Journal of Obstetrics and Gynecology of India最新文献

Background: GDM is an intermediate phase in a woman's life that certainly poses a high risk of type 2 diabetes. Maternal health affects the health of offspring, a precursor of the vicious cycle of diabetes that continues through generations. Knowing the causative factors of GDM is important to breaking this cycle.

Objective: To study the risk factors of GDM in Indian women.

Method: The observational study database records from 2022 to 2023 from 11 different centres across India. We included pregnant women diagnosed with GDM with any OGTT criteria and excluded women with pre-existing diabetes.

Results: A total of 431 women with GDM were included in the study. 166 women were diagnosed with GDM in the 3rd trimester, followed by 235 women in the 2nd trimester, and 30 women in the 1st trimester of pregnancy. Those detected with GDM during the 1st trimester had a BMI of 27.9 kg/m2, followed by 28.3 and 29.3 kg/m2 in 3rd trimester. Multigravida showed a positive correlation with a family history of T2D (0.04), previous history of GDM (p-value < 0.001), history of stillbirth (p-value < 0.001) and hypertension (p-value 0.03).

Conclusion: Pre-pregnancy BMI and women's age at family planning are two important risk factors for the prevention of gestational diabetes.

Background: Preeclampsia is a leading cause of maternal and newborn morbidity and mortality. Metformin prevents preeclampsia by improving cardiovascular function and reducing gestational weight gain.

Aim: The aim of systematic review was to summarize the role of metformin in preeclampsia and report on outcomes of role of metformin in preeclampsia.

Objective: To assess the maternal and perinatal outcomes among women with preclamsia with or without metformin supplementation in addition to usual care.

Method: We searched for publications indexed in PubMed, Web of Science, Psyc INFO, and CINAHL databases using a combination of terms such as "metformin" AND "preeclampsia" OR "hypertension" AND "gestation."

Results: Four empirical studies were identified as relevant to our study. We discovered that the incidence of severe preeclampsia was significantly lower in those who received metformin than in those who did not (12.1% vs. 20.7%, aOR 0.38, 95% CI 0.18-0.81). Metformin treatment significantly reduced the incidence of preeclampsia (P = 0.04) and intrauterine growth restriction (P = 0.035) compared to the control group. One week after taking metformin, maternal sEng and sFLT-1 levels were considerably reduced.

Conclusions: Our findings reveal that Metformin significantly reduced the frequency of superimposed preeclampsia and associated factors in a pregnant woman with chronic hypertension. When compared to other drugs, metformin is more likely to avoid pregnancy-related hypertension disorders. The small number of studies studied, combined with their clinical diversity, make it impossible to generalise these findings to larger groups. Therefore, well designed randomised trials on the use of metformin for the prevention and treatment of pre-eclampsia are essential.

Neuroendocrine tumours are neoplasms that arise from cells of the endocrine (hormonal) and nervous systems. Many are benign, while some are malignant. Neuroendocrine tumours of the ovary are rare and of uncertain histogenesis. They may be primary or metastatic. Primary as well as metastatic neuroendocrine tumour to ovary is extremely rare. The distinction between primary and secondary ovarian tumours is critical since therapy and prognosis differ. Herein, we report a case of a metastatic hepatic neuroendocrine tumour (Grade-2) to ovary which is an uncommon condition, so that both clinician and pathologist will get enlighten with the occurrence of this rare entity. We believed that this was a wonderful chance to raise awareness of neuroendocrine neoplasms, which are quite uncommon in gynecological practices.

Introduction: Women with high Body Mass Index (BMI) are at increased risk of maternal and perinatal complications. These complications range from diabetes, hypertensive disorders, preterm births, increased rates of cesarean births, anesthesia related challenges, macrosomic fetuses, fetal anomalies, stillbirths, postpartum hemorrhage and surgical site infections. In this study, maternal and perinatal outcomes of women with BMI > 50 kg/m² from a single center are presented.

Aims and objectives: The primary objective was to determine the risk of maternal and fetal complications in super obese pregnant women. The secondary objective was to study the incidence of super obesity in the study population.

Methodology: This was a retrospective cohort study conducted over eleven years (January 2013-December 2023) at Fernandez Hospital, a tertiary perinatal care center with approximately 8000 births per annum. Data were sourced from electronic medical records. The study group included women with singleton pregnancies with BMI ≥ 50 kg/m², birthed at the center and the control group included all other women.

Results: The overall incidence of super obesity (BMI ≥ 50 kg/m²) was 1 in 1000 births. On comparing women with various BMI ranges, there was a significant increase in maternal complications such as chronic hypertension, pregnancy induced hypertension, pregestational diabetes mellitus, gestational diabetes mellitus and hypothyroidism (p < 0.001) as the BMI increased. Super obese women experienced high rates of cesarean section (54%, p = 0.009), fetal growth abnormalities like small for gestational age (12%, p = 0.017), large for gestational age (17%, p < 0.001) and stillbirths (1%, p = 0.001).

Conclusion: Adverse maternal and perinatal outcomes are directly proportional to maternal obesity. This emphasizes that these women should be managed at a dedicated clinic for comprehensive multidisciplinary care.

With increase in the longevity of life, the population of women in midlife and older is increasing. Midlife marks a challenging period of a women's life where hormonal changes and menopausal transition occur and the incidence of non-communicable diseases increases. This period of life experience depends on various factors such as ethnicity, country of residence, literacy and socioeconomic class. Gender itself is a key factor that determines an individual's health. The need for a healthy lifestyle from early on needs to be emphasized as it plays a key role in healthy aging. There is also a need to spread awareness on prevention of NCDs and good post-retirement support. National health programs must include older adults and specialized and personalized care given according to their needs. This will help prevent health deterioration in midlife that reduces functional ability, work productivity and increased healthcare costs, leading to economic loss.

