Journal of Obstetrics and Gynecology of India最新文献

Background: A variety of materials and techniques are used for skin closure after caesarean section (CS), common ones being sutures and staples. The technique chosen should be simple, quick, painless, and provide good cosmesis with least wound complications, and there is a need to identify which provides the best outcome.

Objectives: The aim was to compare metallic surgical staples versus subcuticular sutures for skin closure after caesarean delivery in terms of wound complications, skin closure time, pain score on day 3, and patient satisfaction after 6 weeks.

Materials and methods: A total of 300 women undergoing CS with Pfannenstiel incision were randomized into two groups using sealed envelopes. Skin closure was done, and time was noted simultaneously. Wound condition and pain score were assessed on day 3 and 6 weeks post-operatively.

Results: On day 3 post-operatively, 22% patients in each group had abnormal healing. After 6 weeks, 1.37% patients with sutures and 3.44% patients with staples had abnormal healing (p value 0.39). Total 10 patients (3.33%), 5 in each group, underwent resuturing within 6 weeks post-operatively. Staples reduced skin closure time as compared to sutures (p value <0.001). Mean pain score was comparable between two groups on day 3 post-operatively (p value 0.08) and at 6 weeks (p value 0.45). Patient satisfaction score considering the appearance and comfort of scar was comparable between both groups (p value 0.25).

Conclusion: Staples and subcuticular sutures are equivalent to each other, and the choice of skin closure material is at the discretion of the surgeon.

Tumor necrosis factor-alpha, a multifunctional T-helper 1 (Th1) cytokine, plays a significant role in placentation and embryonic development. Altered expression of TNF-α has been implicated in adverse pregnancy outcomes such as recurrent pregnancy loss (RPL) and pre-eclampsia (PE). The use of TNF-α inhibitors (TNFi) like Adalimumab (AD) has garnered attention for its ability to traverse the placental barrier, and modulating maternal immune responses during pregnancy. In this article, we have discussed two patients in whom the immunological factors have been identified in otherwise unexplained RPL and how the use of TNFi could be of help to achieve a viable pregnancy.

Background: Polycystic ovary syndrome (PCOS) is a prevalent endocrine disorder that affects women's health-related quality of life (HRQoL). This study aimed to assess the HRQoL and identify the significant factors associated with it among women with PCOS in Riyadh, Saudi Arabia.

Methods: A cross-sectional study was conducted with 250 Saudi women registered with King Khalid University Hospital (KKUH) in Riyadh. Data were collected using the PCOS questionnaire and the social support survey (SSS) questionnaire. Multiple logistic regression analyses were utilized to explore the association between social support and PCOS HRQoL symptoms.

Results: More than 50% of the women reported that PCOS significantly affected their HRQoL. Lack of social support in form of tangible support was significantly associated with severe PCOS symptoms, namely emotions [2.53 (1.01, 6.33)], body hair [2.82 (1.17, 6.84)], weight [2.35 (1.01, 6.09)], and infertility [11.63 (3.94, 34.34)], whereas lack of emotional support was associated with severe menstrual symptoms [1.86 (1.01, 3.76)]. Marital status [3.87 (1.85, 8.10)], aged < 32 years [2.60 (1.27, 5.31)], and housewives [2.69 (1.05, 5.06)] reported severe infertility symptoms. Employed women [2.22 (1.0, 5.06)] reported severe menstrual symptoms, whereas having BMI ≥ 25 kg/m² [3.31 (1.80, 6.07)] reported weight-related symptoms.

Conclusion: This study highlights the significant impact of social support and sociodemographic factors on women's HRQoL in Saudi Arabia. The study implies the need for tailored interventions to improve the HRQoL of women with PCOS, particularly for those who lack sufficient social support. Health policy should focus on creation of social support groups to provide counseling and support to the women at the community level.

Background: Polycystic ovarian syndrome (PCOS) is a multisystem endocrinopathy with a varied clinical presentation; there are very few studies about relationship of anti-Mullerian hormone (AMH) levels with different clinical, biochemical and hormonal parameters of PCOS. It is still uncertain whether an increase in AMH levels has a positive correlation with hyperandrogenism or with oligoanovulation. This study aims to establish a correlation of AMH levels with clinical, biochemical and hormonal parameters among infertile women with PCOS.

Method: An observational cross-sectional study was conducted at Lady Hardinge Medical College and Hospital, Delhi, during the period November 2018 to March 2020. A total of 143 infertile women between 20 and 35 years of age diagnosed to have PCOS based on the revised Rotterdam diagnostic criteria were recruited. After brief history and examination, blood samples were taken for AMH and other biochemical and hormonal tests. Transvaginal ultrasound was performed to see the ovarian volume, antral follicles and endometrial thickness.

Results: There was a weak positive statistically significant (r = 0.17, p = 0.047) correlation between cycle length and AMH. A weak negative correlation between sex hormone binging globulin (SHBG) and AMH was found, and this correlation was statistically significant (p = 0.007).

Conclusion: Serum AMH is correlated positively with oligoanovulation and negatively with levels of SHBG which suggests an indirect positive correlation of AMH with hyperandrogenism as SHBG is low in women with hyperandrogenism.

Background: Today, the thickness of the endometrium as a key factor plays an important role in pregnancy outcomes of infertile patients. Based on this, it has been shown that endometrial compaction affects fertility success in patients. In this study, the impact of endometrial compaction on pregnancy outcomes (assisted reproductive technology) has been evaluated.

