Journal of South Asian Federation of Obstetrics and Gynaecology

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2017 | July-September | Volume 9 | Issue 3

EDITORIAL

BT Kokila

Relationship between Vitamin D and Insulin Resistance in Polycystic Ovary Syndrome Women

[Year:2017] [Month:July-September] [Volume:9] [Number:3] [Pages:5] [Pages No:211 - 215]

PDF  |  DOI: 10.5005/jp-journals-10006-1497  |  Open Access |  How to cite  | 

Abstract

Garg R, Malhotra J, Singh S, Singh R, Kokila BT, Agrawal P. Relationship between Vitamin D and Insulin Resistance in Polycystic Ovary Syndrome Women. J South Asian Feder Obst Gynae 2017;9(3):211-215.

ORIGINAL ARTICLE

Savita Somalwar, Preksha Jain, Pritesh Jain

Neonatal Outcome and Its Correlation with Hemoglobin A1c in Gestational Diabetes Mellitus

[Year:2017] [Month:July-September] [Volume:9] [Number:3] [Pages:5] [Pages No:216 - 220]

PDF  |  DOI: 10.5005/jp-journals-10006-1498  |  Open Access |  How to cite  | 

Abstract

Aim

To determine neonatal outcome in women with gestational diabetes mellitus (GDM) diagnosed using Diabetes in Pregnancy Study Group of India (DIPSI) recommended method.

Materials and methods

Out of 487 antenatal women, 52 were diagnosed with GDM using DIPSI test. All women were followed up until delivery and evaluated for neonatal outcome and managed accordingly. The appropriate statistical tests for various variables were applied by using Epi Info 7 software and evaluated at the level below than 5%.

Results

Apgar score of <6 at 5 minutes was found in 10 (20%) neonates of GDM mothers as compared with 18 (4.1%) in non-GDM group (p-value of 0.00001). Respiratory distress was present in 19 (38%) neonates in GDM group, while it was 48 (11.1%) in non-GDM group (p-value of 0.00002). Association of GDM and hyperbilirubinemia was nonsignificant in 2 (4%) neonates among GDM group, while it was 6 (1.4%) in non-GDM group. Hypoglycemia was 5 (10%) in GDM group, while 3 (0.7%) in non-GDM group (p-value of <0.0003). A total of 3 (6%) among GDM group had hypocalcemia, while 3 (0.7%) had hypocalcemia in non-GDM group (p-value of 0.02). The neonatal intensive care unit admissions were 29 (58%) in GDM group, while it was 96 (22.1%) neonates belonging to non-GDM group (p-value of 0.00001). No neonatal deaths were reported in GDM group, while there were 2 (0.5%) in non-GDM group. Anomalies were found in 6 (11.5%) in GDM group as compared with 5 (1.1%) in non-GDM (p-value of 0.00001). About 44.2% women with GDM had hemoglobin (Hb)A1c levels between 6 and 6.9%. Among GDM women, 4 (7.7%) had pregnancy losses as compared with 7 (1.6%) in non-GDM group.

Conclusion

The GDM is associated with significant fetal and neonatal morbidity; hence, preconceptional counseling, early diagnosis, and proper treatment are recommended.

Clinical significance

Preconceptional correction of HbA1c is also recommended based on risk of anomalies in fetus of GDM mother.

How to cite this article

Jain P, Somalwar S, Jain P. Neonatal Outcome and Its Correlation with Hemoglobin A1c in Gestational Diabetes Mellitus. J South Asian Feder Obst Gynae 2017;9(3):216-220.

ORIGINAL ARTICLE

Anuja V Bhalerao, Richa Garg

Müllerian Anomalies: A Cause for Primary Amenorrhea

[Year:2017] [Month:July-September] [Volume:9] [Number:3] [Pages:4] [Pages No:221 - 224]

PDF  |  DOI: 10.5005/jp-journals-10006-1499  |  Open Access |  How to cite  | 

Abstract

Introduction

Primary amenorrhea is a challenging entity as it affects the reproductive outcome. Primary amenorrhea is an absence of secondary sexual characters until 14 years of age or absence of menstruation with secondary sexual characters until 16 years of age.

Aim

The aim of this article is to study the frequency, etiologic causes, presentation, diagnosis, and optimal mode of management of primary amenorrhea.

