Journal of South Asian Federation of Obstetrics and Gynaecology

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2024 | April | Volume 16 | Issue S1

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Editor's Desk

Jaideep Malhotra

Medical Disorders in Pregnancy

[Year:2024] [Month:April] [Volume:16] [Number:S1] [Pages:1] [Pages No:Siv - Siv]

   DOI: 10.5005/jsafog-16-S1-Siv  |  Open Access | 

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Original Article

M Kavya Venkatesh, Shraddha K Shetty, GV Chaithra

Morphological and Histopathological Features of Placenta in Women with Gestational Diabetes Mellitus and Its Association with Perinatal Outcome

[Year:2024] [Month:April] [Volume:16] [Number:S1] [Pages:6] [Pages No:S1 - S6]

Keywords: Calcification, Gestational diabetes mellitus, Infarction, Placental weight, Placental shape, Villous edema

   DOI: 10.5005/jp-journals-10006-2389  |  Open Access | 

Abstract

Background: Placenta, a unique vascular organ, acts as a barrier between maternal and fetal circulation, protecting the fetus from adverse effects of maternal diseases. Gestational diabetes mellitus (GDM) alters the placental function leading to histological and morphological changes in placenta. Hyperglycemia affects placental development leading to adverse maternal and perinatal outcomes. Aim: To understand the morphological and histopathological variations of the placenta in GDM pregnancies and its association with the perinatal outcome. Materials and methods: A hospital-based cross-sectional study was conducted in women with singleton pregnancy between 37 and 40 weeks of gestation with GDM (Cases) and compared with women without GDM (Control). The morphological and histopathological features of the placenta were studied, and the associated perinatal outcome was analyzed. Results: In cases, most of the women had babies with birth weight of 3.51–4 kg (57.1%) and was statistically significant (p = 0.001). The mean placental weight among cases and controls was 719.57 ± 110. 8 gm and 380.71 ± 50.59 gm, respectively. Placental histopathological changes (calcification of the placenta, fibrinoid necrosis of villi and immature villous) were noted in cases and were statistically significant (p = 0.001). Abnormal perinatal outcomes were observed in cases with an oval-shaped placenta (64.7%), increased cord thickness (68.4%), fibrinoid necrosis of villi (50%), syncytial knots (61.9%), and immature villous (54.5%). Conclusion: Gestational diabetes mellitus causes an alteration in morphological and histological features of the placenta resulting in adverse perinatal outcomes. Early diagnosis, treatment, and glycemic control aid in reducing perinatal morbidity and mortality.

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Original Article

Fareha Khatoon, Parul Sinha, Ayesha Ahmed, Amrita Singh, Shoadashi Saxena

Flipped Classroom Model for Undergraduate Teaching Using Mixed-methods Approach: A Pilot Project

[Year:2024] [Month:April] [Volume:16] [Number:S1] [Pages:1] [Pages No:S7 - S7]

Keywords: Active learning, Flipped classroom, Focused group discussion, Pilot project

   DOI: 10.5005/jp-journals-10006-2382  |  Open Access | 

Abstract

Aim and background: Despite the vast heterogeneity of teaching methods, there remains a dilemma on what works best for teaching medical students. Flipped classroom teaching is a learner-oriented active teaching-learning methodology with a focus on inculcating different aspects of knowledge attainment in learners including application, analysis, evaluation, and synthesis of knowledge. This study aimed to assess the acceptability of the flipped classroom model for teaching undergraduate medical students. Materials and methods: This was a mixed method qualitative analysis conducted over 3 months utilizing anonymized prevalidated questionnaire for learners and focused group discussion (FGD) for facilitators. A total of 50 students were enrolled for the flipped classroom sessions and feedback was taken with a combination of open and closed-ended questions. Focused group discussion was carried out to discuss the merits and constraints of the teaching methodology. Results were compiled as frequency distribution and the qualitative data was analyzed using pre-formed codes to identify recurring themes and opinions. Results: The majority of students found flipped classrooms to be more interactive and easier to comprehend in comparison with traditional teaching methods. About 72% of students experienced higher confidence levels after the subject was taken up as a flipped classroom. Conclusion: Flipped classroom teaching is acceptable and finds high satisfaction levels amongst medical students. It involves an investment of extra time and energy by the facilitators, especially initially. Clinical significance: This pilot project helps to understand the need for innovating and integrating various teaching techniques for better academic outcomes as well as student satisfaction and promotes further research with a higher sample size to fortify these active teaching methods in the world of education.

