Journal of South Asian Federation of Obstetrics and Gynaecology

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2024 | September-October | Volume 16 | Issue 5

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Editor's Desk

Editor's Desk

[Year:2024] [Month:September-October] [Volume:16] [Number:5] [Pages:1] [Pages No:iv - iv]

   DOI: 10.5005/jsafog-16-5-iv  |  Open Access | 

70

Guest Editorial

Sudha Sharma

Guest Editorial

[Year:2024] [Month:September-October] [Volume:16] [Number:5] [Pages:2] [Pages No:v - vi]

   DOI: 10.5005/jsafog-16-5-v  |  Open Access | 

88

LETTER TO THE EDITOR

Harsha S Gaikwad, Kashika Nagpal, Priyanka Ahuja, Pratima Mittal

Utility of ICD-PM Classification in Assigning Cause of Death in Stillbirths in a Tertiary Care Hospital in North India

[Year:2024] [Month:September-October] [Volume:16] [Number:5] [Pages:5] [Pages No:471 - 475]

Keywords: Classification, India, Stillbirths

   DOI: 10.5005/jp-journals-10006-2514  |  Open Access |  How to cite  | 

Abstract

Background and objectives: There are several classification systems in place to assign cause of death in stillbirths, but there is a lack of uniformity in these systems in providing complete information regarding the cause of stillbirths. Our objectives were: (1) To identify the causes of stillbirth by applying ICD-PM classification. (2) To study the risk factors compared to control cases responsible for stillbirth from the available data. Materials and methods: This was a prospective study conducted in a Tertiary Care Hospital from January 2021 to November 2021 in North India. There were 20,732 total deliveries during this period. A total of 1,495 stillbirths delivered in this period. Women who came with intrauterine fetal demise after 20 weeks of gestation and those who delivered a stillborn baby were included in the study. Women having a live birth served as controls. Antenatal and labor room records, as well as history given by the patient with stillbirths were recorded and critically analyzed. The data were recorded on the stillbirth review form approved by the World Health Organization (WHO) and were analyzed according to the ICD-PM classification. Results: The most common maternal cause of all stillbirths according to the ICD-PM classification in our study was M4 (33%). The most common fetal cause of antepartum stillbirths was A3 (31.93%). The most common fetal condition responsible for intrapartum stillbirths was I3 (55%).

146

RESEARCH ARTICLE

Priyankur Roy, Aditi Nadkarni, Laxmi Narayan Sahoo, Kalyani Singh, Ruchika Garg

Oral vs Vaginal Misoprostol for Medical Termination of Pregnancy

[Year:2024] [Month:September-October] [Volume:16] [Number:5] [Pages:3] [Pages No:476 - 478]

Keywords: Abortion, Medical termination of pregnancy, Misoprostol, Prostaglandin

   DOI: 10.5005/jp-journals-10006-2200  |  Open Access |  How to cite  | 

Abstract

Background: Considering the different available results on the effectiveness of various doses of misoprostol and methods of administration. The aim of this study was to compare oral and vaginal misoprostol for medical termination of pregnancy (MTP). Materials and methods: This randomized clinical trial study was performed on 140 pregnant women, who wanted MTP. Pregnant women were divided randomly into two groups – oral and vaginal misoprostol groups by simple sampling. Misoprostol 400 μg was given to both groups every 4 hours up to five times. The effectiveness of misoprostol (the excretion of gestation products) and its side effects (bleeding, fever, etc.) were studied in two groups. The data collection instrument was a questionnaire. Data were analyzed using SPSS (version 22 software). Results: The results showed that there were no statistically significant differences between the oral (82.3%) and vaginal (80%) misoprostol groups in terms of response to treatment. Although in our study, the need for curettage was higher in the vaginal group (42.8) than in the oral group (34.3), the difference was not statistically significant. The intervals between consuming oral misoprostol pills and the excretion of gestation products in the oral and vaginal groups were 4.09 ± 1.56 and 3.67 ± 1.4 hours, respectively. In terms of complications, only two cases of oral misoprostol group experienced complications. Conclusion: Although the risk of complications in the oral method and the need for curettage in vaginal group is high, the effectiveness of oral and vaginal misoprostol for MTP is similar.

212

RESEARCH ARTICLE

Purnima Upreti

Intrahepatic Cholestasis of Pregnancy and Fetomaternal Outcomes: A Retrospective Study from Uttarakhand, India

[Year:2024] [Month:September-October] [Volume:16] [Number:5] [Pages:7] [Pages No:479 - 485]

Keywords: Bile acid levels, Intrahepatic cholestasis of pregnancy, Meconium-stained liquor, Pregnancy outcomes, Serum ursodeoxycholic acid

   DOI: 10.5005/jp-journals-10006-2459  |  Open Access |  How to cite  | 

Abstract

Background: Intrahepatic cholestasis of pregnancy (ICP) is a late pregnancy disorder marked by generalized itching, elevated liver enzymes, and spontaneous resolution after delivery. Its origins are multifaceted, and its impact on fetomaternal health is noteworthy. However, research on ICP remains limited, especially in Uttarakhand. Aim: This study endeavors to investigate the occurrence, connections, and pregnancy results associated with ICP. Methods: Between July 2020 and June 2022, this retrospective descriptive study was conducted at a tertiary healthcare center in Uttarakhand, India. The study included pregnant women diagnosed with ICP, who met the specified inclusion criteria. Maternal and neonatal data were extracted from medical records and analyzed using SPSS version 23. Results: The study revealed an ICP incidence of 4.3%. Participants aged 26–30 years accounted for 49.5% of the sample, with 50.5% being primigravida. Generalized itching without rashes emerged as the most common symptom. Pre-eclampsia affected 10.9% of participants, and gestational diabetes affected 9.8%. The average period of gestation at delivery was 37 ± 1.2 weeks, with 36.9% of cases requiring induced labor. Cesarean section was performed in 33% of cases, and 22.3% exhibited meconium-stained liquor. Intrapartum fetal distress was observed in 13% of cases. Adverse neonatal outcomes included preterm birth (25.2%), low APGAR scores (7.2%), neonatal intensive care unit (NICU) admission (20.9%), and stillbirths (1.6%). Maternal serum bile acid levels showed a significant association with poor neonatal outcomes. Conclusion: Intrahepatic cholestasis of pregnancy carries increased risks of gestational diabetes mellitus and pre-eclampsia, along with higher rates of induction of labor and cesarean sections. Furthermore, it leads to adverse neonatal outcomes, strongly linked to levels of bile acids in the mother's serum. Clinical significance: The study highlights the significant association between levels of bile acids in the mother's serum and adverse neonatal outcomes. Monitoring maternal serum bile acid levels could predict poor neonatal outcomes and aid in the management of ICP-complicated pregnancies.

246

RESEARCH ARTICLE

Piyali Das, Dibyendu Roy, Satarupa Roy, Debanjan Sinha, Partha P Sharma, Shyamapada Pati

Ultrasonographic Assessment of Fetal Adrenal Gland Volume and Cervical Length in Term and Preterm Birth: A Comparative Prospective Observational Study

[Year:2024] [Month:September-October] [Volume:16] [Number:5] [Pages:5] [Pages No:486 - 490]

Keywords: Cervical length, Fetal adrenal gland volume, Term and preterm birth, 2D ultrasonography

   DOI: 10.5005/jp-journals-10006-2526  |  Open Access |  How to cite  | 

Abstract

Background: Preterm birth (PTB) is a known cause of perinatal complications in modern obstetrics. The exact etiology of PTB is not known. The present study will be focused to identify the association of ultrasonography findings of fetal adrenal gland volume and the relation with the cervical length (CL) in both preterm and term birth. Aim: To evaluate the role of adrenal gland volume of the fetus and CL for prediction of both preterm and term labor by comparing the observed values. This study also tried to find out the cut-off value of these two parameters to determine PTB. Materials and methods: This comparative cross-sectional observational study included 30 preterm pregnant mothers at 280//7-366/7 weeks of gestation and thirty term pregnant mothers at ≥37 weeks of gestation with the clinical diagnosis of labor. All the mothers enrolled in this study underwent trans-abdominal ultrasonography followed by calculation of corrected fetal adrenal gland volume (cFAGV), based on adrenal gland dimension and estimated fetal weight and data were then compared by receiver operator characteristic curve analysis. Results: Preterm mothers had significantly higher cFAGV than term (449.31 ± 64 mm3/kg vs 347.46 ± 58 mm3/kg; p <0.001) with a cut-off 421 mm3/kg with 90% sensitivity and 90% specificity. The difference in CL in both the groups was also significant (mean value 2.36 cm ± 0.26 in preterm mothers vs 3.25 cm ± 0.51 in term mothers; p <0.001) while the cut-off value was found as 2.75 cm with 86.7% sensitivity and 90% specificity. Conclusion: Hence, PTB can now be predicted with the help of ultrasonography-based fetal adrenal gland volume as well as CL estimation which is a non-invasive, cost-effective marker in clinical practice. Clinical significance: Ultrasonographic value of both fetal adrenal gland volume and CL can predict PTB in a more precise way to plan for better obstetric care.

