Journal of Obstetrics and Gynecology of India最新文献

Background: Pregnancy is a special period in a woman's life that involves physical and mental changes. This study aimed at evaluating woman's sexual experience in pregnancy.

Methods: Cross sectional study design. We collected data pertaining to pregnant women's sexual behaviour via a questionnaire from 171 healthy pregnant women. Responses were summarised and comparisons were made between trimesters of pregnancy and primigravidae and multigravidae.

Results: We studied various aspects such as marriage related information, factors affecting sexual activity, frequency of sexual activity across trimesters, causes for abstinence of sexual activity in primigravidae and multigravidae. The majority of women perceived an overall decline in sexual desire progressively increasing in each trimester. None of the patients reported an increase in coital frequency. We determined that in 62 cases, the source of information regarding sexual activity during pregnancy was their partners.

Conclusion: The authors encourage the provision of sexuality education to newlyweds and the resolution of sex-related concerns during pregnancy.

Background: Caesarean delivery may be followed by several complications, surgical site infection (SSI) being one of them. The rate of SSI ranges from 3 to 15% worldwide (1-6). SSI is associated with a maternal mortality rate of up to 1.33%. (3) It places physical and emotional burdens on the mother and her family.

Aim: Study aimed to compare incidence of incisional SSI in two techniques of rectus sheath closure: the conventional continuous method and intermittent in patients undergoing caesarean section.

Methods: Comparative observational study of total 578 patients who underwent caesarean sections was enrolled in the study. These were divided into two equal groups of 289 each and assigned as either continuous or intermittent rectus sheath closure group. Standard surgical steps and post-operative care given to all. Wound complications were analysed in both groups.

Results: Out of total 578 LSCS studied, we have found 47 SSI (8.1%); 10 (3.4%) SSI found in intermittent rectus sheath closure group which is less than in continuous group, 37 (12.8%). Intermittent closure group is associated with less induration, pain at the wound site, serous discharge, and spontaneous superficial dehiscence. Resuturing need was less in intermitant group but significant difference not noted between the two groups (p = 0.651).

Conclusion: Intermittent suturing of rectus sheath is associated with a lower incidence of SSI and fewer clinical manifestations compared to continuous suturing in caesarean section. Adopting the intermittent suturing technique for rectus sheath closure would significantly reduce post-operative complications like wound discharge, wound dehiscence, and improve patient outcomes.

Background: Transvaginal progesterone is used to aid throughout the luteal phase. Administering a dose of gonadotrophin-releasing-hormone analogues (GnRHa) six days following OPU in GnRH antagonist cycles might cause rise in pituitary gonadotropins (luteinizing hormone (LH) and follicle-stimulating hormone (FSH)), leading to rise in steroid synthesis (estradiol (E2) and progesterone (P)) by the corpora lutea (CL). This work aimed to contrast the effect of lipopolysaccharides (LPS) with adding GnRHa to progesterone P, at day six after ovum pickup versus P alone, on the clinical pregnancy rate.

Methods: This open labeled randomized controlled trial study was carried out at women health hospital (WHH), Assiut University on 150 women with antagonist controlled ovarian hyperstimulation protocol (COH). Individuals had been categorized into two groups: Study group: include women who obtained 0.1 mg of GnRH agonist "triptorelin" at day 6 after OPU in addition to (P) since day of oocyte pickup (OPU) compared with the control group: administration of P only since (OPU) as LP support.

Results: Women who received GnRHa 0.1 mg & P as LPS were reported significant higher progesterone level, beta human chorionic gonadotropins (BHCG) level, fetal pulsation, implantation rate, clinical pregnancy rate, biochemical pregnancy rate, ongoing pregnancy and live birth rates contrasted to control group (P < 0.05).

Conclusion: Adding GnRHa to P as LPS is associated with significant higher progesterone level at day 7 after OPU BHCG day 14 of embryo transfer, clinical pregnancy rate, biochemical pregnancy rate, implantation rate, ongoing pregnancy rate, and live birth rate.