Materials and methods

All girls who had not attained menarche until 16 years of age in the absence of secondary sexual characters and until 14 years, if no secondary sexual characters, and were willing for follow-up were subjected to investigations and were treated as per the etiology.

Results

Mayer–Rokitansky–Küster–Hauser (MRKH) syndrome was the most common cause of primary amenorrhea (42.85%) followed by imperforate hymen (28.57%) and transverse vaginal septum (21.42%), one each of low, mid, and high varieties. There was one case of androgen insensitivity syndrome.

Conclusion

Establishing correct diagnosis is essential for planning treatment and management strategies in primary amenorrhea as treatment goals are preservation of fertility and progression of normal development.

How to cite this article

Bhalerao AV, Garg R. Müllerian Anomalies: A Cause for Primary Amenorrhea. J South Asian Feder Obst Gynae 2017;9(3):221-224.

ORIGINAL ARTICLE

Shreyashi Aryal, Sagun B Pant, Sebina Baniya

Gender-based Violence in Women attending Gynecology Outpatient Department in a Hospital of Western Nepal: An Issue of Endurance and Invisibility

[Year:2017] [Month:July-September] [Volume:9] [Number:3] [Pages:5] [Pages No:225 - 229]

PDF  |  DOI: 10.5005/jp-journals-10006-1500  |  Open Access |  How to cite  | 

Abstract

Introduction

Gender-based violence (GBV) is faced by many women in Nepal but health-seeking behavior is rare. A reproductive health facility may be the only place where a woman comes for a health visit. So, health care providers, especially gynecologists, play an important role to identify women suffering from GBV as they see clients suffering from the reproductive health effects of GBV on a daily basis. The purpose of this study was to find the prevalence and severity of GBV in women attending the outpatient department (OPD) and to compare their clinical diagnosis with those not facing GBV.

Materials and methods

This is a prospective study conducted at Lumbini Medical College Teaching Hospital for a period of 3 months enrolling 741 nonpregnant women attending the OPD. A structured questionnaire was used for interview to identify women facing abuse and to assess their gynecological problems.

Results

Out of 741 women, 172 faced GBV, so the prevalence was 23.21%. Emotional and physical abuse was the most common type of abuse faced by 56 (32.56%), but the severity was reported more in sexual abuse [8 (57.14%)]. Pain abdomen was the most common symptom [69 (40.12%)], and chronic pelvic pain (CPP) [60 (34.89%)] was the commonest clinical diagnosis made in these women. Chronic pelvic pain was diagnosed more in women facing abuse (p < 0.001).

Conclusion

In this study, about one in four women in reproductive age group had experienced GBV. Gynecology OPD of a tertiary hospital could be used as a screening setting that can assist in early detection and prevention of GBV in Nepal.

How to cite this article

Aryal S, Pant SB, Baniya S. Gender-based Violence in Women attending Gynecology Outpatient Department in a Hospital of Western Nepal: An Issue of Endurance and Invisibility. J South Asian Feder Obst Gynae 2017;9(3):225-229.

ORIGINAL ARTICLE

GS Jyothi

Internal Iliac Artery Ligation: A Retrospective Analysis of Two Different Approaches

[Year:2017] [Month:July-September] [Volume:9] [Number:3] [Pages:5] [Pages No:230 - 234]

PDF  |  DOI: 10.5005/jp-journals-10006-1501  |  Open Access |  How to cite  | 

Abstract

Aim

To describe two different approaches of performing internal iliac artery ligation and their usefulness in different clinical situations.

Introduction

Internal iliac artery ligation is a very useful method to control pelvic hemorrhage. It can become a necessity at any point of time while performing obstetric or gynecological surgeries, and it is a procedure that needs to be accomplished in a matter of few minutes, before the patient goes into irreversible shock.

Techniques

Internal iliac artery ligation can be done by approaching the artery by opening the retroperitoneal space, either by dividing the round ligament or by opening the pouch of Douglas. The internal iliac artery is identified by locating the bifurcation of the common iliac artery with the ureter crossing it. The external iliac artery is the lateral branch of the common iliac artery and it runs a straight course to continue as the femoral artery in the lower limb. The ureter is identified by peristalsis, and the internal iliac artery is the short medial branch of the common iliac which runs a short course and immediately divides into an anterior and a posterior division, which in turn divide into a number of branches. The uterine artery is the branch of anterior division of the internal iliac artery. The internal iliac artery is ligated by passing a stout suture material under it with the help of a right-angled forceps, or it can be directly occluded with clips, applied using a clip applicator.