142

RESEARCH ARTICLE

Chandana H Sathish, Shakuntala P Nanaiah, Renuka Ramaiah, Nisha Prathap, Satish Prasad

Maternal Subcutaneous Fat Thickness by Ultrasonography and Its Effect on Maternal and Perinatal Outcomes

[Year:2024] [Month:September-October] [Volume:16] [Number:5] [Pages:5] [Pages No:491 - 495]

Keywords: Abruptio placenta, Antepartum hemorrhage, Cesarean section, Fetomaternal outcomes, Gestational diabetes mellitus, Placenta previa, Preeclampsia, Preterm birth

   DOI: 10.5005/jp-journals-10006-2486  |  Open Access |  How to cite  | 

Abstract

Objectives: This study was done to determine the mean maternal abdominal subcutaneous fat thickness (SFT) by ultrasound during 18–24 weeks of gestation and to study its association with maternal outcomes (hypertensive disorders of pregnancy, gestational diabetes, gestational age at delivery, mode of delivery) and the perinatal outcomes (birth weight, APGAR score, and intensive care admission rates). Materials and methods: A prospective longitudinal study was conducted on 158 patients in the Department of Obstetrics and Gynaecology at ESIC Medical College and PGIMSR, Rajajinagar, Bengaluru, from January 2020 to June 2021. A detailed history of patients was obtained using general, systemic, and obstetric examinations and they were followed up with regular antenatal checkups. The abdominal SFT was measured by ultrasonography at 18–24 weeks and correlated with maternal and perinatal outcomes. Results: The mean value of SFT measured at 18–24 weeks was 16.4 mm. The correlation between SFT and the risk of gestational diabetes, hypertensive disorders, preterm birth, cesarean section, large for gestational age, NICU admissions, and low APGAR score was found to be statistically significant with p-value < 0.05. Conclusion: Subcutaneous fat thickness represents maternal central obesity, a more vital risk factor than general obesity in pregnancy. Hence, sonographic assessment of SFT is an excellent, noninvasive, and cost-effective method for safely predicting both maternal and perinatal adverse outcomes.

151

RESEARCH ARTICLE

Nupur Nandi, Ritika Agarwal, Abhijit Haldar

Evaluation of Prevalence, Presenting Symptoms, and Risk Factors of Overactive Bladder among Postmenopausal Women

[Year:2024] [Month:September-October] [Volume:16] [Number:5] [Pages:4] [Pages No:496 - 499]

Keywords: Overactive bladder, Overactive bladder-dry, OAB-questionnaire, Postmenopausal ladies

   DOI: 10.5005/jp-journals-10006-2523  |  Open Access |  How to cite  | 

Abstract

Background: Overactive bladder (OAB) is a syndrome which includes a compelling desire to pass urine leading to increased frequency of voiding in both day and night in the absence of obvious pathology. It may even result to a degree of incontinence. Symptoms of OAB bother a large number of people and the frequency increases with age. Menopause (either surgical/natural) adds more risk for the development of OAB in women. Factors like non-white race, smoking, obesity, depression, irritable bowel syndrome (IBS), diabetes, and neurological diseases like multiple sclerosis may increase the risk. As symptoms of OAB can negatively impact health-related quality of life (HRQL), knowing its prevalence, identification of the most bothering symptom, and risk factors can help to manage the situation. Materials and methods: All postmenopausal women attending OPD not having any obvious gynecological pathology or UTI who gave consent were included. A questionnaire-based cross-sectional study was conducted using validated Bengali/Hindi version of OAB-questionnaire (OAB-q) along with structured proforma among postmenopausal women attending Obstetrics and Gynecology Department of College of Medicine and JNM Hospital, WBUHS, Kalyani, Nadia, West Bengal, India and Venkateshwara Institute of Medical Sciences, Gajraula, Uttar Pradesh, India for a period of 6 months (February 2022–July 2022). Results: In College of Medicine and JNM Hospital, Kalyani, Nadia, West Bengal, India, 382 postmenopausal ladies were evaluated during the said time period and from them, 191 cases were OAB patient. Whereas at Venkateshwara Institute of Medical Sciences, Gajraula, Uttar Pradesh, India, 115 postmenopausal women participated in the study of which 57 women were having OAB. Out of total 497 postmenopausal ladies evaluated, 248 were diagnosed having OAB. Frequency of OAB was 49.89%. Out of 248 OAB patient's, 61.70% women were OAB-dry type and 38.30% were OAB-wet variety (having some degree of incontinence).The most common OAB symptom was an increase in the number of micturition per day (97.17%), followed by nocturia (95.56%). Increasing age and obesity significantly add to the risk of OAB. However high parity (≥3) is not significantly associated with OAB. Use of tobacco in any form is highly a significant risk factor for the development of OAB (p-value < 0.00001). Conclusion: Almost half of the postmenopausal women population are suffering from one or more symptoms of OAB (prevalence 49.89%). Frequency of urination and nocturia are the common presenting symptoms rather than incontinence episodes. Control over weight gain and no tobacco use can reduce the risk of development of OAB.

197

RESEARCH ARTICLE

Varsha Bhausaheb Nimbalkar, Harshada Thakur, Angad Ranadive, Kimaya Mali

Maternal Mortality Indices in Tertiary Care Center of Central India

[Year:2024] [Month:September-October] [Volume:16] [Number:5] [Pages:4] [Pages No:500 - 503]

Keywords: Clinical audit, Maternal mortality, Risk factors, Tertiary care center

   DOI: 10.5005/jp-journals-10006-2472  |  Open Access |  How to cite  | 

Abstract

Introduction: Maternal mortality remains a pressing global concern, with various potential adverse implications for women and their families. The relatively higher maternal mortality rate in India underscores the need for focused attention on maternal health. There is a dearth of relevant actionable data from Central India, which is important for formulating focused recommendations. Methodology: This research paper presents a retrospective observational study conducted over 2.5 years in a tertiary care center in urban India. It included all cases of maternal mortality recorded during the period. Data was collected retrospectively, and statistical assessment was performed using frequency calculations. Demographic characteristics, risk factors, causes of maternal deaths (direct and indirect), obstetric history, management approaches, and preventive measures were studied. Results: Risk factors associated with maternal mortality included severe anemia, postpartum hemorrhage, disseminated intravascular coagulation, severe preeclampsia or eclampsia, septicemia, respiratory diseases, and COVID-19 positivity. A significant majority (88.3%) were unregistered, with no visit to the health center. Direct causes were responsible for 45 (37.5%) deaths, majorly responsible being postpartum hemorrhage (76%), preeclampsia/eclampsia (67%), and sepsis (67%). Indirect causes accounted for 75 (62.5%) maternal deaths, including respiratory diseases (20.8%), cardiovascular diseases (9.2%), gastrointestinal diseases (1.3%), CNS diseases (4%), autoimmune diseases (7%), malignancies (4%), and infections (9%). Conclusion: Strategies and interventions toward improved access to antenatal care even in peripheries, strengthening of referral services, early diagnosis and treatment of medical complications, prevention of infectious diseases, community outreach programs for maternal anemia prevention and further strengthening of tertiary care centers are recommended.

