Journal of Obstetrics and Gynecology of India最新文献

Background: Leptospirosis is one of the most prevalent zoonoses worldwide. Its presentation is varied in severity and non-specific mimicking other infectious diseases and pregnancy conditions such as HELLP or AFLP.

Aims and objectives: This study aims to evaluate the maternal and foetal outcomes of leptospirosis and estimate its prevalence in pregnancy at a tertiary care centre.

Methods: This is an observational descriptive study conducted at a tertiary care teaching hospital in Western India over a duration of 5 years. All pregnant patients diagnosed as leptospirosis via IgM ELISA were included.

Results: A total of 37 patients were enrolled. Majority presented in the first trimester and belonged to the low socio-economic strata. Fever was the most persistent symptom. Five patients had a spontaneous abortion, two underwent MTP, eight had a preterm delivery, whereas 22 patients carried up till term (of which 18 delivered vaginally and four underwent a LSCS). Majority had leucocytosis and were anaemic. Twelve cases had hyperbilirubinaemia, six had deranged transaminases, three had raised serum creatinine values and two had thrombocytopenia. Four patients required management in the ICU out of which two progressed to Weil's disease and one succumbed to death. The research team at our centre yielded an estimated 9.06% prevalence of leptospirosis.

Conclusion: Leptospirosis is often underdiagnosed and hence under-reported. Being a re-emerging infectious disease, an early clinical suspicion and sound understanding of the disease process in pregnant women is required.

Introduction: Polycystic ovary syndrome (PCOS) is the most common endocrine disorder in women of reproductive age, with a prevalence of 8-13% depending on diagnostic criteria. Its pathophysiology is linked to insulin resistance and resulting chronic inflammation. This study compares serum levels of fractalkine and high-sensitivity C-reactive protein (hs-CRP), markers of chronic inflammation, in PCOS patients before and after metformin therapy.

Materials and methods: Thirty women with PCOS were recruited from gynecology and dermatology OPDs. Their serum fractalkine and hs-CRP levels were measured before starting metformin. The patients were then administered metformin, beginning with 500 mg once daily and increasing to 500 mg three times daily over four months, followed by repeat measurements of serum fractalkine and hs-CRP.

Results: Post-metformin therapy, a significant reduction in serum fractalkine levels was observed (from 0.52 ± 0.29 to 0.38 ± 0.21 ng/ml, p = 0.001). Similarly, hs-CRP levels decreased significantly (from 0.71 ± 0.37 to 0.58 ± 0.27 ng/ml, p = 0.016). Clinical improvements in hirsutism, acne, acanthosis, and BMI were also noted, alongside a significant reduction in insulin resistance parameters.

Conclusion: Chronic inflammation in PCOS contributes to insulin resistance. Metformin therapy, by improving insulin resistance, reduces hyperinsulinemia and hyperglycemia, leading to decreased production of reactive oxygen species and amelioration of chronic inflammation. This is evidenced by lowered serum fractalkine and hs-CRP levels and improved insulin resistance parameters in this study.

Artificial intelligence (AI) is on the fast track so far as the growth is concerned, from experimental to implementation in field of medicine. AI should be used ethically and intelligently. Large data base availability, advances in algorithm-theories, computing improvements has led to breakthrough in AI applications in current medicine. Machine learning (ML), which is subset of AI, allows computers to detect patterns through larger data base automatically, that can be used to make predictions. Is it paradigm shift? In the field of Obstetrics and Gynaecology, AI is used in reproductive medicine for diagnosis, treatment with fertility outcome, cancer treatment, USG-MRI images diagnosis, foetal echocardiography, cardiotocography (CTG), preterm labour prediction and urogynaecology. ChatGPT can be helpful in medical writing but there is always a challenge with respect to accuracy and reliability. AI can be used in research and experiments, there by strengthening evidence-based clinical practice. More research is ongoing on personalized diagnosis, treatment and remote medical expert team opinion. It does not replace the medical advice given by the clinician but that should not deter clinician by exploring more uses of AI. Despite various challenges and limitations, integration of AI in medical field is bound to progress in correct direction for better future.

Background: Untimely menopause refers to occurrence of menopause before the age of 40 years or after 55 years, termed as pre-mature or delayed menopause. This is a secondary data analysis of LASI-1 to estimate prevalence of untimely menopause and its determinants.

Materials and methods: LASI-1, a longitudinal study collected detailed information on the psychological, social, economic and health aspects of ageing in India. Baseline data was collected from year 2017-2019 in all 35 states and union territories in India. 73,396 adults were interviewed aged 45 years and above. In this study, we analysed prevalence of untimely menopause and its determinants from the data using bivariate and logistic regression analysis.