Conclusion

Both the approaches are equally effective and easy to perform. Approaching the internal iliac artery through the round ligament is easier in gynecological surgeries, whereas the pouch of Douglas approach is easier during cesarean section.

Clinical significance

Internal iliac artery ligation is almost always performed as an emergency, though the need to perform it can be anticipated in advance and the gynecologist can be prepared for it. It is essential for gynecologists to be conversant with this life and a uterus-saving procedure. There are two approaches of doing this procedure and the choice is entirely on the individual. It may not be possible to approach the pouch of Douglas when there are dense adhesions as in case of a frozen pelvis. And it may be time-consuming to approach the internal iliac artery by dividing the round ligaments when there is postpartum hemorrhage. Therefore, it is useful to know both the approaches, because one might encounter a situation where one may find it difficult to follow the technique one is familiar with.

How to cite this article

Podder AR, Jyothi GS. Internal Iliac Artery Ligation: A Retrospective Analysis of Two Different Approaches. J South Asian Feder Obst Gynae 2017;9(3):230-234.

RESEARCH ARTICLE

Helmy A Rady

Sacrospinous Ligament Fixation in Patients with Second-degree Uterine Prolapse

[Year:2017] [Month:July-September] [Volume:9] [Number:3] [Pages:4] [Pages No:235 - 238]

PDF  |  DOI: 10.5005/jp-journals-10006-1502  |  Open Access |  How to cite  | 

Abstract

Background

Sacrospinous ligament fixation is a simple procedure we use today to treat cases with uterine prolapse.

Aim

The aim is to test the effectiveness of this procedure in the treatment of second-degree uterine prolapse.

Materials and methods

The study included 50 women with second-degree uterine prolapse. Out of 50 women, 25 (group I) were treated with bilateral sacrospinous ligament fixation, while the other 25 (group II) were treated with unilateral sacrospinous ligament fixation. The efficacy and intraoperative and postoperative complications are recorded (follow-up of patients occurred 3 and 6 months postoperatively).

Results

Mean operative time in unilateral sacrospinous fixation is 52 ± 10.6 minutes, while in bilateral procedure, it is 73 ± 12.6 minutes. However, postoperative pain is more in bilateral than unilateral procedure.

Conclusion

Sacrospinous ligament fixation is an effective treatment for patients having second-degree uterine prolapse. Unilateral is better than bilateral sacrospinous operation regarding postoperative pain.

How to cite this article

Rady HA. Sacrospinous Ligament Fixation in Patients with Second-degree Uterine Prolapse. J South Asian Feder Obst Gynae 2017;9(3):235-238.

RESEARCH ARTICLE

Bharti Sahu, Priyadarshini Tiwari, Pooja Saraogi, Poorva Badkur, Varsha R Choudhary

Trends in Maternal Mortality in Medical College Jabalpur, India in the last 15 Years

[Year:2017] [Month:July-September] [Volume:9] [Number:3] [Pages:6] [Pages No:239 - 244]

PDF  |  DOI: 10.5005/jp-journals-10006-1503  |  Open Access |  How to cite  | 

Abstract

Aim

The aim of our article was to study the causes of maternal deaths in our institution from the year 2001 to 2015 and to see whether there has been any decline in the preventable causes of death and if our results are comparable with the statistics of the state.

Materials and methods

The data pertaining to maternal mortality from 2001 to 2016 were entered in Excel sheets, and data analysis was done in Excel software. The impact of government schemes on mortality and antenatal care was evaluated and the problems at the tertiary care center were analyzed.

Results

Eclampsia and anemia, which are largely preventable causes of death, were and still continue to be the leading causes of mortality in our institution which is the tertiary referral center for a large tribal belt. Though data differ, the maternal mortality in our institution rose at the time of implementation of government schemes to fall to previous levels by 2015.