Background: Of all the methods available for fetal weight estimation, ultrasound-based estimation is the commonly used noninvasive and widely available technique. Different population-based models use a combination of fetal measurements for the estimation of fetal weight by ultrasound. Models developed for non-Indian populations give erroneous fetal weight estimates when used for Indian populations. Therefore, there is an immense need to develop an Indian-based model for sonographic fetal weight estimation. This study assesses the fetal weight from different available formulae and compares them with the actual birthweight.

Methodology: This was a prospective study of 154 women assessed by ultrasound within a week of delivery. Ultrasonogram was done and head circumference, biparietal diameter, abdominal circumference and femur length were measured and estimated fetal weight was calculated using Hadlock's formula and Hiwale formula. Actual birth weight of the baby was measured after the delivery. Estimated fetal weight predicted by each formula was compared with respective neonatal actual birth weight.

Results: Out of 154 pregnant women included in the study, 92.8% were of average reproductive age-group, i.e., 20-34 years with minimum age being 18 year and maximum age is 42 year. Birth weight ranged from 780 to 4200 gms, with a mean of 2619.6. Low birthweight babies constituted 34.3% (N = 53). In our study, when weight was calculated using Hiwale method nearly 25.3% of cases had overestimated and 74.7% had underestimated the fetal weight, out of it 45.5% of cases were within the range of ± 10% of the actual birthweight. The difference between mean estimated fetal weight and mean actual birth weight was 194.5 g.

Conclusion: Hadlock's method of fetal weight estimation was found to be more accurate.

Ornithine transcarbamylase (OTC) deficiency is the most common enzyme deficiency of the urea cycle which converts toxic ammonia to urea for its excretion from the body. Symptoms due to the deficiency of the enzyme results in accumulation of ammonium and glutamine in the body. This manifests as vomiting, lethargy, cerebral oedema and coma. In affected male babies born with the metabolic disorder, there is severe neonatal hyperammonaemia. Due to the rarity of the metabolic disorder, diagnosis is delayed with fatal consequences for the newborn. We report here a case of recurrent neonatal deaths in an asymptomatic mother heterozygous for X-linked OTC gene mutation.

Background: Analgesia is an important aspect in post-operative period. Nowadays, various multimodal approaches are used for pain management in surgical patients. With these numerous options, the best choice in setting after LSCS remains debatable. In this study, safety and efficacy of regional blocks like TAP block with ropivacaine for pain control were analysed. This may emerge as a better option for pain control after LSCS with minimal adverse effects to both breastfeeding neonate and mother.

Materials and methods: 250 patients undergoing LSCS (emergency and elective) were prospectively randomized into two groups. One group received intramuscular diclofenac injections thrice daily while another received bilateral TAP block with 20 ml 0.75% ropivacaine. Visual analogue scale (VAS) score, dosage interval, duration of analgesia and rescue dosage requirement between two groups were recorded and analysed.

Results: The mean of total VAS score in group receiving TAP block was lower compared to group receiving IM diclofenac sodium (4.08 ± 3.01 Vs. 14.46 ± 3.98). Also TAP block provided longer duration of analgesia (1227.240 ± 408.118 min vs. 212.120 ± 81.506 min) in single administration. More patients of first group required rescue analgesia within 12 h. Seven patients of diclofenac group required stopping and shifting to alternate analgesic due to inadequate uterine contractions and required uterotonics administration.

Conclusion: 0.75% ropivacaine in TAP block was effective and had better analgesic and safety profile with comparable cost to IM diclofenac and hence should be recommended in this setting.

The object of this review article is to update on the freezing of oocytes for non-medical reasons. Following a review of increased success rate and safety, the cryopreservation of oocytes is no longer considered experimental. The trend of oocyte freezing is increasing amongst woman who wants to delay childbearing for personal, professional and financial reasons. Very few women return to retrieve their warmed frozen oocytes. The current evidence suggests that there is 70% chance of a live birth following cryopreservation of > 20 M II oocytes at < 38 years of age. However, a larger meta-analysis from different centres is needed to confirm the optimum age for oocyte cryopreservation, the optimum number of oocytes required for live birth, cost-effectiveness and how best to give accurate, unbiased updates to the prospective candidate wanting cryofreezing. In this paper, we have attempted to comprehensively review the literature published on the indications, success rates, factors affecting success rates, live birth rates, counselling, return rates and safety of social egg freezing.

Background: The global rise in caesarean section (CS) rates poses a significant public health challenge, being associated with adverse maternal, foetal, and child health outcomes. In response, the World Health Organization advocates for the use of Robson's classification system, which categorizes labouring women into ten groups based on key obstetric characteristics. This facilitates standardized CS audits and targeted clinical interventions.

Methods: To support implementation of Robson's classification in clinical practice, the Robson Caesarean Calc© mobile application was developed by a team at AIIMS Mangalagiri. The app is designed to simplify bedside classification by allowing healthcare workers to input relevant patient data quickly and accurately. It includes features such as rapid data entry, offline functionality for use in low-resource settings, and the ability to save data for audits and research purposes.

Results: The app has been found to enhance CS auditing processes by streamlining the classification workflow and reducing the likelihood of missing data. Its intuitive interface and cross-platform accessibility make it suitable for both senior and junior healthcare providers.

Conclusion: The Robson Caesarean Calc© app is a user-friendly, innovative digital tool that facilitates the implementation of Robson's classification system. Its routine use can improve labor room efficiency, support accurate clinical audits, and contribute to better maternal health outcomes by guiding interventions to address unnecessary CS rates.