Journal of Obstetrics and Gynecology of India最新文献

Objective: To describe the clinical profile, risk factor stratification and outcomes of 102,683 successive births at a perinatal tertiary referral network in India.

Design: Cross-sectional hospital-based study.

Setting: Tertiary Perinatal Referral Center Network in India.

Sample: 102,683 Births.

Methods: This cross-sectional hospital-based study included 102,683 babies birthed by 99,467 women between Jan 2013 and Dec 2023 (11-year period). Women who birthed singletons, twins, triplets or quadruplets were included as cases. The data was collected using an electronic medical record system.

Main outcome measures: Mode of Birth, Postpartum Haemorrhage, Maternal Deaths, Live Birth Rate, Pre-Term Births, Small for Gestational Age.

Results: Overall, 102,683 babies were birthed during the study period. The mean age of the women was 28.3 ± 4.17 years. About half of them (46.6%) were presented during the first trimester. Most of the women had a spontaneous conception (89.14%). One third of the women at presentation were categorized as high risk (34.95%) which increased significantly during pregnancy and birth (75.18%). The most associated co-morbidities were diabetes mellitus (26.4%), thyroid disorders (26.01%) and hypertension (13.27%). The mode of birth included lower segment caesarean Sect. (50%), spontaneous vaginal birth (39.68%) and assisted vaginal birth (9.88%). Post-partum hemorrhage was seen in 7,357 (7.16%) births and atonic (6.16%) was the commonest etiology. The outcomes analyzed were live birth rate (98.86%), pre-term birth rate (16.78%) and small for gestational age (10.84%).

Conclusion: High risk pregnancy is a common occurrence in India. It is important to understand the risk factors and monitor the antenatal and postnatal care to ensure good outcomes for the mother and baby.

Background: Detection of fetal growth restriction (FGR) in appropriate for gestational age (AGA) fetuses has not been comprehensively assessed. This study aim was to evaluate the findings of Doppler ultrasound in AGA fetuses who had a drop of two standard deviations from the estimated fetal weight index (EFW) in the third trimester.

Methods: In this descriptive cross-sectional study, all pregnant women referred to perinatology wards for routine screening in pregnancy with AGA fetuses that have more than 20% drop in the weight percentile in the third trimester of pregnancy were included to the study. After registering the information related to Doppler ultrasound and their demographic characteristics, the patients were followed up, and the information related to the delivery outcome was also recorded.

Results: 74% of the cases had more than 20% drop in the weight percentile. For both categories of weight change, the percentiles of PI-UA, PI-MCA, and CPR were 90%, 50% and 25%, respectively. Results showed the significant difference in the CPR in two groups including aspirin consumption and no taking it (1.93 ± 0.35 vs. 1.66 ± 0.43, P = 0.018).

Conclusion: The color Doppler ultrasound findings can help in better detection of AGA fetuses at risk would enable enhanced surveillance of these cases, and reduction their stillbirth risk.

Introduction: Endometriosis presents as-1. superficial, 2. ovarian endometrioma, and 3. deep infiltrating endometriosis. Obstructive uropathy can rarely result from endometriosis, especially in premenopausal women-incidence being 0.3%-12%.

Case: A 40-year-old married, working female presented to ER with severe left-sided flank pain radiating, lump abdomen, heavy menstrual bleeding, and inability to pass urine. Physical examination revealed a large 24-week lump abdomen. Imaging studies were done with USG showing a large cystic left adnexal mass which was followed by CT urography showing hydroureteronephrosis and a large cystic mass of 10 cm compressing the urinary bladder and ureter, along with uterine adenomyosis. Emergency cystoscopy and left DJ stenting was done to relieve the obstruction which resulted in relief from flank pain. This was followed by laparoscopic hysterectomy with left salpingo-oophorectomy with right salpingectomy and adhesiolysis. Postoperative imaging showed complete resolution of ureteral obstruction and hydronephrosis. Histopathology confirmed endometriotic cyst and adenomyosis.

Discussion: Endometriosis can present with a wide spectrum of symptoms. Involvement of the urinary system in cases of endometriosis might result in compromise of renal function over time. Prompt surgical management is essential in cases of obstructive uropathy. Cases similar to ours have demonstrated the importance of prompt decompression of urinary tract by emergency DJ stenting followed by definitive surgical management of underlying endometriosis. Modern endometriosis management included the conservative laparoscopic surgery and ureterolysis followed by the resection of concomitant endometriosis and a broad-based multidisciplinary approach, centered on a patient's symptoms and priorities.

Conclusion: This case underscores the importance of considering endometriosis as a differential diagnosis of women presenting with urological symptoms as well as the need for collaboration between urologist and gynecologist in such cases solidifying that the rapid intervention and multidisciplinary line of management is essential for optimal patient outcome.

Micronutrients are fundamental in maintaining the general health of a woman and play a pivotal role in reproductive health, with heightened importance during pregnancy and lactation. Deficiencies in vitamins and minerals-common globally-are associated with adverse maternal and fetal outcomes such as anemia, preeclampsia, gestational diabetes, neural tube defects (NTDs), and intrauterine growth restriction. Micronutrients may affect the programming of fetal origin of adult diseases. Micronutrient deficiency also plays a part in gynecological disorders such as polycystic ovary syndrome, infertility, endometriosis, fibroids and certain gynecological malignancies. A systematic review of 31 recent articles, including cohort studies and meta-analyses, was conducted through databases such as PubMed, Google Scholar and ScienceDirect. Twenty-five articles were selected based on relevance and methodological rigor. Deficiencies in iron, folate, vitamin D, zinc, iodine, and vitamin B12 are prevalent among pregnant women, particularly in India. Iron supplementation reduces anemia, but its broader impact remains inconclusive. Folic acid prevents up to 70% of NTDs when started preconceptionally. Calcium and vitamin D lower the risk of preeclampsia. Zinc and iodine deficiencies contribute to poor pregnancy outcomes. Multiple micronutrient supplementation (MMS) has shown superior efficacy compared to iron-folic acid alone in reducing low birth weight and small-for-gestational-age outcomes, though optimal formulations require further study. Adequate micronutrient intake is essential for optimal maternal and fetal health. MMS offers a promising intervention but should be tailored to individual needs to prevent over-supplementation. Future research must address micronutrient interactions, population-specific needs, and personalized nutrition strategies.