Conclusion

There has been a definite reduction in the maternal mortality of the state. In spite of various government schemes for promoting hospital deliveries and registering antenatal patients for care, the preventable causes of death still appear to be leading in maternal mortality. Our antenatal care needs further improvement and so does our tertiary level care.

Clinical significance

Government schemes have helped in getting critical referrals to tertiary care centers. Further reduction in mortality can be achieved only if our antenatal care and tertiary care can be improved.

How to cite this article

Tiwari P, Badkur P, Sahu B, Saraogi P, Choudhary VR. Trends in Maternal Mortality in Medical College Jabalpur, India in the last 15 Years. J South Asian Feder Obst Gynae 2017;9(3):239-244.

RESEARCH ARTICLE

Rashmi Gupta

Female Sterilization Failure reported during 5 Years at a Tertiary Care Teaching Hospital: A Retrospective Survey

[Year:2017] [Month:July-September] [Volume:9] [Number:3] [Pages:5] [Pages No:245 - 249]

PDF  |  DOI: 10.5005/jp-journals-10006-1504  |  Open Access |  How to cite  | 

Abstract

Aim

To study the changing trends of female sterilization failures reported during past 5 years (October 2011 to September 2016), and their etiological factors and outcome of pregnancies resulting due to failure at a tertiary center.

Materials and methods

A retrospective study was conducted that included all women who had reported as tubal ligation failure in the family planning unit of the Department of Obstetrics and Gynaecology in our institution during a 5-year span (2011 to 2016). Data were collected from case records maintained in the Family Planning Unit and Medical Record Department.

Results

Sixty-eight cases of sterilization failure with longest interval of 19 years were documented, out of which 21 (30.9%) were interval laparoscopic ligation, 29 (42.6%) medical termination of pregnancy with lap ligation, 2 (0.9%) postpartum sterilization, and 10 (14.7%) concurrent with lower segment cesarean section. Only 37 (54.41%) patients reported failure in 1st trimester, 4 (5.8%) were beyond 20 weeks gestation, and 2 (2.9%) presented as ruptured ectopic pregnancy. There were six cases (14%) of spontaneous recanalization, three (6.9%) due to tuboperitoneal fistula, and 79% due to improper surgical technique.

Conclusion

Female sterilization failure is a proven entity that can occur at any age, method, and interval. Failures due to improper technique can be prevented by following standard guidelines for tubal sterilization.

How to cite this article

Sharma R, Gupta R, Guleria K, Suneja A. Female Sterilization Failure reported during 5 Years at a Tertiary Care Teaching Hospital: A Retrospective Survey. J South Asian Feder Obst Gynae 2017;9(3):245-249.

RESEARCH ARTICLE

Poornima Shankar, Shaanthy Gunasingh

Role of Magnetic Resonance Imaging in the Diagnosis and Management of Pelvic Floor Dysfunction

[Year:2017] [Month:July-September] [Volume:9] [Number:3] [Pages:5] [Pages No:250 - 254]

PDF  |  DOI: 10.5005/jp-journals-10006-1505  |  Open Access |  How to cite  | 

Abstract

Aim

To study the effect of age and parity in pelvic floor anatomy in women with pelvic floor dysfunction and the changes in pelvic floor anatomy after a course of pelvic floor exercises.

Design

A prospective study at Government Kilpauk Medical College (KMC), Chennai.

Materials and methods

Patients with pelvic floor dysfunction are subjected to clinical examination and magnetic resonance imaging (MRI). The changes in anatomy are analyzed in terms of levator hiatus dimension and descent of the pelvic organs. Substratified analysis is done and mean diameters in each degree of prolapse are identified (Chi-square tests using cross tables). Patients with cystocele, rectocele, or enterocele are also compared in both clinical examination and MRI and the degree of correlation is measured (inter-rater kappa). The changes in pelvic floor anatomy in terms of H line, M line, and levator plate angle with respect to age and parity are studied. In patients with lower degrees of prolapse, the changes in anatomy in terms of H line, M line, and levator plate angle are studied after a course of pelvic floor exercises (post hoc tests and paired t-tests). The area under curve of receiver-operating curve in each degree of prolapse is seen and the critical cut-off value of the various anatomical parameters above which a patient develops a prolapse is calculated.