Fetus near viability approaching hospitals for care is increasing in number in India. However, the lack of evidence and experience may make an obstetrician reluctant to treat fetuses of 22-26 weeks gestation. The present case demonstrates the intact survival of a 23.5-week-old baby with a multidisciplinary approach. Moreover, we have tried to summarize our hospital protocol for obstetrics and neonatal management to optimize the outcome.

Background: Hypertensive disorders of pregnancy (HDP), is a leading cause of morbidity and mortality in both the mother and the fetus. These disorders often lead to significant systemic and ocular changes, particularly in the choroidal vasculature. The sub-foveal choroidal thickness (SFCT) may provide critical insights into these changes and serve as a non-invasive marker for assessing the severity of HDP.

Objective: The study aimed to compare the SFCT in patients with HDP versus normotensive pregnant women in their third trimester and to correlate SFCT with the severity of hypertension.

Methods: This cross-sectional study was conducted at JSS Hospital, Mysuru, involving 100 pregnant women in their third trimester, divided into 51 cases (HDP group) and 49 controls (normotensive group). SFCT was measured using spectral domain optical coherence tomography (SD-OCT). Data was analyzed and SFCT values compared between the two groups using mean arterial pressure (MAP).

Results: Results showed significantly higher SFCT in the HDP group (229.76 μm) compared to controls (173.45 μm), with a p-value < 0.001. The HDP group also had a notably higher MAP (115.07 mmHg vs. 87.63 mmHg), and a positive correlation (r = 0.541, p < 0.001) was found between MAP and SFCT.

Conclusion: The study demonstrates that SFCT is significantly increased in patients with HDP, correlating positively with MAP. Further studies are recommended to explore the broader clinical applications of SFCT in HDP.

Fetal anomalies-also known as congenital anomalies or birth defects-are unusual conditions that affect fetus during pregnancy. It can affect one or multiple organs, can be structural or functional and range from mild, moderate to severe. Fetal anomalies are present in 3-5% of live births. Congenital anomalies are usually detected in prenatal period during anomaly scan around 18-20 weeks. Some may be detected during NT-NB scan (11-14 weeks) or in third trimester. The risk factors could be genetic, environmental or both, and sometimes, no cause is detected. Some anomalies can resolve after birth, or some may need corrective therapy with special monitoring during antenatal period at specialized center. Patients with fetal anomaly incompatible with life, detected before 24 weeks of gestation, are advised to undergo termination, and those beyond 24 weeks, special permission is needed for termination. Early detection and timely intervention are helpful to improve outcome. Children with fetal anomalies are likely to have physical, intellectual, cognitive impairment leading to emotional stress in family. Awareness with regard to nutritional supplements and folic acid needs to be created, and high-risk factors like diabetes, obesity and certain medications need to be taken care of. Those with genetic predisposition needs thorough counseling, detailed investigations and possibility of treatment with pre-genetic diagnosis (PGD) for next pregnancy.

Gastroschisis is a congenital defect where fetal intestines herniate through an abdominal wall opening. Although postnatal surgical repair is standard, fetal surgery via fetoscopic techniques is emerging as a potential intervention, particularly for complex cases. This case report documents a fetoscopic technique for in utero gastroschisis correction with favorable outcomes. A fetoscopic surgery for gastroschisis was performed at 29 weeks of gestation. Using ultrasound guidance, a fetoscope and two trocars were introduced into the amniotic cavity to reposition the herniated intestines into the fetal abdomen and close the abdominal wall defect with a continuous suture. The procedure was completed in 80 min, with fetal vitality monitored during surgery. A live female newborn was delivered by cesarean section at 32 weeks of gestation for premature rupture of ovular membranes, weighing 1620 g. The newborn demonstrated appropriate gastrointestinal function and was discharged at 14 days without the need for further surgical interventions. This case report demonstrates the feasibility and safety of fetoscopic repair of gastroschisis, resulting in favorable neonatal outcomes, including early discharge without additional surgery. The approach warrants further investigation by randomized clinical trial to evaluate its benefits compared to standard postnatal treatment for gastroschisis, especially in complex suspect cases.

Supplementary information: The online version contains supplementary material available at 10.1007/s13224-025-02187-5.