Introduction: Bladder malignancy is uncommon during pregnancy, and there is paucity in the literature about the optimal management. Endoscopic procedures and use of energy sources within bladder always pose a significant risk to pregnancy. Bipolar transurethral resection of bladder tumor allows precise resection, minimizes collateral damage and allows complete resection of tumor. In this retrospective study, we analyze the safety and efficacy of bipolar transurethral resection of bladder tumor in the management of bladder tumor during pregnancy.

Material and methods: This is a retrospective study over a period of 6 years carried out at a tertiary referral center. Pregnancy patients with bladder tumors underwent transurethral bipolar resection of tumor and any complication or adverse event during the procedure were recorded. Disease and obstetric outcome was analyzed to access the safety and effectiveness of this procedure during pregnancy.

Results: Seven pregnant patients were with an average age of 38.5 ± 4.2 years and average gestational age of 21.5 ± 7.5 weeks underwent bipolar TURBT in last 6 years. Smoking as a risk factor was identified in one patient, and one patient had personal history of bladder tumor. Majority of patients presented with gross hematuria (57.14%). The mean resection time was 19.5 ± 8.9 min, and the average hospital stay was 2.5 ± 0.5 days. There was no major complication recorded in intraoperative or postoperative period.

Conclusion: Bipolar TURBT is safe and effective in the management of bladder tumor during pregnancy.

Background: Among the 121 million unintended pregnancies annually of which 61% (73.3 millions) ended up in abortion. This huge 61% figure reminds us of the unmet need for family planning which still remains a global health issue. So, comes the utmost need for post-abortion contraception (PAC) which significantly minimizes the risk of repeat unintended pregnancies. Long acting reversible contraception (LARC), requiring administration less than once a month, remains the most recommended contraceptive method by international bodies like the center for disease control and the American College of Obstetricians and Gynecologists. Still it remains underutilized despite its contraceptive and non-contraceptive benefits. This QI project aimed to address the barriers to acceptance of LARC as a PAC in the Indian scenario, thereby introducing appropriate interventions to improve the existing acceptance rate of LARC by at least 50% by baseline.

Materials and methods: This QI was conducted at a tertiary care teaching hospital over a period of 24 months (July 2021 to June 2023) using a point-of-care QI methodology systematically. This QI study was conducted in three phases: a pre-intervention baseline phase (6 months), an intervention phase with three PDSA cycles (12 months: each PDSA cycle of 4 months) and a post-intervention follow-up phase (6 months). The QI study has been done in strict compliance with the SQUIRE guidelines.

Results: Baseline observations showed poor acceptance of LARC as PAC with the average of 14.5% over a period of six months. After the end of first cycle, LARC acceptance rate improved to 40%. At the end of the second PDSA cycle, the rate of acceptance increased to 52.6%. Highest level of acceptance was observed after the third cycle which was about 75%. Although a minimal decrease in the acceptance of LARC was noted in subsequent months (ranging from 57.8 to 69.2%; average 62.9%), a satisfactory increase in the acceptance of LARC as PAC was observed when compared to the baseline data (acceptance of 14.5%).

Conclusion: Improvement in the acceptance of LARC as PAC was the result of proper communication and effective counselling. It was through the collaborative effort of the entire team and meticulous counselling by doctors, nursing staff and counselors that a good acceptance rate could be sustained over time.

Objective: To determine different clinical, hormonal and biochemical parameters among all four phenotypes of women with PCOS in Eastern India that may help in identifying and intervening the at risk group of women going to develop metabolic syndrome.

Methods: This is a cross-sectional study involving women from Eastern India, suffering from PCOS attending Gynaecological OPD at IPGMER, Kolkata. Consecutive 126 PCOS women recruited, diagnosed using revised Rotterdam criteria 2003, were categorized into four different PCOS phenotypes. Demographic, clinical, biochemical, endocrine and metabolic parameters were analyzed, using SPSS 11.0.

Results: The differences in the levels of Fasting Insulin, glycosylated hemoglobin (Hb A1C), Triglyceride, Cholesterol, high density lipoprotein cholesterol, Total Testosterone, Anti-Müllerian hormone and insulin resistance were statistically significant across the four groups. The prevalence of obesity, abnormal of lipid profile, insulin resistance were highest in phenotype B. Prevalence of metabolic syndrome was much higher in phenotypes A and B (19.51% and 20.0%) compared with phenotype C and D (7.69% and 7.41%).

Conclusion: It's important to recognize PCOS phenotypes, correct the hormonal and metabolic disorder in time to rescue them before PCOS becomes a full blown metabolic syndrome.

Background: FIGO classification of a 100% intramural fibroid contacting the endometrium as type 3.

Objectives: Pros and cons of this modification are discussed.

Conclusion: Hysteroscopic myomectomy of type 3 fibroid is a risky procedure and should be cautiously performed by an expert hysteroscopist. More research is required to assess safety issues and feasibility of either hysteroscopic or laparoscopic myomectomy in type 3 fibroids.