BMD alone does not explain increased fracture risk (e.g., the presence of desmophytes in the vertebral column). Initial evaluation of fracture risk can be carried out automatically based on a single abdomen or chest computed tomography (CT) when FRAX without BMD is not available. As CT has high radiation exposure risk and cost concerns opportunistic screening of osteoporosis can be done when CT is done for other health conditions (from chest, abdomen, pelvis, and spine). Trabecular bone score (TBS) can assess patients with osteophytes as osteophytes lead to inaccurate BMD measurements. Trabecular bone score and quantitative ultrasound assess different characteristics of bones. Magnetic resonance imaging (MRI) may allow the identification of patients with fracture risk not detected by DXA.

294

REVIEW ARTICLE

Srinidhi Rai, Priya Alva, Sriram Naresh

Nurturing the Mind from Within: Exploring the Role of Gut–Microbiota–Brain Axis in Postpartum Depression

[Year:2024] [Month:May-June] [Volume:16] [Number:3] [Pages:4] [Pages No:285 - 288]

Keywords: Postpartum depression, Psychology, Screening

   DOI: 10.5005/jp-journals-10006-2411  |  Open Access |  How to cite  | 

Abstract

The pathophysiology of postpartum depression (PPD) mostly involves disruptions of the immunological system, gut microbiota, neurotransmitters, hormone production, and neuroendocrine regulation. This review explores the reciprocal exchange of signals along the gut–brain axis, with a particular emphasis on the role that gut microorganisms play in neurotransmitter synthesis, precursor generation, and the secretion of vital metabolites, thus unravelling the complex interactions of the microbiota–gut–brain axis to pave a better understanding of microbiota-mediated pathogenesis, avenues for therapeutic possibilities leveraging microbiota–gut–brain axis modulations.

216

REVIEW ARTICLE

Nicole Lopez Diaz, Jhaneiza Matos Canchanya, Diana Matos Quispe, Leslie Martinez Herrera, Alejandra Lopez-Vera, Patricia Llecllish Zarate, Kleider Livias-Moya

Dysfunction and Sexual Self-concept in Infertile Women: A Narrative Review

[Year:2024] [Month:May-June] [Volume:16] [Number:3] [Pages:4] [Pages No:289 - 292]

Keywords: Female sexual dysfunction, Infertility, Self-concept, Women

   DOI: 10.5005/jp-journals-10006-2419  |  Open Access |  How to cite  | 

Abstract

Aim: To summarize the scientific evidence on sexual dysfunction and self-concept in infertile women. Methods: We conducted a theoretical review of articles in PubMed on sexual dysfunction and self-concept in infertile women. The search was carried out using a strategy based on MeSH terms and Boolean operators, which identified 47 articles. The selection of articles was done independently, according to the selection criteria, and finally four articles were included. Results: The review showed results indicating that adequate self-concept positively influences sexual functioning and its domains. Studies agree that infertility negatively affects sexual function, and that sexual function plays an important role in depression and quality of life. Sexual self-concept in infertile women represents a fundamental aspect of improving their psychosocial well-being. Conclusion: Infertility generates a significant impact on health. Specifically, research has demonstrated that sexual dysfunction is a prevalent issue among women with this condition. Furthermore, studies have indicated a relationship between sexual dysfunction and the sexual self- concept of these women.

241

REVIEW ARTICLE

JM Seno Adjie, I Putu Gede Kayika, Arietta Pusponegoro, Bonifasius, Teresa C Rosari, Janice Priscilla, Khansa Qonitah

The Relationship between Breastfeeding Practices and Support with Severity of Postpartum Depression: A Systematic Review and Meta-analysis

[Year:2024] [Month:May-June] [Volume:16] [Number:3] [Pages:10] [Pages No:293 - 302]

Keywords: Breastfeeding practice, Breastfeeding support, Postpartum depression, Systematic review, Meta-analysis

