Journal of Obstetrics and Gynecology of India最新文献

Background of the study: Myths regarding oral health are extensively prevalent and have considerable impact on pregnant women's dental behaviour and practices. Thus, this study sought to understand misconceptions (pregnancy and early childhood oral care) and their determinants amongst pregnant women.

Methods: A questionnaire designed to assess the participants' demographics, parity, oral health behaviour and misconceptions was administered to 305 pregnant women attending antenatal care. Oral health (DMFT, bleeding on probing and periodontal pocket) was examined. Independent t test, analysis of variance and linear regression were used for statistical computations.

Results: Early childhood myths (5.54 ± 1.87) were more prevalent amongst the study population than pregnancy-related myths (3.28 ± 1.89). Bivariate analysis exhibited that myths were significantly more prevalent in mothers who were ≤ 30 years of age (8.79 ± 2.565), primi parous (8.90 ± 2.141), illiterate (9.07 ± 2.764) and who had never visited a dentist (8.46 ± 2.016). Both pregnancy and early childhood myth scores were positively correlated to DMFT (p = 0.00; p = 0.031). Educational status and age were significant negative predictors of myths with p values of 0.00 and 0.34, respectively. Parity emerged as the only significant positive predictor (p = 0.002).

Conclusion: The high prevalence of myths in the present study advocates that standardized, culturally appropriate and simple educational messages need to be developed and delivered to break these misconceptions. Minimum one visit to a dental surgeon during second trimester should be advocated and encouraged for all pregnant women.

Introduction: One of the challenges to menstrual hygiene management in resource-limited settings is limited access to safe and affordable menstrual hygiene products. An alternative to the widely used sanitary pads is the menstrual cup, which has received less attention in low- and middle-income countries. This study was carried out to assess the perception on menstrual cup usage among teens and reproductive age group women assess attending a tertiary care institute in a rural setup in Andhra Pradesh.

Methodology: A prospective cross-sectional study was conducted among 164 teenage and reproductive age group women attending the Outpatient Department of Obstetrics and Gynecology with the help of a semi-structured, pretested and pre-piloted questionnaire to assess the perception of menstrual cup usage among the participants. Data were analyzed statistically using software, menstrual cup knowledge score was calculated based on data obtained from questionnaire.

Results: Most of the study participants (87.8%) were using sanitary pads during menstruation. Cloth was also used by some of the participants (11.59%). Only one participant (0.61%) was reported using menstrual cup. Majority of the participants [121 (73.7%)] reported that they had never heard of menstrual cup, whereas 43 [(26.3%)] study participants reported that they were aware of menstrual cup. Only 2(4.65%) out of 43 participants had a good knowledge on menstrual cup whose knowledge score was 12. Five (11.63%) out of 43 participants had got 0 score and remaining participants got the score between 0 and 12.

Conclusion: Most of the women were not aware of menstrual cup and even if they know about it, they do not have good knowledge about it. Awareness regarding menstrual cup should be promoted through media and awareness programs to reach everyone.

Background: Birth companion (BC) has been globally recognised as an essential component of childbirth care. As our institution did not allow BC in labour, this study was planned as a quality improvement (QI) project to introduce the concept. We aimed to achieve birth companionship from existing 0 to 100% over a period of six months.

Intervention: QI team was constituted, and an initial brainstorming session conducted. A fishbone diagram was drawn to analyse issues that need addressal before implementation of the initiative. The framework was defined, and team members assigned their roles and responsibilities. A series of five successive Plan-Do-Study-Act (PDSA) cycles were carried out over a period of six months, which included introduction of the concept, dissemination of information, infrastructural changes in labour room and introducing column for documentation in birth register. To achieve sustainability, comprehensive group counselling sessions were started for women during antenatal period, and sensitisation classes were regularly conducted for newly inducted trainees and faculty.

Result: Birth companionship was achieved in 98% of cases.