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Original Article

Hanumant V Nipanal, Praveen Uppar, Soubhagya R Talawar, S Susmitha

Comparison of Efficacy of Pervaginal Misoprostol, Intracervical Foley Catheter, Intracervical Dinoprostone on Induction of Labor

[Year:2024] [Month:April] [Volume:16] [Number:S1] [Pages:5] [Pages No:S11 - S15]

Keywords: Dinoprostone, Foley catheter, Misoprostol

   DOI: 10.5005/jp-journals-10006-2358  |  Open Access | 

Abstract

Introduction: Induction methods are many such as intravaginal misoprostol, intracervical Foley catheter, intracervical dinoprostone, etc. Presently, a very limited number of studies are available for comparing all three popular methods intravaginal misoprostol, intracervical Foley catheter, and intracervical dinoprostone. Aims and objectives: Comparison of efficacy of pervaginal misoprostol, intracervical Foley catheter, and intracervical dinoprostone on induction of labor and fetomaternal outcome. Materials and methods: It is a prospective study conducted on 273 patients divided into 3 groups, and each group included 90 study subjects. • Group I – Foley catheter of No. 18 introduced in the cervical canal. The Foley catheter balloon is filled with 50 mL of normal saline. • Group II – Dinoprostone 2.5 mL of 0.5 mg injected into the cervical canal below the internal os under aseptic precautions. • Group III – Tablet misoprostol 25-µg pervaginally put in the posterior fornix. Continuous observation of the patients will be done in all groups. Results: Success of induction was 100% in the Foley catheter, 92.3% in dinoprostone gel, and 90% in the misoprostol group, respectively. Vaginal delivery occurred—83.51% in Foley catheter, 59.34% in dinoprostone gel, and 73.62% in the misoprostol groups, respectively. The mean induction to delivery interval time was 16.78 ± 6.5 hours in the Foley catheter group, 12.87 ± 6.41 hours in the dinoprostone gel group, and 11.16 ± 5.97 in the misoprostol group. Conclusion: Foley catheter is superior to dinoprostone gel and misoprostol in achieving vaginal delivery.

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Original Article

Farhana Giri, Misbah Shawl, Shazia Bashir, Rizwana Habib, Rassieq Aslam

Study of Second Stage Partogram in Detection of Abnormalities of Second Stage

[Year:2024] [Month:April] [Volume:16] [Number:S1] [Pages:4] [Pages No:S16 - S19]

Keywords: Duration of labor, Second stage partogram, Second stage partogram score

   DOI: 10.5005/jp-journals-10006-2365  |  Open Access | 

Abstract

The second stage of labor is critical as well as prime as it affects the maternal and perinatal outcome in the form of risk of prompt hypoxic fetal stress and perineal maternal trauma. The aim of optimizing the second stage management is to understand and rectify the association between the uterine contractions, fetus, and birth canal to reduce the maternal and perinatal complications. Background: Emphasis has been laid on the first stage of labor using partogram and on the third stage of labor, including active management of labor, to provide habile care and decrease complications of the second stage of labor have been ignored. Methods: Once full dilation was achieved, per vaginal examination was done after proper consent. Position and station of head was noted and scored. After 30 minutes, per vaginal examination was repeated and position and station was noted, and then at 15 minutes till delivery. Results: Second stage partogram helps us to early detect the abnormal progress of second stage and to intervene early in terms of augmentation of labor or operative vaginal delivery and prevent maternal and fetal complications. Conclusion: Second stage partograph may help to prognosticate obstetric and perinatal outcome by using variables, such as station and position of head.