Results: In this study, 25,256 women's data was analysed to estimate the prevalence. 7.4%, 17.5% and 13.4% women had pre-mature (menopause less than 40 years), early (between 40 and 44 years) and delayed menopause (after 55 years), more so in a few southern states of the country. Determinants for untimely menopause were area of residence (higher in rural area), education status (greater in higher educational status), working status (more in currently working women), and consumption of alcohol.

Conclusion: There is high prevalence of untimely menopause and more so in a few southern states of the country, which is a cause of concern and needs specific attention.

Introduction: Maternal health services may be adversely impacted during pandemics especially in the low- and middle-income countries. COVID-19 pandemic was such a situation. Here, we describe the status of maternal health services prior to and during the COVID-19 pandemic in India.

Methods: A retrospective cross-sectional household-based survey was conducted among randomly selected 820 mothers with children less than 2 years in Chandigarh and Kalyani, West Bengal, to assess the utilization of antenatal, intrapartum and postnatal care services before March 2020 (pre-pandemic period, n = 413) and after March 2020 (pandemic period, n = 407). Data were managed using REDCap and were analyzed using Statistical Package for Social Sciences (version 25.0). Multivariate logistic regression analysis was used to estimate the adjusted odds ratios (aOR) and significant differences between groups at 95% confidence intervals (CIs).

Results: There was a significant increase in the reporting of pregnancy-related complications during the pandemic (aOR 1.45; 95% CI 1.08-1.94) and a significant increase in utilization of supplementary nutrition services from anganwadis (aOR 1.81; 95% CI 1.33-2.46) during the pandemic. There was a significant decrease in the proportion of women who received financial assistance during delivery in the pandemic period (aOR 0.36; 95% CI 0.17-0.79). Postpartum checkups by healthcare workers significantly decreased during the pandemic period (82.6%) as compared with the pre-pandemic period (82.6%) [aOR 0.84; 95% CI 0.71-0.97].

Conclusions: The COVID-19 pandemic significantly changed the utilization of antenatal, intrapartum and postpartum services in our study areas. While the existing national program and timely pandemic guidelines helped ensure that some services remained uninterrupted, postpartum care was the most affected possibly due to restrictions of field visits by the healthcare workers. Financial assistance for delivery care was also heavily affected during the pandemic.

Background: Pelvic organ prolapse is a common gynecological disorder seen in Asian women, more in rural area. It is seen in both old age and young women. Presenting complaints includes something coming out of vagina, chronic pelvic pain, urinary and bowel symptoms. Sacrohysteropexy is the gold standard procedure for its management. Recently, laparoscopic pectopexy is described as a new alternative procedure, which is equally effective and associated with far lesser complications. Thus, this study is conducted to see the outcomes of laparoscopic pectopexy.

Method: This retrospective observational study is conducted in the department of obstetrics and gynecology, over the period of three years. Thirty-five patients, operated by laparoscopic pectopexy, were included in study. Twenty-five cases were young patient with prolapse, while 10 patients were of vault prolapse. Inclusion criteria were POP-Q stage ≥ II. All cases were done by same surgical team. Data were analyzed in terms of demographic profile. Video recording of surgery were checked to calculate operating time and estimated blood loss. All intraoperative and postoperative complications were recorded. Follow-up was done at 1 month and 6 months.

Results: Out of 35 cases, 10 were vault prolapse and 25 cases were uterine prolapse. No major intraoperative complications like visceral injury and major hemorrhage were found. Average operating time was 96 min. Average estimated blood loss was 50-100 ml. All patients were followed up at 1 month, 3 months and 6 months postoperatively. All patients were highly satisfied with surgery. None of the patients had de novo apical prolapse/recurrence of symptoms.

Conclusion: Laparoscopic pectopexy is a novel promising technique to manage prolapse with minimal intraoperative and postoperative complications. It is a safe and feasible alternative to sacropexy. So, it should be considered as a first-line surgery for management of apical prolapse.

Monochorionic-monoamniotic (MCMA) twin pregnancy discordant for anencephaly is a rare occurrence. Selective reduction versus expectant management is itself a debatable topic. We report such a case managed expectantly with successful outcome. A 30 years old second gravida woman was referred to us with MCMA twin pregnancy discordant for anencephaly at 18 weeks of gestation. She opted for expectant management till 33 weeks when cesarean section was performed for preterm onset of labor. Surviving female neonate weighing 1580 g required nursery care for seven days and was discharged in good condition. She did not have any congenital malformation. Female neonate with anencephaly weighing 1000 g was provided with compassionate care and she died within one hr of birth. This report advocates for the option of expectant management for such a rare condition.