Journal of Obstetrics and Gynecology of India最新文献

Background: Hypertension complicates 5-10% of pregnancies and is a common cause of perinatal death. The perinatal mortality is estimated to be 3 to 5 times higher in hypertensive women compared to those without hypertension.

Methods: A hypertensive mother either with a stillbirth or if baby died within 7 days of life was included as a case. Once a case was recognized, the next two consecutive hypertensive mothers who delivered a live baby, who survived up to 7 days of life, were taken as controls. Fetuses with congenital malformations incompatible with life and multiple pregnancies were excluded from the study. One hundred and twelve women in cases and 224 women in controls were studied.

Results: Among 112 cases of perinatal death, 70% had died in utero before labor. Among the 33 fetuses alive, 50% were born still after labor and 50% died within 7 days of birth. We found that early onset hypertension (< 34 weeks) (p-< 0.001 (Chi2-23.819)), gestational age at termination of 28-32 weeks (OR 2.76), value of serum creatinine > 1.1 mg/dl (OR 10.1), abruption (OR 6.2) and birth weight < 1.5 kg was significantly associated with perinatal mortality (p-0.007, OR 5.7). Abnormal Doppler findings was a predictor of perinatal deaths.

Conclusion: Severely growth retarded fetuses in association with early onset severe preeclampsia are likely to die in utero and need vigilant monitoring antenatally. Abnormal umbilical artery Dopplers predict perinatal mortality. Caesarean section at the gestational age of ≥ 32 weeks and an estimated fetal weight of ≥ 1.2 kg in our hospital resulted in favorable outcome.

Background: Cervical cancer (CC) is a public health problem because of its increasing prevalence and mortality in low- and middle-income countries.

Objective: To study knowledge, attitudes, and practices about CC and screening among women in a referral hospital in Côte d'Ivoire, a sub-Saharan African country.

Materials and methods: A cross-sectional study, from September 1, 2020 to March 1, 2021, in the obstetric gynecology consultation unit of the University Hospital of Cocody. It included patients who gave informed consent. Data were collected using a questionnaire. Data analysis was performed using Epi data 3.1 software (CDC Atlanta-USA).

Results: 1200 women were included (47.2%) with a mean age of 32 years. General knowledge ranged from 6.2 to 32.7% and main risk factors were advanced age (75.2%), HIV infection (60.3%), early marriage (38.2%), and multiple sexual partners (25.8%). 975 women were able to provide a response (81.3%). 85.2% of women identified signs and symptoms: vaginal bleeding (83.6%), intermenstrual bleeding (65.1%), and foul-smelling discharge (11.9%). The level of knowledge of screening was 79% for PAP smear, 72.6% for VIA and 14.2% for LBC. A positive attitude was observed since 87.8% declared they wanted to perform screening. A significant practice (60.4%) was demonstrated, and the screening tests used were visual inspection with acetic acid (52.6%), Pap smear (39.8%) and liquid-based cytology (7.6%).

Conclusion: We revealed a good knowledge of reality of CC, but effective information, education and communication strategies are needed to improve the level of awareness about risk factors, symptoms and preventive methods.

Background/purpose: This study aims to assess lifestyle-related factors such as diet, physical activity and sleep along with common myths, beliefs, and barriers to a healthy lifestyle and resultant postpartum weight retention. It has also explored the association of the aforementioned factors with socio-demographic variables.

Methods: A cross-sectional survey was conducted using a comprehensive pre-validated questionnaire on a convenience sample of postpartum women using a telephonic interview schedule.

Results: A total of 505 postpartum women were recruited with median postpartum weight retention of 5 kg. More than half of the participants had incorrect dietary practices with less than one-tenth of women indulging in low/moderate-intensity physical activity. Postpartum women had poorer diet (p < 0.05) and sleep (p < 0.01) in the initial phase postpartum as compared to late postpartum. These women were also less physically active in the initial months and as the postpartum period progressed their physical activity also improved significantly (p < 0.001). Socio-demographic variables such as socio-economic status, education, and employment status were significantly associated with unhealthy lifestyle practices. Common barriers were lack of knowledge, time constraints, lack of childcare support and cultural myths and beliefs.

Conclusion: The findings of the study will help in developing a comprehensive women-centric weight management module focusing on practical guidelines for lifestyle, breastfeeding and other confounding factors associated with postpartum weight management.