101

CASE SERIES

Kadek F Marta, Olivia L Prawoto, Made BD Aryana, Ryan S Mulyana

Pelvic Organ Prolapse in Young Balinese Women: A Case Series

[Year:2024] [Month:April] [Volume:16] [Number:S1] [Pages:5] [Pages No:S20 - S24]

Keywords: Ligament, Pelvic, Prolapse, Treatment

   DOI: 10.5005/jp-journals-10006-2384  |  Open Access | 

Abstract

Introduction: Pelvic organ prolapse (POP) is an important health problem but it is still receiving little attention, patients often seek medical help only when the disease is very disturbing/severe. Case description: This case report describes a series of three cases of POP in young women who had similar profiles in terms of several characteristics, including age, occupation, ethnicity, BMI, parity, age of the youngest child (years), number of vaginal deliveries, operative vaginal deliveries, episiotomy, birth weight of the largest child, family history of prolapse, diagnosis, and procedures performed. In this case series, conservative operative treatment (Purandare hysteropexy) was carried out, then an examination of the sacrouterine ligament tissue was performed from the operation. The results of the examination showed a decrease in the expression of type I collagen, an increase in type III collagen, an increase in the levels of matrix metalloproteinases-2 (MMP-2), and MMP-9 which based on previous studies are found in patients with POP. Conclusion: Conservative treatment with Purandare hysteropexy was done in all cases, further research is needed to establish whether this condition is the cause of the occurrence of POP in young people and the genetic correlation associated with the disorder.

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CASE SERIES

Prateek Sihag, Balakrishna Kudri, Manvika Chandel, Anupama Tandon, Rajendra Chowdhary

Scar Endometriosis: A Black and White Review of a Red Giant

[Year:2024] [Month:April] [Volume:16] [Number:S1] [Pages:6] [Pages No:S25 - S30]

Keywords: Case report, Cyclical pain, Ectopic endometriotic tissue, Endometriosis, Scar

   DOI: 10.5005/jp-journals-10006-2396  |  Open Access | 

Abstract

Scar endometriosis, a rare but clinically significant condition, arises from the ectopic presence of endometrial tissue in surgical scars following gynecological or obstetric procedures. This review aims to consolidate current knowledge on scar endometriosis, encompassing its pathogenesis, diagnostic challenges, and diverse management approaches. Imaging techniques, including ultrasound and MRI, play a crucial role in preoperative assessment, although definitive diagnosis often relies on histopathological examination post-excision.

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CASE REPORT

Archana Chirag Buch, Mangesh Londhe, Reshma Alexander, Sargam Dhaliwal

Xanthogranulomatous Salpingo-oophoritis with Incidental Pheochromocytoma: A Unique Combination Identified in Two Cases

[Year:2024] [Month:April] [Volume:16] [Number:S1] [Pages:4] [Pages No:S31 - S34]

Keywords: Case report, Oophoritis, Pheochromocytoma, Salpingitis, Xanthogranulomatous

   DOI: 10.5005/jp-journals-10006-2374  |  Open Access | 

Abstract

Lipid-rich foamy macrophages intermingled with lymphocytes, plasma cells, neutrophils, and eosinophils are the hallmark of xanthogranulomatous inflammation. Due to its capacity for mass formation and destructiveness, it is an uncommon entity that mimics neoplasm. Rarely, it is detected in the female genital system; however, it is most frequently seen in the kidney and gallbladder. It is associated with endometriosis, uterine leiomyoma, ovarian hemangioma, and can occur secondary to diverticulitis, chronic bacterial infections, ineffective antibiotic treatment, and uterine artery embolization. The annual incidence of pheochromocytoma is 0.8 per 100,000 person-years and it is a catecholamine-secreting tumor that arises from chromaffin cells in the adrenal medulla. Synchronous presentation of xanthogranulomatous salpingo-oophoritis (XSO) with pheochromocytoma has not been described so far. Hence, we report a series of two such cases mimicking malignancy and have discussed the pathogenesis of the above association.

