Journal of Obstetrics and Gynecology of India最新文献

Context: Thin endometrium during the frozen embryo transfer cycles leads to cycle cancellation. The embryo transfer cycle getting deferred is an unpleasant experience for the patients and the fertility specialist.

Aims: The purpose of this study is to evaluate the effectiveness of Autologous Blood Cell Derivative (ABCD) growth factor concentrate to obtain an optimal thickness of endometrium for embryo transfer during IVF treatments, where rapid regeneration is crucial for the expected therapeutic outcome.

Settings and design: A retrospective cohort study was conducted in Manipal Assisted Reproduction Center, a referral center in Southern India.

Methods and material: Fifty-six patients with thin endometrium were administered three doses of ABCD growth factor concentrate as per the protocol after informed consent. All of them had a history of embryo transfer (ET) cancellation in frozen-thawed embryo cycles due to inadequate growth of the endometrium despite therapy with estrogens and drugs for improving uterine blood circulation.

Results: The endometrium thickness during the implantation window in the patients included in the study averaged 6.48 ± 1.19 mm. After the intervention, 55 out of 56 patients (98.2%) showed a considerable change in the thickness of the endometrium layer with an average thickness of 8.48 ± 1.32 mm (< 0.0001, SE 0.233, 95% CI 1.58-2.5). Out of the 55 patients, 20 got pregnant, i.e., 36.4% pregnancy rate. Till date, thirteen pregnancies had live births (65%), three pregnancies (15%) were biochemical pregnancies, 1 (5%) was ectopic, and three pregnancies (15%) had spontaneous miscarriage before eight weeks. When we compared the endometrial thickness (EMT) in the pregnant and non-pregnant groups pre- and post-ABCD instillation, (6.47 ± 1.31 mm vs 6.48 ± 1.4 mm, p = 0.98 and 8.68 ± 1.32 mm vs 8.48 ± 1.32 mm, p value 0.59) the p value was not statistically significant.

Conclusions: The implantation, clinical pregnancy and live birth rates were 36.4, 30 and 65%, respectively. This result is a significant improvement for patients with thin endometrium for whom we would otherwise cancel the frozen transfer. An autologous resource is a safe, readily available and inexpensive treatment modality.

Introduction: Endometriosis is the condition in which there are ectopic endometrial tissues outside the uterine cavity. The use of nerve sparing technique has been well established in the field of oncology, leading to better quality of life following radical oncologic procedures without compromising on the long-term survival. The objective of this study is to compare the quality of life in terms of sexual function and urinary function in women undergoing nerve sparing surgeries for endometriosis and those undergoing non-nerve sparing surgeries.

Material and methods: Data of 51 patients operated for endometriosis at Galaxy Care Laparoscopic Institute, Pune, India between 1st January 2020 till 31st December 2020 were collected and analysed. We included patients in age group between 38 and 44 years in monogamous relationship, with moderate to severe endometriosis (Revised American Society of Reproductive Medicine r-ASRM score of 16 and above 5), being operated for hysterectomy along with ureterolysis and/or bowel resection (including shaving of rectal endometriosis, discoid resection, segmental resection), and excision of large ovarian endometriomas (> 3 cm size) with cul-de-sac obliteration.

Results: The patients were evaluated for the following factors: age, parity, nature of surgery done, immediate intraoperative complications (bowel injury, bladder injury, ureteric injury), operative time in minutes, average blood loss, length of hospital stay, days to removal of foley's catheter and postoperative urinary and sexual function which were assessed on follow up visit and a 1-year follow up interview. We found that the urinary and sexual function in the group undergoing nerve sparing surgeries was significantly better than the patients undergoing non-nerve sparing surgeries.

Conclusion: Laparoscopic nerve sparing approach for clearance of endometriosis has allowed better quality of life post surgery. Proper understanding and demonstration of pelvic neuroanatomy has made this approach feasible and achievable in carefully selected patients.

Introduction: As the pregnancy advances beyond term, the risk of perinatal morbidity and mortality increases. Hence to prevent these complications associated with postterm pregnancy, induction of labor is done, as per our institution protocol between 40 and 41 weeks of gestation. Induction has its own drawback, so it is essential to identify the women with high chances of failure of induction of labor, to prevent the morbidities associated with induction failure.

Aim: To study the role of ultrasonographic fetal adrenal gland enlargement for the prediction of success of labor induction among primigravida beyond 40 weeks gestation.