196

RESEARCH ARTICLE

Abhipsa Rath, Ajit K Nayak, Rojalin Panda

Evaluation of Cesarean Sections According to Robson Criteria in a Tertiary Care Center: A Cross-sectional Study

[Year:2024] [Month:September-October] [Volume:16] [Number:5] [Pages:5] [Pages No:504 - 508]

Keywords: Cesarean section, Maternal morbidity, Repeat cesareans, Robson classification

   DOI: 10.5005/jp-journals-10006-2509  |  Open Access |  How to cite  | 

Abstract

Aim and background: There are concerns all over the world about the rising rates of cesarean section (CS) both in developed and developing countries. Multiple causes have been identified worldwide for this increase, like decreasing vaginal births after cesarean deliveries, on-demand CSs due to fear of vaginal birth as well as protection from medicolegal litigations. In this study, we have tried to categorize CSs at our tertiary care center with a very high patient load, over a period of 1 year, so that factors influencing the cesareans may be appreciated and appropriate measures may be taken to reduce the rates. Materials and methods: Our objectives were to determine the CS rate using the Robson classification and to determine the absolute and relative contribution of each group under the Robson classification system. Retrospective record analysis of all the births in the Department of Obstetrics and Gynecology either vaginally or by a CS, over the period of 1 year, that is from October 2021 to September 2022. Statistical analysis: All the demographic parameters were expressed statistically as mean, median, and percentages. The CSs were grouped based on Robson's criteria and absolute and relative rates were calculated using percentages. Results: There were around 600–800 deliveries per month making a total of 9110, out of which, vaginal deliveries were 4074 (44.73%) and CSs were 5036 (55.27%). The monthly CS rate ranged from around 49 to around 61% with a mean CS rate of 55.06%. Contribution to the overall CS rate was highest from group X at 22.85% followed by group V (which includes term repeat CSs) at 20.63%. Conclusions: The need of the hour seems to be finding a balance between absolutely indicated procedures and those performed for other equally significant reasons. Clinical significance: Studies like ours, from various population groups with Robson classification of the CSs will be extremely supportive in identifying gaps, and unmet needs, and in reduction of unnecessary surgical procedures as well as increasing the rates where required.

196

RESEARCH ARTICLE

Esther Issac, Anuradha M, Shanmugapriya C, Gowthaman Sankar

Effect of Pregestational Body Mass Index, Trimester-specific Weight Gain, and Total Gestational Weight Gain on Pregnancy Outcomes: A Retrospective Observational Study

[Year:2024] [Month:September-October] [Volume:16] [Number:5] [Pages:6] [Pages No:509 - 514]

Keywords: Fetomaternal outcomes, Gestational weight gain, Pregnancy, Trimester-specific weight gain

   DOI: 10.5005/jp-journals-10006-2493  |  Open Access |  How to cite  | 

Abstract

Background: Overweight women with higher BMI present with an increased risk of complications in gestation, especially the hypertensive disorders of pregnancy (HDP) and gestational diabetes mellitus (GDM). In addition to the increased risk of antenatal complications, there is an increased risk of cesarean delivery and associated morbidities in pregestational overweight or obese women. For the neonate, there is an increased risk of macrosomia, neonatal hypoglycemia or hyperbilirubinemia, in addition to a higher risk of childhood obesity. Materials and methods: This retrospective observational study aimed to investigate the effect of pre-gestational and trimester-specific weight gain on maternal and neonatal outcomes among pregnant women. Using the universe sampling method, we collected obstetric and postnatal details from previous records in the Department of Obstetrics and Gynecology at a tertiary care hospital in Tamil Nadu. Results: The receiver operating characteristics probability curve showed that the model had moderate discrimination capacity for GDM [area under the curve (AUC) = 0.591], gestational hypertension (GHTN) (AUC = 0.531), and pre-labor rupture of membranes (PROM) (AUC = 0.553), but no discriminating ability for large for gestational age (LGA) (AUC = 0.509). Additionally, the model demonstrated moderate discriminating capacity of pre-gestational BMI (AUC = 0.522) and trimester-specific weight gain (AUC for first trimester = 0.533; AUC for second and third trimester = 0.525) in predicting GHTN. Conclusion: First-trimester weight gain and total gestational weight gain (GWG) are positively associated with GDM. Second-trimester weight gain had a positive association with PROM. Third-trimester weight gain was associated with a higher risk for large for gestation babies.

140

RESEARCH ARTICLE

Erika Núñez-Lizárraga, Joel Figueroa-Alvarado, Karina Hammer-Arata, John Barja-Ore

Bibliometric Analysis of the Scientific Production on Postabortion Syndrome

[Year:2024] [Month:September-October] [Volume:16] [Number:5] [Pages:5] [Pages No:515 - 519]

Keywords: Bibliometric analysis, Postabortion, Postabortion syndrome

   DOI: 10.5005/jp-journals-10006-2469  |  Open Access |  How to cite  | 

Abstract

Introduction: Postabortion syndrome (PAS) is a complex problem affecting women's reproductive health. Aim: To analyze the bibliometric parameters of the scientific production indexed in Scopus on PAS. Materials and methods: Cross-sectional study with a bibliometric approach that considered the inclusion of scientific articles on PAS indexed in Scopus. A search strategy using key terms and logical operators was designed for the search. VOSviewer and SciVal were used. Results: The United States is the leading country in scientific productivity on PAS. The journal Contraception (14 articles, 7.2 citations per publication) is the most productive and has the highest average number of citations per article. In terms of institutions, the Guttmacher Institute, Ipas and Harvard University were the leading institutions in terms of productivity in this field of knowledge and had the largest number of authors. However, the University of California at San Francisco had the highest weighted impact. The subcategory of Obstetrics and Gynecology and Public Health (61), Environmental and Occupational Health (35), and Reproductive Medicine (30) had more articles published. Conclusion: The main journals disseminating articles on PAS are of high impact. In addition, US institutions lead this field of knowledge with the largest output and the largest number of collaborative links with countries, such as the UK, Kenya, and Nigeria. There is a need for greater depth and new approaches to research on this topic.

182

RESEARCH ARTICLE

Madhavi Thuramalla, Antony L Aseer, Krishna R Nallamalla, Sathyaprabha Balasubramanian, Manjula Rao

Validation of the Pelvic Floor and Core Exercise Protocol in Indian Women with Chronic Non-specific Low Back Pain

[Year:2024] [Month:September-October] [Volume:16] [Number:5] [Pages:13] [Pages No:520 - 532]

Keywords: Low back pain, Pelvic floor, Validation study, Women

   DOI: 10.5005/jp-journals-10006-2516  |  Open Access |  How to cite  | 

Abstract

Introduction: In India and worldwide, literature on non-specific low back pain (NSLBP) manifests that women are frequently affected. This trend is alarming to physiotherapists, emphasizing that effective exercise programs need to come about. Objectives: In an attempt to minimize the recurrence of NSLBP, the present study evaluated the content validity and interrater reliability of a supervised exercise protocol targeting pelvic floor and core muscles, thereby proposing a valid and reliable protocol that can be applied in the clinical context. Materials and methods: The content validation process consists of two stages: development and expert judgment. The three-phase protocol, developed with thorough literature review, underwent assessment by nine experts who were medical practitioners and physiotherapists. They rated its relevance and ease of performance on a five-point Likert scale. Agreement levels, content validation index, and kappa values were then computed based on their inputs on the protocol. Results: All the exercises in the protocol had an Item Content Validity Index (I-CVI) of 0.8–1.00 for relevance and ease of performance factors, showing complete accordance among experts. The kappa values for the exercises were ranging from 0.53 (moderate agreement) to 0.77 (substantial agreement) for both factors through the three phases in the protocol. Conclusion: Excellent content validity and substantial interrater reliability were found for the chronic NSLBP protocol to be used in Indian women.