Results

Ninety patients with symptoms of pelvic floor dysfunction were studied with clinical examination and MRI. Levator hiatus width cut off at rest above 5 cm and at straining above 5.8 cm develops clinical first-degree prolapse. Levator plate angle of more than 44.4° develops a clinical first-degree prolapse. With increasing age there is an increase in mean values of levator hiatus width at straining, levator plate angle, and descent of various organs. With increasing parity, there is an increase in mean values of levator hiatus width at rest and straining and increase in descent at straining.

Conclusion

Magnetic resonance imaging should be considered as a pretreatment planning tool when the physical findings are equivocal.

How to cite this article

Shankar P, Gunasingh S. Role of Magnetic Resonance Imaging in the Diagnosis and Management of Pelvic Floor Dysfunction. J South Asian Feder Obst Gynae 2017;9(3):250-254.

RESEARCH ARTICLE

Subhash Chandra, Sushma Gaur, Santosh Khajotia, Swati Falodia

Prospective Case–control Study to Predict the Obstetrical (Maternal and Fetal) Outcome after First Trimester Bleeding

[Year:2017] [Month:July-September] [Volume:9] [Number:3] [Pages:5] [Pages No:255 - 259]

PDF  |  DOI: 10.5005/jp-journals-10006-1506  |  Open Access |  How to cite  | 

Abstract

Aims

To study the obstetrical complications in women with first trimester bleeding, to evaluate the perinatal outcome in women with first trimester bleeding, to prognosticate the obstetrical and perinatal outcome based on severity of first trimester bleeding, and to compare it with the obstetrical and perinatal outcome in women having normal pregnancy.

Materials and methods

This study was conducted in the Department of Obstetrics and Gynaecology, PBM and associated group of hospitals attached to Sardar Patel Medical College, Bikaner, India, during the study period of 1 year, i.e., January 2014 to December 2014.

Results

The percentage of stillbirth in study group was 4.9% and in control group it was only 1%. The percentage of early neonatal death in study group was 3.7% and in control group was 2.1%. The difference was found statistically highly significant (p < 0.001). According to antenatal complications, all the parameters were statistically insignificant (p > 0.05) except pregnancy-induced hypertension preterm labor and antepartum hemorrhage where the difference was found statistically significant (p < 0.05), and abortion where the difference was found statistically highly significant (p < 0.001).

Conclusion

In conclusion, considering the results of our study, first trimester vaginal bleeding can be a predicting factor for adverse outcome of mother and infant. It is necessary to increase the knowledge of pregnant women in this regard for close observation. Also, the study is appropriate because the clinical intervention of attentive obstetrician has important role in not only the continuation of pregnancy but also decreasing fetal complications in these high-risk pregnancies.

How to cite this article

Gaur S, Khajotia S, Chandra S, Falodia S. Prospective Case–control Study to Predict the Obstetrical (Maternal and Fetal) Outcome after First Trimester Bleeding. J South Asian Feder Obst Gynae 2017;9(3):255-259.

RESEARCH ARTICLE

Anju Sharma, Nupur Hooja, Brijesh Dadhich, Sapna Aseri, Avantika Sharma, Bhomraj Kumawat

Restricted Use of Episiotomy

[Year:2017] [Month:July-September] [Volume:9] [Number:3] [Pages:3] [Pages No:260 - 262]

PDF  |  DOI: 10.5005/jp-journals-10006-1507  |  Open Access |  How to cite  | 

Abstract

Aim

There is extensive disagreement about the necessity and benefits of routine episiotomy for all. The American Congress of Obstetricians and Gynecologists Committee on Practice Bulletins, 2006 based on good scientific evidence recommends restricted use of episiotomy to be preferred, yet its restricted use is not being practiced. Keeping these in mind, the study was done with the aim to assess the effects of restrictive use of episiotomy during vaginal birth.

Materials and methods

This was a prospective study. Singleton primigravida term vaginal deliveries over 3 months were included. Under the policy of restricted use of episiotomy, great restraint was observed in giving an episiotomy. Mediolateral episiotomy was given in women where expected baby weight >3 kg or perineal tear was anticipated, and in cases of instrumental deliveries. Perineal tears, postpartum status, and satisfaction level of women were compared between patients with or without episiotomy. Data so obtained were analyzed.

