Journal of Obstetrics and Gynecology of India最新文献

Background: Healthcare providers play an important role in responding to violence against women. The healthcare providers have an important role as expert witness in trials related to sexual violence. In India, several policy and legal reforms like MoHFW guidelines and Criminal Law Amendment have been done to establish a sensitive response to survivors of sexual violence. However, several gaps continue to exist in health systems' response in cases of sexual violence. To fill this gap, this paper presents the findings from a tertiary health facility which has implemented evidence-based standardized guidelines for providing care to sexual violence survivors.

Methods: The study was carried out in the OBGY department of a tertiary public health facility of Aurangabad, Maharashtra. The findings are based on the analysis of medicolegal records of 78 cases of sexual violence which came to hospital over a period of 6 months. The information about the profile of survivors, nature of violence, health consequences and compliance to standardized guidelines for medico-legal care was assessed. Additionally, the study also presents findings from in- depth interviews with trained doctors to understand their experiences of providing care and testifying in court in cases of sexual violence.

Results: About 42% of survivors were adult and majority of them gave history of violence from a known abuser (83%). In 82% cases, the survivors reported penetrative sexual violence. The analysis of records indicated sensitive medico-legal care in form of operationalization of informed consent in all cases, collection of relevant samples for evidence collection (93%), and mention of irrelevant comment on hymen in 10 cases. The interviews with providers indicated the need to sensitize police and judges about relevance of medical evidence.

Conclusion: Inservice training of HCPs and system level changes are essential for sensitive medico-legal care.

Surgery for vulval malignancies necessitates extensive resection necessitating the use of musculocutaneous grafts. We present one such case where the patient needed both a V-Y plasty and an anterolateral thigh flap to ensure a tension-free repair. She underwent a partial deep vulvectomy followed by V-Y plasty and ALT flap. The procedure has been described in detail along with intraoperative photographs. She recovered uneventfully and is receiving post-operative adjuvant radiotherapy. We would like to highlight this "additional skill" of plastic surgery which will empower surgeons to undertake radical surgeries to ensure the best outcomes for patients.

Examination of the placenta is the easiest and the most cost-effective method to evaluate fetal abnormalities which might be missed by other antenatal screening techniques. Transient abnormal myelopoeisis (TAM) in placenta is one such condition which is specific for trisomy 21. Its relevance especially lies in cases where phenotypical features of down's syndrome are absent in fetus or the cytogenetic reports are negative, suggesting either confined placental mosaicism or low expression generalized mosaicism. This is imperative in parents' counseling and deciding further patient management because though TAM is a transient phenomenon, it may relapse or progress to acute leukemia.

Herlyn Werner Wunderlich syndrome is a rare congenital disorder affecting 0.16 percent of the female population, characterized by mal-development of Mullerian and mesonephric ducts. It is also known as "Obstructed Hemivagina and Ipsilateral Renal Agenesis" abbreviated as OHVIRA. The two types of OHVIRA based on the degree of obstruction, complete or incomplete OHVIRA. While incomplete may go undiagnosed, complete OHVIRA presents with varying symptoms and complications requiring early diagnosis and intervention. We present a case of a 14-year-old girl who started menstruating two years ago and has regular periods till 6 months ago. She visited the gynecology outpatient department with persistent lower abdominal pain that worsened during menstruation, along with increased swelling and heaviness in her lower abdomen. Her secondary sexual characteristics matched her age. An abdominal ultrasound and transrectal scan showed a left-sided hematometra and hematocolpos with an 800 cc collection due to a complete hemivagina obstruction. An MRI confirmed the absence of the left kidney, two separate uterine horns, fallopian tube, cervix, and upper vagina. The left upper vagina did not connect with the vaginal opening, causing the syndrome. Surgery was performed to remove the vaginal septum, allowing communication between both hemivaginas and draining the hematocolpos and hematometra. Both uterine horns were equally developed. This surgery effectively changed OHVIRA to a uterine didelphys, improving the obstetric prognosis. Diagnosis is challenging for both complete and partial obstructions without a high level of suspicion because symptoms can be vague, and regular periods can still occur from the other functioning uterine horn. Complete obstruction may present after menarche with abdominal pain and swelling due to trapped blood. Early diagnosis and treatment are crucial to prevent endometriosis from blood spilling into the peritoneal cavity, which can lead to infertility issues due to potential damage to the fallopian tube and increased risk of ectopic pregnancy.