289

RESEARCH ARTICLE

Neha Thakur, Archana Kennedyrajan, Neha Aggrawal, Lalita P Nekkatani

Robson Classification in Cesarean Section in Chhattisgarh, India

[Year:2024] [Month:September-October] [Volume:16] [Number:5] [Pages:4] [Pages No:533 - 536]

Keywords: Cesarean section, Induction of labor, Robson classification, Vaginal birth after cesarean section

   DOI: 10.5005/jp-journals-10006-2484  |  Open Access |  How to cite  | 

Abstract

Background: Cesarean sections are becoming more commonplace worldwide. The World Health Organization (WHO) advised utilizing the Robson categorization system to assess and monitor the frequency of cesarean procedures overtime, both within and between healthcare facilities. Aims and objectives: To determine the pattern of obstetric women population. To find which proportion of women have a high CS rate will help us to target specific groups of women for the reduction of overall CS. Materials and methods: This investigation was observational. From September 2022 to August 2023, all cesarean deliveries at Government Medical College, Mahasamund, Chhattisgarh, India, having a gestational age of more than 28 weeks, were included. After using Robson's TGCS, data were entered, examined, and shown as percentages. Results: A total of 3,573 deliveries happened in the study period. Approximately 41.26% of births were cesarean. Women who are nulliparous (46.36%) outnumber those who are multiparous (23.55%). The main relative contributors to the 80.18% overall CS rate were groups I, II, and V. Group VI had a breech, nulliparous CS rate of 82.86%, group IX had a high CS rate of 100%, and group V had a prior CS rate of 94.75%. Conclusion: The findings show that group V had a high CS rate; therefore, steps must be taken to decrease CS in groups I and II, since a reduction in CS in group I would subsequently result in a reduction in group V's group size. These measures include shared decision-making, equality of care, induction of labor and close monitoring, vaginal birth after cesarean section (VBACS) in selected women under supervised conditions, respectful maternity care, positive pregnancy experience, one-to-one intrapartum care, and appropriate regular training of staff involved in the care of pregnant women.

160

RESEARCH ARTICLE

Anak Agung Ngurah Jaya Kusuma, Ida Bagus Gede Fajar Manuaba, Endang Sri Widiyanti, Hartanto

The Profile of Serum Potassium Level and Cardiomegaly in Pregnancy with COVID-19 in Prof. Dr. I.G.N.G. Ngoerah General Hospital

[Year:2024] [Month:September-October] [Volume:16] [Number:5] [Pages:5] [Pages No:537 - 541]

Keywords: Cardiomegaly, COVID-19 in pregnancy, Potassium

   DOI: 10.5005/jp-journals-10006-2440  |  Open Access |  How to cite  | 

Abstract

Aims and background: Coronavirus disease (COVID-19) is a health crisis that also affects pregnant women. Electrolyte imbalance, especially potassium disorders, are commonly found in pregnancy with COVID-19 and can affect patient outcomes. Additionally, potassium disorders in COVID-19 can worsen cardiac outcomes and patient prognosis. This study was conducted to find out the profile of serum potassium levels and cardiomegaly in pregnancy with COVID-19. Materials and methods: This descriptive study was used medical record data. All pregnant women with COVID-19 who were hospitalized and had complete data regarding potassium levels and chest X-ray examinations were included in the study. Data were presented in the form of frequency, percentage, mean, and range. Results: This study included a total of 229 subjects. Most of the subjects’ age was 21–35 years (83.3%) and did not have cardiomegaly (86.2%). The mean potassium level in subjects in 1st trimester was 3.20 ± 0.64, in 2nd trimester was 3.23 ± 0.49, and in 3rd trimester was 3.67 ± 0.58. The average serum potassium level in asymptomatic subjects was 3.87 ± 0.68, while the average serum potassium level in subjects with mild symptoms was 3.59 ± 0.49, with severe symptoms was 3.51 ± 0.55, with critical symptoms was 3.31 ± 0.49, and with moderate symptoms was 3.31 ± 0.45. The majority of subjects with cardiomegaly experienced severe symptoms (31.6%) followed by mild symptoms (23.7%). Conclusion: Pregnant women with COVID-19 who had hypopotassemia were mostly in the first trimester, had asthma comorbidity, were critically and moderately symptomatic with COVID-19, used respiratory supports such as nasal cannula and face mask, and also required intensive care. While pregnant women with COVID-19 who had cardiomegaly, mostly were in the third trimester, had comorbidities, severe COVID-19 symptoms, did not use respiratory supports or intensive care, lower mortality rate, and had good neonatal outcomes. Clinical significance: The COVID-19 in pregnancy with hypopotassemia and cardiomegaly had various adverse outcomes.

128

RESEARCH ARTICLE

Naga P Indrakanti, Anjali S Mudkur, Vidyashree G Poojari, Mehtab Kaur, Dhanya Vikhnan, Pratap K Narayan, Prashanth K Adiga

Prediction of Assisted Reproductive Technology Outcome by Day 5 Estradiol (E2) Levels in Antagonist Cycles

[Year:2024] [Month:September-October] [Volume:16] [Number:5] [Pages:4] [Pages No:542 - 545]

Keywords: Antagonist, Estradiol, M-II oocytes, Ovarian hyperstimulation syndrome

   DOI: 10.5005/jp-journals-10006-2507  |  Open Access |  How to cite  | 

Abstract

Aim and background: Follicle monitoring and hormone levels, particularly those of estradiol (E2), progesterone (P4), follicle-stimulating hormone (FSH), and luteinizing hormone, are critical factors in determining the effectiveness of in vitro fertilization (IVF). Based on their day-5 E2 readings, patients are divided into three groups. Group I comprises values less than 400 pg/mL, group II ranges from 400 to 900 pg/mL, and group III exceeds 900 pg/mL. The study's objectives were to construct a prediction formula for the total number of retrieved oocytes, analyze the mean number of mature and total oocytes, and determine the incidence of ovarian hyperstimulation syndrome (OHSS) in three groups. Materials and methods: The Department of Reproductive Medicine and Surgery at a tertiary care facility in coastal Karnataka carried out this retrospective observational research. The study included 140 patients who underwent IVF stimulation using the antagonist protocol between May 2022 and April 2023, a duration of 1 year. Simple linear regression techniques and receiver operating curve (ROC) curves are utilized in statistical analysis. Results: The average age, duration of infertility, BMI, antral follicle count (AFC), and anti-mullerian hormone (AMH) were in that order 31.51 years, 5.04 years, 24.44 kg/m2, 17.67, and 3.63 ng/mL. Based on the day 5 E2 values and the difference between the day 5 and the trigger E2 values, the quantity and mature oocytes were predicted with statistical significance. The E2 threshold levels on day 5 and the day of trigger to day 5 E2 difference were 946 pg/mL and 2758 pg/mL, respectively, to forecast and prevent OHSS. Conclusion: The current study's measurement of the day-5 E2 level is significant since it aids in the prediction of the number and maturity of oocytes as well as the risk of OHSS.