Results

About 29.8% women delivered with episiotomy, 65.5% had intact perineum; 5.67% women had first-degree perineal tear and only 1.42% women had second-degree perineal tear using a policy of restricted use of episiotomy. None of the women had third- and fourth-degree perineal tear. Patients delivered without episiotomy were more comfortable in terms of less perineal pain, early evacuation of bladder, and ambulation.

Conclusion

With the restricted use of episiotomy using precise clinical judgment, the unnecessary episiotomies could be avoided, giving better care and patient satisfaction with minimum maternal morbidity.

Clinical significance

The policy of restricted use of episiotomy would result in considerable reduction in maternal morbidity, decreased hospital stay and overall cost, and good patient satisfaction level.

How to cite this article

Dadhich B, Hooja N, Sharma A, Aseri S, Sharma A, Kumawat B. Restricted Use of Episiotomy. J South Asian Feder Obst Gynae 2017;9(3):260-262.

RESEARCH ARTICLE

Philby B Menachery, Judith A Noronha, Sweety J Fernandes

Knowledge and Attitude on “Standard Days Method” of Family Planning among Female Postgraduate Students: A Cross-sectional Study

[Year:2017] [Month:July-September] [Volume:9] [Number:3] [Pages:6] [Pages No:263 - 268]

PDF  |  DOI: 10.5005/jp-journals-10006-1508  |  Open Access |  How to cite  | 

Abstract

Background

“Standard Days Method” is a fertility awareness method of family planning that helps to identify the fertile days in a menstrual cycle during which a woman is likely to get pregnant. It is calculated to be 12 days ranging from day 8 through 19 in a menstrual cycle of 26 to 32 days. This study aimed to assess the knowledge and attitude on the “Standard Days Method” of family planning, correlation between knowledge and attitude, and the association between knowledge and attitude with the selected demographic variables.

Materials and methods

A cross-sectional survey was carried out among 540 female students aged 21 to 25 years from selected postgraduate colleges of selected district in Karnataka State of South India. Self-administered questionnaires were used to collect the data.

Results

Majority (94%) of the students surveyed had poor knowledge regarding “Standard Days Method” but majority (54.2%) of them favored the “Standard Days Method”. There was significant weak positive correlation between knowledge and attitude scores (r = 0.292, p < 0.001). The knowledge scores and attitude score had significant association with certain demographic variables.

Conclusion

Awareness program on fertility awareness-based methods of family planning is essential to provide cogent information to young adults, thus empowering them to take wise decisions on planned parenthood.

How to cite this article

Menachery PB, Noronha JA, Fernandes SJ. Knowledge and Attitude on “Standard Days Method” of Family Planning among Female Postgraduate Students: A Cross-sectional Study. J South Asian Feder Obst Gynae 2017;9(3):263-268.

CASE REPORT

Vaginal and Bladder Rupture without Uterine Rupture in Unscarred Uterus

[Year:2017] [Month:July-September] [Volume:9] [Number:3] [Pages:2] [Pages No:269 - 270]

PDF  |  DOI: 10.5005/JSAFOG-9-3-269  |  Open Access |  How to cite  | 

CASE REPORT

Davinder Bhardwaj, Shivendra K Sinha, Arvinder K Heer

Sirenomelia: A Rare Congenital Anomaly

[Year:2017] [Month:July-September] [Volume:9] [Number:3] [Pages:3] [Pages No:271 - 273]

PDF  |  DOI: 10.5005/jp-journals-10006-1510  |  Open Access |  How to cite  | 

Abstract

Introduction

Sirenomelia is a congenital structural anomaly characterized by abnormal development of the caudal region of the body. The peculiar characteristics of sirenomelia are complete fusion of bilateral lower limbs giving the fetus an appearance of mermaid. The other anatomical defects may be renal agenesis, gastrointestinal defects, and absent external genitalia. The outcome of the condition is usually fatal for the baby despite attempts for corrective surgery. This abnormality was initially confused with caudal regression syndrome, but later was given a new name, i.e., sirenomelia mermaid syndrome.