Material and methods: Low-risk primigravidas beyond 40 weeks gestation, scheduled for induction of labor, were enrolled for the study. Fetal adrenal gland dimensions were measured by using abdominal probe Philips HD 7XE and general electronics logiq P6 pro or any ultrasound machine equipped with 7.5-10 MHz linear array probe and 3.5-5 MHz curved array probe.

Results: The fetal adrenal gland length, width and ratio were statistically significant between the successful versus failed induction groups. The cutoff fetal zone ratio > 0.36 for the prediction of successful induction of labor had 90% sensitivity, 89% specificity, 93% PPV and 75% NPV.

Conclusion: Fetal zone enlargement (fetal zone ratio > 0.36) is a strong predictor of successful induction of labor as compared to TVL and Bishop's score. It can be used for screening the women, who are destined for induction failure, so that adverse effects of induction of labor can be avoided.

Introduction: Endocervical curetting (ECC) is mandatory when colposcopy is inadequate or when the Pap smear suggests glandular lesion. When the curette is used, ECC is painful; this necessitated the development of the endocervical brush. There is no consensus on which device yields more sample, detects true cervical precancer (CIN2+) better or highlights the effects of age and parity on ECC yield.

Objective: To compare ECC yield and the ability to pick up CIN2+ by the different devices and effect of parity and age on yield.

Method: Three hundred women referred for colposcopy following positive cervical high-risk HPV DNA test who had inadequate colposcopic examination were randomly allocated to curette, brush and curette and brush groups for ECC. All samples were sent for histology, and the results were compared.

Result: Of the 300 women, 103, 100 and 97 had ECC with curette, brush and curette and brush, respectively. Samples were adequate in 92 (89.3%) of the curette, 69 (69.0%) of the brush and 78 (80.4%) of the curette and brush groups. The curette and curette and brush yielded more samples (p = 0.00) and (p = 0.04), respectively, compared with the brush, but there was no difference in yield between curette and curette and brush (p = 0.06). However, there was no difference in the yield of CIN2+ between the sampling devices. Age and parity had no effect on the sample adequacy by the different devices.

Conclusion: Curette and the curette and brush yielded more samples compared with the brush alone. However, CIN2+ pick-up was similar across all sampling devices.

Study objective: To measure pain using a visual analogue scale (VAS) and analyse its relationships with variables such as menopausal status, parity, uterine and cervical pathology, procedure length, and anxiety in patients undergoing ambulatory hysteroscopy (AH).

Design: Prospective observational study.

Setting: Dr DY Patil Medical Hospital and Research Centre, Dr.D.Y. Patil Vidyapeeth, Pimpri, Pune.

Patients: Seventy-five women.

Intervention: Ambulatory hysteroscopy(AH).

Methodology: AH was performed in seventy-five patients using vaginoscopic approach. At the end of the procedure, the intensity of pain was assessed using the visual analogue scale (VAS), from the score of 0 (no pain) to 10 (intolerable pain). The factors determining pain were assessed.

Results: Patients who underwent AH reported mild pain in 66% of cases, moderate pain in 22%, and severe pain in 12% of cases. The most frequent reason for referral was abnormal uterine bleeding (AUB).In the moderate pain group, the bivariate analysis was statistically significant for menopausal status (P values < 0.001), cervical pathology (< 0.001), and duration of procedure (0.001) and in multivariate analysis nulliparity (0.001) and menopausal status (0.001) were the significant determining factors.In severe pain group, the bivariate analysis was statistically significant for cervical pathology (P value = 0.001) and in multivariate analysis cervical pathology (0.003) and uterine pathology (0.002) were the significant determining factors.

Conclusion: Hysteroscopy is a safe, painless and a gold standard procedure. Pain experienced during AH was significantly influenced by cervical pathology. Gynaecologists in practise should receive training and start using AH to assess the endometrial cavity.

Background: Workplace violence is defined by the World Health Organization (WHO) as incidents where staff is abused, threatened or assaulted in work settings. In emergency predominated branch like obstetrics, there is a need to study the magnitude and impact of violence against healthcare workers (HCW). Materials and Methodology: This cross-sectional study was conducted in the Department of Obstetrics at 2 centres in Lucknow district, for a period of 6 months. The study population included trainee residents, senior residents, nursing staff and consultants. Standard definitions from the WHO were used to define the types of violence. The validated questionnaire was designed in English with 25 questions to understand the incidence of workplace violence, prevention policy, reporting and follow-ups of incidents and impact of violence.