Introduction: Menstrual cups are considered a viable alternative to other menstrual hygiene products in many developed countries yet majority of women in India use pads and cloth for their menstrual hygiene.

Methodology: This prospective interventional questionnaire-based study was conducted among 100 women who tried cups for three menstrual cycles with the aim of highlighting the challenges posed by socio-cultural factors in India which prevent menstrual cups from becoming a mainstream menstrual hygiene product.

Results: Familiarity with pads delayed the switch to menstrual cups even among women who were aware of their benefits. The thought of vaginal insertion was the foremost deterrent along with uncertainty of cup size, need for privacy to sanitise the cup, fear of leakage and infections and familial disapproval. Adaptations to the nuances of cup use were fast and undemanding. No major health concerns were reported with the use of cups.

Discussion: Cultural factors in India pose various challenges to menstrual cup usage. Yet majority of women are likely to continue using menstrual cups after trying them. Women well-versed with sexuality and reproductive health face fewer difficulties and show better compliance.

Conclusion: The foremost challenges found by this study are unique to the Indian context and continue to influence the choice of menstrual product.

Aim: To determine the correlation between vitamin D levels and gestational diabetes mellitus.

Materials and methods: Cross-sectional observational study, conducted in Gauhati Medical College and Hospital, over a period of 1 year, on 350 antenatal patients, with gestational age beyond 24 weeks, keeping in mind the inclusion and exclusion criteria. Age, obstetric score, religion, BMI were noted for all patients. They underwent screening for gestational diabetes mellitus using DIPSI (Diabetes in Pregnancy Study Group of India) guidelines and were divided into two groups. Vitamin D estimation by CLIA method (chemiluminescence method) was done in both groups and results were compared. Association between vitamin D levels and gestational diabetes mellitus was studied using Chi Square Test.

Results: The prevalence of vitamin D deficiency in antenatal patients was found to be 63.7%. 73% of gestational diabetes mellitus patients were deficient in vitamin D. There was a statistically significant association seen between vitamin D level and Gestational diabetes mellitus (p value-0.046). There was 1.34 times increased risk of developing gestational diabetes mellitus when the vitamin D levels were deficient as compared to when the vitamin levels were within the normal range.

Conclusion: There was a high level of vitamin D deficiency in the pregnant women of North East. Due to lack of screening of vitamin D levels, many pregnant women suffer from adverse feto-maternal outcomes. There is a need to identify them early in pregnancy, provide vitamin D supplementation and to decrease the likelihood of them developing complications.

Background: Multiple pregnancies have increased with the use of assisted reproduction, and we expect more women reporting with Rh isoimmunization among multiple gestation in near future. Intrauterine transfusion in singleton itself is technically difficult and requires a lot of skill and precision. Performing double/triple transfusion in twins/triplets is expected to be more demanding.

Aim: To create awareness on the technical difficulties encountered in intrauterine transfusion in twins and triplets.

Methodology: We report a case series of four Rh-isoimmunized twins/triplets in 5 years who presented with severe anemia requiring intrauterine transfusion.

Results: Each of the four sets of cases had their own intricacies that needed to be pondered before tackling them as not much was available in the literature. In Case 1, the first twin intrauterine transfusion in our 20-year-long experience, the difficulty in the approach to the first twin due to a posteriorly placed placenta has been highlighted. Case 2 was rare due to the concomitant presence of atypical antibodies in the mother in addition to Rh-D isoimmunization that made it difficult to cross match any donor blood for intrauterine transfusion. The third case was exclusive due to its monochorionic-diamniotic nature of the twins where the impact of inter-twin anastomosis on the transfusion was to be taken into consideration. Fourth case was a triplet gestation where the difficulty of which cord to be assigned to which fetus, the crowded space for intervention, as well as the risk of prolonged operative time and associated risk of preterm/premature rupture of membranes were our concern.

Conclusion: Intrauterine transfusion (IUT) in twins/triplets is challenging. Difficulties encountered during IUT in multifetal gestation are due to different or uncertain chorionicity, intraplacental anastomosis between vessels, different degree of anemia in twins, difficult to ascertain cord-fetus relationship and difficulty to reach placental insertion site due to crowding by multiple fetal parts.