Case report

We present a case of a 23-year-old primigravida unbooked case reported at 25 weeks 6 days period of gestation with complaint of decreased fetal movements. The ultrasound was suggestive of single live intrauterine fetus of 24 weeks with severe oligohydramnios (amniotic fluid index 1–2 cm). Based on fetal magnetic resonance imaging, which revealed multiple congenital anomalies including nonvisualization of kidneys and poorly formed lower limbs, provisional diagnosis of sirenomelia with renal aplasia incompatible with life was made. She delivered a baby 943 gm with features and appearance suggestive of mermaid syndrome (sirenomelia). Patient was discharged with advice to report early in next pregnancy.

Conclusion

Sirenomelia is a very rare disorder, with prevalence of 1 in 100,000 live births with a total of 300 cases reported until today in which 9 are from India. The precise etiology of sirenomelia is not well understood. Many theories have been proposed, but none of these is considered definitive. It is very important to diagnose this universally fatal condition by ultrasonography in early pregnancy, so that termination of pregnancy can be carried out.

How to cite this article

Verma P, Bhardwaj D, Sinha SK, Heer AK. Sirenomelia: A Rare Congenital Anomaly. J South Asian Feder Obst Gynae 2017;9(3):271-273.

CASE REPORT

Vineet Mishra, Sakshi Nanda, Khushali Gandhi, Pradeep Bandwal, Rajani Nawal

Vaginoplasty with Uterovaginal Anastomosis for partial Vaginal and Complete Cervical Agenesis: A Rare Müllerian Anomaly

[Year:2017] [Month:July-September] [Volume:9] [Number:3] [Pages:3] [Pages No:274 - 276]

PDF  |  DOI: 10.5005/jp-journals-10006-1511  |  Open Access |  How to cite  | 

Abstract

How to cite this article

Mishra VV, Nawal R, Aggarwal R, Nanda S, Bandwal P, Gandhi K. Vaginoplasty with Uterovaginal Anastomosis for partial Vaginal and Complete Cervical Agenesis: A Rare Müllerian Anomaly. J South Asian Feder Obst Gynae 2017;9(3):274-276.

CASE REPORT

Vineet Mishra, Sumesh Choudhary, Himani Agarwal

Selective Fetal Reduction of Conjoined Twins in Twin Pregnancy

[Year:2017] [Month:July-September] [Volume:9] [Number:3] [Pages:3] [Pages No:277 - 279]

PDF  |  DOI: 10.5005/jp-journals-10006-1512  |  Open Access |  How to cite  | 

Abstract

Background

The incidence of conjoined twins is rare. In early pregnancy, transvaginal ultrasound may facilitate diagnosis and prompt intervention can be done.

Case Report

A 35 years old patient with history of infertility for 17 years conceived after In vitro fertilization–embryo transfer with donor oocytes due to ovarian factor; three embryos were transferred. Transvaginal sonography was done on 21st day after transfer and it revealed three gestational sacs with fetal pole in all the sacs. Repeat TVS done on 65th day post embryo transfer revealed one gestational sac with single live embryo, second sac with two embryos joined at thorax and abdomen with a common heart, and two heads. Couple was then counseled for fetal reduction in view of expected poor outcome of conjoined twins. Selective fetal reduction was done at 12 weeks gestation with intra-cardiac potassium chloride administration. Pregnancy is now ongoing with an apparently normal live singleton fetus.

Conclusion

When conjoined twins are detected early, fetal reduction is a good modality of management. These pregnancies are associated with severe complications, maternal and fetal morbidity and mortality. Hence, the sooner the fetal reduction is, the better the management of conjoined twins.

How to cite this article

Choudhary S, Mishra V, Aggarwal R, Agarwal H. Selective Fetal Reduction of Conjoined Twins in Twin Pregnancy. J South Asian Feder Obst Gynae 2017;9(3):277-279.

CASE REPORT

Anuja V Bhalerao, Preksha Jain, Sakshi Aggarwal

Late-onset Congenital Adrenal Hyperplasia or Early-onset Polycystic Ovarian Syndrome: A Clinical Dilemma

[Year:2017] [Month:July-September] [Volume:9] [Number:3] [Pages:3] [Pages No:280 - 282]

PDF  |  DOI: 10.5005/jp-journals-10006-1513  |  Open Access |  How to cite  | 

Abstract

Aim

To differentiate nonclassical congenital adrenal hyperplasia (NCAH) from polycystic ovarian syndrome (PCOS) in a 13-year-old girl.