   DOI: 10.5005/jp-journals-10006-2425  |  Open Access |  How to cite  | 

Abstract

Introduction: Some evidence indicates that breastfeeding could offer protection in case of postnatal depression and support recovery from symptoms. This study investigates the relationship to identify which practices and forms of support prove beneficial. Materials and methods: Literature search was carried out in databases, such as Cochrane, EBSCOhost, EMBASE, ProQuest, PubMed, and Science Direct from 2013 to recent years. The criteria for inclusion are: (1) Randomized controlled trial or observational studies; (2) Study population, postpartum women at risk or having symptoms of postpartum depression (PPD); (3) Intervention, breastfeeding practice or breastfeeding support; (4) Comparison, women without breastfeeding practices or breastfeeding support; (5) Outcome, severity of PPD. Results: Nineteen studies were included in this review; 5 studies about breastfeeding practices and 14 studies about breastfeeding support. These studies were conducted in 11 countries, included a total of 79,303 participants. Breastfeeding exclusivity, duration, satisfaction, and early initiation contributed to the reduction of PPD severity. Breastfeeding educational (MD = –0.59 [95% CI, –0.62, –0.56]; p < 0.01), psychosocial (MD = –2.85 [95% CI, –4.03, –1.68]; p < 0.01; I2 = 0%), and medication support (MD –1.66 [95% CI, –2.48, –0.83], p = 0.38; I2 = 0%) reduced the severity of PPD. Moreover, educational support also decreases the risk of developing PPD (RR 0.84 [95% CI, 0.71–1.00], p = 0.05; I2 = 20%). Conclusion: Breastfeeding practices have been shown to diminish the grading of PPD and serve as a preventive measure against the risk of depressive symptoms throughout the postpartum period. Additionally, breastfeeding support has been found to alleviate the severity of postnatal depression. It is worth noting that psychosocial support is recommended in this regard, further underscoring the importance of holistic support systems for new mothers. Therefore, early initiation of exclusive breastfeeding and maintaining mother satisfaction are beneficial to be encouraged and educated since pregnancy. Clinical significance: Breastfeeding has a vital role in reducing the severity of PPD and preventing the symptoms after childbirth. Supporting mothers through education and encouragement to start breastfeeding since pregnancy proves the importance of providing holistic care for mothers.

305

CASE SERIES

Ruby Bhatia, Kaveripatti K Aishwarya, Sukhbir P Kaur, Rahul Kalyanam

Case Series on Abnormal Low-lying Implantation of Ectopic Pregnancy: A Diagnostic and Management Dilemma

[Year:2024] [Month:May-June] [Volume:16] [Number:3] [Pages:6] [Pages No:303 - 308]

Keywords: Cesarean scar ectopic pregnancy, Diagnosis of ectopic pregnancy, Emergency peripartum hysterectomy, Low-lying implantation of ectopic pregnancy, Obstetric emergency