278

RESEARCH ARTICLE

Amanjot Kaur, Beant Singh, Chinky Thukral

Acute Fatty Liver of Pregnancy: Experience of 8 Cases from a Tertiary Hospital

[Year:2024] [Month:September-October] [Volume:16] [Number:5] [Pages:4] [Pages No:546 - 549]

Keywords: Acute fatty liver of pregnancy, Acute fatty liver, Fatty liver, Fulminant, Gestational, Liver failure, Pregnancy complication

   DOI: 10.5005/jp-journals-10006-2490  |  Open Access |  How to cite  | 

Abstract

Objective: The aim of the present study is to discuss the clinical presentation, laboratory findings, and maternal and fetal outcomes of patients with acute fatty liver of pregnancy (AFLP) presenting to a tertiary care institution. Materials and methods: All pregnant patients presenting to our institution with acute liver failure from January 2019 to December 2020 were evaluated for AFLP based on Swansea criteria. The demographic, clinical, and laboratory parameters of all patients, course of pregnancy, mode of delivery, and maternal and fetal outcomes of the pregnancy were evaluated for all patients. Results: Eight patients were identified to have AFLP during the study period. The mean age at presentation was 26 years, the mean gestational age at presentation was 33 weeks. Three patients were primigravida, two had twin pregnancies, and 40% of patients who delivered had a male fetus. All patients presented with vomiting and jaundice and the majority had abdominal pain. Leukocytosis was observed in 75%, thrombocytopenia in 37.5%, coagulopathy in 37.5%, renal failure in 50%, encephalopathy in 75%, and hypoglycemia in 100% of patients. Two patients had ultrasound findings suggestive of AFLP. Two patients had a cesarean section, three had vaginal deliveries, and three maternal deaths occurred with undelivered status. There were five maternal deaths, and out of the five delivered patients, there were two fetal deaths. Conclusion: Acute fatty liver of pregnancy is associated with high morbidity and mortality. Adverse maternal and fetal prognosis can be prevented by diagnosis early in the course of disease, prompt termination of pregnancy, and good supportive care.

188

RESEARCH ARTICLE

Aditi J Parulekar, Pundalik K Sonawane

An Observational Study to Estimate the Prevalence of Subclinical Hypothyroidism and Anti-TPO Antibodies in Pregnancy and to Compare the Maternal and Fetal Outcomes with Euthyroid Cases

[Year:2024] [Month:September-October] [Volume:16] [Number:5] [Pages:5] [Pages No:550 - 554]

Keywords: Anti-TPO antibodies, Fetal outcome, Levothyroxine, Maternal outcome, Subclinical hypothyroidism

   DOI: 10.5005/jp-journals-10006-2494  |  Open Access |  How to cite  | 

Abstract

Introduction: Thyroid disorders, the second most common endocrinologic issue in pregnant women, even get extended to subclinical hypothyroidism (SCH), which is a condition associated with the risk of pregnancy complications and also adverse effects on the baby's neuropsychological development. This study aims to assess the frequency of SCH and anti-TPO antibodies in pregnant women and compare the outcomes to those of women without thyroid issues. Materials and methods: A hospital-based observational study was conducted as an observational study in a tertiary teaching hospital, 500 pregnant women aged 18–40 underwent thyroid functioning and anti-TPO antibody testing. Cases were managed on the basis of their thyroid and TPO statuses, with comprehensive follow-ups tracking maternal details during antenatal, intrapartum, and postpartum periods, too. Neonatal outcomes, including APGAR scores, Neonatal Intensive Care Unit (NICU) care, and baby weights was documented. Neonatal S.TSH levels were assessed post-birth. Results: Prevalence rates in our study were 32% for SCH, 1.98% for overt hypothyroidism, and 66.02% for euthyroid cases. Out of the 184 patients with SCH, 85 (46.20%) tested positive for anti-TPO antibodies. Women with SCH exhibited a significantly higher rate of cesarean sections; SCH with anti-TPO-Ab positivity correlated notably with preterm delivery, premature rupture of membranes, and hyperbilirubinemia. Conclusion: The study shows that one in three antenatal care patients screened for thyroid disorders was diagnosed with SCH. The condition is linked to complications including an increased incidence of elevated cesarean section rates and NICU admissions compared to pregnant women with a euthyroid state. Clinical significance: Testing for thyroid function and anti-TPO ought to be a routine for every pregnant woman so that they can promptly identify SCH and prevent potential complications associated with pregnancy.

169

CASE REPORT

Shivani V Bhandari, Sumedha K Rawal, Aniket S Kakade, Tushar M Panchanadikar

Uterine Brace Sutures: A Life Saver in Postpartum Hemorrhage

[Year:2024] [Month:September-October] [Volume:16] [Number:5] [Pages:2] [Pages No:555 - 556]

Keywords: Assisted reproductive technology, Case report, Obstetric hysterectomy, Postpartum hemorrhage, Uterine brace sutures

   DOI: 10.5005/jp-journals-10006-2462  |  Open Access |  How to cite  | 

Abstract

Background: Postpartum hemorrhage (PPH) is one of the leading causes of maternal mortality around the world. Clinical course and management, “when” and “how” plays an important role in preserving the uterus. Case presentation: A 35-year-old, Gravida 2, Abortion 1, conceived by in-vitro fertilization-embryo transfer (IVF-ET), presented with established preterm labor at 26 weeks gestation. After an uneventful delivery, the patient landed in the atonic uterus with an entrapped placenta leading to PPH. Results: This case report describes a conservative surgical approach to the management of PPH due to retained placenta with atonicity by manual removal of the placenta and placement of uterine brace sutures, thus saving the uterus. Conclusion: Increasing trends of assisted reproductive technology (ART) pregnancies make it worthwhile to have thorough knowledge, skills, and care facilities to manage fatal complications like PPH and avoid obstetric hysterectomy as it becomes more important to preserve the uterus. Clinical significance: This case has a focus on the current increase in the use of ART, with its associated complications in mind and the need to be well-equipped and versed with uterus-preserving surgeries.

223

CASE REPORT

Tarini Sonwani, Arun Kumar Panda, Mala Sinha

Uterine Angioleiomyoma Masquerading as Ovarian Tumor: A Rare Case Report

[Year:2024] [Month:September-October] [Volume:16] [Number:5] [Pages:4] [Pages No:557 - 560]

Keywords: Angioleiomyoma, Case report, Diagnostic challenges, Histopathological examination, Leiomyoma variant, Uterine neoplasm

   DOI: 10.5005/jp-journals-10006-2442  |  Open Access |  How to cite  | 

Abstract

Aim and background: Angioleiomyoma (AL) is an uncommon kind of leiomyoma distinguished by the excessive growth of smooth muscle cells and capillaries with thick walls. It usually develops in the subcutaneous plane of the lower limbs. However, it can occasionally occur in the female reproductive system. Clinical presentation includes heavy menstrual bleeding, lower abdominal pain, or abdominal mass. Due to the lack of definitive clinical or imaging features, differentiation from leiomyoma relies on histopathological examination. Case description: Here, we present a rare case of a female patient aged 45 years complaining of dull lower abdominal pain. Imaging revealed a complex left adnexal mass, leading to suspicion of ovarian tumor. Exploratory laparotomy revealed a mass arising from the left broad ligament, which was excised along with hysterectomy. Histopathological examination confirmed the diagnosis of AL, and the patient recovered well postoperatively. Conclusion: Angioleiomyoma in the uterine region poses diagnostic challenges due to its rarity and lack of specific imaging features. Preoperative diagnosis is difficult, necessitating histopathological examination for confirmation. Clinicians and pathologists should be aware of this benign entity and differentiate it from potential mimickers to guide appropriate management. Clinical significance: The present case highlights the importance of considering rare uterine AL in the differential diagnosis of pelvic masses, highlighting the necessity for meticulous histopathological examination and timely surgical intervention for optimal patient outcomes.