Background

Hirsutism and virilization are effects of hyperandrogenism by ovaries and adrenal glands. It has a marked psychological and social impact affecting the quality of life; 75% of premenarchal girl have hyperandrogenism, which is due to PCOS but late-onset congenital adrenal hyperplasia cannot be ruled out, and this leaves the clinician in quandary regarding the diagnosis and management.

Case report

A 13½-year-old girl presented with excessive facial hair, hoarseness of voice, and darkening of elbow pits since past 2 months, which was increasing in severity. The patient had not yet attained menarche but had pubarche 1 year back. Examination revealed presence of acanthosis, underdeveloped breasts, and clitoromegaly >3 cm. Levels of 17-hydroxyprogesterone were normal but higher levels were reported poststimulation. Fasting insulin levels were also high. Appropriate treatment was started, which led to improvement in patient's symptoms.

Conclusion

There is significant overlapping between PCOS and NCAH, which warrants accurate diagnosis based on hormonal analysis to institute early and appropriate therapy.

Significance

Early therapy can prevent infertility and androgenic complications later in life.

How to cite this article

Jain P, Bhalerao AV, Aggarwal S. Late-onset Congenital Adrenal Hyperplasia or Early-onset Polycystic Ovarian Syndrome: A Clinical Dilemma. J South Asian Feder Obst Gynae 2017;9(3):280-282.

CASE REPORT

Radhika Gollapudi, S Rammurty

Selective Uterine Artery Embolization: An Effective Treatment Option for Postpartum Hemorrhage due to Pseudoaneurysm of Uterine Artery

[Year:2017] [Month:July-September] [Volume:9] [Number:3] [Pages:4] [Pages No:283 - 286]

PDF  |  DOI: 10.5005/jp-journals-10006-1514  |  Open Access |  How to cite  | 

Abstract

Aim

To demonstrate the efficacy of uterine artery embolization in the management of postpartum hemorrhage (PPH) due to pseudoaneurysm of the uterine artery.

Background

Postpartum hemorrhage is a leading cause of maternal mortality in India. Secondary PPH is a rare cause but potentially life threatening. Common causes of secondary PPH are retained products of conception, subinvolution of uterus, and endometritis. Pseudoaneurysm is an uncommon cause of secondary PPH following operative delivery. Color Doppler ultrasound is a useful diagnostic tool and angiography is necessary to localize and treat by embolization.

Case report

We report two cases of secondary PPH due to pseudoaneurysm of uterine artery, which were managed by selective embolization of uterine artery.

Conclusion

Angiographic embolization of uterine artery is a safe and reliable technique for management of secondary PPH due to pseudoaneurysm. If diagnosed early, the need for hysterectomy is prevented.

Clinical significance

Uterine artery embolization has emerged as a simple, effective, and fertility-sparing treatment for PPH.

How to cite this article

Gollapudi R, Rammurty S. Selective Uterine Artery Embolization: An Effective Treatment Option for Postpartum Hemorrhage due to Pseudoaneurysm of Uterine Artery. J South Asian Feder Obst Gynae 2017;9(3):283-286.

CASE REPORT

Priyankur Roy, Vineet Mishra, Preeti Goyal

Successful Conservative Management of Spontaneous Unilateral Adrenal Hemorrhage in Pregnancy

[Year:2017] [Month:July-September] [Volume:9] [Number:3] [Pages:2] [Pages No:287 - 288]

PDF  |  DOI: 10.5005/jp-journals-10006-1515  |  Open Access |  How to cite  | 

Abstract

How to cite this article

Mishra VV, Goyal P, Choudhary S, Aggarwal R, Roy P. Successful Conservative Management of Spontaneous Unilateral Adrenal Hemorrhage in Pregnancy. J South Asian Feder Obst Gynae 2017;9(3):287-288.

Book Review

Selvapriya Saravanan

Book Review

[Year:2017] [Month:July-September] [Volume:9] [Number:3] [Pages:1] [Pages No:289 - 289]

PDF  |  DOI: 10.5005/jsafog-9-3-289  |  Open Access |  How to cite  | 

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