   DOI: 10.5005/jp-journals-10006-2407  |  Open Access |  How to cite  | 

Abstract

Introduction: Ectopic pregnancy occurs when implantation of a blastocyst takes place in a site other than the endometrium of the uterine cavity. Cesarean scar (CS) site ectopic has an incidence of 1 in 1,800, which occurs when a blastocyst implants in the anterior lower uterine segment at the site of the CS. Here we report a series of four rare cases of low-lying implantation ectopic pregnancy (LLIEP) and different treatment modalities performed in such scenarios. Case 1: A 28-year-old P2L2A1 presented to the emergency obstetrical unit with complaints of bleeding per vagina for 15 days. She provided a history of medical termination of pregnancy (MTP) pill intake at 1 month of gestation, followed by bleeding per vagina for 1 week. Dilatation and curettage were done on a private hospital patient, after which she continued to bleed for 10–12 days, associated with the passage of clots. Per abdomen examination, uterus was 12–14 weeks old, soft, non-tense, and non-tender. On p/s examination, 20-cc foul-smelling, blood-stained discharge was noted. The uterus was 12 weeks old, anteverted, tender, and mobile. A mass of 10 × 7 × 6 cm was felt in the anterior fornix, not separate from the uterus, extending into the right fornix. No fullness felt in the pouch of Douglas. Investigations: Hb-6.9 g/dL, Beta HCG-1250 IU/mL. A provisional diagnosis of septic incomplete abortion with severe anemia from two previous cesarean deliveries was made. Ultrasound revealed large vascular retained products of conceptions (RPOCs), but the exact location of RPOCs was not identified. Anterior myometrial wall thinning was noted. The patient was taken up for diagnostic laparoscopy with suction and evacuation under general anesthesia. On laparoscopy, dense adhesions are seen between the anterior abdominal walls, omentum, and anterior surface of the uterus until the fundus. The left side of the uterus could not be seen due to adhesions. Under vision suction, evacuation was started. There was torrential hemorrhage per vaginam. A decision for an emergency laparotomy was taken. A typical hourglass appearance of the uterus is noted. A small, non-pregnant firm fundus sits over the top of a large 10 × 8 × 7 cm lower uterine segment and a profusely thinned-out anterior wall. Myometrium was deficient on the anterior surface of the lower segment. Only the serosal layer was identified, through which products of conception were seen. A diagnosis of low-lying implantation of pregnancy was made. Cauliflower-shaped fungating growth was visualized after the serosal layer gave away. A lifesaving hysterectomy was done due to torrential bleeding. A cut section showed a non-pregnant fundus with a ballooned-out cervix. Histopathology confirmed the diagnosis of LIEEP. A total of six units of packed red cells and four frozen plasmas were transfused, and the patient was a maternal near-miss later discharged on day 7. Case 2: A 28-year-old G3P2L2 patient who had two previous lower segment cesarean section (LSCS) presented to us post-self-MTP pill intake with spotting pv at 9+5 weeks of gestation. Ultrasound revealed a type 1 CS ectopic pregnancy with a crown-rump length corresponding to 7+3 weeks and evidence of a fetal pole without cardiac activity in the lower uterine segment. β-hCG levels are 52,540 IU. Both medical and surgical options were explained to the patient, and she insisted on medical management. A multi-dose regimen of methotrexate was given, following which there was a significant fall in β-hCG levels. The patient came to the emergency room with torrential bleeding on day 19 in hypovolemic shock. Resuscitation and emergency lifesaving hysterectomy were done, and she was discharged on postoperative day 4. Case 3: A 37-year-old female G4P2L1A1 with 2 months of amenorrhea was referred in view of an ultrasound scan depicting pregnancy in the lower uterine segment with absent cardiac activity. Serum βhCG 6000 mIU/mL. Transvaginal sonography (TVS) depicted a gestational sac of diameter 12 mm in the lower uterine segment, eccentrically located in the anterior wall of the uterus, abutting the previous CS; the yolk sac and fetal pole were visualized; cardiac activity was absent; and a probable diagnosis of CS ectopic pregnancy was made. Medical management using a methotrexate regimen was chosen after informed consent, and 1 mg/kg (84 mg calculated dose) was administered intramuscularly on days 1, 3, 5, and 7 with folinic acid (0.1 mg/kg) on alternate days. Vital signs remained stable, and levels of βhCG declined. However, the patient's successive ultrasounds revealed an increase in MSD from 1.2 cm on day 0 to 1.7 cm on day 10, with the gestational sac protruding toward the endometrial cavity. Suction evacuation was done under ultrasound sonography (USG) guidance. At follow-up, βHCG was 36.1 and 1.4 mIU/mL after 1 and 2 weeks, respectively. Case 4: A 33-year-old, G3P2L2 31 weeks, presented with a complaint of bleeding per vaginam and fever since one day. The patient did not perceive fetal movements throughout the pregnancy. Ultrasonography done 2 days back depicted an intrauterine death at 20 weeks gestation. On per abdomen examination the uterus was 20 weeks, non tense, non tender and with no fetal heart sound. os was closed, cervix posterior, and uneffaced. A bedside ultrasonography reconfirmed intrauterine death at 20 weeks gestation. The lower uterine segment was distended, with the fetus primarily in the lower uterine segment. Cervical ripening and induction were done with dinoprostone gel 0.5 mg eight hourly for three doses, to which there was no response. On repeat examination, the cervix was high up, 10–20% effaced, loose hanging, 3 cm dilated, and the presenting part felt with the tip of the finger, which was soft placenta. The patient was taken up for a Cesarean section. There was a typical hourglass appearance of the uterus; an empty upper segment of the uterus was sitting on top of an overly distended Couvelaire lower uterine segment. A dead fetus of 20 weeks gestation was lying transversely in the leaves of the left broad ligament, while a separated placenta was lying in the lower uterine segment. The tissues were foul-smelling. A peripartum hysterectomy with repair of a broad ligament hematoma was done. Massive blood transfusions and intensive care unit (ICU) for 24 hours were given. The patient was discharged on POD 11. Low-lying implantation of ectopic pregnancy is a life-threatening cause of maternal morbidity and mortality. Currently, there are increasing trends in the incidence of LLIEP due to clinical suspicion and better diagnostic modalities. TVS, Color Doppler, and magnetic resonance imaging (MRI) remain gold standard modalities for the early diagnosis of LLIEP. Failure or delay in diagnosing it will lead to catastrophic complications, which can cause obstetric emergencies.