163

CASE REPORT

Raja Rajeswari KS, Sadhana Karthikeyan, Priya Shaunthini

Cervical Ectopic Pregnancy with Diagnostic Challenges and Conservative Surgical Management: A Case Report

[Year:2024] [Month:September-October] [Volume:16] [Number:5] [Pages:3] [Pages No:561 - 563]

Keywords: Case report, Cervical ectopic, Descending cervical artery ligation, Sliding sign

   DOI: 10.5005/jp-journals-10006-2506  |  Open Access |  How to cite  | 

Abstract

Cervical ectopic is a rare potentially life-threatening condition where a fertilized egg implants in cervical canal instead of uterine cavity. This abnormal implantation can lead to catastrophic hemorrhage. This condition poses significant diagnostic and management challenges and we present one such case. She was a 30-year-old parous woman with previous two cesarean sections on lactational amenorrhea with complaints of bleeding per vaginum for 15 days, with an ultrasound scan done elsewhere suggestive of cesarean scar ectopic pregnancy. Sonological and clinical examination clinched the diagnosis of cervical ectopic pregnancy. She was initially started on medical management, which failed and she had profuse bleeding per vaginum, hence had to proceed to surgical management. With preparedness for all consequences, proceeded with suction evacuation under ultrasound guidance. When bleeding was profuse even after complete evacuation tried bilateral descending cervical artery ligation which helped to achieve complete hemostasis. Diagnostic hysteroscopy was done to confirm the findings. Intracervical Foley's tamponade was kept at the end of the procedure. We are presenting this case to emphasize the importance of applying clinical guidelines promptly and correctly in our day today's clinical practice to achieve the best outcome. Early detection and prompt intervention are crucial to prevent complications and preserve fertility.

184

CASE REPORT

Sumedha Gupta, Varsha Motwani, Kaushal Kalra

Challenges in Diagnosis: Ovarian Dysgerminoma Presenting as Torsion in a Prepubertal Girl: A Case Report

[Year:2024] [Month:September-October] [Volume:16] [Number:5] [Pages:4] [Pages No:564 - 567]

Keywords: Case report, Malignant germ cell tumor, Metastasis, Ovarian dysgerminoma, Torsion

   DOI: 10.5005/jp-journals-10006-2498  |  Open Access |  How to cite  | 

Abstract

Aim and background: Dysgerminoma is the most common malignant germ cell tumor of the ovary; it usually affects people under the age of twenty and usually manifests as abdominal pain, distention, and a palpable mass. Just 10% of ovarian tumors in patients under the age of 18 are malignant, with functional cysts accounting for the majority of cases. Case description: Here, we describe an uncommon case of an 11-year-old girl who had abdominal discomfort, and torsion and was diagnosed with dysgerminoma. Following a right-sided salpingo-oophorectomy to preserve fertility, the patient was diagnosed with stage III dysgerminoma on histopathology due to omental metastasis. The patient underwent adjuvant chemotherapy due to tumor metastasis to the omentum. Conclusion: Ideally, young patients receiving adjuvant treatment for metastases should have fertility-sparing surgery. Postoperative monitoring and regular follow-up are essential for the early detection and management of patients with metastases, even without any disease indications. Clinical significance: This case underscores the importance of considering dysgerminoma in pediatric patients who present with abdominal symptoms, and highlights the importance of management strategies for treating this rare ovarian malignancy in young individuals.

138

CASE REPORT

Aditya Rajiv Nimbkar, Kimaya Mali, Jyotsna Dwivedi, Sankrutee Inamdar

The Astonishing, Classical Blueberry Muffin Rash: An Obstetric Case Report on Fetal Outcome in Congenital Rubella Syndrome

[Year:2024] [Month:September-October] [Volume:16] [Number:5] [Pages:3] [Pages No:568 - 570]

Keywords: Blueberry muffin rash, Case report, Congenital cataract, Congenital rubella syndrome, Hepatomegaly, In vitro fertilization, Measles, Mumps, Rubella vaccination, Toxoplasma, Rubella, Cytomegalovirus, Herpes zoster infections

   DOI: 10.5005/jp-journals-10006-2499  |  Open Access |  How to cite  | 

Abstract

Background: A family awaits perhaps the biggest moment of joy of their lives on New Year's Eve when a 37-year-old female with twin gestation is conceived after several years through In vitro fertilization. But a rude shock hits the doctors as well as the expecting parents when one of the twin babies, is found to have congenital rubella syndrome, which had gone undiagnosed throughout the antenatal period. A classical blueberry muffin appearance, after moments of confoundment, reveals the diagnosis and a lesson on the importance of pre-conceptional immunization and monitoring of the second twin from its affliction. Aim: To understand intrauterine infections, especially rubella, its prevention, and clinical presentation. Case description: A 37-year-old female with twin gestation conceived via assisted reproductive techniques, delivered a child with congenital rubella syndrome. Clinical significance and conclusion: Intrauterine infections can be a significant cause of sporadic abortions and congenital abnormalities. The prevention, diagnosis, and timely treatment can prevent its deleterious fetal effects. Also, an attempt to understand a rare, but classical presentation of congenital rubella—blueberry muffin rash—and its other autopsy findings.

172

CASE REPORT

Jijisha Ali, Josephine Jose, Sami Talo, Rida Maryum, Yevginiy Karamurzin

A Rare Case Report of Deep Aggressive Angiomyxoma Mimicking Bartholin's Cyst

[Year:2024] [Month:September-October] [Volume:16] [Number:5] [Pages:3] [Pages No:571 - 573]

Keywords: Angiomyxoma, Bartholin's cyst, Case report, Recurrence, Vulval lesion

   DOI: 10.5005/jp-journals-10006-2467  |  Open Access |  How to cite  | 

Abstract

We present a case of deep aggressive angiomyxoma (AA) of a vulval lesion. This case report is of a 32-year-old female (para 1, living 1) who presented to the gynecological outpatient department with complaints of a lump felt in her left vagina for 1 month. This was initially misdiagnosed as a Bartholin gland cyst. She underwent excision of Bartholin's gland under anesthesia. The histopathology reported a deep AA of the vulval lesion. Despite the rarity of this condition, with only 350 cases reported so far, it is crucial to include it in the range of differential diagnoses for a pelvic mass, considering the locally aggressive characteristics of this tumor and its tendency to recur.

201

CASE REPORT

Pushpa Nagar, Aditi Bansal

Urethral Leiomyoma in Pregnancy: A Rare Case Report

[Year:2024] [Month:September-October] [Volume:16] [Number:5] [Pages:2] [Pages No:574 - 575]

Keywords: Case report, Pregnancy, Singleton pregnancy, Suburethral leiomyoma

   DOI: 10.5005/jp-journals-10006-2511  |  Open Access |  How to cite  | 

Abstract

Leiomyoma is a benign tumor of smooth muscle cells. It appears to occur mainly in genitourinary and gastrointestinal site but urethra is a rare site. Thorough imaging and cystourethroscopy were done to identify the correct anatomical location of the tumor. We present the case of urethral leiomyoma during pregnancy presented with tender vaginal mass causing obstructive urinary symptoms. Surgical excision through vaginal route was done without breaching the urethral mucosa and muscle. Histopathology and immunohistochemistry were performed to confirm the diagnosis. No postoperative complications were noted.

112

CASE REPORT

Mary Devasiya, Akshaya Murali, Anitha Santosh, Madhu Swetha Sharma

Maternal Myasthenia Gravis: A Case Report

[Year:2024] [Month:September-October] [Volume:16] [Number:5] [Pages:2] [Pages No:576 - 577]

Keywords: Case report, Fetomaternal outcomes, Myasthenia gravis, Neurological disorder

   DOI: 10.5005/jp-journals-10006-2512  |  Open Access |  How to cite  | 

Abstract

Introduction: Myasthenia gravis (MG) is an acquired neuromuscular disorder that presents with clinical weakness and fatigue of the skeletal muscles. Pregnancy can have significant effects on the course of myasthenia gravis. Patients with well-controlled MG prior to conception usually have a benign disease course during pregnancy, although a small number may deteriorate during the postpartum period. Case description: A 22-year-old primigravida was referred to our hospital for further antenatal management, as she was a known case of MG. Myasthenia gravis was diagnosed at the age of 17, when she developed drooping of eyelids, and weakness of both upper and lower limbs. Acetylcholine receptor antibodies were positive. Her symptoms improved with oral prednisolone and pyridostigmine, but caused bilateral avascular necrosis of the hip requiring core decompression surgery. She further required thymectomy a year later. The patient's myasthenic symptoms were well-controlled prior to conception and she remained asymptomatic throughout pregnancy while continuing pyridostigmine. She underwent an elective cesarean section at 39 weeks of pregnancy due to her prior history of avascular necrosis of bilateral hip and her postpartum period was uneventful. Conclusion: Pregnancies associated with MG can have a stable disease course if adequately stabilized with drugs or thymectomy prior to pregnancy. Antenatal management by a multidisciplinary approach, along with appropriate immunosuppressants can improve both maternal and neonatal outcomes.