Conclusion: The QI tools helped in preparation and planning of changes by breaking down a large problem into smaller sections and covering all aspects of challenges in a systematic manner using team-based approach. National directives and recommendations, sensitisation of leadership and training of stakeholders were found to be important facilitators. Robust systems of monitoring and successive PDSA cycles were needed for continuous improvement and sustainability of the idea.

Objective: To evaluate the role of placental vascularisation indices using 3D-Power Doppler and placental elasticity using Shear Wave Elastography (SWE) in Fetal Growth Restricted (FGR) pregnancies and to assess their correlation with perinatal outcomes.

Methods: This prospective case-control study was conducted from June 2018-2020. Thirty women with FGR and thirty controls (24-36 weeks) underwent grayscale and Doppler ultrasonography followed by measurement of vascularisation indices and SWE from the central and peripheral parts of fetal and maternal surfaces of the placenta. Participants were followed till delivery and perinatal outcomes were noted.

Results: Vascularisation indices were significantly reduced among FGR vs. controls: Vascularisation Index (VI): 20.90 ± 5.46 vs. 31.49 ± 3.89, Flow Index (FI): 26.29 ± 1.70 vs. 30.85 ± 2.02, Vascularisation- Flow Index (VFI): 7.06 ± 2.42 vs. 12.37 ± 2.43, p < 0.001. The mean placental SWE (17.36 ± 1.50 kPa) in FGR pregnancies was significantly higher as compared to controls (4.14 ± 1.14 kPa), p < 0.001. Neonatal polycythaemia and hyperbilirubinemia were significantly increased in FGR pregnancies with higher SWE value. Receiver operating characteristic curve-based cut-off of VI for intensive care requirement was 23.0 (sensitivity: 75%, specificity: 71%) and for tachypnea was 22.8 (73% sensitivity and specificity). The cut-off of FI for low birth weight was 25.7 (sensitivity: 69.6%, specificity: 71.4%).

Conclusion: This study demonstrates that increased placental stiffness and reduced vascularisation in FGR indicate possible placental pathology. Both modalities help in predicting perinatal complications. Hence, vascularisation indices and SWE reflect the extent of placental insufficiency and can be useful adjuncts in diagnosis.

Purpose of study: To study the epidemiology and various methods of repair of vaginal vault prolapse in selected group of patients and the benefits of various modes of treatment in the management of vault prolapse.

Methods: Thirty-seven patients with grade lll or lV vault prolapse were enrolled in our study. Sacrospinous fixation was performed in 37 patients. High risk factors for prolapse, surgical results and complications were evaluated.

Results: In the current study, maximum cases of vault prolapse, 67.6%, were in the age group of 51-60 years. Out of 37 patients, 18.9% had a history of chronic cough secondary to bronchial asthma or past history of tuberculosis And 13.5% had a bowel dysfunction (chronic constipation). Vaginal vault prolapse most commonly was seen following vaginal hysterectomy (43.3%) as compared to total abdominal hysterectomy (29.7%). Most common surgery was performed for post-hysterectomy vault prolapse being sacrospinous fixation in the current study. In total, 29.7% of the patients had early post-operative complications like urinary tract infection (16.2%), urinary retention (5.4%) and buttock pain (5.4%), and 2.7% had vaginal cuff cellulitis. Dyspareunia is a common complication post-operatively following sacrospinous fixation, due to shortening of vaginal length post-procedure.

Conclusion: Only 29.7% patients had complications, among which most common complication was urinary tract infection, which was treated with injectable antibiotics, urinary retention and buttock pain being the less common complication. Dyspareunia was present only in 18.9% cases post-operatively due to vaginal shortening associated with the procedure. Sacrospinous fixation is a safe and effective procedure.

Supplementary information: The online version contains supplementary material available at 10.1007/s13224-023-01757-9.