Results: With a response rate of 90%, 274 HCW participated in the study. In total, 172 HCW (62.7%) either faced physical or verbal assault. In 70% of incidents, patient, their relatives or public were perpetrators of violence, and the rest 30% incidents were by colleagues or management. Majority of the incidents were in emergency areas. Only 22% of the abused reported to the concerned authorities. At least 123 (71.5%) HCW were extremely dissatisfied with the action taken. Action was taken against only 9.8% of the perpetrators. None of the respondents received any training to handle workplace violence.

Conclusion: There is an alarming high prevalence of workplace violence by patients and colleagues. Adequate training to handle these incidents, improvement of working environment and unconditional support from management will bring a positive work experience.

Supplementary information: The online version contains supplementary material available at 10.1007/s13224-023-01809-0.

Objective: To study the perinatal outcome in fetuses diagnosed with congenital diaphragmatic hernia (CDH).

Methods: Thirty-two pregnant women with antenatal diagnosis of CDH in fetus, who delivered between 2018 and 2021, were included in the study. Postnatally eventration of diaphragm was diagnosed in 3 neonates and were excluded.

Results: The median gestational age at diagnosis was 23 weeks (IQR: 216-261 weeks). The mean O/E LHR was 34.88 ± 9.03%, and the O/E LHR was significantly lower in fetuses who did not survive (40.81 ± 4.25 vs 31.26 ± 9.33; p = 0.0037). On ROC analysis, at a cutoff of ≤ 32.93, O/E LHR had a specificity of 100% with a sensitivity of 72.22% in predicting mortality. Cases with liver herniation were not significantly different between survivors versus non-survivors. The overall survival rate was 37.93%, and the leading cause of death was severe persistent pulmonary hypertension.

Conclusion: O/E LHR can predict mortality in neonates with antenatal diagnosis of CDH. The presence of pulmonary hypertension was the leading cause of death in these neonates.

Background: Urbanization and industrialization in developing and developed countries have led to rise of intrauterine environmental toxins-PM2.5, PM10, NO₂ and Ozone.

Aim: To determine association of ambient air pollution exposure with prematurity and low birth weight.

Materials and methods: It is a retrospective cohort study done from January 2021 till June 2022 in a tertiary care hospital, New Delhi. Purposive sampling was done, and for each patient, criteria pollutants exposure was recorded from the government recording stations nearest to her residence and pregnancy outcome correlated with same.

Results: Total 1155 deliveries were recruited. Significant association was found between PM2.5 exposure and preterm birth during first trimester (p < 0.05). Significant association was found between ozone exposure and preterm birth during second trimester (p < 0.05). Significant association was also found between NO₂ exposure and preterm birth during first and second trimester (p < 0.05). Maternal PM2.5 exposure during first trimester was significantly associated with low birth weight (p < 0.05). PM10 exposure during first trimester was significantly associated with low birth weight (p < 0.05).

Conclusion: Current study reveals direct relationship between ambient air pollution exposure and pregnancy outcomes (preterm birth and low birth weight).

Background: Endometriosis is one of the chronic and prevalent diseases among women. There is limited knowledge about its pathophysiology at the cellular and molecular levels, causing a lack of a definite cure for this disease. In this study, differentially expressed genes (DEGs) between ectopic and paired eutopic endometrium in women with endometriosis were analyzed through bioinformatics analysis for better understanding of the molecular pathogenesis of endometriosis.

Methods: Gene expression data of ectopic and paired eutopic endometrium were taken from the Gene Expression Omnibus database. DEGs were screened by the Limma package in R with considering specific criteria. Then, the protein-protein interaction network was reconstructed between DEGs. The fast unfolding clustering algorithm was used to find sub-networks (modules). Finally, the three most relevant modules were selected and the functional and pathway enrichment analyses were performed for the selected modules.

Results: A total of 380 DEGs (245 up-regulated and 135 down-regulated) were identified in the ectopic endometrium and compared with paired eutopic endometrium. The DEGs were predominantly enriched in an ensemble of genes encoding the extracellular matrix and associated proteins, metabolic pathways, cell adhesions and the innate immune system. Importantly, DPT, ASPN, CHRDL1, CSTA, HGD, MPZ, PED1A, and CLEC10A were identified as novel DEGs between the human ectopic tissue of endometrium and its paired eutopic endometrium.

Conclusion: The results of this study can open up a new window to better understanding of the molecular pathogenesis of endometriosis and can be considered for designing new treatment modalities.