Background: It is difficult to achieve health related Sustainable Development Goals when a higher proportion of birth delivery occurs through cesarean section (CS) than vaginal delivery without considerable medical benefits. This study aims to identify the spatial hot spot clustering and determinants of cesarean section in northeastern states, India.

Methods: The study utilized data from the fifth round of the National Family Health Survey (NFHS-5, 2019-2021), which included responses from 34,222 mothers who delivered live births in the five years preceding the survey. The study investigated spatial hot spot clustering of CS prevalence using Getis-Ord Gi* statistics and applied multiscale geographically weighted regression (MGWR) to identify spatial clusters in the relationships between predictor variables and CS delivery.

Results: The study identified spatial hot spot clustering of CS rates in districts of Sikkim, western and southern Tripura, eastern and western Assam, and central Manipur. MGWR results indicated that significant determinants of CS include maternal age (30-49 years), first birth order, highest educational level, high body mass index, and highest wealth quintile, with regression coefficients varying significantly by district in this region.

Conclusion: The study found that CS rates vary by clusters in the districts of northeastern states of India. It suggests that piloting educational interventions for pregnant women and regularly monitoring CS facilities could be initial strategies to better understand and address the higher CS trends in these regions.

Background: To investigate the myocardial performance index (MPI), global sphericity index (GSI) and pulmonary vein pulsatility index (PVPI) changes in FGR fetuses in an Indian population.

Method: In this prospective observational study, 70 fetuses from 26 weeks to term were recruited into two groups: 35 fetuses with appropriate growth (controls) and 35 with EFW < 10th centile, which were further classified into SGA (n = 14) and FGR (n = 21) based on vessel Doppler parameter (umbilical artery PI > 95th centile, CPR < 5th centile). PVPI, MPI and GSI were measured and compared among groups.

Result: Mean PVPI was increased in FGR 0.91 ± 0.23 compared to controls 0.79 ± 0.19 (p = 0.021) and showed an increasing trend across groups-controls, SGA and FGR. The mean GSI was decreased in FGR 1.16 ± 0.12 compared to controls 1.33 ± 0.33 (p = 0.047), indicating a more globular heart. Though the mean MPI did not show a statistically significant difference between the groups, its component ET (ejection time) was shorter in FGR 158.28 ± 17.81 compared to controls 165.54 ± 13.78 (p = 0.047).

Conclusion: Growth-restricted fetuses undergo cardiac remodeling due to hemodynamic redistribution and show a decreased global sphericity index, indicating a more globular heart. Additionally pulmonary vein Doppler changes like increased PVPI reflect atrial dynamic changes which can be used as an early predictor of compromise as these occur before DV changes.

Background: Gestational Diabetes Mellitus (GDM) is linked with a multitude of adverse perinatal outcomes. There is a want for standard guidelines regarding the usage of Metformin in GDM. We aimed to study the perinatal outcomes in women diagnosed with GDM treated primarily with Metformin with or without Insulin.

Methods: We conducted a randomized controlled pilot study. with a total of 75 women, divided into three groups: GDM treated with Metformin with or without Insulin (Group M), GDM on Insulin alone (Group I), and healthy pregnant women as controls (Group H), with 25 subjects in each group. At delivery, fetal and maternal outcomes were documented.

Results: The mean age in groups M, I and H were 27.4, 26.2, and 27.3 years respectively. The baseline mean HOMA-IR were 3.9 and 4.1 for Group M and Group I, respectively (p-0.560). The mean fetal birth weight was 2.95 ± 0.54 kg, 2.8 ± 0.41 kg, and 2.97 ± 0.65 kg in Groups M, H, and I, respectively (p = 0.527). The mean newborn HOMA-IR in Groups M and I was 1.8 ± 0.4 and 1.7 ± 0.5, respectively (p = 0.185). The adverse events in newborns were 20% (n = 5), 16% (n = 4) and 16% (n = 4) in Groups M, H, and I respectively (p = 0.403). The incidence of caesarean deliveries was 40% (n = 10), 48% (n = 12) and 24% (n = 6) in Groups M, H, and I respectively (p-0.253).

Conclusion: The study revealed identical maternal and fetal outcomes in women treated with Metformin as the primary drug compared to conventional treatment with Insulin in GDM.