Stillbirth is over-represented in lower and lower-middle-income countries and understandably this has motivated greater research investment in the development of prediction models. Prediction is particularly challenging for pregnancy outcomes because only part of the population is represented in observational research. Notably, unrecognised pregnancies and miscarriages are typically excluded from the development of prediction models and the consequences of such selection are not well understood. Other methodological challenges in developing stillbirth prediction models are within the control of the researcher. Identifying whether the intended model is for aetiological explanation versus prediction, attainment of a sufficiently large representative sample, and internal and external validation are among such methodological considerations. These considerations are discussed in relation to a recently published study on prediction of stillbirth after 28 weeks of pregnancy for women with hypertensive disorders of pregnancy in India. The predictive ability of this model amounts to the flip of a coin. Future screening based on such a model may be expensive, increase psychological distress among patients and introduce additional iatrogenic perinatal morbidities from over-treatment. Future research should address the methodological considerations described in this article.

Objectives: Study the impact of intra-facility interventions on the modifiable factors causing stillbirths (SB), using point-of-care quality improvement (POCQI) methodology.

Material and methods: Stillbirth data during the 9 months pre-intervention period were reviewed to identify the common preventable causes. Two interventions, namely, ultrasound at 34-36 weeks gestation and intrapartum monitoring on a common customized labor chart for all health-care providers, were done. Post-intervention data were collected to observe the impact of the interventions.

Results: The stillbirth rate reduced from 212/5940 deliveries (35.7/1000) in the pre-intervention period to 165/5993 deliveries (27.7/1000) in the post-intervention period (p = 0.011). The intra-facility failure to identify FGR significantly reduced in the post-intervention group (p = 0.033), leading to 63% (RR 0.37) reduction in its risk. Using a common customized labor chart led to a significant decline in the inadequate monitoring as a provider-related cause of stillbirth (p < 0.001) leading to its 42% decline as contributor to modifiable cause of SB (RR 0.48).

Conclusion: Reviewing the perinatal death surveillance response (PDSR) data, identifying gaps in care, and using improvement methodology for instituting corrective measures play an important role in reducing intramural stillbirths.

The regulatory vacuum in the field of ART in India was filled when in December 2021, the Assisted Reproductive Technology (Regulation) Act, 2021 (ART Act) (https://egazette.nic.in/WriteReadData/2021/232025.pdf) and the Surrogacy (Regulation) Act, 2021 (SR Act) were passed. We surveyed medical professionals to understand their knowledge, attitude and perception towards the Acts and to offer an initial, snapshot assessment of their impact on the medical community. The government has already signalled its intent to implement the Acts and has published several notifications/gazettes to clarify and amend the issues surrounding the Acts (https://artsurrogacy.gov.in/NationalArtSurrogacy/faces/HomePage.xhtml#). We hope that these responses will help to voice the thoughts, concerns and suggestions from of ART service providers for ART to further clarify and rationalise the laws. Infertility is already a much stigmatised problem which deserves to be a higher public health priority. While the laws are a welcome step, changes in both laws is are the need of the hour to make ART more accessible, available and affordable to the millions of couples who need these services and for the health care providers who to be able to deliver them.

Purpose: To evaluate whether elective single embryo transfer in patients with suboptimal response to ovarian stimulation is detrimental to pregnancy rates compared to double embryo transfer.

Methods: A case-control retrospective study was performed in a cohort of couples undergoing IVF at the Infertility Unit of the ASST Lariana with ≤ 9 oocytes and at least 2 viable embryos. A total of 424 women were analyzed in the "double embryo transfer" group (n = 212) and elective "single embryo transfer" group (n = 212); they were matched 1:1 for female age, ovarian reserve and number of previous cycles. Cumulative clinical pregnancy rate per oocyte retrieval was the main outcome.

Results: The cumulative pregnancy rate per cycle, including the fresh embryo and subsequent frozen embryo transfers, was 26% and 26%, respectively. Considering the main confounding factors, a binomial logistic model indicated that the cumulative clinical pregnancy rate was not significantly affected when a single embryo transfer was performed in women recovering up to nine oocytes.

Conclusion: Live birth rate was similar between the two groups, while twin pregnancies were significantly reduced in women receiving single embryo transfer suggesting that elective single embryo transfer in patients with a limited number of embryos is not detrimental to pregnancy rates.