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CASE REPORT

Zhong Ning Neoh, Ma Saung Oo, Alik R Zakaria, Anna L Roslani

Case Report: Unusual Presentation of Spontaneous Rupture of Ovarian Teratoma

[Year:2024] [Month:April] [Volume:16] [Number:S1] [Pages:4] [Pages No:S35 - S38]

Keywords: Case report, Chemical peritonitis, Mature cystic teratoma, Spontaneous rupture

   DOI: 10.5005/jp-journals-10006-2377  |  Open Access | 

Abstract

Background: Mature cystic teratoma (MCT) comprises 95% of ovarian germ cell tumors with 10–25% incidence in adults. The sequelae include torsion (15%), malignant transformation (1–2%), infection (1%), and rupture (0.3–2%). Spontaneous ruptures of MCT with spillage of sebaceous material into the abdominal cavity are rare due to its thick capsules. Ruptured ovarian teratoma can lead to chemical peritonitis, which is uncommon with diverse presentations. It presents with contralateral abdominal pain due to spillage of its contents into the opposite side of the abdominal cavity following tumor rupture. Case description: This is an unusual presentation of twisted and ruptured ovarian teratoma. A 26-year-old para 1 presented with persistent left lower abdominal pain that radiated to right and sought treatment from various clinics for a week duration. She was referred to a tertiary hospital for ruling out acute appendicitis for right-sided lower abdominal pain where the appendix is located. At first, she presented with sudden onset of moderate-to-severe left iliac fossa (LIF) pain during a bowel opening 5 days ago. Subsequently, the pain radiated to the right iliac fossa (RIF) and worsened on the day of admission. She also had multiple episodes of vomiting and vague suprapubic mass for 1 week. Abdominal examination revealed a palpable cystic suprapubic mass which is about 10 × 8 cm with persistent RIF pain. Ultrasonography showed a solid cystic mass at the LIF measured about 11 × 6 cm and the right ovary was visualized, with normal size uterus and thin endometrial lining. There was significant amount of free fluid, with normal kidneys seen. Ultrasound examination provided an inconclusive diagnosis and an emergency laparotomy was performed for suspicion of a ruptured ovarian cyst with a differential diagnosis of a perforated appendix. There was a twisted and ruptured left ovarian teratoma with a gangrenous base found intraoperatively which contains sebum, hair, and slough at the anterior part of the uterus and thicken omentum. Left-sided salpingo-oophorectomy and omentectomy were done. The peritoneal cavity was washed with copious amounts of warm saline. Conclusion: A ruptured dermoid cyst is one of the gynecological emergencies but is often an overlooked diagnosis. Mature ovarian teratoma consists of well-differentiated germ cell layers derivatives developing as hair, muscle, teeth, or bone. The size of dermoid cysts and torsion with infarction can contribute to their rupture. Correct diagnosis and timely surgical intervention are essential for preventing chemical peritonitis, long-term sequelae, and conserving the reproductive function.

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CASE REPORT

Shikha S Thakur, Shaheen Anjum, Shagufta Qadri

Malignant Struma Ovarii—Management and Follow-up of a Rare Ovarian Tumor: A Case Report

[Year:2024] [Month:April] [Volume:16] [Number:S1] [Pages:4] [Pages No:S39 - S42]

Keywords: Case report, Dermoid cyst, Mature cystic teratoma, Patient care technician, Struma ovarii