Material and methods: This prospective cohort study included 253 patients undergoing embryo transfer, who referred to the infertility center of Shariati Hospital in Tehran during 2021-2022. They were examined from the point of relationship between endometrial thickness changes and fertility rate in frozen embryo transfer and fresh cycles. After preparing the endometrium, the thickness was evaluated using ultrasound.

Result: The results showed that the percentage of chemical and clinical pregnancy in the compact group was higher compared to the non-compact one, which was statistically significant (p < 0.05). The rate of pregnancy in four groups of 5, 10, 15, and %20 compaction was 77(30.4%), 49(19.4%), 28(11.1%), and 14(5.5%), respectively.

Conclusion: Finally, endometrial compaction can be associated with an increase in chemical and clinical pregnancy rate in infertile patients. In addition, secondary thickness has predictive value for clinical pregnancy.

Background: Pregnancy-related deaths and complications have remained unacceptably high, particularly in low- and middle-income countries. Manipur is the most prevalent state for pregnancy wastage in India with an increasing trend over the last two decades.

Aim: The study aims to explore the level, pattern, spatial clustering, and determinants of pregnancy wastage in Manipur.

Data and methods: We utilized the NFHS-4 (2015-2016) and NFHS-5(2019-2021) data of Manipur. The Getis-OrdGi* spatial statistical tool was used to identify the hotspots clusters. Bayesian logistic regression analysis was applied to identify the determinants of pregnancy wastage.

Results: The major hotspot clusters for pregnancy wastage were found in the valley districts, namely Imphal East, Imphal West, Thoubal, and Bishnupur. Further, a significant decline in hotspot clusters can be seen in the last five years. BMI was found to be a significant determinant for both abortion and miscarriage. Education, working status, number of antenatal care visits, wealth index and use of smokeless tobacco were associated with higher risks of having abortion among women.

Conclusion: The results highlight the need to develop district- centric antenatal care services to reduce the risk of pregnancy-related complications. Intervention should be tailored according to the life style choices and unique cultural practices of women in Manipur, India. It may also be beneficial to study the factors associated with declining hotspot clusters in some districts of Manipur.

Purpose: Vaginal flora alterations (AVF) have been implicated in both health and disease states. Few studies have looked at the connection between AVF and adverse fetomaternal outcomes(AFMOs), and even fewer have assessed their concurrent link with gestational diabetes mellitus (GDM). Therefore, this study investigated the association between AVF and GDM and their impact on AFMOs. In addition, we assessed the antimicrobial resistance(AMR) of isolated pathogens and sought to identify the associated risk factors.

Methods: This prospective, cross-sectional study was conducted among 640 pregnant women; divided into two groups, GDM and non-GDM. We administered standardized questionnaires to collect data regarding sociodemographic and clinical characteristics; collected vaginal samples at 26-38 weeks for Nugent scoring and determination of bacterial and fungal species; assessed AMR of the isolated pathogens and followed up patients for assessment of AFMOs.

Results: We found AVF in 47.5% of participants, with 36.6% having single AVF and 10.9% mixed AVF. There was a significantly higher occurrence of all studied AVF subtypes in GDM group. We noted high prevalence of AMR and MDR among isolated pathogens. We also found association of AFMO with different AVF subtypes, with higher prevalence of AFMOs among participants with mixed AVF.

Conclusion: The impact of AVF on AFMOs, along with their association with hyperglycemia; provides a potential avenue for working on minimizing AFMOs, which will eventually contribute toward improving the health of both the women and their offspring. The high prevalence of AVF and AMR in this study, calls for effective infection control and stewardship programmes.

Supplementary information: The online version contains supplementary material available at 10.1007/s13224-024-02095-0.

Aims and objectives: Ultrasound has an important role in in pregnancy complicated by hyperglycaemia. This study is to assess the association between third trimester ultrasound parameters and adverse outcomes in hyperglycaemic pregnant women & neonates.

Methodology: A prospective observational study including 166 hyperglycemic pregnant women (39-preexisting; 127-GDM) Ultrasound was done between 34 weeks gestation and beyond to note parameters i.e. FW centile, AC centile, CPR ratio, AFI. All were followed till delivery; adverse outcomes noted (C-section done for fetal distress, arterial cord blood ph < 7.1, 5 min APGAR < 7, admission to neonatal unit, neonatal hypoglycemia, perinatal death). Composite adverse outcomes were determined by having any 2/7 above-described outcomes. Ultrasound parameters were then correlated with composite adverse outcomes and correlation was determined.

Results: Out of 166; in 66 pregnancies composite adverse neonatal outcomes were present. Women with HIP having > 90th centile of estimated fetal weight have 3.52 times higher chances [OR 3.52 & 95% CI (1.55-7.97)] of having CAO compared to rest of the women. Statistically, a significant association was found for Composite Adverse Outcomes and deranged AFI (p value < 0.018). Women with HIP having Polyhydramnios have 3.13 times higher odds [OR 3.13 & 95% CI (1.08-8.94)] of having CAO compared to rest of the women. Further, Women with HIP having cerebroplacental insufficiency i.e. CPR < 1 have 4.2 times higher odds [OR 4.200 (CI 1.825-9.668)] of having CAO compared to rest of the women with HIP i.e. women having CPR > 1.

Conclusion: In women with hyperglycemia, third trimester USG parameters have an important role in predicting adverse outcomes beyond the impact of maternal predictors. The best combination of USG parameters detecting Composite Adverse Outcomes was EFW < 10th centile and CPR < 1 (OR 14.61). So third trimester sonographic parameters appears to be promising tool to preplan deliveries that should be conducted in tertiary care centres to reduce perinatal morbidity and mortality.