208

CASE REPORT

Shrutika S Khapre, Deepti Shrivastava, Mangesh D Hivre

Endometrial Receptivity Array—A Promising Remedy for Women Afflicted with Recurrent Implantation Failure: A Case Report

[Year:2024] [Month:May-June] [Volume:16] [Number:3] [Pages:4] [Pages No:309 - 312]

Keywords: Case report, Endometrial receptivity array, In vitro fertilization, Personalized embryo transfer, Recurrent implantation failure, Window of implantation

   DOI: 10.5005/jp-journals-10006-2410  |  Open Access |  How to cite  | 

Abstract

Aim and background: An endometrial receptivity array (ERA) is a test for assessing the endometrium's gene expression profile concerning receptivity for embryo implantation. The primary significance of the ERA test is its ability to objectively assess the window of implantation (WOI), thereby facilitating the development of the personalized embryo transfer (pET) concept. Case description: A patient, aged 38 years, married for 16 years, a case of secondary infertility, had three unsuccessful attempts of intrauterine insemination and six unsuccessful attempts of In vitro fertilization (IVF). Given her history of recurrent implantation failures (RIF), she underwent the ERA test. The ERA indicated a pre-receptive result. She conceived in the very first attempt of ERA-guided pET. The patient delivered a female child at 34 weeks by a lower segment cesarean section. Conclusion: The ERA test accurately and sensitively identifies endometrial gene expressions, enabling the decision of the most suitable time for embryo transfer. Clinical significance: In vitro fertilization success rates could rise if the endometrial factor were personalized using an objective and reproducible diagnostic method like ERA in RIF patients.

219

CASE REPORT

Agniv Sarkar, Manoranjan Mahapatra, Jita Parija, Smruthisudha Pattnaik

A Case of Leiomyosarcoma of Vaginal Vault in a Post-hysterectomy Patient

[Year:2024] [Month:May-June] [Volume:16] [Number:3] [Pages:2] [Pages No:313 - 314]

Keywords: Case report, Leiomyosarcoma, Pelvic mass, Smooth muscle antigen-positive leiomyosarcoma, Spindle cell carcinoma

   DOI: 10.5005/jp-journals-10006-2032  |  Open Access |  How to cite  | 

Abstract

Leiomyosarcoma usually arises de novo from uterine smooth muscle, although it may rarely arise from a preexisting leiomyoma. They are usually accompanied by pain, sensation of pressure, and abnormal uterine bleeding (AUB). Rapid enlargement of fibroid or rapidly increasing pain may be a symptom too. In this case, a 62-year-old woman came to the outpatient department (OPD) with a complaint of pain abdomen for the last 3 months. She is (P2L2), post-menopausal for the last 12 years. She had a history of total abdominal hysterectomy (TAH) + bilateral salpingo-oophorectomy (BSO) 10 years back. On examination, she had a pelvic mass of 8 × 6 cm solid variegated. Outside, fine needle aspiration cytology (FNAC) report revealed it to be a spindle cell carcinoma. In our institute, tumor markers came out to be normal and contrast-enhanced computed tomography (CECT) imaging suggested a solid mass arising from vaginal vault. On laparotomy, a solid mass of 8 × 8 cm was found attached to the vaginal vault. All other organs were normal. Final holoprosencephaly (HPE) report came out to be leiomyosarcoma with immunohistochemistry (IHC) of smooth muscle antigen (SMA)-positive.

157

CASE REPORT

Jalormy Joshi, Amardeep Tembhare

Pregnancy with Cardiac Pacemaker: A Multidisciplinary Approach to Rare Case Management

[Year:2024] [Month:May-June] [Volume:16] [Number:3] [Pages:4] [Pages No:315 - 318]

Keywords: Case report, Multidisciplinary approach, Pacemaker, Pregnancy

   DOI: 10.5005/jp-journals-10006-2375  |  Open Access |  How to cite  | 

Abstract

Background: The prevalence of pregnant women arriving with pacemakers has increased due to advancements in pediatric cardiology and surgery. A multidisciplinary approach in the management of these patients leads to better maternal and perinatal outcomes. Case description: A 26 years term primigravida with labor pain since 3 hours presented to us. She has a history of permanent pacemaker in situ after ASD repair done 10 years back. She delivered a healthy child of 2.5 kg by LSCS and got discharged on 7th postoperative day in stable and satisfactory condition. Conclusion: Pregnant patient with pacemaker requires a multidisciplinary approach. A team of skilled obstetrician, cardiologist, and anesthesiologist is required. All patients with cardiovascular diseases need to be closely monitored during and after pregnancy and should return to their baseline cardiac status after postpartum.

