Journal of Obstetrics and Gynecology of India最新文献

Objective: To test the validity of the novel Menstrual Health Index (MHI) in order to assess safety of menstrual health and hygiene practices in adolescents and young adults.

Methods: This is a community-level prospective questionnaire-based study conducted in females between the age group of 11 and 23 years. The number of participants was 2860. The participants were asked to fill in the questionnaire pertaining to four components of menstrual health, viz., menstrual cycle, menstrual absorbents, psychosocial aspects and WASH component associated with menstruation. Based on the score assigned to each component, Menstrual Health Index was calculated. A score of 0-12 was considered poor, 12-24 was considered average, and 24-36 was considered good. Educational interventions were designed to improve the MHI in that particular population according to component analysis. After 3 months, MHI was rescored to see the improvement.

Results: A total of 3000 females were handed over the proforma and 2860 females participated.Among participants, 45.4% were from urban area, rest were from rural areas (35.6%) and slum areas (19%). Majority of the respondents were in the age group of 14-16 years (62%). Poor MHI (0-12 score) was seen in 48%, average score (13-24) was found in 37%, and good score was found in 15% participants. When individual components of MHI were assessed, it was found that, as high as 35% of the girls had limited accessibility to menstrual blood absorbents, 43% skipped school for more 4 times in a year, 26% suffered from severe dysmenorrhea, 32% reported difficulty in maintaining privacy while using WASH facilities and 54% were using clean sanitary pads as menstrual sanitation option. Best composite MHI was observed in urban areas, followed by rural and then slum area. In urban area and rural area, menstrual cycle component score was least. In rural area, sanitation component score was least and in slum area, WASH component scored the worst. Severe premenstrual dysphoric disorder was recorded in urban area, and maximum abstinence from school due to menstruation was seen in rural areas.An improvement in score was seen in 87% of the girls (93% individual and 87% composite), after 3 months of education and interventional strategies.

Conclusion: Menstrual health is not limited to cycle frequency and duration normalcy. It is a comprehensive subject, encompassing physical, social, psychological and geopolitical aspects. Assessing prevailing menstrual practices in a population, particularly in adolescents, is imperative to design IEC tools, and these objectives are aligned with SDG-M goals of Swachh Bharat Mission. MHI serves as a good screening tool to interrogate KAP in a particular area. Individual problems can also be addressed in a fruitful manner. Rights-based approach to provide essential infrastructure and provisions to promote safe and dignified practices t

Background: Worldwide one of the major problems of human reproduction that haunts men and women is infertility. Hysterosalpingography (HSG) and laparoscopy (LS) are the two most important modalities to evaluate infertility. Our aim is to compare the efficacy of both.

Methodology: This is a prospective study. One hundred and five females of both primary and secondary infertility together were included. Detailed history, examination and routine investigations were carried out. Tuberculosis polymerase chain reaction (TBPCR) was made from endometrial biopsy sample for all patients. Ovulation study was done by transvaginal ultrasonography. Hysterosalpingography and diagnostic laparoscopy were done.

Results: Out of 105 infertile patients, 51.42% were in 26-30 years group. 52.3% were from lower economic group. 55.23% presented between 1 to 5 years of infertility. Twelve patients had used contraception in the past. Sixteen patients were serologically positive. Twenty-nine patients were with positive TBPCR among 105 females. Fifty-four and fifty-six patients had patent tubes by HSG and laparoscopy, respectively. Uterine filling defects and congenital anomalies could be detected four times more by HSG than by laparoscopy. TO mass was detected only by laparoscopy. Bilateral spill was present in 66.6% by HSG and 67.6% by laparoscopy and unilateral spillage in 22.8% and 21.9%, respectively. The sensitivity, specificity and accuracy of HSG in predicting unilateral block taking laparoscopy as gold standard are 85%, 96.4% and 94.2%, respectively, and sensitivity and specificity of bilateral tubal block are 81.8% and 98%, respectively.

Conclusions: HSG and laparoscopy are not alternative, but complimentary in diagnosing tubal pathologies. HSG remains as primary screening procedure, but laparoscopy is gold standard.

Introduction: While dealing with the COVID-19-related morbidities and mortalities in general, its adverse impact on non-COVID-19 maternal mortalities was completely forgotten so our aim is to study the adverse consequences of the COVID-19 pandemic on non-COVID-19 hospital births and non-COVID-19 maternal mortalities.

Methodology: Retrospective observational study was done in the Department of Obstetrics and Gynecology, Swaroop Rani Hospital, Prayagraj, to compare the non-COVID-19 hospital births, referrals, and non-COVID-19 maternal mortalities during 15 months of pre-pandemic period (March 2018 to May 2019) and 15 months of pandemic period (March 2020 to May 2021 period) and to assess their relation to GRSI using chi-square test, paired T test and Pearson's Correlation Coefficient.

Result: The total non-COVID-19 hospital births decreased by 4.32% in pandemic period as compared to pre-pandemic period. Monthly hospital births decreased drastically, to 32.7% during the end of the first pandemic wave and to 60.17% during the second wave. 67% increase in the total referral and a significant decrease in the quality of referral leading to significantly higher non-COVID-19 maternal mortality figures (p value 0.00003) during the pandemic period. Leading causes of mortalities were uterine rupture (p value 0.00001), septic abortion (p value 0.0001), primary postpartum hemorrhage (p value 0.002) and preeclampsia (p value 0.003).

Conclusion: While the world is talking only about COVID deaths, increased non-COVID-19 maternal mortalities during the COVID pandemic need equal attention and call for more stringent government guidelines for the care of non-COVID-19 pregnant women as well during the pandemic period.