143

CASE REPORT

Rupita Kulshrestha, Smriti Agrawal, Tushant Kumar, Nuzhat Hussain

Smooth Muscle Tumor of Uncertain Malignant Potential: An Unexpected Diagnosis in a Young Female

[Year:2024] [Month:September-October] [Volume:16] [Number:5] [Pages:3] [Pages No:578 - 580]

Keywords: Case report, Fibroid, Malignancy, Myomectomy, Recurrence, Smooth muscle tumor of uncertain malignant potential

   DOI: 10.5005/jp-journals-10006-2508  |  Open Access |  How to cite  | 

Abstract

A 25-year-old married nulliparous female with suspected fibroid uterus was admitted to the emergency ward with complaints of heaviness in the pelvic region, increased uterine bleeding for the past year, and torrential bleeding episodes. She was clinically very pale and presented with shock symptoms in an emergency. Conservative management with a blood transfusion was performed. Radiological imaging revealed a fibroid uterus with gross cystic degeneration. Her nulliparous state necessitated an abdominal myomectomy. However, the planes were not well-defined, and the cystic fluid was profuse; therefore, the final diagnosis was inconclusive. Her histopathology report revealed a uterine smooth muscle tumor of uncertain malignant potential (STUMP).

104

CASE REPORT

Leonardo Alexandra, Rudy Arnold Lengkong, Dislih Lingkan Imelda Panelewen, Marshal Justitia Wenas, Abraham Alvin Lyndall Maukar

Gartner's Duct Cyst in Recurrent Vaginal Infection: A Case Report

[Year:2024] [Month:September-October] [Volume:16] [Number:5] [Pages:2] [Pages No:581 - 582]

Keywords: Case report, Gartner's duct cyst, Pelvic mass, Recurrent vaginal infection, Vaginal cyst, Wolffian duct

   DOI: 10.5005/jp-journals-10006-2524  |  Open Access |  How to cite  | 

Abstract

Gartner's duct cysts are benign lesions that arise from the remnant of the Wolffian duct that in females supposed to regress and form a vaginal inclusion cyst. Gartner's duct cyst mostly came without any symptoms. It was found during a pelvic examination which is commonly on the anterolateral side of the proximate vaginal wall and is usually small with a diameter of less than 2 cm. We present a 29-year-old multiparous woman with a chief complaint of a vaginal mass protruding causing vaginal discomfort and recurrent vaginal discharge. The examination found a vaginal cyst sized 3 × 3 cm on the anterolateral aspect of the vagina with a milky white discharge found in the vaginal canal. Transvaginal ultrasound found a hypoechoic appearance at the vaginal wall suggesting a vaginal cyst. The patient then underwent surgical excision with a histopathology result consistent with the Gartner duct cyst characteristics.

237

CASE SERIES

Mahalakshmi Mahalingam, Meena T Sundarraj, Geetha Mohan, Sangeetha Ramesh, Sharmiladevi Kothandaraman

Pregnancy-related Acute Kidney Injury: Our Experience in a Tertiary Care Center

[Year:2024] [Month:September-October] [Volume:16] [Number:5] [Pages:5] [Pages No:583 - 587]

Keywords: Acute kidney injury, Hypertensive disorders of pregnancy, Maternal mortality, Maternal sepsis, Preeclampsia, Pregnancy-related acute kidney injury

   DOI: 10.5005/jp-journals-10006-2505  |  Open Access |  How to cite  | 

Abstract

Background: Pregnancy-related acute kidney injury (PRAKI) has been identified as an autonomous risk factor for maternal death. The key to solving this problem is the early identification, and diagnosis of PRAKI and management of the underlying factors responsible. Pregnancy-related acute kidney injury does not stop with affecting the current pregnancy; it has lasting impacts in terms of chronic kidney disease. Hence, it is crucial to investigate factors leading to PRAKI in order to understand its impact on both maternal and fetal outcomes and improve the management strategies. The primary objective of this study is to comprehensively analyze the variables contributing to PRAKI in terms of maternal age, parity, mode of delivery, time of diagnosis and etiology. A secondary objective is to study the maternal and fetal outcomes and the variables impacting maternal mortality in cases of PRAKI. Methods: A retrospective observational study was conducted for a period of 1 year, from January to December 2019. All women with a diagnosis of PRAKI according to KDIGO criteria, admitted to institute of obstetrics and gynecology, Chennai, irrespective of gestational age, delivery status and recovery status, were included in the study. Of the 16,469 deliveries in the year 2019 at the Institute of Obstetrics and Gynecology, 19 qualified the PRAKI diagnostic criteria according to KDIGO. Data regarding the demographic data, clinical presentation, etiology of acute kidney injury (AKI), laboratory investigations including blood biochemistry and hemogram, dialysis dependency, transfusion dependency, maternal outcome and fetal outcome were collected from the hospital database. The data were tabulated using MS Excel. SPSS v23 was used for statistical analysis. Results: In our hospital, the incidence of PRAKI per 10,000 admissions for delivery is 11.5; Mean age in our study was 25.26 ± 3.59, and 63.2% of affected population belonged to the 20–25-year age-group, in par with the recent literature. Prim gravida was most frequently affected. All the 19 cases diagnosed as PRAKI in our study was diagnosed exclusively in the postpartum period, with 12 cases (63.2%) occurring within 48 hours of postpartum indicating the better management of early trimester complications and rise in the hypertensive disorders of pregnancy. Severe preeclampsia (52.6%) and sepsis (31.6%) were identified as the most frequent underlying conditions resulting in PRAKI. We report a higher rate of maternal mortality compared with other literature. Hemolysis, elevated liver enzymes, and low platelet levels (HELLP) and Abruption, which are severe complications of hypertensive disorders of the pregnancy were reported in higher proportions in our study, contributing to the maternal mortality being reported as high as 57.9%. the fetal loss was also elevated at 43.75%. Conclusion: The global incidence of PRAKI has increased, especially in developing countries. In our observation, majority of PRAKI occurred in primigravida and in the postpartum period, consistent with recent trends. The maternal mortality rates related to PRAKI were alarmingly high, especially in association with hypertensive disorders and sepsis. The presence of severe preeclampsia and sepsis prominently influenced outcomes in our study. Acute kidney injury being a significant contributor to maternal as well as fetal mortality and morbidity, its prompt identification and management are imperative.

306

BRIEF RESEARCH COMMUNICATION

Ashwini de Abrew, Saroj Jayasinghe, Marzia Lazzerini

Improving the Knowledge and Awareness of Labor Care Providers on Respectful Maternal Care in Sri Lanka: An Intervention Using Spiritual Principles

[Year:2024] [Month:September-October] [Volume:16] [Number:5] [Pages:3] [Pages No:588 - 590]

Keywords: Attitudes, Low middle-income country, Midwife, Quality improvement, Respectful maternity care, Supportive care

   DOI: 10.5005/jp-journals-10006-2510  |  Open Access |  How to cite  | 

Abstract

Respectful care during labor can improve obstetric outcomes in many ways, while abusive and disrespectful care may lead to poor obstetric outcomes. Many factors, including lack of knowledge, poor attitude toward supportive care, and subjective norms, influence the behavior of healthcare providers, leading to abusive and disrespectful care. We developed and implemented a workshop on respectful maternity care (RMC) for healthcare providers, highlighting spiritual principles that closely resonated with the cultural background of the participants. This workshop included a presentation by a Buddhist priest who emphasized the importance of compassionate and RMC according to four Buddhist principles known as the Brahma-vihāras: Metta, Karuna, Muditha, and Upekkha. Core Buddhist principles were connected with domains of RMC in a culturally appropriate manner to improve the knowledge, awareness, and attitudes toward compassionate, supportive, and respectful care among labor care providers in Sri Lanka. A total of 116 labor care providers participated in the workshop, and feedback was received from 115 (99.1%). One hundred seven (93.0%) reported improvement in their knowledge of RMC, and 109 (94.8%) reported improvement in attitudes toward RMC after attending this program. 110 (95.6%) agreed that the inclusion of this approach to the standard scientific program was thought-provoking. The results suggest that the inclusion of spiritual principles would resonate with the majority of labor care providers, and further studies are warranted to explore the impact.