320

CASE REPORT

Yash Bahuguna, Asmita Patil, Bhavna Trivedi

A Rare Case of Management of Pemphigus Vulgaris in Pregnancy and Newborn

[Year:2024] [Month:May-June] [Volume:16] [Number:3] [Pages:3] [Pages No:319 - 321]

Keywords: Antenatal care, Bad obstetrics history, Case report, Fetomaternal outcomes, High risk pregnancy, Neonatal pemphigus, Pemphigus vulgaris, Pregnancy

   DOI: 10.5005/jp-journals-10006-2415  |  Open Access |  How to cite  | 

Abstract

Pemphigus vulgaris (PV) is a rare autoimmune disorder that causes flaccid vesiculobullous lesions and erosions on the skin, with an annual incidence of 0.09–1.8% in India. Its occurrence during pregnancy is even rarer, with only 47 cases reported in the literature over a 49 years. The condition can worsen during the first and second trimesters and postpartum, with a phase of waning during the third trimester, which may be associated with endogenous corticosteroid secretion. The condition can affect various parts of the body, including pressure points, skin-to-skin contact areas, and oral and nasal mucosae. It can also lead to a transient benign form of neonatal lesions called pemphigus neonatorum due to transplacental transmission. Complications such as infertility and stillbirth can occur in women suffering from PV. This is a case of ART with IVF conception and managed successfully by our hospital, it was well-controlled with oral steroids and had an uneventful course in pregnancy, transient neonatal lesions also appeared after birth, which were managed successfully. Exacerbation postpartum was also seen but occurred due to non-compliance with corticosteroid therapy by the patient.

224

CASE REPORT

Vineet Mishra, Manisha Chhetry, Ketul Pathak, Sumesh Choudhary

Uterine Artery Embolization for Acquired Arteriovenous Malformation in Young Patients with Abnormal Uterine Bleeding: From Diagnosis to Management Asking the Right Questions! Insights from a Case Report

[Year:2024] [Month:May-June] [Volume:16] [Number:3] [Pages:3] [Pages No:322 - 324]

Keywords: Abnormal uterine bleeding, Arteriovenous malformation, Case report, Uterine artery embolization

   DOI: 10.5005/jp-journals-10006-2416  |  Open Access |  How to cite  | 

Abstract

Aim and background: Uterine arteriovenous malformation (AVM) is a rare cause of abnormal uterine bleeding (AUB) in young patients. The condition could be congenital or acquired following uterine trauma due to curettage, or uterine surgeries like myomectomy or cesarean section. Case description: Here we report a 29-year-old lady with previous two therapeutic curettages for missed abortions, who presented with recurrent AUB requiring multiple blood transfusions. Ultrasound and Doppler studies of the pelvis showed features consistent with AVM. The patient underwent angiography of the internal iliac and uterine arteries confirming the AVM on the right side. Successful embolization was performed using n-butyl cyanoacrylate and lipiodol mixture. The patient was discharged after 24 hours of the procedure and the bleeding was effectively controlled. Conclusion and clinical significance: Uterine AVM should be a differential in all young patients with AUB who have a history of uterine instrumentation and a negative pregnancy test. A high degree of clinical suspicion should be maintained to diagnose the condition. Uterine artery embolization is a viable option for acquired AVM in young patients with AUB.

195

CASE REPORT

Guramrit Kaur, Neethika Raghuwanshi

A Rare Manifestation of Giant Chorangioma with Brain Disorder

[Year:2024] [Month:May-June] [Volume:16] [Number:3] [Pages:5] [Pages No:325 - 329]

Keywords: Case report, Chorangioma, Hypoplasia, Placenta, Polyhydramnios, Preterm labor, Sigmoid sinus, Transverse sinus, Tumor

   DOI: 10.5005/jp-journals-10006-2421  |  Open Access |  How to cite  | 

Abstract

Background: Chorangioma are benign vascular tumors of the placenta that are nontrophoblastic in nature. The clinical importance of these tumors correlates with their size, with chorangioma larger than 4 cm being linked to complications for both the mother and the fetus. Case description: We present a rare case of 20-year-old primigravida female patient who presented to us at 35 weeks of gestation with a positive sickling test history and pain in the abdomen. Ultrasound showed a single live fetus with polyhydramnios, and a distinct hypoechoic lesion adjacent to the umbilical cord insertion site along the subchorionic plane of the placenta, suggestive of a chorangioma. Histopathological examination confirmed the placental chorangioma. The uniqueness of this case report lies in the presence of a hypoplastic left transverse sinus and sigmoid sinus following delivery without any fetal complications. However, such accidental diagnoses may cause a lot of complications during and after childbirth. Conclusion: It is crucial to implement routine and timely antenatal care to detect and manage potential complications effectively.

115

© Jaypee Brothers Medical Publishers (P) LTD.