Background: The effectiveness and safety of pituitrin injection coupled with hysteroscopy and suction curettage as treatment for type I cesarean scar pregnancy (CSP) have not been studied enough in the literature, by comparing it to uterine artery embolization (UAE) followed by suction curettage we aim to determine its efficacy.

Materials and methods: Data of 53 patients (the PIT group) with type I CSP treated with pituitrin injection combined with hysteroscopic suction curettage and 137 patients (the UAE group) with type I CSP treated with UAE followed by suction curettage were collected in retrospect. The clinical data were analyzed statistically to compare the efficacy and safety between the two groups.

Results: The PIT group had a shorter duration of postoperative vaginal bleeding, postoperative hospitalization, and overall hospitalization length (P < 0.05). The PIT group had lower overall hospitalization costs and a lower rate of adverse events than the UAE group (P < 0.05). There was no significant difference between the two groups in terms of treatment success rate, the average length of operation, blood loss during the procedure, time when serum β-hCG returned to normal range, and menstrual recovery time after hospital release (P > 0.05).

Conclusion: UAE and pituitrin injection followed by hysteroscopic suction curettage are good choices for type I CSP treatment. However, pituitrin injection with hysteroscopic suction curettage outperforms UAE followed by suction curettage. Thus, pituitrin injection may be an option of high priority for type I CSP.

Objective: To compare the feto-maternal outcomes among various BMI groups as per Asia Pacific Standards.

Method: This is a retrospective non-interventional observational study on 1396 antenatal women with singleton pregnancy. Their BMI based on pre-pregnancy weight was calculated and the women were divided into various groups as per Asia Pacific standards for BMI classification. Details of associated morbidities and delivery outcomes were noted in a pre-structured proforma and a comparison was made among the various groups using Chi square test. A p value of < 0.05 was taken as significant.

Results: Among the 1396 women under study, 10.6% were underweight, 36% had normal weight, 21% were overweight while 32% were obese or very obese. There was a significant association of low BMI with preterm labor (p value 0.03) and fetal growth restriction (p value < 0.01). Overweight and obese women were found to be more prone to hypertensive disorders of pregnancy (p value- 0.002), gestational diabetes (p value- 0.003) and overweight women were more prone to cholestasis of pregnancy (p value 0.03). The women with higher BMI had a significantly higher requirement of induction of labor (p value-0.0002). There was significant increased number of babies more than 90th percentile in overweight and obese women (p value 0.003). However, there was no change in Neonatal ICU admissions (p value 0.85) or neonatal mortality.

Conclusion: Asia Pacific references should be used for studies related to all studies on BMI and pregnancy. All women having BMI outside the normal BMI spectrum are at increased risk of antenatal and postnatal complications. Early identification of such women will enable careful evaluation and counseling to improve the reproductive outcome and feto-maternal health.

Introduction: Gestational diabetes is defined as the carbohydrate intolerance of variable severity with onset or first recognition during pregnancy. Gestational glucose intolerance (GGI) is used to indicate pregnant women whose 2-h postprandial glucose is > 120 mg/dl and below 140 mg/dl (Diabetes in Pregnancy Study Group of India, DIPSI criteria).

Aim: This study was planned to see whether intervention in GGI group helps to improve feto-maternal outcomes.

Methodology: This open-label randomized control trial was conducted in Department of Obstetrics and Gynaecology of King George's Medical University, Lucknow. Inclusion criteria were all the antenatal women attending the antenatal clinic and diagnosed as GGI, and exclusion criteria were overt diabetes.

Results: Total of 1866 antenatal women were screened, and among them, 220 (11.8%) women were diagnosed as gestational diabetes; 412 (22.1%) women were diagnosed as GGI. The mean fasting blood sugars in the women with GGI who had medical nutrition therapy were much lower than the women with GGI who did not have any intervention. The present study showed the women with GGI had higher complications like polyhydramnios, PPROM, foetal growth restriction, macrosomia, preeclampsia, preterm labour and vaginal candidiasis more in the women with GGI as compared to euglycaemic women.

Conclusion: The present study of nutritional intervention in GGI group has shown trend towards lesser complication if we start medical nutrition therapy reflected by delayed development of GDM and less neonatal hypoglycaemia and hyperbilirubinemia.

Postpartum collapse is a life-threatening condition caused by obstetrical and non-obstetrical events. In this case report, we discuss a case of postpartum collapse in COVID-19-positive woman who required intensive care and mechanical ventilation for two days. After confusing collision of many provisional diagnoses soldiering for three days, she was ultimately diagnosed with malignant catatonia. Targeted therapy with lorazepam challenge resulted in drastic improvement, and she was discharged with her baby in healthy condition.

Purpose of the study: The unmet need for contraception in the postpartum period is a major challenge in our country. Unintended pregnancies are highest in the first year after birth, and postpartum IUCD insertion is an effective way to counter this problem. This study was planned to build up data for acceptance and follow-up of postpartum IUCD insertions.

Methods: The present study has included data of PPIUCD insertions and follow-up from seven institutions over a period of 6 months. The case recruitment lasted for 3 months, including only those who had PPIUCD insertions in this period, and they were followed up for a period of 6 months. The follow-up of patients was at 6 weeks and 6 months. All issues were addressed including side effects, expulsions, myths surrounding the device, etc., along with routine postnatal care.

Results and conclusion: There were 5227 deliveries and 1895 insertions. The acceptance rate was 36%, and a follow-up at 6 weeks and 6 months showed up an expulsion rate of approximately 4% and a removal rate of 5%. Overall, at the end of 6 months we have a continuation rate of 90%. This shows that a dedicated approach to postpartum contraception will definitely bring down incidence of unintended pregnancies.