   DOI: 10.5005/jp-journals-10006-2385  |  Open Access | 

Abstract

Mature cystic ovarian teratomas (MCT) are the commonest germ cell tumors accounting for about 30–45% of all ovarian neoplasms and 60% of all benign neoplasms arising in the ovary. Only 2% of MCTs undergo malignant transformation. We report a rare case of a 48-year-old woman diagnosed with a primary malignant struma ovarii arising in a dermoid cyst of the ovary. The patient was admitted with the complaint of pelvic pain and a pelvic mass in the lower abdomen on gynecological examination and ultrasonography showed a dermoid cyst of the ovary. Preoperative tumor markers and routine biochemistry were unremarkable. A laparoscopic left-sided salpingo-oophorectomy was done. Histopathology of the tissue showed a malignant struma ovarii and immunohistochemistry (CK-19 levels) similar to the guidelines for primary thyroid gland disease. The patient was subsequently taken up for staging laparotomy with total abdominal hysterectomy with right salpingo-oophorectomy and retroperitoneal pelvic and para-aortic lymphadenectomy and omentectomy. The histopathological report of all staging tissues was normal and surgical staging IA was assigned. Thyroglobulin level was monitored in the postoperative period. She is free of the disease for the last 2 years.

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REVIEW ARTICLE

S Shantha Kumari, Basab Mukherjee, Jai Bhagwan Sharma, Girija Wagh, Kavita Bapat, Reena Wani, Sneha Bhuyar, Vaishali Chavan, Aruna Suman, Chaitanya Ganpule, Deepa Mukundan

Federation of Obstetric and Gynecological Societies of India Consensus Recommendations for the Management of Postpartum Anemia with Specific Reference to Usage of Ferric Carboxymaltose

[Year:2024] [Month:April] [Volume:16] [Number:S1] [Pages:7] [Pages No:S43 - S49]

Keywords: Ferric carboxymaltose, Iron deficiency anemia, Postpartum anemia, Postpartum care

   DOI: 10.5005/jp-journals-10006-2373  |  Open Access | 

Abstract

Background: India has a substantially high burden of postpartum anemia (PPA). Several countries have guidelines regarding screening, diagnosis, and management of PPA. However, different modalities of treatment are followed in clinical practice, and consensus on management of PPA is lacking among the Indian practitioners. Aim: To review the current evidence and come to a consensus regarding definition, classification, appropriate time of screening and diagnosis, along with management of PPA, with specific reference to usage of ferric carboxymaltose (FCM). Methodology: The core committee comprised of 11 obstetricians. Using the modified Delphi method, eight statements were created, discussed, and ranked by the obstetricians and recommendations were recorded. Statements were ranked on a 9-point Likert's scale ranging from 1 (strongly disagree) to 9 (strongly agree). For each statement, the scores of all the obstetricians were summed and an average score of ≥7.00 was required to attain the consensus. Results: The cut-off hemoglobin (Hb) levels of above 11 gm/dL within 1-week postdelivery is termed as PPA. Postpartum anemia severity can be graded as mild, moderate, and severe with Hb levels of 10–10.9, 7–9.9, and below 7 gm/dL, respectively. All postpartum women (PPW) should be universally screened with Hb estimation and complete blood count (CBC) within 24–48 hours of delivery, prior to discharge, and repeat Hb estimation should be performed at 6 weeks postdelivery. Ferric carboxymaltose is superior to oral and other intravenous (IV) iron therapies and all PPW should be discharged with a single dose of FCM after an informed decision. Additionally, oral iron (OI) is not required during or following FCM administration, the decision to start oral therapy can be taken after 4 weeks of discharge, if required. Conclusion: Ferric carboxymaltose is a safe, effective, well-tolerated, and economical option for managing PPA and shall be practiced in all women with PPA before discharge.

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DRUG UPDATE

Ruchika Garg

Fezolinetant: Newer Non-hormonal Treatment of Vasomotor Symptoms

[Year:2024] [Month:April] [Volume:16] [Number:S1] [Pages:1] [Pages No:S50 - S50]

   DOI: 10.5005/jp-journals-10006-2372  |  Open Access | 

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Book Review

Ruchika Garg

Practical Guide to Ovulation Induction

[Year:2024] [Month:April] [Volume:16] [Number:S1] [Pages:1] [Pages No:S51 - S51]

   DOI: 10.5005/jsafog-16-S1-S51  |  Open Access | 

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