523

EXPERT VIEW/REVIEW PAPER

Santosh M Dahifale, Nikita R Vijay

Exploring the Impact of Prepregnancy Body Mass Index on Obstetric Outcomes: A Comprehensive Review

[Year:2024] [Month:September-October] [Volume:16] [Number:5] [Pages:4] [Pages No:591 - 594]

Keywords: Body mass index, Gestational diabetes mellitus, Obstetric outcome

   DOI: 10.5005/jp-journals-10006-2502  |  Open Access |  How to cite  | 

Abstract

Aim: Because pregnancy-related changes in a woman's body mass index (BMI) have a major impact on maternal and newborn health outcomes, these alterations have become a focus of attention in the fields of obstetrics and maternal-fetal medicine. We seek to clarify the complex relationships between prepregnancy BMI and perinatal outcomes, fetal health, and maternal health by critically analyzing and synthesizing a wide range of research findings. Materials and methods: A thorough search of the literature was part of our approach, and we used academic databases like PubMed, MEDLINE, Embase, Scopus, and Web of Science. We used a mix of pertinent MeSH terms and keywords associated with prepregnancy BMI and obstetric outcomes. We considered research that looked into the relationship between prepregnancy BMI and different obstetric outcomes, and that was published between 2020 and the present. Excluded studies did not have precise prepregnancy BMI-related outcomes or peer-reviewed validation. Prepregnancy BMI categories, obstetric outcomes, participant characteristics, sample size, and study design were all covered by the identical form used for data extraction. Using the proper instruments, a quality evaluation was carried out, assessing the study design, sample representativeness, exposure measurement, and result ascertainment. Results: Our thorough investigation shows that prenatal BMI has a significant impact on the health of both the mother and the fetus. Underweight women have an increased risk of preterm births, low birth weight babies, and inadequate gestational weight gain. On the other hand, women who are overweight or obese are more likely to experience adverse outcomes such as gestational diabetes, preeclampsia, macrosomia, and excessive prenatal weight gain. These results highlight the significance of encouraging a healthy pre-conception weight to improve obstetric outcomes and highlight the crucial role that prepregnancy BMI plays in prenatal care and risk assessment. Conclusion: This review highlights the need for targeted healthcare programs to reduce the negative effects of obesity and encourage healthier pregnancies, offering insightful information to researchers, politicians, and healthcare practitioners. The results support evidence-based practice and worldwide improvements in maternal and newborn health, making a valuable contribution to the continuing evolution of maternal-fetal medicine.

167

EXPERT VIEW/REVIEW PAPER

Deepthy Balakrishnan, Ruchika Garg

Emerging Trends in Treatment of Hot Flashes at Menopause: A Review

[Year:2024] [Month:September-October] [Volume:16] [Number:5] [Pages:7] [Pages No:595 - 601]

Keywords: Hot flashes, Menopause, Menopausal hormone replacement therapy, Menopausal transition

   DOI: 10.5005/jp-journals-10006-2501  |  Open Access |  How to cite  | 

Abstract

Hot flashes represent a prevalent symptom prompting menopausal women to seek assistance. The utilization of treatment among these women is notably low, particularly in countries such as India, where women may display hesitancy toward regular follow-up. Hormone replacement therapy (HRT) has been identified as the standard treatment for addressing hot flashes in menopausal women. Notably, several guidelines have advocated for the safe use of HRT in healthy women under the age of 60 who have entered menopause within the past decade. It is recommended that women with comorbidities undergo assessment and receive personalized treatment plans. Non-hormonal treatments and complementary therapies should be considered for women unable to undergo HRT. Additionally, emerging pharmaceuticals may serve as viable substitutes for traditional HRT. This review provides insight into both current and forthcoming treatments for hot flashes.

291

REVIEW ARTICLE

Pinky Mishra, Ritu Sharma, Ruchi Verma

Clinical Profile of Patients with Peripartum Cardiomyopathy: A Single-center Experience and Review of Literature

[Year:2024] [Month:September-October] [Volume:16] [Number:5] [Pages:9] [Pages No:602 - 610]

Keywords: Echocardiography, Left ventricle ejection fraction, Peripartum cardiomyopathy, Pulmonary edema, Systolic dysfunction

   DOI: 10.5005/jp-journals-10006-2497  |  Open Access |  How to cite  | 

Abstract

Aim and background: Peripartum cardiomyopathy (PPCM) refers to a heart failure secondary to systolic dysfunction with left ventricular ejection fraction <45%, with no known prior cardiac disease. The clinical features of PPCM overlaps with physiological symptoms of pregnancy, leading to its delayed diagnosis and increased morbidity and mortality. The aim of this case series and review of literature is to increase the awareness of general care physician and obstetricians to this rare clinical entity. Case description: This is a case series of 5 patients with PPCM. All the patients were young (aged 22–30 years). All five of them presented in their third trimester with features of congestive heart failure. The most common high-risk factor among all patients was hypertension. Bedside echocardiography revealed LV dilatation with left ventricle ejection fraction (LVEF) <45% suggestive of PPCM. Patients were managed by multidisciplinary team and active management of heart failure was done. Two out of five patients were delivered vaginally, while the rest three underwent cesarean section for different indications. One of the two patients delivered vaginally underwent cardiac arrest 2 hours post-delivery and could not be resuscitated. Four out of 5 patients survived. Three of them were discharged home with no other sequelae and recovered their left ventricular functions at variable time periods after delivery. One of these four patients had the longest duration of hospital stay of 3 months. She suffered two episodes of cardiac arrest post-delivery. Patient suffered the cerebrovascular injury and developed paraplegia. Physiotherapy and rehabilitation were started along with the heart failure medications and were discharged home on the same. Her left ventricular functions did not recovered even at 12 months follow-up. Conclusion: Association of preeclampsia in this condition warrants future research to ascertain if recovery of ventricular function and hence the recovery of patient is different when PPCM is not associated with preeclampsia and if the management also differs in both the scenarios. Clinical significance: Echocardiography remains the gold standard in diagnosing the condition and must be incorporated in the initial workup of patients presenting with features of heart failure in late third trimester and early postpartum period.

239

REVIEW ARTICLE

RM Saraogi, Sunita Chandra, Ashish Parulekar, Rakesh Pandia, Abhijeet Shirsat, Heena Bhojwani

Oral Natural Micronized Progesterone: A Review of Its Implications in Obstetric Indications

[Year:2024] [Month:September-October] [Volume:16] [Number:5] [Pages:6] [Pages No:611 - 616]

Keywords: In vitro fertilization, Natural micronized progesterone, Preterm birth, Recurrent miscarriage, Sustained release, Threatened miscarriage

   DOI: 10.5005/jp-journals-10006-2496  |  Open Access |  How to cite  | 

Abstract

Progesterone is vital for sustaining pregnancy. Progesterone deficiency is considered a risk factor for infertility, threatened or recurrent miscarriages, and preterm births. Exogenous progesterone is a viable alternative for obstetric indications linked to low progesterone activity. Oral natural micronized progesterone (NMP) is beneficial in luteal phase support for in vitro fertilization (IVF), intrauterine insemination (IUI), threatened miscarriage, and preterm birth prevention. However, it necessitates frequent dosing and induces side effects owing to its active metabolites. To address these concerns, a sustained release (SR) formulation was developed and it presents a feasible option for addressing obstetric indications linked to inadequate endogenous progesterone levels. This review summarizes the benefits, efficacy, and safety of oral NMP and its SR formulation in obstetric indications.

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