Pubic symphysis septic arthritis is a rare condition mainly associated with pregnancy. Fewer than 35 cases have been reported. We report a case that occurred after delivery by caesarean section, and which was due to Cutibacterium acnes. Management involved three lines of antibiotic therapy and surgical debridement. The combination of this rare pathology and a germ often considered commensal led to an erratic diagnosis for almost six years. One of the consequences, in addition to chronic pain, was destabilization of the pelvic girdle, necessitating surgery. After more than 18 months of follow-up, there was no relapse.

Background: The escalating global concern over increased body weight in adolescents, coupled with the rising rates of adolescent pregnancy worldwide, presents a significant challenge to healthcare systems. We plan to identify the maternal and neonatal consequences associated with pre-pregnancy overweight in adolescent women.

Methods: Throughout five years, all singleton adolescent pregnant women with pre-pregnancy self-reported body mass index (BMI) of 18.5- ≤ 29.9 were involved during the first-trimester visit. Two groups were generated: overweight and appropriate-weight (BMI 25-29.9 and 18.5-24.9, respectively). Obstetric and neonatal outcomes were observed prospectively and statistically adjusted for the confounding factors.

Results: The overweight group (223 women) had significantly higher pregnancy weight gain, birth weight, and gestational age than the appropriate-weight group (621 women). Most obstetric outcomes occurred significantly in overweight women like primary Cesarean section (CS) [odds ratio (OR) (95%confidence interval (CI)) = 1.5 (1.06-2.2)], cephalopelvic disproportion [OR (95% CI) = 1.3 (1.1-1.8)], labor induction [OR (95% CI) = 1.2 (1.09-2.3)]. Regarding neonatal outcomes, macrosomia [OR (95% CI) = 1.6 (1.3-2.7)] and non-reassuring fetal status (NRFS) [OR (95% CI) = 1.1(1.0-1.7)] had higher statistical significance in overweight women. Oppositely, small for gestational age [OR (95% CI) = 0.7(0.4-0.9)] and low birth weight [OR (95% CI) = 0.5(0.3-0.8)] were more frequent in appropriate-weight women.

Conclusion: Overweight adolescent pregnant women exhibited significantly higher percentages of obstetrical outcomes, like as primary CS, failure to progress, labor induction, postdate delivery, gestational diabetes, and gestational hypertension. Additionally, elevated rates of neonatal complications were found, including macrosomia and NRFS.

Background: Ascertaining the nature of adnexal mass in a pregnant woman and timely decision for surgical or conservative management is a dilemma. Present study was conducted to evaluate clinicopathological features and obstetric outcomes of pregnancies with persistent adnexal masses.

Method: A retrospective study was conducted and case records of pregnant women with persistent adnexal mass diagnosed during pregnancy or incidentally during caesarean delivery (CS), between January 2012 and June 2022 were reviewed. A total of 63 cases were recruited. The clinicopathological profile and clinical outcome were analyzed.

Results: During the study period, 63 pregnant women were diagnosed with persistent adnexal masses during pregnancy. Diagnosis was predominantly incidental either during routine USG (54.0%), or during CS (27.0%), and only 12.7% presented with acute abdomen. Forty-two cases were diagnosed during first or early second trimester. Out of these 42 women, 21 were managed conservatively and 11 masses were removed at time of CS. Out of total of 63 pregnancies with adnexal masses, 53 underwent surgical management. The majority i.e., 90% were benign and 10% were malignant; with mature teratoma being most common (32%) histology. In four of five malignant cases, diagnosis was made in antenatal period itself. All benign masses had uneventful course during pregnancy; only one had cyst rupture at 35 weeks and one was diagnosed with malignancy.