Introduction: Retained products of conception (RPOC) generally result after first half of pregnancy termination and also may occur after vaginal or cesarean delivery. It frequently presents with irregular or continuous vaginal bleeding, lower abdominal and pelvic pain, and discharge per vaginum due to infection; it can also cause late complications like formation of intrauterine adhesions and subfertility. The diagnosis of the RPOC along with the symptoms is generally supported by ultrasonography with or without colour Doppler. The patient also undergoes uterine vasculature assessment to diagnose arteriovenous malformation (AVM). The management of RPOC has been conventionally done with blind dilation and suction curettage (D and C); however, expectant management, uterine artery embolization, and hysteroscopic resection of RPOC are safe and efficient alternatives.

Materials and methods: In this review, we analyse the current available evidence regarding the clinical presentation, diagnosis and treatment of RPOC comparing the sensitivity, specificity, outcomes, pros and cons of various methods.

Conclusion: RPOC is a common complication associated with early and late complications. The judicious use of antibiotics along with interventional radiology and hysteroscopy forms the backbone for the treatment of this condition.

Context: Carcinoma Cervix is one of the leading prevalent cancers in India especially in rural population and causes a significant mortality. WHO has launched many projects for prevention, screening and treatment plans. Even after many projects, Cervical Cancer persists as a heavy burden public health problem in rural India.

Aims: To calculate survival of cancer cervix patients in a rural population-based RCC and to discuss the factors affecting it.

Methods and material: A hospital-based gathering of retrospective data of the patients diagnosed with carcinoma cervix over 5 years from January 2013 to December 2017 (single institution analysis). We included 751 patient's data from our cancer registry for analysis. Data related to demographics, treatment and follow up records were taken and statistical analysis done.

Results: The survival rates were 64.0%, 50.0%, 36.9% and 17.5% for Stage I, Stage II, Stage III and Stage IV, respectively. The best survival outcomes were for those treated with only surgery. Involvement of nodes had poor survival than those with no involvement. Various patient-related factors like Religion, Education and Marital status are found to be non-significant factors even-though they have survival differences. STAGE of the disease emerged as a significant prognostic factor.

Conclusion: Our study concluded that higher stage and nodal involvement had poor outcomes and also lower survival compared to Western and Indian literature. We should also address all the socio-economic factors that affects survival. Randomized prospective studies are needed to evaluate the effect of socio-economic factors on survival.

Background: Frozen section (FS) is an important decision making intraoperative tool in a non-oncology center especially in a region where women are often "lost to followup".

Objectives: Evaluate the use of FS in non-oncology setup for ovarian and uterine masses.

Methods: A retrospective analysis of women who had undergone surgery with frozen section for large abdominopelvic masses at Central Referral Hospital, Sikkim, India, from July 2017 to July 2021.

Results: 22 women were taken into study out of which 18 had FS for ovarian masses while 4 had frozen section for large uterine masses. All ovarian masses looked malignant on imaging while only 7 looked malignant intraoperatively. FS detected 8 women (44%) with ovarian malignancy out of which 2 were suspicious. The 2 suspicious cases were benign on final histopathology. FS was negative for malignancy in 10 women (56%) out of which 2 were borderline sero-mucinous on final histopathology. FS for ovarian masses showed sensitivity: 66.7% specificity: 83.3%, NPV: 83.3% and Accuracy of 80% when compared to the final histopathology. Intraoperatively 3 out of 4 uterine masses looked malignant. However, all of the uterine masses were negative on FS and final histopathology.

Conclusion: Non-oncology centers are burdened with variety of benign surgeries, hence, FS is effective in detecting malignancy in ovarian tumors but not so in large uterine masses. Performing FS prevents "lost to follow ups" in ovarian tumors while avoiding it, saves time of experts while dealing with large uterine masses.

Human papillomavirus (HPV) infection, particularly infection with HPVs 16 and 18, is a major cause of cervical cancer. The current high-risk HPV screening or diagnosis tests use cytological or molecular techniques that are primarily based on qualitative HPV DNA detection. Comparative studies, however, revealed that different assays have varying sensitivities for detecting specific HPV types. Here, we developed and optimized a sensitive PCR (Polymerase Chain Reaction) assay for detection of high-risk HPV-16 and HPV-18. The PCR parameters were optimized, and analytical specificities were validated. Performance of developed PCR assay was evaluated in clinical samples (n = 100) which showed 100% specificity for both the assays and 96.97% and 94.12% sensitivity for HPV-16 and HPV-18, respectively. The developed assay demonstrated high sensitivity and specificity for detection of high-risk HPV-16 and HPV-18, making it applicable to routine HPV detection practices.