Conclusion: Adnexal masses having benign features on imaging can be managed conservatively till delivery as the chance of missing malignancy is minimal. Surgery for adnexal masses in pregnancy doesn't adversely affect feto-maternal outcomes.

Purpose of the study: This study aimed to evaluate and compare the diagnostic accuracy of two ultrasound scoring systems, Assessment of Different Neoplasias in the Adnexa (ADNEX) Model and Gynecology Imaging Reporting and Data System (GI-RADS), for the preoperative assessment of adnexal masses taking histopathology as gold standard.

Methods: This analytical study assessed 60 patients of age > 14 years with adnexal masses, planned for surgery. Ultrasound assessment and risk categorization according to ADNEX and GI-RADS were performed 2-3 days prior to surgery. Histopathology was used as a reference standard for the calculation of validity of two ultrasound scoring systems for diagnosis of adnexal masses.

Results: Out of 60 women (mean age, 35.52 ± 13.86 years; range, 16-70 years) with adnexal masses, 24 were malignant and 36 were benign. The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and accuracy for the ADNEX model were 87.50%, 91.7%, 87.50%, 91.7% and 90.0%, respectively. The sensitivity, specificity, PPV, NPV and accuracy of the GI-RADS category were 95.8%, 61.1%, 62.2%, 95.7% and 75.0%, respectively. The diagnostic performance of the ADNEX model was better as compared to GI-RADS in terms of specificity and positive predictive value with a significant difference (p < 0.05). The area under curve (AUC) was 0.957 and 0.919 for ADNEX and GI-RADS, respectively (p = 0.252).

Conclusion: Although both ADNEX and GI-RADS systems had satisfactory diagnostic performances and high negative predictive values, the ADNEX model showed better specificity and positive predictive value in comparison with GI-RADS.

Accessory cavitated uterine malformation (ACUM) is rare congenital anomaly of uterus, there is accessory cavity with functional endometrium, which does not have any connection to main uterine cavity, due to which patient typically presents with cyclical abdominal pain which starts after menstruation. Most common complaint being severe dysmenorrhea, which may require taking pain killers every cycle for pain relief, dysmenorrhea not relieving on taking Nsaids and also hormonal treatment will always point toward suspicion of having ACUM. 3D and 4D ultrasonography can help diagnosis the ACUM, hysteroscopy and sonosalphingography could aid in diagnosis, MRI abdomen and pelvis is more specific non-invasive investigation to diagnose as in this case. Surgical excision by laparoscopy is the gold standard treatment in these cases and can offer significant relief in symptoms.

Background: To assess women's preference and intention to use postpartum contraceptives according to the Interaction Model of Client Health Behavior (IMCHB).

Method: The study was cross-sectional and conducted in the outpatient clinics of a university hospital between March and June 2023. The sample consisted of 951 women between the ages of 15 and 49, who had given birth at least once, and had no history of menopause. Descriptive Information Form, Family Planning Attitude Scale, Contraceptive Knowledge Assessment Scale, and Contraceptive Intent Questionnaire were used as data collection tools. Moreover, Cox's IMCHB constitutes the study's theoretical framework.

Results: In the present study, it was determined that the contraceptive method used before pregnancy, emergency contraceptive experience, access and provision of contraceptive methods, and continuation of contraceptive method had a significant effect on contraceptive method preferences in the postpartum period. It was determined that each unit increase in the continuation of the contraceptive method used before pregnancy in the postpartum period increased the intention to use by 0.244 points, each unit increase in contraceptive knowledge level increased by 0.202 points, and each unit increase in positive attitude toward family planning increased by 0.102 points. Each unit increase in the desire to become pregnant again decreased the intention to contraceptive use by 0.230 points.

Conclusion: To increase the use of modern and effective contraceptives in the postpartum period and prevent unwanted pregnancies, it is necessary to evaluate the factors affecting contraceptive method use, preferences, and intentions of women and their husbands together.